293 resultados para BILIOPANCREATIC DIVERSION
Resumo:
La recerca es proposa conèixer el temps objectiu que triga el sistema penal juvenil a donar resposta a les conductes presumptament delictives dels joves que hi arriben. L’interès per comptabilitzar i analitzar aquest temps de resposta del sistema penal juvenil es basa en dos motius: el primer és conèixer la incidència que té el temps en l’eficiència del sistema, eficiència que se sol associar al fet que es resolguin els assumptes amb agilitat. El segon motiu té a veure amb l’eficàcia de la pena o de la resposta que l’infractor pugui rebre. Des de l’àmbit penal i criminològic diversos autors, citats en la recerca, assenyalen que una resposta més ràpida fa la pena més eficaç. La recerca ha estudiat 8.059 procediments oberts a Catalunya l’any 2008 a joves infractors i en dona dades de la durada segons algunes variables (referides a les característiques dels joves, als fets delictius, al tipus de resolució, al territori que l’ha gestionat, als casos en els que s’ha fet mediació i reparació de menors, etc.). En els casos que ha estat possible, també s’ha fet una comparació entre l’any d’estudi (2008) i un any de control (2005) per saber quines han estat les diferències. Aquesta és la primera recerca que es publica a Catalunya sobre el total de temps que triga la justícia penal a donar resposta a una infracció presumptament comesa per un menor.
Resumo:
The Spanish judicial system is independent and headed by the Supreme Court. Spain has a civil law system. The criminal procedure is governed by the legality principle--by opposition to the opportunity or expediency principle--which implies that prosecution must take place in all cases in which sufficient evidence exists of guilt. Traditionally, the role of the PPS in Spain has been very limited during the investigative stage of the process. That stage is under the responsibility of the Examining Magistrate (EM). Since the end of the 1980s, a series of modifications has been introduced in order to extend the functions of the PPS. In 1988, the PPS received extended competences which allow them to receive reports of offenses. Upon knowing of an offense (reported or known to have been committed), the PPS can initiate the criminal proceeding. The PPS is also allowed to lead a sort of plea bargain under a series of restrictive conditions and only for some offenses. At the same time, the PPS received extended competences in the juvenile justice criminal proceeding in 2000. With all this said, the role of the PPS has not changed radically and, during the investigative stage of the process, their main role remains the presentation of the accusation, playing a more active role during the trial stage of the proceeding. In this article the national criminal justice system of Spain is described. Special attention is paid to the function of the PPS within this framework and its relationship to police and courts. The article refers to legal provisions and the factual handling of criminal cases.
Resumo:
Este estudio aporta datos sobre el tiempo objetivo que tarda el sistema penal juvenil en dar respuesta a las conductas presuntamente delictivas de los jóvenes que llegan al sistema. El interés por contar y analizar este tiempo de respuesta del sistema penal juvenil se basa en dos justificaciones: la primera es conocer la incidencia que tiene el paso del tiempo en la eficiencia del sistema, eficiencia que se suele asociar al hecho que se resuelvan los casos con rapidez. El segundo motivo tiene que ver con la eficacia de la pena o de la respuesta que el infractor pueda recibir. Desde el ámbito penal y criminológico diversos autores, citados en la investigación, señalan que una respuesta más rápida hace la pena más eficaz. La investigación ha estudiado 8.059 procedimientos abiertos en Catalunya el año 2008 a jóvenes infractores y da datos respecto la duración según algunas variables (referidas a las características de los jóvenes, los hechos delictivos, el tipo de resolución, el territorio que la ha gestionado, los casos en los que se ha realizado una mediación y reparación de menores, etc.). En los casos que ha sido posible, también se ha realizado una comparación entre el año de estudio (2008) y un año de control (2005), para conocer cuales han sido estas diferencias. Es la primera investigación que se publica en Catalunya sobre el total de tiempo que tarda la justicia penal en dar respuesta a una infracción presuntamente cometida por un menor.
Resumo:
BACKGROUND/AIMS: Switzerland's drug policy model has always been unique and progressive, but there is a need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and access to treatment. To obtain a "real-world" view on OMT, the study approached its goals from two different angles: from the perspectives of the OMT patients and of the physicians who treat patients with maintenance therapy. The IMPROVE study collected a large body of data on OMT in Switzerland. This paper presents a small subset of the dataset, focusing on the research design and methodology, the profile of the participants and the responses to several key questions addressed by the questionnaires. METHODS: IMPROVE was an observational, questionnaire-based cross-sectional study on OMT conducted in Switzerland. Respondents consisted of OMT patients and treating physicians from various regions of the country. Data were collected using questionnaires in German and French. Physicians were interviewed by phone with a computer-based questionnaire. Patients self-completed a paper-based questionnaire at the physicians' offices or OMT treatment centres. RESULTS: A total of 200 physicians and 207 patients participated in the study. Liquid methadone and methadone tablets or capsules were the medications most commonly prescribed by physicians (60% and 20% of patient load, respectively) whereas buprenorphine use was less frequent. Patients (88%) and physicians (83%) were generally satisfied with the OMT currently offered. The current political framework and lack of training or information were cited as determining factors that deter physicians from engaging in OMT. About 31% of OMT physicians interviewed were ≥60 years old, indicating an ageing population. Diversion and misuse were considered a significant problem in Switzerland by 45% of the physicians. CONCLUSION: The subset of IMPROVE data presented gives a present-day, real-life overview of the OMT landscape in Switzerland. It represents a valuable resource for policy makers, key opinion leaders and drug addiction researchers and will be a useful basis for improving the current Swiss OMT model.
Resumo:
Although Iowa has some of the most productive agricultural land in the nation, it also maintains a very extensive road network.Consequently, landowners and roadway officials often must deal with drainage issues affecting private lands and public highways. However, many individuals are unfamiliar with legal drainage requirements, practices, and procedures, which can result in misunderstandings concerning maintenance responsibilities for drainage facilities, sometimes leading to litigation. To assist propertyowners, public agencies, and others with interest in better understanding drainage maintenance responsibilities, a reference manual was developed to describe Iowa’s drainage laws and offer interpretations in a clear and concise manner. To develop a comprehensive drainage manual, researchers identified and reviewed current available literature. These resources described pertinent drainage issues and presented explanations of legal responsibilities. The literature review included manuals and guides from Iowa, surrounding states, and federal agencies. Researchers developed a survey to assess the needs and interestsof potential users of an Iowa drainage law manual. Survey responses were used to identify common problems and concerns among individuals who encounter drainage issues on a regular basis. Issues mentioned in the survey responses included interpretation of drainage laws and commonly encountered questions relating to public improvements and private interests. Many individuals, including county engineers, stated interest in specific topics such as maintenance and/or diversion of drainage, landowner issues, and upstream and downstream impacts. Overall, the survey provided researchers with valuable information regarding drainage issues, problems, current policies, and concerns. A comprehensive manual of Iowa drainage law will assist agencies and individuals in interpreting current code requirements and in implementing effective and beneficial solutions when dealing with drainage issues.
Reorganization of a deeply incised drainage: role of deformation, sedimentation and groundwater flow
Resumo:
Deeply incised drainage networks are thought to be robust and not easily modified, and are commonly used as passive markers of horizontal strain. Yet, reorganizations (rearrangements) appear in the geologic record. We provide field evidence of the reorganization of a Miocene drainage network in response to strike-slip and vertical displacements in Guatemala. The drainage was deeply incised into a 50-km-wide orogen located along the North America-Caribbean plate boundary. It rearranged twice, first during the Late Miocene in response to transpressional uplift along the Polochic fault, and again in the Quaternary in response to transtensional uplift along secondary faults. The pattern of reorganization resembles that produced by the tectonic defeat of rivers that cross growing tectonic structures. Compilation of remote sensing data, field mapping, sediment provenance study, grain-size analysis and Ar(40)/Ar(39) dating from paleovalleys and their fill reveals that the classic mechanisms of river diversion, such as river avulsion over bedrock, or capture driven by surface runoff, are not sufficient to produce the observed diversions. The sites of diversion coincide spatially with limestone belts and reactivated fault zones, suggesting that solution-triggered or deformation-triggered permeability have helped breaching of interfluves. The diversions are also related temporally and spatially to the accumulation of sediment fills in the valleys, upstream of the rising structures. We infer that the breaching of the interfluves was achieved by headward erosion along tributaries fed by groundwater flow tracking from the valleys soon to be captured. Fault zones and limestone belts provided the pathways, and the aquifers occupying the valley fills provided the head pressure that enhanced groundwater circulation. The defeat of rivers crossing the rising structures results essentially from the tectonically enhanced activation of groundwater flow between catchments.
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Roux-en-Y gastric bypass (RYGBP) is currently the most common bariatric procedure. One of its late complications is the development of internal hernia, which can lead to acute intestinal obstruction or recurrent colicky abdominal pain. The aim of this paper is to present a new, unusual, and so far not reported type of internal hernia. A common computerized database is maintained for all patients undergoing bariatric surgery in our departments. The charts of patients with the diagnosis of internal hernia were reviewed. Three patients were identified who developed acute intestinal obstruction due to an internal hernia located between the jejunojejunostomy and the end of the biliopancreatic limb, directly between two jejunal limbs with no mesentery involved. Another seven patients with intermittent colicky abdominal pain, re-explored for the suspicion of internal hernia, were found to also have an open window of the same location apart from a hernia at one of the typical hernia sites. Since this gap is systematically closed during RYGBP, no other patient has been observed with this problem. Even very small defects can lead to the development of internal hernias after RYGBP. Patients with suggestive symptoms must be explored. Closure of the jejunojejunal defect with nonabsorbable sutures prevents the development of an internal hernia between the jejunal loops at the jejunojejunostomy.
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We report the 32nd case of congenital absence of portal vein in an 18-year-old female adult associated with multiple focal nodular hyperplasia of the liver. The association of various hepatic tumors has been observed in half of the publications about congenital absence of portal vein. Hepatic tumors seem to result from systemic diversion of portal vein flow with a resultant increase of arterial flow causing important vascular and nutritif changes the liver and consequent parenchymal transformation.
Resumo:
Pancreaticoduodenectomy is a major procedure in visceral surgery. Post-operative mortality is around 5% in high-volume hospitals, thanks to improvement in global patients care. Morbidity remains high though. The treatment of complications most often require a multidisciplinary approach. Delayed gastric emptying, intraabdominal abscesses and pancreatic fistulas are the most frequent complications. Post-pancreatectomy hemorrhage, although more rare, is a severe and dreadful event. Despite its morbidity, duodenopancreatectomy significantly improves survival of patients with biliopancreatic cancer. Early recognition of these complications and a prompt treatment increase the safety of this procedure.
Resumo:
The focus of this report is a capacity analysis of two long-term urban freeway Work Zones. Work Zone #1 tapered four mainline lanes to two, using two separate tapers; Work Zone #2 tapered two mainline lanes to one. Work Zone throughput was analyzed throughout the day over multiple days and traffic operations conditions were analyzed up to a distance of five miles upstream of the Work Zone entrance. Historical data from pavement-embedded detectors were used to analyze traffic conditions. The database consisted of five-minute volume, speed and occupancy data collected from 78 detectors for a total of 50 days. Congestion during each analyzed Work Zone existed for more than fourteen hours each day; Work Zone impacts adversely affected freeway operations over distances of 3.7 to 4.2 miles. Speed and occupancy conditions further upstream were, however, not affected, or even improved due to significant trip diversion. Work Zone capacity was defined based on the maximum traffic flows observed over a one-hour period; throughput values were also compiled over longer periods of time when traffic was within 90% of the maximum observed one-hour flows, as well as over the multi-hour mid-day period. The Highway Capacity Manual freeway capacity definition based on the maximum observed 15-min period was not used, since it would have no practical application in estimating Work Zone throughput when congested conditions prevail for the majority of the hours of the day. Certain noteworthy changes took place for the duration of the analyzed Work Zones: per-lane throughput dropped; morning peak periods started earlier, evening peak periods ended later and lasted longer; mid-day volumes dropped accompanied by the highest occupancies of the day. Trip diversion was evident in lower volumes entering the analyzed freeway corridor, higher volumes using off-ramps and lower volumes using onramps upstream of the Work Zones. The majority of diverted traffic comprised smaller vehicles (vehicles up to 21 feet in length); combination truck volumes increased and their use of the median lane increased, contrary to smaller vehicles that shifted toward a heavier use of the shoulder lane.
Resumo:
In the last decade, Intelligent Transportation Systems (ITS) have increasingly been deployed in work zones by state departments of transportation. Also known as smart work zone systems they improve traffic operations and safety by providing real-time information to travelers, monitoring traffic conditions, and managing incidents. Although there have been numerous ITS deployments in work zones, a framework for evaluating the effectiveness of these deployments does not exist. To justify the continued development and implementation of smart work zone systems, this study developed a framework to determine ITS effectiveness for specific work zone projects. The framework recommends using one or more of five performance measures: diversion rate, delay time, queue length, crash frequency, and speed. The monetary benefits and costs of ITS deployment in a work zone can then be computed using the performance measure values. Such ITS computations include additional considerations that are typically not present in standard benefit-cost computations. The proposed framework will allow for consistency in performance measures across different ITS studies thus allowing for comparisons across studies or for meta analysis. In addition, guidance on the circumstances under which ITS deployment is recommended for a work zone is provided. The framework was illustrated using two case studies: one urban work zone on I-70 and one rural work zone on I-44, in Missouri. The goals of the two ITS deployments were different – the I-70 ITS deployment was targeted at improving mobility whereas the I-44 deployment was targeted at improving safety. For the I-70 site, only permanent ITS equipment that was already in place was used for the project and no temporary ITS equipment was deployed. The permanent DMS equipment serves multiple purposes, and it is arguable whether that cost should be attributed to the work zone project. The data collection effort for the I-70 site was very significant as portable surveillance captured the actual diversion flows to alternative routes. The benefit-cost ratio for the I-70 site was 2.1 to 1 if adjusted equipment costs were included and 6.9 to 1 without equipment costs. The safety-focused I-44 ITS deployment had an estimated benefit-cost ratio of 3.2 to 1.
Resumo:
Wounding plant tissues initiates large-scale changes in transcription coupled to growth arrest, allowing resource diversion for defense. These processes are mediated in large part by the potent lipid regulator jasmonic acid (JA). Genes selected from a list of wound-inducible transcripts regulated by the jasmonate pathway were overexpressed in Arabidopsis thaliana, and the transgenic plants were then assayed for sensitivity to methyl jasmonate (MeJA). When grown in the presence of MeJA, the roots of plants overexpressing a gene of unknown function were longer than those of wild-type plants. When transcript levels for this gene, which we named JASMONATE-ASSOCIATED1 (JAS1), were reduced by RNA interference, the plants showed increased sensitivity to MeJA and growth was inhibited. These gain- and loss-of-function assays suggest that this gene acts as a repressor of JA-inhibited growth. An alternative transcript from the gene encoding a second protein isoform with a longer C terminus failed to repress jasmonate sensitivity. This identified a conserved C-terminal sequence in JAS1 and related genes, all of which also contain Zim motifs and many of which are jasmonate-regulated. Both forms of JAS1 were found to localize to the nucleus in transient expression assays. Physiological tests of growth responses after wounding were consistent with the fact that JAS1 is a repressor of JA-regulated growth retardation.
Resumo:
A statewide study was performed to develop regional regression equations for estimating selected annual exceedance- probability statistics for ungaged stream sites in Iowa. The study area comprises streamgages located within Iowa and 50 miles beyond the State’s borders. Annual exceedanceprobability estimates were computed for 518 streamgages by using the expected moments algorithm to fit a Pearson Type III distribution to the logarithms of annual peak discharges for each streamgage using annual peak-discharge data through 2010. The estimation of the selected statistics included a Bayesian weighted least-squares/generalized least-squares regression analysis to update regional skew coefficients for the 518 streamgages. Low-outlier and historic information were incorporated into the annual exceedance-probability analyses, and a generalized Grubbs-Beck test was used to detect multiple potentially influential low flows. Also, geographic information system software was used to measure 59 selected basin characteristics for each streamgage. Regional regression analysis, using generalized leastsquares regression, was used to develop a set of equations for each flood region in Iowa for estimating discharges for ungaged stream sites with 50-, 20-, 10-, 4-, 2-, 1-, 0.5-, and 0.2-percent annual exceedance probabilities, which are equivalent to annual flood-frequency recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years, respectively. A total of 394 streamgages were included in the development of regional regression equations for three flood regions (regions 1, 2, and 3) that were defined for Iowa based on landform regions and soil regions. Average standard errors of prediction range from 31.8 to 45.2 percent for flood region 1, 19.4 to 46.8 percent for flood region 2, and 26.5 to 43.1 percent for flood region 3. The pseudo coefficients of determination for the generalized leastsquares equations range from 90.8 to 96.2 percent for flood region 1, 91.5 to 97.9 percent for flood region 2, and 92.4 to 96.0 percent for flood region 3. The regression equations are applicable only to stream sites in Iowa with flows not significantly affected by regulation, diversion, channelization, backwater, or urbanization and with basin characteristics within the range of those used to develop the equations. These regression equations will be implemented within the U.S. Geological Survey StreamStats Web-based geographic information system tool. StreamStats allows users to click on any ungaged site on a river and compute estimates of the eight selected statistics; in addition, 90-percent prediction intervals and the measured basin characteristics for the ungaged sites also are provided by the Web-based tool. StreamStats also allows users to click on any streamgage in Iowa and estimates computed for these eight selected statistics are provided for the streamgage.
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On July 1, 2005, the State of Iowa implemented a 70 mile per hour (mph) speed limit on most rural Interstates. This document reports on a study of the safety effect of this change. Changes in speeds, traffic volume on and off the rural Interstate system (diversion), and safety (crashes) for on- and off-system roads were studied. After the change, mean and 85th percentile speeds increased by about 2 mph on rural Interstates, but speeding was reduced (the number of drivers exceeding the speed limit by 10 mph decreased from 20 per cent to about 8 per cent). Daytime and nighttime serious crashes were studied for a period of 14 and a half years prior to the change and 2 and a half years afterwards. Simple descriptive statistics reveal increases in all crash severity categories for the 2 and a half year period following the speed limit increase when compared to the most recent comparable 2 and a half year period prior to the increase. When compared to longer term trends, the increases were less pronounced in some severity levels and types, and for a few severity levels the average crash frequencies were observed to decrease. However, fatal and other serious cross-median crashes increased by relatively larger amounts as compared to expected random variation. The study also analyzed crash frequencies grouped into six-month periods, revealing similar findings.
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The Iowa Prescription Monitoring Program (PMP) provides authorized prescribers and pharmacists with information regarding their patients’ use of controlled substances and is used as a tool in determining appropriate prescribing and treatment of patients without fear of contributing to a patient’s abuse of or dependence on addictive drugs or diversion of those drugs to illicit use. Iowa pharmacies are required to report to the Iowa PMP all Schedule II, III, and IV controlled substances dispensed by the pharmacy to ambulatory patients.