Vincristine and intestinal pseudo-obstruction in children: report of 5 cases, literature review, and suggested management.

Summary: Intestinal pseudo-obstruction is a rare complication resulting from a variety of disorders. Symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, and malnutrition. Vincristine-related pseudo-obstruction has been reported in the literature, but its description in children and recommendations for management are lacking. A review of the literature revealed 21 reported pediatric cases of vincristine-related pseudo-obstruction. Most have, however, been attributed to a drug interaction with itraconazole, accidental vincristine overdose, or liver failure. Potential genetic causes are rarely addressed. We present here 5 cases of pseudo-obstruction related to vincristine without any identifiable predisposing factors, and a suggested algorithm for management

Toward partial reorientation of land management for sustainability in view of material circulation: biophysical and historical analysis

This paper explores two major issues, from biophysical and historical viewpoints. We examine land management, which we define as the long-term fertility maintenance of land in relation to agriculture, fishery and forestry. We also explore humans’ positive role as agents aiming to reinforce harmonious materials circulation within the land. Liebig’s view on nature, agriculture and land, emphasizes the maintenance of long-term land fertility based on his agronomical thought that the circulation of matter in agricultural fields must be maintained with manure as much as possible. The thoughts of several classical economists, on nature, agriculture and land are reassessed from Liebig’s view point. Then, the land management problem is discussed at a much more fundamental level, to understand the necessary conditions for life in relation to land management. This point is analyzed in terms of two mechanisms: entropy disposal on the earth, and material circulation against gravitational field. Finally from the historical example of the metropolis of Edo, it is shown that there is yet another necessary condition for the sustainable management of land based on the creation of harmonious material cycles among cities, farm land, forests and surrounding sea areas in which humans play a vital role as agent.

Guidelines for the clinical management of atrial fibrillation: a practical perspective.

Since the management of atrial fibrillation may be difficult in the individual patient, our purpose was to develop simple clinical recommendations to help the general internist manage this common clinical problem. Systematic review of the literature with evaluation of data-related evidence and framing of graded recommendations. Atrial fibrillation affects some 1% of the population in Western countries and is linked to a significant increase in morbidity and mortality. The management of atrial fibrillation requires individualised evaluation of the risks and benefits of therapeutic modalities, relying whenever possible on simple and validated tools. The two main points requiring a decision in clinical management are 1) whether or not to implement thromboembolic prevention therapy, and 2) whether preference should be given to a "rate control" or "rhythm control" strategy. Thromboembolic prophylaxis should be prescribed after individualised risk assessment: for patients at risk, oral anticoagulation with warfarin decreases the rate of embolic complications by 60% and aspirin by 20%, at the expense of an increased incidence of haemorrhagic complications. "Rate control" and "rhythm control" strategies are probably equivalent, and the choice should also be made on an individualised basis. To assist the physician in making his choices for the care of an atrial fibrillation patient we propose specific tables and algorithms, with graded recommendations. On the evidence of data from the literature we propose simple algorithms and tables for the clinical management of atrial fibrillation in the individual patient.

Tax Coordination Between Regions in Spain. The Role of the Courts

Overview of the Tax Coordination of the Regions in Spain from the point of view of the role of the Courts in developing the present system

Tax Coordination Between Regions in Spain - Role of the Courts

Análisis de la jurisprudencia constitucional española sobre la distribución de competencias tributarias entre los distintos niveles de gobierno.

Le management de juridiction : analyse comparative de l'organisation et du fonctionnement managérial de cinq juridictions du pouvoir judiciaire à Genève

Cette étude comparative analyse le management au sein de cinq juridictions du pouvoir judiciaire genevois. Elle s'intéresse en particulier au président et au greffier de juridiction, qui, dans ces structures, sont investis de cette mission, et se fonde sur une conception actualisée du cycle traditionnel de management. Comment fonctionnent et s'organisent les juridictions du point de vue managérial ? Comment les managers se répartissent-ils leur rôle et leurs responsabilités ? Quelles sont les pratiques managériales utilisées, et comment sont-elles perçues par les collaborateurs et les managers ? Cet ouvrage a pour objectif de répondre à ces questions et de formuler une série de recommandations visant l'optimisation du management juridictionnel au sein du pouvoir judiciaire à Genève.

Ra isotopes and Rn as a tool for the water management resources: the Alberquillas aquifer (Málaga-Granada)

The aim of this project is to evaluate the importance of submarine groundwater discharge sector in order to improve the water balance in Málaga-Granada region. The approach of this study arose from the the geology and the aquifers that indicate that there could be some discharge to the sea between Maro (Málaga) and Almuñécar (Granada) and the Andalusian’s Government and its Water Agence were really interested in evaluating it because there is a lot of population and few water available and the magnitude of groundwater discharge has generated controversy. Is well known that water is a scarce resource in this area and it’s very important for the society and for the environment. The legislation, the water policies, the knowledge of the aquifer and the geology, the water dynamics, the land use and the water perception in the society might help the management of this resource not just in Andalusia but in all the Mediterranean basin. The main objective is to evaluate the submarine groundwater discharge from the Alberquillas Aqufier to the sea by measuring 222Rn and Ra isotopes. Specific objectives have been established to achieve the main objective: A) Reveal the importance of water resources in the Mediterranean basin; B) Learn radiometric techniques for the study of groundwater discharge to the sea; C) Learn of sampling techniques of water samples for the measurement of Ra and Rn; D) Learn the techniques for measuring Ra (RaDeCC) and Rn (RAD7); E) Interpretation and discussion of results. During this semester, and in addition of the present study in Málaga- Granada region, the author has participated in the initial phase (sampling, analysis and interpretation of preliminary results) of other research projects focused on the study of submarine groundwater discharges through the use of Ra isotopes and 222Rn. These studies have been developed in different areas, including Alt Empordà (Roses and Sant Pere Pescador), Maresme with CMIMA’s group (Mediterranean Center for Marine and Environmental Research), Delta de l’Ebre, Peñíscola and Mallorca with the IMEDEA’s group (Mediterranean Institute for Advanced Studies).

Tax evasion, technology shocks, and the cyclicality of government revenues

This paper analyzes the behavior of the tax revenue to output ratio over the business cycle. In order to replicate the empirical evidence, we develop a simple model combining the standard Ak growth model with the tax evasion phenomenon. When individuals conceal part of their true income from the tax authority, they face the risk of being audited and hence of paying the corresponding fine. Under the empirically plausible assumptions that the intertemporal elasticity of substitution exhibits a sufficiently small value and that productivity shocks are serially correlated, we show that the elasticity of government revenue with respect to output is larger than one, which agrees with the empirical evidence. This result holds even if the tax system displays flat tax rates. We extend the previous setup to generate larger fiscal deficits when the economy experiences a recession.

Proposed guidelines for the diagnosis and management of methylmalonic and propionic acidemia.

Methylmalonic and propionic acidemia (MMA/PA) are inborn errors of metabolism characterized by accumulation of propionic acid and/or methylmalonic acid due to deficiency of methylmalonyl-CoA mutase (MUT) or propionyl-CoA carboxylase (PCC). MMA has an estimated incidence of ~ 1: 50,000 and PA of ~ 1:100'000 -150,000. Patients present either shortly after birth with acute deterioration, metabolic acidosis and hyperammonemia or later at any age with a more heterogeneous clinical picture, leading to early death or to severe neurological handicap in many survivors. Mental outcome tends to be worse in PA and late complications include chronic kidney disease almost exclusively in MMA and cardiomyopathy mainly in PA. Except for vitamin B12 responsive forms of MMA the outcome remains poor despite the existence of apparently effective therapy with a low protein diet and carnitine. This may be related to under recognition and delayed diagnosis due to nonspecific clinical presentation and insufficient awareness of health care professionals because of disease rarity.

Clinical benefits of an adherence monitoring program in the management of secondary hyperparathyroidism with cinacalcet: results of a prospective randomized controlled study.

BACKGROUND/AIMS: One of the causes of uncontrolled secondary hyperparathyroidism (sHPT) is patient's poor drug adherence. We evaluated the clinical benefits of an integrated care approach on the control of sHPT by cinacalcet. METHODS: Prospective, randomized, controlled, multicenter, open-label study. Fifty hemodialysis patients on a stable dose of cinacalcet were randomized to an integrated care approach (IC) or usual care approach (UC). In the IC group, cinacalcet adherence was monitored using an electronic system. Results were discussed with the patients in motivational interviews, and drug prescription adapted accordingly. In the UC group, drug adherence was monitored, but results were not available. RESULTS: At six months, 84% of patients in the IC group achieved recommended iPTH targets versus 55% in the UC group (P = 0.04). The mean cinacalcet taking adherence improved by 10.8% in the IC group and declined by 5.3% in the UC group (P = 0.02). Concomitantly, the mean dose of cinacalcet was reduced by 7.2 mg/day in the IC group and increased by 6.4 mg/day in the UC group (P = 0.03). CONCLUSIONS: The use of a drug adherence monitoring program in the management of sHPT in hemodialysis patients receiving cinacalcet improves drug adherence and iPTH control and allows a reduction in the dose of cinacalcet.

Rapid detection of enterovirus in cerebrospinal fluid by a fully-automated PCR assay is associated with improved management of aseptic meningitis in adult patients.

BACKGROUND: Enterovirus (EV) is the most frequent cause of aseptic meningitis (AM). Lack of microbiological documentation results in unnecessary antimicrobial therapy and hospitalization. OBJECTIVES: To assess the impact of rapid EV detection in cerebrospinal fluid (CSF) by a fully-automated PCR (GeneXpert EV assay, GXEA) on the management of AM. STUDY DESIGN: Observational study in adult patients with AM. Three groups were analyzed according to EV documentation in CSF: group A=no PCR or negative PCR (n=17), group B=positive real-time PCR (n=20), and group C=positive GXEA (n=22). Clinical, laboratory and health-care costs data were compared. RESULTS: Clinical characteristics were similar in the 3 groups. Median turn-around time of EV PCR decreased from 60h (IQR (interquartile range) 44-87) in group B to 5h (IQR 4-11) in group C (p<0.0001). Median duration of antibiotics was 1 (IQR 0-6), 1 (0-1.9), and 0.5 days (single dose) in groups A, B, and C, respectively (p<0.001). Median length of hospitalization was 4 days (2.5-7.5), 2 (1-3.7), and 0.5 (0.3-0.7), respectively (p<0.001). Median hospitalization costs were $5458 (2676-6274) in group A, $2796 (2062-5726) in group B, and $921 (765-1230) in group C (p<0.0001). CONCLUSIONS: Rapid EV detection in CSF by a fully-automated PCR improves management of AM by significantly reducing antibiotic use, hospitalization length and costs.

The Rise of The Swiss Tax Haven in the Interwar Period: An International Comparison

The history of tax havens during the decades before World War II is still little known. To date, the studies that have focused on the 1920s and 1930s have presented either a very general perspective on the development of tax havens or a narrow national point of view. Based on unpublished historical archives of five countries (Switzerland, Great Britain, Belgium, France, Germany), this paper offers therefore a new comparative appraisal of international tax competition during this period in order to answer the following question: What was the specificity of the Swiss case - already considered a quintessential tax haven at the time - in comparison to other banking centres? The findings of this research study are twofold. First, the 1920s and 1930s appear as something of a golden age of opportunity for avoiding taxation through the relocation of assets. Most of the financial centres granted consistent tax benefits for imported capital, while the limited degree of international cooperation and the usual guarantee of banking secrecy in European countries prevented the taxation of exported assets. Second, within this general environment, the fiscal strategies of a tax haven like Switzerland differed from those of a great financial power like Great Britain. Whereas the Swiss administration readily placed itself at the service of the banking community, British policy was more balanced between the contradictory interests of the Board of Inland Revenue, the Treasury, and the English business circles.