Plötzlicher Tod infolge eines persistierenden Ductus arteriosus. Fall eines 4 Tage alt gewordenen Säuglings

Ein persistierender Ductus arteriosus (Ductus Botalli) ist seit Jahren als Ursache eines plötzlichen und unerwarteten Neugeborenentods und pulmonaler Hämorrhagien identifiziert. Insbesondere Frühgeborene weisen ein erhöhtes Risiko zur Entwicklung eines hämodynamisch signifikanten persistierenden Ductus arteriosus auf. Vorgestellt wird der plötzliche und unerwartete Todesfall eines 4 Tage alt gewordenen Säuglings, der 2 Wochen vor dem errechneten Termin geboren worden war. Bei der Obduktion zeigte sich ein sehr muskelkräftiger arterieller Gefäßkurzschluss zwischen der A. pulmonalis und dem Aortenbogen mit einem Durchmesser knapp unter dem der A. pulmonalis. Als Folge der pulmonalen Hyperperfusion fanden sich eine massive akute Blutstauung und kongestives Herzversagen infolge des „shunting“ von der systemischen in die pulmonale Zirkulation.

Capital Accumulation in the Presence of Informal Credit Contracts: Does the Incentive Mechanism Work Better than Credit Rationing Under Asymmetric Information?

Credit markets with asymmetric information often prefer credit rationing as a profit maximizing device. This paper asks whether the presence of informal credit markets reduces the cost of credit rationing, that is, whether it can alleviate the impact of asymmetric information based on the available information. We used a dynamic general equilibrium model with heterogenous agents to assess this. Using Indian credit market data our study shows that the presence of informal credit market can reduce the cost of credit rationing by separating high risk firms from the low risk firms in the informal market. But even after this improvement, the steady state capital accumulation is still much lower as compared to incentive based market clearing rates. Through self revelation of each firm's type, based on the incentive mechanism, banks can diversify their risk by achieving a separating equilibrium in the loan market. The incentive mechanism helps banks to increase capital accumulation in the long run by charging lower rates and lending relatively higher amount to the less risky firms. Another important finding of this study is that self-revelation leads to very significant welfare improvement, as measured by consumptiuon equivalence.

Does the Presence of Surplus Labor Hinder Production in Indian Manufacturing?

Input congestion occurs at a given input bundle when the assumption of free disposability of inputs does not hold and an increase in input leads to a decline in output. In this paper we employ the nonparametric method of Data Envelopment Analysis (DEA) to examine the question on input congestion with respect to labor, using state level data from the Annual Survey of Industries for the period 1986-87 through 1999-2000. When the standard assumption of strong disposability is relaxed for the labor inputs, the nonparametric analysis of state-level data from Indian manufacturing shows considerable measure of labor input congestion. While in selected states congestion comes from non-production workers as well, the principal source of labor congestion is production labor. There is no evidence that the problem of labor congestion has become less severe during the post-Reform years. It appears that market forces without any major institutional changes in enforcement of labor discipline cannot eliminate congestion.

Federally regulated institutional review boards: The aspects of a "model" IRB---Is the current system in need of a tune up or complete overhaul?

Institutional Review Boards (IRBs) are the primary gatekeepers for the protection of ethical standards of federally regulated research on human subjects in this country. This paper focuses on what general, broad measures that may be instituted or enhanced to exemplify a "model IRB". This is done by examining the current regulatory standards of federally regulated IRBs, not private or commercial boards, and how many of those standards have been found either inadequate or not generally understood or followed. The analysis includes suggestions on how to bring about changes in order to make the IRB process more efficient, less subject to litigation, and create standardized educational protocols for members. The paper also considers how to include better oversight for multi-center research, increased centralization of IRBs, utilization of Data Safety Monitoring Boards when necessary, payment for research protocol review, voluntary accreditation, and the institution of evaluation/quality assurance programs. ^ This is a policy study utilizing secondary analysis of publicly available data. Therefore, the research for this paper focuses on scholarly medical/legal journals, web information from the Department of Health and Human Services, Federal Drug Administration, and the Office of the Inspector General, Accreditation Programs, law review articles, and current regulations applicable to the relevant portions of the paper. ^ Two issues are found to be consistently cited by the literature as major concerns. One is a need for basic, standardized educational requirements across all IRBs and its members, and secondly, much stricter and more informed management of continuing research. There is no federally regulated formal education system currently in place for IRB members, except for certain NIH-based trials. Also, IRBs are not keeping up with research once a study has begun, and although regulated to do so, it does not appear to be a great priority. This is the area most in danger of increased litigation. Other issues such as voluntary accreditation and outcomes evaluation are slowing gaining steam as the processes are becoming more available and more sought after, such as JCAHO accrediting of hospitals. ^ Adopting the principles discussed in this paper should promote better use of a local IRBs time, money, and expertise for protecting the vulnerable population in their care. Without further improvements to the system, there is concern that private and commercial IRBs will attempt to create a monopoly on much of the clinical research in the future as they are not as heavily regulated and can therefore offer companies quicker and more convenient reviews. IRBs need to consider the advantages of charging for their unique and important services as a cost of doing business. More importantly, there must be a minimum standard of education for all IRB members in the area of the ethical standards of human research and a greater emphasis placed on the follow-up of ongoing research as this is the most critical time for study participants and may soon lead to the largest area for litigation. Additionally, there should be a centralized IRB for multi-site trials or a study website with important information affecting the trial in real time. There needs to be development of standards and metrics to assess the performance of the IRBs for quality assurance and outcome evaluations. The boards should not be content to run the business of human subjects' research without determining how well that function is actually being carried out. It is important that federally regulated IRBs provide excellence in human research and promote those values most important to the public at large.^

The epidemiology of dengue among children less than 18 months of age in Puerto Rico, 1999--2011

Between 1999 and 2011, 4,178 suspected dengue cases in children less than 18 months of age were reported to the Centers for Disease Control and Prevention Dengue Branch in Puerto Rico. Of the 4,178, 813 were determined to be laboratory-positive and 737 laboratory-negative. Those remaining were either laboratory-indeterminate, not processed or positive for Leptospira . On average, 63 laboratory-positive cases were reported per year. Laboratory-positive cases had a median age of 8.5 months. Among these cases, the median age for those with dengue fever was 8.7 months and 7.9 months for dengue hemorrhagic fever. Clinical signs and symptoms indicative of dengue were greatest among laboratory-positive cases and included fever, rash, thrombocytopenia, bleeding manifestations, and petechiae. The most common symptoms among patients who were laboratory-negative were fever, nasal congestion, cough, diarrhea, and vomiting. Using the 1997 WHO guidelines, nearly 50% of the laboratory-positive cases met the case definition for dengue fever, and 61 of these were further determined to meet the case definition for dengue hemorrhagic fever. In comparison, 15% of laboratory-negative cases met the case definition for dengue fever and less than 1% for dengue hemorrhagic fever. None of the laboratory-positive or laboratory-negative cases met the criteria for dengue shock syndrome.^

Pore water concentrations and solid phase concentrations of sediment cores from the Ligurian continental slope

In October 1979, a period of heavy rainfall along the French Riviera was followed by the collapse of the Ligurian continental slope adjacent to the airport of Nice, France. A body of slope sediments, which was shortly beforehand affected by construction work south of the airport, was mobilized and traveled hundreds of kilometers downslope into the Var submarine canyon and, eventually, into the deep Ligurian basin. As a direct consequence, the construction was destroyed, seafloor cables were torn, and a small tsunami hit Antibes shortly after the failure. Hypotheses regarding the trigger mechanism include (i) vertical loading by construction of an embankment south of the airport, (ii) failure of a layer of sensitive clay within the slope sequence, and (iii) excess pore fluid pressures from charged aquifers in the underground. Over the previous decades, both the sensitive clay layers and the permeable sand and gravel layers were sampled to detect freshened waters. In 2007, the landslide scar and adjacent slopes were revisited for high-resolution seafloor mapping and systematic sampling. Results from half a dozen gravity and push cores in the shallow slope area reveal a limited zone of freshening (i.e. groundwater influence). A 100-250 m wide zone of the margin shows pore water salinities of 5-50% SW concentration and depletion in Cl, SO4, but Cr enrichment, while cores east or west of the landslide scar show regular SW profiles. Most interestingly, the three cores inside the landslide scar hint towards a complex hydrological system with at least two sources for groundwater. The aquifer system also showed strong freshening after a period of several months without significant precipitation. This freshening implies that charged coarse-grained layers represent a permanent threat to the slope's stability, not just after periods of major rainfall such as in October 1979.

Infrastructure Development of Railway in Cambodia: A Long Term Strategy

Infrastructure development means for the making of living environment, transport and communications, disaster prevention and national land conservation, agriculture, forestry and fisheries, and energy production and supply. Transport infrastructure development in Cambodia involved with (1) road, (2) railway, (3) port, inland-water way and (4) aviation. All model of transport infrastructure have special different kinds of importance. Railway is different from other base important of railways are transport passengers and traffic freight especially transport for heavy goods in huge capacity and in long distance by safer and faster. Transport in Cambodia for traffic freight export import base from Thailand and other via Sisophon and Shihanoukvill port. Traffic is increasing rapidly during nowadays railway condition in adequate of demand required. This is why Railway is selected as the topic of this paper to prevent monopoly of road transport. This paper, does review about infrastructure development plan for Railway in Cambodia as a long term strategy by review and analysis forecast on the previous performance of Royal Railways of Cambodia (RRC) transport traffic involved with condition of infrastructure development of railway in Cambodia. And also review the plan of development RRC but just only detail a plan of rehabilitation that is immediately needed. Suggest some recommendation at the last part. As Cambodia is a member country of ASEAN and also Mekong sub-region. For make sure that transport networks work effectively with a progress of economic integration, we make clear what is important for infrastructure development of railway in Cambodia from the standpoint of the development plan of Mekong sub-region. This paper is organized by 4 sections. Section 1 review about Infrastructure Development of Railway in Cambodia (IDRC) Historical Background, Follow by Section 2 will review the Current Situation of IDRC and some analysis of transport performance from previous years, Then Section 3 review of the focusing on traffic transport of RRC in the future, Section 4 review Infrastructure Development of Railway in Cambodia Future plans in long term; at last conclusion and recommendation. In section 1 does review history background of RRC from the rail first begun. But why is needed to review? Because of history background is involved infrastructure development of RRC in present time. History background made big gaps constraint and obstacle for socioeconomic development and poverty reduction, also left Cambodia with tragedy and left developed behind. After that remain infrastructure development needs huge fund and long time for restoration, reconstruction, rehabilitation and development into new technology as most of world practice.

Transport costs, distance, and time : evidence from the Japanese Census of Logistics

Geographic distance is a standard proxy for transport costs under the simple assumption that freight fees increase monotonically over space. Using the Japanese Census of Logistics, this paper examines the extent to which transport distance and time affect freight costs across shipping modes, commodity groups, and prefecture pairs. The results show substantial heterogeneity in transport costs and time across shipping modes. Consistent with an iceberg formulation of transport costs, distance has a significantly positive effect on freight costs by air transportation. However, I find the puzzling results that business enterprises are likely to pay more for short-distance shipments by truck, ship, and railroad transportation. As a plausible explanation, I discuss aggregation bias arising from freight-specific premiums for timely, frequent, and small-batch shipments.

Transport modal choice by multinational firms : firm-level evidence from Southeast Asia

We examine transport modal decision by multinational firms to shed light on the role of freight logistics in multinational activity. Using a firm-level survey in Southeast Asia, we show that foreign ownership has a significantly positive and quantitatively large impact on the likelihood that air/sea transportation is chosen relative to truck shipping. This result is robust to the shipping distance, cross-border freight, and transport infrastructure. Both foreign-owned exporters and importers also tend to use air/sea transportation. Thus, our analysis presents a new distinction between multinational and domestic firms in their decision over transport modes.

Directional imbalance of freight rates : evidence from Japanese inter-prefectural data

By analyzing a comprehensive dataset on transport transactions in Japan, we describe a directional imbalance in freight rates by transport mode and examine its potential sources, such as economies of density and directionally imbalanced transport flow. There are certain numbers of observed links which show asymmetric transport costs. Instrumental variable analysis is used to show that economies of density account for deviation from symmetric freight rates between prefectures. Our results show that a 10% increase in outbound transport flow relative to inbound transport flow leads to a 2.1% decrease in outbound freight rate relative to inbound freight rate.