Étude exploratoire du recours à des interventions médicales de type "lourd' pour soulager la souffrance existentielle en fin de vie

Au cours du siècle dernier, des améliorations au niveau des conditions de vie ainsi que des avancées importantes dans les sciences biomédicales ont permis de repousser les frontières de la vie. Jusqu’au début du XXe Siècle, la mort était un processus relativement bref, survenant à la suite de maladies infectieuses et avait lieu à la maison. À présent, elle survient plutôt après une longue bataille contre des maladies incurables et des afflictions diverses liées à la vieillesse et a le plus souvent lieu à l’hôpital. Pour comprendre la souffrance du malade d’aujourd’hui et l’aborder, il faut comprendre ce qu’engendre comme ressenti ce nouveau contexte de fin de vie autant pour le patient que pour le clinicien qui en prend soin. Cette thèse se veut ainsi une étude exploratoire et critique des enjeux psychologiques relatifs à cette mort contemporaine avec un intérêt premier pour l’optimisation du soulagement de la souffrance existentielle du patient dans ce contexte. D’abord, je m’intéresserai à la souffrance du patient. À travers un examen critique des écrits, une définition précise et opérationnelle, comportant des critères distinctifs, de ce qu’est la souffrance existentielle en fin de vie sera proposée. Je poserai ainsi l’hypothèse que la souffrance peut être définie comme une forme de construction de l’esprit s’articulant autour de trois concepts : intégrité, altérité et temporalité. D’abord, intégrité au sens où initialement l’individu malade se sent menacé dans sa personne (relation à soi). Ensuite, altérité au sens où la perception de ses conditions extérieures a un impact sur la détresse ressentie (relation à l’Autre). Et finalement, temporalité au sens où l’individu souffrant de façon existentielle semble bien souvent piégé dans un espace-temps particulier (relation au temps). Ensuite, je m’intéresserai à la souffrance du soignant. Dans le contexte d’une condition terminale, il arrive que des interventions lourdes (p. ex. : sédation palliative profonde, interventions invasives) soient discutées et même proposées par un soignant. Je ferai ressortir diverses sources de souffrance propres au soignant et générées par son contact avec le patient (exemples de sources de souffrance : idéal malmené, valeurs personnelles, sentiment d’impuissance, réactions de transfert et de contre-transfert, identification au patient, angoisse de mort). Ensuite, je mettrai en lumière comment ces dites sources de souffrance peuvent constituer des barrières à l’approche de la souffrance du patient, notamment par l’influence possible sur l’approche thérapeutique choisie. On constatera ainsi que la souffrance d’un soignant contribue par moment à mettre en place des mesures visant davantage à l’apaiser lui-même au détriment de son patient. En dernier lieu, j'élaborerai sur la façon dont la rencontre entre un soignant et un patient peut devenir un espace privilégié afin d'aborder la souffrance. J'émettrai certaines suggestions afin d'améliorer les soins de fin de vie par un accompagnement parvenant à mettre la technologie médicale au service de la compassion tout en maintenant la singularité de l'expérience du patient. Pour le soignant, ceci nécessitera une amélioration de sa formation, une prise de conscience de ses propres souffrances et une compréhension de ses limites à soulager l'Autre.

Bioactivity, proximate, mineral and volatile profiles along the flowering stages of Opuntia microdasys (Lehm.): defining potential applications

Opuntia spp. flowers have been traditionally used for medical purposes, mostly because of their diversity in bioactive molecules with health promoting properties. The proximate, mineral and volatile compound profiles, together with the cytotoxic and antimicrobial properties were characterized in O. microdasys flowers at different maturity stages, revealing several statistically significant differences. O. microdasys stood out mainly for its high contents of dietary fiber, potassium and camphor, and its high activities against HCT15 cells, Staphylococcus aureus, Aspergillus versicolor and Penicillium funiculosum. The vegetative stage showed the highest cytotoxic and antifungal activities, whilst the full flowering stage was particularly active against bacterial species. The complete dataset has been classified by principal component analysis, achieving clearly identifiable groups for each flowering stage, elucidating also the most distinctive features, and comprehensively profiling each of the assayed stages. The results might be useful to define the best flowering stage considering practical application purposes.

La lengua de las inscripciones métricas del Peloponeso (siglos VII- IV a.C.)

Many works deal with the study of Greek epigrams. These texts gather precious historical, religious and epigraphic content whose analysis has been addressed from a literary point of view. The degree of dependence of Hellenistic epigrams of earlier period epigrams are of great interest, as shown by recent and numerous papers on this matter (Harder et al . 1998; 2002; 2006; 2012; Bing and Bruss 2007; Baumbach et al. 2010). Another major line of research is focused on the origin of epigrams and their relation to elegy (Gentilli 1968; Passa 1998b) or to hexametric poetry and the oral-formulaic language inherited from Homeric tradition (di Tillio 1969; Moranti 1971, 1972; Gentili and Giannini 1977). Furthermore, other authors, such as Day (2010), have pointed out the significance of the performative and ritual nature of epigrams. Likewise, this field of study has undergone a renewal because of new papyrological findings enriching the existing epigram collection corpora. Compared to all these works, monographs and studies dedicated to the analysis of the language of the verse inscriptions are fewer. Many of them explore the linguistic differences between literary epigrams and those epigrams preserved by epigraphic means, as well as the degree of intervention of later tradition on such texts (Tiberi 1996, del Barrio Vega 2008; Kaczko 2009). The first exclusively linguistic reviews were published by the end of the 19th century (Wagner 1883; Fengler 1892), however, they are descriptive analyses lacking from an independent methodology. Kock(1910) was the first researcher who systematized and suggested a linguistic hypothesis and upheld the use of epichoric dialects by poets. His theory was supported by adepts such as Kretschmer (1913; 1915) although some discordant voices appeared soon, such as Buck (1923) who denied the existence of a linguistic standard and endorsed the importance of the Ionic model over the epichoric one. Traditionally, Greek language manuals point out the significance of the Ionic model and accept the adaptation of Homeric language to epichoric dialect. The study of verse inscription language was not systematically resumed until Mickey's publications (1981a; 1981b). According to this researcher, epigraphic poetry consists of a tempered version of the epichoric dialect where the dialect-characteristic features are avoided. Following the same line but with some differences, Alonso Déniz and Nieto Izquierdo (2009) conclude that the most distinctive features of Argolic are not avoided, at least at the metrical inscriptions from Argolid...

Automated sparse 3D point cloud generation of infrastructure using its distinctive visual features

The commercial far-range (>10 m) spatial data collection methods for acquiring infrastructure’s geometric data are not completely automated because of the necessary manual pre- and/or post-processing work. The required amount of human intervention and, in some cases, the high equipment costs associated with these methods impede their adoption by the majority of infrastructure mapping activities. This paper presents an automated stereo vision-based method, as an alternative and inexpensive solution, to producing a sparse Euclidean 3D point cloud of an infrastructure scene utilizing two video streams captured by a set of two calibrated cameras. In this process SURF features are automatically detected and matched between each pair of stereo video frames. 3D coordinates of the matched feature points are then calculated via triangulation. The detected SURF features in two successive video frames are automatically matched and the RANSAC algorithm is used to discard mismatches. The quaternion motion estimation method is then used along with bundle adjustment optimization to register successive point clouds. The method was tested on a database of infrastructure stereo video streams. The validity and statistical significance of the results were evaluated by comparing the spatial distance of randomly selected feature points with their corresponding tape measurements.

Identifying Decisive Features for Distinctive Analysis of Writings in Malayalam

This paper presents a writer identification scheme for Malayalam documents. As the accomplishment rate of a scheme is highly dependent on the features extracted from the documents, the process of feature selection and extraction is highly relevant. The paper describes a set of novel features exclusively for Malayalam language. The features were studied in detail which resulted in a comparative study of all the features. The features are fused to form the feature vector or knowledge vector. This knowledge vector is then used in all the phases of the writer identification scheme. The scheme has been tested on a test bed of 280 writers of which 50 writers having only one page, 215 writers with at least 2 pages and 15 writers with at least 4 pages. To perform a comparative evaluation of the scheme the test is conducted using WD-LBP method also. A recognition rate of around 95% was obtained for the proposed approach

Nonprofit Boards in Australia: A Distinctive Governance Appoach

This article reports the findings into patterns of governance on nonprofit boards in Australia. The research surveys 118 boards, upon which serve a total of 1405 directors. The findings indicate that nonprofit boards can mimic some aspects of a shareholder approach to governance. But nonprofit boards, in the main, indicate priorities and activities of a stakeholder approach to governance. The features of `isomorphism' that arise largely stem from legislative requirements in corporate governance. Generally, nonprofit directors are influenced by agenda and motivations that can be differentiated from the influences upon director activity in the corporate sector. The study indicates that nonprofit boards prize knowledge and loyalty to the sector when considering board composition. The survey suggests nonprofits ``compensate'' for the demands placed upon them about fiduciary duty and due diligence responsibilities with the diverse intellectual expertise of non-executive directors. Nonprofit boards possess greater diversity than boards in the corporate sector; they include more women as directors than corporate boards and they include a greater proportion of directors from minority groups. While strategic issues feature significantly as a task of the nonprofit board, they distinguish themselves from their corporate counterparts by engaging in operational management. The findings indicate that, in the main, directors on nonprofit boards deliberate and operate in ways distinctive from their corporate counterparts. Such findings offer a contribution to the reform of Corporations Law in other countries and the likely consequence on boards outside the corporate sector.

Scene signatures : localised and point-less features for localisation

This paper is about localising across extreme lighting and weather conditions. We depart from the traditional point-feature-based approach as matching under dramatic appearance changes is a brittle and hard thing. Point feature detectors are fixed and rigid procedures which pass over an image examining small, low-level structure such as corners or blobs. They apply the same criteria applied all images of all places. This paper takes a contrary view and asks what is possible if instead we learn a bespoke detector for every place. Our localisation task then turns into curating a large bank of spatially indexed detectors and we show that this yields vastly superior performance in terms of robustness in exchange for a reduced but tolerable metric precision. We present an unsupervised system that produces broad-region detectors for distinctive visual elements, called scene signatures, which can be associated across almost all appearance changes. We show, using 21km of data collected over a period of 3 months, that our system is capable of producing metric localisation estimates from night-to-day or summer-to-winter conditions.

Bassenthwaite Lake: a general assessment of environmental and biological features and their susceptibility to change

Bassenthwaite (Lake) is one of the larger Cumbrian lakes, certainly one of the most distinctive, and of considerable conservation and amenity value. Although its shores lack sizeable settlements, its main inflow receives sewage effluent from a major tourist centre (Keswick) and is subject to episodic floods. These influences, the growing development of leisure activities at the lake (e.g. sailing, time-share units), and recent road-construction, have led to past appraisals of ecological impacts and lake management. The lake has not been the subject of intense and long-term ecological study, but much scattered information exists that is relevant to future management decisions. In the present Report, commissioned by North West Water, such information - published and unpublished - is surveyed. Especial attention is given to evidence bearing on susceptibility to change, affecting the lake environment and its biota or species of conservation interest. Extensive use has been made of the results of a recent (1986-7) seasonal survey by the FBA.

A general assessment of environmental and biological features of Windermere and their susceptibility to change

Bassenthwaite (Lake) is one of the larger Cumbrian lakes, certainly one of the most distinctive, and of considerable conservation and amenity value. Although its shores lack sizeable settlements, its main inflow receives sewage effluent from a major tourist centre (Keswick) and is subject to episodic floods. These influences, the growing development of leisure activities at the lake (e.g. sailing, time-share units), and recent road-construction, have led to past appraisals of ecological impacts and lake management. The lake has not been the subject of intense and long-term ecological study, but much scattered information exists that is relevant to future management decisions. In the present Report, commissioned by North West Water, such information - published and unpublished - is surveyed. Especial attention is given to evidence bearing on susceptibility to change, affecting the lake environment and its biota or species of conservation interest. Extensive use has been made of the results of a recent (1986-7) seasonal survey by the FBA.

Investigating machine learning techniques for detection of depression using structural MRI volumetric features

Structural MRI offers anatomical details and high sensitivity to pathological changes. It can demonstrate certain patterns of brain changes present at a structural level. Research to date has shown that volumetric analysis of brain regions has importance in depression detection. However, such analysis has had very minimal use in depression detection studies at individual level. Optimally combining various brain volumetric features/attributes, and summarizing the data into a distinctive set of variables remain difficult. This study investigates machine learning algorithms that automatically identify relevant data attributes for depression detection. Different machine learning techniques are studied for depression classification based on attributes extracted from structural MRI (sMRI) data. The attributes include volume calculated from whole brain, white matter, grey matter and hippocampus. Attributes subset selection is performed aiming to remove redundant attributes using three filtering methods and one hybrid method, in combination with ranker search algorithms. The highest average classification accuracy, obtained by using a combination of both SVM-EM and IG-Random Tree algorithms, is 85.23%. The classification approach implemented in this study can achieve higher accuracy than most reported studies using sMRI data, specifically for detection of depression.

Clinical features of obsessive-compulsive disorder with hoarding symptoms: A multicenter study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

SED-brachydactyly and distinctive speech: Report of a new familial case

Background: Spondyloepiphyseal dysplasia-brachydactyly and distinctive speech (SED-BDS) is a syndrome characterized by short stature, disproportionately short limbs, peculiar face, thick and abundant hair, high-pitched and coarse voice, small epiphyses, brachymetacarpalia, brachymetatarsalia and brachy-phalangia of fingers and toes, small pelvis and delayed carpal bone age, among other features. Case Report: We report a Brazilian patient with father, brother and sister presenting with the same typical features of the syndrome. Clinically, he showed disproportionately short stature, rhizo-meso-acromelic shortness of the extremities, short hands and feet, a peculiar distinctive high-pitched voice, peculiar facies, and other features already reported as characteristic of this syndrome. Radiographic fndings included shape anomalies of the vertebral bodies such as cuboid-shaped vertebral bodies, mild scoliosis, short and broad tubular bones, brachymetacarpalia, brachymetatarsalia, and brachy-dactyly, lumbar hyperlordosis, generalized osteopenia, and hypoplastic iliac wings. Conclusions: Few cases have been described, as this is a rare skeletal dysplasia. This paper describes a new familial case of SED-BDS. © The American Journal of Case Reports.

Clinical features of obsessive-compulsive disorder with hoarding symptoms: A multicenter study

Background: Factor analyses indicate that hoarding symptoms constitute a distinctive dimension of obsessive-compulsive disorder (OCD), usually associated with higher severity and limited insight. The aim was to compare demographic and clinical features of OCD patients with and without hoarding symptoms. Method: A cross sectional study was conducted with 1001 DSM-IV OCD patients from the Brazilian Research Consortium of Obsessive-Compulsive Spectrum Disorders (CTOC), using several instruments. The presence and severity of hoarding symptoms were determined using the Dimensional Yale-Brown Obsessive-Compulsive Scale. Statistical univariate analyses comparing factors possibly associated with hoarding symptoms were conducted, followed by logistic regression to adjust the results for possible confounders. Results: Approximately half of the sample (52.7%, n = 528) presented hoarding symptoms, but only four patients presented solely the hoarding dimension. Hoarding was the least severe dimension in the total sample (mean score: 3.89). The most common lifetime hoarding symptom was the obsessive thought of needing to collect and keep things for the future (44.0%, n = 440). After logistic regression, the following variables remained independently associated with hoarding symptoms: being older, living alone, earlier age of symptoms onset, insidious onset of obsessions, higher anxiety scores, poorer insight and higher frequency of the symmetry-ordering symptom dimension. Concerning comorbidities, major depressive, posttraumatic stress and attention deficit/hyperactivity disorders, compulsive buying and tic disorders remained associated with the hoarding dimension. Conclusion: OCD hoarding patients are more likely to present certain clinical features, but further studies are needed to determine whether OCD patients with hoarding symptoms constitute an etiologically discrete subgroup. (C) 2012 Elsevier Ltd. All rights reserved.

Astroblastoma with rhabdoid features and favorable long-term outcome: report of a case with a 12-year follow-up

Astroblastoma is a historically traded microscopic diagnosis to denote a rare neuroepithelial tumor of uncertain nosology, involving a distinctive pattern of pseudorosette arrangement of neoplastic cells. While displaying some glial properties, the latter shall not - by definition - be either reducible to or part of any conventional glioma type. We report on clinicopathologic correlations in a case of astroblastoma involving an extensive rhabdoid phenotype of tumor cells. The male patient was operated on at the age of 53 and 59 years for a left parietal tumor measuring 5.8 cm in diameter at the first presentation. On magnetic resonance imaging and angiography, both the primary and its recurrence were discrete, highly vascularized, and contrast-enhancing. The second surgery was complemented with radiotherapy of 66 Gy, followed by chemotherapy with Temozolomide. Twelve years into clinical history, the patient has stable minimal residual disease at the age of 65. A review of pathology samples from both surgeries showed well-differentiated astroblastoma according to current standards, with an MIB-1 labeling index of 1% and 4%, respectively. Neither of the specimens involved cellular anaplasia, overt mitotic activity, microvascular proliferation, or palisading necrosis. Most tumor cells harbored paranuclear filamentous rhabdoid inclusions that were immunostained for vimentin and, in part, also for GFAP. No polyantigenic reactivity was observed. This example contributes another facet to the spectrum of the so-called composite rhabdoid tumors. Involving a low-grade parent neoplasm, it also further substantiates the incipient perception that the rhabdoid phenotype neither is a peculiar but nonspecific convergence point of anaplastic evolution, nor are such lesions indiscriminately bound for a relentless course.

A distinctive clade B HIV type 1 is heterosexually transmitted in Trinidad and Tobago

HIV-1 transmission worldwide is predominantly associated with heterosexual activity, and non-clade B viruses account for the most spread. The HIV-1 epidemic in Trinidad/Tobago and the Caribbean shares many features with such heterosexual epidemics, including a prominent role for coincident sexually transmitted diseases. This study evaluates the molecular epidemiology of HIV-1 in Trinidad/Tobago during a period when abrupt transition from homosexual to heterosexual transmission occurred in the absence of injecting drug use, concomitant with a rapid rise in HIV-1 prevalence in the heterosexual population. Of 31 viral isolates studied during 1987–1995, all cluster with subtype B reference strains. In the analysis of full env genes from 22 early seroconverters, the Trinidad isolates constitute a significant subcluster within the B subtype. The Trinidad V3 consensus sequence differs by a single amino acid from the prototype B V3 consensus and demonstrates stability over the decade of this study. In the majority of isolates, the V3 loop of env contains a signature threonine deletion that marks the lineage of the Trinidad HIV-1 clade B epidemic from pre-1984. No phenotypic features, including syncitium induction, neutralization profiles, and chemokine receptor usage, distinguish this virus population from other subtype B viruses. Thus, although the subtype B HIV-1 viruses being transmitted in Trinidad are genetically distinguishable from other subtype B viruses, this is probably the result of a strong founder effect in a geographically circumscribed population rather than genetic selection for heterosexual transmission. These results demonstrate that canonical clade B HIV-1 can generate a typical heterosexual epidemic.