Study design for technology assessment: critical issues.

The epidemiological methods have become useful tools for the assessment of the effectiveness and safety of health care technologies. The experimental methods, namely the randomized controlled trials (RCT), give the best evidence of the effect of a technology. However, the ethical issues and the very nature of the intervention under study sometimes make it difficult to carry out an RCT. Therefore, quasi-experimental and non-experimental study designs are also applied. The critical issues concerning these designs are discussed. The results of evaluative studies are of importance for decision-makers in health policy. The measurements of the impact of a medical technology should go beyond a statement of its effectiveness, because the essential outcome of an intervention or programme is the health status and quality of life of the individuals and populations concerned.

Intratypic differentiation of polioviruses isolated from suspected cases of poliomyelitis in Brazil during the period of 1990 to 1993

This study analyzed 3129 fecal samples derived from 1626 patients with sudden onset acute flaccid paralysis clinically compatible with poliomyelitis. The samples were collected in the period ranging from January 1990 to September 1993 in all regions of Brazil. Among the 1626 cases studied, 196 had isolation of poliovirus. Nevertheless, it was observed that some factors influenced the isolation rate and the intratypic characterization of these polioviruses. No cases of acute flaccid paralysis has been found to be etiologically related with wild polioviruses.

Traitement de l'ischémie critique chronique des membres inférieurs en 2014 [Treatment of critical lower limb ischemia].

Critical limb ischemia is a major public health problem in our western countries due to the epidemia of (diabesity). The outcome of patients suffering from critical limb ischemia reains poor with an amputation free survival rate at one year of about 50%. The treatment should be multidiciplinary and done in emergency in specialized centers to ensure the limb salvage: this management should be centered aroud 3 axis: the screening of the cardiovascular risk factors, the best medical treatment and the invasive approaches. Due to multiple endovascular technical innovations, more frail patients with com plex diseases can be treated with good results. Therefore, the endovascular treatment is essential in the management of such patients by vascular surgeons.

A critical application of securitization theory: overcoming the normative dilemma of writing security

This article addresses the normative dilemma located within the application of `securitization,’ as a method of understanding the social construction of threats and security policies. Securitization as a theoretical and practical undertaking is being increasingly used by scholars and practitioners. This scholarly endeavour wishes to provide those wishing to engage with securitization with an alternative application of this theory; one which is sensitive to and self-reflective of the possible normative consequences of its employment. This article argues that discussing and analyzing securitization processes have normative implications, which is understood here to be the negative securitization of a referent. The negative securitization of a referent is asserted to be carried out through the unchallenged analysis of securitization processes which have emerged through relations of exclusion and power. It then offers a critical understanding and application of securitization studies as a way of overcoming the identified normative dilemma. First, it examines how the Copenhagen School’s formation of securitization theory gives rise to a normative dilemma, which is situated in the performative and symbolic power of security as a political invocation and theoretical concept. Second, it evaluates previous attempts to overcome the normative dilemma of securitization studies, outlining the obstacles that each individual proposal faces. Third, this article argues that the normative dilemma of applying securitization can be avoided by firstly, deconstructing the institutional power of security actors and dominant security subjectivities and secondly, by addressing countering or alternative approaches to security and incorporating different security subjectivities. Examples of the securitization of international terrorism and immigration are prominent throughout.

Territorial autonomy and self-determination conflicts: opportunity and willingness cases from Bolivia, Niger, and Thailand

The paradox of autonomy is about whether self-rule accommodates or exacerbates armed conflict. This study attempts to unpack the puzzle examining the effectiveness of territorial autonomy as a state response to self-determination conflicts throughout the world. It challenges the conflict-inducing features of autonomy arguing that territorial autonomy can mitigate armed conflict by channeling group grievances into peaceful forms of protest. Thus, this study aims at arriving at a comprehensive theory that identifies which factors are responsible for violent escalation of conflicts grounded in self-determination demands. By using the concepts of opportunity structures and willingness dimension, this study shows that conflict escalation only takes place when minorities with greater bargaining power vis-à-vis the center, in contexts of high levels of economic inequality within dyad, are mobilized around autonomy and separatist demands.

Schistosomiasis in a low prevalence area: incomplete urbanization increasing risk of infection in Paracambi, RJ, Brazil

The risk of schistosomiais infection and heavy infection in the locality of Sabugo was evaluated in relation to housing in areas with different urbanization development and to residential supply with snail-infested water. Critical sanitary conditions were found in areas of incomplete urbanization, where healthy water supply sources were scarce, and draining of sewage, without previous treatment, was made directly to the water-bodies used for domestic and leisure activities, despite being Biomphalaria tenagophila snail breeding-places. Stool examinations (Kato-Katz and Lutz methods) showed prevalence of 2.9%, mean intensity of 79 eggs per gram of stool and 47% of positive cases presenting intense infection. The use of snail-contaminated water for domestic purposes was considered a risk factor for infection. It is concluded that incomplete urbanization would facilitate transmission, probably enhancing the intensity of infection and that a low prevalence could hide a highly focal transmission. The relevance of these facts upon the efficiency of epidemiologic study methods and disease control planning are then discussed.

Scientific Evidence in Europe : Admissibility, Evaluation and Equality of Arms

This study was commissioned by the European Committee on Crime Problems at the Council of Europe to describe and discuss the standards used to asses the admissibility and appraisal of scientific evidence in various member countries. After documenting cases in which faulty forensic evidence seems to have played a critical role, the authors describe the legal foundations of the issues of admissibility and assessment of the probative value in the field of scientific evidence, contrasting criminal justice systems of accusatorial and inquisitorial tradition and the various risks that they pose in terms of equality of arms. Special attention is given to communication issues between lawyers and scientific experts. The authors eventually investigate possible ways of improving the system. Among these mechanisms, emphasis is put on the adoption of a common terminology for expressing the weight of evidence. It is also proposed to adopt an harmonized interpretation framework among forensic experts rooted in good practices of logical inference.

Vincristine and intestinal pseudo-obstruction in children: report of 5 cases, literature review, and suggested management.

Summary: Intestinal pseudo-obstruction is a rare complication resulting from a variety of disorders. Symptoms include abdominal pain, nausea, vomiting, diarrhea, constipation, and malnutrition. Vincristine-related pseudo-obstruction has been reported in the literature, but its description in children and recommendations for management are lacking. A review of the literature revealed 21 reported pediatric cases of vincristine-related pseudo-obstruction. Most have, however, been attributed to a drug interaction with itraconazole, accidental vincristine overdose, or liver failure. Potential genetic causes are rarely addressed. We present here 5 cases of pseudo-obstruction related to vincristine without any identifiable predisposing factors, and a suggested algorithm for management

A critical role for the T cell receptor alpha-chain connecting peptide domain in positive selection of CD1-independent NKT cells.

Natural killer T (NKT) cells are a subset of mature alpha beta TCR(+) cells that co-express NK lineage markers. Whereas most NKT cells express a canonical Valpha14/Vbeta8.2 TCR and are selected by CD1d, a minority of NKT cells express a diverse TCR repertoire and develop independently of CD1d. Little is known about the selection requirements of CD1d-independent NKT cells. We show here that NKT cells develop in RAG-deficient mice expressing an MHC class II-restricted transgenic TCR (Valpha2/Vbeta8.1) but only under conditions that lead to negative selection of conventional T cells. Moreover development of NKT cells in these mice is absolutely dependent upon an intact TCR alpha-chain connecting peptide domain, which is required for positive selection of conventional T cells via recruitment of the ERK signaling pathway. Collectively our data demonstrate that NKT cells can develop as a result of high avidity TCR/MHC class II interactions and suggest that common signaling pathways are involved in the positive selection of CD1d-independent NKT cells and conventional T cells.

Der Radioimmunoassay zur Ermittlung des carcinoembryonalen Antigens (CEA), seine Bedeutung und Limitierung während der postoperativen Kontrollperiode von Patienten mit colorectalem Carcino

Carcinoembryonic antigen (CEA) is a tumor marker defined by specific heterologous antisera. Elevated levels of circulating CEA can be detected by radioimmunoassay in most cases of colorectal carcinoma, depending on the degree of tumor spread. The fact that elevation of CEA level can also be observed in other types of carcinomas and in several nonmalignant conditions greatly limits the value of the CEA test for the early diagnosis of colorectal carcinomas. Repeated CEA measurements and their critical interpretation, however, appear to be of importance after tumor resection for the detection of tumor recurrence during the postoperative follow-up period.

How critical is timing for the diagnosis of influenza in general practice?

Résumé La performance diagnostic des signes et symptômes de la grippe a principalement été étudiée dans le cadre d'études contrôlées avec des critères d'inclusion stricts. Il apparaît nécessaire d'évaluer ces prédicteurs dans le cadre d'une consultation ambulatoire habituelle en tenant compte du délai écoulé entre le début des symptômes et la première consultation ainsi que la situation épidémiologique. Cette étude prospective a été menée à la Policlinique Médicale Universitaire durant l'hiver 1999-2000. Les patients étaient inclus s'ils présentaient un syndrome grippal et si le praticien suspectait une infection à Influenza. Le médecin administrait un questionnaire puis une culture d'un frottis de gorge était réalisée afin de documenter l'infection. 201 patients ont été inclus dans l'étude. 52% avaient une culture positive pour Influenza. En analyse univariée, une température > 37.8° (OR 4.2; 95% CI 2.3-7.7), une durée des symptômes < 48h (OR 3.2; 1.8-5.7), une toux (OR 3.2; 1-10.4) et des myalgies (OR 2.8; 1.0-7.5) étaient associés au diagnostic de grippe. En analyse de régression logistique, le modèle le plus performant qui prédisait la grippe était l'association d'une durée des symptômes <48h, une consultation en début d'épidémie, une température > 37.8° et une toux (sensibilité 79%, spécificité 69%, valeur prédictive positive 67%, une valeur prédictive négative de 73% et aire sous la courbe (ROC) de 0.74). En plus des signes et symptômes prédicteurs de la grippe, le médecin de premier recours devrait prendre en compte dans son jugement la durée des symptômes avant la première consultation et le contexte épidémiologique (début, pic, fin de l'épidémie), car ces deux paramètres modifient considérablement la valeurs des prédicteurs lors de l'évaluation de la probabilité clinique d'un patient d'avoir une infection à Influenza.

GABA receptor subunits in human auditory cortex in normal and stroke cases.

GABA receptors are ubiquitous in the cerebral cortex and play a major role in shaping responses of cortical neurons. GABAA and GABAB receptor subunit expression was visualized by immunohistochemistry in human auditory areas from both hemispheres in 9 normal subjects (aged 43-85 years; time between death and fixation 6-24 hours) and in 4 stroke patients (aged 59-87 years; time between death and fixation 7-24 hours) and analyzed qualitatively for GABAA and semiquantitatively for GABAB receptor subunits. In normal brains, the primary auditory area (TC) and the surrounding areas TB and TA displayed distinct GABAA receptor subunit labeling with differences among cortical layers and areas. In postacute and chronic stroke we found a layer-selective downregulation of the alpha-2 subunit in the anatomically intact cerebral cortex of the intact and of the lesioned hemisphere, whereas the alpha-1, alpha-3 and beta-2/3 subunits maintained normal levels of expression. The GABAB receptors had a distinct laminar pattern in auditory areas and minor differences among areas. Unlike in other pathologies, there is no modulation of the GABAB receptor expression in subacute or chronic stroke.

A modified Hortega-Globus stain is superior to Bielschowsky and Bodian stains for demonstrating neuritic plaques.

The quantitative assessment of the age-dependent number of neuritic plaques is essential for the diagnosis of Alzheimer type dementia. This study reports the superiority of a modified Hortega-Globus stain compared to Bielschowsky and Bodian stains applied to samples obtained from ten brains of patients with a clinical history of progressive dementia. In two of ten cases only the modified Hortega-Globus stain allowed confirmation of the diagnosis of senile dementia of the Alzheimer type (SDAT). The counts of neuritic plaques in sections stained by other methods were not sufficient to establish the histological diagnosis of SDAT. These results indicate that the choice of the most sensitive staining method is critical for the correct histopathologic diagnosis of the Alzheimer type dementia.

Screening for elevated blood pressure in children and adolescents: a critical appraisal.

Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies.