877 resultados para Multiple priors and posteriors


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Background: In recent years, an increasing number of auto-antibodies (AB) have been detected in the CSF and serum of patients with new onset epilepsy. Some of these patients develop convulsive or nonconvulsive status epilepticus (AB-SE), necessitating intensive medical care and administration of multiple antiepileptic and immunomodulatory treatments of uncertain effectiveness. Objectives: In this retrospective multicenter survey we aimed to determine the spectrum of gravity, the duration and the prognosis of the disorder. In addition, we sought to identify the antibodies associated with this condition, as well as determine whether there is a most effective treatment regime. Methods: 12 European Neurology University Clinics, with extensive experience in the treatment of SE patients, were sent a detailed questionnaire regarding symptoms and treatment of AB-SE patients. Seven centers responded positively, providing a total of 13 patients above the age of 16. Results: AB-SE affects mainly women (12/13, 92%) with a variable age at onset (17-69 years, median: 25 years). The duration of the disease is also variable (10 days to 12 years, median: 2 months). Only the 3 oldest patients died (55-69 years). Most patients were diagnosed with anti NMDAR encephalitis (8/13) and had oligoclonal bands in the CSF (9/13). No specific treatment regimen (antiepileptic, immunomodulatory) was found to be clearly superior. Most of the surviving 10 patients (77%) recovered completely or nearly so within 2 years of index poststatus. Conclusion: AB-SE is a severe but potentially reversible condition. Long duration does not seem to imply fatal outcome; however, age older than 50 years at time of onset appears to be a risk factor for death. There was no evidence for an optimal antiepileptic or immunomodulatory treatment. A prospective multicenter study is warranted in order to stratify the optimal treatment algorithm, determine clear risk factors of unfavorable outcome and long-term prognosis.

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The interaction of Schistosoma mansoni with its host's immune system is largely affected by multiple specific and non-specific evasion mechanisms employed by the parasite to reduce the host's immune reactivity. Only little is known about these mechanisms on the molecular level. The four molecules described below are intrinsic parasitic proteins recently identified and studied in our laboratory. 1. m28-A 28kDa membrane serine protease. m28 cleaves iC3b and can thus restrict attack by effector cells utilizing complement receptors (especially CR3). Treatment with protease inhibitors potentiates killing of schistosomula by complement plus neutrophils. 2. Smpi56-A 56kDa serine protease inhibitor. Smpi56 binds covalently to m28 and to neutrophil's elastase and blocks their proteolytic activity. 3. P70-A 70kDa C3b binding protein. The postulated activity of P70 includes binding to C3b and blocking of complement activation of the C3 step. 4. SCIP-1-A 94kDa schistosome complement inhibitor. SCIP-1 shows antigenic and functional similarities to the human 18kDa complement inhibitor CD59. Like CD59, SCIP-1 binds to C8 and C9 and blocks formation of the complement membrane attack complex. Antibodies directed to human CD59 bind to schistosomula and potentiate their killing by complement. The structure and function of these four proteins as well as their capacity to induce protection from infection with S. mansoni are under investigation.

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La potenciación de procesos de aprendizaje y memoria por autoestimación eléctrica intracraneal (AEIC) se ha observado principalmente en tareas de aprendizaje de tipo implícito, caracterizado por necesitar de múltiples ensayos y por dar lugar a una respuesta conductual rígida. Los efectos de la AEIC sobre formas de aprendizaje consideradas más complejas, como la memoria de navegación espacial, son menos conocidos. En nuestro laboratorio hemos observado recientemente que el tratamiento de AEIC es también capaz de facilitar tanto la adquisición como la retención de una tarea relacional, en el laberinto acuático de Morris (MWM) (Ruiz-Medina et al., 2008). El proyecto de investigación objeto de esta memoria continúa el estudio de este efecto potenciador yendo un paso más allá al profundizar en los mecanismos neurales de este efecto. Lo relativo a las espinas dendríticas, su tamaño, forma y aparición es uno de los campos más actuales en el estudio de las bases neurales de la memoria. Trabajos previos apuntan a un incremento en la densidad de espinas inmaduras -las consideradas de aprendizaje- como efecto tanto del entrenamiento en el MWM como de la AEIC. Relacionar la potenciación de memoria en el MWM resultado de la AEIC con cambios significativos en la población de espinas dendríticas hipocampales sería uno de los principales objetivos del presente trabajo, que se realizará en colaboración con el Instituto Ramón y Cajal de Madrid.

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Interleukin 5 (IL-5) is a critical cytokine for the maturation of eosinophil precursors to eosinophils in the bone marrow and those eosinophils then accumulate in the lungs during asthma. We have studied anti IL-5 antibodies on allergic responses in mice, guinea pigs and monkeys and are extending this experiment into humans with a humanized antibody. In a monkey model of pulmonary inflammation and airway hyperreactivity, we found that the TRFK-5 antibody blocked both responses for three months following a single dose of 0.3 mg/kg, i.v. This antibody also blocked lung eosinophilia in mice by inhibiting release from the bone marrow. To facilitate multiple dosing and to reduce immunogenicity in humans, we prepared Sch 55700, a humanized antibody against IL-5. Sch 55700 was also active against lung eosinophilia in allergic monkeys and mice and against pulmonary eosinophilia and airway hyperresponsiveness in guinea pigs. Furthermore, as opposed to steroids, Sch 55700 did not cause immunosuppression in guinea pigs. Studies with this antibody in humans will be critical to establishing the therapeutic potential of IL-5 inhibition.

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Purpose/Objective(s): RTwith TMZ is the standard for GBM. dd TMZ causes prolongedMGMTdepletion in mononuclear cells and possibly in tumor. The RTOG 0525 trial (ASCO 2011) did not show an advantage from dd TMZ for survival or progression free survival. We conducted exploratory, hypothesis-generating subset analyses to detect possible benefit from dd TMZ.Materials/Methods: Patients were randomized to std (150-200 mg/m2 x 5 d) or dd TMZ (75-100 mg/m2 x 21 d) q 4 weeks for 6- 12 cycles. Eligibility included age.18, KPS$ 60, and. 1 cm2 tissue for prospective MGMTanalysis for stratification. Furtheranalyses were performed for all randomized patients (''intent-to-treat'', ITT), and for all patients starting protocol therapy (SPT). Subset analyses were performed by RPA class (III, IV, V), KPS (90-100, = 50,\50), resection (partial, total), gender (female, male), and neurologic dysfunction (nf = none, minor, moderate).Results: No significant difference was seen for median OS (16.6 vs. 14.9 months), or PFS (5.5 vs. 6.7 months, p = 0.06). MGMT methylation was linked to improved OS (21.2 vs. 14 months, p\0.0001), and PFS (8.7 vs. 5.7 months, p\0.0001). For the ITT (n = 833), there was no OS benefit from dd TMZ in any subset. Two subsets showed a PFS benefit for dd TMZ: RPA class III (6.2 vs. 12.6 months, HR 0.69, p = 0.03) and nf = minor (HR 0.77, p = 0.01). For RPA III, dd dramatically delayed progression, but post-progression dd patients died more quickly than std. A similar pattern for nf = minor was observed. For the SPT group (n = 714) there was neither PFS nor OS benefit for dd TMZ, overall. For RPA class III and nf = minor, there was a PFS benefit for dd TMZ (HR 0.73, p = 0.08; HR 0.77, p = 0.02). For nf = moderate subset, both ITT and SPT, the std arm showed superior OS (14.4 vs. 10.9 months) compared to dd, without improved PFS (HR 1.46, p = 0.03; and HR 1.74, p = 0.01. In terms of methylation status within this subset, there were more methylated patients in the std arm of the ITT subset (n = 159; 32 vs. 24%). For the SPT subset (n = 124), methylation status was similar between arms.Conclusions: This study did not demonstrate improved OS for dd TMZ for any subgroup, but for 2 highly functional subgroups, PFS was significantly increased. These data generate the testable hypothesis that intensive treatment may selectively improve disease control in those most likely able to tolerate dd therapy. Interpretation of this should be considered carefully due to small sample size, the process of multiple observations, and other confounders.Acknowledgment: This project was supported by RTOG grant U10 CA21661, and CCOP grant U10 CA37422 from the National Cancer Institute (NCI).

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RésuméCette thèse traite d'un domaine d'application de l'écologie industrielle, les symbioses industrielles, comme stratégie d'amélioration de la consommation des ressources matérielles et énergétiques et de la gestion des déchets par les activités économiques. Les symbioses industrielles cherchent à créer de nouvelles collaborations directement entre les acteurs économiques d'un territoire dans le but d'échanger de l'information, des matières premières et des déchets, et d'intensifier les mutualisations de services et d'infrastructures possibles entre entreprises voisines. Ces quatre types de collaboration sont représentés schématiquement dans la figure ci-dessous.Dans ce travail, la détection et la mise en oeuvre de symbioses industrielles sont abordées sous plusieurs angles. Les recherches réalisées concernent le développement de procédures de mise en oeuvre s'adressant aux collectivités publiques, aux institutions académiques et aux bureaux de conseil dans le domaine de l'environnement. Les objectifs des procédures sont de créer une dynamique de collaboration et de confiance entre les acteurs économiques et l'administration publique d'un territoire afin de détecter des symbioses industrielles potentielles. Ces procédures requièrent la gestion de grandes quantités d'informations relatives aux flux de matière et d'énergie.Un travail de terrain, réalisé sur les territoires du canton de Genève et de Lausanne Région et utilisé comme études de cas, a permis de mettre en évidence un grand nombre de symbioses industrielles qui existent déjà en Suisse romande. Plusieurs dizaines d'exemples ont été identifiés principalement dans lesdomaines de la gestion de l'eau, de l'énergie, des produits chimiques et des matériaux de construction. La législation suisse autoriserait cependant la concrétisation de nombreuses autres opportunités. Dans cette recherche, celles-ci sont évaluées techniquement, légalement, économiquement et environnementalement. La création d'un référentiel d'évaluation des opportunités permet de déterminer quelles sont les symbioses industrielles techniquement réalisables et pertinentes dans le contexte suisse et dans quels cas celles-ci représenteraient une réelle plus-value par rapport à l'utilisation actuelle de la ressource et aux filières existantes de collecte et de valorisation des déchets.Finalement, un logiciel, SymbioGIS, destiné à soutenir la détection et l'évaluation de symbioses industrielles potentielles a été développé. Il s'agit d'une interface web accessible pour de nombreux utilisateurs, couplée à une interface de systèmes d'information géographique. En plus de la détection de symbioses industrielles, plusieurs fonctionnalités sont proposées pour faciliter la prise en compte des flux de matière et d'énergie dans les problématiques liées à l'aménagement du territoire et au positionnement des activités économiques.En conclusion, cette recherche met en évidence la nécessité de rapprocher les institutions publiques en charge de la protection de l'environnement, de la promotion économique et de l'aménagement du territoire pour favoriser l'essor des symbioses industrielles comme stratégie pour la gestion des ressources matérielles et énergétiques. Elle propose des pistes pour intensifier les collaborations entre ces domaines et accélérer le partage des connaissances liées aux flux de matière et d'énergie et à leur cheminement au sein des activités économiques afin de rendre le système industriel existant en Suisse romande viable à long terme. Parallèlement, elle étudie les possibilités de transposer ces considérations et les procédures et outils développés dans le contexte économique et social de la région Asie-Pacifique, où se trouvent aujourd'hui de nombreuses activités de production.SummaryIndustrial symbioses: A new strategy for improving how economic activities use material and energy resourcesThis thesis focuses on one application of industrial ecology, industrial symbioses, as a strategy for improving how economic activities consume material and energy resources. Industrial symbioses seek to create new collaborations among economic players with the goal of exchanging information, raw materials, and waste directly among area businesses, and to step up the potential pooling of services and infrastructure among neighboring companies.The identification and implementation of industrial symbioses are studied from several angles. The research first examines the development of implementation procedures for government bodies, academic institutions, and environmental consulting services. The purpose of the procedures is to create a dynamic of collaboration and trust between the economic players and the public officials in a region in order to identify potential industrial symbioses. The procedures necessitate managing large amounts of information about material and energy flows.Fieldwork conducted in the canton of Geneva and the Lausanne region, and used as case studies for the research, highlights a great number of industrial symbioses that already exist in French-speaking Switzerland. Several dozen examples are identified, primarily in the areas of water management, energy, chemical products, and building materials; however, Swiss law would permit many others. The research evaluates these opportunities from a technical, legal, economic, and environmental standpoint. By developing an assessment framework it is possible to determine which industrial symbioses are technically feasible and pertinent in Switzerland, and under what circumstances they would represent real added value compared to the current use of the resource and to existing systems for collecting and reusing waste.Lastly, SymbioGIS software was developed to help identify and assess potential industrial symbioses. The program's Web-based interface can be accessed by multiple users and is coupled with an interface that provides geographic information. In addition to identifying industrial symbioses, several program functionalities make it easier to consider material and energy flows with regard to local development issues and siting economic activities.In conclusion, the research highlights the need to bring together public institutions charged with protecting the environment, promoting economic activity, and overseeing development in order to foster the expansion of industrial symbioses as a strategy for managing material and energy resources. It proposes solutions for stepping up collaboration among these players and accelerating the sharing of knowledge about material and energy flows and their paths within economic activities with the goal of making theexisting industrial system in French-speaking Switzerland viable long-term. Also examined were thepossibilities of transposing these considerations and the study's findings about Switzerland to the economic and social context of the Asia-Pacific region, where much production is now located.

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Report for the scientific sojourn at the UC Berkeley, USA, from march until july 2008. This document starts by surveying the literature on economic federalism and relating it to network industries. The insights and some new developments (which focus on the role of interjurisdictional externalities, multiple objectives and investment incentives) are used to analyze regulatory arrangements in telecommunications and energy in the EU and the US. In the long history of vertically integrated monopolies in telecommunications and energy, there was a historical trend to move regulation up in the vertical structure of government, at least form the local level to the state or nation-state level. This move alleviated the pressure on regulators to renege on the commitment not to expropriate sunk investments, although it did not eliminate the practice of taxation by regulation that was the result of multiple interest group action. Although central or federal policy making is more focused and especialized and makes it difficult for more interest groups to organize, it is not clear that under all conditions central powers will not be associated with underinvestment. When technology makes the introduction of competition in some segments possible, the possibilities for organizing the institutional architechture of regulation expand. The central level may focus on structural regulation and the location of behavioral regulation of the remaining monopolists may be resolved in a cooperative way or concentrated at the level where the relevant spillovers are internalized.

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Atendre la planificació dels plans d’aula per a tot l’alumnat des d’un enfocament d’inclusió i atendre la planificació d’accés de cadascun i cadascuna de les alumnes a tot allò que es desenvoluparà a l’aula, són els propòsits del enfocament basat en el Disseny de Programacions Múltiples i Plans Educatius Individualitzats. Des d’aquest enfocament es planteja un procediment de planificacions “per versions” en el sentit que es considera que, inicialment, no es fa necessari preveure tots els detalls de l’activitat docent que es prepara, sinó el disposar d’uns primers esborranys que poden ser suficients i funcionals o que, en el cas de ser necessàries majors concrecions, aquestes es puguin anar introduint progressivament durant el mateix procés docent. El conèixer els canvis que es produiran en el moment de la implementació és l’objectiu d’aquest treball perquè tenim la convicció que si anticipem els possibles canvis que es produiran sabrem els components en els quals convé inicialment, planificar amb major intensitat i detall i quins són aquells altres components sobre els quals la intensitat de la planificació pot ser menys intensa i així facilitar la tasca dels professionals a l’hora de programar.

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Cleusonite, (Pb,Sr)(U4+,U6+) (Fe2+,Zn)(2) (Ti,Fe2+,Fe3+)(18) (O,OH)(38), is a new member of the crichtonite group. It was found at two occurrences in greenschist facies metamorphosed gneissic series of the Mont Fort and Siviez-Mischabel Nappes in Valais, Switzerland (Cleuson and Bella Tolla summit), and named after the type locality. It occurs as black opaque cm-sized tabular crystals with a bright sub-metallic lustre. The crystals consist of multiple rhombohedra and hexagonal prisms that are generally twinned. Measured density is 4.74(4) g/cm(3) and can be corrected to 4.93(12) g/cm(3) for macroscopic swelling due to radiation damage; the calculated density varies from 5.02(6) (untreated) to 5.27(5) (heat-treated crystals); the difference is related to the cell swelling due to the metamictisation. The empirical formula for cleusonite from Cleuson is (Pb0.89Sr0.12)(Sigma=1.01) (U0.79+4U0.30+6)(Sigma=1.09) (Fe1.91+2Zn0.09)(Sigma=2.00) (Ti11.80Fe3.44+2Fe2.33+3V0.19+5Mn0.08Al0.07)(Sigma=17.90) [O-35.37(OH)(2.63)](Sigma=38). Cations were measured by electron microprobe, the presence of structural (OH) was confirmed by infrared spectroscopy and the U6+/U4+ and Fe2+/Fe3+ ratios were determined by X-ray photoelectron spectroscopy. Cleusonite is partly metamict, and untreated crystals only show three major X-ray diffraction peaks. Because of this radiation-damaged state, the mineral appears optically isotropic and shows a light-grey to white colour in reflected polarized light. Cleusonite is trigonal, space group R $(3) over bar $, and unit-cell parameters are varying from a = 10.576(3), c = 21.325(5) angstrom (untreated crystal) to a = 10.4188(6), c = 20.942(1) angstrom (800 degrees C treatment) and to a = 10.385(2), c = 20.900(7) angstrom (1000 degrees C treatment). The three cells give a common axial ratio 2.01 (1), which is identical to the measured morphological one 2.04(6). ne name cleusonite also applies to the previously described ``uranium-rich senaite'' from Alinci (Macedonia) and the ``plumbodavidite'' from Huanglongpu (China).

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We investigated the interleukin (IL-4) levels in BALB/c mice immunized with Anisakis extract in single or multiple doses and in mice orally infected with a larva. From animals immunized maximum responses were obtained with the multiple doses with an only IL-4 peak. Conversely, in the mice inoculated with a larva per os, the IL-4 levels showed two peaks of different rates.

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In November of 2001 the Government launched its new National Health Strategy â?" â?oQuality and Fairness, A Health System for youâ?Âù (hereafter referred to as Quality and Fairness). Quality and Fairness was developed following one of the largest consultation processes ever undertaken in the public service. It sets out the vision for the health service, the four principles upon which this vision will be built, it also establishes four National goals and finally sets out six â?~frameworks for changeâ?T, which will be used to achieve the vision, principles and goals. One of the six frameworks for change is Developing Human Resources. The health service is one of the largest employers in the public sector, with the employment level at the end of 2001 approaching 93,000 full time employees. These employees are spread across a large number of organisations, in multiple locations and settings across the country. Each employee plays a key role in the delivery of health service, in all settings, to the public. Download document here

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1 6 STRUCTURE OF THIS THESIS -Chapter I presents the motivations of this dissertation by illustrating two gaps in the current body of knowledge that are worth filling, describes the research problem addressed by this thesis and presents the research methodology used to achieve this goal. -Chapter 2 shows a review of the existing literature showing that environment analysis is a vital strategic task, that it shall be supported by adapted information systems, and that there is thus a need for developing a conceptual model of the environment that provides a reference framework for better integrating the various existing methods and a more formal definition of the various aspect to support the development of suitable tools. -Chapter 3 proposes a conceptual model that specifies the various enviromnental aspects that are relevant for strategic decision making, how they relate to each other, and ,defines them in a more formal way that is more suited for information systems development. -Chapter 4 is dedicated to the evaluation of the proposed model on the basis of its application to a concrete environment to evaluate its suitability to describe the current conditions and potential evolution of a real environment and get an idea of its usefulness. -Chapter 5 goes a step further by assembling a toolbox describing a set of methods that can be used to analyze the various environmental aspects put forward by the model and by providing more detailed specifications for a number of them to show how our model can be used to facilitate their implementation as software tools. -Chapter 6 describes a prototype of a strategic decision support tool that allow the analysis of some of the aspects of the environment that are not well supported by existing tools and namely to analyze the relationship between multiple actors and issues. The usefulness of this prototype is evaluated on the basis of its application to a concrete environment. -Chapter 7 finally concludes this thesis by making a summary of its various contributions and by proposing further interesting research directions.

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Astrocytes are the brain non-nerve cells competent for the expression of clear and dense-core vesicles (DCVs) and for their regulated exocytosis. This process, called gliosecretion, nearly resembles the neurosecretion occurring in neurons and neurosecretory cells. REST/NRSF is a transcription repressor known to orchestrate nerve-cell differentiation, governing the expression of hundreds of neuron-specific genes through their repression in the non-nerve and their fine modulation in the nerve cells. Our previous studies in neurosecretory rat PC12 cells identified REST as the critical factor for the expression not only of individual genes, but also of the whole neurosecretory process via multiple, direct and indirect mechanisms (D'Alessandro et al., J. Neurochem., 2008; Klajn et al., J. Neurosci., 2009). Therefore we wondered whether gliosecretion was governed by REST. We investigated rat astrocyte primary cultures: they exhibited high REST, which directly represses the transcription of at least one target gene, and expressed neither DCVs nor their markers (granins, peptides, membrane proteins). Transfection of a dominant-negative construct of REST (REST/ DBD-GFP) induced the appearance of DCVs filled with secretogranin2 and NPY that are distinct from other intracellular organelles. TIRF analysis of astrocytes co-transfected with REST/DBD-GFP and NPY-mRFP constructs revealed NPY-mRFP-positive DCVs undergoing Ca2þ-dependent exocytosis, largely prevented by BoNT/B. Immunohistochemistry of the I-II layers of the human temporal brain cortex showed all neurons and microglia exhibiting the expected inappreciable and high levels of REST, respectively. In contrast astrocyte RESTwas variable, going from inappreciable to high, accompanied by variable expression of DCVs. In this work it has been demonstrated that astrocyte DCV expression and gliosecretion are governed by REST (Prada et al., 2011 in press). The variable in situ REST levels may contribute to the well known structural/functional heterogeneity of astrocytes and this new observation might be of great interest for the understanding of both astrocyte physiology and pathology.

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BACKGROUND: Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs. METHODS: All patients admitted to the ICU, aged >18 years, with an ICU stay >24h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area. FINDINGS: Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36+/-14 years old and burned 27+/-15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24h (p<0.0001) followed by a later reduction with lower pain scores (p<0.0001), less procedural related anxiety, less procedures under anaesthesia, reduced total grafting requirements (p=0.014), and lower hospital costs per patient. CONCLUSION: A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits.

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SUMMARY: Large sets of data, such as expression profiles from many samples, require analytic tools to reduce their complexity. The Iterative Signature Algorithm (ISA) is a biclustering algorithm. It was designed to decompose a large set of data into so-called 'modules'. In the context of gene expression data, these modules consist of subsets of genes that exhibit a coherent expression profile only over a subset of microarray experiments. Genes and arrays may be attributed to multiple modules and the level of required coherence can be varied resulting in different 'resolutions' of the modular mapping. In this short note, we introduce two BioConductor software packages written in GNU R: The isa2 package includes an optimized implementation of the ISA and the eisa package provides a convenient interface to run the ISA, visualize its output and put the biclusters into biological context. Potential users of these packages are all R and BioConductor users dealing with tabular (e.g. gene expression) data. AVAILABILITY: http://www.unil.ch/cbg/ISA CONTACT: sven.bergmann@unil.ch