The predictive value of trabecular bone score (TBS) on whole lumbar vertebrae mechanics: an ex vivo study.

We investigated the association of trabecular bone score (TBS) with microarchitecture and mechanical behavior of human lumbar vertebrae. We found that TBS reflects vertebral trabecular microarchitecture and is an independent predictor of vertebral mechanics. However, the addition of TBS to areal BMD (aBMD) did not significantly improve prediction of vertebral strength. INTRODUCTION: The trabecular bone score (TBS) is a gray-level measure of texture using a modified experimental variogram which can be extracted from dual-energy X-ray absorptiometry (DXA) images. The current study aimed to confirm whether TBS is associated with trabecular microarchitecture and mechanics of human lumbar vertebrae, and if its combination with BMD improves prediction of fracture risk. METHODS: Lumbar vertebrae (L3) were harvested fresh from 16 donors. The anteroposterior and lateral bone mineral content (BMC) and areal BMD (aBMD) of the vertebral body were measured using DXA; then, the TBS was extracted using TBS iNsight software (Medimaps SA, France). The trabecular bone volume (Tb.BV/tissue volume, TV), trabecular thickness (Tb.Th), degree of anisotropy, and structure model index (SMI) were measured using microcomputed tomography. Quasi-static uniaxial compressive testing was performed on L3 vertebral bodies to assess failure load and stiffness. RESULTS: The TBS was significantly correlated to Tb.BV/TV and SMI (râeuro0/00=âeuro0/000.58 and -0.62; pâeuro0/00=âeuro0/000.02, 0.01), but not related to BMC and BMD. TBS was significantly correlated with stiffness (râeuro0/00=âeuro0/000.64; pâeuro0/00=âeuro0/000.007), independently of bone mass. Using stepwise multiple regression models, we failed to demonstrate that the combination of BMD and TBS was better at explaining mechanical behavior than either variable alone. However, the combination TBS, Tb.Th, and BMC did perform better than each parameter alone, explaining 79 % of the variability in stiffness. CONCLUSIONS: In our study, TBS was associated with microarchitecture parameters and with vertebral mechanical behavior, but TBS did not improve prediction of vertebral biomechanical properties in addition to aBMD.

The predictive value of preoperative B-type natriuretic peptide in children undergooing heart surgery.

Introduction: Low cardiac output syndrome is frequent in childrenafter heart surgery for congenital heart disease and may result in pooroutcome and increased morbidity. In the adult population, preoperativebrain natriuretic peptide (BNP) was shown to be predictive of postoperative complications. In children, the value of preoperative BNP onpostoperative outcome is not so clear. The aim of this study was todetermine the predictive value of preoperative BNP on postoperativeoutcome and low cardiac output syndrome in children after heartsurgery for congenital heart disease.Methods: We examined, retrospectively, the postoperative course of97 pediatric patients (mean age 3.7 years, range 0-14 years old) whounderwent heart surgery in a tertiary care pediatric intensive caresetting. NTproBNP was measured preoperatively in all patients(median 412 pg/ml, range 12-35'000 pg/ml). Patients were divided intothree groups according to their NTproBNP levels (group 1: 0-300 pg/ml, group 2: 300-600 pg/ml, group 3: >600 pg/ml) and then,correlations with postoperative outcomes were examined.Results: We found that patients with a high preoperative BNP requiredmore frequently prolonged (>2 days) mechanical ventilation (33%vs 40% vs 61%, p = 0.045) and stayed more frequently longer than6 days in the intensive care unit (42% vs 50% vs 71%, p = 0.03).However, high preoperative BNP was not correlated with occurrenceof low cardiac output syndrome.Conclusion: Preoperative BNP cannot be used, in children, as areliable and sole predictor of postoperative low cardiac outputsyndrome. However it may help identify, before surgery, those patientsat risk of having a difficult postoperative course.

Enabling mobile access to digital libraries in digital divide contexts

Digital libraries (DL) have had a tremendous impact on improving the accessibility of scientific and academic publications. In developing countries, they seem to be the great hope, due to the serious existing problems with the traditional publishing and distribution mechanisms and to the potential they have on enabling access to a great panoply of publications. Moreover, accessing digital libraries over mobile devices has the potential of reaching a broader community of users and on helping to bridge the digital divide, since there are very reduced computer and Internet penetration rates in these countries, along with a higher mobile phone usage. For developed countries, accessing digital libraries on the go might also bring important added value. This paper features an analysis of the major issues related to making digital libraries accessible over mobile devices. A specific study on the possibility of using mobile digital libraries in a developing country context is also presented along with a proposal for making DSpace based digital libraries accessible over mobile phones.

Desenvolvimento de um modelo de Política de Segurança da Informação em conformidade com a Gestão de Riscos: Estudo do caso Uni Piaget CV

Este trabalho foi realizado no âmbito do regulamento dos Cursos de Graduação da Universidade Jean Piaget de Cabo Verde, apresenta a concepção de um Modelo de Política de Segurança da Informação em conformidade com a Gestão de Riscos, evidenciado a importância que a mesma possui, como mecanismo de protecção da informação. Apresenta assim um modelo desenvolvido na Universidade Jean Piaget de Cabo Verde a fim de preservar os recursos pertinentes da organização ao que se refere a segurança da informação, onde a partir de uma Avaliação/Análise de Risco efectuado previamente, desenvolveu-se um modelo de PSI que assegure a conformidade com a Gestão de Risco, sendo este (PSI) o ponto de partida no processo de implementação da segurança da informação. Os objectivos traçados foram atingidos com sucesso sem grandes sobressaltos.

O coaching e o seu papel na melhoria do desempenho dos colaboradores nas organizações: Estudo exploratório na Empresa Transcor CV, SA

No contexto actual do mundo organizacional, o desenvolvimento de pessoas e o trabalho em equipa representam oportunidades valiosas para a sustentabilidade e o alcance de resultados. Para tornarem-se competitivas e assegurarem sua permanência no mercado, as organizações criam mecanismos que permitem a inovação contínua de seus processos de trabalho. A área de gestão de Pessoas têm beneficiado dessa procura por novas formas de trabalho por meio da evolução das suas práticas, especialmente no que diz respeito ao desenvolvimento pessoal e profissional, como forma de manter a competitividade na empresa. A metodologia do coaching apresenta-se como uma ferramenta importante que estimula o surgimento da liderança, potencializa o desenvolvimento de pessoas e a adaptação as mudanças. Pois o Coaching ocupa, segundo a literatura uma posição de destaque, constituindo-se uma ferramenta promotora do desenvolvimento de pessoas, com vista a melhoria do desempenho individual e organizacional. Com o objectivo de ampliar conhecimentos sobre a metodologia de coaching e sua aplicabilidade numa empresa, foi realizado um estudo de caráter exploratório na empresa Transcor SV, SA que permite familiarizar a mesmo com esta ferramenta, compreendendo uma análise qualitativa e quantitativa dos aspectos do ambiente organizacional, objectivando de forma geral, analisar o papel do coaching na melhoria do desempenho dos colaboradores nas organizações. Com essa investigação conclui-se que efectivamente, os processos de Coaching se apresentam como uma ferramenta de desenvolvimento pessoal e profissional com impacto e influência em vários níveis e áreas do indivíduo e da organização.

Feasibility of a knowledge translation CME program: courriels Cochrane.

INTRODUCTION: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e-mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). METHOD: We recruited French-speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. RESULTS: The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) conta-ined 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. DISCUSSION: Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self-reported knowledge translation associated with Cochrane reviews.

Formation continue: comment concilier devoir et besoins [Continuing education: how to reconcile needs and wants]

La formation continue fait à l'évidence partie intégrante de la vie du médecin, elle est non seulement un devoir éthique envers les patients mais également l'expression du besoin de se maintenir «à la page» dans sa pratique quotidienne, conséquence des progrès rapides en médecine, particulièrement en oncologie médicale. Elle peut être également source de plaisir quand il s'agit d'accroître ses connaissances. Ses règles minimales ont été définies depuis plusieurs années par la FMH qui délègue aux sociétés de disciplines son application pratique. En 2008, une révision nécessaire pour différentes raisons a facilité le calcul des crédits. Même si le total des heures de formation est resté le même (50 crédits), il a été partagé par deux : 25 pour la formation spécifique et 25 qui peuvent être acquis dans une autre discipline (révision de mars 2009 du Règlement pour la formation continue, art. 5a). Cette révision n'a pas réjoui toutes les sociétés de spécialistes qui gardent la faculté de revoir à la hausse le minimum jugé nécessaire à leur discipline. La quantité des offres de formation continue pour les médecins pose le problème d'être proprement pléthorique (congrès nationaux et internationaux, e-learning, symposiums locaux, etc.), il n'en va pas de même de leur qualité. Dans le domaine de l'oncologie médicale, les offres sont abondantes dans un contexte de marketing évident : les maisons pharmaceutiques parrainent des réunions avec un orateur mercenaire, prestigieux si possible, invité à vanter un produit spécifique dans un cycle de présentations en différents lieux de Romandie (avec à chaque fois, la possibilité d'inscrire des crédits à l'actif des participants)... Elles soutiennent également, par leur logistique, de miniconférences organisées par les différentes institutions locales et auxquelles les médecins ne participent que de façon sporadique vu leur intérêt souvent très secondaire - il n'est pas rare que l'auditoire médical se résume à cinq ou dix participants. Au final, ces offres dispersées et de qualité discutable monopolisent les ressources qui se raréfient rapidement dans le contexte économique actuel et qui doivent impérativement être utilisées de manière plus judicieuse, notamment en évitant les manifestations répétitives. Devant toutes ces offres, il est souvent difficile pour la société de discipline de séparer le bon grain de l'ivraie et en conséquence d'attribuer de manière objective les crédits de formation. Partant de ce constat, un petit groupe romand de médecins oncologues praticiens installés et des centres universitaires ont réfléchi à l'idée de regrouper au sein d'une seule structure romande l'organisation d'une formation continue qui réponde à la fois aux besoins et à l'exigence de qualité. Ses tâches sont multiples : mettre sur pied annuellement plusieurs demi-journées de formation, préaviser avec un comité scientifique de la qualité de la formation continue distillée sur son territoire de compétence (sans empiéter sur les prérogatives de la commission pour la formation postgraduée de la Société suisse d'oncologie médicale - SSOM) en rapprochant les centres universitaires, les hôpitaux cantonaux et régionaux, et les praticiens. Ainsi est née l'association FoROMe (Formation romande en oncologie médicale). Sa légitimité a été établie par la SSOM et par le Comité pour la formation postgraduée et continue (nouvellement SIWF) de la FMH. Elle est maintenant en mesure de mettre en application les tâches pour lesquelles elle a été constituée. Il est évident que cela n'ira pas sans résistance et que certains diront qu'ils ne voient pas la nécessité d'une structure supplémentaire, que les sociétés de disciplines font très bien leur travail, qu'il s'agit encore là d'une atteinte à la liberté. Cependant les nécessités économiques vont tôt ou tard venir au secours de la logique pour confirmer les changements que cette démarche a permis d'anticiper. A l'avenir, il s'agira d'assurer le bien-fondé de cette initiative et de rester vigilant au bon fonctionnement de cette structure à la satisfaction de nos membres.

Predictive value of the MGMT promoter methylation status in metastatic melanoma patients receiving first-line temozolomide plus bevacizumab in the trial SAKK 50/07.

The O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status is a predictive parameter for the response of malignant gliomas to alkylating agents such as temozolomide. First clinical trials with temozolomide plus bevacizumab therapy in metastatic melanoma patients are ongoing, although the predictive value of the MGMT promoter methylation status in this setting remains unclear. We assessed MGMT promoter methylation in formalin-fixed, primary tumor tissue of metastatic melanoma patients treated with first-line temozolomide and bevacizumab from the trial SAKK 50/07 by methylation-specific polymerase chain reaction. In addition, the MGMT expression levels were also analyzed by MGMT immunohistochemistry. Eleven of 42 primary melanomas (26%) revealed a methylated MGMT promoter. Promoter methylation was significantly associated with response rates CR + PR versus SD + PD according to RECIST (response evaluation criteria in solid tumors) (p<0.05) with a trend to prolonged median progression-free survival (8.1 versus 3.4 months, p>0.05). Immunohistochemically different protein expression patterns with heterogeneous and homogeneous nuclear MGMT expression were identified. Negative MGMT expression levels were associated with overall disease stabilization CR+PR+SD versus PD (p=0.05). There was only a poor correlation between MGMT methylation and lack of MGMT expression. A significant proportion of melanomas have a methylated MGMT promoter. The MGMT promoter methylation status may be a promising predictive marker for temozolomide therapy in metastatic melanoma patients. Larger sample sizes may help to validate significant differences in survival type endpoints.

Transportation choices and the value of statistical life

This paper exploits an unusual transportation setting to estimate the value of a statistical life(VSL). We estimate the trade-offs individuals are willing to make between mortality risk andcost as they travel to and from the international airport in Sierra Leone (which is separated fromthe capital Freetown by a body of water). Travelers choose from among multiple transportoptions ? namely, ferry, helicopter, hovercraft, and water taxi. The setting and original datasetallow us to address some typical omitted variable concerns in order to generate some of the firstrevealed preference VSL estimates from Africa. The data also allows us to compare VSLestimates for travelers from 56 countries, including 20 African and 36 non-African countries, allfacing the same choice situation. The average VSL estimate for African travelers in the sample isUS$577,000 compared to US$924,000 for non-Africans. Individual characteristics, particularlyjob earnings, can largely account for the difference between Africans and non-Africans; Africansin the sample typically earn somewhat less. There is little evidence that individual VSL estimatesare driven by a lack of information, predicted life expectancy, or cultural norms around risktakingor fatalism. The data implies an income elasticity of the VSL of 1.77. These revealedpreference VSL estimates from a developing country fill an important gap in the existingliterature, and can be used for a variety of public policy purposes, including in current debateswithin Sierra Leone regarding the desirability of constructing new transportation infrastructure.

Changing healthcare: stakeholder perceptions of the burden of chronic disease and the value of teams, measurements and communication.

Canadian healthcare is changing. Over the course of the past decade, the Health Care in Canada Survey (HCIC) has annually measured the reactions of the public and professional stakeholders to many of these change forces. In HCIC 2008, for the first time, the public's perception of their health status and all stakeholders' views of the burden and effective management of chronic diseases were sought. Overall, Canadians perceive themselves as healthy, with 84% of adults reporting good-to-excellent health. However, good health decreased with age as the occurrence of chronic illness rose, from 12% in the age group 18-24 to 65% for the population =65 years. More than 70% of all stakeholders were strongly or somewhat supportive of the implementation of coordinated care, or disease management programs, to improve the care of patients with chronic illnesses. Concordant support was also expressed for key disease management components, including coordinated interventions to improve home, community and self-care; increased wellness promotion; and increased use of clinical measurements and feedback to all stakeholders. However, there were also important areas of non-concordance. For example, the public and doctors consistently expressed less support than other stakeholders for the value of team care, including the use of non-physician professionals to provide patient care; increased patient involvement in decision-making; and the use of electronic health records to facilitate communication. The actual participation in disease management programs averaged 34% for professionals and 25% for the public. We conclude that chronic diseases are common, age-related and burdensome in Canada. Disease management or coordinated intervention often delivered by teams is also relatively common, despite its less-than-universal acceptance by all stakeholders. Further insights are needed, particularly into the variable perceptions of the value and efficacy of team-delivered healthcare and its important components.

Frações de zinco em solo arenoso e suas relações com disponibilidade para Cynodon spp cv. Tifton-85

Para avaliar um esquema de fracionamento de zinco em Argissolo arenoso e suas relações com a disponibilidade de Zn para Cynodon spp cv. Tifton-85, realizou-se um experimento em casa de vegetação, em esquema fatorial 5 x 2 x 2 (5 doses de Zn, 2 doses de calcário e 2 épocas de amostragem), em delineamento inteiramente casualizado, com três repetições. As doses de Zn foram de 0; 2,5; 5,0; 7,5 e 10 mg dm-3; metade dos vasos não recebeu calagem (V = 42 %) e metade recebeu a calagem com vistas em elevar o índice de saturação por bases a 70 %. As épocas de amostragem foram 30 e 150 dias após aplicação de Zn, respectivamente, antes do plantio e depois do 3º corte de Tifton-85. A aplicação de Zn resultou em aumento significativo do elemento nas frações: trocável, óxidos de Mn, matéria orgânica e óxidos de Fe. O Zn ligado aos óxidos de Mn aumentou significativamente com a calagem. Após 150 dias de experimentação, houve diminuição do Zn trocável, ligado aos óxidos de Mn, à matéria orgânica e aos óxidos de Fe, e aumento na fração residual. A distribuição de Zn nas frações do solo foi: residual > óxidos de Fe > óxidos de Mn > trocável > matéria orgânica. As relações entre as características estudadas mostraram que tanto o Zn-DTPA quanto o Zn trocável, ligado à M.O. e aos óxidos de Mn, foram eficientes para representar o Zn absorvido pela planta.

Eficiência da fertilização nitrogenada com uréia (15N) em Brachiaria brizantha cv. Marandu associada ao parcelamento de superfosfato simples e cloreto de potássio

Em pastagens, a avaliação da eficiência do processo de fertilização com N-uréia é importante em virtude das altas doses utilizadas. Vários trabalhos relatam que a aplicação de uréia associada com cloreto de potássio (KCl) e superfosfato simples (SFS) pode melhorar a sua eficiência. Na recuperação de pastagens degradadas ou em sistemas de exploração intensiva, as quantidades de KCl e SFS empregadas como fertilização corretiva são altas e aplicadas em novembro, no início da estação das águas. O parcelamento do KCl e SFS associado às coberturas nitrogenadas com uréia seria de fácil adoção sem custos adicionais. Com o objetivo de avaliar este manejo, foi desenvolvido um experimento em que se realizou o balanço anual da aplicação de 15N da uréia quando o SFS e, ou, o KCl foram parcelados, associados à aplicação da uréia em cinco coberturas, ou quando ambos foram aplicados de uma só vez, no mês de novembro. A maior produção de forragem ocorreu quando o SFS foi parcelado, seguido pelo parcelamento do KCl, da aplicação única de ambos e, finalmente, do parcelamento dos dois. A recuperação do N-uréia na parte aérea e no sistema solo-pastagem não diferiu com os tratamentos. Entretanto, a recuperação na coroa da planta e no sistema radicular diferiu entre os tratamentos e mostrou-se positivamente correlacionada com a produção de forragem. A recuperação de fertilizante na liteira foi favorecida pelo parcelamento do KCl. Apesar de não ter sido verificado aumento na recuperação total do sistema entre os tratamentos, o parcelamento do KCl e do SFS tem sido indicado por melhorar a recuperação do N-uréia em várias estruturas da planta, refletindo em maior produção da forrageira.

The Social Value of Being Ambivalent: Self-Presentational Concerns in the Expression of Attitudinal Ambivalence

We tested whether individuals can exert control over the expression of attitudinal ambivalence and if this control is exerted with self-presentational concerns. Using the self-presentation paradigm, participants reported more ambivalence about Genetically Modified Organisms ("GMO") in a standard and a self-enhancement (present yourself positively) conditions than in a self-depreciation (present yourself negatively) condition, on both felt (Experiments 1a and 2a) and potential ambivalence, in its cognitive (Experiments 1b and 2b) and affective components (Experiments 1b and 2c). The role of ambivalent attitudes in conveying a positive social value was confirmed by the fact that the above effect was found on a controversial attitude object (GMOs) but the opposite appeared on a non-controversial one (e.g. tooth brushing, a truism; Experiment 3). Such a reversal was obtained by directly manipulating the perception of controversy on GMOs (Experiment 4). Attitudinal ambivalence may thus serve an adaptive function, i.e. achieving a positive social value.

Diagnostic value of vestibulo-ocular reflex parameters in the detection and characterization of labyrinthine lesions.

OBJECTIVE: To evaluate the power of various parameters of the vestibulo-ocular reflex (VOR) in detecting unilateral peripheral vestibular dysfunction and in characterizing certain inner ear pathologies. STUDY DESIGN: Prospective study of consecutive ambulatory patients presenting with acute onset of peripheral vertigo and spontaneous nystagmus. SETTING: Tertiary referral center. PATIENTS: Seventy-four patients (40 females, 34 males) and 22 normal subjects (11 females, 11 males) were included in the study. Patients were classified in three main diagnoses: vestibular neuritis: 40; viral labyrinthitis: 22; Meniere's disease: 12. METHODS: The VOR function was evaluated by standard caloric and impulse rotary tests (velocity step). A mathematical model of vestibular function was used to characterize the VOR response to rotational stimulation. The diagnostic value of the different VOR parameters was assessed by uni- and multivariable logistic regression. RESULTS: In univariable analysis, caloric asymmetry emerged as the most powerful VOR parameter in identifying unilateral vestibular deficit, with a boundary limit set at 20%. In multivariable analysis, the combination of caloric asymmetry and rotational time constant asymmetry significantly improved the discriminatory power over caloric alone (p&lt;0.0001) and produced a detection score with a correct classification of 92.4%. In discriminating labyrinthine diseases, different combinations of the VOR parameters were obtained for each diagnosis (p&lt;0.003) supporting that the VOR characteristics differ between the three inner ear disorders. However, the clinical usefulness of these characteristics in separating the pathologies was limited. CONCLUSION: We propose a powerful logistic model combining the indices of caloric and time constant asymmetries to detect a peripheral vestibular loss, with an accuracy of 92.4%. Based on vestibular data only, the discrimination between the different inner ear diseases is statistically possible, which supports different pathophysiologic changes in labyrinthine pathologies.