@neurIST infrastructure for advanced disease management through integration of heterogeneous data, computing, and complex processing services

The increasing volume of data describing humandisease processes and the growing complexity of understanding, managing, and sharing such data presents a huge challenge for clinicians and medical researchers. This paper presents the@neurIST system, which provides an infrastructure for biomedical research while aiding clinical care, by bringing together heterogeneous data and complex processing and computing services. Although @neurIST targets the investigation and treatment of cerebral aneurysms, the system’s architecture is generic enough that it could be adapted to the treatment of other diseases.Innovations in @neurIST include confining the patient data pertaining to aneurysms inside a single environment that offers cliniciansthe tools to analyze and interpret patient data and make use of knowledge-based guidance in planning their treatment. Medicalresearchers gain access to a critical mass of aneurysm related data due to the system’s ability to federate distributed informationsources. A semantically mediated grid infrastructure ensures that both clinicians and researchers are able to seamlessly access andwork on data that is distributed across multiple sites in a secure way in addition to providing computing resources on demand forperforming computationally intensive simulations for treatment planning and research.

Castor et Pollux. Séjour de l'éternelle paix / Rameau, comp.. Iphigénie en Tauride. Unis dès la plus tendre enfance / Gluck, comp. ; Mons. Léon Beyle, T ; avec accompagnement d'orchestre

Titre uniforme : [Castor et Pollux. RCT 32A-B]. Extrait

Transition from pediatric to adult health care: expectations of adolescents with chronic disorders and their parents.

The aim of this study was to assess the expectations of adolescents with chronic disorders with regard to transition from pediatric to adult health care and to compare them with the expectations of their parents. A cross-sectional study was carried out including 283 adolescents with chronic disorders, aged 14-25 years (median age, 16.0 years), and not yet transferred to adult health care, and their 318 parents from two university children's hospitals. The majority of adolescents and parents (64%/70%) perceived the ages of 18-19 years and older as the best time to transfer to adult health care. Chronological age and feeling too old to see a pediatrician were reported as the most important decision factors for the transfer while the severity of the disease was not considered important. The most relevant barriers were feeling at ease with the pediatrician (45%/38%), anxiety (20%/24%), and lack of information about the adult specialist and health care (18%/27%). Of the 51% of adolescents with whom the pediatric specialist had spoken about the transfer, 53% of adolescents and 69% of parents preferred a joint transfer meeting with the pediatric and adult specialist, and 24% of these adolescents declared that their health professional had offered this option. In summary, the age preference for adolescents with chronic disorders and their parents to transfer to adult health care was higher than the upper age limits for admission to pediatric health care in many European countries. Anxiety and a lack of information of both adolescents and their parents were among the most important barriers for a smooth and timely transfer according to adolescents and parents.

Conservation of oceanic island floras: Present and future global challenges

Currentthreatstotheplanet’sbiodiversityareunprecedented,andtheyparticularlyimperilinsular floras.Inthisinvestigation,weusethethreatfactorsidentifiedbytheMillenniumEcosystem Assessmentasthemaindriversofbiodiversitylossonislandstodefineandrank13current,continuing threatstotheplantdiversityofninefocalarchipelagoswherevolcanicorigin(orintheSeychellesa prolongedisolationafteracontinentalorigin)hasproducedahighdegreeofendemicityandfragilityin the faceofhabitatalteration.Wealsoconductaglobalendangermentassessmentbasedonthe numbersofinsularendemicplantsintheendangered(EN)andcriticallyendangered(CR)IUCN categoriesfor53islandgroupswithanestimated9951endemicplantspecies,providinga representativesampleoftheworld’sinsularsystemsandtheirfloristicrichness.Ouranalysesindicate that isolationdoesnotsignificantlyinfluenceendangerment,butplantendemicsfromverysmall islandsaremoreoftencriticallyendangered.Weestimatethatbetween3500and6800oftheestimated 70,000 insularendemicplantspeciesworldwidemightbehighlythreatened(CR+EN)andbetweenca. 2000 and2800ofthemincriticaldangerofextinction(CR).Basedontheseanalyses,andona worldwideliteraturereviewofthebiologicalthreatfactorsconsidered,weidentifychallenging questionsforconservationresearch,asking(i)whatarethemosturgentprioritiesfortheconservation of insularspeciesandfloras,and(ii)withtheknowledgeandassetsavailable,howcanweimprovethe impactofconservationscienceandpracticeonthepreservationofislandbiodiversity?Ouranalysis indicatesthatthesynergisticactionofmanythreatfactorscaninducemajorecologicaldisturbances, leadingtomultipleextinctions.Wereviewweaknessesandstrengthsinconservationresearchand managementintheninefocalarchipelagos,andhighlighttheurgentneedforconservationscientiststo shareknowledgeandexpertise,identifyanddiscusscommonchallenges,andformulatemulti- disciplinaryconservationobjectivesforinsularplantendemicsworldwide.Toourknowledge,thisisthe mostup-to-dateandcomprehensivesurveyyettoreviewthethreatfactorstonativeplantsonoceanic islandsanddefinepriorityresearchquestions.

Predicting Adverse Events in Children with Fever and Chemotherapy-Induced Neutropenia. Results of the Prospective Multicenter SPOG 2003 FN Study

PURPOSE To develop a score predicting the risk of adverse events (AEs) in pediatric patients with cancer who experience fever and neutropenia (FN) and to evaluate its performance. PATIENTS AND METHODS Pediatric patients with cancer presenting with FN induced by nonmyeloablative chemotherapy were observed in a prospective multicenter study. A score predicting the risk of future AEs (ie, serious medical complication, microbiologically defined infection, radiologically confirmed pneumonia) was developed from a multivariate mixed logistic regression model. Its cross-validated predictive performance was compared with that of published risk prediction rules. Results An AE was reported in 122 (29%) of 423 FN episodes. In 57 episodes (13%), the first AE was known only after reassessment after 8 to 24 hours of inpatient management. Predicting AE at reassessment was better than prediction at presentation with FN. A differential leukocyte count did not increase the predictive performance. The score predicting future AE in 358 episodes without known AE at reassessment used the following four variables: preceding chemotherapy more intensive than acute lymphoblastic leukemia maintenance (weight = 4), hemoglobin > or = 90 g/L (weight = 5), leukocyte count less than 0.3 G/L (weight = 3), and platelet count less than 50 G/L (weight = 3). A score (sum of weights) > or = 9 predicted future AEs. The cross-validated performance of this score exceeded the performance of published risk prediction rules. At an overall sensitivity of 92%, 35% of the episodes were classified as low risk, with a specificity of 45% and a negative predictive value of 93%. CONCLUSION This score, based on four routinely accessible characteristics, accurately identifies pediatric patients with cancer with FN at risk for AEs after reassessment.