Undertreatment of acute pain (oligoanalgesia) and medical practice variation in prehospital analgesia of adult trauma patients: a 10 yr retrospective study.

BACKGROUND: Prehospital oligoanalgesia is prevalent among trauma victims, even when the emergency medical services team includes a physician. We investigated if not only patients' characteristics but physicians' practice variations contributed to prehospital oligoanalgesia. METHODS: Patient records of conscious adult trauma victims transported by our air rescue helicopter service over 10 yr were reviewed retrospectively. Oligoanalgesia was defined as a numeric rating scale (NRS) >3 at hospital admission. Multilevel logistic regression analysis was used to predict oligoanalgesia, accounting first for patient case-mix, and then physician-level clustering. The intraclass correlation was expressed as the median odds ratio (MOR). RESULTS: A total of 1202 patients and 77 physicians were included in the study. NRS at the scene was 6.9 (1.9). The prevalence of oligoanalgesia was 43%. Physicians had a median of 5.7 yr (inter-quartile range: 4.2-7.5) of post-graduate training and 27% were female. In our multilevel analysis, significant predictors of oligoanalgesia were: no analgesia [odds ratio (OR) 8.8], National Advisory Committee for Aeronautics V on site (OR 4.4), NRS on site (OR 1.5 per additional NRS unit >4), female physician (OR 2.0), and years of post-graduate experience [>4.0 to ≤5.0 (OR 1.3), >3.0 to ≤4.0 (OR 1.6), >2.0 to ≤3.0 (OR 2.6), and ≤2.0 yr (OR 16.7)]. The MOR was 2.6, and was statistically significant. CONCLUSIONS: Physicians' practice variations contributed to oligoanalgesia, a factor often overlooked in analyses of prehospital pain management. Further exploration of the sources of these variations may provide innovative targets for quality improvement programmes to achieve consistent pain relief for trauma victims.

Variation of the Chlorophyll a Related to Sea Surface Temperature, Wind and Geostrophic Currents in the Cape Verde Region Using Satellite Data

We present a comparative analysis of satellite derived climatologies in the Cape Verde region (CV). In order to establish chlorophyll a variability, in relation to other oceanographic phenomena, a set of, relatively long (from five to eight years), time series of chlorophyll a, sea surface temperature, wind and geostrophic currents, were ensembled for the Eastern Central Atlantic (ECA). We studied seasonal and inter-annual variability of phytoplankton concentration, in relation to the rest of the variables, with a special focus in CV. We compared the situation within the archipelago with those of the surrounding marine environments, such as the North West African Upwelling (NWAU), North Atlantic Subtropical Gyre (NASTG), North Equatorial Counter Current (NECC) and Guinea Dome (GD). At the seasonal scale, CV region behaves partly as the surrounding areas, nevertheless, some autochthonous features were also found. The maximum peak of the pigment having a positive correlation with temperature is found at the end of the year for all the points in the archipelago; a less remarkable rise with negative correlation is also detected in February for points CV2 and CV4. This is behavior that none of the surrounding environments have shown. This enrichment was found to be preceded by a drastic drop in wind intensity (SW Monsoon) during summer months. The inter-annual analysis shows a tendency for decreasing of the chlorophyll a concentration.

Variation of the Chlorophyll a Related to Sea Surface Temperature, Wind and Geostrophic Currents in the Cape Verde Region Using Satellite Data

We present a comparative analysis of satellite derived climatologies in the Cape Verde region (CV). In order to establish chlorophyll a variability, in relation to other oceanographic phenomena, a set of, relatively long (from five to eight years), time series of chlorophyll a, sea surface temperature, wind and geostrophic currents, were ensembled for the Eastern Central Atlantic (ECA). We studied seasonal and inter-annual variability of phytoplankton concentration, in relation to the rest of the variables, with a special focus in CV. We compared the situation within the archipelago with those of the surrounding marine environments, such as the North West African Upwelling (NWAU), North Atlantic Subtropical Gyre (NASTG), North Equatorial Counter Current (NECC) and Guinea Dome (GD). At the seasonal scale, CV region behaves partly as the surrounding areas, nevertheless, some autochthonous features were also found. The maximum peak of the pigment having a positive correlation with temperature is found at the end of the year for all the points in the archipelago; a less remarkable rise with negative correlation is also detected in February for points CV2 and CV4. This is behavior that none of the surrounding environments have shown. This enrichment was found to be preceded by a drastic drop in wind intensity (SW Monsoon) during summer months. The inter-annual analysis shows a tendency for decreasing of the chlorophyll a concentration.

The mechanisms of agglomeration: Evidence from the effect of inter-industry relations on the location of new firms

The objective of this paper is to explore the relative importance of each of Marshall's agglomeration mechanisms by examining the location of new manufacturing firms in Spain. In particular, we estimate the count of new firms by industry and location as a function of (pre-determined) local employment levels in industries that: 1) use similar workers (labor market pooling); 2) have a customer- supplier relationship (input sharing); and 3) use similar technologies (knowledge spillovers). We examine the variation in the creation of new firms across cities and across municipalities within large cities to shed light on the geographical scope of each of the three agglomeration mechanisms. We find evidence of all three agglomeration mechanisms, although their incidence differs depending on the geographical scale of the analysis.

The mechanisms of agglomeration: Evidence from the effect of inter-industry relations on the location of new firms

The objective of this paper is to explore the relative importance of each of Marshall's agglomeration mechanisms by examining the location of new manufacturing firms in Spain. In particular, we estimate the count of new firms by industry and location as a function of (pre-determined) local employment levels in industries that: 1) use similar workers (labor market pooling); 2) have a customer- supplier relationship (input sharing); and 3) use similar technologies (knowledge spillovers). We examine the variation in the creation of new firms across cities and across municipalities within large cities to shed light on the geographical scope of each of the three agglomeration mechanisms. We find evidence of all three agglomeration mechanisms, although their incidence differs depending on the geographical scale of the analysis.

A multi-center study: intra-scan and inter-scan variability of diffusion spectrum imaging.

The objective of this study was to investigate whether it is possible to pool together diffusion spectrum imaging data from four different scanners, located at three different sites. Two of the scanners had identical configuration whereas two did not. To measure the variability, we extracted three scalar maps (ADC, FA and GFA) from the DSI and utilized a region and a tract-based analysis. Additionally, a phantom study was performed to rule out some potential factors arising from the scanner performance in case some systematic bias occurred in the subject study. This work was split into three experiments: intra-scanner reproducibility, reproducibility with twin-scanner settings and reproducibility with other configurations. Overall for the intra-scanner and twin-scanner experiments, the region-based analysis coefficient of variation (CV) was in a range of 1%-4.2% and below 3% for almost every bundle for the tract-based analysis. The uncinate fasciculus showed the worst reproducibility, especially for FA and GFA values (CV 3.7-6%). For the GFA and FA maps, an ICC value of 0.7 and above is observed in almost all the regions/tracts. Looking at the last experiment, it was found that there is a very high similarity of the outcomes from the two scanners with identical setting. However, this was not the case for the two other imagers. Given the fact that the overall variation in our study is low for the imagers with identical settings, our findings support the feasibility of cross-site pooling of DSI data from identical scanners.

A comparative study on inter and intralaboratory reproducibility of renin measurement with a conventional enzymatic method and a new chemiluminescent assay of immunoreactive renin.

BACKGROUND: The activity of the renin-angiotensin system is usually evaluated as plasma renin activity (PRA, ngAI/ml per h) but the reproducibility of this enzymatic assay is notoriously scarce. We compared the inter and intralaboratory reproducibilities of PRA with those of a new automated chemiluminescent assay, which allows the direct quantification of immunoreactive renin [chemiluminescent immunoreactive renin (CLIR), microU/ml]. METHODS: Aliquots from six pool plasmas of patients with very low to very high PRA levels were measured in 12 centres with both the enzymatic and the direct assays. The same methods were applied to three control plasma preparations with known renin content. RESULTS: In pool plasmas, mean PRA values ranged from 0.14 +/- 0.08 to 18.9 +/- 4.1 ngAI/ml per h, whereas those of CLIR ranged from 4.2 +/- 1.7 to 436 +/- 47 microU/ml. In control plasmas, mean values of PRA and of CLIR were always within the expected range. Overall, there was a significant correlation between the two methods (r = 0.73, P < 0.01). Similar correlations were found in plasmas subdivided in those with low, intermediate and high PRA. However, the coefficients of variation among laboratories found for PRA were always higher than those of CLIR, ranging from 59.4 to 17.1% for PRA, and from 41.0 to 10.7% for CLIR (P < 0.01). Also, the mean intralaboratory variability was higher for PRA than for CLIR, being respectively, 8.5 and 4.5% (P < 0.01). CONCLUSION: The measurement of renin with the chemiluminescent method is a reliable alternative to PRA, having the advantage of a superior inter and intralaboratory reproducibility.

Lipoprotein distribution and biological variation of 24S- and 27-hydroxycholesterol in healthy volunteers.

24S- and 27-hydroxycholesterol are obligatory intermediates of cholesterol catabolism and play an important role in the maintenance of whole-body cholesterol homeostasis. Using an HPLC-MS method for oxysterol quantification, the distribution of esterified and unesterified oxysterols in lipoprotein subfractions as well as the influence of daytime, food intake and menstrual cycle on oxysterol concentrations were investigated in healthy volunteers. Moreover, reference intervals for 24S- and 27-hydroxycholesterol in plasma as well as the corresponding levels for 27-hydroxycholesterol in the HDL subfraction were established in 100 healthy volunteers. Both circulating oxysterols are mainly transported in association with HDL and LDL--primarily in the esterified form. No significant diurnal changes and no variations during menstrual cycle of either absolute or cholesterol-related plasma levels were detected. In contrast to 24S-hydroxycholesterol in plasma and 27-hydroxycholesterol in the HDL subfraction, the 95% reference intervals of 27-hydroxycholesterol both in plasma and the non-HDL subfraction were higher in males than in females. The concentrations of 27-hydroxycholesterol in plasma and the non-HDL subfraction showed strong positive correlations with the concentrations of cholesterol, non-HDL cholesterol and triglycerides. Our data on the lipoprotein distribution of oxysterols as well as on their intra- and inter-individual variation set the stage for future clinical studies.

Diagnostic interview for genetic studies (DIGS): inter-rater and test-retest reliability of alcohol and drug diagnoses

The semi-structured diagnostic interview for genetic studies (DIGS) was developed to assess major mood and psychotic disorders and their spectrum manifestations in genetic studies. Our research group developed a French version of the DIGS and tested its inter-rater and test-retest reliability in psychiatric patients. In this article, we present estimates of the reliability of substance use and antisocial personality disorders. High kappa coefficients for inter-rater reliability were found for drug and alcohol as well as antisocial personality diagnoses and slightly lower kappas for test-retest reliability. Combined with evidence of the reliability of major mood and psychotic disorders, these findings support the suitability of the DIGS for studies of familial aggregation and comorbidity of psychiatric disorders including substance use and antisocial personality disorders.

Genetic variation among pathogens causing "Helminthosporium" diseases of rice, maize and wheat

Twenty isolates of four fungal species, agents of "Helminthosporium" diseases in cereals, were collected from different regions: nine Bipolarisoryzae isolated from rice (Oryza sativa), seven B.sorokiniana from wheat (Triticum aestivum), two B. maydis, and two Exserohilumturcicum from maize (Zea mays). The strains were compared by PCR-RFLP and RAPD analysis. Size polymorphism among the isolates in the ITS region comprising the 5.8 S rDNA indicated genetic differences among the isolates, while a UPGMA phenogram constructed after the digestion of this region with restriction enzymes showed inter- and intra-specific polymorphism. The RAPD profiles indicated an expressive level of polymorphism among different species, compared with a low level of polymorphism among isolates of the same species. A UPGMA phenogram grouped the isolates according to the species and their host plant. RAPD profiles did not reveal polymorphism that directly correlated climatic factors with geographic source of the isolates of B. sorokiniana, and B. oryzae. Teleomorphic species revealed high similarity with their correspondent anamorphs.

Distyly and variation in floral traits in natural populations of Psychotria ipecacuanha (Brot.) Stokes (Rubiaceae)

Psychotria ipecacuanha is a perennial, medicinal herb that grows in clusters in the understory of humid, shady areas of the Atlantic Rain Forest of southeastern Brazil. The present study characterized the variation in floral traits among 35 clusters from three natural populations of this plant species. Field observations showed that the clusters are isomorphic, that is, a given cluster will either set long-styled or short-styled flowers. Stigmas and anthers are reciprocally placed in each morph, a dimorphism characteristic of distyly. The populations are isoplethic, that is, a given population exhibits an equilibrium 1:1 ratio of floral morphs. Morphometric analyses revealed that anther length, stigma length, corolla diameter, and pollen grain diameter were consistently greater in short-styled flowers, regardless of the population investigated. Significant differences for floral traits in the short-styled morph were found among populations. Floral traits in the long-styled morph also showed some significant differences among populations, but not for stigma height and corolla length. Controlled pollinations carried out in natural populations showed that fruit production was higher after inter-morph pollination. Nevertheless, observations of pollen tube growth in style, and also fruit production after spontaneous self-pollination and intra-morph pollination, indicated partial intramorph compatibility in this plant species.

Seasonal variation in the reproductive biology of the ring -billed gull (Larus delawarensis)

The reproductive biology of the Ring-billed Gull (Larus delawarensis) was studied on Gull Island, Presqu'ile Provincial Park, Ontario, in 1976 and 1977. Early started clutches (comprising the majority of clutches on Gull Island) in 1977 produced more chicks per nest (2.20 ± 0.09) than late started clutches (0.86 ± 0.13) as a result of reductions in mean clutch size, hatching success and fledging success with date of clutch initiation. Seasonal changes in mean clutch size, hatching success and fledging success also resulted in early clutches, initiated at the peak of clutch starts, producing more chicks per nest (2.34 ± 0.11) than either pre-peak (2.13 ± 0.20) or post-peak (1.82 ± 0.29) clutches. Possible reasons for these trends, including the observed predominance of immature plumaged, breeding gulls in late started areas, are discussed. Clutches were deserted at night for varying lengths of time from at least 15 April until 10 May, 1977. It is suggested that this nocturnal desertion behaviour resulted in the enhancement of inter- and intra-clutch hatching synchrony in early started areas and further, that this may in part explain the existence of the behaviour in terms of its adaptive significance.

Potentiel d’une approche populationnelle orientée vers la reconfiguration des environnements urbains pour améliorer la sécurité des piétons

INTRODUCTION : En milieu urbain, l’amélioration de la sécurité des piétons pose un défi de santé publique. Pour chaque décès attribuable aux collisions routières, il y a des centaines de personnes blessées et, dans les pays riches, la diminution du nombre annuel de piétons décédés s’expliquerait en partie par la diminution de la marche. Les stratégies préventives prédominantes n’interviennent pas sur le volume de circulation automobile, un facteur pourtant fondamental. De plus, les interventions environnementales pour améliorer la sécurité des infrastructures routières se limitent habituellement aux sites comptant le plus grand nombre de décès ou de blessés. Cette thèse vise à décrire la contribution des volumes de circulation automobile, des pratiques locales de marche et de la géométrie des routes au nombre et à la répartition des piétons blessés en milieu urbain, et d’ainsi établir le potentiel d’une approche populationnelle orientée vers la reconfiguration des environnements urbains pour améliorer la sécurité des piétons. MÉTHODE : Le devis est de type descriptif et transversal. Les principales sources de données sont les registres des services ambulanciers d’Urgences-santé (blessés de la route), l’enquête Origine-Destination (volumes de circulation automobile), la Géobase du réseau routier montréalais (géométrie des routes) et le recensement canadien (pratiques locales de marche, position socioéconomique). Les analyses descriptives comprennent la localisation cartographique (coordonnées x,y) de l’ensemble des sites de collision. Des modèles de régression multi-niveaux nichent les intersections dans les secteurs de recensement et dans les arrondissements. RÉSULTATS : Les analyses descriptives démontrent une grande dispersion des sites de collision au sein des quartiers. Les analyses multivariées démontrent les effets significatifs, indépendants du volume de circulation automobile, de la présence d’artère(s) et d’une quatrième branche aux intersections, ainsi que du volume de marche dans le secteur, sur le nombre de piétons blessés aux intersections. L’analyse multi-niveaux démontre une grande variation spatiale de l’effet du volume de circulation automobile. Les facteurs environnementaux expliquent une part substantielle de la variation spatiale du nombre de blessés et du gradient socioéconomique observé. DISCUSSION : La grande dispersion des sites de collision confirme la pertinence d’une approche ne se limitant pas aux sites comptant le plus grand nombre de blessés. Les résultats suggèrent que des stratégies préventives basées sur des approches environnementales et populationnelle pourraient considérablement réduire le nombre de piétons blessés ainsi que les inégalités observées entre les quartiers.

Genomic architecture of sickle cell disease clinical variation in children from West Africa : a case-control study design

Contexte : L’anémie falciforme ou drépanocytose est un problème de santé important, particulièrement pour les patients d’origine africaine. La variation phénotypique de l’anémie falciforme est problématique pour le suivi et le traitement des patients. L’architecture génomique responsable de cette variabilité est peu connue. Principe : Mieux saisir la contribution génétique de la variation clinique de cette maladie facilitera l’identification des patients à risque de développer des phénotypes sévères, ainsi que l’adaptation des soins. Objectifs : L’objectif général de cette thèse est de combler les lacunes relatives aux connaissances sur l’épidémiologie génomique de l’anémie falciforme à l’aide d’une cohorte issue au Bénin. Les objectifs spécifiques sont les suivants : 1) caractériser les profils d’expressions génomiques associés à la sévérité de l’anémie falciforme ; 2) identifier des biomarqueurs de la sévérité de l’anémie falciforme ; 3) identifier la régulation génétique des variations transcriptionelles ; 4) identifier des interactions statistiques entre le génotype et le niveau de sévérité associé à l’expression ; 5) identifier des cibles de médicaments pour améliorer l’état des patients atteints d’anémie falciforme. Méthode : Une étude cas-témoins de 250 patients et 61 frères et soeurs non-atteints a été menée au Centre de Prise en charge Médical Intégré du Nourrisson et de la Femme Enceinte atteints de Drépanocytose, au Bénin entre février et décembre 2010. Résultats : Notre analyse a montré que des profils d’expressions sont associés avec la sévérité de l’anémie falciforme. Ces profils sont enrichis de génes des voies biologiques qui contribuent à la progression de la maladie : l’activation plaquettaire, les lymphocytes B, le stress, l’inflammation et la prolifération cellulaire. Des biomarqueurs transcriptionnels ont permis de distinguer les patients ayant des niveaux de sévérité clinique différents. La régulation génétique de la variation de l’expression des gènes a été démontrée et des interactions ont été identifiées. Sur la base de ces résultats génétiques, des cibles de médicaments sont proposées. Conclusion: Ce travail de thèse permet de mieux comprendre l’impact de la génomique sur la sévérité de l’anémie falciforme et ouvre des perspectives de développement de traitements ciblés pour améliorer les soins offerts aux patients.

Variations inter- et intra-spécifiques de la phytoextraction des éléments traces As, Cd, Cu, Ni, Pb et Zn chez trois cultivars de saule

La phytoextraction représente une solution environnementale prometteuse face au problème de contamination des sols en éléments traces (É.T). La présente étude s’intéresse aux différences intra et interspécifiques (S. purpurea, S. dasyclados, S. miyabeana) de trois cultivars de saule lorsqu’ils sont utilisés pour la phytoextration de six É.T. (As, Cd, Cu, Ni, Pb et Zn). Les objectifs sont (i) décrire les variations intrapécifiques du cultivar FISH CREEK (S. purpurea) lorsqu’il est utilisé pour la phytoextraction sur deux sites d’étude; et (ii) décrire les variations intra et interspécifiques des cultivars FISH CREEK (S. purpurea), SV1 (S. dasyclados) et SX67 (S. miyabeana) lorsqu’ils sont utilisés pour la phytoextraction d’un site d’étude. Les indicateurs de variations intra et interspécifiques sélectionnés sont les suivants : la biomasse totale, les concentrations en É.T. extraits et les facteurs de translocation (x ̅ pondérée des conc. É.T. dans les parties aériennes / conc. É.T. dans les racines). La contribution des propriétés du sol (degré de contamination, caractéristiques physicochimiques) à la phytoextraction a été évaluée. Les cultivars ont présenté des variations interspécifiques significatives. Cependant, les variations intraspécifiques sur un site d’étude étaient parfois plus importantes que celles mesurées entre les trois différents cultivars. L’amplitude des variations intraspécifiques que présentent le cultivar FISH CREEK sur deux sites d’étude est attribuée à l’influence du pH, de la minéralogie et au contenu en matière organique, lesquelles diffèrent entre les deux sites. Il a aussi été démontré que la phytoextraction des É.T. n’était pas systématiquement corrélée de façon positive avec le degré de contamination. Cela suggère que les concentrations en É.T. mesurées dans le sol ne peuvent pas expliquer à elles seules la variation des concentrations mesurées dans les tissus. L’implication des mécanismes de rétention dans le sol semblent être davantage responsable des variations observées. La compartimentation des É.T. suggère que le saule est efficace pour l’extraction du Cd et du Zn et qu’il est efficace pour la phytostabilisation de l’As, du Cu, du Ni, et du Pb. En ce qui concerne les quantités extraites, le cultivar FISH CREEK semble le plus performant dans la présente étude.