Steroid profiles of professional soccer players: an international comparative study.

BACKGROUND AND OBJECTIVES: Urinary steroid profiling is used in doping controls to detect testosterone abuse. A testosterone over epitestosterone (T/E) ratio exceeding 4.0 is considered as suspicious of testosterone administration, irrespectively of individual heterogeneous factors such as the athlete's ethnicity. A deletion polymorphism in the UGT2B17 gene was demonstrated to account for a significant part of the interindividual variability in the T/E between Caucasians and Asians. Here, the variability of urinary steroid profiles was examined in a widely heterogeneous cohort of professional soccer players. Method: The steroid profile of 57 Africans, 32 Asians, 50 Caucasians and 32 Hispanics was determined by gas chromatography-mass spectrometry. RESULTS: Significant differences have been observed between all ethnic groups. After estimation of the prevalence of the UGT2B17 deletion/deletion genotype (African: 22%; Asian: 81%; Caucasian: 10%; Hispanic: 7%), ethnic-specific thresholds were developed for a specificity of 99% for the T/E (African: 5.6; Asian: 3.8; Caucasian: 5.7; Hispanic: 5.8). Finally, another polymorphism could be hypothesised in Asians based on specific concentration ratio of 5alpha-/5beta-androstane-3alpha,17beta-diol in urine. CONCLUSION: These results demonstrate that a unique and non-specific threshold to evidence testosterone misuse is not fit for purpose. An athlete's endocrinological passport consisting of a longitudinal follow-up together with the ethnicity and/or the genotype would strongly enhance the detection of testosterone abuse. Finally, additional genotyping studies should be undertaken to determine whether the remaining unexplained disparities have an environmental or a genetic origin.

Historia de Vida de Andrés Díaz de Rábago S.J. (1947-1957): O cómo la Guerra Civil China cambió la estructura de la Compañía de Jesús en Asia.

Peer-reviewed

Nouveau regard sur l'information documentaire publique : régulation d'une ressource en émergence dans l'univers des archives, des bibliothèques et de l'administration suisses

Résumé : Ce travail jette un regard nouveau sur l'information documentaire publique. A travers l'analyse des régulations qui régissent l'archivage, la préservation du patrimoine documentaire et la gestion des documents au niveau national en Suisse, il propose en effet l'application d'un concept d'analyse fédérateur, habituellement exploité pour la compréhension du fonctionnement des res¬sources naturelles. Après avoir exposé que la création, la gestion et la préservation de l'information sont historiquement liées à l'exercice du pouvoir, au système politique en place et au développement des technologies de l'information, ce travail montre que - à la suite des importants changements dus au développe¬ment de la société du savoir et des nouvelles technologies de l'information - les politiques concernées en Suisse sont en train de converger. Ce mouve¬ment, signe de la lente reconnaissance de l'existence d'une ressource unique, va de pair avec le développement d'un système de règles. Cette ressource, désignée par le terme générique d'information, est en train de devenir un enjeu politique et économique fondamental : comme les ressources natu¬relles, elle exige de la part des acteurs publics une prise en charge appropriée afin d'assurer sa durabilité - c'est-à-dire sa capacité de renouvellement - en régulant les rivalités entre usages compétitifs, qui risquent de mettre cette ressource en péril. Ainsi, par l'application d'un modèle d'analyse appelé Régime institutionnel des ressources (RIR), ce travail évalue la durabilité de la ressource information en vérifiant l'existence et la mise en oeuvre de règles pour cha¬cun des usages identifiés de cette ressource. A partir des huit études de cas (consacrées aux archives d'Etat, aux Helvetica, aux données météoro¬logiques et climatologiques, aux données statistiques, aux données d'observation des sols, aux données de la mensuration officielle, aux don¬nées d'état civil et aux données de la taxe sur la valeur ajoutée), notre analyse qualitative montre que, si la durabilité de la ressource est assurée à court terme, elle ne l'est pas sur le long terme. En effet, en dépit des progrès significatifs qui ont été faits ces dernières années, notamment en termes de gestion des documents, le régime institu¬tionnel de la ressource information présente des failles : les principales rivalités existantes ne sont pas contrôlées par des régulations spécifiques. Ainsi, l'identification des informations disponibles, la traçabilité de celles-ci, la sélection de celles qu'il convient de préserver à long terme et, enfin, leur conservation physique continueront à poser problème à l'avenir. Le document se clôt sur l'encouragement à poursuivre les travaux scienti¬fiques et politiques dans ce domaine, dans le but de bénéficier enfin d'une compréhension plus approfondie des mécanismes qui le régissent.

Growth, Democracy, and Civil War

Does economic growth affect the likelihood of civil war? Answering this question requires dealing with reverse causation. Our approach exploits that international commodity prices have a significant effect on the income growth of Sub-Saharan African countries. We show that lower income growth makes civil war more likely in non-democracies. This effect is significantly weaker in democracies; as a result, we find no link between growth and civil war in these countries. Our reducedform results also indicate that lower international commodity price growth has no effect on civil war in democracies, but raises the likelihood of civil war incidence and onset in nondemocracies.

STRATEGIES TO SURPASS THE VULNERABILITY OF THE SMALL ISLAND STATES WITH FEW RESOURCES: THE CASE OF CAPE VERDE

The problem of small Island Developing States (SIDS) is quite recent, end of the 80s and 90s, still looking for a theoretical consolidation. SIDS, as small states in development, formed by one or several islands geographically dispersed, present reduced population, market, territory, natural resources, including drinkable water, and, in great number of the cases, low level of economic activity, factors that together, hinder the gathering of scale economies. To these diseconomies they come to join the more elevated costs in transports and communications which, allies to lower productivities, to a smaller quality and diversification of its productions, which difficult its integration in the world economy. In some SIDS these factors are not dissociating of the few investments in infrastructures, in the formation of human resources and in productive investments, just as it happens in most of the developing countries. In ecological terms, many of them with shortage of natural resources, but integrating important ecosystems in national and world terms, but with great fragility relatively to the pollution action, of excessive fishing, of uncontrolled development of tourism, factors that, conjugated and associated to the stove effect, condition the climate and the slope of the medium level of the sea water and therefore could put in cause the own survival of some of them. The drive to the awareness of the international community towards its problems summed up with the accomplishment by the United Nations in the Barbados’s Conference, 1994 where the right to the development was emphasized, through the going up the appropriate strategies and the Programme of Action for the Sustainable Development of the SIDS. The orientation of the regional and international cooperation in that sense, sharing technology (namely clean technology and control and administration environmental technology), information and creation of capacity-building, supplying means, including financial resources, creating non discriminatory and just trade rules, it would drive to the establishment of a world system economically more equal, in which the production, the consumption, the pollution levels, the demographic politics were guided towards the sustainability. It constituted an important step for the recognition for the international community on the specificities of those states and it allowed the definition of a group of norms and politics to implement at the national, regional and international level and it was important that they continued in the sense of the sustainable development. But this Conference had in its origin previous summits: the Summit of Rio de Janeiro about Environment and Development, accomplished in 1992, which left an important document - the Agenda 21, in the Conference of Stockholm at 1972 and even in the Conference of Ramsar, 1971 about “Wetlands.” CENTRO DE ESTUDOS AFRICANOS Occasional Papers © CEA - Centro de Estudos Africanos 4 Later, the Valletta Declaration, Malta, 1998, the Forum of Small States, 2002, get the international community's attention for the problems of SIDS again, in the sense that they act to increase its resilience. If the definition of “vulnerability” was the inability of the countries to resist economical, ecological and socially to the external shocks and “resilience” as the potential for them to absorb and minimize the impact of those shocks, presenting a structure that allows them to be little affected by them, a part of the available studies, dated of the 90s, indicate that the SIDS are more vulnerable than the other developing countries. The vulnerability of SIDS results from the fact the they present an assemblage of characteristics that turns them less capable of resisting or they advance strategies that allow a larger resilience to the external shocks, either anthropogenic (economical, financial, environmental) or even natural, connected with the vicissitudes of the nature. If these vulnerability factors were grouped with the expansion of the economic capitalist system at world level, the economic and financial globalisation, the incessant search of growing profits on the part of the multinational enterprises, the technological accelerated evolution drives to a situation of disfavour of the more poor. The creation of the resilience to the external shocks, to the process of globalisation, demands from SIDS and of many other developing countries the endogen definition of strategies and solid but flexible programs of integrated development. These must be assumed by the instituted power, but also by the other stakeholders, including companies and organizations of the civil society and for the population in general. But that demands strong investment in the formation of human resources, in infrastructures, in investigation centres; it demands the creation capacity not only to produce, but also to produce differently and do international marketing. It demands institutional capacity. Cape Verde is on its way to this stage.

Estimating the effect of transitory economic shocks on civil conflict

This note tries to clarify some remaining issues in the debate on the effect of income shocks oncivil conflict. Section 1 discusses the discrepant findings on the effect of rainfall shocks oncivil conflict in Miguel and Satyanath (2010, 2011) and Ciccone (2011). Section 2 develops aninstrumental variables approach to estimate the effect of transitory (rainfall-driven) incomeshocks on civil conflict and contrasts the conclusions with those of Miguel, Satyanath, andSergenti (2004) and Miguel and Satyanath (2010, 2011). Throughout, the note uses the data ofMiguel, Satyanath, and Sergenti to focus on the methodological issues at the core of the debate(for results using the latest data see Ciccone, 2011).

The aftermath of Civil War

Using an event-study methodology, this paper analyzes the aftermath of civil war in a cross-section of countries. It focuses on those experiences where the end of conflict marks the beginning of a relatively lasting peace. The paper considers 41 countries involved in internal wars in the period 1960-2003. In order to provide a comprehensive evaluation of the aftermath of war, the paper considers a host of social areas represented by basic indicators of economic performance, health and education, political development, demographic trends, and conflict and security issues. For each of these indicators, the paper first compares the post- and pre-war situations and then examines their dynamic trends during the post-conflict period. It conducts this analysis both in absolute and relative terms, the latter in relation to control groups of otherwise similar countries. The paper concludes that, even though war has devastating effects and its aftermath can be immensely difficult, when the end of war marks the beginning of lasting peace, recovery and improvement are indeed achieved.

The colonial origins of Civil War

The dominant hypothesis in the literature that studies conflict is that poverty is the main cause of civil wars. We instead analyze the effect of institutions on civil war, controlling for income per capita. In our set up, institutions are endogenous and colonial origins affect civil wars through their legacy on institutions. Our results indicate that institutions, proxied by the protection of property rights, rule of law and the efficiency of the legal system, are a fundamental cause of civil war. In particular, an improvement in institutions from the median value in the sample to the 75th percentile is associated with a 38 percentage points reduction in the incidence of civil wars. Moreover, once institutions are included as explaining civil wars, income does not have any effect on civil war, either directly or indirectly.

Effects of a treatment gap during adjuvant chemotherapy in node-positive breast cancer: results of International Breast Cancer Study Group (IBCSG) Trials 13-93 and 14-93.

BACKGROUND: The International Breast Cancer Study Group (IBCSG) conducted two complementary randomized trials to assess whether a treatment-free gap during adjuvant chemotherapy influenced outcome. PATIENTS AND METHODS: From 1993 to 1999, IBCSG Trials 13-93 and 14-93 enrolled 2215 premenopausal and postmenopausal women with axillary node-positive, operable breast cancer. All patients received cyclophosphamide (Cytoxan, C) plus either doxorubicin (Adriamycin, A) or epirubicin (E) for four courses followed immediately (No Gap) or after a 16-week delay (Gap) by classical cyclophosphamide, methotrexate, and fluorouracil (CMF) for three courses. The median follow-up was 7.7 years. RESULTS: The Gap and No-Gap groups had similar disease-free survival (DFS) and overall survival (OS). No identified subgroup showed a statistically significant difference, but exploratory subgroup analysis noted a trend towards decreased DFS for Gap compared with No Gap for women with estrogen receptor (ER)-negative tumors not receiving tamoxifen, especially evident during the first 2 years. CONCLUSIONS: A 16-week gap between adjuvant AC/EC and CMF provided no benefit and may have increased early recurrence rates in patients with ER-negative tumors.

Economic shocks and civil conflict: A comment

Miguel, Satyanath, and Sergenti (2004) argue that lowerrainfall levels and negative rainfall shocks increase conflictrisk in Sub-Saharan Africa. This conclusion rests on theirfinding of a negative correlation between conflict in t andrainfall growth between t-1 and t-2. I argue that this findingis driven by a positive correlation between conflict in t andrainfall levels in t-2. If lower rainfall levels or negativerainfall shocks increased conflict, one might have expectedMSS s finding to reflect a negative correlation betweenconflict in t and rainfall levels in t-1. In the latest data,conflict is unrelated to rainfall.

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.

OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the GRADE system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost), or clearly do not. Weak recommendations indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include: early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures prior to antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for post-operative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B) targeting a blood glucose < 150 mg/dL after initial stabilization ( 2C ); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper GI bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include: greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSION: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.

A reflection about the social and technological aspects in flood risk management - the case of the Italian Civil Protection

The right of a person to be protected from natural hazards is a characteristic of the social and economical development of the society. This paper is a contribution to the reflection about the role of Civil Protection organizations in a modern society. The paper is based in the inaugural conference made by the authors on the 9th Plinius Conference on Mediterranean Storms. Two major issues are considered. The first one is sociological; the Civil Protection organizations and the responsible administration of the land use planning should be perceived as reliable as possible, in order to get consensus on the restrictions they pose, temporary or definitely, on the individual free use of the territory as well as in the entire warning system. The second one is technological: in order to be reliable they have to issue timely alert and warning to the population at large, but such alarms should be as "true" as possible. With this aim, the paper summarizes the historical evolution of the risk assessment, starting from the original concept of "hazard", introducing the concepts of "scenario of event" and "scenario of risk" and ending with a discussion about the uncertainties and limits of the most advanced and efficient tools to predict, to forecast and to observe the ground effects affecting people and their properties. The discussion is centred in the case of heavy rains and flood events in the North-West of Mediterranean Region.

Determination of testosterone misuse in sport, an international comparative study

Introduction: Urinary steroid profiling is used in doping controls to detect testosterone abuse. A testosterone over epitestosterone (T/E) ratio exceeding 4.0 is considered as suspicious of testosterone administration, irrespectively of individual heterogeneous factors such as the athlete's ethnicity. A deletion polymorphism in the UGT2B17 gene was demonstrated to account for a significant part of the inter-individual variability in the T/E between Caucasians and Asians. However, the anti-doping strategy includes the determination of carbon isotope ratio on androgen metabolites which has been demonstrated to be reliable for the direct detection of testosterone misuse. Herein, we examined the profiles and the variability in the 13C/12Cratios of urinary steroids in a widely heterogeneous cohort of professional soccer players residing in different world countries (Argentina, Italy, Japan, South-Africa, Switzerland and Uganda). Aim: The determination of threshold values based on genotype information and diet specific of the ethnicity is expected to enhance significantly the detection of testosterone misuse. Methods: The steroid profile of 57 Africans, 32 Asians, 50 Caucasians and 32 Hispanics was determined by gas chromatography-mass spectrometry. The carbon isotope ratio of selected androgens in urine specimens were determined by means of gas chromatography/combustion/isotope ratio mass spectrometry (GC-C-IRMS). Results: Significant differences have been observed between all ethnic groups. After estimation of the prevalence of the UGT2B17 deletion/deletion genotype (African:22%; Asian:81%; Caucasian:10%; Hispanic:7%), ethnicspecific thresholds were developed for a specificity of 99% for the T/E (African:5.6; Asian:3.8; Caucasian:5.7; Hispanic:5.8). Italian and Swiss populations recorded an enrichment in 13C of the urinary steroids with respect to the other groups, thereby supporting consumption of a relatively larger proportion of C3 plants in their diet. Noteworthy, detection criteria based on the difference in the carbon isotope ratio of androsterone and pregnanediol for each population were well below the established threshold value for positive cases. Conclusion: These profiling results demonstrate that a unique and nonspecific threshold to evidence testosterone misuse is not fit for purpose. In addition, the carbon isotopic ratio from these different diet groups highlight the importance to adapt the criteria for increasing the sensitivity in the detection of exogenous testosterone. In conclusion, it may be emphasized that combining the use of isotope ratio mass spectrometry including refined interpretation criteria for positivity and the subject-based profiling of steroids will most probably improve the efficiency of the confirmatory test.

International Standardisation and Local Participatory Dynamics : The INTERNORM Project

This paper presents a pilot project (INTERNORM) funded by the University of Lausanne (2010 - 2013) to support the involvement of civil society organisations (CSO) in international standard setting bodies such as the ISO. It analyses how a distinct participatory mechanism can influence the institutional environment of technical diplomacy in which standards are shaped. The project is an attempt to respond to the democratic deficit attested in the field of international standardisation, formally open to civil society participation, but still largely dominated by expert knowledge and market players. Many international standards have direct implications on society as a whole, but CSOs (consumers and environmental associations, trade unions) are largely under-represented in negotiation arenas. The paper draws upon international relations literature on new institutional forms in global governance and studies of participation in science and technology. It argues that there are significant limitations to the rise of civil society participation in such global governance mechanisms. The INTERNORM project has been designed as a platform of knowledge exchange between CSO and academic experts, with earmarked funding and official membership to a national standardisation body. But INTERNORM cannot substitute for a long- established lack of resources in time, money and expertise of CSOs. Despite high entry costs into technical diplomacy, participation thus appears as less a matter of upstream engagement, or of procedure only, than of dedicated means to shift the geometry of actors and the framing of socio-technical change.