Key elements for, and indicators of, a successful transition: an international Delphi study.

PURPOSE: The purpose of this study was to reach an international consensus to determine what key elements should be part of a transition program and what indicators could be used to assess its success. METHODS: For this purpose, a Delphi study including an international panel of 37 experts was carried out. The study consisted of three rounds, with response rates ranging from 86.5% to 95%. At each round, experts were asked to assess key elements (defined as the most important elements for the task) and indicators (defined as quantifiable characteristics). At each round, panelists were contacted via e-mail explaining them the tasks to be done and giving them the Web link where to complete the questionnaire. At Round 3, each key element and indicator was assessed as essential, very important, important, accessory, or unnecessary. A 70% agreement was used as cutoff. RESULTS: At Round 3, more than 70% of panelists agreed on six key elements being essential, with one of them (Assuring a good coordination between pediatric and adult professionals) reaching an almost complete consensus (97%). Additionally, 11 more obtained more than 70% agreement when combined with the Very important category. Among indicators, only one (Patient not lost to follow-up) was considered almost unanimously (91%) as essential by the panelists and seven others also reached consensus when the Very important category was included. CONCLUSIONS: Using these results as a framework to develop guidelines at local, national, and international levels would allow better assessing and comparing transition programs.

Population Size and Civil Conflict Risk: Is There A Causal Link?

[spa] La estimación del impacto del tamaño de la populación sobre la probabilidad de conflicto civil se complica por el sesgo de endogeneidad y las variables omitidas. Este artículo trata el problema de causalidad utilizando métodos de variables instrumentales en un panel de 37 países del África Sub-sahariana en el período 1981-2004. Encontramos que un aumento de la población en un 1% aumenta la probabilidad de conflicto civil por un 5.2%.

Do mediterranean genera not included in Tachet et al. (2002) have mediterranean trait characteristics?

Do mediterranean genera not included in Tachet et al. 2002 have mediterranean trait characteristics? Multiple-trait databases are increasingly used in community ecology in different regions of the world. In Europe, Tachet et al.(2002) compiled an aquatic macroinvertebrate database for 473 taxa using information on 11 biological traits described by 63 categories. However, less studied regions, at the time of the compilation of the database, such as the mediterranean Basin, can harbour exclusive genera, which were not included in Tachet"s database. In a large-scale study across the mediterranean Basin, we found 44 genera that were not included in Tachet"s database (NEW genera). Our main aim was to compile trait information for these NEW genera and assess whether these genera had specific traits that could explain their exclusivity to the Mediterranean region. We compared the trait characteristics of NEW genera to those of genera only found in Mediterranean or temperate regions that were included in the Tachet"s database (MED and TEM genera, respectively). We found that NEW genera had more mediterranean characteristics than TEM genera and that some trait categories of NEW genera were even more mediterranean-like than the traits of MED genera (e.g., diapause). Therefore, our results suggest that the specific biological traits of these NEW genera allow them to cope successfully and exclusively with the harsh environmental conditions of the mediterranean climate rivers, which could partially explain their absence in Tachet"s database. Other explanations, such as the limited dispersal ability of these NEW genera to reach and colonize temperate Europe or the rarity of these NEW genera, should also be considered. We provide biological traits of the NEW genera to be used in future studies on the mediterranean river ecology.

Characteristics of 2D convective structures in Catalonia (NE Spain): an analysis using radar data and GIS

Flood simulation studies use spatial-temporal rainfall data input into distributed hydrological models. A correct description of rainfall in space and in time contributes to improvements on hydrological modelling and design. This work is focused on the analysis of 2-D convective structures (rain cells), whose contribution is especially significant in most flood events. The objective of this paper is to provide statistical descriptors and distribution functions for convective structure characteristics of precipitation systems producing floods in Catalonia (NE Spain). To achieve this purpose heavy rainfall events recorded between 1996 and 2000 have been analysed. By means of weather radar, and applying 2-D radar algorithms a distinction between convective and stratiform precipitation is made. These data are introduced and analyzed with a GIS. In a first step different groups of connected pixels with convective precipitation are identified. Only convective structures with an area greater than 32 km2 are selected. Then, geometric characteristics (area, perimeter, orientation and dimensions of the ellipse), and rainfall statistics (maximum, mean, minimum, range, standard deviation, and sum) of these structures are obtained and stored in a database. Finally, descriptive statistics for selected characteristics are calculated and statistical distributions are fitted to the observed frequency distributions. Statistical analyses reveal that the Generalized Pareto distribution for the area and the Generalized Extreme Value distribution for the perimeter, dimensions, orientation and mean areal precipitation are the statistical distributions that best fit the observed ones of these parameters. The statistical descriptors and the probability distribution functions obtained are of direct use as an input in spatial rainfall generators.

The contribution of individual and professional characteristics to general and work-related well-being

Cette thèse porte sur la contribution des caractéristiques individuelles et des situations professionnelles au bien-être. En combinant différentes perspectives théoriques, notamment la théorie de la construction de la carrière, la théorie de la justice organisationnelle, les modèles du bien-être au travail, et les conceptualisations de l'incivilité au travail, un certain nombre d'hypothèses sont proposées concernant le lien entre certaines caractéristiques individuelles et situationnelles et le bien-être général et professionnel. Les deux premières études se focalisent sur la validation d'une échelle d'adaptabilités de carrière et sur le rôle médiateur de cette adaptabilité dans la relation entre des dispositions et le bien-être. La troisième étude évolue l'hypothèse d'un possible effet de médiation de l'adaptabilité mais cette fois de la relation entre insécurité professionnelle et charge de travail d'une part et le bien-être d'autre part. La quatrième étude adopte une perspective longitudinale et analyse les associations entre les dimensions de la personnalité, l'adaptabilité de carrière et le bien-être dans quatre parcours professionnels différents. La cinquième étude porte sur une autre caractéristique individuelle, à savoir la croyance en un monde juste. Cette étude illustre comment la croyance en un monde juste influence les perceptions de justice organisationnelle une année après, qui ont une incidence importante sur le bien-être. Enfin, la dernière étude se concentre sur une population spécifique, les immigrants en Suisse, et souligne qu'être la cible d'incivilité sur le lieu de travail est généralement liée au pays d'origine. Globalement, cette thèse met en évidence que les caractéristiques individuelles ont des effets tant directs qu'indirects sur le bien-être et que ces mêmes caractéristiques explique en partie, les relations entre la situation professionnelle et le bien-être. Plus spécifiquement, des situations professionnelles peuvent influencer l'expression de certaines caractéristiques individuelles, soit en contribuant à leurs activations ou à leurs inhibitions. De plus, l'impact des caractéristiques individuelles sur le bien-être semble dépendre de la situation professionnelle. Il est donc important de considérer les influences simultanées et réciproques des caractéristiques individuelles et de la situation contextuelle et professionnelle pour rendre compte du bien-être général et professionnel. -- This thesis explores how individual characteristics and professional situations correspond to well-being. Drawing from various theoretical backgrounds, such as career construction theory, justice theory, models of job strain, and theories on subtle discrimination, a number of specific hypotheses are put forward pertaining to a selection of individual and professional aspects as well as general and work-related well-being. The six studies presented in this thesis focus on specific aspects and adopt different methodological and theoretical approaches. The first two studies concern the validation of the career adapt-abilities scale and test the potential of career adapt-abilities to mediate the relationship between dispositions and outcomes. The third study extends the hypothesis of career adapt-abilities as a mediator and finds that it mediates the effects of job insecurity and job strain on general and professional well-being. The fourth study adopts a longitudinal approach and tests the associations between personality traits and career adaptability and well-being in four different professional situations. Study five concerns another individual characteristic, belief in a just world, and illustrates how justice beliefs drive perceptions of organizational justice, which in turn impact, on well-being outcomes one year later. The final study focuses on the professional experiences of a specific population, immigrants in Switzerland, and confirms that being a target of incivilities is related to national origin. Globally, this thesis finds that individual characteristics have direct and indirect influences on well-being and that these characteristics may also mediate the associations between professional situations and outcomes. In particular, the professional situation may alter the display of individual characteristics, either by contributing to their activation or their depletion, and the ways in which individual factors influence well-being does seem to depend on the professional situation. It is thus necessary to adopt a "both...and" perspective when studying the impact of individual and professional characteristics as these factors mutually influence each other.

Repeatability, correlation and path analysis of physical and chemical characteristics of peach fruits

This study aimed to determine the number of measurements necessary to evaluate physical and chemical characteristics of peach fruits, study the relationships between them and their direct and indirect effects on the content of ascorbic acid and total carotenoids. The characteristics skin and pulp color, fruit weight, suture, equatorial and polar diameters, firmness, soluble solids (SS), titratable acidity (TA), SS/TA ratio, ascorbic acid and total carotenoids were evaluated in 39 cultivars of peach and 3 cultivars of nectarine from the orchard of the Universidade Federal de Viçosa. The repeatability coefficient was estimated by ANOVA and CPCOR. Phenotypic correlation coefficients (rf) were estimated and, after the multicollinearity diagnostics, they were unfolded to direct and indirect effects of the explanatory variables on the response variable using path analysis. There was agreement on the magnitude of repeatability coefficients obtained by the two methods; however, they varied among the 14 characteristics. The highest correlations were found between FW, SD, ED and PD. Seven fruits are sufficient to evaluate the physical and chemical characteristics of peach with a correlation coefficient of 90%. The characteristics considered in the path diagrams (b* skin, hº skin, b* pulp, hº pulp, ED, PD, FIR, SS, SS/AT and TC) are not the main determinants of the ascorbic acid. The yellow hue of the pulp (hº pulp) has the potential to be used in indirect selection for total carotenoids.

Pathomorphological and CT-angiographical characteristics of coronary atherosclerotic plaques in cases of sudden cardiac death.

The goal of this study was to assess the localization and types of thrombosed plaques in cases of sudden cardiac death attributed to coronary artery disease and to evaluate possible correlations with body mass index (BMI) and increased heart weight. This retrospective study was performed on forensic cases for which the cause of death was attributed to coronary artery disease. A complete autopsy and a multi-phase postmortem computed tomography (CT) angiography (MPMCTA) were performed in all cases. Eighty-five cases were selected (mean age, 55.18 ± 11.04 years; 72 men and 13 women). MPMCTA performed prior to autopsy enabled an evaluation of coronary artery perfusion before dissection of the body and helped therefore to guide sampling for histology. An acute coronary thrombosis was found in 57 cases, which included plaque erosion in 26 cases (mean age, 46.73 ± 8.33 years) and rupture or intra-plaque hemorrhage in 31 cases (mean age, 58.23 ± 10.62 years). Erosions were most frequently found in the left anterior descending artery (61.5 %), while only 35.48 % of ruptures were observed in this artery. Chronic coronary pathology was considered as the main cause of death in 28 cases (mean age, 59.64 ± 9.47 years). Sixty-two of the cases (72.94 %) had a BMI in the overweight category (BMI ≥25), with the highest mean BMI in patients with chronic coronary pathology without acute thrombosis found at autopsy. The heart weight was above the predicted reference values in 52 cases (61.18 %). Our results are in accordance with previously published studies on the spatial distribution of vulnerable plaques. We observed a higher percentage of eroded plaques than previously reported. Patients with coronary erosions were significantly younger than those with plaque rupture or those without an acute coronary thrombosis (p values <0.0001). BMI and heart weight were significantly higher for cases without thrombosis in comparison with those with plaque rupture (p values 0.028 and 0.003, respectively). Our results indicating that increased BMI and overweight hearts are associated with chronic ischemic heart disease are compatible with clinical studies. Performing more postmortem studies on forensic autopsies, including modern radiological examinations with MPMCTA, can enhance the detection of vulnerable plaques in living patients and prevent sudden cardiac death.

Type 1 diabetes mellitus in people with pharmacoresistant epilepsy: Prevalence and clinical characteristics.

BACKGROUND: There have been inconsistent reports on the potential association between diabetes mellitus and epilepsy. METHODS: We examined a consecutive cohort of 2016 people with pharmacoresistant epilepsy admitted to a tertiary medical centre. RESULTS: We identified 20 individuals with type 1 diabetes mellitus (T1DM); a point prevalence of 9.9 (95% CI: 6.4, 15.3) cases per 1000 individuals. This represents a more than two-fold increase relative to published prevalence estimates of T1DM in the general population. The onset of T1DM preceded that of epilepsy in 80% of individuals, by a median of 1.5 years. Individuals with T1DM were significantly more likely to have cryptogenic/unknown epilepsy relative to those with type 2 diabetes mellitus or without diabetes (85% versus 35% and 49%, p=0.045). All individuals with T1DM had focal epilepsy, the majority of which were temporal lobe in origin, although there was no evidence that this proportion was any different from those without T1DM (p>0.999). CONCLUSIONS: The prevalence of T1DM appears to be increased in people with pharmacoresistant epilepsy and is associated with cryptogenic/unknown epilepsy. These findings may have pathophysiological implications, especially in the context of anti-glutamic acid decarboxylase antibodies.

The high-speed induction motor: calculating the effects of solid-rotor material on machine characteristics

A method for the analysis of high-speed solid-rotor induction motors in presented. The analysis is based on a new combination of the three dimensional linear method and the transfer matrix method. Both saturation and finite length effects are taken into account. The active region of the solid rotor is divided into saturated and unsaturated parts. The time dependence is assumed to be sinusoidal and phasor quantities are used in the solution. The method is applied to the calculation of smooth solid rotors manufactured of different materials. Six rotor materials are tested: three construction steels, pure iron, a cobaltiron alloy and an aluminium alloy. The results obtained by the method agree fairly well with the measurement quantities.

Las personas mayores como actores en la comunidad rural: innovación y empowerment

Este artículo parte de dos ideas ampliamenteaceptadas en la literatura gerontológica actual, envejecer es un proceso heterogéneo íntimamente relacionado con el entorno y, el envejecimiento activo y satisfactorio esta vinculado con la participación social. Ahora bien, sigue existiendo un gran desconocimiento de los procesos de envejecimiento característicos de las zonas rurales y una falta de características de losprofesionales rurales y de las estrategias innovadoras para promover el envejecimiento activo y el fortalecimiento de estas comunidades. El artículo estábasado en los resultados obtenidos en unainvestigación cualitativa, realizada en la comarca del Alt Empordà, Catalunya. Con un total de 53 participantes. Los resultados muestran el significado que tiene lacomunidad para las personas mayores del entorno rural, confirman la necesidad de un perfil profesional rural y elaboran propuestas de acción contextualizadasque permiten reforzar a la comunidad, sin urbanizarla, a través del fortalecimiento de sistemas de participación social

Physical Activity and Snus: Is There a Link?

The study aimed at assessing the link between physical activity (PA), sports activity and snus use among young men in Switzerland. Data from the Cohort Study on Substance Use Risk Factors (C-SURF) were used to measure PA with the International Physical Activity Questionnaire and sports activity with a single item. Multivariate logistic regression analysis was conducted to measure the association between snus use, PA and sports activity. Similar models were run for smoking and snuff use. Snus use increased in a dose-response association with PA (high level: OR = 1.72; 95% CI 1.16-2.55) and with individuals exercising once a week or more often (OR = 1.65; 95% CI 1.26-2.16; p < 0.001) or almost every day (OR = 2.27; 95% CI 1.72-3.01; p < 0.001) in separate models. Entered simultaneously, only sports and exercise maintained a basically unchanged significant dose-response relationship, whereas PA became non-significant. A non-significant dose-response relation was found for cigarette smoking and snuff use, indicating that the association with sport is specific to snus and not to tobacco use in general or smokeless tobacco in particular. This study showed that the association between snus use and sports is not specific to Nordic countries.

Patients' characteristics associated with the decision of "do not attempt cardiopulmonary resuscitation" order in a Swiss hospital

Présentation En accord avec la loi suisse, seul le patient peut décider de la notification, dans son dossier, d'un ordre de «non réanimation » (DNACPR) en cas d'arrêt cardio-respiratoire. L'équipe médicale peut exceptionnellement prendre une telle décision, si elle juge qu'une réanimation n'a aucune chance d'aboutir. Les mécanismes menant à ce processus de décision n'ont pas encore été complètement investigués, en particulier en Suisse. Enjeu Notre étude vise à déterminer la prévalence de l'ordre de «non réanimation» après l'admission, l'auteur de cette décision, ainsi que son association avec certaines caractéristiques propres aux patients : le sexe, l'âge, la situation familiale, la nationalité, la religion, le nombre et le type de comorbidités. Nous cherchons ainsi à mieux définir quels sont les facteurs importants dans ce processus décisionnel complexe où le jugement médical, ainsi que l'information apportée aux patients sont primordiaux. Contexte de recherche Nous avons effectué une étude observationnelle sur une durée de 6 semaines, en analysant les formulaires d'admission de 194 patients hospitalisés dans le service de médecine interne du CHUV, dans les 72 heures après leur admission. Résultats L'étude montre que plus de la moitié des 194 dossiers de patients analysés ont un ordre de « non réanimation » (DNACPR) (53%). 27% de ces décisions ont été prises par les patients eux-mêmes, 12% par leur représentant thérapeutique/famille et 61% par les équipes médicales. Nous trouvons une association statistiquement significative entre l'ordre DNACPR et l'âge, avec un âge moyen de 80.7 +-10.8 ans dans le groupe « non réanimation » versus 67.5 +- 15.1 ans dans le groupe « réanimation », entre l'ordre DNACPR et une pathologie oncologique, quel que soit le stade de cette dernière, ainsi qu'entre l'ordre DNACPR et la religion protestante. Une analyse de sous-groupe montre que l'âge, ainsi que la pathologie oncologique sont statistiquement significatifs lors de l'analyse des décisions prises par les équipes médicales. La religion protestante est, quant à elle, significative lors de l'analyse des décisions prises par le patient ou son représentant. Perspectives Contrairement aux publications passées, cette étude montre une prédominance de l'ordre de «non réanimation » (DNACPR) à l'admission dans un service de médecine interne, principalement sur décision médicale. La plupart des patients ont été jugés incapables de discernement sur la question ou n'ont tout simplement pas été impliqués dans le processus décisionnel. Une réflexion doit avoir lieu afin de prendre des mesures de sensibilisation auprès des équipes médicales et d'approfondir la formation médicale et éthique sur le sujet de la détermination de l'attitude de réanimation. D'autres études qualitatives permettraient de mieux comprendre les motivations ayant mené à ces nombreuses décisions médicales, ainsi que les critères importants pour les patients.

Evolving characteristics and outcome of secondary acute promyelocytic leukemia (APL): A prospective analysis by the French-Belgian-Swiss APL group.

BACKGROUND: Reports of patients with secondary acute promyelocytic leukemia (APL) have increased in recent years, particularly for those who received treatment with mitoxantrone, and retrospective studies have suggested that their characteristics and outcomes were similar to those of patients with de novo APL. METHODS: The authors investigated patients with de novo and secondary APL who were included in the ongoing APL-2006 trial. Patients with secondary APL who were included in that trial also were compared with a previous retrospective cohort of patients with secondary APL. RESULTS: In the APL-2006 trial, 42 of 280 patients (15%) had secondary APL. Compared with the retrospective cohort, patients with secondary APL in the APL-2006 trial had a lower incidence of prior breast carcinoma (35.7% vs 57%; P = .03) and a higher incidence of prior prostate carcinoma (26.2% vs 4.7%; P < .001). Treatment of the primary tumor in the APL-2006 trial less frequently included combined radiochemotherapy (28.6% vs 47.2%; P = .044) and no mitoxantrone (0% vs 46.7%; P = .016) but more frequently included anthracyclines (53.3% vs 38.3%; P = .015). In the APL-2006 trial, patients who had secondary APL, compared with those who had de novo APL, were older (mean, 60.2 years vs 48.7 years, respectively; P < .0001) but had a similar complete response rate (97.6% vs 90.3%, respectively), cumulative incidence of relapse (0% vs 1.8%, respectively), and overall survival (92.3% vs 90.9%, respectively) at 18 months. CONCLUSIONS: Although the incidence of secondary APL appears to be stable over time, evolving strategies for the treatment of primary cancers have reduced its occurrence among breast cancer patients but have increased its incidence among patients with prostate cancer. The current results confirm prospectively that patients with secondary APL have characteristics and outcomes similar to those of patients with de novo APL. Cancer 2015;121:2393-2399. © 2015 American Cancer Society.

Characteristics of non-responders to self-reported questionnaires in a large inflammatory bowel disease cohort study.

BACKGROUND: A major threat to the validity of longitudinal cohort studies is non-response to follow-up, which can lead to erroneous conclusions. The objective of this study was to evaluate the profile of non-responders to self-reported questionnaires in the Swiss inflammatory bowel disease (IBD) Cohort. METHODS: We used data from adult patients enrolled between November 2006 and June 2011. Responders versus non-responders were compared according to socio-demographic, clinical and psychosocial characteristics. Odds ratio for non-response to initial patient questionnaire (IPQ) compared to 1-year follow-up questionnaire (FPQ) were calculated. RESULTS: A total of 1943 patients received IPQ, in which 331 (17%) did not respond. Factors inversely associated with non-response to IPQ were age >50 and female gender (OR = 0.37; p < 0.001 respectively OR = 0.63; p = 0.003) among Crohn's disease (CD) patients, and disease duration >16 years (OR = 0.48; p = 0.025) among patients with ulcerative colitis (UC). FPQ was sent to 1586 patients who had completed the IPQ; 263 (17%) did not respond. Risk factors of non-response to FPQ were mild depression (OR = 2.17; p = 0.003) for CD, and mild anxiety (OR = 1.83; p = 0.024) for UC. Factors inversely associated with non-response to FPQ were: age >30 years, colonic only disease location, higher education and higher IBD-related quality of life for CD, and age >50 years or having a positive social support for UC. CONCLUSIONS: Characteristics of non-responders differed between UC and CD. The risk of non-response to repetitive solicitations (longitudinal versus transversal study) seemed to decrease with age. Assessing non-respondents' characteristics is important to document potential bias in longitudinal studies.

Publication trends of shared decision making in 15 high impact medical journals: a full-text review with bibliometric analysis.

BACKGROUND: Shared Decision Making (SDM) is increasingly advocated as a model for medical decision making. However, there is still low use of SDM in clinical practice. High impact factor journals might represent an efficient way for its dissemination. We aimed to identify and characterize publication trends of SDM in 15 high impact medical journals. METHODS: We selected the 15 general and internal medicine journals with the highest impact factor publishing original articles, letters and editorials. We retrieved publications from 1996 to 2011 through the full-text search function on each journal website and abstracted bibliometric data. We included publications of any type containing the phrase "shared decision making" or five other variants in their abstract or full text. These were referred to as SDM publications. A polynomial Poisson regression model with logarithmic link function was used to assess the evolution across the period of the number of SDM publications according to publication characteristics. RESULTS: We identified 1285 SDM publications out of 229,179 publications in 15 journals from 1996 to 2011. The absolute number of SDM publications by journal ranged from 2 to 273 over 16 years. SDM publications increased both in absolute and relative numbers per year, from 46 (0.32% relative to all publications from the 15 journals) in 1996 to 165 (1.17%) in 2011. This growth was exponential (P < 0.01). We found fewer research publications (465, 36.2% of all SDM publications) than non-research publications, which included non-systematic reviews, letters, and editorials. The increase of research publications across time was linear. Full-text search retrieved ten times more SDM publications than a similar PubMed search (1285 vs. 119 respectively). CONCLUSION: This review in full-text showed that SDM publications increased exponentially in major medical journals from 1996 to 2011. This growth might reflect an increased dissemination of the SDM concept to the medical community.