'Do not attempt resuscitation' and 'cardiopulmonary resuscitation' in an inpatient setting: factors influencing physicians' decisions in Switzerland.

OBJECTIVE: To determine the prevalence of cardiopulmonary resuscitation (CPR) and do-not-attempt-resuscitation (DNAR) orders, to define factors associated with CPR/DNAR orders and to explore how physicians make and document these decisions. METHODS: We prospectively reviewed CPR/DNAR forms of 1,446 patients admitted to the General Internal Medicine Department of the Geneva University Hospitals, a tertiary-care teaching hospital in Switzerland. We additionally administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. RESULTS: 21.2% of the patients had a DNAR order, 61.7% a CPR order and 17.1% had neither. The two main factors associated with DNAR orders were a worse prognosis and/or a worse quality of life. Others factors were an older age, cancer and psychiatric diagnoses, and the absence of decision-making capacity. Residents gave four major justifications for DNAR orders: important comorbid conditions (34%), the patients' or their family's resuscitation preferences (18%), the patients' age (14.2%), and the absence of decision-making capacity (8%). Residents who wrote DNAR orders were more experienced. In many of the DNAR or CPR forms (19.8 and 16%, respectively), the order was written using a variety of formulations. For 24% of the residents, the distinction between the resuscitation order and the care objective was not clear. 38% of the residents found the resuscitation form useful. CONCLUSION: Patients' prognosis and quality of life were the two main independent factors associated with CPR/DNAR orders. However, in the majority of cases, residents evaluated prognosis only intuitively, and quality of life without involving the patients. The distinction between CPR/DNAR orders and the care objectives was not always clear. Specific training regarding CPR/DNAR orders is necessary to improve the CPR/DNAR decision process used by physicians.

Enhancing centralized enforcement of EU law : Pandora's toolbox ?

State compliance with EU Law is crucial to the very existence of the Union. Traditionally, it has been secured through a combination of strong "private" and of weak "centralized" enforcement. However, this arrangement is no longer perceived to be sufficient. By endowing the Union with new tools vis-à-vis its Member States - penalties, conditionality, and the like - current reforms try to complement symbolic sanctioning with real "consequences". The goal is to reinforce the authority of EU Law. In this article, we question whether the new toolbox is fit for the purpose, or whether it risks to produce adverse effects which might even go as far as upsetting the Union's constitutional template.

Compétences en soins patiatifs : que faut-il savoir faire en tant que médecin [Competencies in palliative care : what should the physicians be able to do?]

Palliative patients (patients with progressive incurable illnesses) have a number of needs, early and late in their illness trajectories. This article highlights some of the most important competencies required by physicians to address these needs. They cover a broad spectrum of domains and include pain and symptom management, communication, disclosure, prognostication, and psychological, social and spiritual needs. All physicians, generalists and specialists alike, should possess the basic competencies but should also recognize that some patients, especially those not responding to initial strategies, require timely referrals to specialized palliative care teams.

Archaeological and archaeomagnetic dating at a site from the ager Tarraconensis (Tarragona, Spain): El Vila-sec Roman pottery

A very accurate archaeological dating of a Roman site in NE Spain (El Vila-sec) was made based on the typology of pottery artifacts. Three different phases were identifi ed with activity ranging from the mid- 1st century BC to the early-3rd century AD. Analyses of bricks from kilns at El Vila-sec produced data on their stored archaeomagnetic vector. These data were compared with the secular variation curve for the Iberian Peninsula and the SCHA.DIF.3K regional archaeomagnetic model. Both, the reference curve and the model, produced probability distributions for the final period of use for two kilns from the second archaeological phase that were not used during the third phase. At a 95% con fidence level, both time distributions cover a wide chronological range including the presumed archaeological age. Both the Iberian secular variation curve and the SCHA.DIF.3K regional model proved to be suitable models for dating the site, although on their own they do not produce a single unambiguous solution. This archaeomagnetic approach could also be applied to neighbouring archaeological sites that have an imprecise archaeological age.

Double-blind comparison of indapamide with a placebo in hypertensive patients treated by practicing physicians.

The antihypertensive effect of indapamide (2.5 mg/day) was compared to that obtained with a placebo in a controlled trial carried out by 11 physicians in their private practice. Thirty-one patients with uncomplicated essential hypertension were included. After a run-in period of 3 weeks without any treatment, either indapamide (n = 16) or a placebo (n = 15) were administered for 8 weeks in double-blind fashion. Blood pressure decreased in both groups. In patients treated with indapamide, systolic pressure was significantly lower than in those given the placebo at 3 out of the 4 follow-up visits; diastolic pressure, however, was significantly lower only at the end of the trial. Both the active drug and the placebo were well tolerated. No significant change in body weight, plasma potassium and uric acid occurred during the study in either group of patients. It appears therefore that indapamide, at a dose which apparently has no major diuretic effect, may be useful for practitioners in managing patients with mild to moderate hypertension.

Issue review : school aid law changes.

This issue review examines law changes made during the past three legislative sessions, 2006 through 2008, that directly impact the Iowa School Aid Formula.

Iowa Law Enforcement Academy Annual Report FY2014

Iowa Law Enforcement Academy provided 383 training opportunities for law enforcement, jailers, and telecommunicators for a total of 3584 individuals receiving training. The Academy remains committed to bringing cutting edge programming to law enforcement, jailers, and telecommunicators across Iowa, as evidenced by partnerships with the Federal Law Enforcement Training Center, the International Association of Chiefs of Police, the Secret Service, the Midwest Counterdrug Training Center, Northwestern University’s Center for Public Safety, and many others. The Academy is looking forward to growing its presence within the law enforcement community as the “go to” resource by also serving as a bulletin board for training around the state.

Yearbook of Private International Law, Volume XIV, 2012/2013

The "Yearbook of Private International Law" provides all about the conflict of laws developments of 2012 and 2013 in one book: Volume XIV (2012/2013) includes contributions on the proposed codification of the General Part of Private International Law in Europe, on the reform of the Chinese legal system as well as on defamation and violation of personality rights (the latter in a whole section). Furthermore, the book deals with the application of EU legislation on jurisdiction and enforcement of judgements, the recognition of judgements overturned by another judgement, and the conflict of decisions in international arbitration. Reports and court decisions from the Netherlands, Turkey, India, Finland, Croatia and Switzerland and a summary of two dissertations on the role of sovereignty and choice of courts agreements complete the book.

Les bouchers bleus : grand roman historique / par Fernand-Hue ; nombreuses gravures sur bois et illustrations dans et hors texte par Gil Baer

Collection : Nouvelle bibliothèque illustrée de vulgarisation

Water planning law and government.

Water planning efforts typically identify problems and needs. But simply calling attention to issues is usually not enough to spur action; the end result of many well-intentioned planning efforts is a report that ends up gathering dust on a shelf. Vague recommendations like “Water conservation measures should be implemented” usually accomplish little by themselves as they don’t assign responsibility to anyone. Success is more likely when an implementation strategy — who can and should do what — is developed as part of the planning process. The more detailed and specific the implementation strategy, the greater the chance that something will actually be done. The question then becomes who has the legal authority or responsibility to do what? Are new laws and programs needed or can existing ones be used to implement the recommendations? ... This document is divided into four main parts. The first, “Carrots and Sticks” looks at two basic approaches — regulatory and non-regulatory — that can be, and are, used to carry out water policy. Both have advantages and disadvantages that need to be considered. The second, “The powers of federal, state and local governments…,” looks at the constitutional powers the federal government and state and local governments have to carry out water policy. An initial look at the U. S. Constitution might suggest the federal government’s regulatory authority over water is limited but, in fact, its powers are very substantial. States have considerable authority to do a number of things but have to be mindful of any federal efforts that might conflict with those state efforts. And local governments can only do those things the state constitution or state legislature says they can do and must conform to any requirements or limitations on those powers that are contained in the enabling acts. Parts three and four examine in more detail the main programs and agencies at the federal level as well as Iowa’s state and local levels and the roles they play in national and state water policy.

Iowa Law Enforcement Academy Agency Performance Plan FY 2015, February 5, 2015

Performance Plan

Iowa Law Enforcement Academy Performance Plan, FY2015

Iowa Law Enforcement Academy Performance Plan