Evaluation of metabolic syndrome and associations with inflammation and graft function in renal transplant recipients

INTRODUCTION: Cardiovascular disease (CVD) is a major determinant of mortality in renal transplant recipients (RTR). Metabolic syndrome (MS) and chronic inflammation are currently considered non traditional risk factors for cardiovascular disease. This study evaluates the frequency of these conditions their associations with graft function. OBJECTIVE: To evaluate the prevalence of metabolic syndrome (MS) and inflammation and their associations with graft function in renal transplant recipients. METHODS: A cross-sectional study was carried out with 200 RTR. MS was defined by the NCEP-ATP III criteria. Inflammation was assessed by CRP levels. Renal function was assessed by GFR estimation using the MDRD equation. RESULTS: MS occurred in 71 patients (35.5%). Patients with MS had higher CPR and decreased GFR levels. Inflammation was present in 99 patients (49.5%). Mean waist perimeter, body mass index, triglycerides and serum total cholesterol were significantly higher in inflamed patients. An association between MS and inflammation was demonstrated, 48 (67.6%) patients with MS were inflamed and among those without MS the rate of inflamed patients was 39.5% (51 patients) (p < 0.001). A significantly higher percentage of patients with MS in the group of patients in chronic renal disease stages III and IV was observed. CONCLUSION: In RTR there is a significant association among MS and inflammation. MS is negatively associated with graft function. The clinical implications of these findings must be evaluated in longitudinal studies.

Evaluation of the main energy scenarios for the global energy transition

Energy scenarios are used as a tool to examine credible future states and pathways. The one who constructs a scenario defines the framework in which the possible outcomes exist. The credibility of a scenario depends on its compatibility with real world experiences, and on how well the general information of the study, methodology, and originality and processing of data are disclosed. In the thesis, selected global energy scenarios’ transparency and desirability from the society’s point of view were evaluated based on literature derived criteria. The global energy transition consists of changes to social conventions and economic development in addition to technological development. Energy solutions are economic and ethical choices due to far-reaching impacts of energy decision-making. Currently the global energy system is mostly based on fossil fuels, which is unsustainable over the long-term due to various reasons: negative climate change impacts, negative health impacts, depletion of fossil fuel reserves, resource-use conflicts with water management and food supply, loss of biodiversity, challenge to preserve ecosystems and resources for future generations, and inability of fossil fuels to provide universal access to modern energy services. Nuclear power and carbon capture and storage cannot be regarded as sustainable energy solutions due to their inherent risks and required long-term storage. The energy transition is driven by a growing energy demand, decreasing costs of renewables, modularity and scalability of renewable technologies, macroeconomic benefits of using renewables, investors’ risk awareness, renewable energy related attractive business opportunities, almost even distribution of solar and wind resources on the planet, growing awareness of the planet’s environmental status, environmental movements and tougher environmental legislation. Many of the investigated scenarios identified solar and wind power as a backbone for future energy systems. The scenarios, in which the solar and wind potentials were deployed in largest scale, met best the set out sustainability criteria. In future research, energy scenarios’ transparency can be improved by better disclosure on who has ordered the study, clarifying the funding, clearly referencing to used sources and indicating processed data, and by exploring how variations in cost assumptions and deployment of technologies influence on the outcomes of the study.

Course/instructor evaluation : perspectives of part-time graduate students

This study explored 6 part-time graduate students' perspectives on course/instructor evaluation. The purpose was to explore whether a link exists between the evaluation for course and instructors as contained in the Faculty of Education courselinstructor evaluation form and the needs of part-time students enrolled in that program. The literature review provided contextual information concerning the 3 main subject areas based upon which the research questions were designed: learner needs in the context of part-time graduate students, courselinstructor eval~ation, and the potential lack of congruency between the 2. Using a semistructured interview process, participants identified criteria important or relevant to the evaluation process and incongruent with the course/instructor evaluation form. A qualitative research methodology using a grounded theory approach contributed to the theory on the nature of course evaluation instruments in a graduate program and addressed the notion of where power was situated within the evaluation process. Findings suggested that the concepts of relevance and the instructor's role that participants identified as important in their graduate learning experience were congruent with what they considered important components of the course/instructor evaluation form. Participants noted a lack of congruency between their expectations of a quality graduate learning experience and the format, content, intent, and timing of the evaluation process. The study confirmed that students did want a voice in the evaluation of their learning experience at both the course and program levels.

I Believe in me, not OCB: Evaluation of Group Function-Based CBT as a Treatment for Obsessive Compulsive Behaviour in Four Children with HFA

Researchers have conceptualized repetitive behaviours in individuals with Autism Spectrum Disorder (ASD) on a continuum oflower-Ievel, motoric, repetitive behaviours and higher-order, repetitive behaviours that include symptoms ofOCD (Hollander, Wang, Braun, & Marsh, 2009). Although obsessional, ritualistic, and stereotyped behaviours are a core feature of ASD, individuals with ASD frequently experience obsessions and compulsions that meet DSM-IV-TR (American Psychiatric Association, 2000) criteria for Obsessive-Compulsive Disorder (OCD). Given the acknowledged difficulty in differentiating between OCD and Autism-related obsessive-compulsive phenomena, the present study uses the term Obsessive Compulsive Behaviour (OCB) to represent both phenomena. This study used a multiple baseline design across behaviours and ABC designs (Cooper, Heron, & Heward, 2007) to investigate if a 9-week Group Function-Based Cognitive Behavioural Therapy (CBT) decreased OCB in four children (ages 7 - 11 years) with High Functioning Autism (HFA). Key treatment components included traditional CBT components (awareness training, cognitive-behavioural skills training, exposure and response prevention) as well as function-based assessment and intervention. Time series data indicated significant decreases in OCBs. Standardized assessments showed decreases in symptom severity, and increases in quality of life for the participants and their families. Issues regarding symptom presentation, assessment, and treatment of a dually diagnosed child are discussed.

Intertemporal Social Evaluation

Intertemporal social-evaluation rules provide us with social criteria that can be used to assess the relative desirability of utility distributions across generations. The trade-offs between the well-being of different generations implicit in each such rule reflect the underlying ethical position on issues of intergenerational equity or justice. We employ an axiomatic approach in order to identify ethically attractive socialevaluation procedures. In particular, we explore the possibilities of using welfare information and non-welfare information in a model of intertemporal social evaluation. We focus on the individuals’ birth dates and lengths of life as the relevant non-welfare information. As usual, welfare information is given by lifetime utilities. It is assumed that this information is available for each alternative to be ranked. Various weakenings of the Pareto principle are employed in order to allow birth dates or lengths of life (or both) to matter in social evaluation. In addition, we impose standard properties such as continuity and anonymity and we examine the consequences of an intertemporal independence property. For each of the Pareto conditions employed, we characterize all social-evaluation rules satisfying it and our other axioms. The resulting rules are birth-date dependent or lifetime-dependent versions of generalized utilitarianism. Furthermore, we discuss the ethical and axiomatic foundations of geometric discounting in the context of our model.

Economic evaluation of prevention of mother – to – child – transmission of HIV/AIDS interventions in developing countries : a systematic review

Les gouvernements mondiaux et les organismes internationaux ont placé une haute priorité dans la prévention de la transmission mère-enfant du VIH. Cependant, bien qu'il y ait eu des progrès énormes rapportés dans des nations industrialisées, la situation dans les pays en voie de développement est encore déplorable; on y constate un grand écart entre l’engagement international pour réduire cette voie de transmission et l'accès aux interventions. Ceci peut être attribué à la situation économique déplorable dans plusieurs pays en voie de développement. Des interventions prioritaires en santé doivent donc être soigneusement sélectionnées afin de maximiser l'utilisation efficace des ressources limitées. L’évaluation économique est un outil efficace qui peut aider des décideurs à identifier quelles stratégies choisir. L'objectif de cette revue systématique est de recenser toutes les études d'évaluation économique existantes qui ont été effectuées dans les pays en voie de développement sur la prévention de la transmission mère-enfant du VIH. Notre revue a retenu 16 articles qui ont répondu aux critères d'inclusion. Nous avons conçu un formulaire pour l’extraction de données, puis nous avons soumis les articles à un contrôle rigoureux de qualité. Nos résultats ont exposé un certain nombre de défauts dans la qualité des études choisies. Nous avons également noté une forte hétérogénéité dans les estimations des paramètres de coût et d'efficacité de base, dans la méthodologie appliquée, ainsi que dans les écarts utilisés dans les analyses de sensibilité. Quelques interventions comportant la thérapie à la zidovudine ou à la nevirapine à court terme se sont avérées rentables, et ont enregistré des valeurs acceptables de coût-utilité. Les résultats des évaluations économiques analysées dans cette revue ont varié sur la base des facteurs suivants : la prévalence du VIH, la classification du pays selon le revenu, les infrastructures disponible, les coûts du personnel, et finalement les coûts des interventions, particulièrement les prix des médicaments.

Exploration des effets d’un programme de réadaptation visant l’amélioration des activités et la participation des personnes cérébrolésées. Application à l’activité cuisine

Thèse réalisée en cotutelle France- Québec

The use of a multiple criteria decision analysis to evaluate the effectiveness of landscape and habitat enhancement mechanisms: an example from the South Downs

A range of funding schemes and policy instruments exist to effect enhancement of the landscapes and habitats of the UK. While a number of assessments of these mechanisms have been conducted, little research has been undertaken to compare both quantitatively and qualitatively their relative effectiveness across a range of criteria. It is argued that few tools are available for such a multi-faceted evaluation of effectiveness. A form of Multiple Criteria Decision Analysis (MCDA) is justified and utilized as a framework in which to evaluate the effectiveness of nine mechanisms in relation to the protection of existing areas of chalk grassland and the creation of new areas in the South Downs of England. These include established schemes, such as the Countryside Stewardship and Environmentally Sensitive Area Schemes, along with other less common mechanisms, for example, land purchase and tender schemes. The steps involved in applying an MCDA to evaluate such mechanisms are identified and the process is described. Quantitative results from the comparison of the effectiveness of different mechanisms are presented, although the broader aim of the paper is that of demonstrating the performance of MCDA as a tool for measuring the effectiveness of mechanisms aimed at landscape and habitat enhancement.

An evaluation of a Bayesian method of dose escalation based on bivariate binary responses

Recently, various approaches have been suggested for dose escalation studies based on observations of both undesirable events and evidence of therapeutic benefit. This article concerns a Bayesian approach to dose escalation that requires the user to make numerous design decisions relating to the number of doses to make available, the choice of the prior distribution, the imposition of safety constraints and stopping rules, and the criteria by which the design is to be optimized. Results are presented of a substantial simulation study conducted to investigate the influence of some of these factors on the safety and the accuracy of the procedure with a view toward providing general guidance for investigators conducting such studies. The Bayesian procedures evaluated use logistic regression to model the two responses, which are both assumed to be binary. The simulation study is based on features of a recently completed study of a compound with potential benefit to patients suffering from inflammatory diseases of the lung.

A statistical evaluation of the fixed dose procedure

The fixed-dose procedure (FDP) was introduced as OECD Test Guideline 420 in 1992, as an alternative to the conventional median lethal dose (LD50) test for the assessment of acute oral toxicity (OECD Test Guideline 401). The FDP uses fewer animals and causes less suffering than the conventional test, while providing information on the acute toxicity to allow substances to be ranked according to the EU hazard classification system. Recently the FDP has been revised, with the aim of providing further reductions and refinements, and classification according to the criteria of the Globally Harmonized Hazard Classification and Labelling scheme (GHS). This paper describes the revised FDP and analyses its properties, as determined by a statistical modelling approach. The analysis shows that the revised FDP classifies substances for acute oral toxicity generally in the same, or a more stringent, hazard class as that based on the LD50 value, according to either the GHS or the EU classification scheme. The likelihood of achieving the same classification is greatest for substances with a steep dose-response curve and median toxic dose (TD50) close to the LD50. The revised FDP usually requires five or six animals with two or fewer dying as a result of treatment in most cases.

Evaluation of agri-environmental and forestry schemes with multiple objectives

The evaluation of EU policy in the area of rural land use management often encounters problems of multiple and poorly articulated objectives. Agri-environmental policy has a range of aims, including natural resource protection, biodiversity conservation and the protection and enhancement of landscape quality. Forestry policy, in addition to production and environmental objectives, increasingly has social aims, including enhancement of human health and wellbeing, lifelong learning, and the cultural and amenity value of the landscape. Many of these aims are intangible, making them hard to define and quantify. This article describes two approaches for dealing with such situations, both of which rely on substantial participation by stakeholders. The first is the Agri-Environment Footprint Index, a form of multi-criteria participatory approach. The other, applied here to forestry, has been the development of ‘multi-purpose’ approaches to evaluation, which respond to the diverse needs of stakeholders through the use of mixed methods and a broad suite of indicators, selected through a participatory process. Each makes use of case studies and involves stakeholders in the evaluation process, thereby enhancing their commitment to the programmes and increasing their sustainability. Both also demonstrate more ‘holistic’ approaches to evaluation than the formal methods prescribed in the EU Common Monitoring and Evaluation Framework.

Standardized evaluation of algorithms for computer-aided diagnosis of dementia based on structural MRI: The CADDementia challenge

Algorithms for computer-aided diagnosis of dementia based on structural MRI have demonstrated high performance in the literature, but are difficult to compare as different data sets and methodology were used for evaluation. In addition, it is unclear how the algorithms would perform on previously unseen data, and thus, how they would perform in clinical practice when there is no real opportunity to adapt the algorithm to the data at hand. To address these comparability, generalizability and clinical applicability issues, we organized a grand challenge that aimed to objectively compare algorithms based on a clinically representative multi-center data set. Using clinical practice as the starting point, the goal was to reproduce the clinical diagnosis. Therefore, we evaluated algorithms for multi-class classification of three diagnostic groups: patients with probable Alzheimer's disease, patients with mild cognitive impairment and healthy controls. The diagnosis based on clinical criteria was used as reference standard, as it was the best available reference despite its known limitations. For evaluation, a previously unseen test set was used consisting of 354 T1-weighted MRI scans with the diagnoses blinded. Fifteen research teams participated with a total of 29 algorithms. The algorithms were trained on a small training set (n = 30) and optionally on data from other sources (e.g., the Alzheimer's Disease Neuroimaging Initiative, the Australian Imaging Biomarkers and Lifestyle flagship study of aging). The best performing algorithm yielded an accuracy of 63.0% and an area under the receiver-operating-characteristic curve (AUC) of 78.8%. In general, the best performances were achieved using feature extraction based on voxel-based morphometry or a combination of features that included volume, cortical thickness, shape and intensity. The challenge is open for new submissions via the web-based framework: http://caddementia.grand-challenge.org.

Testicular traits as selection criteria for young Nellore bulls

The objective of this study was to evaluate the possible use of biometric testicular traits as selection criteria for young Nellore bulls using Bayesian inference to estimate heritability coefficients and genetic correlations. Multitrait analysis was performed including 17,211 records of scrotal circumference obtained during andrological assessment (SCAND) and 15,313 records of testicular volume and shape. In addition, 50,809 records of scrotal circumference at 18 mo (SC18), used as an anchor trait, were analyzed. The (co) variance components and breeding values were estimated by Gibbs sampling using the Gibbs2F90 program under an animal model that included contemporary groups as fixed effects, age of the animal as a linear covariate, and direct additive genetic effects as random effects. Heritabilities of 0.42, 0.43, 0.31, 0.20, 0.04, 0.16, 0.15, and 0.10 were obtained for SC18, SCAND, testicular volume, testicular shape, minor defects, major defects, total defects, and satisfactory andrological evaluation, respectively. The genetic correlations between SC18 and the other traits were 0.84 (SCAND), 0.75 (testicular shape), 0.44 (testicular volume), -0.23 (minor defects), -0.16 (major defects), -0.24 (total defects), and 0.56 (satisfactory andrological evaluation). Genetic correlations of 0.94 and 0.52 were obtained between SCAND and testicular volume and shape, respectively, and of 0.52 between testicular volume and testicular shape. In addition to favorable genetic parameter estimates, SC18 was found to be the most advantageous testicular trait due to its easy measurement before andrological assessment of the animals, even though the utilization of biometric testicular traits as selection criteria was also found to be possible. In conclusion, SC18 and biometric testicular traits can be adopted as a selection criterion to improve the fertility of young Nellore bulls.

Comparing finite state machine test coverage criteria

To plan testing activities, testers face the challenge of determining a strategy, including a test coverage criterion that offers an acceptable compromise between the available resources and test goals. Known theoretical properties of coverage criteria do not always help and, thus, empirical data are needed. The results of an experimental evaluation of several coverage criteria for finite state machines (FSMs) are presented, namely, state and transition coverage; initialisation fault and transition fault coverage. The first two criteria focus on FSM structure, whereas the other two on potential faults in FSM implementations. The authors elaborate a comparison approach that includes random generation of FSM, construction of an adequate test suite and test minimisation for each criterion to ensure that tests are obtained in a uniform way. The last step uses an improved greedy algorithm.