Eligibility for renal denervation: experience at 11 European expert centers.

Based on the SYMPLICITY studies and CE (Conformité Européenne) certification, renal denervation is currently applied as a novel treatment of resistant hypertension in Europe. However, information on the proportion of patients with resistant hypertension qualifying for renal denervation after a thorough work-up and treatment adjustment remains scarce. The aim of this study was to investigate the proportion of patients eligible for renal denervation and the reasons for noneligibility at 11 expert centers participating in the European Network COordinating Research on renal Denervation in treatment-resistant hypertension (ENCOReD). The analysis included 731 patients. Age averaged 61.6 years, office blood pressure at screening was 177/96 mm Hg, and the number of blood pressure-lowering drugs taken was 4.1. Specialists referred 75.6% of patients. The proportion of patients eligible for renal denervation according to the SYMPLICITY HTN-2 criteria and each center's criteria was 42.5% (95% confidence interval, 38.0%-47.0%) and 39.7% (36.2%-43.2%), respectively. The main reasons of noneligibility were normalization of blood pressure after treatment adjustment (46.9%), unsuitable renal arterial anatomy (17.0%), and previously undetected secondary causes of hypertension (11.1%). In conclusion, after careful screening and treatment adjustment at hypertension expert centers, only ≈40% of patients referred for renal denervation, mostly by specialists, were eligible for the procedure. The most frequent cause of ineligibility (approximately half of cases) was blood pressure normalization after treatment adjustment by a hypertension specialist. Our findings highlight that hypertension centers with a record in clinical experience and research should remain the gatekeepers before renal denervation is considered.

Cinema and the Work of Doré

According to Ray Harryhausen, a special effects expert in the film industry, "Gustave Doré would have made a great director of photography . . . He saw things from the point of view of the camera." Doré's work has had a permanent impact on the imaginative realm of film since its very early days. In return, the silver screen has etched Doré into the 20th century imagination. Almost every film about the Bible since The Life and Passion of Jesus Christ produced by Pathé in 1902 refers to his illustrations, and every film adaptation of Dante or Don Quixote has used him as a model, from Georg Wilhelm Pabst and Orson Welles to Terry Gilliam. All films dealing with life in London in the Victorian era by directors ranging from David Lean, to Roman Polanski and Tim Burton draw on the visions in London: a pilgrimage for their sets. A large number of dream fantastical or phantasmagorical scenes take their inspiration from Doré's graphic world, beginning with Georges Méliès' A Trip to the Moon in 1902. In the realm of cartoons and animation, Walt Disney owes a huge debt to Doré. Doré primal forests, from Atala in particular, were also used in the various versions of King Kong from 1933 to the 2005 film by Peter Jackson, who had already drawn on Doré for The Lord of the Rings. Jean Cocteau was also indebted to the illustrations for Perrault's Fairy Tales for his Beauty and the Beast (1945), as was George Lucas for the character Chewbacca in Star Wars (1977) and even the Harry Potter film series. Through his influence on film history, Doré shaped the mass culture imagination.

Quality of Qualitative Research in the Health Sciences : Analysis of the Common Criteria Present in 58 Assessment Guidelines by Expert Users

The number of qualitative research methods has grown substantially over the last twenty years, both in social sciences and, more recently, in the health sciences. This growth came with questions on the quality criteria needed to evaluate this work, and numerous guidelines were published. The latters include many discrepancies though, both in their vocabulary and construction. Many expert evaluators decry the absence of consensual and reliable evaluation tools. The authors present the results of an evaluation of 58 existing guidelines in 4 major health science fields (medicine and epidemiology; nursing and health education; social sciences and public health; psychology / psychiatry, research methods and organization) by expert users (article reviewers, experts allocating funds, editors, etc.). The results propose a toolbox containing 12 consensual criteria with the definitions given by expert users. They also indicate in which disciplinary field each type of criteria is known to be more or less essential. Nevertheless, the authors highlight the limitations of the criteria comparability, as soon as one focuses on their specific definitions. They conclude that each criterion in the toolbox must be explained to come to broader consensus and identify definitions that are consensual to all the fields examined and easily operational.

Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators.

OBJECTIVE: To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. DESIGN: A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. SETTING: International group of countries participating to OECD projects. PARTICIPANTS: Members of the OECD HCQI expert group. RESULTS: A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. CONCLUSIONS: The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies.

Scientific creativity and diversity of physical work environment: framework development

The aim of this research was to develop a framework to analyze how physical environment influences scientific creativity. Due to the relative novelty of this topic, there is still a gap in the unified method to study connection between physical environment and creativity. Therefore, in order to study this issue deeply, the qualitative method was used (interviews and qualitative questionnaire). Scientists (PhD students and senior researchers) of Graduate School of Management were interviewed to build the model and one expert interview was conducted to assess its validity. The model highlights several dimensions via which physical environment can influence scientific creativity: Comfort, Instruments and Diversity. Comfort and Instruments are considered to be related mostly to productivity, an initial requirement for creativity, while Diversity is the factor responsible for supporting all the stages of scientific creative process. Thus, creative physical environment is not one place by its nature, but an aggregative phenomenon. Due to two levels of analysis, the model is named the two-level model of creative physical environment.

The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

Background: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. METHODS: To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. CONCLUSIONS: In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.

Report of the Expert Group Meeting on the Caribbean Information Society

The meeting was convened as part of this office's strategy to continue to provide support to CDCC Member States in implementing the WSIS Plan of Action. The thirty two participants were in general knowledgeable about the Information Society activities of their respective governments and organisations. The objective of the meeting was to apprise CDCC Member Countries of the activities which the Secretariat had undertaken in the area of Information and Communications Technology for Development as a follow up to the Twentieth Session of the CDCC and in response to the resolution tabled at that session; to facilitate the exchange of information among countries and agencies in the region with respect to ICTs for development in general and the WSIS process in particular; hear reports on progress made at the national level, with special focus on the area of e-government and government policies in the area of ICTs; and to get a snapshot as to where the region is positioned vis a vis the WSIS agenda. A Caribbean ICT Stocktaking report was presented and there was an update on the e-LAC strategy. Several recommendations were made with respect to ECLAC's continuing involvement in this area - among them, that ECLAC should assist countries with preparing national e-strategies, develop strategic partnerships especially with the CARICOM Secretariat, develop databases and other information four use by the CDCC countries and continue its stocktaking work

Report on the implementation of the ECLAC work programme subregional activities for the Caribbean 2006-2007 biennium [Covering the period 1 Janurary 2006- 31 December 2007]

The focus of the activities of the Economic Commission for Latin America and the Caribbean/Caribbean Development and Cooperation Committee (ECLAC/CDCC) secretariat during the 2006-2007 biennium continued to be on assistance to member governments of the subregion with policy-making and development strategies, especially on issues relevant to the promotion of the economic, social, and environmental dimensions of development in the Caribbean. The Subregional Headquarters for the Caribbean worked closely with member countries of the CDCC in an effort to ensure the relevance of outputs which would inform policy options. This involved the strengthening of partnerships with both regional and subregional institutions and relevant agencies of the United Nations system working in the Caribbean. A major decision was taken to refocus the operational aspects of the secretariat to ensure that they were relevant to the development goals of its members. This involved the introduction of a thematic approach to the work of the office. One of the changes resulting from this was the restructuring and renaming of the Caribbean Documentation Centre. The Caribbean Knowledge Management Centre (CKMC), as it is now known, has changed its emphasis from organizing and disseminating documents, and is now a more proactive partner in the research undertaken by staff and other users of the service. The CKMC manages the ECLAC website, the public face of the organization. Newsletters and all other documents, including Information and Communications Technology (ICT) profiles of selected countries, prepared by the secretariat, are now available online at the ECLAC/CDCC website www.eclacpos.org . The Caribbean Knowledge Management Portal was launched at a meeting of information specialists in St. Vincent and the Grenadines in 2007. In addition to reaching a wider public, this measure was introduced as a means of reducing the cost of printing or disseminating publications. In spite of the unusually high vacancy rate, at both the international and local levels, during the biennium, the subregional headquarters accomplished 98 per cent of the 119 outputs earmarked for the period. Using vacant positions to carry out the assignments was not an easy task, given the complexity in recruiting qualified and experienced persons for short periods. Nevertheless, consultancy services and short-term replacement staff greatly aided the delivery of these outputs. All the same, 35 work months remained unused during the biennium, leaving 301 work months to complete the outputs. In addition to the unoccupied positions, the work of the subprogramme was severely affected by the rising cost of regional and subregional travel which limited the ability of staff to network and interact with colleagues of member countries. This also hampered the outreach programme carried out mainly through ad hoc expert group meetings. In spite of these shortcomings, the period proved to be successful for the subprogramme as it engaged the attention of member countries in its work either through direct or indirect participation. Staff members completed 36 technical papers plus the reports of the meetings and workshops. A total of 523 persons, representing member countries, participated in the 18 intergovernmental and expert meetings convened by the secretariat in the 24-month period. In its effort to build technical capacity, the subprogramme convened 15 workshops/seminars which offered training for 446 persons.

Cross-cultural adaptation of the Work Disability Diagnosis Interview (WoDDI) for the Brazilian context

The Work Disability Diagnosis Interview (WoDDI) is a structured interview guide developed by the University of Sherbrooke, Canada to help clinicians detect the most important work-related disability predictors and to identify one or more causes of prolonged absenteeism. This methodological study aims for the cross-cultural adaptation of the WoDDI for the Brazilian context. The method followed international guidelines for studies of this kind, including the following steps: initial translation, synthesis of translations, back translation, evaluation by an expert committee and testing of the penultimate version. These steps allowed obtaining conceptual, semantic, idiomatic, experiential and operational equivalences, in addition to content validity. The results showed that the translated WoDDI is adapted to the Brazilian context and can be used after training.

Towards a precise test for malaria diagnosis in the Brazilian Amazon: comparison among field microscopy, a rapid diagnostic test, nested PCR, and a computational expert system based on artificial neural networks

Abstract Background Accurate malaria diagnosis is mandatory for the treatment and management of severe cases. Moreover, individuals with asymptomatic malaria are not usually screened by health care facilities, which further complicates disease control efforts. The present study compared the performances of a malaria rapid diagnosis test (RDT), the thick blood smear method and nested PCR for the diagnosis of symptomatic malaria in the Brazilian Amazon. In addition, an innovative computational approach was tested for the diagnosis of asymptomatic malaria. Methods The study was divided in two parts. For the first part, passive case detection was performed in 311 individuals with malaria-related symptoms from a recently urbanized community in the Brazilian Amazon. A cross-sectional investigation compared the diagnostic performance of the RDT Optimal-IT, nested PCR and light microscopy. The second part of the study involved active case detection of asymptomatic malaria in 380 individuals from riverine communities in Rondônia, Brazil. The performances of microscopy, nested PCR and an expert computational system based on artificial neural networks (MalDANN) using epidemiological data were compared. Results Nested PCR was shown to be the gold standard for diagnosis of both symptomatic and asymptomatic malaria because it detected the major number of cases and presented the maximum specificity. Surprisingly, the RDT was superior to microscopy in the diagnosis of cases with low parasitaemia. Nevertheless, RDT could not discriminate the Plasmodium species in 12 cases of mixed infections (Plasmodium vivax + Plasmodium falciparum). Moreover, the microscopy presented low performance in the detection of asymptomatic cases (61.25% of correct diagnoses). The MalDANN system using epidemiological data was worse that the light microscopy (56% of correct diagnoses). However, when information regarding plasma levels of interleukin-10 and interferon-gamma were inputted, the MalDANN performance sensibly increased (80% correct diagnoses). Conclusions An RDT for malaria diagnosis may find a promising use in the Brazilian Amazon integrating a rational diagnostic approach. Despite the low performance of the MalDANN test using solely epidemiological data, an approach based on neural networks may be feasible in cases where simpler methods for discriminating individuals below and above threshold cytokine levels are available.

Niemann-Pick disease type C symptomatology: an expert-based clinical description

Niemann-Pick disease type C (NP-C) is a rare, progressive, irreversible disease leading to disabling neurological manifestations and premature death. The estimated disease incidence is 1:120,000 live births, but this likely represents an underestimate, as the disease may be under-diagnosed due to its highly heterogeneous presentation. NP-C is characterised by visceral, neurological and psychiatric manifestations that are not specific to the disease and that can be found in other conditions. The aim of this review is to provide non-specialists with an expert-based, detailed description of NP-C signs and symptoms, including how they present in patients and how they can be assessed. Early disease detection should rely on seeking a combination of signs and symptoms, rather than isolated findings. Examples of combinations which are strongly suggestive of NP-C include: splenomegaly and vertical supranuclear gaze palsy (VSGP); splenomegaly and clumsiness; splenomegaly and schizophrenia-like psychosis; psychotic symptoms and cognitive decline; and ataxia with dystonia, dysarthria/dysphagia and cognitive decline. VSGP is a hallmark of NP-C and becomes highly specific of the disease when it occurs in combination with other manifestations (e.g. splenomegaly, ataxia). In young infants (<2 years), abnormal saccades may first manifest as slowing and shortening of upward saccades, long before gaze palsy onset. While visceral manifestations tend to predominate during the perinatal and infantile period (2 months–6 years of age), neurological and psychiatric involvement is more prominent during the juvenile/adult period (>6 years of age). Psychosis in NP-C is atypical and variably responsive to treatment. Progressive cognitive decline, which always occurs in patients with NP-C, manifests as memory and executive impairment in juvenile/adult patients. Disease prognosis mainly correlates with the age at onset of the neurological signs, with early-onset forms progressing faster. Therefore, a detailed and descriptive picture of NP-C signs and symptoms may help improve disease detection and early diagnosis, so that therapy with miglustat (Zavesca®), the only available treatment approved to date, can be started as soon as neurological symptoms appear, in order to slow disease progression.

Predictors of temporary and permanent work disability in patients with inflammatory bowel disease: results of the swiss inflammatory bowel disease cohort study

BACKGROUND Inflammatory bowel disease can decrease the quality of life and induce work disability. We sought to (1) identify and quantify the predictors of disease-specific work disability in patients with inflammatory bowel disease and (2) assess the suitability of using cross-sectional data to predict future outcomes, using the Swiss Inflammatory Bowel Disease Cohort Study data. METHODS A total of 1187 patients were enrolled and followed up for an average of 13 months. Predictors included patient and disease characteristics and drug utilization. Potential predictors were identified through an expert panel and published literature. We estimated adjusted effect estimates with 95% confidence intervals using logistic and zero-inflated Poisson regression. RESULTS Overall, 699 (58.9%) experienced Crohn's disease and 488 (41.1%) had ulcerative colitis. Most important predictors for temporary work disability in patients with Crohn's disease included gender, disease duration, disease activity, C-reactive protein level, smoking, depressive symptoms, fistulas, extraintestinal manifestations, and the use of immunosuppressants/steroids. Temporary work disability in patients with ulcerative colitis was associated with age, disease duration, disease activity, and the use of steroids/antibiotics. In all patients, disease activity emerged as the only predictor of permanent work disability. Comparing data at enrollment versus follow-up yielded substantial differences regarding disability and predictors, with follow-up data showing greater predictor effects. CONCLUSIONS We identified predictors of work disability in patients with Crohn's disease and ulcerative colitis. Our findings can help in forecasting these disease courses and guide the choice of appropriate measures to prevent adverse outcomes. Comparing cross-sectional and longitudinal data showed that the conduction of cohort studies is inevitable for the examination of disability.

Expert systems for quality prediction in structural engineering

This work deals with quality level prediction in concrete structures through the helpful assistance of an expert system wich is able to apply reasoning to this field of structural engineering. Evidences, hypotheses and factors related to this human knowledge field have been codified into a Knowledge Base in terms of probabilities for the presence of either hypotheses or evidences,and conditional presence of both. Human experts in structural engineering and safety of structures gave their invaluable knowledge and assistance necessary when constructing the "computer knowledge body".

Los agentes de la edificación desde el punto de vista de la Gestión Integral de Proyectos: diferencias y semejanzas entre la Legislación Española y los Estándares Internacionales = Expert agents in the Global Development of a building project: differences and similarities between Spanish and International contexts.

Desde los años 60, crece en Europa y Estados Unidos la preocupación y la necesidad de mejorar los procesos de gerencia de los proyectos de construcción al volverse estos más complejos. Esto ha llevado a la continua aparición de nuevos profesionales desde la fecha citada hasta nuestros días. De ahí la complejidad de conocer las cualidades de cada uno de ellos, así como las funciones a realizar o la formación que deben tener para poder desarrollar el puesto de trabajo según el papel que desempeñan para cada actividad. Muchos agentes son los que pueden intervenir en la edificación, muchas son las funciones que llevan a cabo estos agentes, muchas son las habilidades que se necesitan para realizar estas misiones, y una buena gestión de la edificación es la que hay que desarrollar para lograr el gran éxito. El presente trabajo fin de máster, dirigido a arquitectos, arquitectos técnicos, ingenieros, abogados, economistas y todos los profesionales del sector inmobiliario y de la construcción, trata de resolver todas aquellas dudas sobre los diferentes sujetos que estarán presentes desde la definición del proyecto en la fase inicial hasta el final de la obra, pasando por las fases de pre-construcción, construcción y post-construcción. (ENGLISH VERSION) Since the 1960s, most construction projects have become more and more complex, and new concerns and necessities related to the management of a project have been on the rise in Europe and in the United States. Thence, the need for more specialized professionals in the field has become a common fact, as well as the inclusion of new curricular subjects in most building engineering studies. There are different agents that play a relevant role in a building project; some of them are expected to perform a highly specialized set of functions that require specific management skills for the work to be successful. This research work—aimed mainly at engineers, quantity surveyors, lawyers, economists, real estate and construction professionals—shows the major implications of the building construction process including both pre-tender/construction and post-tender/construction stages as far as the main expert agents are involved.

Low-Cost Radar-Based Target Identification Prototype using an Expert System

Smart and green cities are hot topics in current research because people are becoming more conscious about their impact on the environment and the sustainability of their cities as the population increases. Many researchers are searching for mechanisms that can reduce power consumption and pollution in the city environment. This paper addresses the issue of public lighting and how it can be improved in order to achieve a more energy efficient city. This work is focused on making the process of turning the streetlights on and off more intelligent so that they consume less power and cause less light pollution. The proposed solution is comprised of a radar device and an expert system implemented on a low-cost platform based on a DSP. By analyzing the radar echo in both the frequency and time domains, the system is able to detect and identify objects moving in front of it. This information is used to decide whether or not the streetlight should be turned on. Experimental results show that the proposed system can provide hit rates over 80%, promising a good performance. In addition, the proposed solution could be useful in kind of other applications such as intelligent security and surveillance systems and home automation.