Poumon et grossesse [Lung and pregnancy].

During pregnancy several adaptations develop in response to the enhanced maternal and fetal metabolic needs. This review summarizes the major cardiorespiratory modifications of pregnancy as well as their consequences in chronic respiratory diseases such as restrictive ventilatory defects (post-tuberculosis pneumonectomy, kyphoscoliosis, neuromuscular disorders), asthma, cystic fibrosis, and pulmonary hypertension. It is important to recognize early the cardiorespiratory situations for which pregnancy is contraindicated or associated with a high risk of respiratory complications. Clinical management by an expert and often pluridisciplinary team is recommended.

Microarray profiling of mononuclear peripheral blood cells identifies novel candidate genes related to chemoradiation response in rectal cancer.

Preoperative chemoradiation significantly improves oncological outcome in locally advanced rectal cancer. However there is no effective method of predicting tumor response to chemoradiation in these patients. Peripheral blood mononuclear cells have emerged recently as pathology markers of cancer and other diseases, making possible their use as therapy predictors. Furthermore, the importance of the immune response in radiosensivity of solid organs led us to hypothesized that microarray gene expression profiling of peripheral blood mononuclear cells could identify patients with response to chemoradiation in rectal cancer. Thirty five 35 patients with locally advanced rectal cancer were recruited initially to perform the study. Peripheral blood samples were obtained before neaodjuvant treatment. RNA was extracted and purified to obtain cDNA and cRNA for hybridization of microarrays included in Human WG CodeLink bioarrays. Quantitative real time PCR was used to validate microarray experiment data. Results were correlated with pathological response, according to Mandard´s criteria and final UICC Stage (patients with tumor regression grade 1-2 and downstaging being defined as responders and patients with grade 3-5 and no downstaging as non-responders). Twenty seven out of 35 patients were finally included in the study. We performed a multiple t-test using Significance Analysis of Microarrays, to find those genes differing significantly in expression, between responders (n = 11) and non-responders (n = 16) to CRT. The differently expressed genes were: BC 035656.1, CIR, PRDM2, CAPG, FALZ, HLA-DPB2, NUPL2, and ZFP36. The measurement of FALZ (p = 0.029) gene expression level determined by qRT-PCR, showed statistically significant differences between the two groups. Gene expression profiling reveals novel genes in peripheral blood samples of mononuclear cells that could predict responders and non-responders to chemoradiation in patients with locally advanced rectal cancer. Moreover, our investigation added further evidence to the importance of mononuclear cells' mediated response in the neoadjuvant treatment of rectal cancer.

The STOP the Bleeding Campaign.

According to the World Health Organization, traumatic injuries worldwide are responsible for over 5 million deaths annually. Post-traumatic bleeding caused by traumatic injury-associated coagulopathy is the leading cause of potentially preventable death among trauma patients. Despite these facts, awareness of this problem is insufficient and treatment options are often unclear. The STOP the Bleeding Campaign therefore aims to increase awareness of the phenomenon of post-traumatic coagulopathy and its appropriate management by publishing European guidelines for the management of the bleeding trauma patient, by promoting and monitoring the implementation of these guidelines and by preparing promotional and educational material, organising activities and developing health quality management tools. The campaign aims to reduce the number of patients who die within 24 hours after arrival in the hospital due to exsanguination by a minimum of 20% within the next 5 years.

Expression profiling of rectal tumors defines response to neoadjuvant treatment related genes.

To date, no effective method exists that predicts the response to preoperative chemoradiation (CRT) in locally advanced rectal cancer (LARC). Nevertheless, identification of patients who have a higher likelihood of responding to preoperative CRT could be crucial in decreasing treatment morbidity and avoiding expensive and time-consuming treatments. The aim of this study was to identify signatures or molecular markers related to response to pre-operative CRT in LARC. We analyzed the gene expression profiles of 26 pre-treatment biopsies of LARC (10 responders and 16 non-responders) without metastasis using Human WG CodeLink microarray platform. Two hundred and fifty seven genes were differentially over-expressed in the responder patient subgroup. Ingenuity Pathway Analysis revealed a significant ratio of differentially expressed genes related to cancer, cellular growth and proliferation pathways, and c-Myc network. We demonstrated that high Gng4, c-Myc, Pola1, and Rrm1 mRNA expression levels was a significant prognostic factor for response to treatment in LARC patients (p<0.05). Using this gene set, we were able to establish a new model for predicting the response to CRT in rectal cancer with a sensitivity of 60% and 100% specificity. Our results reflect the value of gene expression profiling to gain insight about the molecular pathways involved in the response to treatment of LARC patients. These findings could be clinically relevant and support the use of mRNA levels when aiming to identify patients who respond to CRT therapy.

El blog y otras herramientas comunicativas de la biblioteca del Área de Gestión Sanitaria Este de Málaga - Axarquía

In 2006 the Library of the Andalusian Public Health System (BVSSPA) is constituted as a Virtual Library which provides Resources and Services that are accessed through inter-hospital local area network (corporate intranet) and Internet. On the other hand, the Hospital de la Axarquia still did not have any institutional or self-presence on the Internet and the librarian ask the need to create a space for communication with the "digital users" of the Library of the area through a website. MATERIALS AND METHODS. The reasons why we opted for a blog were: -It was necessary to make no financial outlay for its establishment. It allowed for great versatility, both in its administration and in its management by users. -The ability to compile on the same platform different Web 2.0 communication tools. Between different options available we chose Blogger Google Inc. The blog allowed entry to the 2.0 services or Social Web in the library. The benefits offered were many, especially the visibility of the service and communication with the user. 2.0 tools that have been incorporated into the library are: content syndication (RSS) which allowed users to stay informed about updates to the blog. Share documents and other multimedia as presentations through SlideShare, images through Flickr or Picasa, or videos (YouTube). And the presence on social network like Facebook and Twitter. RESULTS. The analysis of the activity we has been traking by Google Analytics tool, helping to determine the number of blog visits. Since its stablishment, on November 17th 2006, until November 29th 2010 the blog has received 15,787 visitors, 38,422 page views were consulted, at each visit on average 2.4 pages were consulted and each visit has an average stay at the site of 4'31''. DISCUSSION. The blog has served as a communication and information tool with the user. Since the creation of the blog we have incorporated technologies and tools to interact with the user. With all the tools used we have applied the concept of "open source" and the contents were generated from the activities organized in the Knowledge Management Unit from the anatomo-clinical sessions, the training activities, dissemination events, etc. The result has been the customization of library services, contextualized in the Knowledge Management Unit - Axarquia. In social networks we have shared information and files with the professionals and the community. CONCLUSIONS. The blog has allowed us to explore technologies that allow us to communicate with the user and the community, disseminate information and documents with the participation of users and become the "Interactive Library" we aspire to be.

Delay for admission of unstable hospitalized patients to intensive care unit: a need for a medical emergency team?

INTRODUCTION. Patients admitted in Intensive Care Unit (ICU) from general wards are more severe and have a higher mortality than those admitted from emergency department as reported [1]. The majority of them develop signs of instability (e.g. tachypnea, tachycardia, hypotension, decreased oxygen saturation and change in conscious state) several hours before ICU admission. Considering this fact and that in-hospital cardiac arrests and unexpected deaths are usually preceded by warning signs, immediate on site intervention by specialists may be effective. This gave an impulse to medical emergency team (MET) implementation, which has been shown to decrease cardiac arrest, morbidity and mortality in several hospitals. OBJECTIVES AND METHODS. In order to verify if the same was true in our hospital and to determine if there was a need for MET, we prospectively collected all non elective ICU admissions of already hospitalized patients (general wards) and of patients remaining more than 3 h in emergency department (considered hospitalized). Instability criteria leading to MET call correspond to those described in the literature. The delay between the development of one criterion and ICU admission was registered. RESULTS. During an observation period of 12 months, 321 patients with our MET criteria were admitted to ICU. 88 patients came from the emergency department, 115 from the surgical and 113 from the medical ward. 65% were male. The median age was 65 years (range 17-89). The delay fromMETcriteria development to ICU admission was higher than 8 h in 155 patients, with a median delay of 32 h and a range of 8.4 h to 10 days. For the remaining 166 patients, an early MET criterion was present up to 8 h (median delay 3 h) before ICU admission. These results are quite concordant with the data reported in the literature (ref 1-8). 122 patients presented signs of sepsis or septic shock, 70 patients a respiratory failure, 58 patients a cardiac emergency. Cardiac arrest represent 5% of our collective of patients. CONCLUSIONS.Similar to others observations, the majority of hospitalized patients admitted on emergency basis in our ICU have warning signs lasting for several hours. More than half of them were unstable for more than 8 h. This shows there is plenty of time for early acute management by dedicated and specialized team such as MET. However, further studies are required to determine if MET implementation can reduce in-hospital cardiac arrests and influence the morbidity, the length of stay and the mortality.

Analysis and evaluation of techniques for the extraction of classes in the ontology learning process

This paper analyzes and evaluates, in the context of Ontology learning, some techniques to identify and extract candidate terms to classes of a taxonomy. Besides, this work points out some inconsistencies that may be occurring in the preprocessing of text corpus, and proposes techniques to obtain good terms candidate to classes of a taxonomy.

Bit loading for MIMO with statistical channel information at the transmitter and ZF receivers

For single-user MIMO communication with uncoded and coded QAM signals, we propose bit and power loading schemes that rely only on channel distribution information at the transmitter. To that end, we develop the relationship between the average bit error probability at the output of a ZF linear receiver and the bit rates and powers allocated at the transmitter. This relationship, and the fact that a ZF receiver decouples the MIMO parallel channels, allow leveraging bit loading algorithms already existing in the literature. We solve dual bit rate maximization and power minimization problems and present performance resultsthat illustrate the gains of the proposed scheme with respect toa non-optimized transmission.

Internet e-ethics in confrontation with an activists' agenda: Yahoo! on trial

A prolonged confrontation between Yahoo! Inc. and French anti-racismactivists who ask for the removal of Nazi items from auction sitesas well as restricted access to neo-Nazis sites is analyzed. We presentthe case and its development up to the decision of Yahoo! Inc. to removethe items from yahoo.com following a French court s verdict against thefirm. Using a business ethics approach, we distinguish the legal,technical, philosophical and managerial issues involved in the case andtheir management by Yahoo! We conclude on the difficulty of governingrelations with society from corporate and legal affairs departments atthe headquarters level, and on the clash of two visions over theregulation of social freedom.

Le syndrome métabolique: des spécialistes au médecin de premier recours [Metabolic syndrome: from specialists to the first aid physician]

Numerous algorithms originating from evidence-based medicine already exist; in spite of this, metabolic syndrome management remains problematical and needs to be improved. Specialists, working interactively and referring to clinical scenarios, pooled their specific areas of expertise in a transverse perspective of the metabolic syndrome management by the primary care physician. This concerted multidisciplinary approach has clearly revealed that a bio-psycho-social approach is absolutely essential in the management of this type of patients.

Rakennusinvestointien käsittelyprosessin tehostaminen

Suomen valtionhallinnon maaliskuussa 2005 julkaisemat tuloksellisuuden tavoitteet koskettavat kaikkia hallinnonaloja. Maa- ja metsätalousministeriön ohjeistamat Työvoima- ja elinkeinokeskusten maaseutuosastot ovat yksikköjä, joita vaikuttavuus- ja tuloksellisuustavoitteet velvoittavat. Tehokasta elintarviketuotantoa ja maatalouden kustannuskehityksen hallintaa voidaan tarkastella kiinteiden tuotannontekijöiden, kuten maatalousrakennusten ja investointituilla tuetun rakentamisen, vaikuttavuuden kautta. Työn tavoitteena oli tehostaa rakennusinvestointien käsittelyprosessia: kehittää sekä tehostamisen menetelmiä että työväline toiminnan ohjaukseen maa- ja metsätalousministeriölle. Ratkaisuja etsittiin teorian ja empirian pohjalta kehitettävien käsitteistöjen ja menetelmien avulla. Teoriaosuudessa haettiin kirjallisuudesta välineitä joilla prosesseja voitaisiin analysoida, mitata ja kehittää. Prosessimallinnukset, Italian vastaavan järjestelmän tutkimus ja Suomen rakennustoimelle tehty kysely muodostavat empiirisen aineiston, jonka perusteella lopulliset tehostamisen keinot ja konstruktiot kehitettiin. Tehostamisen menetelmäksi kehitettiinaluehallinnolle sovellettu suorituskyvyn mittausjärjestelmä, panosprisma. Tuloksellisuus, vaikuttavuus ja laatu riippuvat työn tuottamisen lähtökohdista. Prosessia voidaan tehostaa kiinnittämällä huomiota tulosohjaukseen, asiakirjojen saatavuuteen ja laatuun, neuvonnan oikea-aikaiseen ajoittuvuuteen ja riittävyyteen sekä tietojärjestelmien kehittämiseen. Näiden avulla voidaan saavuttaa käsittelyprosessin aika- ja kustannussäästöjä, tukivarojen käyttöön saaminen ja hyödynnettävyys paranevat ja tukipäätöksen tuottamisen asiakaspalveluprosessi tehostuu.

Muutosjohtaminen liikkeenjohdon konsultointiyrityksissä, Case: Kolme konsultointiyritystä

Tutkielma tutkii konsultointiyritysten harjoittamaa muutosjohtamista. Tutkielman tavoitteena on selvittää millaisia menetelmiä konsultointiyritykset käyttävät muutoksen johtamiseen. Tutkielma esittää organisaatiomuutoksen ilmiönä ja selvittää miten muutosta johdetaan. Tutkielma keskittyy konsultointiyritysten muutoksen johtamisessa käyttämiin muutosmalleihin ja -palveluihin. Tutkimusmetodologiana tutkielmassa käytettiin laadullista tapaustutkimusta ja tutkimusaineistonakonsultointiyritysten internet - sivuja. Tutkielmassa havaittiin kirjallisuudessa esiteltyjen muutosmallien identtisyys konsultointiyritysten käyttämien mallien kanssa. Tutkielman tuloksena luotiin synteesi muutosjohtamisen malleista. Tutkielmassa selvisi myös muutospalveluiden kehittyminen laajaksi, kaikkia palveluita tukevaksi funktioksi liikkeenjohdon konsultointiyrityksissä.

Toimintolaskennan hyödyntäminen Kelan johtamisessa ja toiminnan ohjauksessa

Pro gradu-tutkielman päätavoite on mallintaa toimintolaskennan ja sen tulosten hyödyntämisen mahdollisuuksia Kelan johtamisessa. Tutkielma on empiirinen työ ja sen tutkimusmenetelmänä on case-tutkimus. Tutkielman doktriini koostui eritoten julkishallinnon toimintolaskentaa jatoimintojohtamista koskevasta kirjallisuudesta. Tutkielman empiirinen aineisto kerättiin haastatteluin, dokumentteja tutkimalla sekä havainnoimalla työskentelyä Kelan päätoimitalossa Helsingissä. Tutkielman perusteella Kelalla on laajat mahdollisuudet hyödyntää toimintolaskentaa johtamisessa. Hyödyntämisen mahdollisuudet voidaan ryhmitellä sisäisen laskennan tehtävien mukaisesti. Tehtävät ovat raportointi ulkoisille sidosryhmille ja tiedon tuottaminen strategiseen ja operatiiviseen johtamiseen. Ulkoisiin sidosryhmiin liittyviä mahdollisuuksia ovat tulosten raportointi, rahoituksen uudistaminen, lainmuutoskustannusten arviointi sekä muilta organisaatioilta ja asiakkailta veloitettavien palveluiden hinnoittelu ja hintojen perusteleminen. Strategiseen ohjaukseen liittyviä mahdollisuuksia ovat tulosohjauksen kehittäminen, investointilaskelmat sekä ulkoistamispäätökset. Operatiiviseen ohjaukseen liittyviä mahdollisuuksia ovat puolestaan prosessien analysointi ja kehittäminen, benchmarking, sisäinen hinnoittelu ja tulosten viestiminen henkilöstölle. Sekä strategiseen että operatiiviseen ohjaukseen liittyviä hyödyntämisen mahdollisuuksia ovat resurssien käytönseuranta ja tehostaminen, työn tasauksen kehittäminen sekä suorituksen mittaaminen.

Kehityskeskustelujen kehittäminen ja mandollisuudet Case: Oy Sinebrychoff Ab / Kerava

Tutkielman tarkoituksena on kehittää kehityskeskusteluja ja selvittää niiden mahdollisuudet kiinteänä osana johtamisjärjestelmää. Tutkielman kohdeyritys on Oy Sinebrychoff Ab Keravalla. Tavoitteena on tutkia kehityskeskustelujen toimivuutta eri yritystasoilla, uuden tietokonejärjestelmä Arkin toimivuutta kehityskeskusteluiden työkaluna sekä hankkia kokemuksia kehityskeskusteluiden toimivuudesta ennen ja nyt. Tutkimusmenetelmänä käytettiin kvalitatiivista teemahaastattelua. Haastattelujen suorien lainausten kautta annetaan myös lukijalle mahdollisuus pohtia tutkimusongelmien ratkaisuja. Kehityskeskustelut toimivat vaihtelevasti eri yritystasoilla. Ylempien toimihenkilöiden ja toimihenkilöiden kohdalla kehityskeskustelujen tarkoitus ymmärretään ja sen mahdollisuudettiedostetaan toisin, kun mitä alemmas yritystasoilla mennään. Näissä henkilöstöryhmissä suhtautuminen keskusteluihin haastattelujen perusteella on jonkin verran negatiivisempaa.

On the innovation capacity of technologyrelated knowledge-intensive business services. A case study of the technology and engineering consulting (TEC) sector in Singapore

Even though the research on innovation in services has expanded remarkably especially during the past two decades, there is still a need to increase understanding on the special characteristics of service innovation. In addition to studying innovation in service companies and industries, research has also recently focused more on services in innovation, as especially the significance of so-called knowledge intensive business services (KIBS) for the competitive edge of their clients, othercompanies, regions and even nations has been proved in several previous studies. This study focuses on studying technology-based KIBS firms, and technology andengineering consulting (TEC) sector in particular. These firms have multiple roles in innovation systems, and thus, there is also a need for in-depth studies that increase knowledge about the types and dimensions of service innovations as well as underlying mechanisms and procedures which make the innovations successful. The main aim of this study is to generate new knowledge in the fragmented research field of service innovation management by recognizing the different typesof innovations in TEC services and some of the enablers of and barriers to innovation capacity in the field, especially from the knowledge management perspective. The study also aims to shed light on some of the existing routines and new constructions needed for enhancing service innovation and knowledge processing activities in KIBS companies of the TEC sector. The main samples of data in this research include literature reviews and public data sources, and a qualitative research approach with exploratory case studies conducted with the help of the interviews at technology consulting companies in Singapore in 2006. These complement the qualitative interview data gathered previously in Finland during a larger research project in the years 2004-2005. The data is also supplemented by a survey conducted in Singapore. The respondents for the survey by Tan (2007) were technology consulting companies who operate in the Singapore region. The purpose ofthe quantitative part of the study was to validate and further examine specificaspects such as the influence of knowledge management activities on innovativeness and different types of service innovations, in which the technology consultancies are involved. Singapore is known as a South-east Asian knowledge hub and is thus a significant research area where several multinational knowledge-intensive service firms operate. Typically, the service innovations identified in the studied TEC firms were formed by several dimensions of innovations. In addition to technological aspects, innovations were, for instance, related to new client interfaces and service delivery processes. The main enablers of and barriers to innovation seem to be partly similar in Singaporean firms as compared to the earlier study of Finnish TEC firms. Empirical studies also brought forth the significance of various sources of knowledge and knowledge processing activities as themain driving forces of service innovation in technology-related KIBS firms. A framework was also developed to study the effect of knowledge processing capabilities as well as some moderators on the innovativeness of TEC firms. Especially efficient knowledge acquisition and environmental dynamism seem to influence the innovativeness of TEC firms positively. The results of the study also contributeto the present service innovation literature by focusing more on 'innovation within KIBs' rather than 'innovation through KIBS', which has been the typical viewpoint stressed in the previous literature. Additionally, the study provides several possibilities for further research.