New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania.

INTRODUCTION: The decline of malaria and scale-up of rapid diagnostic tests calls for a revision of IMCI. A new algorithm (ALMANACH) running on mobile technology was developed based on the latest evidence. The objective was to ensure that ALMANACH was safe, while keeping a low rate of antibiotic prescription. METHODS: Consecutive children aged 2-59 months with acute illness were managed using ALMANACH (2 intervention facilities), or standard practice (2 control facilities) in Tanzania. Primary outcomes were proportion of children cured at day 7 and who received antibiotics on day 0. RESULTS: 130/842 (15∙4%) in ALMANACH and 241/623 (38∙7%) in control arm were diagnosed with an infection in need for antibiotic, while 3∙8% and 9∙6% had malaria. 815/838 (97∙3%;96∙1-98.4%) were cured at D7 using ALMANACH versus 573/623 (92∙0%;89∙8-94∙1%) using standard practice (p<0∙001). Of 23 children not cured at D7 using ALMANACH, 44% had skin problems, 30% pneumonia, 26% upper respiratory infection and 13% likely viral infection at D0. Secondary hospitalization occurred for one child using ALMANACH and one who eventually died using standard practice. At D0, antibiotics were prescribed to 15∙4% (12∙9-17∙9%) using ALMANACH versus 84∙3% (81∙4-87∙1%) using standard practice (p<0∙001). 2∙3% (1∙3-3.3) versus 3∙2% (1∙8-4∙6%) received an antibiotic secondarily. CONCLUSION: Management of children using ALMANACH improve clinical outcome and reduce antibiotic prescription by 80%. This was achieved through more accurate diagnoses and hence better identification of children in need of antibiotic treatment or not. The building on mobile technology allows easy access and rapid update of the decision chart. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201011000262218.

Le diabète dans le canton de Vaud : évaluation de la pratique des professionnel(le)s de santé et de la collaboration interprofessionnelle

Contexte: Le Programme cantonal diabète se développe depuis 2010 dans le canton de Vaud. Il a pour objectif de limiter l'évolution de l'incidence du diabète et d'améliorer la prise en charge des patients diabétiques. - Méthodes: Cette étude vise à recueillir des données concernant : 1) la collaboration interprofessionnelle, 2) la pratique professionnelle au regard du « Chronic care model », ainsi que 3) la connaissance et la mise en pratique des recommandations pour la pratique clinique (RPC) auprès du patient diabétique. Les professionnels de santé (PdS) suivant ont été sollicités pour participer à cette étude : médecins et infirmier(ère)s spécialisé(e)s en diabétologie, médecins de premiers recours et infirmier(ère)s en soins généraux. Cette étude comporte un volet quantitatif où les PdS étaient invités à répondre à un questionnaire sur Internet, et un volet qualitatif où des PdS ont été réunis lors de trois focus groups pour recueillir leurs avis sur les trois thématiques de l'étude.

Dynamic range extension of SiPM detectors with the time-gated operation

The silicon photomultiplier (SiPM) is a novel detector technology that has undergone a fast development in the last few years, owing to its single-photon resolution and ultra-fast response time. However, the typical high dark count rates of the sensor may prevent the detection of low intensity radiation fluxes. In this article, the time-gated operation with short active periods in the nanosecond range is proposed as a solution to reduce the number of cells fired due to noise and thus increase the dynamic range. The technique is aimed at application fields that function under a trigger command, such as gated fluorescence lifetime imaging microscopy.

Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study.

BACKGROUND: The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. METHODS: Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. RESULTS: EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). CONCLUSIONS: In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.

Russian mobile telecommunications market: players and trends

Objective of this work was to clarify the competitive situation of Russian mobile telecommunications market: who are the main players, are there many regional operators, what is the possibility of new entrants and how intensive is the competition. In the beginning the history of Russian mobile telecommunications sector is described. In the next chapter environmental factors of the market are examined with the help of PESTEL analysis. After that, players of the market are introduced to ease the following of next chapters. The main theory for this work was industry analysis of five competitive forces by Michael Porter, which is presented before the theory related industry analysis of Russian mobile telecommunications industry. Research for the industry analysis is mainly based on up-to-date articles describing Russian market. As a result of the industry analysis, competitive situation of Russian mobile telecommunications industry and the future prospects are described with the help of factors coming from the PESTEL-analysis. Finally development and future prospects for Russian 3G are reported. As a result of this work, it can be said that Russian mobile telecommunications market is not likely to maintain the growth of previous years, because the market is near saturation. According to passive SIM-cards it has already received saturated. The saturation will also make the market share game between operators more volatile. The market is dominated by three national operators that covered 88% of the income in the first half of 2007. In addition to these three, there are also several regional operators. Structure of the market is likely to consolidate.

La collaboration interprofessionnelle à l'interface des institutions socio-éducative et psychiatrique. Jeux et enjeux de l'intervention auprès de personnes en situation de handicap mental et de troubles psychiques

La prise en charge et le suivi de personnes en situation de handicap mental souffrant de troubles psychiques et se trouvant donc à l'interface des domaines socio:éducatif et psychiatrique, constituent des défis complexes en matière de collaboration interprofessionnelle. Dans le canton de Vaud, les acteurs concernés par ce problème s'efforcent depuis de nombreuses années de créer des réseaux pluridisciplinaires visant un meilleur échange entre professionnels et le développement de compétences et de connaissances permettant d'améliorer le bien:être des bénéficiaires. Ce travail se propose ainsi d'étudier et de questionner ces modalités de travail dans une perspective socioculturelle (Vygotski, 1934/1997), afin d'en comprendre le fonctionnement, d'en éclairer les mécanismes et de fournir des pistes de réflexion aux professionnels. Il repose sur un travail de terrain mené auprès des membres du Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM) du Département de psychiatrie du CHUV, dont la mission principale est de faciliter la collaboration entre les institutions socio:éducatives et psychiatriques spécialisées dans le suivi des personnes en situation de handicap mental et souffrant de troubles psychiques. Le travail empirique est basé sur une approche qualitative et compréhensive des interactions sociales, et procède par une étude de terrain approfondie. Les données recueillies sont variées : notes de terrain et récolte de documentation, enregistrement de réunions d'équipe au sein du DCPHM et de réunions de réseau, et entretiens de différents types. L'analyse montre que le travail de collaboration qui incombe à l'équipe est constitué d'obstacles qui sont autant d'occasions de développement professionnel et de construction identitaire. Les résultats mettent en lumière des mécanismes discursifs de catégorisation concourant à la fois à la construction des patients comme objets d'activité, et à la construction d'une place qui légitime les interventions de l'équipe dans le paysage socio:éducatif et psychiatrique vaudois et la met au centre de l'arène professionnelle. -- Care and follow:up for people with mental disabilities suffering from psychological disorders : therefore at the interface between the socio:educational and psychiatric fields : represent complex challenges in terms of interprofessional collaboration. In the canton of Vaud, the caregivers involved in this issue have been trying for years to build multidisciplinary networks in order to better exchange between professionals and develop skills and knowledge to improve the recipients' well:being. This work thus proposes to study and question these working methods in a sociocultural perspective (Vygotski, 1934/1997) so as to understand how they operate, highlight inherent mechanisms and provide actionable insights to the professionals. It is based on fieldwork conducted among members of the Dispositif de Collaboration Psychiatrie Handicap Mental (DCPHM), of the Psychiatry Department at the CHUV University Hospital in Lausanne, whose main mission is to facilitate collaboration between the socio:educational and psychiatric institutions specialising in monitoring people presenting with both mental handicap and psychiatric disorder. The empirical work is based on a qualitative and comprehensive approach to social interactions, and conducted based on an in:depth field study. The data collected are varied - field notes and documentation collection, recordings of team meetings within the DCPHM and network meetings, and various types of interviews. The analysis shows that the collaborative work that befalls the team consists of obstacles, all of which provide opportunities for professional development and identity construction. The results highlight discursive strategies of categorisation which contribute both to the construction of the patients as objects of activity and to building a position that legitimates the team's interventions in the socio: educational and psychiatric landscape of canton Vaud and puts it in the centre of the professional arena.

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1899 (A1).

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1902 (A4)-1903.

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1902/12 (A3).

L'Année coloniale / publiée sous la direction de MM. Ch. Mourey,... Louis Brunel,... ; avec la collaboration de MM. le Général Gallieni, Picquié et Teissier

1900 (A2).

Optimizing Mobile Java Location-Based Services in Symbian OS

This thesis evaluates methods for obtaining high performance in applications running on the mobile Java platform. Based on the evaluated methods, an optimization was done to a Java extension API running on top the Symbian operating system. The API provides location-based services for mobile Java applications. As a part of this thesis, the JNI implementation in Symbian OS was also benchmarked. A benchmarking tool was implemented in the analysis phase in order to implement extensive performance test set. Based on the benchmark results, it was noted that the landmarks implementation of the API was performing very slowly with large amounts of data. The existing implementation proved to be very inconvenient for optimization because the early implementers did not take performance and design issues into consideration. A completely new architecture was implemented for the API in order to provide scalable landmark initialization and data extraction by using lazy initialization methods. Additionally, runtime memory consumption was also an important part of the optimization. The improvement proved to be very efficient based on the measurements after the optimization. Most of the common API use cases performed extremely well compared to the old implementation. Performance optimization is an important quality attribute of any piece of software especially in embedded mobile devices. Typically, projects get into trouble with performance because there are no clear performance targets and knowledge how to achieve them. Well-known guidelines and performance models help to achieve good overall performance in Java applications and programming interfaces.

Evolution of Ba and Role of Absorptive Capacity in Collaboration between MNCs and Chinese Universities in China

During the recent years, collaboration with Chinese universities has aroused growing interest among multinational companies (MNCs). Cross-cultural university-industry (U-I) collaboration creates various challenges in collaborative knowledge creation and innovation due to the differences e.g. between university and company motivation, objectives and activities. Also different values, norms, and means of actions result often in collisions and misunderstandings. This thesis examines the establishment of the relationships and the evolution of the collaboration between MNCs and Chinese universities. Empirical findings underscore that the partners in collaboration are required to possess research interest as well as capability to acquire, assimilate and exploit new external knowledge. Time and communication have a critical role in the evolution of the collaboration. In China the personal relationships, guanxi, play an important role. Collaborative knowledge creation requires a platform, Ba, which enables the creation of common understanding, commitment, trust and mutual respect. Empirical data has been collected through interviewing company experts and academe of Chinese universities from ICT and forest industries as well as attending panel discussions and meetings with the experts from the field of study.