Penser la médecine communautaire s'apprend avec les pairs. [The spirit of community medicine: students learning from students].

At the University of Lausanne third-year medical students are given the task of spending a month investigating a question of community medicine. In 2009, four students evaluated the legitimacy of health insurers intervening in the management of depression. They found that health insurers put pressure on public authorities during the development of legislation governing the health system and reimbursement for treatment. This fact emerged during the scientific investigation led jointly by the team in the course of the "module of immersion in community medicine." This paper presents each step of their study. The example chosen illustrates the learning objectives covered by the module.

Minimal information about T cell assays: the process of reaching the community of T cell immunologists in cancer and beyond.

Many assays to evaluate the nature, breadth, and quality of antigen-specific T cell responses are currently applied in human medicine. In most cases, assay-related protocols are developed on an individual laboratory basis, resulting in a large number of different protocols being applied worldwide. Together with the inherent complexity of cellular assays, this leads to unnecessary limitations in the ability to compare results generated across institutions. Over the past few years a number of critical assay parameters have been identified which influence test performance irrespective of protocol, material, and reagents used. Describing these critical factors as an integral part of any published report will both facilitate the comparison of data generated across institutions and lead to improvements in the assays themselves. To this end, the Minimal Information About T Cell Assays (MIATA) project was initiated. The objective of MIATA is to achieve a broad consensus on which T cell assay parameters should be reported in scientific publications and to propose a mechanism for reporting these in a systematic manner. To add maximum value for the scientific community, a step-wise, open, and field-spanning approach has been taken to achieve technical precision, user-friendliness, adequate incorporation of concerns, and high acceptance among peers. Here, we describe the past, present, and future perspectives of the MIATA project. We suggest that the approach taken can be generically applied to projects in which a broad consensus has to be reached among scientists working in fragmented fields, such as immunology. An additional objective of this undertaking is to engage the broader scientific community to comment on MIATA and to become an active participant in the project.

International Accounting Standards –normistoon siirtymisen vaikutukset suomalaisten pörssiyritysten taloushallintoon ja tilinpäätökseen

Tutkimuksen päätavoitteena oli selvittää, mitä vaikutuksia IAS-tilinpäätösstandardien käyttöön siirtyminen aiheuttaa suomalaisten pörssiyritysten tilinpäätöksissä ja taloushallinnossa. Tähän tavoitteeseen edettiin alatavoitteiden avulla. Näitä olivat tilinpäätösten kansainvälisen harmonisoinnin, Euroopan Unionin IAS-asetuksen ja itse IAS-tilinpäätöksen selvittäminen. Tutkimusaineisto koostuu kirjallisuudesta ja suomalaisille pörssiyrityksille tehdystä kyselystä. Tutkimuksen teoriaosassa käytetään käsiteanalyyttista ja empiirisessä osassa nomoteettista tutkimusotetta. Tutkielman mukaan tiedon lisääntyminen lisää myönteisyyttä IAS-standardistoa kohtaan. Henkilöstön koulutus onkin avainasemassa siirtymäprojektissa. Toinen merkittävä vaikutus on uuden laskentaohjeistuksen luontitarve. Merkittävin standardi vaikutuksiltaan on IAS 14 Segmenttiraportointi.

The first report in Brazil of severe infection caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emergent pathogen in Brazil. However, there are no data on the prevalence of CA-MRSA. We report here the first well-characterized case of severe life-threatening CA-MRSA infection in a child living in Rio de Janeiro city. The patient had many complications including hematogenous osteomyelitis and involvement of multiple sites requiring drainage of soft-tissue abscess, and pleural and pericardial empyema. The MRSA isolates recovered were genotyped using PFGE, SCCmec typing and multilocus sequence typing. Disk diffusion tests were performed following Clinical and Laboratory Standards Institute recommendations. In addition, the presence of Panton-Valentine leukocidin (PVL) was assessed by PCR amplification, using specific primers for lukF-pv (encoding for the F subunit of the PVL). The bacterial isolates were related to the ST30-SCCmecIV lineage (Oceania Southwest Pacific clone), a PVL producer CA-MRSA previously detected in Porto Alegre, RS, Brazil. Also, the isolates analyzed were susceptible to all non-β-lactam antibiotics tested. The present report demonstrates that disseminated CA-MRSA disease is also occurring in Rio de Janeiro. Thus, the empirical treatment of moderate or severe infections suspected of being associated with CA-MRSA needs to be reviewed in order to allow prompt initiation of an effective therapy that also covers these microorganisms.

Deinstitutionalization and community inclusion of individuals with intellectual disabilities in Ontario : a case analysis

In the last few decades, there have been significant changes in the way people with intellectual disabilities (ID) live in many countries around the world. Large isolated institutions have been replaced by community-based housing. This study examined the deinstitutionalization process in Ontario and it's effects on the lives of three individuals with ID. A case analysis approach was used allowing for in depth evaluation of the quality of life of these participants following their discharge with a focus on family involvement, community engagement, and choice making. A discrepancy analysis between the Essential Elements Plan (EEP), constructed when they were entering the community placement, and the current living arrangements was also done. The results of this study suggested that with community living comes improvements in family interactions, community engagement, and decision-making. However, these improvements were found to be minimal. Also, little discrepancy was found between the EEPs and their actual placements.

Which Legal Standards Should Apply To Web-logs? The present legal position of Internet journals in the European iuris prudence in the light of the European Parliament Committee’s on Culture and Education report and Polish Supreme Court decision

The article discusses the present status of weblogs and examines whether legal standards applicable to traditional press and media should be applied to that specific forum. The analysis is based on two key documents: the Draft Report on the concentration and pluralism in the media in European Union (2007/2253(INI)) of the European Parliament Committee on Culture and Education presented in March 2008 and a landmark decision of the Polish Supreme Court from July 26, 2007 (IV KK 174/07) in the light of present judicial tendency in other European countries. The first of the mentioned documents calls for the “clarification of the legal status of different categories of weblog authors and publishers as well as disclosure of interests and voluntary labelling of weblogs”. It emphasizes that the “undetermined and unindicated status of authors and publishers of weblogs causes uncertainties regarding impartiality, reliability, source protection, applicability of ethical codes and the assignment of liability in the event of lawsuits”. The position of the European Parliament, expressed in the document, raises serious questions on the limits of freedom of thought and speech on the Internet and on the degree of acceptable state control. A recent Polish Supreme Court decision, which caused quite a stir in the Polish Internet community, seems to head in the very direction recommended by the EP Culture Committee. In a case of two editors of a web journal (“czasopismo internetowe”) called “Szyciepoprzemysku”, available on-line, accused of publishing a journal without the proper registration, the Polish Supreme Court stated that “journals and periodicals do not lose the character of a press release due solely to the fact that they appear in the form of an  Internet transmission”, and that ‘’the publishing of press in an electronic form, available on the Internet, requires  registration”. The decision was most surprising, as prior lower courts decisions declined the possibility to register Internet periodicals. The accused were acquitted in the name of the constitutional principle of the rule of law (art. 7 of the Polish Constitution) and the ensuing obligation to protect the trust of a citizen to the state (a conviction in this case would break the collateral estoppel rule), however the decision quickly awoke media frenzy and raised the fear of a need to register all websites that were regularly updated. The spokesman of the Polish Supreme Court later explained that the sentence of the Court was not intended to cause a mass registration of all Internet “periodicals” and that neither weblogs nor Internet sites, that were regularly updated, needed registration. Such an interpretation of the Polish press law did not appear clear based only on the original text of the judgment and the decision as such still raises serious practical questions. The article aims to examine the status of Internet logs as press and seeks the compromise between the concerns expressed by European authorities and the freedom of thought and speech exercised on the Internet.

Risk Assessment of Rooftop- Collected Rainwater for Individual Household and Community Use in Central Kerala, India

Water quality of rooftop-collected rainwater is an issue of increased interest particularly in developing countries where the collected water is used as a source of drinking water. Bacteriological and chemical parameters of 25 samples of rooftop-harvested rainwater stored in ferrocement tanks were analyzed in the study described in this article. Except for the pH and lower dissolved oxygen levels, all other physicochemical parameters were within World Health Organization guidelines. Bacteriological results revealed that the rooftop-harvested rainwater stored in tanks does not often meet the bacteriological quality standards prescribed for drinking water. Fifty percent of samples of harvested rainwater for rural and urban community use and 20% of the samples for individual household use showed the presence of E. coli. Fecal coliform/fecal streptococci ratios revealed nonhuman animal sources of fecal pollution. Risk assessment of bacterial isolates from the harvested rainwater showed high resistance to ampicillin, erythromycin, penicillin, and vancomycin. Multiple antibiotic resistance (MAR) indexing of the isolates and elucidation of the resistance patterns revealed that 73% of the isolates exhibited MAR

The METAFOR project: preserving data through metadata standards for climate models and simulations

Climate modeling is a complex process, requiring accurate and complete metadata in order to identify, assess and use climate data stored in digital repositories. The preservation of such data is increasingly important given the development of ever-increasingly complex models to predict the effects of global climate change. The EU METAFOR project has developed a Common Information Model (CIM) to describe climate data and the models and modelling environments that produce this data. There is a wide degree of variability between different climate models and modelling groups. To accommodate this, the CIM has been designed to be highly generic and flexible, with extensibility built in. METAFOR describes the climate modelling process simply as "an activity undertaken using software on computers to produce data." This process has been described as separate UML packages (and, ultimately, XML schemas). This fairly generic structure canbe paired with more specific "controlled vocabularies" in order to restrict the range of valid CIM instances. The CIM will aid digital preservation of climate models as it will provide an accepted standard structure for the model metadata. Tools to write and manage CIM instances, and to allow convenient and powerful searches of CIM databases,. Are also under development. Community buy-in of the CIM has been achieved through a continual process of consultation with the climate modelling community, and through the METAFOR team’s development of a questionnaire that will be used to collect the metadata for the Intergovernmental Panel on Climate Change’s (IPCC) Coupled Model Intercomparison Project Phase 5 (CMIP5) model runs.

Verbal hygiene in the Hong Kong gay community

This paper explores the status and function of English among gay men in Hong Kong through the analysis of postings about English on a popular gay internet forum. The forum, gayhk.com, while mainly featuring discussions about sex, fashion, entertainment and relationships, also contains a surprising amount of discussion about the English language, mostly taking the form of what Cameron refers to as ‘verbal hygiene’ – the enforcement of language ‘standards’ through the criticism of the language use of particular individuals or groups. The analysis of these postings sees them not just as evidence of language attitudes within the gay community, but also as tools with which Chinese gay men in postcolonial Hong Kong position themselves in relation to one another, in relation to ‘foreign’ gay men, and in relation to the wider population of Hong Kong.

Application of the concepts of agro-tourism, agricultural diversification and food and nutrition for the development of Caribbean communities with reference to standards and priority setting

Introduction There is a renewed call for a new approach to development with emphasis on community empowerment or participation, with the belief that more sustainable activities will be undertaken in those communities. Much of that call, however, is coming not from within the communities, but primarily from advocates of change who may have little to do with those communities. What then will the new approach bring apart from a change in who are the decision-makers? And how do we ensure that the change that is called for will, in fact, bring added benefits to the communities themselves? To be sure, there are some successful stories of a community approach to problem solving. However, there are also many more stories of project failures. Serious analytical work, therefore, needs to be done to determine the factors that promote a successful community-based approach; when this approach should be used; and the methodology that should be employed. In an attempt to determine these factors, a brief analysis will be made of some of the governing structures in the subregion and their possible impact on the proposed new approach. Some of the earlier efforts at stakeholder and community approach to projects will also be examined as well as the new development strategy that is prompting the call for this new paradigm. The new paradigm focuses to a large extent on decision-making and community empowerment. With few exceptions, it is short on the promotion of tangible activities that are based on the resource inventory of the communities. This is not surprising, since, as noted before, the advocates of community empowerment may have very little connection with the communities and, in most cases, are unfamiliar with the resource base. Hence, a theoretical case is made, suggesting more style than substance. Another obvious shortcoming of this new paradigm is its continued over- dependence on assistance from the outside to build communities. Externally funded projects, seminars and meetings outside of the communities and foreign technical assistance continue to dominate these projects. While, of course, all communities have basic common needs such as water, health, education and electricity, there is sufficient diversity within communities to allow for tailoring of activities and programmes such that their differences become assets. It is in that context, that agro-tourism activities, standards, agricultural diversification, food and nutrition and priority setting have been chosen as aspects and activities for promoting community development, drawing on the various strengths of communities, rural or urban.

Susceptibility of Escherichia coli strains isolated from outpatient children with community-acquired urinary tract infection in southern Switzerland

BACKGROUND: Based on antimicrobial resistance patterns found in Swiss university hospitals, treatment with a third-generation cephalosporin is currently advised for Swiss children with urinary tract infection. OBJECTIVE: The aim of this study was to prospectively assess the susceptibility of Escherichia coli strains isolated from children with symptomatic community-acquired urinary tract infection. METHODS: The antimicrobial susceptibility of E coli strains causing symptomatic community-acquired urinary tract infections was assessed in outpatient children attending the emergency management unit at the Department of Pediatrics, Mendrisio and Bellinzona Hospitals, Switzerland. Strains from children receiving antimicrobial prophylaxis or prescribed antimicrobials in the previous 4 weeks were excluded. Clinical and Laboratory Standards Institute methods were used for culture and identification of pathogens. E coli susceptibility testing was performed using the disk diffusion technique. RESULTS: Strains from 100 consecutive outpatient children (73 girls, 27 boys; aged 5 weeks-17 years [median, 33 months]; 100% white) were assessed. High rates of ampicillin and cotrimoxazole resistance (39 and 21 strains, respectively) and low rates of nitrofurantoin resistance (4 strains) were identified. No resistance was identified for coamoxiclav or third-generation cephalosporins. CONCLUSIONS: In these Swiss outpatient children with symptomatic community-acquired urinary tract infection, without antimicrobial prophylaxis or recent prescription of antimicrobials, uropathogenic E coli strains resistant in vitro to ampicillin and cotrimoxazole were common. However, in vitro resistance to nitrofurantoin, coamoxiclav, and third-generation cephalosporins was uncommon.

Community Research as a Factor Building Inclusive Community in Lithuania

Social and political change in Europe, increasing labour mobility, development of the new European social policy and increasingly global nature of the social problems had a profound effect on the socio-cultural and socio-educational work in community and on its objectives. In order to keep these new communitarian standards of social policy, the first steps have to be made in fostering local community with the perspective it will reach the western European communitarian level. That is the reason why university in these changes started to turn more and more to the society and first of all has put a great emphasis on the community research. This initiative was induced by non-existence of civic tradition during the communist period, the gap in the development of civil society and its culture, the weakness and the poorness of the third sector. This paper is based on the analysis of the community and civil society research conducted during recent years by the researchers of Kaunas University of Technology, Faculty of Social Sciences. The paper involves a review of the research methodology, interpretation of the received data and summary of the results. It discusses both theoretical and empirical possibilities of building and developing inclusive community.

Towards science-based sediment quality standards-Effects of field-collected sediments in rainbow trout (Oncorhynchus mykiss).

Sediments can act as long-term sinks for environmental pollutants. Within the past decades, dioxin-like compounds (DLCs) such as polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), polychlorinated biphenyls (PCBs), and polycyclic aromatic hydrocarbons (PAHs) have attracted significant attention in the scientific community. To investigate the time- and concentration-dependent uptake of DLCs and PAHs in rainbow trout (Oncorhynchus mykiss) and their associated toxicological effects, we conducted exposure experiments using suspensions of three field-collected sediments from the rivers Rhine and Elbe, which were chosen to represent different contamination levels. Five serial dilutions of contaminated sediments were tested; these originated from the Prossen and Zollelbe sampling sites (both in the river Elbe, Germany) and from Ehrenbreitstein (Rhine, Germany), with lower levels of contamination. Fish were exposed to suspensions of these dilutions under semi-static conditions for 90 days. Analysis of muscle tissue by high resolution gas chromatography and mass spectrometry and of bile liquid by high-performance liquid chromatography showed that particle-bound PCDD/Fs, PCBs and PAHs were readily bioavailable from re-suspended sediments. Uptake of these contaminants and the associated toxicological effects in fish were largely proportional to their sediment concentrations. The changes in the investigated biomarkers closely reflected the different sediment contamination levels: cytochrome P450 1A mRNA expression and 7-ethoxyresorufin-O-deethylase activity in fish livers responded immediately and with high sensitivity, while increased frequencies of micronuclei and other nuclear aberrations, as well as histopathological and gross pathological lesions, were strong indicators of the potential long-term effects of re-suspension events. Our study clearly demonstrates that sediment re-suspension can lead to accumulation of PCDD/Fs and PCBs in fish, resulting in potentially adverse toxicological effects. For a sound risk assessment within the implementation of the European Water Framework Directive and related legislation, we propose a strong emphasis on sediment-bound contaminants in the context of integrated river basin management plans.

Microbial community, biomarker concentrations and their isotopic signature in sediment of Gullfaks and Tommeliten methane seeps in the Northern North Sea

Gullfaks is one of the four major Norwegian oil and gas fields, located in the northeastern edge of the North Sea Plateau. Tommeliten lies in the greater Ekofisk area in the central North Sea. During the cruises HE 208 and AL 267 several seep locations of the North Sea were visited. At the Heincke seep at Gullfaks, sediments were sampled in May 2004 (HE 208) using a video-guided multiple corer system (MUC; Octopus, Kiel). The samples were recovered from an area densely covered with bacterial mats where gas ebullition was observed. The coarse sands limited MUC penetration depth to maximal 30 centimeters and the highly permeable sands did not allow for a high-resolution, vertical subsampling because of pore water loss. The gas flare mapping and videographic observation at Tommeliten indicated an area of gas emission with a few small patches of bacterial mats with diameters <50 cm from most of which a single stream of gas bubbles emerged. The patches were spaced apart by 10-100 m. Sampling of sediments covered by bacterial mats was only possible with 3 small push cores (3.8 cm diameter) mounted to ROV Cherokee. These cores were sampled in 3 cm intervals. Lipid biomarker extraction from 10 -17 g wet sediment was carried out as described in detail elsewhere (Elvert et al., 2003; doi:10.1080/01490450303894). Briefly, defined concentrations of cholestane, nonadecanol and nonadecanolic acid with known delta 13C-values were added to the sediments prior to extraction as internal standards for the hydrocarbon, alcohol and fatty acid fraction, respectively. Total lipid extracts were obtained from the sediment by ultrasonification with organic solvents of decreasing polarity. Esterified fatty acids (FAs) were cleaved from the glycerol head group by saponification with methanolic KOH solution. From this mixture, the neutral fraction was extracted with hexane. After subsequent acidification, FAs were extracted with hexane. For analysis, FAs were methylated using BF3 in methanol yielding fatty acid methyl esters (FAMES). The fixation for total cell counts and CARD-FISH were performed on-board directly after sampling. For both methods, sediments were fixed in formaldehyde solution. After two hours, aliquots for CARD-FISH staining were washed with 1* PBS (10mmol/l sodium phosphate solution, 130mmol/l NaCl, adjusted to a pH of 7.2) and finally stored in a 1:1 PBS:ethanol solution at -20°C until further processing. Samples for total cell counts were stored in formalin at 4°C until analysis. For sandy samples, the total cell count/CARD-FISH protocol was optimized to separate sand particles from the cells. Cells were dislodged from sediment grains and brought into solution with the supernatant by sonicating each sample onice for 2 minutes at 50W. This procedure was repeated four times and supernatants were combined. The sediment samples were brought to a final dilution of 1:2000 to 1:4000 and filtered onto 0.2µm GTTP filters (Millipore, Eschbonn, Germany).

Aeronautical Metadata Profile based on Geographic International Standards

The aeronautical information plays an essential rolein air safety, chief objective of the aeronautical industry. Community policies and projects are being currently developed for the adequate management of a single European air space. To make this possible, an appropriate information management and a set of tools that allow sharing and exchanging this information, ensuring its interoperability and integrity, are necessary. This paper presents the development and implementation of a metadata profile for description of the aeronautical information based on international regulations and recommendations applied within the geographic scope. The elements taken into account for its development are described, as well as the implementation process and the results obtained.