Exclusion of lumbar arteries by aortic endovascular grafts: can angiography demonstrate sealing characteristics?

BACKGROUND: This study evaluates sealing characteristics of two designs of endovascular grafts by angiographic demonstration of exclusion of porcine lumbar arteries. METHODS: 6 endovascular grafts (3 self-expandable with integrated polyurethane wall versus 3 nitinol structures covered with polyester fabric) were implanted in 6 porcine aortae. Perfusion of lumbar arteries was assessed by angiography after implantation and by angiography and dissection at graft explantation after 4 +/- 2 months. Tissue healing was evaluated by light and scanning electron microscopy. RESULTS: Immediate exclusion of the lumbar arteries was achieved in 14/31 vessels (12 by polyurethane grafts and 2 by polyester grafts, p < 0.001). Follow-up angiography and dissection at explantation revealed perfusion of 30/31 lumbar arteries with a collateral network in most cases. Another reason for reperfusion of initially excluded branches was distention of the polyurethane grafts with resulting shortening allowing reperfusion of 8 of the 31 originally covered branches. Histological examination revealed a complete neointimal lining and a tight contact between endovascular grafts and aorta. CONCLUSIONS: The immediate angiographic demonstration of exclusion of lumbar arteries predicts sealing characteristics of endovascular grafts. Later angiographic reappearance is due to development of a collateral network and possible shortening of self-expandable devices.

Dynamic price competition with fixed capacities

Many revenue management (RM) industries are characterized by (a) fixed capacities in theshort term (e.g., hotel rooms, seats on an airline flight), (b) homogeneous products (e.g., twoairline flights between the same cities at similar times), and (c) customer purchasing decisionslargely influenced by price. Competition in these industries is also very high even with just twoor three direct competitors in a market. However, RM competition is not well understood andpractically all known implementations of RM software and most published models of RM donot explicitly model competition. For this reason, there has been considerable recent interestand research activity to understand RM competition. In this paper we study price competitionfor an oligopoly in a dynamic setting, where each of the sellers has a fixed number of unitsavailable for sale over a fixed number of periods. Demand is stochastic, and depending on howit evolves, sellers may change their prices at any time. This reflects the fact that firms constantly,and almost costlessly, change their prices (alternately, allocations at a price in quantity-basedRM), reacting either to updates in their estimates of market demand, competitor prices, orinventory levels. We first prove existence of a unique subgame-perfect equilibrium for a duopoly.In equilibrium, in each state sellers engage in Bertrand competition, so that the seller withthe lowest reservation value ends up selling a unit at a price that is equal to the equilibriumreservation value of the competitor. This structure hence extends the marginal-value conceptof bid-price control, used in many RM implementations, to a competitive model. In addition,we show that the seller with the lowest capacity sells all its units first. Furthermore, we extendthe results transparently to n firms and perform a number of numerical comparative staticsexploiting the uniqueness of the subgame-perfect equilibrium.

Perfil dos Turistas que Visitam a Ilha de São Vicente

O presente trabalho tem por objectivo definir o perfil do turista que visitou a ilha de São Vicente e avaliar o grau de satisfação do turista enquanto consumidor de diferentes bens e serviços, nos meses de Maio e Junho do decorrente ano. Para se fazer uma abordagem qualitativa falou-se da problemática do mercado turístico - procura e oferta turística – e a importância da segmentação desse sistema turístico juntamente com algumas teorias do comportamento do consumidor. Por sua vez, para o estudo do perfil e satisfação dos turistas utilizou-se uma abordagem quantitativa, através da aplicação de questionários no Aeroporto Internacional Cesária Évora e entrevistas aos estabelecimentos hoteleiros, 150 e 7 respectivamente. Após a análise explicativa, com base na bibliografia seleccionada, nas entrevistas e questionários realizados, os resultados da pesquisa indicam que estudar o perfil e a satisfação dos turistas permite fazer um levantamento de diversas variáveis importantes como, por exemplo, a nacionalidade do turista, a principal razão e objectivo da viagem e o que gostaram, ou desejavam ver no destino. E assim, entender-se o perfil do visitante e propor-se estratégias, que contribuam para um planeamento sustentável do desenvolvimento turístico na região pretendida. A complexidade do processo de decisão do turista por um ou outro destino é que verdadeiramente motiva esta pesquisa. The objective of the following work is to define the profile of a tourist that visited São Vicente, and evaluate the levels of satisfaction of the tourist as a consumer of different items and services, on May and June of the current year. For a quality methodological approach, the problematic of the touristic industry (demand and touristic offer) – the essential of subdivision of these touristic systems alongside with the principles of the consumer behavior were discussed. In continuity, to define the profile and satisfaction of the tourists, a quantity approach was also used, through the application of questionnaires at the International Airport Cesária Évora and interviews throughout hotel establishments, 150 and 7 respectively. After an explanatory analyses, based on a selected bibliography, the applied interviews and questionnaires, the outcome of this research shows that by studying the profile and the satisfaction of the tourists allows to have variable important results, for example, the tourist´s nationality, the main reason and objective of the trip and what they enjoyed or would like to see on their destination. Thus, understanding the visitor´s profile and suggesting strategies, that contributes for a sustainable planning of a touristic development on the intended region. The process complexity of the decision making of the tourist for one destination is truly the main motivation for this research.

Is it really worth the effort to renounce to 5 mm trocars?

Objective: Single port laparoscopy andNOTES aim at decreasing the number¦of trocars, at a price of increased technical difficulty and cost, without until now¦any proof of benefit for the patient.Morbidity related to 5 mm trocar sites (TS)¦is claimed to be low, but there are no good quality data on this topic. The aim¦of the present prospective study is to measure the morbidity and overall specific¦impact related to the 5 mm TS and compare them to larger TS.¦Methods:Wecollected prospectively data on 300 consecutive patients operated¦by laparoscopy in our institution between 2009 and 2010. Pain, morbidity,¦cosmetic, and overall patient discomfort were assessed specifically for each¦TS, using standardized questionnaires, at 3 time points: at discharge from¦the hospital, at 1 month and at 6 months after surgery. Results were compared¦between 5 mmand larger TS (10 mm, 12 mmand 15 mm).Trocar sites replaced¦by a minilaparotomy or a stoma were excluded from analysis. In this study we¦present the short-term results.¦Results: Three-hundred patients (mean age 47·5, women 55%) were operated¦with 1074 TS of which 477(44%) were 5 mm TS. Indication to laparoscopy was¦cholecystectomy (31·3%), appendectomy (26·6%), upper GI surgery (16·3%),¦colon resection (13·3%) or other (12·3%). Follow-up at 1 month was completed¦in 90%.¦The 5 mm TS had an infection rate of 0·2%, and a hematoma rate of 1·7%.¦VAS pain scores at the 5mm TS were ≤3 in 91·6% at rest and in 75·9% upon¦effort at discharge, and in 97% at 1 month. Median patient scar assessment¦score (PSAS) of the 5 mm TS at 1 month was 6 (IQR: 2-9) out of 60 (0 =¦best score). Overall discomfort of the 5 mm TS in a VAS scale was 0 in 77%¦and ≤3 in 95% of patients at 1 month. Morbidity, pain assessments, PSAS, and¦overall discomfort scores were all significantly better for 5 mm TS compared to¦larger TS.¦Conclusion: Morbidity, pain, cosmetic impact and overall patient's discomfort¦related to a 5 mm trocar site is extremely low. For this reason, any potential¦advantage related to omitting 5 mm trocars to perform the same type of surgery¦will be difficult to demonstrate.

Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

OBJECTIVE: In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. METHODS: This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. RESULTS: During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. CONCLUSIONS: This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.

Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland.

BACKGROUND:  Socioeconomic status is thought to have a significant influence on stroke incidence, risk factors and outcome. Its influence on acute stroke severity, stroke mechanisms, and acute recanalisation treatment is less known. METHODS:  Over a 4-year period, all ischaemic stroke patients admitted within 24 h were entered prospectively in a stroke registry. Data included insurance status, demographics, risk factors, time to hospital arrival, initial stroke severity (NIHSS), etiology, use of acute treatments, short-term outcome (modified Rankin Scale, mRS). Private insured patients (PI) were compared with basic insured patients (BI). RESULTS:  Of 1062 consecutive acute ischaemic stroke patients, 203 had PI and 859 had BI. They were 585 men and 477 women. Both populations were similar in age, cardiovascular risk factors and preventive medications. The onset to admission time, thrombolysis rate, and stroke etiology according to TOAST classification were not different between PI and BI. Mean NIHSS at admission was significantly higher for BI. Good outcome (mRS ≤ 2) at 7 days and 3 months was more frequent in PI than in BI. CONCLUSION:  We found better outcome and lesser stroke severity on admission in patients with higher socioeconomic status in an acute stroke population. The reason for milder strokes in patients with better socioeconomic status in a universal health care system needs to be explained.

Assessment of a new MRI classification of spinal stenosis based on cross-sectional morphology of the dural sac : FM2

Introduction: Quantitative measures of degree of lumbar spinal stenosis (LSS) such as antero-posterior diameter of the canal or dural sac cross sectional area vary widely and do not correlate with clinical symptoms or results of surgical decompression. In an effort to improve quantification of stenosis we have developed a grading system based on the morphology of the dural sac and its contents as seen on T2 axial images. The grading comprises seven categories ranging form normal to the most severe stenosis and takes into account the ratio of rootlet/CSF content. Material and methods: Fifty T2 axial MRI images taken at disc level from twenty seven symptomatic lumbar spinal stenosis patients who underwent decompressive surgery were classified into seven categories by five observers and reclassified 2 weeks later by the same investigators. Intra- and inter-observer reliability of the classification were assessed using Cohen's and Fleiss' kappa statistics, respectively. Results: Generally, the morphology grading system itself was well adopted by the observers. Its success in application is strongly influenced by the identification of the dural sac. The average intraobserver Cohen's kappa was 0.53 ± 0.2. The inter-observer Fleiss' kappa was 0.38 ± 0.02 in the first rating and 0.3 ± 0.03 in the second rating repeated after two weeks. Discussion: In this attempt, the teaching of the observers was limited to an introduction to the general idea of the morphology grading system and one example MRI image per category. The identification of the dimension of the dural sac may be a difficult issue in absence of complete T1 T2 MRI image series as it was the case here. The similarity of the CSF to possibly present fat on T2 images was the main reason of mismatch in the assignment of the cases to a category. The Fleiss correlation factors of the five observers are fair and the proposed morphology grading system is promising.

Os impostos diferidos no contexto Cabo-Verdiano: Impacto nas demonstrações financeiras

A contabilização dos impostos diferidos surge do facto da legislação fiscal e das normas contabilísticas poderem ser diferentes no que respeita ao reconhecimento e mensuração de activos, passivos, gastos e rendimentos. Para eliminar o efeito das diferenças de carácter temporal, das demonstrações financeiras, foram criadas normas contabilísticas que disciplinam a contabilização do imposto sobre o rendimento, através do reconhecimento de activos e passivos por impostos diferidos. Seguindo esta tendência, Cabo Verde introduziu, através do SNCRF - Sistema de Normalização contabilística e de relato financeiro, a NRF 22Imposto sobre o rendimento, que exige a contabilização de impostos diferidos nas diferenças temporárias entre a contabilidade e a fiscalidade. No entanto esta norma não está sendo observada, devido, na opinião de vários profissionais da área, a complexidade do assunto “imposto diferido”. Por esta razão, traçamos como objectivos deste trabalho, explicar a problemática dos impostos diferidos, evidenciando a importância do seu reconhecimento nas demonstrações financeiras. Concluímos que, a não contabilização de impostos diferidos pode pôr em causa a informação contida nas demonstrações financeiras e, consequentemente, as decisões que se toma com base nelas.The accounting of deferred taxes arises from the fact that tax legislation and accounting standards may differ regarding to the recognition and measurement of assets, liabilities, expenses and income. To eliminate the effect of the temporary differences in the financial statements, accounting standards have been established to regulate the accounting of income tax trough the recognition of assets and liabilities by deferred taxes. Following this trend, Cape Verde has introduced through the SNCRF - Standardization System of Accounting and Financial Reporting, the standard NRF 22 - Income Tax, which demands the recognition of deferred taxes in the temporary differences between accounting and taxation. However according to the opinion of some professors, this standard is not being observed due to the complexity of the subject "deferred tax". For this reason, we defined the following objectives for this work: explain the issue of deferred taxes, evidencing the importance of its recognition in the financial statements. We have concluded that, the not accounting of deferred taxes may jeopardize the information contained in the financial statements and consequently, the decisions made based on them.

A dilution cost approach to financial intermediation and securities markets

This paper proposes a model of financial markets and corporate finance,with asymmetric information and no taxes, where equity issues, Bankdebt and Bond financing may all co-exist in equilibrium. The paperemphasizes the relationship Banking aspect of financial intermediation:firms turn to banks as a source of investment mainly because banks aregood at helping them through times of financial distress. The debtrestructuring service that banks may offer, however, is costly. Therefore,the firms which do not expect to be financially distressed prefer toobtain a cheaper market source of funding through bond or equity issues.This explains why bank lending and bond financing may co-exist inequilibrium. The reason why firms or banks also issue equity in our modelis simply to avoid bankruptcy. Banks have the additional motive that theyneed to satisfy minimum capital adequacy requeriments. Several types ofequilibria are possible, one of which has all the main characteristics ofa "credit crunch". This multiplicity implies that the channels of monetarypolicy may depend on the type of equilibrium that prevails, leadingsometimes to support a "credit view" and other times the classical "moneyview".

Vários percursos diversas identificações : descendentes de migrantes cabo-verdianos no Bairro do Talude - Unhos

The research presented here aimed to analyze the processes of integration of Cape Verdeans immigrants descendants of living in the neighborhood of Talude, Town of Unhos, Municipality of Loures. To analyze the central object of research - the process of integration of descendants of migrants in the neighborhood of Talude we tried to answer the following questions, which reflect the objectives of the research:  What are the paths of socialization the descendants of immigrants: at the family, at school, in employment, in the neighborhood and in other activities?  What is the influence of gender relations in the processes of integration of descendants?  What are the perception the of immigrants descendants living in the neighborhood of Talude in relation to how they are viewed by residents of the Town residents in the neighborhood? And the people or society in general? And what influence these perceptions have in their process of integration? This study consists in two parts: the design of the survey, which is depicted on the reason for the choice of topic, the definition of the topic, research objectives, the method that was used in the course of investigation and the framing of the issue. In the second part, the analysis of data in different pathways: family, neighborhood, school, labor market, in other activities, the influence of gender and image(s). As a general conclusion we can say that there are several factors that contribute to the identification of immigrant descendants (there are no apparent factors that predominate) and the images they have of themselves and the Portuguese society in general are diverse.

Pertenças identitárias de jovens do Casal da Boba

Resumo - O trabalho que aqui se apresenta centra-se numa reflexão sobre as pertenças identitárias de jovens descendentes de imigrantes cabo-verdianos. O objectivo principal do estudo é o de contribuir para compreender como é que estes jovens definem e afirmam as suas pertenças identitárias. Os jovens em estudo estabelecem relações com dois códigos culturais, um transmitido no seio familiar e outro pelo contacto com a sociedade portuguesa e nessa medida a sua gestão identitária é complexa. Os descendentes de imigrantes cabo-verdianos ou novos portugueses têm múltiplas referências e pertenças identitárias e representam parte da juventude portuguesa de hoje.

Why do emerging economies borrow short term?

We argue that one reason why emerging economies borrow short term is that it is cheaperthan borrowing long term. This is especially the case during crises, as in these episodes therelative cost of long-term borrowing increases. We construct a unique database of sovereignbond prices, returns, and issuances at di¤erent maturities for 11 emerging economies from 1990to 2009 and present a set of new stylized facts. On average, these countries pay a higher riskpremium on long-term than on short-term bonds. During crises, the di¤erence between the tworisk premia increases and issuance shifts towards shorter maturities. To illustrate our argument,we present a simple model in which the maturity structure is the outcome of a risk sharingproblem between an emerging economy subject to rollover crises and risk averse internationalinvestors.

Appraising and selecting strategies to combat and mitigate desertification based on stakeholder knowledge and globalbest practices in Cape Verde Archipelago

Cape Verde is considered part of Sahelian Africa, where drought and desertification are common occurrences. The main activity of the rural population is rain-fed agriculture, which over time has been increasingly challenged by high temporal and spatial rainfall variability, lack of inputs, limited land area, fragmentation of land, steep slopes, pests, lack of mechanization and loss of top soil by water erosion. Human activities, largely through poor farming practices and deforestation (Gomez, 1989) have accelerated natural erosion processes, shifting the balance between soil erosion and soil formation (Norton, 1987). According to previous studies, vegetation cover is one of the most important factors in controlling soil loss (Cyr et al., 1995; Hupy, 2004; Zhang et al., 2004; Zhou et al., 2006). For this reason, reforestation is a touchstone of the Cape Verdean policy to combat desertification. After Independence in 1975, the Cape Verde government had pressing and closely entangled environmental and socio-economic issues to address, as long-term desertification had resulted in a lack of soil cover, severe soil erosion and a scarcity of water resources and fuel wood. Across the archipelago, desertification was resulting from a variety of processes including poor farming practices, soil erosion by water and wind, soil and water salinity in coastal areas due to over pumping and seawater intrusion, drought and unplanned urbanization (DGA-MAAP, 2004). All these issues directly affected socio-economic vulnerability in rural areas, where about 70% of people depended directly or indirectly on agriculture in 1975. By becoming part of the Inter- State Committee for the Fight against Drought in the Sahel in 1975, the government of Cape Verde gained structured support to address these issues more efficiently. Presentday policies and strategies were defined on the basis of rational use of resources and human efforts and were incorporated into three subsequent national plans: the National Action Plan for Development (NDP) (1982–1986), the NDP (1986–1990) and the NDP (1991–1995) (Carvalho

Pitfalls in the modeling of forward-looking price setting and investment decisions

The present paper makes progress in explaining the role of capital for inflation and output dynamics. We followWoodford (2003, Ch. 5) in assuming Calvo pricing combined with a convex capital adjustment cost at the firm level. Our main result is that capital accumulation affects inflation dynamics primarily through its impact on the marginal cost. This mechanism is much simpler than the one implied by the analysis in Woodford's text. The reason is that his analysis suffers from a conceptual mistake, as we show. The latter obscures the economic mechanism through which capital affects inflation and output dynamics in the Calvo model, as discussed in Woodford (2004).

A constituição e o funcionamento de uma comunidade de prática de professores em educação para o desenvolvimento sustentável

Os conceitos de desenvolvimento sustentável e de educação para o desenvolvimento sustentável estão ainda em evolução o que torna pertinente, hoje, a tentativa de uma clarificação conceptual e sua posterior operacionalização. Além de promover a definição e uso correto dos termos, compete também ao ensino criar e desenvolver as competências necessárias para a sua operacionalidade. Esta investigação pretende contribuir para a autoformação de professores, nomeadamente de professores de Física e Química, em educação para o desenvolvimento sustentável. Pretende que os professores, e aqueles que beneficiam da sua ação, possam ser cidadãos críticos e responsáveis, numa sociedade local e simultaneamente global, que vive num tempo concreto mas, cada vez mais, consciente das repercussões futuras das suas ações e decisões. Tendo por base este objetivo criou-se uma comunidade de prática virtual constituída por professores de Física e Química de Portugal e de países africanos de língua oficial portuguesa. A formação em educação para o desenvolvimento sustentável constituiu o domínio da comunidade de prática. A água foi o tema motivador e aglutinador, pois sendo essencial à vida, torna-se no contexto educativo, e concretamente em educação para o desenvolvimento sustentável, num desafio ético, simultaneamente social, económico, ambiental e político. A prática reflexiva constituiu uma ferramenta fundamental da atividade da comunidade. Da análise da prática desta comunidade, que constituiu o objeto desta investigação, verificámos que os diferentes contextos geográficos, educacionais, culturais e de desenvolvimento dos professores proporcionaram uma participação diversificada na comunidade de prática. Esta participação permitiu, aos membros da referida comunidade, a criação e/ou o desenvolvimento das competências requeridas em educação para o desenvolvimento sustentável. Apesar da pertinência do tema confrontámo-nos com a falta de projetos de investigação semelhantes ao desta investigação, o que constituiu um maior desafio à sua realização.