Les routes d’invasion du criocère du lis (Lilioceris lilii) en Amérique du Nord

Le criocère du lis, Lilioceris lilii (Coleoptera : Chrysomelidae), un ravageur de lis et de fritillaires d’origine eurasienne, a été observé pour la première fois en Amérique du Nord en 1943 sur l’Ile de Montréal au Canada. Après y avoir été confiné pendant environ 25 années, ce coléoptère a par la suite progressé rapidement sur le territoire nord-américain. Actuellement, on l’observe dans huit provinces canadiennes et huit états américains. Cette étude a investigué les routes d’invasion utilisées par le criocère du lis au Canada et aux États- Unis avec l’aide de marqueurs génétiques AFLP. Pour ce faire, 516 individus parmi 34 sites en Amérique du Nord et en Europe ont été échantillonnés et analysés. Le premier objectif était de déterminer, en analysant la structure génétique des populations nord-américains, s’il y avait eu une ou plusieurs introductions en provenance d’Europe. Le deuxième objectif était d’identifier l’origine de la ou des populations introduites en Amérique du Nord. Finalement, le troisième objectif consistait à proposer un scénario d’invasion de L. lilii en Amérique du Nord basé sur les données de première mention et de structure génétique des populations échantillonnées. Les résultats démontrent une signature génétique distincte entre les criocères du lis du Canada et ceux des États-Unis, suggérant ainsi deux sources d’introductions indépendantes en Amérique du Nord, soit une première introduction à Montréal, Québec, dans les années 1940 et une seconde aux États-Unis au début des années 1990 à Cambridge, Massachusetts. De plus, les deux populations nord-américaines semblent provenir de différentes régions du nord de l’Europe, ce qui est conséquent avec le scénario suggérant deux sources d’introductions indépendantes. Chacune des populations aurait par la suite progressé respectivement dans leur pays d’introduction selon une dispersion de type stratifiée. En effet, la progression continue de L. lilii dans certaines régions suggère une dispersion naturelle de l’espèce sur le territoire nord-américain, alors que la progression rapide sur de longues distances semble être causée par le transport anthropique de lis contaminés.

Le rôle des festivals de cinéma internationaux dans l'émergence du cinéma iranien

Jusqu’à la fin du vingtième siècle, les études sur le cinéma iranien ont tendance à aborder ce cinéma par rapport à la Révolution islamique de 1979, c’est-à-dire à le diviser en deux époques, prérévolutionnaire et postrévolutionnaire. Cette recherche s’inscrit dans une pensée récente qui étudie l’émergence de ce cinéma national en tant que cheminement continu et dominé par des politiques culturelles contradictoires et ambiguës. Dans cette étude, nous ferons au premier chapitre un survol de l’histoire du cinéma iranien, avec un intérêt particulier pour la culture des festivals. Il s’agira de décrypter les enjeux politiques et culturels qui dirigent les décisions du gouvernement et des professionnels de l’industrie. Le deuxième chapitre proposera un questionnement sur la notion de cinéma national, et appliquera cette notion au cinéma iranien. Une attention particulière sera portée à la Fondation du cinéma Farabi, une institution clé dans la promotion du cinéma national et dans l’émergence des films iraniens dans les festivals de films internationaux. Finalement, le troisième chapitre présentera le rôle des festivals dans l’industrie cinématographique ainsi qu’une analyse de l’évolution des films iraniens présentés au Festival des films du monde de Montréal afin de démontrer l’influence des politiques culturelles iraniennes floues sur la présence des films iraniens dans les festivals occidentaux.

Comunicação e envolvimento: possibilidades de interconexões entre família-escola?

Família e escola são considerados contextos primordiais para o desenvolvimento humano, sendo desejável que haja um elo adequado entre esses espaços. Pautado nessa premissa, este artigo objetiva analisar as relações estabelecidas entre a escola e a família de crianças com baixo rendimento escolar, salientando que a escola pesquisada adota o regime de progressão continuada. O referencial teórico do estudo foi a perspectiva bioecológica de Bronfenbrenner. Participaram da pesquisa seis crianças, seus respectivos responsáveis e professoras. A coleta de dados consistiu de entrevistas semiestruturadas e observações. Os dados foram coligidos em duas categorias: envolvimento e comunicação. Embora os resultados destaquem a comunicação como principal veículo de trocas entre os dois contextos, essa necessita ser aprimorada. A família e a escola compreendem que devem trabalhar em colaboração, mas tal relação precisa ser reconstruída, pois se mostra assimétrica e repleta de preconceitos.

Avaliação, sistema de ciclos e regime de progressão continuada: progressão das aprendizagens do aluno ou progressão de fluxo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Recursos e condições adversas na história pregressa de crianças de 4ª série do ensino fundamental

Pós-graduação em Educação Escolar - FCLAR

TÁTICAS DE PROFESSORES: UMA REFLEXÃO SOBRE O CENÁRIO AVALIATIVO NO REGIME DE PROGRESSÃO CONTINUADA.

Este estudo qualitativo foi elaborado por meio de pesquisa bibliográfica de estudiosos do tema da avaliação do rendimento de alunos, como Luckesi (2005), Hoffmann (2003), Paro (2003), Hadji (1994) e Figari (1996), e de pesquisa de campo, com o objetivo de investigar como está ocorrendo a avaliação do ensino fundamental da rede pública paulista, na vigência do regime de progressão continuada. Considerando que os fundamentos da prática avaliativa distam quase sempre dos apregoados pela política educacional instituída e com o propósito de verificar se isto está ocorrendo com a política de progressão continuada, participei, durante um ano letivo, das atividades educacionais de uma escola pública da periferia da Grande São Paulo, observando, colhendo depoimentos e anotando cuidadosamente tudo o que vivenciei nesse período. Para empreender uma leitura dos dados coletados, busquei também o apoio no construto teórico de Michel de Certeau, para quem aos "produtos impostos" códigos, leis, políticas culturais, etc. rigorosamente organizados de forma a atribuir um lugar, um papel ao homem ordinário, contrapõem-se práticas construídas no processo de apropriação desses produtos. Por meio de suas "artes de fazer", os usuários reinventam o cotidiano. Utilizando-se de "táticas astuciosas", o usuário da cultura reapropria-se dos espaços, altera-lhes os códigos e deles faz uso "a seu jeito". Nesta pesquisa, que enfoca as relações dos protagonistas de processos avaliativos escolares, confirmam-se os postulados de Certeau, que não conferem ao consumidor da política um lugar passivo. Como já foi caracterizado por este instigante pensador, o usuário da política (o instituinte), enquanto portador de astúcias, move-se no campo espacial do outro (o instituído) e, taticamente, fazendo uso de práticas não previstas, escreve uma "outra história". O principal objetivo deste trabalho foi contribuir com reflexões que mostrem a importância de se analisar as tensões geradas por políticas educacionais impostas, desprovidas de sentido para aqueles que não participam de sua elaboração, o que tem provocado movimentos táticos de seus usuários, neste caso, os docentes, os quais, sem as condições objetivas necessárias para promover a política instituída, enunciada no discurso, utilizam-se do seu potencial instituinte de transformação, escrevendo uma "outra história".

TÁTICAS DE PROFESSORES: UMA REFLEXÃO SOBRE O CENÁRIO AVALIATIVO NO REGIME DE PROGRESSÃO CONTINUADA.

Este estudo qualitativo foi elaborado por meio de pesquisa bibliográfica de estudiosos do tema da avaliação do rendimento de alunos, como Luckesi (2005), Hoffmann (2003), Paro (2003), Hadji (1994) e Figari (1996), e de pesquisa de campo, com o objetivo de investigar como está ocorrendo a avaliação do ensino fundamental da rede pública paulista, na vigência do regime de progressão continuada. Considerando que os fundamentos da prática avaliativa distam quase sempre dos apregoados pela política educacional instituída e com o propósito de verificar se isto está ocorrendo com a política de progressão continuada, participei, durante um ano letivo, das atividades educacionais de uma escola pública da periferia da Grande São Paulo, observando, colhendo depoimentos e anotando cuidadosamente tudo o que vivenciei nesse período. Para empreender uma leitura dos dados coletados, busquei também o apoio no construto teórico de Michel de Certeau, para quem aos "produtos impostos" códigos, leis, políticas culturais, etc. rigorosamente organizados de forma a atribuir um lugar, um papel ao homem ordinário, contrapõem-se práticas construídas no processo de apropriação desses produtos. Por meio de suas "artes de fazer", os usuários reinventam o cotidiano. Utilizando-se de "táticas astuciosas", o usuário da cultura reapropria-se dos espaços, altera-lhes os códigos e deles faz uso "a seu jeito". Nesta pesquisa, que enfoca as relações dos protagonistas de processos avaliativos escolares, confirmam-se os postulados de Certeau, que não conferem ao consumidor da política um lugar passivo. Como já foi caracterizado por este instigante pensador, o usuário da política (o instituinte), enquanto portador de astúcias, move-se no campo espacial do outro (o instituído) e, taticamente, fazendo uso de práticas não previstas, escreve uma "outra história". O principal objetivo deste trabalho foi contribuir com reflexões que mostrem a importância de se analisar as tensões geradas por políticas educacionais impostas, desprovidas de sentido para aqueles que não participam de sua elaboração, o que tem provocado movimentos táticos de seus usuários, neste caso, os docentes, os quais, sem as condições objetivas necessárias para promover a política instituída, enunciada no discurso, utilizam-se do seu potencial instituinte de transformação, escrevendo uma "outra história".

Illuminating Inner Life : A Comparison of Virginia Woolf's To the Lighthouse and Arthur Schnitzler's Fräulein Else

In the early 20th century, authors increasingly experimented with literary techniques striving towards two common aims: to illumine the inner life of their protagonists and to diverge from conventional forms of literary representations of reality. This shared endeavour was sparked by changes in society: industrialisation, developments in psychology, and the gradual decay of empires, such as the Victorian (1837–1901) and the Austro-Hungarian (1867–1918). Those developments yielded a sense of uncertainty and disorientation, which led to a so-called “turn [inwards]” in the arts (Micale 2). In this context, this essay examines Virginia Woolf’s (1882–1941) development of her literary technique by comparing To the Lighthouse (1927), written in free indirect discourse, with Arthur Schnitzler’s (1862–1932) Fräulein Else (1924), written in interior monologue. Instead of applying Freud’s theories of consciousness, I will demonstrate how empiricist psychology informed and partly helped shape the two narrative techniques by referring to Ernst Mach’s (1838–1916) idea of the unstable self, and William James’ (1842–1910) concept of the stream of consciousness. Furthermore, I will show that there is a continuous progression of literary ideas from Schnitzler’s Viennese fin-de-siècle connected to impressionism, towards Woolf’s Bloomsbury aesthetics connected to Paul Cézanne’s post-impressionist logic of sensations. In addition to that, I address how the women’s movement, starting in the end of the 19th century, inspired Woolf and Schnitzler to utilise their techniques as a means of revealing women’s restricted position in society. Methodologically, I will analyse the two novels’ narrative techniques applying close reading and by that point out their differences and similarities in connection to the above-mentioned theories as well as the two author’s literary approaches. I argue that this comparison demonstrates that modernist literary techniques of representing interiority evolved from interior monologue towards free indirect discourse. This progression also implicates that modernism can be seen as a continuum reaching back to the fin-de-siècle and culminating in the 1920s. 

TÁTICAS DE PROFESSORES: UMA REFLEXÃO SOBRE O CENÁRIO AVALIATIVO NO REGIME DE PROGRESSÃO CONTINUADA.

Este estudo qualitativo foi elaborado por meio de pesquisa bibliográfica de estudiosos do tema da avaliação do rendimento de alunos, como Luckesi (2005), Hoffmann (2003), Paro (2003), Hadji (1994) e Figari (1996), e de pesquisa de campo, com o objetivo de investigar como está ocorrendo a avaliação do ensino fundamental da rede pública paulista, na vigência do regime de progressão continuada. Considerando que os fundamentos da prática avaliativa distam quase sempre dos apregoados pela política educacional instituída e com o propósito de verificar se isto está ocorrendo com a política de progressão continuada, participei, durante um ano letivo, das atividades educacionais de uma escola pública da periferia da Grande São Paulo, observando, colhendo depoimentos e anotando cuidadosamente tudo o que vivenciei nesse período. Para empreender uma leitura dos dados coletados, busquei também o apoio no construto teórico de Michel de Certeau, para quem aos "produtos impostos" códigos, leis, políticas culturais, etc. rigorosamente organizados de forma a atribuir um lugar, um papel ao homem ordinário, contrapõem-se práticas construídas no processo de apropriação desses produtos. Por meio de suas "artes de fazer", os usuários reinventam o cotidiano. Utilizando-se de "táticas astuciosas", o usuário da cultura reapropria-se dos espaços, altera-lhes os códigos e deles faz uso "a seu jeito". Nesta pesquisa, que enfoca as relações dos protagonistas de processos avaliativos escolares, confirmam-se os postulados de Certeau, que não conferem ao consumidor da política um lugar passivo. Como já foi caracterizado por este instigante pensador, o usuário da política (o instituinte), enquanto portador de astúcias, move-se no campo espacial do outro (o instituído) e, taticamente, fazendo uso de práticas não previstas, escreve uma "outra história". O principal objetivo deste trabalho foi contribuir com reflexões que mostrem a importância de se analisar as tensões geradas por políticas educacionais impostas, desprovidas de sentido para aqueles que não participam de sua elaboração, o que tem provocado movimentos táticos de seus usuários, neste caso, os docentes, os quais, sem as condições objetivas necessárias para promover a política instituída, enunciada no discurso, utilizam-se do seu potencial instituinte de transformação, escrevendo uma "outra história".

Importance of early and continuous use of protein restriction on the progression of adriamycin nephropathy

Three experimental protocols were carried out with the aim of evaluating the role of protein restriction on the progression of the established adriamycin-induced nephropathy, and whether the protective effect of the diet persists after the diet is discontinued. The effect of a low protein diet (LPD) was studied for 6 weeks in protocol 1, 16 weeks in protocol 2 and for 28 weeks in protocol 3. In protocol 3, one group (LL) received LPD and another (NN) was given a normal protein diet (NPD). A third group (LN) received LPD for 16 weeks and then NPD for 12 weeks and a fourth group (NL) was fed NPD for 16 weeks and then LPD for 12 weeks. In protocol I the tubulo- interstitial index (TILl) of rats on LPD (Md = 2, P25 = 0.0; P75 = 3.5) after six weeks, was smaller than that of the animals on NPD (Md = 6.0; P25 = 3.0; P75 = 8.0; p < 0.05). In protocol 2, the group taking LPD presented an area of interstitial fibrosis (IF) (Md= 0.5%, P25 0.2%; P75 = 1.9%) smaller than that of the NPD group (Md = 6.8%; P25 = 5.2%; P75 = 7.1%; P < 0.05). No significant difference in the area of glomerulosclerosis (GSA) was observed between the animals on LPD (Md = 0.0%; P25 = 0.0%, P75 = 0.0%) and NPD (Md = 0.37%; P25 = 02% P75 = 1.25%; p > 0.05). In protocol 3, the group LL showed GSA (Md = 1.3%; P25 0.6%, P75 = 2.5%) and IF (Md = 3.60/0; P25 = 1.6%; P75 = 5.9%) smaller that those of LN (GSA Md = 10.1%; P25 = 6.6%; P75 = 14.8%; IF; Md = 17.3%; P25 = 14.1%; P75 = 24,5%), NL (GSA: Md = 9.1%; P25 = 5,8%; P75 = 11.7%; IF; Md = 25.0%; P25 = 20.4%; P75 = 30%), and NN (GSA: Md = 6. 75%; P25 = 4.9%; P75 = 11.7%; IF: Md = 20.9%; P25 = 16.2%; P75 = 32.4%). In conclusion, in order to be effective, LPD must be introduced early and maintained for a long period of tune.

Distribution and abundance of sardine (Sardina pilchardus) eggs in the English Channel from Continuous Plankton Recorder sampling

Continuous Plankton Recorder (CPR) samples from the English Channel and adjacent Celtic shelf, taken over the period 1958-1980, were analysed for sardine (Sardina pilchardus) eggs. Results showed the progression of sardine spawning along the English Channel from west to east from March to August and a return from east to west from September to November. This corresponds with the two seasonal peaks of sardine egg abundance in the western Channel: the main summer peak being in May/June, with a smaller autumn peak in October/November. Long-term changes in sardine egg abundance in CPR samples showed a decline in summer spawning from the late 1960s, but no clear trend in autumn-spawned egg abundance. Similar patterns were observed in the numbers of sardine eggs sampled by conventional plankton net tows at the time-series Station L5 off Plymouth. This supports the use of the longer time-series of sardine egg data at L5 as being representative of a wider area and emphasizes the importance in continuation of the L5 time-series.

Intermittent versus continuous oxaliplatin and fluoropyrimidine combination chemotherapy for first-line treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trial

Background: When cure is impossible, cancer treatment should focus on both length and quality of life. Maximisation of time without toxic effects could be one effective strategy to achieve both of these goals. The COIN trial assessed preplanned treatment holidays in advanced colorectal cancer to achieve this aim. Methods: COIN was a randomised controlled trial in patients with previously untreated advanced colorectal cancer. Patients received either continuous oxaliplatin and fluoropyrimidine combination (arm A), continuous chemotherapy plus cetuximab (arm B), or intermittent (arm C) chemotherapy. In arms A and B, treatment continued until development of progressive disease, cumulative toxic effects, or the patient chose to stop. In arm C, patients who had not progressed at their 12-week scan started a chemotherapy-free interval until evidence of disease progression, when the same treatment was restarted. Randomisation was done centrally (via telephone) by the MRC Clinical Trials Unit using minimisation. Treatment allocation was not masked. The comparison of arms A and B is described in a companion paper. Here, we compare arms A and C, with the primary objective of establishing whether overall survival on intermittent therapy was non-inferior to that on continuous therapy, with a predefined non-inferiority boundary of 1·162. Intention-to-treat (ITT) and per-protocol analyses were done. This trial is registered, ISRCTN27286448. Findings: 1630 patients were randomly assigned to treatment groups (815 to continuous and 815 to intermittent therapy). Median survival in the ITT population (n=815 in both groups) was 15·8 months (IQR 9·4—26·1) in arm A and 14·4 months (8·0—24·7) in arm C (hazard ratio [HR] 1·084, 80% CI 1·008—1·165). In the per-protocol population (arm A, n=467; arm C, n=511), median survival was 19·6 months (13·0—28·1) in arm A and 18·0 months (12·1—29·3) in arm C (HR 1·087, 0·986—1·198). The upper limits of CIs for HRs in both analyses were greater than the predefined non-inferiority boundary. Preplanned subgroup analyses in the per-protocol population showed that a raised baseline platelet count, defined as 400 000 per µL or higher (271 [28%] of 978 patients), was associated with poor survival with intermittent chemotherapy: the HR for comparison of arm C and arm A in patients with a normal platelet count was 0·96 (95% CI 0·80—1·15, p=0·66), versus 1·54 (1·17—2·03, p=0·0018) in patients with a raised platelet count (p=0·0027 for interaction). In the per-protocol population, more patients on continuous than on intermittent treatment had grade 3 or worse haematological toxic effects (72 [15%] vs 60 [12%]), whereas nausea and vomiting were more common on intermittent treatment (11 [2%] vs 43 [8%]). Grade 3 or worse peripheral neuropathy (126 [27%] vs 25 [5%]) and hand—foot syndrome (21 [4%] vs 15 [3%]) were more frequent on continuous than on intermittent treatment. Interpretation: Although this trial did not show non-inferiority of intermittent compared with continuous chemotherapy for advanced colorectal cancer in terms of overall survival, chemotherapy-free intervals remain a treatment option for some patients with advanced colorectal cancer, offering reduced time on chemotherapy, reduced cumulative toxic effects, and improved quality of life. Subgroup analyses suggest that patients with normal baseline platelet counts could gain the benefits of intermittent chemotherapy without detriment in survival, whereas those with raised baseline platelet counts have impaired survival and quality of life with intermittent chemotherapy and should not receive a treatment break.

Intermittent chemotherapy plus either intermittent or continuous cetuximab for first-line treatment of patients with KRAS wild-type advanced colorectal cancer (COIN-B): a randomised phase 2 trial

Background: Advanced colorectal cancer is treated with a combination of cytotoxic drugs and targeted treatments. However, how best to minimise the time spent taking cytotoxic drugs and whether molecular selection can refine this further is unknown. The primary aim of this study was to establish how cetuximab might be safely and effectively added to intermittent chemotherapy.

Methods: COIN-B was an open-label, multicentre, randomised, exploratory phase 2 trial done at 30 hospitals in the UK and one in Cyprus. We enrolled patients with advanced colorectal cancer who had received no previous chemotherapy for metastases. Randomisation was done centrally (by telephone) by the Medical Research Council Clinical Trials Unit using minimisation with a random element. Treatment allocation was not masked. Patients were assigned (1:1) to intermittent chemotherapy plus intermittent cetuximab or to intermittent chemotherapy plus continuous cetuximab. Chemotherapy was FOLFOX (folinic acid and oxaliplatin followed by bolus and infused fluorouracil). Patients in both groups received FOLFOX and weekly cetuximab for 12 weeks, then either had a planned interruption (those taking intermittent cetuximab) or planned maintenance by continuing on weekly cetuximab (continuous cetuximab). On RECIST progression, FOLFOX plus cetuximab or FOLFOX was recommenced for 12 weeks followed by further interruption or maintenance cetuximab, respectively. The primary outcome was failure-free survival at 10 months. The primary analysis population consisted of patients who completed 12 weeks of treatment without progression, death, or leaving the trial. We tested BRAF and NRAS status retrospectively. The trial was registered, ISRCTN38375681.

Findings: We registered 401 patients, 226 of whom were enrolled. Results for 169 with KRAS wild-type are reported here, 78 (46%) assigned to intermittent cetuximab and 91 (54%) to continuous cetuximab. 64 patients assigned to intermittent cetuximab and 66 of those assigned to continuous cetuximab were included in the primary analysis. 10-month failure-free survival was 50% (lower bound of 95% CI 39) in the intermittent group versus 52% (lower bound of 95% CI 41) in the continuous group; median failure-free survival was 12·2 months (95% CI 8·8–15·6) and 14·3 months (10·7–20·4), respectively. The most common grade 3–4 adverse events were skin rash (21 [27%] of 77 patients vs 20 [22%] of 92 patients), neutropenia (22 [29%] vs 30 [33%]), diarrhoea (14 [18%] vs 23 [25%]), and lethargy (20 [26%] vs 19 [21%]).

Interpretation: Cetuximab was safely incorporated in two first-line intermittent chemotherapy strategies. Maintenance of biological monotherapy, with less cytotoxic chemotherapy within the first 6 months, in molecularly selected patients is promising and should be validated in phase 3 trials.

Neer Award 2007: Reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction. An experimental study in sheep

HYPOTHESIS: Chronic rotator cuff tears are associated with irreversible architectural muscle changes and a high rate of repair failure. The changes observed in man and their irreversibility with a single stage repair can be reproduced in sheep. It was the purpose of this experiment to test the hypothesis that slow, continuous elongation of a retracted musculotendinous unit allows reversal of the currently irreversible structural muscle changes. MATERIALS AND METHODS: The infraspinatus tendon of 12 sheep was released using a greater tuberosity osteotomy and allowed to retract for 4 months. Then, a new device was mounted on the scapular spine and used to extend the infraspinatus muscuculotendinous unit transcutaneously by 1 mm per day. Thereafter, the tendon was repaired back to the greater tuberosity. We assessed the muscular architecture using magnetic resonance imaging, macroscopic dissection, histology, and electron microscopy. Fatty infiltration (in Hounsfield units 1/4 HU) and muscular cross-sectional area (in % of the control side) were monitored with computed tomography at tendon release, initiation of elongation, repair, and at sacrifice. RESULTS: Sixteen weeks after tendon release, the mean tendon retraction was 29 +/- 6 mm (14% of original length, P = .008). In 8 sheep, elongation was achieved as planned (group I), but in 4, the elongation failed technically (group II). The mean traction time was 24 +/- 6 days with a mean traction distance of 19 +/- 4 mm. At sacrifice, the mean pennation angle in the infraspinatus of group I was not different from the control side (29.8 degrees +/-7.5 degrees vs. 30 degrees +/-6 degrees , P = .575). In group II, the pennation angle had increased from 30 degrees +/-6 degrees to 55 degrees +/-14 degrees (P = .035). There was no fatty infiltration at the time of tendon release. After retraction, there was a significant increase in fatty infiltration of the infraspinatus muscle and a decrease of its cross-sectional area to 57% of the contralateral side (P = .0001). During traction, the degree of fatty infiltration remained unchanged (36 HU to 38 HU, P = .381), and atrophy improved to a muscle square area of 78% of the contralateral side (P = .0001) in group I. In group II, an increase of fatty infiltration was measured from 36 HU to 28 HU; however, this increase was not significant (P = .144). Atrophy did not change in group II (57-55%, P = .946). At sacrifice, the remaining muscle mass was 64% in group I and 46% in group II (P = .019). DISCUSSION: Our preliminary results document, that continuous elongation of a retracted, fatty infiltrated and atrophied musculotendinous unit is technically feasible. CONCLUSION: In the sheep, continuous elongation can lead to restoration of normal muscle architecture, to partial reversal of muscle atrophy, and to arrest of the progression of fatty infiltration. LEVEL OF EVIDENCE: Basic science level 2; Prospective comparative therapeutic study.

gems: An R Package for Simulating from Disease Progression Models

Mathematical models of disease progression predict disease outcomes and are useful epidemiological tools for planners and evaluators of health interventions. The R package gems is a tool that simulates disease progression in patients and predicts the effect of different interventions on patient outcome. Disease progression is represented by a series of events (e.g., diagnosis, treatment and death), displayed in a directed acyclic graph. The vertices correspond to disease states and the directed edges represent events. The package gems allows simulations based on a generalized multistate model that can be described by a directed acyclic graph with continuous transition-specific hazard functions. The user can specify an arbitrary hazard function and its parameters. The model includes parameter uncertainty, does not need to be a Markov model, and may take the history of previous events into account. Applications are not limited to the medical field and extend to other areas where multistate simulation is of interest. We provide a technical explanation of the multistate models used by gems, explain the functions of gems and their arguments, and show a sample application.