Treatment options related to clinical type

Treatment of status epilepticus (SE) consists in the sequential administration of three lines of drugs. The first is represented by benzodiazepines, and enjoys quite robust scientific evidence. The second one includes (phos-) phenytoin, valproate, phenobarbital, and increasingly levetiracetam, but its rationale is relatively scarce. The third line is pharmacological coma induction with barbiturates, propofol, or midazolam, which lacks the support of prospective, controlled studies and is reserved for refractory SE. Several other drugs are used after failure of this scheme, including newer antiepileptic compounds, other medications, and non-pharmacological approaches; no comparative assessment of their respective role has been conducted. It is important to tailor this relatively simple protocol to each particular situation; the supposed advantages of coma induction should be balanced with the morbidity related to prolonged mechanical ventilation. Awide consensus exists to treat generalized-convulsive SE and SE in coma soon and aggressively, to prevent a dismal outcome. On the other side, it is unclear if complex-partial SE induces permanent neuronal damage, and absence SE has an excellent prognosis: it appears therefore advisable not to proceed automatically to coma induction in these cases. SE related to post-anoxic coma has generally a poor prognosis, but some selected cases seem to be amenable to a better outcome if treated. SE prognosis depends on etiology, the biological background including age and comorbidities, and, possibly, treatment; each of these points deserves to be specifically addressed. A simple prognostic score has been recently validated and, helping to orient early treatment strategies and improve SE management.

O Turismo de Cruzeiros na Ilha de São Vicente - Harmonia entre a Procura e Oferta Turística

Este trabalho aborda o sector do Turismo de Cruzeiros Marítimos na ilha de São Vicente, visando aferir em que medida a oferta turística da ilha encontra-se equilibrada com a procura dos navios de cruzeiros. O turismo em Cabo Verde é considerado como o sector central de desenvolvimento da economia do país e o mercado do turismo de cruzeiros marítimos apresenta uma excelente alternativa para a maximização dos impactos socioeconómicos na ilha de São Vicente. Quanto à metodologia, a pesquisa foi caracterizada como exploratória e descritiva, com uma abordagem tanto qualitativa como quantitativa. O uso da técnica da observação directa, como recurso metodológico na colecta dos dados, levou a concluir que a estrutura portuária da cidade é bastante atractiva no que tange à questão de segurança, da paisagem e dos recursos naturais oferecidos na ilha. Também a utilização do programa SPSS no tratamento dos inquéritos recolhidos possibilitou a realização de várias análises o que permitiu chegar a conclusões importantes da investigação. A pesquisa foi desenvolvida com base a pesquisa bibliográfica, consulta em sites de Internet e acesso a documentos que possuem informações sobre a evolução do turismo de cruzeiros em São Vicente. This work intends to study the sector of Cruise Tourism in São Vicente Island, in Cape Verde. Its main objective is to gauge to what extent the touristic offer is balanced with the demand for this specific niche of tourism. Tourism in Cape Verde is being considered as a central sector for economic growth, and this type of tourism surely presents itself as an excellent alternative for the maximization of social and economic impacts, in the island. In terms of methodology used, this research is seen as both exploratory and descriptive; hence, it has a qualitative and a quantitative approach. Direct observation as a methodological resource has allowed us to conclude that the island’s port infrastructure is very attractive in terms of safety, landscape, and natural resources the island has to offer its visitors. The use of SPSS for data treatment, in terms of our survey, allowed the realization of many analyses that lead to very important conclusions to this research. The research also relied on bibliographic review, web surfing for information, and analyses of documentation related to the evolution of cruise tourism in São Vicente.

Bringing game theory to hypothesis testing: Establishing finite sample bounds on inference

Small sample properties are of fundamental interest when only limited data is avail-able. Exact inference is limited by constraints imposed by speci.c nonrandomizedtests and of course also by lack of more data. These e¤ects can be separated as we propose to evaluate a test by comparing its type II error to the minimal type II error among all tests for the given sample. Game theory is used to establish this minimal type II error, the associated randomized test is characterized as part of a Nash equilibrium of a .ctitious game against nature.We use this method to investigate sequential tests for the di¤erence between twomeans when outcomes are constrained to belong to a given bounded set. Tests ofinequality and of noninferiority are included. We .nd that inference in terms oftype II error based on a balanced sample cannot be improved by sequential sampling or even by observing counter factual evidence providing there is a reasonable gap between the hypotheses.

Credit rationing and crowding out during the Industrial Revolution: Evidence from Hoare's Bank, 1702-1862

Crowding-out during the British Industrial Revolution has long been one of the leadingexplanations for slow growth during the Industrial Revolution, but little empirical evidence exists to support it. We argue that examinations of interest rates are fundamentally misguided, and that the eighteenth- and early nineteenth-century private loan market balanced through quantity rationing. Using a unique set of observations on lending volume at a London goldsmith bank, Hoare s, we document the impact of wartime financing on private credit markets. We conclude that there is considerable evidence that government borrowing, especially during wartime, crowded out private credit.

Low compliance with dietary recommendations for food intake among adults.

BACKGROUND & AIMS: To assess the adherence to the national dietary recommendations and to identify factors contributing to dietary compliance in Switzerland. METHODS: Population-based cross-sectional study in Lausanne, Switzerland (CoLaus study), 2009-2012. Dietary intake was assessed using a validated food frequency questionnaire. Participants were dichotomized according to whether they followed the national recommendations for fruits, vegetables, meat, fish and dairy products. RESULTS: Data from 4371 participants (54% women, mean age ± SD: 57.6 ± 10.5 years) were analyzed. Compliance with the recommendations was low: only 39.4%, 7.1%, 61.3%, 66.4%, and 8.4% complied with the Swiss recommendations for fruit (≥2/day), vegetables (≥3/day), meat (≤5/week), fish (≥1/week) and dairy products (≥3/day), respectively. In multivariate analyses, gender, age, smoking status, Swiss-born status, education, being on a diet and body mass index were associated with dietary compliance, while no difference was found between women before and after menopause. Factors specifically associated with fruits, vegetables, meat, fish or dairy products recommendations were identified. CONCLUSION: The low degree of compliance with dietary recommendations calls for a continued effort to increase the population awareness of the importance of a healthy and balanced diet, especially for vegetables and dairy products. This study identified determinants that should guide this effort.

Operação e Distribuição na Worten.pt na Sonae Distribuição

As organizações são sistemas abertos que operam através de diversos mecanismos de cooperação com outras organizações. O ambiente externo à empresa é de rápida mudança e de muita concorrência, o que exige que as empresas lutem para manterem seus domínios. A estratégia empresarial define a forma como a empresa interage com o seu contexto ambiental. Além de ter uma estratégia é necessário que todas as acções de melhoria da empresa estejam alinhadas com a estratégia. Neste contexto foi realizado este projecto, cujo objectivo é implementar acções de melhoria nas operações e na distribuição da Worten Online para torná-las mais eficientes assegurando um melhor serviço ao cliente. A implementação de acções de melhoria foi feita com base no conceito Balanced Scorecard (BSC) e seguindo um ciclo PDCA (Planeamento; Execução (Desenvolvimento), Verificar (controlo) e Acção). Inicialmente foi feita a análise da situação da empresa e a identificação de problemas. A fase seguinte foi o desenho de soluções para os problemas identificados. A Worten online apresenta oportunidades de melhoria associadas aos processos de picking, facturação e distribuição que potenciam melhorias em todo o negócio. Os principais problemas estão relacionados com a falta de organização do trabalho e do espaço, falta de padronização dos processos e a falta de foco nos resultados. Para resolver os problemas operacionais foram implementadas várias acções de melhoria como os 5S, a normalização de processos de ruptura, devoluções, picking, embalamento e facturação. Foram implementadas melhorias associadas à inovação e desenvolvimento, para automatizar alguns processos e eliminar desperdícios que tenham impacto nas operações. Tendo em conta o Balanced Scorecard foram implementados os indicadores de desempenho em toda a Worten Online.(...)

Position statement--altitude training for improving team-sport players' performance: current knowledge and unresolved issues.

Despite the limited research on the effects of altitude (or hypoxic) training interventions on team-sport performance, players from all around the world engaged in these sports are now using altitude training more than ever before. In March 2013, an Altitude Training and Team Sports conference was held in Doha, Qatar, to establish a forum of research and practical insights into this rapidly growing field. A round-table meeting in which the panellists engaged in focused discussions concluded this conference. This has resulted in the present position statement, designed to highlight some key issues raised during the debates and to integrate the ideas into a shared conceptual framework. The present signposting document has been developed for use by support teams (coaches, performance scientists, physicians, strength and conditioning staff) and other professionals who have an interest in the practical application of altitude training for team sports. After more than four decades of research, there is still no consensus on the optimal strategies to elicit the best results from altitude training in a team-sport population. However, there are some recommended strategies discussed in this position statement to adopt for improving the acclimatisation process when training/competing at altitude and for potentially enhancing sea-level performance. It is our hope that this information will be intriguing, balanced and, more importantly, stimulating to the point that it promotes constructive discussion and serves as a guide for future research aimed at advancing the bourgeoning body of knowledge in the area of altitude training for team sports.

Planeamento de Experiências: Modelos e desafios dos Planos em Blocos Incompletos

O principal objetivo de um Planeamento de Experiências reside essencialmente na procura de relações entre variáveis e na comparação de níveis de fatores, recorrendo ao tratamento estatístico dos dados recolhidos. A utilização de blocos no Planeamento de Experiências é fundamental, pois permite reduzir ou eliminar a variabilidade introduzida por fatores que podem influenciar a experiência mas que não interessam e/ou não foram explicitamente incluídos durante o planeamento. Neste trabalho apresentamos os resultados do estudo e investigação dos Planos em Blocos Incompletos Equilibrados (BIBD), Planos em Blocos Incompletos Equilibrados com repetição de blocos (BIBDR) e Planos em Blocos Incompletos com blocos de diferentes dimensões (VBBD). Exploramos algumas propriedades e métodos de construção destes planos e ilustramos, sempre que possível, com exemplos. Tendo como base o planeamento em blocos, apresentamos uma aplicação dos BIBDR na área da Educação com o objetivo de comparar cinco domínios do pensamento algébrico de uma amostra de alunos do 1º ano do ensino superior em Cabo Verde. Para a análise dos dados da amostra foi utilizado o software R, versão 2.12.1. Pudemos constatar que existem diferenças significativas entre alguns dos domínios do pensamento algébrico, nomeadamente entre os domínios da Generalização da Aritmética e Tecnicismo Algébrico com os restantes domínios. Recomendamos a escolha de uma amostra mais representativa constituída por alunos de todas as instituições superiores de Cabo Verde.

Planeamento de experiências : modelos e desafios dos planos em blocos incompletos

The main purpose of an Experimental Design resides mainly in the search for relationships between variables and in comparing levels of factors, using statistical treatment of collected data. The use of blocks in Experimental Design is essential because it allows reducing or eliminating the variability introduced by factors that can influence the experience but are not of main interest and/or were not explicitly included during experiments. In this work we present the results of the study and research of Balanced Incomplete Block Designs (BIBD), Balanced Incomplete Block Designs with repeated blocks (BIBDR) and the Incomplete Blocks Designs with blocks with different dimensions (VBBD). We explore some properties and construction methods of such designs and illustrate, when possible, with examples. Based on Block Designs, we present an application of BIBDR in Education, with the aim of comparing five domains of algebraic thinking in a sample of 1st year students of higher education in Cape Verde. For the analysis of sample data, the software R was used, version 2.12.1. We observed that significant differences exist between some of the domains of algebraic thinking, especially among the domains of Generalization of Arithmetic and Algebraic Technicality with the remaining areas. For a more representative sample, we recommend a bigger sample consisting of students from all higher institutions of Cape Verde.

Planeamento de experiências : modelos e desafios dos planos em blocos incompletos

The main purpose of an Experimental Design resides mainly in the search for relationships between variables and in comparing levels of factors, using statistical treatment of collected data. The use of blocks in Experimental Design is essential because it allows reducing or eliminating the variability introduced by factors that can influence the experience but are not of main interest and/or were not explicitly included during experiments. In this work we present the results of the study and research of Balanced Incomplete Block Designs (BIBD), Balanced Incomplete Block Designs with repeated blocks (BIBDR) and the Incomplete Blocks Designs with blocks with different dimensions (VBBD). We explore some properties and construction methods of such designs and illustrate, when possible, with examples. Based on Block Designs, we present an application of BIBDR in Education, with the aim of comparing five domains of algebraic thinking in a sample of 1st year students of higher education in Cape Verde. For the analysis of sample data, the software R was used, version 2.12.1. We observed that significant differences exist between some of the domains of algebraic thinking, especially among the domains of Generalization of Arithmetic and Algebraic Technicality with the remaining areas. For a more representative sample, we recommend a bigger sample consisting of students from all higher institutions of Cape Verde.

2009-2013 Iowa Transportation Improvement Program

The Iowa Transportation Improvement Program (Program) is published to inform Iowans of planned investments in our state's transportation system. The Iowa Transportation Commission (Commission) and Iowa Department of Transportation (Iowa DOT) are committed to programming those investments in a fiscally responsible manner. Iowa's transportation system is multi-modal; therefore, the Program encompasses investments in aviation, transit, railroads, trails, and highways. A major component of the Program is the highway section. The FY2009-2013 highway section is financially balanced and was developed to achieve several objectives. The Commission's primary highway investment objective is the safety, maintenance and preservation of Iowa's existing highway system. The Commission has allocated an annual average of $321 million to achieve this objective. This includes $185 million in 2009 and $170 million annually in years 2010-2013 for preserving the interstate system. It includes $114 million in 2009, $100 million in 2010 and $90 million annually in years 2011-2013 for non-interstate pavement preservation. It includes $38 million annually in 2009 and 2010, and $35 million annually in years 2011-2013 for non-interstate bridges. In addition, $15 million annually is allocated for safety projects. However, due to increasing construction costs, flattened revenues and overall highway systems needs, the Commission acknowledges that insufficient funds are being invested in the maintenance and preservation of the existing highway system. Another objective involves investing in projects that have received funding from the federal transportation act and/or subsequent federal transportation appropriation acts. In particular, funding is being used where it will complete a project, corridor or useable segment of a larger project. As an investment goal, the Commission also wishes to advance highway projects that address the state's highway capacity and economic development needs. Projects that address these needs and were included for completion in the previous program have been advanced into this year's Program to maintain their scheduled completion. This program also includes a small number of other projects that generally either represent a final phase of a partially programmed project or an additional segment of a partially completed corridor. The TIME-21 bill, Senate File 2420, signed by Governor Chet Culver on April 22, provides additional funding to cities, counties and the Iowa DOT for road improvements. This will result in additional revenue to the Primary Road Fund beginning in the second half of FY2009 and gradually increase over time. The additional funding will be included in future highway programming objectives and proposals and is not reflected in this highway program. The Iowa DOT and Commission appreciate the public's involvement in the state's transportation planning process. Comments received personally, by letter, or through participation in the Commission's regular meetings or public input meetings held around the state each year are invaluable in providing guidance for the future of Iowa's transportation system. It should be noted that this document is a planning guide. It does not represent a binding commitment or obligation of the Commission or Iowa DOT, and is subject to change. You are invited to visit the Iowa DOT's Web site at iowadot.gov for additional and regular updates about the department's programs and activities.

Planeamento de experiências : modelos e desafios dos planos em blocos incompletos.

O principal objetivo de um Planeamento de Experiências reside essencialmente na procura de relações entre variáveis e na comparação de níveis de fatores, recorrendo ao tratamento estatístico dos dados recolhidos. A utilização de blocos no Planeamento de Experiências é fundamental, pois permite reduzir ou eliminar a variabilidade introduzida por fatores que podem influenciar a experiência mas que não interessam e/ou não foram explicitamente incluídos durante o planeamento. Neste trabalho apresentamos os resultados do estudo e investigação dos Planos em Blocos Incompletos Equilibrados (BIBD), Planos em Blocos Incompletos Equilibrados com repetição de blocos (BIBDR) e Planos em Blocos Incompletos com blocos de diferentes dimensões (VBBD). Exploramos algumas propriedades e métodos de construção destes planos e ilustramos, sempre que possível, com exemplos. Tendo como base o planeamento em blocos, apresentamos uma aplicação dos BIBDR na área da Educação com o objetivo de comparar cinco domínios do pensamento algébrico de uma amostra de alunos do 1º ano do ensino superior em Cabo Verde. Para a análise dos dados da amostra foi utilizado o software R, versão 2.12.1. Pudemos constatar que existem diferenças significativas entre alguns dos domínios do pensamento algébrico, nomeadamente entre os domínios da Generalização da Aritmética e Tecnicismo Algébrico com os restantes domínios. Recomendamos a escolha de uma amostra mais representativa constituída por alunos de todas as instituições superiores de Cabo Verde

Balance Between Investment Protection and Sustainable Development in BITs: the Example of Switzerland

The objective of this article is to examine how substantive and procedural rights granted to foreign investors by Swiss bits are gradually being balanced with social and environmental provisions. Switzerland has enjoyed a long bit practice, as it signed its first treaty with Tunisia fifty years ago. Swiss bits rely on the post-establishment model and include usual standards of treatment. From 1981, they also systematically provide for a dispute settlement mechanism for disputes arising between an investor and a host State. Since the Switzerland - El Salvador bit in 1994, sustainable development concerns have been expressly inserted in some Swiss bits, as well as in several recent free trade agreements. Provisions on this theme are however far from being systematic in Switzerland's bit practice and essentially remain declaratory in nature. The trend towards wider inclusion of sustainable development provisions in bits still faces several practical and political challenges.

Evolution in heterogeneous populations: from migration models to fixation probabilities.

Although dispersal is recognized as a key issue in several fields of population biology (such as behavioral ecology, population genetics, metapopulation dynamics or evolutionary modeling), these disciplines focus on different aspects of the concept and often make different implicit assumptions regarding migration models. Using simulations, we investigate how such assumptions translate into effective gene flow and fixation probability of selected alleles. Assumptions regarding migration type (e.g. source-sink, resident pre-emption, or balanced dispersal) and patterns (e.g. stepping-stone versus island dispersal) have large impacts when demes differ in sizes or selective pressures. The effects of fragmentation, as well as the spatial localization of newly arising mutations, also strongly depend on migration type and patterns. Migration rate also matters: depending on the migration type, fixation probabilities at an intermediate migration rate may lie outside the range defined by the low- and high-migration limits when demes differ in sizes. Given the extreme sensitivity of fixation probability to characteristics of dispersal, we underline the importance of making explicit (and documenting empirically) the crucial ecological/ behavioral assumptions underlying migration models.

Total shoulder arthroplasty: downward inclination of the glenoid component to balance supraspinatus deficiency.

HYPOTHESIS: Supraspinatus deficiency associated with total shoulder arthroplasty (TSA) provokes eccentric loading and may induce loosening of the glenoid component. A downward inclination of the glenoid component has been proposed to balance supraspinatus deficiency. METHODS: This hypothesis was assessed by a numeric musculoskeletal model of the glenohumeral joint during active abduction. Three cases were compared: TSA with normal muscular function, TSA with supraspinatus deficiency, and TSA with supraspinatus deficiency and downward inclination of the glenoid. RESULTS: Supraspinatus deficiency increased humeral migration and eccentric loading. A downward inclination of the glenoid partly balanced the loss of stability, but this potential advantage was counterbalanced by an important stress increase within the glenoid cement. The additional subchondral bone reaming required to incline the glenoid component indeed reduced the bone support, increasing cement deformation and stress. CONCLUSION: Glenoid inclination should not be obtained at the expense of subchondral bone support.