Transformations in Deuteronomistic and Biblical Historiography. On "Book-Finding" and other Literary Strategies

L'a. cherche à dater l'historiographie deutéronomiste et à établir une transformation à l'intérieur de cette historiographie. Les écrits de propagande de l'époque de Josias (Rois, Deutéronome, Josué, Exode et Nombres) ont été changés après la catastrophe de 597/87 en récit historique prenant une distance et présentant la Tora prenant la relève de l'autorité perdue du Temple. L'A. peut ainsi pencher pour une rédaction de ce courant historiographique datant de l'époque post-éxilique.

Chronic illness, life style and emotional health in adolescence: results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland.

The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P=0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P=0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. CONCLUSION: experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

Comunicar la ciudad desde el paisaje: hacia una teoría del landscape branding

La necesidad de descodificar los significados inherentes al paisaje, la interactuación sociedadpaisaje (comunicación intra e interpersonal) y, más recientemente, los usos de paisaje a modo de aparador territorial mediático en el ámbito, por ejemplo, de la comunicación publicitaria, del citymarketing o del place branding (comunicación masiva), sirven para plantear el estudio de lo que, de algún modo, representa la persuasión del paisaje, la cual incluye claros tintes emocionales y simbólicos y, por tanto, también comunicacionales. El paisaje en su condición de imagen y/o rostro del territorio acumula la esencia del mensaje implícito en el espacio, posicionándose, de este modo, como la gran metáfora comunicativa de la ciudad. En este sentido, el trabajo de comunicación específico con el intangible paisajístico, unido a la reciente explosión de las denominadas geografías emocionales, plantea una teoría del mensaje territorial basada en la unión de las variables geografía, paisaje, emoción y comunicación. Históricamente, de los estudios de paisaje se han ocupado los geógrafos, arquitectos, historiadores, sociólogos o ambientólogos, entre muchos otros, sin embargo, el paisaje se ha mantenido poco explorado desde la perspectiva de la comunicación. En este sentido, es notoria la proliferación de análisis que ponen el acento en el papel que desarrolla el territorio como mediador de procesos de comunicación o en el estudio de procesos de retroalimentación entre la sociedad y sus espacios (cognición y/o percepción). El actual mercadeo identitario con los lugares se concreta en la creciente producción de marcas territoriales, las cuales acumulan, en los últimos tiempos, un importante protagonismo.

Strategies for improving outcomes in NSCLC: a look to the future.

Advances in the management of non-small cell lung cancer (NSCLC) over the past 30 years have led to small increases in 5-year survival rates across Europe, though further improvements may require new treatment strategies. In order to improve efficiency and reduce the cost of development, future trials for new targeted agents in NSCLC should aim to recruit patients on the basis of tumour biology rather than clinical characteristics. However, identification of predictive biomarkers is required to maximise the benefits of new approaches and expedite the drug development process. Nevertheless, the NSCLC landscape is changing rapidly, and recent improvements in our understanding of the molecular biology of the disease will help in the identification of novel targeted agents as well as assisting in the development of personalised strategies for the numerous small subsets of defined NSCLC. Progress in imaging and treatment delivery is also likely to improve outcomes for patients with the disease. This article outlines recent progress in the treatment of NSCLC, identifies current challenges and describes proposals for improving the future management of the disease. It is hoped that implementation of some of these strategies will go some way to improving the outlook for patients with NSCLC.

Treatment strategies in primary vitreoretinal lymphoma: a 17-center European collaborative study.

IMPORTANCE: The best treatment option for primary vitreoretinal lymphoma (PVRL) without signs of central nervous system lymphoma (CNSL) involvement determined on magnetic resonance imaging or in cerebrospinal fluid is unknown. OBJECTIVE: To evaluate the outcomes of treatment regimens used for PVRL in the prevention of subsequent CNSL. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at 17 referral ophthalmologic centers in Europe. We reviewed clinical, laboratory, and imaging data on 78 patients with PVRL who did not have CNSL on presentation between January 1, 1991, and December 31, 2012, with a focus on the incidence of CNS manifestations during the follow-up period. INTERVENTIONS: The term extensive treatment was used for various combinations of systemic and intrathecal chemotherapy, whole-brain radiotherapy, and peripheral blood stem cell transplantation. Therapy to prevent CNSL included ocular radiotherapy and/or ocular chemotherapy (group A, 31 patients), extensive systemic treatment (group B, 21 patients), and a combination of ocular and extensive treatment (group C, 23 patients); 3 patients did not receive treatment. A total of 40 patients received systemic chemotherapy. MAIN OUTCOMES AND MEASURES: Development of CNSL following the diagnosis of PVRL relative to the use or nonuse of systemic chemotherapy and other treatment regimens. RESULTS: Overall, CNSL developed in 28 of 78 patients (36%) at a median follow-up of 49 months. Specifically, CNSL developed in 10 of 31 (32%) in group A, 9 of 21 (43%) in group B, and 9 of 23 (39%) in group C. The 5-year cumulative survival rate was lower in patients with CNSL (35% [95% CI, 50% to 86%]) than in patients without CNSL (68% [95% CI, 19% to 51%]; P = .003) and was similar among all treatment groups (P = .10). Adverse systemic effects occurred in 9 of 40 (23%) patients receiving systemic chemotherapy; the most common of these effects was acute renal failure. CONCLUSIONS AND RELEVANCE: In the present series of patients with isolated PVRL, the use of systemic chemotherapy was not proven to prevent CNSL and was associated with more severe adverse effects compared with local treatment.

Cohesion, satisfaction with family bonds, and emotional well-being in families with adolescents

The present paper investigated whether higher cohesion and satisfaction with family bonds were associated with the daily experience of emotional well-being in varying social circumstances. Using a sample of school-age adolescents (N = 95) and both their parents, data were gathered daily over 1 week using a diary approach in addition to self-report instruments. Multilevel analyses revealed higher cohesion to be associated with well-being in fathers and adolescents, but not in mothers. Parents also reported higher well-being when with friends or colleagues than when alone. Moreover, fathers who scored higher on cohesion reported higher well-being when with family members than when alone, whereas adolescents who scored higher on satisfaction with bonds reported lower well-being when with peers or siblings than when alone.

L' Impacte de la mort en estudiants d'infermeria durant el seu primer període de pràctiques

La mort i el procés de morir són fets quotidians en les persones grans i, conseqüentment, en els centres sociosanitaris, on bona part de les persones usuàries són d’edat avançada. Tot i que es tracta d’un fenomen natural que s’inclou dins del cicle vital de les persones, en la nostra societat la mort encara provoca rebuig, por, ansietat, tristesa i inquietud. En aquest marc, les estudiants1 d’infermeria són un col·lectiu que poden patir especialment l’impacte de la mort. Primer, perquè com a membres de la societat tenen interioritzat el codi social preestablert envers aquest tema i, segon, perquè durant la seva formació estan en contacte amb persones que estan al final de la vida i poden presenciar vivències de mort. En el primer període de pràctiques dels estudis d’infermeria, les estudiants han de fer front a diverses situacions del dia a dia fins aleshores desconegudes. Els conflictes interpersonals amb l'equip de treball i la inseguretat sobre les habilitats i les competències professionals són alguns dels aspectes que acostumen a viure amb més tensió. Tot i això, el que més impacte els provoca és la cura de les persones al final de la vida. Davant d'una situació de tensió, la persona viu un component estressor, que suposa el punt d’inflexió. A partir d’aquí s’activen els components adaptatius, que és el que emocionalment fa que la persona pugui fer front a aquesta situació estressant. A més, hi ha un component de suport, que són les ajudes que té. Segons com es treballi el component adaptatiu farà que la persona reaccioni en un futur de forma més automàtica i inconscient o, al contrari, que la persona respongui de forma més conscient i intencionada. El present treball està concebut per comprendre quins elements psicosocials – components estressors i components de suport– poden afectar a les estudiants que presencien la vivència de la mort de malalts geriàtrics terminals en el primer període de pràctiques en un centre sociosanitari. S’ha dissenyat un estudi descriptiu transversal quantitatiu, de caràcter exploratori, per tal de descriure la freqüència i algunes característiques psicosocials al voltant de la mort en estudiants d'infermeria en el seu primer període de pràctiques, tant a nivell personal com a nivell professional. La mostra de l'estudi són 65 estudiants, la majoria són dones d'entre els 18 i els 29 anys –més d’un 90%–. Els resultats indiquen que un 80% dels futurs professionals estudiats han patit la mort d’alguna persona significativa al llarg de la seva vida; d'aquests, gairebé un de cada quatre presenta dol complicat. Quant a la vivència de mort en les pràctiques, el 83% l'ha experimentat. Tot i aquest elevat percentatge, no totes les experiències tenen una connotació negativa. En prop de la meitat dels casos, les morts són percebudes com una experiència enriquidora i natural. Els components estressors més impactants que les estudiants han viscut durant les pràctiques per la mort d’alguna persona malalta són: la reacció de la família del finat, el patiment que es genera al seu voltant, algun signe o símptoma físic experimentat pel malalt al final del procés, i la pròpia reacció emocional. Els components de suport expressats són: saber gestionar les pròpies emocions, tenir més formació sobre relació d’ ajuda i empatia, tenir més formació en control de símptomes i comunicació, per atendre usuaris –tant malalts com familiars- i que algú els informés i orientés en el procés. Altres resultats a tenir en compte són que la població estudiada té més preocupació o inquietud per la mort i el procés de morir de la persona estimada i menys per la pròpia mort. A més, tot i que la meitat no hagués escollit geriatria com opció a les primeres pràctiques clíniques, gairebé tot el grup estudiat ho recomanaria després d'haver viscut l'experiència. Les implicacions pràctiques d'aquest estudi porten a pensar que es pot reorientar la informació i preparació que es dóna a les estudiants d’infermeria abans del primer contacte amb la realitat dels centres sociosanitaris, així com també el paper de formació i suport que pot fer tant la persona tutora de pràctiques com les infermeres de referència dels diferents centres. En conclusió, caldria dissenyar estratègies formatives i de suport entorn a la preparació psicològica personal de l’estudiant; entorn a l’acompanyament, les cures pal·liatives i el dol; i valorar la seva eficiència en el futur.

Workgroup report: incorporating in vitro alternative methods for developmental neurotoxicity into international hazard and risk assessment strategies.

This is the report of the first workshop on Incorporating In Vitro Alternative Methods for Developmental Neurotoxicity (DNT) Testing into International Hazard and Risk Assessment Strategies, held in Ispra, Italy, on 19-21 April 2005. The workshop was hosted by the European Centre for the Validation of Alternative Methods (ECVAM) and jointly organized by ECVAM, the European Chemical Industry Council, and the Johns Hopkins University Center for Alternatives to Animal Testing. The primary aim of the workshop was to identify and catalog potential methods that could be used to assess how data from in vitro alternative methods could help to predict and identify DNT hazards. Working groups focused on two different aspects: a) details on the science available in the field of DNT, including discussions on the models available to capture the critical DNT mechanisms and processes, and b) policy and strategy aspects to assess the integration of alternative methods in a regulatory framework. This report summarizes these discussions and details the recommendations and priorities for future work.

Therapeutic strategies to improve control of hypertension.

Blood pressure is poorly controlled in most European countries and the control rate is even lower in high-risk patients such as patients with chronic kidney disease, diabetic patients or previous coronary heart disease. Several factors have been associated with poor control, some of which involve the characteristic of the patients themselves, such as socioeconomic factors, or unsuitable life-styles, other factors related to hypertension or to associated comorbidity, but there are also factors directly associated with antihypertensive therapy, mainly involving adherence problems, therapeutic inertia and therapeutic strategies unsuited to difficult-to-control hypertensive patients.It is common knowledge that only 30% of hypertensive patients can be controlled using monotherapy; all the rest require a combination of two or more antihypertensive drugs, and this can be a barrier to good adherence and log-term persistence in patients who also often need to use other drugs, such as antidiabetic agents, statins or antiplatelet agents. The fixed combinations of three antihypertensive agents currently available can facilitate long-term control of these patients in clinical practice. If well tolerated, a long-term therapeutic regimen that includes a diuretic, an ACE inhibitor or an angiotensin receptor blocker, and a calcium channel blocker is the recommended optimal triple therapy.

Time-lapse and probabilistic inversion strategies for plane-wave electromagnetic data.

L'utilisation efficace des systèmes géothermaux, la séquestration du CO2 pour limiter le changement climatique et la prévention de l'intrusion d'eau salée dans les aquifères costaux ne sont que quelques exemples qui démontrent notre besoin en technologies nouvelles pour suivre l'évolution des processus souterrains à partir de la surface. Un défi majeur est d'assurer la caractérisation et l'optimisation des performances de ces technologies à différentes échelles spatiales et temporelles. Les méthodes électromagnétiques (EM) d'ondes planes sont sensibles à la conductivité électrique du sous-sol et, par conséquent, à la conductivité électrique des fluides saturant la roche, à la présence de fractures connectées, à la température et aux matériaux géologiques. Ces méthodes sont régies par des équations valides sur de larges gammes de fréquences, permettant détudier de manières analogues des processus allant de quelques mètres sous la surface jusqu'à plusieurs kilomètres de profondeur. Néanmoins, ces méthodes sont soumises à une perte de résolution avec la profondeur à cause des propriétés diffusives du champ électromagnétique. Pour cette raison, l'estimation des modèles du sous-sol par ces méthodes doit prendre en compte des informations a priori afin de contraindre les modèles autant que possible et de permettre la quantification des incertitudes de ces modèles de façon appropriée. Dans la présente thèse, je développe des approches permettant la caractérisation statique et dynamique du sous-sol à l'aide d'ondes EM planes. Dans une première partie, je présente une approche déterministe permettant de réaliser des inversions répétées dans le temps (time-lapse) de données d'ondes EM planes en deux dimensions. Cette stratégie est basée sur l'incorporation dans l'algorithme d'informations a priori en fonction des changements du modèle de conductivité électrique attendus. Ceci est réalisé en intégrant une régularisation stochastique et des contraintes flexibles par rapport à la gamme des changements attendus en utilisant les multiplicateurs de Lagrange. J'utilise des normes différentes de la norme l2 pour contraindre la structure du modèle et obtenir des transitions abruptes entre les régions du model qui subissent des changements dans le temps et celles qui n'en subissent pas. Aussi, j'incorpore une stratégie afin d'éliminer les erreurs systématiques de données time-lapse. Ce travail a mis en évidence l'amélioration de la caractérisation des changements temporels par rapport aux approches classiques qui réalisent des inversions indépendantes à chaque pas de temps et comparent les modèles. Dans la seconde partie de cette thèse, j'adopte un formalisme bayésien et je teste la possibilité de quantifier les incertitudes sur les paramètres du modèle dans l'inversion d'ondes EM planes. Pour ce faire, je présente une stratégie d'inversion probabiliste basée sur des pixels à deux dimensions pour des inversions de données d'ondes EM planes et de tomographies de résistivité électrique (ERT) séparées et jointes. Je compare les incertitudes des paramètres du modèle en considérant différents types d'information a priori sur la structure du modèle et différentes fonctions de vraisemblance pour décrire les erreurs sur les données. Les résultats indiquent que la régularisation du modèle est nécessaire lorsqu'on a à faire à un large nombre de paramètres car cela permet d'accélérer la convergence des chaînes et d'obtenir des modèles plus réalistes. Cependent, ces contraintes mènent à des incertitudes d'estimations plus faibles, ce qui implique des distributions a posteriori qui ne contiennent pas le vrai modèledans les régions ou` la méthode présente une sensibilité limitée. Cette situation peut être améliorée en combinant des méthodes d'ondes EM planes avec d'autres méthodes complémentaires telles que l'ERT. De plus, je montre que le poids de régularisation des paramètres et l'écart-type des erreurs sur les données peuvent être retrouvés par une inversion probabiliste. Finalement, j'évalue la possibilité de caractériser une distribution tridimensionnelle d'un panache de traceur salin injecté dans le sous-sol en réalisant une inversion probabiliste time-lapse tridimensionnelle d'ondes EM planes. Etant donné que les inversions probabilistes sont très coûteuses en temps de calcul lorsque l'espace des paramètres présente une grande dimension, je propose une stratégie de réduction du modèle ou` les coefficients de décomposition des moments de Legendre du panache de traceur injecté ainsi que sa position sont estimés. Pour ce faire, un modèle de résistivité de base est nécessaire. Il peut être obtenu avant l'expérience time-lapse. Un test synthétique montre que la méthodologie marche bien quand le modèle de résistivité de base est caractérisé correctement. Cette méthodologie est aussi appliquée à un test de trac¸age par injection d'une solution saline et d'acides réalisé dans un système géothermal en Australie, puis comparée à une inversion time-lapse tridimensionnelle réalisée selon une approche déterministe. L'inversion probabiliste permet de mieux contraindre le panache du traceur salin gr^ace à la grande quantité d'informations a priori incluse dans l'algorithme. Néanmoins, les changements de conductivités nécessaires pour expliquer les changements observés dans les données sont plus grands que ce qu'expliquent notre connaissance actuelle des phénomenès physiques. Ce problème peut être lié à la qualité limitée du modèle de résistivité de base utilisé, indiquant ainsi que des efforts plus grands devront être fournis dans le futur pour obtenir des modèles de base de bonne qualité avant de réaliser des expériences dynamiques. Les études décrites dans cette thèse montrent que les méthodes d'ondes EM planes sont très utiles pour caractériser et suivre les variations temporelles du sous-sol sur de larges échelles. Les présentes approches améliorent l'évaluation des modèles obtenus, autant en termes d'incorporation d'informations a priori, qu'en termes de quantification d'incertitudes a posteriori. De plus, les stratégies développées peuvent être appliquées à d'autres méthodes géophysiques, et offrent une grande flexibilité pour l'incorporation d'informations additionnelles lorsqu'elles sont disponibles. -- The efficient use of geothermal systems, the sequestration of CO2 to mitigate climate change, and the prevention of seawater intrusion in coastal aquifers are only some examples that demonstrate the need for novel technologies to monitor subsurface processes from the surface. A main challenge is to assure optimal performance of such technologies at different temporal and spatial scales. Plane-wave electromagnetic (EM) methods are sensitive to subsurface electrical conductivity and consequently to fluid conductivity, fracture connectivity, temperature, and rock mineralogy. These methods have governing equations that are the same over a large range of frequencies, thus allowing to study in an analogous manner processes on scales ranging from few meters close to the surface down to several hundreds of kilometers depth. Unfortunately, they suffer from a significant resolution loss with depth due to the diffusive nature of the electromagnetic fields. Therefore, estimations of subsurface models that use these methods should incorporate a priori information to better constrain the models, and provide appropriate measures of model uncertainty. During my thesis, I have developed approaches to improve the static and dynamic characterization of the subsurface with plane-wave EM methods. In the first part of this thesis, I present a two-dimensional deterministic approach to perform time-lapse inversion of plane-wave EM data. The strategy is based on the incorporation of prior information into the inversion algorithm regarding the expected temporal changes in electrical conductivity. This is done by incorporating a flexible stochastic regularization and constraints regarding the expected ranges of the changes by using Lagrange multipliers. I use non-l2 norms to penalize the model update in order to obtain sharp transitions between regions that experience temporal changes and regions that do not. I also incorporate a time-lapse differencing strategy to remove systematic errors in the time-lapse inversion. This work presents improvements in the characterization of temporal changes with respect to the classical approach of performing separate inversions and computing differences between the models. In the second part of this thesis, I adopt a Bayesian framework and use Markov chain Monte Carlo (MCMC) simulations to quantify model parameter uncertainty in plane-wave EM inversion. For this purpose, I present a two-dimensional pixel-based probabilistic inversion strategy for separate and joint inversions of plane-wave EM and electrical resistivity tomography (ERT) data. I compare the uncertainties of the model parameters when considering different types of prior information on the model structure and different likelihood functions to describe the data errors. The results indicate that model regularization is necessary when dealing with a large number of model parameters because it helps to accelerate the convergence of the chains and leads to more realistic models. These constraints also lead to smaller uncertainty estimates, which imply posterior distributions that do not include the true underlying model in regions where the method has limited sensitivity. This situation can be improved by combining planewave EM methods with complimentary geophysical methods such as ERT. In addition, I show that an appropriate regularization weight and the standard deviation of the data errors can be retrieved by the MCMC inversion. Finally, I evaluate the possibility of characterizing the three-dimensional distribution of an injected water plume by performing three-dimensional time-lapse MCMC inversion of planewave EM data. Since MCMC inversion involves a significant computational burden in high parameter dimensions, I propose a model reduction strategy where the coefficients of a Legendre moment decomposition of the injected water plume and its location are estimated. For this purpose, a base resistivity model is needed which is obtained prior to the time-lapse experiment. A synthetic test shows that the methodology works well when the base resistivity model is correctly characterized. The methodology is also applied to an injection experiment performed in a geothermal system in Australia, and compared to a three-dimensional time-lapse inversion performed within a deterministic framework. The MCMC inversion better constrains the water plumes due to the larger amount of prior information that is included in the algorithm. The conductivity changes needed to explain the time-lapse data are much larger than what is physically possible based on present day understandings. This issue may be related to the base resistivity model used, therefore indicating that more efforts should be given to obtain high-quality base models prior to dynamic experiments. The studies described herein give clear evidence that plane-wave EM methods are useful to characterize and monitor the subsurface at a wide range of scales. The presented approaches contribute to an improved appraisal of the obtained models, both in terms of the incorporation of prior information in the algorithms and the posterior uncertainty quantification. In addition, the developed strategies can be applied to other geophysical methods, and offer great flexibility to incorporate additional information when available.

One minute of grief: Emotional processing in short-term dynamic psychotherapy for adjustment disorder.

OBJECTIVE: Depth of emotional processing has shown to be related to outcome across approaches to psychotherapy. Moreover, a specific emotional sequence has been postulated and tested in several studies on experiential psychotherapy (Pascual-Leone & Greenberg, 2007). This process-outcome study aims at reproducing the sequential model of emotional processing in psychodynamic psychotherapy for adjustment disorder and linking these variables with ultimate therapeutic outcome. METHOD: In this study, 32 patients underwent short-term dynamic psychotherapy. On the basis of reliable clinical change statistics, a subgroup (n = 16) presented with good outcome and another subgroup (n = 16) had a poor outcome in the end of treatment. The strongest alliance session of each case was rated using the observer-rated system Classification of Affective Meaning States. Reliability coefficients for the measure were excellent (κ = .82). RESULTS: Using 1 min as the fine-grained unit of analysis, results showed that the experience of fundamentally adaptive grief was more common in the in-session process of patients with good outcome, compared with those with poor outcomes (χ2 = 6.56, p = .01, d = 1.23). This variable alone predicted 19% of the change in depressive symptoms as measured by the Beck Depression Inventory at the end of treatment. Moreover, sequences of the original model were supported and related to outcome. CONCLUSIONS: These results are discussed within the framework of the sequential model of emotional processing and its possible relevance for psychodynamic psychotherapy. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

From current immunosuppressive strategies to clinical tolerance of allografts.

In order to prevent allograft rejection, most current immunosuppressive drugs nonspecifically target T-cell activation, clonal expansion or differentiation into effector cells. Experimental models have shown that it is possible to exploit the central and peripheral mechanisms that normally maintain immune homeostasis and tolerance to self-antigens, in order to induce tolerance to alloantigens. Central tolerance results from intrathymic deletion of T cells with high avidity for thymically expressed antigens. Peripheral tolerance to nonself-molecules can be achieved by various mechanisms including deletion of activated/effector T cells, anergy induction and active regulation of effector T cells. In this article, we briefly discuss the pathways of allorecognition and their relevance to current immunosuppressive strategies and to the induction of transplantation tolerance (through haematopoietic mixed chimerism, depleting protocols, costimulatory blockade and regulatory T cells). We then review the prospect of clinical applicability of these protocols in solid organ transplantation.

Effect of different warm-up strategies on simulated laparoscopy performance: a randomized controlled trial.

OBJECTIVE: The objective of this trial was to assess which type of warm-up has the highest effect on virtual reality (VR) laparoscopy performance. The following warm-up strategies were applied: a hands-on exercise (group 1), a cognitive exercise (group 2), and no warm-up (control, group 3). DESIGN: This is a 3-arm randomized controlled trial. SETTING: The trial was conducted at the department of surgery of the University Hospital Basel in Switzerland. PARTICIPANTS: A total of 94 participants, all laypersons without any surgical or VR experience, completed the study. RESULTS: A total of 96 participants were randomized, 31 to group 1, 31 to group 2, and 32 to group 3. There were 2 postrandomization exclusions. In the multivariate analysis, we found no evidence that the intervention had an effect on VR performance as represented by 6 calculated subscores of accuracy, time, and path length for (1) camera manipulation and (2) hand-eye coordination combined with 2-handed maneuvers (p = 0.795). Neither the comparison of the average of the intervention groups (groups 1 and 2) vs control (group 3) nor the pairwise comparisons revealed any significant differences in VR performance, neither multivariate nor univariate. VR performance improved with increasing performance score in the cognitive exercise warm-up (iPad 3D puzzle) for accuracy, time, and path length in the camera navigation task. CONCLUSIONS: We were unable to show an effect of the 2 tested warm-up strategies on VR performance in laypersons. We are currently designing a follow-up study including surgeons rather than laypersons with a longer warm-up exercise, which is more closely related to the final task.

The so-called "Spanish model" - Tobacco industry strategies and its impact in Europe and Latin America

Background To demonstrate the tobacco industry rationale behind the "Spanish model" on non-smokers' protection in hospitality venues and the impact it had on some European and Latin American countries between 2006 and 2011. Methods Tobacco industry documents research triangulated against news and media reports. Results As an alternative to the successful implementation of 100% smoke-free policies, several European and Latin American countries introduced partial smoking bans based on the so-called "Spanish model", a legal framework widely advocated by parts of the hospitality industry with striking similarities to "accommodation programmes" promoted by the tobacco industry in the late 1990s. These developments started with the implementation of the Spanish tobacco control law (Ley 28/2005) in 2006 and have increased since then. Conclusion The Spanish experience demonstrates that partial smoking bans often resemble tobacco industry strategies and are used to spread a failed approach on international level. Researchers, advocates and policy makers should be aware of this ineffective policy.