Characteristics and quality of care of diabetic patients residing int the canton of Vaud

Introduction: Within the framework of the «Programme cantonal Diabète», we aimed at collecting data to 1) describe the population of diabetic patients in the canton of Vaud, and 2) assess the quality of their care. Methods: A cross-sectional study was conducted in the fall of 2011. Out of 140 randomly selected community pharmacies registered in the canton of Vaud, 56 accepted to participate in patients' recruitment. Noninstitutionalized adult diabetic patients (disease duration >12 months) visiting a pharmacy with a prescription for oral anti-diabetic drugs, insulin, glycemic strips or glucose meter were eligible. Patients not residing in the canton of Vaud, not speaking and understanding French well enough, presenting obvious cognitive impairment, and women with gestational diabetes, were excluded. Using a self-administered questionnaire, data was collected on patients' characteristics and diabetes as well as various process (e.g. recommended annual screenings) and outcomes quality of care indicators. Descriptive analyses were performed. Results: A total of 406 patients with diabetes participated. Mean age was 64 years, 41% were women and 63% were married. Patients reported type 1, 2 and other types of diabetes in 13%, 69% and 19%, respectively. They were treated with oral anti-diabetic drugs, insulin or both in 50%, 23% and 27% of the cases. Half of the patients did not report any diabetes-related complication. Glucose self-monitoring was reported by 82% of the patients. Of those who were aware of HbA1C (n = 218), 98% reported at least one HbA1C control during the last 12 months. During that same time frame, 97% and 95% reported at least one blood pressure and weight measure, 94% reported having had a cholesterol check, 74%, 68% and 64% had eyes, feet and urine screening respectively. 62% of the patients had been immunized against influenza. At least 76% of the patients had a minimum of 5 of the 7 described process indicators performed during the last 12 months. Among patients who knew the value (n = 145), mean HbA1C was 7.4 (SD 1.2). Conclusion: This study targeting community-based diabetic patients shows that while routine clinical and laboratory tests were annually performed in the vast majority of patients, feet and urine screening, as well as influenza immunization, were less often reported by patients. The proportion of patients with diabetes having had at least 5 out of the 7 annual screenings performed was nevertheless very high.

Influence of stationary phase and eluent properties on chromatographic separation of carbohydrates

In this thesis, the sorption and elastic properties of the cation-exchange resins were studied to explain the liquid chromatographic separation of carbohydrates. Na+, Ca2+ and La3+ form strong poly(styrene-co-divinylbenzene) (SCE) as well as Na+ and Ca2+ form weak acrylic (WCE) cation-exchange resins at different cross-link densities were treated within this work. The focus was on the effects of water-alcohol mixtures, mostly aqueous ethanol, and that of the carbohydrates. The carbohydrates examined were rhamnose, xylose, glucose, fructose, arabinose, sucrose, xylitol and sorbitol. In addition to linear chromatographic conditions, non-linear conditions more typical for industrial applications were studied. Both experimental and modeling aspectswere covered. The aqueous alcohol sorption on the cation-exchangers were experimentally determined and theoretically calculated. The sorption model includes elastic parameters, which were obtained from sorption data combined with elasticity measurements. As hydrophilic materials cation-exchangers are water selective and shrink when an organic solvent is added. At a certain deswelling degree the elastic resins go through glass transition and become as glass-like material. Theincreasing cross-link level and the valence of the counterion decrease the sorption of solvent components in the water-rich solutions. The cross-linkage or thecounterions have less effect on the water selectivity than the resin type or the used alcohol. The amount of water sorbed is higher in the WCE resin and, moreover, the WCE resin is more water selective than the corresponding SCE resin. Theincreased aliphatic part of lower alcohols tend to increase the water selectivity, i.e. the resins are more water selective in 2-propanol than in ethanol solutions. Both the sorption behavior of carbohydrates and the sorption differences between carbohydrates are considerably affected by the eluent composition and theresin characteristics. The carbohydrate sorption was experimentally examined and modeled. In all cases, sorption and moreover the separation of carbohydrates are dominated by three phenomena: partition, ligand exchange and size exclusion. The sorption of hydrophilic carbohydrates increases when alcohol is added into the eluent or when carbohydrate is able to form coordination complexes with the counterions, especially with multivalent counterions. Decreasing polarity of the eluent enhances the complex stability. Size exclusion effect is more prominent when the resin becomes tighter or carbohydrate size increases. On the other hand,the elution volumes between different sized carbohydrates decreases with the decreasing polarity of the eluent. The chromatographic separation of carbohydrateswas modeled, using rhamnose and xylose as target molecules. The thermodynamic sorption model was successfully implemented in the rate-based column model. The experimental chromatographic data were fitted by using only one adjustable parameter. In addition to the fitted data also simulated data were generated and utilized in explaining the effect of the eluent composition and of the resin characteristics on the carbohydrate separation.

Fingermark initial composition and aging using Fourier transform infrared microscopy (μ-FTIR)

This study investigated fingermark residues using Fourier transform infrared microscopy (μ- FTIR) in order to obtain fundamental information about the marks' initial composition and aging kinetics. This knowledge would be an asset for fundamental research on fingermarks, such as for dating purposes. Attenuated Total Reflection (ATR) and single-point reflection modes were tested on fresh fingermarks. ATR proved to be better suited and this mode was subsequently selected for further aging studies. Eccrine and sebaceous material was found in fresh and aged fingermarks and the spectral regions 1000-1850 cm-1 and 2700-3600 cm-1 were identified as the most informative. The impact of substrates (aluminium and glass slides) and storage conditions (storage in the light and in the dark) on fingermark aging was also studied. Chemometric analyses showed that fingermarks could be grouped according to their age regardless of the substrate when they were stored in an open box kept in an air-conditioned laboratory at around 20°C next to a window. On the contrary, when fingermarks were stored in the dark, only specimens deposited on the same substrate could be grouped by age. Thus, the substrate appeared to influence aging of fingermarks in the dark. Furthermore, PLS regression analyses were conducted in order to study the possibility of modelling fingermark aging for potential fingermark dating applications. The resulting models showed an overall precision of ±3 days and clearly demonstrated their capability to differentiate older fingermarks (20 and 34-days old) from newer ones (1, 3, 7 and 9-days old) regardless of the substrate and lighting conditions. These results are promising from a fingermark dating perspective. Further research is required to fully validate such models and assess their robustness and limitations in uncontrolled casework conditions.

AA amyloidosis treated with tocilizumab: case series and updated literature review.

BACKGROUND: In published case reports, tocilizumab (TCZ) has shown good efficacy for AA amyloidosis in almost all patients. We investigated the efficacy and safety of TCZ in AA amyloidosis in a multicentre study of unselected cases. METHODS: We e-mailed rheumatology and internal medicine departments in France, Switzerland and North Africa by using the Club Rhumatismes Inflammation (CRI) network and the French TCZ registry, Registry RoAcTEmra (REGATE), to gather data on consecutive patients with histologically proven AA amyloidosis who had received at least one TCZ infusion. Efficacy was defined as a sustained decrease in proteinuria level and/or stable or improved glomerular filtration rate (GFR) and by TCZ maintenance. RESULTS: We collected 12 cases of AA amyloidosis treated with TCZ as monotherapy (mean age of patients 63 ± 16.2 years, amyloidosis duration 20.6 ± 31.3 months): eight patients had rheumatoid arthritis (RA), six with previous failure of anti-tumor necrosis factor α (anti-TNF-α) therapy. In total, 11 patients had renal involvement, with two already on hemodialysis (not included in the renal efficacy assessment). For the nine other patients, baseline GFR and proteinuria level were 53.6 ± 32.8 mL/min and 5 ± 3.3 g/24 h, respectively. The mean follow-up was 13.1 ± 11 months. TCZ was effective for six of the eight RA patients (87.5%) according to European League Against Rheumatism response criteria (four good and two moderate responders). As expected, C-reactive protein (CRP) level decreased with treatment for 11 patients. Renal amyloidosis (n = 9) progressed in three patients and was stabilized in three. Overall, three patients showed improvement, with sustained decrease in proteinuria level (42%, 82% and 96%). Baseline CRP level was higher in subsequent responders to TCZ than other patients (p = 0.02). Among the six RA patients with previous anti-TNF-α therapy, amyloidosis was ameliorated in one and stabilized in three. Three serious adverse events occurred (two diverticulitis and one major calciphylaxia due to renal failure). Finally, 7 of 12 (58%) patients continued TCZ. CONCLUSIONS: The efficacy of TCZ for AA amyloidosis varies depending on the inflammatory status at treatment onset. Discrepancies between our study of unselected consecutive patients and reported cases may be due to publication bias. These results support further prospective trials of TCZ for AA amyloidosis.

High-resolution computed tomography and histopathological findings in hypersensitivity pneumonitis: a pictorial essay

Abstract Hypersensitivity pneumonitis is a diffuse interstitial and granulomatous lung disease caused by the inhalation of any one of a number of antigens. The objective of this study was to illustrate the spectrum of abnormalities in high-resolution computed tomography and histopathological findings related to hypersensitivity pneumonitis. We retrospectively evaluated patients who had been diagnosed with hypersensitivity pneumonitis (on the basis of clinical-radiological or clinical-radiological-pathological correlations) and had undergone lung biopsy. Hypersensitivity pneumonitis is clinically divided into acute, subacute, and chronic forms; high-resolution computed tomography findings correlate with the time of exposure; and the two occasionally overlap. In the subacute form, centrilobular micronodules, ground-glass opacities, and air trapping are characteristic high-resolution computed tomography findings, whereas histopathology shows lymphocytic inflammatory infiltrates, bronchiolitis, variable degrees of organizing pneumonia, and giant cells. In the chronic form, high-resolution computed tomography shows traction bronchiectasis, honeycombing, and lung fibrosis, the last also being seen in the biopsy sample. A definitive diagnosis of hypersensitivity pneumonitis can be made only through a multidisciplinary approach, by correlating clinical findings, exposure history, high-resolution computed tomography findings, and lung biopsy findings.

Symmetric pollen mitosis I and suppression of pollen mitosis II prevent pollen development in Brachiaria jubata (Gramineae)

Microsporogenesis and pollen development were analyzed in a tetraploid (2n = 4x = 36) accession of the forage grass Brachiaria jubata (BRA 007820) from the Embrapa Beef Cattle Brachiaria collection that showed partial male sterility. Microsporocytes and pollen grains were prepared by squashing and staining with 0.5% propionic carmine. The meiotic process was typical of polyploids, with precocious chromosome migration to the poles and laggards in both meiosis I and II, resulting in tetrads with micronuclei in some microspores. After callose dissolution, microspores were released into the anther locule and appeared to be normal. Although each microspore initiated its differentiation into a pollen grain, in 11.1% of them nucleus polarization was not observed, i.e., pollen mitosis I was symmetric and the typical hemispherical cell plate was not detected. After a central cytokinesis, two equal-sized cells showing equal chromatin condensation and the same nuclear shape and size were formed. Generative cells and vegetative cells could not be distinguished. These cells did not undergo the second pollen mitosis and after completion of pollen wall synthesis each gave rise to a sterile and uninucleate pollen grain. The frequency of abnormal pollen mitosis varied among flowers and also among inflorescences. All plants were equally affected. The absence of fertile sperm cells in a considerable amount of pollen grains in this accession of B. jubata may compromise its use in breeding and could explain, at least in part, why seed production is low when compared with the amount of flowers per raceme.

In vitro inhibitory effects of imatinib mesylate on stromal cells and hematopoietic progenitors from bone marrow

Imatinib mesylate (IM) is used to treat chronic myeloid leukemia (CML) because it selectively inhibits tyrosine kinase, which is a hallmark of CML oncogenesis. Recent studies have shown that IM inhibits the growth of several non-malignant hematopoietic and fibroblast cells from bone marrow (BM). The aim of the present study was to evaluate the effects of IM on stromal and hematopoietic progenitor cells, specifically in the colony-forming units of granulocyte/macrophage (CFU-GM), using BM cultures from 108 1.5- to 2-month-old healthy Swiss mice. The results showed that low concentrations of IM (1.25 µM) reduced the growth of CFU-GM in clonogenic assays. In culture assays with stromal cells, fibroblast proliferation and α-SMA expression by immunocytochemistry analysis were also reduced in a concentration-dependent manner, with a survival rate of approximately 50% with a dose of 2.5 µM. Cell viability and morphology were analyzed using MTT and staining with acrydine orange/ethidium bromide. Most cells were found to be viable after treatment with 5 µM IM, although there was gradual growth inhibition of fibroblastic cells while the number of round cells (macrophage-like cells) increased. At higher concentrations (15 µM), the majority of cells were apoptotic and cell growth ceased completely. Oil red staining revealed the presence of adipocytes only in untreated cells (control). Cell cycle analysis of stromal cells by flow cytometry showed a blockade at the G0/G1 phases in groups treated with 5-15 µM. These results suggest that IM differentially inhibits the survival of different types of BM cells since toxic effects were achieved.

Postharvest respiratory activity and changes in some chemical constituents during maturation of yellow mombin (Spondias mombin) fruit

Mature fruit from the yellow mombin (Spondias mombin) was monitored for its respiration activity. Mature green fruit from the yellow mombin was stored in closed glass chambers and the concentration of oxygen and carbon dioxide at the end of a six hour respiration period was determined. At the same interval of time, the lid of the chamber was opened for air renewal. The increase in carbon dioxide and decrease in oxygen concentration demonstrated that the fruit was climacteric. The maximum liberation of CO2 54.2 mL Kg-1 h-1 and maximum absorption of O2 49.0 mL Kg-1 h-1 occurred 186 hours after the harvest which, obviously, represented the optimum fruit quality after the senescence process started. The respiratory quotient of fruit at a climacteric maximum was 1.11 representing the oxidation of carbohydrates. Total soluble solids increased from 9.1 °Brix (initial) to 13.7 °Brix (climacteric maximum) during maturation, while the total number of acids in the fruit decreased during maturation i.e. from 1.55% initially to 1.40% at pre-climacteric, 1.0% at climacteric maximum and 0.8% in the post-climacteric stage. A similar behaviour was observed in the case of ascorbic acid. There was a continuous decrease in chlorophyll and a continuous increase in the carotenoid content of fruit during maturation.

Phase transitions in biodegradable films based on blends of gelatin and poly (vinyl alcohol)

The aim of this work was to study the effect of the hydrolysis degree (HD) and the concentration (C PVA) of two types of poly (vinyl alcohol) (PVA) and the effect of the type and the concentration of plasticizers on the phase properties of biodegradable films based on blends of gelatin and PVA, using a response-surface methodology. The films were made by casting and the studied properties were their glass (Tg) and melting (Tm) transition temperatures, which were determined by diferential scanning calorimetry (DSC). For the data obtained on the first scan, the fitting of the linear model was statistically significant and predictive only for the second melting temperature. In this case, the most important effect on the second Tm of the first scan was due to the HD of the PVA. In relation to the second scan, the linear model could be fit to Tg data with only two statistically significant parameters. Both the PVA and plasticizer concentrations had an important effect on Tg. Concerning the second Tm of the second scan, the linear model was fit to data with two statistically significant parameters, namely the HD and the plasticizer concentration. But, the most important effect was provoked by the HD of the PVA.

Tetrazolium test for evaluating triticale seed viability

Freshly harvested triticale seeds are usually dormant, making the immediate evaluation of the physiological potential of seed lots difficult. We evaluated different triphenyl tetrazolium chloride (TTC) test methods for rapidly determining the viability of four seed lots of x.Triticosecale Wittmack cultivar IPR111. The test variables were: Preconditioning, (i) placing whole seeds between moistened paper towels or (ii) directly soaking the seeds in water, both procedures being conducted at 20 ºC for 18 hours; Post-conditioning seed preparation, (i) longitudinal bisection of the seed through the embryo with one half being stained and the other discarded or (ii) longitudinal bisection with both halves being stained; Staining for three and four hours, in the dark, with 0.1%, 0.5% or 1.0% (w/v) TTC according to the preconditioning method described above, (i) both halves of each seed were placed on filter paper moistened with TTC and maintained at 40 ºC or (ii) one half of each seed was immersed in 5 mL of TTC solution in a 100 mL glass beaker at 30 ºC. The best results were obtained by preconditioning seeds between moistened paper towels at 20 ºC for 18 hours and staining on filter paper with 1.0% (w/v) TTC for three hours at 40 ºC.

Patterns in space : a regional study of motif in Minoan wall painting

This thesis consists of a quantitative analysis of the regional prevalence of certain artistic motifs as they appear in Minoan wall painting of the Neopalatial period. This will help to establish the relative degree of artistic autonomy exercised by each of the sites included in this study. The results show that the argument for itinerant artists during this time period is a strong one, but the assumption that these travelling artists were being controlled by any one palace-centre is erroneous. Rather, the similarities and differences seen suggest that the choices were predicated either by the specific patrons, or by the function of the associated building or room. Thus, the motifs found within this study should be understood as constituting a cultural identity, with greater or lesser degrees of regional homogeneity, which act as one facet of a number of cultural indicators that can be used to better understand the role of artists and regional dynamics on the island during the Bronze Age.

Niagara Falls Seminary [school for young Ladies] advertisement, ca. 1840

One broadside advertising the Niagara Falls Seminary [school for young Ladies], run by Mrs. Shotter of Drummondville, ca. 1840. The advertisement contains information about fees and courses, including a complete English education, music, French, drawing and flower painting, and dancing. The bottom of the page contains a list of references for Mrs. Shotter, including Ex-Consul Buchanan, Colonel Delatre, Rev. W. Leeming, Rector of Chippawa (all of Drummondville); Dr. Mewburn (Stamford); Rev. T.B. Fuller, Rector of Thorold; John Stayner, Esq., P.M. Queenston; William Gamble, Esq., Milton, near Toronto; and Hon. John Hamilton, Kingston.

Niagara Falls Seminary [school for young Ladies] advertisement, ca. 1840

One broadside advertising the Niagara Falls Seminary [school for young Ladies], run by Mrs. Shotter of Drummondville, ca. 1840. The advertisement contains information about fees and courses, including a complete English education, music, French, drawing and flower painting, and dancing. The bottom of the page contains a list of references for Mrs. Shotter, including Ex-Consul Buchanan, Colonel Delatre, Rev. W. Leeming, Rector of Chippawa (all of Drummondville); Dr. Mewburn (Stamford); Rev. T.B. Fuller, Rector of Thorold; John Stayner, Esq., P.M. Queenston; William Gamble, Esq., Milton, near Toronto; and Hon. John Hamilton, Kingston.

Letter to S.D. Woodruff from George C. Flint and Co.

Letter to S.D. Woodruff from George C. Flint and Co., Upholsterers and Furniture Manufacturers of New York regarding items such as mantle glass, cornices and fabrics. They have enclosed a handwritten price list with this letter (4 pages, handwritten), Sept. 13, 1876.

Symbolique florale dans le tableau de Jean-Baptiste Belin de Fontenay Vase d’or, fleurs et buste de Louis XIV (1687)

Le tableau de Jean-Baptiste Belin de Fontenay intitulé Vase d’or, fleurs et buste de Louis XIV est le morceau de réception que le peintre a présenté à l’Académie royale de peinture et de sculpture en 1687. Malheureusement peu étudié, ce tableau n’en comporte pas moins trois problématiques très intéressantes. Tout d’abord, il rassemble trois genres de peinture dans une seule composition : la nature morte, le portrait et la peinture d’histoire, illustrés respectivement par les fleurs, le buste du roi et la pièce d’armure. L’association de ces trois genres dans un tableau de nature morte est peu commune dans la peinture française du 17e siècle. Il est donc nécessaire de vérifier s’il existe un lien entre les fleurs, l’image de Louis XIV et l’armure. Ensuite, le contraste entre la polychromie des fleurs et la monochromie de la sculpture et de l’ameublement est frappante ; il est possible de lier ce contraste au phénomène des débats entre le dessin et la couleur de l’Académie royale de peinture et de sculpture à la deuxième moitié du 17e siècle. D’ailleurs, les fleurs, qui n’étaient pas le sujet central dans le programme original de Le Brun, deviennent le sujet principal du tableau et occupent une place plus importante que le buste de Louis XIV. Cette modification n’a cependant pas choqué les juges de l’Académie puisque la toile a été acceptée sans contestation. Elle amène donc à s’interroger sur la hiérarchie des genres de peinture qui est la doctrine officielle de l’Académie royale de peinture et de sculpture de l’époque. Le noyau de la recherche consiste à vérifier si les fleurs n’occupent qu’une simple fonction décorative ou si elles peuvent être associées à des symboles. Notre recherche examine d’abord l’utilisation des symboles floraux dans la culture française du 17e siècle. Par la suite, elle étudie cette utilisation dans le domaine politique, à savoir que les fleurs pourraient être liées à la louange de Louis XIV. Enfin, elle analyse les domaines artistiques et esthétiques, c’est-à-dire la façon dont le tableau reflète, par l’utilisation des symboles floraux, l’évolution des théories de l’art, la hiérarchie des genres de peinture et les débats du dessin et de la couleur, en France, durant la deuxième moitié du 17e siècle.