Efficacy of Preoperative Chemotherapy in Treatment of Children With Wilms’ Tumor: A Meta-Analysis

Context: To assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups. Objectives: In the presence of these controversies, a meta-analysis that examines the efficacy of preoperative chemotherapy in Wilms’ tumor patients and specific subgroups is needed to clarify these issues. The objective of this meta-analysis is to assess the efficacy of preoperative chemotherapy in Wilms’ tumor patients and explore its true value for specific subgroups. Data Sources: Computer-based systematic search with “preoperative chemotherapy”, “Neoadjuvant Therapy” and “Wilms’ tumor” as search terms till January 2013 was performed. Study Selection: No language restrictions were applied. Searches were limited to randomized clinical trials (RCTs) or retrospective studies in human participants under 18 years. A manual examination of references in selected articles was also performed. Data Extraction: Relative Risk (RR) and their 95% Confidence Interval (CI) for Tumor Shrinkage (TS), total Tumor Resection (TR), Event-Free Survival (EFS) and details of subgroup analysis were extracted. Meta-analysis was carried out with the help of the software STATA 11.0. Finally, four original Randomized Clinical Trials (RCTs) and 28 retrospective studies with 2375 patients were included. Results: For preoperative chemotherapy vs. up-front surgery (PC vs. SU) group, the pooled RR was 9.109 for TS (95% CI: 5.109 - 16.241; P < 0.001), 1.291 for TR (95% CI: 1.124 - 1.483; P < 0.001) and 1.101 for EFS (95% CI: 0.980 - 1.238; P = 0.106). For subgroup short course vs. long course (SC vs. LC), the pooled RR was 1.097 for TS (95% CI: 0.784 - 1.563; P = 0.587), 1.197 for TR (95% CI: 0.960 - 1.493; P = 0.110) and 1.006 for EFS (95% CI: 0.910 - 1.250; P = 0.430). Conclusions: Short course preoperative chemotherapy is as effective as long course and preoperative chemotherapy only benefits Wilms’ tumor patients in tumor shrinkage and resection but not event-free survival.

A Systematic Review of Studies on Blood Pressure in Iranian Pediatric Population: First Report From the Middle East and North Africa

Context:Blood pressure (BP) tracks from childhood to adulthood, and has ethnic variations. Therefore, it is important to assess the situation of pediatric BP in different populations. This study aims to systematically review the studies conducted on BP in Iranian children and adolescents. Evidence Acquisition: We conducted a systematic review on published and national data about pediatric BP in Iran, our search was conducted in Pub Med, Medline, ISI, and Scopus, as well as in national databases including Scientific Information database (SID), IranMedex and Irandoc from 1990 to 2014. Results: We found 1373 records in the primary search including 840 from international and 533 from national databases. After selection and quality assessment phases, data were extracted from 36 papers and four national data sources. Mean systolic BP (SBP) varied from 90.1 ± 14 mmHg (95% CI 89.25, 90.94) to 120.2 ± 12.3 (118.98, 121.41) mmHg, and for diastolic BP (DBP) from 50.7 ± 11.4 (50.01, 51.38) to 79.2 ± 12.3 (77.95, 80.44) mmHg. The frequency of elevated BP had large variation in sub-national studies with rates as low as 0.4% (0.009, 1.98) for high SBP and as high as 24.1% (20.8, 27.67) for high DBP. At national level, three surveys reported slightly raised rates of elevated BP from 2009 to 2012. Conclusions: The findings provide practical information on BP levels in Iranian pediatric population. Although differences exist on the findings of various studies, this review underscores the necessity of tracking BP from childhood, and implementing interventions for primordial prevention of hypertension.

APPLICATION OF AN IMPUTATION METHOD FOR GEOSPATIAL INVENTORY OF FOREST STRUCTURAL ATTRIBUTES ACROSS MULTIPLE SPATIAL SCALES IN THE LAKE STATES, U.S.A.

Credible spatial information characterizing the structure and site quality of forests is critical to sustainable forest management and planning, especially given the increasing demands and threats to forest products and services. Forest managers and planners are required to evaluate forest conditions over a broad range of scales, contingent on operational or reporting requirements. Traditionally, forest inventory estimates are generated via a design-based approach that involves generalizing sample plot measurements to characterize an unknown population across a larger area of interest. However, field plot measurements are costly and as a consequence spatial coverage is limited. Remote sensing technologies have shown remarkable success in augmenting limited sample plot data to generate stand- and landscape-level spatial predictions of forest inventory attributes. Further enhancement of forest inventory approaches that couple field measurements with cutting edge remotely sensed and geospatial datasets are essential to sustainable forest management. We evaluated a novel Random Forest based k Nearest Neighbors (RF-kNN) imputation approach to couple remote sensing and geospatial data with field inventory collected by different sampling methods to generate forest inventory information across large spatial extents. The forest inventory data collected by the FIA program of US Forest Service was integrated with optical remote sensing and other geospatial datasets to produce biomass distribution maps for a part of the Lake States and species-specific site index maps for the entire Lake State. Targeting small-area application of the state-of-art remote sensing, LiDAR (light detection and ranging) data was integrated with the field data collected by an inexpensive method, called variable plot sampling, in the Ford Forest of Michigan Tech to derive standing volume map in a cost-effective way. The outputs of the RF-kNN imputation were compared with independent validation datasets and extant map products based on different sampling and modeling strategies. The RF-kNN modeling approach was found to be very effective, especially for large-area estimation, and produced results statistically equivalent to the field observations or the estimates derived from secondary data sources. The models are useful to resource managers for operational and strategic purposes.

UNDERSTANDING ESSAY RATING AS A SOCIALLY MEDIATED ACTIVITY: THE CASE OF A HIGH-STAKES ENGLISH TEST IN CHINA

Thesis (Ph.D, Education) -- Queen's University, 2016-09-22 22:05:24.246

Techniques for distributed theory synthesis in multiagent systems

Data sources are often dispersed geographically in real life applications. Finding a knowledge model may require to join all the data sources and to run a machine learning algorithm on the joint set. We present an alternative based on a Multi Agent System (MAS): an agent mines one data source in order to extract a local theory (knowledge model) and then merges it with the previous MAS theory using a knowledge fusion technique. This way, we obtain a global theory that summarizes the distributed knowledge without spending resources and time in joining data sources. New experiments have been executed including statistical significance analysis. The results show that, as a result of knowledge fusion, the accuracy of initial theories is significantly improved as well as the accuracy of the monolithic solution.

Multi-Scale Governance of Sustainable Natural Resource Use—Challenges and Opportunities for Monitoring and Institutional Development at the National and Global Level

In a globalized economy, the use of natural resources is determined by the demand of modern production and consumption systems, and by infrastructure development. Sustainable natural resource use will require good governance and management based on sound scientific information, data and indicators. There is a rich literature on natural resource management, yet the national and global scale and macro-economic policy making has been underrepresented. We provide an overview of the scholarly literature on multi-scale governance of natural resources, focusing on the information required by relevant actors from local to global scale. Global natural resource use is largely determined by national, regional, and local policies. We observe that in recent decades, the development of public policies of natural resource use has been fostered by an “inspiration cycle” between the research, policy and statistics community, fostering social learning. Effective natural resource policies require adequate monitoring tools, in particular indicators for the use of materials, energy, land, and water as well as waste and GHG emissions of national economies. We summarize the state-of-the-art of the application of accounting methods and data sources for national material flow accounts and indicators, including territorial and product-life-cycle based approaches. We show how accounts on natural resource use can inform the Sustainable Development Goals (SDGs) and argue that information on natural resource use, and in particular footprint indicators, will be indispensable for a consistent implementation of the SDGs. We recognize that improving the knowledge base for global natural resource use will require further institutional development including at national and international levels, for which we outline options.

L’infirmière en GMF : vers une meilleure connaissance des activités réalisées auprès des personnes atteintes de maladies chroniques

Résumé : Contexte : Depuis la création des Groupes de médecine de famille (GMF), les infirmières peuvent assurer le suivi des personnes atteintes de maladies chroniques (MC). Il existe des écarts entre la littérature et la pratique. Un constat provincial permettra une compréhension des enjeux d’optimisation de la pratique infirmière auprès de cette clientèle grandissante. Objectifs : 1) décrire les activités de l’infirmière en GMF auprès des personnes atteintes de MC; 2) décrire les éléments contextuels déterminants de ces activités; 3) dresser un portrait provincial des activités des infirmières de GMF auprès des personnes atteintes de MC. Méthode : Un devis mixte séquentiel exploratoire en trois volets a été effectué. Volet 1 : Une étude de cas multiple a été réalisée auprès de dix infirmières de GMF. Cinq sources de données ont été utilisées : 1) observation des rencontres infirmière-patient (n=10); 2) entrevues individuelles avec chaque infirmière (n=10); 3) entrevues individuelles avec chaque patient (n=10); 4) audit des notes infirmières au dossier des patients participant (n=10) et; 5) documents administratifs décrivant la pratique des infirmières à l’intérieur des GMF. L’analyse qualitative a permis de générer une liste d’activités et de décrire les éléments contextuels qui déterminent les activités. Volet 2 : Un questionnaire électronique a été créé à l’aide de la liste d’activités produite lors du Volet 1 et de la recension des écrits. Il a été validé et prétesté. Volet 3 : Une enquête provinciale a été réalisée auprès de 322 infirmières de GMF. Des analyses descriptives telles que des fréquences, moyennes, étendues et écarts types ont été effectuées. Résultats : Volet 1 : les activités des infirmières de GMF auprès des personnes atteintes de MC sont regroupées en cinq domaines. Des éléments liés à l’organisation, aux infirmières et aux personnes atteintes de MC peuvent influencer les activités. Volet 3 : 266 infirmières ont complété le questionnaire. Les résultats démontrent que leurs activités se situent principalement dans les domaines de la Promotion de la santé et de l’Évaluation globale de la condition de la personne. Les activités en lien avec la Collaboration infirmière-médecin et l’Organisation de l’offre de services sont réalisées de façon occasionnelle. Conclusion : Cette étude a permis une description en profondeur des activités des infirmières de GMF auprès des personnes atteintes de MC. Il s’agissait d’un jalon important en vue d’optimiser les interventions liées à la prise en charge des MC en soins de première ligne.

Caracterización sociodemográfica de las enfermedades huérfanas en Colombia

Las enfermedades huérfanas en Colombia, se definen como aquellas crónicamente debilitantes, que amenazan la vida, de baja prevalencia (menor 1/5000) y alta complejidad. Se estima que a nivel mundial existen entre 6000 a 8000 enfermedades raras diferentes(1). Varios países a nivel mundial individual o colectivamente, en los últimos años han creado políticas e incentivos para la investigación y protección de los pacientes con enfermedades raras. Sin embargo, a pesar del creciente número de publicaciones; la información sobre su etiología, fisiología, historia natural y datos epidemiológicos persiste escasa o ausente. Los registros de pacientes, son una valiosa herramienta para la caracterización de las enfermedades, su manejo y desenlaces con o sin tratamiento. Permiten mejorar políticas de salud pública y cuidado del paciente, contribuyendo a mejorar desenlaces sociales, económicos y de calidad de vida. En Colombia, bajo el decreto 1954 de 2012 y las resoluciones 3681 de 2013 y 0430 de 2013 se creó el fundamento legal para la creación de un registro nacional de enfermedades huérfanas. El presente estudio busca determinar la caracterización socio-demográfica y la prevalencia de las enfermedades huérfanas en Colombia en el periodo 2013. Métodos: Se realizó un estudio observacional de corte transversal de fuente secundaria sobre pacientes con enfermedades huérfanas en el territorio nacional; basándose en el registro nacional de enfermedades huérfanas obtenido por el Ministerio de Salud y Protección Social en el periodo 2013 bajo la normativa del decreto 1954 de 2012 y las resoluciones 3681 de 2013 y 0430 de 2013. Las bases de datos obtenidas fueron re-categorizadas en Excel versión 15.17 para la extracción de datos y su análisis estadístico posterior, fue realizado en el paquete estadístico para las ciencias sociales (SPSS v.20, Chicago, IL). Resultados: Se encontraron un total de 13173 pacientes con enfermedades huérfanas para el 2013. De estos, el 53.96% (7132) eran de género femenino y el 46.03% (6083) masculino; la mediana de la edad fue de 28 años con un rango inter-cuartil de 39 años, el 9% de los pacientes presentaron discapacidad. El registro contenía un total de 653 enfermedades huérfanas; el 34% del total de las enfermedades listadas en nuestro país (2). Las patologías más frecuentes fueron el Déficit Congénito del Factor VIII, Miastenia Grave, Enfermedad de Von Willebrand, Estatura Baja por Anomalía de Hormona de Crecimiento y Displasia Broncopulmonar. Discusión: Se estimó que aproximadamente 3.3 millones de colombianos debían tener una enfermedad huérfana para el 2013. El registro nacional logró recolectar datos de 13173 (0.4%). Este bajo número de pacientes, marca un importante sub-registro que se debe al uso de los códigos CIE-10, desconocimiento del personal de salud frente a las enfermedades huérfanas y clasificación errónea de los pacientes. Se encontraron un total de 653 enfermedades, un 34% de las enfermedades reportadas en el listado nacional de enfermedades huérfanas (2) y un 7% del total de enfermedades reportadas en ORPHANET para el periodo 2013 (3). Conclusiones: La recolección de datos y la sensibilización sobre las enfermedades huérfanas al personal de salud, es una estrategia de vital importancia para el diagnóstico temprano, medidas específicas de control e intervenciones de los pacientes. El identificar apropiadamente a los pacientes con este tipo de patologías, permite su ingreso en el registro y por ende mejora el sub-registro de datos. Sin embargo, cabe aclarar que el panorama ideal sería, el uso de un sistema de recolección diferente al CIE-10 y que abarque en mayor medida la totalidad de las enfermedades huérfanas.

Prevalencia de morbilidad osteomuscular en una empresa de servicios de seguridad electrónica en Bogotá, 2013

Introducción: actualmente los trastornos músculo esqueléticos (TME) han sido reconocidos como la principal causa de morbilidad en el trabajo, dado el porcentaje de ausentismo laboral que representa, generando reducción en la productividad de las industrias. Una visión general de la prevalencia en TME puede conducir a métodos de prevención de morbilidad adecuados para cada tipo de proceso, y así proporcionar un ambiente más seguro y confortable. Objetivo: determinar la prevalencia de síntomas osteomusculares y su relación con factores individuales y laborales en personal de una empresa dedicada a prestar servicio de seguridad electrónica en Bogotá, en el 2013. Métodos: estudio de corte transversal, desarrollado a partir de fuentes de datos secundarios de una población de 199 trabajadores, con información sociodemográfica y síntomas osteomusculares en los distintos roles laborales (administrativo, soporte y de campo) de una empresa de servicios en seguridad electrónica. Se usaron métodos estadísticos para el cálculo de proporciones, se estimaron las prevalencias osteomusculares globales, realizando comparaciones por rol laboral. La revisión de la asociación entre factores sociodemográficos y laborales con síntomas de TME se hizo a través de la prueba Chi2 de asociación o prueba exacta de Fisher. Resultados: Los segmentos que mostraron la mayor frecuencia en morbilidad de TME fueron espalda, cuello, muñecas y manos. Se encontró asociación entre dolor de hombros y brazos con la edad, OR=0,54 (IC95%=0,30-0,95) y tiempo en el cargo, OR=1,855(IC 95%=1,043-3,297); entre dolor de cuello y edad OR=0,50 (IC95%=0,27-0,90) y entre dolor de muñecas y/o manos con tiempo en el cargo, OR=1,827(IC 95%=1,032-3,235). Conclusión: Se presenta morbilidad por TME en varios segmentos, derivados de factores (individuales y laborales), ratificando la importancia de hacer intervenciones integrales de control de riesgos para su prevención.

Mercadeo farmacéutico de productos bajo prescripción: efectos de las estrategias Direct-to-Consumer-Advertising en el comportamiento de los consumidores y de prescripción de los médicos

Este proyecto se origina en el interés de analizar las estrategias actuales de promoción de productos farmacéuticos, en el marco del debate sobre el efecto persuasivo o informativo que la publicidad directa tiene sobre los consumidores. El objetivo es determinar el efecto de las estrategias de promoción directa para consumidores (Direct to Consumer Advertising [DTCA]) sobre el comportamiento de compra de pacientes y las prescripciones que formulan los médicos en el mercado de productos bajo receta en Estados Unidos. Para tal fin se propuso realizar una monografía que incluyera una revisión de literatura de carácter argumentativo, consultando información de nivel secundario en bases de datos científicas cuyos contenidos obedecieran a criterios metodológicos determinados por la naturaleza argumentativa del estudio. Adicionalmente, se analizó el debate sobre estos anuncios a la luz de dos estudios realizados a pacientes con cáncer de seno, próstata y colon, liderados por el Pennsylvania Cancer Registry con los productos biofarmacéuticos Avodart® y Flomax®. Finalmente, la investigación se fundamentó en la relación del mercado farmacéutico en Estados Unidos con cada uno de los agentes que interactúan en él; consumidores, médicos prescriptores y empresas farmacéuticas, así como el valor que estos comparten través de dichas interacciones. Se concluye que el comportamiento de compra de los consumidores está determinado por la naturaleza de la patología que padecen y el comportamiento de los profesionales que prescriben a sus pacientes se ve influenciado por los anuncios DTCA.

Pacote de sincronização de réplicas de bases de dados

A replicação de base de dados tem como objectivo a cópia de dados entre bases de dados distribuídas numa rede de computadores. A replicação de dados é importante em várias situações, desde a realização de cópias de segurança da informação, ao balanceamento de carga, à distribuição da informação por vários locais, até à integração de sistemas heterogéneos. A replicação possibilita uma diminuição do tráfego de rede, pois os dados ficam disponíveis localmente possibilitando também o seu acesso no caso de indisponibilidade da rede. Esta dissertação baseia-se na realização de um trabalho que consistiu no desenvolvimento de uma aplicação genérica para a replicação de bases de dados a disponibilizar como open source software. A aplicação desenvolvida possibilita a integração de dados entre vários sistemas, com foco na integração de dados heterogéneos, na fragmentação de dados e também na possibilidade de adaptação a várias situações. ABSTRACT: Data replication is a mechanism to synchronize and integrate data between distributed databases over a computer network. Data replication is an important tool in several situations, such as the creation of backup systems, load balancing between various nodes, distribution of information between various locations, integration of heterogeneous systems. Replication enables a reduction in network traffic, because data remains available locally even in the event of a temporary network failure. This thesis is based on the work carried out to develop an application for database replication to be made accessible as open source software. The application that was built allows for data integration between various systems, with particular focus on, amongst others, the integration of heterogeneous data, the fragmentation of data, replication in cascade, data format changes between replicas, master/slave and multi master synchronization.

Trans-national cooperation: an asset in the Portuguese overseas trade. Foreigners operating in the Portuguese overseas trade, 1580-1590

This paper aims to discuss the role of foreign merchants, operating from Portugal, in the Portuguese overseas trade, during the first ten years of Iberian Union. The focus is not in products or routes, but in the mechanisms of association of such merchants. Iberian Union created a legal framework which prohibited the interference and trade of Portuguese agents in the Spanish Empire and vice-versa. Due to the imperialist wars of the Habsburgs, the Portuguese Empire also suffered from Dutch and English rivalry both in the Indic and in the Atlantic and also from the embargos of Dutch and English products and ships in Iberian ports. In such conjuncture, how did merchants related with each other? What was the impact of the political union of the Portuguese and Spanish crowns in trading associations? The used data sources are the notarial contracts of Lisbon for the same period. The paper highlights the role of Castilian merchants in the Portuguese trade, but it also stresses that Iberian partnerships have prevailed before 1580. The role of other merchants, such as Flemish/Dutch, Germans, Italians and French, is also considered. The paper discusses how and why did these merchants join in trans-national partnerships and what was their role in the Portuguese trade network at the time.

Mapping spatial and temporal potassium balances in Brazilian soils of south-west Goias.

Introduction: Brazil, is one of the main agricultural producers in the world ranking 1st in the production of sugarcane, coffee and oranges. It is also 2nd as world producer of soybeans and a leader in the harvested yields of many other crops. The annual consumption of mineral fertilizers exceeds 20 million mt, 30% of which corresponds to potash fertilizers (ANDA, 2006). From this statistic it may be supposed that fertilizer application in Brazil is rather high, compared with many other countries. However, even if it is assumed that only one fourth of this enormous 8.5 million km2 territory is used for agriculture, average levels of fertilizer application per hectare of arable land are not high enough for sustainable production. One of the major constraints is the relatively low natural fertility status of the soils which contain excessive Fe and Al oxides. Agriculture is also often practised on sandy soils so that the heavy rainfall causes large losses of nutrients through leaching. In general, nutrient removal by crops such as sugarcane and tropical fruits is much more than the average nutrient application via fertilization, especially in regions with a long history of agricultural production. In the recently developed areas, especially in the Cerrado (Brazilian savanna) where agriculture has expanded since 1980, soils are even poorer than in the "old" agricultural regions, and high costs of mineral fertilizers have become a significant input factor in determining soybean, maize and cotton planting. The consumption of mineral fertilizers throughout Brazil is very uneven. According to the 1995/96 Agricultural Census, only in eight of the total of 26 Brazilian states, were 50 per cent or more of the farms treated "systematically" with mineral fertilizers; in many states it was less than 25 per cent, and in five states even less than 12 per cent (Brazilian Institute for Geography and Statistics; Censo Agropecuario1995/96, Instituto Brazileiro de Geografia e Estadistica; IBGE, www.ibge.gov.br). The geographical application distribution pattern of mineral fertilizers may be considered as an important field of research. Understanding geographical disparities in fertilization level requires a complex approach. This includes evaluation of the availability of nutrients in the soil (and related soil properties e.g. CEC and texture), the input of nutrients with fertilizer application, and the removal of nutrients by harvested yields. When all these data are compiled, it is possible to evaluate the balance of particular nutrients for certain areas, and make conclusions as to where agricultural practices should be optimized. This kind of research is somewhat complicated, because it relies on completely different sources of data, usually from incomparable data sources, e.g. soil characteristics attributed to soil type areas, in contrast to yields by administrative regions, or farms. A priority tool in this case is the Geographical Information System (GIS), which enables attribution of data from different fields to the same territorial units, and makes possible integration of these data in an "inputoutput" model, where "input" is the natural availability of a nutrient in the soil plus fertilization, and "output" export of the same nutrient with the removed harvested yield.

Sacra dell'Italia medio adriatica in età repubblicana. Aspetti materiali, profili ideali, interazioni culturali

La ricerca tenta di descrivere le fisionomie storico-archeologiche della colonizzazione romano-latina dell’Italia medio adriatica dalla prospettiva dei fenomeni religiosi e delle dinamiche attinenti al culto. Ci si interroga, in particolare, sui rapporti tra romanizzazione e sfera del “sacro” e su quali siano stati gli esiti e i riflessi sul piano religioso della dialettica culturale tra Tirreno e Adriatico in età repubblicana. Ovvero, su come le dinamiche proprie del culto e del rito fossero coinvolte, riflettendoli, nei più ampi processi di scambio e di interazione culturale correlati alla colonizzazione romano-latina del comparto medio adriatico della Penisola tra III e I secolo a.C. Partendo dalla sistematizzazione razionale di una base documentaria significativa e attraverso il riesame critico di un dossier storico-archeologico eterogeneo, la ricerca procede con taglio tematico verso la ricostruzione dei cd. “sacra coloniali” e dei principali aspetti che concorrono alla definizione di una fenomenologia del sacro della colonizzazione romano-latina dell’Italia medio adriatica.

Essays on social networks, altruism and information diffusion

This dissertation consists of three standalone articles that contribute to the economics literature concerning technology adoption, information diffusion, and network economics in one way or another, using a couple of primary data sources from Ethiopia. The first empirical paper identifies the main behavioral factors affecting the adoption of brand new (radical) and upgraded (incremental) bioenergy innovations in Ethiopia. The results highlight the importance of targeting different instruments to increase the adoption rate of the two types of innovations. The second and the third empirical papers of this thesis, use primary data collected from 3,693 high school students in Ethiopia, and shed light on how we should select informants to effectively and equitably disseminate new information, mainly concerning environmental issues. There are different well-recognized standard centrality measures that are used to select informants. These standard centrality measures, however, are based on the network topology---shaped only by the number of connections---and fail to incorporate the intrinsic motivations of the informants. This thesis introduces an augmented centrality measure (ACM) by modifying the eigenvector centrality measure through weighting the adjacency matrix with the altruism levels of connected nodes. The results from the two papers suggest that targeting informants based on network position and behavioral attributes ensures more effective and equitable (gender perspective) transmission of information in social networks than selecting informants on network centrality measures alone. Notably, when the information is concerned with environmental issues.