A U-shaped association between intensity of Internet use and adolescent health.

OBJECTIVE: To examine the relationship between different Internet-use intensities and adolescent mental and somatic health. METHODS: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health, a nationally representative survey of adolescents aged 16 to 20 years in post-mandatory school. From a self-administered anonymous questionnaire, 3906 adolescent boys and 3305 girls were categorized into 4 groups according to their intensity of Internet use: heavy Internet users (HIUs; >2 hours/day), regular Internet users (RIUs; several days per week and <= 2 hours/day), occasional users (<= 1 hour/week), and non-Internet users (NIUs; no use in the previous month). Health factors examined were perceived health, depression, overweight, headaches and back pain, and insufficient sleep. RESULTS: In controlled multivariate analysis, using RIUs as a reference, HIUs of both genders were more likely to report higher depressive scores, whereas only male users were found at increased risk of overweight and female users at increased risk of insufficient sleep. Male NIUs and female NIUs and occasional users also were found at increased risk of higher depressive scores. Back-pain complaints were found predominantly among male NIUs. CONCLUSIONS: Our study provides evidence of a U-shaped relationship between intensity of Internet use and poorer mental health of adolescents. In addition, HIUs were confirmed at increased risk for somatic health problems. Thus, health professionals should be on the alert when caring for adolescents who report either heavy Internet use or very little/none. Also, they should consider regular Internet use as a normative behavior without major health consequence. Pediatrics 2011;127:e330-e335

Reporting intellectual capital in Spain

This study reports on the analysis of annual reports from 14- listed companies in Spainover a five-year period, from 1998 to 2002. Companies in the sample are selected on thebasis of their knowledge-based assets and incentives to report on Intellectual Capital.The empirical analysis is twofold:1) Firstly, we analyse the value of intellectual capital using a value-based approach,through the difference between market and book value over the period considered. Results show that there is a general decrease in the 'hidden value' of these companies, probably due to the general trend in stock markets.2) Secondly, we carry out a content-based analysis of the complete annual reports of the companies over the five year period. Preliminary findings seem to suggest that although the level of disclosure has increased over time, this is mainly in the form of narrative. Overall, the level of disclosure of intellectual capital remains low.

Voting with preferences over margins of victory

This paper analyzes a two-alternative voting model with the distinctive feature that voters have preferences over margins of victory. We study voting contests with a finite as well as an infinite number of voters, and with and without mandatory voting. The main result of the paper is the existence and characterization of a unique equilibrium outcome in all those situations. At equilibrium, voters who prefer a larger support for one of the alternatives vote for such alternative.The model also provides a formal argument for the conditional sincerity voting condition in Alesina and Rosenthal (1995) and the benefit of voting function in Llavador (2006). Finally, we offer new insights on explaining why some citizens may vote strategically for an alternative different from the one declared as the most preferred.

The benefits of limited feedback in organizations

In most firms, managers periodically assess workers' performance. Evidence suggeststhat managers withhold information during these reviews, and some observersargue that this necessarily reduces surplus. This paper assesses the validity of thisargument when workers have career concerns. Disclosure has two effects: it exposesthe worker to uncertainty about future effort levels, but allows him to use current effortto influence his employer's beliefs about future effort. The surplus-maximizingdisclosure policy reveals output realizations in the center of the distribution, butnot in the tails. Thus, it is efficient for firms to reveal some but not all performanceinformation.

Window-dressing in German interwar balance sheets

German accounting rules value assets and liabilities asymmetricallyand thus lead to grossly distorted balance sheets. In the interwardebate on a reform of disclosure regulation, financial expertsconsidered the (undisclosed) tax balance sheet, which had to bedrawn up separately for the corporate tax assessment, as a paradigmfor adequate financial disclosure. However, due to tax secrecy thaywere barred from analyzing tax documents. Using archival evidence,we analyze tax balance sheets from which the reliability of disclosedbalance sheets of the interwar period can be assessed. It emergesthat companies overstated their profits in the middand late 1920s,but grossly understated them in the Nazi economy.

Avaliação Externa de Escolas: Estudo Comparativo entre Portugal e Cabo Verde

A avaliação externa de escolas assumiu, nos últimos anos, uma grande centralidade nas políticas educativas e apercebemos que cada vez mais, se tornou uma exigência nos estabelecimentos de ensino. É nesta perspetiva que levamos a cabo uma investigação cuja preocupação central assenta na avaliação externa de escolas como nosso objeto de estudo, uma vez que, devido à pertinência atribuída pelas políticas educativas e sustentada nas boas práticas internacionais é considerada um gerador de mudança que contribui para a melhoria da aprendizagem dos alunos e para o desenvolvimento das instituições. Assim, optamos por realizar o trabalho segundo uma abordagem predominantemente qualitativa, através de um inquérito por entrevistas, com o propósito de obter dados que permitissem compreender e conhecer o modelo da avaliação externa de escolas, que, enquanto área de avaliação e de melhorias é assumida como uma das prioridades na educação, que caminha para o progresso das escolas, qualificando-as, com o objetivo de gerar impacto na melhoria dos resultados dos alunos. De uma forma global constatamos que nas últimas décadas, particularmente em Portugal, varias foram as iniciativas de avaliação de escolas e que a lei nº 31/2002, de 20 de dezembro, veio dar continuidade aos programas antes implementados, atribuindo-lhe um caráter obrigatório. Entretanto, Cabo Verde não dispõe de nenhum regulamento que estabeleça a obrigatoriedade da mesma, mas tendo consciência do impacto que a avaliação externa de escolas tem suscitado em muitos países europeus, a inspeção - geral da educação iniciou-se uma experiência em março de 2012, mas falta ainda fazer a revisão dos normativos que permitam regularizar este fenómeno, de modo a que se torne seja uma prática regularizada e consistente. De acordo com os argumentos dos entrevistados, os dados revelam-se que, a avaliação externa de escolas têm como finalidade a melhoria do sistema educativo e os efeitos nomeadamente a este nível são o desenvolvimento a nível institucional e profissional dos professores, a boa gestão pedagógica e ainda o de produzir uma cultura de autoavaliação nas escolas.

Concomitant Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: Ten-year Follow-up of a Randomized Phase III Trial (SAKK 10/94)

Purpose/Objective(s): To analyze the long-term outcome of treatment with concomitant cisplatin and hyperfractionated radiotherapy in locally advanced head and neck cancer compared with hyperfractionated radiotherapy alone.Materials/Methods: From July 1994 to July 2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiotherapy (median dose 74.4 Gy; 1.2 Gy twice daily) or the same radiotherapy combined with two cycles of concomitant cisplatin (20mg/m2 for 5 consecutive days of weeks 1 and 5). The primary endpoint was time to any treatment failure; secondary endpoints were locoregional failure, metastatic failure, overall survival, and late toxicity assessed according to RTOG criteria. The trial was registered at the National Institutes of Health (www.clinicaltrials.gov; identifier number: NCT00002654).Results: Median follow-up was 9.5 years (range, 0.1 - 15.4 years). Median time to any treatment failure was not significantly different between treatment arms (p = 0.19). Locoregional control (p\0.05), distant metastasis-free survival (p = 0.02) and cancer specific survival (p = 0.03) were significantly improved in the combined treatment arm, with no difference in late toxicity between treatment arms. However, overall survival was not significantly different (p = 0.19). Conclusions: After long-term follow-up combined treatment with cisplatin and hyperfractionated, radiotherapy maintained an improved locoregional control, distant metastasis-free survival, and cancer specific survival as compared to hyperfractionated radiotherapy alone with no difference in late toxicity.Author Disclosure: P. Ghadjar, None; M. Simcock, None; G. Studer, None; A.S. Allal, None; M. Ozsahin, None; J. Bernier, None; M. To¨ pfer, None; F. Zimmermann, None; C. Glanzmann, None; D.M. Aebersold, None.

Co-infecção por vírus da hepatite B e vírus da imunodeficiência humana em países africanos

Introdução: Actualmente, estima-se que existam dois milhões de indivíduos infectados por vírus da hepatite B (VHB) e que, cerca de 25% dos indivíduos com infecção crónica morrem devido a sequelas resultantes da infecção por VHB. Paralelamente, calcula-se que existam cerca de 33 milhões de indivíduos infectados por VIH, sendo que 22, 5 milhões residem na região de África a sul do Sara. Na região de África a sul do Sara existem poucos estudos efectuados no âmbito da co-infecção por VIH/VHB. Contudo, dos estudos existentes, esta taxa pode situar-se entre os 2,4% e os 9,9%. Objectivo: Avaliar as taxas de seroprevalência de VHB e VIH, assim como a taxa de co-infecção por VIH/VHB em Angola, Cabo Verde, Guiné-Bissau e Moçambique. Métodos: Foram efectuadas duas pesquisas bibliográficas neste estudo. A primeira, realizada nos meses de Setembro/Outubro 2008, tinha como objectivo contextualizar a infecção por VHB, VIH e a co-infecção por VIH/VHB nos países desenvolvidos e nos países em desenvolvimento. A segunda pesquisa foi efectuada durante o mês de Agosto de 2009, e visava apenas cobrir a realidade dos países em análise, relativamente aos objectivos previamente delineados do estudo. Resultados: Em Moçambique, constatou-se que a seroprevalência de VIH-1 tinha quadriplicado entre 1993 (1,17%) e o ano 2000 (4,5%). Na Guiné-Bissau, entre 1997 e 1999, também a seroprevalência de VIH-1 duplicou (2,5% e 5,2%, respectivamente). Em Cabo-Verde, no ano de 2006, a seroprevalência de VIH era 2,4%, enquanto que a seroprevalência da infecção por VHB era 4,4%. Em Angola, no ano de 2005, a seroprevalência de VIH era de 2,5%. Neste estudo também foi avaliada a co-infecção, sendo que nenhum caso foi diagnosticado. Conclusão: É urgente realizarem-se mais estudos nos países PALOP, no âmbito da seroprevalência das monoinfecções VIH e VHB, assim como na co-infecção por VIH/VHB, uma vez que existe pouca informação disponível. De qualquer modo, sendo a infecção por VHB uma doença prevenível por vacina, é fundamental que os planos de vacinação continuem a ser postos em prática nos países onde já estão implementados e, no caso dos países que ainda não os têm, que a sua implementação seja efectuada de forma sustentada e o mais brevemente possível.

Expertise and finance: Mergers motivated by technological change

This paper argues that a large technological innovation may lead to a merger wave by inducing entrepreneurs to seek funds from technologically knowledgeable firms -experts. When a large technological innovation occurs, the ability of non-experts (banks) to discriminate between good and bad quality projects is reduced. Experts can continue to charge a low rate of interest for financing because their expertise enables them to identify good quality projects and to avoid unprofitable investments. On the other hand, non-experts now charge a higher rate of interest in order to screen bad projects. More entrepreneurs, therefore, disclose their projects to experts to raise funds from them. Such experts are, however, able to copy the projects and disclosure to them invites the possibility of competition. Thus the entrepreneur and the expert may merge so as to achieve product market collusion. As well as rationalizing mergers, the model can also explain various forms of venture financing by experts such as corporate investors and business angels.

Transcatheter aortic valve implantation (TAVI): state of the art techniques and future perspectives.

Transcatheter aortic valve therapies are the newest established techniques for the treatment of high risk patients affected by severe symptomatic aortic valve stenosis. The transapical approach requires a left anterolateral mini-thoracotomy, whereas the transfemoral method requires an adequate peripheral vascular access and can be performed fully percutaneously. Alternatively, the trans-subclavian access has been recently proposed as a third promising approach. Depending on the technique, the fine stent-valve positioning can be performed with or without contrast injections. The transapical echo-guided stent-valve implantation without angiography (the Lausanne technique) relies entirely on transoesophageal echocardiogramme imaging for the fine stent-valve positioning and it has been proved that this technique prevents the onset of postoperative contrast-related acute kidney failure. Recent published reports have shown good hospital outcomes and short-term results after transcatheter aortic valve implantation, but there are no proven advantages in using the transfemoral or the transapical technique. In particular, the transapical series have a higher mean logistic Euroscore of 27-35%, a procedural success rate above 95% and a mean 30-day mortality between 7.5 and 17.5%, whereas the transfemoral results show a lower logistic Euroscore of 23-25.5%, a procedural success rate above 90% and a 30-day mortality of 7-10.8%. Nevertheless, further clinical trials and long-term results are mandatory to confirm this positive trend. Future perspectives in transcatheter aortic valve therapies would be the development of intravascular devices for the ablation of the diseased valve leaflets and the launch of new stent-valves with improved haemodynamic, different sizes and smaller delivery systems.

Conflicts of interest, information provision and competition in banking

In some markets, such as the market for drugs or for financial services, sellers have better information than buyersregarding the matching between the buyer's needs and the good's actual characteristics. Depending on the market structure,this may lead to conflicts of interest and/or the underprovision of information by the seller. This paper studies this issuein the market for financial services. The analysis presents a new model of competition between banks, as banks' pricecompetition influences the ensuing incentives for truthful information revelation. We compare two different firm structures,specialized banking, where financial institutions provide a unique financial product, and one-stop banking, where a financialinstitution is able to provide several financial products which are horizontally differentiated. We show first that, althoughconflicts of interest may prevent information disclosure under monopoly, competition forces full information provision forsufficiently high reputation costs. Second, in the presence of market power, one-stop banks will use information strategicallyto increase product differentiation and therefore will always provide reliable information and charge higher rices thanspecialized banks, thus providing a new justification for the creation of one-stop banks. Finally, we show that, ifindependent financial advisers are able to provide reliable information, this increases product differentiation and thereforemarket power, so that it is in the interest of financial intermediaries to promote external independent financial advice.

Troubles du cycle à l'adolescence: une banalité [Menstrual disorders in adolescents: commonplace or worrisome?].

The first menstrual cycles following menarche are often caracterized by irregular and/or heavy bleeding. The adolescent patient may be worried by these episodes of bleeding. In 50-80% of cases these are anovulatory bleeding due to the immaturity of the gonadotrophic axis. Nevertheless pathologies such as von Willebrand disease, genital infection, polycystic ovary syndrom, eating disorders, a tumor or a pregnancy may be diagnosed by bleeding abnormalities. The challenge for the physician is to distinguish between bleeding abnormalities secondary to anovulation and pathologies where investigations and specific follow-up is mandatory. Adolescents who experience abnormal bleeding must be counceled according to their perceptions and expectations.

State of Iowa Employee Handbook, Revised October 2003

I hope you will find a great deal of challenge and personal satisfaction in your employment with the State. You have an important role in accomplishing the goals of your department and of state government. The State has a proud tradition built on the excellence of its employees and their work. We challenge you to help maintain and improve upon this tradition. You soon will discover that our pride is contagious! As a state employee, it is very important that you always present the best possible image to the public. Remember to act promptly, be courteous, and treat people, our customers, respectfully. Your actions will make a lasting impression .... be sure it is a positive one. This is your employee handbook. This information is based on Iowa Department of Administrative Services – Human Resources Enterprise (DAS-HRE) rules and policies. Much of the information in this handbook is also covered in the State’s collective bargaining agreements. Where there are differences between a collective bargaining agreement and this handbook, the collective bargaining agreement prevails for employees covered by the agreement. Where there are differences between this handbook and DAS-HRE rules and policies, DAS-HRE rules and policies prevail. Some of the employee benefit plans described in this handbook are subject to legal requirements concerning reporting and disclosure. This handbook contains highlights of those plans. For complete details about benefit plans, consult the benefit handbooks and the official plan documents. In case of any discrepancy, the official plan documents prevail. Of course, changes in laws may affect the benefit programs described in this handbook. The State of Iowa reserves the right to amend the contents of this handbook at any time without prior notice. The provisions of this handbook and other policies do not establish contractual rights or conditions of employment between the State and its employees.

Pupillographic investigation of the relative afferent pupillary defect associated with a midbrain lesion.

OBJECTIVE: To identify clinical and pupillographic features of patients with a relative afferent pupillary defect (RAPD) without visual acuity or visual field loss caused by a lesion in the dorsal midbrain. DESIGN: Experimental study. PARTICIPANTS AND CONTROLS: Four patients with a dorsal midbrain lesion who had normal visual fields and a clinically detectable RAPD. METHODS: The pupil response from full-field and hemifield light stimulation over a range of light intensities was measured by computerized binocular pupillography. MAIN OUTCOME MEASURES: The mean of the direct and consensual pupil response to full-field and hemifield light stimulation was plotted as a function of stimulus light intensity. RESULTS: All 4 subjects showed decreased pupillographic responses at all intensities to full-field light stimulation in the eye with the clinical RAPD. The pupillographic responses to hemifield stimulation showed a homonymous pattern of deficit on the side ipsilateral to the RAPD, similar to that observed in a previously reported patient with an optic tract lesion. CONCLUSIONS: The basis of a midbrain RAPD is the nasal-temporal asymmetry of pupillomotor input that becomes manifest when a unilateral postchiasmal lesion interrupts homonymously paired fibers traveling in the contralateral optic tract or midbrain pathway to the pupillomotor center, respectively. The pupillographic characteristics of an RAPD resulting from a dorsal midbrain lesion thus resemble those of an RAPD resulting from a unilateral optic tract lesion, but without the homonymous visual field defect. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Recent decrease in the prevalence of congenital heart defects in europe.

OBJECTIVES: To examine trends in the prevalence of congenital heart defects (CHDs) in Europe and to compare these trends with the recent decrease in the prevalence of CHDs in Canada (Quebec) that was attributed to the policy of mandatory folic acid fortification. STUDY DESIGN: We used data for the period 1990-2007 for 47 508 cases of CHD not associated with a chromosomal anomaly from 29 population-based European Surveillance of Congenital Anomalies registries in 16 countries covering 7.3 million births. We estimated trends for all CHDs combined and separately for 3 severity groups using random-effects Poisson regression models with splines. RESULTS: We found that the total prevalence of CHDs increased during the 1990s and the early 2000s until 2004 and decreased thereafter. We found essentially no trend in total prevalence of the most severe group (group I), whereas the prevalence of severity group II increased until about 2000 and decreased thereafter. Trends for severity group III (the most prevalent group) paralleled those for all CHDs combined. CONCLUSIONS: The prevalence of CHDs decreased in recent years in Europe in the absence of a policy for mandatory folic acid fortification. One possible explanation for this decrease may be an as-yet-undocumented increase in folic acid intake of women in Europe following recommendations for folic acid supplementation and/or voluntary fortification. However, alternative hypotheses, including reductions in risk factors of CHDs (eg, maternal smoking) and improved management of maternal chronic health conditions (eg, diabetes), must also be considered for explaining the observed decrease in the prevalence of CHDs in Europe or elsewhere.