L'utilisation des anticoagulants oraux directs chez les patients âgés : les limites de la médecine fondée sur les preuves [The use of the new direct oral anticoagulants among older subjects: The limits of the evidence-based medicine?].

The growing use of direct oral anticoagulants, in particular among older subjects, raises questions about the limits of the evidence-based medicine. The phase III studies that have validated the efficacy and the safety profile of these molecules (dabigatran, rivaroxaban, apixaban, edoxaban) in their both indications, the venous thromboembolic disease and the non-valvular atrial fibrillation raise concerns in four major fields: the financial support of pharmaceutical companies, the links of interest for many authors with the industry, the study design (exclusively non-inferiority studies), and the poor representativeness of the older subjects included. All these points are discussed, using data of sub-groups studies, post-marketing studies and recent meta-analysis. The lack of data for the very old subjects, with frailty or comorbidities, remains the main concern from these phase III studies.

Magnetic resonance imaging of the vagina: an overview for radiologists with emphasis on clinical decision making

AbstractMagnetic resonance imaging is a method with high contrast resolution widely used in the assessment of pelvic gynecological diseases. However, the potential of such method to diagnose vaginal lesions is still underestimated, probably due to the scarce literature approaching the theme, the poor familiarity of radiologists with vaginal diseases, some of them relatively rare, and to the many peculiarities involved in the assessment of the vagina. Thus, the authors illustrate the role of magnetic resonance imaging in the evaluation of vaginal diseases and the main relevant findings to be considered in the clinical decision making process.

The summer North Atlantic Oscillation in CMIP3 models and related uncertainties in projected summer drying in Europe

This paper discusses uncertainties in model projections of summer drying in the Euro-Mediterranean region related to errors and uncertainties in the simulation of the summer NAO (SNAO). The SNAO is the leading mode of summer SLP variability in the North Atlantic/European sector and modulates precipitation not only in the vicinity of the SLP dipole (northwest Europe) but also in the Mediterranean region. An analysis of CMIP3 models is conducted to determine the extent to which models reproduce the signature of the SNAO and its impact on precipitation and to assess the role of the SNAO in the projected precipitation reductions. Most models correctly simulate the spatial pattern of the SNAO and the dry anomalies in northwest Europe that accompany the positive phase. The models also capture the concurrent wet conditions in the Mediterranean, but the amplitude of this signal is too weak, especially in the east. This error is related to the poor simulation of the upper-level circulation response to a positive SNAO, namely the observed trough over the Balkans that creates potential instability and favors precipitation. The SNAO is generally projected to trend upwards in CMIP3 models, leading to a consistent signal of precipitation reduction in NW Europe, but the intensity of the trend varies greatly across models, resulting in large uncertainties in the magnitude of the projected drying. In the Mediterranean, because the simulated influence of the SNAO is too weak, no precipitation increase occurs even in the presence of a strong SNAO trend, reducing confidence in these projections.

Energy balance in the poultry-shed system and its influence on broiler performance

ABSTRACTThe objective of this study was to determine the energy balance of the poultry-shed system and its effect on broiler performance during the production cycle. The experimental design was completely random with sub-divided blocks. The blocks were composed of five different types of sheds and the sub-blocks of the evaluation times (00:00 h to 23:00 h), allowing an analysis of variance and a comparison between means with the Tukey test. There were no significant differences between the mean values of the exchanges of sensible, latent and total heat between the poultry sheds but the differences for the evaluation times were significant (P<0.05). There was no significant difference between sheds 1 and 4 for broiler productive performance regarding weight gain, feed consumption and feed conversion. Bird performance was significant (P<0.05) for the remaining poultry sheds. The productive indexes remained below the ranges considered ideal for broilers and values in the final weeks were characterized by the poor installation efficiency in controlling temperature variations and, consequently, the energy balance in the system, which adversely affected bird productive performance.

The Brazilian investment in science and technology

An analysis of Brazilian federal expenditures in science and technology is presented is this study. The 1990-1999 data were compiled from records provided by two federal agencies (MCT and CNPq) responsible for managing most of the national budget related to these activities. The results indicate that the federal investments in Brazilian science and technology stagnated during the last decade (US$ 2.32 billion in 1990, US$ 2.39 billion in 1996, and US$ 2.36 billion in 1999). In contrast, a great increase in private investments in research was acknowledged both by industry and by the government during the same period, from US$ 2.12 to US$ 4.64 billion. However, this investment did not result in an increase in invention patents granted to residents (492 in 1990 and only 232 in 1997) or in a reduction of patent costs. Despite this unfavorable scenario, the number of graduate programs in the country has increased two-fold in the last decade and the contribution of Brazilians to the database of the Institute for Scientific Information has increased 4.7-fold from 1990 (2,725 scientific publications) to 2000 (12,686 scientific publications). Unstable federal resources for science, together with the poor returns of private resources in terms of developing new technologies, may jeopardize the future of Brazilian technological development.

Analytics for the modified kraft pulps

Tämän diplomityön tavoitteena on kehittää sopiva analyyttinen menetelmä muokatun kraft-sellukuidun substituutioasteen (DS) kvantitatiivista määrittämistä varten. Muokkauksella tarkoitetaan tässä yhteydessä joko kovalenttisesti tai adsorption avulla tapahtuvaa molekyylin kiinnittymistä sellukuidun pinnalle. Työn kirjallisuusosuudessa käsitellään lyhyesti eri muokkaustapoja ja yhdisteitä joiden avulla voidaan saavuttaa haluttuja ominaisuuksia sellusta valmistetuille lopputuotteille. Lisäksi kirjallisuusosuudessa käydään läpi käyttötarkoitukseen soveltuvimpia suoria ja epäsuoria analyysimenetelmiä. Analyysimenetelmistä kaikkein lupaavimpia testattiin työn kokeellisessa osassa. Diplomityön kokeellisessa osassa keskityttiin kehittämään muokatulle sellulle kvantitatiivista menetelmää DS:n määrittämiseksi Fourier-muunnos infrapuna-vaimennettu kokonaisheijastus (FTIR-ATR) spektrometrillä. Kirjallisuuskatsauksessa ei löytynyt yhtään dokumentoitua tutkimusta, jossa FTIR-ATR menetelmää olisi käytetty muokatun sellukuidun kvantitatiiviseen tutkimukseen. Muiden analyysimenetelmien, kuten alkuaineanalyysin, termogravimetrisen analyysin (TGA) ja valomikroskopian avulla pyrittiin tuottamaan lisätietoa muokkauksesta. Kvantitatiivisen FTIR-ATR menetelmän kehitykseen käytetyt muokatut sellukuidut olivat selluloosa-asetaattia ja selluloosa betainaattia. Saatujen tulosten perusteella muokattujen sulfiitti- ja kraft sellukuitujen DS:n kvantitatiivinen määrittäminen on mahdollista FTIR-ATR menetelmällä. Vähäinen kalibrointipisteiden määrä vaikeutti tarkan analyysimenetelmän tekemistä. Kehitetyn menetelmän suurimpina ongelmina olivat kiinteiden näytteiden heterogeenisyys sekä mahdollisten epäpuhtauksien tunnistaminen. Jatkotutkimusten avulla kehitettyä menetelmää on kuitenkin mahdollista käyttää muokattujen sellukuitujen jatkuvaan analysointiin selluteollisuudessa.

Solutions to water problems in the bottom of the pyramid market

Solving the water crisis in the developing world is a critical issue. Four billion people in the globe, so called the Base of the Pyramid (BoP) population suffer from inadequate access to safe drinking water, while millions die daily from waterborne diseases and lack of clean water. The BoP people desperately need to obtain a satisfactory access to safe water sources. In order to address the issue, this research has been carried out. To provide holistic consideration to the matter, comprehensive exploration of various causes of the water crisis and its impacts in developing countries were discussed. Then, various viable and relevant solutions to the problem have been thoroughly scrutinized, including scientific, rational, practical and speculative approaches, examination of existing methods, technologies and products at the BoP water market. The role of clean water to the sustainable development was specifically featured. The paper also has studied social and economic factors, actors and circumstances which affect the market development of clean water technologies in the BoP. Possibilities and potentials of successful business between foreign water enterprises and BoP consumers were considered, while primary obstacles are deliberated on, with suggestion of the ways to tackle them. Technologies and products which are needed by the poor must be affordable, sustainable and of an appropriate quality. The crucial question of technology transfer was soundly discussed with pointing out main hindrances on the way of its implementation between the developed and developing world. The means to overcome these barriers were properly observed as well. To explore to some extent the possibility and feasibility of technology transfer from Finland to the BoP sector, 3 case study analyses have been implemented. Personal discussions in form of interviews were conducted at Kemira, Outotec and Fenno Water, Finnish water treatment and supply enterprises. The results of the interviews shed light on the specific practical matters, actual obstacles and potential solutions of the technology transfer from Finland to low-income countries.

Factors affecting a woman's decision to leave an abusive relationship : the theory of planned behaviour /

The present study tested the appHcabiUty of Ajzen's (1985) theory of planned behaviour (TPB), an extension of Fishbein and Ajzen's (1975) theory of reasoned action (TRA), for the first time, in the context of abused women's decision to leave their abusive relationships. The TPB, as a means of predicting women's decision to leave their abusive partners' was drawn from Strube's (1988, 1991) proposed decision-making model based on the principle that the decision-making process is a rational, deliberative process, and regardless of outcome, was a result of a logical assessment of the available data. As a means of predicting those behaviours not under volitional control, Ajzen's (1985) TPB incorporated a measure of perceived behavioural control. Data were collected in two phases, ranging from 6 months to 1 year apart. It was hypothesized that, to the extent that an abused woman held positive attitudes, subjective norms conducive to leaving, and perceived control over leaving, she would form an intention to leave and thus, increase the likelihood of actually leaving her partner. Furthermore, it was expected that perceptions of control would predict leaving behaviour over and above attitude and subjective norm. In addition, severity and frequency of abuse were assessed, as were demographic variables. The TPB failed to account significantly for variability in either intentions or leaving behaviour. All of the variance was attributed to those variables associated with the theory of reasoned action, with social influence emerging as the strongest predictor of a woman's intentions. The poor performance of this model is attributed to measurement problems with aspects of attitude and perceived control, as well as a lack of power due to the small sample size. The insufficiency of perceived control to predict behaviour also suggests that, on the surface at least, other factors may be at work in this context. Implications of these results, and recommendations such as, the importance of obtaining representative samples, the inclusion of self-esteem and emotions as predictor variables in this model, a reevaluation of the target behaviovu" as nonvolitional, and longitudinal studies spanning a longer time period for future research within the context of decision-making are discussed.

Information processing in sleep-onset insomnia : a test of the neurocognitive model /

The present thesis study is a systematic investigation of information processing at sleep onset, using auditory event-related potentials (ERPs) as a test of the neurocognitive model of insomnia. Insomnia is an extremely prevalent disorder in society resulting in problems with daytime functioning (e.g., memory, concentration, job performance, mood, job and driving safety). Various models have been put forth in an effort to better understand the etiology and pathophysiology of this disorder. One of the newer models, the neurocognitive model of insomnia, suggests that chronic insomnia occurs through conditioned central nervous system arousal. This arousal is reflected through increased information processing which may interfere with sleep initiation or maintenance. The present thesis employed event-related potentials as a direct method to test information processing during the sleep-onset period. Thirteen poor sleepers with sleep-onset insomnia and 1 2 good sleepers participated in the present study. All poor sleepers met the diagnostic criteria for psychophysiological insomnia and had a complaint of problems with sleep initiation. All good sleepers reported no trouble sleeping and no excessive daytime sleepiness. Good and poor sleepers spent two nights at the Brock University Sleep Research Laboratory. The first night was used to screen for sleep disorders; the second night was used to investigate information processing during the sleep-onset period. Both groups underwent a repeated sleep-onsets task during which an auditory oddball paradigm was delivered. Participants signalled detection of a higher pitch target tone with a button press as they fell asleep. In addition, waking alert ERPs were recorded 1 hour before and after sleep on both Nights 1 and 2.As predicted by the neurocognitive model of insomnia, increased CNS activity was found in the poor sleepers; this was reflected by their smaller amplitude P2 component seen during wake of the sleep-onset period. Unlike the P2 component, the Nl, N350, and P300 did not vary between the groups. The smaller P2 seen in our poor sleepers indicates that they have a deficit in the sleep initiation processes. Specifically, poor sleepers do not disengage their attention from the outside environment to the same extent as good sleepers during the sleep-onset period. The lack of findings for the N350 suggest that this sleep component may be intact in those with insomnia and that it is the waking components (i.e., Nl, P2) that may be leading to the deficit in sleep initiation. Further, it may be that the mechanism responsible for the disruption of sleep initiation in the poor sleepers is most reflected by the P2 component. Future research investigating ERPs in insomnia should focus on the identification of the components most sensitive to sleep disruption. As well, methods should be developed in order to more clearly identify the various types of insomnia populations in research contexts (e.g., psychophysiological vs. sleep-state misperception) and the various individual (personality characteristics, motivation) and environmental factors (arousal-related variables) that influence particular ERP components. Insomnia has serious consequences for health, safety, and daytime functioning, thus research efforts should continue in order to help alleviate this highly prevalent condition.

Some aspects of the chemistry of Reissert compounds / |nDurga Prasad Aysola. -- 260 St. Catharines [Ont. : s. n.],

1-(0- and m-Ohlorobenzoyl)isoquinolines have been synthesized by two routes involving Reissert compounds. One route involves condensation of 2-benzoyl-l,2-dihydroisoquinaldonitrile with the appropriate chlorobenzaldehyde and the second involves rearrangement of the appropriate Z-(chlorobenzoyl)-l,Z-dihydroisoquinaldonitrile under basic conditions. The action of potassamide in anhydrous liquid ammonia on both ketones gave unexpectedly N-(l-isoquinolyl)benzamide (67) as the major product and the use of dibenzo-18-crown-6-ether 98% substantially improved the yd..e.ld in the case of l-chloroketone. This amide (67) exhibits unusual hydrogen bonding. 1-(o-chlorobenzoyl)-6,7-dimethoxyisoquinoline (79) was prepared in very s,amll quantities by the route involving condensation of 2-benzoyll, Z-dihydro-6,7-dimethoxyisoquinaldonitrile with o-chlorobenzaldehyde. The poor yields are due to the instability of the anion of 2-benzoyl1, Z-dihydro-6,7-dimethoxyisoquinaldonitrile. Attempted preparation of the ketone (79) by rearrangement of 2-(o-chlorobenzoyl)-l,2-dihydro6,7- dimethoxyisoquinaldonitrile under basic conditions yielded the start~ng material (Reissert compound) and 6,7-dimethoxyisoquinoline. The action of potassamide in anhydrous liquid ammonia on l-(o-bromo-4,5-dimethoxybenzoyl)isoquinoline (85), which was prepared by the route involving the condensation of 2-benzoyl-l,4-dihydroisoquinaldonitrile with o-bromo-4,5-dimethoxybenzaldehyde, gave two products, which have not yet been identified. The ketone (85) and its precursors are interest~ng in that their 20 eV and 70 eV mass spectra do not show molecular ions.

Visual word learning in good and poor readers

Forty students from regular, grade five classes were divided into two groups of twenty, a good reader group and a' poor reader group, on the basis. of their reading scores on Canadian Achievement Tests. .The subjects took. part in four experimental conditions iM which they .learned lists of pronounceable and unprono~nceable pseudowords, some with semantic referents, and responded to questions designed tci test visual perceptu~l learning and lexical ·and semantic association learning. It' was hypothesized "that the good reade~ group would be able to make use of graphemic and phonemic redundancy patterns in order to improv~·visuSl perceptual learning and lexical and semantic association lea~ningto a greater extent. than would .the poor reader gr6up. The data supported this hypothesis, and also indicated that, although the poor readers were less adept at using familiar sound and letter patterns, they were more dependent on· such pa~terns as an aid to visual recognition memory and semantic recall than were the good readers. It wa.s postulated that poor readers are in a double- ~ . bind situatio~ of having to choose between using weak graphemic-semantic associations or gr~pheme-phoneme associations which are also weak and which have hindered them in developing automaticity in. reading.

ASSESSING THE PERFORMANCE OF EMERGING MARKET MUTUAL FUNDS IN CANADA

Emerging markets have received wide attention from investors around the globe because of their return potential and risk diversification. This research examines the selection and timing performance of Canadian mutual funds which invest in fixed-income and equity securities in emerging markets. We use (un)conditional two- and five-factor benchmark models that accommodate the dynamics of returns in emerging markets. We also adopt the cross-sectional bootstrap methodology to distinguish between ‘skill’ and ‘luck’ for individual funds. All the tests are conducted using a comprehensive data set of bond and equity emerging funds over the period of 1989-2011. The risk-adjusted measures of performance are estimated using the least squares method with the Newey-West adjustment for standard errors that are robust to conditional heteroskedasticity and autocorrelation. The performance statistics of the emerging funds before (after) management-related costs are insignificantly positive (significantly negative). They are sensitive to the chosen benchmark model and conditional information improves selection performance. The timing statistics are largely insignificant throughout the sample period and are not sensitive to the benchmark model. Evidence of timing and selecting abilities is obtained in a small number of funds which is not sensitive to the fees structure. We also find evidence that a majority of individual funds provide zero (very few provide positive) abnormal return before fees and a significantly negative return after fees. At the negative end of the tail of performance distribution, our resampling tests fail to reject the role of bad luck in the poor performance of funds and we conclude that most of them are merely ‘unlucky’.

Assessing waiting times in the clinical trajectory of patients with lung cancer

Le cancer du poumon a une incidence et une létalité parmi les plus hautes de tous les cancers diagnostiqués au Canada. En considérant la gravité du pronostic et des symptômes de la maladie, l’accès au traitement dans les plus brefs de délais est essentiel. Malgré l’engagement du gouvernement fédéral et les gouvernements provinciaux de réduire les délais de temps d’attente, des balises pour les temps d’attente pour le traitement d’un cancer ne sont toujours pas établis. En outre, le compte-rendu des indicateurs des temps d’attente n’est pas uniforme à travers les provinces. Une des solutions proposées pour la réduction des temps d’attente pour le traitement du cancer est les équipes interdisciplinaires. J’ai complété un audit du programme interdisciplinaire traitant le cancer du poumon à l’Hôpital général juif (l’HGJ) de 2004 à 2007. Les objectifs primaires de l’étude étaient : (1) de faire un audit de la performance de l’équipe interdisciplinaire à l’HGJ en ce qui concerne les temps d’attente pour les intervalles critiques et les sous-groupes de patients ; (2) de comparer les temps d’attente dans la trajectoire clinique des patients traités à l’HGJ avec les balises qui existent ; (3) de déterminer les facteurs associés aux délais plus longs dans cette population. Un objectif secondaire de l’étude était de suggérer des mesures visant à réduire les temps d’attente. Le service clinique à l’HGJ a été évalué selon les balises proposées par le British Thoracic Society, Cancer Care Ontario, et la balise pan-canadienne pour la radiothérapie. Les patients de l’HGJ ont subi un délai médian de 9 jours pour l’intervalle «Ready to treat to first treatment», et un délai médian de 30 jours pour l’intervalle entre le premier contact avec l’hôpital et le premier traitement. Les patients âgés de plus de 65 ans, les patients avec une capacité physique diminuée, et les patients avec un stade de tumeur limité étaient plus à risque d’échouer les balises pour les temps d’attente.

The human right to water - normative foundations and ethical implications

La présente contribution examine les fondements normatifs ainsi que les implications éthiques du droit à l’eau, tel qu’il fut reconnu en 2002 par le comité onusien des droits économiques, sociaux et culturels. Il sera défendu que le droit à l’eau potable peut être justifié en tant que droit moral fondamental, de par son caractère indispensable en vue de la garantie des conditions basiques de survie. Cet état de fait, cependant, s’avère moins évident au vue d’un droit à l’eau d’usage non-domestique. Ici, la discussion se rapproche des débats accompagnant le concept beaucoup plus complexe des droits sociaux et économiques. Par rapport à ce groupe de droits, la question de l’allocation est des plus controversées: à qui incombe-t-il de garantir leur respect? Dans le but d’éviter cette problématique d’allocation, le présent essai soulèvera la question de savoir, si la limitation de l’accès à l’eau peut être conçue comme une violation d’autres droits moraux: bien qu’il y ait des cas où des entreprises transnationales déploient des activités nuisibles à l’égard des populations pauvres en polluant sciemment leurs ressources en eau ou en initiant et en exécutant des stratégies de privatisation les privant de leurs droits, la crise globale de l’eau ne saura être rattachée uniquement aux effets de la mondialisation. Plutôt, l’on reconnaîtra la nécessité d’efforts positifs et soutenus de la part des pays développés en vue de la réalisation d’un approvisionnement suffisant en eau pour tous.

Facteurs environnementaux et symptômes des troubles oculaires et cutanés chez les enfants de moins de cinq ans : cas des zones de l’Observatoire de population de Ouagadougou

Les risques liés à l’environnement immédiat, notamment le manque d’accès à l’eau potable, à l’assainissement, à un logement décent et à un milieu de vie sain constituent un des facteurs à l’origine de la mauvaise santé des enfants de moins de cinq ans dans les pays en développement. Les objectifs principaux poursuivis dans cette recherche sont de mesurer l’influence de ces risques de l’environnement immédiat sur la prévalence des symptômes des troubles oculaires et celle des symptômes des troubles cutanés chez les enfants de moins de cinq ans à Ouagadougou et de rechercher les autres déterminants sous-jacents de la prévalence de ces symptômes dans cette ville. Nous utilisons les données de l’enquête réalisée en février 2010 sur l’état de santé et le comportement sanitaire associé aux maladies et symptômes récents et les données sur les événements démographiques et sur les conditions de vie des ménages collectées en mai 2009 durant le round 1 de l’enquête ménage. L’échantillon de l’étude est constitué de 950 enfants issus de 736 ménages sélectionnés aléatoirement dans cinq quartiers périphériques de la ville de Ouagadougou. Nous avons recouru à l’analyse descriptive fondée sur les tableaux croisés et les tests du chi-2, et à l’analyse de la régression logistique multivariée ayant permis d’étudier les risques relatifs de la survenue desdits symptômes. L’analyse descriptive montre que certaines variables de l’environnement immédiat, en l’occurrence le mode d’évacuation des ordures ménagères, le type de toilette utilisé le plus souvent par la plupart des membres du ménage et le type de quartier de résidence, sont associés à la prévalence des troubles oculaires. Mais une analyse approfondie à l’aide de la régression logistique multivariée n’a confirmé que l’effet du type de quartier de résidence. Concernant la prévalence des symptômes des troubles cutanés, en analyse bi-variée, les variables de l’environnement immédiat qui y sont associées sont la nature du sol intérieur et le mode d’évacuation des eaux usées. L’analyse multivariée semble confirmer les effets de ces variables. Nous avons relevé quelques limites des données utilisées, notamment la faible taille de l’échantillon, la non-confirmation par voie médicale des données sanitaires et le caractère transversal desdites données. Toutefois, les résultats trouvés pourront être utiles aux planificateurs et décideurs qui ont la charge de la gestion de l’espace urbain dans le but de mieux concevoir de nouvelles politiques urbaines mettant l’accent sur la restructuration des quartiers précaires afin de mieux combattre les maladies évitables. En conclusion, en tenant compte des limites relevées, il serait utile de procéder à d’autres investigations afin de tirer des conclusions moins sujettes à débat du point de vue méthodologique.