Particularités de la prise en charge des infections chez le patient neutropénique [Special feature in the handling of infectious in neutropenic patients]

Les progrès continus des connaissances réalisés dans le domaine de l'oncohématologie depuis quelques décennies ont permis une amélioration considérable du pronostic de la plupart des formes de cancer. Toutefois, la morbidité et la mortalité attribuables aux infections apparaissent actuellement comme les principaux facteurs limitant l'agressivité des traitements de la maladie cancéreuse, et un meilleur contrôle de ces dernières est devenu l'un des éléments essentiels de la prise en charge de ce type de patients. Une recherche clinique intense a permis d'en identifier les grands principes qui sont exposés dans cet article. Un algorithme thérapeutique susceptible de guider le clinicien face au développement d'un état fébrile, toujours suspect d'infection chez le patient cancéreux neutropénique, est ensuite proposé.

Knowledge management for systems biology a general and visually driven framework applied to translational medicine

Background: To enhance our understanding of complex biological systems like diseases we need to put all of the available data into context and use this to detect relations, pattern and rules which allow predictive hypotheses to be defined. Life science has become a data rich science with information about the behaviour of millions of entities like genes, chemical compounds, diseases, cell types and organs, which are organised in many different databases and/or spread throughout the literature. Existing knowledge such as genotype - phenotype relations or signal transduction pathways must be semantically integrated and dynamically organised into structured networks that are connected with clinical and experimental data. Different approaches to this challenge exist but so far none has proven entirely satisfactory. Results: To address this challenge we previously developed a generic knowledge management framework, BioXM™, which allows the dynamic, graphic generation of domain specific knowledge representation models based on specific objects and their relations supporting annotations and ontologies. Here we demonstrate the utility of BioXM for knowledge management in systems biology as part of the EU FP6 BioBridge project on translational approaches to chronic diseases. From clinical and experimental data, text-mining results and public databases we generate a chronic obstructive pulmonary disease (COPD) knowledge base and demonstrate its use by mining specific molecular networks together with integrated clinical and experimental data. Conclusions: We generate the first semantically integrated COPD specific public knowledge base and find that for the integration of clinical and experimental data with pre-existing knowledge the configuration based set-up enabled by BioXM reduced implementation time and effort for the knowledge base compared to similar systems implemented as classical software development projects. The knowledgebase enables the retrieval of sub-networks including protein-protein interaction, pathway, gene - disease and gene - compound data which are used for subsequent data analysis, modelling and simulation. Pre-structured queries and reports enhance usability; establishing their use in everyday clinical settings requires further simplification with a browser based interface which is currently under development.

The role of computational fluid dynamics in the management of unruptured intracranial aneurysms: a clinicians' view

Objective: The importance of hemodynamics in the etiopathogenesis of intracranial aneurysms (IAs) is widely accepted.Computational fluid dynamics (CFD) is being used increasingly for hemodynamic predictions. However, alogn with thecontinuing development and validation of these tools, it is imperative to collect the opinion of the clinicians. Methods: A workshopon CFD was conducted during the European Society of Minimally Invasive Neurological Therapy (ESMINT) Teaching Course,Lisbon, Portugal. 36 delegates, mostly clinicians, performed supervised CFD analysis for an IA, using the @neuFuse softwaredeveloped within the European project @neurIST. Feedback on the workshop was collected and analyzed. The performancewas assessed on a scale of 1 to 4 and, compared with experts’ performance. Results: Current dilemmas in the management ofunruptured IAs remained the most important motivating factor to attend the workshop and majority of participants showedinterest in participating in a multicentric trial. The participants achieved an average score of 2.52 (range 0–4) which was 63% (range 0–100%) of an expert user. Conclusions: Although participants showed a manifest interest in CFD, there was a clear lack ofawareness concerning the role of hemodynamics in the etiopathogenesis of IAs and the use of CFD in this context. More effortstherefore are required to enhance understanding of the clinicians in the subject.

A context-based methodology for integrating Web 2.0 services in learning scenarios

The emergence of the Web 2.0 technologies in the last years havechanged the way people interact with knowledge. Services for cooperation andcollaboration have placed the user in the centre of a new knowledge buildingspace. The development of new second generation learning environments canbenefit from the potential of these Web 2.0 services when applied to aneducational context. We propose a methodology for designing learningenvironments that relates Web 2.0 services with the functional requirements ofthese environments. In particular, we concentrate on the design of the KRSMsystem to discuss the components of this methodology and its application.

Can fisheries-induced evolution shift reference points for fisheries management?

Biological reference points are important tools for fisheries management. Reference points are not static, but may change when a population's environment or the population itself changes. Fisheries-induced evolution is one mechanism that can alter population characteristics, leading to "shifting" reference points by modifying the underlying biological processes or by changing the perception of a fishery system. The former causes changes in "true" reference points, whereas the latter is caused by changes in the yardsticks used to quantify a system's status. Unaccounted shifts of either kind imply that reference points gradually lose their intended meaning. This can lead to increased precaution, which is safe, but potentially costly. Shifts can also occur in more perilous directions, such that actual risks are greater than anticipated. Our qualitative analysis suggests that all commonly used reference points are susceptible to shifting through fisheries-induced evolution, including the limit and "precautionary" reference points for spawning-stock biomass, Blim and Bpa, and the target reference point for fishing mortality, F0.1. Our findings call for increased awareness of fisheries-induced changes and highlight the value of always basing reference points on adequately updated information, to capture all changes in the biological processes that drive fish population dynamics.

Movement, impacts and management of plant distributions in response to climate change: insights from invasions

A major challenge in this era of rapid climate change is to predict changes in species distributions and their impacts on ecosystems, and, if necessary, to recommend management strategies for maintenance of biodiversity or ecosystem services. Biological invasions, studied in most biomes of the world, can provide useful analogs for some of the ecological consequences of species distribution shifts in response to climate change. Invasions illustrate the adaptive and interactive responses that can occur when species are confronted with new environmental conditions. Invasion ecology complements climate change research and provides insights into the following questions: i) how will species distributions respond to climate change? ii) how will species movement affect recipient ecosystems? and iii) should we, and if so how can we, manage species and ecosystems in the face of climate change? Invasion ecology demonstrates that a trait-based approach can help to predict spread speeds and impacts on ecosystems, and has the potential to predict climate change impacts on species ranges and recipient ecosystems. However, there is a need to analyse traits in the context of life-history and demography, the stage in the colonisation process (e.g., spread, establishment or impact), the distribution of suitable habitats in the landscape, and the novel abiotic and biotic conditions under which those traits are expressed. As is the case with climate change, invasion ecology is embedded within complex societal goals. Both disciplines converge on similar questions of "when to intervene?" and "what to do?" which call for a better understanding of the ecological processes and social values associated with changing ecosystems.

Appropriate management of special situations in Crohn's disease (upper gastro-intestinal; extra-intestinal manifestations; drug safety during pregnancy and breastfeeding): results of a multidisciplinary international expert panel-EPACT II

Introduction: High-grade evidence is lacking for most therapeutic decisions in Crohn's disease. Appropriateness criteria were developed for upper gastro-intestinal, extra-intestinal manifestations and drug safety during conception, pregnancy and breastfeeding in patients with Crohn's disease, to assist the physician in clinical decision making. Methods: The European Panel on the Appropriateness of Crohn's Disease Therapy (EPACT II), a multidisciplinary international European expert panel, rated clinical scenarios based on evidence from the published literature and panelists' own clinical expertise. Median ratings (on a 9-point scale) were stratified into three categories: appropriate (7-9), uncertain (4-6 with or without disagreement) and inappropriate (1-3). Experts were also asked to rank appropriate medications by priority. Results: Proton pump inhibitors, steroids, azathioprine/6-mercaptopurine and infliximab are appropriate for upper gastro-duodenal Crohn's disease; for stenosis, endoscopic balloon dilation is the first-tine therapy, although surgery is also appropriate. Ursodeoxycholic acid is the only appropriate treatment for primary sclerosing cholangitis. Infliximab is appropriate for Pyoderma gangrenosum, ankylosing spondylitis and uveitis, steroids for Pyoderma gangrenosum and ankylosing spondylitis, adalimumab for Pyoderma gangrenosum and ankylosing spondylitis, cyclosporine-A/tacrolimus for Pyoderma gangrenosum. Mesalamine, sulfasalazine, prednisone, azathioprine/6-mercaptopurine, ciprofloxacin, and probiotics, may be administered safety during pregnancy or for patients wishing to conceive, with the exception that mate patients considering conception should avoid sulfasalazine. Metronidazol is considered safe in the 2nd and 3rd trimesters whereas infliximab is rated safe in the 1st trimester but uncertain in the 2nd and 3rd trimesters. Methotrexate is always contraindicated at conception, during pregnancy or during breastfeeding, due to its known teratogenicity. Mesalamine, prednisone, probiotics and infliximab are considered safe during breastfeeding. Conclusion: EPACT II recommendations are freely available online (www.epact.ch). The validity of these criteria should now be tested by prospective evaluation. (C) 2009 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

Health care management autonomy: Evidence from the Catalonian hospital sector in a decentralised Spain

The organisation of inpatient care provision has undergone significant reform in many southern European countries. Overall across Europe, public management is moving towards the introduction of more flexibility and autonomy . In this setting, the promotion of the further decentralisation of health care provision stands out as a key salient policy option in all countries that have hitherto had a traditionally centralised structure. Yet, the success of the underlying incentives that decentralised structures create relies on the institutional design at the organisational level, especially in respect of achieving efficiency and promoting policy innovation without harming the essential principle of equal access for equal need that grounds National Health Systems (NHS). This paper explores some of the specific organisational developments of decentralisation structures drawing from the Spanish experience, and particularly those in the Catalonia. This experience provides some evidence of the extent to which organisation decentralisation structures that expand levels of autonomy and flexibility lead to organisational innovation while promoting activity and efficiency. In addition to this pure managerial decentralisation process, Spain is of particular interest as a result of the specific regional NHS decentralisation that started in the early 1980 s and was completed in 2002 when all seventeen autonomous communities that make up the country had responsibility for health care services.Already there is some evidence to suggest that this process of decentralisation has been accompanied by a degree of policy innovation and informal regional cooperation. Indeed, the Spanish experience is relevant because both institutional changes took place, namely managerial decentralisation leading to higher flexibility and autonomy- alongside an increasing political decentralisation at the regional level. The coincidence of both processes could potentially explain why some organisation and policy innovation resulting from policy experimentation at the regional level might be an additional featureto take into account when examining the benefits of decentralisation.

Drivers and sources of supply flexibility: An exploratory study

Purpose - There has been much research on manufacturing flexibility, but supply chain flexibility is still an under-investigated area. This paper focuses on supply flexibility, the aspects of flexibility related to the upstream supply chain. Our purpose is to investigate why and how firms increase supply flexibility.Methodology/Approach An exploratory multiple case study was conducted. We analyzed seven Spanish manufacturers from different sectors (automotive, apparel, electronics and electrical equipment).Findings - The results show that there are some major reasons why firms need supply flexibility (manufacturing schedule fluctuations, JIT purchasing, manufacturing slack capacity, low level of parts commonality, demand volatility, demand seasonality and forecast accuracy), and that companies increase this type of flexibility by implementing two main strategies: to increase suppliers responsiveness capability and flexible sourcing . The results also suggest that the supply flexibility strategy selected depends on two factors: the supplier searching and switching costs and the type of uncertainty (mix, volume or delivery).Research limitations - This paper has some limitations common to all case studies, such as the subjectivity of the analysis, and the questionable generalizability of results (since the sample of firms is not statistically significant).Implications - Our study contributes to the existing literature by empirically investigating which are the main reasons for companies needing to increase supply flexibility, how they increase this flexibility, and suggesting some factors that could influence the selection of a particular supply flexibility strategy.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

A gestão das Instituições de Ensino Superior está a ser repensada num contexto de globalização tendo em conta a missão destas, a responsabilidade e a sua cultura (ou culturas), impondo-se novos modelos de gestão e governação. A Qualidade e a Responsabilidade Social do Ensino Superior constituem um tema pertinente e actual. As transformações estruturais que as sociedades atravessam aconselham e justificam da parte do Ensino Superior uma atitude consentânea com as necessidades daquelas. Os desafios que, as Instituições de Ensino Superior enfrentam, exigem novas perspectivas estratégicas e nova visão perante cenários de incerteza que surgem a nível mundial, desempenhando a liderança um papel fundamental na qualidade destas instituições. Neste sentido, lança-se no presente estudo, a seguinte questão: Que Modelos de Gestão e Governação contribuem para a melhoria da Qualidade no Ensino Superior? A metodologia utilizada para a realização deste estudo passa pelo delineamento de uma estratégia com cinco fases: elaboração de um plano ajustável à evolução do trabalho, levantamento do estado da arte de uma forma gradual, trabalho de pesquisa e criação, escrita da tese e análise crítica e reflexão. Para além de outros aspectos relevantes no domínio do Ensino Superior, foram estudados diversos modelos, Modelos de Excelência, modelos para implementação de Sistemas de Gestão da Qualidade, Gestão Ambiental, Gestão da Segurança e Saúde do Trabalho, Gestão de Risco; entre outros. Criaram-se diversos Indicadores de Responsabilidade Social neste contexto e foi feito um estudo piloto no âmbito da Responsabilidade Social em Instituições de Ensino Superior. Por último, destacaram-se as conclusões que decorrem do estudo piloto efectuado, bem como reflexões que surgem da investigação teórica realizada. O estudo piloto efectuado permitiu concluir, por exemplo, que existem indícios de algum alheamento no seio das Instituições às temáticas relacionadas com os princípios éticos e com a educação ambiental. Por outro lado, uma grande parte dos indivíduos inquiridos disseram não ter qualquer opinião quando confrontados com questões sobre Participação Social Responsável, Investigação Socialmente Útil e Gestão Social do Conhecimento. Conclui-se que as questões para as pessoas ainda são muito vagas, daí que, faça sentido o debate de todas estas questões, bem como estudos que contribuam para uma mudança de paradigma relativamente à educação, e em particular no Ensino Superior, com vista à qualidade, num sentido abrangente.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

The management of Higher Education Institutions is being rethought, with the mission and culture of the institutions changing due to globalization, resulting in new models of management and governance. The quality of Higher Education and its obligations to society are of current importance. The structural changes that the society has gone through requires a response in higher education that matches the changing needs of the society. Higher Education Institutions require new perspectives and a new strategic vision to cope with the uncertainty arising at a global scale, and this plays a role in their quality and whether they are leading institutions. Thus the following question arises: Which forms of management and governance contribute to the improvement of quality in higher education? The methodology for this study was designed with five stages: preparation of a plan of work within the thesis, the gradual progression to understanding the up-to-date understanding of Higher Education Research, generating research hypotheses and creating further understanding, writing the thesis with critical analysis and reflection. In addition to other relevant issues in higher education, different models were studied: Models of excellence, Models for implementation of Quality Management Systems, Environmental Management, Occupational Health and Safety Management, Risk Management, among others. Several indicators of Social Responsibility were created in this context and a pilot study was conducted in the area of Social Responsibility in Higher Education Institutions. Finally the conclusions resulting from the pilot study are presented and questions arising from the theoretical research are discussed. For example, the pilot study showed that there are indicators of a lack of understanding within the institutions to issues related to ethical and environmental education. Moreover, a large proportion of respondents said individuals have no opinion when confronted with questions on Responsible Social Involvement and Social Research and Social Management of Useful Knowledge. It is concluded that people have a vague awareness of these issues, so these concepts are new to them.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

The management of Higher Education Institutions is being rethought, with the mission and culture of the institutions changing due to globalization, resulting in new models of management and governance. The quality of Higher Education and its obligations to society are of current importance. The structural changes that the society has gone through requires a response in higher education that matches the changing needs of the society. Higher Education Institutions require new perspectives and a new strategic vision to cope with the uncertainty arising at a global scale, and this plays a role in their quality and whether they are leading institutions. Thus the following question arises: Which forms of management and governance contribute to the improvement of quality in higher education? The methodology for this study was designed with five stages: preparation of a plan of work within the thesis, the gradual progression to understanding the up-to-date understanding of Higher Education Research, generating research hypotheses and creating further understanding, writing the thesis with critical analysis and reflection. In addition to other relevant issues in higher education, different models were studied: Models of excellence, Models for implementation of Quality Management Systems, Environmental Management, Occupational Health and Safety Management, Risk Management, among others. Several indicators of Social Responsibility were created in this context and a pilot study was conducted in the area of Social Responsibility in Higher Education Institutions. Finally the conclusions resulting from the pilot study are presented and questions arising from the theoretical research are discussed. For example, the pilot study showed that there are indicators of a lack of understanding within the institutions to issues related to ethical and environmental education. Moreover, a large proportion of respondents said individuals have no opinion when confronted with questions on Responsible Social Involvement and Social Research and Social Management of Useful Knowledge. It is concluded that people have a vague awareness of these issues, so these concepts are new to them.

Sistemas da qualidade no ensino superior : contributos para modelos de melhoria da qualidade e responsabilidade social

The management of Higher Education Institutions is being rethought, with the mission and culture of the institutions changing due to globalization, resulting in new models of management and governance. The quality of Higher Education and its obligations to society are of current importance. The structural changes that the society has gone through requires a response in higher education that matches the changing needs of the society. Higher Education Institutions require new perspectives and a new strategic vision to cope with the uncertainty arising at a global scale, and this plays a role in their quality and whether they are leading institutions. Thus the following question arises: Which forms of management and governance contribute to the improvement of quality in higher education? The methodology for this study was designed with five stages: preparation of a plan of work within the thesis, the gradual progression to understanding the up-to-date understanding of Higher Education Research, generating research hypotheses and creating further understanding, writing the thesis with critical analysis and reflection. In addition to other relevant issues in higher education, different models were studied: Models of excellence, Models for implementation of Quality Management Systems, Environmental Management, Occupational Health and Safety Management, Risk Management, among others. Several indicators of Social Responsibility were created in this context and a pilot study was conducted in the area of Social Responsibility in Higher Education Institutions. Finally the conclusions resulting from the pilot study are presented and questions arising from the theoretical research are discussed. For example, the pilot study showed that there are indicators of a lack of understanding within the institutions to issues related to ethical and environmental education. Moreover, a large proportion of respondents said individuals have no opinion when confronted with questions on Responsible Social Involvement and Social Research and Social Management of Useful Knowledge. It is concluded that people have a vague awareness of these issues, so these concepts are new to them.

The impact of Economics on health policy and management in Spain

BackgroundDespite the intrinsic value of scientific disciplines, such as Economics, it is appropriate to gauge the impact of its applications on social welfare, or at least Health Economics (HE) case- its influence on health policy and management.MethodsThe three relevant features of knowledge (production, diffusion and application) are analyzed, more from an emic perspective the one used in Anthropology relying on the experience of the members of a culture- than from an etic approach seated on material descriptions and dubious statistics.ResultsThe soundness of the principles and results of HE depends on its disciplinary foundations,whereas its relevance than does not imply translation into practice- is more linked with the problems studied. Important contributions from Economics to the health sphere are recorded.HE in Spain ranks seventh in the world despite the relatively minor HE contents of its clinical and health services research journals.HE has in Spain more presence than influence, having failed to impregnate sufficiently thedaily events.ConclusionsHE knowledge required by a politician, a health manager or a clinician is rather limited; the main impact of HE could be to develop their intuition and awareness.

Making land-use fit to planning goals. Weaknesses and opportunities within the Swiss land management regime

In Switzerland, the issue of land consumption has made it to the front of the political agenda in recent years. Studies conducted on a national level have concluded that there is an excess of land zoned for construction (ARE, 2008), which is seen as contributing to urban sprawl. This situation is looked upon as a failure of the Federal Law on Spatial Planning (LAT, 1979) and there is a political push to change it in order to reinforce zoning regulations. In this article, we look on the issue from a different angle. While there may be large quantities of land zoned for construction, in many urban areas land actually available for development is scarce. Building on the idea that planning's efficiency is linked to its capacity of influencing actual land-use, we focus on how this situation can be dealt with within the current Swiss institutional context.