1000 resultados para administration publique


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This document produced by the Iowa Department of Administrative Services has been developed to provide a multitude of information about executive branch agencies/department on a single sheet of paper. The facts provides general information, contact information, workforce data, leave and benefits information and affirmative action data.

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This document produced by the Iowa Department of Administrative Services has been developed to provide a multitude of information about executive branch agencies/department on a single sheet of paper. The facts provides general information, contact information, workforce data, leave and benefits information and affirmative action data.

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This document produced by the Iowa Department of Administrative Services has been developed to provide a multitude of information about executive branch agencies/department on a single sheet of paper. The facts provides general information, contact information, workforce data, leave and benefits information and affirmative action data.

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En France, la décentralisation et la territorialisation de l'action publique ont fait des sports de nature un objet d'action publique légitime en donnant naissance à de nouveaux outils de management public dédiés à la concertation et à la planification des usages de la nature. Nés de l'article 52 de la Loi sur le sport modifiée en 2000, la Commission Départementale des Espaces, Sites et Itinéraires relatifs aux sports de nature (CDESI) et le Plan Départemental des Espaces Sites et Itinéraires relatifs aux sports de nature (PDESI) sont des outils de concertation territoriale dédiés à la gestion publique des sports de nature au niveau départemental. Un enjeu de ce travail tient à l'appréhension des transformations de l'action publique en s'attachant à l'étude des dispositifs de concertation sur les sports de nature. Un deuxième enjeu de ce travail s'attache à mettre en évidence les effets de la concertation en analysant les interactions et les différents modes d'engagements des acteurs au cours de la « chose publique en train de se faire » (Cefaï, 2002). Les acteurs s'engagent non seulement dans la concertation comprise comme une activité sociale faite d'interactions, mais ils s'engagent également dans la concertation en tant que processus d'action publique. Aussi, un autre enjeu de ce travail est d'appréhender les effets de la concertation par une analyse processuelle des engagements (Fillieule, 2004) des acteurs et des organisations. En mobilisant les outils conceptuels de la sociologie interactionniste, de la sociologie pragmatique, ainsi que de la sociologie structuraliste, l'analyse des situations interactionnelles a notamment permis d'identifier les procédures de cadrage et les techniques dramaturgiques mises en oeuvre par les interactants, ainsi que les répertoires argumentatifs mobilisés par ces acteurs pendant l « 'épreuve » de la concertation. Les confrontations des points de vue et les justifications des prises de positions des acteurs peuvent faire évoluer la configuration initiale des jeux d'acteurs même si, pour certains, ces changements ne restent parfois qu'éphémères. Les organisations s'engagent dans la concertation en fonction de la revendication d'une légitimité qui est à comprendre comme une forme militantisme institutionnel s'articulant autour de la valorisation d'une expertise militante, environnementale, institutionnelle, ou encore de leur statut de partenaire institutionnel. In France, decentralization and territorialization of public action have made outdoor sports become an object of public policies justifiable by giving birth to new tools of public management dedicated to the public consultation, the dialogue, and the planning of the uses of the landscapes. Indeed, born of article 52 of the Law on sport modified in 2000, the Departmental committee for Spaces, Sites and Routes relative to natural sports ( CDESI) and the Departmental Plan of Spaces Sites and Routes relative to natural sports ( PDESI) are governance tools dedicated to the public management of outdoor sports for counties. A challenge of this work is to understand the changes of public policy by focusing on the study of mechanisms for consultation on outdoor sports. A second item of this work is to highlight the effects of cooperation by focusing on the analysis of interactions and actor's commitments during the "public thing in the making" (Cefaï, 2002). Actors commit themselves not only in the dialogue included as a social activity made by interactions, but they also take part to the dialogue included as a process of public action. Also, another issue of this work is to understand the effects of consultation by a processual approach of individual commitments (Fillieule, 2004) of actors and organizations. Using the conceptual tools of symbolic interactionism, pragmatic sociology, and structuralist sociology, the analysis of interactional situations has highlighted the framing work and procedures implemented by the interactants, as well as the dramaturgical techniques and argumentative directories which, they mobilize during the "test" of the consultation. Confrontation of viewpoints and justifications of interactants' positions can evolve from their initial configuration sets, even if for some of them these changes are sometimes ephemeral. Organizations involve themselves according to demands of legitimacy which, are to understand as a shape institutional militancy articulating around the valuation of a militant, environmental, institutional expertise, or still around their status of institutional partner.

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Background and objective: Patients in the ICU often get many intravenous (iv) drugs at the same time. Even with three-lumen central venous catheters, the administration of more than one drug in the same iv line (IVL) is frequently necessary. The objective of this study was to observe how nurses managed to administer these many medications and to evaluate the proportion of two-drugs associations (TDA) that are compatible or not, based on known compatibility data. Design: Observational prospective study over 4 consecutive months. All patients receiving simultaneously more than one drugs in the same IVL (Y-site injection or mixed in the same container) were included. For each patient, all iv drugs were recorded, as well as concentration, infusion solution, location on the IVL system, time, rate and duration of administration. For each association of two or more drugs, compatibility of each drug was checked with each other. Compatibilities between these pairs of drugs were assessed using published data (mainly Trissel LA. Handbook on Injectable Drugs and Trissel's Tables of Physical Compatibility) and visual tests performed in our quality control laboratory. Setting: 34 beds university hospital adult ICU. Main outcome measures: Percentage of compatibilities and incompatibilities between drugs administered in the same IVL. Results: We observed 1,913 associations of drugs administered together in the same IVL, 783 implying only two drugs. The average number of drugs per IVL was 3.1 ± 0.8 (range: 2-9). 83.2% of the drugs were given by continuous infusion, 14.3% by intermittent infusion and 2.5% in bolus. The associations observed allowed to form 8,421 pairs of drugs (71.7% drug-drug and 28.3% drug-solute). According to literature data, 80.2% of the association were considered as compatible and 4.4% incompatible. 15.4% were not interpretable because of different conditions between local practices and those described in the literature (drug concentration, solute, etc.) or because of a lack of data. After laboratory tests performed on the most used drugs (furosemide, KH2PO4, morphine HCl, etc.), the proportion of compatible TDA raised to 85.7%, the incompatible stayed at 4.6% and only 9.7% remain unknown or not interpretable. Conclusions: Nurses managed the administration of iv medications quite well, as only less than 5% of observed TDA were considered as incompatible. But the 10% of TDA with unavailable compatibility data should have been avoided too, since the consequences of their concomitant administration cannot be predictable. For practical reasons, drugs were analysed only by pairs, which constitutes the main limit of this work. The average number of drugs in the same association being three, laboratory tests are currently performed to evaluate some of the most observed three-drugs associations.

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The Rebuild Iowa Office (RIO) continues to coordinate the state‘s recovery effort from the storms, tornadoes and floods of 2008. Much has been accomplished since the Office‘s last quarterly report was issued in July 2010. State funding has been disbursed to help Iowans with unmet needs and housing. Local governments and entities are utilizing millions of federal dollars so thousands of disaster-impacted homeowners can be offered a buyout. More infrastructure projects are under construction and new neighborhoods are being built with mitigation efforts in mind. However, as Iowa continues to celebrate many successes along the road to recovery, it must also address the numerous challenges that are encountered along the path. Recovering from the state‘s largest disaster must be looked at as a marathon, not a sprint. Over the past three months, the RIO has especially remained focused on helping small business owners impacted by the 2008 disasters. Many disaster-affected businesses have reopened their doors, however their debt load continues to be overwhelming and many still struggle with the timeliness of the disbursement of funds. This report describes how programs and recent modifications are working to assist recovering businesses. This report contains updates on housing progress while outlining the complexities behind certain programs and the bottlenecks communities are facing due to strict federal guidelines for implementation. This following pages also describe how Iowa is implementing Smart Planning principles, publicizing flood awareness through outreach efforts and preparing a blueprint for the state to follow when future disasters occur. As always, the RIO recognizes and thanks the countless leaders and front-line workers from local, regional, state and federal government, businesses, non-profit organizations and private citizens that have provided input, support and leadership. Their dedication to Iowa‘s disaster recovery has made the plans and projects on the following pages possible.

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[Table des matières] 1. Méthodologie. 1.1. Questions d'évaluation. 1.2. Collecte de l'information. 1.3. Validation. 1. 4. Analyse. 1.5. Utilité. 2. Planification de l'intervention en 2000, par domaine. 2.1. Clé de lecture des théories d'action. 2. 2. Les domaines de : la prévention, des thérapies et traitements, de la réduction des risques, de la formation, de la coordination, Campagne, migration et santé, de l'épidémiologie, de la recherche, de l'évaluation. 3. Evolution de la stratégie entre 1998 et 2000. 4. Théories d'action en 1998. 5. Dimensions de la théorie d'action globale 2000.

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FHWA and the Iowa Department of Transportation are proposing geometric and capacity improvements to the Interstate 29 and Interstate 80 mainline in Segment 3 and the I-80/I-29 East System interchange, the South Expressway interchange, the U.S. Highway 275 interchange, and the Madison Avenue interchange to to safely and efficiently of transportation in the City of Council Bluffs, the Iowa DOT is also proposing to eliminate several railroad alignments and to develop new, consolidated tracks in Segment 3.

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Description of the Proposed Action The Iowa Department of Transportation (Iowa DOT) and the Federal Highway Administration (FHWA) propose to improve a 3.9-mile segment of Iowa Highway 86 (IA 86) from Iowa Highway 9 (IA 9) to near the Minnesota border within Dickinson County, Iowa (the Project). The existing IA 86 has narrow travel lanes and shoulders, steep foreslopes, and poor vertical alignment. Environmental Assessment Availability The Environmental Assessment (EA) for the Project was signed on June 30, 2011, and distributed to selected federal, state, and local resource agencies on July 5, 2011, for review and comment. A Notice of Public Hearing and Environmental Assessment Availability was published in the legal section of the Estherville Daily News on July 5, 2011, and the Ocheyedan Press-Melvin News and Dickinson County News on July 6, 2011. Review and Comment Period A review and comment period was established for receipt of comments on the EA, with an expiration date of August 8, 2011. A public hearing for the Project was held at the Dickinson County Courthouse on July 21, 2011. The public hearing used a combined open forum and formal format. A transcript of this meeting has been prepared and is available upon request.

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Delta(9)-Tetrahydrocannabinol (THC) is frequently found in the blood of drivers suspected of driving under the influence of cannabis or involved in traffic crashes. The present study used a double-blind crossover design to compare the effects of medium (16.5 mg THC) and high doses (45.7 mg THC) of hemp milk decoctions or of a medium dose of dronabinol (20 mg synthetic THC, Marinol on several skills required for safe driving. Forensic interpretation of cannabinoids blood concentrations were attempted using the models proposed by Daldrup (cannabis influencing factor or CIF) and Huestis and coworkers. First, the time concentration-profiles of THC, 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) (active metabolite of THC), and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THCCOOH) in whole blood were determined by gas chromatography-mass spectrometry-negative ion chemical ionization. Compared to smoking studies, relatively low concentrations were measured in blood. The highest mean THC concentration (8.4 ng/mL) was achieved 1 h after ingestion of the strongest decoction. Mean maximum 11-OH-THC level (12.3 ng/mL) slightly exceeded that of THC. THCCOOH reached its highest mean concentration (66.2 ng/mL) 2.5-5.5 h after intake. Individual blood levels showed considerable intersubject variability. The willingness to drive was influenced by the importance of the requested task. Under significant cannabinoids influence, the participants refused to drive when they were asked whether they would agree to accomplish several unimportant tasks, (e.g., driving a friend to a party). Most of the participants reported a significant feeling of intoxication and did not appreciate the effects, notably those felt after drinking the strongest decoction. Road sign and tracking testing revealed obvious and statistically significant differences between placebo and treatments. A marked impairment was detected after ingestion of the strongest decoction. A CIF value, which relies on the molar ratio of main active to inactive cannabinoids, greater than 10 was found to correlate with a strong feeling of intoxication. It also matched with a significant decrease in the willingness to drive, and it matched also with a significant impairment in tracking performances. The mathematic model II proposed by Huestis et al. (1992) provided at best a rough estimate of the time of oral administration with 27% of actual values being out of range of the 95% confidence interval. The sum of THC and 11-OH-THC blood concentrations provided a better estimate of impairment than THC alone. This controlled clinical study points out the negative influence on fitness to drive after medium or high dose oral THC or dronabinol.

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Introduction: Though a trial of intrathecal (IT) therapy should always be performed before implantation of a definitive intrathecal pump, there is no agreement as to how this test should be performed. Ziconotide is trialed in most of cases with continuous IT administration using implanted catheters. Unlike other intrathecal drugs, there is little experience with single bolus IT injections of ziconotide. The aim of the study is to assess the feasibility of single-shot IT trialing with ziconotide. Patients and methods: Eleven consecutive patients with chronic neuropathic intractable pain were trialed with a single IT bolus of 2.5 mcg of ziconotide. Pain and side effects are monitored for at least 72 hours after the injection. Depending on the response, a second injection is given a week later, with either the same dose (if VAS decreased ≥50% without side effects), a higher dose of 3.75 mcg (if VAS decreased <50% without side effects) or a lower dose of 1.25 mcg (if VAS decreased ≥50% but with side effects). If VAS decreased less than 50% and side effects occurred, no further injection was performed. When VAS decreased >50% without side effects after the first or the second dose, the result is confirmed by one more injection of the same dose one week later. The trial is considered positive if two successive injections provide a VAS decreased more than 50% without side effects. Results: Eleven patients (6 females and 5 males) were included. Nine patients experienced modest or no pain relief. Four of these had significant side effects (dizziness, nausea, vomiting or abdominal pain) and had no further injection. In the others 5, one patient retired from study and four received a second injection of 3.75 mcg. The trial was negative in all 5 cases because of side effects (dizziness, drowsiness, weakness, muscle cramps), the pain decreased in only 2 patients. Two patients experienced profound pain relief with an IT injection of 2.5 mcg. One patient had no side effects and the other had dizziness and drowsiness that disappeared with an injection of 1.25 mcg. Pain relief without adverse effects was confirmed with the second injection. The trial was considered positive for those two patients. Discussion and conclusion: The response rate of 18% (2/11) is consistent with the success rate of a continuous infusion trialing with an implanted catheter. Single-shot injection of ziconotide may therefore predict efficacy.

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The in vivo effects of Diaspirin Crosslinked Hemoglobin (DCLHb, Baxter Healthcare Corp.) on hematology and biochemistry are unknown. This study includes 6 calves (71.2+/-1.3 kg). In each animal a total of 2 litres of blood was exchanged for the same amount of hydroxylethyl starch (Haes, Fresenius) (n=3) or DCLHb (n=3), which is equivalent to 28cc/kg of blood substitute, over a period of 5 hours. The animals were allowed to survive 7 days. Blood samples were taken hourly during the perfusion protocol, at postoperative day (POD) 1, 2 and 7. ANOVA test was used for repeated measurements. Blood cell profiles were similar in both groups. Peak methemoglobinemia was 4.2% in the DCLHb group. Osmolarity was significantly higher in the DCLHb group with the greatest difference at POD 1 and 2. Postmortem analysis of the major organs did not show any sign of hemoglobin deposit in the DCLHb group. In the given setup DCLHb can be administered in a large quantity with good hematological tolerance and without any deposits in major organs. A prolonged plasma expander effect was observed.