The provision of education and training for healthcare professionals through the medium of the internet

This paper describes a new initiative to provide Internet based courses to student and professional occupational therapists in four centres in the UK, Belgium the Netherlands and Sweden. The basis of this collaborative Occupational Therapy Internet School (OTIS) is the concept of the “Virtual College”. This comprises the design and implementation of a sophisticated Internet-based system through which courses can be managed, prepared and delivered online in an effective fashion, and where students can communicate both with the staff and their peers. The aim is to support and facilitate the whole range of educational activities within a remote electronic environment. A major feature of the course organisation is the adoption of a problem-based approach in which students will collaborate internationally to propose effective intervention in given case study scenarios. The paper outlines the rationale for OTIS, the content and structure of the courseware, the technical specification of the system and evaluation criteria. In addition to the more conventional web-based learning facilities generally offered, a number of agent-based approaches are being adopted to assist in the management of the course by ensuring the proper delivery of course materials and to assist the functioning of project groups. </p

Ethnic differences in diabetes, cardiovascular risk factors and health care: the Amsterdam Health Survey of 2004

The prevalence of diabetes in inhabitants of Amsterdam (18 years and older) is 4%. The prevalence of diabetes is three times higher among Turkish people and four times higher among Moroccans in comparison to Dutch people. Turkish diabetes patients have a higher mean body mass index compared to Dutch diabetes patients, but Turkish and Moroccan diabetes patients are admitted to hospital less often than Dutch diabetes patients. It is important for policy makers to know the differences in disease prevalence and health care use between ethnic groups, considering the expected rise in the proportion of immigrants. These results formed contributions to this report that was brought out by the National Institute for Public Health and the Environment and in cooperation with the Amsterdam Health Monitor of the Amsterdam Health Service. Forty-three percent of the 4042 invited Amsterdam inhabitants participated in the study in 2004. Ethnic differences in health and health care use were analyzed for the age group of 18-70 years, standardized for age and gender. Turkish and Moroccan people without diabetes differed from Dutch people without diabetes on many counts. For example, Turkish and Moroccan people were more often overweight and had higher mean blood glucose levels. They visited their general practitioners more often and experienced their own health as being moderate or poor on a more frequent basis. Turkish people without diabetes experienced more serious cardiac problems than Dutch people. The prevalence of cardiovascular risk factors in diabetes patients was high among all ethnic groups. In general, cardiovascular risk factors were more frequent in Turkish diabetes patients, and to a lesser extent in Moroccan diabetes patients, compared to Dutch diabetes patients. Treatment of cardiovascular risk factors in diabetes patients is important for the prevention of or delay in cardiovascular complications.De prevalentie van diabetes bij inwoners van Amsterdam (18 jaar en ouder) wordt geschat op vier procent. Turken en Marokkanen hebben respectievelijk driemaal en viermaal vaker diabetes vergeleken met Nederlanders. Turkse diabeten zijn gemiddeld zwaarder dan Nederlandse diabeten. Turkse en Marokkaanse diabeten worden echter minder vaak opgenomen in een ziekenhuis dan Nederlandse diabeten. Een beschrijving van etniciteitverschillen in het voorkomen van ziekten en zorggebruik is van belang voor het beleid omdat immigranten een steeds groter deel van de bevolking zullen gaan uitmaken. De Amsterdamse Gezondheidsmonitor 2004 is uitgevoerd door de GGD Amsterdam in samenwerking met het RIVM. Drieenveertig procent van 4042 uitgenodigde Amsterdammers (18 jaar en ouder) heeft aan het onderzoek meegedaan. Etnische verschillen in gezondheid en zorg werden geanalyseerd voor de leeftijd 18-70 jaar, gestandaardiseerd naar leeftijd en geslacht. Turken en Marokkanen zonder diabetes verschilden op bijna alle uitkomsten van Nederlanders zonder diabetes. Turken en Marokkanen waren bijvoorbeeld gemiddeld zwaarder dan Nederlanders en zij hadden hogere gemiddelde bloedglucosewaarden. Zij gingen vaker naar de huisarts en waren minder tevreden over de eigen gezondheid. Acht procent van de Turken zonder diabetes heeft ooit een ernstige hartaandoening gehad, dit is bijna viermaal zo vaak als bij Nederlanders zonder diabetes. Risicofactoren voor hart- en vaatziekten kwamen veel voor bij diabeten uit alle etnische groepen. Turkse diabeten, en in mindere mate Marokkaanse diabeten, hadden over het algemeen een ongunstiger risicoprofiel dan Nederlandse diabeten. Behandeling van het risicoprofiel van diabetespatienten is belangrijk om het optreden van complicaties te voorkomen of uit te stellen

Serious adverse events and deaths in PCSK9 inhibitor trials reported on ClinicalTrials.gov:a systematic review

Background: Previous reviews of PCSK9 inhibitor trials are limited by a focus on composite cardiovascular outcomes. ClinicalTrials.gov provides trial results for individual clinical outcomes. Aim of this systematic review was to assess the effect of PCSK9 inhibitors on the risk of myocardial infarction, stroke/TIA, heart failure, diabetes mellitus, neurocognitive events, all-cause serious adverse events (SAE), and all-cause deaths as registered on ClinicalTrials.gov. Methods: PubMed, regulatory reports, ClinicalTrials.gov, and company websites were used to search studies. Randomized trials comparing PCSK9 inhibitor with placebo in participants with hypercholesterolemia were eligible. Study characteristics, risk of bias, and numbers of participants with the outcomes of interest were collected. Results: We identified 33 lipid-lowering and 4 clinical outcomes trials with results on ClinicalTrials.gov (n = 16,958 and n = 73,836, respectively). Risk of bias was generally high. PCSK9 inhibitors did not affect the risk of any of the investigated outcomes in either type of trial. However, in clinical outcomes studies, alirocumab decreased the risk of all-cause SAE (OR 0.92; 95% CI 0.86–0.98), and evolocumab probably increased the risk of mortality (OR 1.12; 95% CI 1.00–1.25). Conclusions: Our meta-analysis of clinical events registered on ClinicalTrials.gov did not show that PCSK9 inhibitors improve cardiovascular health. Evolocumab increased the risk of all-cause mortality

A subset of malignant mesothelioma tumors retain osteogenic potential

Malignant mesothelioma (MM) is an aggressive serosal tumor associated with asbestos exposure. We previously demonstrated that mesothelial cells differentiate into cells of different mesenchymal lineages and hypothesize that osseous tissue observed in a subset of MM patients is due to local differentiation of MM cells. In this study, the capacity of human and mouse MM cells to differentiate into osteoblast-like cells was determined in vitro using a functional model of bone nodule formation and in vivo using an established model of MM. Human and murine MM cell lines cultured in osteogenic medium expressed alkaline phosphatase and formed mineralized bone-like nodules. Several human and mouse MM cell lines also expressed a number of osteoblast phenotype markers, including runt-related transcription factor 2 (RUNX2), osteopontin, osteonectin and bone sialoprotein mRNA and protein. Histological analysis of murine MM tumors identified areas of ossification within the tumor, similar to those observed in human MM biopsies. These data demonstrate the ability of MM to differentiate into another mesenchymal cell type and suggest that MM cells may contribute to the formation of the heterologous elements observed in MM tumors

Organic and conventional tomato cropping systems.

Among several alternative agricultural systems have been developed, organic agriculture has deserved increasing interest from. The objective of this paper was comparing both organic (OS) and conventional (CS) tomato cropping systems for varieties Débora and Santa Clara, through an interdisciplinary study. The experiment was set up in a randomized blocks design with six replicates, in a dystrophic Ultisol plots measuring 25 ´ 17 m. Cropping procedures followed by either local conventional or organic growers practices recommendations. Fertilization in the OS was done with organic compost, single superphosphate, dolomitic limes (5L, 60 g, and 60 g per pit), and sprayed twice a week with biofertilizer. Fertilization in the CS was done with 200 g 4-14-8 (NPK) per pit and, after planting, 30 g N, 33 g K and 10.5 g P per pit; from 52 days after planting forth, plants were sprayed once a week with foliar fertilizer. In the CS, a blend of insecticides, fungicides and miticides was sprayed twice a week, after planting. In the OS, extracts of black pepper, garlic, and Eucalyptus; Bordeaux mixture, and biofertilizer, were applied twice a week to control diseases and pests. Tomato spotted wilt was the most important disease in the OS, resulting in smaller plant development, number of flower clusters and yield. In the CS, the disease was kept under control, and the population of thrips, the virus vector, occurred at lower levels than in the OS. Variety Santa Clara presented greater incidence of the viral disease, and for this reason had a poorer performance than 'Débora', especially in the OS. Occurrence of Liriomyza spp. was significantly smaller in the OS, possibly because of the greater frequency of Chrysoperla. The CS had smaller incidence of leaf spots caused by Septoria lycopersici and Xanthomonas vesicatoria. However, early blight and fruit rot caused by Alternaria solani occurred in larger numbers. No differences were observed with regard to the communities of fungi and bacteria in the phylloplane, and to the occurrence of weeds

Binary metal oxides for composite ultrafiltration membranes

A new ultrafiltration membrane was developed by the incorporation of binary metal oxides inside polyethersulfone. Physico-chemical characterization of the binary metal oxides demonstrated that the presence of Ti in the TiO2?ZrO2 system results in an increase of the size of the oxides, and also their dispersity. The crystalline phases of the synthesized binary metal oxides were identified as srilankite and zirconium titanium oxide. The effect of the addition of ZrO2 can be expressed in terms of the inhibition of crystal growth of anocrystalline TiO2 during the synthesis process. For photocatalytic applications the band gap of the synthesized semiconductors was determined, confirming a gradual increase (blue shift) in the band gap as the amount of Zr loading increases. Distinct distributions of binary metal oxides were found along the permeation axis for the synthesized membranes. Particles with Ti are more uniformly dispersed throughout the membrane cross-section. The physico-chemical characterization of membranes showed a strong correlation between some key membrane properties and the spatial particle distribution in the membrane structure. The proximity of metal oxide fillers to the membrane surface determines the hydrophilicity and porosity of modified membranes. Membranes incorporating binary metal oxides were found to be promising candidates for wastewater treatment by ultrafiltration, considering the observed improvement influx and anti-fouling properties of doped membranes. Multi-run fouling tests of doped membranes confirmed the stability of permeation through membranes embedded with binary TiO2?ZrO2 particles