Impact of extracardiac findings during cardiac MR on patient management and outcome.

BACKGROUND: Cardiac magnetic resonance (CMR) is increasingly used to assess heart diseases. Relevant non-cardiac diseases may also be incidentally found on CMR images. The aim of this study was to determine the prevalence and nature of incidental extra-cardiac findings (IEF) and their clinical impact in non-selected patients referred for CMR. MATERIAL/METHODS: MR images of 762 consecutive patients (515 men, age: 56±18 years) referred for CMR were prospectively interpreted by 2 radiologists blinded for any previous imaging study. IEFs were classified as major when requiring treatment, follow-up, or further investigation. Clinical follow-up was performed by checking hospital information records and by calling referring physicians. The 2 endpoints were: 1) non-cardiac death and new treatment related to major IEFs, and 2) hospitalization related to major IEFs during follow-up. RESULTS: Major IEFs were proven in 129 patients (18.6% of the study population), 14% of those being unknown before CMR. During 15±6 month follow-up, treatment of confirmed major IEFs was initiated in 1.4%, and no non-cardiac deaths occurred. Hospitalization occurred in 8 patients (1.0% of the study population) with confirmed major IEFs and none occurred in the remaining 110 patients with unconfirmed/unexplored major IEFs (p<0.001). CONCLUSIONS: Screening for major IEFs in a population referred for routine CMR changed management in 1.4% of patients. Major IEFs unknown before CMR but without further exploration, however, carried a favorable prognosis over a follow-up period of 15 months.

Using narratives to study the impact of social networks on the educational paths of immigrant students

This paper presents the qualitative data collection process aimed at the study of the impactsocial relations and networks have on educational paths of immigrant students. In theframework of a R & D longitudinal study funded by the Ministry of Science and Innovation(2012-2014), the research team tracked the path of 87 immigrant students, from whom only 17successfully achieved the transition through the first and second year of Post-16 Education.A vast range of literature notes that relationships are an important part of migration process andsocial integration analysis, as well as school history in terms of success or failure. Through thefieldwork researchers collect the personal networks of all immigrant students from 3 highschools who were at that time attending last course of compulsory school. The network structureinfluences their social capital and therefore determines the resources, goods and types of supportindividuals can access. All these aspects are influential elements in the configuration anddevelopment of academic trajectories of immigrant students.At the end of the second year of Post-16 Education (two years later), the study captures personalnetworks of these students again, analyses and discusses their evolution and influence on theirpaths through qualitative interviews. Such interviews facilitated the discussion of theirrelationships while providing interesting narratives that are presented in the text. In order to do so, the biographical interpretive narrative method of interviewing is implemented.

Prevalence of iodine inadequacy in Switzerland assessed by the estimated average requirement cut-point method in relation to the impact of iodized salt.

OBJECTIVE: To assess the iodine status of Swiss population groups and to evaluate the influence of iodized salt as a vector for iodine fortification. DESIGN: The relationship between 24 h urinary iodine and Na excretions was assessed in the general population after correcting for confounders. Single-day intakes were estimated assuming that 92 % of dietary iodine was excreted in 24 h urine. Usual intake distributions were derived for male and female population groups after adjustment for within-subject variability. The estimated average requirement (EAR) cut-point method was applied as guidance to assess the inadequacy of the iodine supply. SETTING: Public health strategies to reduce the dietary salt intake in the general population may affect its iodine supply. SUBJECTS: The study population (1481 volunteers, aged ≥15 years) was randomly selected from three different linguistic regions of Switzerland. RESULTS: The 24 h urine samples from 1420 participants were determined to be properly collected. Mean iodine intakes obtained for men (n 705) and women (n 715) were 179 (sd 68.1) µg/d and 138 (sd 57.8) µg/d, respectively. Urinary Na and Ca, and BMI were significantly and positively associated with higher iodine intake, as were men and non-smokers. Fifty-four per cent of the total iodine intake originated from iodized salt. The prevalence of inadequate iodine intake as estimated by the EAR cut-point method was 2 % for men and 14 % for women. CONCLUSIONS: The estimated prevalence of inadequate iodine intake was within the optimal target range of 2-3 % for men, but not for women.

Impact of ITC in primary schools in Castile and Lion

Estudio acerca de los trabajos sobre el impacto de las tecnologías de la información y comunicación en la etapa de primaria a nivel general y, más concretamente, en la comunidad de Castilla y León. Además, se estudian las posibilidades para abordar una investigación sobre cómo influyen las TIC en los aprendizajes y las motivaciones de los alumnos.

The Impact of a Character Posture Model on the Communication of Affect in an Immersive Virtual Environment

This paper presents the quantitative and qualitative findings from an experiment designed to evaluate a developing model of affective postures for full-body virtual characters in immersive virtual environments (IVEs). Forty-nine participants were each requested to explore a virtual environment by asking two virtual characters for instructions. The participants used a CAVE-like system to explore the environment. Participant responses and their impression of the virtual characters were evaluated through a wide variety of both quantitative and qualitative methods. Combining a controlled experimental approach with various data-collection methods provided a number of advantages such as providing a reason to the quantitative results. The quantitative results indicate that posture plays an important role in the communication of affect by virtual characters. The qualitative findings indicated that participants attribute a variety of psychological states to the behavioral cues displayed by virtual characters. In addition, participants tended to interpret the social context portrayed by the virtual characters in a holistic manner. This suggests that one aspect of the virtual scene colors the perception of the whole social context portrayed by the virtual characters. We conclude by discussing the importance of designing holistically congruent virtual characters especially in immersive settings.

Impact of case management on frequent users quality of life : a randomized controlled trial

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system.

The Impact of Catechol-O-Methyltransferase and Dopamine D4 Receptor Genotypes on Neurophysiological Markers of Performance Monitoring

Dynamic adaptations of one"s behavior by means of performance monitoring are a central function of the human executive system, that underlies considerable interindividual variation. Converging evidence from electrophysiological and neuroimaging studies in both animals and humans hints atthe importance ofthe dopaminergic system forthe regulation of performance monitoring. Here, we studied the impact of two polymorphisms affecting dopaminergic functioning in the prefrontal cortex [catechol-O-methyltransferase (COMT) Val108/158Met and dopamine D4 receptor (DRD4) single-nucleotide polymorphism (SNP)-521] on neurophysiological correlates of performance monitoring. We applied a modified version of a standard flanker task with an embedded stop-signal task to tap into the different functions involved, particularly error monitoring, conflict detection and inhibitory processes. Participants homozygous for the DRD4 T allele produced an increased error-related negativity after both choice errors and failed inhibitions compared with C-homozygotes. This was associated with pronounced compensatory behavior reflected in higher post-error slowing. No group differences were seen in the incompatibility N2, suggesting distinct effects of the DRD4 polymorphism on error monitoring processes. Additionally, participants homozygous for the COMTVal allele, with a thereby diminished prefrontal dopaminergic level, revealed increased prefrontal processing related to inhibitory functions, reflected in the enhanced stop-signal-related components N2 and P3a. The results extend previous findings from mainly behavioral and neuroimaging data on the relationship between dopaminergic genes and executive functions and present possible underlying mechanisms for the previously suggested association between these dopaminergic polymorphisms and psychiatric disorders as schizophrenia or attention deficit hyperactivity disorder.

THE IMPACT OF ARCHITECTURAL DESIGN ON SOFTWARE DEVELOPMENT

Tässä työssä tutkitaan ohjelmistoarkkitehtuurisuunnitteluominaisuuksien vaikutusta erään client-server –arkkitehtuuriin perustuvan mobiilipalvelusovelluksen suunnittelu- ja toteutusaikaan. Kyseinen tutkimus perustuu reaalielämän projektiin, jonka kvalitatiivinen analyysi paljasti arkkitehtuurikompponenttien välisten kytkentöjen merkittävästi vaikuttavan projektin työmäärään. Työn päätavoite oli kvantitatiivisesti tutkia yllä mainitun havainnon oikeellisuus. Tavoitteen saavuttamiseksi suunniteltiin ohjelmistoarkkitehtuurisuunnittelun mittaristo kuvaamaan kyseisen järjestelmän alijärjestelmien arkkitehtuuria ja luotiin kaksi suunniteltua mittaristoa käyttävää, työmäärää (komponentin suunnittelu-, toteutus- ja testausaikojen summa) arvioivaa mallia, joista toinen on lineaarinen ja toinen epälineaarinen. Näiden mallien kertoimet sovitettiin optimoimalla niiden arvot epälineaarista gloobaalioptimointimenetelmää, differentiaalievoluutioalgoritmia, käyttäen, niin että mallien antamat arvot vastasivat parhaiten mitattua työmäärää sekä kaikilla ominaisuuksilla eli attribuuteilla että vain osalla niistä (yksi jätettiin vuorotellen pois). Kun arkkitehtuurikompenttien väliset kytkennät jätettiin malleista pois, mitattujen ja arvoitujen työmäärien välinen ero (ilmaistuna virheenä) kasvoi eräässä tapauksessa 367 % entisestä tarkoittaen sitä, että näin muodostettu malli vastasi toteutusaikoja huonosti annetulla ainestolla. Tämä oli suurin havaitu virhe kaikkien poisjätettyjen ominaisuuksien kesken. Saadun tuloksen perusteella päätettiin, että kyseisen järjestelmän toteutusajat ovat vahvasti riippuvaisia kytkentöjen määrästä, ja näin ollen kytkentöjen määrä oli mitä todennäköisemmin kaikista tärkein työmäärään vaikuttava tekijä tutkitun järjestelmän arkkitehtuurisuunnittelussa.

Impact of open-ocean convection on particle fluxes and sediment dynamics in the deep margin of the Gulf of Lions.

Abstract. The deep outer margin of the Gulf of Lions and the adjacent basin, in the western Mediterranean Sea, are regularly impacted by open-ocean convection, a major hydrodynamic event responsible for the ventilation of the deep water in the western Mediterranean Basin. However, the impact of open-ocean convection on the flux and transport of particulate matter remains poorly understood. The variability of water mass properties (i.e., temperature and salinity), currents, and particle fluxes were monitored between September 2007 and April 2009 at five instrumented mooring lines deployed between 2050 and 2350-m depth in the deepest continental margin and adjacent basin. Four of the lines followed a NW-SE transect, while the fifth one was located on a sediment wave field to the west. The results of the main, central line SC2350 ("LION") located at 42 02.50 N, 4 410 E, at 2350-m depth, show that open-ocean convection reached midwater depth ( 1000-m depth) during winter 2007-2008, and reached the seabed ( 2350-m depth) during winter 2008-2009. Horizontal currents were unusually strong with speeds up to 39 cm s−1 during winter 2008-2009. The measurements at all 5 different locations indicate that mid-depth and near-bottom currents and particle fluxes gave relatively consistent values of similar magnitude across the study area except during winter 2008-2009, when near-bottom fluxes abruptly increased by one to two orders of magnitude. Particulate organic carbon contents, which generally vary between 3 and 5 %, were abnormally low ( 1 %) during winter 2008-2009 and approached those observed in surface sediments (0.6 %). Turbidity profiles made in the region demonstrated the existence of a bottom nepheloid layer, several hundred meters thick, and related to the resuspension of bottom sediments. These observations support the view that open-ocean deep convection events in the Gulf of Lions can cause significant remobilization of sediments in the deep outer margin and the basin, with a subsequent alteration of the seabed likely impacting the functioning of the deep-sea ecosystem.

Potential impact of environmental bacteriophages in spreading antibiotic resistance genes

The idea that bacteriophage transduction plays a role in the horizontal transfer of antibiotic resistance genes is gaining momentum. Such transduction might be vital in horizontal transfer from environmental to human body-associated biomes and here we review many lines of evidence supporting this notion. It is well accepted that bacteriophages are the most abundant entities in most environments, where they have been shown to be quite persistent. This fact, together with the ability of many phages to infect bacteria belonging to different taxa, makes them suitable vehicles for gene transfer. Metagenomic studies confirm that substantial percentages of the bacteriophage particles present in most environments contain bacterial genes, including mobile genetic elements and antibiotic resistance genes. When specific genes of resistance to antibiotics are detected by real-time PCR in the bacteriophage populations of different environments, only tenfold lower numbers of these genes are observed, compared with those found in the corresponding bacterial populations. In addition, the antibiotic resistance genes from these bacteriophages are functional and generate resistance to the bacteria when these genes are transfected. Finally, reports about the transduction of antibiotic resistance genes are on the increase.

Status epilepticus: impact of therapeutic coma on outcome.

OBJECTIVES: Therapeutic coma is advocated in guidelines for management of refractory status epilepticus; this is, however, based on weak evidence. We here address the specific impact of therapeutic coma on status epilepticus outcome. DESIGN: Retrospective assessment of a prospectively collected cohort. SETTING: Academic hospital. PATIENTS: Consecutive adults with incident status epilepticus lasting greater than or equal to 30 minutes, admitted between 2006 and 2013. MEASUREMENTS AND MAIN RESULTS: We recorded prospectively demographics, clinical status epilepticus features, treatment, and outcome at discharge and retrospectively medical comorbidities, hospital stay, and infectious complications. Associations between potential predictors and clinical outcome were analyzed using multinomial logistic regressions. Of 467 patients with incident status epilepticus, 238 returned to baseline (51.1%), 162 had new disability (34.6%), and 67 died (14.3%); 50 subjects (10.7%) were managed with therapeutic coma. Therapeutic coma was associated with poorer outcome in the whole cohort (relative risk ratio for new disability, 6.86; 95% CI, 2.84-16.56; for mortality, 9.10; 95% CI, 3.17-26.16); the effect was more important in patients with complex partial compared with generalized convulsive or nonconvulsive status epilepticus in coma. Prevalence of infections was higher (odds ratio, 3.81; 95% CI, 1.66-8.75), and median hospital stay in patients discharged alive was longer (16 d [range, 2-240 d] vs 9 d [range, 1-57 d]; p < 0.001) in subjects managed with therapeutic coma. CONCLUSIONS: This study provides class III evidence that therapeutic coma is associated with poorer outcome after status epilepticus; furthermore, it portends higher infection rates and longer hospitalizations. These data suggest caution in the straightforward use of this approach, especially in patients with complex partial status epilepticus.

Trace element monitoring in the ICU: quality and economic impact of a change in sampling practice.

BACKGROUND & AIMS: Trace elements (TE) are involved in the immune and antioxidant defences which are of particular importance during critical illness. Determining plasma TE levels is costly. The present quality control study aimed at assessing the economic impact of a computer reminded blood sampling versus a risk guided on-demand monitoring of plasma concentrations of selenium, copper, and zinc. METHODS: Retrospective analysis of 2 cohorts of patients admitted during 6 months periods in 2006 and 2009 to the ICU of a University hospital. INCLUSION CRITERIA: to receive intravenous micronutrient supplements and/or to have a TE sampling during ICU stay. The TE samplings were triggered by computerized reminder in 2006 versus guided by nutritionists in 2009. RESULTS: During the 2 periods 636 patients met the inclusion criteria out of 2406 consecutive admissions, representing 29.7% and 24.9% respectively of the periods' admissions. The 2009 patients had higher SAPS2 scores (p = 0.02) and lower BMI compared to 2006 (p = 0.007). The number of laboratory determinations was drastically reduced in 2009, particularly during the first week, despite the higher severity of the cohort, resulting in à 55% cost reduction. CONCLUSIONS: The monitoring of TE concentrations guided by a nutritionist resulted in a reduction of the sampling frequency, and targeting on the sickest high risk patients, requiring a nutritional prescription adaptation. This control leads to cost reduction compared to an automated sampling prescription.

'Steal me if you can!' The impact of campaign messages on associative issue ownership

Whereas extant work on issue ownership treats voters' issue ownership perceptions as independent variables to explain electoral choice or party behaviour, this article examines whether parties can, by communicating on an issue, turn voters' perceptions of issue ownership to their advantage. In contrast to most previous studies that have focused on competence ownership - measured as a party's capacity to handle an issue - this article analyses the short-term and long-term impact of campaign messages on voters' perceptions of associative ownership, which refers to the voters' spontaneous party-issue association, regardless of whether or not voters consider the party as the most competent at dealing with the issue at hand. Based on an online experimental design in Belgium, we show that parties are unable to steal issues that are associated with another party. However, by communicating on their own issues, parties can reinforce their reputation as an associative owner - but only in the short run and only if their previous ownership reputation is not overly strong.

Governance by Contract? The impact of the International Finance Corporation's Social Conditionality on Worker Organization and Social Dialogue

This study considers the question of the relationship between private labour regulation and workers' capacity to take collective action through the lens of an empirical study of the International Finance Corporation's (IFC) 'performance standards' system of social and environmental conditionality. The study covered some 150 IFC client businesses in four world regions, drawing on data made public by the IFC as well as the results of a dedicated field survey that gathered information directly from workers, managers and union representatives. The study found that the application of the performance standards system has had remarkably little impact on union membership and social dialogue. In those few cases where change could be causally linked to the standards, the effect depended on the presence of workers' organizations that already had the capacity to take effective action on behalf of their members. The study also uncovered some prima facie evidence of breaches of freedom of association rights occurring with no reaction from IFC. The study concludes that the lack of impact is largely due to the private contractual structure that supposedly guarantees standards compliance.