How to set up and apply reference levels in fluoroscopy at a national level.

A nationwide survey was launched to investigate the use of fluoroscopy and establish national reference levels (RL) for dose-intensive procedures. The 2-year investigation covered five radiology and nine cardiology departments in public hospitals and private clinics, and focused on 12 examination types: 6 diagnostic and 6 interventional. A total of 1,000 examinations was registered. Information including the fluoroscopy time (T), the number of frames (N) and the dose-area product (DAP) was provided. The data set was used to establish the distributions of T, N and the DAP and the associated RL values. The examinations were pooled to improve the statistics. A wide variation in dose and image quality in fixed geometry was observed. As an example, the skin dose rate for abdominal examinations varied in the range of 10 to 45 mGy/min for comparable image quality. A wide variability was found for several types of examinations, mainly complex ones. DAP RLs of 210, 125, 80, 240, 440 and 110 Gy cm2 were established for lower limb and iliac angiography, cerebral angiography, coronary angiography, biliary drainage and stenting, cerebral embolization and PTCA, respectively. The RL values established are compared to the data published in the literature.

Is output performance all about the resources? A fuzzy-set Qualitative Comparative Analysis of street-level bureaucrats in Switzerland

This article refines Lipsky’s (1980) assertion that lacking resources negatively affect output performance. It uses fuzzy-set Qualitative Comparative Analysis to analyse the nuanced interplay of contextual and individual determinants of the output performance of veterinary inspectors as street-level bureaucrats in Switzerland. Moving ‘beyond Lipsky’, the study builds on recent theoretical contributions and a systematic comparison across organizational contexts. Against a widespread assumption, output performance is not all about the resources. The impact of perceived available resources hinges on caseloads, which prove to be more decisive. These contextual factors interact with individual attitudes emerging from diverse public accountabilities. The results contextualize the often-emphasized importance of worker-client interaction. In a setting where clients cannot escape the interaction, street-level bureaucrats are not primarily held accountable by them. Studies of output performance should thus sensibly consider gaps between what is being demanded of and offered to street-level bureaucrats, and the latter’s multiple embeddedness.

Intermediate (field) (direct and general support) and depot level maintenance manual : generator set, diesel engine driven, tactical skid mtd. 15 kw, 3 phase, 4 wire, 120/208 and 240/416 volts : DoD model MEP-004A ... 6115-00-463-9094.

"January 1975."

Intermediate (field) (direct and general support) and depot level maintenance manual : generator set, diesel engine driven, tactical skid mtd 5kw, 1 phase - 2 wire, 1 phase - 3 wire, 3 phase - 4 wire, 120, 120/240 and 120/208 volts, DoD model MEP-002A, class utility, hertz 60, NSN 6115-00-465-1044.

"July 1977."

Operator, organizational, intermediate (field), (direct support and general support), and depot level maintenance manual : generator set, tactical, gasoline engine, air cooled, 5 KW, AC, 120/240V single phase, 120/208V 3 phase, skid mounted, tubular frame (less engine) military design ; DoD model MEP-017A, MEP-022A, class utility ... 6115-00-017-8241.

"December 1977."

Intermediate (field) (direct and general support) and depot level maintenance manual : generator set, diesel engine driven, tactical skid MTD. 15 KW, 3 phase, 4 wire, 120/208 and 240/416 volts : DoD model MEP-004A ... 6115-00-463-9094.

"January 1975."

Intermediate (field) (direct and general support) and depot level maintenance manual : generator set, diesel engine driven, tactical skid MTD 5KW, 1 phase-2 wire, 1 phase-3 wire, 3 phase-4 wire, 120, 120/240 and 120/208 volts, DoD model MEP-002A, class utility, hertz 60, NSN 6115-00-465-1044.

"July 1977."

Intermediate (field) (direct and general support) and depot level maintenance : generator set, diesel engine driven, tactical skid MTD., 200 KW, 3 phase, 4 wire, 120/208 and 240/416 volts : DoD model MEP009A, MEP108A, class utility, precise ... 6115-00-403-3762.

"20 October 1977."

Intermediate (field) (direct and general support) and depot level maintenance manual : generator set, diesel engine driven, tactical skid MTD 10KW, 1 phase-2 wire, 1 phase-3 wire, 3 phase-4 wire, 120, 120/240 and 120/208 volts : DoD model MEP-003A, class utility, hertz 60, NSN 6115-00-465-1030.

"July 1977."

Intermediate (field) (direct and general support) and depot level maintenance manual : generator set, diesel engine driven, tactical skid mtd. 30 kw, 3 phase, 4 wire, 120/208 and 240/416 volts : DoD model MEP-005A ... 6115-463-9094.

"January 1975."

Intermediate (field), (direct and general support) and depot level maintenance : generator set, aviation, gas turbine engine driven, integral trailer mounted, 10KW, 28 volts : DoD model MEP 362A, class precise, mode DC, NSN 6115-01-161-3992.

Includes index.

Comparison Between Single-Diode Low-Level Laser Therapy (LLLT) and LED Multi-Diode (Cluster) Therapy (LEDT) Applications Before High-Intensity Exercise

Background Data and Objective: There is anecdotal evidence that low-level laser therapy (LLLT) may affect the development of muscular fatigue, minor muscle damage, and recovery after heavy exercises. Although manufacturers claim that cluster probes (LEDT) maybe more effective than single-diode lasers in clinical settings, there is a lack of head-to-head comparisons in controlled trials. This study was designed to compare the effect of single-diode LLLT and cluster LEDT before heavy exercise. Materials and Methods: This was a randomized, placebo-controlled, double-blind cross-over study. Young male volleyball players (n = 8) were enrolled and asked to perform three Wingate cycle tests after 4 x 30 sec LLLT or LEDT pretreatment of the rectus femoris muscle with either (1) an active LEDT cluster-probe (660/850 nm, 10/30mW), (2) a placebo cluster-probe with no output, and (3) a single-diode 810-nm 200-mW laser. Results: The active LEDT group had significantly decreased post-exercise creatine kinase (CK) levels (-18.88 +/- 41.48U/L), compared to the placebo cluster group (26.88 +/- 15.18U/L) (p < 0.05) and the active single-diode laser group (43.38 +/- 32.90U/L) (p<0.01). None of the pre-exercise LLLT or LEDT protocols enhanced performance on the Wingate tests or reduced post-exercise blood lactate levels. However, a non-significant tendency toward lower post-exercise blood lactate levels in the treated groups should be explored further. Conclusion: In this experimental set-up, only the active LEDT probe decreased post-exercise CK levels after the Wingate cycle test. Neither performance nor blood lactate levels were significantly affected by this protocol of pre-exercise LEDT or LLLT.

Individual-level diet variation in four species of Brazilian frogs

Many natural populations exploiting a wide range of resources are actually composed of relatively specialized individuals. This interindividual variation is thought to be a consequence of the invasion of `empty` niches in depauperate communities, generally in temperate regions. If individual niches are constrained by functional trade-offs, the expansion of the population niche is only achieved by an increase in interindividual variation, consistent with the `niche variation hypothesis`. According to this hypothesis, we should not expect interindividual variation in species belonging to highly diverse, packed communities. In the present study, we measured the degree of interindividual diet variation in four species of frogs of the highly diverse Brazilian Cerrado, using both gut contents and delta(13)C stable isotopes. We found evidence of significant diet variation in the four species, indicating that this phenomenon is not restricted to depauperate communities in temperate regions. The lack of correlations between the frogs` morphology and diet indicate that trade-offs do not depend on the morphological characters measured here and are probably not biomechanical. The nature of the trade-offs remains unknown, but are likely to be cognitive or physiological. Finally, we found a positive correlation between the population niche width and the degree of diet variation, but a null model showed that this correlation can be generated by individuals sampling randomly from a common set of resources. Therefore, albeit consistent with, our results cannot be taken as evidence in favour of the niche variation hypothesis.

Pricing farm-level agricultural insurance: a Bayesian approach

This paper applies Hierarchical Bayesian Models to price farm-level yield insurance contracts. This methodology considers the temporal effect, the spatial dependence and spatio-temporal models. One of the major advantages of this framework is that an estimate of the premium rate is obtained directly from the posterior distribution. These methods were applied to a farm-level data set of soybean in the State of the Parana (Brazil), for the period between 1994 and 2003. The model selection was based on a posterior predictive criterion. This study improves considerably the estimation of the fair premium rates considering the small number of observations.

Opportunistic and partisan election cycles in Brazil: new evidence at the municipal level

This article tests the hypothesis of opportunistic and partisan cycle models using a new large data set of Brazilian municipalities over the 1989-2005 period. The results show an increase in total and current expenditures and a decrease in municipal investments, local tax revenues, and budget surplus in election years. They also show that partisan ideology exerts a relative influence on the performance of the local public accounts. These results confirm that both opportunistic and partisan cycles have occurred in the management of the budgets of Brazilian municipalities after the end of the military government.