Le diagnostic des tuméfactions latérales solides cervicales chez l'enfant

Introduction : Faute de tests diagnostiques précis, une étude histologique est souvent nécessaire pour diagnostiquer les tuméfactions latérales solides cervicales (TLSC) chez l’enfant. Nous étudierons les modalités diagnostiques pour les TLSC afin de créer une approche diagnostique standardisée intégrant de nouveaux outils diagnostics à ceux actuellement offerts. Méthodologie : Après révision des étiologies et des modalités diagnostiques, une revue de la littérature a été effectuée. Une étude rétrospective entre 2002 à 2012 est présentée suivie d’une étude de faisabilité de la cytoponction. Puis, un arbre décisionnel est créé basé sur nos résultats et sur l’avis d’un groupe d’experts de différentes disciplines médicales. Résultats : Le diagnostic différentiel des TLSC est varié, la littérature scientifique est désuète et la comparaison reste difficile. Pour nos 42 enfants avec un âge médian de sept ans, les tuméfactions inflammatoires représentent 59% (26/44 biopsies) des TLSC, surtout des lymphadénites à mycobactérie atypique (13/26) qui ont un dépistage ardu et multimodal. La biopsie fut peu contributive à la prise en charge dans 39% (17/44) des cas. La cytoponction sous échoguidance est une technique diagnostique faisable et moins invasive que la biopsie. L’arbre décisionnel offre aux cliniciens une approche diagnostique standardisée des TLSC appuyée sur des faits scientifiques que nous souhaitons valider par une étude prospective. Conclusion : Les TLSC chez l’enfant représentent un défi diagnostic et notre arbre décisionnel répond au manque de standardisation dans l’approche diagnostique. Une étude prospective sur notre arbre décisionnel est en voie d’acceptation au CHU Sainte-Justine.

The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

Background: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. METHODS: To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. CONCLUSIONS: In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.

Public Opinion and Global Justice

The concept of global justice has been developed to stress the worldwide implications of moral problems. Not much, however, has been written about the actual politics of global justice. This article focuses on public opinion and argues that attitudes about international redistribution are not a simple projection of attitudes about the domestic situation. In countries where domestic income redistribution is seen as an important priority, foreign aid is less popular; where this is less so, there is more concern for the fate of the poor in the South. Far from reflecting a lack of coherence in public opinion, these counterintuitive results need to be understood in connection with policy achievements in donor countries. The authors' empirical findings suggest that although the commitment to redistribute is stronger at the national level, relationships of solidarity do not stop at national boundaries. The achievement of justice at home in fact sustains justice abroad.

Farm Programmes of Electronic Media: A Comparative Study of Audience Perception in Kerala

Farm communication and extension programs are vital part of the farm development attempts. Electronic media plays a major role in farm extension activities. Kerala, the consumer state, which was a complete agricultural state in pre-independence period, is the sprouting land of agricultural extension and publication activities in print media. Later AIR (All India Radio) farm programs and farm broadcasting of Doordarshan enriched the role of electronic media in farm extension activities. The media saturated southern state of India received this new electronic media farm communication revolution whole heartedly. However, after 1990, Kerala witnessed a flood of private T V channels and currently there are 24 channels in this regional language, named Malayalam. All major news and entertainment channels are broadcasting farm programs. Farm programs of AIR and Doordarshan, broadcasted in Malayalam language, have been well accepted to the farmers‘ in Kerala. However, post-independence period, witnessed the formation of Kerala state in Indian Union and the first ballot-elected communist Government started its administration. After the land reform bills, the state witnessed a gradual decrease in agricultural production. Even if it is not reflected much in the attitude and practices of farm community and farm broadcast of traditional electronic broadcasting, a change is observable after the post-liberalization era of India. Private Television channels, which were focused on entertainment value of programs, started broadcasting farm programs and the parameters of program production went through certain changes. In this situation, there is ample relevance for a study about the farm programs of electronic media in terms of a comparative study of audience perception. The study is limited in the state of Kerala as it is the most media saturated state in India. The study analyzes the rate, nature and scope of adoption of farming methods transmitted through electronic media (T.V. and Radio) in Malayalam language.All kinds of Farm programs including comprehensive program serials, success stories, seasonal cropping methods, experts opinion, been analyzed on the basis of the following objectives.  To find whether propagating new farm methods through farm programs in electronic media or the availability of adequate infrastructure and economic factors make a farmer to adopt a new farming method.  To find which electronic media has more influence on farmers to adopt agricultural programs.  To find which form of electronic media gets better feedback from farmers  To find out whether the programs of T.V. or Radio is more acceptable to farmers than the print media.  To find whether farmers gets the message through their preferred medium for the message. The researcher recorded opinions from a panel of agricultural officers, farm Information officers, agro extension researchers and experts. According to their opinions and guidelines, a pilot study is designed and conducted in Kanjikuzhy Panchayath, in Alappuzha district, Kerala. The Panchayath is selected by considering its ideal nature of being the sample for a social Science research. Besides, the nature of farming in the Panchayath, which devoid of the cultivation of cash crops also supported its sample value. As per the observations from the pilot study, researcher confirmed the Triangulation method as the methodology of research. The questionnaire survey, being the primary part contained 42 Questions with 6 independent and 32 dependent variables. The survey is conducted among 400 respondents in Idukki, Alappuzha and Pathanamthitta districts considering geographical differences and distribution of different types of crops. The response from a total of 360 respondents, 120 from each district, finally selected for tabulation and data analysis.The data analysis, based on percentage analysis, along with the results from focus group discussion among a selected group of 20 farmers, together produced the results as follows. Farmers, who are the audience of farm programs, have a very serious approach towards the medium. They are maintaining a critical point of view towards the content of the programs. Farmers are reasonably aware about the financial side of the programs and the monitory aspirations of both private and Government owned Television channels. Even though, the farmers are not aware on the technical terminology and jargons, they have ideas about success stories, program serials and they are even informed about channels are not maintaining an audience research section like AIR. Though the farmers accept Doordarshan as the credential source of farm information and methods, they are inclined to the entertainment value of programs too. They prefer to have more entertainment value for the programs of Doordarshan. Surprisingly, they have very solid suggestions on even about the shots which add entertainment value to the farm broadcasting methods of Doordarshan. Farmers are very much aware about the fact that media is just an instrument for inspiration and persuasion. They strongly believe that the source of information and new methods is agricultural research and an effective change happens only when there are adequate infrastructure and marketing facilities, along with the proper support from Government agricultural guideline and support systems like Krishi Bhavans. They strongly believe that media alone cannot create any magic in increasing agricultural production. Farmers are pointing out the lack of response to the feedback and queries of farmers on farming methods, as an evidence for the difference in levels of commitment of Government and private owned Television channels.Farmers are still perceiving AIR farm programs are far more committed to farmers and farming than any other electronic medium. However, they are seriously lacking Radio receivers with medium wave reception facility. Farmers perceive that the farming methods on new crops are more adoptable than the farming methods of traditional crops in both private and Government owned Television channels. There are multiple factors behind this observation from farmers. Farmers changed in terms of viewing habits and they prefer success stories, which are totally irrelevant and they even think that such stories encourage people to go for farming and they opined that such stories are good sources of inspiration. However, they are all very much sure about the importance and particular about the presence of entertainment factor even in farm programs. Farmers expect direct interaction of any expert of the new farming method to implement the method in their agriculture practices. Though introduction of a new idea in the T.V. is acceptable, farmers need the direct instruction of expert on field to start implementing the new farming practices Farmers still have an affinity towards print media reports and agricultural pages and they have complaints to print media on the removal of agricultural information pages from news papers. They prefer the reports in print media as it facilitates them to collect and refer articles when they need it. Farmers are having an eye of doubt about the credibility of farm programs by private T.V. channels. Even if they prefer private Television channels for listening and adopting new farming methods and other farm information, they scrutinize programs to know whether they are sponsored programs by agrochemical or agro-fertilizer manufacturer.

Acquiring expert knowledge for the design of conceptual information systems

Conceptual Information Systems unfold the conceptual structure of data stored in relational databases. In the design phase of the system, conceptual hierarchies have to be created which describe different aspects of the data. In this paper, we describe two principal ways of designing such conceptual hierarchies, data driven design and theory driven design and discuss advantages and drawbacks. The central part of the paper shows how Attribute Exploration, a knowledge acquisition tool developped by B. Ganter can be applied for narrowing the gap between both approaches.

Interacting software-agents to support a kind of expert supervision systems

Expert supervision systems are software applications specially designed to automate process monitoring. The goal is to reduce the dependency on human operators to assure the correct operation of a process including faulty situations. Construction of this kind of application involves an important task of design and development in order to represent and to manipulate process data and behaviour at different degrees of abstraction for interfacing with data acquisition systems connected to the process. This is an open problem that becomes more complex with the number of variables, parameters and relations to account for the complexity of the process. Multiple specialised modules tuned to solve simpler tasks that operate under a co-ordination provide a solution. A modular architecture based on concepts of software agents, taking advantage of the integration of diverse knowledge-based techniques, is proposed for this purpose. The components (software agents, communication mechanisms and perception/action mechanisms) are based on ICa (Intelligent Control architecture), software middleware supporting the build-up of applications with software agent features

Expert supervision based on cases

The paper focuses on taking advantage of large amounts of data that are systematically stored in plants (by means of SCADA systems), but not exploited enough in order to achieve supervisory goals (fault detection, diagnosis and reconfiguration). The methodology of case base reasoning (CBR) is proposed to perform supervisory tasks in industrial processes by re-using the stored data. The goal is to take advantage of experiences, registered in a suitable structure as cam, avoiding the tedious task of knowledge acquisition and representation needed by other reasoning techniques as expert systems. An outlook of CBR terminology and basic concepts are presented. The adaptation of CBR in performing expert supervisory tasks, taking into account the particularities and difficulties derived from dynamic systems, is discussed. A special interest is focused in proposing a general case definition suitable for supervisory tasks. Finally, this structure and the whole methodology is tested in a application example for monitoring a real drier chamber

Expectativas del nuevo proyecto para la reforma al sistema de salud 2013

Esta investigación se desarrolla, bajo una hipótesis, la cual se busca comprobar, analizando la evidencia encontrada en documentos Teóricos investigativos de autores expertos y especialistas en el tema y en publicaciones de la prensa nacional además de las leyes que corresponden a las dos reformas de la salud la 1122 de 2007 y la 1438 de 2011. La hipótesis planteada para esta investigación es que “mientras los nuevos planteamientos para la reforma de la salud no incluyan dentro de su propuesta una solución evidente a los principales problemas encontrados en el sistema de salud actual y no establezca un control fiscal y una regulación verdadera sobre el manejo de los fondos del sistema de salud; Los principios de universalidad, eficiencia, integralidad, libre escogencia, competencia sana y calidad no serán cumplidos y por lo tanto el pueblo Colombiano no podrá ejercer su derecho a la salud como lo plantea la Constitución Política de Colombia de 1991 y la ley 100 de 1993. Para comprobar la hipótesis se han seleccionado como documentos a analizar, tres publicaciones de la prensa nacional, cuatro de autores expertos y especializados en el tema y tres documentos adicionales que corresponden a las dos reformas realizadas al sistema de salud en los años 2007 y 2011 y a la nueva propuesta radicada por el gobierno nacional a inicios de este año. Es de suma importancia conocer las apreciaciones de los autores sobre el grupo de variables que se utilizarán para desarrollar este estudio. Estas variables pertenecen a aquellas que influencian el equilibrio financiero y que adicionalmente afectan directamente a la población impactando su bienestar y su calidad de vida. Entre esas variables se destacan (i) aspectos demográficos y de la fuerza laboral, (ii) aspectos económicos como los niveles de ingreso, salarios y empleo, (iii) cobertura del sistema de salud, (iv) calidad y acceso a los servicios del sistema, (v) duplicidad del gasto (vi) flujo de los recursos del sistema de salud (problemas institucionales), (vii) Gasto en salud y estabilidad financiera y (viii) regulación financiera. El Formato utilizado para la comparación análisis y síntesis de los documentos teóricos investigativos y de las publicaciones de la prensa nacional, consta de tres cuerpos. El primero, contiene las características relacionadas con tiempo y espacio de la publicación. El segundo, hace énfasis en el contenido y en los temas y variables de interés para el desarrollo de la investigación. Y el tercero hace énfasis en el contenido y en los temas y variables de interés para el desarrollo de la investigación. Al hacer el análisis, síntesis y comparación de estos artículos se resolverán algunos interrogantes que pueden llevarnos a comprobar la hipótesis como los son:¿Cuáles han sido los principales logros en salud con el sistema actual?, ¿Cuáles han sido las principales fallas o problemas en el sistema actual de salud?, ¿Hay un buen manejo de los fondos destinados al sistema de Salud actual?, ¿La gestión financiera del Sistema de Salud Colombiano, permite que este sea un sistema de salud sostenible y perdurable para todos los colombianos?. Adicionalmente, existen otros interrogantes a destacar como lo son ¿En qué consiste la nueva reforma de Salud propuesta para el 2013?, ¿Los cambios planteados en la última propuesta para hacer una reforma al sistema de salud, realmente conducen a un avance o dejan de lado los principales problemas de la seguridad social en Colombia?, ¿La nueva propuesta para la reforma de la salud busca lograr una mejora radical en la gestión financiera del Sistema de Salud Colombiano?, ¿Cuál es la percepción de los principales autores, especialistas en el tema en cuanto a la erradicación total de los problemas más álgidos en el actual Sistema de Salud Colombiano, con la nueva propuesta para la reforma de la salud para el 2013? Este trabajo de investigación surgió debido a la radicación de una nueva propuesta para la reforma a la salud y la polémica que se ha generado alrededor de esta. Veinte años después de la aprobación de la ley 100, se han identificado logros importantes principalmente en cuanto a cobertura; lastimosamente, actualmente se han manifestado problemas financieros y de liquidez, a pesar de lo cual, vale la pena destacar que el sistema fue rentable e incluso generó excedentes financieros en su operación, durante sus primeros 10 años de funcionamiento. Ahora, según la evidencia teórica investigativa y de la prensa nacional, se determinará si la nueva propuesta para la reforma de la salud es una buena opción para el país.

Expert. 'Experto'.

Expert, y su programa asociado Gestor, está dirigido a alumnos de ESO a partir de 12 años. Se trata de un software educativo pensado para ayudar en el planteamiento y resolución de problemas: Expert permite ejercitarse (al alumno) a través de la resolución de problemas e incluye un sistema experto de ayuda. Por su parte, Gestor permite añadir nuevos problemas al profesor o alumno a través de una base de datos. Este programa pretende emular al profesor en el planteamiento, ayuda y resolución de actividades, siendo muy apropiado para matemáticas, física, química, cálculo mercantil y otros temas. Incluye un breve manual de instalación y utilización.

Desenvolupament d'un sistema expert com a eina per a una millor gestió de la qualitat de les aigües fluvials

Avui en dia no es pot negar el fet que els humans són un component més de les conques fluvials i que la seva activitat afecta enormement la qualitat de les aigües. A nivell europeu, l'elevada densitat de població situada en les conques fluvials ha comportat un increment de la mala qualitat de les seves aigües fluvials. En les darreres dècades l'increment de les càrregues de nutrients en els sistemes aquàtics ha esdevingut un problema prioritari a solucionar per les administracions competents en matèria d'aigua. La gestió dels ecosistemes fluvials no és una tasca fàcil. Els gestors es troben amb què són sistemes molt complexos, donada l'estreta relació existent entre els ecosistemes fluvials i els ecosistemes terrestres que drenen. Addicionalment a la complexitat d'aquests sistemes es troba la dificultat associada de la gestió o control de les entrades de substàncies contaminants tant de fonts puntuals com difoses. Per totes aquestes raons la gestió de la qualitat de les aigües fluvials esdevé una tasca complexa que requereix un enfocament multidisciplinar. Per tal d'assolir aquest enfocament diverses eines han estat utilitzades, des de models matemàtics fins a sistemes experts i sistemes de suport a la decisió. Però, la major part dels esforços han estat encarats cap a la resolució de problemes de reduïda complexitat, fent que molts dels problemes ambientals complexos, com ara la gestió dels ecosistemes fluvials, no hagin estat vertaderament tractats. Per tant, es requereix l'aplicació d'eines que siguin de gran ajuda en els processos de presa de decisions i que incorporin un ampli coneixement heurístic i empíric: sistemes experts i sistemes de suport a la decisió. L'òptima gestió de la qualitat de l'aigua fluvial requereix una aproximació integrada i multidisciplinar, que pot ésser aconseguida amb una eina intel·ligent construïda sobre els conceptes i mètodes del raonament humà. La present tesi descriu la metodologia desenvolupada i aplicada per a la creació i construcció d'un Sistema Expert, així com el procés de desenvolupament d'aquest Sistema Expert, com el principal mòdul de raonament d'un Sistema de Suport a la Decisió Ambiental. L'objectiu principal de la present tesi ha estat el desenvolupament d'una eina d'ajuda en el procés de presa de decisions dels gestors de l'aigua en la gestió de trams fluvials alterats antròpicament per tal de millorar la qualitat de la seva aigua fluvial. Alhora, es mostra el funcionament de l'eina desenvolupada a través de dos casos d'estudi. Els resultats derivats del Sistema Expert desenvolupat, implementat i presentat en la present tesi mostren que aquests sistemes poden ésser eines útils per a millorar la gestió dels ecosistemes fluvials.

The new professional: underdog or expert? New Museology in the 21th century

For a long time, museum’s form and function were impregnated with social exclusion, only accessible for a prosperous and educated minority. It held the monopoly on the past and therefore in a way on the present and the future. However times have changed and different perspectives on museum practices have been taken. In 1989 the British Peter Vergo mentioned as quoted below, a number of possible museologies, including a ‘new’, and therefore presumably an ‘old’ type of museology: “At the simplest level I would define it, as a state of widespread dissatisfaction with the ‘old’ museology, both within and outside the museum profession; and though the reader may object that such a definition is not merely negative, but circular, I would retort that what is wrong with the ‘old’ museology is that it is too much about museum methods, and too little about purposes of museums; that museology has in the past only frequently been seen, if it has been seen at all, as a theoretical and humanistic discipline.” (Vergo, 1989)