Data bases for the assessment of medical technologies: examples from Europe.

The assessment of medical technologies has to answer several questions ranging from safety and effectiveness to complex economical, social, and health policy issues. The type of data needed to carry out such evaluation depends on the specific questions to be answered, as well as on the stage of development of a technology. Basically two types of data may be distinguished: (a) general demographic, administrative, or financial data which has been collected not specifically for technology assessment; (b) the data collected with respect either to a specific technology or to a disease or medical problem. On the basis of a pilot inquiry in Europe and bibliographic research, the following categories of type (b) data bases have been identified: registries, clinical data bases, banks of factual and bibliographic knowledge, and expert systems. Examples of each category are discussed briefly. The following aims for further research and practical goals are proposed: criteria for the minimal data set required, improvement to the registries and clinical data banks, and development of an international clearinghouse to enhance information diffusion on both existing data bases and available reports on medical technology assessments.

L'exégèse et l'air du temps

La théologie est-elle une science ? Ce débat n'est pas nouveau, et il accompagne les différentes disciplines de la théologie au moins depuis le siècle des Lumières. Dans la discussion actuelle, par exemple entre théologie et sciences religieuses, les disciplines théologiques qui apparaissent souvent comme les plus "scientifiques" sont les sciences bibliques et l'histoire du christianisme. Il ne fait à mon avis aucun doute qu'il s'agit là des disciplines qui posent le moins problème pour une position qu'on pourrait qualifier de "laïque". Et cependant, ce serait un leurre de croire que ces méthodes sont exemptes de présuppositions théologiques ou idéologiques. Je n'ai pas l'intention d'entrer ici dans le débat sur le problème de l'objectivité de la science, faute de temps et de compétence. J'aimerais plus modestement montrer, à partir de l'exégèse de la Bible hébraïque, l'interconnexion - pas toujours consciente - entre certains modèles exégétiques et les options idéologiques des savants qui défendent ou promeuvent ces modèles.

lntroducció de tècniques d'aprenentatge col·laboratiu en I'àmbit de bases de dades amb el suport de les tecnologies de la informació

Els canvi recents en els plans d’estudis de la UPC i la UOC tenen en compte el nou espai europeu d’educació superior (EEES). Una de les conseqüències directes a aquests canvis es la necessitat d'aprofitar i optimitzar el temps dedicat a les activitats d'aprenentatge que requereixen la participació activa de l’estudiant i que es realitzen de manera continuada durant el semestre. A més, I'EEES destaca la importància de les pràctiques, les relacions interpersonals i la capacitat per treballar en equip, suggerint la reducció de classes magistrals i l’augment d’activitats que fomentin tant el treball personal de l’estudiant com el cooperatiu. En l’àmbit de la docència informàtica d’assignatures de bases de dades el problema és especialment complex degut a que els enunciats de les proves no acostumen a tenir una solució única. Nosaltres hem desenvolupat una eina anomenada LEARN-SQL, l’objectiu de la qual és corregir automàticament qualsevol tipus de sentència SQL (consultes, actualitzacions, procediments emmagatzemats, disparadors, etc.) i discernir si la resposta aportada per l’estudiant és o no és correcta amb independència de la solució concreta que aquest proposi. D’aquesta manera potenciem l’autoaprenentatge i l’autoavaluació, fent possible la semi-presencialitat supervisada i facilitant l’aprenentatge individualitzat segons les necessitats de cada estudiant. Addicionalment, aquesta eina ajuda als professors a dissenyar les proves d’avaluació, permetent també la opció de revisar qualitativament les solucions aportades pels estudiants. Per últim, el sistema proporciona ajuda als estudiants per a que aprenguin dels seus propis errors, proporcionant retroalimentació de qualitat.

Egg Structures of Anopheles fluminensis and Anopheles shannoni

Eggs of two species belonging to the Arribalzagia Series of the Laticorn Section of Anopheles (Anopheles) collected in Brazil are described from scanning electron micrographs. The An. fluminensis egg is long with shallow floats displaced far dorsally. The narrow deck region is overlain by a frill modified into prominent ridges that are nearly continuous to both ends of the egg. Slightly opened decks at both poles contain an average of four lobed tubercles. Polygonal, plastron-type chorionic cells cover the lateral and dorsal surfaces. The egg of An. shannoni is unique in possessing 22-27 fingerlike filaments that project with regular spacing from each of its massive floats. These filaments and their bases are highly perforated and are believed to trap air and support flotation of the egg with the dorsal surface up, contrary to the usual orientation for anophelines. The eggs are compared with those of related species bearing similar structures, notably An. fluminensis with An. mediopunctatus s.s and An. shannoni with An. peryassui

Systemic modulation of peripheral eosinophilia (air pouch model) in Schistosoma mansoni infection

Schistosoma mansoni infection induces in their hosts a marked and sustained eosinophilia, which is influenced or modulated by complex mechanisms, that vary according to the phase of infection. To address this phenomenon, we used the air pouch (AP) model in control and infected Swiss webster mice, analyzing the cellular, tissue response and local expression of adhesion molecules [CD18 (beta 2-chain), CD44, ICAM-1 (CD54), L-selectin (CD62L), CD49d (alpha 4-chain), LFA1 (CD11a)]. Infected animals were studied at 3 (pre-oviposition phase), 7 (acute phase), and 14 (chronic phase) weeks after infection (5-6 mice/period of infection). Normal mice were age-matched. Results showed that after egg stimulation, compared with matched controls, the infected mice, at each point of infection, showed a lower eosinophil response in the acute (7 weeks) and chronic phase (14 weeks) of infection. However, when the infected mice were in pre-oviposition phase (3 weeks) their eosinophil response surpassed the control ones. In the AP wall of infected mice, a significant decrease in the expression of ICAM-1 and CD44 in fibroblastic-like cells and a reduction in the number of CD18 and CD11a in migratory cells were observed. The other adhesion molecules were negative or weakly expressed. The results indicated that in the air pouch model, in S. mansoni-infected mice: (1) eosinophil response is strikingly down-regulated, during the acute ovular phase; (2) in the pre-oviposition phase, in contrast, it occurs an up-regulatory modulation of eosinophil response, in which the mechanisms are completely unknown; (3) in the chronic phase of the infection, the down modulation of eosinophil response is less pronounced; 4) Down-regulation of adhesion molecules, specially of ICAM-1 appear to be associated with the lower eosinophil response.

Knowledge of Glasgow coma scale by air-rescue physicians.

OBJECTIVE: To assess the theoretical and practical knowledge of the Glasgow Coma Scale (GCS) by trained Air-rescue physicians in Switzerland. METHODS: Prospective anonymous observational study with a specially designed questionnaire. General knowledge of the GCS and its use in a clinical case were assessed. RESULTS: From 130 questionnaires send out, 103 were returned (response rate of 79.2%) and analyzed. Theoretical knowledge of the GCS was consistent for registrars, fellows, consultants and private practitioners active in physician-staffed helicopters. The clinical case was wrongly scored by 38 participants (36.9%). Wrong evaluation of the motor component occurred in 28 questionnaires (27.2%), and 19 errors were made for the verbal score (18.5%). Errors were made most frequently by registrars (47.5%, p = 0.09), followed by fellows (31.6%, p = 0.67) and private practitioners (18.4%, p = 1.00). Consultants made significantly less errors than the rest of the participating physicians (0%, p < 0.05). No statistically significant differences were shown between anesthetists, general practitioners, internal medicine trainees or others. CONCLUSION: Although the theoretical knowledge of the GCS by out-of-hospital physicians is correct, significant errors were made in scoring a clinical case. Less experienced physicians had a higher rate of errors. Further emphasis on teaching the GCS is mandatory.

Les bases moléculaires de l'obésité : vers de nouvelles thérapeutiques ?

Obesity is an increasingly serious health problem, and is highly associated with insulin-resistance and dyslipidemia. The mechanisms involved in the development of this disorder are still poorly understood, although significant progress has been recently made in the elucidation of their molecular basis. The major causes leading to obesity are defects in the regulation of fat metabolism. Several mutations identified in different animal models have unveiled the roles of a number of genes in the regulation of energy balance. These dicoveries, together with the fact that some of these mutations have been found in humans, have lead to the conclusion that obesity is due to nutritional or environmental factors, but also involves genetic factors. A number of important peripheric factors participate in the regulation processes, such as the adipocyte-specific hormone leptin, and the nuclear homone receptors PPARs. A general scheme can now be drawn which includes some key factors and their respective interactions.

Phase 1 Study of an Inactivated Vaccine against American Tegumentary Leishmaniasis in Normal Volunteers in Brazil

A Phase 1 double-blind placebo-controlled study was performed to evaluate a vaccine against American tegumentary leishmaniasis in 61 healthy male volunteers. Side effects and the immune response to the vaccine were evaluated, with 1- and 2- dose schemes, with intervals of 7 or 21 days, each dose containing 1440 mg of protein N antigen of a single strain of Leishmania amazonensis (PH 8) diluted in merthiolated saline (1:10,000). Merthiolated saline and an inert substance were used as placebos. No significant clinical alterations were found following the respective injections in the vaccinated individuals as compared to the placebos, except for local pain, which was associated significantly with injection of the vaccine. The laboratory alterations we observed bore no association with the clinical findings and were unimportant. We observed no differences between the groups with regard to seroconversion or the Montenegro skin test. However, the group that received a single dose of the vaccine and the one that received two doses with a 21-day interval displayed cutaneous induration significantly larger than in the control group, with 100%, 100%, and 66% conversion in the skin test, respectively. We concluded that the vaccine does not present any major side effect that would contraindicate its use in healthy individuals.

Reinfection in American Cutaneous Leishmaniasis: Evaluation of Clinical Outcomes in the Hamster Model

There is no clear understanding of the outcome of reinfection in New World cutaneous leishmaniasis, and its role in the relationship to the development of protection or secondary disease. For this reason, reinfection experiments with homologous (Leishmania panamensis-L. panamensis) and heterologous (L. major-L. panamensis) species of leishmaniae were conducted in the hamster model. The different protocols for primary infections prior to the challenge with L. panamensis were as follows: (a) L. major, single promastigote injection, (b) L. major, three booster infections, (c) L. panamensis, followed by antimonial treatment to achieve subclinical infection, (d) L. panamensis, with active lesions, (e) sham infected, naive controls. Although all reinfected hamsters developed lesions upon challenge, animals with active primary lesions due to L. panamensis, and receiving booster infections of L. major had the most benign secondary lesions (58-91% and 69-76% smaller than controls, respectively, P<0.05). Subclinically infected animals had intermediate lesions (40-64% smaller than controls, P<0.05), while hamsters which received a single dose of L. major had no significant improvement over controls. Our results suggested that L. major could elicit a cross protective response to L. panamensis, and that the presence and number of amastigotes persisting after a primary infection may influence the clinical outcome of reinfections.

Entorn web per a consultes on-line sobre bases de dades d'imatges

Creació d'un entorn web que consisteix en un sistema per fer consultes en línia a bases de dades d'imatges. Aquestes consultes es fan per contingut, a partir de mètodes creats pel grup de recerca CAT (Color and Texture) del CVC (Centre de Visió per Computador). L'aplicació web permet afegir nous mètodes que els membres del grup han programat amb Matlab.