Under-investigation of older people with abnormal chest radiographs

Background: Whilst many authors have previously suggested that older people are under-represented in the investigation and management of lung cancer, few data are available as to the effect of age on the subsequent investigation and management of a patient with an abnormal chest radiograph. Methods: During a 3-month period in a university teaching hospital, all abnormal chest radiographs suggestive of a possible diagnosis of lung cancer were identified, and patients subsequently followed to determine investigation, management and date of death over a 5-year period. Results: Thirty-seven younger (less than or equal to69 years, median age 62 years) and 43 older patients ( 670 years, median age 80 years) were identified. Of the 80 patients with a possible bronchial carcinoma only 59% had a further chest radiograph performed. Bronchoscopy was performed in 34% of patients, but a biopsy of the lesion was undertaken in only 24% of patients. Sixteen of the 80 patients, irrespective of what investigations had been undertaken, were referred for an oncological or surgical opinion. During the study period ( 3 months), 24% of the patients died. At 6, 24 and 60 months, respectively, the total deaths were 40, 78 and 88%. Conclusion: Older patients compared with those aged less than 70 years were less likely to be investigated, further, were more likely to be managed differently (i.e., less aggressively) and more likely to die within each time interval. In more of the older group a presumed death certificate diagnosis of pneumonia was made. When an abnormal chest radiograph raises the possibility of an underlying bronchial carcinoma, the finding of this study suggests that an ageist attitude influences the subsequent management of some patients. Copyright (C) 2005 S. Karger AG, Basel.

The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach

Background: Postnatal depression (PND) is associated with poor cognitive functioning in infancy and the early school years; long-term effects on academic outcome are not known. Method: Children of postnatally depressed (N = 50) and non-depressed mothers (N = 39), studied from infancy, were followed up at 16 years. We examined the effects on General Certificate of Secondary Education (GCSE) exam performance of maternal depression (postnatal and subsequent) and IQ, child sex and earlier cognitive development, and mother–child interactions, using structural equation modelling (SEM). Results: Boys, but not girls, of PND mothers had poorer GCSE results than control children. This was principally accounted for by effects on early child cognitive functioning, which showed strong continuity from infancy. PND had continuing negative effects on maternal interactions through childhood, and these also contributed to poorer GCSE performance. Neither chronic, nor recent, exposure to maternal depression had significant effects. Conclusions: The adverse effects of PND on male infants’ cognitive functioning may persist through development. Continuing difficulties in mother–child interactions are also important, suggesting that both early intervention and continuing monitoring of mothers with PND may be warranted.

The accuracy of students' predictions of their GCSE grades

The paper reports a study that investigated the relationship between students’ self-predicted and actual General Certificate of Secondary Education results in order to establish the extent of over- and under-prediction and whether this varies by subject and across genders and socio-economic groupings. It also considered the relationship between actual and predicted attainment and attitudes towards going to university. The sample consisted of 109 young people in two schools being followed up from an earlier study. Just over 50% of predictions were accurate and students were much more likely to over-predict than to under-predict. Most errors of prediction were only one grade out and may reflect examination unreliability as well as student misperceptions. Girls were slightly less likely than boys to over-predict but there were no differences associated with social background. Higher levels of attainment, both actual and predicted, were strongly associated with positive attitudes to university. Differences between predictions and results are likely to reflect examination errors as well as pupil errors. There is no evidence that students from more advantaged social backgrounds over-estimate themselves compared with other students, although boys over-estimate themselves compared with girls.

Low-frequency volatility of real estate securities in relation to macroeconomic risk

Real estate securities have a number of distinct characteristics that differentiate them from stocks generally. Key amongst them is that under-pinning the firms are both real as well as investment assets. The connections between the underlying macro-economy and listed real estate firms is therefore clearly demonstrated and of heightened importance. To consider the linkages with the underlying macro-economic fundamentals we extract the ‘low-frequency’ volatility component from aggregate volatility shocks in 11 international markets over the 1990-2014 period. This is achieved using Engle and Rangel’s (2008) Spline-Generalized Autoregressive Conditional Heteroskedasticity (Spline-GARCH) model. The estimated low-frequency volatility is then examined together with low-frequency macro data in a fixed-effect pooled regression framework. The analysis reveals that the low-frequency volatility of real estate securities has strong and positive association with most of the macroeconomic risk proxies examined. These include interest rates, inflation, GDP and foreign exchange rates.

'The house of books': libraries and archives in Ancient Egypt

In 1957, John Sperry Jr. published an article in Libri entitled “Egyptian libraries: a survey of the evidence.” Some 55 years on, this article revisits the subject, taking into account research undertaken in the field of Egyptology over the last half a century. Based on an extended essay written for the online Certificate in Egyptology course at the University of Manchester, this article considers the evidence for the existence of “institutional” (that is, created for the use and functioning of the state) libraries and archives in Ancient Egypt throughout the dynastic period (c.3500−30 B.C.); their history, purpose and, to some extent, their administration. It also considers an aspect not explored in Sperry’s article, that of “private” libraries in Ancient Egypt (texts collected by an individual for their own personal use). Whilst estimated literacy levels within the general population precluded the widespread collection of texts for personal edification, there is evidence to suggest that private libraries were present in Ancient Egypt. The article concludes with a brief assessment of the legacy of these ancient libraries and their influence on the creation of the Library of Alexandria, in both its ancient and modern manifestations.

Energy performance ratings and house prices in Wales: an empirical study

This paper investigates the effect of Energy Performance Certificate (EPC) ratings on residential prices in Wales. Drawing on a sample of approximately 192,000 transactions, the capitalisation of energy efficiency ratings into house prices is investigated using two approaches. The first adopts a cross-sectional framework to investigate the effect of EPC rating on price. The second approach applies a repeat-sales methodology to investigate the impact of EPC rating on house price appreciation. Statistically significant positive price premiums are estimated for dwellings in EPC bands A/B (12.8%) and C (3.5%) compared to houses in band D. For dwellings in band E (−3.6%) and F (−6.5%) there are statistically significant discounts. Such effects may not be the result of energy performance alone. In addition to energy cost differences, the price effect may be due to additional benefits of energy efficient features. An analysis of the private rental segment reveals that, in contrast to the general market, low-EPC rated dwellings were not traded at a significant discount. This suggests different implicit prices of potential energy savings for landlords and owner-occupiers.

Using problem-based learning in a chemistry practical class for pharmacy students and engaging them with feedback

Objective: To introduce a new approach to problem based learning (PBL) used in the context of medicinal chemistry practical class teaching pharmacy students. Design: The described chemistry practical is based on independent studies by small groups of undergraduate students (4-5), who design their own practical work taking relevant professional standards into account. Students are carefully guided by feedback and acquire a set of skills important to their future profession as healthcare professionals. This model has been tailored to the application of PBL in a chemistry practical class setting for a large student cohort (150 students). Assessment: The achievement of learning outcomes is based on the submission of relevant documentation including a certificate of analysis, in addition to peer assessment. Some of the learning outcomes are also assessed in the final written examination at the end of the academic year. Conclusion: The described design of a novel PBL chemistry laboratory course for pharmacy students has been found to be successful. Self-reflective learning and engagement with feedback were encouraged, and students enjoyed the challenging learning experience. Skills that are highly essential for the students’ future careers as healthcare professionals are promoted.

Chagas disease-related mortality trends, state of Sao Paulo, Brazil, 1985 to 2006: a study using multiple causes of death

Objectives. To study mortality trends related to Chagas disease taking into account all mentions of this cause listed on any line or part of the death certificate. Methods. Mortality data for 1985-2006 were obtained from the multiple cause-of-death database maintained by the Sao Paulo State Data Analysis System (SEADE). Chagas disease was classified as the underlying cause-of-death or as an associated cause-of-death (non-underlying). The total number of times Chagas disease was mentioned on the death certificates was also considered. Results. During this 22-year period, there were 40 002 deaths related to Chagas disease: 34 917 (87.29%) classified as the underlying cause-of-death and 5 085 (12.71%) as an associated cause-of-death. The results show a 56.07% decline in the death rate due to Chagas disease as the underlying cause and a stabilized rate as associated cause. The number of deaths was 44.5% higher among men. The fact that 83.5% of the deaths occurred after 45 years of age reflects a cohort effect. The main causes associated with Chagas disease as the underlying cause-of-death were direct complications due to cardiac involvement, such as conduction disorders, arrhythmias and heart failure. Ischemic heart disease, cerebrovascular disorders and neoplasms were the main underlying causes when Chagas was an associated cause-of-death. Conclusions. For the total mentions to Chagas disease, a 51.34% decline in the death rate was observed, whereas the decline in the number of deaths was only 5.91%, being lower among women and showing a shift of deaths to older age brackets. Using the multiple cause-of-death method contributed to the understanding of the natural history of Chagas disease.

Paracoccidioidomycosis-related mortality trend, state of Sao Paulo, Brazil: a study using multiple causes of death

Objective. To investigate mortality in which paracoccidioidomycosis appears on any line or part of the death certificate. Method. Mortality data for 1985-2005 were obtained from the multiple cause-of-death database maintained by the Sao Paulo State Data Analysis System (SEADE). Standardized mortality coefficients were calculated for paracoccidioidomycosis as the underlying cause-of-death and as an associated cause-of-death, as well as for the total number of times paracoccidioidomycosis was mentioned on the death certificates. Results. During this 21-year period, there were 1950 deaths related to paracoccidioidomycosis; the disease was the underlying cause-of-death in 1 164 cases (59.69%) and an associated cause-of-death in 786 (40.31%). Between 1985 and 2005 records show a 59.8% decline in the mortality coefficient due to paracoccidioidomycosis as the underlying cause and a 53.0% decline in the mortality as associated cause. The largest number of deaths occurred among men, in the older age groups, and among rural workers, with an upward trend in winter months. The main causes associated with paracoccidioidomycosis as the underlying cause-of-death were pulmonary fibrosis, chronic lower respiratory tract diseases, and pneumonias. Malignant neoplasms and AIDS were the main underlying causes when paracoccidioidomycosis was an associated cause-of-death. The decision tables had to be adapted for the automated processing of causes of death in death certificates where paracoccidioidomycosis was mentioned. Conclusions. Using the multiple cause-of-death method together with the traditional underlying cause-of-death approach provides a new angle on research aimed at broadening our understanding of the natural history of paracoccidioidomycosis.

Synthesis of L1(0) Fe-Pd films by electrodeposition and thermal annealing

Fe-Pd alloy films have been prepared by electrochemical deposition from an alkaline electrolyte containing Fe sulfate, Pd chloride and 5-sulfosalicylic acid onto polycrystalline titanium substrates. The as-deposited films were nanocrystalline and magnetically soft (coercivity similar to 25 Oe). L1(0) Fe-Pd films with a (111) preferred orientation were obtained by post-deposition thermal annealing of films with composition about 37 at% Fe in an (Ar + 5% H-2) gas flow at 500 degrees C. Such films exhibit hard magnetic properties, with a coercivity up to 1880 Oe, and a slightly anisotropic magnetic response, with a larger in-plane remanence. Preliminary magnetic investigations support magnetization switching through pinning of domain walls. (c) 2008 Elsevier B.V. All rights reserved.

Extern Web-service-lösning vid SSAB Tunnplåt i Borlänge- för kommunikation med sina distributions lager

Detta examensarbete har utförts på SSAB- Tunnplåt i Borlänge under vårterminen 2004 och omfattar 10 veckors arbete.SSAB sköter idag sin kommunikation med distributionslagren via fax, telefon eller e-post. Eftersom detta är ett ganska tidskrävande kommunikationssätt, vill SSAB ha en smidigare och snabbare kommunikationslösning. Den lösning som SSAB vill ha är en extern Web-service-lösning för att upprätta en säker kommunikation med sina distributionslager.Parallellt med byggandet av Web-service-lösningen arbetades en förvaltningsmodell fram. Den beskriver hur förvaltningsorganisationen med dess rutiner kan se ut vid implementering av lösningen.För att skapa en säker förbindelse med Web-servicen skall en webbklient användas som i sin tur anropar en COM+ komponent. Detta för att kunna skicka med certifikatet ifrån webbklienten till webbservern där Web-servicen ligger. COM+ komponenten måste få tillgång till en användarprofil när den kommunicerar med Web-servicen. Detta för att kunna upprätta en SSL-förbindelse i det inledande skedet. SSL-förbindelsen skall läggas i den VPN-tunnel som mVPN tillhandahåller via WSSAL.

Frieda Levine Miller Scrapbook

Frieda Levine Miller was born to William and Sarah Ida Levine on March 26, 1896 and died August 24, 1990. The scrapbook contains family memories, death certificate, eulogies, newspaper clippings, family photographs, a high school graduation program, letters, and announcement of the marriage of her daughter Glenyce.

Depinning do fluxo de Josephson em compósitos YBa 2 Cu 3 O 7-delta/Ag

Apresenta-se neste trabalho um estudo experimental da dinâmica do fluxo magnético intergranular no cuprato supercondutor Y Ba2Cu3O7 e nos compósitos Y Ba2CU3O7 fi/Ag para várias concentrações de prata. Verificou-se que sob certas condições é possível separar os efeitos da dinâmica do fluxo de Josephson daqueles resultantes da dinâmica de Abrikosov. Através da técnica de medidas de magnetização DC foram obtidas as linhas de depinning inicial e de irreversibilidade magnética em campo magnético aplicado até 120 Oe. O revestimento dos grãos supercondutores aparentemente não afeta a energia de acoplamento dos elos fracos entre os grãos e o potencial de pinning até 16.1 % em peso de prata. A vantagem da mistura da prata é que esta melhora as propriedades mecânicas dos óxidos supercondutores além de melhorar as correntes críticas do sistema. Observamos que o depinning do fluxo de Josephson começa numa temperatura bem definida, dependendo do campo magnético aplicado e gradualmente aumenta com a temperatura até ou muito próximo do limite de irreversibilidade, acima do qual todo o fluxo intergranular (e intragranular) está livre. As linhas de irreversibilidade das nossas amostras podem ser entendidas dentro do modelo do Vidro supercondutor.

Programa brasileiro de acreditação hospitalar: sua influência no credenciamento de hospitais em operadoras de plano de saúde

This dissertation presents the result of a study accomplished on the degree of use of the certificate of hospital Accreditation as one of the criteria for the accreditation of hospitals by the health insurance companies. Should be emphasized that the Accreditation Certificate represents the main final product of Hospital Accreditation Brazilian Program, being the first emitted when the hospital assists to the quality patterns specified by the Program. In that way, the study focus was, in general terms, Hospital Accreditation Brazilian Program and, more strictly, the Accreditation Certificate and it use. To reach the objectives proposed by the study, interviews were accomplished with the professionals responsible for the accreditation of the hospitals in the main health insurance companies of Brazil. In the total, five companies were consulted among the ten larger health insurance companies of Brazil, considering the number of beneficiaries. To complement the research, additional information were collected in the National Agency of Supplemental Health. It was verified, through the research, that the health insurance companies don't use the Accreditation Certificate given by the Hospital Accreditation Brazilian Program to accredit hospitals.

Certidão de regularidade fiscal federal : repensando a relação entre fisco e contribuinte a partir do paradigma do serviço e da confiança

O presente texto é resultado de uma pesquisa que visa a entender a atuação da Administração Tributária Federal brasileira no tocante ao estímulo ao pagamento de tributos. Trata-se de conhecer o processo de obtenção de certidões de regularidade fiscal junto à Receita Federal e à Procuradoria da Fazenda Nacional, bem como a possível política pública pretendida com a introdução daquelas no Sistema Tributário Nacional, a fim de se identificarem os pressupostos que determinam a atuação destes órgãos na indução do comportamento dos contribuintes, para, então, contrapô-los aos novos paradigmas de atuação das Administrações Fiscais, pensados por James Alm. Para tanto, o trabalho foi dividido em quatro partes. Na primeira, apresenta-se o referencial teórico que guiará todo o estudo. Inicia-se pela discussão do atual contexto dos países em desenvolvimento no tocante às formas de interação entre setor público e privado, o chamado Novo Estado Desenvolvimentista. Em seguida, após essa incursão nas modernas formas de Administração Pública para os países em desenvolvimento, ingressa-se no debate acerca das recentes teorias sobre atuação das Administrações Tributárias, em especial, sobre o paradigma do serviço e da confiança proposto por James Alm e sua adequação ao Novo Estado Desenvolvimentista. Nessa oportunidade, são fixados, então, os parâmetros pelos quais será avaliada a atuação da Administração Tributária Federal brasileira. Na segunda parte do trabalho, depois do mapeamento e classificação das normas que tratam sobre certidões de regularidade fiscal, são descritos o contexto histórico e debates legislativos referentes à produção dessas mesmas normas a fim de se identificarem os interesses e a possível política pública querida com a introdução daquelas certidões no Sistema Tributário Nacional. Na terceira parte, há o relato do processo de obtenção desses documentos de prova de regularidade fiscal. Pretende-se, com isso, descrever como Receita Federal e Procuradoria da Fazenda Nacional prestam o serviço de emissão deles. Diante das informações construídas no segundo e terceiro capítulos, bem como dos conceitos teóricos estabelecidos no primeiro tópico, avaliar-se-á, num quarto momento, a atuação da Administração Tributária Federal quanto aos métodos de que se vale para incentivar a obediência à legislação tributária. Após a elaboração desse diagnóstico, são apresentadas possíveis alternativas para que o relacionamento entre Fisco e contribuintes brasileiros esteja mais coerente com os padrões propostos pelo modelo teórico eleito.