Les arènes de la normalisation internationale à l'épreuve de la participation : le projet INTERNORM

Our paper presents a pilot project (INTERNORM) funded by the University of Lausanne to support the involvement of not-for-profit organisations in international standard setting bodies such as the ISO. It analyses preliminary results on how a distinct participatory mechanism can influence the institutional environment of technical diplomacy in which ISO standards are developed. It reflects on the contribution of innovative deliberative mechanisms to democratise the field of international standardisation, largely dominated by expert knowledge and market players. It draws upon international relations literature on new institutional forms in global governance and social studies of science on participatory issues in science-society relations. The paper argues that there are significant limitations to the rise of civil society participation in such global governance mechanisms and examines several types of barriers to the involvement of not-for-profit organisations in ISO standard-setting processes. Notre communication porte sur un projet pilote (INTERNORM) financé par l'Université de Lausanne pour favoriser l'implication des acteurs associatifs dans l'élaboration des normes internationales de type ISO. Elle analyse les effets d'un dispositif participatif sur l'environnement institutionnel très particulier de la diplomatie technique ayant cours à l'ISO. Elle présente les résultats intermédiaires d'une réflexion sur l'apport de dispositifs délibératifs pour démocratiser le champ de la normalisation internationale, largement dominé par le savoir expert et les acteurs économiques. Elle situe cette réflexion au croisement des travaux de relations internationales sur les nouvelles formes institutionnelles de la gouvernance de la mondialisation et des études sociales des sciences et des techniques sur la participation dans les rapports science - société. En identifiant plusieurs registres dans lesquels situer les difficultés d'une plus grande implication des acteurs associatifs dans les procédures d'élaboration de spécifications techniques de type ISO, nous posons l'hypothèse qu'il existe d'importantes limites à l'accroissement de la dimension participative de la gouvernance globale.

Long-term ex vivo expansion of human fetal liver primitive haematopoietic progenitor cells in stroma-free cultures

Successful expansion of haematopoietic cells in ex vivo cultures will have important applications in transplantation, gene therapy, immunotherapy and potentially also in the production of non-haematopoietic cell types. Haematopoietic stem cells (HSC), with their capacity to both self-renew and differentiate into all blood lineages, represent the ideal target for expansion protocols. However, human HSC are rare, poorly characterized phenotypically and genotypically, and difficult to test functionally. Defining optimal culture parameters for ex vivo expansion has been a major challenge. We devised a simple and reproducible stroma-free liquid culture system enabling long-term expansion of putative haematopoietic progenitors contained within frozen human fetal liver (FL) crude cell suspensions. Starting from a small number of total nucleated cells, a massive haematopoietic cell expansion, reaching > 1013-fold the input cell number after approximately 300 d of culture, was consistently achieved. Cells with a primitive phenotype were present throughout the culture and also underwent a continuous expansion. Moreover, the capacity for multilineage lymphomyeloid differentiation, as well as the recloning capacity of primitive myeloid progenitors, was maintained in culture. With its better proliferative potential as compared with adult sources, FL represents a promising alternative source of HSC and the culture system described here should be useful for clinical applications.

Prenatal exposure to traffic-related air pollution and ultrasound measures of fetal growth in the INMA Sabadell cohort

Background: Few studies have used longitudinal ultrasound measurements to assess the effect of traffic-related air pollution on fetal growth.Objective: We examined the relationship between exposure to nitrogen dioxide (NO2) and aromatic hydrocarbons [benzene, toluene, ethylbenzene, m/p-xylene, and o-xylene (BTEX)] on fetal growth assessed by 1,692 ultrasound measurements among 562 pregnant women from the Sabadell cohort of the Spanish INMA (Environment and Childhood) study.Methods: We used temporally adjusted land-use regression models to estimate exposures to NO2 and BTEX. We fitted mixed-effects models to estimate longitudinal growth curves for femur length (FL), head circumference (HC), abdominal circumference (AC), biparietal diameter (BPD), and estimated fetal weight (EFW). Unconditional and conditional SD scores were calculated at 12, 20, and 32 weeks of gestation. Sensitivity analyses were performed considering time–activity patterns during pregnancy.Results: Exposure to BTEX from early pregnancy was negatively associated with growth in BPD during weeks 20–32. None of the other fetal growth parameters were associated with exposure to air pollution during pregnancy. When considering only women who spent 2 hr/day in nonresidential outdoor locations, effect estimates were stronger and statistically significant for the association between NO2 and growth in HC during weeks 12–20 and growth in AC, BPD, and EFW during weeks 20–32.Conclusions: Our results lend some support to an effect of exposure to traffic-related air pollutants from early pregnancy on fetal growth during mid-pregnancy.

Non-invasive monitoring of diaphragmatic timing by means of surface contact sensors: an experimental study in dogs

Background: Non-invasive monitoring of respiratory muscle function is an area of increasing research interest, resulting in the appearance of new monitoring devices, one of these being piezoelectric contact sensors. The present study was designed to test whether the use of piezoelectric contact (non-invasive) sensors could be useful in respiratory monitoring, in particular in measuring the timing of diaphragmatic contraction.Methods: Experiments were performed in an animal model: three pentobarbital anesthetized mongrel dogs. The motion of the thoracic cage was acquired by means of a piezoelectric contact sensor placed on the costal wall. This signal is compared with direct measurements of the diaphragmatic muscle length, made by sonomicrometry. Furthermore, to assess the diaphragmatic function other respiratory signals were acquired: respiratory airflow and transdiaphragmatic pressure. Diaphragm contraction time was estimated with these four signals. Using diaphragm length signal as reference, contraction times estimated with the other three signals were compared with the contraction time estimated with diaphragm length signal.Results: The contraction time estimated with the TM signal tends to give a reading 0.06 seconds lower than the measure made with the DL signal (-0.21 and 0.00 for FL and DP signals, respectively), with a standard deviation of 0.05 seconds (0.08 and 0.06 for FL and DP signals, respectively). Correlation coefficients indicated a close link between time contraction estimated with TM signal and contraction time estimated with DL signal (a Pearson correlation coefficient of 0.98, a reliability coefficient of 0.95, a slope of 1.01 and a Spearman's rank-order coefficient of 0.98). In general, correlation coefficients and mean and standard deviation of the difference were better in the inspiratory load respiratory test than in spontaneous ventilation tests.Conclusion: The technique presented in this work provides a non-invasive method to assess the timing of diaphragmatic contraction in canines, using a piezoelectric contact sensor placed on the costal wall.

Automated Segmentation of Cerebral Vasculature with Aneurysms in 3DRA and TOF-MRA using Geodesic Active Regions: an Evaluation Study

Purpose: To evaluate the suitability of an improved version of an automatic segmentation method based on geodesic active regions (GAR) for segmenting cerebral vasculature with aneurysms from 3D X-ray reconstruc-tion angiography (3DRA) and time of °ight magnetic resonance angiography (TOF-MRA) images available in the clinical routine.Methods: Three aspects of the GAR method have been improved: execution time, robustness to variability in imaging protocols and robustness to variability in image spatial resolutions. The improved GAR was retrospectively evaluated on images from patients containing intracranial aneurysms in the area of the Circle of Willis and imaged with two modalities: 3DRA and TOF-MRA. Images were obtained from two clinical centers, each using di®erent imaging equipment. Evaluation included qualitative and quantitative analyses ofthe segmentation results on 20 images from 10 patients. The gold standard was built from 660 cross-sections (33 per image) of vessels and aneurysms, manually measured by interventional neuroradiologists. GAR has also been compared to an interactive segmentation method: iso-intensity surface extraction (ISE). In addition, since patients had been imaged with the two modalities, we performed an inter-modality agreement analysis with respect to both the manual measurements and each of the two segmentation methods. Results: Both GAR and ISE di®ered from the gold standard within acceptable limits compared to the imaging resolution. GAR (ISE, respectively) had an average accuracy of 0.20 (0.24) mm for 3DRA and 0.27 (0.30) mm for TOF-MRA, and had a repeatability of 0.05 (0.20) mm. Compared to ISE, GAR had a lower qualitative error in the vessel region and a lower quantitative error in the aneurysm region. The repeatabilityof GAR was superior to manual measurements and ISE. The inter-modality agreement was similar between GAR and the manual measurements. Conclusions: The improved GAR method outperformed ISE qualitatively as well as quantitatively and is suitable for segmenting 3DRA and TOF-MRA images from clinical routine.

Conclusion : les usages possibles et contestables des normes et des institutions dans l'internationalisation des services

The conclusion of this volume on technical standards in the regulation of services reviews the authors' contributions to understanding the relation between tertiarisation, internationalisation and standardisation from three distinct perspectives : theoretical, institutional, and sectorial. It argues that conventional views on conditions for standardisation and internationalisation of service activities are overly restrictive, making them dependent on sectorial and institutional specificity. In emphasizing the possible and contestable uses of service standards, the volume opens a critical debate on service offshoring, underlining the social and historical constructions of its transnational logic.

Dimensionamento informatizado de profissionais de enfermagem: avaliação de um software

A complexidade para operacionalizar o método de dimensionamento de profissionais de enfermagem, diante das inúmeras variáveis relativas à identificação da carga de trabalho, do tempo efetivo de trabalho dos profissionais e do Índice de Segurança Técnica (IST), evidenciou a necessidade de desenvolver um software, denominado: Dimensionamento Informatizado de Profissionais de Enfermagem (DIPE). Este estudo exploratório descritivo teve como objetivo avaliar a qualidade técnica e o desempenho funcional do DIPE. Participaram como sujeitos da pesquisa dezoito avaliadores, sendo dez enfermeiros docentes ou enfermeiros gerentes de unidades de saúde hospitalar e oito especialistas em informática em saúde. A avaliação do software baseou-se na norma NBR ISO/IEC 9126-1, considerando as características funcionalidade, confiabilidade, usabilidade, eficiência e ma­nutenibilidade. A avaliação do software obteve resultados positivos, sobre os quais os avaliadores concordaram em todas as características avaliadas. As sugestões relatadas serão importantes para a proposição de melhorias e aprimoramento do DIPE.

Study of protein complexes

Summary : A lot of information can be obtained on proteins when proteomics methods are used. In our study, we aimed to characterize complexes containing pro-apoptotic proteins by different proteomics methods and finally focused on PIDD (p53-induced protein with a death domain), for which the most interesting results were obtained. PIDD has been shown to function as a molecular switch between genotoxic stress-induced apoptotis and genotoxic stress-induced cell survival through NF-κB activation. To exert these two functions, PIDD forms alternate complexes respectively with caspase2 and CRADD on one hand and RIP 1 and NEMO on the other hand. The first part of our study focuses on the processing of PIDD. PIDD full length (FL) is constitutively cleaved into three fragments, an N-terminal one (PIDD-N) and two fragments containing the C-terminus (PIDD-C and PIDD-CC). Localization of the two PIDD cleavage sites by mass spectrometry (MS) allowed to understand that PIDD is probably not cleaved by proteases but is subject to protein (self-)splicing and also to map the PIDD-N, PIDD-C and PIDD-CC fragments exactly. Further characterization of these three fragments by Tinel et al. (Tinel et al., 2007) showed that PIDD-C is involved in activation of an apoptotic pathway while PIDD-CC is involved in NF-κB activation. We also found that PIDD is subject to proline-directed phosphorylation at two serine residues in PIDD-N, the regulatory fragment of PIDD. The second part of the study aimed at identifying by proteomics techniques proteins that co-purify with PIDD and therefore are putative cellular interaction partners. In this respect we analyzed samples obtained in different conditions or with different PIDD constructs corresponding to processed fragments. This allowed us to identify a large number of potential interactors for PIDD. For example, by comparing data obtained from PIDD-C and PIDD-FL affinity purifications, we found that the Hsp90 chaperone system interacts strongly with PIDD-N. In the third part of this study, we developed methods to selectively and rapidly quantify by MS proteins of interest in PIDD affinity purifications or negative controls. Using these tools we detected significant changes in PIDD-FL-copurifying proteins treated by heat shock. Overall, our studies provide informative data on the processing of PIDD and its possible involvement in several molecular pathways.

Elaboração de diagnósticos e intervenções à luz de diferentes sistemas de classificações de enfermagem

Este estudo faz uma análise sobre o uso de diferentes sistemas de classificação e o atendimento aos padrões estabelecidos pela ISO 18.104:2003 a partir de uma situação clínica fictícia. Foram elaborados diagnósticos e intervenções de enfermagem utilizando a NANDA-I, NIC e CIPE®, e analisou-se a correspondência terminológica destes sistemas de classificação ao modelo proposto pela norma ISO 18.104:2003. Para a construção de diagnósticos de enfermagem, a NANDA-I e a CIPE® adequando-se à norma ISO 18.104:2003. Para a construção das intervenções de enfermagem, a CIPE® atende ao modelo de referência terminológica proposto pela ISO 18104:2003. Por sua vez, a NIC não propõe um modelo de referência terminológica combinatória. A unificação das terminologias de enfermagem depende da revisão, padronização e teste dessas classificações para o estabelecimento de uma linguagem comum e sólida da profissão.

Elokuva Internetissä : katsaus elokuvaan verkossa sekä suunnitelma Uhripuu-elokuvan julkaisemisesta

Opinnäytetyössäni tarkastellaan Internet-elokuvan historiaa sekä nykyistä tilaa. Käyn läpi yleisimmät katseluohjelmat: QuickTime Player, Windows Media Player, RealPlayer ja Flash Player sekä Internet-elokuvasivustot: YouTube, IFILM, AtomFilm ja Pixoff.net. Kerron myös Flash-elokuvista ja siitä miten Internet on luonut kokonaan uuden elokuvan muodon sekä Internetissä julkaistuista Dogma 2001 The New Rules for Internet Cinema -säännöistä. Käsittelen myös lyhyesti miten Internet-elokuva on vaikuttanut perinteiseen elokuvaan. Käsittelen perinteisen, isolta ruudulta katsottavaksi tehdyn, elokuvan julkaisemista Internetissä. Tarkastelen kahta verkossa julkaistua elokuvaa: Star Wreck ja The Silent City ja käyn läpi miksi ne on julkaistu Internetissä. Star Wreck on tamperelainen poikkeuksellisen kunnianhimoinen amatööriprojekti. The Silent City on taas irlantilaisen 3D-animaattorin, Ruairi Robinsonin, lyhytelokuva, jonka hän on tehnyt työnäytteeksi Hollywoodiin. Käsittelen myös ohjaaja David Lynchin verkkosivut, koska ne ovat Internetissä ainoaa laatuaan ja mainio ympäristö elokuvan julkaisemiseen. Kerron oman Uhripuu-kauhuelokuvani synnystä ja tekoprosessista. Uhripuun idea sai alkunsa Iso-Britanniassa vuoden 2004 alussa. Käsikirjoitus sai lopullisen muotonsa keväällä 2006. Käsittelen miksi ja miten se julkaistaan Internetissä. Kerron elokuvan Internet-sivujen sisällöstä ja sen jaosta eri osiin: Tarina, Rooleissa, Tekijät, Uhripuista, Traileri, Näin tehtiin, Kuvagalleria, E-kortti, Näe/Katso elokuva. Koska olen saanut koulutukseni nimenomaan verkkoviestinnän enkä audiovisuaalisen viestinnän puolella, Uhripuu-elokuvan tekoprosessi on ollut minulle elokuvakoulu. Sen tekemisen aikana olen oppinut elokuvan tekemisestä paljon. Elokuva kuvattiin HD-tarkkuuksilla, jotta kuva ei kärsisi liikaa jälkikäsittelyssä. Mitä tulee elokuvan ja Internetin yhteiseen tulevaisuuteen, näyttää siltä, että nämä kaksi mediaa ovat yhdistymässä yhä enemmän toisiinsa.

Processo de enfermagem informatizado: metodologia para associação da avaliação clínica, diagnósticos, intervenções e resultados

O Processo de Enfermagem é uma tecnologia do cuidado que orienta a sequência do raciocínio clínico e melhora a qualidade do cuidado. Este artigo trata-se do relato do desenvolvimento de um Processo de Enfermagem Informatizado (PEI) para Unidade de Terapia Intensiva. O presente estudo foi desenvolvido em três principais etapas: discussão e compreensão da norma International Organization for Standard 18.104; aprofundamento teórico sobre a CIPE® 1.0; associação das informações aos diagnósticos e intervenções de Enfermagem. A base do conhecimento foi organizada segundo a CIPE® Versão 1.0. O resultado foi a reestruturação do PEI a partir da associação das avaliações clínicas aos diagnósticos e intervenções que permitem documentar a prática clínica de enfermagem, além de fornecerem apoio para a tomada de decisão. As etapas metodológicas empregadas permitiram fazer a associação entre a avaliação clínica, os diagnósticos, as intervenções e os resultados da CIPE® 1.0 com a ISO 18.104.

Diagnósticos e intervenções de enfermagem para pacientes portadores de insuficiência cardíaca congestiva utilizando a CIPE®

Estudo exploratório-descritivo, desenvolvido com o objetivo de construir afirmativas de diagnósticos e intervenções de enfermagem para pacientes portadores de insuficiência cardíaca congestiva. Para tanto, foram identificados na CIPE® 53 termos do eixo foco, que nortearam a construção dessas afirmativas utilizando as diretrizes do Conselho Internacional de Enfermeiros e a ISO 18.104. Foram construídas 92 afirmativas de diagnósticos de enfermagem, que depois de normalizadas, passaram a 66 e foram separadas de acordo com o modelo fisiopatológico, assim distribuídas: 13 para taquicardia, 20 para dispneia, 19 para edema e 14 para congestão. Para essas afirmativas construíram-se 234 intervenções, levando em consideração os termos do Modelo de Sete Eixos da CIPE®, a literatura da área e a experiência clínica das autoras. Espera-se que as afirmativas de diagnósticos e intervenções de enfermagem elaboradas possam favorecer a avaliação de indivíduos portadores de ICC e a construção de um subconjunto terminológico da CIPE®.

Administration of Il-18bp by Gene Therapy Reduces Inflammation and Prevents Joint Destruction by Downregulation of Mmp9 In Rat Aia: Role ff Mmp9 In Bone and Joint Destruction in Arthritis

Background and objectives Interleukin 18 (IL-18) is a pleiotropic cytokine involved in rheumatoid arthritis (RA) pathogenesis. This study was carried out to evaluate the effi cacy of IL-18 binding protein (IL-18BP) gene therapy in the rat adjuvant- induced arthritis (AIA) model and to decipher the mechanisms by which IL-18BP delivery lessens bone destruction.Materials and methods Arthritis was induced in female Lewis rat by Mycobacterium butyricum and the mRNA expression of IL-18 and IL-18BP was determined in the joints. In a preventive study, rats were divided into an adenovirus producing IL-18BP-Fc (AdmIL-18BP-Fc) group (n=8) and an adenovirus producing green fl uorescent protein (AdGFP) group (n=7). On day 8 after AIA induction, adenoviruses were injected. Clinical parameters were assessed. At day 18, during maximal arthritis, the rats were euthanized, ankles were collected and x-rays were performed. mRNA and protein were extracted from joints for analysis by quantitative reverse transcriptase-PCR, multiplex, Western blot and zymography.Results The authors observed a decrease in the (IL-18BP/ IL-18) ratio from day 7 to 45. Administration of AdmIL-18BPd-Fc decreased clinical parameters and prevented bone and joint destruction compared to AdGFP administration. IL-18BP delivery reduced the (receptor activator of nuclear factor κB ligand (RANKL)/osteoprotegerin (OPG)) ratio by 70%, the matrix metalloproteinase 9 (MMP9) level by 33% and the tartrate-resistant acid phosphatase (TRAP) level by 44% in the joint homogenates from AdmIL-18BPd-Fc compared to AdGFP treated rats.Conclusions In rat AIA, a decrease in the (IL-18BP/IL-18) ratio was observed. IL-18BP delivery prevented joint and bone destruction by downregulating MMP9, (RANKL/OPG) and TRAP, suggesting a potential benefi t of a similar therapy in RA.Abstract topics Towards novel therapeutic strategies.

Implementação de Sistemas de Gestão da Qualidade: O Caso da Cabo Verde Telecom

A pesquisa tem por objectivo avaliar a implementação do sistema de gestão da qualidade na Cabo Verde Telecom. O tema escolhido justifica-se pela importância do sector das telecomunicações na geração de empregos e rendimentos em Cabo Verde. Tal facto exige que resultados positivos relacionados à melhoria da qualidade sejam alcançados de modo a responder ao ritmo de constante incerteza, actualização no padrão de consumo e busca permanente de melhoria dos serviços prestados. No que se refere à revisão da literatura, faz-se uma resenha histórica da gestão da qualidade, aborda-se as diferentes dimensões da qualidade, a qualidade total, os principais autores, o modelo da EFQM, as normas ISO 9000, a qualidade em serviços e, porque os recursos humanos constituem um factor crítico de sucesso de qualquer sistema de gestão da qualidade, faz-se uma breve referência à gestão da mudança organizacional. O método utilizado é o estudo de caso. A recolha de dados é feita através da observação, da aplicação de questionários e entrevistas semi-estruturadas e do recurso a fontes secundárias – análise documental. A metodologia de análise é descritivo-quantitativa. Os resultados da pesquisa mostram que a implementação do sistema de gestão da qualidade na empresa assenta nos princípios que norteiam a cultura da gestão da qualidade subjacentes às normas ISO 9000:2000. Quanto ao grau de aplicação e adesão aos princípios referidos, pode-se concluir que se verifica uma evolução positiva, mas não na dimensão desejada.

Qualidade no Atendimento ao Cliente como Estratégia Competitiva

Na busca de um melhor posicionamento competitivo no mercado global, as empresas com uma visão estratégica não desperdiçam mais seu tempo ocupando-se apenas em conquistar eficiência operacional. Os objectivos específicos definidos para este trabalho de pesquisa propiciaram o levantamento das dimensões indicadas pela literatura que determinam a qualidade no atendimento a clientes e identificá-las na prática, no caso estudado. O facto da empresa apresentar gaps críticos nas dimensões consideradas mais importantes para os inquiridos nos resultados obtidos com o estudo. Isto demonstram que a CVTelecom necessita de acções de melhoria para adaptar à realidade do mercado global proporcionando um atendimento com qualidade desejada que promove a fidelização de seus mais de 57.000 clientes. Dentre os diversos processos que vêm sendo melhorados para o alcance da maior satisfação dos clientes podem ser citados os investimentos recentes feitos no processo de apoio ao cliente que já teve o certificado da ISO 9001:2000 pela APCER. Em suma, concluiu-se com o estudo de caso, CVTelecom apresenta uma razoável performance no atendimento aos seus clientes, necessitando de algumas acções estratégicas que podem favorecer-lhe na minimização ou na eliminação dos gaps apresentados, dentre elas a necessidade de se conhecer e implementar o Marketing de Relacionamento (CRM), promover uma acção de melhoria no processo de apoio ao cliente, viabilizar a adopção de um manual de procedimento de atendimento ao cliente.