Proliferation capacity and cytotoxic activity are mediated by functionally and phenotypically distinct virus-specific CD8 T cells defined by interleukin-7R{alpha} (CD127) and perforin expression.

Cytotoxicity and proliferation capacity are key functions of antiviral CD8 T cells. In the present study, we investigated a series of markers to define these functions in virus-specific CD8 T cells. We provide evidence that there is a lack of coexpression of perforin and CD127 in human CD8 T cells. CD127 expression on virus-specific CD8 T cells correlated positively with proliferation capacity and negatively with perforin expression and cytotoxicity. Influenza virus-, cytomegalovirus-, and Epstein-Barr virus/human immunodeficiency virus type 1-specific CD8 T cells were predominantly composed of CD127(+) perforin(-)/CD127(-) perforin(+), and CD127(-)/perforin(-) CD8 T cells, respectively. CD127(-)/perforin(-) and CD127(-)/perforin(+) cells expressed significantly more PD-1 and CD57, respectively. Consistently, intracellular cytokine (gamma interferon, tumor necrosis factor alpha, and interleukin-2 [IL-2]) responses combined to perforin detection confirmed that virus-specific CD8 T cells were mostly composed of either perforin(+)/IL-2(-) or perforin(-)/IL-2(+) cells. In addition, perforin expression and IL-2 secretion were negatively correlated in virus-specific CD8 T cells (P < 0.01). As previously shown for perforin, changes in antigen exposure modulated also CD127 expression. Based on the above results, proliferating (CD127(+)/IL-2-secreting) and cytotoxic (perforin(+)) CD8 T cells were contained within phenotypically distinct T-cell populations at different stages of activation or differentiation and showed different levels of exhaustion and senescence. Furthermore, the composition of proliferating and cytotoxic CD8 T cells for a given antiviral CD8 T-cell population appeared to be influenced by antigen exposure. These results advance our understanding of the relationship between cytotoxicity, proliferation capacity, the levels of senescence and exhaustion, and antigen exposure of antiviral memory CD8 T cells.

Long-term health-related quality of life and walking capacity of lung recipients with and without bronchiolitis obliterans syndrome.

BACKGROUND: Outcome after lung transplantation (LTx) is affected by the onset of bronchiolitis obliterans syndrome (BOS) and lung function decline. Reduced health-related quality of life (HRQL) and physical mobility have been shown in patients developing BOS, but the impact on the capacity to walk is unknown. We aimed to compare the long-term HRQL and 6-minute walk test (6MWT) between lung recipients affected or not by BOS Grade > or =2. METHODS: Fifty-eight patients were prospectively followed for 5.6 +/- 2.9 years after LTx. Assessments included the St George's Respiratory Questionnaire (SGRQ) and the 6MWT, which were performed yearly. Moreover, clinical complications were recorded to estimate the proportion of the follow-up time lived without clinical intercurrences after transplant. Analyses were performed using adjusted linear regression and repeated-measures analysis of variance. RESULTS: BOS was a significant predictor of lower SGRQ scores (p < 0.01) and reduced time free of clinical complications (p = 0.001), but not of 6MWT distance (p = 0.12). At 7 years post-transplant, results were: 69.0 +/- 21.8% vs 86.9 +/- 5.6%, p < 0.05 (SGRQ); 58.5 +/- 21.6% vs 88.7 +/- 11.4%, p < 0.01 (proportion of time lived without clinical complications); and 82.2 +/- 10.9% vs 91.9 +/- 14.2%, p = 0.27 (percent of predicted 6MWT), respectively, for patients with BOS and without BOS. CONCLUSIONS: Despite significantly less time lived without clinical complications and progressive decline of self-reported health status, the capacity to walk of patients affected by BOS remained relatively stable over time. These findings may indicate that the development of moderate to severe BOS does not prevent lung recipients from walking independently and pursuing an autonomous life.

Acute Hospital Bed Capacity - A National Review

The Programme for Prosperity and Fairness outlined the commitment of the Government to a review of hospital bed capacity in both acute and non-acute settings, to be carried out by the Department of Health and Children in conjunction with the Department of Finance and in consultation with the Social Partners. The focus of this report is on bed capacity in publicly-funded acute hospitals in Ireland. The capacity needs of the sub-acute sector have been assessed separately in the context of the Health Strategy, Quality and Fairness: A Health System for You. Download document here

Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome

La teràpia suplementària de ferro millora la capacitat d’exercici i la qualitat de vida en malalts amb una cardiopatia congènita cianòtica i/ o síndrome d’Eisenmenger El dèficit de ferro és una troballa comú en la cardiopatia congènita cianòtica, i pot ser la causa d’una reducció en la capacitat d’exercici. Actualment, està indicada la reposició dels dipòsits de ferro en aquest grup de malalts, éssent les evidències científiques escasses. En el present treball investiguem la seguretat i eficàcia del tractament amb ferro en malalts amb una cardiopatia congènita cianòtica. Per tal motiu, vint-i-cinc malalts amb una cardiopatia congenita cianòtica i dèficit de ferro van ser inclosos de forma prospectiva entre Agost del 2008 i Gener del 2009. El tractament utilitzat fou fumarat ferròs oral, fins a una dosi màxima de 200 mg tres vegades al dia. En l’anàlisi basal i als tres mesos de seguiment es va utilitzar el test de qualitat de vida “CAMPHOR”, el test de la marxa dels 6 minuts i la prova d’esforç amb consum d’oxigen. L’edat mitja fou 39.9+/-10.9 anys, 80% dones. Catorze malalts tenien la síndrome d’Eisenmenger, sis una malaltia cianòtica complexa i cinc circulació de Fontan. Cap d’ells va haver d'interrompre el tractament degut a efectes adversos. Després de tres mesos de tractament, l’hemoglobina (19.0+/-2.9g/dL a 20.4+/-2.7g/dL, p&0.001), ferritina (13.3+/-4.7mug/L a 54.1+/-24.2mug/L, p&0.001) i saturació de transferrina (17.8+/-9.6% a 34.8+/-23.4%, p&0.001) van augmentar significativament. També hi va haver una millora significativa en la puntuació del test de qualitat de vida (20.7+/-10.9 a 16.2+/-10.4, p=0.001) i el test de la marxa (371.7+/-84.7m a 402.8.0+/-74.9m, p=0.001). No es van evidenciar canvis significatius en els valors de consum d’oxigen (40.7+/-9.2% a 43.8+/-12.4%, p=0.15). En definitiva, la teràpia suplementària amb ferro en els malats amb una cardiopatia congènita cianòtica i dèficit de ferro és segura i millora la qualitat de vida i la capacitat funcional. En aquest grup de malalts, per tant, és aconsellable identificar el dèficit de ferro i restaurar-ne els seus dipòsits.

Assessment of the capacity to consent to treatment in patients admitted to acute medical wards

RAPPORT DE SYNTHÈSE : Introduction: L'évaluation de la capacité de discernement est importante d'un point de vue légal et éthique dans l'activité médicale quotidienne. Dans cette étude, nous avons évalué attentivement la capacité de discernement chez les patients admis dans un service médical aigu en utilisant l'évaluation du personnel médical, le score spécifique de Silberfeld, le MMSE ainsi que l'évaluation du psychiatre. Méthode : Pendant 3 mois, 195 patients admis dans un service de médecine interne d'un hôpital universitaire ont été inclus et leur capacité de discernement a été évaluée durant les premières 72 heures d'admission. Résultats : Sur les 195 patients, 38 furent incapables de discernement manifestement (patients inconscients ou avec des déficits cognitifs sévères) et 14 furent considérés incapables de discernement par le psychiatre (prévalence de l'incapacité de discernement de 26.7%). La corrélation entre l'évaluation du psychiatre et le questionnaire de Silberfeld fut faible (sensibilité 35.7%, spécificité 91.6%). Les cliniciens expérimentés montrèrent une plus haute corrélation (sensibilité 57.1 %, spécificité 96.5%). L'avis partagé par l'assistant, par le chef de clinique et l'infirmière se révéla le meilleur indicateur de l'évaluation psychiatrique (sensibilité 78.6%, spécificité 94.3%). Conclusion : La prévalence de l'incapacité de discernement chez les patients admis dans un service de médecine interne est élevée. Alors que le questionnaire de Silberfeld et le MMSE ne sont pas indiqués pour évaluer la capacité de discernement dans cette étude, l'évaluation par une équipe médicale multidisciplinaire reflète le mieux l'évaluation du psychiatre.

Future Dementia Care in Ireland: Sharing the Evidence to Mobilise Action

A major challenge facing societies across the world today is population ageing. The fact that people are living longer and the notable improvements in the overall quality of life and well-being of older people today needs to be celebrated. However, population ageing will inevitably result in an increase in disability and a very significant increase in the incidence of age-related health problems especially Alzheimer's disease and the related dementias. Click here to download PDF 2.5mb

When Cooperation Stumbles: the effects of grades on indicators of cooperation

(English Abstract) In western societies, grades are to date the most widespread means by which achievement and performance are assessed in educational contexts. Grades are used for their capacity to provide individuals with a clear indicator of success or failure, in particular in comparison to others; in this respect, we study their impact on particular work contexts requiring cooperation. Indeed, students are often exhorted to cooperate and work in groups, while at the same time assessed with grades and focused on inter-individual comparison. However, to the best of our knowledge, no work has investigated the effects of grades on cooperation and on indicators of cooperation, a central question to be addressed given its significance for educational trends encouraging cooperative practices, and which we propose to explore in the experimental parts of this thesis. The first experimental chapter, Chapter 4, investigates the effect of grades with regards to their capacity to highlight individual visibility and at the same time social comparison. It tries to disentangle which of these facets could affect a motivated bias likely to reduce cooperation, namely individuals' preference for information confirming their own choice. In two experiments, results showed that a graded-cooperative situation increased this preference effect in comparison to other conditions where only individual visibility was manipulated, and furthermore increased individuals' perception of a competitive atmosphere. Chapter 5 investigates the effect of grades on direct cooperative inter- individual interactions, namely on group information sharing. Two experiments showed that grades hindered informational communication between individuals, leading them to withhold crucial task-information. Finally, Chapter 6 investigates the effects of grades on another indicator of group cooperation, namely inter-individual coordination. Results indicated that showcasing grades at the onset of a cooperative task necessitating inter-individual coordination decreased group performance and elicited more negative dominant behaviours amongst participants. Together these results provide evidence that grades hamper group cooperation. We conclude by discussing implications for the practice of grading in Education. ------------------------------------------------------- (Résumé en langue française) Dans la plupart des pays occidentaux, les notes sont majoritairement utilisées pour évaluer la performance et rendre compte de la réussite scolaire des individus. Dans cette perspective, elles sont non seulement un indicateur de succès ou d'échec, mais aussi de la valeur comparative des individus. Dans cette thèse nous proposons de tester l'effet des notes lorsque celles-ci sont utilisées dans des contextes bien spécifiques de coopération. En effet, si les notes et la comparaison sociale sont pratique courante, les étudiants sont souvent encouragés et amenés à coopérer en groupe. Cependant, à notre connaissance, point d'études ont testé l'effet des notes sur la coopération; études qui seraient pourtant légitimes étant donné la tendance existante en milieu éducatif à encourager les pratiques coopératives. C'est précisément ce que proposent de faire les chapitres expérimentaux de cette thèse. Le premier (Chapitre 4) teste l'effet des notes au regard de leur capacité à accentuer à la fois la visibilité et la comparaison sociale. Deux expériences investiguent l'effet des notes et tentent de démêler ce qui, de la visibilité individuelle, de la comparaison sociale ou des deux, pourrait affecter un biais motivationnel qui réduit la propension à coopérer: la propension à préférer les informations qui confirment les choix de l'individu. Les résultats montrent qu'en situation coopérative, les notes accroissent ce biais comparativement à des situations où seule la visibilité individuelle est soulignée, suggérant de plus que les notes produisent une focalisation des individus sur une comparaison sociale compétitive. Le second (Chapitre 5) teste l'effet des notes sur les interactions coopératives des individus, précisément sur le partage d'information. Deux expériences montrent que dans un contexte de travail en groupe coopératif, les notes entravent le bon partage des informations entre individus, les amenant à faire de la rétention d'information. Enfin, le troisième (Chapitre 6) investigue l'effet des notes sur un autre indicateur de coopération en groupe: la coordination interindividuelle. Les résultats montrent que les notes réduisent la coordination des individus et les mènent à avoir des comportements de dominance négative entre eux. En somme, les notes entravent la coopération et réduisent les comportements coopératifs entre individus. Enfin, nous discutons des implications pour le milieu éducatif.

Triatoma rubrovaria (Blanchard, 1843) (Hemiptera - Reduviidae - Triatominae) IV: bionomic aspects on the vector capacity of nymphs

Triatoma rubrovaria has become the most frequently captured triatomine species since the control of T. infestans in the state of Rio Grande do Sul (RS), Brazil. The aim of this study was to evaluate aspects of the vectorial competence of T. rubrovaria using nymphs raised in laboratory under environmental conditions of temperature and humidity and fed on mice. The average developmental period of T. rubrovaria was 180.1 days. The percentage of defecation shortly after feeding was still higher than previous studies in which samples of T. rubrovaria subjected to a slight starvation period before the blood meal were used. The obtained results support former indication that T. rubrovaria presents bionomic characteristics propitious to be a good vector of Trypanosoma cruzi to man. Therefore its domiciliary invasion process must be continuously monitored.

Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarters 1 to 3 2009/10

Hospitals and care homes are making use of new measures designed to protect people unable to give consent for their care.The Mental Capacity Act Deprivation of Liberty Safeguards were introduced by law on 1 April 2009 to provide a legal framework for depriving someone of their liberty where they are unable to give informed consent regarding their care. The statistics presented here provide the first official information about authorisations to legally detain a person using the legislation.The safeguards apply to people aged 18 and above who suffer from a mental disorder of the mind (such as dementia or a profound learning disability) and who lack capacity to give consent to the arrangements made for their care and / or treatment. The safeguards cover people in all hospitals and care homes in the statutory, independent and voluntary sectors.A rigorous, standardised assessment and authorisation process is used to ensure only appropriate use is made of the safeguards.Key facts?The number of authorisation requests were: 1,772 in quarter 1 1,681 in quarter 2 and, 1,869 in quarter 3. ?Of the total assessments completed in each quarter, a higher proportion were for females than for males ?For each quarter, around three out of four assessments were made by local authorities while the remaining ones were made by primary care trusts. ?The percentage of authorisations granted leading to someone being deprived of their liberty varied between 33.5 per cent and 50.7 per cent across quarters 1 to 3. ?At 31 December 2009 1,074 people were subject to such authorisations.Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarter 1 (0.31MB)Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarter 2 (0.31MB)Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarter 3 (0.31MB)Have your say - give us your comments on this publication��

Regional guidelines for nurses when sharing information with NIGALA

Effective safeguarding children practice depends upon information sharing, collaboration and understanding between families, agencies and professionals. Nurses are required to work in partnership with other disciplines and agencies to safeguard and promote the health and wellbeing of children and young people. This includes working in partnership with the guardian ad litem (guardian) appointed by the court when making decisions regarding the best interests of a child or young person.This guidance replaces previous regional guidance. Regional implementation will ensure that information held by nurses is shared with the guardian in a consistent, timely and appropriate manner, so that informed decisions can be made in the best interests of children and young people.

Pédiatrie. 5. Le partage de l'information médicale en 2012 [Pediatrics. Sharing of the medical letter with the patient].

Some paediatrics centres routinely send the medical consultation letter not only to the primary or referring physician but to the patient and his/her family as well. This way of sharing medical information is appreciated not only by the patients themselves but also by a majority of physicians.

Building Capacity in Developing Countries : OER for Food Safety

The Food Safety Knowledge Network (FSKN) was developed through the collaboration of Michigan State University and a professional network of international food industry retailers and manufacturers. The key objective of the FSKN project is to provide technical resources, in a cost effective way, in order to promote food safety in developing countries and for small and less developed companies. FSKN uses a competency based model including a framework, OERs, and assessments. These tools are being used to support face-to-face training, fully online training, and to gauge the learning outcomes of a series of pilot groups which were held in India, Egypt, and China.

How to foster sharing of educational resources?

The future of OER is highly dependent on the future of education in general. A future that will be determined by major changes in society that demand more people with a higher education and life long learning. Each vision for the long term future needs to take the qualitative and quantitative demands into account. Backcasting from a vision we arrive at useful steps to take, some of which we managed to start up in the form of pilots as part of the European research project Share.TEC.

TwHistory : Sharing History Using Twitter

In light of the fact that several studies indicate that students can benefit from deeper understandings of the processes by which historical accounts are constructed, history educators have increasingly been focused on finding ways to teach students how to read and reason about events in the same manner as professional historians (Wineburg, 2001; Spoehr & Spoehr, 1994; Hynd, Holschuh, & Hubbard, 2004; Wiley & Voss, 1996). One possible resource for supporting this development may come out of emerging web-based technologies. New technologies and increased access to historical records and artifacts posted the Internet may be precisely the tools that can help students (Bass, Rosenzweig, & Mason, 1999). Given the right context, we believe it is possible to combine such resources and tools to create an environment for students that could strengthen their abilities to read and reason about historical events. Moreover, we believe that social media, specifically, microblogging (Nardi, Schiano, Gumbrecht, & Swartz, 2004) could play a key role.

Resource dimensioning aspect of heterogeneous traffic with different service requirements: Integration versus segregation

In this paper, we consider the ATM networks in which the virtual path concept is implemented. The question of how to multiplex two or more diverse traffic classes while providing different quality of service requirements is a very complicated open problem. Two distinct options are available: integration and segregation. In an integration approach all the traffic from different connections are multiplexed onto one VP. This implies that the most restrictive QOS requirements must be applied to all services. Therefore, link utilization will be decreased because unnecessarily stringent QOS is provided to all connections. With the segregation approach the problem can be much simplified if different types of traffic are separated by assigning a VP with dedicated resources (buffers and links). Therefore, resources may not be efficiently utilized because no sharing of bandwidth can take place across the VP. The probability that the bandwidth required by the accepted connections exceeds the capacity of the link is evaluated with the probability of congestion (PC). Since the PC can be expressed as the CLP, we shall simply carry out bandwidth allocation using the PC. We first focus on the influence of some parameters (CLP, bit rate and burstiness) on the capacity required by a VP supporting a single traffic class using the new convolution approach. Numerical results are presented both to compare the required capacity and to observe which conditions under each approach are preferred