Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience

The characteristic features of Whipple's disease include abdominal pain, diarrhoea, wasting, and arthralgias, with the causative agent, Tropheryma whipplei, being detected mainly in intestinal biopsies. PCR technology has led to the identification of T. whipplei in specimens from various other locations, including the central nervous system and the heart. T. whipplei is now recognized as one of the causes of culture-negative endocarditis, and endocarditis can be the only manifestation of the infection with T. whipplei. Although it is considered a rare disease, the true incidence of endocarditis due to T. whipplei is not clearly established. With the increasing use of molecular methods, it is likely that T. whipplei will be more frequently identified. Questions also remain about the genetic variability of T. whipplei strains, optimal diagnostic procedures and therapeutic options. In the present study, we provide clinical data on four new patients with documented endocarditis due to T. whipplei in the context of the available published literature. There was no clinical involvement of the gastrointestinal tract. Genetic analysis of the T. whipplei strains with DNA isolated from the excised heart valves revealed little to no genetic variability. In a selected case, we describe acridine orange staining for early detection of the disease, prompting early adaptation of the antibiotic therapy. We provide long-term follow-up data on the patients. In our hands, an initial 2-week course of intravenous antibiotics followed by cotrimoxazole for at least 1 year was a suitable treatment option for T. whipplei endocarditis.

Treatment of pediatric myelodysplastic syndromes and juvenile myelomonocytic leukemia: the Brazilian experience in the past decade

Background: Therapy strategies for myelodysplastic syndromes (MDS) and juvenile myelomonocytic leukemia (JMML) vary considerably. Objective: To review the treatment of Brazilian children who were diagnosed with MDS or JMML in the past decade and reported to the Brazilian Cooperative Group on Pediatric Myelodysplastic syndromes (BCG-MDS-PED). Results: of 173 children reported to the BCG-MDS-PED from January 1997 to January 2003 with a suspected diagnosis of MDS or JMML, 91 had the diagnosis confirmed after central review of the bone marrow aspirate and biopsy. Information on previous treatments was available for 78 MDS/JMML patients. Treatment varied from different schedules of low-dose (14%) and standard-dose chemotherapy (50%), granulocyte-colony-stimulating factor (G-CSF 7%), interferon (5%), steroids (2%) and erythropoietin (2%) to allogeneic stem-cell transplantation (SCT) (14%). No survival advantage could be demonstrated based on Hasle's classification or based on treatment. Conclusion: This report reflects the current practice in treating Brazilian children with MDS/JMML without specific Cooperative Group guidelines. Treatment modalities were very heterogeneous. The strategies for implementing a national protocol should consider international guidelines and focus on local experience and available resources. (C) 2004 Elsevier Ltd. All rights reserved.

THERE GOES THE ELECTORAL NEIGHBORHOOD: LOCAL NETWORKS, ATTRIBUTION OF RESPONSIBILITY, AND THE (UN) FAIRNESS OF ELECTIONS

During the last two decades there have been but a handful of recorded cases of electoral fraud in Latin America. However, survey research consistently shows that often citizens do not trust the integrity of the electoral process. This dissertation addresses the puzzle by explaining the mismatch between how elections are conducted and how the process is perceived. My theoretical contribution provides a double-folded argument. First, voters’ trust in their community members (“the local experience”) impacts their level of confidence in the electoral process. Since voters often find their peers working at polling stations, negative opinions about them translate into negative opinions about the election. Second, perceptions of unfairness of the system (“the global effect”) negatively impact the way people perceive the transparency of the electoral process. When the political system fails to account for social injustice, citizens lose faith in the mechanism designed to elect representatives -and ultimately a set of policies. The fact that certain groups are systematically disregarded by the system triggers the notion that the electoral process is flawed. This is motivated by either egotropic or sociotropic considerations. To test these hypotheses, I employ a survey conducted in Costa Rica, El Salvador, Honduras, and Guatemala during May/June 2014, which includes a population-based experiment. I show that Voters who trust their peers consistently have higher confidence in the electoral process. Whereas respondents who were primed about social unfairness (treatment) expressed less confidence in the quality of the election. Finally, I find that the local experience is predominant over the global effect. The treatment has a statistically significant effect only for respondents who trust their community. Attribution of responsibility for voters who are skeptics of their peers is clear and simple, leaving no room for a more diffuse mechanism, the unfairness of the political system. Finally, now I extend analysis to the Latin America region. Using data from LAPOP that comprises four waves of surveys in 22 countries, I confirm the influence of the “local experience” and the “global effect” as determinants of the level of confidence in the electoral process.

Risk-assessment practices in the private rental sector : implications for low-income renters (Final Report)

This report focuses on risk-assessment practices in the private rental market, with particular consideration of their impact on low-income renters. It is based on the fieldwork undertaken in the second stage of the research process that followed completion of the Positioning Paper. The key research question this study addressed was: What are the various factors included in ‘risk-assessments’ by real estate agents in allocating ‘affordable’ tenancies? How are these risks quantified and managed? What are the key outcomes of their decision-making? The study builds on previous research demonstrating that a relatively large proportion of low-cost private rental accommodation is occupied by moderate- to high-income households (Wulff and Yates 2001; Seelig 2001; Yates et al. 2004). This is occurring in an environment where the private rental sector is now the de facto main provider of rental housing for lower-income households across Australia (Seelig et al. 2005) and where a number of factors are implicated in patterns of ‘income–rent mismatching’. These include ongoing shifts in public housing assistance; issues concerning eligibility for rent assistance; ‘supply’ factors, such as loss of low-cost rental stock through upgrading and/or transfer to owner-occupied housing; patterns of supply and demand driven largely by middle- to high-income owner-investors and renters; and patterns of housing need among low-income households for whom affordable housing is not appropriate. In formulating a way of approaching the analysis of ‘risk-assessment’ in rental housing management, this study has applied three sociological perspectives on risk: Beck’s (1992) formulation of risk society as entailing processes of ‘individualisation’; a socio-cultural perspective which emphasises the situated nature of perceptions of risk; and a perspective which has drawn attention to different modes of institutional governance of subjects, as ‘carriers of specific indicators of risk’. The private rental market was viewed as a social institution, and the research strategy was informed by ‘institutional ethnography’ as a method of enquiry. The study was based on interviews with property managers, real estate industry representatives, tenant advocates and community housing providers. The primary focus of inquiry was on ‘the moment of allocation’. Six local areas across metropolitan and regional Queensland, New South Wales, and South Australia were selected as case study localities. In terms of the main findings, it is evident that access to private rental housing is not just a matter of ‘supply and demand’. It is also about assessment of risk among applicants. Risk – perceived or actual – is thus a critical factor in deciding who gets housed, and how. Risk and its assessment matter in the context of housing provision and in the development of policy responses. The outcomes from this study also highlight a number of salient points: 1.There are two principal forms of risk associated with property management: financial risk and risk of litigation. 2. Certain tenant characteristics and/or circumstances – ability to pay and ability to care for the rented property – are the main factors focused on in assessing risk among applicants for rental housing. Signals of either ‘(in)ability to pay’ and/or ‘(in)ability to care for the property’ are almost always interpreted as markers of high levels of risk. 3. The processing of tenancy applications entails a complex and variable mix of formal and informal strategies of risk-assessment and allocation where sorting (out), ranking, discriminating and handing over characterise the process. 4. In the eyes of property managers, ‘suitable’ tenants can be conceptualised as those who are resourceful, reputable, competent, strategic and presentable. 5. Property managers clearly articulated concern about risks entailed in a number of characteristics or situations. Being on a low income was the principal and overarching factor which agents considered. Others included: - unemployment - ‘big’ families; sole parent families - domestic violence - marital breakdown - shift from home ownership to private rental - Aboriginality and specific ethnicities - physical incapacity - aspects of ‘presentation’. The financial vulnerability of applicants in these groups can be invoked, alongside expressed concerns about compromised capacities to manage income and/or ‘care for’ the property, as legitimate grounds for rejection or a lower ranking. 6. At the level of face-to-face interaction between the property manager and applicants, more intuitive assessments of risk based upon past experience or ‘gut feelings’ come into play. These judgements are interwoven with more systematic procedures of tenant selection. The findings suggest that considerable ‘risk’ is associated with low-income status, either directly or insofar as it is associated with other forms of perceived risk, and that such risks are likely to impede access to the professionally managed private rental market. Detailed analysis suggests that opportunities for access to housing by low-income householders also arise where, for example: - the ‘local experience’ of an agency and/or property manager works in favour of particular applicants - applicants can demonstrate available social support and financial guarantors - an applicant’s preference or need for longer-term rental is seen to provide a level of financial security for the landlord - applicants are prepared to agree to specific, more stringent conditions for inspection of properties and review of contracts - the particular circumstances and motivations of landlords lead them to consider a wider range of applicants - In particular circumstances, property managers are prepared to give special consideration to applicants who appear worthy, albeit ‘risky’. The strategic actions of demonstrating and documenting on the part of vulnerable (low-income) tenant applicants can improve their chances of being perceived as resourceful, capable and ‘savvy’. Such actions are significant because they help to persuade property managers not only that the applicant may have sufficient resources (personal and material) but that they accept that the onus is on themselves to show they are reputable, and that they have valued ‘competencies’ and understand ‘how the system works’. The parameters of the market do shape the processes of risk-assessment and, ultimately, the strategic relation of power between property manager and the tenant applicant. Low vacancy rates and limited supply of lower-cost rental stock, in all areas, mean that there are many more tenant applicants than available properties, creating a highly competitive environment for applicants. The fundamental problem of supply is an aspect of the market that severely limits the chances of access to appropriate and affordable housing for low-income rental housing applicants. There is recognition of the impact of this problem of supply. The study indicates three main directions for future focus in policy and program development: providing appropriate supports to tenants to access and sustain private rental housing, addressing issues of discrimination and privacy arising in the processes of selecting suitable tenants, and addressing problems of supply.

Challenging industry conceptions with provotypes

Design researchers have an important role to play when engaged with user-driven design projects in industry. Design researchers can craft ethnographic material to facilitate transfers of user-knowledge to industry, and demonstrate how this material can be used in the design of new products and services. However, ethnographic findings can reveal issues that are in tension with conceptions of the project members from industry. Instead of brushing these tensions aside, we propose provotyping (provocative prototyping) as an approach to constructively build on them as a resource for change. Provotypes are ethnographically rooted, technically working, robust artefacts that deliberately challenge stakeholder conceptions by reifying and exposing tensions that surround a field of organisational interest. The daily and local experience of provotypes aims to stir dialectical processes of reflection on how conceptions currently are, and fuel the front end of a development process by speculating how conceptions could be different. In this article we start by making explicit the relation between provotypes, practices of critical design and organisational sense-making. We then illustrate, through a multi-stakeholder project concerning the field of indoor climate, how provotypes facilitate transfers of user knowledge to industry, and how they contribute to the development of new products and services. We end by framing the role of the design researcher and discuss the politics that are inherent to design provocations.

Community projects : extending the community lawyering model

Law schools in Australia and the United Kingdom are increasingly adopting clinical legal education (CLE) as an important part of their curriculum. Models of CLE are emerging in those jurisdictions which draw on local experience and the strong tradition of CLE and community lawyering in the United States. The purpose of this article is to examine the pedagogy that underlies CLE and to consider how it can be applied to newly emerging models of CLE. In particular, it will evaluate a community project legal clinic in which students work on social justice projects in partnership with a range of community organisations, not limited to legal centres, with a view to determining whether pedagogical goals are being met in the way that the course is being delivered. This article argues that community project legal clinics can result in positive student learning outcomes in relation to the development of a pro bono ethos and commitment to social justice, lawyering skills including client communication, and the development of a positive professional legal identity. Part II of the article provides a brief overview of the history of CLE in Australia, the United Kingdom and the United States, noting the trend towards the development of community lawyering clinics. Part III examines the benefits of community lawyering clinics focusing on the benefits for student learning and the service-learning pedagogy applied in community lawyering clinics in the United States. Finally, part IV looks at a case study of a new community project clinic in Australia that draws upon the service-learning pedagogy of community lawyering CLE. In the community project clinic, students engage in service-learning through undertaking projects with not-for-profit community organisations. Community partners identify relevant issues and needs, and the students work in interdisciplinary teams to address these. Law students working in these teams are often exposed to a broader social problem or issue than they would experience in a traditional ‘in-person’ legal clinic. Initial evaluation suggests that this model for community clinics in law schools assists students to develop lawyering skills and a positive legal identity including awareness of and support for pro bono legal work and a sense of belonging in the legal profession.

Bangarra Dance Theatre: Copyright law and Indigenous culture

This article considers the artistic and legal practices of Bangarra Dance Theatre in a case study of copyright law management in relation to Indigenous culture. It is grounded in the particular local experience, knowledge and understanding of copyright law displayed by the performing arts company. The first part considers the special relationship between Bangarra Dance Theatre and the Munyarrun Clan. It examines the contractual arrangements developed to recognise communal ownership. The next section examines the role of the artistic director and choreographer. It looks at the founder, Carole Johnson, and her successor, Stephen Page. The third part of the article focuses on the role of the composer, David Page. It examines his ambition to set up a Indigenous recording company, Nikinali. Part 4 focuses upon the role of the artistic designers. It looks at the contributions of artistic designers such as Fiona Foley. Part 5 deals with broadcasts of performances on television, film, and multi-media. Part 6 considers the collaborations of Bangarra Dance Theatre with the Australian Ballet, and the Sydney Organising Committee for the Olympic Games. The conclusion considers how Bangarra Dance Theatre has played a part ina general campaign to increase protection of Indigenous copyright law.

Sustainable Grazing in the Channel Country Floodplains (phase 2) : A technical report on findings between March 2003 and June 2006

‘Sustainable Grazing in the Channel Country Floodplains’ was initiated by industry to redress the lack of objective information for sustainable management in the floodplains of Cooper Creek and the Diamantina and Georgina Rivers. The project has maintained links with the grazing community and has extensively drawn upon expert local experience and knowledge. The project has provided tools for managers to better anticipate the size of beneficial flooding arising from rains in the upper catchment and to more objectively assess the value of the pasture resulting from flooding. The latest information from the project has enabled customisation of the EDGENetwork™ Grazing Land Management training package for the Channel Country. In combination, these tools will assist in making earlier cattle stocking decisions, including when cattle may need to be mustered out of floodplain paddocks, how many additional cattle will be required to take advantage of the flood–grown pasture, and the timing of cattle turnoff. These will reduce costs by providing a greater lead time to plan cattle movements and purchases, and may enhance the sustainability of the resource base by better matching cattle numbers with the feed on offer.

Redes de criação e compartilhamento entre docentes artistas

Este trabalho pretende refletir sobre a formação continuada de docentes em artes em diálogo com as tecnologias digitais na perspectiva inclusiva desses profissionais, frente à urgência de se desenvolver competências para o uso da máquina. Desta forma destaco a experiência local em arte, educação e tecnologia dos professores de artes do Núcleo de Arte Copacabana (Unidade de Extensão Educacional/ SME/ Rio de Janeiro), que em 2008 constituiu-se em um grupo de formação continuada para o domínio da nova linguagem e hoje se revela em ações inovadoras na sua prática. Nesse contexto de aprendizagem colaborativa tenciono partir para reflexões mais amplas sobre a condição do professor como aprendiz em sua própria função de educar, ratificando a necessidade desse ensino/aprendizagem também na formação inicial em artes. A motivação para a pesquisa está no largo campo a ser explorado da inclusão digital, das inovações pedagógicas, dos novos paradigmas educacionais deflagrados pela equipagem tecnodigital e dos percursos informacionais implicados nos novos processos de ensino aprendizagem. O papel do pesquisador se destaca pela inseção ativa no grupo pesquisado, definindo-se como experiência reflexiva pela via da pesquisa ação

Immersion professionnelle et intégration en emploi des immigrants : l’exemple du PRIIME (Programme d’aide à l’intégration des immigrants et des minorités visibles en emploi)

Les immigrants qualifiés rencontrent plusieurs obstacles sur le marché du travail au Québec. Parmi les plus importants, selon les employeurs, on note leur manque d’expérience québécoise. Le Programme d’aide à l’intégration des immigrants et minorités visibles en emploi (PRIIME), géré par Emploi-Québec, veut combler cette lacune en offrant aux immigrants une expérience québécoise dans leur domaine de qualification. Cette recherche a donc pour but d’examiner dans quelle mesure un programme d’immersion professionnelle tel que le PRIIME permet une meilleure intégration des immigrants qualifiés dans leur domaine et de voir si celle-ci se poursuit à la suite du programme. L’approche qualitative permet de mieux comprendre les différents points de vue : employeurs, immigrants et intervenants au PRIIME. On observe que la participation des immigrants au PRIIME permet de réduire leur degré de déqualification en emploi, mais pas complètement. Ainsi elle permet souvent de retrouver un emploi lié au domaine de formation, mais en dessous du niveau de qualifications des immigrants. Le PRIIME rend également possible un maintien en emploi, sauf que l’effet n’est observé qu’à court terme. De plus, la participation au programme ne suffit pas pour que l’immigrant soit en mesure de contrer les obstacles à l’intégration professionnelle, car les quatre volets principaux du PRIIME sont très rarement appliqués ensemble dans une entreprise. Finalement, dans la perspective des marchés transitionnels de travail, la participation au PRIIME représente une « transition critique » offrant aux immigrants une meilleure intégration professionnelle à long terme. En somme, nous concluons que le PRIIME réduit uniquement le degré de déqualification des immigrants en les rapprochant de leur domaine de formation. Toutefois, il ne tient pas compte du niveau d’éducation de la personne. Même avec le PRIIME, plusieurs immigrants se voient forcés de recommencer leur carrière.

A vision for attaining food security

Food is fundamental to human wellbeing and development. Increased food production remains a cornerstone strategy in the effort to alleviate global food insecurity. But despite the fact that global food production over the past half century has kept ahead of demand, today around one billion people do not have enough to eat, and a further billion lack adequate nutrition. Food insecurity is facing mounting supply-side and demand-side pressures; key among these are climate change, urbanisation, globalisation, population increases, disease, as well as a number of other factors that are changing patterns of food consumption. Many of the challenges to equitable food access are concentrated in developing countries where environmental pressures including climate change, population growth and other socio-economic issues are concentrated. Together these factors impede people's access to sufficient, nutritious food; chiefly through affecting livelihoods, income and food prices. Food security and human development go hand in hand, and their outcomes are co-determined to a significant degree. The challenge of food security is multi-scalar and cross-sector in nature. Addressing it will require the work of diverse actors to bring sustained improvements inhuman development and to reduce pressure on the environment. Unless there is investment in future food systems that are similarly cross-level, cross-scale and cross-sector, sustained improvements in human wellbeing together with reduced environmental risks and scarcities will not be achieved. This paper reviews current thinking, and outlines these challenges. It suggests that essential elements in a successfully adaptive and proactive food system include: learning through connectivity between scales to local experience and technologies high levels of interaction between diverse actors and sectors ranging from primary producers to retailers and consumers, and use of frontier technologies.

An assessment of the economic and social impacts of climate change on the Coastal and Marine Sector in the Caribbean

Climate change poses special challenges for Caribbean decision makers related to the uncertainties inherent in future climate projections and the complex linkages between climate change, physical and biological systems, and socioeconomic sectors. At present, however, the Caribbean subregion lacks the adaptive capacity needed to address these challenges. The present report assesses the economic and social impacts of climate change on the coastal and marine sector in the Caribbean until 2050. It aims both to provide Caribbean decision makers with cutting edge information on the vulnerability to climate change of the subregion, and to facilitate the development of adaptation strategies informed by both local experience and expert knowledge.

Policy Brief: an assessment of the economic and social impacts of climate change on the coastal and marine sector in the Caribbean

Caribbean policymakers are faced with special challenges from climate change and these are related to the uncertainties inherent in future climate projections and the complex linkages among climate change, physical and biological systems and socioeconomic sectors. The impacts of climate change threaten development in the Caribbean and may well erode previous gains in development as evidenced by the increased incidence of climate migrants internationally. This brief which is based on a recent study conducted by the Economic Commission for Latin America and the Caribbean (LC/CAR/L.395)1 provides a synthesis of the assessment of the economic and social impacts of climate change on the coastal and marine sector in the Caribbean which were undertaken. It provides Caribbean policymakers with cutting-edge information on the region’s vulnerability and encourages the development of adaptation strategies informed by both local experience and expert knowledge. It proceeds from an acknowledgement that the unique combination of natural resources, ecosystems, economic activities, and human population settlements of the Caribbean will not be immune to the impacts of climate change, and local communities, countries and the subregion as a whole need to plan for, and adapt to, these effects. Climate and extreme weather hazards related to the coastal and marine sector encompass the distinct but related factors of sea level rise, increasing coastal water temperatures, tropical storms and hurricanes. Potential vulnerabilities for coastal zones include increased shoreline erosion leading to alteration of the coastline, loss of coastal wetlands, and changes in the abundance and diversity of fish and other marine populations. The study examines four key themes in the analysis: climate, vulnerability, economic and social costs associated with climate change impacts, and adaptive measures.

From «Pflantz-Gart» to «Stammregister». On the history of knowledge of fruit cultivation in the canton of Bern

Among the efforts for the improvement of agricultural productivity, the cultivation of useful plants is particularly at the center of the Economic Enlightenment. In contrast to fodder and textile plants, cereals and potatoes, fruit trees are not included among its favoured subjects. This may be considered as astonishing in view of the significance that fruit has acquired in the contemporary diet. Be that as it may, efforts to improve fruit cultivation go back to even before the classical period of the Economic Enlightenment. The example of Bern in particular is suited to such an analysis over the Longue durée that covers the time from Daniel Rhagor’s «Pflantz-Gart» (1639) to the «Register of varieties of excellent species of pome fruits for the canton of Bern» (Stammregister, 1865). From the perspective of the history of knowledge, the connections between scholarly knowledge and local experience on the one hand and the changing actors in these knowledge systems on the other hand are of special interest here