Soins palliatifs et soins de support: à la frontière de la toute-puissance médicale [Palliative and supportive care: at the frontiers of medical omnipotence].

Cancer patients have physical, social, spiritual and emotional needs. They may suffer from severe physical symptoms, from social isolation, spiritual abandonment, and emotions such as sadness and anxiety, or feelings of deception, helplessness, anger and guilt. In some of them, the disease is rapidly progressing and ultimately they die. Their demanding care evokes intense feelings in health care providers, the more since these incurable patients represent a challenge, which could be condensed under the heading "the challenge of medical omnipotence". We suppose that the way health care providers cope with these circumstances has a profound influence on the way these patients are cared for. The attitudes towards the emerging heterogeneous movement of palliative and supportive care and towards its different models of implementation can be viewed from this point of view. We try to demonstrate these interrelations and to discuss the danger that may arise if they remain obscure and unreflected.

On optimal learning schedules and the marginal value of cumulative cultural evolution.

The age-dependent choice between expressing individual learning (IL) or social learning (SL) affects cumulative cultural evolution. A learning schedule in which SL precedes IL is supportive of cumulative culture because the amount of nongenetically encoded adaptive information acquired by previous generations can be absorbed by an individual and augmented. Devoting time and energy to learning, however, reduces the resources available for other life-history components. Learning schedules and life history thus coevolve. Here, we analyze a model where individuals may have up to three distinct life stages: "infants" using IL or oblique SL, "juveniles" implementing IL or horizontal SL, and adults obtaining material resources with learned information. We study the dynamic allocation of IL and SL within life stages and how this coevolves with the length of the learning stages. Although no learning may be evolutionary stable, we find conditions where cumulative cultural evolution can be selected for. In that case, the evolutionary stable learning schedule causes individuals to use oblique SL during infancy and a mixture between IL and horizontal SL when juvenile. We also find that the selected pattern of oblique SL increases the amount of information in the population, but horizontal SL does not do so.

Didactique de la géographie et formation initiale des enseignants spécialistes : conception et première évaluation du nouveau dispositif de formation initiale des enseignants de géographie du Secondaire supérieur à la HEP Vaud

Geography as a school subject is specifically thought for and by the schools. The contents of the school subject, nowadays, do not reflect the concerns and the evolution of the discipline as such. Nevertheless, official curricula set school objectives that address issues affecting the world and people's lives. These issues are coherent with the ones addressed by geography as a social science, that is to say the study of how people and their environment interact and how societies are interconnected through space. On an every day basis, Geography as a school subject is most of the time reduced to accumulating knowledge outside any given context. This knowledge may even be partially untrue or old and the related activities focus on low cognitive tensions. These practices do not contribute to the learners' understanding of the world because it does not allow them to build a geographical competence, which they. will need as future citizens in order to make responsible choices when they are confronted to questions related to how the locations of human and physical features are influenced by each other and how they interact across space. The central part of the text relies on the ideas and the processes discussed in the publications, which constitute the published file; it is divided into two parts. The first part (chapter 4) presents a didactic approach, which gives meaningful insights into Geography as a school subject and shows a brief account of the theoretical background that supports it. This socio-constructivist approach relies on the main following features: a priming stage (élément déclencheur), which presents geographical knowledge as an issue to be explored, discussed or solved; the issue is given to learners;. the planning of the teaching-learning sequence in small units launched by the main issue in the priming stage ; the interconnections of geographical knowledge with integrative concepts ; the synthetic stage or reporting stage where final concepts and knowledge are put together in order to be learned. Such an approach allows learners to re-invest the knowledge they have built themselves. This knowledge is organised by geographical integrative concepts, which represent true thinking operative tools and with which key issues in the geographical thinking are associated. The second part of the text (chapter 5) displays the didactic principles that governed the conception of the new initial training course for the future upper secondary school teachers at the HEP Vaud. The ambition of this course is to prepare future teachers to plan and realize the teaching of geography that provides pupils with the tools to understand better how people and their environment interact and how societies are interconnected through space. One of the tools for the teachers is the conceptual framework, whose most salient interest is to be relevant at every stage of the preparation and planning of the teaching, including the necessary epistemological reflection that should always be present. The synthesis of the text starts with a short account of the first evaluation of the new course. Various reflections on the future concerns and issues, that the didactics and methodology of Geography will be confronted with, constitute the synthesis.

Learning spatial filters for multispectral image segmentation

We present a novel filtering method for multispectral satellite image classification. The proposed method learns a set of spatial filters that maximize class separability of binary support vector machine (SVM) through a gradient descent approach. Regularization issues are discussed in detail and a Frobenius-norm regularization is proposed to efficiently exclude uninformative filters coefficients. Experiments carried out on multiclass one-against-all classification and target detection show the capabilities of the learned spatial filters.

Argumentation and education. Theoretical foundations and practices

During the last decade, argumentation has attracted growing attention as a means to elicit processes (linguistic, logical, dialogical, psychological, etc.) that can sustain or provoke reasoning and learning. Constituting an important dimension of daily life and of professional activities, argumentation plays a special role in democracies and is at the heart of philosophical reasoning and scientific inquiry. Argumentation, as such, requires specific intellectual and social skills. Hence, argumentation will have an increasing importance in education, both because it is a critical competence that has to be learned, and because argumentation can be used to foster learning in philosophy, history, sciences and in many other domains. Argumentation and Education answers these and other questions by providing both theoretical backgrounds, in psychology, education and theory of argumentation, and concrete examples of experiments and results in school contexts in a range of domains. It reports on existing innovative practices in education settings at various levels.

The SLC2 family of facilitated hexose and polyol transporters.

The SLC2 family of glucose and polyol transporters comprises 13 members, the glucose transporters (GLUT) 1-12 and the H(+)- myo-inositol cotransporter (HMIT). These proteins all contain 12 transmembrane domains with both the amino and carboxy-terminal ends located on the cytoplasmic side of the plasma membrane and a N-linked oligosaccharide side-chain located either on the first or fifth extracellular loop. Based on sequence comparison, the GLUT isoforms can be grouped into three classes: class I comprises GLUT1-4; class II, GLUT6, 8, 10, and 12 and class III, GLUT5, 7, 9, 11 and HMIT. Despite their sequence similarity and the presence of class-specific signature sequences, these transporters carry various hexoses and HMIT is a H(+)/ myo-inositol co-transporter. Furthermore, the substrate transported by some isoforms has not yet been identified. Tissue- and cell-specific expression of the well-characterized GLUT isoforms underlies their specific role in the control of whole-body glucose homeostasis. Numerous studies with transgenic or knockout mice indeed support an important role for these transporters in the control of glucose utilization, glucose storage and glucose sensing. Much remains to be learned about the transport functions of the recently discovered isoforms (GLUT6-13 and HMIT) and their physiological role in the metabolism of glucose, myo-inositol and perhaps other substrates.

Après votre arrêt cardiaque, vous prendrez bien un peu d'élixir de (sur)vie [After your heart arrest, would you like to test a medicinal elixir?].

So far, cardiac arrest is still associated with high mortality or severe neurological disability in survivors. At the tissue level, cardiac arrest results into an acute condition of generalized hypoxia. A better understanding of the pathophysiology of ischemia-reperfusion and of the inflammatory response that develops after cardiac arrest could help to design novel therapeutic strategies in the future. It seems unlikely that a single drug, acting as a <magic bullet>, might be able to improve survival or neurological prognosis. Lessons learned from pathophysiological mechanisms rather indicate that combined therapies, involving thrombolysis, neuroprotective agents, antioxidants and anti-inflammatory molecules, together with temperature cooling, might represent helpful strategies to improve patient's outcome after cardiac arrest.

Swiss DVI at the tsunami disaster: expect the unexpected.

The conclusions reached while considering various aspects of the implemented strategy in the identification procedures in the wake of the tsunami disaster of December 26, 2004 are outlined. The lessons to be learned are discussed.

Biosafety of Recombinant Adeno-associated Virus Vectors.

It is hoped that the use of gene transfer technology to treat both monogenetic and acquired diseases may soon become a common therapy option in medicine. For gene therapy to achieve this objective, any gene delivery method will have to meet several criteria, including ease of manufacturing, efficient gene transfer to target tissue, long-term gene expression to alleviate the disease, and most importantly safety in patients. Viral vectors are an attractive choice for use in gene therapy protocols due to their relative efficiency in gene delivery. Since there is inherent risk in using viruses, investigators in the gene therapy community have devoted extensive efforts toward reengineering viral vectors for enhance safety. Here we review the approaches and technologies that are being evaluated for the use of recombinant vectors based upon adeno-associated virus (AAV) in the treatment of a variety of human diseases. AAV is currently the only known human DNA virus that is non-pathogenic and AAV-based vectors are classified as Risk Group 1 agents for all laboratory and animal studies carried out in the US. Although its apparent safety in natural infection and animals appears well documented, we examine the accumulated knowledge on the biology and vectorology of AAV, lessons learned from gene therapy clinical trials, and how this information is impacting current vector design and manufacturing with an overall emphasis on biosafety.

Workshop: Capacity building for national public health advocacy: case studies from national associations

The first statement of the EUPHA on the Future of Public Health in Europe refers to the need for going 'to policymakers, politicians and practitioners in all sectors of society and advise them on how to promote public health throughout society'. WHO-EURO Director General Marc Danzon, quoted in the second EUPHA statement on the responsibility of policy makers indicates that 'learning is not systematically applied in health policy development in our continent'. Statement 3 calls for the integration of public health into the political agenda in all sectors. The first EUPHA president, Louise Gunning-Schepers, quoted in Statement 10 called on EUPHA to become 'a powerful advocate of the public health community'. In addition to the above, the EU is now actively seeking ways to build capacity to implement its health strategy. Learning and building the capacity to achieve our aims The aims and objectives to promote the public's health as reflected in EUPHA's 10 statements are also mirrored in the national public health associations. However, many of EUPHA's national associations have little or limited experience in promoting public health policy at the national level. To assist in the learning of advocacy for public health policies, case studies presenting experiences of national public health organizations in lobbying for national public health policy will be presented and discussed. In addition to sharing experiences, the presentations will identify successful approaches to public health advocacy as well as lessons learned from unsuccessful attempts.

The forensic radiographer: a new member in the medicolegal team.

Multidetector computed tomography is becoming more widespread in forensic medicine. In most services, autopsy assistants perform the radiological examination. We introduced professional radiographers into the legal medicine service and hypothesized they would also be able to take over duties currently reserved for other specialists. The aims of this study were to evaluate if radiographers could be trained as "forensic radiographers" by (1) integrating graduated medical radiographers into the legal medicine service, (2) investigating the advantages of this collaboration, and (3) defining the duties of the forensic radiographers.The study was performed prospectively on a group of 8 recruited radiographers who underwent a testing period with special training. They learned the basics of medicolegal case treatment, the autonomous execution of postmortem computed tomography angiography, and postprocessing of data. Seven of 8 radiographers finished the training and were integrated into our service. Although all radiographers were able to fulfill the duties demanded after the training period, some radiographers could not enter or complete the program because they were unable to work with dead bodies.Our study presents the advantages of integrating radiographers into the medicolegal team and proposes how to train the forensic radiographers. In addition, the duties and responsibilities of these new specialists are defined.

Plasticity of lifespan: a reaction norm perspective.

It is a well-appreciated fact that in many organisms the process of ageing reacts highly plastically, so that lifespan increases or decreases when the environment changes. The perhaps best-known example of such lifespan plasticity is dietary restriction (DR), a phenomenon whereby reduced food intake without malnutrition extends lifespan (typically at the expense of reduced fecundity) and which has been documented in numerous species, from invertebrates to mammals. For the evolutionary biologist, DR and other cases of lifespan plasticity are examples of a more general phenomenon called phenotypic plasticity, the ability of a single genotype to produce different phenotypes (e.g. lifespan) in response to changes in the environment (e.g. changes in diet). To analyse phenotypic plasticity, evolutionary biologists (and epidemiologists) often use a conceptual and statistical framework based on reaction norms (genotype-specific response curves) and genotype × environment interactions (G × E; differences in the plastic response among genotypes), concepts that biologists who are working on molecular aspects of ageing are usually not familiar with. Here I briefly discuss what has been learned about lifespan plasticity or, more generally, about plasticity of somatic maintenance and survival ability. In particular, I argue that adopting the conceptual framework of reaction norms and G × E interactions, as used by evolutionary biologists, is crucially important for our understanding of the mechanisms underlying DR and other forms of lifespan or survival plasticity.

Palliative and supportive care: at the frontier of medical omnipotence.

Cancer patients have physical, social, spiritual an emotional needs. They may suffer from severe physical symptoms, from social isolation and a sense of spiritual abandonment, and emotions such as sadness and anxiety, or feeling of deception, helplessness, anger and guilt. In some of them, the disease is rapidly progressive and they ultimately die. Their demanding care evokes intense feelings in health care providers, the more so since these incurable patients represent a challenge, which can be characterized as one of 'medical omnipotence'. It may be assumed that the way health care providers cope with these circumstances profoundly influences the way these patients are cared for. Attitudes regarding the emerging heterogeneous movement of palliative and supportive care and its different models of implementation can be viewed form this vantage point. Here we look at these interrelations and discuss the potential pitfalls if they are ignored and remain unexamined.

The immune space: a concept and template for rationalizing vaccine development.

Abstract Empirical testing of candidate vaccines has led to the successful development of a number of lifesaving vaccines. The advent of new tools to manipulate antigens and new methods and vectors for vaccine delivery has led to a veritable explosion of potential vaccine designs. As a result, selection of candidate vaccines suitable for large-scale efficacy testing has become more challenging. This is especially true for diseases such as dengue, HIV, and tuberculosis where there is no validated animal model or correlate of immune protection. Establishing guidelines for the selection of vaccine candidates for advanced testing has become a necessity. A number of factors could be considered in making these decisions, including, for example, safety in animal and human studies, immune profile, protection in animal studies, production processes with product quality and stability, availability of resources, and estimated cost of goods. The "immune space template" proposed here provides a standardized approach by which the quality, level, and durability of immune responses elicited in early human trials by a candidate vaccine can be described. The immune response profile will demonstrate if and how the candidate is unique relative to other candidates, especially those that have preceded it into efficacy testing and, thus, what new information concerning potential immune correlates could be learned from an efficacy trial. A thorough characterization of immune responses should also provide insight into a developer's rationale for the vaccine's proposed mechanism of action. HIV vaccine researchers plan to include this general approach in up-selecting candidates for the next large efficacy trial. This "immune space" approach may also be applicable to other vaccine development endeavors where correlates of vaccine-induced immune protection remain unknown.

Structural brain plasticity in Parkinson's disease induced by balance training.

We investigated morphometric brain changes in patients with Parkinson's disease (PD) that are associated with balance training. A total of 20 patients and 16 healthy matched controls learned a balance task over a period of 6 weeks. Balance testing and structural magnetic resonance imaging were performed before and after 2, 4, and 6 training weeks. Balance performance was re-evaluated after ∼20 months. Balance training resulted in performance improvements in both groups. Voxel-based morphometry revealed learning-dependent gray matter changes in the left hippocampus in healthy controls. In PD patients, performance improvements were correlated with gray matter changes in the right anterior precuneus, left inferior parietal cortex, left ventral premotor cortex, bilateral anterior cingulate cortex, and left middle temporal gyrus. Furthermore, a TIME × GROUP interaction analysis revealed time-dependent gray matter changes in the right cerebellum. Our results highlight training-induced balance improvements in PD patients that may be associated with specific patterns of structural brain plasticity. In summary, we provide novel evidence for the capacity of the human brain to undergo learning-related structural plasticity even in a pathophysiological disease state such as in PD.