Are agent-based simulations robust? The wholesale electricity trading case

Agent-based computational economics is becoming widely used in practice. This paperexplores the consistency of some of its standard techniques. We focus in particular on prevailingwholesale electricity trading simulation methods. We include different supply and demandrepresentations and propose the Experience-Weighted Attractions method to include severalbehavioural algorithms. We compare the results across assumptions and to economic theorypredictions. The match is good under best-response and reinforcement learning but not underfictitious play. The simulations perform well under flat and upward-slopping supply bidding,and also for plausible demand elasticity assumptions. Learning is influenced by the number ofbids per plant and the initial conditions. The overall conclusion is that agent-based simulationassumptions are far from innocuous. We link their performance to underlying features, andidentify those that are better suited to model wholesale electricity markets.

O Dualismo Cultural: os Luso-Caboverdianos entre a Escola a Família e a Comunidade (Estudo de Caso)

A tese que ora findamos visa a obtenção do grau de doutora em Educação, na Especialidade de Desenvolvimento Curricular, pelo Departamento do Currículo e Tecnologia Educativa, do Instituto de Educação e Psicologia, da Universidade do Minho. Intitulado o dualismo cultural: os luso-caboverdianos entre a escola, a família e a comunidade, o presente estudo centra-se numa abordagem crítica da escolaridade básica obrigatória, no qual procurámos compreender e explicar as condições de realização deste nível de ensino pelos jovens de ascendência caboverdiana, nascidos em Portugal, na qualidade de sujeitos biculturais em consequência da simbiose das culturas caboverdeana e portuguesa. Isto para concluirmos se na oferta do serviço educativo e de formação estão acautelados os seus direitos de cidadania e de participação na sociedade em que se encontram inseridos e a que pertencem de facto. Nesta investigação foi fundamental analisar a oferta de educação básica, entender as representações de alunos lusocaboverdeanos acerca da sua identidade cultural e das suas percepções sobre a formação académica que recebem; reconhecer representações e percepções de professores acerca da realidade educativa portuguesa, o enquadramento da multiculturalidade e a docência em turmas com alunos luso-caboverdianos, e compreender as percepções de pais e encarregados da educação caboverdeanos acerca da realidade educativa portuguesa e do enquadramento dos seus filhos na escola, para perceber se o insucesso educativo dos luso-caboverdeanos está relacionado com a condição de aluno “culturalmente diferente” ou se tem a sua origem na escola e no currículo da escolaridade obrigatória e, assim, contribuir com subsídios teóricos e práticos para o aprofundamento da problemática da multiculturalidade em Portugal, com vista à sua potenciação e normalização no sistema educativo. Estando perante uma sociedade de formação multicultural reafirmada com a colonização, justifica-se, em Portugal, a preocupação com a temática da diversidade cultural nas políticas educativas, resultante da consciencialização da manifestação da diversidade cultural no contexto escolar, podendo a sua omissão constituir num factor de insucesso educativo. Por isso, integramos nesta investigação matérias como: uma conceptualização do multiculturalismo com vista a questionar e clarificar os conceitos e as perspectivas inerentes a este fenómeno. Uma tentativa de desocultar para perceber o conteúdo simbólico e os porquês das políticas de integração das minorias etnicoculturais que, ao que parece, nos tempos que correm, por quase toda a parte, se converteram numa prioridade absoluta e inadiável. Estabelecemos uma ponte entre a génese do campo curricular e a construção de um currículo multi e/ou intercultural, merecendo devida atenção as tendências que dominam as discussões e a produção científica actuais nestes domínios. Problematizámos o currículo e identidade na escolaridade obrigatória nas dimensões inserção sociocultural, promoção da igualdade de sucesso educativo e inclusão dos sujeitos e o currículo e a educação para o exercício da cidadania numa escola que se quer plural. Neste último debatemos o conteúdo político da educação para a cidadania, as políticas educativas e curriculares e a escolaridade básica obrigatória como uma proposta que continua em aberto, por isso, passível de adequação às necessidades de uma educação da e para a diversidade. Procurámos fazer uma análise das políticas de integração socioeducativa da diversidade cultural, com destaque para o quadro legal que regula a integração das minorias étnicas na escola básica portuguesa, com particular incidência sobre as crianças pertencentes à comunidade caboverdeana nascidas em território português, procurando concluir acerca da existência, ou não, de posições e opções de políticas educativas concretas face à necessidade de dar prosseguimento à educação multicultural neste contexto. Tratou-se de uma investigação qualitativa holística, que permitiu desenvolver compreensões profundas dos fenómenos a partir das evidências reunidas, do estudo das representações dos sujeitos sobre quem recaem os resultados da investigação, mas também de sujeitos que, assim como o meio envolvente, estabelecem uma relação indirecta com os mesmos resultados. Circunscrito a um estudo de caso, a reflexão e a partilha de conhecimento e informações possibilitou desenvolver uma compreensão sobre a problemática estudada. Dos resultados obtidos, destacámos aqui que, em Portugal, apesar da absorvência da diversidade cultural nas política educativa, não se concretizou, ainda, uma proposta que, na prática, crie a reciprocidade entre as questões etnicoculturais e o sucesso e/ou insucesso educativos das minorias em educação com ganhos decisivos no combate ao insucesso e ao abandono escolar. Continua-se a desenvolver uma educação igualitarista monocultural pela via da homogeneização curricular, assente na noção de que povos e grupos podem estar em condições de igualdade se reunidos numa cultura comum. Aparentemente sob pilares democráticos, esta educação multicultural segue a concepção liberal associando essencialismo, universalismo e igualitarismo, resultando num propósito civilizacional excludente das minorias etnicoculturais. As conclusões chegadas permitem-nos defender a dessacralização do currículo nacional comum e uniforme e a defesa de uma proposta curricular baseada numa cultura científica global e necessária, de acordo com as faixas etárias e níveis de ensino, com campos de integração obrigatória de conteúdos territorializados alicerçados no interculturalismo como estratégia promotora da interacção crítica e solidária entre diferentes sujeitos e grupos culturais, permissiva da construção de identidades próprias e da confissão da diferença cultural, associada ao intraculturalismo como uma via permeabilizadora da educação democrática como garante da cidadania plena a todos os indivíduos, como condição fundamental para o estabelecimento das condições de igualdade e de garantia de sucesso em educação.

Médecine d'urgence [Emergency medicine: updates 2011].

Emergency medicine physicians aim to stabilize or restore vital functions, establish diagnosis, initiate specific treatments and adequately orientate patients. This year, new evidences have improved our knowledge about diagnostic strategy for patients with acute non traumatic headache, treatment of acute atrial fibrillation and outpatient management of acute pulmonary embolism. Reducing injection pain of local anesthetics, reducing irradiation by using alternative diagnostic tools in appendicitis suspicion, and identification of trauma patients who benefit from tranexamic acid administration are other illustrations of the efforts to improve efficacy, safety and comfort in the management of emergency patients.

Perception et communication du risque: du diabète à la maladie cardiovasculaire [Risk perception and communication: from diabetes to cardiovascular diseases].

Evidence-based medicine has enabled to approach disease in a more rational and scientific way. Clinical research has identified behaviours and risk factors that could cause disease often "silent" at the beginning, such as diabetes. Despite the clear impact of these evidences on public health, it seems that the individual risk perception level remains weak. To mention as well, the health professionals very often have a different views, which makes it difficult to communicate the risk with patients. In this article we describe the principles of risk perception, the diabetes related risk perception concerning cardiovascular complications, and suggest some practical strategies and tools which could improve risk communication in the everyday practice.

Acceptance of inflammatory bowel disease treatment recommendations based on appropriateness ratings : do practicing gastroenterologists agree with experts?

BACKGROUND: Appropriateness criteria for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) have been developed by experts' panels. Little is known about the acceptance of such recommendations by care providers. The aim was to explore how treatment decisions of practicing gastroenterologists differ from experts using a vignette case study and a focus group. METHODS: Seventeen clinical vignettes were drawn from clinical indications evaluated by the expert panel. A vignette case questionnaire asking for treatment options in 9-10 clinical situations was submitted to 26 practicing gastroenterologists. For each vignette case, practitioners' answers on treatments deemed appropriate were compared to panel decisions. Qualitative analysis was made based on focus group discussion to explore acceptance and divergence reasons. RESULTS: 239 clinical vignettes were completed, 98 for CD and 141 for UC. Divergence between proposed treatments and results from panels was more frequent for CD (34%) than for UC (27%). Among UC clinical vignettes, the main divergences with the panel were linked to 5-ASA failure assessment and to situations where stopping treatment was the main decision. For CD, the care provider propositions diverged with the panel in mild-to-moderate active disease, where practitioners were more prone to an accelerated step up than the panel's recommendations. CONCLUSIONS: In about one third of vignettes cases, IBD treatment propositions made by practicing gastroenterologists diverged as compared to expert recommendations. Practicing gastroenterologists may experience difficulties in applying recommendations in daily practice.

A wavelet-based method for the determination of the relative resolution between remotely sensed images

Spatial resolution is a key parameter of all remote sensing satellites and platforms. The nominal spatial resolution of satellites is a well-known characteristic because it is directly related to the area in ground that represents a pixel in the detector. Nevertheless, in practice, the actual resolution of a specific image obtained from a satellite is difficult to know precisely because it depends on many other factors such as atmospheric conditions. However, if one has two or more images of the same region, it is possible to compare their relative resolutions. In this paper, a wavelet-decomposition-based method for the determination of the relative resolution between two remotely sensed images of the same area is proposed. The method can be applied to panchromatic, multispectral, and mixed (one panchromatic and one multispectral) images. As an example, the method was applied to compute the relative resolution between SPOT-3, Landsat-5, and Landsat-7 panchromatic and multispectral images taken under similar as well as under very different conditions. On the other hand, if the true absolute resolution of one of the images of the pair is known, the resolution of the other can be computed. Thus, in the last part of this paper, a spatial calibrator that is designed and constructed to help compute the absolute resolution of a single remotely sensed image is described, and an example of its use is presented.

Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: a prospective study.

BACKGROUND: Prospective data describing the appropriateness of use of colonoscopy based on detailed panel-based clinical criteria are not available. METHODS: In a cohort of 553 consecutive patients referred for colonoscopy to two university-based Swiss outpatient clinics, the percentage of patients who underwent colonoscopy for appropriate, equivocal, and inappropriate indications and the relationship between appropriateness of use and the presence of relevant endoscopic lesions was prospectively assessed. This assessment was based on criteria of the American Society for Gastrointestinal Endoscopy and explicit American and Swiss criteria developed in 1994 by a formal panel process using the RAND/UCLA appropriateness method. RESULTS: The procedures were rated appropriate or equivocal in 72.2% by criteria of the American Society for Gastrointestinal Endoscopy, in 68.5% by explicit American criteria, and in 74.4% by explicit Swiss criteria (not statistically significant, NS). Inappropriate use (overuse) of colonoscopy was found in 27.8%, 31.5%, and 25.6%, respectively (NS). The proportion of appropriate procedures was higher with increasing age. Almost all reasons for using colonoscopy could be assessed by the two explicit criteria sets, whereas 28.4% of reasons for using colonoscopy could not be evaluated by the criteria of the American Society for Gastrointestinal Endoscopy (p < 0.0001). The probability of finding a relevant endoscopic lesion was distinctly higher in the procedures rated appropriate or equivocal than in procedures judged inappropriate. CONCLUSIONS: The rate of inappropriate use of colonoscopy is substantial in Switzerland. Explicit criteria allow assessment of almost all indications encountered in clinical practice. In this study, all sets of appropriateness criteria significantly enhanced the probability of finding a relevant endoscopic lesion during colonoscopy.

Brief DISCERN, six questions for the evaluation of evidence-based content of health-related websites.

OBJECTIVE: To extract and to validate a brief version of the DISCERN which could identify mental health-related websites with good content quality. METHOD: The present study is based on the analysis of data issued from six previous studies which used DISCERN and a standardized tool for the evaluation of content quality (evidence-based health information) of 388 mental health-related websites. After extracting the Brief DISCERN, several psychometric properties (content validity through a Factor analysis, internal consistency by the Cronbach's alpha index, predictive validity through the diagnostic tests, concurrent validity by the strength of association between the Brief DISCERN and the original DISCERN scores) were investigated to ascertain its general applicability. RESULTS: A Brief DISCERN composed of two factors and six items was extracted from the original 16 items version of the DISCERN. Cronbach's alpha coefficients were more than acceptable for the complete questionnaire (alpha=0.74) and for the two distinct domains: treatments information (alpha=0.87) and reliability (alpha=0.83). Sensibility and specificity of the Brief DISCERN cut-off score > or =16 in the detection of good content quality websites were 0.357 and 0.945, respectively. Its predictive positive and negative values were 0.98 and 0.83, respectively. A statistically significant linear correlation was found between the total scores of the Brief DISCERN and those of the original DISCERN (r=0.84 and p<0.0005). CONCLUSION: The Brief DISCERN seems to be a reliable and valid instrument able to discriminate between websites with good and poor content quality. PRACTICE IMPLICATIONS: The Brief DISCERN is a simple tool which could facilitate the identification of good information on the web by patients and general consumers.

Rituximab dans le traitement des maladies rénales glomérulaires: indications et evidences cliniques [Rationale and clinical evidence for the use of rituximab in glomerular diseases].

Autoimmune glomerulopathies are an important cause of chronic kidney disease. Conventional treatments based on steroids, antiproliferative and cytotoxic agents are efficacious, but highly toxic. Because of their central role in the pathogenesis of autoimmunity, B cells have become an attractive therapeutic target. Rituximab is a monoclonal antibody directed against CD20 expressed on the surface of B cells, inducing profound depletion of B cells in the peripheral blood. In spite of encouraging results regarding the off-label use of Rituximab in membranous nephropathy, systemic lupus erythematosus and small vessel vasculitis, controlled, long-term data, and data with specific renal endpoints are currently lacking.

Médecine interne hospitalière: l'année 2009 en revue (1). La perspective des chefs de clinique [Hospital based internal medicine: the year 2009 in review (I). The perspective of chief residents]

Internists must regularly adjust their patients care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2009. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modern medical practice based on evidence.

A new accelerometric method to assess the daily walking practice.

OBJECTIVE: To describe a method to obtain a profile of the duration and intensity (speed) of walking periods over 24 hours in women under free-living conditions. DESIGN: A new method based on accelerometry was designed for analyzing walking activity. In order to take into account inter-individual variability of acceleration, an individual calibration process was used. Different experiments were performed to highlight the variability of acceleration vs walking speed relationship, to analyze the speed prediction accuracy of the method, and to test the assessment of walking distance and duration over 24-h. SUBJECTS: Twenty-eight women were studied (mean+/-s.d.) age: 39.3+/-8.9 y; body mass: 79.7+/-11.1 kg; body height: 162.9+/-5.4 cm; and body mass index (BMI) 30.0+/-3.8 kg/m(2). RESULTS: Accelerometer output was significantly correlated with speed during treadmill walking (r=0.95, P<0.01), and short unconstrained walks (r=0.86, P<0.01), although with a large inter-individual variation of the regression parameters. By using individual calibration, it was possible to predict walking speed on a standard urban circuit (predicted vs measured r=0.93, P<0.01, s.e.e.=0.51 km/h). In the free-living experiment, women spent on average 79.9+/-36.0 (range: 31.7-168.2) min/day in displacement activities, from which discontinuous short walking activities represented about 2/3 and continuous ones 1/3. Total walking distance averaged 2.1+/-1.2 (range: 0.4-4.7) km/day. It was performed at an average speed of 5.0+/-0.5 (range: 4.1-6.0) km/h. CONCLUSION: An accelerometer measuring the anteroposterior acceleration of the body can estimate walking speed together with the pattern, intensity and duration of daily walking activity.

Insuffisance rénate chronique: attitudes et pratiques de dépistages en l'absence d'etudes randomisées. [Chronic kidney disease: screening attitude and practice in the absence of randomized controlled trials].

Au vu de l'augmentation de la prévalence de l'insuffisance rénale chronique (IRC), une détection précoce a été proposée. Certaines organisations de santé proposent des mesures de détection précoce (par exemple : taux de filtration glomérulaire). L'efficacité du dépistage de l'IRC n'est cependant pas connue puisqu'aucune étude randomisée contrôlée n'a été conduite. Si le test de dépistage de l'IRC est simple et peu onéreux, un dépistage n'est justifié que s'il améliore le pronostic par rapport à l'absence de dépistage avec un rapport risques-bénéfices favorable et un rapport coût-efficacité acceptable. Sur la base d'études observationnelles et de modèles de rapport coût-efficacité, le dépistage de l'IRC doit être proposé chez les patients hypertendus et/ou diabétiques mais pas dans la population générale. [Abstract] Given the increasing prevalence of chronic kidney disease (CKD), early detection has been proposed. Some organizations recommend CKD screening. Yet, the efficacy of CKD screening is unknown given the absence of randomized controlled trial conducted so far. While CKD screening tests (e.g., glomerular filtration rate) are simple and inexpensive, CKD screening can only be justified if it reduces CKD-related mortality and/or CKD-related morbidity compared to no screening. In addition, CKD screening must provide more benefits than risks to the participants and must be cost-effective. Based on observational studies and cost-effectiveness models, CKD screening has to be proposed to high risk population (patients with hypertension and/or diabetes) but not to the general population.

How can we teach EBM in clinical practice? : an analysis of barriers to implementation of on-the-job EBM teaching and learning.

Introduction: Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries. Methods: A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier. Results: The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries. Conclusion: Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

Science, practice and patient needs: the work of the Plinius Maior Society.

The Plinius Maior Society is a European multinational, multidisciplinary group of clinicians and researchers in the alcoholism field, which strives for a comprehensive care concept in the management of alcoholism and alcohol-related problems. The Society, using evidence-based medicine, has developed a set of protocols, in the forms of guidelines, flow-charts, leaflets and booklets, for use as tools in research on and treatment of alcohol dependence, with a view to standardize clinical research procedures and to bridge the gap between the alcoholism researcher, practitioner and patient. These protocols or tools have been subjected to a review process during their preparation, and further comments on their validity will be integrated in their updates. Seven protocols have so far been developed, two of which, 'Guidelines on Evaluation of Treatment of Alcohol Dependence' and 'Detection and Management of Patients with Psychiatric and Alcohol Use Disorders', are aimed at the clinical researcher and specialists, whereas three others [in the form of decision trees (flow-charts)] are aimed at the general practitioner and other primary health care providers. These are entitled 'Alcohol Risk Assessment and Intervention in Primary Care', 'Withdrawal from Alcohol at Home' and 'Brief Intervention in Patients with Alcohol-Related Problems'. The remaining two tools are booklets aimed at the patient, one to support initiatives for detection of drinking problems and primary intervention, namely 'Do you have this Problem? Discuss it with your Doctor!', and the other to assist the patient in relapse prevention after the early stages of treatment, namely 'On the Way to Recovery'. The protocols for the general practitioners and patients have so far been produced in seven European languages, and, as with the Guidelines, feedback from target users will be collected and incorporated in future updates. The Society continually seeks to consider areas of clinical importance for its work and, as it enters the new millennium, it hopes to address and make a significant contribution to the most pressing problem in the management of alcohol dependence, namely relapse.

Recommendations for raloxifene use in daily clinical practice in the Swiss setting.

BACKGROUND/AIM: Raloxifene is the first selective estrogen receptor modulator that has been approved for the treatment and prevention of osteoporosis in postmenopausal women in Europe and in the US. Although raloxifene reduces the risk of invasive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer, it is approved in that indication in the US but not in the EU. The aim was to characterize the clinical profiles of postmenopausal women expected to benefit most from therapy with raloxifene based on published scientific evidence to date. METHODS: Key individual patient characteristics relevant to the prescription of raloxifene in daily practice were defined by a board of Swiss experts in the fields of menopause and metabolic bone diseases and linked to published scientific evidence. Consensus was reached about translating these insights into daily practice. RESULTS: Through estrogen agonistic effects on bone, raloxifene reduces biochemical markers of bone turnover to premenopausal levels, increases bone mineral density (BMD) at the lumbar spine, proximal femur, and total body, and reduces vertebral fracture risk in women with osteopenia or osteoporosis with and without prevalent vertebral fracture. Through estrogen antagonistic effects on breast tissue, raloxifene reduces the risk of invasive estrogen-receptor positive breast cancer in postmenopausal women with osteoporosis and in postmenopausal women at high risk for invasive breast cancer. Finally, raloxifene increases the incidence of hot flushes, the risk of venous thromboembolic events, and the risk of fatal stroke in postmenopausal women at increased risk for coronary heart disease. Postmenopausal women in whom the use of raloxifene is considered can be categorized in a 2 × 2 matrix reflecting their bone status (osteopenic or osteoporotic based on their BMD T-score by dual energy X-ray absorptiometry) and their breast cancer risk (low or high based on the modified Gail model). Women at high risk of breast cancer should be considered for treatment with raloxifene. CONCLUSION: Postmenopausal women between 50 and 70 years of age without climacteric symptoms with either osteopenia or osteoporosis should be evaluated with regard to their breast cancer risk and considered for treatment with raloxifene within the framework of its contraindications and precautions.