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Background Health care-acquired infections are one of the top causes of mortality in the United States (Stone, 2009; Scott, 2009). Hand hygiene (HH) can reduce the incidence of such infections. Adherence to HH practices remains challenging for health care workers (World Health Organization, 2014). This investigation compared results of private and public HH feedback at the team and individual level. Methods A quality improvement study was conducted in 2 units utilizing HH radiofrequency identification (RFID) technology. Each unit was assigned either private or public feedback mechanisms. The study was divided into 3 phases; baseline, team, and individual. Time series analysis compared HH compliance by health care workers' role and feedback mechanisms. Results Individual HH compliance were the highest in both groups. The private group compliance was 63.3% (P ≤ .0001) and the public group compliance was 55.4% (P = .0001). During the team feedback phase, HH compliance decreased in the private group to 42.79% (P = .006); however, compliance increased in the public feedback group to 42.5% (P = .2661). The physician role in the private group decreased by 12% (P = .1804) during the individual phase. Conclusions HH data provided at the individual level and posted publicly could improve HH compliance. Use of RFID measurement technology can provide organizations with tools to measure HH compliance.

Successful enteral feeding depends on patent enteral feeding tubes to permit trouble-free entry of nutritional formula into the alimentary tract. However, tube clogs can be a challenging complication of enteral feeding. This report addresses questions about using a papain-based enzyme solution to unclog enteral feeding tubes, including any effects that papain may have on patients and if solution use should be contraindicated in patients on ketogenic diets. The gastrointestinal tract is not permissive for significant papain activity and papain absorbed into the blood would likely be neutralized by antiproteases. In vitro examinations do not suggest toxic effects of papain in vivo, and those recognized in the latter setting are due to papain loads that exceed those used to unclog enteral feeding tubes. Allergies to papain occur infrequently and are probably attributable to an immunoglobulin E-mediated reaction to this enzyme. Although the amount of carbohydrate consumed upon single use of the unclogging solution is very low, a provider should decide whether using the papain-based enzyme solution for enteral feeding purposes is appropriate in patients who practice ketogenic diets. The benefits of using the papain-based enzyme solution to unclog enteral feeding tubes appear to outweigh any risks associated with its use.

Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue disease (CTD). Data on use of prostanoids in this particular subset of patients are lacking. We aimed to describe the characteristics of patients with PAH-CTD treated with prostanoids and the outcomes under treatment.In this multicenter retrospective study, all patients treated with prostanoids since 2006 were included. Data on PAH and CTD were collected at the time of prostanoid introduction and under treatment.Twenty-one patients were included, of whom 20 (95%) had limited cutaneous systemic sclerosis. Nineteen patients were treated with oral monotherapy or combination before addition of prostanoid. Treprostinil was the most used molecule (57% of patients). At the time of prostanoid introduction, 90% of patients were considered at high risk for death. Among patients who had right heart catheterization during follow-up, there was no significant difference in haemodynamics. No extrarespiratory worsening of the CTD was reported. The 1-year survival under prostanoid was 62%. In univariate analysis, NYHA functional class was associated with survival under treatment.This study provides original data on use of prostanoids in a cohort consisting mainly of systemic sclerosis. It underlines the difficulty to achieve a standardized assessment in this subset of patients. Safety profile was comparable with data reported in idiopathic PAH.

Many countries do not have a newborn screening (NBS) program, and immigrants from such countries are at risk for late diagnosis of phenylketonuria (PKU). In this international survey, 52 of 259 patients (20%) with late diagnosed PKU were immigrants, and 145 of the 259 (55%) were born before NBS or in a location without NBS. ispartof: JOURNAL OF PEDIATRICS vol:239 pages:231-+ ispartof: location:United States status: published

It is common to initiate a long-term corticosteroid therapy for inflammatory diseases. Various specialists are involved in this prescription, and associated measures to prevent side effects are not consensual, with the exception of osteoporosis. The specialty of the prescriber has indeed a significant impact on the attention paid to the adjuvant associated measures. The aim of this review was to draw a summary of the side effects of long-term corticosteroid therapy and of the existing recommendations related to associated measures to prevent them. Unfortunately, it is difficult to give clear recommendations because of the lack of evidence in some fields, especially as they should be adapted to patient's age and comorbidities. We propose a summary table of associated measures to long-term steroid therapy prescription and suggest a monitoring frequency.

Resume La mastocytose systemique est une pathologie a risque de reactions allergiques. L’anaphylaxie aux venins d’hymenopteres y est particulierement frequente et severe. Notre propos est d’insister sur des points particuliers de cette association qui, s’ils sont meconnus, peuvent etre a l’origine d’erreurs de diagnostic. Ces points particuliers sont les suivants : les accidents allergiques apres piqure d’hymenopteres des patients atteints de mastocytose sont souvent atypiques, le bilan allergologique montre souvent une sensibilisation faible au venin et le diagnostic d’allergie est parfois de ce fait recuse. Une demarche diagnostique rigoureuse doit donc etre menee dans toutes les situations ou une mastocytose est suggeree par l’histoire clinique et un taux de tryptase intercritique eleve. Les traitements de desensibilisation au venin sont la pierre angulaire pour prevenir les recidives de choc mais sont plus souvent que dans la population generale emailles de reactions syndromiques. Une grande vigilance doit encadrer ces traitements.

Biomass, biobased materials and food waste are considered priority areas for Europe's transition towards a circular economy (CE). Waste management is a central activity for this transition and offers multiple CE implementation options which should be evaluated from environmental perspective. The purpose of this work was to analyze the environmental consequences when redirecting biowaste flows from conventional to more circular management systems and to identify the CE option with the best environmental performance. We were particularly interested in studying the combined management of green and food waste, analyzing the challenges when introducing separate collection and different treatment processes, and evaluating the substitution potential for by-products. To determine environmental impacts, we performed a life cycle assessment (LCA) based on local data. Following the purpose analyzing a change in the system, we applied a consequential LCA and compared impacts from processes that are replaced with impacts from alternative management options such as co-composting, anaerobic digestion (AD) and decentralized composting. The LCA results show clear advantages for impacts on ecosystems and resource use for the local AD system with separate combined collection. The decentralized system shows reductions in resource use, whereas the industrial co-composting system has higher or similar impacts than the baseline scenario. We conclude that local systems with combined food and green waste management can show benefits if process emissions are properly managed and if by-products are used in applications with high substitution potentials. However, a change towards a CE does not necessarily result in environmental benefits. Our research highlights the complexity of biowaste systems and proposes a novel combination of local data, databases and models to handle this issue. With this research we are further contributing to the understanding of the combined management of food and green waste, which is a relevant, but so far under-researched, management option for cities., SCOPUS: ar.j, info:eu-repo/semantics/published

Summary Osteoporosis is considered the most frequent skeletal manifestation of systemic mastocytosis (SM). We performed a retrospective analysis of sixty patients (37 males and 23 females) who underwent a bone biopsy in the assessment of SM or in the assessment of unexplained bone fragility. Thirty-three had simultaneously a bone marrow biopsy with a Jamshidi's needle; this sample was used for immunohistochemical analysis (tryptase, c-KIT. CD20, VCAM-1). Bone biopsy was realized in 42 cases in the assessment of SM to provide histologic proof of the disease and in 18 cases in the assessment of unexplained bone fragility and surprisingly revealed a SM. An increased bone turnover was observed in patients with SM with elevated eroded surfaces, osteoclast number and bone formation rate. In addition to nodules of mast cells (MC), a high number of MC was directly apposed on the trabeculae, affixed on the osteoblasts or the lining cells. The VCAM-1 adhesion protein recognizing α4β7 and α4β1 integrins may be a candidate to explain this particular adherence. One third of the bone marrow biopsies did not exhibit MC nodules or MC infiltration and led to a false negative diagnosis for SM. SM can be discovered in the assessment of fracture or osteoporosis. Transiliac bone biopsy allows for the diagnosis of the disease more accurately than bone marrow biopsy; it also provides a histomorphometric analysis of bone remodeling.

Without reliable diagnostic modalities, determination of the nature of illness can be equivocal, and thus could subject patients to no helpful treatments or unfounded medical interventions and associated financial burdens. Several diagnostic techniques for health care professionals to investigate th

Resume Il est notoire que l’immunotherapie au venin d’hymenoptere est source d’effets secondaires allergiques chez les patients porteurs de mastocytose. Nous presentons le cas d’un patient de 30 ans allergique au venin de guepe ayant presente une anaphylaxie severe avec lourdes sequelles neurologiques. Le bilan a confirme que le patient etait atteint de mastocytose systemique. L’indication d’immunotherapie a ete retenue compte tenu du risque potentiellement vital en cas de nouvelle piqure. La tolerance de l’immunotherapie ne fut pas bonne et nous presentons les moyens mis en place pour y remedier et finalement realiser avec succes cette immunotherapie.

Details on raw data distribution, meteorological conditions, additionnal representations of the results

Ten to 15% of common variable immunodeficiencies (CVID) develop auto-immune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Treatment is based on immunosuppressants, which produce blocking effects in the CVID. Our objective was to assess their risk-benefit ratio in these immunocompromised patients.We identified 17 articles detailing the treatment of AIHA and/or ITP in patients suffering from CVID through a systematic review of the MEDLINE database.The increased infectious risk with corticosteroids does not call into question their place in the first line of treatment of ITP and AIHA in CVID. High-doses immunoglobulin therapy remain reserved for ITP with a high risk of bleeding. In second-line treatment, rituximab appears to be effective, with a lower infectious risk than the splenectomy. Immunosuppressants (azathioprine, methotrexate, mycophenolate, cyclophosphamide, vincristine, ciclosporine) are moderately effective and often lead to severe infections, meaning that their use is justified only in resistant cases and steroid-sparing. Dapsone, danazol and anti-D immunoglobulins have an unfavorable risk-benefit ratio. The place of TPO receptor agonists is still to be defined. The establishment of immunoglobulin replacement in the place of immunosuppressants (except for short-term corticotherapy) or splenectomy appears to be essential to limit the risk of infections, including in the absence of previous infections.The presence of CVID does not mean that it is necessary to give up on corticosteroids as a first-line treatment and rituximab as a second-line treatment for AIHA and ITP, but it should be in addition to immunoglobulin replacement. A splenectomy should be reserved as a third-line treatment.

Gaucher disease (GD) is a rare genetic lysosomal storage disorder caused by a beta-glucocerebrosidase deficiency and responsible for a lysosomal storage disorder. GD is characterized by haematological, visceral and bone involvements. The aim of this study was to describe the diagnostic journey of type 1 GD patients as well as the role of the internist.A retrospective multicentric study involving type 1 GD patients has been conducted in 16 centers, between 2009 and 2011.Fifty-five type 1 GD patients were included, under the care of an internist or an haematologist. They were originally hospitalized in 8 different specialized units. Diagnosis was established by bone-marrow aspiration in 22 patients (40%), by enzymatic assay of glucocerebrosidase activity in 15 patients (27%), and by bone-marrow biopsy in 9 patients (16%). The use of enzymatic assay became more frequent after 1990. The delay between first hospitalization due to GD symptoms and definitive diagnosis was less than one year for 38 patients. Patients with suspected GD were mainly referred to an internist physician.GD seems to be better recognized and quickly diagnosed since 1990 in spite of the multiplicity of journeys. The role of the internist seems important.

Chronic urticaria is common and is generally idiopathic ("spontaneous"). Links between solid cancer and chronic urticaria have been mentioned in the literature.We report the case of a 63-year-old man presenting with superficial chronic urticaria associated with adenocarcinoma of the ethmoid sinus. We discuss the possibility of systemic origin in light of the severity of the disease and its resistance to treatment. Only recurrent ethmoidal cancer was highlighted. Curative care resulted in complete resolution of the urticaria without relapse at 32 months of follow-up.In a literature review, we collected 17 cases of superficial chronic urticaria associated with cancer. These cases were marked by synchronous progression and by the inefficacy (86%) of anti-histamines and systemic corticosteroids. Although cases of chronic superficial urticaria associated with cancer remain rare, the condition merits discussion due to its severity and significant resistance to therapy.

International audience; L’évaluation directe de la régulation biologique nécessite de pouvoir mesurer l’action desauxiliaires de cultures pour limiter les dégâts associés à la présence de bioagresseurs, ce qui estparticulièrement complexe. Pour mesurer la régulation biologique, de nombreuses études utilisentl’occurrence ou à l’abondance des auxiliaires comme proxy, inférant leur rôle dans la prédation d’aprèsla connaissance de leurs régimes alimentaires. Une solution alternative est d’exposer dans les parcellescultivées des proies dites sentinelles, fixées sur des cartes (« cartes de prédation »), et de mesurer lesniveaux de prédation, c’est-à-dire la proportion de proies consommées pendant une durée déterminée.Dans le cadre du projet SEBIOPAG-PHYTO, des cartes de prédations de trois types de proiessentinelles (graines adventices, pucerons, oeufs de lépidoptère) ont été utilisées dans 100 parcellescultivées, pendant trois années consécutives et à deux périodes dans l’année. Les 100 parcelles sontréparties en cinq sites de 20 parcelles couvrant une gamme de paysages et de situations deproductions. Dans un objectif méthodologique, nous présentons ici une analyse i) de la variabilité desmesures de prédation des proies sentinelles en fonction des caractéristiques du dispositif (types deculture, variabilité interannuelle, site géographique, conditions météorologiques), ii) des corrélationsentre proies, et iii) de la dépendance statistique entre cartes prédatées au sein d’une même parcelle etentre proies prédatées sur une même carte.Les données récoltées indiquent de fortes variations des taux de prédations, y compris au seind’un même site géographique et d’une même année. Lorsqu’on considère l’ensemble du jeu dedonnées, on détecte un effet de l’année et/ou du site géographique mais ces effets sont indissociablesde l’effet culture. Si on restreint l’analyse à trois types de cultures bien représentés dans le jeu dedonnées (céréales d’hiver, cultures d’été et oléagineux), on détecte essentiellement un effet de l’année,qui varie en fonction du type de proie. Bien que le type de culture ne semble pas être un déterminantmajeur des variations de taux de prédation observés à l’échelle nationale, on observe des effets liésaux sites géographiques qui dépendent du type de culture. Le taux d’humidité de l’air influence a uneffet positif sur la prédation des oeufs d’Ephestia et de graines d’adventices et un effet négatif sur laprédation des puerons, la vitesse du vent a un effet négatif sur la prédation des Ephestia et de graines.Par ailleurs, les niveaux de prédation des différentes proies sont peu corrélés entre eux et sont doncdes indicateurs potentiels non redondants. La majorité des cartes de pucerons posées au sol etprésentant de la prédation ont été complétement consommées. On retrouve cette tendance pour lescartes de graines avec toutefois aussi un nombre supérieur à l’attendu de cartes avec seulement uneou deux graines consommées. Les parcelles présentant de la prédation sur les cartes de puceronsposées au sol avaient quasiment toujours presque toutes leurs cartes prédatées. On retrouve la mêmetendance pour les cartes de graines mais dans une moindre mesure. Ces résultats serviront de pointde départ pour la recherche des déterminants paysagers et agronomiques des niveaux de prédations.

The 2015 International Panel for neuromyelitis optica (NMO) spectrum disorders (NMOSD) diagnosis (IPND) criteria was recently proposed. However, because there are no studies evaluating application of the IPND criteria in Latin American populations, we aimed to assess whether these new criteria improve the diagnostic rate and reduce the time taken to make the diagnosis in a cohort of Latin American patients.We reviewed medical records and applied both the 2006 and 2015 diagnostic criteria to all patients seen in four centers in Argentina, Brazil and Venezuela. Patients with multiple sclerosis (MS, n = 915) or other well-established central nervous system (CNS) inflammatory diseases were excluded. AQP4-ab status was measured using indirect immunofluorescence (23%) and cell-based assay (CBA, 77%). In addition, data on gender, ethnicity, age and symptoms at onset, relapses, neuroimaging and immunosuppressive therapy were collected.A total of 104 patients were classified as presenting NMOSD (2015 IPND). Of these, 64 patients (61.5%) fulfilled the 2006 NMO criteria (32 AQP4-ab positive, 17 AQP4-ab negative and 15 unknown). Thus, 40 new patients (38.5%) were classified as presenting NMOSD using the 2015 IPND criteria (33 AQP4-ab positive, 5 AQP4-ab negative and 2 unknown AQP4-ab status), with a median time taken to fulfill the 2015 NMOSD criteria (n = 104) of 1 month (95% CI: 0.6-1.3) and a median time taken to fulfill the 2006 NMO criteria (n = 64) of 18 months (95% CI: 9-26) (log-rank test: p0.0001). Females, with median age of 37 years, white ethnicity and recurrent course, predominated in all samples. Ninety-nine patients (95.1%) had at least 1 of the 3 major core clinical characteristics, of which optic neuritis (56.7%) was the most frequent symptom at disease onset.This study showed that there was a 62.5% increase in the rate of diagnosing NMOSD through the 2015 IPND criteria, in comparison with the 2006 NMO criteria, with a shorter median time to diagnosis.

Essentials Patients at high-risk of occult cancer may benefit from extensive screening. We validated the RIETE cancer score in the MVTEP study. One in three patients were classified as high-risk, 10% of whom had cancer diagnosed. The RIETE score identifies a subgroup at high risk for cancer. SummaryBackground Most recent trials evaluating extensive screening strategies for occult cancer in patients with unprovoked venous thromboembolism have failed, because, among other reasons, of an overall low rate of occult cancer. The RIETE investigators recently proposed a score aimed at identifying a subgroup at higher risk. Methods We retrospectively computed the RIETE score for all patients included in the MVTEP study, which evaluated the accuracy of [¹⁸F]fluorodeoxyglucose-positron emission tomography in the screening of occult cancer in patients with unprovoked venous thromboembolism. Performance of the RIETE score was assessed according to the proportion of patients classified in each risk group, and the corresponding rates of cancer diagnosis. Results Among the 386 patients included in the analysis, 136 patients (35.3%) were classified as high risk by the RIETE score. Cancer was diagnosed in 16 (11.8%) of them, whereas it was diagnosed in nine (3.6%) of the 250 patients with a low RIETE cancer score: odds ratio of 3.6 (95% confidence interval [CI] 1.53–8.32). The area under the receiver operating characteristic curve was 0.63 (95% CI 0.51–0.74). Conclusion The RIETE score seems to be able to identify a subgroup at high risk for cancer (10%) in our specific dataset of patients with unprovoked venous thromboembolism.

Objective:To adapt existing DPP intervention components to be contextually and culturally relevant to SA communities.Design and method:Diabetes screening using a brief questionnaire, anthropometric and blood pressure measurements estimated diabetes risk in 25–65-year-old black and mixed-ancestry par

A wide variety of optronic sensors, on board a satellite or airborne platform, are used for remote sensing, surveillance applications, and telecommunications. Cloud presence in the field of view is one of the key factors limiting the performances of these sensors. Consequently, cloud presence must be taken into account in order to evaluate their performances. To that end, a Monte Carlo method is used. Geometrical and optical cloud properties necessary to build the model are obtained from Cloud–Aerosol Lidar with Orthogonal Polarization (CALIOP) measurements that enable one to deal with the optically thinnest clouds. Different viewing geometries are presented, corresponding to surveillance missions by an airborne sensor with close-to-the-horizon viewing and to an optical link between an aircraft and a satellite. Results obtained are compared to a previous study and improvements reached with this new method are discussed.

Les manifestations de la maladie thromboembolique veineuse (MTEV) sont frequentes chez le patient hospitalise et en particulier dans les services de reanimation. Cependant, la MTEV ne se resume pas aux thromboses des membres, eventuellement compliquees d’embolie pulmonaire, et peut se manifester sous des formes plus severes ou concerner des localisations inhabituelles ou multiples. L’objectif de cet article est de passer en revue ces thromboses veineuses de localisation ou de severite inhabituelles. La problematique des thromboses arterielles non atheromateuses sera egalement abordee mais de facon plus breve. Nous evoquerons ensuite le syndrome catastrophique des antiphospholipides, dont la gravite et la complexite amenent le plus souvent le patient en unite de soins intensifs.

Statistics learners often bypass the critical step of understanding a problem before executing solutions. Worked-out examples that identify problem information (e.g., data type, number of groups, purpose of analysis) key to determining a solution (e.g., t test, chi-square, correlation) can address this concern. The authors examined the effectiveness of 3 kinds of worked examples on 96 college students’ problem understanding based on their problem categorizations and explanations: correct schema, contrasting schema (correct and incorrect features), and no schema (traditional solution-only examples). The contrasting- and correct-schema examples were more effective than were the no-schema examples—but neither schema was more effective than the other—in helping students construct accurate and complete problem schemata where data type and number of groups were prominently featured.

Acid sphingomyelinase deficiency (ASMD) is an autosomal recessive disease with a clinical spectrum ranging from a neurovisceral infantile form (Niemann-Pick disease type A) to a chronic visceral form also encountered in adults (Niemann-Pick disease type B, NP-B).Retrospective multicentric analysis of French adult patients with ASMD over the period 1985-March 2015. Clinical, biological, and imaging data were analyzed.Twenty-eight patients (19 males, 9 females) were analyzed. Diagnosis was made before the age of 10 years in 16 cases. Main symptoms at diagnosis were spleen/liver enlargement and interstitial lung disease. Biological abnormalities included: thrombocytopenia (platelet count150 000/mmASMD in adulthood (NP-B) associates spleen/liver enlargement and interstitial lung disease. Early diagnosis and appropriate management are essential for reducing the risk of complications, improving quality of life, and avoiding inappropriate procedures such as splenectomy. To date, only symptomatic therapy is available. A phase 2/3 therapeutic trial with IV infusion of recombinant enzyme is on-going.

The Kharyaga field, operated by Total E&P Russie, is located 60 km north of the Arctic circle in northern Russia. This field is currently producing approximately 35,000bbl/d and production contains H2S and high wax contents. In 2013, works on site to maintain the production plateau and build a Gas Treatment Unit to stop operational flaring were launched. As a result, more than a thousand construction contractors from mostly Russian companies were mobilized on site, in addition to the permanent workforce of 150 people. This paper will describe the "Improvement-Card", a scheme aimed at promoting a positive attitude towards reporting of substandard situations/good practices and at rewarding active participation for their resolution, when necessary. Early capture and elimination of risk situations is widely recognized as fundamental in the prevention of actual accidents. However, because of a local cultural resistance to use "Anomaly Cards", too often associated with the concept of guilty party, new documents called "Improvement Cards" or "I-Cards" were launched in 2014. These new I-Cards contain three main fields that need to be filled: "What I saw", "What I did" and "What I recommend". The system is also associated with a scoring scale, and each card, depending on its originality, learning value and reproducibility is given a number of points. Of course, active involvement in the resolution of the situation generates more points than just its reporting. Points are accumulated on individual accounts and entitle card authors to redeem gifts from a catalogue, ranking from a pen to a week end for two people in Paris. This paper will provide information about the communication campaigns associated with the change of reporting schemes, the results in terms of numbers and nature of the events reported, and the main difficulties met to involve both Company personnel and Contractors. A special mention will also be made of the promotion campaign organized, during World Safety Day 2015, where "I-Card tokens" (worth 100 points each) were distributed during management visits, to recognize good practices. For the future, general recommendations with regards to management of event reporting, analysis of information, feed back to card originators and reward campaigns will also be formulated.

Anaphylaxis to the mosquito is rare. We report 4 cases of patients with severe anaphylactic reaction after mosquito bites. These 4 patients have systemic mastocytosis. This combination of 2 rare diseases does not seem to be the result of chance and we recommend in case of anaphylaxis to the mosquito to carry out an assay of serum tryptase intercritical and in case of elevation to address the patient to our colleagues internists to search for a mastocytosis.

International audience; Since 1999, “emerging” (EM) strains of Watermelon mosaic virus (WMV) have been detected in cucurbit crops of southeastern France, probably as a result of recent introductions. Population genetic approaches were used to study the structure of EM isolates in southeastern France and to identify factors involved in their spatial distribution. A population clustering method (SAMOVA) and a maximum-difference algorithm (Monmonier's algorithm) were combined to visualize and quantify barriers to gene flow between populations. Both methods yielded similar results and two main barriers were identified. A North/South oriented barrier may be related to physical obstacles to gene flow (Rhône River, presence of an area with few cucurbit crops). Although the barrier was very strong, some “crossing” events were detected. A second barrier, oriented Northwest to Southeast, was not correlated with obvious geographical features. The two methods used here are complementary and confirm the limited spread of WMV-EM isolates. This approach can be useful in epidemiology studies to characterize the structure of viral populations and identify barriers to gene flow.

We report a case study that explored how three college students mentally represented the knowledge they held of inferential statistics, how this knowledge was connected, and how it was applied in two problem solving situations. A concept map task and two problem categorization tasks were used along with interviews to gather the data. We found that the students’ representations were based on incomplete statistical understanding. Although they grasped various concepts and inferential tests, the students rarely linked key concepts together or to tests nor did they accurately apply that knowledge to categorize word problems. We suggest that one reason the students had difficulty applying their knowledge is that it was not sufficiently integrated. In addition, we found that varying the instruction for the categorization task elicited different mental representations. One instruction was particularly effective in revealing students’ partial understandings. This finding suggests that modifying the task format as we have done could be a useful diagnostic tool.

The case study examined two groups of grade 7 students as they engaged in four inquiry phases: posing a question and collecting, analyzing, and representing data. Previous studies reported analyses of statistical reasoning on a single inquiry phase. Our goal was to identify the modes of statistical reasoning displayed during group discussions in all phases as children designed and conducted their own inquiry. A content analysis of audio and video recorded discussions yielded 10 statistical reasoning modes: six relate to Garfield and Gal’s [Garfield, J., Gal, I. (1999). Teaching and assessing statistical reasoning. In L. V. Stiff, & F. R. Curcio (Eds.), Developing mathematical reasoning in grades K-12. 1999 Yearbook (pp. 207–219). Reston, VA: National Council of Teachers of Mathematics] statistical reasoning types involved in the collection, analysis, and representation of data and four modes deal with an aspect of inquiry not exclusively focused upon in the literature on statistical reasoning—i.e., the problem-posing phase. Although students’ reasoning reflected an incomplete understanding of statistics they serve as building blocks for instruction.

Resume Nous rapportons une observation de periarterite noueuse (PAN) revelee par des hemorragies cerebrales par rupture d'anevrismes. Une patiente de 40 ans a presente a 12 jours d'intervalle deux hematomes intracerebraux, le second par rupture d'anevrismes. Le diagnostic de PAN a ete porte sur l'histologie de l'anevrisme montrant des lesions de vascularite, sur l'arteriographie evocatrice de PAN par ses localisations renales et spleniques, sur l'alteration de l'etat general, et sur la presence depuis plusieurs annees de nouures cutanees caracteristiques. L'evolution a ete globalement favorable sous corticotherapie et cyclophosphamide. Les accidents vasculaires hemorragiques cerebraux sont rares dans la PAN et exceptionnellement revelateurs de la maladie.

To define parameters predictive of lymphoma development in patients with primary Sjögren's syndrome (SS).A multicenter case-control survey was performed to identify predictors of lymphoma. Cases were patients who developed lymphoma after diagnosis of primary SS and were mainly recruited through the Club Rhumatismes et Inflammation network. For each case, 2 controls (matched for disease duration and age) were randomly selected among patients with primary SS and without lymphoma. Cases and controls were compared using univariate analysis and then using multivariate analysis to identify independent predictors of lymphoma.One hundred one patients with primary SS and lymphoma were included. Eighty-seven patients were women (86.1%), and the mean ± SD age at lymphoma diagnosis was 57.4 ± 12.6 years. The most frequent histologic type was B cell non-Hodgkin's lymphoma (NHL) in 99 of 101 patients, with marginal-zone lymphoma in 76 of the 99 patients (76.8%) including 58 (58.6%) with lymphoma of the mucosa-associated lymphoid tissue type. Lymphomas were most frequently located in the salivary glands (43 patients). A specific treatment was initiated at diagnosis in 87 patients with B cell NHL, and 61 patients (61.6%) achieved complete sustained remission after the first line of treatment. In the multivariate analysis, salivary gland enlargement, the presence of rheumatoid factor (RF), low C4, cryoglobulinemia, lymphopenia, and disease activity according to the European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (excluding the lymphoma domain) were found to be predictors of lymphoma. No previous treatment for primary SS was associated with any effect on lymphoma occurrence.In addition to previously known factors predictive of lymphoma occurrence, the independent roles of RF and disease activity were demonstrated in this case-control study of primary SS-associated lymphoma. Our findings highlight the roles of chronic antigenic stimulation and disease activity in the development of this severe complication.

This case study examines the validity of 1 measure of representation and employs multiple measures to examine whether they provide mutually informative or independent pieces of information. These measures include (a) concept maps, which measure how individuals represent their content knowledge of a domain as a whole; (b) problem sorts, which measure how individuals represent a specific aspect of their knowledge on word problems; and (c) structured interviews, which identify the reasons underlying sorting and concept mapping performance. Data from statistics instructors showed that the sorting task was a useful measure of representation when supplemented with instructors' explanations of their rationales. Moreover, concept maps assisted in the interpretation of performance on the sorting task. Concept maps and problem sorts were mutually informative, with the former providing a broader picture and the latter illustrating how particular concepts became salient when applied to a different context.

To delineate the relative contributions of alpha4 and alphaL to mediate interleukin-4 (IL-4) induced leukocyte rolling, and the subsets of leukocytes that use these pathways to adhere.Intravital microscopy was used to examine leukocytes in venules of cremaster muscles of mice receiving intrascrotal injections of IL-4. alpha4 and alphaL monoclonal antibodies (mAbs) were administrated either prior to (prophylactic) or 24 h following (therapeutic) treatment with IL-4. In addition, fluorescent microspheres coated with mAbs directed against CD4, CD8, or Gr-1 were injected into mice and the number of subset-specific adherent leukocytes was measured.Prophylactic inhibition of alpha4 and alphaL integrins prevented IL-4-induced leukocyte rolling flux (p.05) and increased leukocyte rolling velocity twofold (p.05), respectively, while blocking either integrin eliminated IL-4-induced leukocyte adhesion (p.05). In contrast, therapeutic administration of both anti-alpha4 and anti-alphaL mAbs was necessary to completely inhibit IL-4-induced leukocyte adhesion (p.05). Furthermore, CD8+ and Gr-1+ leukocytes utilized alpha4 and alphaL to adhere to postcapillary venules, whereas CD4+ leukocytes primarily utilized alpha4.Following tissue activation with IL-4, alpha4 and alphaL initiate the attachment and deceleration, respectively, of leukocytes during rolling, and are responsible for mediating the adhesion CD4+, CD8+, Gr-1+ leukocytes.

N-Formylypeptides such as fMet-Leu-Phe (fMLF) potently induce superoxide production through NADPH oxidase activation. The receptors that mediate this response have not been defined. Here, we provide definitive proof using a mouse model that formyl peptide receptor (FPR) is a receptor, but not the only receptor, that mediates fMLF-induced oxidase activation. In wild-type (FPR(+/+)) mouse neutrophils, superoxide production is dependent on the concentration of fMLF with an EC(50) of approximately 5 microM and a peak at approximately 50 microM. In contrast, FPR-deficient (FPR(-/-)) mouse neutrophils produced markedly less superoxide with an EC(50) of approximately 50 microM and a peak at approximately 200 microM. Yet, FPR(+/+) and FPR(-/-) neutrophils showed similar oxidase activation kinetics and G(i) protein-dependent pharmacological sensitivities. These results suggested that a second receptor, likely FPR2, mediates superoxide production at high concentrations of fMLF. This less sensitive second pathway may permit continued oxidant generation in response to formyl peptides when FPR is desensitized in high concentrations of the chemotactic gradient.