A new look at atrial fibrillation: lessons learned from drugs, pacing, and ablation therapies.

Atrial fibrillation (AF) is the most common arrhythmia and among the leading causes of stroke and heart failure in Western populations. Despite the increasing size of clinical trials assessing the efficacy and safety of AF therapies, achieved outcomes have not always matched expectations. Considering that AF is a symptom of many possible underlying diseases, clinical research for this arrhythmia should take into account their respective pathophysiology. Accordingly, the definition of the study populations to be included should rely on the established as well as on the new classifications of AF and take advantage from a differentiated look at the AF-electrocardiogram and from increasingly large spectrum of biomarkers. Such an integrated approach could bring researchers and treating physicians one step closer to the ultimate vision of personalized therapy, which, in this case, means an AF therapy based on refined diagnostic elements in accordance with scientific evidence gathered from clinical trials. By applying clear-cut patient inclusion criteria, future studies will be of smaller size and thus of lower cost. In addition, the findings from such studies will be of greater predictive value at the individual patient level, allowing for pinpointed therapeutic decisions in daily practice.

Limits and possibilities experienced by nurses in the treatment of women with chronic venous ulcers

Objective To understand the experiences and expectations of nurses in the treatment of women with chronic venous ulcers. Method Phenomenological research was based on Alfred Schütz, whose statements were obtained in January, 2012, through semi-structured interviews with seven nurses. Results The nurse reveals the difficulties presented by the woman in performing self-care, the perceived limitations in the treatment anchored in motivation, and the values and beliefs of women. It showed professional frustration because venous leg ulcer recurrence, lack of inputs, interdisciplinary work and training of nursing staff. There was an expected adherence to the treatment of women, and it emphasized the need for ongoing care, supported self-care and standard practices in treatment. Conclusion That treatment of chronic venous leg ulcers constitutes a challenge that requires collective investment, involving women, professionals, managers and health institutions.

Quand faut-il opérer une fracture diaphysaire de l'humérus [When to operate humeral shaft fractures?].

Most humeral shaft fractures are amenable to nonoperative treatment. According to shoulder and elbow functions, humeral shaft malunions are well tolerated with deformities up to 30 degrees of varus, 20 degrees of anterior bowing and 15 degrees of internal rotation. Limitations to nonoperative treatment do exist. Open fractures with extensive soft-tissue lesions, penetrating open fractures with neurological or vascular impairment are best managed with immediate stabilization. However the appropriate treatment strategy has to be adapted for each patient. Patient expectations, fracture propensity for nonunion, ability to tolerate nonoperative treatment for medical or social reasons should be taken into consideration for operative indication.

PERCEPTIONS AND EXPERIENCES OF ELDERLY RESIDENTS IN A NURSING HOME

The objective of this study was to evaluate the perception of the elderly residents of a long-stay nursing home on the process of institutionalization. We interviewed 14 subjects, five women and nine men, aged between 60 and 92 years. Data collection was conducted with a semi-structured sociodemographic interview, which presented the guiding question: “Tell me about how is your life, what do you do and how did you come to live here”. From the analysis, we found topics related to feelings of abandonment, loneliness, anger, ingratitude, living with chronic pain, satisfaction of property in the nursing home, productivity and social relationship. Given the thematic analysis, it was possible to group them into three categories such as: what the elderly feel, what the elderly perceive and what the elderly desire. As a result, we need public policies that addresses to the service provided by institutions regarding elderly expectations.

Chronic Disease in the Elderly: Spirituality and Coping

This is an exploratory study using a qualitative methodology which aimed to identify and understand the role of spirituality in the management of chronic disease in the elderly. The discourse analysis revealed the following central themes: multidimensional impact of chronic diseases, coping and expectations of the elderly. Regarding coping with chronic diseases, the individual coping, social support and religiosity/spirituality/faith were analyzed. The results showed the changes brought about the diagnosis of chronic disease and its implications for the adaptation to the new way of life. The management of these changes is complex and many factors influence positively and negatively in order to deal with the new condition. The results showed that spirituality/religiosity /faith interfere positively in addressing the barriers and difficulties of life, strengthening the resilience of the patient, thus improving their quality of life.

Adesão de Cabo Verde à Organização Mundial do Comércio - Problemas, Desafios e Perspectivas

A dinâmica de desenvolvimento de Cabo Verde vem sendo uma constante, com ganhos significativos para o país, como atestam a recente adesão à Organização Mundial do Comércio, a graduação a País de Rendimento Médio e a Parceria Especial com a União Europeia. No dia 23 de Julho de 2008, Cabo Verde tornou-se no 153º Estado membro da Organização Mundial do Comércio, sendo que nesta conquista foi o primeiro país Africano e o terceiro País Menos Avançado a conseguir este importante marco via negocial. As vantagens advenientes desta adesão são muitas, sendo de destacar a maior confiança dos investidores no país ao propiciar-se a expansão do mercado e a realização de negócios num ambiente mais seguro e estável, e ainda a possibilidade de melhoria da qualidade de prestação de serviços, uma vez que tudo passou a ser norteado por padrões e regras do comércio internacional. Este trabalho foi elaborado com base em pesquisa bibliográfica e exploratória necessária à construção de um referencial teórico sobre o assunto em questão, tendo como base artigos, livros, revistas e consultas em websites. Finalizando, para avaliação, apresentamos uma componente prática com base num questionário aplicado ao tecido empresarial, com perguntas abertas e de múltipla escolha, onde os inquiridos puderam fazer a sua apreciação relativa ao processo de adesão, e às expectativas advenientes. Os resultados obtidos no final do trabalho mostraram de forma clara e inequívoca a necessidade de Cabo Verde se reorganizar, reforçar o sector privado e a competitividade das empresas, através de, designadamente: melhoria do ambiente fiscal das empresas, fomento e apoio às pequenas e médias empresas. Outrossim, há que dar seguimento as reformas no sector comercial, capacitando e formando quadros nacionais uma vez que estes desempenham um papel essencial no crescimento económico do país e permitem dar maior previsibilidade aos investidores, sendo este último um dos pilares decisivos no requisito do investimento externo. The dynamics of the development of Cape Verde is becoming a constant, with significant gains to the country, as attests the recent adhesion to the World Trade Organization, the graduation to Country of Medium Revenue, as well as the Special Partnership with the European Union. On July 23, 2008, Cape Verde became the 153rd State member of the World Trade Organization, and in this conquest it was the first African country and the third Less Advanced Country to get this mark through negotiable way. The advantages proceeding from this adhesion are many, highlighting the investors' largest trust in the country when propitiating the expansion of the market and the accomplishment of business in a safer and stable atmosphere, and still the possibility of improvement of the quality of installment of services, once everything started being guided by patterns and rules of the international trade. This work was elaborated based on bibliographical and exploratory researches necessary to the construction of the theoretical referential about the subject in question, based on articles, books, magazines and website researches. Concluding, for evaluation, we presented a practical component based on a questionnaire applied to the managerial stuff, with open and multiple choice questions, where the inquired could make his appreciation related to the adhesion process, and the proceeding expectations. The results obtained at the end of the work, showed in a clear way the need of Cape Verde to organize, to reinforce the private sector and the competitiveness of the companies, through, namely: the improvement of the fiscal atmosphere of the companies, fomentation and support of the small and medium companies. Meanwhile, it is important to continue the reforms in the commercial sector, qualifying and forming national staff once they play an essential part in the economic growth of the country and allow giving a larger previsibility to the investors, being this last one, one of the decisive pillars in the requirement of the external investment.

LSTA Five Year Plan 2003-2007, 2007

The Iowa Commission of Libraries, the State Library’s governing board, convened the Library Services Task Force in August 2000. This group consisted of 46 Iowans from across the state, including librarians from all types of libraries, library trustees, legislators, members of Iowa Regional Library system (now called Library Service Areas) and Area Education Agencies, and citizens. Their mission was to make recommendations to the Commission on positioning libraries to effectively and efficiently meet the future needs of Iowans. Needs and expectations of Iowa Library customers and funding authorities were identified and examined by the Task Force, and are reflected in its recommendations. The Commission received the Task Force recommendations in December 2000, carefully studied them, solicited input from the Iowa library community, and with a few changes, forwarded the recommendations to the Governor and the Iowa General Assembly. These recommendations are now known as Iowa Commission of Libraries priorities and serve as a blueprint for future development of the Iowa library system. A second need assessment was conducted in 2001 as part of the process to formulate the joint Library Service Area – State Library Plan of Service 2003-2005. Biennial development of this plan is mandated by the Code of Iowa. In 2001, Library Service Area and Library Development staff from the State Library chose to completely revamp this plan, and used the process outlined in the The New Planning for Results by Sandra Nelson (the Public Library Association planning model) to do so. The group conducted a strengths/weaknesses/opportunities/threat analysis of the Iowa library situation, identified needs and put them in priority order, and identified service responses. Needs identified by the Library Services Task Force were similar to those identified by the Library Service Area and Library Development staff group. These needs were further analyzed and documented by State Library staff during the development of the LSTA plan. Sources consulted are identified in the text of the LSTA plan and/or listed at the close of this document. The text of the Library Services Task Force report and the documents created during the development of the Plan of Service 2003-2005 are cited in the appendix to this document.

Motivating Students to Learn English: Intrinsic and Extrinsic Strategies to Meet the Needs of First Time Learners

Motivation is the key to learning. The present study is about the relationship between intrinsic and extrinsic motivation as they affect learning with regard to students who are learning EFL for the first time. Cape Verdean seventh grade students learning English for the first time are generally very enthusiastic about the language before they start learning it in the high school. However, that enthusiasm seems not to be maintained throughout the school year and oftentimes teachers hear them complain about the difficulties of mastering aspects of the language. It seems that for some reason their motivation is undermined. Why does that happen? Is it the students’ fault or the teacher’s? If it the teacher’s fault, which motivation strategies work best to cope with this problem: intrinsic or extrinsic? With this in mind I asked the question: What is the relationship between students’ needs, interests, goals and expectations to learn English as a foreign language and teachers’ roles as facilitators and motivators? There are many studies that have been carried out in the field of motivation, and up to now, there seems to be no consensus of which is the best. For the purposes of this paper, three main theories will be discussed that have prevailed in the field of motivational psychology: the behavioural, the cognitive and the humanistic theories. Within these theories sub-theories are discussed and their relationship is explained with intrinsic and extrinsic motivation regarding Cape Verdean students learning English for the first time.

First impressions matter: Signalling as a source of policy dynamics

We first establish that policymakers on the Bank of England's Monetary PolicyCommittee choose lower interest rates with experience. We then reject increasingconfidence in private information or learning about the structure of the macroeconomy as explanations for this shift. Instead, a model in which voters signal theirhawkishness to observers better fits the data. The motivation for signalling is consistent with wanting to control inflation expectations, but not career concerns orpleasing colleagues. There is also no evidence of capture by industry. The papersuggests that policy-motivated reputation building may be important for explainingdynamics in experts' policy choices.

A model of shadow banking

We present a model of shadow banking in which financial intermediaries originate and trade loans, assemble these loans into diversified portfolios, and then finance these portfolios externally with riskless debt. In this model: i) outside investor wealth drives the demand for riskless debt and indirectly for securitization, ii) intermediary assets and leverage move together as in Adrian and Shin (2010), and iii) intermediaries increase their exposure to systematic risk as they reduce their idiosyncratic risk through diversification, as in Acharya, Schnabl, and Suarez (2010). Under rational expectations, the shadow banking system is stable and improves welfare. When investors and intermediaries neglect tail risks, however, the expansion of risky lending and the concentration of risks in the intermediaries create financial fragility and fluctuations in liquidity over time.

Approximate knowledge of rationality and correlated equilibria

We extend Aumann's theorem [Aumann 1987], deriving correlated equilibria as a consequence of common priors and common knowledge of rationality, by explicitly allowing for non-rational behavior. Wereplace the assumption of common knowledge of rationality with a substantially weaker one, joint p-belief of rationality, where agents believe the other agents are rational with probability p or more. We show that behavior in this case constitutes a kind of correlated equilibrium satisfying certain p-belief constraints, and that it varies continuously in the parameters p and, for p sufficiently close to one,with high probability is supported on strategies that survive the iterated elimination of strictly dominated strategies. Finally, we extend the analysis to characterizing rational expectations of interimtypes, to games of incomplete information, as well as to the case of non-common priors.

Fiscal policy, pricing frictions and monetary accommodation

We investigate the theoretical conditions for effectiveness of government consumptionexpenditure expansions using US, Euro area and UK data. Fiscal expansions taking placewhen monetary policy is accommodative lead to large output multipliers in normal times.The 2009-2010 packages need not produce significant output multipliers, may havemoderate debt effects, and only generate temporary inflation. Expenditure expansionsaccompanied by deficit/debt consolidations schemes may lead to short run output gains buttheir success depends on how monetary policy and expectations behave. Trade opennessand the cyclicality of the labor wedge explain cross-country differences in the magnitude ofthe multipliers.

Two-sided learning in New Keynesian models: Dynamics, (lack of) convergence and the value of information

This paper investigates the role of learning by private agents and the central bank(two-sided learning) in a New Keynesian framework in which both sides of the economyhave asymmetric and imperfect knowledge about the true data generating process. Weassume that all agents employ the data that they observe (which may be distinct fordifferent sets of agents) to form beliefs about unknown aspects of the true model ofthe economy, use their beliefs to decide on actions, and revise these beliefs througha statistical learning algorithm as new information becomes available. We study theshort-run dynamics of our model and derive its policy recommendations, particularlywith respect to central bank communications. We demonstrate that two-sided learningcan generate substantial increases in volatility and persistence, and alter the behaviorof the variables in the model in a significant way. Our simulations do not convergeto a symmetric rational expectations equilibrium and we highlight one source thatinvalidates the convergence results of Marcet and Sargent (1989). Finally, we identifya novel aspect of central bank communication in models of learning: communicationcan be harmful if the central bank's model is substantially mis-specified.

Determining underlying macroeconomic fundamentals during emerging market crises: Are conditions as bad as they seem?

Emerging market crises are characterized by large swings in both macroeconomic fundamentalsand asset prices. The economic significance of observed movements in macroeconomicvariables is obscured by the brief and extreme nature of crises. In this paper we propose to study the macroeconomic consequences of crises by studying the behavior of effective fundamentals, constructed by studying the relative movements of stock prices during crises. We find that these effective fundamentals provide a different picture than that implied by observed fundamentals. First, asset prices often reflect expectations of improvement in fundamentals after the initial devaluations; specifically, effective depreciations are positive but not as large as the observed ones. Second, crises vary in their effect on credit market conditions, with investors expecting tightening of credit in some cases (Mexico 1994, Philippines 1997), but loosening of credit in others (Sweden 1992, Korea 1997, Brazil 1999).

Competency Guide, 2006

On the Human Resource Management Roadmap (see page 7 of the State of Iowa Workforce Planning Guide, February 2006) there is a bar that crosses all four phases of human resource management. That section indicates that competencies are an integral part of the entire employment cycle. Competencies describe job requirements, which means they lay out the expectations for the job incumbent as well as the supervisor as they relate to planning for the job, recruiting and filling the job, developing the incumbent’s skills, assessing the incumbent’s performance, and finally, determining how those same competencies relate, if at all, to refilling the position when it becomes vacant in the future.