Responsiveness et changement thérapeutique au travers de l'études de cas

Le concept de responsiveness ou « responsivité » a été proposé dans le domaine de la recherche en psychothérapie pour décrire l'influence mutuelle qui s'exerce continuellement entre patient et thérapeute. La nature responsive des psychothérapies pose alors un problème majeur aux chercheurs, qui adoptent généralement des plans de recherche impliquant des liens de cause à effet et sont en échec dans leur entreprise de mieux comprendre le changement thérapeutique. L'objectif de notre travail est de proposer des pistes pour répondre à ce problème. Nous avons adopté la méthode d'étude de cas, qui permet une analyse en profondeur et en contexte des processus de changement. Dans les deux premières phases de la recherche, nous nous situions dans une approche spécifique à la recherche qualitative en psychothérapie. Nous avons tout d'abord analysé comment le changement s'effectuait chez le patient, en identifiant pas à pas le niveau d'assimilation de ses expériences problématiques. Nous avons ensuite tenté d'appréhender le rôle du thérapeute dans le processus de changement. Notre objectif était d'analyser comment la responsivité du thérapeute pouvait faciliter le processus de changement chez le patient à chaque instant de la thérapie. En suivant une procédure inspirée de l'analyse de la tâche, nous avons identifié pour chaque niveau d'assimilation des interventions thérapeutiques suivies de progression, et élaboré un modèle empirique séquentiel. Dans la troisième phase de la recherche, nous avons effectué un tournant dans notre parcours et sommes allée du côté des sciences du langage. En adoptant une approche dialogique du discours, notre objectif était d'éclairer notre objet d'étude à partir d'une nouvelle perspective et d'ouvrir la réflexion. Nous avons ainsi pu répondre à certaines limites rencontrées dans les premières phases de la recherche, et faire émerger de nouvelles questions et perspectives pour l'étude des processus de changement dans une dimension interactive. -- The concept of responsiveness was developed in psychotherapy research to describe the mutual and constant influence between patient and therapist. The responsive nature of psychotherapy is a serious problem for researchers, who generally adopt research designs involving cause-effect reasoning and fail to better understand therapeutic change. The purpose of our work is to propose some viable possibilities to respond to this problem. We chose the case study method, which enables an analysis in depth and in context of change processes. In the two first phases of research, our approach was specific to qualitative psychotherapy research. We first analyzed how change occurred in the patient, by identifying moment-by-moment the level of assimilation of his or her problematic experiences. We then tried to apprehend the therapist role in the change process. Our aim was to analyze how the therapist responsiveness could facilitate the patient change process at any moment of psychotherapy. We followed a procedure inspired by task analysis and, for each level of assimilation, we identified therapist interventions followed by progression, and elaborated an empirical sequential model. The third phase of research was a turning point, as we went in the field of linguistics. We adopted a dialogical approach of discourse to open up reflection. Thus, we could answer some limitations encountered in the first phases of research, and new questions and perspectives to study change process taking into account the interactive dimension emerged.

Impact of model complexity on cross-temporal transferability in Maxent species distribution models: An assessment using paleobotanical data

Maximum entropy modeling (Maxent) is a widely used algorithm for predicting species distributions across space and time. Properly assessing the uncertainty in such predictions is non-trivial and requires validation with independent datasets. Notably, model complexity (number of model parameters) remains a major concern in relation to overfitting and, hence, transferability of Maxent models. An emerging approach is to validate the cross-temporal transferability of model predictions using paleoecological data. In this study, we assess the effect of model complexity on the performance of Maxent projections across time using two European plant species (Alnus giutinosa (L.) Gaertn. and Corylus avellana L) with an extensive late Quaternary fossil record in Spain as a study case. We fit 110 models with different levels of complexity under present time and tested model performance using AUC (area under the receiver operating characteristic curve) and AlCc (corrected Akaike Information Criterion) through the standard procedure of randomly partitioning current occurrence data. We then compared these results to an independent validation by projecting the models to mid-Holocene (6000 years before present) climatic conditions in Spain to assess their ability to predict fossil pollen presence-absence and abundance. We find that calibrating Maxent models with default settings result in the generation of overly complex models. While model performance increased with model complexity when predicting current distributions, it was higher with intermediate complexity when predicting mid-Holocene distributions. Hence, models of intermediate complexity resulted in the best trade-off to predict species distributions across time. Reliable temporal model transferability is especially relevant for forecasting species distributions under future climate change. Consequently, species-specific model tuning should be used to find the best modeling settings to control for complexity, notably with paleoecological data to independently validate model projections. For cross-temporal projections of species distributions for which paleoecological data is not available, models of intermediate complexity should be selected.

CRESCIMENTO, DESENVOLVIMENTO E PRODUÇÃO DE MORANGUEIRO A PARTIR DE MUDAS COM DIFERENTES VOLUMES DE TORRÃO

RESUMO O objetivo deste estudo foi avaliar a influência do volume de alvéolos em bandejas no crescimento, no desenvolvimento de mudas e na produção de frutas do morangueiro. Os tratamentos consistiram em quatro volumes de alvéolos (50; 100; 180 e 312 mL) e duas cultivares (‘Camarosa’ e ‘Aromas’), em delineamento experimental de blocos ao acaso, com quatro repetições, nove plantas por parcela, conduzido no período entre abril e dezembro de 2011. Avaliaram-se os seguintes parâmetros: qualidade, crescimento, desenvolvimento das mudas e produção de frutas. Mudas com torrão produzidas em recipientes com maior volume de alvéolos proporcionaram maior precocidade e produção, em decorrência do maior diâmetro da coroa e a massa seca de parte aérea e raízes. Obteve-se correlação significativa entre a massa seca de raízes, massa seca da parte aérea e o diâmetro da coroa com a produção precoce de frutas. A qualidade da muda influencia diretamente na precocidade e na produção de frutas de morangueiro.

Scoring criteria for portable monitor recordings: a comparison of four hypopnoea definitions in a population-based cohort.

RATIONALE: Limited-channel portable monitors (PMs) are increasingly used as an alternative to polysomnography (PSG) for the diagnosis of obstructive sleep apnoea (OSA). However, recommendations for the scoring of PM recordings are still lacking. Pulse-wave amplitude (PWA) drops, considered as surrogates for EEG arousals, may increase the detection sensitivity for respiratory events in PM recordings. OBJECTIVES: To investigate the performance of four different hypopnoea scoring criteria, using 3% or 4% oxygen desaturation levels, including or not PWA drops as surrogates for EEG arousals, and to determine the impact of measured versus reported sleep time on OSA diagnosis. METHODS: Subjects drawn from a population-based cohort underwent a complete home PSG. The PSG recordings were scored using the 2012 American Academy of Sleep Medicine criteria to determine the apnoea-hypopnoea index (AHI). Recordings were then rescored using only parameters available on type 3 PM devices according to different hypopnoea criteria and patients-reported sleep duration to determine the 'portable monitor AHIs' (PM-AHIs). MAIN RESULTS: 312 subjects were included. Overall, PM-AHIs showed a good concordance with the PSG-based AHI although it tended to slightly underestimate it. The PM-AHI using 3% desaturation without PWA drops showed the best diagnostic accuracy for AHI thresholds of ≥5/h and ≥15/h (correctly classifying 94.55% and 93.27% of subjects, respectively, vs 80.13% and 87.50% with PWA drops). There was a significant but modest correlation between PWA drops and EEG arousals (r=0.20, p=0.0004). CONCLUSION: Interpretation of PM recordings using hypopnoea criteria which include 3% desaturation without PWA drops as EEG arousal surrogate showed the best diagnosis accuracy compared with full PSG.

The efficiency of indicator groups for the conservation of amphibians in the Brazilian Atlantic Forest

The adequate selection of indicator groups of biodiversity is an important aspect of the systematic conservation planning. However, these assessments differ in the spatial scale, in the methods used and in the groups considered to accomplish this task, which generally produces contradictory results. The quantification of the spatial congruence between species richness and complementarity among different taxonomic groups is a fundamental step to identify potential indicator groups. Using a constructive approach, the main purposes of this study were to evaluate the performance and efficiency of eight potential indicator groups representing amphibian diversity in the Brazilian Atlantic Forest. Data on the geographic range of amphibian species that occur in the Brazilian Atlantic Forest was overlapped to the full geographic extent of the biome, which was divided into a regular equal-area grid. Optimization routines based on the concept of complementarily were applied to verify the performance of each indicator group selected in relation to the representativeness of the amphibians in the Brazilian Atlantic Forest as a whole, which were solved by the algorithm"simulated annealing", through the use of the software MARXAN. Some indicator groups were substantially more effective than others in regards to the representation of the taxonomic groups assessed, which was confirmed by the high significance of data (F = 312.76; p < 0.01). Leiuperidae was considered as the best indicator group among the families analyzed, as it showed a good performance, representing 71% of amphibian species in the Brazilian Atlantic Forest (i.e. 290 species), which may be associated with the diffuse geographic distribution of its species. This study promotes understanding of how the diversity standards of amphibians can be informative for systematic conservation planning on a regional scale.

Are open mandibular fractures still an emergency?

INTRODUCTION: Early surgical management is often advocated for fractures of the tooth-bearing portion of the mandible. A 6-hour delay has been mentioned for the fixation of these fractures. Our aim was to bring this paradigm into question. METHODS: All patients referred to our department from September 2012 to May 2014 for fractures of the tooth-bearing portion of the mandible were retrospectively included. For each patient, age, gender, aetiology of the fracture, and characteristics of the fractures were recorded. Tobacco and/or alcohol addictions, diabetes and mandibular dental condition were taken into account. We also noticed the preoperative delay and the occurrence of complications such as: haematoma, infection, wound dehiscence, osteosynthesis failure and pseudarthrosis. RESULTS: Among the 47 patients referred, 36 were treated with a delay of more than 6hours (76.6%). In 88.8% of the cases, the reason for this delay was unavoidable. The mean delay time from trauma to surgery was 52hours (range: 7-312). Forty-nine percent of the patients had comorbidities. Complications occurred in 6 patients leading to an overall complication rate of 16.67%. A statistically significant higher complication rate was observed among smokers (P=0.006). No statistical relationship was found between the delay and the occurrence of complications (P=0.994). This study suggests that fractures of the tooth-bearing portion of the mandible should no longer be considered as an emergency that must be treated within a 6-hour delay.

1.2

Le projet Lausanne cohorte 65+ a été conçu en 2003, dans le contexte d'une ville suisse francophone de 125 000 habitants située au centre d'une agglomération lausannoise qui en comptait alors quelque 312 000 et d'un canton de Vaud peuplé de 641 000 résidents. La population étudiée dans ce projet, bien que géographiquement très ciblée, était alors confrontée à des questions sanitaires assez banales dans une Europe exposée à un vieillissement démographique en accélération. Elles étaient, pour l'essentiel, centrées sur la prise en charge de la dépendance fonctionnelle liée au grand âge.

Poliitikot Naturan pöyhijöinä

Keskustelua

High-Resolution Magnetic Resonance Imaging Can Reliably Detect Orbital Tumor Recurrence after Enucleation in Children with Retinoblastoma.

PURPOSE: Orbital tumor recurrence is a rare but serious complication in children with retinoblastoma, leading to a high risk of metastasis and death. Therefore, we assume that these recurrences have to be detected and treated as early as possible. Preliminary studies used magnetic resonance imaging (MRI) to evaluate postsurgical findings in the orbit. In this study, we assessed the diagnostic accuracy of high-resolution MRI to detect orbital tumor recurrence in children with retinoblastoma in a large study cohort. DESIGN: Consecutive retrospective study (2007-2013) assessing MRI findings after enucleation. PARTICIPANTS: A total of 103 MRI examinations of 55 orbits (50 children, 27 male/23 female, mean age 16.3±12.4 months) with a median time of 8 months (range, 0-93) after enucleation for retinoblastoma. METHODS: High-resolution MRI using orbital surface coils was performed on 1.5 Tesla MRI systems to assess abnormal orbital findings. MAIN OUTCOME MEASURES: Five European experts in retinoblastoma imaging evaluated the MRI examinations regarding the presence of abnormal orbital gadolinium enhancement and judged them as "definitive tumor," "suspicious of tumor," "postsurgical condition/scar formation," or "without pathologic findings." The findings were correlated to histopathology (if available), MRI, and clinical follow-up. RESULTS: Abnormal orbital enhancement was a common finding after enucleation (100% in the first 3 months after enucleation, 64.3% >3 years after enucleation). All histopathologically confirmed tumor recurrences (3 of 55 orbits, 5.5%) were correctly judged as "definitive tumor" in MRI. Two orbits from 2 children rated as "suspicious of tumor" received intravenous chemotherapy without histopathologic confirmation; further follow-up (67 and 47 months) revealed no sign of tumor recurrence. In 90.2%, no tumor was suspected on MRI, which was clinically confirmed during follow-up (median follow-up after enucleation, 45 months; range, 8-126). CONCLUSIONS: High-resolution MRI with orbital surface coils may reliably distinguish between common postsurgical contrast enhancement and orbital tumor recurrence, and therefore may be a useful tool to evaluate orbital tumor recurrence after enucleation in children with retinoblastoma. We recommend high-resolution MRI as a potential screening tool for the orbit in children with retinoblastoma to exclude tumor recurrence, especially in high-risk patients within the critical first 2 years after enucleation.

Berceuse

Soitinnus: piano.

Validação de metodologia analítica para o doseamento simultâneo de mebendazol e tiabendazol por cromatografia líquida de alta eficiência

The aim of this work was to develop and validate an analytical methodology for simultaneous determination of mebendazole and thiabendazole, two benzimidazoles used as anthelmintics. The method was based on high performance liquid chromatography, using a C18 column, a mobile phase composed of KH2PO4 0.05 mol L-1 and methanol 40:60 (v/v) and UV detection at 312 nm. The results showed that the method presented linearity from 60.0 to 140.0 µg mL-1 for mebendazole and from 99.6 to 232.4 g µL-1 for thiabendazole and it was considered selective, accurate, precise and robust according to the specific resolution from ANVISA, the Brazilian regulatory agency.

La première génération d’écrivains d’origine amazighe dans la littérature catalane: Laila Karrouch (Nador, 1977) et Najat El Hachmi (Nador, 1979). Leur signification et valeur.

La Catalogne a accueilli entre la fin du XXe siècle et le début du XXIe siècle une importante vague d’immigrés aux origines les plus diverses. Les Marocains ont constitué le premier flot de cette vague et ont donné naissance, par le biais des oeuvres de Laila Karrouch et de Najat El Hachmi, à une littérature pionnière construite dans la tension entre deux mondes, le Maghreb et la Catalogne. Cette littérature, faite d’expériences vécues profondes, va permettre à beaucoup d’autres, à la fois, de garder leur identité et de se sentir citoyens de leur nouveau pays.

Triterpenes and antitubercular activity of Byrsonima crassa

We evaluated the potential antitubercular activity of triterpenes obtained from leaves and bark of Byrsonima crassa. From chloroform extracts of the leaves, by bioassay-guided fractionation, we obtained mixtures of known triterpenes: α-amyrin, β-amyrin and their acetates, lupeol, oleanolic acid, ursolic acid and α-amyrinone. Tested against Mycobacterium tuberculosis, the triterpenes exhibited minimum inhibitory concentrations (MICs) of 31.25 - 312.25 µg/mL. β-amyrin and friedelin, isolated from the chloroform extract of bark, showed MICs of 312.25 and 125 µg/mL respectively. This is the first report of the identification and determination of the activity of B. crassa triterpenes against M. tuberculosis.