bluuebunny/crossref_metadata_2025 huggingface dataset:
DISCUSSÃO CRÍTICA SOBRE EDUCAÇÃO AMBIENTAL E O ENSINO DE BIOLOGIA PARA A PRÁTICA SOCIAL?
Authors: Silva de Assis Aiany Ruth
Published: March 2017

O artigo propõe discutir o papel que a Educação Ambiental enquanto prática educativa presente nos discursos acadêmicos, visando minimizar os problemas ambientais decorrentes, possibilitando a ampliação dos conhecimentos do papel ecológico da escola no contexto contemporâneo. A pesquisa busca novos caminhos para compreender como está sendo trabalhada a Educação Ambiental nas escolas e a contribuição do ensino de Biologia. O artigo propõe abordar a temática baseado na vivência no ambiente escolar com subsídios nos referenciais teóricos. A Educação Ambiental no ensino formal pode levar os alunos a terem mudanças de comportamentos, de maneira a sensibilizá-los quanto aos problemas ambientais que pode comprometer a vida das futuras gerações de humanos. Ações voltadas para a preservação, conservação e recuperação do ambiente podem contribuir para o crescimento socioambiental, questão de educação para o ambiente, uma abordagem multidisciplinar. Todo o quadro pedagógico das escolas pode contribuir para a promoção da EA, área do conhecimento que abrange todos os níveis de ensino, incluindo o nível não-formal, com a finalidade de sensibilizar a população para os cuidados ambientais.
AS POLÍTICAS PÚBLICAS DE CONSERVAÇÃO NO ORDENAMENTO TERRITORIAL?
Authors: Foleto Eliane Maria
Published: March 2017

O processo desordenado de ocupação de áreas que deveriam ser conservadas, pela sua fragilidade à ocupação, como as Áreas de Preservação Permanente (APPs) ? de margem, nascentes, encostas ?, requer medidas eficazes para impor restrição de usos e ocupação, ordenando o espaço. Perante essa realidade, torna-se necessária a ação do poder público no sentido de proteger as áreas ambientalmente frágeis à ocupação, já definidas por lei, e as que ainda não foram ocupadas e mantêm ecossistemas naturais, buscando garantir a continuidade dos serviços ambientais, que trazem benefícios à qualidade de vida e protegem a população do risco. Nesse enfoque de áreas protegidas como ferramenta de ordenamento territorial, o artigo tem como objetivo analisar as políticas de conservação, que impõem restrições de uso, como a do Código Florestal e a que institui as Unidades de Conservação (UCs). Por se tratar de uma discussão teórica, o artigo foi elaborado através de uma pesquisa bibliográfica. Pode-se observar que as Políticas Públicas de Conservação, como a que define as APPs e as UCs, são um componente a mais no sistema de ordenamento territorial, que é um processo dinâmico que visa avaliar e planejar o uso do solo e o manejo dos recursos naturais, em várias escalas do nacional ao local, considerando o equilíbrio ecológico e a proteção do ambiente e da qualidade de vida da população.
Prospective Evaluation of Intra-Articular Dextrose Prolotherapy for Treatment of Osteoarthritis in Dogs
Authors: Sherwood J. Matthew , Roush James K. , Armbrust Laura J. , Renberg Walter C.
Published: March 2017

The objective of this study was to evaluate intra-articular dextrose prolotherapy for osteoarthritis of the elbow or stifle in dogs in a randomized, double-blind, placebo-controlled, prospective pilot study. Seventeen dogs were evaluated with 10 meeting inclusion criteria for this study. Evaluations included orthopedic exam, visual lameness scoring, Canine Brief Pain Inventory (CBPI), goniometry, kinetic gait analysis, and radiography. Initial lameness score, age, body weight, duration of lameness, and CBPI scores did not differ between groups. Change in CBPI pain severity score in the prolotherapy group from wk 6–12 was significantly less improved than in the placebo group, with no other significant differences in pain severity or pain interference scores between groups. Range of motion and radiographic scores did not differ between groups at any time. Mean kinetic forces improved in prolotherapy dogs but were not significantly different between treatment groups at any time. Although easily performed and well-tolerated, there were no statistically significant benefits of dextrose prolotherapy for treatment of osteoarthritis of the elbow and stifle in dogs. Post hoc power analysis of these sample means and standard deviations found that 29–106 animals per group would be necessary to demonstrate significant differences in kinetic forces, providing useful guidance for future studies.
Nuevos Reportes de Arrecifes Coralinos en el Caribe de Honduras
Authors: Alegría Andrés , Pérez Cristhian
Published: March 2017

La exploración de los arrecifes coralinos en el Caribe hondureño ha sido enfocada principalmente en las inmediaciones de las Islas de la Bahía y de los Cayos Cochinos, mientras que mucho menos se conoce sobre la distribución, extensión y salud de estos ecosistemas a lo largo de la plataforma continental dentro de los primeros 10 km de la costa. Sin embargo, la pesca cotidiana de especies asociadas a arrecifes (e.g. Lutjanus synagris, Ocyurus chrysurus) capturadas cerca de la costa por los pescadores artesanales es evidencia sobre la presencia de  arrecifes coralinos agregados a lo largo de la plataforma continental. Tras una exploración inicial dentro y alrededor del Refugio de Vida Silvestre Barras de Cuero y Salado identificamos 15 sitios con cobertura bentónica arrecifal previamente no documentada.Ceiba, 2016. Volumen 54(2):157-166
Abundancia Relativa del Colibrí Esmeralda (Amazilia luciae) en su Comunidad de Aves en el Valle de Agalta, Olancho, Honduras
Authors: Mora José Manuel , Espinal Mario Roberto , Germer Luis Daniel , López Lucía Isabel
Published: March 2017

El colibrí esmeralda hondureño (Amazilia luciae) es la única ave endémica de Honduras. Esta especie ha sido catalogada como una de las aves más amenazadas de Centroamérica. El colibrí esmeralda existe solamente en seis áreas de bosque seco de Honduras. En el oriente se conoce de los valles de Agalta y Telica (Olancho) y el valle de Aguán (Yoro). En el occidente se ha observado en los valles de Tencoa, Quimistán y Jicatuyo (Santa Bárbara y Cortés). El hábitat de bosque seco del valle de Agalta ha sido eliminado y deteriorado y para el 2102 solo permanecían 20 fragmentos de diferentes tamaños. En estos fragmentos censamos las aves con énfasis en el colibrí esmeralda. Hicimos 50 transeptos de punto y categorizamos a las aves según su abundancia. El colibrí esmeralda resultó ser relativamente común en el área. Lo encontramos en 10 de los fragmentos de bosque seco de Agalta. Esta fue la única especie especialista de las 90 que detectamos en el valle. Las demás especies son generalistas y la mayoría comunes o abundantes. Una de las especies comunes fue Arremonops chloronotus twomeyi, una subespecie que solo existe en los valles secos de Agalta y Aguán. A pesar de que observamos al colibrí, principalmente en los bordes de bosque seco, el mayor problema para su conservación en Agalta es la tenencia de la tierra. Diecinueve de los remanentes de bosque seco en Agalta son propiedad privada, el otro es municipal. Planteamos algunas alternativas para la conservación del colibrí esmeralda en Agalta. De estas, la que podría ser más factible es la creación de un programa de pagos por servicios ambientales (PSA). La regeneración del bosque en potreros en desuso actualmente no es una solución a largo plazo si siguen en manos privadas. Los propietarios privados protegerán el bosque si reciben estímulos económicos para hacerlo. Un PSA podría obtener parte de su financiamiento para operar por medio de un peaje ambiental en la carretera Gualaco-San Esteban.Ceiba, 2016. Volumen 54(2)127-138
CARACTERÍSTICAS DOS IDOSOS SUBMETIDOS AOS EXAMES PARA A CARTEIRA DE HABILITAÇÃO VEICULAR
Authors: Lenardt Maria Helena , Carneiro Nathalia Hammerschmidt Kolb , Binotto Maria Angélica , Cechinel Clovis , Lourenço Tânia Maria , Sakai Letícia Marie
Published: March 2017

Trata-se de estudo quantitativo descritivo retrospectivo, cujo objetivo foi rastrear as características dos idosos que realizam o exame de aptidão física e mental para a carteira nacional de habilitação veicular. Coletaram-se dados em 1023 formulários de idosos com idade ≥ 60 anos em uma clínica de medicina do tráfego na cidade de Curitiba-PR. Houve predomínio de homens (n=713; 69,7%), idade entre 60 e 64,9 anos (n=418; 40,9%), uso de medicamentos (n=621; 60,7%), sobrepeso (n=419; 41%) e acuidade visual diminuída (n=573; 56%). Quanto à aptidão para dirigir, 216 (21,1%) foram considerados aptos; 803 (78,5%) aptos com restrição e quatro (0,4%) inaptos temporários. A maioria dos idosos motoristas é idoso-jovem, do sexo masculino e que possui restrição para dirigir pelo uso de lentes oculares. Os resultados fornecem subsídios para o avanço da temática em estudos que têm por objetivo aprimorar as avaliações dos idosos e, consequentemente, contribuir para um trânsito mais seguro.
Capital Structure Choice and Firm Value: New Empirical Evidence from Asymmetric Causality Test
Authors: Demirgunes Kartal
Published: March 2017

This study aims to analyze the possible asymmetric causal relationship between capital structure and firm value by employing the asymmetric causality test of Hatemi-J (2012), on a time series data of Turkish manufacturing industry (consisting of Borsa Istanbul listed manufacturing firms) for the period of 1990.Q1-2015.Q4. Test results point out a unidirectional asymmetric causal relationship between capital structure and firm value, indicating that capital structure Granger-cause firm value when shocks are negative, but not when shocks are positive. More explicitly, a decrease in total debt ratio leads to a decrease in the market-to-book value ratio. Considering the effect of only negative shock, this empirical finding also supports partial evidence to the validity of trade-off theory which predicts a positive relationship between debt level and firm value.
Physical Examination of Knee Ligament Injuries
Authors: Bronstein Robert D. , Schaffer Joseph C.
Published: March 2017

The knee is one of the most commonly injured joints in the body. A thorough history and physical examination of the knee facilitates accurate diagnosis of ligament injury. Several examination techniques for the knee ligaments that were developed before advanced imaging remain as accurate or more accurate than these newer imaging modalities. Proper use of these examination techniques requires an understanding of the anatomy and pathophysiology of knee ligament injuries. Advanced imaging can be used to augment a history and examination when necessary, but should not replace a thorough history and physical examination.
Advances in anticoagulation management of patients undergoing cardioversion of nonvalvular atrial fibrillation
Authors: Bonou Maria , Toutouzas Konstantinos , Diamantopoulos Panagiotis , Viniou Nora , Barbetseas John , Benetos Georgios
Published: March 2017

Atrial fibrillation (AF) is a major cause of stroke. The restoration of sinus rhythm through cardioversion, either chemical or electrical is a common practice. Interestingly, there is an incremental increase from the baseline risk for embolisation in the immediate post-cardioversion period, with most events occurring within 10 days from cardioversion. Especially patients with recent onset AF show the lowest rates of antithrombotic therapy, while having a high stroke risk. Despite the increased risk for embolisation, anticoagulation in patients undergoing cardioversion of atrial fibrillation is often inadequate. Moreover, since the implementation of non-vitamin K antagonists oral anticoagulants (DOACs) there are several therapeutic approaches for pericardioversion anticoagulant therapy and not all suits to all patients. In addition, the extensive use of transesophageal echocardiography provides an alternative strategy, especially useful for patients of high haemorrhagic risk. In this review article, we aim to provide an update on the anticoagulation strategies for patients undergoing cardioversion of non-valvular atrial fibrillation in the advent of the use of DOACs.
Physiotherapy Treatments in Musculoskeletal Pathologies Associated with Haemophilia
Authors: Guodemar-Pérez Jesús , Ruiz-López Montserrat , Rodríguez-López Elena , García-Fernández Pablo , Hervás-Pérez Juan Pablo
Published: March 2017

The aim of this study is to offer physiotherapists a synthesis of the main therapeutic tools available for the treatment of musculoskeletal pathologies in patients with haemophilia, according to the scientific literature. Although bleeds are recognised as no longer being a cause of death for people with haemophilia, the accompanying musculoskeletal injuries now represent the main problem associated with this disorder. There is a lack of clear guidelines to date regarding the physiotherapy treatment of these disorders. We performed a keyword searches of Pubmed, Scopus, Sciencedirect, Cochrane and PEDro databases. In total, 555 references were retrieved, of which only 55 fulfilled the inclusion criteria. Publications were grouped by the main symptoms caused by haemophilia and the physiotherapy treatments available. The literature reviewed shows that physiotherapists have a range of therapeutic tools at their disposal for the treatment of the main musculoskeletal disorders suffered by patients with haemophilia. Physiotherapy interventions act upon inflammation and pain, as well as favouring the reabsorption of haematomas, preventing muscle fibrosis and joint ankylosis and recovering the joint range from prior to the lesions. Also, these interventions help prevent muscle atrophy and provide patients with the optimal physical conditions for facing the small and repetitive injuries that, over time, can have a detrimental effect on their quality of life. Conclusion: Haemophilic patients suffer from a series of musculoskeletal disorders, which are associated with important functional disability. Physiotherapy and adapted sports are essential for decreasing disability and improving the quality of life of affected patients.
The Efficiency of Arbuscular Mycorrhizal Fungi in Promoting Alfalfa Growth in Acid Soils
Authors: Huang Lei , He Yuji , Guo Yanjun
Published: March 2017

High concentrations of soil Al3+ in acid soil severely influence the growth of Medicago sativa (alfalfa). The objective of the current study was to analyze whether Arbuscular Mycorrhizal Fungi (AMF) inoculation could improve alfalfa growth in acid soils. A two-way completely randomized factorial design was employed for M. sativa and M. lupulina (black medick) with two inoculations (rhizobia and AMF) and three Al3+ levels, and replicated four times. The soil Al3+ levels were adjusted to 900 mg/kg, 1000 mg/kg and 1100 mg/kg. Spores of AMF were isolated directly from rhizosphere soils of black medick. The rhizobia were isolated from root nodules in fields separately from two plant species. At each Al3+ level, there were four inoculations, non-inoculation, AMF solely, rhizobia solely and dual-inoculation with AMF and rhizobia. Soil Al3+ concentration significantly limited above- and below-ground growth of both alfalfa and black medick, reducing plant height, branching number, shoot and root weight, and root length, surface area and volume. Compared to rhizobia, AMF showed a higher tolerance to soil Al3+. AMF inoculation increased the shoot and root weight of both plant species under most circumstances. Overall, AMF colonization had a trend in increasing the contents of phosphorus in both plant species at all Al3+ concentrations but not nitrogen and potassium. Dual inoculation significantly increased nodulation ability, enabling both plant species to form nodules at 900 and 1000 mg/kg Al3+. Though the soil Al3+ concentration influenced the efficiency of AMF inoculation, AMF inoculation improved nodulation, increased plant growth and nutrient uptake, suggesting that it was an alternative way in improving alfalfa growth in acid soils.
Effect of Nitrogen Fertilizer and Its Application Efficiency on Two Local Sorghum Cultivars Sorghum bicolor L. Moench
Authors: Muflahi Abdulla A. Mohamed , Basuaid Ahmed Saleh
Published: March 2017

A field experiment was carried out at El-Kod Agricultural Research Station, Abyan Delta, Abyan Governorate during the seasons 2014 and 2015 in soil sandy silt to assess four levels of nitrogen fertilizers (0, 55, 110 and 165 kg N/ha) utilizing urea fertilizer (46% N) on some crop characteristics and efficiency of nitrogen application on two local cultivars of sorghum (Sorghum bicolor L. Moench). Split plot design was applied in four replicates. Fertilizer levels were distributed in main plots whereas, the cultivars in subplots. The results revealed significant differences between cultivars Benny and Saif in all characteristics during the two seasons. Cultivar Benny was significantly superior to cultivar Saif in all crop characteristics, except the length of spike which was significantly superior in Saif cultivar compared to cultivar Benny in both seasons. The increase in nitrogen level led to significant increase in all parameters of crop growth under study in both seasons, where the highest dose of nitrogen (165 kg N/ha) gave highest grain yield (3013 and 3201 kg/ha) in both seasons respectively, while the efficiency of nitrogen utilization declined with increased level of nitrogen application and highest value in nitrogen efficiency (12.78 kg grain/kg N). The interaction between cultivars and nitrogen fertilizer showed significant differences in terms of all studied parameters during both seasons. The cultivar Benny responded to high level of nitrogen (165 kg N/ha) and gave high grain yield (3640 and 3305 kg/ha) in both seasons respectively. The results yielded significant effect for efficiency of nitrogen application on grain yield between the cultivars, the levels of fertilizers and their interaction in the first season whereas, no significant differences were detected in the second season.
Cell Thermoregulation: Problems, Advances and Perspectives
Authors: Ibraimov A. I.
Published: March 2017

Thermoregulation at organism level is the well-established fact. The question on possibility of thermoregulation at the cell level remains opened. Based on study of distribution of chromosomal heterochromatin regions (HRs) in various human populations, in norm and at some forms of pathology the hypothesis about thermoregulation existence at the cell level has been presented. The essence of hypothesis of cell thermoregulation (СТ) is elimination of the temperature difference between the nucleus and cytoplasm when the nucleus temperature becomes higher than the cytoplasm temperature. The nucleus, in contrast to the cytoplasm, cannot conduct heat directly in the extracellular space, from where the heat is taken by the circulating flow of sap, lymph and blood. Thus, the nucleus can conduct heat only in the cytoplasm. With this, the nucleus has two options for the dissipation of heat surplus: either by increasing its volume or increasing the heat conductivity of the nuclear envelope. As the first option is limited, and the second one is hampered because of thickness of the cell membranes, apparently the higher eukaryotes took advantage of the opportunity of a dense layer of peripheral condensed chromatin (CC) as heat conductor for a more efficient elimination of the temperature difference between the nucleus and cytoplasm. The СС localized between a nucleus and cytoplasm is made of different types of chromosomal HRs. For this reason, СС is subject to wide variability in population. Obviously, the density of the СС packing depends on the type and quantity of chromosomal HRs in its structure that can affect upon its heat-conducting ability. If the situation is this then we are entitled to expect a new type of variability with all consequences resulting from here.
The Cardinality of the Set of Zeros of Homogeneous Linear Recurring Sequences over Finite Fields
Authors: Kottegoda Yasanthi , Fitzgerald Robert
Published: March 2017

Consider homogeneous linear recurring sequences over a finite field $\mathbb{F}_{q}$, based on the irreducible characteristic polynomial of degree $d$ and order $m$. We give upper and lower bounds, and in some cases the exact values of the cardinality of the set of zeros of the sequences within its least period. We also prove that the cyclotomy bound introduced here is the best upper bound as it is reached in infinitely many cases. In addition, the exact number of occurrences of zeros is determined using the correlation with irreducible cyclic codes when $(q^{d}-1)/ m$ follows the quadratic residue conditions and also when it has the form $q^{2a}-q^{a}+1$ where $a\in \mathbb{N}$.
Evaluation of the impact of osteopathic techniques and physical exercises on the range of motion and sensation of pain in the frozen shoulder - a case report
Authors: W. Romanowski Mateusz , Dwornik Michał , Kwaśniewska Anna , Nowacka Katarzyna , Samborski Włodzimierz
Published: March 2017

ABSTRACT: This research presents the case of a patient with a frozen shoulder and assesses the impact of osteopathic techniques and physical exercises for this condition. The article describes the epidemiology, etiology, pathogenesis, clinical symptoms and treatment options for frozen shoulder. It also contains information on how to conduct clinical tests and diagnosis of the adhesive capsulitis. We assessed the range of flexion, external rotation, internal rotation and the intensity of pain of the patients frozen shoulder. In this case study frozen shoulder developed typically, in three stages “freezing”, “frozen”, “thawing”. The treatment significantly increased the range of motion of the shoulder joint and reduced sensation of pain. The analysis shows that the osteopathic techniques and physical exercises are an effective form of rehabilitation and pain management. Further studies are needed in this area.
When Corporate Communication Goes Public: Communication Policies in Public Communication
Authors: Ditlevsen Marianne Grove , Kastberg Peter
Published: March 2017

This article deals with communication policies within the public sector. It takes its point of departure within the overall framework of corporate communication and hence exclusively sees communication policies from that perspective. Communication policies are seen as means of corporate communication. As means of corporate communication they feature what we have labelled ‘mediational properties’ within an organization. As such they – from a communicative point of view – constitute the interface between the strategic and the operational levels of communication management. As policies they should support decision making processes when it comes to ensuring that any instance of communication is in line with the mission, vision and values of an organisation. And they should offer a deﬁ nite course of communicative action contingent on situational factors. The contextual background of the article is the re-structuring of the Danish regional political landscape, which is to have taken place by January 1st 2007. Communicating the mission, vision and values of the new municipalities is seen as an essential part of re-conﬁgurating and maintaining political legitimacy in the transaction period and beyond. The empirical part of the article deals with an extensive corpus analysis of a broad selection of authentic communication policies stemming from Danish municipalities. The analytical framework applied gives rise to a number of new observations regarding the generic heterogeneity of communication policies. The analysis also delivers new input to the theoretical discussion of the status of communication policies within a corporate communication framework in general and within a current Danish municipality setting in particular.
Thematic Sections
Authors: Pálfi Loránd-Levente
Published: March 2017

No abstract.
Alphabetical Table of Contents
Authors: Pálfi Loránd-Levente
Published: March 2017

No abstract.
Dansk register
Authors: Pálfi Lórand-Levente
Published: March 2017

No abstract.
Pertinence d’accompagner des adultes avec troubles du spectre autistique et déficience intellectuelle profonde en Snoezelen®
Authors: Chapeau Nathalie , Carchon Isabelle
Published: March 2017

Cette étude comparative « avant-après » questionne la pertinence de l’utilisation du Snoezelen® auprès de personnes adultes atteintes de troubles du spectre autistique (TSA) et présentant une déficience intellectuelle profonde associée. Le degré d’investissement sensoriel des activités proposées, le degré d’autonomie et les autostimulations de quatre patients associant TSA et déficience intellectuelle profonde sont évalués à l’aide d’une échelle de type Likert en salle Snoezelen® pour huit critères soient cinq types d’explorations sensorielles (tactile, vibratoire, vestibulaire, auditif, visuel) et trois capacités spécifiques (détente, conscience de soi à travers un miroir, déplacements) sur deux ans. Les conclusions montrent un meilleur investissement des activités proposées, une augmentation des autonomies et une diminution des autostimulations au sein de la salle Snoezelen®.
Une approche énactive du développement des compétences en milieu scolaire
Authors: Terré Nicolas , Sève Carole , Saury Jacques
Published: March 2017

Cet article propose d’explorer d’autres voies que celles des conceptions théoriques dominantes de la compétence. À cette fin, nous commençons par délimiter le « challenge conceptuel » que représente la tenue des postulats de l’énaction dans la description du développement des compétences. Puis, à la suite d’une étude empirique menée auprès de lycéens au cours d’une séquence d’éducation physique (Terré, 2015), le développement des compétences est analysé à partir de l’expérience des élèves. Des hypothèses explicatives sont proposées pour esquisser les contours d’une conception énactive du développement des compétences dont la caractéristique majeure est de considérer l’ancrage du développement des compétences – et conjointement de la pérennité des connaissances – dans des histoires. C’est en s’engageant dans des histoires que les actions et les interprétations des élèves prennent une épaisseur temporelle et qu’ils construisent des « dispositions à agir » constitutives de compétences. Cette analyse se poursuit par la proposition d’inverser la relation généralement établie entre la construction de connaissances et le développement de compétences : les connaissances construites au cours de ces épisodes seraient le produit de la compétence en développement, et non l’inverse. À titre spéculatif, plusieurs axes de transformation des pratiques d’enseignement sont proposés pour favoriser l’engagement des élèves dans des histoires.
Évaluer des compétences : un jugement d’adaptabilité
Authors: Chauvigné Christian
Published: March 2017

En s’appuyant sur le concept de « schème » (Piaget, 1967) pour définir la compétence comme « organisation invariante de la conduite pour une classe de situations données » (Vergnaud, 1990), la problématique de l’évaluation des compétences, déjà très documentée, ouvre à de nouvelles interrogations et perspectives, qu’il s’agisse de développer ces compétences ou de valider socialement leur acquisition.

L’une des caractéristiques de la compétence ainsi définie est d’être doublement adaptative : son organisation permet l’adaptation aux situations et sa mise en oeuvre, dans l’activité, permet l’adaptation de son organisation. Ainsi, les compétences ne cessent d’évoluer en fonction des activités déployées par les sujets. Il en découle qu’il existe toujours différentes manières d’être compétent et que chaque sujet développe de manière spécifique ses compétences. Par ailleurs, toute évaluation dans ce registre est non seulement diagnostique, mais aussi pronostique; reconnaître une compétence comme « acquise » suppose toujours de faire un pari sur l’extension de l’organisation de l’activité constatée à des situations non testées, voire non connues. Analysée sous cet angle, l’évaluation des compétences procède d’un jugement sur l’adaptabilité du construit cognitif constaté, tandis que la certification des compétences procède d’un jugement d’acceptabilité portant sur cette adaptabilité pour un champ d’intervention donné.
Alcohol use, viral hepatitis and liver fibrosis among HIV‐positive persons in West Africa: a cross‐sectional study
Authors: Jaquet Antoine , Wandeler Gilles , Nouaman Marcellin , Ekouevi Didier K , Tine Judicaël , Patassi Akouda , Coffie Patrick A , Tanon Aristophane , Seydi Moussa , Attia Alain , Dabis François
Published: March 2017

Introduction: Liver fibrosis is often the first stage of liver disease in people living with HIV (PLWHIV) in industrialized countries. However, little is known about liver fibrosis and its correlates among PLWHIV in sub‐Saharan Africa.

Methods: The study was undertaken in three HIV referral clinics in Côte d’Ivoire, Senegal and Togo. Enrolled PLWHIV underwent a non‐invasive assessment of liver fibrosis combining liver stiffness measure (LSM) with transient elastography and the aspartate aminotransferase‐to‐platelet ratio index (APRI). Significant liver fibrosis was defined as LSM ≥7.1 kPa. Patients were screened for alcohol use (alcohol use disorder identification test (AUDIT)‐C questionnaire), hepatitis B virus (HBV) antigen, hepatitis Delta virus (HDV) antibody and anti‐hepatitis C (HCV) antibody. A logistic regression model was used to identify the factors associated with significant liver fibrosis.

Results: A total of 807 PLWHIV were screened at a median age of 43 years (interquartile range (IQR): 36–50). Their median CD4 count was 393 cells/mm3 (IQR: 234–563) and 682 (84.5%) were on antiretroviral therapy (ART). The prevalence of significant fibrosis was 5.3% (3.8–6.7). Infections with HBV and HCV were identified in 74 (9.2%) and nine (1.1%) participants. Main factors associated with liver fibrosis were alcohol use (AUDIT‐C >6): (odds ratio (OR) = 4.0, confidence interval (CI): 1.2–14.0), (Ref. AUDIT‐C <4) and HBV infection (OR = 2.9, CI: 1.2–7.2). Of the 74 patients positively screened for HBV, 50.0% were on a tenofovir‐based ART regimen. Overall, 10% of HIV/HBV coinfected patients were detected with a positive HDV antibody with a higher prevalence in patients with a significant liver fibrosis (43.0%) compared to others (6.3%) (p = 0.01).

Conclusions: Considering the WHO recommendations to screen for HBV infection and treat co‐infected patients with tenofovir‐based ART, screening of alcohol use and brief interventions to prevent alcohol abuse should be implemented in West Africa, especially in HBV/HIV co‐infected patients.
Client uptake of safer conception strategies: implementation outcomes from the Sakh'umndeni Safer Conception Clinic in South Africa
Authors: Schwartz Sheree R , Bassett Jean , Holmes Charles B , Yende Nompumelelo , Phofa Rebecca , Sanne Ian , Van Rie Annelies
Published: March 2017

Introduction: Implementation of safer conception services for HIV‐affected couples within primary healthcare clinics in resource‐limited settings remains limited. We review service utilization and safer conception strategy uptake during the first three years of Sakh'umndeni, which is a safer conception clinic in South Africa.

Methods: Sakh'umndeni is located at Witkoppen Health and Welfare Centre, a high‐volume primary healthcare clinic in northern Johannesburg. Men and women desiring to conceive in less than or equal to six months and in relationships in which one or both partners are living with HIV are eligible for safer conception services. Clients receive a baseline health assessment and counselling around periconception HIV risk reduction strategies and choose which strategies they plan to use. Clients are followed‐up monthly. We describe client service utilization and uptake and continuation of safer conception methods. Factors associated with male partner attendance are assessed using robust Poisson regression.

Results: Overall 440 individuals utilized the service including 157 couples in which both partners attended (55%) and 126 unaccompanied female partners. Over half of the couples (55%) represented were in serodiscordant/unknown status relationships. Higher economic status and HIV‐negative status of the women increased male partner involvement, while HIV‐negative status of the men decreased male involvement. Regarding safer conception strategies, uptake of antiretroviral therapy initiation (90%), vaginal self‐insemination among partnerships with HIV‐negative men (75%) and timed condomless intercourse strategies (48%) were variable, but generally high. Overall uptake of pre‐exposure prophylaxis (PrEP) was 23% and was lower among HIV‐negative men than women (7% vs. 44%, p < 0.001). Male medical circumcision (MMC) was used by 28% of HIV‐negative men. Over 80% of clients took up at least one recommended safer conception strategy. Continuation of selected strategies over attempted conception attempts was >60%.

Conclusions: Safer conception strategies are generally used by clients per recommendations. High uptake of strategies suggests that the proposed combination prevention methods are acceptable to clients and appropriate for scale‐up; however, low uptake of PrEP and MMC among HIV‐negative men needs improvement. Targeted community‐based efforts to reach men unlinked to safer conception services are needed, alongside streamlined approaches for service scale‐up within existing HIV and non‐HIV service delivery platforms.
Achieving pregnancy safely for HIV‐serodiscordant couples: a social ecological approach
Authors: Saleem Haneefa T , Narasimhan Manjulaa , Denison Julie A , Kennedy Caitlin E
Published: March 2017

The recognition and fulfilment of the sexual and reproductive health and rights (SRHR) of all individuals and couples affected by HIV, including HIV‐serodiscordant couples, requires intervention strategies aimed at achieving safe and healthy pregnancies and preventing undesired pregnancies. Reducing risk of horizontal and vertical transmission and addressing HIV‐related infertility are key components of such interventions. In this commentary, we present challenges and opportunities for achieving safe pregnancies for serodiscordant couples through a social ecological lens. At the individual level, knowledge (e.g. of HIV status, assisted reproductive technologies) and skills (e.g. adhering to antiretroviral therapy or pre‐exposure prophylaxis) are important. At the couple level, communication between partners around HIV status disclosure, fertility desires and safer pregnancy is required. Within the structural domain, social norms, stigma and discrimination from families, community and social networks influence individual and couple experiences. The availability and quality of safer conception and fertility support services within the healthcare system remains essential, including training for healthcare providers and strengthening integration of SRHR and HIV services. Policies, legislation and funding can improve access to SRHR services. A social ecological framework allows us to examine interactions between levels and how interventions at multiple levels can better support HIV‐serodiscordant couples to achieve safe pregnancies. Strategies to achieve safer pregnancies should consider interrelated challenges at different levels of a social ecological framework. Interventions across multiple levels, implemented concurrently, have the potential to maximize impact and ensure the full SRHR of HIV‐serodiscordant couples.
Discovering sparse transcription factor codes for cell states and state transitions during development
Authors: Furchtgott Leon A , Melton Samuel , Menon Vilas , Ramanathan Sharad
Published: March 2017

Computational analysis of gene expression to determine both the sequence of lineage choices made by multipotent cells and to identify the genes influencing these decisions is challenging. Here we discover a pattern in the expression levels of a sparse subset of genes among cell types in B- and T-cell developmental lineages that correlates with developmental topologies. We develop a statistical framework using this pattern to simultaneously infer lineage transitions and the genes that determine these relationships. We use this technique to reconstruct the early hematopoietic and intestinal developmental trees. We extend this framework to analyze single-cell RNA-seq data from early human cortical development, inferring a neocortical-hindbrain split in early progenitor cells and the key genes that could control this lineage decision. Our work allows us to simultaneously infer both the identity and lineage of cell types as well as a small set of key genes whose expression patterns reflect these relationships.
Externally induced frontoparietal synchronization modulates network dynamics and enhances working memory performance
Authors: Violante Ines R , Li Lucia M , Carmichael David W , Lorenz Romy , Leech Robert , Hampshire Adam , Rothwell John C , Sharp David J
Published: March 2017

Cognitive functions such as working memory (WM) are emergent properties of large-scale network interactions. Synchronisation of oscillatory activity might contribute to WM by enabling the coordination of long-range processes. However, causal evidence for the way oscillatory activity shapes network dynamics and behavior in humans is limited. Here we applied transcranial alternating current stimulation (tACS) to exogenously modulate oscillatory activity in a right frontoparietal network that supports WM. Externally induced synchronization improved performance when cognitive demands were high. Simultaneously collected fMRI data reveals tACS effects dependent on the relative phase of the stimulation and the internal cognitive processing state. Specifically, synchronous tACS during the verbal WM task increased parietal activity, which correlated with behavioral performance. Furthermore, functional connectivity results indicate that the relative phase of frontoparietal stimulation influences information flow within the WM network. Overall, our findings demonstrate a link between behavioral performance in a demanding WM task and large-scale brain synchronization.
From big data to diagnosis and prognosis: gene expression signatures in liver hepatocellular carcinoma
Authors: Yang Hong , Zhang Xin , Cai Xiao-yong , Wen Dong-yue , Ye Zhi-hua , Liang Liang , Zhang Lu , Wang Han-lin , Chen Gang , Feng Zhen-bo
Published: March 2017

Background

Liver hepatocellular carcinoma accounts for the overwhelming majority of primary liver cancers and its belated diagnosis and poor prognosis call for novel biomarkers to be discovered, which, in the era of big data, innovative bioinformatics and computational techniques can prove to be highly helpful in.

Methods

Big data aggregated from The Cancer Genome Atlas and Natural Language Processing were integrated to generate differentially expressed genes. Relevant signaling pathways of differentially expressed genes went through Gene Ontology enrichment analysis, Kyoto Encyclopedia of Genes and Genomes and Panther pathway enrichment analysis and protein-protein interaction network. The pathway ranked high in the enrichment analysis was further investigated, and selected genes with top priority were evaluated and assessed in terms of their diagnostic and prognostic values.

Results

A list of 389 genes was generated by overlapping genes from The Cancer Genome Atlas and Natural Language Processing. Three pathways demonstrated top priorities, and the one with specific associations with cancers, ‘pathways in cancer,’ was analyzed with its four highlighted genes, namely, BIRC5, E2F1, CCNE1, and CDKN2A, which were validated using Oncomine. The detection pool composed of the four genes presented satisfactory diagnostic power with an outstanding integrated AUC of 0.990 (95% CI [0.982–0.998],P < 0.001, sensitivity: 96.0%, specificity: 96.5%). BIRC5 (P = 0.021) and CCNE1 (P = 0.027) were associated with poor prognosis, while CDKN2A (P = 0.066) and E2F1 (P = 0.088) demonstrated no statistically significant differences.

Discussion

The study illustrates liver hepatocellular carcinoma gene signatures, related pathways and networks from the perspective of big data, featuring the cancer-specific pathway with priority, ‘pathways in cancer.’ The detection pool of the four highlighted genes, namely BIRC5, E2F1, CCNE1 and CDKN2A, should be further investigated given its high evidence level of diagnosis, whereas the prognostic powers of BIRC5 and CCNE1 are equally attractive and worthy of attention.
Dedifferentiated Liposarcoma of Retroperitoneum With Extensive Osteosarcomatous Component
Authors: Trombatore Claudia , Rosario Caltabiano , Giovanni Li Destri , Gaetano Magro , Giuseppe Petrillo , Antonio Di Cataldo
Published: March 2017

Dedifferentiated liposarcoma (DDLS) is a rare subtype of liposarcoma composed of 2 components: a well-differentiated liposarcoma (WDLS) and a nonlipogenic sarcoma (dedifferentiation component), represented in >90% of cases by a high grade undifferentiated pleomorphic sarcoma, in the form of both small microscopic foci and/or grossly recognizable nodular masses. The paper reports a rare case of a retroperitoneal DDLS, in which approximately half of a tumor mass is composed of a high-grade osteosarcoma. A 68-year-old Caucasian woman affected by abdominal discomfort. Clinical examination showed a large, hard and fixed abdominal mass. Computed tomography scan revealed a huge retroperitoneal mass composed of 2 distinct components: the upper part showed a hypodense tissue, while the lower part showed a higher density and coarse calcifications. Patient underwent to a challenging surgical resection of the mass that, at histological examination, resulted to be a DDLS, in which a WDLS coexisted with an osteosarcoma. Presurgical diagnosis of DDLS is difficult due to the great morphologic variability of the dedifferentiated component, ranging from low to high-grade nonlipogenic sarcoma. The present case contributes to widen the morphological spectrum of DDLS, emphasizing the possibility that a retroperitoneal mass with a dual tissue component, one of which containing extensive areas with coarse calcifications, is highly suspected to be a DDLS with an osteosarcomatous component. This pre-operative finding should alert the surgeon because it has a significant impact on prognosis, increasing the risk of local recurrence and of death by disease in a few months after diagnosis.
Appraisal of Aggressive Excisional Biopsy for a Possible Isolated Lung Metastasis of Pancreatic Cancer: Repeated Extirpation Contributes to Long Survival
Authors: Takahashi Kana , Yoshioka Masato , Uchinami Hiroshi , Watanabe Go , Kudoh Kazuhiro , Yagi Fumitaka , Saito Hajime , Minamiya Yoshihiro , Yamamoto Yuzo
Published: March 2017

Although rare, there is a group of patients in whom lung metastases of pancreatic cancer develop isolatedly. We here report two cases of isolated lung metastasis of pancreatic cancer who gained long survival by repeated surgical resections of the nodules. Case 1: A 63-year-old man developed a 5-mm isolated lung metastasis 25 months after distal pancreatectomy for the primary cancer. He underwent an excisional biopsy for diagnosis and treatment. Although new lesions developed after this excision, additional extirpation of the chemotherapy-resistant tumor nodule realized a tumor-free survival for 15 months and total 74 months survival since pancreatectomy. Case 2: A 75-year-old man developed a 10-mm isolated lung metastasis of pancreatic cancer 13 months after distal pancreatectomy and underwent an excisional biopsy. In spite of adjuvant chemotherapy, 18 months later, a new lesion developed in the lung field neighboring the site of the first metastasis. He received a redo resection and has had a tumor-free period for 20 months until now. He has survived for 55 months since distal pancreatectomy. Aggressive excisional biopsy and repeated surgical resection could be recommended as a treatment option for isolated lung metastasis of pancreatic cancer.
An Analysis on Aerodynamic and Acoustic Changes After Thyroidectomy
Authors: Yılmaz Beyhan , Bakır Salih , Yılmaz Edip Erdal , Şengül Engin , Uslukaya Ömer , Gül Aylin , Özkurt Fazıl Emre , Topçu İsmail
Published: March 2017

The purpose of this study was to investigate the aerodynamic and acoustic changes after thyroidectomy without laryngeal nerve injury by using objective methods. Voice samples of sustained /α/ recorded from 44 adults preoperatively and nearly 1 week and 3 months after thyroidectomy were analyzed for mean vocal fundamental frequency (Mean Fo, Hz), maximum fundamental frequency (Max Fo, Hz), minimum fundamental frequency (Min Fo, Hz), jitter, shimmer, glottal to noise excitation ratio (GNE), irregularity, noise, overall severity, S time, Z time, S/Z ratio, and maximum phonation time (MPT). Voice samples were analyzed using the lingWAVES software. The comparisons of preoperative and early and late postoperative acoustic parameters revealed significant differences in Mean F0, Max F0, MPT, and S Time between the early and late postoperative periods. The voice changes after thyroidectomy were not affected by age, sex, or surgical procedure, but they differed between the benign and malignant nature of the tumor. Patients with malignant tumors showed a greater decrease in Mean F0 and Max F0 compared with the patients with benign tumors, and this difference was statistically significant. Voice changes may occur after thyroidectomy even in the patients with no evidence of laryngeal nerve damage, and these changes can be assessed with objective measurement methods. This information should be explained to the patients during the preoperative counseling, and proper informed consent is ethically and legally required for all planned thyroidectomies.
Delayed Traumatic Diaphragmatic Hernia With Bacterial Pleuritis
Authors: Ohkura Yu , Haruta Shusuke , Maeda Yusuke , Shinohara Hisashi , Ueno Masaki , Udagawa Harushi
Published: March 2017

Thoraco-abdominal blunt trauma may cause traumatic diaphragmatic hernia. Here, we report a case of delayed traumatic diaphragmatic rupture with herniation of multiple viscera along with bacterial pleuritis without perforation or necrosis. A 72-year-old man presented with severe left-sided chest pain and dyspnea following a fall in the bathroom on the previous day; he had hit the left side and back of the chest against a faucet. Computed tomography (CT) revealed pneumoderma, mediastinal emphysema, pneumothorax, and fractures of the 8th–11th left ribs. We diagnosed traumatic pneumothorax, which was treated by a thoracostomy tube inserted into the pleural space. Approximately 6 months later, he presented again with fever (39.2°C), dyspnea, and coughing. The white blood cell count and C-reactive protein were elevated at 20.3 × 103/μL and 28.7 mg/dL, respectively. A CT scan revealed left-sided pleural effusion and diaphragmatic hernia. Thoracocentesis was performed for the pleural effusion, and bacterial cultivation tests revealed Bacteroides fragilis; therefore, antibiotics were administered for 3 weeks. Subsequently, diaphragmatic hernia repair was performed. Laparotomy via a left subcostal incision revealed a defect measuring 60 × 60 mm; this was repaired with uninterrupted absorbable sutures without using a hernia mesh to avoid infection. The postoperative course was uneventful, and no recurrence was noted at the 1-year follow-up. We repaired delayed traumatic diaphragmatic rupture with herniation of multiple viscera by simple suturing without using a hernia mesh following the treatment of associated bacterial pleuritis.