979 resultados para step-up -hakkuri


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És àmpliament conegut que l'europeïtzació ha guanyat molt terreny en els estudis europeus. Des de finals de la dècada de 1990, ha gaudit d'una important expansió per tal d'avaluar l'eficàcia de les polítiques a escala europea en l'àmbit intern. En aquest procés la política energètica ha jugat un paper molt paradoxal, sent persistentment exclosos de l'agenda de recerca de la europeïtzació, encara que la seva creixent importància en l'elaboració de polítiques comunitàries. No obstant això, la realitat és que, tot i haver estat reconegut recentment com una àrea de la UE amb l'aplicació del Tractat de Lisboa, també ha estat influenciat, directament o indirectament, pels efectes de l'europeïtzació. Com a resultat d'això, la política energètica ha estat considerat com un "cas especial" de l'europeïtzació, portant fins al moment per a la construcció d'un sector caracteritzat la política energètica europea. En aquest context, el present treball pretén explicar l'europeïtzació de les polítiques energètiques nacionals en l'elaboració de l'actuació de la UE per mitjà de la seva competència ambiental. Més explícitament, aquesta investigació tracta de la naturalesa de la reglamentació comunitària en matèria d'energia renovable com un mecanisme d'europeïtzació amb especial èmfasi en el seu impacte a Espanya. Aquest treball sosté que (1) la lluita europea contra el canvi climàtic s'ha obert un camí per a la participació de la UE en matèria de política energètica, i que (2) encara que limitat aquest procés està produint alguns canvis en les polítiques energètiques nacionals. Universitat

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There is an increasing trend in the incidence of cancer worldwide, and it has been accepted that environmental factors account for an important proportion of the global burden. The present paper reports preliminary findings on the influence of the historical exposure to a group of persistent organic pollutants on total cancer risk, at year 9 in the follow-up of a cohort from Southern Spain. A cohort of 368 participants (median age 51 years) was recruited in 2003. Their historical exposure was estimated by analyzing residues of persistent organic pollutants in adipose tissue. Estimation of cancer incidence was based on data from a population-based cancer registry. Statistical analyses were performed using multivariable Cox-regression models. In males, PCB 153 concentrations were positively associated with total cancer risk, with an adjusted hazard ratio (95% confidence interval) of 1.20 (1.01-1.41) for an increment of 100 ng/g lipid. Our preliminary findings suggest a potential relationship between the historical exposure to persistent organic pollutants and the risk of cancer in men. However, these results should be interpreted with caution and require verification during the future follow-up of this cohort.

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The aim of this paper is to analyse the main agreements on the EU’s External Action agreed within the European Convention and the IGC taking into account why, how and who reached the consensus on them. In other words, this paper will explore the principles followed in order to improve the instruments of the EU’s External Action such as authority, coherence, visibility, efficiency and credibility.

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Introduction: The use of bioabsorbable materials for orthopaedic useand traumatic fracture fixation in children has been poorly investigatedin the litterature and the effects on growing bones seem contradictory.The aim of the study is to compare the clinical and radiological resultsand evolution between bioabsorbable and traditional K-Wires for thetreatment of elbow epiphyseal fractures in children.Method: From jan. 2008 to Dec. 2009 21 children with similar fracturesand age were separated in two groups according to the way of fracturefixation: bioabsorbable K-Wire group and traditional K-Wire group.Follow-up was done at 3, 6 and 12 month post-operatively. Range ofmotion and elbow stability were measured for all patients. Theradiological evolution of the two groups were compared in term ofconsolidation, ossous resorption and radiolucencies. The clinicalresults were compared according to the Mayo Elbow Peformancescore. Controlateral elbow is compared with injured elbow in the twogroups.Results: In the bioabsorbable K-wire group, there were 10 children,including 5 girles and 5 boys with an average age of 9.5 years, rangingfrom 5 to 14 years. They were 7 external condylar fractures and3 epitrochlear fractures. In the traditional K-Wire group there were11 children, 2 girls and 9 boys with an average age of 7.6 years,ranging from 4 to 14 years. There were 10 external condylar fracturesand 1 epitrochlear fracture. At first follow up. The Mayo ElbowPerformance score was 93.8 (85-100 )for the bioabsorbable K-Wiregroup and 95.5 (85-100) for the traditional K-Wire group. In twochildren from the bioabsorbable K-Wire group there were transitoryradiolucencies along the wire tract on the x-ray, without clinicalmanifestation of it.We didn't see any premature closure of growingcartilage.Discussion: There is no significant differencies in term of clinical andradiological outcome between the two groups. The use ofbioabsorbable pins seems to be a good alternative to removabletraditional materials, avoiding a second operation.

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OBJECTIVE To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS). METHODS This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years. RESULTS The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ≥ 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique variable associated with overall mortality. CONCLUSIONS TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.

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A single-step PCR assay with genus-specific primers for the amplification of a 223-bp region of the sequence encoding a 31-kDa immunogenetic Brucella abortus protein (BCSP31) was used for the rapid diagnosis of human brucellosis. We examined peripheral blood from 47 patients, with a total of 50 cases of brucellosis, and a group of 60 control subjects, composed of patients with febrile syndromes of several etiologies other than brucellosis, asymptomatic subjects seropositive for Brucella antibodies, and healthy subjects. Diagnosis of brucellosis was established in 35 cases (70%) by isolation of Brucella in blood culture and in the other 15 cases (30%) by clinical and serological means. The sensitivity of our PCR assay was 100%, since it correctly identified all 50 cases of brucellosis, regardless of the duration of the disease, the positivity of the blood culture, or the presence of focal forms. The specificity of the test was 98.3%, and the only false-positive result was for a patient who had had brucellosis 2 months before and possibly had a self-limited relapse. In those patients who relapsed, the results of our PCR assay were positive for both the initial infection and the relapse, becoming negative once the relapse treatment was completed and remaining negative in the follow-up tests at 2, 4, and 6 months. In conclusion, these results suggest that the PCR assay is rapid and easy to perform and highly sensitive and specific, and it may therefore be considered a useful tool for diagnosis of human brucellosis.

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The present thesis is about cognitions of left-wing activists and the role they play to better understand contentious participation. It compares activists of three post-industrial social movement organizations in Switzerland, i.e. Solidarity across Borders defending migrant's rights, the Society of Threatened People promoting collective human rights and Greenpeace protecting the environment. It makes use of an innovative mixed methods design combining survey and interview data. The main theoretical contribution is to conceptualize an analytical tool enabling to grasp the cognitive map of these activists by putting forward the concept of strong citizen, summing up their relation to society and politics. The relation to society consists of an extensive relation to others and an interconnected vision of society. Consequently, their primary concerns include the handing of common goods and the equal treatment of individuals with regard to common goods. The relation to politics incorporates a critical and vigilant citizen. They are critical towards political authorities and they appreciate political action by organized groups of the civil society. The thesis states that only by having such worldviews activists are able to construct an injustice, agency and identity frame for the claims of their organizations. Thus, the present work delivers a parsimonious answer to the question of where an injustice, agency and identity frame comes from. It does so by a systematic analysis of four specific arguments. First, it empirically demonstrates that these activists have - at the aggregate level - specific cognitive resources compared to the general population. Second, it describes the content of this specific cognitive outlook by evaluating the appropriateness of the strong citizen concept. Third, it looks at variations between activist's communities and shows that activists of more challenging protest issues are stronger citizens than activists of more mainstream protests. Finally, cognitions are not the only part of the story if one looks at contentious participation. Other factors, i.e. social networks and biographical availability, matter too. Therefore, I test if cognitions are able to contribute in explaining differences between activists' communities if one controls for other factors. In sum, this thesis is thus a first step to demonstrate why one should be concerned about activists' cognitions. - Cette thèse s'intéresse aux cognitions des activistes de gauche et à leur rôle dans le phénomène de la participation contestataire. Des activistes de trois organisations post- industrielles en Suisse sont comparé, à savoir Solidarité sans Frontières qui défend les droits des migrants, la Société des Peuples menacés qui promeut les droits des collectivités minoritaires et Greenpeace qui oeuvre pour la protection de l'environnement. Cette recherche utilise un « mixed methods design » en combinant de manière innovant des données de sondage et d'entretiens. Ma principale contribution théorique réside dans la conceptualisation d'un outil analytique qui permet de saisir la « carte cognitive » des activistes, à travers le concept de « strong citizen » qui se réfère à la relation spécifique qu'entretiennent certains individus avec la société et la politique. Ces individus sont caractérisés par une vision inclusive et interconnectée de la société, ainsi que par une conception politique du citoyen comme critique et vigilant. Mon argument principal est celui selon lequel seuls les individus possédant ce type particulier de cognitions sont capable de construire un cadre d'injustice, d'« agency » et d'identité. Cette thèse apporte donc quelques éléments de réponse à la question de l'origine de ces cadres cognitifs qui sont cruciales pour la participation. Pour ce faire, quatre aspects spécifiques sont analysés de manière systématique. Premièrement, je démontre empiriquement, au niveau agrégé, que ces activistes possèdent effectivement des ressources cognitives spécifiques - en comparaison avec la population générale. Deuxièmement, j'analyse le contenu de ces cognitions, ce qui me permet notamment d'évaluer la pertinence et l'adéquation du concept de « strong citizen ». Troisièmement, en m'intéressant cette fois aux variations entre communautés d'activistes, je démontre que ceux réunis autour d'enjeux protestataires très revendicatifs sont, d'un point de vue cognitif, plus proches de la figure du « strong citizen » que ceux mobilisés sur des enjeux plus consensuels. Finalement, d'autres facteurs, à savoir les réseaux sociaux et la disponibilité biographique, sont intégrés à l'analyse afin de mesurer le réel pouvoir explicatif des cognitions dans l'explication des différences observées entre communautés d'activistes. A travers ces analyses, cette thèse met en avant l'importance du rôle des cognitions dans l'étude de la participation contestataire.

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La tomodensitométrie (CT) est une technique d'imagerie dont l'intérêt n'a cessé de croître depuis son apparition dans le début des années 70. Dans le domaine médical, son utilisation est incontournable à tel point que ce système d'imagerie pourrait être amené à devenir victime de son succès si son impact au niveau de l'exposition de la population ne fait pas l'objet d'une attention particulière. Bien évidemment, l'augmentation du nombre d'examens CT a permis d'améliorer la prise en charge des patients ou a rendu certaines procédures moins invasives. Toutefois, pour assurer que le compromis risque - bénéfice soit toujours en faveur du patient, il est nécessaire d'éviter de délivrer des doses non utiles au diagnostic.¦Si cette action est importante chez l'adulte elle doit être une priorité lorsque les examens se font chez l'enfant, en particulier lorsque l'on suit des pathologies qui nécessitent plusieurs examens CT au cours de la vie du patient. En effet, les enfants et jeunes adultes sont plus radiosensibles. De plus, leur espérance de vie étant supérieure à celle de l'adulte, ils présentent un risque accru de développer un cancer radio-induit dont la phase de latence peut être supérieure à vingt ans. Partant du principe que chaque examen radiologique est justifié, il devient dès lors nécessaire d'optimiser les protocoles d'acquisitions pour s'assurer que le patient ne soit pas irradié inutilement. L'avancée technologique au niveau du CT est très rapide et depuis 2009, de nouvelles techniques de reconstructions d'images, dites itératives, ont été introduites afin de réduire la dose et améliorer la qualité d'image.¦Le présent travail a pour objectif de déterminer le potentiel des reconstructions itératives statistiques pour réduire au minimum les doses délivrées lors d'examens CT chez l'enfant et le jeune adulte tout en conservant une qualité d'image permettant le diagnostic, ceci afin de proposer des protocoles optimisés.¦L'optimisation d'un protocole d'examen CT nécessite de pouvoir évaluer la dose délivrée et la qualité d'image utile au diagnostic. Alors que la dose est estimée au moyen d'indices CT (CTDIV0| et DLP), ce travail a la particularité d'utiliser deux approches radicalement différentes pour évaluer la qualité d'image. La première approche dite « physique », se base sur le calcul de métriques physiques (SD, MTF, NPS, etc.) mesurées dans des conditions bien définies, le plus souvent sur fantômes. Bien que cette démarche soit limitée car elle n'intègre pas la perception des radiologues, elle permet de caractériser de manière rapide et simple certaines propriétés d'une image. La seconde approche, dite « clinique », est basée sur l'évaluation de structures anatomiques (critères diagnostiques) présentes sur les images de patients. Des radiologues, impliqués dans l'étape d'évaluation, doivent qualifier la qualité des structures d'un point de vue diagnostique en utilisant une échelle de notation simple. Cette approche, lourde à mettre en place, a l'avantage d'être proche du travail du radiologue et peut être considérée comme méthode de référence.¦Parmi les principaux résultats de ce travail, il a été montré que les algorithmes itératifs statistiques étudiés en clinique (ASIR?, VEO?) ont un important potentiel pour réduire la dose au CT (jusqu'à-90%). Cependant, par leur fonctionnement, ils modifient l'apparence de l'image en entraînant un changement de texture qui pourrait affecter la qualité du diagnostic. En comparant les résultats fournis par les approches « clinique » et « physique », il a été montré que ce changement de texture se traduit par une modification du spectre fréquentiel du bruit dont l'analyse permet d'anticiper ou d'éviter une perte diagnostique. Ce travail montre également que l'intégration de ces nouvelles techniques de reconstruction en clinique ne peut se faire de manière simple sur la base de protocoles utilisant des reconstructions classiques. Les conclusions de ce travail ainsi que les outils développés pourront également guider de futures études dans le domaine de la qualité d'image, comme par exemple, l'analyse de textures ou la modélisation d'observateurs pour le CT.¦-¦Computed tomography (CT) is an imaging technique in which interest has been growing since it first began to be used in the early 1970s. In the clinical environment, this imaging system has emerged as the gold standard modality because of its high sensitivity in producing accurate diagnostic images. However, even if a direct benefit to patient healthcare is attributed to CT, the dramatic increase of the number of CT examinations performed has raised concerns about the potential negative effects of ionizing radiation on the population. To insure a benefit - risk that works in favor of a patient, it is important to balance image quality and dose in order to avoid unnecessary patient exposure.¦If this balance is important for adults, it should be an absolute priority for children undergoing CT examinations, especially for patients suffering from diseases requiring several follow-up examinations over the patient's lifetime. Indeed, children and young adults are more sensitive to ionizing radiation and have an extended life span in comparison to adults. For this population, the risk of developing cancer, whose latency period exceeds 20 years, is significantly higher than for adults. Assuming that each patient examination is justified, it then becomes a priority to optimize CT acquisition protocols in order to minimize the delivered dose to the patient. Over the past few years, CT advances have been developing at a rapid pace. Since 2009, new iterative image reconstruction techniques, called statistical iterative reconstructions, have been introduced in order to decrease patient exposure and improve image quality.¦The goal of the present work was to determine the potential of statistical iterative reconstructions to reduce dose as much as possible without compromising image quality and maintain diagnosis of children and young adult examinations.¦The optimization step requires the evaluation of the delivered dose and image quality useful to perform diagnosis. While the dose is estimated using CT indices (CTDIV0| and DLP), the particularity of this research was to use two radically different approaches to evaluate image quality. The first approach, called the "physical approach", computed physical metrics (SD, MTF, NPS, etc.) measured on phantoms in well-known conditions. Although this technique has some limitations because it does not take radiologist perspective into account, it enables the physical characterization of image properties in a simple and timely way. The second approach, called the "clinical approach", was based on the evaluation of anatomical structures (diagnostic criteria) present on patient images. Radiologists, involved in the assessment step, were asked to score image quality of structures for diagnostic purposes using a simple rating scale. This approach is relatively complicated to implement and also time-consuming. Nevertheless, it has the advantage of being very close to the practice of radiologists and is considered as a reference method.¦Primarily, this work revealed that the statistical iterative reconstructions studied in clinic (ASIR? and VECO have a strong potential to reduce CT dose (up to -90%). However, by their mechanisms, they lead to a modification of the image appearance with a change in image texture which may then effect the quality of the diagnosis. By comparing the results of the "clinical" and "physical" approach, it was showed that a change in texture is related to a modification of the noise spectrum bandwidth. The NPS analysis makes possible to anticipate or avoid a decrease in image quality. This project demonstrated that integrating these new statistical iterative reconstruction techniques can be complex and cannot be made on the basis of protocols using conventional reconstructions. The conclusions of this work and the image quality tools developed will be able to guide future studies in the field of image quality as texture analysis or model observers dedicated to CT.

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L’informe que es presenta en aquest llibre és el resultat d’un nou acord de col·laboració entre el Programa de les Nacions Unides per als Assentaments Humans (ONU-Habitat) i l’Institut de Seguretat Pública de Catalunya, impulsat amb l’objectiu de millorar la seguretat en esdeveniments públics en els espais urbans a l’Àfrica. La fase pilot es va dur a terme el 2010, durant els dos seminaris de formació realitzats a Mollet del Vallès (Barcelona) com a part de la Plataforma Policia per al Desenvolupament Urbà (PPUD). En aquest informe es descriuen els orígens i l’estat de la iniciativa i resumeix els resultats. També s’inclouen algunes recomanacions per a millorar la seguretat d’esdeveniments públics. Font d'informació: http://www.onuhabitat.org.

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One of the challenges of tumour immunology remains the identification of strongly immunogenic tumour antigens for vaccination. Reverse immunology, that is, the procedure to predict and identify immunogenic peptides from the sequence of a gene product of interest, has been postulated to be a particularly efficient, high-throughput approach for tumour antigen discovery. Over one decade after this concept was born, we discuss the reverse immunology approach in terms of costs and efficacy: data mining with bioinformatic algorithms, molecular methods to identify tumour-specific transcripts, prediction and determination of proteasomal cleavage sites, peptide-binding prediction to HLA molecules and experimental validation, assessment of the in vitro and in vivo immunogenic potential of selected peptide antigens, isolation of specific cytolytic T lymphocyte clones and final validation in functional assays of tumour cell recognition. We conclude that the overall low sensitivity and yield of every prediction step often requires a compensatory up-scaling of the initial number of candidate sequences to be screened, rendering reverse immunology an unexpectedly complex approach.

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Background: Adenovirus serotype 5 (Ad5) phase IIb vaccine trial (STEP) was prematurely stopped due to a lack of efficacy and two-fold higher incidence of HIV infection among Ad5 seropositive vaccine recipients. We have recently demonstrated that Ad5 immune complexes (Ad5 ICs)-mediated activation of the dendritic cell (DC)-T cell axis was associated with the enhancement of HIV infection in vitro. Although the direct role of Ad5 neutralizing antibodies (NAbs) in the increase of HIV susceptibility during the STEP trial is still under debate, vector-specific NAbs remain a major hurdle for vector-based gene therapies or vaccine strategies. To surmount this obstacle, vectors based on ''rare'' Ad serotypes including Ad6, Ad26, Ad36 and Ad41 were engineered.Methods: The present study aimed to determine whether Ad ICmediated DC maturation could be circumvented using these Advector candidates.Results: We found that all Ad vectors tested forming ICs with plasma containing serotype-specific NAbs had the capacity to 1) mature human DCs as monitored by the up-regulation of costimulatory molecules and the release of pro-inflammatory cytokines (TNF-a), via the stabilization of Ad capsid at endosomal but not lysosomal pH rendering Ad DNA/TLR9 interactions possible and 2) potentiate Ad-specific CD4 and CD8 T cell responses.Conclusion: In conclusion, despite a conserved DC maturation potential, the low prevalence of serotype-specific NAbs renders rare Ad vectors attractive for vaccine strategies.

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Purpose: Although young males encounter sexually-related concerns, they are mostly absent from specialized services. Our objective is to assess whether the internet is used by boys to find answers to these types of problems and questions. Methods: In the context of a qualitative study assessing young males' barriers to access sexual and reproductive health facilities, we conducted two focus groups gathering 12 boys aged 17-20. Discussions were triggered through the presentation of four vignettes corresponding to questions posted by 17-20 year old boys and girls on an information website for adolescents (www.ciao.ch), concerning various sexual dysfunction situations. In order to avoid having to talk about their own experience, participants were asked what they would do in those cases. Results: In general, the internet was mentioned quite thoroughly as a means of searching for information through research engines and a place to address professionals for advice.Within the hierarchy of consultation possibilities, the internet was given the first place as a way to deal with these types of problems presenting many advantages: (1) the internet enables to maintain intimacy; (2) it is anonymous (use of a pseudo); (3) it avoids having to confront someone face-to-face with personal problems which can be embarrassing and challenging for one's pride; (4) it is free; and (5) it is accessible at all times. In other words, participants value the internet as a positive tool to avoid many barriers which prevent offline consultations to take place. Most participants consider the internet at least as a first step in trying to solve a problem; for instance, by better defining the seriousness of a problem and judging if it is worth consulting a doctor. However, despite the positive qualities of the internet, they do put forward the importance of having specialists answering questions, trustworthiness, and being followed-up by the same person. Participants suggested that a strategy to break down barriers for boys to consult in face-to-face settings is to have a consultation on the internet as a first step which could then guide the person to an in-person consultation if necessary. Conclusions: The internet as a means of obtaining information or consulting received high marks overall. Although the internet cannot replace an in-person consultation, the screen and the keyboard have the advantage of not involving a face-to-face encounter and raise the possibility of discussing sexual problems anonymously and in private. The internet tools together with other new technologies should continue to develop in a secure manner as a space providing prevention messages and to become an easy access door to sexual and reproductive health services for young men, which can then guide youths to appropriate resource persons. Sources of support: This study was supported by the Maurice Chalumeau Foundation, Switzerland.