Towards a consensus view on understanding nanomaterials hazards and managing exposure

The aim of this article is to present an overview of salient issues of exposure, characterisation and hazard assessment of nanomaterials as they emerged from the consensus-building of experts undertaken within the four year European Commission coordination project NanoImpactNet. The approach adopted is to consolidate and condense the findings and problem-identification in such a way as to identify knowledge-gaps and generate a set of interim recommendations of use to industry, regulators, research bodies and funders. The categories of recommendation arising from the consensual view address: significant gaps in vital factual knowledge of exposure, characterisation and hazards; the development, dissemination and standardisation of appropriate laboratory protocols; address a wide range of technical issues in establishing an adequate risk assessment platform; the more efficient and coordinated gathering of basic data; greater inter-organisational cooperation; regulatory harmonization; the wider use of the life-cycle approaches; and the wider involvement of all stakeholders in the discussion and solution-finding efforts for nanosafety.

Managing the Sick Child in the Era of Declining Malaria Transmission: Development of ALMANACH, an Electronic Algorithm for Appropriate Use of Antimicrobials.

OBJECTIVE: To review the available knowledge on epidemiology and diagnoses of acute infections in children aged 2 to 59 months in primary care setting and develop an electronic algorithm for the Integrated Management of Childhood Illness to reach optimal clinical outcome and rational use of medicines. METHODS: A structured literature review in Medline, Embase and the Cochrane Database of Systematic Review (CDRS) looked for available estimations of diseases prevalence in outpatients aged 2-59 months, and for available evidence on i) accuracy of clinical predictors, and ii) performance of point-of-care tests for targeted diseases. A new algorithm for the management of childhood illness (ALMANACH) was designed based on evidence retrieved and results of a study on etiologies of fever in Tanzanian children outpatients. FINDINGS: The major changes in ALMANACH compared to IMCI (2008 version) are the following: i) assessment of 10 danger signs, ii) classification of non-severe children into febrile and non-febrile illness, the latter receiving no antibiotics, iii) classification of pneumonia based on a respiratory rate threshold of 50 assessed twice for febrile children 12-59 months; iv) malaria rapid diagnostic test performed for all febrile children. In the absence of identified source of fever at the end of the assessment, v) urine dipstick performed for febrile children <2 years to consider urinary tract infection, vi) classification of 'possible typhoid' for febrile children >2 years with abdominal tenderness; and lastly vii) classification of 'likely viral infection' in case of negative results. CONCLUSION: This smartphone-run algorithm based on new evidence and two point-of-care tests should improve the quality of care of <5 year children and lead to more rational use of antimicrobials.

Caregiver's interpret infants' early gestures based on shared knowledge about referents

Gestures are the first forms of conventional communication that young children develop in order to intentionally convey a specific message. However, at first, infants rarely communicate successfully with their gestures, prompting caregivers to interpret them. Although the role of caregivers in early communication development has been examined, little is known about how caregivers attribute a specific communicative function to infants' gestures. In this study, we argue that caregivers rely on the knowledge about the referent that is shared with infants in order to interpret what communicative function infants wish to convey with their gestures. We videotaped interactions from six caregiver-infant dyads playing with toys when infants were 8, 10, 12, 14, and 16 months old. We coded infants' gesture production and we determined whether caregivers interpreted those gestures as conveying a clear communicative function or not; we also coded whether infants used objects according to their conventions of use as a measure of shared knowledge about the referent. Results revealed an association between infants' increasing knowledge of object use and maternal interpretations of infants' gestures as conveying a clear communicative function. Our findings emphasize the importance of shared knowledge in shaping infants' emergent communicative skills.

Angiotensinergic innervation of the kidney: present knowledge and its significance.

Intrarenal neurotransmission implies the co-release of neuropeptides at the neuro-effector junction with direct influence on parameters of kidney function. The presence of an angiotensin (Ang) II-containing phenotype in catecholaminergic postganglionic and sensory fibers of the kidney, based on immunocytological investigations, has only recently been reported. These angiotensinergic fibers display a distinct morphology and intrarenal distribution, suggesting anatomical and functional subspecialization linked to neuronal Ang II-expression. This review discusses the present knowledge concerning these fibers, and their significance for renal physiology and the pathogenesis of hypertension in light of established mechanisms. The data suggest a new role of Ang II as a co-transmitter stimulating renal target cells or modulating nerve traffic from or to the kidney. Neuronal Ang II is likely to be an independent source of intrarenal Ang II. Further physiological experimentation will have to explore the role of the angiotensinergic renal innervation and integrate it into existing concepts.

Which prior knowledge? Quantification of in vivo brain 13C MR spectra following 13C glucose infusion using AMARES.

The recent developments in high magnetic field 13C magnetic resonance spectroscopy with improved localization and shimming techniques have led to important gains in sensitivity and spectral resolution of 13C in vivo spectra in the rodent brain, enabling the separation of several 13C isotopomers of glutamate and glutamine. In this context, the assumptions used in spectral quantification might have a significant impact on the determination of the 13C concentrations and the related metabolic fluxes. In this study, the time domain spectral quantification algorithm AMARES (advanced method for accurate, robust and efficient spectral fitting) was applied to 13 C magnetic resonance spectroscopy spectra acquired in the rat brain at 9.4 T, following infusion of [1,6-(13)C2 ] glucose. Using both Monte Carlo simulations and in vivo data, the goal of this work was: (1) to validate the quantification of in vivo 13C isotopomers using AMARES; (2) to assess the impact of the prior knowledge on the quantification of in vivo 13C isotopomers using AMARES; (3) to compare AMARES and LCModel (linear combination of model spectra) for the quantification of in vivo 13C spectra. AMARES led to accurate and reliable 13C spectral quantification similar to those obtained using LCModel, when the frequency shifts, J-coupling constants and phase patterns of the different 13C isotopomers were included as prior knowledge in the analysis.

A Modulated Closed Form solution for Quantitative Susceptibility Mapping - A thorough evaluation and comparison to iterative methods based on edge prior knowledge.

The aim of this study is to perform a thorough comparison of quantitative susceptibility mapping (QSM) techniques and their dependence on the assumptions made. The compared methodologies were: two iterative single orientation methodologies minimizing the l2, l1TV norm of the prior knowledge of the edges of the object, one over-determined multiple orientation method (COSMOS) and anewly proposed modulated closed-form solution (MCF). The performance of these methods was compared using a numerical phantom and in-vivo high resolution (0.65mm isotropic) brain data acquired at 7T using a new coil combination method. For all QSM methods, the relevant regularization and prior-knowledge parameters were systematically changed in order to evaluate the optimal reconstruction in the presence and absence of a ground truth. Additionally, the QSM contrast was compared to conventional gradient recalled echo (GRE) magnitude and R2* maps obtained from the same dataset. The QSM reconstruction results of the single orientation methods show comparable performance. The MCF method has the highest correlation (corrMCF=0.95, r(2)MCF =0.97) with the state of the art method (COSMOS) with additional advantage of extreme fast computation time. The l-curve method gave the visually most satisfactory balance between reduction of streaking artifacts and over-regularization with the latter being overemphasized when the using the COSMOS susceptibility maps as ground-truth. R2* and susceptibility maps, when calculated from the same datasets, although based on distinct features of the data, have a comparable ability to distinguish deep gray matter structures.

The relationship between HRM practices and organizational commitment of knowledge workers. Facts obtained from Swiss SMEs

This paper explores the effects of human resource management (HRM) practices in Swiss small -to-medium enterprises (SMEs). More specifically, the main objective of this study is to assess the impacts of HRM practices developed in Swiss SMEs upon the commitment of knowledge workers. Using data from a survey of over 198 knowledge workers, this study shows the importance of looking closer at HRM practices and, furthermore, to really investigate the impacts of the different HRM practices on employees' commitment. Results show, for example, that organisational support, procedural justice and the reputation of the organisation may clearly influence knowledge workers' commitment, whereas other HRM practices such as involvement in the decision-making, skills management or even the degree of satisfaction with pay do not have any impact on knowledge workers' commitment.

Knowledge of Glasgow coma scale by air-rescue physicians.

OBJECTIVE: To assess the theoretical and practical knowledge of the Glasgow Coma Scale (GCS) by trained Air-rescue physicians in Switzerland. METHODS: Prospective anonymous observational study with a specially designed questionnaire. General knowledge of the GCS and its use in a clinical case were assessed. RESULTS: From 130 questionnaires send out, 103 were returned (response rate of 79.2%) and analyzed. Theoretical knowledge of the GCS was consistent for registrars, fellows, consultants and private practitioners active in physician-staffed helicopters. The clinical case was wrongly scored by 38 participants (36.9%). Wrong evaluation of the motor component occurred in 28 questionnaires (27.2%), and 19 errors were made for the verbal score (18.5%). Errors were made most frequently by registrars (47.5%, p = 0.09), followed by fellows (31.6%, p = 0.67) and private practitioners (18.4%, p = 1.00). Consultants made significantly less errors than the rest of the participating physicians (0%, p < 0.05). No statistically significant differences were shown between anesthetists, general practitioners, internal medicine trainees or others. CONCLUSION: Although the theoretical knowledge of the GCS by out-of-hospital physicians is correct, significant errors were made in scoring a clinical case. Less experienced physicians had a higher rate of errors. Further emphasis on teaching the GCS is mandatory.

Les symbioses industrielles : une nouvelle stratégie pour l'amélioration de l'utilisation des ressources matérielles et énergétiques par les activités économiques

RésuméCette thèse traite d'un domaine d'application de l'écologie industrielle, les symbioses industrielles, comme stratégie d'amélioration de la consommation des ressources matérielles et énergétiques et de la gestion des déchets par les activités économiques. Les symbioses industrielles cherchent à créer de nouvelles collaborations directement entre les acteurs économiques d'un territoire dans le but d'échanger de l'information, des matières premières et des déchets, et d'intensifier les mutualisations de services et d'infrastructures possibles entre entreprises voisines. Ces quatre types de collaboration sont représentés schématiquement dans la figure ci-dessous.Dans ce travail, la détection et la mise en oeuvre de symbioses industrielles sont abordées sous plusieurs angles. Les recherches réalisées concernent le développement de procédures de mise en oeuvre s'adressant aux collectivités publiques, aux institutions académiques et aux bureaux de conseil dans le domaine de l'environnement. Les objectifs des procédures sont de créer une dynamique de collaboration et de confiance entre les acteurs économiques et l'administration publique d'un territoire afin de détecter des symbioses industrielles potentielles. Ces procédures requièrent la gestion de grandes quantités d'informations relatives aux flux de matière et d'énergie.Un travail de terrain, réalisé sur les territoires du canton de Genève et de Lausanne Région et utilisé comme études de cas, a permis de mettre en évidence un grand nombre de symbioses industrielles qui existent déjà en Suisse romande. Plusieurs dizaines d'exemples ont été identifiés principalement dans lesdomaines de la gestion de l'eau, de l'énergie, des produits chimiques et des matériaux de construction. La législation suisse autoriserait cependant la concrétisation de nombreuses autres opportunités. Dans cette recherche, celles-ci sont évaluées techniquement, légalement, économiquement et environnementalement. La création d'un référentiel d'évaluation des opportunités permet de déterminer quelles sont les symbioses industrielles techniquement réalisables et pertinentes dans le contexte suisse et dans quels cas celles-ci représenteraient une réelle plus-value par rapport à l'utilisation actuelle de la ressource et aux filières existantes de collecte et de valorisation des déchets.Finalement, un logiciel, SymbioGIS, destiné à soutenir la détection et l'évaluation de symbioses industrielles potentielles a été développé. Il s'agit d'une interface web accessible pour de nombreux utilisateurs, couplée à une interface de systèmes d'information géographique. En plus de la détection de symbioses industrielles, plusieurs fonctionnalités sont proposées pour faciliter la prise en compte des flux de matière et d'énergie dans les problématiques liées à l'aménagement du territoire et au positionnement des activités économiques.En conclusion, cette recherche met en évidence la nécessité de rapprocher les institutions publiques en charge de la protection de l'environnement, de la promotion économique et de l'aménagement du territoire pour favoriser l'essor des symbioses industrielles comme stratégie pour la gestion des ressources matérielles et énergétiques. Elle propose des pistes pour intensifier les collaborations entre ces domaines et accélérer le partage des connaissances liées aux flux de matière et d'énergie et à leur cheminement au sein des activités économiques afin de rendre le système industriel existant en Suisse romande viable à long terme. Parallèlement, elle étudie les possibilités de transposer ces considérations et les procédures et outils développés dans le contexte économique et social de la région Asie-Pacifique, où se trouvent aujourd'hui de nombreuses activités de production.SummaryIndustrial symbioses: A new strategy for improving how economic activities use material and energy resourcesThis thesis focuses on one application of industrial ecology, industrial symbioses, as a strategy for improving how economic activities consume material and energy resources. Industrial symbioses seek to create new collaborations among economic players with the goal of exchanging information, raw materials, and waste directly among area businesses, and to step up the potential pooling of services and infrastructure among neighboring companies.The identification and implementation of industrial symbioses are studied from several angles. The research first examines the development of implementation procedures for government bodies, academic institutions, and environmental consulting services. The purpose of the procedures is to create a dynamic of collaboration and trust between the economic players and the public officials in a region in order to identify potential industrial symbioses. The procedures necessitate managing large amounts of information about material and energy flows.Fieldwork conducted in the canton of Geneva and the Lausanne region, and used as case studies for the research, highlights a great number of industrial symbioses that already exist in French-speaking Switzerland. Several dozen examples are identified, primarily in the areas of water management, energy, chemical products, and building materials; however, Swiss law would permit many others. The research evaluates these opportunities from a technical, legal, economic, and environmental standpoint. By developing an assessment framework it is possible to determine which industrial symbioses are technically feasible and pertinent in Switzerland, and under what circumstances they would represent real added value compared to the current use of the resource and to existing systems for collecting and reusing waste.Lastly, SymbioGIS software was developed to help identify and assess potential industrial symbioses. The program's Web-based interface can be accessed by multiple users and is coupled with an interface that provides geographic information. In addition to identifying industrial symbioses, several program functionalities make it easier to consider material and energy flows with regard to local development issues and siting economic activities.In conclusion, the research highlights the need to bring together public institutions charged with protecting the environment, promoting economic activity, and overseeing development in order to foster the expansion of industrial symbioses as a strategy for managing material and energy resources. It proposes solutions for stepping up collaboration among these players and accelerating the sharing of knowledge about material and energy flows and their paths within economic activities with the goal of making theexisting industrial system in French-speaking Switzerland viable long-term. Also examined were thepossibilities of transposing these considerations and the study's findings about Switzerland to the economic and social context of the Asia-Pacific region, where much production is now located.

The dermatologists' role in managing psoriatic arthritis: results of a swiss delphi exercise intended to improve collaboration with rheumatologists.

BACKGROUND: Psoriatic arthritis (PsA) substantially impacts the management of psoriatic disease. OBJECTIVE: This study aimed to generate an interdisciplinary national consensus on recommendations of how PsA should be managed. METHODS: Based on a systematic literature search, an interdisciplinary expert group identified important domains and went through 3 rounds of a Delphi exercise, followed by a nominal group discussion to generate specific recommendations. RESULTS: A strong consensus was reached on numerous central messages regarding the impact of PsA, screening procedures, organization of the interaction between dermatologists and rheumatologists, and treatment goals. CONCLUSION: These recommendations can serve as a template for similar initiatives in other countries. At the same time, they highlight the need to take into account the impact of the respective national health care system. © 2015 S. Karger AG, Basel.

Knowledge of Glasgow coma scale by air-rescue physicians

Rapport de synthèse Introduction : Le Glasgow coma score (GCS) est un outil reconnu permettant l'évaluation des patients après avoir subi un traumatisme crânien. Il est réputé pour sa simplicité et sa reproductibilité permettant ainsi aux soignants une évaluation appropriée et continue du status neurologique des patients. Le GCS est composé de trois catégories évaluant la réponse oculaire, verbale et motrice. En Suisse, les soins préhospitaliers aux patients victimes d'un trauma crânien sévère sont effectués par des médecins, essdntiellement à bord des hélicoptères médicalisés. Avant une anesthésie générale nécessaire à ces patients, une évaluation du GCS est essentielle indiquant au personnel hospitalier la gravité des lésions cérébrales. Afin d'évaluer la connaissance du GCS par les médecins à bord des hélicoptères médicalisés en Suisse, nous avons élaboré un questionnaire, contenant dans une première partie des questions sur les connaissances générales du GCS suivi d'un cas clinique. Objectif : Evaluation des connaissances pratiques et théoriques du GCS par les médecins travaillant à bord des hélicoptères médicalisés en Suisse. Méthode : Etude observationnelle prospective et anonymisée à l'aide d'un questionnaire. Evaluation des connaissances générales du GCS et de son utilisation clinique lors de la présentation d'un cas. Résultats : 16 des 18 bases d'hélicoptères médicalisés suisses ont participé à notre étude. 130 questionnaires ont été envoyés et le taux de réponse a été de 79.2%. Les connaissances théoriques du GCS étaient comparables pour tous les médecins indépendamment de leur niveau de formation. Des erreurs dans l'appréciation du cas clinique étaient présentes chez 36.9% des participants. 27.2% ont commis des erreurs dans le score moteur et 18.5% dans le score verbal. Les erreurs ont été répertoriées le plus fréquemment chez les médecins assistants (47.5%, p=0.09), suivi par les chefs de clinique (31.6%, p=0.67) et les médecins installés en cabinet (18.4%, p=1.00). Les médecins cadres ont fait significativement moins d'erreurs que les autres participants (0%, p<0.05). Aucune différence significative n'à été observée entre les différentes spécialités (anesthésie, médecine interne, médecine général et «autres »). Conclusion Même si les connaissances théoriques du GCS sont adéquates parmi les médecins travaillant à bord des hélicoptères médicalisés, des erreurs dans son application clinique sont présentes dans plus d'un tiers des cas. Les médecins avec le moins d'expériences professionnelle font le plus d'erreurs. Au vu de l'importance de l'évaluation correcte du score de Glasgow initial, une amélioration des connaissances est indispensable.

NanoImpactNet - Stakeholders' knowledge needs for research on the health and environmental impact of nanomaterials

NanoImpactNet (NIN) is a multidisciplinary European Commission funded network on the environmental, health and safety (EHS) impact of nanomaterials. The 24 founding scientific institutes are leading European research groups active in the fields of nanosafety, nanorisk assessment and nanotoxicology. This 4−year project is the new focal point for information exchange within the research community. Contact with other stakeholders is vital and their needs are being surveyed. NIN is communicating with 100s of stakeholders: businesses; internet platforms; industry associations; regulators; policy makers; national ministries; international agencies; standard−setting bodies and NGOs concerned by labour rights, EHS or animal welfare. To improve this communication, internet research, a questionnaire distributed via partners and targeted phone calls were used to identify stakeholders' interests and needs. Knowledge gaps and the necessity for further data mentioned by representatives of all stakeholder groups in the targeted phone calls concerned: potential toxic and safety hazards of nanomaterials throughout their lifecycles; fate and persistence of nanoparticles in humans, animals and the environment; risks associated to nanoparticle exposure; participation in the preparation of nomenclature, standards, methodologies, protocols and benchmarks; development of best practice guidelines; voluntary schemes on responsibility; databases of materials, research topics and themes. Findings show that stakeholders and NIN researchers share very similar knowledge needs, and that open communication and free movement of knowledge will benefit both researchers and industry. Consequently NIN will encourage stakeholders to be active members. These survey findings will be used to improve NIN's communication tools to further build on interdisciplinary relationships towards a healthy future with nanotechnology.