<p>Vaccination as a part of the preventative public health project has for many years been one of the important tasks of the children's health care. The vaccination program has been adjusted to current research and the health situation in the country. Having their children vaccinated is not something obvious for all parents, though. Especially the vaccination against measles, whooping cough and German measles have been questioned. The purpose of this literature study was to investigate the reasons for the resistance to vaccinate and to illuminate the security creating advice of the nurse at the public health centre. The study showed that there were varying ways to look at the MPR-vaccination among the parents. It could be considered as something injuring while childhood illnesses were sometimes considered as something positive. The social circumstances and a lack of trust were also factors that influenced the parents. It was also obvious that the parents need a district nurse that is a good listener and who can give advice individually and also give information that creates security. This information consists of telling the parents that the MPR-vaccine does not cause autism or chronic intestine disease. Furthermore, there is a need to inform of the illnesses and their risks. This information is objectively given by a well informed nurse, whose task it is to work for a vaccination program with the widest coverage possible.</p>

Vaccination as a part of the preventative public health project has for many years been one of the important tasks of the children's health care. The vaccination program has been adjusted to current research and the health situation in the country. Having their children vaccinated is not something obvious for all parents, though. Especially the vaccination against measles, whooping cough and German measles have been questioned. The purpose of this literature study was to investigate the reasons for the resistance to vaccinate and to illuminate the security creating advice of the nurse at the public health centre. The study showed that there were varying ways to look at the MPR-vaccination among the parents. It could be considered as something injuring while childhood illnesses were sometimes considered as something positive. The social circumstances and a lack of trust were also factors that influenced the parents. It was also obvious that the parents need a district nurse that is a good listener and who can give advice individually and also give information that creates security. This information consists of telling the parents that the MPR-vaccine does not cause autism or chronic intestine disease. Furthermore, there is a need to inform of the illnesses and their risks. This information is objectively given by a well informed nurse, whose task it is to work for a vaccination program with the widest coverage possible.

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An ad hoc mobile network is a collection of mobile nodes that are dynamically and arbitrarily located in such a manner that the interconnections between nodes are capable of changing on a continual basis. In order to simplify communication within the network, a routing protocol is used to discover routes between nodes. The primary goal of such an ad hoc network routing protocol is correct and efficient route establishment between a pair of nodes so that messages may be delivered on time. Route construction should be done with a minimum of overhead and bandwidth consumption. This document describes the Optimized Link State Routing (OLSR) protocol for mobile ad hoc networks. The key concept used in the protocol is that of multipoint relays (MPRs). MPRs provide an efficient mechanism for flooding control traffic by reducing the number of transmissions required.

Os modelos básicos da MPR são usados como blocos de construção de uma máquina estocástica que simula o responder operante. A máquina-MPR é então testada sob uma ampla variedade de condições experimentais, e prova sua capacidade de produzir com realismo: (a) distribuições de IRT, (b) padrões do responder intra-sessão, e (c) as relações entre taxa de reforçamento e taxa de resposta sob esquemas de intervalo e de razão. Em outro conjunto de experimentos, o modelo demonstra propriedades emergentes realistas e reproduz fenômenos bem conhecidos no âmbito dos esquemas múltiplos, como (d) contraste comportamental e (e) desaceleração da extinção ambos além do alcance original da MPR. No último capítulo do estudo, a máquina-MPR é dotada de um modelo de controle temporal. Essa nova configuração, chamada tMPR, se mostra capaz de simular (f) o comportamento de timing que emerge sob esquemas previsíveis de intervalo, assim como (g) as propriedades centrais desse tipo de comportamento. O poder de abarcar um vasto domínio de fenômenos operantes com um mecanismo simples que roda sobre um conjunto de parâmetros com valores fixos e o fato de que ela faz isso a partir de uma arquitetura que pode ser facilmente expandida, faz da máquina-MPR uma plataforma útil para a integração de teorias. À medida que outros pesquisadores enriquecerem o framework com novos módulos, ele poderá ajudar a elucidar como diferentes aspectos do comportamento operante interagem uns com os outros, pavimentando a transição de uma análise do comportamento para uma síntese comportamental. / The basic models of MPR are used as the building blocks of a stochastic machine that simulates operant responding. The MPR-machine is then tested under a wide variety of experimental conditions, and proves its ability to produce realistic (a) IRT distributions, (b) within-session patterns of responding, and (c) relations between reinforcement rate and response rate under interval and ratio schedules. In another set of experiments, the model show realistic emergent properties and reproduces well known multiple schedule phenomena, such as (d) behavioral contrast and (e) extinction deceleration all of them beyond the original reach of MPR. In the last chapter of the study, the MPR-machine is embodied with a model of temporal control. The new configuration, named tMPR, proves itself able to simulate (f) the timing behavior that arises under predictable interval schedules as well as (g) the central properties of this behavior. The power to account for a vast domain of operant behavior phenomena with a simple mechanism that runs on a fixed set of parameter values and the fact that it does so based on an architecture that can be easily expanded to accommodate new models makes the MPR-machine a useful platform for theory integration. As other researchers enrich the framework with new modules, it may help to elucidate how different aspects of operant behavior interact with one another, paving the transition from a behavior analysis to a behavioral synthesis.

Os modelos básicos da MPR são usados como blocos de construção de uma máquina estocástica que simula o responder operante. A máquina-MPR é então testada sob uma ampla variedade de condições experimentais, e prova sua capacidade de produzir com realismo: (a) distribuições de IRT, (b) padrões do responder intra-sessão, e (c) as relações entre taxa de reforçamento e taxa de resposta sob esquemas de intervalo e de razão. Em outro conjunto de experimentos, o modelo demonstra propriedades emergentes realistas e reproduz fenômenos bem conhecidos no âmbito dos esquemas múltiplos, como (d) contraste comportamental e (e) desaceleração da extinção ambos além do alcance original da MPR. No último capítulo do estudo, a máquina-MPR é dotada de um modelo de controle temporal. Essa nova configuração, chamada tMPR, se mostra capaz de simular (f) o comportamento de timing que emerge sob esquemas previsíveis de intervalo, assim como (g) as propriedades centrais desse tipo de comportamento. O poder de abarcar um vasto domínio de fenômenos operantes com um mecanismo simples que roda sobre um conjunto de parâmetros com valores fixos e o fato de que ela faz isso a partir de uma arquitetura que pode ser facilmente expandida, faz da máquina-MPR uma plataforma útil para a integração de teorias. À medida que outros pesquisadores enriquecerem o framework com novos módulos, ele poderá ajudar a elucidar como diferentes aspectos do comportamento operante interagem uns com os outros, pavimentando a transição de uma análise do comportamento para uma síntese comportamental. / The basic models of MPR are used as the building blocks of a stochastic machine that simulates operant responding. The MPR-machine is then tested under a wide variety of experimental conditions, and proves its ability to produce realistic (a) IRT distributions, (b) within-session patterns of responding, and (c) relations between reinforcement rate and response rate under interval and ratio schedules. In another set of experiments, the model show realistic emergent properties and reproduces well known multiple schedule phenomena, such as (d) behavioral contrast and (e) extinction deceleration all of them beyond the original reach of MPR. In the last chapter of the study, the MPR-machine is embodied with a model of temporal control. The new configuration, named tMPR, proves itself able to simulate (f) the timing behavior that arises under predictable interval schedules as well as (g) the central properties of this behavior. The power to account for a vast domain of operant behavior phenomena with a simple mechanism that runs on a fixed set of parameter values and the fact that it does so based on an architecture that can be easily expanded to accommodate new models makes the MPR-machine a useful platform for theory integration. As other researchers enrich the framework with new modules, it may help to elucidate how different aspects of operant behavior interact with one another, paving the transition from a behavior analysis to a behavioral synthesis.

Statins are commonly used for treating the elevation of lipids in the blood stream, also known as hyperlipidemia. Statins are considered to be an economical and effective way to achieve desirable long-term health outcomes for hyperlipdemic patients, however, ensuring adequate adherence to statin medications is often difficult as hyperlipidemia is an asymptomatic condition and patients sometimes fail to recognize the importance of being adherent to their statin medications. The purpose of this study was to evaluate impact of enrollment under Medicaid and Medicare Part D and patient out-of-pocket costs on patient statin adherence, persistence, and mean number of gap days per claim. A retrospective claims database was used in this study to conduct repeated measures analyses on statin prescription claims from independent community pharmacies in Texas. The pre-period in this study extended from January 1, 2005 to September 30, 2005 (Medicaid period) and the post-period extended from January 1, 2006 to September 30, 2006 (Medicare period). The study population consisted of dual-eligible beneficiaries in Texas who had at least two stain claims in the pre and post-periods each. The final study population comprised of 1734 Texas dual-eligible beneficiaries with 6064 statin claims during the pre-period and 7956 claims during the post-period. Patients had an average of 3.49 statin claims during the pre-period and 4.58 statin claims during the post-period. Patients were dispensed an average of 57.34 days of drug supply per claim during the pre-period and 42.02 days of drug supply per claim during the post-period. The results from this study showed that out-of-pocket costs for patients increased from $0.39 per claim under Medicaid to $13.36 per claim under Medicare Part D. Patient adherence to statins was assessed by calculating medication possession ratio (MPR). The results showed that mean patient MPR increased from 75.71 percent under Medicaid to 79.37 percent under Medicare. Results from generalized estimating equations showed that odds of being adherent (i.e., MPR ≥ 80 percent) to statins increased by 36 percent when patients were covered under Medicare Part D. Linear mixed model analysis showed that MPR increased by 3.66 percent when patients were covered under Medicare Part D compared to Medicaid. Also, patient MPR was found to increase by 0.13 percent when patient out-of-pocket payment increased by $1.00. Patient persistence was calculated by measuring gaps in therapy and patients with a gap of 60 or more days were considered to have discontinued therapy. Patients were found to be persistent to their drug therapy for an average of 151.76 days under Medicaid and 159.75 days under Medicare. Linear mixed model analysis showed that patient persistence increased by 7.99 days when patients were enrolled under Medicare Part D compared to Medicaid. Days of persistence was also found to increase by 0.41 days when patient out-of-pocket costs increased by $1.00. Mean number of gap days per claim during the Medicaid period was 11.91 days and decreased to 8.38 days during the Medicare period. Linear mixed model analysis showed that mean number of gap days per claim decreased by 3.52 days when patients were enrolled under Medicare Part D compared to Medicaid. Mean number of gap days in therapy were found to decrease by 0.10 days when patient out-of-pocket costs increased by $1.00. The results of this study showed that implementation of Medicare Part D resulted in an increase in MPR and persistence and a decrease in mean number of gap days per claim for Texas dual-eligible beneficiaries. The results also suggest that increased out-of-pocket costs under Medicare Part D may not have had a negative impact on statin drug utilization by dual-eligible beneficiaries in Texas. / text

Résumé : Calnuc est une protéine ubiquitaire qui lie le calcium et qui est présente au réseau trans-golgien (TGN) ainsi qu'aux endosomes. Notre groupe a précédemment mis en évidence le rôle de Calnuc dans le transport de Low density lipoprotein receptor-related protein 9 (LRP9), un récepteur aux lipoprotéines de faible densité qui cycle entre le TGN et les endosomes. Les récepteurs lysosomiaux au mannose-6-phosphate (MPR) et Sortiline sont bien caractérisés et empruntent également cette voie. À l'image de LRP9, nous avons montré que Calnuc prévient leur dégradation aux lysosomes en participant à leur recyclage à partir des endosomes vers le TGN. En fait, Calnuc est importante pour l'activation et l'association membranaire de Rab7, une petite protéine G qui recrute ensuite le complexe Rétromère responsable du transport rétrograde des récepteurs. La glycoprotéine lysosomiale Ceroid lipofuscinosis neuronal 5 (CLN5) est également impliquée dans ce processus. La structure et la fonction de cette dernière n'étant pas clairement définies, nous avons établi qu'elle est synthétisée sous forme d’une glycoprotéine transmembranaire de type II, mais son domaine N-terminal cytoplasmique et son segment transmembranaire sont rapidement éliminés suivant le clivage du peptide signal de manière à former une protéine CLN5 mature fortement associée à la membrane par une hélice amphipathique (AH). La compréhension des propriétés de base de CLN5 est particulièrement pertinente puisque la protéine est impliquée dans certaines variantes de céroïdes-lipofuscinoses neuronales (NCL), une maladie neurodégénérative rare causée par une surcharge des lysosomes. D'ailleurs, nos données indiquent que les mutants pathologiques de CLN5 dépourvus de cette AH perdent leur association membranaire, sont retenus au réticulum endoplasmique et sont rapidement dégradés. En raison de la similitude des fonctions de Calnuc et de CLN5 au niveau du triage endosomial, nous avons exploré le lien entre les deux protéines. Calnuc cytosolique et CLN5 luminale semblent former un complexe, par l'intermédiaire de la protéine transmembranaire CLN3, de façon à influencer l'activité de Rab7. CLN3 étant aussi associée aux NCL, nous avons finalement exploré la potentielle implication de Calnuc dans la maladie. L'absence de Calnuc entraîne des phénotypes cellulaires typiques des NCL comme un engorgement des lysosomes, une accumulation de matériel autofluorescent et une augmentation de l'autophagie. Les niveaux protéiques de Calnuc sont diminués dans toutes les lignées de fibroblastes de patients atteints de NCL disponibles ce qui indique que Calnuc pourrait être impliquée dans certains types de NCL. La présente thèse couvre donc la découverte de la fonction de Calnuc dans le transport intracellulaire, jusqu'à son implication potentielle dans les NCL, de même qu'une étude topologique de CLN5. / Abstract : Calnuc is a ubiquitous Ca2+-binding protein present on the trans-Golgi network (TGN) and endosomes. We previously highlighted the role of Calnuc in the transport of Low density lipoprotein receptor-related protein 9 (LRP9), a low density lipoprotein (LDL) receptor that cycles between the TGN and endosomes. Lysosomal receptors mannose-6-phosphate receptor (MPR) and Sortilin are well-characterized and also use the TGN-to-endosome trafficking pathway. Similarly to LPR9, we showed that Calnuc prevent their degradation in lysosomes by acting in their recycling from endosomes to the TGN. In fact, Calnuc is a important for the activation and the membrane association of Rab7, a small G protein which then recruit the Retromer complex known to be responsible for the retrograde transport of receptors. Lysosomal glycoprotein Ceroid lipofuscinosis neuronal 5 (CLN5) is also involved in this process. Because its structure and function have not yet been clearly defined, we established that it is synthesized as a type II transmembrane (TM) glycoprotein, but its cytoplasmic N-terminus and TM segment are rapidly removed following signal-peptide cleavage to generate mature CLN5 which is tightly associated to membrane through an amphipathic helix (AH). The understanding of the basic properties of CLN5 is particularly important given that CLN5 is involved in some variants of neuronal ceroid lipofuscinosis (NCL), a rare neurodegenerative disease caused by lysosomal overload. Moreover, our data indicate that CLN5 pathological mutants deprived of AH lose their membrane association, are retained in the endoplasmic reticulum, and are rapidly degraded. Based on the similarity featured by Calnuc and CLN5 in endosomal sorting, we explored the link between these two proteins. Cytosolic Calnuc and luminal CLN5 seem to form a complex, through the transmembrane protein CLN3, in order to influence the activity of Rab7. As CLN3 is also associated with NCL, we finally explored the potential involvement of Calnuc in this disease. Canuc depletion leads to typical NCL phenotypes such as lysosome enlargement, accumulation of autofluorescent material and of an increased of autophagy induction. Canuc's levels are decreased in all fibroblasts cell lines of NCL patients available indicating that Calnuc could be involved in some types of NCL. This thesis thus covers the discovery of the function of Calnuc in intracellular transport up to its potential involvement in the NCL, as well as a topological study CLN5.

The aim of this study was to determine whether or not the Mouvement Populaire de la Revolution (MPR) as a single political party in Zaire has brought about national integration in the country. The Charter of the Party, herein referred to as the Nsele Manifesto, states that "the MPR intends to restore the state authority and the union of the Zaireans for the sake and the grandeur of the Republic." Carried out from a historical materialist perspective, the study comes up with three major findings. First, from a behavioral standpoint the MPR has implemented a vertical integration in Zaire as opposed to horizontal integration. Second, from a materialist viewpoint the MPR, in its relations to the means of production with the environment, has become a major factor in the class structure in Zaire. Third, the issue of ethnicization of power which, as of late has become one of great interest to social scientists in general and to students of Zairean politics in particular, has been given enough attention in this study. However, this research takes the position that scholars should be cautious in their effort to apprehend the processes of power diffusion on the one hand, and the dialectics of class and ethnicity on the other hand. Indeed, to overemphasize one aspect such as ethnicization of power leads to an obscurantist explanation of a socio-political reality as complex as contemporary African politics dictates. Moreover, for scholars interested in qualitative social change, such an approach fails to comprehend contradictions underlying the political make up of Zaire. Only a thorough analysis of these contradictions can enable one to seize the essential significance concealed behind the party slogan of "MPR=SERVIR."

Bakgrund: Vaccinationstäckning är ett av de viktigaste och mest kostnadseffektiva sättet att förbättra den globala folkhälsan. Trots det uppfattas vacciner som osäkert och onödigt av allt fler individer. Försämrad vaccinationstäckning påverkar flockimmuniteten med ökad risk för nya sjukdomsutbrott och epidemier. Syfte: Syftet var att undersöka och sammanställa den vetenskapliga litteraturen om vilka faktorer som påverkar vårdnadshavarnas beslut att vaccinera eller inte vaccinera sina barn mot mässling-påssjuka-röda hund (MPR). Metod: Systematisk litteraturöversikt där totalt tio vetenskapliga artiklar ligger till grund för resultatet. The Health Belief Model har använts som teoretisk utgångspunkt. Resultat: Flera faktorer var viktiga för föräldrars beslut om vaccination. Fem faktorer identifierades som påverkar föräldrar att inte vaccinera sina barn: att föredra naturlig immunisering, rädsla för biverkningar, rädsla för vaccinet, misstro till myndigheter och förebygga sjukdom genom livsstil. Fyra faktorer som påverkar föräldrar att låta vaccinera sina barn identifierades: att undvika sjukdom, värna om flockimmunitet, fördelar överväger nackdelar samt kunskap och information om sjukdomarna och vaccinet. I resultatet identifierades också ett bifynd, att låta barnets immunsystem mogna innan vaccination. Både föräldrar som vaccinerade och inte vaccinerade sina barn tyckte att det fanns för lite information om vaccinet och dess biverkningar. Slutsats: Flera faktorer påverkar föräldrars beslut om vaccination för sina barn mot MPR. Både föräldrar som vaccinerar och inte vaccinerar sina barn tycker informationen om vaccin och dess biverkningar är för knapphändig och svårtillgänglig. Det är viktigt som sjuksköterska att ha kunskap om vilka faktorer som påverkar föräldrars beslut för att kunna bemöta föräldrars oro och bistå med adekvat och evidensbaserad information. / Background: Vaccination coverage is one of the most important and cost-effective ways to improve global health. Despite this more and more people feel uncertain about vaccinations. Impaired vaccination coverage affects the herd immunity and leads to an increased risk of disease outbreaks and epidemics. Aim: The aim of this study was to examine which factors influence parents’ decisions regarding vaccination of their children against measles-mumps-rubella (MMR). Method: A systematic review where the result is based on ten scientific articles. The Health Belief Model was used as theoretical framework. Results: Several factors were important for the decision to vaccinate or not. Five factors were identified among parents not vaccinating: to prefer natural immunization, fear of side effects, fear of the vaccine, mistrust in the authorities and prevent disease through lifestyle. While four factors were identified among parents vaccinating: to prevent disease, to protect the herd immunity, the advantages outweigh disadvantages, and knowledge and information about the disease and the vaccine. In addition, the finding, to let the child's immune system mature before vaccination was identified. Both parents who accept vaccination and parents who decline vaccination of their children considered the information about the vaccine inadequate. Conclusion: Several factors influence parents’ decision regarding vaccination of their children against MMR. Both parents who accept vaccination and parents who decline vaccination of their children consider the information about the vaccine and its side effects too scant and difficult to access. It's important that nurses have knowledge about factors that influence parents' decisions in order to respond to their concerns and provide appropriate and evidence-based information.