Guidelines for clinical practice

Clinical practice guidelines are systematically developed statements that are intended to support medical decision making in well-defined clinical situations. Essentially, their object is to reduce the variability in medical practice, to improve quality, and to make appropriated control of the financial resources possible. Internationally, ever more organisations, associations, and institutions are concerned with the development of guidelines in many different areas of care. Making implicit knowledge explicit is one of the associated advantages of guidelines: they have a potential utility in training, in process evaluation, and in the reevaluation of outcome studies. In liability issues, their existence has a double effect: they can be used to justify medical behaviour, and they constitute a generally accepted reference point. A derivative problem is the legal liability of the compilers of the guidelines. The principle of the guideline approach can be challenged academically: science cannot give a definition of optimal care with absolute certainty. What is called objectivity often rests on methodologically disputable analyses; also the opinion of opinion leaders is not always a guarantee for scientific soundness. Moreover, patients are not all identical: biological variability, situational factors, patient expectations, and other elements play a role in this differentiation. Clinicians are often hesitant with respect to clinical guidelines: they are afraid of cookbook medicine and curtailment of their professional autonomy. Patients fear reduction of individualization of care and the use of guidelines as a rationing instrument. The effects of the introduction of clinical practice guidelines on medical practice, on the results and on the cost of care vary but are generally considered to be favourable. The choice of appropriate strategies in development, dissemination, and implementation turns out to be of critical importance. The article ends with concrete suggestions for the various steps in the development of guidelines and their actual compilation.     

Synthesis and properties of aminopropyl nucleic acids

Oligonucleotides that contain up to three aminopropyl nucleoside analogues have been synthesized. Dimers of aminopropyl adenine and thymidine were prepared and used as building blocks by applying phosphoramidite chemistry. Both R and S isomers of the aminopropyl nucleosides were used. This incorporation led to a reduction of thermal stability of double-stranded DNA. Furthermore, the (R)-adenine analogue, which yielded (S)-APNA, can be considered as a candidate for universal base pairing.     

A remark on the complexity of consistent conjunctive query answering under primary key violations

A natural way for capturing uncertainty in the relational data model is by allowing relations that violate their primary key. A repair of such relation is obtained by selecting a maximal number of tuples without ever selecting two tuples that agree on their primary key. Given a Boolean query q, CERTAINTY(q) is the problem that takes as input a relational database and asks whether q evaluates to true on every repair of that database. In recent years, CERTAINTY(q) has been studied primarily for conjunctive queries. Conditions have been determined under which CERTAINTY(q) is coNP-complete, first-order expressible, or not first-order expressible. A remaining open question was whether there exist conjunctive queries q without self-join such that CERTAINTY(q) is in PTIME but not first-order expressible. We answer this question affirmatively.     

Information and communication technologies in the life of university freshmen: An analysis of change

The passage from secondary school to university puts students in an environment with different expectations. Not only the expectations towards learning might change, but also towards ICT competences and computer use. The purpose of this article is to find out whether freshmen, after 6 months at the university, changed their self-perception of ICT competences and computer use in comparison with their behaviour at secondary school, and what factors can explain the self-perception of ICT competences and computer use in secondary school, in the university and their possible change. Based on a panel research among 714 freshmen of a large university, this article answers the following questions: (1) What is the self-perception of ICT competences among freshmen and is there a change in this self-perception 6 months after entering the university? (2) How often and for what purpose do freshmen use a computer and is there a change in the frequency of the use of a computer? (3) What factors might influence this attitude, behaviour, and possible change? In function of the basic components of Unified Theory of Acceptance and Use of Technology (Venkatesh, Morris, Davis, & Davis, 2003) hypotheses was developed and tested to answer these questions. Students who consider the computer to be a useful instrument, have control over the computer, possess a certain level of Internet competence, and are at ease with computers are more likely to have the skills needed to maintain a computer, to develop a web site, and to use basic ICT skills. The predictors have little influence on Internet usage. The same predictors contribute modestly to the explanation of the different frequencies of computer use, and a few of the predictors explain parts of change in ICT skills and frequency of computer use.     

液相包覆制备Ce-TZP陶瓷的力学性能与稳定行为

采用XRD、SEM、TEM等分析手段对由液相包覆工艺制备的Ce—TZP陶瓷的微结构进行了研究，并和共沉淀粉体制备的Ce—TZP陶瓷进行了对比分析．力学性能表明，同共沉淀粉体制备的Ce—TZP陶瓷相比，由液相包覆工艺制备的Ce—TZP陶瓷虽硬度下降，但断裂韧性改善；液相添加少量Al2O3硬度随之增加、断裂韧性显著提高．电镜分析表明，液相包覆工艺制备的Ce—TZP陶瓷晶粒尺寸分布宽化，一部分晶粒尺寸较大但CeO2含量低、易发生马氏体相转变晶粒的存在是断裂韧性改善的主要原因．陶瓷体中单斜相大晶粒与四方相之间的残余应力、添加少量Al2O3在晶界上易形成薄的非晶包裹层，是增加可相变四方相数量，提高断裂韧性的其它机制。     

Urinary aflatoxin M1 in Port-au-Prince and a rural community in north-east Haiti

Aflatoxins (AFs) are hepatocarcinogenic mycotoxins that can contaminate grains and oil seeds in tropical and sub-tropical areas and have been detected in maize and peanut products of Haiti. The first objective was to assess human exposure to AFs among Haitians at an urban hospital (GHESKIO) and a rural health centre (HCBH). The second objective was to test the association between AF exposure and reported dietary intake of potentially contaminated foods, such as maize, peanut products and milk. Measurement of urinary AFM1 by HPLC revealed that among 367 participants 14% and 22% at GHESKIO and HCBH, respectively, had detectable AFM1. The maximum and median AFM1 concentrations for all detected samples were 700 pg AFM1 ml^–1 and 11.7 pg ml^–1, respectively. Detection of AFM1 was significantly associated with peanut consumption (p < 0.05). Controlling for diet and age group in a logit model, patients who reported peanut consumption the day of the survey and patients from HCBH had greater log odds of excreting detectable AFM1 (p < 0.001 and 0.002, respectively); females had lower log odds (p = 0.020). Recalled frequency of consuming non-dairy animal-sourced foods, an indicator of diet quality, approached significance (p = 0.056) as an inverse predictor of urinary AFM1 detection. The findings augur the need for interventions that will improve food safety in Haiti and limit exposure to AFs, particularly among rural communities.     

Selective Laser Melting process optimization of Ti–Mo–TiC metal matrix composites

Selective Laser Melting (SLM) was used to process a powder mixture of CP Ti, 6.5 wt% Mo and 3.5 wt% Mo₂C. The process parameters were optimized to obtain full-density, crack free parts. After the in situ decomposition of Mo₂C in favor of the formation of TiC, the material consisted of a homogeneous dispersion of submicrometer sized TiC platelets in a β-(Ti,Mo) matrix exhibiting a high hardness up to 550 HV and compressive yield stress of 1164 ± 37 MPa. The microstructure and mechanical properties could be tailored by variation of the process parameters within the high-density processing window, as well as through post-process heat treatments.     

Impact of the Cd2+ treatment on the electrical properties of Cu2ZnSnSe4 and Cu(In,Ga)Se2 solar cells

The present contribution aims at determining the impact of modifying the properties of the absorber/buffer layer interface on the electrical performance of Cu₂ZnSnSe₄ (CZTSe) thin‐film solar cells, by using a Cd²⁺ partial electrolyte (Cd PE) treatment of the absorber before the buffer layer deposition. In this work, CZTSe/CdS solar cells with and without Cd PE treatment were compared with their respective Cu(In,Ga)Se₂ (CIGSe)/CdS references. The Cd PE treatment was performed in a chemical bath for 7 min at 70 °C using a basic solution of cadmium acetate. X‐ray photoemission spectroscopy measurements have revealed the presence of Cd at the absorber surface after the treatment. The solar cells were characterized using current density–voltage (J–V), external quantum efficiency, and drive‐level capacitance profiling measurements. For the CZTSe‐based devices, the fill factor increased from 57.7% to 64.0% when using the Cd PE treatment, leading to the improvement of the efficiency (η) from 8.3% to 9.0% for the best solar cells. Similar observations were made on the CIGSe solar cell reference. This effect comes from a considerable reduction of the series resistance (R_S) of the dark and light J–V, as determined using the one‐diode model. The crossover effect between dark and light J–V curves is also significantly reduced by Cd PE treatment. Copyright © 2015 John Wiley & Sons, Ltd.