Tailored thoracomyoplasty as a valid treatment option for chronic postlobectomy empyema.

BACKGROUND: Chronic post-lobectomy empyema is rare but may require space obliteration for infection control. We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection control and functional outcome. METHODS: We retrospectively analyzed 17 patients (11 men, 6 women) with chronic postlobectomy empyema who were treated by thoracomyoplasty in our institution between 2000 and 2011. All patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n = 6). In 5 patients, bronchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior-rhomboid myoplasty, which also served to close a bronchopleural fistula, if present. The first rib was resected in 11 of 17 patients. RESULTS: The 90-day mortality was 11.7%. Thoracomyoplasty was successful in all surviving patients with respect to infection control, space obliteration, and definitive closure of bronchopleural fistula, irrespective of the type of infection, the presence of a bronchopleural fistula, or whether a first rib resection was performed. Postlobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEV(1) of 63.0% ± 8.5% and 51.5% ± 4.2% (p = 0.01) and a mean predicted DLCO of 59.8% ± 11.6% and 54.5% ± 12.5%, respectively. Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy. CONCLUSIONS: Tailored thoracomyoplasty represents a valid option for patients with chronic postlobectomy empyema without requiring a preceding open window thoracostomy. Space obliteration and infection control were equally obtained with and without first rib resection.

Audit report on the Iowa Water Pollution Control Works Financing Program and the Iowa Drinking Water Facilities Financing Program, joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2014

Audit report on the Iowa Water Pollution Control Works Financing Program and the Iowa Drinking Water Facilities Financing Program, joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2014

Audit report on the Iowa Water Pollution Control Works Financing Program (Clean Water Program) and the Iowa Drinking Water Facilities Financing Program (Drinking Water Program), joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2005

Audit report on the Iowa Water Pollution Control Works Financing Program (Clean Water Program) and the Iowa Drinking Water Facilities Financing Program (Drinking Water Program), joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2005

Audit report on the Iowa Water Pollution Control Works Financing Program (Clean Water Program) and the Iowa Drinking Water Facilities Financing Program (Drinking Water Program), joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2004

Audit report on the Iowa Water Pollution Control Works Financing Program (Clean Water Program) and the Iowa Drinking Water Facilities Financing Program (Drinking Water Program), joint programs of the Iowa Finance Authority and the Iowa Department of Natural Resources, for the year ended June 30, 2004

Human papillomavirus (HPV) vaccines as an option for preventing cervical malignancies: (how) effective and safe?

We carried out a systematic review of HPV vaccine pre- and post-licensure trials to assess the evidence of their effectiveness and safety. We find that HPV vaccine clinical trials design, and data interpretation of both efficacy and safety outcomes, were largely inadequate. Additionally, we note evidence of selective reporting of results from clinical trials (i.e., exclusion of vaccine efficacy figures related to study subgroups in which efficacy might be lower or even negative from peer-reviewed publications). Given this, the widespread optimism regarding HPV vaccines long-term benefits appears to rest on a number of unproven assumptions (or such which are at odd with factual evidence) and significant misinterpretation of available data. For example, the claim that HPV vaccination will result in approximately 70% reduction of cervical cancers is made despite the fact that the clinical trials data have not demonstrated to date that the vaccines have actually prevented a single case of cervical cancer (let alone cervical cancer death), nor that the current overly optimistic surrogate marker-based extrapolations are justified. Likewise, the notion that HPV vaccines have an impressive safety profile is only supported by highly flawed design of safety trials and is contrary to accumulating evidence from vaccine safety surveillance databases and case reports which continue to link HPV vaccination to serious adverse outcomes (including death and permanent disabilities). We thus conclude that further reduction of cervical cancers might be best achieved by optimizing cervical screening (which carries no such risks) and targeting other factors of the disease rather than by the reliance on vaccines with questionable efficacy and safety profiles.

Attachés d'administration centrale. Constitution initiale des nouveaux corps . [Instruction du 11 avril 1956 des secrétaires d'Etat au Budget et à la présidence du conseil (Fonction publique) relative à la constitution initiale des nouveaux corps d'attachés d'administration. - Annexes. I. Programme des matières à option "Administration générale" du concours spécial prévu à l'article 23 ; II. Textes de base : Loi du 3 février 1953 et du 3 avril 1955. Décret du 16 décembre 1955 portant règlement d'administration publique relatif au statut particulier des attachés d'administration centrale. III. Organisation et programme du concours normal prévu aux articles 5 et 12 du décret du 16 décembre 1955.]

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A Feasibility Study of a Pelleting Plant as an Option for By Product Upgrading in Wood-Processing Industry

Tämän kannattavuustutkimuksen lähtökohtana oli se, että Yhtyneet Sahat Oy:n Kaukaan sahalla ja Luumäen jatkojalostuslaitoksella haluttiin selvittää pellettitehtaan kannattavuus nykyisessä markkinatilanteessa. Tämä työon luonteeltaan teknis-taloudellinen selvitys eli ns. feasibility study. Pelletöintiprosessi on tekniikaltaan yksinkertainen eikä edellytä korkea teknologian laitteita. Toimiala on maailmanlaajuisesti varsin uusi. Suomessa pellettimarkkinat ovat vielä pienet ja kehittymättömät, mutta kasvua on viime vuosina tapahtunut. Valtaosa kotimaan tuotannosta menee vientiin. Investoinnin laskentaprosessissa saadut tuotannon alkuarvot sekä kustannusrakenteen määrittelyt ovat perustana varsinaisille kannattavuuslaskelmille. Laskelmista on selvitetty investointeihin liittyvät yleisimmät taloudelliset tunnusluvut ja herkimpiä muuttujia on tutkittu ja pohdittu herkkyysanalyysiä apuna käyttäen.

Ist die «Polypille» in der kardiovaskulären Prävention eine Option [Is the "polypill" in cardiovascular prevention an option]

Fallvignette: Ein 58-jähriger Mann hatte vor einem Jahr einen Herzinfarkt, der mit einem beschichteten Stent versorgt wurde. Im Beruf hat er eine verantwortungsvolle Position und ist häufig geschäftlich unterwegs. Er gibt an, dass er Mühe mit der Einnahme seiner fünf Medikamente (Statin, β-Blocker, ACE-Hemmer, Clopidogrel, Acetylsalizylsäure) hat und dass er ab und zu vergisst, eines zu nehmen. Frage: Könnte ihm ein Kombinationspräparat (Polypille) helfen, seine Medikamente regelmässig einzunehmen? Hintergrund: Weltweit sind Herz-Kreislauf-Erkrankungen die führende Ursache für Tod und Behinderung. Um diese Krankheitslast zu vermindern, ist eine bevölkerungsbezogene Prävention entscheidend, bei der bekannte kardiovaskuläre Risikofaktoren kontrolliert werden. Das Konzept der Polypille mit einer fixen Kombination von mindestens einem Antihypertensivum und einem Statin wurde vor allem in Hinblick auf Entwicklungs- und Schwellenländer entwickelt. Die Primärprävention ist in diesen Ländern schwierig durch führbar; eine einzige Tablette wäre dort eine kostengünstige Variante. Aber auch in reichen Ländern könnte die Polypille sinnvoll sein, um z.B. die Compliance bei multimorbiden Patienten zu verbessern. Als Polypille werden verschiedene Kombinationen von Medikamenten angeboten, ihre Wirksamkeit und möglichen Nebenwirkungen sind jedoch unklar. Ziel dieses Reviews war, ihre Wirksamkeit in der primären und sekundären Prävention bezüglich Mortalität, nicht-tödliche kardiovaskuläre Ereignisse und Blutdruck-bzw. Lipidsenkung zu überprüfen.

Transferring control demands across incidental learning tasks - Stronger sequence usage in serial reaction task after shortcut option in letter string checking

After incidentally learning about a hidden regularity, participants can either continue to solve the task as instructed or, alternatively, apply a shortcut. Past research suggests that the amount of conflict implied by adopting a shortcut seems to bias the decision for vs. against continuing instruction-coherent task processing. We explored whether this decision might transfer from one incidental learning task to the next. Theories that conceptualize strategy change in incidental learning as a learning-plus-decision phenomenon suggest that high demands to adhere to instruction-coherent task processing in Task 1 will impede shortcut usage in Task 2, whereas low control demands will foster it. We sequentially applied two established incidental learning tasks differing in stimuli, responses and hidden regularity (the alphabet verification task followed by the serial reaction task, SRT). While some participants experienced a complete redundancy in the task material of the alphabet verification task (low demands to adhere to instructions), for others the redundancy was only partial. Thus, shortcut application would have led to errors (high demands to follow instructions). The low control demand condition showed the strongest usage of the fixed and repeating sequence of responses in the SRT. The transfer results are in line with the learning-plus-decision view of strategy change in incidental learning, rather than with resource theories of self-control.

Renewal equations for option pricing

In this paper we will develop a methodology for obtaining pricing expressions for financial instruments whose underlying asset can be described through a simple continuous-time random walk (CTRW) market model. Our approach is very natural to the issue because it is based in the use of renewal equations, and therefore it enhances the potential use of CTRW techniques in finance. We solve these equations for typical contract specifications, in a particular but exemplifying case. We also show how a formal general solution can be found for more exotic derivatives, and we compare prices for alternative models of the underlying. Finally, we recover the celebrated results for the Wiener process under certain limits.

Sildenafil as a therapeutic option for digital ischemic ulceration: case report.

We report the case of a 37-year-old woman who developed critical upper limb ischemia caused by a cervical rib. Because the malformation was initially undiagnosed, a vascular bypass was performed, and failure occurred. Following a 6-month therapy with sildenafil, revascularization of the arm was successful and amputation was avoided. A 6-year follow-up shows a rich collateral network at the compression site and normal values of digital plethysmography. Because hand surgeons often see patients with digital ulcerations and other manifestations of peripheral vascular pathology, therapy of ischemia with sildenafil could be an effective treatment option in patients not responding to classic drugs.

Financing public education when altruistic agents have retirement concerns

[cat]El capital humà i, per tant, l’educació tenen un impacte en el benestar futur de la societat. En aquest treball s’estudia la connexió entre el suport dels votants per una educació pública i les preocupacions sobre la seva jubilació. Mostrem com els votants anticipen els efectes positius que té l’educació sobre les pensions futures. Així, el recolzament a un sistema educatiu públic s’incrementa si el sistema de pensions és més redistributiu, cosa que també es dóna entre els ciutadans que prefereixen una educació privada. També mostrem que el tipus d’equilibri “ends against the middle” pot ocórrer fins i tot quan la taxa impositiva preferida pels votants és decreixent amb la renda.

Financing public education when altruistic agents have retirement concerns

[cat]El capital humà i, per tant, l’educació tenen un impacte en el benestar futur de la societat. En aquest treball s’estudia la connexió entre el suport dels votants per una educació pública i les preocupacions sobre la seva jubilació. Mostrem com els votants anticipen els efectes positius que té l’educació sobre les pensions futures. Així, el recolzament a un sistema educatiu públic s’incrementa si el sistema de pensions és més redistributiu, cosa que també es dóna entre els ciutadans que prefereixen una educació privada. També mostrem que el tipus d’equilibri “ends against the middle” pot ocórrer fins i tot quan la taxa impositiva preferida pels votants és decreixent amb la renda.

On Option Price Information Content and Extraction of Implied Probability Distributions

In this study we used market settlement prices of European call options on stock index futures to extract implied probability distribution function (PDF). The method used produces a PDF of returns of an underlying asset at expiration date from implied volatility smile. With this method, the assumption of lognormal distribution (Black-Scholes model) is tested. The market view of the asset price dynamics can then be used for various purposes (hedging, speculation). We used the so called smoothing approach for implied PDF extraction presented by Shimko (1993). In our analysis we obtained implied volatility smiles from index futures markets (S&P 500 and DAX indices) and standardized them. The method introduced by Breeden and Litzenberger (1978) was then used on PDF extraction. The results show significant deviations from the assumption of lognormal returns for S&P500 options while DAX options mostly fit the lognormal distribution. A deviant subjective view of PDF can be used to form a strategy as discussed in the last section.