Glucocorticoid Treatment in Childhood Nephrotic Syndrome : weighting the cornerstone

Understanding which factors influence relapse patterns in childhood nephrotic syndrome is clinically very relevant and could aid in developing new treatment strategies. Clinicians are continuously challenged to reduce relapse rates and at the same time to avoid glucocorticoid toxicity. Both intrinsic and environmental factors may take part in the underlying pathophysiological process and its impact on clinical course. Though glucocorticoids are the cornerstone of treatment, little is known about how individual handling of these drugs may affect the clinical course in children with nephrotic syndrome. Possible explanations for this include the complicated methods required to evaluate these factors and the low incidence of the disease. The general aim of this thesis is to provide better understanding of the variability in the clinical course of childhood nephrotic syndrome. Within this context, special attention is given to the role of glucocorticoids in terms of treatment duration, metabolism and sensitivity

Statistical attribute filtering to detect faint extended astronomical sources

Abstract In astronomy, sky surveys contain a large number of light-emitting sources, often with intensities close to the noise level. Automatic extraction of astronomical objects is therefore needed. SExtractor is a widely used program for automated source extraction and cataloguing, but it is not optimal with faint extended sources. Using SExtractor as a reference, the paper describes an improvement of a previous method proposed by the authors. It is a Max-Tree-based method for extraction of faint extended sources without using a stronger image smoothing. The Max-Tree structure is a hierarchical representation of an image, in which attributes can be computed in every node. Object detection is performed on the nodes of the tree and it relies on the distribution of a statistic calculated using the power attribute, compared to the expected distribution in case of noise. Statistical tests are presented, a comparison with the object extraction of SExtractor is shown and results are discussed.</jats:p

In vitro sensitivity to methyl-prednisolone is associated with clinical response in pediatric idiopathic nephrotic syndrome

The aim of this study was to evaluate the in vitro steroid sensitivity as a predictor of clinical response to glucocorticoids in childhood idiopathic nephrotic syndrome (INS). Seventy-four patients (median age 4.33, interquartile range [IQR] 2.82-7.23; 63.5% male) were enrolled in a prospective multicenter study: in vitro steroid inhibition of patients' peripheral blood mononuclear cell proliferation was evaluated by [methyl-(3) H] thymidine incorporation assay at disease onset (T0) and after 4 weeks (T4) of treatment. Steroid dependence was associated with increased in vitro sensitivity at T4 assessed both as drug concentration inducing 50% of inhibition (IC50 ; odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.24-0.85; P = 0.0094) and maximum inhibition at the highest drug concentration (Imax ; OR = 1.13, 95% CI = 1.02-1.31; P = 0.017). IC50 > 4.4 nM and Imax < 92% at T4 were good predictors for optimal clinical response. These results suggest that this test may be useful for predicting the response to glucocorticoid therapy in pediatric INS

Intrauterine growth restriction is associated with persistent aortic wall thickening and glomerular proteinuria during infancy

Low birth weight, caused either by preterm birth or by intrauterine growth restriction, has recently been associated with increased rates of adult renal and cardiovascular disease. Since aortic intima–media thickening is a noninvasive marker of preclinical vascular disease, we compared abdominal aortic intima–media thickness among intrauterine growth restricted and equivalent gestational age fetuses in utero and at 18 months of age. The relationship between intrauterine growth restriction, fetal aortic thickening, and glomerular function during infancy was measured by enrolling 44 mothers with single-fetus pregnancies at 32 weeks gestation: 23 growth restricted and 21 of appropriate gestational age as controls. Abdominal aortic intima–media thickness was measured by ultrasound at enrollment and again at 18 months of age. Fetuses with intrauterine growth restriction had significantly higher abdominal aortic intima–media thickness compared with age controls when measured both in utero and at 18 months. At 18 months, the median urinary microalbumin and median albumin–creatinine ratio were significantly higher in those infants who experienced intrauterine growth restriction compared to the controls. Our results show that intrauterine growth restriction is associated with persistent aortic wall thickening and significantly higher microalbuminuria during infancy

The "greater goods" response to the argument from divine hiddenness

Arguments from divine hiddenness attempt to demonstrate that the apparent hiddenness of God is a reason for thinking God does not exist. One of the most prominent arguments from divine hiddenness maintains that if God existed He would do what He could to ensure that all persons have access to conscious personal relationship with Him. But since such relationship is impossible for those who do not believe God exists, God would ensure that everyone has evidence sufficient to believe that He exists. That there are people who do not believe God exists due only to a lack of evidence is therefore a reason for thinking that God does not exist. One of the most prominent ways to respond to this kind of argument from divine hiddenness is to maintain that God withholds evidence of Himself in order to bring about some greater good or another. But there are a few challenges facing these âgreater goodsâ responses. First, some proposed greater goods benefit only someone other than the nonbeliever; one might argue that God would not withhold evidence sufficient for belief from one person entirely for the benefit of another person. Second, some proposed greater goods presuppose libertarian free will; but it has been argued that God would not allow such free will due to the great evil it brings about. Third, if a conscious personal relationship with God is greater than all other goods we might wonder how there could be goods for the sake of which God would be willing to withhold such relationship from some people. Finally, if God is infinitely resourceful and if all goods come from God, it is somewhat puzzling how there could be goods which preclude conscious personal relationship with God. In this thesis I aim to address these challenges to greater goods responses to the hiddenness argument.</p

Zijn wiskundedocenten goed voorbereid op hun taak?

Deze scriptie gaat over lastige onderdelen in het leerplan wiskunde na de invoering van de tweede fase in 1998. Deze problemen kunnen inhoudelijk maar ook didactisch van aard zijn. De resultaten van de enquête geven aan dat vooral voortgezette meetkunde en continue dynamische modellen maar soms ook kansrekening, statistiek en lineair programmeren onderdelen zijn waar docenten zelf de opgaven lastig vinden. De belangrijkste onderwerpen die didactische problemen geven zijn vooral de praktische opdracht en ICT in de wiskundeles. Het is heel begrijpelijk dat deze Iaatste twee onderwerpen lastig zijn omdat de meeste docenten deze niet in de opleiding hebben gehad. Omdat de praktische opdracht in de enquête verreweg het meest wordt aangekruist als problematisch onderwerp heb 1k me verder op dit onderdeel gericht. Eerst heb ik de definitie, doel en opbouw besproken. De specifieke problemen die docenten tegenkomen op het gebied van organisatie, begeleiding en beoordeling passeren de revue. Via twee verschillende voorbeelden laat ik zien hoe men de praktische opdracht in de praktijk kan toepassen. Om docenten te bekwamen in de uitvoering van de praktische opdracht beveel 1k het volgen van een cursus aan. Daarbij heb ik funk nagedacht over de vraag hoe 1k docenten kan motiveren om mee te doen aan deze cursus. Uitgaande van de cursist heb 1k doelen gesteld waardoor 1k verwacht dat men het de moelte waard vindt om mee te doen. Ter ondersteuning van de cursus wordt gebruik gemaakt van een elektronische leeromgeving. Het lijkt mij een uitdaging voor de cursisten om daarmee te experimenteren. Het is van belang dat een docent tijd en energie steekt in de organisatie, begeleiding en beoordeling van de praktische opdracht. Net zoals bij de gewone lessen is een goede voorbereiding nodig. Een goede organisatle, het bedenken van leuke onderwerpen, een adequate begeleiding en het maken van een passend beoordelingsformulier zijn noodzakelijke voorwaarden voor een succesvolle uitvoering. Verder zal het proces gedeeltelijk moeten plaatsvinden in de "eigen tijd" van de docent. Hierbij geldt: wat je geeft krijg je terug. Als de docent de leerfingen adequate huip geeft zal dat de kwaliteit van het verslag ten goede komen. Ovengens zou het een docent wiskunde moeten aanspreken dat een leerling op een constructieve manier met wiskunde bezig is! Uit de literatuur blijkt dat samenwerken, kennis delen en ervaringen uitwisselen effect heeft op het leerproces van docenten. Deze elementen komen ruimschoots aan bod in de cursus. De winst zal zijn dat de deelnemende docenten op een - voor hen en voor de leerlingen - meer bevredigende manier omgaan met de praktische opdracht.