Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Genomics of clinal variation in Drosophila: disentangling the interactions of selection and demography.

Clines in phenotypes and genotype frequencies across environmental gradients are commonly taken as evidence for spatially varying selection. Classical examples include the latitudinal clines in various species of Drosophila, which often occur in parallel fashion on multiple continents. Today, genomewide analysis of such clinal systems provides a fantastic opportunity for unravelling the genetics of adaptation, yet major challenges remain. A well-known but often neglected problem is that demographic processes can also generate clinality, independent of or coincident with selection. A closely related issue is how to identify true genic targets of clinal selection. In this issue of Molecular Ecology, three studies illustrate these challenges and how they might be met. Bergland et al. report evidence suggesting that the well-known parallel latitudinal clines in North American and Australian D. melanogaster are confounded by admixture from Africa and Europe, highlighting the importance of distinguishing demographic from adaptive clines. In a companion study, Machado et al. provide the first genomic comparison of latitudinal differentiation in D. melanogaster and its sister species D. simulans. While D. simulans is less clinal than D. melanogaster, a significant fraction of clinal genes is shared between both species, suggesting the existence of convergent adaptation to clinaly varying selection pressures. Finally, by drawing on several independent sources of evidence, Bo?ičević et al. identify a functional network of eight clinal genes that are likely involved in cold adaptation. Together, these studies remind us that clinality does not necessarily imply selection and that separating adaptive signal from demographic noise requires great effort and care.

Role of references in international industrial marketing : a theory-building case study about supplier’s processes of utilizing references

Scientific studies regarding specifically references do not seem to exist. However, the utilization of references is an important practice for many companies involved in industrial marketing. The purpose of the study is to increase the understanding about the utilization of references in international industrial marketing in order to contribute to the development of a theory of reference behavior. Specifically, the modes of reference usage in industry, the factors affecting a supplier's reference behavior, and the question how references are actually utilized, are explored in the study. Due to the explorative nature of the study, a research design was followed where theory and empirical studies alternated. An Exploratory Framework was developed to guide a pilot case study that resulted in Framework 1. Results of the pilot study guided an expanded literature review that was used to develop first a Structural Framework and a Process Framework which were combined in Framework 2. Then, the second empirical phase of the case study was conducted in the same (pilot) case company. In this phase, Decision Systems Analysis (DSA) was used as the analysis method. The DSA procedure consists of three interviewing waves: initial interviews, reinterviews, and validating interviews. Four reference decision processes were identified, described and analyzed in the form of flowchart descriptions. The flowchart descriptions were used to explore new constructs and to develop new propositions to develop Framework 2 further. The quality of the study was ascertained by many actions in both empirical parts of the study. The construct validity of the study was ascertained by using multiple sources of evidence and by asking the key informant to review the pilot case report. The DSA method itself includes procedures assuring validity. Because of the choice to conduct a single case study, external validity was not even pursued. High reliability was pursued through detailed documentation and thorough reporting of evidence. It was concluded that the core of the concept of reference is a customer relationship regardless of the concrete forms a reference might take in its utilization. Depending on various contingencies, references might have various tasks inside the four roles of increasing 1) efficiency of sales and sales management, 2) efficiency of the business, 3) effectiveness of marketing activities, and 4) effectiveness in establishing, maintaining and enhancing customer relationships. Thus, references have not only external but internal tasks as well. A supplier's reference behavior might be affected by many hierarchical conditions. Additionally, the empirical study showed that the supplier can utilize its references as a continuous, all pervasive decision making process through various practices. The process includes both individual and unstructured decision making subprocesses. The proposed concept of reference can be used to guide a reference policy recommendable for companies for which the utilization of references is important. The significance of the study is threefold: proposing the concept of reference, developing a framework of a supplier's reference behavior and its short term process of utilizing references, and conceptual structuring of an unstructured and in industrial marketing important phenomenon to four roles.

Problems and potentialities of e-Learning for regular undergraduate courses in emergency medicine

BACKGROUND: E-learning techniques are spreading at great speed in medicine, raising concerns about the impact of adopting them. Websites especially designed to host courses are becoming more common. There is a lack of evidence that these systems could enhance student knowledge acquisition. GOAL: To evaluate the impact of using dedicated-website tools over cognition of medical students exposed to a first-aid course. METHODS: Prospective study of 184 medical students exposed to a twenty-hour first-aid course. We generated a dedicated-website with several sections (lectures, additional reading material, video and multiple choice exercises). We constructed variables expressing the student's access to each section. The evaluation was composed of fifty multiple-choice tests, based on clinical problems. We used multiple linear regression to adjust for potential confounders. RESULTS: There was no association of website intensity of exposure and the outcome - beta-coeficient 0.27 (95%CI - 0.454 - 1.004). These findings were not altered after adjustment for potential confounders - 0.165 (95%CI -0.628 - 0.960). CONCLUSION: A dedicated website with passive and active capabilities for aiding in person learning had not shown association with a better outcome.

Solving the puzzle of mobile learning adoption

The dissertation seeks to explore how to improve users‘ adoption of mobile learning in current education systems. Considering the difference between basic and tertiary education in China, the research consists of two separate but interrelated parts, which focus on the use of mobile learning in basic and tertiary education contexts, respectively. In the dissertation, two adoption frameworks are developed based on previous studies. The frameworks are then evaluated using different technologies. Concerning mobile learning use in basic education settings, case study methodology is utilized. A leading provider of mobile learning services and products in China, Noah Ltd., is investigated. Multiple sources of evidence are collected to test the framework. Regarding mobile learning adoption in tertiary education contexts, survey research methodology is utilized. Based on 209 useful responses, the framework is evaluated using structural equation modelling technology. Four proposed determinants of intention to use are evaluated, which are perceived ease of use, perceived near-term usefulness, perceived ong-term usefulness and personal innovativeness. The dissertation provides a number of new insights for both researchers and practitioners. In particular, the dissertation specifies a practical solution to deal with the disruptive effects of mobile learning in basic education, which keeps the use of mobile learning away from the schools across such as European countries. A list of new and innovative mobile learning technologies is systematically introduced as well. Further, the research identifies several key factors driving mobile learning adoption in tertiary education settings. In theory, the dissertation suggests that since the technology acceptance model is initiated in work-oriented innovations by testing employees, it is not necessarily the best model for studying educational innovations. The results also suggest that perceived longterm usefulness for educational systems should be as important as perceived usefulness for utilitarian systems, and perceived enjoyment for hedonic systems. A classification based on the nature of systems purpose (utilitarian, hedonic or educational) would contribute to a better understanding of the essence of IT innovation adoption.

Configuration management process improvement : a case study of a Pan-Nordic insurance company

Configuration management is often seen as an enabler for the main IT Service Management (ITSM) processes such as Incident and Problem management. A decent level of quality of IT configuration data is required in order to carry out routines of these processes. This case study examines the state of configuration management in a multinational organization and aims at identification of methods for its improvement. The author has stayed five months with this company in order to collect different sources of evidence and to make observations. The main source of data for this study is interviews with some of the key employees of the assigned organization who are involved into the ITSM processes. This study concludes the maturity level of the existing configuration management process to be repeatable but intuitive, and outlines the principal requirements for its improvement. A match between the requirements identified in the organization and the requirements stated in the ISO/IEC 20000 standard indicates the possibility of adopting ITIL guidelines as a method for configuration management process improvement. The outcome of the study presents a set of recommendations for improvement that considers the process, the information model and the information system for configuration management in the case organization.

Applications of augmented reality for sales in apparel industry in Russia

The sustainable growth of video interactivity technologies on different platforms in the lasts years opens good prospects for augmented reality technology adoption on different markets. In the end of 2011 there was an improvement in technology which allows building the 3D model of human body. Such an improvement could be used in apparel industry. The main goal of the study is to understand the level of acceptance of augmented reality as a technology on the Russian apparel market. For a more accurate investigation, a new model accounting for augmented reality characteristics, as well as for similarities and differences between online and offline customer behavior in apparel industry, was developed. As a result of the survey, the weights of different purchase intention factors for Russian consumer were found, and the information about Russian consumers’ preferences towards the augmented reality features in apparel market, especially in fitting time, real-time interaction and fitting quality peculiarities, was presented.

Growth, nodulation, and yield of soybean and associated weeds as affected by weed management

Two field experiments were conducted at the experimental farm of the National Research Centre at Shalakan, Kalubia Governorate, Egypt, during 2006 and 2007 seasons, to study the effect of three pre-emergence herbicides, prometryn [at the rate of 0.75, 1.5 and 2.25 kg ha-1], oxadiargyl [at the rate of 240, 480 and 720 g ha-1] and butralin [at the rate of 1.20, 2.40 and 3.36 kg ha-1], two hand hoeing treatments and a nonweeded check, on weed infestation, nodulation, growth, yield and yield attributes of soybean plants. Two hand hoeing treatments resulted in the highest weed depression expressed as the lowest fresh and dry weights of broadleaved, grassy and total weeds. The reduction percentage in weed dry matter compared to the nonweeded treatment was 98.3, 92.64 and 96.9% in broadleaved, grassy and total weeds, respectively. Application of the three herbicides at higher or recommended doses significantly reduced fresh and dry weight of the weeds compared to the nonweeded treatment. The results indicated that all the three herbicides at rates higher than the recommended markedly decreased the number, fresh and dry weight of nodules as well as root, shoot and total dry weight plant-1, while application of two hand hoeing treatments significantly increased these traits. Two hand hoeing treatments and pre-emergence herbicides at the recommended rates markedly increased soybean yield and its attributes. Two hand hoeing treatments gave the highest values of number of pods per plant-1, weight of pods per plant-1 and number of seeds per plant-1 by 140.7, 150.0 and 59.8%, respectively, compared to the nonweeded treatment. On the other hand, oxadiargyl at the recommended rate (480 g ha-1) was the best treatment for promoting seed yield (g plant-1), seed yield (kg ha-1) and biological yield (g plant-1) compared to the nonweeded treatment by 87.3, 85.0 and 88.2%, respectively. Prometryn at the rate of 1.50 kg ha-1, followed by two hand hoeing treatments, produced the highest shoot and seed protein percentage as well as seed oil percentage, compared to the other weed control treatments.

Allelopathic effects of Eucalyptus citriodora on amaryllis and associated grassy weed

A Petri dish assay was carried out for screening different concentrations of aqueous extracts of fresh and dry leaves of Eucalyptus citriodora on germination and seedling growth of wild oat weed (Avena fatua). Seed germination, root and shoot length of wild oat exhibited different degrees of inhibition according to the concentration of the aqueous extract. Maximum inhibitions of germination percentage, root and shoot length were recorded when using 25% fresh leaf extract. Based on this preliminary work (Petri dish assay), studies were conducted under greenhouse conditions at the National Research Center, Egypt, in the two winter seasons of 2006/2007 and 2007/2008 to evaluate the effects of foliar and soil treatments of aqueous extracts of Eucalyptus citriodora fresh and dry leaves on wild oat weed as well as on the growth and flowering of amaryllis (Hippeastrum hybridum), compared with the recommended dose of the herbicide tralkoxydim. Amaryllis fresh and dry weights as well as flowering increased significantly when treated with the previous extracts, especially the fresh leaf extract. However, the fresh and dry weights of wild oat were significantly reduced by the aqueous extracts, either fresh or dry, indicating phytotoxic effects. Tralkoxydim caused complete inhibition of wild oat as compared with the control. The studies involved estimation of the endogenous contents of total phenols in weed. With all the treatments, the inhibitory effects on weeds were correlated with accumulation of the internal contents of total phenols, compared to their respective controls. The amount of phenols correlated well with the weed's growth performance. This study establishes the effect of the aqueous extracts on the weed wild oat, associated with amaryllis, which may serve as a tool in establishing their herbicidal potential.

The seed coat as a modulator of seed-environment relationships in Fabaceae

The seed coat is one of the main determinants of seed germination, vigor and longevity potentials. It is also intimately associated with temporal and spatial dispersion of seed germination in a large number of plant species. The understanding of its properties and characteristics may explain, anticipate or even allow the modification of seed performance under certain environmental conditions. There is a growing volume of evidence associating seed coat characteristics to specific seed problems. For example, susceptibility to mechanical damage is related to lignin content of the seed coat, while seed longevity and tolerance to field weathering depends on seed coat integrity. Seed performance in many legumes has been associated with certain seed coat structures, such as the hilum, strophiole and micropyle. In soybean, permeability is also related with porosity, color, and cerosity, that affect seed vigor, storage potential, resistance to shrinking and fungi infection, and to susceptibility to imbibition damage. The understanding of these associations is necessary before genetic alterations through breeding for desirable characteristics and is fundamental for the development and improvement of seed pre-sowing treatments, production, handling and quality evaluation procedures, which may ultimately result in reduction of seed quality losses and increase the efficiency of agricultural production systems.

Localization of the cotyledon reserves of Theobroma grandiflorum (Willd. ex Spreng.) K. Schum., T. subincanum Mart., T. bicolor Bonpl. and their analogies with T. cacao L.

Cotyledon mesophyll cell morphology and lipid and protein synthesis of T. grandiflorum, T. subincanum and T. bicolor were analyzed and compared with T. cacao. These species possess foliar cotyledons folded around the hypocotyl radicle axis, typical of Sterculiaceae. Fruit size, morphology and weight are very distinct amongst the four species and so are the respective seeds. The main axis of the T. grandiflorum and T. bicolor seeds measured about 30 mm, while T. subincanum and T. cacao seeds measured 17 mm and 26 mm respectively. The seed weights of T. grandiflorum, T. bicolor, T. subincanum and T. cacao were 11.6 g, 9.4 g, 2.1 g and 3.0 g, respectively. The cotyledon mesophylls of the four species contained mainly polysaccharides and lipid-protein reserve cells. Theobroma cacao, T. grandiflorum and T. subincanum were composed of greater than 50% lipids. For the four species, lipid globules gradually accumulated adjacent to the cell wall, and these globules measured from 1 to 3 µm. TEM showed low-density proteins inside the central vacuole of the young mesophyll cells of T. cacao. The protein reserves of the mature cells were densely scattered amongst the lipid bodies, and a few starch granules occurred together with the cotyledon mesophyll of the four species. Polyphenolic cells were found throughout the mesophyll cells or aligned with the respective vascular bundles. Immature cells demonstrated the capacity to synthesize all these reserves, but gradually the pre-determined cells produced mainly lipid-protein reserves. Besides the unique characteristics of the T. cacao products, the lipid-protein synthesis capacities of T. grandiflorum, T. subincanum and T. bicolor suggest various possibilities for new industrialized food, pharmaceutical and cosmetic products.

Diallel cross analysis for young plants of brachytic maize (Zea mays L.) varieties

Six brachytic maize varieties were crossed in a diallel mating scheme. Both varieties and crosses were grown hydroponically in a greenhouse, in randomized complete blocks with three replications in two seasons. Four brachytic double cross hybrids were used as checks. Twenty-eight days after planting, data for eight traits were taken for weights of the total plant (TPW), top plant (TOW), total roots (TRW), seminal roots (SRW), and nodal roots (NRW) and number of total roots (TRN), seminal roots (SRN), and nodal roots (NRN). Ten plants were measured in each plot and all the analyses were accomplished with plot means. In the diallel cross the top plant contributed 57.6% of the total plant weight, for seminal roots 15.4%, and for nodal roots 27.0%. Root number distribution was 36.7% seminal roots and 63.3% nodal roots. Approximately the same ratios were observed in the checks. The average heterosis effects were nonsignificant for all traits; the other components of heterosis (variety and specific heterosis) also were not important sources of variation in young plants. The overall results suggest that nonadditive gene action is not an important source of variation for the plant and root system of young plants. The positive correlation coefficients for combinations of traits indicated that they are under the control of a polygenic system

Cytokine production profile of heart-infiltrating T cells in Chagas' disease cardiomyopathy

The hallmark of chronic Chagas' disease cardiomyopathy (CCC) is the finding of a T cell-rich inflammatory mononuclear cell infiltrate in the presence of extremely few parasites in the heart lesions. The scarcity of parasites in affected heart tissue casts doubt on the direct participation of Trypanosoma cruzi in CCC heart tissue lesions, and suggests the possible involvement of autoimmunity. The cells in the infiltrate are presumably the ultimate effectors of tissue damage, and there is evidence that such cells recognize cardiac myosin in molecular mimicry with T. cruzi proteins rather than primary reactivity to T. cruzi antigens (Cunha-Neto et al. (1996) Journal of Clinical Investigation, 98: 1709-1712). Recently, we have studied heart-infiltrating T cells at the functional level. In this short review we summarize the studies about the role of cytokines in human and experimental T. cruzi infection, along with our data on heart-infiltrating T cells in human Chagas' cardiomyopathy. The bulk of evidence points to a significant production of IFN-g and TNF-a which may be linked to T. cruzi-induced IL-12 production

Role of non-nitric oxide non-prostaglandin endothelium-derived relaxing factor(s) in bradykinin vasodilation

The most conspicuous effect of bradykinin following its administration into the systemic circulation is a transient hypotension due to vasodilation. In the present study most of the available evidence regarding the mechanisms involved in bradykinin-induced arterial vasodilation is reviewed. It has become firmly established that in most species vasodilation in response to bradykinin is mediated by the release of endothelial relaxing factors following the activation of B2-receptors. Although in some cases the action of bradykinin is entirely mediated by the endothelial release of nitric oxide (NO) and/or prostacyclin (PGI2), a large amount of evidence has been accumulated during the last 10 years indicating that a non-NO/PGI2 factor accounts for bradykinin-induced vasodilation in a wide variety of perfused vascular beds and isolated small arteries from several species including humans. Since the effect of the non-NO/PGI2 endothelium-derived relaxing factor is practically abolished by disrupting the K+ electrochemical gradient together with the fact that bradykinin causes endothelium-dependent hyperpolarization of vascular smooth muscle cells, the action of such factor has been attributed to the opening of K+ channels in these cells. The pharmacological characteristics of these channels are not uniform among the different blood vessels in which they have been examined. Although there is some evidence indicating a role for KCa or KV channels, our findings in the mesenteric bed together with other reports indicate that the K+ channels involved do not correspond exactly to any of those already described. In addition, the chemical identity of such hyperpolarizing factor is still a matter of controversy. The postulated main contenders are epoxyeicosatrienoic acids or endocannabinoid agonists for the CB1-receptors. Based on the available reports and on data from our laboratory in the rat mesenteric bed, we conclude that the NO/PGI2-independent endothelium-dependent vasodilation induced by BK is unlikely to involve a cytochrome P450 arachidonic acid metabolite or an endocannabinoid agonist.

Effect of metabolic acidosis on renal tubular sodium handling in rats as determined by lithium clearance

Systemic metabolic acidosis is known to cause a decrease in salt and water reabsorption by the kidney. We have used renal lithium clearance to investigate the effect of chronic, NH4Cl-induced metabolic acidosis on the renal handling of Na+ in male Wistar-Hannover rats (200-250 g). Chronic acidosis (pH 7.16 ± 0.13) caused a sustained increase in renal fractional Na+ excretion (267.9 ± 36.4%), accompanied by an increase in fractional proximal (113.3 ± 3.6%) and post-proximal (179.7 ± 20.2%) Na+ and urinary K+ (163.4 ± 5.6%) excretion when compared to control and pair-fed rats. These differences occurred in spite of an unchanged creatinine clearance and Na+ filtered load. A lower final body weight was observed in the acidotic (232 ± 4.6 g) and pair-fed (225 ± 3.6 g) rats compared to the controls (258 ± 3.7 g). In contrast, there was a significant increase in the kidney weights of acidotic rats (1.73 ± 0.05 g) compared to the other experimental groups (control, 1.46 ± 0.05 g; pair-fed, 1.4 ± 0.05 g). We suggest that altered renal Na+ and K+ handling in acidotic rats may result from a reciprocal relationship between the level of metabolism in renal tubules and ion transport.