Cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation.

OBJECTIVES: The aims of this study were to assess the 1-year cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation to prevent both rejection and infectious complications. METHODS: Patients (pts) transplanted from January 2000 to March 2003 (Group A) and treated with a conventional protocol were compared with pts submitted to a combined regimen including universal cytomegalovirus (CMV) prophylaxis between April 2003 and July 2005 (Group B). Costs were computed from the hospital accounting system for hospital stays, and official tariffs for outpatient visits. Patients with incomplete costs data were excluded from analysis. RESULTS: Fifty-three patients were analyzed in Group A, and 60 in Group B. Baseline characteristics including CMV serostatus were not significantly different between the two groups. Over 12 months after transplantation, acute rejections decreased from 41.5 percent in Group A to 6.7 percent in Group B (p < .001), and CMV infections from 47 percent to 15 percent (p < .001). Overall, readmissions decreased from 68 percent to 55 percent (p = .160), and average hospital days from 28 +/- 19 to 20 +/- 11 days (p < .007). The average number of outpatient visits decreased from 49 +/- 10 to 39 +/- 8 (p < .001). Average 1-year immunosuppressive and CMV prophylaxis costs (per patient) increased from CHF20,402 +/- 7,273 to 27,375 +/- 6,063 (p < .001), graft rejection costs decreased from CHF4,595 +/- 10,182 to 650 +/- 3,167 (p = .005), CMV treatment costs from CHF2,270 +/- 6,161 to 101 +/- 326 (p = .008), and outpatient visits costs from CHF8,466 +/- 1'721 to 6,749 +/- 1,159 (p < .001). Altogether, 1-year treatment costs decreased from CHF39'957 +/- 16,573 to 36,204 +/- 6,901 (p = .115). CONCLUSIONS: The new combined regimen administered in Group B was significantly more effective, and its additional costs were more than offset by savings associated with complications avoidance.

Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: a mixed methods study.

INTRODUCTION: Congenital hypogonadotropic hypogonadism (CHH) is a rare, genetic, reproductive endocrine disorder characterized by absent puberty and infertility. Limited information is available on the psychosocial impact of CHH and psychosexual development in these patients. AIM: The aim of this study was to determine the impact of CHH on psychosexual development in men on long-term treatment. METHODS: A sequential mixed methods explanatory design was used. First, an online survey (quantitative) was used to quantify the frequency of psychosexual problems among CHH men. Second, patient focus groups (qualitative) were conducted to explore survey findings in detail and develop a working model to guide potential nursing and interdisciplinary interventions. MAIN OUTCOME MEASURES: Patient characteristics, frequency of body shame, difficulty with intimate relationships, and never having been sexually active were assessed. Additionally, we collected subjective patient-reported outcomes regarding the impact of CHH on psychological/emotional well-being, intimate relationships, and sexual activity. RESULTS: A total of 101 CHH men on long-term treatment (>1 year) were included for the analysis of the online survey (mean age 37 ± 11 years, range 19-66, median 36). Half (52/101, 51%) of the men had been seen at a specialized academic center and 37/101 (37%) reported having had fertility-inducing treatment. A high percentage of CHH men experience psychosexual problems including difficulty with intimate relationships (70%) and body image concerns/body shame (94/101, 93%), and the percentage of men never having been sexually active is five times the rate in a reference group (26% vs. 5.4%, P < 0.001). Focus groups revealed persisting body shame and low self-esteem despite long-term treatment that has lasting impact on psychosexual functioning. CONCLUSIONS: CHH men frequently experience psychosexual problems that pose barriers to intimate relationships and initiating sexual activity. These lingering effects cause significant distress and are not ameliorated by long-term treatment. Psychosexual assessment in CHH men with appropriate psychological support and treatment should be warranted in these patients. Dwyer AA, Quinton R, Pitteloud N, and Morin D. Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: A mixed methods study. Sex Med 2015;3:32-41.

Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice.

Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.

Ninety-day oral toxicity studies on two genetically modified maize MON810 varieties in Wistar Han RCC rats (EU 7th Framework Programme project GRACE)

The GMO Risk Assessment and Communication of Evidence (GRACE; www.grace-fp7.eu) project is funded by the European Commission within the 7th Framework Programme. A key objective of GRACE is to conduct 90-day animal feeding trials, animal studies with an extended time frame as well as analytical, in vitro and in silico studies on genetically modified (GM) maize in order to comparatively evaluate their use in GM plant risk assessment. In the present study, the results of two 90-day feeding trials with two different GM maize MON810 varieties, their near-isogenic non-GM varieties and four additional conventional maize varieties are presented. The feeding trials were performed by taking into account the guidance for such studies published by the EFSA Scientific Committee in 2011 and the OECD Test Guideline 408. The results obtained show that the MON810 maize at a level of up to 33 % in the diet did not induce adverse effects in male and female Wistar Han RCC rats after subchronic exposure, independently of the two different genetic backgrounds of the event

Visual impairment and multimorbidity in a representative sample of the Spanish population

BACKGROUND: In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning. METHODS: Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity. RESULTS: The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning. CONCLUSIONS: Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.

Z2Z4-Additive Perdect Codes in Steganography

Steganography is an information hiding application which aims tohide secret data imperceptibly into a cover object. In this paper, we describe anovel coding method based on Z2Z4-additive codes in which data is embeddedby distorting each cover symbol by one unit at most (+-1-steganography). Thismethod is optimal and solves the problem encountered by the most e cientmethods known today, concerning the treatment of boundary values. Theperformance of this new technique is compared with that of the mentionedmethods and with the well-known rate-distortion upper bound to conclude thata higher payload can be obtained for a given distortion by using the proposedmethod.

Early Childhood Mathematics Education: Research, Curriculum and Educational Practice

This article reviews data obtained through research into early childhood mathematics education in Spain. It analyses the current curricular directions in mathematics education with early learners. It also provides an overview of mathematical practices in early childhood education classrooms to analyse the commonalities and differences between research, curriculum and educational practice. A review of the research presented at SEIEM symposia from 1997 until 2012 demonstrates: a) very little research has been done, a trend that is repeated in other areas, such as the JCR-Social Sciences Edition or the PME; b) the first steps have been taken to create a more and more cohesive body of research, although until now there has not been enough data to outline the curricular directions; and c) some discrepancies still exist between the mathematical practices in early childhood education classrooms and the official guidelines

A Comparative Study of the Effectiveness of a Prefabricated Appliance and a Stabilization Appliance in the Treatment of Myofascial pain and Headache

The aim of this thesis was to evaluate the short- and long-term effectiveness of a prefabricated occlusal appliance (R) on patients with myofascial pain and headache by comparing it with the treatment of the stabilization appliance (S). Another aim was to evaluate the effect of appliance treatment on stress-related salivary parameters like cortisol and IgA, as well as on flow rate values in these patients. Sixty-five patients diagnosed with myofascial temporomandibular disorder (TMD) pain, of whom 94% suffered concomitantly from headache, at two centres for Stomatognathic Physiology, one in Sweden and one in Finland, were included in this randomized controlled trial using Research Diagnostic Criteria for TMD (RDC/TMD), with history questionnaires and clinical examinations performed at baseline and at 6- and 10-weeks, and 6- and 12-month follow-ups. Patients were randomly assigned either to the R or the S group. Treatment outcome was measured according to IMMPACT (Initiative on Methods, Measurements, and Pain Assessment in Clinical Trials), i.e. four chronic pain outcome domains: pain intensity, overall improvement, physical and emotional functioning. Changes in frequency and intensity of headache were recorded. Thirty-nine patients participated in the saliva study. Salivary analyses were performed at 6 and 10 weeks. The results revealed no differences between groups at baseline. At all follow-ups, all four outcome measures, as well as frequency and intensity of headache, showed statistically significant within-group improvement compared to baseline, without significant differences between groups. No treatment-induced changes in saliva parameters could be registered. In conclusion, the effectiveness of the prefabricated appliance seemed to be similar to that of the stabilization appliance in alleviating myofascial pain, and frequency and intensity of headache, in the short as well as the long term. However, no changes in salivary parameters were observed during treatment.

Evaluating the Maturity of Data Management Practices in a Major Energy Provider Company

Data is the most important asset of a company in the information age. Other assets, such as technology, facilities or products can be copied or reverse-engineered, employees can be brought over, but data remains unique to every company. As data management topics are slowly moving from unknown unknowns to known unknowns, tools to evaluate and manage data properly are developed and refined. Many projects are in progress today to develop various maturity models for evaluating information and data management practices. These maturity models come in many shapes and sizes: from short and concise ones meant for a quick assessment, to complex ones that call for an expert assessment by experienced consultants. In this paper several of them, made not only by external inter-organizational groups and authors, but also developed internally at a Major Energy Provider Company (MEPC) are juxtaposed and thoroughly analyzed. Apart from analyzing the available maturity models related to Data Management, this paper also selects the one with the most merit and describes and analyzes using it to perform a maturity assessment in MEPC. The utility of maturity models is two-fold: descriptive and prescriptive. Besides recording the current state of Data Management practices maturity by performing the assessments, this maturity model is also used to chart the way forward. Thus, after the current situation is presented, analysis and recommendations on how to improve it based on the definitions of higher levels of maturity are given. Generally, the main trend observed was the widening of the Data Management field to include more business and “soft” areas (as opposed to technical ones) and the change of focus towards business value of data, while assuming that the underlying IT systems for managing data are “ideal”, that is, left to the purely technical disciplines to design and maintain. This trend is not only present in Data Management but in other technological areas as well, where more and more attention is given to innovative use of technology, while acknowledging that the strategic importance of IT as such is diminishing.

Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

PURPOSE: It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).METHODS: This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).RESULTS: Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.CONCLUSIONS: These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.

Learning information technology business in a changing industry landscape. Introducing Team Entrepreneurship in Renewing Bachelor Education in Renewing Bachelor Education in Information

Speed, uncertainty and complexity are increasing in the business world all the time. When knowledge and skills become quickly irrelevant, new challenges are set for information technology (IT) education. Meta-learning skills – learning how to learn rapidly - and innovation skills have become more essential than single technologies or other specific issues. The drastic changes in the information and communications technology (ICT) sector have caused a need to reconsider how IT Bachelor education in Universities of Applied Sciences should be organized and employed to cope with the change. The objective of the study was to evaluate how a new approach to IT Bachelor education, the ICT entrepreneurship study path (ICT-ESP) fits IT Bachelor education in a Finnish University of Applied Sciences. This kind of educational arrangement has not been employed elsewhere in the context of IT Bachelor education. The study presents the results of a four-year period during which IT Bachelor education was renewed in a Finnish University of Applied Sciences. The learning environment was organized into an ICT-ESP based on Nonaka’s knowledge theory and Kolb’s experiental learning. The IT students who studied in the ICT-ESP established a cooperative and learned ICT by running their cooperative at the University of Applied Sciences. The students (called team entrepreneurs) studied by reading theory in books and other sources of explicit information, doing projects for their customers, and reflecting in training sessions on what was learnt by doing and by studying the literature. Action research was used as the research strategy in this study. Empirical data was collected via theme-based interviews, direct observation, and participative observation. Grounded theory method was utilized in the data analysis and the theoretical sampling was used to guide the data collection. The context of the University of Applied Sciences provided a good basis for fostering team entrepreneurship. However, the results showed that the employment of the ICT-ESP did not fit into the IT Bachelor education well enough. The ICT-ESP was cognitively too tough for the team entrepreneurs because they had two different set of rules to follow in their studies. The conventional courses engaged lot of energy which should have been spent for professional development in the ICT-ESP. The amount of competencies needed in the ICT-ESP for professional development was greater than those needed for any other ways of studying. The team entrepreneurs needed to develop skills in ICT, leadership and self-leadership, team development and entrepreneurship skills. The entrepreneurship skills included skills on marketing and sales, brand development, productization, and business administration. Considering the three-year time the team entrepreneurs spent in the ICT-ESP, the challenges were remarkable. Changes to the organization of IT Bachelor education are also suggested in the study. At first, it should be admitted that the ICT-ESP produces IT Bachelors with a different set of competencies compared to the conventional way of educating IT Bachelors. Secondly, the number of courses on general topics in mathematics, physics, and languages for team entrepreneurs studying in the ICTESP should be reconsidered and the conventional course-based teaching of the topics should be reorganized to support the team coaching process of the team entrepreneurs with their practiceoriented projects. Third, the upcoming team entrepreneurs should be equipped with relevant information about the ICT-ESP and what it would require in practice to study as a team entrepreneur. Finally, the upcoming team entrepreneurs should be carefully selected before they start in the ICT-ESP to have a possibility to eliminate solo players and those who have a too romantic view of being a team entrepreneur. The results gained in the study provided answers to the original research questions and the objectives of the study were met. Even though the IT degree programme was terminated during the research process, the amount of qualitative data gathered made it possible to justify the interpretations done.

Using Tomato Analyzer software to determine embryo size in x-rayed seeds

A primary interest of image analysis of X-rayed seeds is to identify whether the extent of fill in the embryo cavity is associated with to seed physiological quality. The objective of this research was to verify the accuracy of the freely available Tomato Analyzer (TA) software developed at The Ohio State University to determine the ratio of embryo size over total seed area. Seeds of pumpkin, watermelon, cucumber and cotton were X-rayed and analyzed by the software which defines seed and embryo boundaries and automatically generates numerical values to quantify that ratio. Results showed that the TA has the sensitivity to evaluate the extent of embryo growth within the cucurbits and cotton seeds and is a promising alternative for this assessment in other seed species.

The roles and tasks of salespeople in Software-as-a-Service company's value-based sales process

Recent research in relationships marketing and sales and sales management emphasizes companies’ ability to create customer value as a core of all business-to-business relationships. The role of individual salespeople in business relation-ships is commonly acknowledged, but has been largely neglected in extant literature. This study offers especially more detailed perspective on salespeople’s roles and tasks in business-to-business value-based sales process. It focuses especially on Software-as-a-Service business environment. The objective of the study is to find out how salespeople can create value in Software-as-a-Service value-based sales process. It determines value-based sales process, salespeople’s roles and tasks in it, and combines value assessment in to process. The results indicate that salespeople have to adapt different selling roles and tasks in Software-as-a-Service value-based sales process to be able to support the customer’s value-in-use experience. The process itself is highly complex, consisting of multiple facets and selling behaviors, and involves relevant actors from both parties of relationship. The study concludes with a discussion of possibilities that provide interesting aspects for future research.

Adolescent girls and mathematics: classroom performance, attitudes toward mathematics and perceptions of parental attitudes /

The purpose of this study was to determine the extent to which gender differences exist in student attitudes toward mathematics and in their performance in mathematics at the Grade Seven and Eight level. The study also questioned how parents influence the attitudes of this grade level of male and female students toward mathematics. Historically, the literature has demonstrated gender differences in the attitudes of students toward mathematics, and in parental support for classroom performance in mathematics. This study was an attempt to examine these differences at one senior public school in the Peel Board of Education. One hundred three Grade Seven and Eight students at a middle school in the Peel Board of Education volunteered to take part in a survey that examined their attitudes toward mathematics, their perceptions of their parents' attitudes toward mathematics and support for good performance in the mathematics classroom, parental expectations for education and future career choices. Gender differences related to performance levels in the mathematics classroom were examined using Pearson contingency analyses. Items from the survey that showed significant differences involved confidence in mathematics and confidence in writing mathematics tests, as well as a belief in the ability to work on mathematics problems. Male students in both the high and low performance groups demonstrated higher levels of confidence than the females in those groups. Female students, however, indicated interest in careers that would require training and knowledge of higher mathematics. Some of the reasons given to explain the gender differences in confidence levels included socialization pressures on females, peer acceptance, and attribution of success. Perceived parental support showed no significant differences across gender groups or performance levels. Possible explanations dealt with the family structure of the participants in the study. Studies that, in the past, have demonstrated gender differences in confidence levels were supported by this study, and discussed in detail. Studies that reported on differences in parental support for student performance, based on the gender of the parent, were not confirmed by this study, and reasons for this were also discussed. The implications for the classroom include: 1) build on the female students' strengths that will allow them to enjoy their experiences in mathematics; 2) stop using the boys as a comparison group; and 3) make students more aware of the need to continue studying mathematics to ensure a wider choice of future careers.

Completing the picture: the effects of video game practice on verbal and performance I.Q. scores in high functioning children

The strength and nature of the video game practice effect on tests of visual and perceptual skills were examined using high functioning Grades Four and Five students who had been tested with the WISC-R .for the purpose of gifted identification and placement. The control group, who did not own and .play video games on a sustained basis, and the experimental group, who did own a video game system and had some mastery of video games, including the -Nintendo game, "Tetris", were each composed of 18 juniorg:r;-ade students and were chosen from pre-existing conditions. The experimental group corresponded to the control group in terms of age, sex, and community. Data on the Verbal and Performance I.Q. Scores were· collected for both groups and the author was interested in the difference between the Verbal and Performance Scores within each group, anticipating a P > V outcome for the experimental group. The results showed a significant P > V difference in the experimental, video game playing group, as expected, but no significant difference between the Performance $cores of the control and experimental groups. The results, thus, indicated lower Verbal I.Q. Scores in the experimental group relat'ive to 'the control group.' The study conclu~ed that information about a sUbject's video game experience and "learhing style pref~rence is important for a clear interpretation of the Verbal and Performance I.Q. Scores of the WISC-R. Although the time spent on video game play may, 'indeed, increase P~rformance Scores relative to Verbal Scores for an individual, the possibilities exist that the time borrowed and spent away from language based activities may retard verbal growth and/or that the cognitive style associated with some Performance I.Q.subtests may have a negative effect on the approach to the tasks on the Verbal I.Q. Scale. The study also discussed the possibility that exposure to ,the video game experience, in pre-puberty, can provide spatial instruction which will result in improved spatial skills. strong spatial skills have been linked to improved performance and preference in mathematics, science, and engineering and it was suggested that appropriate video game play might be a way to involve girls more in the fields of mathematics and science.