Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travellers with fever

Si le tableau clinique évoque une malaria et que le résultat des examens parasitologiques n?est pas disponible ou est négatif, le praticien n?a pas d?information basée sur l?évidence pour savoir s?il doit donner ou non un traitement présomptif. Afin d?identifier les facteurs cliniques et paracliniques prédictifs d?une parasitémie à Plasmodium, nous avons mené une étude prospective chez les voyageurs ou migrants en provenance d?une zone tropicale ou subtropicale et qui consultaient pour de la fièvre. Le questionnaire comprenait 49 items explorant les données démographiques, les caractéristiques du voyage, les éléments de l?anamnèse et de l?examen clinique ainsi que les résultats de laboratoire. 336 sujets avec données complètes ont été recrutés (97 patients atteints de malaria et 239 contrôles avec fièvre et examen parasitologique négatif). L?analyse de régression multivariée a permis d?identifier les facteurs prédictifs de maiaria suivants : prophylaxie inadéquate, sudations, absence de douleur abdominale, température )38"C, mauvais état général, splénomégalie, compte leucocytaire (1 O x 1 03/L, plaquettes ~ 1 5 0 x l 03/L, taux d?hémoglobine <12 g/dL et éosinophiles (5%. La présence d?une splénomégalie avait le coefficient de probabilité positif pour un diagnostic de malaria le plus élevé (1 3.6) ; venait ensuite la présence d?une thrombopénie (1 1 .O). Dans le contexte de la consultation ambulatoire de la Policlinique Médicale Universitaire (prévalence de malaria de 29%), la probabilité post- test d?avoir un examen parasitologique positif était de 85% pour la splénomégalie et de 82% pour la thrombopénie. Même si le seuil thérapeutique n?est pas absolument défini, il semble raisonnable d?envisager un traitement présomptif lorsque la probabilité post- test est >80%. Si le médecin est réticent à administrer un traitement sans documentation parasitologique, il devrait au moins se retenir d?entreprendre d?autres investigations coûteuses, et plutôt répéter l?examen parasitologique après 12-24 heures.

Clinical Utility of the 2 New Scales of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): A Naturalistic, Prospective Study in a Psychiatric Unit for Adolescents.

OBJECTIVES: The goal of this study was to assess the clinical usefulness of the emotional symptoms (Emo) and externalizing problems (Ext) scales compared with the Total score on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). METHODS: The HoNOSCA was rated at admission and discharge for 260 adolescent inpatients. The primary outcomes assessed were (a) the sensitivity of the 3 HoNOSCA scores to clinical improvement; and (b) the between diagnoses discriminative value of these scores. RESULTS: Analyses of variances [2 (time: admission vs. discharge) ×5 (diagnostic groups)] revealed a main effect of time for the 3 scores, a main effect of the diagnostic group for the Total and Ext scores, and an interaction effect between time and diagnosis for the Emo score. A moderate correlation was observed between the change in Ext and Emo scores between admission and discharge. DISCUSSION: These 2 new scales of the HoNOSCA demonstrated good clinical utility and the ability to assess different aspects of clinical improvements. A significant discriminative value of both scores was observed. SIGNIFICANT OUTCOMES: The clinical utility of the 2 new scales on the HoNOSCA was established. These 2 new scales provided a sensitive measure of clinical outcome for assessing improvement between admission and discharge on a psychiatric inpatient unit for adolescents, regardless of diagnostic group, and captured additional information about clinical improvements. Adolescents with psychosis and conduct disorders presented with higher externalizing symptoms than those with other disorders, as rated on the HoNOSCA, at admission and discharge. The Emo score differentiated between clinical improvement in patients with psychosis versus eating disorders. LIMITATIONS: The sample in this study represented a homogeneous population of adolescent inpatients, so that further research is needed before these findings can be generalized to outpatients. In addition, the small number of patients in some diagnostic groups did not allow for their inclusion in some of the statistical analyses.

Risk assessment tool for radical technologies – Case Technology A and Technology B

Työssä testataan radikaalien teknologioiden liiketoimintariskien evaluointityökalua. Työn teoreettinen tausta koostuu teknologia- ja innovaatioteorioista hyödyntäen myös resurssipohjaista yritysteoriaa täydennettynä evolutionäärisellä teorialla. Teoreettisessa osuudessa rakennetaan viitekehys, jolla liiketoimintariskejä voidaan arvioida ja muodostaa riskiprofiili. Liiketoimintariskien muuttujina ovat markkina-, teknologia- ja organisaatioriskit. Primäärisenä tietolähteenä käytettiin teema- ja strukturoituja haastatteluita. Ensimmäinen haastattelu käsitti evaluointityökalun käytettävyyttä ja riskienhallintaa yleensä. Loput haastattelut liittyivät teknologian A ja teknologian B liiketoimintariskien arvioimiseen. Tulokset osoittavat molemmat teknologiat sisältävän radikaaleille teknologioille ominaisia epävarmuustekijöitä. Riskiprofiilin hyödyllisyys liittyy liiketoimintariskien samanaikaiseen havaitsemiseen auttaen näin päätöksenteossa. Tärkeää evaluoinnissa on kiinnittää huomiota näkökulmaan, josta riskejä tarkastellaan riskiprofiilin validiteetin parantamiseksi.

Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making.

BACKGROUND AND PURPOSE: For the STroke Imaging Research (STIR) and VISTA-Imaging Investigators The purpose of this study was to collect precise information on the typical imaging decisions given specific clinical acute stroke scenarios. Stroke centers worldwide were surveyed regarding typical imaging used to work up representative acute stroke patients, make treatment decisions, and willingness to enroll in clinical trials. METHODS: STroke Imaging Research and Virtual International Stroke Trials Archive-Imaging circulated an online survey of clinical case vignettes through its website, the websites of national professional societies from multiple countries as well as through email distribution lists from STroke Imaging Research and participating societies. Survey responders were asked to select the typical imaging work-up for each clinical vignette presented. Actual images were not presented to the survey responders. Instead, the survey then displayed several types of imaging findings offered by the imaging strategy, and the responders selected the appropriate therapy and whether to enroll into a clinical trial considering time from onset, clinical presentation, and imaging findings. A follow-up survey focusing on 6 h from onset was conducted after the release of the positive endovascular trials. RESULTS: We received 548 responses from 35 countries including 282 individual centers; 78% of the centers originating from Australia, Brazil, France, Germany, Spain, United Kingdom, and United States. The specific onset windows presented influenced the type of imaging work-up selected more than the clinical scenario. Magnetic Resonance Imaging usage (27-28%) was substantial, in particular for wake-up stroke. Following the release of the positive trials, selection of perfusion imaging significantly increased for imaging strategy. CONCLUSIONS: Usage of vascular or perfusion imaging by Computed Tomography or Magnetic Resonance Imaging beyond just parenchymal imaging was the primary work-up (62-87%) across all clinical vignettes and time windows. Perfusion imaging with Computed Tomography or Magnetic Resonance Imaging was associated with increased probability of enrollment into clinical trials for 0-3 h. Following the release of the positive endovascular trials, selection of endovascular only treatment for 6 h increased across all clinical vignettes.

Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.

alfa e b-glucosidases como alvos moleculares para desenvolvimento de fármacos

Glucosidases are involved in key steps in the processing of oligosaccharides by cleaving O-glucose residues. Since they catalyze breaking and transfer reactions of glucosidic groups for the normal growth and development of all the cells, defects or genetic deficiencies in these enzymes are associated with serious disorders of the carbohydrate metabolism. Thus, glucosidases represent important targets to develop inhibitors, owing to their potential activities against viruses, tumoral growth and metastasis, diabetes, Gaucher's disease and other syndromes associated with the lisosomal storage of glucoesphingolipids, and osteoarthritis. This paper presents a description of the biochemical pathways and mechanisms of alpha and beta-glucosidases, and the currently available drugs capable to inhibit these enzymes.

Química Sem Fronteiras: o desafio da energia

Coal, natural gas and petroleum-based liquid fuels are still the most widely used energy sources in modern society. The current scenario contrasts with the foreseen shortage of petroleum that was spread out in the beginning of the XXI century, when the concept of "energy security" emerged as an urgent agenda to ensure a good balance between energy supply and demand. Much beyond protecting refineries and oil ducts from terrorist attacks, these issues soon developed to a portfolio of measures related to process sustainability, involving at least three fundamental dimensions: (a) the need for technological breakthroughs to improve energy production worldwide; (b) the improvement of energy efficiency in all sectors of modern society; and (c) the increase of the social perception that education is a key-word towards a better use of our energy resources. Together with these technological, economic or social issues, "energy security" is also strongly influenced by environmental issues involving greenhouse gas emissions, loss of biodiversity in environmentally sensitive areas, pollution and poor solid waste management. For these and other reasons, the implementation of more sustainable practices in our currently available industrial facilities and the search for alternative energy sources that could partly replace the fossil fuels became a major priority throughout the world. Regarding fossil fuels, the main technological bottlenecks are related to the exploitation of less accessible petroleum resources such as those in the pre-salt layer, ranging from the proper characterization of these deep-water oil reservoirs, the development of lighter and more efficient equipment for both exploration and exploitation, the optimization of the drilling techniques, the achievement of further improvements in production yields and the establishment of specialized training programs for the technical staff. The production of natural gas from shale is also emerging in several countries but its production in large scale has several problems ranging from the unavoidable environmental impact of shale mining as well as to the bad consequences of its large scale exploitation in the past. The large scale use of coal has similar environmental problems, which are aggravated by difficulties in its proper characterization. Also, the mitigation of harmful gases and particulate matter that are released as a result of combustion is still depending on the development of new gas cleaning technologies including more efficient catalysts to improve its emission profile. On the other hand, biofuels are still struggling to fulfill their role in reducing our high dependence on fossil fuels. Fatty acid alkyl esters (biodiesel) from vegetable oils and ethanol from cane sucrose and corn starch are mature technologies whose market share is partially limited by the availability of their raw materials. For this reason, there has been a great effort to develop "second-generation" technologies to produce methanol, ethanol, butanol, biodiesel, biogas (methane), bio-oils, syngas and synthetic fuels from lower grade renewable feedstocks such as lignocellulosic materials whose consumption would not interfere with the rather sensitive issues of food security. Advanced fermentation processes are envisaged as "third generation" technologies and these are primarily linked to the use of algae feedstocks as well as other organisms that could produce biofuels or simply provide microbial biomass for the processes listed above. Due to the complexity and cost of their production chain, "third generation" technologies usually aim at high value added biofuels such as biojet fuel, biohydrogen and hydrocarbons with a fuel performance similar to diesel or gasoline, situations in which the use of genetically modified organisms is usually required. In general, the main challenges in this field could be summarized as follows: (a) the need for prospecting alternative sources of biomass that are not linked to the food chain; (b) the intensive use of green chemistry principles in our current industrial activities; (c) the development of mature technologies for the production of second and third generation biofuels; (d) the development of safe bioprocesses that are based on environmentally benign microorganisms; (e) the scale-up of potential technologies to a suitable demonstration scale; and (f) the full understanding of the technological and environmental implications of the food vs. fuel debate. On the basis of these, the main objective of this article is to stimulate the discussion and help the decision making regarding "energy security" issues and their challenges for modern society, in such a way to encourage the participation of the Brazilian Chemistry community in the design of a road map for a safer, sustainable and prosper future for our nation.

Introduktionen av kärnkraften i Finland

Finlands industri har av tradition varit starkt energikrävande. Träförädlingsindustrin, som fick sin egentliga start i medlet på 1800-talet, använde stora mängder energi liksom metallförädlingsföretagen i ett senare skede. Krigstiden med sin energiransonering visade handgripligen för allmänheten liksom för specialisterna att en tillräcklig tillgång till energi är ett livsvillkor för vår industri och därmed för vårt land. Efterkrigstiden kännetecknades av en allt snabbare utbyggnad av den på vatten- och ångkraft baserade elkraftskapaciteten, en utbyggnad som den inhemska verkstadsindustrin i stor utsträckning deltog i. Men redan på 1950-talet var vattenkraften till stor del utbyggd, varför den privata såväl som den statliga sektorns intresse allt mera inriktade sig på den speciellt i USA favoriserade atomenergin. Efter fördjupade studier i kärnfysik och kärnteknik vid the International School of Nuclear Science and Engineering i USA deltog författaren av dessa rader intensivt (först som Ahlströmanställd och senare som VD för Finnatom) i den utvecklingsverksamhet inom det kärntekniska området som inte bara elproducenterna utan även verkstadsindustrin i vårt land genomförde. Det var därför naturligt för mig att som objekt för min doktorsavhandling välja introduktionen av kärnkraften i Finland med speciell fokus på den inhemska verkstadsindustrins roll. Jag ställde följande forskningsfrågor: a. När och hur skedde introduktionen av kärnkraften i Finland? b. Vilka var orsakerna till och resultatet av denna introduktion? c. Vilken var den inhemska verkstadsindustrins roll? Ett grundligt studium av litteraturen inklusive mötesprotokoll och tidningsreferat samt personligen genomförda intervjuer med ett trettiotal av de verkliga aktörerna i den långa och komplicerade introduktionsprocessen ledde till en teori, vars riktighet jag anser mig ha kunnat bevisa. Den inhemska verkstadsindustrins roll var synnerligen central. Dess representanter lyckades, bl.a. refererande till erfarenheterna från utbyggnaden av vatten- och ångkraften liksom till byggandet av den underkritiska milan YXP samt forskningsreaktorn TRIGA, övertyga beslutsfattarna om att den besatt nödig kompetens för att kompensera den kompetensbrist som kunde iakttas inom vissa områden hos den sovjetiska kärnkraftverksleverantören. De inhemska leveranserna påverkade även driftsresultatet, speciellt i fallet Lovisa, i positiv riktning. Introduktionsprocessen, som omfattade tiden från slutet av 1950-talet till början på 1980-talet, beskrevs, noterande bl.a. J. W. Creswells anvisningar, i detalj i avhandlingen. Introduktionen fick som resultat konkurrenskraftig elkraft, impuls till start av nya företag, exempelvis Nokia Elektronik, liksom en klar höjning av den tekniska nivån hos vår industri, inkluderande kärnteknisk tillverkning i stor skala. Katastrofen i Tjernobyl i slutet av april 1986 innebar emellertid att utvecklingen tog en paus på ett par decennier. Erfarenheterna från introduktionsfasen kan förhoppningsvis utnyttjas till fullo nu, när utbyggnaden av kärnkraften återupptagits i vårt land.

Breaking down the boundaries to storing, sharing and publishing research data

Presentation at Open Repositories 2014, Helsinki, Finland, June 9-13, 2014

Histoire, par JEAN LE FERON, de la maison d'Harcourt, depuis Bernard, seigneur d'Harcourt, qui est donné comme vivant sous Rollon, premier duc de Normandie, jusqu'à Claude, sire de Rieux, sixième comte d'Harcourt, lequel vivait sous François Ier, roi de France. Premiers mots : « Chacune nation se donne la gloire et honneur d'estre produite et yssue de la noblesse des Troyens... ». Derniers mots : « ... led. sieur Claude de Ryeux, delivré de l'emprisonnement moyennant sa ransson par luy payée ». (Fol. 1 à 36 et 39 à 52).

Contient : « Extraict tiré de Longey, 5 lieues de Falaize, autour d'une salle », concernant « messire Jehan de Harcourt, dict le preuxdhomme, conte d'Aresecot,... messire Robert de Harcourt, conte d'Aresecot,... messire Richard de Harcourt, conte d'Aresecot,... messire Raoul d'Harcourt, conte d'Aresecot... » ; « Genealogie de Harcourt » ; Un acte de HENRI IV, roi de France, portant « erection du marquisat de La Motte Harcourt » au bailliage de Caen, en faveur de « Pierre de Ha[r]court », gentilhomme de sa chambre et capitaine de cinquante hommes d'armes de ses ordonnances, et des héritiers dudit Pierre d'Harcourt. St-Denis en France, août 1593. Copie

School funding and education policy-making models in Ontario /

The purpose of this thesis is to examine various policy implementation models, and to determine what use they are to a government. In order to insure that governmental proposals are created and exercised in an effective manner, there roust be some guidelines in place which will assist in resolving difficult situations. All governments face the challenge of responding to public demand, by delivering the type of policy responses that will attempt to answer those demands. The problem for those people in positions of policy-making responsibility is to balance the competitive forces that would influence policy. This thesis examines provincial government policy in two unique cases. The first is the revolutionary recommendations brought forth in the Hall -Dennis Report. The second is the question of extending full -funding to the end of high school in the separate school system. These two cases illustrate how divergent and problematic the policy-making duties of any government may be. In order to respond to these political challenges decision-makers must have a clear understanding of what they are attempting to do. They must also have an assortment of policy-making models that will insure a policy response effectively deals with the issue under examination. A government must make every effort to insure that all policymaking methods are considered, and that the data gathered is inserted into the most appropriate model. Currently, there is considerable debate over the benefits of the progressive individualistic education approach as proposed by the Hall -Dennis Committee. This debate is usually intensified during periods of economic uncertainty. Periodically, the province will also experience brief yet equally intense debate on the question of separate school funding. At one level, this debate centres around the efficiency of maintaining two parallel education systems, but the debate frequently has undertones of the religious animosity common in Ontario's history. As a result of the two policy cases under study we may ask ourselves these questions: a) did the policies in question improve the general quality of life in the province? and b) did the policies unite the province? In the cases of educational instruction and finance the debate is ongoing and unsettling. Currently, there is a widespread belief that provincial students at the elementary and secondary levels of education are not being educated adequately to meet the challenges of the twenty-first century. The perceived culprit is individual education which sees students progressing through the system at their own pace and not meeting adequate education standards. The question of the finance of Catholic education occasionally rears its head in a painful fashion within the province. Some public school supporters tend to take extension as a personal religious defeat, rather than an opportunity to demonstrate that educational diversity can be accommodated within Canada's most populated province. This thesis is an attempt to analyze how successful provincial policy-implementation models were in answering public demand. A majority of the public did not demand additional separate school funding, yet it was put into place. The same majority did insist on an examination of educational methods, and the government did put changes in place. It will also demonstrate how policy if wisely created may spread additional benefits to the public at large. Catholic students currently enjoy a much improved financial contribution from the province, yet these additional funds were taken from somewhere. The public system had it funds reduced with what would appear to be minimal impact. This impact indicates that government policy is still sensitive to the strongly held convictions of those people in opposition to a given policy.

Breaking the silence : exploring the workplace experiences of six women with learning disabilities

In the current economic climate, employees are expected to upgrade their skills in order to remain productive and competitive in the workplace, and many women with learning disabilities! may feel doubly challenged when dealing with such expectations. Although the number of people with reported learning disabilities who enter the workforce is expected to increase, a dearth of research focuses on work-related experiences of women with learning disabilities; consequently, employers and educators often are unaware ofthe obstacles and demands facing such individuals. This qualitative narrative study sheds light on the work experiences of women with diagnosed or suspected learning disabilities. The study used semistructured interviews to explore their perspectives and reflections on learnlng in order to: (a) raise awareness of the needs of women with learning disabilities, (b) enhance their opportunities to learn in the workplace, and (c) draw attention to the need for improvement of inclusiveness in the workplace, especially for hidden disabilities. Study findings reveal that participants' learning was influenced by work relationships, the learning environments, self-determination, and taking personal responsibility. Moreover, the main accommodation requested was to have supportive and understanding work relationships and environments. Recommendations are made for future research and workplace improvements, most notably that no employees should be left behind through an employee-centered approach.