Decision-theoretic analysis of forensic sampling criteria using Bayesian decision networks

Sampling issues represent a topic of ongoing interest to the forensic science community essentially because of their crucial role in laboratory planning and working protocols. For this purpose, forensic literature described thorough (Bayesian) probabilistic sampling approaches. These are now widely implemented in practice. They allow, for instance, to obtain probability statements that parameters of interest (e.g., the proportion of a seizure of items that present particular features, such as an illegal substance) satisfy particular criteria (e.g., a threshold or an otherwise limiting value). Currently, there are many approaches that allow one to derive probability statements relating to a population proportion, but questions on how a forensic decision maker - typically a client of a forensic examination or a scientist acting on behalf of a client - ought actually to decide about a proportion or a sample size, remained largely unexplored to date. The research presented here intends to address methodology from decision theory that may help to cope usefully with the wide range of sampling issues typically encountered in forensic science applications. The procedures explored in this paper enable scientists to address a variety of concepts such as the (net) value of sample information, the (expected) value of sample information or the (expected) decision loss. All of these aspects directly relate to questions that are regularly encountered in casework. Besides probability theory and Bayesian inference, the proposed approach requires some additional elements from decision theory that may increase the efforts needed for practical implementation. In view of this challenge, the present paper will emphasise the merits of graphical modelling concepts, such as decision trees and Bayesian decision networks. These can support forensic scientists in applying the methodology in practice. How this may be achieved is illustrated with several examples. The graphical devices invoked here also serve the purpose of supporting the discussion of the similarities, differences and complementary aspects of existing Bayesian probabilistic sampling criteria and the decision-theoretic approach proposed throughout this paper.

Opportunities and constraints in schistosomiasis vaccine development: infection characteristics and industry realities

The notes provided in this article relate to two components of the development of vaccines against schistosomiasis: (1) The characteristics of schistosome infections (eg. features of the schistosome life cycle), and the parasite itself, that have implications for vaccination strategies; (2) The characteristics of the biopharmaceutical industry that have implications for product development. As will be seen, these two topic areas are not vastly disparate.

Photographic art and dealing with death

Recently, we were faced with a request from a student photographer who wanted to take pictures of bodies donated to our institute and used for dissection courses for medical students or for scientific purposes. Students are expressly forbidden to take pictures in the dissection hall; however, we allowed this student photographer to do her diploma work in our institute. The reason why she was proposing such a topic was that her brother died young and her parents donated his body to science. To overcome this loss of a loved one, she wanted to know what happens to the donated bodies. She followed the procedure of embalming and different dissections that took place during the summer semester and she took pictures throughout. The outcome of this work was a very nice photographic document, called 'dissection', a book with many pictures but no figure legends. The image document shows the different steps in the preparation and preservation of bodies and the work of an anatomist in the dissection hall. As we impose rules on our students, we had also to give directives in the use of the photographs taken, especially for a photographer who will use the most prominent pictures for exhibitions, i.e. that the pictures do not show names or are used for publication on the internet, or show identification numbers of cadavers, or give indication ofn the institution and are relatively anonymous. This story tells how one can deal with death and at the same time advance one's personal career. The author represents the Swiss Anatomical Society SGAHE and is supported by the Swiss Academy of Science, ScNat.

A research agenda for malaria eradication: vaccines.

Vaccines could be a crucial component of efforts to eradicate malaria. Current attempts to develop malaria vaccines are primarily focused on Plasmodium falciparum and are directed towards reducing morbidity and mortality. Continued support for these efforts is essential, but if malaria vaccines are to be used as part of a repertoire of tools for elimination or eradication of malaria, they will need to have an impact on malaria transmission. We introduce the concept of "vaccines that interrupt malaria transmission" (VIMT), which includes not only "classical" transmission-blocking vaccines that target the sexual and mosquito stages but also pre-erythrocytic and asexual stage vaccines that have an effect on transmission. VIMT may also include vaccines that target the vector to disrupt parasite development in the mosquito. Importantly, if eradication is to be achieved, malaria vaccine development efforts will need to target other malaria parasite species, especially Plasmodium vivax, where novel therapeutic vaccines against hypnozoites or preventive vaccines with effect against multiple stages could have enormous impact. A target product profile (TPP) for VIMT is proposed and a research agenda to address current knowledge gaps and develop tools necessary for design and development of VIMT is presented.

Activem la filosofia del llenguatge

En el projecte de millora de la qualitat docent “Activem al filosofia del llenguatge” hi han participat 11 professors i professores de la Universitat de Barcelona, la Universitat Autònoma de Barcelona, la Universitat de Girona i la Universitat Rovira i Virgili. Aquest grup de docents constitueixen la pràctica totalitat del professors que imparteixen regularment matèries de filosofia del llenguatge en les universitats catalanes. Aquest projecte ha consistit en dissenyar, elaborar i aplicar diferents eines que tenen per objectiu ajudar als alumnes a passar d’una actitud passiva de receptors de classes, a una actitud activa vers els continguts dels cursos troncals de filosofia del llenguatge. La contribució al canvi d’actitud del “rebre” al “fer” s’ha buscat amb la combinació de diferents propostes: la selecció de textos clàssics breus, importants i clars que els estudiants tenien que llegir i rellegir amb deteniment relacionats amb cadascun dels temes tractats en el curs i, vinculat a això, l’elaboració de “preguntes per a guiar la lectura” que ajuden als estudiants a centrar la atenció en els aspectes més pertinents i importants de cadascun d’aquests textos, l’elaboració de dossiers electrònics vinculats a cadascun dels diferents temes que es tracten en aquests cursos, l’elaboració per a cadascun dels temes de diferents exercicis i “preguntes de discussió”, la creació d’un fòrum de discussió electrònic, i la celebració de “jornades de debat” que es centraven en algunes de les “preguntes de discussió”. Hem pogut constatar la necessitat de trobar en el futur maneres d’aplicar les diferents eines que hem dissenyat de forma que els estudiants facin ús de forma encara més general d’aquestes eines.

High altitude, a natural research laboratory for the study of cardiovascular physiology and pathophysiology.

High altitude constitutes an exciting natural laboratory for medical research. Although initially, the aim of high-altitude research was to understand the adaption of the organism to hypoxia and find treatments for altitude-related diseases, during the past decade or so, the scope of this research has broadened considerably. Two important observations led the foundation for the broadening of the scientific scope of high-altitude research. First, high-altitude pulmonary edema represents a unique model that allows studying fundamental mechanisms of pulmonary hypertension and lung edema in humans. Second, the ambient hypoxia associated with high-altitude exposure facilitates the detection of pulmonary and systemic vascular dysfunction at an early stage. Here, we will review studies that, by capitalizing on these observations, have led to the description of novel mechanisms underpinning lung edema and pulmonary hypertension and to the first direct demonstration of fetal programming of vascular dysfunction in humans.

Desenvolupament de problemes virtuals i interactius per a l’aprenentatge de la Microbiologia

La finalitat del projecte ha estat desenvolupar un espai virtual teòric-pràctic per a l’aprenentatge de la Microbiologia. Aquest espai virtual, basat en l'aprenentatge a través de problemes, s’ha anomenat “Microbiologia Interactiva” i proposa a l’alumne les següents àrees temàtiques: Introducció a les tècniques de la Microbiologia; Estructura i funció de la cèl.lula microbiana; Creixement i control microbià; Microbiologia molecular; Fisiologia i metabolisme microbians; Virologia; Ecologia Microbiana; Diversitat microbiana. Per a cada temàtica s’han definit unes competències a assolir a través de la resolució de problemes teòrics o pràctics. En aquest darrer cas, se li proposa a l’alumne que entri en el laboratori virtual per a la resolució dels casos pràctics plantejats. A més, per a la resolució dels problemes, l’alumne disposa d’un seguit de recursos per a cada temàtica. Finalment, també s’inclouen activitats de relació i d’ampliació per tal d’estimular la discussió, l’esperit crìtic, el treball en grup i la recerca bibliogràfica. A més, per tal de facilitar el seu ús, el web disposa també d'un tutorial. El web “Microbiologia Interactiva” es va introduir de forma pilat en l’ensenyament de l'assignatura de Microbiologia de la Llicenciatura de Biologia i de la de Microbiologia I de la llicenciatura de Biotecnologia de la Universitat Autònoma de Barcelona (UAB) durant el curs 2007-08. Al llarg d'aquest curs es va valorar la seva utilitat i acceptació per part dels alumnes mitjançant enquestes. Els bons resultats obtinguts van aconsellar que aquesta eina fora ja utilitzada en totes les assignatures generals de Microbiologia de les llicenciatures de Biologia, Biotecnologia, Bioquímica, Química, Enginyeria Química, Ciències Ambientals i Ciència i Tecnologia dels Aliments de la UAB. Actualment el web s’està també utilitzant amb molt bons resultats a les assignatures de Microbiologia dels nous graus que ofereix la Facultat de Biociències de la UAB. Així doncs, en aquest projecte s’han assolit amb escreix els objectius previstos. Es pot consultar el web desenvolupat a l’adreça http://microbiologia.uab.cat//Microbiologia_Interactiva_Web/.

Laboratori Virtual de Psicologia Bàsica

El Laboratori Virtual de Psicologia Bàsica (LVPB) és una eina que acompanya a l’estudiant en un recorregut a través d’experiments que s’han convertit en clàssics de la Psicologia Cognitiva. La plataforma reprodueix experiments provinents de l’estudi de l’atenció, l’emoció, el llenguatge, la memòria, la motivació, el pensament i la percepció. En cada experiment, el LVPB presenta un text introductori amb alguns articles de referència on es van proposar per primera vegada aquests experiments. El LVPB es basa en la plataforma d’e-learning Moodle, el que permet que cada estudiant tingui el seu propi espai en el qual guardar les dades, els resultats i les anàlisis que hagi realitzat. Tota la interacció amb el sistema queda enregistrada i pot ésser consultada tant per l’estudiant com pel seu professor en qualsevol moment. Això permet que el LVPB pugui ser utilitzat també com a eina d’avaluació per part del professor. La plataforma es troba disponible en la següent adreça: http://psicovirtual.uab.es/lvpb

Guidelines for the clinical management of atrial fibrillation: a practical perspective.

Since the management of atrial fibrillation may be difficult in the individual patient, our purpose was to develop simple clinical recommendations to help the general internist manage this common clinical problem. Systematic review of the literature with evaluation of data-related evidence and framing of graded recommendations. Atrial fibrillation affects some 1% of the population in Western countries and is linked to a significant increase in morbidity and mortality. The management of atrial fibrillation requires individualised evaluation of the risks and benefits of therapeutic modalities, relying whenever possible on simple and validated tools. The two main points requiring a decision in clinical management are 1) whether or not to implement thromboembolic prevention therapy, and 2) whether preference should be given to a "rate control" or "rhythm control" strategy. Thromboembolic prophylaxis should be prescribed after individualised risk assessment: for patients at risk, oral anticoagulation with warfarin decreases the rate of embolic complications by 60% and aspirin by 20%, at the expense of an increased incidence of haemorrhagic complications. "Rate control" and "rhythm control" strategies are probably equivalent, and the choice should also be made on an individualised basis. To assist the physician in making his choices for the care of an atrial fibrillation patient we propose specific tables and algorithms, with graded recommendations. On the evidence of data from the literature we propose simple algorithms and tables for the clinical management of atrial fibrillation in the individual patient.

Appropriate treatment for Crohn's disease: methodology and summary results of a multidisciplinary international expert panel approach--EPACT.

BACKGROUND/AIMS: For many therapeutic decisions in Crohn's disease (CD), high-grade evidence is lacking. To assist clinical decision-making, explicit panel-based appropriateness criteria were developed by an international, multidisciplinary expert panel. METHODS: 10 gastroenterologists, 3 surgeons and 2 general practitioners from 12 European countries assessed the appropriateness of therapy for CD using the RAND Appropriateness Method. Their assessment was based on the study of a recent literature review of the subject, combined with their own expert clinical judgment. Panelists rated clinical indications and treatment options using a 9-point scale (1 = extremely inappropriate; 9 = extremely appropriate). These scenarios were then discussed in detail at the panel meeting and re-rated. Median ratings and disagreement were used to aggregate ratings into three assessment categories: appropriate (A), uncertain (U) and inappropriate (I). RESULTS: 569 specific indications were rated, dealing with 9 clinical presentations: mild/moderate luminal CD (n = 104), severe CD (n = 126), steroid-dependent CD (n = 25), steroid-refractory CD (n = 37), fistulizing CD (n = 49), fibrostenotic CD (n = 35), maintenance of medical remission of CD (n = 84), maintenance of surgical remission (n = 78), drug safety in pregnancy (n = 24) and use of infliximab (n = 7). Overall, 146 indications (26%) were judged appropriate, 129 (23%) uncertain and 294 (52%) inappropriate. Frank disagreement was low (14% overall) with the greatest disagreement (54% of scenarios) being observed for treatment of steroid-refractory disease. CONCLUSIONS: Detailed explicit appropriateness criteria for the appropriate use of therapy for CD were developed for the first time by a European expert panel. Disease location, severity and previous treatments were the main factors taken into account. User-friendly access to EPACT criteria is available via an Internet site, www.epact.ch, allowing prospective evaluation and improvement of appropriateness of current CD therapy.

Prévenir la prise de poids à l'arrêt du tabac: pas de solution miracle: revue Cochrane pour le praticien. [Preventing weight gain in smoking cessation: there is no miracle solution]

http://resfranco.cochrane.org/sites/resfranco.cochrane.org/files/uploads/Arrettabac2009.pdf

Health intervention and decline in infant mortality rates. Milk depots in Spain (1900-1936)

The role of public health has been a central topic on the classical debate about the historical mortality decline in Europe. One of these health initiatives were the Milk Depots. Spain set up those centres from the late 19th century until the beginning of the Civil War. The goal of this paper is to evaluate the effect of this health intervention on the infant mortality decline during this period. This study works out three kinds of sources: Statistical Yearbooks, Official documents and local records produced by the same Milk Depot. It analyses data available for all the country and one local case such as the Barcelona’s Milk Depot (1904-1935). The main methodological issue deals with the measurement of the effect of the Milk Depot activities on the pattern of changes of infant mortality. Results suggest that Milk Depots have a positive but quite moderate effect on the improving of overall levels of child survival.

The basilar artery international cooperation study (BASICS).

Basilar artery occlusion is a rare cause of stroke with a high case fatality rate and an often poor clinical outcome among survivors. Our limited knowledge on the outcome in patients with basilar artery occlusion comes from small case series of selected patients.STUDY AIM: The main purpose of the registry is to collect preliminary data that will help direct the design of a future clinical treatment trial. The target number of patients included is 500.DESIGN: BASICS is a prospective, observational, multi-center, international registry of consecutive patients presenting with a symptomatic and radiologically confirmed basilar artery occlusion.STUDY OUTCOMES: From November 2002 until December 2006 data have been collected on 400 patients, from 42 centers in 12 countries. Most patients were treated with IA therapy (55%), followed by antithrombotics (29%) and IV thrombolysis (6%). The overall mortality was 45%.