Associates of an elevated natriuretic peptide level in stable heart failure patients:implications for targeted management

BACKGROUND: Persistently elevated natriuretic peptide (NP) levels in heart failure (HF) patients are associated with impaired prognosis. Recent work suggests that NP-guided therapy can improve outcome, but the mechanisms behind an elevated BNP remain unclear. Among the potential stimuli for NP in clinically stable patients are persistent occult fluid overload, wall stress, inflammation, fibrosis, and ischemia. The purpose of this study was to identify associates of B-type natriuretic peptide (BNP) in a stable HF population.

METHODS: In a prospective observational study of 179 stable HF patients, the association between BNP and markers of collagen metabolism, inflammation, and Doppler-echocardiographic parameters including left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), and E/e prime (E/e') was measured.

RESULTS: Univariable associates of elevated BNP were age, LVEF, LAVI, E/e', creatinine, and markers of collagen turnover. In a multiple linear regression model, age, creatinine, and LVEF remained significant associates of BNP. E/e' and markers of collagen turnover had a persistent impact on BNP independent of these covariates.

CONCLUSION: Multiple variables are associated with persistently elevated BNP levels in stable HF patients. Clarification of the relative importance of NP stimuli may help refine NP-guided therapy, potentially improving outcome for this at-risk population.

Association Between Results of a Gene Expression Signature Assay and Recurrence-Free Interval in Patients With Stage II Colon Cancer in Cancer and Leukemia Group B 9581 (Alliance)

PURPOSE: Conventional staging methods are inadequate to identify patients with stage II colon cancer (CC) who are at high risk of recurrence after surgery with curative intent. ColDx is a gene expression, microarray-based assay shown to be independently prognostic for recurrence-free interval (RFI) and overall survival in CC. The objective of this study was to further validate ColDx using formalin-fixed, paraffin-embedded specimens collected as part of the Alliance phase III trial, C9581.

PATIENTS AND METHODS: C9581 evaluated edrecolomab versus observation in patients with stage II CC and reported no survival benefit. Under an initial case-cohort sampling design, a randomly selected subcohort (RS) comprised 514 patients from 901 eligible patients with available tissue. Forty-nine additional patients with recurrence events were included in the analysis. Final analysis comprised 393 patients: 360 RS (58 events) and 33 non-RS events. Risk status was determined for each patient by ColDx. The Self-Prentice method was used to test the association between the resulting ColDx risk score and RFI adjusting for standard prognostic variables.

RESULTS: Fifty-five percent of patients (216 of 393) were classified as high risk. After adjustment for prognostic variables that included mismatch repair (MMR) deficiency, ColDx high-risk patients exhibited significantly worse RFI (multivariable hazard ratio, 2.13; 95% CI, 1.3 to 3.5; P < .01). Age and MMR status were marginally significant. RFI at 5 years for patients classified as high risk was 82% (95% CI, 79% to 85%), compared with 91% (95% CI, 89% to 93%) for patients classified as low risk.

CONCLUSION: ColDx is associated with RFI in the C9581 subsample in the presence of other prognostic factors, including MMR deficiency. ColDx could be incorporated with the traditional clinical markers of risk to refine patient prognosis.

Catalyst screening: Refinement of the origin of the volcano curve and its implication in heterogeneous catalysis

Understanding the overall catalytic activity trend for rational catalyst design is one of the core goals in heterogeneous catalysis. In the past two decades, the development of density functional theory (DFT) and surface kinetics make it feasible to theoretically evaluate and predict the catalytic activity variation of catalysts within a descriptor-based framework. Thereinto, the concept of the volcano curve, which reveals the general activity trend, usually constitutes the basic foundation of catalyst screening. However, although it is a widely accepted concept in heterogeneous catalysis, its origin lacks a clear physical picture and definite interpretation. Herein, starting with a brief review of the development of the catalyst screening framework, we use a two-step kinetic model to refine and clarify the origin of the volcano curve with a full analytical analysis by integrating the surface kinetics and the results of first-principles calculations. It is mathematically demonstrated that the volcano curve is an essential property in catalysis, which results from the self-poisoning effect accompanying the catalytic adsorption process. Specifically, when adsorption is strong, it is the rapid decrease of surface free sites rather than the augmentation of energy barriers that inhibits the overall reaction rate and results in the volcano curve. Some interesting points and implications in assisting catalyst screening are also discussed based on the kinetic derivation. Moreover, recent applications of the volcano curve for catalyst design in two important photoelectrocatalytic processes (the hydrogen evolution reaction and dye-sensitized solar cells) are also briefly discussed.

Analyse de la valeur pronostique du contexte immunologique du cancer superficiel de la vessie

Le cancer de la vessie est le 5e plus répandu au Canada. Les tumeurs vésicales non-infiltrant le muscle (TVNIM) représentent 70-75% des tumeurs au premier diagnostic. Après une résection transurétrale de tumeur de vessie (RTUTV), 60-70 % des patients souffriront de récidive et 10-20 % de progression vers l’infiltration du muscle (TVIM). Présentement, l’évaluation du risque de récidive ou de progression pour sélectionner le traitement approprié est basée sur les caractéristiques cliniques et pathologiques. La gestion des TVNIM à haut risque est l’un des aspects les plus difficiles à gérer pour un uro-oncologue et il est bien connu que l’issue clinique peut varier significativement entre des patients ayant une tumeur de même stade. Il serait donc important de détecter les tumeurs les plus susceptibles de récidiver et de progresser pour ajuster le traitement en conséquence. L’objectif de mon projet était d’analyser la valeur pronostique du contexte immunologique des TVNIM pour prédire leurs probabilités de récidive ou de progression vers l’infiltration du muscle. Mon premier volet consistait à évaluer la valeur pronostique de l’infiltration des cellules immunes, telles que les cellules dendritiques infiltrant les tumeurs (TIDC), les cellules T infiltrant les tumeurs (TIL) et les macrophages associés aux tumeurs (TAM) dans une cohorte de 106 TVNIM initiales. Les données d’infiltration des TIDC et des TIL dans les TVNIM démontrent leur importance dans l’évolution des patients atteints du cancer de la vessie et pourraient aider à identifier les TVNIM à haut risque. Mon deuxième volet consistait à caractériser un profil d’expression génique associé aux immunités innée et adaptative dans une série de 22 TVNIM. Cependant, le faible nombre de tumeurs disponibles a empêché d’obtenir une conclusion. Notre étude a permis de confirmer que la composition et le phénotype des cellules immunes infiltrant les TVNIM ont un impact sur l’évolution de ces tumeurs.

Fatores de longevidade do programa Central do Cidadão no Rio Grande do Norte

The public management reform in Brazil, since 1995, provoked new experiences in public administration. Among the new models of public service the one-stop shopping has distinguished and was adopted at Rio Grande do Norte with the Citizens Center Program. The one-stop shopping assembles in the same place many public services with appropriate structure, enabled human resources and citizens focus processes. The goal of this research was understand how citizens focus processes help to explain Citizens Center Program s longevity. It was made a case study and the research tools were applied with Citizen Center Programs workers and citizen-users at South Unit of Citizen Center Program placed at Via Direta Mall, Natal. The major contributions for Citizen Center Program s longevity were imputed to Basic Operation Processes. The most spoken features in Citizen Center Program mentioned were quality, efficiency, celerity e personal appearance, what demonstrate concern and care with citizen-users. Worker s personal appearance, accommodation, celerity, politeness and attending capacity planning were high evaluated by citizen-users revealing the wisely choice of use a large quality concept and citizenship concept in public administration. Citizen-users also pointed the necessity of refine and enlarge the communication ways that form an essential mechanism to public citizen focus administration. Not ignoring the policy aspect citizen focus processes were noticed like especial management actions that make easier citizen s activities and public service access, what generate satisfaction to citizen-users. It s possible to conclude that the high level approving evaluation of Citizen Center Program consolidates it an especial public policy that serves citizen s necessities e create appropriate legitimacy conditions of the public policy making harder the choice of ending the policy even in more fragile moments strongly contributing for its longevity

Conception, fabrication et caractérisation d'un biocapteur SPR à base de guides d'ondes photoniques sur substrat de verre

Résumé : Malgré le nombre croissant de capteurs dans les domaines de la chimie et la biologie, il reste encore à étudier en profondeur la complexité des interactions entre les différentes molécules présentes lors d’une détection à l’interface solide-liquide. Dans ce cadre, il est de tout intérêt de croiser différentes méthodes de détection afin d’obtenir des informations complémentaires. Le principal objectif de cette étude est de dimensionner, fabriquer et caractériser un détecteur optique intégré sur verre basé sur la résonance plasmonique de surface, destiné à terme à être combiné avec d’autres techniques de détection, dont un microcalorimètre. La résonance plasmonique de surface est une technique reconnue pour sa sensibilité adaptée à la détection de surface, qui a l’avantage d’être sans marquage et permet de fournir un suivi en temps réel de la cinétique d’une réaction. L’avantage principal de ce capteur est qu’il a été dimensionné pour une large gamme d’indice de réfraction de l’analyte, allant de 1,33 à 1,48. Ces valeurs correspondent à la plupart des entités biologiques associées à leurs couches d’accroche dont les matrices de polymères, présentés dans ce travail. Étant donné que beaucoup d’études biologiques nécessitent la comparaison de la mesure à une référence ou à une autre mesure, le second objectif du projet est d’étudier le potentiel du système SPR intégré sur verre pour la détection multi-analyte. Les trois premiers chapitres se concentrent sur l’objectif principal du projet. Le dimensionnement du dispositif est ainsi présenté, basé sur deux modélisations différentes, associées à plusieurs outils de calcul analytique et numérique. La première modélisation, basée sur l’approximation des interactions faibles, permet d’obtenir la plupart des informations nécessaires au dimensionnement du dispositif. La seconde modélisation, sans approximation, permet de valider le premier modèle approché et de compléter et affiner le dimensionnement. Le procédé de fabrication de la puce optique sur verre est ensuite décrit, ainsi que les instruments et protocoles de caractérisation. Un dispositif est obtenu présentant des sensibilités volumiques entre 1000 nm/RIU et 6000 nm/RIU suivant l’indice de réfraction de l’analyte. L’intégration 3D du guide grâce à son enterrage sélectif dans le verre confère au dispositif une grande compacité, le rendant adapté à la cointégration avec un microcalorimètre en particulier. Le dernier chapitre de la thèse présente l’étude de plusieurs techniques de multiplexage spectral adaptées à un système SPR intégré, exploitant en particulier la technologie sur verre. L’objectif est de fournir au moins deux détections simultanées. Dans ce cadre, plusieurs solutions sont proposées et les dispositifs associés sont dimensionnés, fabriqués et testés.

Unlocking Characteristics of Outstanding Leadership in Schools and Colleges in England

The workshop will invite participants to engage in a discussion of the characteristics of outstanding leadership by taking part in an interactive activity which we have developed and used in different types of schools and colleges in England. The activity uses Q-methodology to develop and refine characteristics of outstanding leaders and outstanding leadership in education from a range of stakeholder perspectives. Q-methodology is a research method which originates from psychology and is used to study people's subjective viewpoints. We are applying the methodology to the study of enacted leadership practice in different educational contexts. Our sample of stakeholders consists of school and college leaders, governors, middle leaders, teachers, teacher educators, researchers and scholars in educational leadership and management research and practice. The range of contexts in which they work represents different age phases of education; primary, secondary and further education colleges, urban and rural schools and colleges and selective and non-selective schools. In the workshop participants will be invited to take part in the Q-sort activity we have used with in our research, using statements from leadership theory and practice. The Q-sort will be followed by discussion and reflection on the statements in relation to participants’ own experiences of leadership, management and governance in different contexts.

Ultraäänen käyttö ligniinin ja hemiselluloosan ertuksessa puu-uutteesta

Puusta valmistetussa puu-uutteessa on puun polymeerejä, ligniiniä ja hemiselluloosaa, joiden käyttöä halutaan lisätä biojalostamoissa. Polymeerit tulisi erottaa mahdollisimman puhtaasti jatkojalostusta varten. Erotus voidaan tehdä ultrasuodatuksella. Puu-uutetta pitää kuitenkin esikäsitellä, sillä polymeerit ovat lähes samankokoisia. Ultraäänikäsittelyn on osoitettu kasvattavan ligniinin moolimassaa, jolloin myös erotus parantuisi. Ultraäänikäsittely on aikaisemmin käytettyihin esikäsittelymenetelmiin verrattuna ympäristöystävällisempi, sillä sen käytössä ei tarvita erillisiä kemikaaleja. Tämän työn tavoitteena oli selvittää, kuinka ultraäänikäsittely vaikuttaa ligniinin ja hemiselluloosan erotukseen PHWE-puu-uutteesta. Näytteen pH säädettiin emäksiseksi, näyte ultraäänikäsiteltiin eri koeolosuhteissa ja ultrasuodatettiin. Ultraäänikäsiteltyä näytettä verrattiin käsittelemättömään referenssinäytteeseen. Näytteet analysoitiin UV- ja TOC-analyyseillä konsentraattien ligniini- ja hiilipitoisuuksien selvittämiseksi. Lisäksi tarkasteltiin suodatusprosessin parametreja. Tulosten perusteella ultraäänikäsittely paransi ligniinin ja hemiselluloosan erotusta erilleen. Erotus parani eniten pH 12 -näytteessä, joka ultraäänikäsiteltiin 65 °C lämpötilassa, 45 minuutin ajan laiteteholla 175 W.

Avanço dos biomateriais e técnicas na correção dos defeitos ósseos maxilares

Introdução: Determinar as causas da perda óssea nos maxilares, compreender os mecanismos biológicos desencadeados após a perda dental e criar recursos técnicos no intúito de prevenir e/ou minimizar as sequélas decorrentes, tem sido ao longo dos anos uma das vertentes de maior pesquisa e desenvolvimento na medicina dental . Objetivo: Assim, o objetivo desta dissertação é realizar uma revisão da literatura sobre os avanços nos biomateriais e técnicas na correção dos defeitos ósseos maxilares, para que seja possível, futuramente, ampliar as suas aplicações em Medicina Dentária, ultrapassando as limitações das técnicas e materiais existentes atualmente. Metodologia: Para isso, foi realizada uma pesquisa de artigos na base de dados PubMed, Bireme, Lilacs, Medline, revistas e periódicos nos idiomas: português, inglês e espanhol; assim como livros consagrados na literatura médico-odontológica,com o recurso a limites e palavras-chave de forma a refinar essa pesquisa. Desenvolvimento: Os avanços nos biomateriais e técnicas na correção dos defeitos ósseos maxilares tem seguido, assim como os implantes dentais, dois principais eixos de pesquisa, primeiro no que diz respeito aos biomateriais empregados pós-exodontia, a prevenir a reabsorção osséa e aqueles utilizados à fim de corrigir defeitos já existentes; a aplicação destes materiais recai sobre fatores que são decisivos na escolha do cirurgião, tais como: disponibilidade, necessidade de procedimento cirúrgico adicional, compatibilidade, morbidade do enxerto, qualidade do osso resultante e tempo de neo-formação. Segundo, as técnicas e recursos desenvolvidos para garantir a eficáz correção do defeito, assim como proporcionar procedimentos menos traumaticos ao organismo e de maior simplicidade e previsibilidade na sua execução e reprodução pelos profissionais. Discussão: Os trabalhos desenvolvidos em volta dos biomateriais atualmente buscam não só o substituto ideal, mas sim a melhoria na interação entre o osso hospedeiro e o biomaterial enxertado perante os recursos já utilizados e consagrados pelas literaturas; assim como a utilização das técnicas já protocoladas de forma associada a estes novos materiais. Conclusão: As pesquisas sobre o aperfeiçoamento do processo de regeneração óssea nos defeitos maxilares avançam na questão de promover a rápida e eficaz interação entre organismo e biomaterial, a fim de trazer soluções para problemas como a anti-genicidade, previsibilidade dimensional, menor tempo entre a enxertia e a reabilitação protética e agrega-se a utilização de recursos técnicos práticos, uma vez que o planejamento da reabilitação inicia-se nas decisões pré-exodontias e pré-implantares.

The use of motivational interviews by nurses to promote health behaviors in adolescents: A scoping review protocol

Abstract The developmental changes during adolescence may affect subsequent risk for diseases and health-related behaviors. Motivational Interview (MI) may be taken as an essential tool in the provision of nursing care to adolescents, being itself a workspace with possible therapeutic effects. At this context, it is important to examine and map the use of MI by nurses in their clinical practice with adolescents to promote health behaviors. Objetives A scoping review has been currently undertaking to find out what is the current extent of the use of nurse-led MI; which adolescent populations were included; in which contexts nurses use MI; which MI techniques/strategies have been used and what outcomes on health behaviors promotion have been reported. The first task was to develop a search strategy to identify relevant studies for this review. It is described here the experience in constructing a search strategy for this review. Methodology This scoping review will be informed by JBI methodology. An initial search of MEDLINE and CINAHL was undertaken. An analysis of the text words contained in the title and abstract, and of the index terms used to describe the searched articles were retrieved and these were then used to construct a search strategy for use in Medline and Cinahl. Results Analysis of the text words and the index terms generated 19 keywords: It was identified 5 synonyms for "Adolescents", 12 for "MI" and 2 for "nurse". A new research formula was designed using the text words identified. Adolescen*[Title/Abstract]) OR Younger*[Title/Abstract]) OR Youth*[Title/Abstract]) OR Teen*[Title/Abstract]) OR Adolescent[MeSH Terms])) AND (((((((((((("Motivational interview"[Title/Abstract]) OR "Motivational intervention"[Title/Abstract]) OR "Motivational interviews"[Title/Abstract]) OR "Motivational interventions"[Title/Abstract]) OR "motivational interviewing"[Title/Abstract]) OR "motivational counseling"[Title/Abstract]) OR "motivational support"[Title/Abstract]) OR "Motivational enhancement"[Title/Abstract]) OR "Brief intervention"[Title/Abstract]) OR "Brief interventions"[Title/Abstract]) OR Motivational Interviewing[MeSH Terms]) OR Directive Counseling[MeSH Terms])) AND ((nurs*[Text Word]) OR Nurses[MeSH Terms]). Limiters - Language: English, Portuguese, Spanish. In MEDLINE this research formula generated 125 results. Other 16 databases referenced at the protocol will be searched to identify additional studies. Articles identified from the final search will be assessed for relevance to the review, based on information provided in the title and abstract. The full article will be retrieved for all studies that meet the inclusion criteria of the review. Conclusions It was presented here the initial results of this search. Next steps of this study will be to develop and refine the search strategy for use in other databases. It is expected that findings from this Scoping Review provide needed information to nurses related to the use of MI to promote health behaviors in adolescents and inform opportunities for future development in nursing practice.

A Triple-Isotope Approach to Predict the Breeding Origins of European Bats

Despite a commitment by the European Union to protect its migratory bat populations, conservation efforts are hindered by a poor understanding of bat migratory strategies and connectivity between breeding and wintering grounds. Traditional methods like mark-recapture are ineffective to study broad-scale bat migratory patterns. Stable hydrogen isotopes (delta D) have been proven useful in establishing spatial migratory connectivity of animal populations. Before applying this tool, the method was calibrated using bat samples of known origin. Here we established the potential of delta D as a robust geographical tracer of breeding origins of European bats by measuring delta D in hair of five sedentary bat species from 45 locations throughout Europe. The delta D of bat hair strongly correlated with well-established spatial isotopic patterns in mean annual precipitation in Europe, and therefore was highly correlated with latitude. We calculated a linear mixed-effects model, with species as random effect, linking delta D of bat hair to precipitation delta D of the areas of hair growth. This model can be used to predict breeding origins of European migrating bats. We used delta C-13 and delta N-15 to discriminate among potential origins of bats, and found that these isotopes can be used as variables to further refine origin predictions. A triple-isotope approach could thereby pinpoint populations or subpopulations that have distinct origins. Our results further corroborated stable isotope analysis as a powerful method to delineate animal migrations in Europe.

Farm practices to manage the impact of severe tropical cyclone damage on banana production – a case study from tropical Australia

Most Australian banana production occurs on the north-eastern tropical coast between latitudes 15-18°S, and can experience summer cyclone activity. Damage from severe tropical cyclones has serious impact on banana-based livelihoods. The most significant impacts include immediate loss of production and income for several months, the region-wide synchronization of cropping and the expense of rehabilitating affected plantations. Severe tropical cyclones have directly affected the main production region twice in recent years Tropical Cyclone (TC) Larry (Category 4) in March 2006 and TC Yasi (Category 5) in February 2011. Based on TC Larry experiences, pre- and post-cyclone farm practices were developed to reduce these impacts in future cyclonic events. The main pre-cyclone farm practice focused on maintaining production units and an earlier return to fruit production by partially or completely removing the plant canopy to reduce wind resistance. Post-cyclone farm practices focused on managing the industry-wide crop synchronization using crop timing techniques to achieve a staggered return to cropping by scheduling production to provide continuous fruit supply. With TC Yasi in 2011, some banana producers implemented these practices, allowing them to examine their effectiveness in reducing cyclonic impacts. Additional research and development activities were conducted to refine our understanding of their effectiveness and improve their application for future cyclonic events. Based on these activities and farm-based observations, suggested practice-based management strategies can be developed to help reduce the impact of severe tropical cyclones in the future. Canopy removal maintained banana plants as productive units, and provided earlier but smaller bunches, generating earlier-than-expected income. Queensland producers expressed willingness to adopt canopy removal for future cyclone threats where appropriate, despite its labor-intensiveness. Mechanization would allow larger scale adoption. Implementing a staggered cropping program successfully achieved a consistent, continuous fruit supply after a cyclone impact. Both techniques should be applicable to other cyclone-prone regions.

The Productive use of Failure to Generate Witnesses from Divergent Proof Attempts for Coinduction

Coinduction is a proof rule. It is the dual of induction. It allows reasoning about non--well--founded structures such as lazy lists or streams and is of particular use for reasoning about equivalences. A central difficulty in the automation of coinductive proof is the choice of a relation (called a bisimulation). We present an automation of coinductive theorem proving. This automation is based on the idea of proof planning. Proof planning constructs the higher level steps in a proof, using knowledge of the general structure of a family of proofs and exploiting this knowledge to control the proof search. Part of proof planning involves the use of failure information to modify the plan by the use of a proof critic which exploits the information gained from the failed proof attempt. Our approach to the problem was to develop a strategy that makes an initial simple guess at a bisimulation and then uses generalisation techniques, motivated by a critic, to refine this guess, so that a larger class of coinductive problems can be automatically verified. The implementation of this strategy has focused on the use of coinduction to prove the equivalence of programs in a small lazy functional language which is similar to Haskell. We have developed a proof plan for coinduction and a critic associated with this proof plan. These have been implemented in CoClam, an extended version of Clam with encouraging results. The planner has been successfully tested on a number of theorems.

Case Based Heuristic Selection for Timetabling Problems

This paper presents a case-based heuristic selection approach for automated university course and exam timetabling. The method described in this paper is motivated by the goal of developing timetabling systems that are fundamentally more general than the current state of the art. Heuristics that worked well in previous similar situations are memorized in a case base and are retrieved for solving the problem in hand. Knowledge discovery techniques are employed in two distinct scenarios. Firstly, we model the problem and the problem solving situations along with specific heuristics for those problems. Secondly, we refine the case base and discard cases which prove to be non-useful in solving new problems. Experimental results are presented and analyzed. It is shown that case based reasoning can act effectively as an intelligent approach to learn which heuristics work well for particular timetabling situations. We conclude by outlining and discussing potential research issues in this critical area of knowledge discovery for different difficult timetabling problems.

Task-based approach used on surfaces sampling strategy definition: the case of antineoplastic occupational exposure

Task-based approach implicates identifying all the tasks developed in each workplace aiming to refine the exposure characterization. The starting point of this approach is the recognition that only through a more detailed and comprehensive understanding of tasks is possible to understand, in more detail, the exposure scenario. In addition allows also the most suitable risk management measures identification. This approach can be also used when there is a need of identifying the workplace surfaces for sampling chemicals that have the dermal exposure route as the most important. In this case is possible to identify, through detail observation of tasks performance, the surfaces that involves higher contact (frequency) by the workers and can be contaminated. Identify the surfaces to sample when performing occupational exposure assessment to antineoplasic agents. Surfaces selection done based on the task-based approach.