Définition et prise en charge de l'échec d'une première injection de toxine botulique Botox(®) 200 U pour hyperactivité détrusorienne neurogène : résultats de l'enquête DETOX [Definition of botulinum toxin failure in neurogenic detrusor overactivity: Preliminary results of the DETOX survey].

OBJECTIVE: There is currently no guideline regarding the management of neurogenic detrusor overactivity (NDO) refractory to intra-detrusor botulinum toxin injections. The primary objective of the present study was to find a consensus definition of failure of botulinum toxin intra-detrusor injections for NDO. The secondary objective was to report current trends in the managment of NDO refractory to botulinum toxin. METHODS: A survey was created, based on data drawn from current literature, and sent via e-mail to all the experts form the Group for research in neurourology in french language (GENULF) and from the comittee of neurourology of the French urological association (AFU). The experts who did not answer to the first e-mail were contacted again twice. Main results from the survey are presented and expressed as numbers and proportions. RESULTS: Out of the 42 experts contacted, 21 responded to the survey. Nineteen participants considered that the definition of failure should be a combination of clinical and urodynamics criteria. Among the urodynamics criteria, the persistence of a maximum detrusor pressure>40cm H2O was the most supported by the experts (18/21, 85%). According to the vast majority of participants (19/21, 90.5%), the impact of injections on urinary incontinence should be included in the definition of failure. Regarding the management, most experts considered that the first line treatment in case of failure of a first intra-detrusor injection of Botox(®) 200 U should be a repeat injection of Botox(®) at a higher dosage (300 U) (15/20, 75%), regardless of the presence or not of urodynamics risk factors of upper tract damage (16/20, 80%). CONCLUSION: This work has provided a first overview of the definition of failure of intra-detrusor injections of botulinum toxin in the management of NDO. For 90.5% of the experts involved, the definition of failure should be clinical and urodynamic and most participants (75%) considered that, in case of failure of a first injection of Botox(®) 200 U, repeat injection of Botox(®) 300 U should be the first line treatment. Level of proof 4.

Programme de prise en charge des maladies chroniques : quels bénéfices dans l'asthme? : revue Cochrane pour le praticien

L'asthme impose un fardeau important sur les patients et les systèmes de soins. Les programmes de prise en charge des maladies chroniques (chronic disease management) ont pour but d'améliorer la qualité et l'efficacité des soins et du suivi des patients. Ils se composent d'une série d'interventions centrées sur les besoins des patients, encouragent la coordination et l'intégration des soins fournis par différents professionnels de la santé et mettent l'accent sur l'éducation du patient et l'autogestion de sa maladie. L'objectif de cette revue était d'évaluer l'efficacité de tels programmes chez l'adulte asthmatique.

Au sortir de l'hôpital, comment renforcer la continuité de la prise en charge médicale [Discharge from hospital: how to improve continuity of medical care?].

Early readmission is the major success indicator of the transition between hospital and home. Patients admitted with heart failure reach a 20% rate. Potentially avoidable readmissions, defined as unpredictable and related to a known condition during index hospitalization, represent the improvement margin. For these latter, implementation of specific interventions can be effective. Complex interventions on transition, including several modalities and seeking to encourage patient autonomy seem more effective than others. We describe two models: a pragmatic one developed in a regional hospital, and a more complex one developed in a university hospital during the LEAR-HF study. In both cases, it is imperative to work on "medical liability": should it extend beyond discharge up to the threshold of the private practice?

ÉVALUATION DE LA PÉNIBILITÉ DE LA PRISE EN CHARGE DES PATIENTS SOUFFRANT DE TROUBLES PSYCHIQUES EN MILIEU PÉNITENTIAIRE

Contexte: Les Établissements de la Plaine de l'Orbe accueillent des patients souffrant de troubles psychiques sévères et incarcérés sous le coup d'une mesure pénale ou y purgeant une peine. Dans le cadre d'une étude des besoins, l'équipe du Service de Médecine et Psychiatrie Pénitentiaire (SMPP) souhaite développer un outil permettant d'évaluer la pénibilité de la prise en charge de ces patients difficiles. Il y a en effet dans ce contexte, une nécessité d'améliorer l'offre de soins qui est actuellement limitée. Ceci dans la perspective de l'ouverture en 2016 d'un Etablissement de Réinsertion Sécurisée (ERS) sur le site de Cery et de la création d'un Centre de Soins aux Etablissements de la Plaine de l'Orbe à l'horizon 2018. Objectifs: Déterminer les différents critères définissant la pénibilité Élaborer un outil pratique, facilement utilisable en clinique permettant d'évaluer la pénibilité d'un patient ou d'une cohorte L'outil devra avoir une utilité à un niveau individuel (meilleure représentation des problématiques d'un patient, évolutivité de la situation) ainsi que sur une cohorte de patients (aide à l'évaluation des ressources nécessaires ou à l'évaluation de la charge de travail pour une équipe)

The role of surface vertical mixing in phytoplankton distribution in a stratified reservoir

We investigated convection caused by surface cooling and mixing attributable to wind shear stress and their roles as agents for the transport of phytoplankton cells in the water column by carrying out two daily surveys during the stratified period of the Sau reservoir. Green algae, diatoms, and cryptophyceae were the dominant phytoplankton communities during the surveys carried out in the middle (July) and end (September) of the stratified period. We show that a system with a linear stratification and that is subject to weak surface forcing, with weak winds , < 4 m S (-1) and low energy dissipation rate values of the order of 1028 m2 s23 or lower, enables the formation of thin phytoplankton layers. These layers quickly disappear when water parcels mix because there is a medium external forcing (convection) induced by the night surface cooling, which is characterized by energy dissipation rates on the order of , 5x10(-8)m2s(-3). During both surveys the wind generated internal waves during the entire diurnal cycle. During the day, and because of the weak winds, phytoplankton layers rise in the water column up to a depth determined by both solar heating and internal waves. In contrast, during the night phytoplankton mixes down to a depth determined by both convection and internal waves. These internal waves, together with the wind-driven current generated at the surface, seem to be the agents responsible for the horizontal transport of phytoplankton across the reservoir.

Garvey-Kelson relations for nuclear charge radii

The Garvey-Kelson relations (GKRs) are algebraic expressions originally developed to predict nuclear masses. In this letter we show that the GKRs provide a fruitful framework for the prediction of other physical observables that also display a slowly-varying dynamics. Based on this concept, we extend the GKRs to the study of nuclear charge radii. The GKRs are tested on 455 out of the approximately 800 nuclei whose charge radius is experimentally known. We find a rms deviation between the GK predictions and the experimental values of only 0.01 fm. This should be contrasted against some of the most successful microscopic models that yield rms deviations almost three times as large. Predictions -with reliable uncertainties- are provided for 116 nuclei whose charge radius is presently unknown.

Lysine-based surfactants in nanovesicle formulations: the role of cationic charge position and hydrophobicity in in vitro cytotoxicity and intracellular delivery

Understanding nanomaterial interactions within cells is of increasing importance for assessing their toxicity and cellular transport. Here, we developed nanovesicles containing bioactive cationic lysine-based amphiphiles, and assessed whether these cationic compounds increase the likelihood of intracellular delivery and modulate toxicity. We found different cytotoxic responses among the formulations, depending on surfactant, cell line and endpoint assayed. The induction of mitochondrial dysfunction, oxidative stress and apoptosis were the general mechanisms underlying cytotoxicity. Fluorescence microscopy analysis demonstrated that nanovesicles were internalized by HeLa cells, and evidenced that their ability to release endocytosed materials into cell cytoplasm depends on the structural parameters of amphiphiles. The cationic charge position and hydrophobicity of surfactants determine the nanovesicle interactions within the cell and, thus, the resulting toxicity and intracellular behavior after cell uptake of the nanomaterial. The insights into some toxicity mechanisms of these new nanomaterials contribute to reducing the uncertainty surrounding their potential health hazards.

Photometric procedure for quantitative analysis of Aflatoxin B1 in peanuts by thin-layer chromatography using charge coupled device detector

A photometric procedure was developed for determination of aflatoxin B1 in peanuts by TLC-CCD technique. The quantification and detection limit were 1.2 μg kg-1 and 0.4 ng per spot, respectively, with mean recovery of 98%. The CCD camera is sufficiently sensitive to detect small changes in spots fluorescence intensity and the results for performance confirmed the efficiency of the method. Another important property of CCD detector is its linearity for a wide range of luminous stimulus determined by analysis of five-point calibration curves using the intensity of AFB1 fluorescence versus AFB1 concentration (0.8 to 4.8 ng per spot). The method was applied to the analysis of thirty nine peanut samples and aflatoxin B1 levels ranged from 16 to 115 μg kg-1. The TLC-CCD and the photometric procedure developed in this study demonstrated to be a simple and efficient tool for quantitative analyses of AFB1 in peanut samples.

Charge transport in disordered materials : simulations, theory, and numerical modeling of hopping transport and electron-hole recombination

Min avhandling behandlar hur oordnade material leder elektrisk ström. Bland materialen som studeras finns ledande polymerer, d.v.s. plaster som leder ström, och mer allmänt organiska halvledare. Av de här materialen har man kunnat bygga elektroniska komponenter, och man hoppas på att kunna trycka hela kretsar av organiska material. För de här tillämpningarna är det viktigt att förstå hur materialen själva leder elektrisk ström. Termen oordnade material syftar på material som saknar kristallstruktur. Oordningen gör att elektronernas tillstånd blir lokaliserade i rummet, så att en elektron i ett visst tillstånd är begränsad t.ex. till en molekyl eller ett segment av en polymer. Det här kan jämföras med kristallina material, där ett elektrontillstånd är utspritt över hela kristallen (men i stället har en väldefinierad rörelsemängd). Elektronerna (eller hålen) i det oordnade materialet kan röra sig genom att tunnelera mellan de lokaliserade tillstånden. Utgående från egenskaperna för den här tunneleringsprocessen, kan man bestämma transportegenskaperna för hela materialet. Det här är utgångspunkten för den så kallade hopptransportmodellen, som jag har använt mig av. Hopptransportmodellen innehåller flera drastiska förenklingar. Till exempel betraktas elektrontillstånden som punktformiga, så att tunneleringssannolikheten mellan två tillstånd endast beror på avståndet mellan dem, och inte på deras relativa orientation. En annan förenkling är att behandla det kvantmekaniska tunneleringsproblemet som en klassisk process, en slumpvandring. Trots de här grova approximationerna visar hopptransportmodellen ändå många av de fenomen som uppträder i de verkliga materialen som man vill modellera. Man kan kanske säga att hopptransportmodellen är den enklaste modell för oordnade material som fortfarande är intressant att studera. Man har inte hittat exakta analytiska lösningar för hopptransportmodellen, därför använder man approximationer och numeriska metoder, ofta i form av datorberäkningar. Vi har använt både analytiska metoder och numeriska beräkningar för att studera olika aspekter av hopptransportmodellen. En viktig del av artiklarna som min avhandling baserar sig på är att jämföra analytiska och numeriska resultat. Min andel av arbetet har främst varit att utveckla de numeriska metoderna och applicera dem på hopptransportmodellen. Därför fokuserar jag på den här delen av arbetet i avhandlingens introduktionsdel. Ett sätt att studera hopptransportmodellen numeriskt är att direkt utföra en slumpvandringsprocess med ett datorprogram. Genom att föra statisik över slumpvandringen kan man beräkna olika transportegenskaper i modellen. Det här är en så kallad Monte Carlo-metod, eftersom själva beräkningen är en slumpmässig process. I stället för att följa rörelsebanan för enskilda elektroner, kan man beräkna sannolikheten vid jämvikt för att hitta en elektron i olika tillstånd. Man ställer upp ett system av ekvationer, som relaterar sannolikheterna för att hitta elektronen i olika tillstånd i systemet med flödet, strömmen, mellan de olika tillstånden. Genom att lösa ekvationssystemet fås sannolikhetsfördelningen för elektronerna. Från sannolikhetsfördelningen kan sedan strömmen och materialets transportegenskaper beräknas. En aspekt av hopptransportmodellen som vi studerat är elektronernas diffusion, d.v.s. deras slumpmässiga rörelse. Om man betraktar en samling elektroner, så sprider den med tiden ut sig över ett större område. Det är känt att diffusionshastigheten beror av elfältet, så att elektronerna sprider sig fortare om de påverkas av ett elektriskt fält. Vi har undersökt den här processen, och visat att beteendet är väldigt olika i endimensionella system, jämfört med två- och tredimensionella. I två och tre dimensioner beror diffusionskoefficienten kvadratiskt av elfältet, medan beroendet i en dimension är linjärt. En annan aspekt vi studerat är negativ differentiell konduktivitet, d.v.s. att strömmen i ett material minskar då man ökar spänningen över det. Eftersom det här fenomenet har uppmätts i organiska minnesceller, ville vi undersöka om fenomenet också kan uppstå i hopptransportmodellen. Det visade sig att det i modellen finns två olika mekanismer som kan ge upphov till negativ differentiell konduktivitet. Dels kan elektronerna fastna i fällor, återvändsgränder i systemet, som är sådana att det är svårare att ta sig ur dem då elfältet är stort. Då kan elektronernas medelhastighet och därmed strömmen i materialet minska med ökande elfält. Elektrisk växelverkan mellan elektronerna kan också leda till samma beteende, genom en så kallad coulombblockad. En coulombblockad kan uppstå om antalet ledningselektroner i materialet ökar med ökande spänning. Elektronerna repellerar varandra och ett större antal elektroner kan leda till att transporten blir långsammare, d.v.s. att strömmen minskar.

Rankine-prosessin mallinnus keskilämpötila-alueessa

Tämä diplomityö on osa FCEP hankkeen Lappeenrannan teknillisessä yliopistossa tehtävää tutkimusta polttomoottoreiden energiatehokkuuden parantamisesta. Työn tavoitteena on saada tutkimustietoa polttomoottoreiden ahtoilman hukkalämmön hyödyntämisestä sähköntuotannossa Rankine-prosessilla. Tavoitteena on myös suorittaa ahtoilman hukkalämpöä hyödyntävän koelaitteiston prosessitekninen mitoitus. Työssä kartoitetaan sovelluskohteeseen sopivimmat kiertoaineet sekä suoritetaan prosessin lämmönsiirtimien ja putkiston lämpö- ja virtaustekninen päämitoitus. Työssä tarkasteltavaksi moottoriksi valittiin Wärtsilä 4R32 – moottori. Laskennat suoritettiin moottorin valmistajan antamien arvojen perusteella. Laskennan perusperiaatteena oli vertailla vesihöyryprosessia ja ORC-prosessia keskilämpötilaisen ahtoilman hyödyntämisessä. Työssä vertailtiin 12 eri kiertoaineen prosessihyötysuhdetta, saatavaa sähkötehoa sekä prosessin painetasoja. Kiertoainevertailun perusteella koelaitteeseen valittiin neljä kohteeseen parhaiten soveltuvinta kiertoainetta, joille mitoitettiin höyrystin, lauhdutin, rekuperaattori ja putkisto. Diplomityön laskennan perusteella tutkimuksen kohteena olleen moottorin sähköntuotannon lisäykseksi saatiin 1,77 %, kun ahtoilman hukkalämpö muunnetaan Rankine-prosessilla sähköksi. Työssä saatiin arvokasta tietoa polttomoottorin ahtoilman hukkalämmön sähköksi muuntamisesta sekä vesihöyryprosessilla, että ORC-prosessilla.

Raw water use charge reduction for the rural sector in the PCJ Watershed

The deficient environmental preservation on agricultural properties has reflected in great soil losses for erosion and the high rate of sedimentation. Therefore, this work brings the application of software to demonstrate that planters can get benefits by the conservationist practices. The benefits will be obtained from the environment aspect (erosion and sedimentation control), as well as economical aspect (financial incentives). A proposal has been created by the Technical Chamber of Rural Water Use and Conservation (CT-Rural) to estimate the reduction in raw water use charge for the rural water users of the PCJ Watershed - this reduction is being possible since January 2007, at the PCJ Committee. The software develops a simple relationship, so that if the rural conservationist action goes more efficient, such as if the conserved rural area goes larger, then the reduction value will bring better benefits for the rural water users. Within the purposes of this study, there is the idealization of mechanisms that may support specific management matters related to the water users of federal rivers from the rural sector of PCJ Watershed.

Performance impact of the application of castor oil biodiesel in diesel engines

The use of renewable fuels, such as the biodiesel, can ease the demand of fossil fuel for the power generation and transportation fields in rural area. In this work, the performance impact of the application of castor oil biodiesel is evaluated with an automotive and a stationary diesel engine. The application of B20 and B10 biodiesel blends and pre-heated net biodiesel is considered. The viability of the employment of B10 and B20 blends to mobility and power generation was observed from dynamometric bench tests, where this blends performed similar to fossil diesel. With the pre-heated net biodiesel, however, a brake torque loss and a specific consumption increase were observed with relation to diesel fuel.

Design of Pulsed Electroacoustic Measurement System for Space Charge Characterisation

Pulsed electroacoustic (PEA) method is a commonly used non-destructive technique for investigating space charges. It has been developed since early 1980s. These days there is continuing interest for better understanding of the influence of space charge on the reliability of solid electrical insulation under high electric field. The PEA method is widely used for space charge profiling for its robust and relatively inexpensive features. The PEA technique relies on a voltage impulse used to temporarily disturb the space charge equilibrium in a dielectric. The acoustic wave is generated by charge movement in the sample and detected by means of a piezoelectric film. The spatial distribution of the space charge is contained within the detected signal. The principle of such a system is already well established, and several kinds of setups have been constructed for different measurement needs. This thesis presents the design of a PEA measurement system as a systems engineering project. The operating principle and some recent developments are summarised. The steps of electrical and mechanical design of the instrument are discussed. A common procedure for measuring space charges is explained and applied to verify the functionality of the system. The measurement system is provided as an additional basic research tool for the Corporate Research Centre of ABB (China) Ltd. It can be used to characterise flat samples with thickness of 0.2–0.5 mm under DC stress. The spatial resolution of the measurement is 20 μm.