Guidelines for the Development of Comprehensive Care Centers for Congenital Adrenal Hyperplasia: Guidance from the CARES Foundation Initiative

Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH) often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA), New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC), and National Newborn Screening and Genetics Resource Center (NNSGRC) also participated. Thus, this document should serve as a "roadmap" for the development phases of comprehensive care centers (CCC) for individuals and families affected by CAH.

A cátedra UNESCO de direito à educação da Faculdade de Direito: democracia, cidadania e direito à educação

Regimes democráticos se consolidam na medida de sua aceitação pela maioria, o que supõe conhecimento e confiança nas instituições políticas e jurídicas. A educação de qualidade é relevante para a governança democrática e para a formação da cidadania, posto propiciar o acesso a ferramentas cognitivas necessárias para a participação política relevante. As interações entre a democracia, o direito à educação e as políticas públicas de educação são analisadas pela Cátedra UNESCO no projeto de pesquisa “Brasil 25 anos de democracia” sob o ângulo da função promocional do Direito à Educação da FD, em parceria com o Núcleo de Políticas Públicas da USP, com. O foco da pesquisa é a atividade do Supremo Tribunal Federal (STF), a do Superior Tribunal de Justiça (STJ) e a do Congresso Nacional, no período compreendido entre os anos 2000 e 2010.

Query rewriting in information retrieval: automatic context extraction from local user documents to improve query results

The central objective of research in Information Retrieval (IR) is to discover new techniques to retrieve relevant information in order to satisfy an Information Need. The Information Need is satisfied when relevant information can be provided to the user. In IR, relevance is a fundamental concept which has changed over time, from popular to personal, i.e., what was considered relevant before was information for the whole population, but what is considered relevant now is specific information for each user. Hence, there is a need to connect the behavior of the system to the condition of a particular person and his social context; thereby an interdisciplinary sector called Human-Centered Computing was born. For the modern search engine, the information extracted for the individual user is crucial. According to the Personalized Search (PS), two different techniques are necessary to personalize a search: contextualization (interconnected conditions that occur in an activity), and individualization (characteristics that distinguish an individual). This movement of focus to the individual's need undermines the rigid linearity of the classical model overtaken the ``berry picking'' model which explains that the terms change thanks to the informational feedback received from the search activity introducing the concept of evolution of search terms. The development of Information Foraging theory, which observed the correlations between animal foraging and human information foraging, also contributed to this transformation through attempts to optimize the cost-benefit ratio. This thesis arose from the need to satisfy human individuality when searching for information, and it develops a synergistic collaboration between the frontiers of technological innovation and the recent advances in IR. The search method developed exploits what is relevant for the user by changing radically the way in which an Information Need is expressed, because now it is expressed through the generation of the query and its own context. As a matter of fact the method was born under the pretense to improve the quality of search by rewriting the query based on the contexts automatically generated from a local knowledge base. Furthermore, the idea of optimizing each IR system has led to develop it as a middleware of interaction between the user and the IR system. Thereby the system has just two possible actions: rewriting the query, and reordering the result. Equivalent actions to the approach was described from the PS that generally exploits information derived from analysis of user behavior, while the proposed approach exploits knowledge provided by the user. The thesis went further to generate a novel method for an assessment procedure, according to the "Cranfield paradigm", in order to evaluate this type of IR systems. The results achieved are interesting considering both the effectiveness achieved and the innovative approach undertaken together with the several applications inspired using a local knowledge base.

L’«educativo» in sanità: reti di complessità e orizzonti di possibilità

La tesi analizza il dialogo tra due prospettive disciplinari: pedagogia e scienze mediche aprendo ad una serie di riflessioni operative e metodologiche per lo sviluppo della competenza educativa in sanità. Si tratta di un lavoro di ricerca pedagogica articolata in due parti:una teoretica e una empirica. La prima parte pone l’attenzione in modo particolare all’epistemologia della cura sanitaria nella prospettiva della complessità e agli elementi che definiscono la competenza educativa degli operatori. La seconda parte presenta i dati di una indagine esplorativa realizzata tramite focus group che ha coinvolto medici, infermieri, ostetriche e fisioterapisti della provincia di Bologna e medici, infermieri e fisioterapisti del Canton Ticino, Svizzera per far emergere le esperienze, i vissuti e le opinioni legate alle azioni educative sanitarie

Politiche attive del lavoro e ammortizzatori sociali in deroga: misure difensive o di promozione delle capacità?

Il tema generale del dottorato di ricerca è l'analisi delle politiche di attivazione in Italia durante la crisi economica. La combinazione di politiche attive e passive del lavoro viene interpretata ricorrendo al quadro teorico proposto da Amartya Sen e basato sul concetto di capability. Abbiamo considerato le misure nazionali e regionali nel quadro delle linee guida europee e analizzato le tendenze verso l'empowerment dei beneficiari di politiche del lavoro attraverso il concetto di capability proposto da Sen. La ricerca empirica ha utilizzato diversi strumenti per la raccolta dei dati: focus group, un questionario inviato ad un campione di 1.200 lavoratori, e interviste.

Ambienti innovativi per l'apprendimento: Modelli interpretativi e contributi di esperienze. Uno studio sull'organizzazione di Scuola-Città Pestalozzi a Firenze

La tesi affronta il tema dell'innovazione della scuola, oggetto di costante attenzione da parte delle organizzazioni internazionali e dei sistemi educativi nazionali, per le sue implicazioni economiche, sociali e politiche, e intende portare un contributo allo studio sistematico e analitico dei progetti e delle esperienze di innovazione complessiva dell'ambiente di apprendimento. Il concetto di ambiente di apprendimento viene approfondito nelle diverse prospettive di riferimento, con specifica attenzione al framework del progetto "Innovative Learning Environments" [ILE], dell’Organisation For Economic And Cultural Development [OECD] che, con una prospettiva dichiaratamente olistica, individua nel dispositivo dell’ambiente di apprendimento la chiave per l’innovazione dell’istruzione nella direzione delle competenze per il ventunesimo Secolo. I criteri presenti nel quadro di riferimento del progetto sono stati utilizzati per un’analisi dell’esperienza proposta come caso di studio, Scuola-Città Pestalozzi a Firenze, presa in esame perché nell’anno scolastico 2011/2012 ha messo in pratica appunto un “disegno” di trasformazione dell’ambiente di apprendimento e in particolare dei caratteri del tempo/scuola. La ricerca, condotta con una metodologia qualitativa, è stata orientata a far emergere le interpretazioni dei protagonisti dell’innovazione indagata: dall’analisi del progetto e di tutta la documentazione fornita dalla scuola è scaturita la traccia per un focus-group esplorativo attraverso il quale sono stati selezionati i temi per le interviste semistrutturate rivolte ai docenti (scuola primaria e scuola secondaria di primo grado). Per quanto concerne l’interpretazione dei risultati, le trascrizioni delle interviste sono state analizzate con un approccio fenomenografico, attraverso l’individuazione di unità testuali logicamente connesse a categorie concettuali pertinenti. L’analisi dei materiali empirici ha permesso di enucleare categorie interpretative rispetto alla natura e agli scopi delle esperienze di insegnamento/apprendimento, al processo organizzativo, alla sostenibilità. Tra le implicazioni della ricerca si ritengono particolarmente rilevanti quelle relative alla funzione docente.

Speziation von Neptunium bei der Migration in Tongestein

Die vorliegende Arbeit wurde im Rahmen eines Stipendiums des interdisziplinärenrnGraduiertenkollegs 826 „Spurenanalytik von Elementspezies: Methodenentwicklung und Anwendungen“, gefördert durch die Deutsche Forschungsgemeinschaft (DFG) und das Land Rheinland-Pfalz, angefertigt. Dabei sollten neue Erkenntnisse über die Wechselwirkung zwischen Neptunium und natürlichem Tongestein mit Hinblick auf die Endlagerung wärmeentwickelnder radioaktiver Abfälle in einem geologischen Tiefenlager gewonnen werden. Auf Grund seiner langen Halbwertszeit von mehr als zwei Millionen Jahren wird Np-237 einen signifikanten Anteil an der Radiotoxizität dieser Abfälle nach Lagerzeiten von mehr als 1000 Jahren haben. Np tritt in Lösung unter umweltrelevanten Bedingungen in den Oxidationsstufen +IV und +V auf. Auf Grund der guten Löslichkeit und daher höheren Mobilität ist Np(V) als die gefährlichere Spezies einzustufen. In den Migrationsstudien wurdernOpalinuston (OPA) aus Mont Terri, Schweiz, als natürliches Referenzmaterial verwendet. Der Fokus dieser Arbeit lag dabei auf der Speziation von Np an der Mineraloberfläche mittels synchrotronbasierter Röntgenabsorptionsspektroskopie (EXAFS/XANES).rnDie Wechselwirkung zwischen Np(V) und OPA wurde zunächst in Batch- und Diffusionsexperimenten in Abhängigkeit verschiedener experimenteller Parameter (u.a. pH, Temperatur, Hintergrundelektrolyt, Einfluss von Huminsäure, Konkurrenz mit U(VI), aerobe/anaerobe Bedingungen) untersucht. Die Untersuchung der Np-Speziation erfolgt zum einen an Pulverproben aus Batch-Experimenten unter aeroben und anaeroben Bedingungen, welche mittels EXAFS-Spektroskopie untersucht wurden. Zum anderen wurden ortsaufgelöste μ-XANES-Messungen an Np-Anreicherungen auf OPA-Dünnschliffen und in Diffusionsproben durchgeführt. Durch Kombination der Spektroskopie mit μ-Rötngenfluoreszenzmapping (XRF) und μ-Röntgenbeugung (XRD) konnten zudem Erkenntnisse über die Elementverteilung von Np und anderen im Opalinuston enthaltenen Elementen sowie über kristalline Mineralphasen im Umfeld von Bereichen erhöhter Np-Konzentration erhalten werden.rnSowohl Sorptionsexperimente als auch die spektroskopischen Untersuchungen zeigten eine teilweise Reduktion von Np(V) zu Np(IV) bei der Wechselwirkung mit OPA. Dabei konnte Pyrit als eine der redoxaktiven Phasen identifiziert werden. In diesem Zusammenhang ist die Bildung schwerlöslicher Np(IV)-Spezies mit Hinblick auf die Endlagerung positiv zu bewerten.

Problems in functioning from the patient perspective using the International Classification of Functioning, Disability and Health (ICF) as a reference

We conducted a qualitative, multicenter study using a focus group design to explore the lived experiences of persons with any kind of primary sleep disorder with regard to functioning and contextual factors using six open-ended questions related to the International Classification of Functioning, Disability and Health (ICF) components. We classified the results using the ICF as a frame of reference. We identified the meaningful concepts within the transcribed data and then linked them to ICF categories according to established linking rules. The six focus groups with 27 participants yielded a total of 6986 relevant concepts, which were linked to a total of 168 different second-level ICF categories. From the patient perspective, the ICF components: (1) Body Functions; (2) Activities & Participation; and (3) Environmental Factors were equally represented; while (4) Body Structures appeared poignantly less frequently. Out of the total number of concepts, 1843 concepts (26%) were assigned to the ICF component Personal Factors, which is not yet classified but could indicate important aspects of resource management and strategy development of those who have a sleep disorder. Therefore, treatment of patients with sleep disorders must not be limited to anatomical and (patho-)physiological changes, but should also consider a more comprehensive view that includes patient's demands, strategies and resources in daily life and the contextual circumstances surrounding the individual.

Ablation of the tumor suppressor histidine triad nucleotide binding protein 1 is protective against hepatic ischemia/reperfusion injury

The identification of cellular pathways capable of limiting ischemia/reperfusion (I/R) injury remains a frontier in medicine, and its clinical relevance is urgent. Histidine triad nucleotide binding protein 1 (HINT1) is a tumor suppressor that influences apoptosis. Because apoptotic pathways are a feature of I/R injury, we asked whether Hint1 influences hepatic I/R injury. Hint1(-/-) and C57BL/6 mice were subjected to 70% liver ischemia followed by reperfusion for 3 or 24 hours or to a sham operation. The serum aminotransferase levels, histological lesions, apoptosis, reactive oxygen species, and expression of B cell lymphoma 2-associated X protein (Bax), heme oxygenase 1 (HO-1), interleukin-6 (IL-6), IL-10, tumor necrosis factor-a, Src, nuclear factor kappa B (p65/RelA), and c-Jun were quantified. The responses to toll-like receptor ligands and nicotinamide adenine dinucleotide phosphate oxidase activity in Kupffer cells were compared in Hint1(-/-) mice and C57BL/6 mice. After I/R, the levels of serum aminotransferases, parenchymal necrosis, and hepatocellular apoptosis were significantly lower in Hint1(-/-) mice versus control mice. Furthermore, Bax expression decreased more than 2-fold in Hint1(-/-) mice, and the increases in reactive oxygen species and HO-1 expression that were evident in wild-type mice after I/R were absent in Hint1(-/-) mice. The phosphorylation of Src and the nuclear translocation of p65 were increased in Hint1(-/-) mice, whereas the nuclear expression of phosphorylated c-Jun was decreased. The levels of the protective cytokines IL-6 and IL-10 were increased in Hint1(-/-) mice. These effects increased survival after I/R in mice lacking Hint1. Hint1(-/-) Kupffer cells were less activated than control cells after stimulation with lipopolysaccharides. CONCLUSION: The Hint1 protein influences the course of I/R injury, and its ablation in Kupffer cells may limit the extent of the injury.

La 'grande chasse' chez les Pygmées Baka du Sud-Est Cameroun. Contribution à l'Anthropologie de l'environnement.

This thesis focuses on “The “great hunting” among the Baka pygmies of the Southeastern Cameroon. A contribution to Anthropology of environment. The problematic in the study is the confrontation of great hunting among the Baka with the institutional, socio-economic and ecological change in forest. The goal is to analyze the mechanisms of adaptation of this game against these changes that affect the Baka environment. The proposed hypothesis suggests that Baka Pygmies have restructured the preparatory ceremonies of the great hunting following changes that occurred in their environmental milieu. Certain ritual animals have been substituted. Hunting lands, tools, methods and periods were also modified. The great hunting is opened to Baka hunters and non Baka hunters. Qualitative techniques, including observation, interviews and focus group discussions were used for data collection. The observations allowed us to understand the reality of driving forces in the forest as well as tools for hunting, hunting land and even the species sought. Interviews and focus group discussions were consolidated data on the ancient practice of hunting for rituals like Jengi and Beka, on the current practice of this hunting and on the impact of the of the modification of this hunting practice on the Baka culture. The results of this research show that the Baka have taken important measure to adapt their great hunting to the changing time and space. But the restructuring of this hunting varies from one village to another. As and when we leave the depths of the forest to the city of Yokadouma the great hunting is practiced less and less. Baka use illegal hunting tools and even fully protected species in their great hunting and in rituals celebrations. The overexploitation of forest resources, the creation of protected areas, full protection of certain large mammals and the action of ecoguards are something of an obstacle to the ancient practice of hunting for ritual. In most of camp where hunting is no more existing, ritual ceremonies are less and less celebrated. The study is divided into five chapters. The first chapter is related to the literature review, the theoretical framework, the definition of concepts, the second focuses on the geographical presentation of the study area, the third chapter looks at factors affecting the great hunting, the fourth chapter deal with the changes observed in the Baka’s great hunting, and the fifth chapter examines consequences of the restriction or suppression of the hunt on the Baka socio culture.

Citizenship Education – Between Social Inequality and the Promises of Modernity

For several reasons citizenship and democracy has moved into political and research focus. Socio-cultural tensions and inequalities created by globalisation processes boosted by neo-liberal modes of government seem to inspire a concern with “social cohesion”, and the European Community assigns a key role to education in engendering European democratic citizenship. It can be questioned whether it is within the scope of educational programmes to ensure social integration and democracy. However, to clarify the perspectives of the educational issue, the article discusses the conflicts and relationships between cultural identity and democracy within a framework of modernity before returning to the issue of education for democratic citizenship. It is shown on the basis of empirical studies that family background interacts with school factors in the reproduction of democratic inequalities. It is also indicated, however, that this must not be considered an unchangeable pedagogical fact, and the article briefly sketches a set of pedagogical and research challenges concerned with educating for democratic empowerment at different levels of school practice. Although this paper focuses on education and the educational system, the arguments and findings presented can also claim relevance for social pedagogy and social work, esp. in respect of recent developments that stress the educational dimensions of social work.

Micro-blogging adoption in the enterprise: an empirical analysis

Given the increasing interest in using social software for company-internal communication and collaboration, this paper examines drivers and inhibitors of micro-blogging adoption at the workplace. While nearly one in two companies is currently planning to introduce social software, there is no empirically validated research on employees’ adoption. In this paper, we build on previous focus group results and test our research model in an empirical study using Structural Equation Modeling. Based on our findings, we derive recommendations on how to foster adoption. We suggest that micro-blogging should be presented to employees as an efficient means of communication, personal brand building, and knowledge management. In order to particularly promote content contribution, privacy concerns should be eased by setting clear rules on who has access to postings and for how long they will be archived.

Multiprofessional collaboration in teaching practices in all-day-schools in Switzerland

Multiprofessional collaboration in settings of extended education has been an important research topic in the past 40 years and has been discussed as a means to improve educational achievement, foster professional development, and support teachers in their everyday work. Several recent studies in multiprofessional settings found that collaboration practices often remain on a student-centered, time-limited, and superficial level of exchange, whereas higher forms of collaboration are very rare (Dizinger, Fussangel, Kasper, 2011). Furthermore there exists an obvious research gap on collaboration in Swiss all-day schools (Jutzi&Thomann, 2012). In this study we analyzed practices of multiprofessional collaboration in school-based and community-based extracurricular activities of all-day schools in Switzerland. The aim of this qualitative study of 10 all-day schools was to answer the following questions: (a) What forms of collaboration (informal/formal) are used between the different professionals? and (b) Are there different types of all-day schools with regard to distinctive and consistent types of collaboration? We conducted 18 problem-centered interviews (with the principals/heads of the all-day schools) and 10 focus group discussions (teams). In the process of data evaluation, we applied the method of qualitative content analysis. The results show that multiprofessional collabo ration is taking place in all of the all-day schools examined in the study. However, the collaborative practices differ in their level of intensity, design, and purpose.

Development, implementation, and evaluation of a structured reporting web tool for abdominal aortic aneurysms

BACKGROUND The majority of radiological reports are lacking a standard structure. Even within a specialized area of radiology, each report has its individual structure with regards to details and order, often containing too much of non-relevant information the referring physician is not interested in. For gathering relevant clinical key parameters in an efficient way or to support long-term therapy monitoring, structured reporting might be advantageous. OBJECTIVE Despite of new technologies in medical information systems, medical reporting is still not dynamic. To improve the quality of communication in radiology reports, a new structured reporting system was developed for abdominal aortic aneurysms (AAA), intended to enhance professional communication by providing the pertinent clinical information in a predefined standard. METHODS Actual state analysis was performed within the departments of radiology and vascular surgery by developing a Technology Acceptance Model. The SWOT (strengths, weaknesses, opportunities, and threats) analysis focused on optimization of the radiology reporting of patients with AAA. Definition of clinical parameters was achieved by interviewing experienced clinicians in radiology and vascular surgery. For evaluation, a focus group (4 radiologists) looked at the reports of 16 patients. The usability and reliability of the method was validated in a real-world test environment in the field of radiology. RESULTS A Web-based application for radiological "structured reporting" (SR) was successfully standardized for AAA. Its organization comprises three main categories: characteristics of pathology and adjacent anatomy, measurements, and additional findings. Using different graphical widgets (eg, drop-down menus) in each category facilitate predefined data entries. Measurement parameters shown in a diagram can be defined for clinical monitoring and be adducted for quick adjudications. Figures for optional use to guide and standardize the reporting are embedded. Analysis of variance shows decreased average time required with SR to obtain a radiological report compared to free-text reporting (P=.0001). Questionnaire responses confirm a high acceptance rate by the user. CONCLUSIONS The new SR system may support efficient radiological reporting for initial diagnosis and follow-up for AAA. Perceived advantages of our SR platform are ease of use, which may lead to more accurate decision support. The new system is open to communicate not only with clinical partners but also with Radiology Information and Hospital Information Systems.

Children's Perceptions of Male and Female Athletes as Presented in Sports Illustrated for Kids

Despite gains made by Title IX in the past 36 years, including increased female participation in high school and collegiate sport, there is evidence that gender equity in sport is not fully achieved. Researchers target the media because they tend to shape social values and disseminate information to the masses (Kane, 1978, in Fink & Kensicki, 2002). As sports become more pervasive, framing theory has become particularly relevant. The purpose of this study is to build on the Hardin et al. (2002) study by examining the relationship among media sports coverage, gender equity in sport and the perceptions young sports fans begin to form about gender and sport based on media consumption. The researcher hypothesized that since women face discrimination in sport starting from the time that they choose to participate, children will perceive male athletes and their sports as more legitimate. Additionally, the media play a major role in shaping the views of audiences, so the way that they represent male and female athletes, including juxtaposing them, may have an impact on children. The researcher conducted a content analysis of 24 Sports Illustrated for Kids issues from 1996 to 1999 and 24 issues from 2006 to 2007. The researcher analyzed the content of photographs (N=3219) and of headlines (N=762) by using the definitions determined by Hardin et al. (2002). We found that there is a disproportionate amount of coverage devoted to male athletes and that the discrepancy between media representation between men and women in sport has grown since the mid-1990s. This study also includes a focus group conducted with three children from a community swimming program in a northeastern town and found that those children were acutely aware of the differences between men and women in sport based on the discussion. The researcher does not attempt to find a causal relationship between these children’s perceptions and the way media represents them, but rather uses the focus group to complement the content analysis. As children become sports consumers in later life, future research exploring the relationship between children’s perceptions and the media’s representations need to be done before causality and the significance of media effects are determined.