La médecine ambulatoire youth-friendly. [Youth-friendly outpatient care].

Ambulatory pediatric and family medicine takes care of adolescent patients, most of whom regularly consult a physician. Consultations with young people involve issues specifically related to their age. Regarding health care systems and physicians, adolescents' expectations vary from those of adults, not so much in terms of the issues discussed but in terms of the priorities that they give to them. Confidential interviews are not always proposed but are highly appreciated, as are certain personal qualities on the part of the caregivers such as honesty, respect, and friendliness. Finally, easy access to care together with the continuity of care are essential. Prevention of risk behaviors by screening and health education is clearly insufficient. This issue could be approached during the consultation through a psychosocial history. This is a good opportunity to discuss sensitive issues that adolescents seldom bring up themselves. More systematic prevention would probably decrease youth morbidity and mortality, which are both closely related to risk behaviors. To meet these expectations and special health care needs, the World Health Organization has developed the concept of youth-friendly health services. This concept can be applied in both a specialized adolescence center and a pediatric or family practice. Youth-friendly services are still rarely evaluated but seem to bring a clear benefit in terms of patient satisfaction and access to care.

Female adolescents' views on a youth-friendly clinic

Rapport de synthèse : La satisfaction des patients concernant leur prise en charge fait maintenant partie intégrante de la qualité des soins. Elle a été évaluée à maintes reprises chez des patients adultes ou pédiatriques, mais rarement chez des patients adolescents. Les attentes des adolescents par rapport aux services de soins ont par contre été souvent étudiées et certains facteurs semblent particulièrement importants. Parmi ceux-ci, citons la confidentialité, le respect, l'honnêteté, l'écoute, l'accès aux soins ou le fait d'avoir des informations compréhensibles. L'Organisation Mondiale de la Santé a développé le concept de 'Youth-friendly health services' pour répondre aux besoins et attentes particuliers des adolescents. Il est basé sur sept principes : l'accessibilité, l'équité, l'efficience, l'efficacité, le fait d'être approprié et compréhensible. Notre objectif était d'évaluer la satisfaction des adolescentes consultant dans une clinique multidisciplinaire pour adolescents basée sur le modèle 'Youth-friendly health services' et de déterminer les facteurs qui y sont associés. Nous avons fait une enquête transversale dans une clinique pour adolescents à Lausanne entre mars et mai 2008 moyennant un questionnaire anonyme auto-administré. Tous les patients qui avaient consulté au moins une fois auparavant étaient éligibles. Nous avons ensuite éliminé les garçons, en très petit nombre et donc de faible valeur statistique. Trois cents onze patientes âgées de 12 à 22 ans ont été inclues dans l'étude. Nous avons effectué des analyses bivariées pour comparer les patientes satisfaites et non satisfaites puis avons construit un modèle log- linéaire afin de déterminer les facteurs directement ou indirectement liés à la satisfaction des patientes. Nonante-quatre pourcent des patientes étaient satisfaites. Les facteurs significativement associés à la satisfaction des adolescentes étaient les suivants : Les jeunes filles se sentaient plus écoutées en ce qui concerne leurs plaintes, et avaient plus l'impression que le soignant les comprenait. Elles avaient aussi moins changé de soignant durant le suivi, avaient plus l'impression d'avoir bénéficié du traitement adéquat et pensaient avoir plus suivi les conseils du soignant. Le modèle log-linéaire que nous avons effectué a mis en avant quatre facteurs directement liés à la satisfaction des patientes, qui sont la continuité des soins, le résultat de la prise en charge, l'adhérence au traitement et le sentiment d'être comprise par le soignant. Ces résultats mettent en avant l'importance de la relation interpersonnelle entre le soignant et le patient, mais rendent aussi attentif à des aspects qui pourraient être améliorés, en ce qui concerne par exemple la continuité des soins. En effet, une clinique comme la nôtre fait partie d'un hôpital de formation et le tournus fréquent des soignants est inévitable. Les changements de médecins et autres soignants devraient alors être préparés et expliqués aux patients avec la plus grande attention. L'adhérence au traitement semble être fortement liée à la satisfaction des patients, mais la nature de notre étude ne permet pas de conclure à une relation de cause à effet. Nous pouvons tout de même supposer qu'elle est une conséquence de la satisfaction des patients. Enfin, la confidentialité et l'accès aux soins souvent cités comme essentiels à la satisfaction des patients dans la littérature étaient secondaires dans notre étude. En conclusion, la satisfaction des adolescentes était principalement basée sur une relation de confiance de longue durée avec leurs soignants. Les pédiatres occupent une place privilégiée pour répondre à ces besoins parce qu'ils connaissent leurs patients depuis l'enfance. Ils devraient cependant garder à l'esprit que la relation avec le patient change au moment de l'adolescence et que les jeunes sont très sensibles à la relation de confiance interpersonnelle qu'ils ont avec leur médecin.

New reference tables and user-friendly Internet application for predicted heart weights.

BACKGROUND: Knowledge of normal heart weight ranges is important information for pathologists. Comparing the measured heart weight to reference values is one of the key elements used to determine if the heart is pathological, as heart weight increases in many cardiac pathologies. The current reference tables are old and in need of an update. AIMS: The purposes of this study are to establish new reference tables for normal heart weights in the local population and to determine the best predictive factor for normal heart weight. We also aim to provide technical support to calculate the predictive normal heart weight. METHODS: The reference values are based on retrospective analysis of adult Caucasian autopsy cases without any obvious pathology that were collected at the University Centre of Legal Medicine in Lausanne from 2007 to 2011. We selected 288 cases. The mean age was 39.2 years. There were 118 men and 170 women. Regression analyses were performed to assess the relationship of heart weight to body weight, body height, body mass index (BMI) and body surface area (BSA). RESULTS: The heart weight increased along with an increase in all the parameters studied. The mean heart weight was greater in men than in women at a similar body weight. BSA was determined to be the best predictor for normal heart weight. New reference tables for predicted heart weights are presented as a web application that enable the comparison of heart weights observed at autopsy with the reference values. CONCLUSIONS: The reference tables for heart weight and other organs should be systematically updated and adapted for the local population. Web access and smartphone applications for the predicted heart weight represent important investigational tools.

Five-year monitoring of a gay-friendly voluntary counselling and testing facility in Switzerland: who got tested and why?

ABSTRACT: BACKGROUND: An increase in new HIV cases among men who have sex with men (MSM) has been reported in Switzerland since 2001. A rapid result HIV testing for MSM through voluntary counselling and testing (VCT) facility ("Checkpoint") was opened in Geneva in 2005. This gay-friendly facility, the first to open in Switzerland, provides testing for sexually transmitted infections (STI) and rapid result HIV testing and counselling. Our objective was to analyze Checkpoint's activity over its first five years of activity and its ability to attract at-risk MSM. METHODS: We used routine data collected anonymously about the facility activity (number of clients, number of tests, and test results) and about the characteristics of the clientele (sociodemographic data, sexual risk behaviour, and reasons for testing) from 2005 to 2009. RESULTS: The yearly number of HIV tests performed increased from 249 in 2005 to 561 in 2009. The annual proportion of positive tests among tests performed varied between 2% and 3%. Among MSM clients, the median annual number of anal intercourse (AI) partners was three. Roughly 30% of all MSM clients had at least one unprotected anal intercourse (UAI) experience in the previous 12 months with a partner of different/unknown HIV status.The main reason for testing in 2007, 2008, and 2009 was "sexual risk exposure" (~40%), followed by "routine" testing (~30%) and "condom stopping in the beginning of a new steady relationship" (~10%). Clients who came to the facility after a sexual risk exposure, compared to clients who came for "routine testing" or "condom stopping" reasons, had the highest number of AI partners in the previous 12 months, were more likely to have had UAI with a partner of different/unknown HIV status in the previous 12 months (respectively 57.3%, 12.5%, 23.5%), more likely to have had an STI diagnosed in the past (41.6%, 32.2%, 22.9%), and more likely to report recent feelings of sadness or depression (42.6%; 32.8%, 18.5%). CONCLUSION: Many of Checkpoint's clients reported elevated sexual risk exposure and risk factors, and the annual proportion of new HIV cases in the facility is stable. This VCT facility attracts the intended population and appears to be a useful tool contributing to the fight against the HIV epidemic among MSM in Switzerland.

A user-friendly web portal for T-Coffee on supercomputers

Background: Parallel T-Coffee (PTC) was the first parallel implementation of the T-Coffee multiple sequence alignment tool. It is based on MPI and RMA mechanisms. Its purpose is to reduce the execution time of the large-scale sequence alignments. It can be run on distributed memory clusters allowing users to align data sets consisting of hundreds of proteins within a reasonable time. However, most of the potential users of this tool are not familiar with the use of grids or supercomputers. Results: In this paper we show how PTC can be easily deployed and controlled on a super computer architecture using a web portal developed using Rapid. Rapid is a tool for efficiently generating standardized portlets for a wide range of applications and the approach described here is generic enough to be applied to other applications, or to deploy PTC on different HPC environments. Conclusions: The PTC portal allows users to upload a large number of sequences to be aligned by the parallel version of TC that cannot be aligned by a single machine due to memory and execution time constraints. The web portal provides a user-friendly solution.

Privacy-friendly Business Models for Location-Based Mobile Services

This paper presents a theoretical model to analyze the privacy issues around location based mobile business models. We report the results of an exploratory field experiment in Switzerland that assessed the factors driving user payoff in mobile business. We found that (1) the personal data disclosed has a negative effect on user payoff; (2) the amount of personalization available has a direct and positive effect, as well as a moderating effect on user payoff; (3) the amount of control over user's personal data has a direct and positive effect, as well as a moderating effect on user payoff. The results suggest that privacy protection could be the main value proposition in the B2C mobile market. From our theoretical model we derive a set of guidelines to design a privacy-friendly business model pattern for third-party services. We discuss four examples to show the mobile platform can play a key role in the implementation of these new business models.

Unsaturated Polyester Coatings containing Biocides

Vesistöissä laivojen pintaan tarttuvat eliöt ovat sekä taloudellinen että kosmeettinen ongelma. Kontrolloimattoman eliöiden kiinnittymisen seurauksena aiheutuu kitkaa, joka puolestaan hidastaa laivan nopeutta ja aiheuttaa polttoaineen kulutuksen kasvua. Tavallisesti eliöiden kiinnittymistä ehkäistään kiinnittymisenestomaalien avulla. Niiden toiminta perustuu biosidien liukenemiseen, jolloin veden ja pinnoitteen väliselle rajapinnalle muodostuu korkea biosidipitoisuus, joka estää eliöiden kiinnittymistä pinnalle. Maailmanlaajuinen orgaanisten tinayhdisteiden käyttökielto kiinnittymisen-estomaaleissa tulee voimaan vuoden 2003 alusta. Tällä hetkellä 70 % maailman laivastoista on suojattu orgaanista tinayhdistettä sisältävällä kiinnittymisenestomaalilla. Nyt onkin kasvava tarve kehittää uusia ympäristöystävällisempiä kiinnittymisenesto-pinnoitteita. Todennäköisesti tinayhdisteet tullaan korvaamaan synteettisillä orgaanisilla yhdisteillä käytettyinä yhdessä kuparin kanssa. Työn tarkoituksena oli valmistaa ympäristöystävällisempi tyydyttämätön polyesteripinnoite, joka itsessään ehkäisisi eliöiden kiinnittymistä. Kirjallisuusosassa tutustuttiin markkinoilla oleviin biosideihin, niiden myrkyllisyyteen ja vaikutuksiin ympäristölle sekä muuttuvaan lainsäädäntöön. Työssä tarkasteltiin myös tällä hetkellä markkinoilla olevia pinnoitteita ja niiden toimintamekanismeja sekä myrkyttömiä vaihtoehtopinnoitteita kiinnittymisenestoon. Kokeellinen osa koostui kahdesta osasta. Ensimmäisessä osassa tutkittiin biosidien sopivuutta käytettäväksi yhdessä tyydyttymättömän polyesterin kanssa. Yhteensopivuutta määritettiin applikaatiotesteillä ja pinnoitteen käyttäytymisen perusteella. Toinen vaihe oli selvittää pinnoitteen tehokkuus leväntarttumista vastaan. Tyydyttymätön polyesteri gel coat kiinnittymisenesto-ominaisuuksilla valmistettiin dispergoimalla biosideja tyydyttymättömään polyesterigeeliin. Yhteensopivuustestien tulosten perusteella huomattiin, ettei biosidien lisääminen geeliin vaikuta mainittavasti applikaatio-ominaisuuksien huononemiseen. Brookfield viskositeetin stabiilisuus jopa paranee ja yksi työssä käytetyistä biosideista parantaa pinnoitteen säänkestoominaisuuksia. Tässä työssä ei pystytty määrittämään eri biosidien välisiä eroja tehokkuudessa levää vastaan.

Safety and sustainability research for university schools of fine arts

Designing new teaching programs for both undergraduate and graduate university studies involves integrating concepts and methodologies regarding quality, work safety and hazard prevention, and environmental protection. One of the challenges facing Spanish research within the realm of European Higher Education concerns health and safety issues in the Arts.In the case of Fine Arts, student exploration is one of the fundamental pillars of the study program; therefore it is imperative that art studios be optimized. This optimization affects both designated resources (infrastructures, materials, equipment, etc.) and organization of the teaching force.In this context, the aim of our research is to improve educational practices by designing quality measures that are both friendly to the environment and hazardous free. The aim here is to assure adequate art studio and laboratory management, and provide students with hazard free health and environmentally safe concepts that can be incorporated in their professional lives.The school of Fine Arts at the University of Barcelona is part of a pilot program, where our experience in educational innovation and research is serving as a reference for the implantation of OSHAS 18001 norms.

Safety and sustainability research for university schools of fine arts

Designing new teaching programs for both undergraduate and graduate university studies involves integrating concepts and methodologies regarding quality, work safety and hazard prevention, and environmental protection. One of the challenges facing Spanish research within the realm of European Higher Education concerns health and safety issues in the Arts.In the case of Fine Arts, student exploration is one of the fundamental pillars of the study program; therefore it is imperative that art studios be optimized. This optimization affects both designated resources (infrastructures, materials, equipment, etc.) and organization of the teaching force.In this context, the aim of our research is to improve educational practices by designing quality measures that are both friendly to the environment and hazardous free. The aim here is to assure adequate art studio and laboratory management, and provide students with hazard free health and environmentally safe concepts that can be incorporated in their professional lives.The school of Fine Arts at the University of Barcelona is part of a pilot program, where our experience in educational innovation and research is serving as a reference for the implantation of OSHAS 18001 norms.

Services "amis des jeunes": promouvoir des soins adaptés aux adolescents [Youth friendly health services: how to promote quality health care for adolescents].

Beaucoup de jeunes éprouvent des difficultés à demander une aide médicale et psychosociale alors qu'ils en auraient bien besoin. Cela est lié au processus d'autonomisation propre à cette période de la vie : les adolescents souhaitent résoudre leurs problèmes eux-mêmes. Pour améliorer la qualité des soins aux jeunes, l'Organisation mondiale de la santé, avec l'UNICEF et d'autres organismes, a développé le concept de youth friendly health services ; services amis des jeunes. Ce concept repose sur plusieurs principes, comme l'accessibilité, la flexibilité, une formation spécifique du personnel, le respect de la neutralité et de la confidentialité, compétences communicationnelles, etc. L'application de cette approche ne se limite pas aux centres spécialisés en médecine de l'adolescence, mais devra être progressivement implantée dans toutes les structures de soins accueillant des jeunes. Many young people have difficulties requesting medical or psychosocial support, although some badly need it. This difficulty is related to the fact that, as part of their search for autonomy, young people prefer to solve their problems by themselves. To improve the quality of care, the World Health Organization, UNICEF and allied organizations have developed the concept of "Youth friendly health services". This concept includes policies and strategies to improve the accessibility and flexibility, staff's competence and communication skills, etc. Such an approach should not be limited to specialized centers for adolescent health. It should be adopted by all health care institutions dealing with young people.

Safety and sustainability research for university schools of fine arts

Designing new teaching programs for both undergraduate and graduate university studies involves integrating concepts and methodologies regarding quality, work safety and hazard prevention, and environmental protection. One of the challenges facing Spanish research within the realm of European Higher Education concerns health and safety issues in the Arts.In the case of Fine Arts, student exploration is one of the fundamental pillars of the study program; therefore it is imperative that art studios be optimized. This optimization affects both designated resources (infrastructures, materials, equipment, etc.) and organization of the teaching force.In this context, the aim of our research is to improve educational practices by designing quality measures that are both friendly to the environment and hazardous free. The aim here is to assure adequate art studio and laboratory management, and provide students with hazard free health and environmentally safe concepts that can be incorporated in their professional lives.The school of Fine Arts at the University of Barcelona is part of a pilot program, where our experience in educational innovation and research is serving as a reference for the implantation of OSHAS 18001 norms.

Environmentally induced changes in carotenoid-based coloration of female lizards: a comment on Vercken et al.

Colouration may either reflect a discrete polymorphism potentially related to life-history strategies, a continuous signal related to individual quality or a combination of both. Recently, Vercken et al. [J. Evol. Biol. (2007) 221] proposed three discrete ventral colour morphs in female common lizards, Lacerta vivipara, and suggested that they reflect alternative reproductive strategies. Here, we provide a quantitative assessment of the phenotypic distribution and determinants of the proposed colour polymorphism. Based on reflectance spectra, we found no evidence for three distinct visual colour classes, but observed continuous variation in colour from pale yellow to orange. Based on a 2-year experiment, we also provide evidence for reversible colour plasticity in response to a manipulation of the adult population sex ratio; yet, a significant portion of the colour variation was invariant throughout an adult female's life. Our results are thus in agreement with continuous colour variation in adults determined by environmental factors and potentially also by genetic factors.

Hydrometallurgical recovery of valuable metals from secondary raw materials

Wastes and side streams in the mining industry and different anthropogenic wastes often contain valuable metals in such concentrations their recovery may be economically viable. These raw materials are collectively called secondary raw materials. The recovery of metals from these materials is also environmentally favorable, since many of the metals, for example heavy metals, are hazardous to the environment. This has been noticed in legislative bodies, and strict regulations for handling both mining and anthropogenic wastes have been developed, mainly in the last decade. In the mining and metallurgy industry, important secondary raw materials include, for example, steelmaking dusts (recoverable metals e.g. Zn and Mo), zinc plant residues (Ag, Au, Ga, Ge, In) and waste slurry from Bayer process alumina production (Ga, REE, Ti, V). From anthropogenic wastes, waste electrical and electronic equipment (WEEE), among them LCD screens and fluorescent lamps, are clearly the most important from a metals recovery point of view. Metals that are commonly recovered from WEEE include, for example, Ag, Au, Cu, Pd and Pt. In LCD screens indium, and in fluorescent lamps, REEs, are possible target metals. Hydrometallurgical processing routes are highly suitable for the treatment of complex and/or low grade raw materials, as secondary raw materials often are. These solid or liquid raw materials often contain large amounts of base metals, for example. Thus, in order to recover valuable metals, with small concentrations, highly selective separation methods, such as hydrometallurgical routes, are needed. In addition, hydrometallurgical processes are also seen as more environmental friendly, and they have lower energy consumption, when compared to pyrometallurgical processes. In this thesis, solvent extraction and ion exchange are the most important hydrometallurgical separation methods studied. Solvent extraction is a mainstream unit operation in the metallurgical industry for all kinds of metals, but for ion exchange, practical applications are not as widespread. However, ion exchange is known to be particularly suitable for dilute feed solutions and complex separation tasks, which makes it a viable option, especially for processing secondary raw materials. Recovering valuable metals was studied with five different raw materials, which included liquid and solid side streams from metallurgical industries and WEEE. Recovery of high purity (99.7%) In, from LCD screens, was achieved by leaching with H2SO4, extracting In and Sn to D2EHPA, and selectively stripping In to HCl. In was also concentrated in the solvent extraction stage from 44 mg/L to 6.5 g/L. Ge was recovered as a side product from two different base metal process liquors with Nmethylglucamine functional chelating ion exchange resin (IRA-743). Based on equilibrium and dynamic modeling, a mechanism for this moderately complex adsorption process was suggested. Eu and Y were leached with high yields (91 and 83%) by 2 M H2SO4 from a fluorescent lamp precipitate of waste treatment plant. The waste also contained significant amounts of other REEs such as Gd and Tb, but these were not leached with common mineral acids in ambient conditions. Zn was selectively leached over Fe from steelmaking dusts with a controlled acidic leaching method, in which the pH did not go below, but was held close as possible to, 3. Mo was also present in the other studied dust, and was leached with pure water more effectively than with the acidic methods. Good yield and selectivity in the solvent extraction of Zn was achieved by D2EHPA. However, Fe needs to be eliminated in advance, either by the controlled leaching method or, for example, by precipitation. 100% Pure Mo/Cr product was achieved with quaternary ammonium salt (Aliquat 336) directly from the water leachate, without pH adjustment (pH 13.7). A Mo/Cr mixture was also obtained from H2SO4 leachates with hydroxyoxime LIX 84-I and trioctylamine (TOA), but the purities were 70% at most. However with Aliquat 336, again an over 99% pure mixture was obtained. High selectivity for Mo over Cr was not achieved with any of the studied reagents. Ag-NaCl solution was purified from divalent impurity metals by aminomethylphosphonium functional Lewatit TP-260 ion exchange resin. A novel preconditioning method, named controlled partial neutralization, with conjugate bases of weak organic acids, was used to control the pH in the column to avoid capacity losses or precipitations. Counter-current SMB was shown to be a better process configuration than either batch column operation or the cross-current operation conventionally used in the metallurgical industry. The raw materials used in this thesis were also evaluated from an economic point of view, and the precipitate from a waste fluorescent lamp treatment process was clearly shown to be the most promising.