[Lettre autographe signée de Giuseppe Verdi adressée à Du Locle, Sant'Agata, 14 octobre 1875]

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Validation of a clinical prediction score for ruling out coronary heart disease in primary care patients with chest pain.

Background: A patient's chest pain raises concern for the possibility of coronary heart disease (CHD). An easy to use clinical prediction rule has been derived from the TOPIC study in Lausanne. Our objective is to validate this clinical score for ruling out CHD in primary care patients with chest pain. Methods: This secondary analysis used data collected from a oneyear follow-up cohort study attending 76 GPs in Germany. Patients attending their GP with chest pain were questioned on their age, gender, duration of chest pain (1-60 min), sternal pain location, pain increases with exertion, absence of tenderness point at palpation, cardiovascular risks factors, and personal history of cardiovascular disease. Area under the curve (ROC), sensitivity and specificity of the Lausanne CHD score were calculated for patients with full data. Results: 1190 patients were included. Full data was available for 509 patients (42.8%). Missing data was not related to having CHD (p = 0.397) or having a cardiovascular risk factor (p = 0.275). 76 (14.9%) were diagnosed with a CHD. Prevalence of CHD were respectively of 68/344 (19.8%), 2/62 (3.2%), 6/103 (5.8%) in the high, intermediate and low risk category. ROC was of 72.9 (CI95% 66.8; 78.9). Ruling out patients with low risk has a sensitivity of 92.1% (CI95% 83.0; 96.7) and a specificity of 22.4% (CI95% 18.6%; 26.7%). Conclusion: The Lausanne CHD score shows reasonably good sensitivity and can be used to rule out coronary events in patients with chest pain. Patients at risk of CHD for other rarer reasons should nevertheless also be investigated.

Early stage primary bone lymphoma - a retrospective, multicenter rare cancer network (rcn) study

Purpose: Primary bone lymphoma (PBL) accounts for less than 1% of all malignant lymphomas, and 4-5% of all extra-nodal lymphomas. In this study, the disease profile, outcome, and prognostic factors were assessed in patients with stage I and II PBL.Patients and Methods: Thirteen Rare Cancer Network (RCN) institutions enrolled 116 consecutive patients with PBL treated between 1987 and 2008 in this study. Inclusion criteria were age > 16 years, stage I and II, minimum 6 months follow-up and a biopsy-proven confirmation of non-Hodgkin's lymphoma (NHL). Eighty-seven patients underwent chemoradiotherapy (CXRT), 15 radiotherapy (RT) without (13) or with (2) surgery, 14 chemotherapy (CXT) without (9) or with (5) surgery. Median RT dose was 40 Gy (range: 4-60). The median number of CXT cycles was 6 (range: 2-8). Median follow-up was 41 months (range: 6-242).Results: The overall response rate at the end of treatment was 91% (CR 74%, PR 17%). Local recurrence or progression was observed in 12 (10%) patients, and systemic recurrence in 17 (15%). Causes of death included disease progression in 21, unrelated in 5, CXT-related toxicity in 1, and second primary cancer in 2 patients. The 5-yr overall survival (OS), lymphoma-specific survival (LSS), and local control (LC) were 76%, 78% and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for OS were age <50 years (P=0.008), international prognostic index (IPI) score ≤1 (P=0.009), high grade histology (P=0.04), CXRT (P=0.05), CXT (P=0,0004), complete response (CR) (P<0.0001), number of CXT cycles ( ≥6 ) (P=0.01), and RT dose > 40 Gy (P=0.005). All above-mentioned parameters were also significant for LSS except for age and number of chemotherapy cycles. For LC, only CR and stage I were favorable factors. In multivariate analysis, IPI score, RT dose, complete response, and chemotherapy were independently influencing the outcome (OS and LSS). Complete response at the end of treatment was the only predicting factor for LC. Six patients developed grade 3 or more toxicities, according to Common Terminology Criteria for Adverse Events (CTCAE) V3.0.Conclusion: This large multicenter study confirms the relatively good prognosis of early stage PBL treated with combined CXRT. Local control was excellent, while systemic failures were rare. An adequate dose of RT (40 Gy or more) and complete CXT regime (≥ 6 cycles) were associated with better outcome.

House File 811 Legislative Report, December 14, 2009

The department of Human Services provides child protective and child welfare services to eligible families in the state of Iowa. Children ages 0-17 may receive services that include child protective assessments, child in need of assistance, safety plan services, family safety, risk and permanency services, foster care and case management. A confirmed child abuse assessment may lead to involvement with juvenile court via an adjudication hearing. The court provides oversight and support to the family to increase safety for the children. Al child abuse assessments, regardless of disposition, are sent to juvenile court for review and information.

Iowa Crop and Weather Report, May 14, 2012, Vol. 12. no. 11

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Iowa Secretary of Agriculture Bill Northey today commented on the Iowa Crops and Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October.

Iowa Crop and Weather Report, June 4, 2012, Vol. 12. no. 14

Report produced by the The Department of Agriculture and Land Stewardship, Climatology Bureau. Iowa Secretary of Agriculture Bill Northey today commented on the Iowa Crops and Weather report released by the USDA National Agricultural Statistical Service. The report is released weekly from April through October.

Iowa Agri-News, July 7, 2012, Vol. 12, no. 14

Crop and livestock summaries for the state of Iowa, produced by the Iowa Department of Agriculture.

The Update, May 14, 2012

The Update is a bi-weekly web newsletter published by the Iowa Department of Public Health's Bureau of Family Health. It is posted the second and fourth week of every month, and provides useful job resource information for departmental health care professionals, information on training opportunities, interdepartmental reports and meetings, and additional information pertinent to health care professionals.

Quick Reads, May 14, 2012

IDPH Quick Reads is an electronic newsletter produced by the Director’s Office at the Iowa Department of Public Health. IDPH Quick Reads are published every three to four weeks.

Secure and Prepared Newsletter, August 10, 2012, Vol. 8, no. 14

A bi-weekly newsletter for those involved in the fields of homeland security and/or emergency management

A comparison of in vivo 13C MR brain glycogen quantification at 9.4 and 14.1 T.

The high molecular weight and low concentration of brain glycogen render its noninvasive quantification challenging. Therefore, the precision increase of the quantification by localized (13) C MR at 9.4 to 14.1 T was investigated. Signal-to-noise ratio increased by 66%, slightly offset by a T(1) increase of 332 ± 15 to 521 ± 34 ms. Isotopic enrichment after long-term (13) C administration was comparable (≈ 40%) as was the nominal linewidth of glycogen C1 (≈ 50 Hz). Among the factors that contributed to the 66% observed increase in signal-to-noise ratio, the T(1) relaxation time impacted the effective signal-to-noise ratio by only 10% at a repetition time = 1 s. The signal-to-noise ratio increase together with the larger spectral dispersion at 14.1 T resulted in a better defined baseline, which allowed for more accurate fitting. Quantified glycogen concentrations were 5.8 ± 0.9 mM at 9.4 T and 6.0 ± 0.4 mM at 14.1 T; the decreased standard deviation demonstrates the compounded effect of increased magnetization and improved baseline on the precision of glycogen quantification.

Diagnòstic en profunditat sobre la integració dels i les joves de 14 a 18 anys migrats a Catalunya

La present recerca s’emmarca doncs, a l’eix 3 definit pel Pacte Nacional per a la Immigració (PNI), sobre la integració de la nova població catalana i de la societat d’acollida en una cultura pública comuna, mantenint la cohesió social. Entenem la integració com un procés dinàmic d’apropament i empatia recíprocs entre la persona migrada i la societat d’acollida, fet que suposa el reconeixement dels valors de cada grup en la seva diferència i en la seva igualtat per tal d’ enriquir al conjunt social. Apostem per la integració des d’un enfocament intercultural de diàleg i intercanvi, on el reconeixement de la condició de ciutadania, és indispensable i, ha de permetre tenir presents totes les dimensions de la integració: estructural, cognitiva i cultural, social i de la identitat (Martínez, 2006). Aquest repte es tradueix en la construcció de la ciutadania des de la diversitat ètnica i cultural avançant així cap a una autèntica interculturalitat. Es parteix d’un concepte d’integració bidireccional, dinàmic i continu, entre els joves migrats i la resta, coincideix totalment amb el que reconeix el PNI. La finalitat d’aquesta recerca és identificar els elements clau de l’estat actual de la integració dels joves migrats a Catalunya, per això cal definir tant els elements constitutius com els entramats del procés de la integració d’aquesta joventut al context català. La metodologia serà un estudi per enquesta, amb una mostra de 3000 joves de Catalunya. L’estudi descriptiu es complementarà amb grups de discussió de joves i entrevistes a agents socials i educatius implicats en l’acompanyament a aquests joves. Plantegem, per tant, un estudi descriptiu-comprensiu, que combina el treball sobre dades quantitatives i dades qualitatives en funció de l’objecte a valorar, sota una lògica de complementarietat (Bericat, 1998). En l’estudi per enquesta, s’aplicarà el “Qüestionari de cohesió social entre joves” elaborat per Palou (2009). Per l’aproximació qualitativa, es faran grups de discussió amb joves per analitzar en profunditat la seva realitat; i finalment, es faran entrevistes en profunditat a agents socials i educatius. El rigor metodològic permetrà que aquesta anàlisi en profunditat tingui per fruit línies clares per a elaborar propostes afavoridores per la convivència i la cohesió social.La integració a una cultura pública comuna (objectiu clau del PNI i el Pla de ciutadania i immigració 2009-2012) passa per l'Administració més propera a les persones (en aquest cas, els joves migrats i migrades del municipi), a través de les polítiques de ciutadania per a la joventut. Els resultats del present projecte pretenen orientar propostes d’actuació en aquest nivell, bé sigui en clau d’acollida i coneixement de la llengua i l’entorn com d’integració al teixit social i associatiu del barri o municipi.Més enllà de la política pública local, l’aplicabilitat del projecte que es presenta també troba un altre encaix en les polítiques educatives de Catalunya i, més concretament, en el Pla per a la llengua i la cohesió social. Educació i convivència intercultural (Departament d’Educació, 2007), Dins de les seves línies estratègiques, aquest Pla contempla el reforç de la xarxa estable de l’entorn escolar amb la col•laboració dels diferents serveis i recursos municipals (entitats d'àmbit social, cultural o esportiu), a través d’iniciatives com els Plans Educatius d’Entorn (PEE).