Alcoholic steatohepatitis

Severe alcoholic steatohepatitis has a poor prognosis and is characterized by jaundice and signs of liver failure. Its incidence is unknown, but prevalence is around 20% in cohorts of alcoholics undergoing liver biopsy. Diagnosis is established with elevated liver transaminases, neutrophil counts, serum bilirubin, and impaired coagulation and a history of excessive alcohol consumption, and exclusion of other etiologies. Histology is helpful but not mandatory. Prognostic scores include the Maddrey's discriminant function, the model of end-stage liver disease, and the Glasgow Alcoholic Hepatitis Score. Pathophysiology involves hepatic fat storage, increased hepatic uptake of gut-derived endotoxins triggering Kupffer cell activation and release of proinflammatory triggers, induction of cytochrome P4502E1 producing toxic acetaldehyde and reactive oxygen species, and ethanol-mediated hyperhomocysteinemia causing endoplasmic reticulum stress. Treatment includes abstinence, enteral nutrition, corticosteroids, and possibly pentoxifylline. A debate is ongoing whether certain patients with severe alcoholic steatohepatitis could be eligible for liver transplantation.

Biologics in rheumatoid arthritis--recommendations for Swiss practice

The new paradigm of therapy in rheumatoid arthritis is to aim toward early and complete remission, using a larger use of conventional DMARDs and biologic agents. The present recommendations were established through a consensus to help practitioners in their daily use of those agents, to reflect the current "best practice" in Switzerland.

Educating...for what?: Engagement and Citizenry

Higgins School of the Humanities/Difficult Dialogues: Video Recording from 11/3/2011 event featuring Tom Hayden and Bob Ross "Engagement and Citizenry" Event Description: During their undergraduate years, students participate in a community that is a microcosm of society, and have the opportunity to learn about what it means to be a member of a society—a citizen—while they live it. How do we as educators (and humanists) best support and model this process? Where in our pedagogy can we enhance and develop the qualities of skillful empathy, effective analysis and motivated responsibility that good citizenship demands? Our guest for a conversation on engagement and citizenry is long-time activist Tom Hayden, who was the primary author of the Port Huron Statement of Students for a Democratic Society, which became known for its advocacy of “participatory democracy”. He is joined in conversation by Professor Bob Ross of Clark University, who participated with Hayden in the founding of SDS.

A model of osteoporosis impact in Switzerland 2000-2020

The aim of our study was to develop a modeling framework suitable to quantify the incidence, absolute number and economic impact of osteoporosis-attributable hip, vertebral and distal forearm fractures, with a particular focus on change over time, and with application to the situation in Switzerland from 2000 to 2020. A Markov process model was developed and analyzed by Monte Carlo simulation. A demographic scenario provided by the Swiss Federal Statistical Office and various Swiss and international data sources were used as model inputs. Demographic and epidemiologic input parameters were reproduced correctly, confirming the internal validity of the model. The proportion of the Swiss population aged 50 years or over will rise from 33.3% in 2000 to 41.3% in 2020. At the total population level, osteoporosis-attributable incidence will rise from 1.16 to 1.54 per 1,000 person-years in the case of hip fracture, from 3.28 to 4.18 per 1,000 person-years in the case of radiographic vertebral fracture, and from 0.59 to 0.70 per 1,000 person-years in the case of distal forearm fracture. Osteoporosis-attributable hip fracture numbers will rise from 8,375 to 11,353, vertebral fracture numbers will rise from 23,584 to 30,883, and distal forearm fracture numbers will rise from 4,209 to 5,186. Population-level osteoporosis-related direct medical inpatient costs per year will rise from 713.4 million Swiss francs (CHF) to CHF946.2 million. These figures correspond to 1.6% and 2.2% of Swiss health care expenditures in 2000. The modeling framework described can be applied to a wide variety of settings. It can be used to assess the impact of new prevention, diagnostic and treatment strategies. In Switzerland incidences of osteoporotic hip, vertebral and distal forearm fracture will rise by 33%, 27%, and 19%, respectively, between 2000 and 2020, if current prevention and treatment patterns are maintained. Corresponding absolute fracture numbers will rise by 36%, 31%, and 23%. Related direct medical inpatient costs are predicted to increase by 33%; however, this estimate is subject to uncertainty due to limited availability of input data.

Beitrag zur Prozessstandardisierung in der Intralogistik

Ein dynamisches Umfeld erforderte die permanente Anpassung (intra-)logistischer Prozesse zur Aufrechterhaltung der Leistungs- und Wettbewerbsfähigkeit von Unternehmen. In der Standardisierung von Prozessen und in unternehmensübergreifenden Prozessmodellen wurden Schlüsselfaktoren für ein effizientes Geschäftsprozessmanagement gesehen, insbesondere in Netzwerken. In der Praxis fehlten wissenschaftlich fundierte und detaillierte Referenzprozessmodelle für die (Intra-)Logistik. Mit der Erforschung und Entwicklung eines Referenzprozessmodells und der prototypischen Realisierung einer Prozess-Workbench zur generischen Erstellung wandelbarer Prozessketten wurde ein Beitrag zur Prozessstandardisierung in der Logistik geleistet. Im Folgenden wird der beschrittene Lösungsweg dargestellt, der erstens aus der Entwicklung eines Metamodells für die Referenzmodellierung, zweitens aus dem empirischen Nachweis der Generierung eines Referenzprozessmodells aus „atomaren“ Elementen und drittens aus der Modellevaluation bestand.

The E-learning Circle – a holistic software design tool for e-learning

The article introduces the E-learning Circle, a tool developed to assure the quality of the software design process of e-learning systems, considering pedagogical principles as well as technology. The E-learning Circle consists of a number of concentric circles which are divided into three sectors. The content of the inner circles is based on pedagogical principles, while the outer circle specifies how the pedagogical principles may be implemented with technology. The circle’s centre is dedicated to the subject taught, ensuring focus on the specific subject’s properties. The three sectors represent the student, the teacher and the learning objectives. The strengths of the E-learning Circle are the compact presentation combined with the overview it provides, as well as the usefulness of a design tool dealing with complexity, providing a common language and embedding best practice. The E-learning Circle is not a prescriptive method, but is useful in several design models and processes. The article presents two projects where the E-learning Circle was used as a design tool.

Auslegung, Konstruktion und Fertigung von strömungsmechanischen Funktionsprototypen mittels Rapid Manufacturing

Bei der Fertigung von Funktionsbauteilen für Strömungsversuche spielt das Design und die Komplexität der Bauteilgeometrie eine wesentliche Rolle. Ziel der interdisziplinären Zusammenarbeit der Lehrstühle Strömungsmaschinen, Rechnereinsatz in der Konstruktion und Fertigungstechnik mit dem Rapid Technology Center (RTC) an der Universität Duisburg-Essen ist es, das Potenzial der additiven Fertigungsverfahren bei der Herstellung von Funktionsprototypen für strömungsmechanische Anwendungen effektiv zu nutzen. An verschiedenen, auf dieser Kooperation beruhenden, Best Practise Beispielen wird gezeigt wie das Laser-Sintern in die Prozesskette zur Herstellung von Laufrädern u. Ä. in unterschiedlichen Größenordnungen integriert werden kann. In diesem Zusammenhang werden auch die Vorüberlegungen (z. B. durch Simulation), Wechselwirkungen und Folgeprozesse, die mit dieser Fertigungstechnologie verbunden sind, aufgezeigt.

Auslegung, Konstruktion und Fertigung von strömungsmechanischen Funktionsprototypen mittels Rapid Manufacturing

Bei der Fertigung von Funktionsbauteilen für Strömungsversuche spielt das Design und die Komplexität der Bauteilgeometrie eine wesentliche Rolle. Ziel der interdisziplinären Zusammenarbeit der Lehrstühle Strömungsmaschinen, Rechnereinsatz in der Konstruktion und Fertigungstechnik mit dem Rapid Technology Center (RTC) an der Universität Duisburg-Essen ist es, das Potenzial der additiven Fertigungsverfahren bei der Herstellung von Funktionsprototypen für strömungsmechanische Anwendungen effektiv zu nutzen. An verschiedenen, auf dieser Kooperation beruhenden, Best Practise Beispielen wird gezeigt wie das Laser-Sintern in die Prozesskette zur Herstellung von Laufrädern u. Ä. in unterschiedlichen Größenordnungen integriert werden kann. In diesem Zusammenhang werden auch die Vorüberlegungen (z. B. durch Simulation), Wechselwirkungen und Folgeprozesse, die mit dieser Fertigungstechnologie verbunden sind, aufgezeigt.

Explaining Emergence and Consequences of Specific Formal Controls in IS Outsourcing – A Process-View

IS outsourcing projects often fail to achieve project goals. To inhibit this failure, managers need to design formal controls that are tailored to the specific contextual demands. However, the dynamic and uncertain nature of IS outsourcing projects makes the design of such specific formal controls at the outset of a project challenging. Hence, the process of translating high-level project goals into specific formal controls becomes crucial for success or failure of IS outsourcing projects. Based on a comparative case study of four IS outsourcing projects, our study enhances current understanding of such translation processes and their consequences by developing a process model that explains the success or failure to achieve high-level project goals as an outcome of two unique translation patterns. This novel process-based explanation for how and why IS outsourcing projects succeed or fail has important implications for control theory and IS project escalation literature.

Genetic analysis of white facial and leg markings in the Swiss Franches-Montagnes Horse Breed

White markings and spotting patterns in animal species are thought to be a result of the domestication process. They often serve for the identification of individuals but sometimes are accompanied by complex pathological syndromes. In the Swiss Franches-Montagnes horse population, white markings increased vastly in size and occurrence during the past 30 years, although the breeding goal demands a horse with as little depigmented areas as possible. In order to improve selection and avoid more excessive depigmentation on the population level, we estimated population parameters and breeding values for white head and anterior and posterior leg markings. Heritabilities and genetic correlations for the traits were high (h(2) > 0.5). A strong positive correlation was found between the chestnut allele at the melanocortin-1-receptor gene locus and the extent of white markings. Segregation analysis revealed that our data fit best to a model including a polygenic effect and a biallelic locus with a dominant-recessive mode of inheritance. The recessive allele was found to be the white trait-increasing allele. Multilocus linkage disequilibrium analysis allowed the mapping of the putative major locus to a chromosomal region on ECA3q harboring the KIT gene.

The Emergence of Formal Control Specificity in Information Systems Outsourcing: A Process-View

Information systems (IS) outsourcing projects often fail to achieve initial goals. To avoid project failure, managers need to design formal controls that meet the specific contextual demands of the project. However, the dynamic and uncertain nature of IS outsourcing projects makes it difficult to design such specific formal controls at the outset of a project. It is hence crucial to translate high-level project goals into specific formal controls during the course of a project. This study seeks to understand the underlying patterns of such translation processes. Based on a comparative case study of four outsourced software development projects, we inductively develop a process model that consists of three unique patterns. The process model shows that the performance implications of emergent controls with higher specificity depend on differences in the translation process. Specific formal controls have positive implications for goal achievement if only the stakeholder context is adapted, while they are negative for goal achievement if in the translation process tasks are unintendedly adapted. In the latter case projects incrementally drift away from their initial direction. Our findings help to better understand control dynamics in IS outsourcing projects. We contribute to a process theoretic understanding of IS outsourcing governance and we derive implications for control theory and the IS project escalation literature.

Pre-clinical in vivo models for the screening of bone biomaterials for oral/craniofacial indications: focus on small-animal models.

Preclinical in vivo experimental studies are performed for evaluating proof-of-principle concepts, safety and possible unwanted reactions of candidate bone biomaterials before proceeding to clinical testing. Specifically, models involving small animals have been developed for screening bone biomaterials for their potential to enhance bone formation. No single model can completely recreate the anatomic, physiologic, biomechanic and functional environment of the human mouth and jaws. Relevant aspects regarding physiology, anatomy, dimensions and handling are discussed in this paper to elucidate the advantages and disadvantages of small-animal models. Model selection should be based not on the 'expertise' or capacities of the team, but rather on a scientifically solid rationale, and the animal model selected should reflect the question for which an answer is sought. The rationale for using heterotopic or orthotopic testing sites, and intraosseous, periosseous or extraskeletal defect models, is discussed. The paper also discusses the relevance of critical size defect modeling, with focus on calvarial defects in rodents. In addition, the rabbit sinus model and the capsule model in the rat mandible are presented and discussed in detail. All animal experiments should be designed with care and include sample-size and study-power calculations, thus allowing generation of meaningful data. Moreover, animal experiments are subject to ethical approval by the relevant authority. All procedures and the postoperative handling and care, including postoperative analgesics, should follow best practice.

Clinical acid-base pathophysiology: disorders of plasma anion gap.

The plasma anion gap is a frequently used parameter in the clinical diagnosis of a variety of conditions. The commonest application of the anion gap is to classify cases of metabolic acidosis into those that do and those that do not leave unmeasured anions in the plasma. While this algorithm is useful in streamlining the diagnostic process, it should not be used solely in this fashion. The anion gap measures the difference between the unmeasured anions and unmeasured cations and thus conveys much more information to the clinician than just quantifying anions of strong acids. In this chapter, the significance of the anion gap is emphasized and several examples are given to illustrate a more analytic approach to using the clinical anion gap; these include disorders of low anion gap, respiratory alkalosis and pyroglutamic acidosis.

Quality standards for bone conduction implants.

CONCLUSION Bone conduction implants are useful in patients with conductive and mixed hearing loss for whom conventional surgery or hearing aids are no longer an option. They may also be used in patients affected by single-sided deafness. OBJECTIVES To establish a consensus on the quality standards required for centers willing to create a bone conduction implant program. METHOD To ensure a consistently high level of service and to provide patients with the best possible solution the members of the HEARRING network have established a set of quality standards for bone conduction implants. These standards constitute a realistic minimum attainable by all implant clinics and should be employed alongside current best practice guidelines. RESULTS Fifteen items are thoroughly analyzed. They include team structure, accommodation and clinical facilities, selection criteria, evaluation process, complete preoperative and surgical information, postoperative fitting and assessment, follow-up, device failure, clinical management, transfer of care and patient complaints.

Chimpanzee: A predictive model for the human cytochrome P450 3A subfamily

The human cytochrome P450 3A (CYP3A) subfamily is responsible for most of the metabolism of therapeutic drugs; however, an adequate in vivo model has yet to be discovered. This study begins with an investigation of a controversial topic surrounding the human CYP3As--estrogen regulation. A novel approach to this topic was used by defining expression in the estrogen-responsive endometrium. This study shows that estrogen down-regulates CYP3A4 expression in the endometrium. On the other hand, analogous studies showed an increase in CYP3A expression as age increases in liver tissue. Following the discussion of estrogen regulation, is an investigation of the cross-species relationships among all of the CYP3As was completed. The study compares isoforms from piscines, avians, rodents, canines, ovines, bovines, and primates. Using the traditional phylogenetic analyses and employing a novel approach using exon and intron lengths, the results show that only another primate could be the best animal model for analysis of the regulation of the expression of the human CYP3As. This analysis also demonstrated that the chimpanzee seems to be the best available human model. Moreover, the study showed the presence and similarities of one additional isoform in the chimpanzee genome that is absent in humans. Based on these results, initial characterization of the chimpanzee CYP3A subfamily was begun. While the human genome contains four isoforms--CYP3A4, CYP3A5, CYP3A7, and CYP3A43--the chimpanzee genome has five, the four previously mentioned and CYP3A67. Both species express CYP3A4, CYP3A5, and CYP3A43, but humans express CYP3A7 while chimpanzees express CYP3A67. In humans, CYP3A4 is expressed at higher levels than the other isoforms, but some chimpanzee individuals express CYP3A67 at higher levels than CYP3A4. Such a difference is expected to alter significantly the total CYP3A metabolism. On the other hand, any study considering individual isoforms would still constitute a valid method of study for the human CYP3A4, CYP3A5, and CYP3A43 isoforms. ^