2015 Update on Acute Adverse Reactions to Gadolinium based Contrast Agents in Cardiovascular MR. Large Multi-National and Multi-Ethnical Population Experience With 37788 Patients From the EuroCMR Registry.

OBJECTIVES: Specifically we aim to demonstrate that the results of our earlier safety data hold true in this much larger multi-national and multi-ethnical population. BACKGROUND: We sought to re-evaluate the frequency, manifestations, and severity of acute adverse reactions associated with administration of several gadolinium- based contrast agents during routine CMR on a European level. METHODS: Multi-centre, multi-national, and multi-ethnical registry with consecutive enrolment of patients in 57 European centres. RESULTS: During the current observation 37,788 doses of Gadolinium based contrast agent were administered to 37,788 patients. The mean dose was 24.7 ml (range 5-80 ml), which is equivalent to 0.123 mmol/kg (range 0.01 - 0.3 mmol/kg). Forty-five acute adverse reactions due to contrast administration occurred (0.12%). Most reactions were classified as mild (43 of 45) according to the American College of Radiology definition. The most frequent complaints following contrast administration were rashes and hives (15 of 45), followed by nausea (10 of 45) and flushes (10 of 45). The event rate ranged from 0.05% (linear non-ionic agent gadodiamide) to 0.42% (linear ionic agent gadobenate dimeglumine). Interestingly, we also found different event rates between the three main indications for CMR ranging from 0.05% (risk stratification in suspected CAD) to 0.22% (viability in known CAD). CONCLUSIONS: The current data indicate that the results of the earlier safety data hold true in this much larger multi-national and multi-ethnical population. Thus, the "off-label" use of Gadolinium based contrast in cardiovascular MR should be regarded as safe concerning the frequency, manifestation and severity of acute events.

Posttraumatic stress avoidance symptoms as mediators in the development of alcohol use disorders after exposure to childhood sexual abuse in a Swiss community sample.

This study examined the role of posttraumatic stress disorder (PTSD) symptoms of re-experience, avoidance, and hyperarousal in the relationship between different types of trauma and alcohol use disorders (AUD). We used data from 731 trauma-exposed individuals who participated in the first wave of the PsyCoLaus-study. Trauma characteristics were assessed relatively to the occurrence of lifetime PTSD symptoms and AUD. The results suggest that lifetime and childhood sexual abuse as well as overall childhood trauma were directly linked to AUD and PTSD symptoms, in particular to avoidance symptoms. From single symptom clusters PTSD avoidance was found to specifically mediate the trauma-AUD pathway. Both childhood and sexual trauma strongly contribute to the comorbidity of PTSD and AUD and avoidance-type symptoms appear to play a central role in maintaining this association. Hence, the alleviation of avoidance symptoms might be an important target for therapeutic intervention among victims of sexual abuse before specific addiction treatment is initiated.

Clinical utility of a molecular test in adjuvant treatment decision making in women with endocrine-sensitive early stage breast cancer: a retrospective, single center one year experience

Background. Molecular tests for breast cancer (BC) risk assessment are reimbursed by health insurances in Switzerland since the beginning of year 2015. The main current role of these tests is to help oncologists to decide about the usefulness of adjuvant chemotherapy in patients with early stage endocrine-sensitive and human epidermal growth factor receptor 2 (HER2)-negative BC. These gene expression signatures aim at predicting the risk of recurrence in this subgroup. One of them (OncotypeDx/OT) also predicts distant metastases rate with or without the addition of cytotoxic chemotherapy to endocrine therapy. The clinical utility of these tests -in addition to existing so-called "clinico-pathological" prognostic and predictive criteria (e.g. stage, grade, biomarkers status)-is still debated. We report a single center one year experience of the use of one molecular test (OT) in clinical decision making. Methods. We extracted from the CHUV Breast Cancer Center data base the total number of BC cases with estrogen-receptor positive (ER+), HER2-negative early breast cancer (node negative (pN0) disease or micrometastases in up to 3 lymph nodes) operated between September 2014 and August 2015. For the cases from this group in which a molecular test had been decided by the tumor board, we collected the clinicopathologic parameters, the initial tumor board decision, and the final adjuvant systemic therapy decision. Results. A molecular test (OT) was done in 12.2% of patients with ER + HER2 negative early BC. The median age was 57.4 years and the median invasive tumor size was 1.7 cm. These patients were classified by ODX testing (Recurrence Score) into low-, intermediate-, and high risk groups, respectively in 27.2%, 63.6% and 9% of cases. Treatment recommendations changed in 18.2%, predominantly from chemotherapyendocrine therapy to endocrine treatment alone. Of 8 patients originally recommended chemotherapy, 25% were recommended endocrine treatment alone after receiving the Recurrence Score result. Conclusions. Though reimbursed by health insurances since January 2015, molecular tests are used moderately in our institution as per the decision of the multidisciplinary tumor board. It's mainly used to obtain a complementary confirmation supporting the decision of no chemotherapy. The OncotypeDx Recurrence Score results were in the intermediate group in 66% of the 9 tested cases but contributed to avoid chemotherapy in 2 patients during the last 12 months.

Belgian experience with triple therapy with boceprevir and telaprevir in genotype 1 infected patients who inject drugs.

No data have been reported yet on treatment outcome in persons who inject drugs (PWID) infected with hepatitis C virus treated with boceprevir or telaprevir in combination with peginterferon (Peg IFN) and ribavirin (RBV). Additionally, there are concerns about the safety of boceprevir and telaprevir in some subgroups of patients with hepatitis C (HCV). In a cohort of HCV patients infected with genotype 1 in Belgium, treatment outcome of patients infected due to IV drug use was analyzed and compared with patients who have no history of substance use. The study population consisted of 179 patients: 78 PWID and 101 controls treated with boceprevir (n = 79) or telaprevir (n = 100) additional to Peg IFN and RBV; 53 (30%) had advanced disease (F3, F4) and 79 (44%) had an antiviral therapy previously. There were no significant differences in the baseline characteristics between both groups, except that PWID patients were more frequently infected with genotype 1a (67% vs 21%), were younger and were predominantly male. Psychiatric complaints during follow-up occurred more frequently in the PWID patients: 24% versus 11% (P = .02). Treatment failure for other reasons than absence of viral response was 70% and 64% in PWID and non-PWID respectively. The sustained viral response (SVR) rates were similar in both groups (71% in PWID vs 72% in non-PWID); with a non-inferiority test with -5% margin there is a difference of -1% (95% CI [-15%, 13%]) and P = 0.30. There are no reasons to exclude PWID from treatment with boceprevir, telaprevir and novel antiviral therapies. J. Med. Virol. 88:94-99, 2016. © 2015 Wiley Periodicals, Inc.

The eTwinning Experience: Beyond the Classroom

The purpose of this paper is to give a presentation of the programme eTwinning, the use of CLIL methodology in eTwinning projects, give a glimpse of a successful project carried out by secondary students and present the future ahead regarding Higher Education. eTwinning offers the suitable environment to use the English language in a “real” context; it can be integrated in any subject due to its cross-curricular nature. In short, it prepares the student for the real world: international research, to get to know other cultures, to communicate and to learn content. I will start by giving a general view of what eTwinning is about. The second part will deal will eTwinning and CLIL. How CLIL methodology fits perfectly in the carrying out of eTwinning projects. In the third part, and drawn from personal experience, a project will be shown: “Addressing the Energy Crunch; Every Little Action Helps” as a good example of how to integrate content-learning in a collaborative project between different schools in Europe. The last part will deal with the future of eTwinning and Higher Education, within the new programme just approved by the European Parliament: Erasmus+ (2014-20).

Elders and the ITCs use to communicate with children and grandchildren

Past research in using ICTs (Information and Communication Technologies) in interpersonal communication showed that age plays an important role. There is a general assumption that the elderly are left behind regarding the adoption and the use of ICTs. Furthermore, elders tend to use ICTs mainly for instrumental purposes and the use is rather non-sophisticated. When elders are using ICTs to maintain their social network, similar patterns could be found: They start using internet, or intensify its use, when their children move abroad while they might decrease using the tool if the motivation ends. In this research we explore elders' incentives to go online and use internet services to communicate; the type of agencies they use to communicate with children and grandchildren abroad; and the situations that make them stop using the ICTs or even reject internet mediated communications. We base our discussion on the empirical evidence the two authors gathered in different cities and countries: Barcelona, Romania, Toronto, Los Angeles, Montevideo and Lima, through semi-structured interviews and observation, with people aged 60 years old and over. The results show that the ability for using ICT tools in an autonomous way is a better explanation than age. In this, we distinguish between assisted users and autonomous users. We found that oldest seniors and those seniors who are less socially active are more likely to be assisted users than those who are socially or professionally active. For them communication with their children and grandchildren abroad follows no agency or it is mediated by significant others from their local social network, who are able to use ICTs and select specific information to share, in the second step, with the elder. For some younger participants the use of ICTs is rather situational and imposed by their children or grandchildren, who installed the tool in the first place and assisted them in using it. Finally, other elders describe a proficient and independent use of ICTs so they use the devices and services the way they want to.We discuss the implications of the patterns in using ICTs, for elders' social life and their relationships with children and grandchildren. First, we emphasis the fact that those elders rejecting the ICTs or being unskilled in using them to communicate might be left out from their family circle, particularly when children are abroad -they would experience more isolation. Second, we underline the fact that when children and grandchildren are the ones that control the ICTs used by their parents and grandparents, they are controlling also the information flow and this will redefine the power relations between elders and their younger relatives.

User Centered Desing in E-Learning Environments : from Usability to Learner Experience

The advent of the Internet had a great impact on distance education and rapidly e-learning has become a killer application. Education institutions worldwide are taking advantage of the available technology in order to facilitate education to a growing audience. Everyday, more and more people use e-learning systems, environments and contents for both training and learning. E-learning promotes educationamong people that due to different reasons could not have access to education: people who could nottravel, people with very little free time, or withdisabilities, etc. As e-learning systems grow and more people are accessing them, it is necessary to consider when designing virtual environments the diverse needs and characteristics that different users have. This allows building systems that people can use easily, efficiently and effectively, where the learning process leads to a good user experience and becomes a good learning experience.

The FaceUOC Project : An Open Social Learning experience by the Open University of Catalonia

The possibilities and expansion of the use of Web 2.0 has opened up a world of possibilities in online learning. In spite of the integration of these tools in education major changes are required in the educational design of instructional processes.This paper presents an educational experience conducted by the Open University of Catalonia using the social network Facebook for the purpose of testing a learning model that uses a participation and collaboration methodology among users based on the use of open educational resources.- The aim of the experience is to test an Open Social Learning (OSL) model, understood to be a virtual learning environment open to the Internet community, based on the use of open resources and on a methodology focused on the participation and collaboration of users in the construction of knowledge.- The topic chosen for this experience in Facebook was 2.0 Journeys: online tools and resources. The objective of this 5 weeks course was to provide students with resources for managing the various textual, photographic, audiovisual and multimedia materials resulting from a journey.- The most important changes in the design and development of a course based on OSL are the role of the teacher, the role of the student, the type of content and the methodology:- The teacher mixes with the participants, guiding them and offering the benefit of his/her experience and knowledge.- Students learn through their participation and collaboration with a mixed group of users.- The content is open and editable under different types of license that specify the level of accessibility.- The methodology of the course was based on the creation of a learning community able to self-manage its learning process. For this a facilitator was needed and also a central activity was established for people to participate and contribute in the community.- We used an ethnographic methodology and also questionnaires to students in order to acquire results regarding the quality of this type of learning experience.- Some of the data obtained raised questions to consider for future designs of educational situations based on OSL:- Difficulties in breaking the facilitator-centred structure- Change in the time required to adapt to the system and to achieve the objectives- Lack of commitment with free courses- The trend to return to traditional ways of learning- Accreditation- This experience has taught all of us that education can happen any time and in any place but not in any way.

Consistency and change in Finnish broadcasting policy : the implementation of digital television and lessons from the Canadian experience

Konsistens och förändring i finländsk etermediapolitik. Implementering av digital television och en jämförelse med Kanada Avhandlingen handlar om hur det finländska televisionssystemet förändrades i slutet av 1990-talet från en nationell institution till ett dualistiskt system som präglas av stark marknadsorientering. Syftet med avhandlingen är att förstå på vilket sätt en så snabb förändring kunde ske och analysera de institutionella faktorerna bakom utvecklingen. På teoretisk nivå diskuteras tesen om det nära sambandet mellan statliga politiska institutioner och rundradioverksamhetens institutioner. Avhandlingen består av två fallstudier. Den första sätter fokus på de första åren av den finländska televisionens digitaliseringsprocess som startade med starka industriell-nationalistiska motiveringar. Analysen, som baserar på offentliga dokument, sträcker sig framtill hösten 2001 då de digitala televisionssändningarna startade och regeringspropositionen om den nya kommunikationsmarknadslagen lämnades till riksdagen. Dessa policy-processer analyseras som en ”marknadisering” av de traditionella styrningsprinciper och idéer gällande finländsk rundradioverksamheten. En jämförelse mellan Finlands och Kanadas nationella rundradiopolitik gör att man kan koppla slutsatserna till den internationella utvecklingen. Jämförelsen visar hur kommunikationspolitiska linjen i de två länderna har kommit att likna varandra trots att ländernas tv-system och deras styrordningar är mycket olika. Exemplet med Kanada visar att den särskilda teknologin inte är viktig utan snarare de kommersiella intressen som står bakom och som beslutsfattare gärna döljer i en nationalistisk retorik. Studien visar att det är viktigt att beakta vilken tyngd man i politiken ger de två sidor som rundradioverksamheten består av: sändningsteknologin och verksamheten som en speciell kulturform. Nationalstatens handlingsutrymme minskar inom fältet om målet är att vara framgångsrik i konkurrensen i den nya internationella ekonomin. Enligt de nyliberalistiska principer som det politiska systemet överlag har tillägnat sig det är önskvärd men också helt inhemska institutionella traditioner och praxis som följdes i den finländska digitaliseringsprocessen främjade utvecklingen som ledde till att nästan alla ursprungliga nationella syften föll sönder.

Experience with an internet-based course for ophthalmology residents

OBJECTIVE: To describe the first experience of an Internet-based course for ophthalmology residents. METHOD: Twenty-three residents were invited to participate in the study; however, only 13 (56.52%) took part, performing the proposed activities and answering a questionnaire. RESULTS: Of the 13 participants, only five (38.46%) completed 100% of the tasks, three (23.07%) completed between 70 and 90%, two (15.38%) completed between 50 and 60% and three (23.07%) completed less than 10% of the tasks. Regarding the use of computers and the Internet in general, all the participants reported using the Internet daily. All of them also affirmed they use the internet to study or to conduct research. CONCLUSION: Despite the advantages of the Internet, medical residents are still very reluctant to its use. Considering the context of information and communication technologies, there is a pressing need to reformulate continuing medical education in order to meet the demand of this new developing world.

Battled nerves : Finnish soldiers' war experience, trauma, and military psychiatry, 1941–44

I min avhandling undersöker jag av kriget framkallade psykiska störningar hos finländska soldater under fortsättningskriget. Vilka var de psykiskt invalidiserade soldaterna och hurudana var deras traumatiska erfarenheter? Vilken var den bredare upplevelsevärlden vid fronten där störningarna uppstod, och hur kan man förklara att majoriteten av soldaterna ändå klarade sig utan mentala rubbningar i denna av våld präglade miljö? Hur förhöll sig Finlands armé i allmänhet och den krigspsykiatri som utvecklades under kriget specifikt till soldaternas psykiska störningar? Som Matti Ponteva redan 1977 utredde, det totala antalet psykiatriska soldatpatienter under fortsättningskriget var ca 15 700 män. I min undersökning betonar jag att den siffran omfattar endast en del av fenomenet: långt ifrån alla finländska soldater som uppvisade psykiska symptom förpassades från fronten i psykiatrisk vård. De finländska psykiatrerna hade före vinterkriget inte kommit i direkt kontakt med av krig orsakade psykiska störningar. Deras kunskaper kom nästan uteslutande från den tyska krigspsykiatrin, där den ledande tanken framför allt efter första världskriget var att förklara psykiska störningar med soldaternas personliga brister och svagheter. Slutligen resonerar jag, varför synen på soldaternas psykiska störningar på ett så markant sätt skilde sig från synen på andra krigsskador. Att soldater stupade eller sårades fysiskt kunde framställas som yttringar av manligt hjältemod och offervillighet. Att brytas ner psykiskt av kriget blev däremot en tom symbol för våldet och saknade annat innehåll än uttryckligen en meningslöshet. Psykiska störningar associerades med ett moraliskt fördömande och ett stigma av skam, och förutom att man tenderade att förneka och marginalisera deras existens försökte man göra en skillnad mellan dem och den egentliga krigsupplevelsen. Det har varit problematiskt att inkludera de psykiskt rubbade soldaterna i den nationella historieskrivningen fram till våra dagar.

Backpacker 2.0 - Contemporary backpackers and their use of social media as an information and communication platform

Long-term independent budget travel to countries far away has become increasingly common over the last few decades, and backpacking has now entered the tourism mainstream. Nowadays, backpackers are a very important segment of the global travel market. Backpacking is a type of tourism that involves a lot of information search activities. The Internet has become a major source of information as well as a platform for tourism business transactions. It allows travelers to gain information very effortlessly and to learn about tourist destinations and products directly from other travelers in the form of electronic word-of-mouth (eWOM). Social media has penetrated and changed the backpacker market, as now modern travelers can stay connected to people at home, read online recommendations, and organize and book their trips very independently. In order to create a wider understanding on modern-day backpackers and their information search and share behavior in the Web 2.0 era, this thesis examined contemporary backpackers and their use of social media as an information and communication platform. In order to achieve this goal, three sub-objectives were identified: 1. to describe contemporary backpacker tourism 2. to examine contemporary backpackers’ travel information search and share behavior 3. to explore the impacts of new information and communications technologies and Web 2.0 on backpacker tourism The empirical data was gathered with an online survey, thus the method of analysis was mainly quantitative, and a qualitative method was used for a brief analysis of open questions. The research included both descriptive and analytical approaches, as the goal was to describe modern-day backpackers, and to examine possible interdependencies between information search and share behavior and background variables. The interdependencies were tested for statistical significance with the help of five research hypotheses. The results suggested that backpackers no longer fall under the original backpacker definitions described some decades ago. Now, they are mainly short-term travelers, whose trips resemble more those of mainstream tourists. They use communication technologies very actively, and particularly social media. Traditional information sources, mainly guide books and recommendations from friends, are of great importance to them but also eWOM sources are widely used in travel decision making. The use of each source varies according to the stage of the trip. All in all, Web 2.0 and new ICTs have transformed the backpacker tourism industry in many ways. Although the experience has become less authentic in some travelers’ eyes, the backpacker culture is still recognizable.

Hacking User Experience in a Repository Service: ScholarSphere as a Case Study

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

Clinical results of the use of mitotane for adrenocortical carcinoma

Mitotane (o,p'-DDD) acts mainly as an inhibitor of intramitochondrial pregnenolone and cortisol synthesis. Its adrenolytic effect depends on metabolic activation due to conversion to o,p'-DDA and o,p'-DDE. The drug has been used for 40 years in the treatment of adrenocortical carcinoma, mainly its regional and metastatic stage, as an adjuvant to surgical resection of the tumor. In the medical literature there are controversial opinions about its efficacy for the treatment of adrenocortical carcinoma. In our experience, mitotane administered immediately after surgery appeared to be much more efficient than when administered later. We have administered this drug in all cases of microscopically confirmed adrenocortical carcinoma, irrespectively of stage at the time of surgery, for fear of a false too optimistic classification. In our series of 82 patients with adrenocortical carcinoma, 59 patients have been treated with mitotane, 32 of them immediately after surgery, and 27 with a delay of 2 to 24 months. Today there are 18 survivors in the group of patients treated with mitotane soon after the operation and only 6 survivors in the group receiving mitotane with a delay. All patients were simultaneously given replacement therapy. Undesired effects of mitotane administration included increased aminotransferase and alkaline phosphatase activity, decreased white cell, platelet or red cell number, and myasthenia. Furthermore, we used mitotane with good results in Cushing's syndrome of non-malignant origin as pre-treatment before surgery or in long-term treatment for patients with poor tolerance of other adrenal inhibitors.

Epidemiological studies in the information and genomics era: experience of the Clinical Genome of Cancer Project in São Paulo, Brazil

Genomics is expanding the horizons of epidemiology, providing a new dimension for classical epidemiological studies and inspiring the development of large-scale multicenter studies with the statistical power necessary for the assessment of gene-gene and gene-environment interactions in cancer etiology and prognosis. This paper describes the methodology of the Clinical Genome of Cancer Project in São Paulo, Brazil (CGCP), which includes patients with nine types of tumors and controls. Three major epidemiological designs were used to reach specific objectives: cross-sectional studies to examine gene expression, case-control studies to evaluate etiological factors, and follow-up studies to analyze genetic profiles in prognosis. The clinical groups included patients' data in the electronic database through the Internet. Two approaches were used for data quality control: continuous data evaluation and data entry consistency. A total of 1749 cases and 1509 controls were entered into the CGCP database from the first trimester of 2002 to the end of 2004. Continuous evaluation showed that, for all tumors taken together, only 0.5% of the general form fields still included potential inconsistencies by the end of 2004. Regarding data entry consistency, the highest percentage of errors (11.8%) was observed for the follow-up form, followed by 6.7% for the clinical form, 4.0% for the general form, and only 1.1% for the pathology form. Good data quality is required for their transformation into useful information for clinical application and for preventive measures. The use of the Internet for communication among researchers and for data entry is perhaps the most innovative feature of the CGCP. The monitoring of patients' data guaranteed their quality.