Official Positions for FRAX® clinical regarding prior fractures from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

The 2010 Position Development Conference addressed four questions related to the impact of previous fractures on 10-year fracture risk as calculated by FRAX(®). To address these questions, PubMed was searched on the keywords "fracture, epidemiology, osteoporosis." Titles of retrieved articles were reviewed for an indication that risk for future fracture was discussed. Abstracts of these articles were reviewed for an indication that one or more of the questions listed above was discussed. For those that did, the articles were reviewed in greater detail to extract the findings and to find additional past work and citing works that also bore on the questions. The official positions and the supporting literature review are presented here. FRAX(®) underestimates fracture probability in persons with a history of multiple fractures (good, A, W). FRAX(®) may underestimate fracture probability in individuals with prevalent severe vertebral fractures (good, A, W). While there is evidence that hip, vertebral, and humeral fractures appear to confer greater risk of subsequent fracture than fractures at other sites, quantification of this incremental risk in FRAX(®) is not possible (fair, B, W). FRAX(®) may underestimate fracture probability in individuals with a parental history of non-hip fragility fracture (fair, B, W). Limitations of the methodology include performance by a single reviewer, preliminary review of the literature being confined to titles, and secondary review being limited to abstracts. Limitations of the evidence base include publication bias, overrepresentation of persons of European descent in the published studies, and technical differences in the methods used to identify prevalent and incident fractures. Emerging topics for future research include fracture epidemiology in non-European populations and men, the impact of fractures in family members other than parents, and the genetic contribution to fracture risk.

Civil society organisations participating in ISO TC 228 and ISO TC 229: the INTERNORM project and its future

This paper presents the first results of the INTERNORM pilot project funded by the University of Lausanne (2010 - 2014) to support the involvement of civil society organisations (CSO) in two ISO technical committees (TC), the ISO TC 228 on "tourism and related services" and the ISO TC 229 on "nanotechnologies". It analyses how a distinct participatory mechanism can influence the institutional environment of technical diplomacy in which standards are shaped. The project is an attempt to respond to the democratic deficit attested in the field of international standardisation, formally open to civil society participation, but still largely dominated by expert knowledge and market players. Many international standards have direct implications on society as a whole, but CSOs (consumers and environmental associations, trade unions) are largely under-represented in negotiation arenas. The paper draws upon international relations literature on new institutional forms in global governance and studies of participation in science and technology to address three questions: to which extent do CSOs identify participation in standardisation as worth of their mobilisation? How is the pluralisation of knowledge and expertise supporting CSO position during the deliberation? To which extent can CSO access and influence standardisation beyond their consultative role? It argues that there are significant limitations to the rise of civil society participation in such global governance mechanisms. Despite high entry costs into technical diplomacy, participation is not so much a matter of upstream engagement, or of procedure and resources only, than of opportunistic CSOs mobilization, of distinct thematic incentives and concrete outcomes to be expected in standardisation arenas or in the broader use of international standards.

High-pressure metamorphism in the Adula nappe - Guide to the excursion of the Swiss Society of Mineralogy and Petrology (September 29 - October 5, 1991)

1st day: Lithology and structure of the northern Adula nappe around Zervreila 2nd day: High-pressure rocks of the Suretta nappe, the middle Adula nappe and its Mesozoic cover - Eclogite near Innerferrara, Suretta nappe - Crossite-bearing prasinite from schistes lustres near Nufenen - Eclogites south of Hinterrhein, Adula nappe - Blueschists and eclogites from Neu-Wahli, Misox zone 3 days: Eclogite boudin and associated whiteschists in the uppermost Calanca valley, middle Adula nappe 4th day: Eclogites, associated metapelites and granitoid gneisses of Trescolmen, middle Adula nappe 5th day: The ultramafic-mafic suite of the Cima Lunga nappe around Cima di Gagnone 6th day: Garnet peridotites and eclogites from Alpe Arami, Cima Lunga nappe

Official Positions for FRAX® Bone Mineral Density and FRAX® simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

Tools to predict fracture risk are useful for selecting patients for pharmacological therapy in order to reduce fracture risk and redirect limited healthcare resources to those who are most likely to benefit. FRAX® is a World Health Organization fracture risk assessment algorithm for estimating the 10-year probability of hip fracture and major osteoporotic fracture. Effective application of FRAX® in clinical practice requires a thorough understanding of its limitations as well as its utility. For some patients, FRAX® may underestimate or overestimate fracture risk. In order to address some of the common issues encountered with the use of FRAX® for individual patients, the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) assigned task forces to review the medical evidence and make recommendations for optimal use of FRAX® in clinical practice. Among the issues addressed were the use of bone mineral density (BMD) measurements at skeletal sites other than the femoral neck, the use of technologies other than dual-energy X-ray absorptiometry, the use of FRAX® without BMD input, the use of FRAX® to monitor treatment, and the addition of the rate of bone loss as a clinical risk factor for FRAX®. The evidence and recommendations were presented to a panel of experts at the Joint ISCD-IOF FRAX® Position Development Conference, resulting in the development of Joint ISCD-IOF Official Positions addressing FRAX®-related issues.

Official positions of the International Society for Clinical Densitometry (ISCD) on DXA evaluation in children and adolescents.

Dual-energy X-ray absorptiometry (DXA) is the most widely used technical instrument for evaluating bone mineral content (BMC) and density (BMD) in patients of all ages. However, its use in pediatric patients, during growth and development, poses a much more complex problem in terms of both the technical aspects and the interpretation of the results. For the adults population, there is a well-defined term of reference: the peak value of BMD attained by young healthy subjects at the end of skeletal growth. During childhood and adolescence, the comparison can be made only with healthy subjects of the same age, sex and ethnicity, but the situation is compounded by the wide individual variation in the process of skeletal growth (pubertal development, hormone action, body size and bone size). The International Society for Clinical Densitometry (ISCD) organized a Pediatric Position Development Conference to discuss the specific problems of bone densitometry in growing subjects (9-19 years of age) and to provide essential recommendations for its clinical use.

Some of the challenges and experiences of formal education in a Mobile-Centric Society (MCS) = Algunos retos y experiencias de la educación formal en la Sociedad Móvil-Céntrica (SMC)

The aim of the paper is to describe some of the challenges faced by schools, or by formal education in general, as a consequence of today"s mobilecentric society (henceforth MCS), the term we will use to denote the new, networked learning ecology that has arisen from the massive penetration of digital media in everyday life. After revisiting some of the ideas of McLuhan and Vygotsky in the light of this new technological scenario, we describe five traits of the MCS and the challenges illustrated through educational practices that we believe schools will face if they wish to preserve their function of individualization and socialization. We believe that despite the emergence of the MCS, the main function of the school is still to provide the"box of tools" (a set of psychological instruments, such as reading, writing, mathematical notation, digital literacy, etc.) that enables people to develop their learning skills and life projects and to become part of communities and groups. However, the complexity and mobility of the new learning environments means that the position held by schools needs to be reevaluated in the face of the informal learning paths and experiences both online and offline to which learners now have access. We also need to reevaluate the meaning of the school itself as an institution and the model of learner it should be training

The international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: evidentiary tables : a statement for healthcare professionals from the neurocritical care society and the European society of intensive care medicine.

A variety of technologies have been developed to assist decision-making during the management of patients with acute brain injury who require intensive care. A large body of research has been generated describing these various technologies. The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) organized an international, multidisciplinary consensus conference to perform a systematic review of the published literature to help develop evidence-based practice recommendations on bedside physiologic monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews on physiologic processes important in the care of acute brain injury. In this article we provide the evidentiary tables for select topics including systemic hemodynamics, intracranial pressure, brain and systemic oxygenation, EEG, brain metabolism, biomarkers, processes of care and monitoring in emerging economies to provide the clinician ready access to evidence that supports recommendations about neuromonitoring.

The international multidisciplinary consensus conference on multimodality monitoring in neurocritical care: a list of recommendations and additional conclusions : a statement for healthcare professionals from the neurocritical care society and the European society of intensive care medicine.

Careful patient monitoring using a variety of techniques including clinical and laboratory evaluation, bedside physiological monitoring with continuous or non-continuous techniques and imaging is fundamental to the care of patients who require neurocritical care. How best to perform and use bedside monitoring is still being elucidated. To create a basic platform for care and a foundation for further research the Neurocritical Care Society in collaboration with the European Society of Intensive Care Medicine, the Society for Critical Care Medicine and the Latin America Brain Injury Consortium organized an international, multidisciplinary consensus conference to develop recommendations about physiologic bedside monitoring. This supplement contains a Consensus Summary Statement with recommendations and individual topic reviews as a background to the recommendations. In this article, we highlight the recommendations and provide additional conclusions as an aid to the reader and to facilitate bedside care.

Social trust : a public good?

Combining theories on social trust and social capital with sociopsychological approaches and applying contextual analyses to Swiss and European survey data, this thesis examines under what circumstances generalised trust, often understood as public good, may not benefit everyone, but instead amplify inequality. The empirical investigation focuses on the Swiss context, but considers different scales of analysis. Two broader questions are addressed. First, might generalised trust imply more or less narrow visions of community and solidarity in different contexts? Applying nonlinear principal component analysis to aggregate indicators, Study 1 explores inclusive and exclusive types of social capital in Europe, measured as regional configurations of generalised trust, civic participation and attitudes towards diversity. Study 2 employs multilevel models to examine how generalised trust, as an individual predisposition and an aggregate climate at the level of Swiss cantons, is linked to equality- directed collective action intention versus radical right support. Second, might high-trust climates impact negatively on disadvantaged members of society, precisely because they reflect a normative discourse of social harmony that impedes recognition of inequality? Study 3 compares how climates of generalised trust at the level of Swiss micro-regions and subjective perceptions of neighbourhood cohesion moderate the negative relationship between socio-economic disadvantage and mental health. Overall, demonstrating beneficial, as well as counterintuitive effects of social trust, this thesis proposes a critical and contextualised approach to the sources and dynamics of social cohesion in democratic societies. -- Cette thèse combine des théories sur le capital social et la confiance sociale avec des approches psychosociales et s'appuie sur des analyses contextuelles de données d'enquêtes suisses et européennes, afin d'étudier dans quelles circonstances la confiance généralisée, souvent présentée comme un bien public, pourrait ne pas bénéficier à tout le monde, mais amplifier les inégalités. Les études empiriques, centrées sur le contexte suisse, intègrent différentes échelles d'analyse et investiguent deux questions principales. Premièrement, la confiance généralisée implique-t-elle des visions plus ou moins restrictives de la communauté et de la solidarité selon le contexte? Dans l'étude 1, une analyse à composantes principales non-linéaire sur des indicateurs agrégés permet d'explorer des types de capital social inclusif et exclusif en Europe, mesurés par des configurations régionales de confiance généralisée, de participation civique, et d'attitudes envers la diversité. L'étude 2 utilise des modèles multiniveaux afin d'analyser comment la confiance généralisée, en tant que prédisposition individuelle et climat agrégé au niveau des cantons suisses, est associée à l'intention de participer à des actions collectives en faveur de l'égalité ou, au contraire, à l'intention de voter pour la droite radicale. Deuxièmement, des climats de haute confiance peuvent-ils avoir un impact négatif sur des membres désavantagés de la société, précisément parce qu'ils reflètent un discours normatif d'harmonie sociale qui empêche la reconnaissance des inégalités? L'étude 3 analyse comment des climats de confiance au niveau des micro-régions suisses et la perception subjective de faire partie d'un environnement cohésif modèrent la relation négative entre le désavantage socio-économique et la santé mentale. En démontrant des effets bénéfiques mais aussi contre-intuitifs de la confiance sociale, cette thèse propose une approche critique et contextualisée des sources et dynamiques de la cohésion sociale dans les sociétés démocratiques.

Opettajan monikulttuurinen työ

Teacher's multicultural work The purpose of the present study is to explore teachers’ conceptions of their work as teachers of multicultural students. Teachers’ experiences of multicultural work and conceptions derived from them are part of the teacher’s multicultural competence which is seen as a key component of the teacher’s multicultural teachership. The teacher’s multicultural competence consists of the teacher’s cultural knowledge, pedagogical skills and experiences and attitudes related to multiculturalism. The teacher’s multicultural competence constitutes the basis on which the teacher implements multicultural education. The foundation for the teacher’s work is laid by laws and decrees, curricula, regulations issued by authorities in charge of the education of immigrant students, resources available and other demands and expectations set by the ambient society. The study was conducted in the city of Turku, Finland. The sample consisted of class teachers who taught both immigrant and majority students. Main objects of study in the theoretical part are the multicultural and pluralistic school and the multicultural teachership. The basic assumption is that the multicultural and pluralistic school forms the frame of activity in which the teacher implements multicultural teaching. The research strategy is based on methodological triangulation. The quantitative part of the study was carried out using a questionnaire typical of survey methods. The questionnaire was returned by 71 teachers. The qualitative part was conducted using theme-based interviews typical of phenomenological philosophical research. Of the total of teachers who returned the questionnaire, twelve (12) teachers were selected for interviews. According to the results, the participating teachers enjoyed their work regardless of the ample extra work caused by the students with immigrant backgrounds. The teachers experienced their work as teachers of multicultural student groups as strenuous, yet challenging. Students with immigrant backgrounds had caused many changes in the teacher’s work. The teachers regarded their multicultural skills as inadequate in relation to the demands of the work. They had not received education related to teaching students with immigrant backgrounds, but they were ready for in-service education. The teachers’ previous attitudes concerning immigrant students had been enforced. Teaching experiences strengthened the earlier, both positive and negative, attitudes. The central problems related to multiculturalism in the teacher’s work were caused by the deficient Finnish skills of the students with immigrant background. This was apparent in both teaching and learning as well as in contacts with parents. The teachers reported on relatively few inclusions of multicultural angles in their teaching. However, they believed that they could aid students with different cultural backgrounds in their integration process. At the same time they felt that their own chances to enhance the students’ cultural identities were slim. On the basis of the interviews conducted in connection with the teacher’s multicultural competence, the teachers were divided into three groups: assimilative, indeterminate and integrating multicultural teachers. The present study provides a strong indication that teachers tend to interpret multiculturalism in narrow terms. School activities, such as Finnish as a second language, first language and religious instruction, which were targeted exclusively at immigrant students were in most cases considered adequate. A holistic, cross-disciplinary, all-inclusive multicultural education that would permeate all school activities remains largely unimplemented.

Preoperative assessment and classification of benign laryngotracheal stenosis: a consensus paper of the European Laryngological Society.

Adult and pediatric laryngotracheal stenoses (LTS) comprise a wide array of various conditions that require precise preoperative assessment and classification to improve comparison of different therapeutic modalities in a matched series of patients. This consensus paper of the European Laryngological Society proposes a five-step endoscopic airway assessment and a standardized reporting system to better differentiate fresh, incipient from mature, cicatricial LTSs, simple one-level from complex multilevel LTSs and finally "healthy" from "severely morbid" patients. The proposed scoring system, which integrates all of these parameters, may be used to help define different groups of LTS patients, choose the best treatment modality for each individual patient and assess distinct post-treatment outcomes accordingly.