Improvement of cardiovascular risk prediction: time to review current knowledge, debates, and fundamentals on how to assess test characteristics.

Cardiovascular risk assessment might be improved with the addition of emerging, new tests derived from atherosclerosis imaging, laboratory tests or functional tests. This article reviews relative risk, odds ratios, receiver-operating curves, posttest risk calculations based on likelihood ratios, the net reclassification improvement and integrated discrimination. This serves to determine whether a new test has an added clinical value on top of conventional risk testing and how this can be verified statistically. Two clinically meaningful examples serve to illustrate novel approaches. This work serves as a review and basic work for the development of new guidelines on cardiovascular risk prediction, taking into account emerging tests, to be proposed by members of the 'Taskforce on Vascular Risk Prediction' under the auspices of the Working Group 'Swiss Atherosclerosis' of the Swiss Society of Cardiology in the future.

Embodying feminist research: learning from action research, political practices, diffractions and collective knowledge.

In the past three decades, feminists and critical theorists have discussed and argued the importance of deconstructing and problematizing social science research methodology in order to question normalized hierarchies concerning the production of knowledge and the status of truth claims. Nevertheless, often, these ideas have basically remained theoretical propositions not embodied in research practices. In fact there is very little published discussion about the difficulties and limits of their practical application. In this paper we introduce some interconnected reflections starting from two different but related experiences of embodying 'feminist activist research'. Our aim is to emphasise the importance of attending to process, making mistakes and learning during fieldwork, as well as experimenting with personalized forms of analysis, such as the construction of narratives and the story-telling process.

Embodying feminist research: learning from action research, political practices, diffractions and collective knowledge.

In the past three decades, feminists and critical theorists have discussed and argued the importance of deconstructing and problematizing social science research methodology in order to question normalized hierarchies concerning the production of knowledge and the status of truth claims. Nevertheless, often, these ideas have basically remained theoretical propositions not embodied in research practices. In fact there is very little published discussion about the difficulties and limits of their practical application. In this paper we introduce some interconnected reflections starting from two different but related experiences of embodying 'feminist activist research'. Our aim is to emphasise the importance of attending to process, making mistakes and learning during fieldwork, as well as experimenting with personalized forms of analysis, such as the construction of narratives and the story-telling process.

Science in Western Islam. The circulation of knowledge in Mediterranean region

La Mediterrània ha estat gresol de la circulació d¿idees i persones des de fa mil·lennis. Durant l¿edat mitjana, però, el moviment més rellevant va ser, tal vegada, el que es va produirentre l¿Orient (Maixriq) i l¿Occident (Magrib) islàmics. Els viatges d¿estudis, íntimament units a les prescripcions religioses,varen convertir els científics musulmans en membres especialment actius en la difusió dels coneixements i dels avenços ques¿anaven adquirint a la capital de l¿imperi, Bagdad. Lluny de ser mers «transportistes» de la ciència, el nivell cultural assolit durantl'edat d'or abbassí els va convertir en un dels clímaxs intel·lectuals de la història. Al principi, tot i restar en un discret segonpla, els científics del nord d¿Àfrica i, especialment, els científicsd'al-Andalus varen tenir un paper essencial en la transmissióde la ciència oriental cap a una Europa que en va recollir el testimoni.Per això l¿aportació de la cultura araboislàmica és un esglaó sense el qual és impossible entendre la ciència posterior.Els camps conreats foren diversos: medicina, agronomia,òptica... però l¿àmbit que presidí la ciència fou, sens dubte,l¿astronomia (relacionada, al seu torn, amb les matemàtiques i la geografia). Els noms dels astrònoms més rellevants (desd¿al-Khwarizmi fins a Azarquiel) i les fites que varen assolir justifiquen que fossin coneguts per un públic ampli. Malgrat tot, continuen essent uns grans desconeguts.

The Interplay of Mastery and Performance Goals in Social Comparison: A Multiple-Goal Perspective.

Régner, Escribe, and Dupeyrat (2007) recently demonstrated that not only performance-approach and performance-avoidance goals (respectively, the desire to outperform others and not to be outperformed by others) but also mastery goals (the desire to acquire knowledge) were related to social comparison orientation (SCO, the tendency to search for social comparison information). In the present article, the possibility of a link between mastery goals and social comparison that depends on the level of performance-approach goals-a possibility supported by a multiple-goal perspective-was tested by examining the interaction effect between mastery and performance-approach goals. This is an important endeavor, as educational settings are rarely free from performance-approach goals, even when mastery goals are promoted. In Study 1, we tested self-set achievement goals (mastery, performance-approach, and performance-avoidance goals) as predictors of SCO; the interaction between mastery goals and performance-approach goals indicated that the higher the performance-approach goal endorsement, the stronger the link between mastery goals and SCO. In Study 2, we manipulated goal conditions; mastery goals predicted interest in social comparison in the performance-approach goal condition only. Results are discussed in terms of the importance of multiple-goal pursuit in academic settings. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

Appropriateness of therapy for active Crohn's disease: results of a multidisciplinary International Expert Panel (EPACT II)

Introduction: The development of novel therapies and the increasing number of trials testing management strategies for luminal Crohn's disease (CD) have not filled all the gaps in our knowledge. Thus, in clinical practice, many decisions for CD patients need to be taken without high quality evidence. For this reason, a multidisciplinary European expert panel followed the RAND method to develop explicit criteria for the management of individual patients with active, steroid-dependent (ST-D) and steroid-refractory (ST-R) CD. Methods: Twelve international experts convened in Geneva, Switzerland in December 2007, to rate explicit clinical scenarios, corresponding to real daily practice, on a 9-point scale according to the literature evidence and their own expertise. Median ratings were stratified into three categories: appropriate (7-9), uncertain (4-6) and inappropriate (1-3). Results: Overall, panelists rated 296 indications pertaining to mild-to-moderate, severe, ST-D, and ST-R CD. In anti-TNF naïve patients, budesonide and prednisone were found appropriate for mildmoderate CD, and infliximab (IFX) when those had previously failed or had not been tolerated. In patients with prior success with IFX, this drug with or without co-administration of a thiopurine analog was favored. Other anti-TNFs were appropriate in case of intolerance or resistance to IFX. High doses steroids, IFX or adalimumab were appropriate in severe active CD. Among 105 indications for ST-D or ST-R disease, the panel considered appropriate the thiopurine analogs, methotrexate, IFX, adalimumab and surgery for limited resection, depending on the outcome of prior therapies. Anti-TNFs were generally considered appropriate in ST-R. Conclusion: Steroids, including budesonide for mild-to-moderate CD, remain first-line therapies in active luminal CD. Anti-TNFs, in particular IFX with respect to the amount of available evidence, remain second-line for most indications. Thiopurine analogs are preferred to anti-TNFs when steroids are not appropriate, except when anti-TNFs were previously successful. These recommendations are available online (www.epact.ch). A prospective evaluation of these criteria in a large database in Switzerland in underway to validate these criteria.

Implementation of guidelines on delirium in a General Hospital: a before-after study of their impact on caregivers' knowledge and clinical skills

INTRODUCTION: Delirium is a highly prevalent disorder, with serious consequences for the hospitalised patient. Nevertheless, it remains under-diagnosed and under-treated. We developed evidence-based clinical practice guidelines (CPGs) focusing on prevention, screening, diagnosis, and treatment of delirium in a general hospital. This article presents the implementation process of these CPGs and a before-after study assessing their impact on healthcare professionals' knowledge and on clinical practice. METHODS: CPGs on delirium were first implemented in two wards (Neurology and Neurosurgery) of the Lausanne university hospital. Interactive one-hour educational sessions for small groups of nurses and physicians were organised. Participants received a summary of the guidelines and completed a multiple choice questionnaire, assessing putative changes in knowledge, before and three months after the educational session. Other indicators such as "diagnosis of delirium" reported in the discharge letters, and mean duration of patients' hospital stay before and after implementation were compared. RESULTS: Eighty percent of the nurses and physicians from the Neurology and Neurosurgery wards attended the educational sessions. Both nurses and physicians significantly improved their knowledge after the implementation (+9 percentage-points). Other indicators were not modified by the intervention. CONCLUSION: A single interactive intervention improved both nurses' and physicians' knowledge on delirium. Sustained and repeated interventions are probably needed to demonstrate changes in clinical practice.

The INTERNORM Project: Bridging Two Worlds of Expert- and Lay-Knowledge in Standardization

This paper presents a pilot project to reinforce participatory practices in standardization. The INTERNORM project creates an interactive knowledge center based on the sharing of academic skills and experiences accumulated by the civil society, especially consumer associations, environmental associations and trade unions to strengthen the participatory process of standardization. The first objective of the project is action-oriented: INTERNORM provides a common knowledge pool supporting the participation of civil society actors to international standard-setting activities by bringing them together with academic experts in working groups and providing logistic and financial support to their participation in meetings of national and international technical committees. The second objective is analytical: the standardization action provides a research field for a better understanding of the participatory dynamics underpinning international standardization. This paper presents three incentives that explain civil society (non-)involvement in standardization that overcome conventional resource-based hypotheses: an operational incentive related to the use of standards in the selective goods provided by associations to their membership; a thematic incentive provided by the setting of priorities by strategic committees created in some standardization organization; and a rhetorical incentive related to the discursive resource that civil society concerns offers to the different stakeholders.

Application of text-mining for updating protein post-translational modification annotation in UniProtKB.

BACKGROUND: The annotation of protein post-translational modifications (PTMs) is an important task of UniProtKB curators and, with continuing improvements in experimental methodology, an ever greater number of articles are being published on this topic. To help curators cope with this growing body of information we have developed a system which extracts information from the scientific literature for the most frequently annotated PTMs in UniProtKB. RESULTS: The procedure uses a pattern-matching and rule-based approach to extract sentences with information on the type and site of modification. A ranked list of protein candidates for the modification is also provided. For PTM extraction, precision varies from 57% to 94%, and recall from 75% to 95%, according to the type of modification. The procedure was used to track new publications on PTMs and to recover potential supporting evidence for phosphorylation sites annotated based on the results of large scale proteomics experiments. CONCLUSIONS: The information retrieval and extraction method we have developed in this study forms the basis of a simple tool for the manual curation of protein post-translational modifications in UniProtKB/Swiss-Prot. Our work demonstrates that even simple text-mining tools can be effectively adapted for database curation tasks, providing that a thorough understanding of the working process and requirements are first obtained. This system can be accessed at http://eagl.unige.ch/PTM/.