Migrated foreign body liver abscess: illustrative case report, systematic review, and proposed diagnostic algorithm.

Pyogenic liver abscess is a severe condition and a therapeutic challenge. Treatment failure may be due to an unrecognized ingested foreign body that migrated from the gastrointestinal tract. There has recently been a marked increase in the number of reported cases of this condition, but initial misdiagnosis as cryptogenic liver abscess still occurs in the majority of cases. We conducted the current study to characterize this entity and provide a diagnostic strategy applicable worldwide. To this end, data were collected from our case and from a systematic review that identified 59 well-described cases. Another systematic review identified series of cryptogenic-and Asian Klebsiella-liver abscess; these data were pooled and compared with the data from the cases of migrated foreign body liver abscess. The review points out the low diagnostic accuracy of history taking, modern imaging, and even surgical exploration. A fistula found through imaging procedures or endoscopy warrants surgical exploration. Findings suggestive of foreign body migration are symptoms of gastrointestinal perforation, computed tomography demonstration of a thickened gastrointestinal wall in continuity with the abscess, and adhesions seen during surgery. Treatment failure, left lobe location, unique location (that is, only 1 abscess location within the liver), and absence of underlying conditions also point to the diagnosis, as shown by comparison with the cryptogenic liver abscess series. This study demonstrates that migrated foreign body liver abscess is a specific entity, increasingly reported. It usually is not cured when unrecognized, and diagnosis is mainly delayed. This study provides what we consider the best available evidence for timely diagnosis with worldwide applicability. Increased awareness is required to treat this underestimated condition effectively, and further studies are needed.

Urban Governance und nachhaltige Quartiere: Ein Beitrag zur Förderung einer dauerhaft nachhaltigen Stadtentwicklung

Seit den 1990er Jahren werden zunehmend nachhaltige Quartiere realisiert. Dabei besteht häufig eine beachtliche Diskrepanz zwischen den Zielen, die von den beteiligten Akteuren angestrebt werden, deren Umsetzung (Realisierungsphase) und deren Erhalt auf Dauer (Nutzungsphase). Es stellt sich folglich die Frage, auf welche Weise die Projektqualität im Sinne einer nachhaltigen Quartiersentwicklung verbessert werden kann. Diese Projekte sind jedoch enorm komplex aufgrund der großen Interdisziplinarität und Interdependenz ihrer Ziele sowie der vielschichtigen Akteursstrukturen. Sie stellen daher be-sonders hohe Anforderungen an die Projektsteuerung. Das konkrete Ziel dieser Arbeit besteht darin, die Bedeutung einer Prozesssteuerung im Sinne von Urban Governance zur Realisierung und zum Erhalt nachhaltiger Quartiere zu untersuchen. Damit soll einen Beitrag zur Förderung einer nachhalti-gen Stadtentwicklung geleistet werden. Die Arbeit stützt sich auf ein umfassendes theoretisches Fundament zum Thema Governance, wobei die relevanten Elemente für den Kontext nachhaltiger Quartiere herausgearbeitet werden. Die Hypothesen prüfen die Bedeutung der Schlüsselcharakteristika von Urban Governance (Kooperation, Partizipation, Verhandlungen) für die Projektqualität während der Realisierungs- und Nutzungsphase. Eine erste empirische Untersuchung wurde an zwanzig europäischen nachhaltigen Modellquartieren vorgenommen. Stärken und Schwächen aus der Perspektive der Nachhaltigkeit werden analysiert, deren Ursachen identifiziert und Handlungsoptio-nen aufgezeigt. Die Erkenntnisse zeigen die Notwendigkeit einer Verbesserung der Projektsteuerung während der Realisierungs- und der Nutzungsphase. Auf der Grundlage dieser Erkenntnisse wird ein umfassender Ansatz zur empirischen Untersuchung von Urban Governance im Kontext nachhaltiger Quartiere entwickelt. Dieser beruht auf dem akteurzentrierten Institutionalismus und den Merkmalen der Urban Governance. Anhand dieses Ansatzes wird mithilfe von Experteninterviews der Realisierungsprozess des nach-haltigen Quartiers Kronsberg (Hannover) analysiert. Betrachtet werden dabei die beteiligten Akteure und ihre Handlungso-rientierungen, die verwendeten Schlüsselinstrumente sowie aufgetretene Divergenzen zwischen Akteuren und deren Auswirkungen auf die Projekt- und Prozessqualität. Eine Vertiefung relevanter Themenfelder wird anhand der Fallstudie Neu-Oerlikon (Zürich) vorgenommen. Diese empirische Arbeit zeigt, dass eine Prozesssteuerung im Sinne von Urban Governance im Vergleich zu einer klassis-chen hierarchischen Steuerung eine notwendige aber nicht hinreichende Bedingung zur Verbesserung der Projektqualität nachhaltiger Quartiere darstellt. An konkreten Beispielen wird herausgearbeitet, dass der Mehrwert einer solchen Steuerung nur unter bestimmten Voraussetzungen erzielt werden kann: In manchen Situationen ist die Steuerungsform Kooperation und die Interaktionsform Verhandlung in ihrer Wirksamkeit zur Sicherung der Projektqualität begrenzt und hierarchische Interventionen sind notwendig. Nicht ein bestimmtes Steuerungsmodell per se ist geeignet, sondern es kommt auf den Ein-zelfall an: auf die Akteursstruktur, die individuellen und institutionellen Handlungsorientierungen der Akteure und deren Ver-haltensweisen, die Rahmenbedingungen und die Ausgestaltung des Urban Governance-Prozesses. Wenn die Spielregeln dieses Prozesses von den Akteuren nicht wirklich angenommen und gelebt werden, dominieren individuelle und institutio-nelle Akteursinteressen zu Lasten der Projektqualität. Ferner zeigen die Untersuchungen, dass die Partizipation der zukünftigen Quartiersnutzer in der Praxis häufig unzureichend ist. Dies führt zu Einbußen in der Projektqualität. Entscheidend ist auf jeden Fall, dass mindestens ein Akteur, in der Regel die öffentliche Hand, präsent ist, der die Definition anspruchsvoller Nachhaltigkeitsstandards, deren Umsetzung und deren Erhalt sichert sowie die notwendigen Rahmenbedingungen dafür schafft. Diese Arbeit belegt darüber hinaus, dass der Erhalt der Projektqualität während der Nutzungsphase (Faktor Zeit) bisher un-zureichend beachtet und in die Projektplanung einbezogen wird. Gerade dieser Aspekt bestimmt aber, ob das Quartier auch auf Dauer dem Nachhaltigkeitsanspruch gerecht werden kann! Tatsächlich handelt es sich um einen fortlaufenden Prozess, der nicht mit der Einweihung des Quartiers abgeschlossen ist. Vor diesem Hintergrund werden relevante Handlungsfelder beschrieben und die Notwendigkeit der langfristigen Fortsetzung einer Steuerung im Sinne von Urban Governance bzw. der Herausbildung einer Urban Governance-Kultur aufgezeigt. Aus den empirischen Erhebungen werden Erfolgs- und Risikofaktoren für Urban Governance-Prozesse während der Realisierungs- und der Nutzungsphase abgeleitet. Ferner werden bisher vernachlässigte Handlungsfelder (langfristiges Umwelt-management, ökologische Finanzierungsformen, urbane Landwirtschaft, Umweltkommunikation, etc.) eruiert. Die Berücksichtigung dieser Erkenntnisse ist unerlässlich für eine Verbesserung der Projektqualität nachhaltiger Quartiere. ---------------------------------------------- Gouvernance urbaine et quartiers durables: Entre intensions et mise en oeuvre --- Résumé --- Depuis les années 90, la thématique des quartiers durables a gagné en importance, même si leur développement s'est avéré difficile. Le décalage entre les objectifs, leur mise en oeuvre et le projet tel qu'il est vécu par ses habitants est souvent important et nécessite d'être réduit. Un quartier durable est par nature un projet complexe, aux objectifs ambitieux situé à la croisée de multiples champs disciplinaires, mobilisant de nombreux acteurs aux intérêts divergents. De plus, chaque projet, du fait des ses spécificités, requiert un pilotage adapté. L'objectif principal de la recherche vise à analyser la nature du pilotage du processus de conception, de réalisation et d'exploitation des quartiers durables. Ses résultats ont pour ambition de contribuer à optimiser et promouvoir le développement urbain durable. Le fondement théorique de la recherche se base sur le concept de gouvernance urbaine, adapté au contexte particulier de la gouvernance des quartiers durables. La gouvernance urbaine, au sens où nous l'entendons, est un mode de pilotage basé sur la coopération entre les acteurs publics et privés. Les hypothèses centrales du travail testent la portée et les limites des caractéristiques-clefs de la gouvernance urbaine (coopération, participation, négociation), ainsi que l'importance de la notion de pérennité pour la qualité du projet. Dans un premier temps, nous avons analysé vingt quartiers durables modèles européens et identifié leurs atouts et leurs faiblesses en termes de durabilité, ainsi que leurs divers modes de pilotage. Les enseignements tirés de ces exemples révèlent la nécessité d'améliorer le pilotage des projets. Dans un deuxième temps, nous avons élaboré une grille d'analyse fine fondée sur l'approche institutionnelle des acteurs et les caractéristiques-clefs de la gouvernance urbaine. En nous appuyant sur cette grille, nous avons analysé le processus de conception et de réalisation du quartier durable de « Kronsberg » (Hanovre) à l'aide des éléments suivants : les acteurs (avec leurs intérêts et objectifs propres), les instruments d'aménagement du territoire, les modes de pilotage, les zones de divergence et de convergence entre les acteurs, ainsi que leurs impacts sur le processus et le projet. Dans un troisième temps, les hypothèses centrales ont été testées sur le quartier de « Neu-Oerlikon » (Zurich) afin d'approfondir et d'élargir les enseignements tirés de celui de « Kronsberg ». Les résultats des analyses mettent en évidence le fait qu'un pilotage de projet selon le modèle de la gouvernance urbaine est certes une condition nécessaire mais non suffisante pour améliorer la qualité du projet. De plus, la valeur ajoutée de la gouvernance urbaine n'est valable qu'à certaines conditions. En effet, la coopération et la négociation peuvent même, dans certaines situations, réduire la qualité du projet ! Le principal enseignement de la recherche révèle qu'il n'y a pas de mode de pilotage idéal, mais que la qualité d'un projet dépend d'une multitude de facteurs, tels que les constellations d'acteurs, leurs intérêts personnels et institutionnels, les conditions cadres et les « règles du jeu » de la gouvernance urbaine. Si les « règles du jeu » en particulier ne sont pas réellement appropriées par l'ensemble des acteurs, les intérêts et les comportements personnels ou institutionnels prédominent au détriment de la qualité du projet. De même, si la participation des futurs usagers à l'élaboration du projet de quartier durable n'est pas assurée, tant la qualité du projet que sa pérennité en pâtissent. Nous avons également constaté que la présence d'un acteur (en règle générale les autorités publiques) qui veille à la définition d'objectifs ambitieux en matière de développement durable et à leur application constitue un apport essentiel à la qualité du projet. En outre, la recherche met en évidence les carences dans le suivi et le maintien à long terme des qualités de durabilité de la phase d'exploitation des projets de quartiers durables analysés. Dans la phase d'exploitation, le degré de coopération diminue généralement et les modes de fonctionnement et de pilotage sectoriels se mettent en place au détriment de la qualité du projet. Cela confirme la nécessité de poursuivre le processus de pilotage selon le modèle de la gouvernance urbaine au-delà de la phase de réalisation des projets. La recherche précise les enjeux des champs d'action de la phase d'exploitation (domaine encore peu étudié) et démontre la pertinence du mode de pilotage préconisé. Enfin, les analyses permettent d'identifier des facteurs de réussite et de risque susceptibles d'influencer les systèmes de gouvernance urbaine, ainsi que les enjeux des domaines de la durabilité encore négligés (agriculture urbaine, gestion environnementale dans la durée, comportement des usagers, financement équitable, etc.). La prise en compte de ces enseignements est essentielle à l'amélioration de la gestion de futurs projets de quartiers durables. ---------------------------------------------- Urban Governance and Sustainable Neighbourhoods: A Contribution to a Lasting Sustainable Development --- Abstract --- Since the 1990s, sustainable neighbourhoods have become an increasingly important topic. However, their development has proven to be difficult. There is an often considerable gap, which must be reduced, between the initial goals, the way they are implemented and how the project is finally inhabited. A sustainable neighbourhood is inherently a complex project, with ambitious goals that lie at the intersection of multiple disciplines, involving numerous stakeholders with diverging interests. Moreover, each project, due to its specific characteristics, requires an adapted steering. The main goal of this research is to analyse the nature of the steering process during the planning, realisation and use of sustainable neighbourhoods. The results aim to contribute to the promotion of sustainable urban development. The theoretical foundation of this research is based on the concept of urban governance, adapted to the particular context of sustainable neighbourhoods. Urban governance is understood in this work, as a mode of project steering based on the cooperation between public and private stakeholders. The central hypotheses of this work test the importance and the limits of the key characteristics of urban governance (cooperation, participation, negotiation) as well as the importance of continuity for the project quality. To begin with, we surveyed and analysed twenty exemplary European sustainable neighbourhoods and identified their strengths and weaknesses in terms of sustainability, as well as their diverse steering modes. The lessons learned from these examples reveal the need to improve the projects' steering. Secondly we elaborated a detailed framework for analysis founded on stakeholder-centred institutionalism and the key characteristics of urban governance. By systematically applying this framework, we analysed the planning and implementation process of the sustainable neighbourhood "Kronsberg" (Hannover). Our focus was on the following dimensions: the stakeholders (with their particular interests and goals), the instruments of spatial planning, the steering modes, the points of divergence and convergence amongst the stakeholders, as well as their impacts on the process and on the project. The final step was to test the core hypotheses on the neighbourhood "Neu-Oerlikon" (Zürich) in order to broaden the lessons learned from "Kronsberg". The results of the analysis highlight the fact that an urban governance type project steering is certainly a necessary but insufficient condition to improve the project quality. Moreover, the added value of urban governance is only valid under certain conditions. In fact, cooperation and negotiation can even in certain situations reduce the project's quality! The main lesson of this research is that there is not an ideal steering mode, but rather that the quality of the project depends on numerous factors, such as the stakeholder constellation, their individual and institutional interests, the general conditions and the "rules of the game" of urban governance. If these "rules of the game" are not really appropriated by all stakeholders, individual and institutional interests and behaviours predominate at the expense of the project's quality. Likewise, if the future users' participation in the project development is insufficient, both the project's quality and its continuity suffer. We have also observed that the presence of a stakeholder (in general the public authorities) who ensures the definition of ambitious goals in terms of sustainable development and their implementation is crucial for the project's quality. Furthermore, this research highlights the deficiencies in the follow-up and long-term preservation of the sustainability qualities in the neighbourhood projects which we have analysed. In the use phase, the degree of cooperation generally diminishes. Attitudes and project management become more sectorial at the expense of the project's quality. This confirms the need to continue the steering process according to the principles of urban governance beyond the project's implementation phase. This research specifies the challenges that affect the use phase (a still neglected area) and shows the relevance of the recommended steering mode. Finally, the analyses also identify the success and risk factors that may influence urban-governance systems, as well as the challenges of still neglected fields of sustainability (urban agriculture, long-term environmental management, user behaviour, fair funding, etc.). Taking into account these outcomes is essential to improve the management of future sustainable-neighbourhood projects.

Reconstruction Of Past Climate Conditions Over Central Europe From Groundwater Data

Here we present a 30 000 years low-resolution climate record reconstructed from groundwater data. The investigated site is located in the Bohemian Cretaceous Basin, in the corridor between the Scandinavian ice sheet and the Alpine ice field. Noble gas temperatures (NGT), obtained from groundwater data, preserved multicentennial temperature variability and indicated a cooling of at least 5-7 °C during the last glacial maximum (LGM). This is further confirmed by the depleted δ18O and δ2H values at the LGM. High excess air (ΔNe) at the end of the Pleistocene is possibly related to abrupt changes in recharge dynamics due to progression and retreat of ice covers and permafrost. These results agree with the fact that during the LGM permafrost and small glaciers developed in the inner valleys of the Giant Mountains (located in the watershed of the aquifers). A temporal decrease of deuterium excess from the pre-industrial Holocene to present days is linked to an increase of the air temperatures, and probably also to an increase of water pressure at the source region of precipitation over the past few hundred years

Schizotypal perceptual aberrations of time: correlation between score, behavior and brain activity.

A fundamental trait of the human self is its continuum experience of space and time. Perceptual aberrations of this spatial and temporal continuity is a major characteristic of schizophrenia spectrum disturbances--including schizophrenia, schizotypal personality disorder and schizotypy. We have previously found the classical Perceptual Aberration Scale (PAS) scores, related to body and space, to be positively correlated with both behavior and temporo-parietal activation in healthy participants performing a task involving self-projection in space. However, not much is known about the relationship between temporal perceptual aberration, behavior and brain activity. To this aim, we composed a temporal Perceptual Aberration Scale (tPAS) similar to the traditional PAS. Testing on 170 participants suggested similar performance for PAS and tPAS. We then correlated tPAS and PAS scores to participants' performance and neural activity in a task of self-projection in time. tPAS scores correlated positively with reaction times across task conditions, as did PAS scores. Evoked potential mapping and electrical neuroimaging showed self-projection in time to recruit a network of brain regions at the left anterior temporal cortex, right temporo-parietal junction, and occipito-temporal cortex, and duration of activation in this network positively correlated with tPAS and PAS scores. These data demonstrate that schizotypal perceptual aberrations of both time and space, as reflected by tPAS and PAS scores, are positively correlated with performance and brain activation during self-projection in time in healthy individuals along the schizophrenia spectrum.

Diverging Cave- and River-Dwelling Newts Exert the Same Mate Preference in their Native Light Conditions

When colonizing a new habitat, populations must adapt their sexual behaviour to new ecological constraints. Because caves display drastically different conditions from surface habitats and cave animals are deprived from visual information, hypogean populations are expected to have modified their mate preference and signalling behaviour after cave colonization. Here, we experimentally examined the female preference and the sexual behaviour of brook newts Calotriton asper from different cave and river populations, either in light or in darkness. Our results suggest that females prefer large individuals in both hypogean and epigean populations, but that this preference is only expressed in the light conditions of their native habitat. Hence, some mate choice criteria would be maintained across genetically divergent populations and throughout dissimilar habitats. However, this sexual behaviour is likely to be expressed via a different sensory pathway in the different habitats, suggesting that a sensory shift has occurred in cave populations, enabling animals to communicate through a non-visual channel.

Use of active personal dosemeters in interventional radiology and cardiology: Tests in laboratory conditions and recommendations - ORAMED project

Active personal dosemeters (APD) have been found to be very efficient tools to reduce occupational doses in many applications of ionizing radiation. In order to be used in interventional radiology and cardiology (IR/IC), APDs should be able to measure low energy photons and pulsed radiation with relatively high instantaneous personal dose equivalent rates. A study concerning the optimization of the use of APDs in IR/IC was performed in the framework of the ORAMED project, a Collaborative Project (2008-2011) supported by the European Commission within its 7th Framework Program. In particular, eight commercial APDs were tested in continuous and pulsed X-ray fields delivered by calibration laboratories in order to evaluate their performances. Most of APDs provide a response in pulsed mode more or less affected by the personal dose equivalent rate, which means they could be used in routine monitoring provided that correction factors are introduced. These results emphasize the importance of adding tests in pulsed mode in type-test procedures for APDs. Some general recommendations are proposed in the end of this paper for the selection and use of APDs at IR/IC workplaces.

Population pharmacokinetics in chronic myeloid leukaemia patients: observations under field-conditions

Introduction: Therapeutic drug monitoring (TDM) of imatinib has been increasingly proposed for chronic myeloid leukaemia (CML) patients, as several studies have found a correlation between trough concentrations (Cmin) >=1000ng/ml and improved response. The pharmacological monitoring project of EUTOS (European Treatment and Outcome Study) was launched to increase the availability of imatinib TDM, standardize labs, and validate proposed Cmin thresholds. Using the collected data, the objective of this analysis was to characterize imatinib Population pharmacokinetics (Pop-PK) in a large cohort of European patients, to quantify its variability and the influence of demographic factors and comedications, and to derive individual exposure variables suitable for further concentration-effect analyses.¦Methods: 4095 PK samples from 2478 adult patients were analyzed between 2006 and 2010 by LC-MS-MS and considered for Pop-PK analysis by NONMEM®. Model building used data from 973 patients with >=2 samples available (2590 samples). A sensitivity analysis was performed using all data. Available comedications (27%) were classified into inducers or inhibitors of P-glycoprotein, CYP3A4/5 and organic-cation-transporter-1 (hOCT-1).¦Results: A one-compartment model with linear elimination, zero-order absorption fitted the data best. Estimated Pop-PK parameters (interindividual variability, IIV %CV) for a 40-year old male patient were: clearance CL = 17.3 L/h (37.7%), volume V = 429L (51.1%), duration of absorption D1 = 3.2h. Outliers, reflecting potential compliance and time recording errors, were taken into account by estimating an IIV on the residual error (35.4%). Intra-individual residuals were 29.1% (proportional) plus ± 84.6 ng/mL (additive). Female patients had a 15.2% lower CL (14.6 L/h). A piece-wise linear effect of age estimated a CL of 18.7 L/h at 20 years, 17.3 L/h at 40 and 13.8 L/h at 60 years. These covariates explained 2% (CL) and 4.5% (V) of IIV variability. No effect of comedication was found. The sensitivity analysis expectedly estimated increased IIV, but similar fixed effect parameters.¦Conclusion: Imatinib PK was well described in a large cohort of CML patients under field conditions and results were concordant with previous studies. Patient characteristics explain only little IIV, confirming limited utility of prior dosage adjustment. As intra-variability is smaller than inter-patient variability, dose adjustment guided by TDM could however be beneficial in order to bring Cmin into a given therapeutic target.

Indeterminate test results of T-SPOT.TB performed under routine field conditions

Interferon-gamma release assays for the diagnosis of tuberculosis (TB) can give indeterminate results. The prevalence of indeterminate test results (ITRs) among T-SPOT.TB tests was assessed. A retrospective analysis of samples processed in 2005 was performed. ITRs were assessed by age, sex, immunosuppression, distance to the laboratory and season. A subgroup of tests performed for specific indications (contact tracing, migrants with positive tuberculin skin test, TB suspects and immunosuppression) were analysed separately. Of a total of 1,429 tests, 49 (3.4%) were indeterminate. ITRs were significantly associated with old age (>75 versus 5-75 yrs; odds ratio (OR) 7.97, 95% confidence interval (CI) 3.968-15.438) and the season during which samples were transported (autumn and winter versus spring and summer; OR 3.47, 95% CI 1.753-7.514). The incidence of ITR was 302 (2.0%) among TB contacts, 75 (1.6%) among immigrants, 156 (3.0%) in TB suspects and 32 (3.0%) among immunosuppressed patients. Sex, young age and distance to the laboratory were not associated with the rate of ITR. Of the 13 tests with ITR that were repeated, 10 gave a clear positive or negative result. Indeterminate test results with T-SPOT.TB under routine conditions were infrequent and more common in individuals aged >75 yrs than in children and younger adults. The incidence of indeterminate test results was low and similar among healthy tuberculosis contacts, immigrants with a positive tuberculin skin test, tuberculosis suspects and the immunosuppressed. The conditions of transportation may influence the incidence of indeterminate test results.