Accès à la thrombolyse lors d'AVC: rôle des secours préhospitaliers et des médecins de premier recours [Access to thrombolysis in stroke: place of the rescue system and of the primary care physician].

Thrombolysis is the most effective treatment improving the outcome of patients suffering from acute stroke. Moreover, its effectiveness increases when administrated as quick as possible after the onset of the first symptoms. Prehospital selection of patients and their immediate transfer to stroke center are the principal factors allowing the practice of thrombolysis within the authorized time frame. On the basis of regional Swiss French data, it seems that patients evaluated by emergency physician and their direct transfer in an acute stroke unit reduces delays and allows for a higher thrombolysis rate.

Primary Care Sensitive Hospitalization: users detect flaws on the access to services

The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.

Cultural singularities: indigenous elderly access to Public Health Service

OBJECTIVEDescribing how Kaingang seniors and their primary caregivers experience access to public health services.METHODA qualitative study guided by ethnography, conducted with 28 elderly and 19 caregivers. Data were collected between November 2010 and February 2013 through interviews and participative observation analyzed by ethnography.RESULTSThe study revealed the benefits and difficulties of the elderly access to health services, the facility to obtain health care resources such as appointments, medications and routine procedures, and the difficulties such as special assistance service problems and delays in the dispatching process between reference services.CONCLUSIONThe importance of knowing and understanding the cultural specificities of the group in order to offer greater opportunities for the elderly access to health services was reinforced.

The Vaccine Formulation Laboratory: a platform for access to adjuvants.

Adjuvants are increasingly used by the vaccine research and development community, particularly for their ability to enhance immune responses and for their dose-sparing properties. However, they are not readily available to the majority of public sector vaccine research groups, and even those with access to suitable adjuvants may still fail in the development of their vaccines because of lack of knowledge on how to correctly formulate the adjuvants. This shortcoming led the World Health Organization to advocate for the establishment of the Vaccine Formulation Laboratory at the University of Lausanne, Switzerland. The primary mission of the laboratory is to transfer adjuvants and formulation technology free of intellectual property rights to academic institutions, small biotechnology companies and developing countries vaccine manufacturers. In this context, the transfer of an oil-in-water emulsion to Bio Farma, an Indonesian vaccine manufacturer, was initiated to increase domestic pandemic influenza vaccine production capacity as part of the national pandemic influenza preparedness plan.

Standardized enforcement: Access to justice vs contractual innovation

We model the different ways in which precedents and contract standardization shapethe development of markets and the law. In a setup where more resourceful parties candistort contract enforcement to their advantage, we find that the introduction of astandard contract reduces enforcement distortions relative to precedents, exerting twoeffects: i) it statically expands the volume of trade, but ii) it crowds out the use ofinnovative contracts, hindering contractual innovation. We shed light on the largescale commercial codification occurred in the 19th century in many countries (evenCommon Law ones) during a period of booming commerce and long distance trade.

Aplicação dos Sistemas de Informação Geográfica nas Energias Renováveis: o Potencial da Energia Solar na Ilha de São Vicente – Cabo Verde

A presente dissertação, tem como foco principal a aplicação dos Sistemas de Informação Geográfica (SIG) ao estudo das energias renováveis, tendo como caso avaliar o potencial solar na ilha de São Vicente do arquipélago de Cabo Verde. A energia do sol é a principal fonte de energia renovável, e está disponível em quase todas as regiões do planeta. Quantificar o potencial energético solar de um lugar ou região é indispensável, para avaliar as potencialidades de produção de energia fotovoltaica. Outro fator importante prende-se com ordenamento territorial associado à exploração desses recursos energéticos, pelo que devem ser avaliadas as condições técnicas, ambientais e económicas, quando se pretende instalar parques para a produção de energia fotovoltaica. Assim, neste trabalho foram aplicadas as ferramentas SIG, para quantificar a radiação solar mensal e anual da ilha de São Vicente, arquipélago de Cabo Verde, através do modelo Solar Analyst. Numa segunda fase, aplicou-se a técnica de análise multicritério em combinação com os SIGs para definir as áreas mais favoráveis para a instalação de parques de produção de energia elétrica a partir da energia solar. Para o cálculo da radiação solar na ilha de São de Vicente, utilizou-se o modelo digital de terreno (MDT) e a latitude da ilha como parâmetros de entrada ao modelo. Para a análise multicritério definiram-se um conjunto de critérios que devem ser considerados na implementação de parques solares, nomeadamente, a disponibilidade de radiação solar existente na área, a distância à rede de transporte de energia elétrica e à rede viária, o declive do terreno, o uso e ocupação do solo e a proximidade às linhas de água. Para auxiliar na atribuição dos pesos aos critérios utilizados na análise aplicou-se a método Analytic Hierarchy Process (AHP). As áreas resultantes do processo da análise multicritério, foram confrontadas com a Carta de Condicionantes do esquema regional de ordenamento da ilha de São Vicente, aferindo a conformidade das propostas e reajustes subsequentes, de modo a obter os resultados finais.

A simple access pricing rule to achieve the Ramsey outcome for interconnected networks

This paper considers a general and informationally efficient approach to determine the optimal access pricing rule for interconnected networks. It shows that there exists a simple rule that achieves the Ramsey outcome as the unique equilibrium when networks compete in linear prices without network-based price discrimination. The approach is informationally efficient in the sense that the regulator is required to know only the marginal cost structure, i.e. the marginal cost of making and terminating a call. The approach is general in that access prices can depend not only on the marginal costs but also on the retail prices, which can be observed by consumers and therefore by the regulator as well. In particular, I consider the set of linear access pricing rules which includes any fixed access price, the Efficient Component Pricing Rule (ECPR) and the Modified ECPR as special cases. I show that in this set, there is a unique rule that implements the Ramsey outcome as the unique equilibrium independently of the underlying demand conditions.

Incidents and complications of totally implanted vascular access devices in children: a prospective study.

BACKGROUND: Totally implanted vascular access devices are frequently used in children for repeated blood samples or intravenous treatments. This prospective study aims at identifying the risk factors associated with infections, obstructions and surgical complications of these devices in pediatric patients. METHODS: From January 2006 to January 2008, all children older than one year of age with a diagnosis of solid or blood cell malignancy were included in the study. Insertion was performed by the surgeon according to a standardized protocol after landmark-guided puncture of the subclavian or internal jugular vein by a senior anesthesiologist. Dressing and post-operative care were standardized. Every manipulation was prospectively recorded by specialized dedicated nurses, and all patients were screened for complications one month post-surgery. RESULTS: 45 consecutive patients 1 to 16 years old were enrolled in the study. Mean age at the time of procedure was 8.5 years (range 1.3-15.6; SD +/- 4.88). There were 12 peroperative adverse events in 45 procedures (27%), detailed as follows: 3 pneumothoraces (7%), 3 hematomas (7%), 6 arterial punctures (13%). Among these events, intervention was necessary for two pneumothorax and one arterial puncture. There was no air embolism. At one month, we recorded 5 post-operative complications (11%): 2 thrombotic obstructions, one unsightly scar, and one scapular pain of unknown etiology. One patient needed repositioning of the catheter. There was no catheter-related infection. CONCLUSION: Prospective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending.

Dessalinização da Água do Mar Através da Energia Solar - Caso de Estudo Salamansa – Cabo Verde

principal objectivo deste trabalho é o estudo da viabilidade técnica e económica da dessalinização da água do mar, utilizando a energia solar, tomando como caso de aplicação uma pequena comunidade rural de Cabo Verde, a vila piscatória de Salamansa, local onde há graves problemas com a disponibilidade de água potável. No entanto, a proximidade do mar e a disponibilidade de energia solar sugerem a dessalinização como processo para mitigar a falta de água. A dessalinização da água do mar pode ser obtida através de diversas técnicas que podem ser agrupadas de acordo com os princípios em que estes processos se baseiam: processos de dessalinização térmica (destilação solar, destilação multi-estágio, destilação multi-efeito, etc.) e processos de dessalinização por membranas (electrodiálise e osmose inversa). A destilação solar passiva foi a tecnologia de dessalinização estudada neste trabalho e que se pode vir a tornar uma alternativa promissora para um fornecimento regular de água. Por outro lado, o uso de fontes alternativas de energia, como a solar, apresenta-se como uma solução para viabilizar a dessalinização em meios semi-áridos como o deste caso de estudo. Fez-se uma modelação matemática da unidade de destilação solar proposta utilizando o Engineering Equation Solver (EES) como ferramenta para ajudar a resolver as equações de balanço térmico. O projecto do destilador solar proposto poderá atender às necessidades de água doce para consumo de 18 famílias constituídas por 5 agregados (92 pessoas) e apresenta uma eficiência média diária de aproximadamente 78% no Verão e 77% no Inverno.

The evolution of inequity in the access to health care in Spain: 1987-2001

This paper reports an analysis of the evolution of equity in access to health care in Spain over the period 1987-2001, a time span covering the development of the modern Spanish National Health System. Our measures of access are the probabilities of visiting a doctor, using emergency services and being hospitalised. For these three measures we obtain indices of horizontal inequity from microeconometric models of utilization that exploit the individual information in the Spanish National Health Surveys of 1987 and 2001. We find that by 2001 the system has improved in the sense that differences in income no longer lead to different access given the same level of need. However, the tenure of private health insurance leads to differences in access given the same level of need, and its contribution to inequity has increased over time, both because insurance is more concentrated among the rich and because the elasticity of utilization for the three services has increased too.

A retail benchmarking approach to efficient two-way access pricing

We study a retail benchmarking approach to determine access prices for interconnected networks. Instead of considering fixed access charges as in the existing literature, we study access pricing rules that determine the access price that network i pays to network j as a linear function of the marginal costs and the retail prices set by both networks. In the case of competition in linear prices, we show that there is a unique linear rule that implements the Ramsey outcome as the unique equilibrium, independently of the underlying demand conditions. In the case of competition in two-part tariffs, we consider a class of access pricing rules, similar to the optimal one under linear prices but based on average retail prices. We show that firms choose the variable price equal to the marginal cost under this class of rules. Therefore, the regulator (or the competition authority) can choose one among the rules to pursue additional objectives such as consumer surplus, network coverage or investment: for instance, we show that both static and dynamic e±ciency can be achieved at the same time.

In situ introducer sheath dilatation for complex aortic access.

Aortic access problems due to diseased or small peripheral vessels are a major issue in endovascular aneurysm repair (EVAR). In the emergency setting, like aortic rupture after blunt trauma, or in patients with a hostile abdomen, a more proximal access to the aorta is not a pleasant perspective. We developed in situ introducer sheath dilatation as a bail-out technique for patients with difficult aortic access under various circumstances including EVAR, intra-aortic balloon pump insertion and cannulation for perfusion. The method described allows to increase the access vessel diameter by 50% (from 6 to 9 mm) or the luminal circumference from 18 to 27 F. We have used this technique in five patients without complication, very much in contrast to the traditionally practiced 'forced device insertion'.

DIGITAL LIBRARY FOR DIGITAL DIVIDE AND ENVIRONMENT OF SCARCE ACCESS TO PRINTED MATERIALS: THE CASE OF UNIVERSITY JEAN PIAGET OF CAPE VERDE

With the failure of the traditional mechanisms of distributing bibliographic materials into developing countries, digital libraries show up as a strong alternative in accomplishing such job, despite the challenges of the digital divide. This paper discusses the challenges of building a digital library (DL) in a developing country. The case of Cape Verde as a digital divide country is analyzed, in terms of current digital library usage and its potentiality for fighting the difficulties in accessing bibliographic resources in the country. The paper also introduces an undergoing project of building a digital library at the University Jean Piaget of Cape Verde.