Outpatient treatment of pulmonary embolism.

Pulmonary embolism (PE) is traditionally treated in hospital. Growing evidence from non randomized prospective studies suggests that a substantial proportion of patients with non-massive PE might be safely treated in the outpatient setting using low molecular weight heparins. Based on this evidence, professional societies started to recommend outpatient care for selected patients with non-massive PE. Despite these recommendations, outpatient treatment of non-massive PE appears to be uncommon in clinical practice. The major barriers to PE outpatient care are, firstly, the uncertainty as how to identify low risk patients with PE who are candidates for outpatient care and secondly the lack of high quality evidence from randomized trials demonstrating the safety of PE outpatient care compared to traditional inpatient management. Also, although clinical prognostic models, echocardiography and cardiac biomarkers accurately identify low risk patients with PE in prospective studies, the benefit of risk stratification strategies based on these instruments should be demonstrated in prospective management studies and clinical trials before they can be implemented as decision aids to guide PE outpatient treatment. Before high quality evidence documenting the safety of an outpatient treatment approach is published, outpatient management of non-massive PE cannot be generally recommended.

Outpatient treatment of pulmonary embolism

Pulmonary embolism (PE) is traditionally treated in hospital. Growing evidence from non randomized prospective studies suggests that a substantial proportion of patients with non-massive PE might be safely treated in the outpatient setting using low molecular weight heparins. Based on this evidence, professional societies started to recommend outpatient care for selected patients with non-massive PE. Despite these recommendations, outpatient treatment of non-massive PE appears to be uncommon in clinical practice. The major barriers to PE outpatient care are, firstly, the uncertainty as how to identify low risk patients with PE who are candidates for outpatient care and secondly the lack of high quality evidence from randomized trials demonstrating the safety of PE outpatient care compared to traditional inpatient management. Also, although clinical prognostic models, echocardiography and cardiac biomarkers accurately identify low risk patients with PE in prospective studies, the benefit of risk stratification strategies based on these instruments should be demonstrated in prospective management studies and clinical trials before they can be implemented as decision aids to guide PE outpatient treatment. Before high quality evidence documenting the safety of an outpatient treatment approach is published, outpatient management of non-massive PE cannot be generally recommended.

Impacts on the deep-sea ecosystem by a severe coastal storm

Major coastal storms, associated with strong winds, high waves and intensified currents, and occasionally with heavy rains and flash floods, are mostly known because of the serious damage they can cause along the shoreline and the threats they pose to navigation. However, there is a profound lack of knowledge on the deep-sea impacts of severe coastal storms. Concurrent measurements of key parameters along the coast and in the deep-sea are extremely rare. Here we present a unique data set showing how one of the most extreme coastal storms of the last decades lashing the Western Mediterranean Sea rapidly impacted the deep-sea ecosystem. The storm peaked the 26th of December 2008 leading to the remobilization of a shallow-water reservoir of marine organic carbon associated with fine particles and resulting in its redistribution across the deep basin. The storm also initiated the movement of large amounts of coarse shelf sediment, which abraded and buried benthic communities. Our findings demonstrate, first, that severe coastal storms are highly efficient in transporting organic carbon from shallow water to deep water, thus contributing to its sequestration and, second, that natural, intermittent atmospheric drivers sensitive to global climate change have the potential to tremendously impact the largest and least known ecosystem on Earth, the deep-sea ecosystem.

Impacts on the deep-sea ecosystem by a severe coastal storm

Major coastal storms, associated with strong winds, high waves and intensified currents, and occasionally with heavy rains and flash floods, are mostly known because of the serious damage they can cause along the shoreline and the threats they pose to navigation. However, there is a profound lack of knowledge on the deep-sea impacts of severe coastal storms. Concurrent measurements of key parameters along the coast and in the deep-sea are extremely rare. Here we present a unique data set showing how one of the most extreme coastal storms of the last decades lashing the Western Mediterranean Sea rapidly impacted the deep-sea ecosystem. The storm peaked the 26th of December 2008 leading to the remobilization of a shallow-water reservoir of marine organic carbon associated with fine particles and resulting in its redistribution across the deep basin. The storm also initiated the movement of large amounts of coarse shelf sediment, which abraded and buried benthic communities. Our findings demonstrate, first, that severe coastal storms are highly efficient in transporting organic carbon from shallow water to deep water, thus contributing to its sequestration and, second, that natural, intermittent atmospheric drivers sensitive to global climate change have the potential to tremendously impact the largest and least known ecosystem on Earth, the deep-sea ecosystem.

Vuosina 1995-1999 myönnettyjen yritystukien vaikuttavuus Etelä-Savossa

Tutkimuksen tavoitteena oli arvioida yritystukien vaikuttavuutta Etelä-Savon metalli- ja puuteollisuuden pienten ja keskisuurten yritysten yleisen kehityksen sekä tuille Suomen laissa ja Euroopan unionin rakennepolitiikassa asetettujen tavoitteiden näkökulmasta. Tuettujen yritysten kehitystä verrattiin ensin muiden Etelä-Savon puu- ja metalliteollisuusyritysten kehitykseen tilastotietojen avulla, minkä jälkeen vaikuttavuuden arviointia syvennettiin haastattelemalla tukea saaneiden yritysten avainhenkilöitä. Arviointi osoitti, että tuella on saatu Etelä-Savossa aikaan samanlaisia vaikutuksia kuin muuallakin Suomessa. Yritystukien avulla voidaan pääasiassa nopeuttaa yritysten hankkeiden toteutusta ja parantaa hankkeiden laatua. Tämä tukien hankkeisiin tuoma lisäarvo ilmenee tuettujen yritysten keskimääräistä voimakkaampana kehityksenä. Kokonaisuutena yritystukijärjestelmä toimii hyvin ja sen avulla voidaan saavuttaa Suomen lain ja Euroopan unionin rakennepolitiikan yritystuille asettamia tavoitteita. Keskeisin tukijärjestelmän kehittämiskohde liittyy tukien kohdistamiseen. Yritystuet pitäisi entistä tehokkaammin pystyä ohjaamaan kehittymiskelpoisille yrityksille, joille tuki on hankkeen toteuttamisen ehdoton edellytys.

Simuloinnin hyödyntäminen kotihoidon kehittämisessä

Ikääntyvien ihmisten kasvava määrä tulevina vuosikymmeninä kuormittaa kaupunkien kotihoitoa enenemässä määrin. Kaupunkien rajalliset resurssit ovat jo nyt koetuksella, eikä nykyiseen tilanteeseen ole nähtävissä huomattavaa parannusta tulevina vuosina. Kotihoidon henkilöstön määrää ei pystytä kasvattamaan riittävästi suhteessa kasvavien asiakasvirtojen kanssa, jotta korkea palvelun laatu voitaisiin taata myös tulevaisuudessa. Lahden kaupungin kotihoito pyrkii etsimään teknisiä ratkaisuja kotihoidon haasteisiin muun muassa kotihoidon töiden jakamiseen kehitetyllä optimointialgoritmilla sekä simuloinnilla. Tämä diplomityö käsittelee toimintatutkimuksen avulla simuloinnin tuomia hyötyjä sekä rajoitteita Lahden kotihoidon näkökulmasta. Launeen alueen kotihoidon haasteita käydään läpi neljässä eri työpajassa. Työssä esitetään Quest-simulointiohjelmiston ominaisuuksia, sekä Launeen alueen simulointimallin luomista aina suunnittelusta verifiointiin. Työn tuottama lisäarvo kotihoidon kehittämisessä tulee ilmi neljässä eri vaihtoehtoajossa kotihoitajien asiakkaalta toiselle kulkemien matkojen ja matkoihin käytettyjen aikojen mittaamisessa.

Grammatikdidaktik: Svensk grammatik och språklig medvetenhet i några läromedel för grundskolans första årskurser

Mitt övergripande forskningsintresse är grammatikdidaktik, medan det explicita syftet med denna licentiatavhandling är att erhålla ny kunskap om grammatikdidaktik så som den synliggörs i nutida läromedel för grundskolans första årskurser. Den empiriska undersökningen är gjord i tre nutida läromedelspaket avsedda för undervisning i skolämnet modersmål och litteratur i årskurs ett och två, läromedlen som undersöks är de finlandssvenska serierna Läseboken och Litteraturboken samt den sverigesvenska serien Kom och läs! Bland resultaten kan nämnas att det finns ett brett spektrum av nivåer av extern grammatik i alla de undersökta läromedelspaketen. Den fonologiska och syntaktiska medvetenheten, vilka bägge är viktiga för läs- och skrivutvecklingen i de diskuterade årskurserna, satsas på i alla tre läromedelspaket. Det jag dock också märkt i läromedlen som kan påverka läs- och skrivutvecklingen är att andelen belägg för grafonomi är större i årskurs två än i årskurs ett. Härigenom får eleverna på detta sätt småningom växa in i en skriftkultur. Det finns betydligt fler muntliga uppgifter i lärarhandledningarna till serierna Litteraturboken och Kom och läs! än i Läseboken. Det exakta ”hur” står inte alltid utskrivet i lärarhandledningarna, men de flesta gånger verkar tanken vara att det rör sig om diskussioner eller andra muntliga genrer. I många fall känns de muntliga uppgifterna mer funktionella än skriftliga uppgifter som inte verkar vara helt genomtänkta. Att mitt material innehåller fler funktionella uppgifter i lärarhandledningar och fler formalistiska eller delvis funktionella uppgifter i arbetsböcker överensstämmer med att lärarhandledningar kan vara en bättre väg för att öka elevernas kunskapssökande och minska förmedlingspedagogiken.

Perceptions de personnes atteintes de cancer quant au soutien offert par l'IPO dans la période entourant l'annonce du diagnostic

L’annonce d’un diagnostic de cancer devrait être considérée par les professionnels de la santé, comme un processus constitué de plusieurs étapes que doit traverser la personne atteinte, plutôt que comme un évènement en soi (Tobin & Begley, 2008). Lors de la période entourant l’annonce du diagnostic, la personne peut être confrontée à des difficultés reliées à la navigation dans un système de santé complexe, en plus des sentiments négatifs engendrés par la crainte de la maladie. Pour soutenir les personnes atteintes de cancer, le programme québécois de lutte contre le cancer (PQLCC), a instauré le rôle de l’infirmière pivot en oncologie (IPO) en 2000. À l’heure actuelle, peu d’études, à notre connaissance, se sont attardées au soutien de l’IPO dans cette période. La présente étude avait pour but, d’explorer les perceptions de personnes atteintes de cancer quant au soutien offert par l’IPO, dans la période entourant l’annonce du diagnostic. L’étudiante-chercheuse s’est inspirée du Cadre de soins de soutien de Fitch (1994) pour entreprendre cette étude qualitative descriptive. Des entrevues individuelles auprès de sept personnes atteintes de différents cancers ont été réalisées. L’analyse de données a été effectuée à l’aide de la méthode de Miles et Huberman (2003), par la transcription intégrale des entrevues. Elle a permis d’identifier trois thèmes soit : le soutien formel requis pour faire face au chaos, le soutien informationnel et émotionnel à parfaire et le soutien disponible apportant sécurité et assurance. Les résultats ont mis en évidence les perceptions de personnes atteintes de cancer quant au soutien offert par l’IPO soit la nécessité de rendre accessible les soins et services de l’IPO plus tôt dans la période entourant l’annonce du diagnostic. Les personnes atteintes de cancer ont besoin d’être aidées à faire face aux difficultés rencontrées lors de cette période, notamment à l’incertitude reliée aux résultats d’examens diagnostics, à l’incompréhension des informations reçues et aux sentiments négatifs engendrés par la menace de la maladie. Les résultats évoquent le souhait des participants, à l’effet que, l’offre de soutien de l’IPO, soit axée sur leurs besoins essentiellement dans les domaines informationnel et émotionnel. Ils auraient souhaité pouvoir, partager leur expérience avec l’IPO, mieux comprendre le diagnostic de cancer et savoir davantage à quoi s’attendre lors du début des traitements. Par ailleurs, savoir que le soutien de l’IPO est disponible apporte aux personnes atteintes de cancer une assurance et une confiance en leur capacité à faire face aux traitements et leur apporte un sentiment de sécurité.

El impacto del TLC con la Unión Europea en el sector lácteo colombiano

En un mundo globalizado como en el que se vive hoy, se necesitan crear acuerdos comerciales e integraciones económicas que ayuden a la expansión comercial de los países que participan en dichos tratados. Por este motivo es que Colombia durante varias décadas ha buscado relaciones comerciales con diferentes países para facilitar la comercialización de los productos colombianos con el resto del mundo. Al entrar en un acuerdo económico como el Tratado del Libre Comercio se necesita tener productos competitivos, de buena calidad y diferenciados para que puedan mantenerse en un mercado internacional. Este es el caso del sector lácteo colombiano, que se ve amenazado por la firma del TLC con la Unión europea, ya que la Unión Europea es exportador neto de leche, y esto hace que el sector este preocupado el bienestar de pequeños productores, lo que traería como consecuencia un problema en la economía del país. Por este motivo el gobierno ha tomado medidas para proteger este sector y evitar repercusiones que pongan en peligro la estabilidad del sector y que se darán ayudas a este sector para que pueda mejorar sus procesos, renovación tecnológica, mejora de la productividad y demás campos en los que están mal para poder competir con los productores europeos, la ayuda es de 30 millones de euros durante los próximos 5 años; también el gobierno ha puesto restricciones a las cantidades que los países europeos puedan comercializar en Colombia con el fin de garantizar el bienestar de este sector.

Hearing-aid volume control adjustment by deaf children

This paper examines hearing aid volume control adjustments by deaf children. Specifically the study looks at how accurately deaf children set the volume controls of their hearing aids, if deaf children are able to comprehend the effects of talker-microphone distance on stimulus intensity, and do deaf children use their hearing aids to monitor their own voices. Access to thesis is restricted. Contact Archives and Rare Books.

Quantitative analysis of accuracy of an inertial/acoustic 6DOF tracking system in motion

An increasing number of neuroscience experiments are using virtual reality to provide a more immersive and less artificial experimental environment. This is particularly useful to navigation and three-dimensional scene perception experiments. Such experiments require accurate real-time tracking of the observer's head in order to render the virtual scene. Here, we present data on the accuracy of a commonly used six degrees of freedom tracker (Intersense IS900) when it is moved in ways typical of virtual reality applications. We compared the reported location of the tracker with its location computed by an optical tracking method. When the tracker was stationary, the root mean square error in spatial accuracy was 0.64 mm. However, we found that errors increased over ten-fold (up to 17 mm) when the tracker moved at speeds common in virtual reality applications. We demonstrate that the errors we report here are predominantly due to inaccuracies of the IS900 system rather than the optical tracking against which it was compared. (c) 2006 Elsevier B.V. All rights reserved.

Compression of polymer brushes: quantitative comparison of self-consistent field theory with experiment

The self-consistent field theory (SCFT) prediction for the compression force between two semi-dilute polymer brushes is compared to the benchmark experiments of Taunton et al. [Nature, 1988, 332, 712]. The comparison is done with previously established parameters, and without any fitting parameters whatsoever. The SCFT provides a significant quantitative improvement over the classical strong-stretching theory (SST), yielding excellent quantitative agreement with the experiment. Contrary to earlier suggestions, chain fluctuations cannot be ignored for normal experimental conditions. Although the analytical expressions of SST provide invaluable aids to understanding the qualitative behavior of polymeric brushes, the numerical SCFT is necessary in order to provide quantitatively accurate predictions.

Essays in heterogeneous agent macroeconomics

This thesis is comprised of three chapters. The first article studies the determinants of the labor force participation of elderly American males and investigates the factors that may account for the changes in retirement between 1950 and 2000. We develop a life-cycle general equilibrium model with endogenous retirement that embeds Social Security legislation and Medicare. Individuals are ex ante heterogeneous with respect to their preferences for leisure and face uncertainty about labor productivity, health status and out-of-pocket medical expenses. The model is calibrated to the U.S. economy in 2000 and is able to reproduce very closely the retirement behavior of the American population. It reproduces the peaks in the distribution of Social Security applications at ages 62 and 65 and the observed facts that low earners and unhealthy individuals retire earlier. It also matches very closely the increase in retirement from 1950 to 2000. Changes in Social Security policy - which became much more generous - and the introduction of Medicare account for most of the expansion of retirement. In contrast, the isolated impact of the increase in longevity was a delaying of retirement. In the second article, I develop an overlapping generations model of criminal behavior, which extends prior research on crime by taking into account individuals' labor supply decisions and the stigma effect that affects convicted offenders, lowering their likelihood of employment. I use the model to guide a quantitative assessment of the determinants of crime and of a counterfactual experiment in which an income redistribution policy is thought as an alternative to greater law enforcement. The model economy considered in this paper is populated by heterogeneous agents who live for a realistic number of periods, have preferences over consumption and leisure, and differ in terms of their age, their skills as well as their employment shocks. In addition, savings may be precautionary and allow partial insurance against the labor income shocks. Because of the lack of full insurance, this model generates an endogenous distribution of wealth across consumers, enabling us to assess the welfare implications of the redistribution policy experiment. I calibrated the model using the US data for 1980 and then use the model to investigate the changes in criminality between 1980 and 1996. The main results that come out of this study are: 1) Law enforcement policy was the most important factor behind the fall in criminality in the period, while the increase in inequality was the most important single factor promoting crime; 2) Stigmatization is not a free-cost crime control policy; 3) Income redistribution can be a powerful alternative policy to fight crime. Finally, the third article studies the impact of HIV/AIDS on per capita income and education. It explores two channels from HIV/AIDS to income that have not been sufficiently stressed by the literature: the reduction of the incentives to study due to shorter expected longevity and the reduction of productivity of experienced workers. In the model individuals live for three periods, may get infected in the second period and with some probability die of Aids before reaching the third period of their life. Parents care for the welfare of the future generations so that they will maximize lifetime utility of their dynasty. The simulations predict that the most affected countries in Sub-Saharan Africa will be in the future, on average, thirty percent poorer than they would be without AIDS. Schooling will decline in some cases by forty percent. These figures are dramatically reduced with widespread medical treatment, as it increases the survival probability and productivity of infected individuals.

Crianças, jovens e literatura: produto de pesquisa patrocinada pelo INEP-INL/FNLIJ

A impressão que se tem é de que o hábito de leitura está Desaparecendo. O próprio McLuhan, no entanto, afirma que "os valores associados à palavra escrita e impressa devem constituir uma parte permanente da herança humana". Mais importante do que discutir sobre o desaparecimento ou a transformação do livro é investigar o que está ocorrendo, nesta sociedade em mudança, com as novas gerações, em relação à leitura em geral e às obras literárias em especial. O problema pesquisado foi expresso na seguinte pergunta: "Quais os comportamentos apresentados pelos alunos do ensino de 1º. grau do Município do Rio de Janeiro no que se refere à leitura de obras literárias infantis e juvenis"? Para responder à questão, procedeu-se à caracterização: dos alunos quanto à leitura; dos ambientes doméstico e escolar no que se referia a incentivo à leitura; das oportunidades de acesso ao livro oferecidas pelas bibliotecas livrarias. A metodologia adotada foi elaborada especialmente para o estudo e pode ser sujeita a controvérsias. Os alunos demonstraram estar lendo obras literárias infanto-juvenis em quantidade insuficiente, apresentando os quadrinhos o maior índice de consumo. Pareciam encontrar-se em estágios de leitura defasados em relação às etapas de desenvolvimento em que provavelmente se encontravam. Presume-se que sofreram influência poderosa dos meios de comunicação de massa. Os ambientes doméstico e escolar, em maioria, não pareceram oferecer as condições desejáveis de estímulo à leitura. As bibliotecas eram em número demasiado insuficiente para atender à clientela real e potencial existente. Nas livrarias, geralmente, não se notou preocupação maior com o atendimento a crianças e jovens. Constatou-se relacionamento entre a formação de hábitos de leitura/interesse em ler dos alunos e: (a) características do lar e da escola; (b) oportunidades de acesso ao livro. Pareceu identificar-se uma situação de depreciação da literatura escrita a par de crescente penetração dos "mass-media”, supondo-se representar tendência universal, decorrente do atual estágio cultural da humanidade. Apresentam-se sugestões (devidamente operacionalizadas), que representam meios atenuantes das deficiências identificadas e subsídios à política do livro, visando ao desenvolvimento de uma programação integrada de incentivo à leitura infanto-juvenil, a níveis de consumo, produção e difusão de obras.

Ilha dos indivíduos: a construção social da fortaleza moderna

The aim of this work is to analyze the phenomenon of the partner-space segregation in the city of Fortaleza, having as reference the sprouting of recent forms of housing that privilege areas with desert-like aspects, and the removal from the popular accumulations, which is becoming the shelter of the populations economically favored of the capital. Our field study was developed in the land division Alpha Village, a located urban enterprise in the east of the city. Different from the research that deals with the question of segregation as a sui generis product of the partner-economic inequality, we opt to an analysis directed more towards the dimension of the subjectivity, searching the roots of the phenomenon in the proper constitution of the human being. From interviews with the inhabitants of the related land division, we decided to analyze the social imaginary significances (Castoriadis) that composed their speech, and that they defined in this way, its representations concerning themselves, as strangers that cross the streets of the cited space, becoming thus suspected in potential. Inside our perspective, the segregation gains a ambiguous connotation, therefore at the same time that it authorizes the symbolic destruction of the other, it is also a tool that aids to support the "pain of the unreliability"