Incidence du coeur pulmonaire aigu et de la thrombose veineuse profonde dans l'embolie pulmonaire aiguë [Incidence of acute cor pulmonale and deep venous thrombosis in acute pulmonary embolism]

OBJECTIVE: Ultrasounds are a useful tool when looking for indirect evidence in favor of pulmonary embolism. The aim of this study was to determine the incidence of acute cor pulmonale and deep venous thrombosis revealed by ultrasonographic techniques in a population of patients presenting with pulmonary embolism. METHODS: 96 consecutive patients with a mean (+/- SD) age of 65 +/- 15 years, admitted to our hospital for pulmonary embolism were included in this study. The diagnosis of pulmonary embolism was made either by spiral computed tomography or selective pulmonary angiography. Each patient subsequently underwent both trans-thoracic echocardiography and venous ultrasonography. The diagnostic criterion used for defining acute cor pulmonale by echocardiography was the right to left ventricular end-diastolic area ratio over (or equal to) 0.6. Diagnosis of deep venous thrombosis was supported by the visualization of thrombi or vein incompressibility and/or the absence of venous flow or loss of flow variability by venous ultrasonography. RESULTS: Using ultrasounds, an acute cor pulmonale was found in 63% of our patients while 79% were found to have deep venous thrombosis and 92% of the patients had either acute cor pulmonale or deep venous thrombosis or both. All of the patients with proximal pulmonary embolism had acute cor pulmonale and/or deep venous thrombosis. The presence of acute cor pulmonale on echocardiography was significantly higher in patients with proximal pulmonary embolism (p < 0.0001). CONCLUSION: This study emphasizes the potential value of ultrasonographic techniques in the diagnosis of acute pulmonary embolism.

What lies behind the devaluation of educational credentials?

Applying fixed-effects models to EULFS data on Spain from 1998 to2006, the paper explores the effects of educational expansion on theoccupational returns to education across different levels of education.We build an indicator of the positional value of education, based on theidea that the value of a given educational credential partly depends onthe percentage of labour market entrants who have reached that level atthe time when individuals enter the labour market -- it is higher whenfewer individuals have reached it, lower otherwise. Our analysis for theSpanish case shows that the decrease in the occupational returns toeducation goes in parallel with the decrease in the positional value ofeducation, but this devaluation of credentials has been stronger ingeneral education (e.g., in humanities or social sciences universitydegrees, or in upper secondary general education) than in specializededucation (e.g., in technical fields in the university, or in uppervocational training). We argue that the reason for this is most likely thatgeneral education provides a more diffuse signal of candidates’ skillsthan specialized education. We also find that this devaluation ofcredentials has been stronger in fields accessed by women in largernumbers in last decades.

Teaching-service integration: implications and roles in experiences of Undergraduate Courses in Nursing

The study aimed at understanding the implications of the teaching-service integration to nursing education from the perspective of teachers, students and professionals in Primary Healthcare as well as identifying the roles of teachers and professionals who follow practical experiences in education. This is a case study of qualitative approach carried out in five undergraduate courses in Nursing in the state of Santa Catarina. A total of 22 teachers and 14 professionals were interviewed and five focus groups were conducted with students. Results are presented in two categories: Implications of the teaching-service integration to education in Nursing: contributing factors and intervening factors and Relationships established in the experiences: a unison speech and a dissonant practice. The contributions of the teaching-service integration are undeniable. Despite this belief, there are intervening factors that need to be on the agenda for discussion. The role of facilitator in education emerged strongly despite conflicting perceptions remain.

Child care and health rights: perspectives of adolescent mothers

AbstractOBJECTIVETo analyze child health care and the defense of their rights from the perspective of adolescent mothers.METHODSAn exploratory study with qualitative thematic analysis of data, based on conceptual aspects of care and the right to health, from semi-structured interviews with 20 adolescent mothers ascribed by Family Health teams.RESULTSMaternal reports indicate that child health care requires responsibility and protection, with health practices that promote child advocacy. Gaps in assistance which preclude the full guarantee of the right to child health care were also highlighted.CONCLUSIONThe right to health care assumed different meanings, and the forms to guarantee them were linked to individual behavior in detriment to broader actions that consider health as a social product, connected to the guarantee of other fundamental rights.

The investigation of deaths in custody: a qualitative analysis of problems and prospects.

The right to be treated humanely when detained is universally recognized. Deficiencies in detention conditions and violence, however, subvert this right. When this occurs, proper medico-legal investigations are critical irrespective of the nature of death. Unfortunately, the very context of custody raises serious concerns over the effectiveness and fairness of medico-legal examinations. The aim of this manuscript is to identify and discuss the practical and ethical difficulties encountered in the medico-legal investigation following deaths in custody. Data for this manuscript come from a larger project on Death in Custody that examined the causes of deaths in custody and the conditions under which these deaths should be investigated and prevented. A total of 33 stakeholders from forensic medicine, law, prison administration or national human rights administration were interviewed. Data obtained were analyzed qualitatively. Forensic experts are an essential part of the criminal justice process as they offer evidence for subsequent indictment and eventual punishment of perpetrators. Their independence when investigating a death in custody was deemed critical and lack thereof, problematic. When experts were not independent, concerns arose in relation to conflicts of interest, biased perspectives, and low-quality forensic reports. The solutions to ensure independent forensic investigations of deaths in custody must be structural and simple: setting binding standards of practice rather than detailed procedures and relying on preexisting national practices as opposed to encouraging new practices that are unattainable for countries with limited resources.

State of Iowa Employee Handbook, Revised October 2003

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.

Towards equivalent health care of prisoners: European soft law and public health policy in Geneva.

Prisoners have a right to health care and to be protected against inhumane and degrading treatment. Health care personnel and public policy makers play a central role in the protection of these rights and in the pursuit of public health goals. This article examines the legal framework for prison medicine in the canton of Geneva, Switzerland and provides examples of this framework that has shaped prisoners' medical care, including preventive measures. Geneva constitutes an intriguing example of how the Council of Europe standards concerning prison medicine have acquired a legal role in a Swiss canton. Learning how these factors have influenced implementation of prison medicine standards in Geneva may be helpful to public health managers elsewhere and encourage the use of similar strategies.

OS CONTRACTOS DE CONCESSÃO NO CONTEXTO DO SISTEMA DE NORMALIZAÇÃO CONTABILÍSTICA E DE RELATO FINANCEIRO

A mudança do normativo contabilístico ocorrido em 2009, alterou o paradigma de reconhecimento e mensuração de activos. Embora a natureza das operações contínua presente no processo contabilístico, muitas coisas foram alteradas tendo em conta a substância da informação e a sua realidade económica. O caso dos contratos de concessão é disto um bom exemplo. Há casos em que no normativo anterior eram reconhecidos como activos fixos tangíveis e actualmente são reconhecidos como intangíveis. O estudo em causa tem como objetivo principal analisar o conceito dos contratos de concessão, bem como os procedimentos para o reconhecimento, mensuração e divulgação nas demonstrações financeiras. Considerados activos intangíveis (de facto a entidade acaba por ter um “Direito” de explorar um determinado activo), o processo contabilístico é feito a luz do disposto na Norma de Relato Financeiro nº6 – Activos Intangíveis. Os contractos de concessão apresentam especificidades próprias e por esta razão o IASB emitiu uma IFRIC (nº 12) com o objectivo de clarificar o tratamento contabilístico desta problemática. Não existindo no normativo nacional tal norma interpretativa as empresas nacionais que convivem com esta realidade vêem-se na contingência de, supletivamente, recorrer às normas internacionais de contabilidade para resolver o assunto. É o caso da ELECTRA para os activos afectos a distribuição. Neste sentido, o estudo debruça sobre esta problemática, apresenta um enquadramento teórico, analisar os principais aspectos de reconhecimento a luz dos dois normativos contabilísticos nacionais (o antigo Plano Nacional de Contabilidade e o actual Sistema de Normalização Contabilística e de Relato Financeiro) e termina utilizando as informações da ELECTRA, SARL para ilustrar este processo de reconhecimento contabilístico. The change of a the accounting regulatory occurred in 2009, changed the paradigm for recognizing and measuring assets. Although the continuous nature of the operations in this accounting process, many things have changed in view of the substance of information and its economic reality. The case of concession contracts, it is a good example. There are cases where the former were recognized as legal and tangible fixed assets are currently recognized as intangible assets. The study is aimed to analyzing the concept of concession contracts, as well as procedures for the recognition, measurement and disclosure in the financial statements. Considered intangible assets (in fact the entity turns out to have a “right” to exploit a particular asset) the accounting process is done in light of the provisions of Financial Reporting Standard No. 6 – Intangible Assets. The concession contracts have specific characteristics and for this reason the IASB issued IFRIC one (Ner. 12 ) in order to clarify the accounting treatment of this problem. In the absence of such a standard national regulatory interpretative national companies that live with this reality find themselves in contingency, additionally, make use of international accounting standards to resolve the matter. ELECTRA is the case of the assets connected to the distribution. In this sense, the study focuses on this issue, presents a theoretical framework to analyze the main aspects of recognition light of both national accounting standards (formerly the National Accounting Standards and the current system of accounting and financial reporting) and ends up using the information the Electra SARL to illustrate this process of accounting recognition.

Award errors and permanent disability benefits in Spain

There is a controversial debate about the effects of permanent disability benefits on labormarket behavior. In this paper we estimate equations for deserving and receiving disabilitybenefits to evaluate the award error as the difference in the probability of receiving anddeserving using survey data from Spain. Our results indicate that individuals aged between55 and 59, self-employers or working in an agricultural sector have a probability of receiving a benefit without deserving it significantly higher than the rest of individuals. We also find evidence of gender discrimination since male have a significantly higher probability of receiving a benefit without deserving it. This seems to confirm that disability benefits are being used as an instrument for exiting the labor market for some individuals approaching the early retirement or those who do not have right to retire early. Taking into account that awarding process depends on Social Security Provincial Department, this means that some departments are applying loosely the disability requirements for granting disability benefits.

RAGBRAI Learn about the Land; Day 6, July 2008

Today you will be biking over the Iowa and Cedar rivers, two major rivers hit by the Iowa flood of 2008. Three miles northeast of North Liberty you’ll cross the Iowa River. The river crested on June 15, 2008 at a record 31.53 ft., three feet higher than the previous record during the flood of 1993. The flooding river caused extensive damage to the University of Iowa (see cover photo of Iowa Memorial Union taken by Univ. Relations, Univ. of Iowa), Coralville, and numerous smaller towns. The flooding of the Cedar River, which RAGBRAI will cross at Sutliff, caused even greater damage. At Cedar Rapids, the 2008 flood crest of 31.12 ft. was over 11 ft. higher than the previous record set in 1851! This massive amount of water inundated downtown Cedar Rapids, Palo, and Columbus Junction and caused massive damage to buildings and infrastructure. When crossing the Cedar River at Sutliff, be sure to look to your right to see the remains of the Historic Sutliff Bridge, one of the many casualties of the Iowa flood of 2008.

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.

Speed Limit Questions? Here’s Your Answer, July 6, 2005

Iowa’s speed regulations are based on the same basic speed law that is used in all 50 states: “Any person driving a motor vehicle on a highway shall drive the same at a careful and prudent speed not greater than nor less than is reasonable and proper, having due regard to the traffic, surface, and width of the highway and of any other conditions then existing, and no person shall drive any vehicle upon a highway at a speed greater than will permit the person to bring it to a stop within the assured clear distance ahead, such driver having the right to assume, however, that all persons using said highway will observe the law.” Statutory limits are based on the concept that uniform categories of highways can be traveled safely at certain preset maximum speeds under ideal conditions. Whether the speed limit is posted or unposted, drivers should reduce their speed below these values in poor weather, heavy traffic, and under other potentially hazardous conditions.

A dynamic analysis of human welfare in a warming planet

Climate science indicates that climate stabilization requires low GHG emissions. Is thisconsistent with nondecreasing human welfare?Our welfare or utility index emphasizes education, knowledge, and the environment. Weconstruct and calibrate a multigenerational model with intertemporal links provided by education,physical capital, knowledge and the environment.We reject discounted utilitarianism and adopt, first, the Pure Sustainability Optimization (orIntergenerational Maximin) criterion, and, second, the Sustainable Growth Optimization criterion,that maximizes the utility of the first generation subject to a given future rate of growth. We applythese criteria to our calibrated model via a novel algorithm inspired by the turnpike property.The computed paths yield levels of utility higher than the level at reference year 2000 for allgenerations. They require the doubling of the fraction of labor resources devoted to the creation ofknowledge relative to the reference level, whereas the fractions of labor allocated to consumptionand leisure are similar to the reference ones. On the other hand, higher growth rates requiresubstantial increases in the fraction of labor devoted to education, together with moderate increasesin the fractions of labor devoted to knowledge and the investment in physical capital.

El dret a la informació del pacient: una aproximació legal i deontològica

[eng] Aim: The paper examines the current situation of recognition of patients' right to information in international standards and in the national laws of Belgium, France, Italy, Spain (and Catalonia), Switzerland and the United Kingdom.Methodology: International standards, laws and codes of ethics of physicians and librarians that are currently in force were identified and analyzed with regard to patients' right to information and the ownership of this right. The related subjects of access to clinical history, advance directives and informed consent were not taken into account.Results: All the standards, laws and codes analyzed deal with guaranteeing access to information. The codes of ethics of both physicians and librarians establish the duty to inform.Conclusions: Librarians must collaborate with physicians in the process of informing patients.