Can the impact of bed closure in intensive care units be reliably monitored?

OBJECTIVE: To assess the properties of various indicators aimed at monitoring the impact on the activity and patient outcome of a bed closure in a surgical intensive care unit (ICU). DESIGN: Comparison before and after the intervention. SETTING: A surgical ICU at a university hospital. PATIENTS: All patients admitted to the unit over two periods of 10 months. INTERVENTION: Closure of one bed out of 17. MEASUREMENTS AND RESULTS: Activity and outcome indicators in the ICU and the structures upstream from it (emergency department, operative theater, recovery room) and downstream from it (intermediate care units). After the bed closure, the monthly medians of admitted patients and ICU hospital days increased from 107 (interquartile range 94-112) to 113 (106-121, P=0.07) and from 360 (325-443) to 395 (345-436, P=0.48), respectively, along with the linear trend observed in our institution. All indicators of workload, patient severity, and outcome remained stable except for SAPS II score, emergency admissions, and ICU readmissions, which increased not only transiently but also on a mid-term basis (10 months), indicating that the process of patient care delivery was no longer predictable. CONCLUSIONS: Health care systems, including ICUs, are extraordinary flexible, and can adapt to multiple external constraints without altering commonly used activity and outcome indicators. It is therefore necessary to set up multiple indicators to be able to reliably monitor the impact of external interventions and intervene rapidly when the system is no longer under control.

09032-017 Miller Creek Watershed Final Report

Miller Creek is on the 2006 Section 303d Impaired Waters List and has a 19,926 acre watershed. All indicators, as reported in the Miller Creek assessment, show that the impairment is due to sediment and nutrient delivery from upland runoff which contributes to elevated water temperatures, excessive algae, and low dissolved oxygen levels within the stream. In an effort to control these problems, the Miller Creek Water Quality Project will target areas of 5 tons per acre or greater soil loss or with 0.5 tons per acre or greater sediment delivery rates. The assessment revealed these targeted priority lands make up 32% or 6,395 acres of the Miller Creek watershed. Priority lands include cropland, pasture land, timber, and sensitive riparian areas. It is the goal of this project to reduce sediment delivery by 70% on 60% or 3,837 acres of these priority lands. This will be accomplished through installation of strategically placed structural practices, rotational grazing systems, and buffer strips. These practices will reduce soil loss, reduce sediment delivery, improve water quality, and improve wildlife habitat in the watershed. Utilizing partnerships with NRCS and IDALS-DSC will be important in making this project successful. In addition to using matching funds from EQIP, WHIP, and CRP, the Monroe SWCD is committed to prioritizing local cost share funds through IFIP and REAP for use in the Miller Creek Watershed.

Overlap Between Common Genetic Polymorphisms Underpinning Kidney Traits and Cardiovascular Disease Phenotypes: The CKDGen Consortium.

BACKGROUND: Chronic kidney disease is associated with cardiovascular disease. We tested for evidence of a shared genetic basis to these traits. STUDY DESIGN: We conducted 2 targeted analyses. First, we examined whether known single-nucleotide polymorphisms (SNPs) underpinning kidney traits were associated with a series of vascular phenotypes. Additionally, we tested whether vascular SNPs were associated with markers of kidney damage. Significance was set to 1.5×10(-4) (0.05/325 tests). SETTING & PARTICIPANTS: Vascular outcomes were analyzed in participants from the AortaGen (20,634), CARDIoGRAM (86,995), CHARGE Eye (15,358), CHARGE IMT (31,181), ICBP (69,395), and NeuroCHARGE (12,385) consortia. Tests for kidney outcomes were conducted in up to 67,093 participants from the CKDGen consortium. PREDICTOR: We used 19 kidney SNPs and 64 vascular SNPs. OUTCOMES & MEASUREMENTS: Vascular outcomes tested were blood pressure, coronary artery disease, carotid intima-media thickness, pulse wave velocity, retinal venular caliber, and brain white matter lesions. Kidney outcomes were estimated glomerular filtration rate and albuminuria. RESULTS: In general, we found that kidney disease variants were not associated with vascular phenotypes (127 of 133 tests were nonsignificant). The one exception was rs653178 near SH2B3 (SH2B adaptor protein 3), which showed direction-consistent association with systolic (P = 9.3 ×10(-10)) and diastolic (P = 1.6 ×10(-14)) blood pressure and coronary artery disease (P = 2.2 ×10(-6)), all previously reported. Similarly, the 64 SNPs associated with vascular phenotypes were not associated with kidney phenotypes (187 of 192 tests were nonsignificant), with the exception of 2 high-correlated SNPs at the SH2B3 locus (P = 1.06 ×10(-07) and P = 7.05 ×10(-08)). LIMITATIONS: The combined effect size of the SNPs for kidney and vascular outcomes may be too low to detect shared genetic associations. CONCLUSIONS: Overall, although we confirmed one locus (SH2B3) as associated with both kidney and cardiovascular disease, our primary findings suggest that there is little overlap between kidney and cardiovascular disease risk variants in the overall population. The reciprocal risks of kidney and cardiovascular disease may not be genetically mediated, but rather a function of the disease milieu itself.

Perfil eletrolítico e peso corporal em suínos submetidos a dietas com diferentes teores de fósforo

O objetivo deste trabalho foi avaliar o efeito de dietas, com diferentes teores de fósforo, no perfil eletrolítico sanguíneo e no ganho de peso corporal em suínos. Foram utilizados 60 suínos híbridos comerciais, machos castrados, com peso corporal médio inicial de 61,07±0,86 kg, com aproximadamente 110 dias de idade. Os animais foram distribuídos em blocos ao acaso, com 5 tratamentos e 12 repetições cada um. Os tratamentos foram constituídos de dietas com 0,135, 0,200, 0,265, 0,330 e 0,395% de fósforo disponível. No início e no final do período experimental, foi determinado o peso corporal e foram coletadas amostras de sangue, sem jejum dos animais, para a mensuração de sódio, potássio, cloreto, magnésio total, fósforo e cálcio ionizado. Observou-se resposta quadrática do peso corporal, de acordo com os tratamentos, e das concentrações séricas de fósforo, magnésio total e cálcio iônico em decorrência dos tratamentos. O ganho de peso corporal foi maior nos animais alimentados com suplementação de fósforo em teores acima de 0,135%. O melhor resultado foi obtido com a dieta de 0,330% de fósforo, porém, o aumento a partir de 0,200% na dieta ocasionou elevação na concentração sérica de fósforo.

Desempenho zootécnico e econômico de juvenis de robalo-peva alimentados com dietas contendo diferentes concentrações proteicas

O objetivo deste trabalho foi avaliar o desempenho zootécnico e econômico de robalo-peva (Centropomus parallelus) alimentado com seis rações práticas, contendo diferentes concentrações proteicas. As dietas foram formuladas para conter as seguintes concentrações proteicas: 375, 395, 416, 438, 473 e 490 g kg-1. Cada dieta foi fornecida até a saciedade aparente duas vezes ao dia, por 90 dias. Ao final do experimento, a composição corporal dos peixes alimentados com as diferentes dietas não diferiu significativamente. O ganho em peso variou de 2,87±0,09 a 4,74±0,02 g, da menor para a maior concentração proteica. A concentração proteica de 490 g kg-1 levou à redução de 2,86±0,13 R$ kg-1 no custo médio de alimentação, ao aumento de 97,82±4,25% no índice de eficiência econômica, e à redução de 102,91±4,58% no índice de custo. A dieta com a maior concentração proteica e a relação energia/proteína de 7,27 Mcal kg-1 promove os melhores índices zootécnicos e econômicos para juvenis de robalo-peva.

Signal transduction in plant-beneficial rhizobacteria with biocontrol properties.

Biological control of root pathogens--mostly fungi--can be achieved by the introduction of selected bacterial inoculants acting as 'biopesticides'. Successful inoculants have been identified among Gram-negative and Gram-positive bacteria, often belonging to Pseudomonas spp. and Bacillus spp., respectively. Biocontrol activity of a model rhizobacterium, P. fluorescens CHAO, depends to a considerable extent on the synthesis of extracellular antimicrobial secondary metabolites and exoenzymes, thought to antagonize the pathogenicity of a variety of phytopathogenic fungi. The regulation of exoproduct formation in P. fluorescens (as well as in other bacteria) depends essentially on the GacS/GacA two-component system, which activates a largely unknown signal transduction pathway. However, recent evidence indicates that GacS/GacA control has a major impact on target gene expression at a post-transcriptional level, involving an mRNA target sequence (typically near the ribosome binding site), two RNA binding proteins (designated RsmA and RsmE), and a regulatory RNA (RsmZ) capable of binding RsmA. The expression and activity of the regulatory system is stimulated by at least one low-molecular-weight signal. The timing and specificity of this switch from primary to secondary metabolism are essential for effective biocontrol.

Concilium Meldense-Parisiense, 845-846.

F. 1 Concile de Meaux-Paris, 845-846 (M. G., Capit., II, 395-421). F. 35v Synode de Beauvais, avril 845 (ibid., 387).

Glial hyaluronate-binding protein expression in aggregating brain cell cultures.

We analyzed the expression of glial hyaluronate-binding protein (GHAP), an integral component of the extracellular matrix, in aggregating brain cell cultures of fetal rat telencephalon using immunofluorescence. GHAP immunoreactivity appeared after 1 week in culture, simultaneous with the first deposits of myelin basic protein, and showed a development-dependent increase. Comparison of glia-enriched and neuron-enriched cultures showed that only glial cells express GHAP. Three peptide growth factors, epidermal growth factor, fibroblast growth factor and platelet-derived growth factor, which are known to stimulate the differentiation of glial cells, modulated the deposit of GHAP immunoreactivity. The 3-dimensional structure of aggregate cultures promoted GHAP deposition, suggesting that cell-cell interactions are required for extracellular matrix formation. Furthermore GHAP production seemed to depend on the developmental stage of the glial cells.

Transsexualisme: enjeux et spécificités liés à la prise en charge d'une demande de réassignation sexuelle [Gender identity disorder: challenges and specificity in the treatment of requests for sexual reassignment].

Gender identity disorder is defined as a permanent desire to relieve one's own sexual features to acquire the sexual features and line to life of the opposite sex. The diagnosis is based on the psychiatric evaluation and treatment on an interdisciplinary approach by endocrinologists, surgeons and psychiatrists, and can be conceptualized into distinct phases: diagnostic evaluation, real life experience, hormonal treatment and surgery. Multiples challenges have to be faced, especially by the psychiatrist who follows the patient during the whole process.

[6 phot. de Nogent-le-Rotrou et une de Granville, don de A. Gouverneur, maire de Nogent, en 1893]

Donateur : Gouverneur, Aristide (1829-1898)

Liikkeenjohdon konsultointi toimialana Suomessa

Tutkimuksen tarkoituksena olikuvata liikkeenjohdon konsultoinnin toimialaa Suomen näkökulmasta. Tutkimuksen pääteemoja olivat toimialan tuotteet ja palvelut, asiakkaat ja markkinat sekä toimialan kilpailu. Tutkimus oli luonteeltaan kvalitatiivinen ja sen pääasiallisena aineistona olivat neljäntoista konsultointiyrityksen internetsivut sekä Talouselämä -lehden teettämät toimialaselvitykset vuosilta 1997-2005. Tutkimuksen tulokset tukivat hyvin aikaisempaa tutkimusta. Keskeisiin tutkimustuloksiin kuuluvat toimialan polarisoituminen isoihin ja pieniin toimijoihin sekä rajojen hämärtyminen konsultoinnin ja tietotekniikka- sekä taloushallinnon välillä. Suuret, kansainväliset konsultointiyritykset tarjoavat yleensä palveluitalaidasta laitaan, pienet sekä harvat keskisuuret yritykset ovat enemmän keskittyneitä tiettyihin palveluihin tai asiakkaisiin. Suuret yritykset ovat laajentuneet entisestään fuusioiden avulla ja pienet puolestaan hakevat kilpailuetua esimerkiksi verkostoitumalla.

Seleção de progênies de maracujazeiro-amarelo (Passiflora edulis f. flavicarpa) quanto à qualidade de frutos

Para garantir a sustentabilidade da cultura do maracujazeiro, na Amazônia, é imprescindível realizar pesquisas que busquem o desenvolvimento de cultivares tolerantes às principais doenças e que apresentem frutos com boas características agroindustriais. Este trabalho teve por objetivo avaliar frutos de progênies de maracujazeiro-amarelo, CPATU-casca-fina (CCF), através de características físicas e físico-químicas, buscando obtenção de plantas com características desejáveis para indústria de suco concentrado e fruto in natura. O estudo foi conduzido em 20 progênies de polinização livre oriundas de uma população formada pela mistura de sementes de plantas selecionadas no segundo ciclo de seleção massal. Colheram-se dez frutos por planta para serem analisados, com base nas seguintes características: peso médio dos frutos; comprimento do fruto; espessura de casca; rendimento de suco; número de sementes por fruto; teor de sólidos solúveis totais (SST); acidez total titulável (ATT); pH e relação STT/ATT. Os dados obtidos foram analisados através de estatística simples, envolvendo média, desvio-padrão e coeficiente de variação. As progênies CPATU-casca-fina apresentaram variação para a maioria das características. Os frutos das progênies CCF-001, CCF-074, CCF-212, CCF-395 e CCF-430 apresentam características desejáveis para o mercado in natura, enquanto os das progênies CCF-192, CCF-281, CCF-391 e CCF-505 têm características importantes para a indústria de suco concentrado.

Usages de l'eau à Gaya (Niger) : entre fortes potentialités et contraintes majeures

Résumé: Le département de Gaya, cadre de notre étude, est situé au sud-ouest de la république du Niger. Il dispose d'un important potentiel hydrique composé des eaux de surface (une centaine de mares permanentes, le fleuve Niger sur 106 km) et de sept aquifères superposés comprenant des nappes de subsurface (affleurantes par endroit) et des nappes artésiennes. L'étude sur les usages de l'eau à Gaya a été menée à travers plusieurs axes centrés sur l'estimation et la répartition spatiale des ressources en eau, le cadre juridique et institutionnel régulant leur mise en valeur, les différents secteurs d'utilisation de l'eau ainsi que les contraintes affectant cette utilisation. L'usage de la cartographie à travers les SIG dans le traitement et l'analyse des données, couplée à notre expérience d'une dizaine d'année de travaux dans la région, a permis de dresser des synthèses richement illustrées permettant de mieux comprendre tous les enjeux liés à la problématique des usages de l'eau dans cette partie du Niger. Contrairement à la vision que l'on a traditionnellement du Sahel où le manque d'eau constitue une des contraintes majeures au développement, ici des conditions locales particulières contredisent ce cliché et transposent le débat sur un autre plan. Il s'agit de la maîtrise de l'eau au niveau local à travers l'élaboration d'une politique appropriée qui tienne compte non seulement des spécificités locales de la ressource, mais aussi des différents types d'usages. La politique de l'eau au Niger, définie selon le Schéma directeur de mise en valeur et de gestion des ressources en eau, à travers la mise en place d'un important arsenal juridique et institutionnel, a eu le mérite de tracer un canevas sur la question, mais a montré ses limites au niveau pratique après dix ans d'essai. En effet au niveau de Gaya, ni l'Etat ni les partenaires au développement (bailleurs de fonds extérieurs) n'ont tenu compte des caractéristiques locales de la ressource ou du contexte socioéconomique particulier de la région. Ce qui a entraîné la réalisation d'infrastructures inadaptées aux réalités hydrogéologiques locales ainsi que des choix inappropriés au niveau de certains aménagements. En dépit de l'abondance de la ressource, son accès tant au niveau quantitatif que qualitatif, reste difficile pour une grande partie des acteurs ruraux. Les différents handicaps rencontrés dans la mise en valeur des ressources en eau résultent de cette incohérence de la politique nationale de l'eau, mais aussi de la difficulté de son application sur le terrain où persiste un pluralisme juridique caractérisé par la cohabitation de deux systèmes de régulation à savoir les droits coutumiers et la législation moderne. Ces différents éléments mis en évidence dans cette étude sur la zone de Gaya pourraient servir de base pour un meilleur aménagement des ressources en eau dans le cadre plus large d'une politique d'aménagement du territoire prenant en compte tous les facteurs tant physiques que socioéconomiques de la région. Abstract: The department of Gaya, in which this study was done, is located in the SW area of the Republic of Niger. It has an important hydrological potential composed of surface water (approximately 100 permanent ponds, 106 km of the Niger River) and 7 bodies of underground water sources including sub-surface and artresan wells. This study of the exploitation of wtaer in Gaya has been carried out employing several parameters based on: the estimation and spacial distribution of water ressources, the juridic and institutional rules governing their utilisation and the various constraints affecting this exploitation. The use of mapping when treating and analysing data, coupled with ten years personel field experience, resulted in a richly illustrated synthesis of this data. This, in turn, led to a better comprehension of all the factors related to problems of water utilisation in this particular region of Niger. Contrary to the generally accepted view that the lack of water ressources is a major contributing factor to the lack of development in the Sahel, in Gaya the local conditions contradict this statement. In this region, and at the local level, the proper use of water is based on the elaboration of an appropriate policy which takes into account not only the local specifics of water ressources but the various types of water utilsation as well. Local use of water and water ressources are dependant on established rules. Water policy in Niger is defined by the General Schema based on an important institutional and judicary arsenal of rules and regulations. However, after a ten-year trial period, this system was shown to have its limitations. In Gaya, neither the State nor the development agencies took into consideration local characteristics nor the socio-economic context of the region. This, in turn, resulted in putting in place infrastructures that were not adapted to local hydrogeological realities as well as inappropriate choices in land planning and development. In spite of the abundance of water ressources, access to them remains difficult for most of the rural population. The various difficulties encountered are the result of incoherent water policies on a national level as well as the lack of practical application in this area. This is due to a double judicary system where two regulatory systems co-exist:traditional laws and modern legislation. the different elements brought out by this study could serve as a basis for a better utilisation of water ressources on a larger scale in which land planning and development policies would take into consideration all the physcial as well as the socio-economical factors of this region.