Interruptions of cART limits CD4 T-cell recovery and increases the risk for opportunistic complications and death.

BACKGROUND: A major goal of antiretroviral therapy (ART) for HIV-1-infected persons is the recovery of CD4 T lymphocytes, resulting in thorough protection against opportunistic complications. Interruptions of ART are still frequent. The long-term effect on CD4 T-cell recovery and clinical events remains unknown. METHODS: Immunological and clinical endpoints were evaluated in 2491 participants of the Swiss HIV Cohort Study initiating ART during a mean follow-up of 7.1 years. Data were analysed in persons with treatment interruptions (n = 1271; group A), continuous ART, but intermittent HIV-1 RNA at least 1000 copies/ml (n = 469; group B) and continuous ART and HIV-1 RNA constantly less than 1000 copies/ml (n = 751; group C). Risk factors for low CD4 T-cell counts and clinical events were analysed using Cox proportional hazards models. RESULTS: In groups A-C, CD4 T lymphocytes increased to a median of 427, 525 and 645 cells/μl at 8 years. In group A, 63.0 and 37.2% reached above 350 and 500 CD4 T cells/μl, whereas in group B 76.3 and 55.8% and in group C 87.3 and 68.0% reached these thresholds (P < 0.001). CD4 T-cell recovery directly depended on the cumulative duration of treatment interruptions. In addition, participants of group A had more Centers for Disease Control and Prevention B/C events, resulting in an increased risk of death. Major risk factors for not reaching CD4 T cells above 500 cells/μl included lower baseline CD4 T-cell count, higher age and hepatitis C virus co-infection. CONCLUSION: In persons receiving continuous ART larger CD4 T-cell recovery and a reduced risk for opportunistic complications and death was observed. CD4 T-cell recovery was smaller in persons with treatment interruptions more than 6 months.

El treball cooperatiu com a mètode d'experimentació en l'art : treballar l'educació artística a l'educació infantil

Els objectius de l’estudi realitzat en aquest treball són: comprovar que l’educació artística també pot ser una eina d’inclusió a l’escola, conèixer els beneficis de l’experimentació/exploració en l’art, i observar com aquests influeixen en l’aprenentatge dels infants, i finalment veure els beneficis del treball cooperatiu com a mètode d’experimentació en l’art. L’estudi s’ha realitzat a partir d’ una recerca teòrica i duent a terme una part pràctica de vàries sessions amb la col·laboració dels infants de P4 de l’escola Joan XXIII d’Hostalets de Balenyà. La pràctica s’ha anomenat “Art amb pedres”, que com el seu nom indica, les pedres eren l’element natural que han utilitzat els infants per a convertir-se en verdaders artistes!

L'Experiència autobiogràfica, l'art i el compromís ètic de l'escriptor: tres eixos de la narrativa de Maria Àngels Anglada

L’obra de M. Àngels Anglada constitueix un tramat complex de lectures i influències que s’interpreta a través de nivells de significació i d’interessos que s’entrecreuen. Com a pilar que sosté tot aquest corpus hi ha un gran bagatge clàssic i una vasta formació literària que, juntament amb l’experiència vital i el posicionament ètic de l’autora, proporcionen les claus de lectura dels seus llibres. Partint d’aquesta idea, l’article aprofundeix en els tres aspectes que considerem eixos fonamentals de l’obra de l’escriptora: els elements autobiogràfics, l’art i el compromís social.

No longitudinal mitochondrial DNA sequence changes in HIV-infected individuals with and without lipoatrophy.

The potential for mitochondrial (mt) DNA mutation accumulation during antiretroviral therapy (ART), and preferential accumulation in patients with lipoatrophy compared with control participants, remains controversial. We sequenced the entire mitochondrial genome, both before ART and after ART exposure, in 29 human immunodeficiency virus (HIV)-infected Swiss HIV Cohort Study participants initiating a first-line thymidine analogue-containing ART regimen. No accumulation of mtDNA mutations or deletions was detected in 13 participants who developed lipoatrophy or in 16 control participants after significant and comparable ART exposure (median duration, 3.3 and 3.7 years, respectively). In HIV-infected persons, the development of lipoatrophy is unlikely to be associated with accumulation of mtDNA mutations detectable in peripheral blood.

Usability of Virtual Museums and the Diffusion of Cultural Heritage

Les prioritats per als museus canvien. La missió de la nova museologia és convertir els museus en llocs per a gaudir i aprendre, cosa que fa que hagin de dur a terme una gestió financera molt semblant a la d'una empresa social que competeixi en el sector del lleure. Amb el pas del temps, els museus han d'establir i aplicar els criteris necessaris per a la supervivència, aplanant el terreny perquè altres institucions públiques siguin més obertes en els seus esforços per comunicar i difondre el seu patrimoni. Ja podem començar a parlar d'algunes conclusions comunament acceptades sobre el comportament dels visitants, que són necessàries per a planificar exposicions futures que vegin l'aprenentatge com un procés constructiu, les col·leccions com a objectes amb significat i les mateixes exposicions com a mitjans de comunicació que haurien de transformar la manera de pensar de l'espectador i que estan al servei del mateix missatge. Sembla que internet representa un mitjà efectiu per a assolir aquests objectius, ja que és capaç (a) d'adaptar-se als interessos i les característiques intel·lectuals d'un públic divers; (b) de redescobrir els significats dels objectes i adquirir un reconeixement sociocultural del seu valor per mitjà del seu potencial interactiu, i (c) de fer ús d'elements atractius i estimulants perquè tothom en gaudeixi. Per a aquest propòsit, és bàsic fer-nos les preguntes següents: quins criteris ha de seguir un museu virtual per a optimar la difusió del seu patrimoni?; quins elements estimulen els usuaris a quedar-se en una pàgina web i fer visites virtuals que els siguin satisfactòries?; quin paper té la usabilitat de l'aplicació en tot això?

Gallery districts of Barcelona: the strategic play of art dealers

This article focuses on Barcelona"s art market to explore the underlying factors behind the clustering of art dealers in several of the city"s districts. Drawing upon quantitative and qualitative data, the article analyses how such clustering reveals a strategic action in the sense attributed to it by Crozier and Friedberg (1981). Gallery districts are not a reflection of structural factors (economic, urban development-related or social) but the result of a combination of strategic choices either individual or collective which explain the permanence of leading gallery districts or the emergence of new ones.

Conflict-based Method for Conceptual Process Synthesis

The changing business environment demands that chemical industrial processes be designed such that they enable the attainment of multi-objective requirements and the enhancement of innovativedesign activities. The requirements and key issues for conceptual process synthesis have changed and are no longer those of conventional process design; there is an increased emphasis on innovative research to develop new concepts, novel techniques and processes. A central issue, how to enhance the creativity of the design process, requires further research into methodologies. The thesis presentsa conflict-based methodology for conceptual process synthesis. The motivation of the work is to support decision-making in design and synthesis and to enhance the creativity of design activities. It deals with the multi-objective requirements and combinatorially complex nature of process synthesis. The work is carriedout based on a new concept and design paradigm adapted from Theory of InventiveProblem Solving methodology (TRIZ). TRIZ is claimed to be a `systematic creativity' framework thanks to its knowledge based and evolutionary-directed nature. The conflict concept, when applied to process synthesis, throws new lights on design problems and activities. The conflict model is proposed as a way of describing design problems and handling design information. The design tasks are represented as groups of conflicts and conflict table is built as the design tool. The general design paradigm is formulated to handle conflicts in both the early and detailed design stages. The methodology developed reflects the conflict nature of process design and synthesis. The method is implemented and verified through case studies of distillation system design, reactor/separator network design and waste minimization. Handling the various levels of conflicts evolve possible design alternatives in a systematic procedure which consists of establishing an efficient and compact solution space for the detailed design stage. The approach also provides the information to bridge the gap between the application of qualitative knowledge in the early stage and quantitative techniques in the detailed design stage. Enhancement of creativity is realized through the better understanding of the design problems gained from the conflict concept and in the improvement in engineering design practice via the systematic nature of the approach.

Right ventricular dysfunction in children and adolescents conceived by assisted reproductive technologies.

Assisted reproductive technologies (ART) predispose the offspring to vascular dysfunction, arterial hypertension, and hypoxic pulmonary hypertension. Recently, cardiac remodeling and dysfunction during fetal and early postnatal life have been reported in offspring of ART, but it is not known whether these cardiac alterations persist later in life and whether confounding factors contribute to this problem. We, therefore, assessed cardiac function and pulmonary artery pressure by echocardiography in 54 healthy children conceived by ART (mean age 11.5 ± 2.4 yr) and 54 age-matched (12.2 ± 2.3 yr) and sex-matched control children. Because ART is often associated with low birth weight and prematurity, two potential confounders associated with cardiac dysfunction, only singletons born with normal birth weight at term were studied. Moreover, because cardiac remodeling in infants conceived by ART was observed in utero, a situation associated with increased right heart load, we also assessed cardiac function during high-altitude exposure, a condition associated with hypoxic pulmonary hypertension-induced right ventricular overload. We found that, while at low altitude cardiac morphometry and function was not different between children conceived by ART and control children, under the stressful conditions of high-altitude-induced pressure overload and hypoxia, larger right ventricular end-diastolic area and diastolic dysfunction (evidenced by lower E-wave tissue Doppler velocity and A-wave tissue Doppler velocity of the lateral tricuspid annulus) were detectable in children and adolescents conceived by ART. In conclusion, right ventricular dysfunction persists in children and adolescents conceived by ART. These cardiac alterations appear to be related to ART per se rather than to low birth weight or prematurity.

Sickness certification in primary care: a survey on views and practices among Swiss physicians.

QUESTIONS UNDER STUDY: Studies from several countries (Scandinavia, United Kingdom) report that general practitioners (GPs) experience problems in sickness certification. Our study explored views of Swiss GPs towards sickness certification, their practice and experience, professional skills and problematic interactions with patients. METHODS: We conducted an online survey among GPs throughout Switzerland, exploring behaviour of physicians, patients and employers with regard to sickness certification; GPs' views about sickness certification; required competences for certifying sickness absence, and approaches to advance their competence. We piloted the questionnaire and disseminated it through the networks of the five Swiss academic institutes for primary care. RESULTS: We received 507 valid responses (response rate 50%). Only 43/507 GPs experienced sickness certification as problematic per se, yet 155/507 experienced problems in sickness certification at least once a week. The 507 GPs identified estimating a long-term prognosis about work capacity (64%), handling conflicts with patients (54%), and determining the reduction of work capacity (42%) as problematic. Over 75% would welcome special training opportunities, e.g., on sickness certifications during residency (93%), in insurance medicine (81%), and conflict management (80%). CONCLUSION: Sickness certification as such does not present a major problem to Swiss GPs, which contrasts with the experience in Scandinavian countries and in the UK. Swiss GPs did identify specific tasks of sickness certification as problematic. Training opportunities on sick-leave certification and insurance medicine in general were welcomed.

Structuration and branding of a religious tourism product: Catalonia sacra

This article aims to provide an overview of the products Catalonia has to offer in terms of religious tourism. The growing interest in this kind of tourism worldwide, and in Catalonia itself, along with the region's wealth of religious heritage (particularly connected to the Christian Church) contrast with the lack of religion-based tourism products available, which results in its absence from the region's image as a tourism destination. In view of this, the Faculty of Tourism (University of Girona), the Vic Bishopric's Albergueria-Centre for Cultural Dissemination and the Tarraconense Episcopal Conference's Interdiocese Secretariat for the Custody and Promotion of Holy Art (SICPAS) decided to address the situation with the help of funding from the Autonomous Government of Catalonia. In order to re-position Christian religious heritage in the image of Catalonia as a tourist destination, the aforementioned parties embarked upon a project to set up a series of routes throughout the region, branded under the name Catalonia Sacra

The Art & Science of Learning Design

We live in an era defined by a wealth of open and readily available information, and the accelerated evolution of social, mobile and creative technologies. The provision of knowledge, once a primary role of educators, is now devolved to an immense web of free and readily accessible sources. Consequently, educators need to redefine their role not just ¿from sage on the stage to guide on the side¿ but, as more and more voices insist, as ¿designers for learning¿.The call for such a repositioning of educators is heard from leaders in the field of technology-enhanced learning (TEL) and resonates well with the growing culture of design-based research in Education. However, it is still struggling to find a foothold in educational practice. We contend that the root causes of this discrepancy are the lack of articulation of design practices and methods, along with a shortage of tools and representations to support such practices, a lack of a culture of teacher-as-designer among practitioners, and insufficient theoretical development.The Art and Science of Learning Design (ASLD) explores the frameworks, methods, and tools available for teachers, technologists and researchers interested in designing for learning Learning Design theories arising from findings of research are explored, drawing upon research and practitioner experiences. It then surveys current trends in the practices, methods, and methodologies of Learning Design. Highlighting the translation of theory into practice, this book showcases some of the latest tools that support the learning design process itself.

Recording and reproducing Soundscapes : using and interpreting data in a creative way

http://elo.aalto.fi/fi/studies/elomedia/dataseminar/

Let Go and Remember. How Finnish Communities Experienced and Memorialized School Shootings

This study examines the aftermath of mass violence in local communities. Two rampage school shootings that occurred in Finland are analyzed and compared to examine the ways in which communities experience, make sense of, and recover from sudden acts of mass violence. The studied cases took place at Jokela High School, in southern Finland, and at a polytechnic university in Kauhajoki, in western Finland, in 2007 and 2008 respectively. Including the perpetrators, 20 people lost their lives in these shootings. These incidents are part of the global school shooting phenomenon with increasing numbers of incidents occurring in the last two decades, mostly in North America and Europe. The dynamic of solidarity and conflict is one of the main themes of this study. It builds upon previous research on mass violence and disasters which suggests that solidarity increases after a crisis, and that this increase is often followed by conflict in the affected communities. This dissertation also draws from theoretical discussions on remembering, narrating, and commemorating traumatic incidents, as well as the idea of a cultural trauma process in which the origins and consequences of traumas are negotiated alongside collective identities. Memorialization practices and narratives about what happened are vital parts of the social memory of crises and disasters, and their inclusive and exclusive characteristics are discussed in this study. The data include two types of qualitative interviews; focused interviews with 11 crisis workers, and focused, narrative interviews with 21 residents of Jokela and 22 residents of Kauhajoki. A quantitative mail survey of the Jokela population (N=330) provided data used in one of the research articles. The results indicate that both communities experienced a process of simultaneous solidarity and conflict after the shootings. In Jokela, the community was constructed as a victim, and public expressions of solidarity and memorialization were promoted as part of the recovery process. In Kauhajoki, the community was portrayed as an incidental site of mass violence, and public expressions of solidarity by distant witnesses were labeled as unnecessary and often criticized. However, after the shooting, the community was somewhat united in its desire to avoid victimization and a prolonged liminal period. This can be understood as a more modest and invisible process of “silent solidarity”. The processes of enforced solidarity were partly made possible by exclusion. In some accounts, the family of the perpetrator in Jokela was excluded from the community. In Kauhajoki, the whole incident was externalized. In both communities, this exclusion included associating the shooting events, certain places, and certain individuals with the concept of evil, which helped to understand and explain the inconceivable incidents. Differences concerning appropriate emotional orientations, memorialization practices and the pace of the recovery created conflict in both communities. In Jokela, attitudes towards the perpetrator and his family were also a source of friction. Traditional gender roles regarding the expression of emotions remained fairly stable after the school shootings, but in an exceptional situation, conflicting interpretations arose concerning how men and women should express emotion. The results from the Jokela community also suggest that while increased solidarity was seen as important part of the recovery process, some negative effects such as collective guilt, group divisions, and stigmatization also emerged. Based on the results, two simultaneous strategies that took place after mass violence were identified; one was a process of fast-paced normalization, and the other was that of memorialization. Both strategies are ways to restore the feeling of security shattered by violent incidents. The Jokela community emphasized remembering while the Kauhajoki community turned more to the normalization strategy. Both strategies have positive and negative consequences. It is important to note that the tendency to memorialize is not the only way of expressing solidarity, as fast normalization includes its own kind of solidarity and helps prevent the negative consequences of intense solidarity.

Metrics for Predicting User Behavior and Experience in an Interactive Storytelling System

In much of the previous research into the field of interactive storytelling, the focus has been on the creation of complete systems, then evaluating the performance of those systems based on user experience. Less focus has been placed on finding general solutions to problems that manifest in many different types of interactive storytelling systems. The goal of this thesis was to identify potential candidates for metrics that a system could use to predict player behavior or how players experience the story they are presented with, and to put these metrics to an empirical test. The three metrics that were used were morality, relationships and conflict. The game used for user testing of the metrics, Regicide is an interactive storytelling experience that was created in conjunction with Eero Itkonen. Data, in the forms of internal system data and survey answers, collected through user testing, was used to evaluate hypotheses for each metric. Out of the three chosen metrics, morality performed the best in this study. Though further research and refinement may be required, the results were promising, and point to the conclusion that user responses to questions of morality are a strong predictor for their choices in similar situations later on in the course of an interactive story. A similar examination for user relationships with other characters in the story did not produce promising results, but several problems were recognized in terms of methodology and further research with a better optimized system may yield different results. On the subject of conflict, several aspects, proposed by Ware et al. (2012), were evaluated separately. Results were inconclusive, with the aspect of directness showing the most promise.