Relative and absolute reliability of the clinical version of the Narrow Path Walking Test (NPWT) under single and dual task conditions.

Decline in gait stability has been associated with increased fall risk in older adults. Reliable and clinically feasible methods of gait instability assessment are needed. This study evaluated the relative and absolute reliability and concurrent validity of the testing procedure of the clinical version of the Narrow Path Walking Test (NPWT) under single task (ST) and dual task (DT) conditions. Thirty independent community-dwelling older adults (65-87 years) were tested twice. Participants were instructed to walk within the 6-m narrow path without stepping out. Trial time, number of steps, trial velocity, number of step errors, and number of cognitive task errors were determined. Intraclass correlation coefficients (ICCs) were calculated as indices of agreement, and a graphic approach called "mountain plot" was applied to help interpret the direction and magnitude of disagreements between testing procedures. Smallest detectable change and smallest real difference (SRD) were computed to determine clinically relevant improvement at group and individual levels, respectively. Concurrent validity was assessed using Performance Oriented Mobility Assessment Tool (POMA) and the Short Physical Performance Battery (SPPB). Test-retest agreement (ICC1,2) varied from 0.77 to 0.92 in ST and from 0.78 to 0.92 in DT conditions, with no apparent systematic differences between testing procedures demonstrated by the mountain plot graphs. Smallest detectable change and smallest real change were small for motor task performance and larger for cognitive errors. Significant correlations were observed for trial velocity and trial time with POMA and SPPB. The present results indicate that the NPWT testing procedure is highly reliable and reproducible.

Preparation with fasting and acipimox increases myocardial glucose uptake in mice during cardiac 18F-FDG microPET

Purpose: Cardiac 18F-FDG PET is considered as the gold standard to assess myocardial metabolism and infarct size. The myocardial demand for glucose can be influenced by fasting and/or following pharmacological preparation. In the rat, it has been previously shown that fasting combined with preconditioning with acipimox, a nicotinic acid derivate and lipidlowering agent, increased dramatically 18F-FDG uptake in the myocardium. Strategies aimed at reducing infarct scar are evaluated in a variety of mouse models. PET would particularly useful for assessing cardiac viability in the mouse. However, prior knowledge of the best preparation protocol is a prerequisite for accurate measurement of glucose uptake in mice. Therefore, we studied the effect of different protocols on 18F-FDG uptake in the mouse heart.Methods: Mice (n = 15) were separated into three treatment groups according to preconditioning and underwent a 18FDG PET scan. Group 1: No preconditioning (n = 3); Group 2: Overnight fasting (n = 8); and Group 3: Overnight fasting and acipimox (25mg/kg SC) (n = 4). MicroPET images were processed with PMOD to determine 18F-FDG mean standard uptake value (SUV) at 30 min for the whole left ventricle (LV) and for each region of the 17-segments AHA model. For comparisons, we used Mann-Whitney test and multilevel mixed-effects linear regression (Stata 11.0).Results: In total, 27 microPET were performed successfully in 15 animals. Overnight fasting led to a dramatic increase in LV-SUV compared to mice without preconditioning (8.6±0.7g/mL vs. 3.7±1.1g/mL, P<0.001). In addition, LV-SUV was slightly but not significantly higher in animals treated with acipimox compared to animals with overnight fasting alone (10.2±0.5 g/mL, P = 0.06). Fastening increased segmental SUV by 5.1±0.5g/mL as compared to free-feeding mice (from 3.7±0.8g/mL to 8.8±0.4g/mL, P<0.001); segmental-SUV also significantly increased after administration of acipimox (from 8.8±0.4g/mL to 10.1±0.4g/mL, P<0.001).Conclusion: Overnight fasting led to myocardial glucose deprivation and increases 18F-FDG myocardial uptake. Additional administration of acipimox enhances myocardial 18F-FDG uptake, at least at the segmental level. Thus, preconditioning with acipimox may provide better image quality that may help for assessing segmental myocardial metabolism.

Early Stage Primary Bone Lymphoma: A Retrospective, Multicenter Rare Cancer Network Study

Purpose/Objective(s): Primary bone lymphoma (PBL) represents less than 1% of all malignant lymphomas, and 4-5% of all extranodal lymphomas. In this study, we assessed the disease profile, outcome, and prognostic factors in patients with stage I and II PBL.Materials/Methods: Between 1987 and 2008, 116 consecutive patients with PBL treated in 13 RCNinstitutions were included in this study. Inclusion criteriawere: age.17 yrs, PBLin stage I and II, andminimum6months follow-up. The median agewas 51 yrs (range: 17-93).Diagnosticwork-up included plain boneXray (74%of patients), scintigraphy (62%), CT-scan (65%),MRI (58%), PET (18%), and bone-marrow biopsy (84%).All patients had biopsy-proven confirmation of non-Hodgkin's lymphoma (NHL). The histopathological type was predominantly diffuse large B-cell lymphoma (78%) and follicular lymphoma (6%), according to theWHOclassification. One hundred patients had a high-grade, 7 intermediate and 9 low-gradeNHL. Ninety-three patients had anAnn-Arbor stage I, and 23 had a stage II. Seventy-seven patients underwent chemoradiotherapy (CXRT), 12 radiotherapy (RT) alone, 10 chemotherapy alone (CXT), 9 surgery followed by CXRT, 5 surgery followed by CXT, and 2 surgery followed by RT. One patient died before treatment.Median RT dosewas 40Gy (range: 4-60).Themedian number ofCXTcycleswas 6 (range, : 2-8).Median follow-upwas 41months (range: 6-242).Results: Following treatment, the overall response rate was 91% (CR 74%, PR 17%). Local recurrence was observed in 12 (10%) patients, and systemic recurrence in 17 (15%) patients. Causes of death included disease progression in 16, unrelated disease in 6, CXT-related toxicity in 1, and secondary cancer in 2 patients. The 5-yr overall survival (OS), disease-free survival (DFS), lymphoma- specific survival (LSS), and local control (LC) were 76%, 69%, 78%, and 92%, respectively. In univariate analyses (log-rank test), favorable prognostic factors for survival were: age\50 years (p = 0.008), IPI score #1 (p = 0.009), complete response (p\0.001), CXT (p = 0.008), number of CXT cycles $6 (p = 0.007), and RT dose . 40 Gy (p = 0.005). In multivariate analysis age, RT dose, complete response, and absence of B symptoms were independent factors influencing the outcome. There were 3 patients developing grade 3 or more (CTCAE.V3.0) toxicities.Conclusions: This large multicenter study, confirms the relatively good prognosis of early stage PBL, treated with combined CXRT. Local control was excellent, and systemic failure occurred infrequently. A sufficient dose of RT (. 40 Gy) and completeCXT regime (. 6 cycles) were associated with a better outcome. Combined modality appears to be the treatment of choice.Author Disclosure: L. Cai, None; M.C. Stauder, None; Y.J. Zhang, None; P. Poortmans, None; Y.X. Li, None; N. Constantinou, None; J. Thariat, None; S. Kadish, None; M. Ozsahin, None; R.O. Mirimanoff, None.

Improvement of a test-chamber for behavioral studies on adult females of Aedes aegypti (Linnaeus) (Diptera, Culicidae)

A test-chamber (K&L-Chamber) made of cardboard and acrylic plastic, and consisting in four sections (A, B, C and D) was developed by Klowden & Lea (1978) for Aedes aegypti host-seeking behavior studies. Later, Foster & Lutes (1985) also used an identical chamber to successfully evaluate the efficacy of electronic repellers. It was described here a modified K&L-Chamber for behavioral studies of Ae. aegypti adults. The chamber was made in polystyrene, consisting of three sections (A, B and C) and using a human hand and a fluorescent lamp as stimulus to attract the mosquitoes. The suitability of the present test-chamber was validated assaying 80 replicates and releasing 10 Ae. aegypti females in each replicate. The females were released in the section A and allowed to fly to the section C. A mean of 96.0% (s.e. 0.213) Ae. aegypti females successfully reached section C. The present test-chamber is cheaper and easier to handle and as efficient as K&L-Chamber, when compared to Foster & Lutes (1978) that noticed 93.8% of Ae. aegypti reaching the trap section.

Improved HIV-1 RNA quantitation by COBAS AmpliPrep/COBAS TaqMan HIV-1 Test, v2.0 using a novel dual-target approach.

BACKGROUND: HIV-1 RNA viral load is a key parameter for reliable treatment monitoring of HIV-1 infection. Accurate HIV-1 RNA quantitation can be impaired by primer and probe sequence polymorphisms as a result of tremendous genetic diversity and ongoing evolution of HIV-1. A novel dual HIV-1 target amplification approach was realized in the quantitative COBAS AmpliPrep/COBAS TaqMan HIV-1 Test, v2.0 (HIV-1 TaqMan test v2.0) to cope with the high genetic diversity of the virus. OBJECTIVES AND STUDY DESIGN: The performance of the new assay was evaluated for sensitivity, dynamic range, precision, subtype inclusivity, diagnostic and analytical specificity, interfering substances, and correlation with the COBAS AmpliPrep/COBAS TaqMan HIV-1 (HIV-1 TaqMan test v1.0) predecessor test in patients specimens. RESULTS: The new assay demonstrated a sensitivity of 20 copies/mL, a linear measuring range of 20-10,000,000 copies/mL, with a lower limit of quantitation of 20 copies/mL. HIV-1 Group M subtypes and HIV-1 Group O were quantified within +/-0.3 log(10) of the assigned titers. Specificity was 100% in 660 tested specimens, no cross reactivity was found for 15 pathogens nor any interference for endogenous substances or 29 drugs. Good comparability with the predecessor assay was demonstrated in 82 positive patient samples. In selected clinical samples 35/66 specimens were found underquantitated in the predecessor assay; all were quantitated correctly in the new assay. CONCLUSIONS: The dual-target approach for the HIV-1 TaqMan test v2.0 enables superior HIV-1 Group M subtype coverage including HIV-1 Group O detection. Correct quantitation of specimens underquantitated in the HIV-1 TaqMan test v1.0 test was demonstrated.

Méthodologie intégrée de microgravimétrie en milieu urbain : test d'application au génie civil sur le métro M2 de Lausanne

RESUME Dès le printemps 2004, la construction d'une 2ème ligne de métro est entreprise dans la ville de Lausanne en Suisse. En reliant Ouchy, au bord du lac Léman (alt. 373 m) à Epalinges (alt. 711 m), le nouveau métro "M2" traversera dès 2008 l'agglomération lausannoise du Sud au Nord sur une distance de 6 km. Depuis l'avant-projet, en 1999, une grande quantité de données géologiques a été récolté et de nombreux forages exécutés sur le site. Ceci nous a donné une occasion unique d'entreprendre une étude de microgravimétrique urbaine de détail. Le mode de creusement du tunnel dépend fortement des matériaux à excaver et il est classiquement du domaine du géologue, avec ses connaissances de la géologie régionale et de la stratigraphie des forages, de fournir à l'ingénieur un modèle géologique. Ce modèle indiquera dans ce cas l'épaisseur des terrains meubles qui recouvrent le soubassement rocheux. La représentativité spatiale d'une information très localisée, comme celle d'un forage, est d'autant plus compliquée que le détail recherché est petit. C'est à ce moment là que la prospection géophysique, plus spécialement gravimétrique, peut apporter des informations complémentaires déterminantes pour régionaliser les données ponctuelles des forages. La microgravimétrie en milieu urbain implique de corriger avec soin les perturbations gravifiques sur la mesure de la pesanteur dues aux effets de la topographie, des bâtiments et des caves afin d'isoler l'effet gravifique dû exclusivement à l'épaisseur du remplissage des terrains meubles. Tenant compte de l'intensité des corrections topographiques en milieu urbain, nous avons donné une grande importance aux sous-sols, leurs effets gravifiques pouvant atteindre l'ordre du dixième de mGal. Nous avons donc intégré ces corrections celle de topographie et traité les effets des bâtiments de manière indépendante. Nous avons inclus dans le modèle numérique de terrain (MNT) la chaussée et les sous-sols afin de construire un modèle numérique de terrain urbain. Nous utiliserons un nouvel acronyme « MNTU »pour décrire ce modèle. Nous proposons d'établir des cartes de corrections topographiques préalables, basées sur les données à disposition fournies par le cadastre en faisant des hypothèses sur la profondeur des sous-sols et la hauteur des bâtiments. Les deux zones de test choisies sont caractéristiques des différents types d'urbanisation présente à Lausanne et se révèlent par conséquent très intéressantes pour élaborer une méthodologie globale de la microgravimétrie urbaine. Le but était d'évaluer l'épaisseur du remplissage morainique sur un fond rocheux molassique se situant à une profondeur variable de quelques mètres à une trentaine de mètres et d'en établir une coupe dans l'axe du futur tracé du métro. Les résultats des modélisations se sont révélés très convaincants en détectant des zones qui diffèrent sensiblement du modèle géologique d'avant projet. Nous avons également démontré que l'application de cette méthode géophysique, non destructive, est à même de limiter le nombre de sondages mécaniques lors de l'avant-projet et du projet définitif, ce qui peut limiter à la fois les coûts et le dérangement engendré par ces travaux de surface. L'adaptabilité de la technique gravimétrique permet d'intervenir dans toutes les différentes phases d'un projet de génie civil comme celui de la construction d'un métro en souterrain. KURZFASSUNG Seit dem Frühling 2004 ist in der Stadt Lausanne (Schweiz) die neue U-Bahn "M2" in Konstruktion. Diese soll auf 6 km Länge die Lausanner Agglomeration von Süd nach Nord durchqueren. Die dem Projekt zu Grunde liegende technische Planung sieht vor, daß die Bahnlinie hauptsächlich in der Molasse angesiedelt sein wird. Seit dem Vorentwurf (1999) ist eine große Anzahl geologischer Angaben gesammelt worden. Daraus ergab sich die einmalige Gelegenheit, die Informationen aus den damit verbundenen zahlreichen Bohrungen zu einer detaillierten mikrogravimetrischen Studie der Stadt Lausanne zu erweitern und zu vervollständigen. Das Ziel bestand darin, die Mächtigkeit der die Molasseüberdeckenden Moräneablagerung abzuschätzen, um eine entsprechendes geologisches Profile entlang der künftigen Bahnlinie zu erstellen. Weiterhin sollte gezeigt werden, daß die Anwendung dieser nicht-invasiven geophysikalischen Methode es ermöglicht, die Anzahl der benötigten Bohrungen sowohl in der Pilotphase wie auch im endgültigen Projekt zu reduzieren, was zu wesentlichen finanziellen Einsparungen in der Ausführung des Werkes beitragen würde. Die beiden in dieser Studie bearbeiteten Testzonen befinden sich im Nordteil und im Stadtzentrum von Lausanne und sind durch eine unterschiedliche Urbanisierung charakterisiert. Das anstehende Gestein liegt in verschiedenen Tiefen: von einigen Metern bis zu etwa dreißig Metern. Diese Zonen weisen alle Schwierigkeiten einer urbanen Bebauung mit hoher Verkehrsdichte auf und waren daher massgebend bei der Ausarbeitung einer globalen mikrogravimetrischen Methodologie für die Stadt Lausanne. Die so entwickelte Technik ermöglicht, die störenden Auswirkungen der Topographie, der Gebäude, der Keller und der Öffentlichen Infrastrukturen sorgfältig zu korrigieren, um so die ausschließlich auf die Mächtigkeit des Lockergesteins zurückzuführenden Effekte zu isolieren. In Bezug auf die Intensität der Auswirkungen der topographischen Korrekturen im Stadtgebiet wurde den Untergeschossen eine besonders grosse Bedeutung zugemessen da die entsprechenden Schwerkrafteffekte eine Grösse von rund einem Zehntel mGal erreichen können. Wir schlagen deshalb vor, vorläufige Karten der topographischen Korrekturen zu erstellen. Diese Korrekturen basieren auf den uns vom Katasterplan gelieferten Daten und einigen Hypothesen bezüglich der Tiefe der Untergeschosse und der Höhe der Gebäude. Die Verfügbarkeit einer derartigen Karte vor der eigentlichen gravimetrischen Messkampagne würde uns erlauben, die Position der Meßstationen besser zu wählen. Wir sahen zudem, daß ein entsprechenden a priori Filter benutzt werden kann, wenn die Form und die Intensität der Anomalie offensichtlich dem entsprechenden Gebäude zugeordnet werden können. Diese Strategie muß jedoch mit Vorsicht angewandt werden, denn falls weitere Anomalien dazukommen, können bedeutende Verschiebungen durch Übèrlagerungen der Schwerewirkung verschiedener Strukturen entstehen. Die Ergebnisse der Modellierung haben sich als sehr überzeugend erwiesen, da sie im Voraus unbekannte sensible Zonen korrekt identifiziert haben. Die Anwendbarkeit der in dieser Arbeit entwickelten gravimetrischen Technik ermöglicht es, während allen Phasen eines Grossbauprojekts, wie zum Beispiel bei der Konstruktion einer unterirdischen U-Bahn, einzugreifen. ABSTRACT Since Spring of 2004 a new metro line has been under construction in the city of Lausanne in Switzerland. The new line, the M2, will be 6 km long and will traverse the city from south to north. The civil engineering project determined that the line would be located primarily in the Molasse. Since the preparatory project in 1999, a great quantity of geological data has been collected, and the many drillings made on the site have proved to be a unique opportunity to undertake a study of urban microgravimetry. The goal was to evaluate the thickness of the morainic filling over the molassic bedrock, and to establish a section along the axis of the future line. It then had to be shown that the application of this nondestructive geophysical method could reduce the number of mechanical surveys required both for a preparatory and a definitive project, which would lead to real savings in the realization of a civil engineering project. The two test zones chosen, one in the northern part of the city and one in the city centre, are characterised by various types of urbanisation. Bedrock is at a depth varying from a few metres to about thirty metres. These zones well exemplify the various difficulties encountered in an urban environment and are therefore very interesting for the development of an overall methodology of urban microgravimetry. Microgravimetry in an urban environment requires careful corrections for gravific disturbances due to the effects of topography, buildings, cellars, and the infrastructure of distribution networks, in order to isolate the gravific effect due exclusively to the thickness of loose soil filling. Bearing in mind the intensity of the topographic corrections in an urban environment, we gave particular importance to basements. Their gravific effects can reach the order of one tenth of one meal, and can influence above all the precision of the Bouguer anomaly. We propose to establish preliminary topographic correction charts based on data provided to us by the land register, by making assumptions on the depths of basements and the heights of buildings. Availability of this chart previous to a gravimetry campaign would enable us to choose optimum measuring sites. We have also seen that an a priori filter can be used when the form and the intensity of the anomaly correspond visually to the corresponding building. This strategy must be used with caution because if other anomalies are to be associated, important shifts can be generated by the superposition of the effects of different structures. The results of the model have proved to be very convincing in detecting previously unknown sensitive zones. The adaptability of the gravimetry technique allows for application in all phases of a civil engineering project such as the construction of an underground metro line. RIASSUNTO Dalla primavera 2004 una nuova linea metropolitana é in costruzione nella città di Losanna in Svizzera. La nuova metropolitana "M2" traverserà per la lunghezza di 6 km il centro urbano di Losanna da sud a nord. II progetto d'ingegneria civile prevedeva un tracciato situato essenzialmente nel fondo roccioso arenaceo terziario (molassa). Dalla redazione del progetto preliminare, avvenuta nel 1999, una grande quantità di dati geologici sono stati raccolti e sono stati eseguiti numerosi sondaggi. Questo sì é presentato come un'occasione unica per mettere a punto uno studio microgravimetrico in ambiente urbano con lo scopo di valutare lo spessore dei terreni sciolti di origine glaciale che ricoprono il fondo roccioso di molassa e di mettere in evidenza come l'applicazione di questo metodo geofisico non distruttivo possa limitare il numero di sondaggi meccanici nella fase di progetto preliminare ed esecutivo con conseguente reale risparmio economico nella realizzazione di una tale opera. Le due zone di test sono situate una nella zona nord e la seconda nel centro storico di Losanna e sono caratterizzate da stili architettonici differenti. II fondo roccioso é situato ad una profondità variabile da qualche metro ad una trentina. Queste due zone sembrano ben rappresentare tutte le difficoltà di un ambiente urbano e ben si prestano per elaborare una metodologia globale per la microgravimetria in ambiente urbano. L'applicazione di questa tecnica nell'ambiente suddetto implica la correzione attenta delle perturbazioni sulla misura dell'accelerazione gravitazionale, causate dalla topografia, gli edifici, le cantine e le infrastrutture dei sottoservizi, per ben isolare il segnale esclusivamente causato dallo spessore dei terreni sciolti. Tenuto conto, dell'intensità delle correzioni topografiche, abbiamo dato grande importanza alle cantine, poiché il loro effetto sulle misure può raggiungere il decimo di mGal. Proponiamo quindi di redigere una carta delle correzioni topografiche preliminare all'acquisizione, facendo delle ipotesi sulla profondità delle cantine e sull'altezza degli edifici, sulla base delle planimetrie catastali. L'analisi di questa carta permetterà di scegliere le posizioni più adatte per le stazioni gravimetriche. Abbiamo anche osservato che un filtro a priori, qualora la forma e l'intensità dell'anomalia fosse facilmente riconducibile in maniera visuale ad un edificio, possa essere efficace. Tuttavia questa strategia deve essere utilizzata con precauzione, poiché può introdurre uno scarto, qualora più anomalie, dovute a differenti strutture, si sovrappongano. I risultati delle modellizzazioni si sono rivelati convincenti, evidenziando zone sensibili non conosciute preventivamente. L'adattabilità della tecnica gravimetrica ha mostrato di poter intervenire in differenti fasi di un progetto di ingegneria civile, quale è quella di un'opera in sotterraneo.

A new blood-based screening test for colorectal cancer: a pilot study

Background: Colorectal cancer (CRC) can be cured when diagnosed in its early or precancerous (adenoma) stages. Mostly due to poor compliance towards invasive screening procedures, detection rates for adenoma and early CRCs are still low. Available non-invasive screening tests have unfortunately low sensitivity and specificity performances. Therefore, there is a large unmet need calling for a cost-effective, reliable and non-invasive test to screen for early neoplastic and pre-neoplastic lesions. Objective: To develop a routine screening test based on a nucleic acids multi-gene assay performed on peripheral blood mononuclear cells (PBMCs) that can detect early CRCs and adenomas. Methods: 116 patients (mean age: 55 years; range: 18 to 74 years; female/male ration 0.98) were included in this pilot, nonblinded, colonoscopy-controlled study. Colonoscopy revealed 21 patients with CRC, 30 patients with adenoma bigger than 1 cm, 24 patients with inflammatory bowel disease (IBD) and 41 patients had no neoplastic or inflammatory lesions. Blood samples were taken from each patient the day of the colonoscopy and PBMCs were purified. Total RNA was extracted following standard procedures. Multiplex RT-qPCR was applied on 92 different candidate biomarkers. Different univariate and multivariate statistical methods were applied on these candidates, and among them, 57 biomarkers with significant p values (<0.01, Wilcoxon test) were selected, including ADAMTS1, MMP9, CXCL10, CXCR4, VEGFA and CDH1. Two distinct biomarker signatures are used to separate patients without neoplastic lesion from those with cancer (named COLOX 1 test), respectively from those with adenoma (named COLOX 2 test). Result: COLOX 1 and 2 tests have successfully separated patients without neoplastic lesion from those with CRC (sensitivity 70%, specificity 90%, AUC 0.88), respectively from those with adenoma bigger than 1cm (sensitivity 61%, specificity 80%, AUC 0.80). 6/24 patients in the IBD group have a positive COLOX 1 test. Conclusion: These two COLOX tests demonstrated an acceptable sensitivity and a high specificity to detect the presence of CRCs and adenomas bigger than 1 cm. The false positives COLOX 1 test in IBD patients could possibly be due to the chronic inflammatory state. A prospective, multicenter, pivotal study is underway in order to confirm these promising results in a larger cohort.

Dealing with clients' diversity in test situations: Client categorisations in psychologists' accounts of their practices

Reducing a test administration to standardised procedures reflects the test designers' standpoint. However, from the practitioners' standpoint, each client is unique. How do psychologists deal with both standardised test administration and clients' diversity? To answer this question, we interviewed 17 psychologists working in three public services for children and adolescents about their assessment practices. We analysed the numerous "client categorisations" they produced in their accounts. We found that they had shared perceptions about their clients' diversity, and reported various non-standard practices that complemented standardised test administration, but also differed from them or were even forbidden. They seem to experience a dilemma between: (a) prescribed and situated practices; (b) scientific and situated reliability; (c) commutative and distributive justice. For practitioners, dealing with clients' diversity this is a practical problem, halfway between a problem-solving task and a moral dilemma.

Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia.

We prospectively compared the diagnostic value of C-reactive protein (CRP) and white blood cell counts for detection of neonatal septicaemia. Sensitivity and specifity in receiver operating characteristics, and positive and negative predictive value of CRP and white blood cell count were compared in 195 critically ill preterm and term newborns clinically suspected of infection. Blood cultures were positive in 33 cases. During the first 3 days after birth CRP elevation (sensitivity 75%, specifity 86%), leukopenia (67%/90%), neutropenia (78%/80%) and immature to total neutrophil count (I/T) ratio (78%/73%) were good diagnostic parameters, as opposed to band forms with absolute count (84%/66%) or percentage (79%/71%), thrombocytopenia (65%/57%) and toxic granulations (44%/94%). Beyond 3 days of age elevated CRP (88%/87%) was the best parameter. Increased total (84%/66%) or percentage band count (79%/71%) were also useful. Leukocytosis (74%/56%), increased neutrophils (67%/65%), I/T ratio (79%/47%), thrombocytopenia (65%/57%) and toxic granulations had a low specifity. The positive predictive value of CRP was 32% before and 37% after 3 days of age, that of leukopenia was 37% in the first 3 days. CONCLUSION: During the first 3 days of life CRP, leukopenia and neutropenia were comparably good tests while after 3 days of life CRP was the best single test in early detection of neonatal septicaemia. Serial CRP estimations confirm the diagnosis, monitor the course of infection and the efficacy of antibiotic treatment.

Inferring transport characteristics in a fractured rock aquifer by combining single-hole ground-penetrating radar reflection monitoring and tracer test data

Investigations of solute transport in fractured rock aquifers often rely on tracer test data acquired at a limited number of observation points. Such data do not, by themselves, allow detailed assessments of the spreading of the injected tracer plume. To better understand the transport behavior in a granitic aquifer, we combine tracer test data with single-hole ground-penetrating radar (GPR) reflection monitoring data. Five successful tracer tests were performed under various experimental conditions between two boreholes 6 m apart. For each experiment, saline tracer was injected into a previously identified packed-off transmissive fracture while repeatedly acquiring single-hole GPR reflection profiles together with electrical conductivity logs in the pumping borehole. By analyzing depth-migrated GPR difference images together with tracer breakthrough curves and associated simplified flow and transport modeling, we estimate (1) the number, the connectivity, and the geometry of fractures that contribute to tracer transport, (2) the velocity and the mass of tracer that was carried along each flow path, and (3) the effective transport parameters of the identified flow paths. We find a qualitative agreement when comparing the time evolution of GPR reflectivity strengths at strategic locations in the formation with those arising from simulated transport. The discrepancies are on the same order as those between observed and simulated breakthrough curves at the outflow locations. The rather subtle and repeatable GPR signals provide useful and complementary information to tracer test data acquired at the outflow locations and may help us to characterize transport phenomena in fractured rock aquifers.

La consultation pour le test sérologique de dépistage VIH : enjeux pour le couple et pour le médecin

La pratique du test au centre de dépistage anonyme VIH de la Policlinique médicale universitaire de Lausanne semble indiquer que de plus en plus de personnes demandent à être testées, souvent au moment inaugural de la constitution de la vie du couple. L'indication au test de dépistage devrait être le résultat d'une négociation entre le patient et son médecin. Ce dernier est en outre confronté à la complexité des enjeux sociétaux et éthiques que le test représente. Il s'agit d'une tâche difficile, d'autant plus que la requête d'un test n'implique pas le seul devenir du sujet, mais aussi, dans la dimension sexuelle, le devenir de la personne qu'il rencontre. L'avènement du Sida a modifié la vie du couple en rendant la sexualité plus problématique et en donnant un caractère impératif l'exigence de négociation entre les partenaires du couple. La pratique de la prévention révèle aussi comment le Sida met en jeu la responsabilité que les médecins ont de négocier avec leurs patients, à l'instar de ce que ces derniers devraient faire avec leur partenaire dans un but de protection.

Qualidade do solo avaliada pelo "Soil Quality Kit Test" em dois experimentos de longa duração no Rio Grande do Sul

A avaliação da qualidade do solo (QS) é importante estratégia no planejamento agrícola, possibilitando a identificação e o aprimoramento de sistemas de manejo com características de alta produtividade e de preservação ambiental. O presente estudo foi realizado em dois experimentos de longa duração (10 e 15 anos) conduzidos no Sul do Brasil e teve por objetivo avaliar o efeito de sistemas de manejo na QS, utilizando um kit de análise expedita de qualidade de solo (KQS), desenvolvido pelo Instituto de Qualidade do Solo-USDA-ARS. A eficiência desse kit foi avaliada pela comparação com os métodos tradicionais utilizados na ciência do solo. Nas duas áreas experimentais investigou-se um total de 12 tratamentos, os quais englobaram sistemas de preparo com diferentes intensidades de revolvimento do solo (preparo convencional, preparo reduzido e plantio direto) e sistemas de culturas com ampla faixa de adição de resíduos vegetais ao solo, além da aplicação de doses anuais de N-uréia, variando de 0 a 144 kg ha-1. Em cada base experimental uma área sob campo natural foi avaliada, servindo como referência da condição do solo na ausência de interferência antrópica. Como indicadores de QS, foram avaliados infiltração de água, respiração do solo, densidade do solo, teor de nitrato+nitrito (N-NO3- + N-NO2-), estabilidade de agregados em água e pH. De maneira geral, os coeficientes de correlação entre os métodos do KQS e os métodos tradicionais foram elevados, sendo o mais alto para o indicador pH (r = 0,98) e o menor para o indicador infiltração de água no solo (r = 0,42). Os tratamentos selecionados foram teoricamente ordenados em ordem crescente de QS, a qual foi reproduzida de forma eficiente pelo índice de estoque de carbono (IEC), calculado pela razão entre o estoque de C orgânico do solo, na camada de 0-5 cm, de cada tratamento e o estoque de C orgânico no solo sob campo natural. Os indicadores estabilidade de agregados, N-NO3- + N-NO2- e respiração do solo foram os mais eficientes em discriminar a QS. O KQS foi eficiente em avaliar a QS dos tratamentos nas duas áreas experimentais. Os níveis mais elevados de QS foram alcançados nos tratamentos com plantio direto e consórcio de gramíneas e leguminosas tropicais, devido à cobertura do solo e às elevadas adições de C e N via resíduos culturais.

Effect of antiviral therapy on circulating cytokeratin-18 fragments in patients with chronic hepatitis C.

Hepatocellular apoptosis plays a major role in the pathogenesis of chronic hepatitis C. It can be measured noninvasively by determining the circulating levels of cytokeratin-18 fragments. We hypothesized that the effect of antiviral therapy on this parameter will be different in patients with a sustained virological response, relapse (REL) and nonresponse (NR). We quantified cytokeratin-18 fragments in plasma of patients participating in the Swiss Hepatitis C cohort, who received antiviral therapy without stopping because of sides effects. A total of 315 patients were included, 183 with a sustained response, 64 with NR and 68 who relapsed. Mean levels ±SD of circulating cytokeratin-18 fragments before therapy were 174 ± 172 U/L for responsders, 188 ± 145 for nonresponders and 269 ± 158 U/L for patients who relapsed. The values were significantly higher in the REL group (ANOVA P < 0.006). A sustained response was associated with a significant improvement of the plasma levels (94 ± 92 U/L, paired test P < 0.000001), whereas there was no improvement in the nonresponder group (183 ± 158 U/L) and in the relapser group (158 ± 148 U/L). There was a weak correlation between alanine aminotransferase (ALT) and cytokeratin-18 fragment levels (r² = 0.35, P < 0.000001) before therapy but not after therapy and none with hepatitis C virus (HCV) viremia. Successful antiviral therapy results in a significant decrease in circulating levels of cytokeratin-18 fragments arguing for a reduction in hepatocellular apoptosis after clearance of the HCV. Baseline cytokeratin-18 fragment levels are higher in relapsers. Correlations with ALT are weak, suggesting that these two tests measure different but related processes.

Level shifts in a panel data based unit root test : an application to the rate of unemployment

Several unit root tests in panel data have recently been proposed. The test developed by Harris and Tzavalis (1999 JoE) performs particularly well when the time dimension is moderate in relation to the cross-section dimension. However, in common with the traditional tests designed for the unidimensional case, it was found to perform poorly when there is a structural break in the time series under the alternative. Here we derive the asymptotic distribution of the test allowing for a shift in the mean, and assess the small sample performance. We apply this new test to show how the hypothesis of (perfect) hysteresis in Spanish unemployment is rejected in favour of the alternative of the natural unemployment rate, when the possibility of a change in the latter is considered.