Développement et pré-test d’un plan de soins de suivi pour des femmes atteintes du cancer de l’endomètre avec traitements adjuvants lors de la transition de la fin du traitement actif vers la survie au cancer

La fin du traitement actif et le début de la phase de survie correspondent à une période de transition qui présente de nombreux défis pour la personne survivante au cancer, les soignants et le système de santé. La phase de survie au cancer est une phase distincte mais négligée du continuum de soins. Pour faciliter la transition de la fin du traitement actif vers la survie et optimiser la coordination des soins de suivi, la mise en place d’un plan de soins de suivi (PSS) est proposée. Le but de cette recherche est de développer, de mettre en place et d’évaluer si un plan de soins de suivi (PSS) permet de répondre aux besoins globaux, de diminuer la détresse émotionnelle et de favoriser les comportements d’autogestion de santé de femmes atteintes du cancer de l’endomètre (FACE) lors de la transition de la fin du traitement actif vers la survie au cancer. Elle comprend deux phases distinctes. La première phase visait d’abord le développement d’un plan de soins de suivi (PSS) pour des femmes atteintes du cancer de l’endomètre avec traitements adjuvants. La sélection du contenu du PSS a été faite à partir de la recension des écrits et des données recueillies lors d’entrevues individuelles avec 19 FACE, 24 professionnels de la santé travaillant avec cette clientèle et quatre gestionnaires de proximité en oncologie. Cette première phase avait également pour but la validation du contenu du PSS auprès de dix professionnels de la santé impliqués dans l’étude. La seconde phase consistait à évaluer la faisabilité, l’acceptabilité du PSS et à en pré-tester l’utilité à répondre aux besoins globaux, à diminuer la détresse émotionnelle (peur de la récidive) et à favoriser l’autogestion de santé auprès d’un groupe de 18 femmes atteintes du cancer de l’endomètre avec traitements adjuvants à la fin du traitement actif vers la survie. Sur le plan de la faisabilité, les résultats suggèrent que la mise en place du PSS comporte des défis en termes de temps, de ressources et de coordination pour l’infirmière pivot en oncologie (IPO). Concernant l’acceptabilité du PSS, les FACE le perçoivent comme un outil d’information utile qui favorise la communication avec le médecin de famille ou d’autres professionnels de la santé. Les IPO soutiennent sa valeur ajoutée à la fin du traitement et soulignent que la discussion du contenu du PSS fait ressortir des éléments de surveillance et de suivi essentiels à prendre en compte pour la phase de survie et permet de mettre l’emphase sur l’autogestion de sa santé. Pour les médecins de famille, le PSS est un outil d’information pour les survivantes qui favorise la réassurance, la communication et la continuité des soins entre professionnels de la santé. Enfin, pour ce qui est de l’utilité du PSS à répondre aux besoins globaux, les résultats suggèrent que l’ensemble des besoins sont plus satisfaits trois mois après la fin des traitements pour le groupe ayant reçu un PSS. Bien que la peur de récidive du cancer (PRC) s’améliore au suivi de trois mois pour le groupe exposé au PSS, 55% des FACE conservent un score cliniquement significatif de 13 à la sous-échelle de sévérité de peur de récidive à la fin du traitement et 42% au suivi de trois mois. Les comportements d’autogestion de santé s’améliorent entre la fin du traitement et le suivi de trois mois pour le groupe exposé un PSS. Considérant ces résultats, la démarche soutient la pertinence de mettre en place un PSS à la fin du traitement actif pour les FACE pour répondre à des besoins d’information, favoriser la communication et la continuité des soins avec les professionnels de la santé et les comportements d’autogestion de santé dans la phase de survie. Cependant, des contraintes de temps, de ressources et de coordination doivent être prises en compte pour sa mise en place dans le milieu clinique. Mots-clés : Transition, fin du traitement actif, besoins, survie au cancer, plan de soins de suivi.

The phase diagram of the mercury-indium alloy system

The mercury-indium phase diagram has been investigated over the whole composition range from -78°C to the melting point of indium, using thermal analysis, X-ray and superconductivity techniques. This is believed to be the first application of superconductivity measurements to phase diagram investigations. A compound, HgIn, of very limited range of composition, melts congruently at -19.3°C; and gives rise to eutectics at 61.5 at. % indium and -31°C, and at 34.7% indium and -37.2°C. The β phase extends from 2.5 to 19.1 % indium and has a maximum melting point of -14.2°C at 14.2% indium. It forms a peritectic or eutectic at a temperature indistinguishable from the melting point of pure mercury with a solid solution in mercury containing some, but less than 0.3%, indium. A transition from face-centred tetragonal to face-centred cubic in the indium-rich solid solutions at about 93% indium gives rise to a peritectic at 108°C. The solubility of mercury in this face-centred cubic phase falls from about 22% at-31°C to 13% at -78°C. © 1963.

410 - Phase transitions induced by coloured voltage noise in nerve membranes

Quantitative conditions are derived under which electrically excitable membranes can undergo a phase transition induced by an externally applied voltage noise. The results obtained for a non-cooperative and a cooperative form of the two-state model are compared. © 1981.

Phase Transitions in Engineered Ultracold Quantum Systems

The study of quantum degenerate gases has many applications in topics such as condensed matter dynamics, precision measurements and quantum phase transitions. We built an apparatus to create 87Rb Bose-Einstein condensates (BECs) and generated, via optical and magnetic interactions, novel quantum systems in which we studied the contained phase transitions. For our first experiment we quenched multi-spin component BECs from a miscible to dynamically unstable immiscible state. The transition rapidly drives any spin fluctuations with a coherent growth process driving the formation of numerous spin polarized domains. At much longer times these domains coarsen as the system approaches equilibrium. For our second experiment we explored the magnetic phases present in a spin-1 spin-orbit coupled BEC and the contained quantum phase transitions. We observed ferromagnetic and unpolarized phases which are stabilized by the spin-orbit coupling’s explicit locking between spin and motion. These two phases are separated by a critical curve containing both first-order and second-order transitions joined at a critical point. The narrow first-order transition gives rise to long-lived metastable states. For our third experiment we prepared independent BECs in a double-well potential, with an artificial magnetic field between the BECs. We transitioned to a single BEC by lowering the barrier while expanding the region of artificial field to cover the resulting single BEC. We compared the vortex distribution nucleated via conventional dynamics to those produced by our procedure, showing our dynamical process populates vortices much more rapidly and in larger number than conventional nucleation.

Shape and chemically anisotropic colloidal particles: A theoretical study of their structure, phase behavior, and slow dynamics

A detailed non-equilibrium state diagram of shape-anisotropic particle fluids is constructed. The effects of particle shape are explored using Naive Mode Coupling Theory (NMCT), and a single particle Non-linear Langevin Equation (NLE) theory. The dynamical behavior of non-ergodic fluids are discussed. We employ a rotationally frozen approach to NMCT in order to determine a transition to center of mass (translational) localization. Both ideal and kinetic glass transitions are found to be highly shape dependent, and uniformly increase with particle dimensionality. The glass transition volume fraction of quasi 1- and 2- dimensional particles fall monotonically with the number of sites (aspect ratio), while 3-dimensional particles display a non-monotonic dependence of glassy vitrification on the number of sites. Introducing interparticle attractions results in a far more complex state diagram. The ideal non-ergodic boundary shows a glass-fluid-gel re-entrance previously predicted for spherical particle fluids. The non-ergodic region of the state diagram presents qualitatively different dynamics in different regimes. They are qualified by the different behaviors of the NLE dynamic free energy. The caging dominated, repulsive glass regime is characterized by long localization lengths and barrier locations, dictated by repulsive hard core interactions, while the bonding dominated gel region has short localization lengths (commensurate with the attraction range), and barrier locations. There exists a small region of the state diagram which is qualified by both glassy and gel localization lengths in the dynamic free energy. A much larger (high volume fraction, and high attraction strength) region of phase space is characterized by short gel-like localization lengths, and long barrier locations. The region is called the attractive glass and represents a 2-step relaxation process whereby a particle first breaks attractive physical bonds, and then escapes its topological cage. The dynamic fragility of fluids are highly particle shape dependent. It increases with particle dimensionality and falls with aspect ratio for quasi 1- and 2- dimentional particles. An ultralocal limit analysis of the NLE theory predicts universalities in the behavior of relaxation times, and elastic moduli. The equlibrium phase diagram of chemically anisotropic Janus spheres and Janus rods are calculated employing a mean field Random Phase Approximation. The calculations for Janus rods are corroborated by the full liquid state Reference Interaction Site Model theory. The Janus particles consist of attractive and repulsive regions. Both rods and spheres display rich phase behavior. The phase diagrams of these systems display fluid, macrophase separated, attraction driven microphase separated, repulsion driven microphase separated and crystalline regimes. Macrophase separation is predicted in highly attractive low volume fraction systems. Attraction driven microphase separation is charaterized by long length scale divergences, where the ordering length scale determines the microphase ordered structures. The ordering length scale of repulsion driven microphase separation is determined by the repulsive range. At the high volume fractions, particles forgo the enthalpic considerations of attractions and repulsions to satisfy hard core constraints and maximize vibrational entropy. This results in site length scale ordering in rods, and the sphere length scale ordering in Janus spheres, i.e., crystallization. A change in the Janus balance of both rods and spheres results in quantitative changes in spinodal temperatures and the position of phase boundaries. However, a change in the block sequence of Janus rods causes qualitative changes in the type of microphase ordered state, and induces prominent features (such as the Lifshitz point) in the phase diagrams of these systems. A detailed study of the number of nearest neighbors in Janus rod systems reflect a deep connection between this local measure of structure, and the structure factor which represents the most global measure of order.

The transition to agriculture in south-wertern Europe : new isotopic insights from Portugal's Atlantic coast

For the past 15 years, a succession of stable isotope studies have documented the abrupt dietary transition from the Mesolithic to the Neolithic in Western and Northern Europe. Portugal, with its Late Mesolithic shell middens and burials apparently coexisting with the earliest Neolithic, further illustrates the nature of that transition. Individuals from Neolithic contexts there had significantly different diets to their Mesolithic counterparts. No evidence was found for a transitional phase between the marine oriented Mesolithic subsistence regimes and the domesticated, terrestrial Neolithic diet. Two later Neolithic individuals, however, showed evidence for partial reliance on marine or aquatic foods. This raises questions about the possible persistence of marine dietary regimes beyond the Mesolithic period. This article is followed by a brief note by Mary Jackes and David Lubell.

Phase transitions in gene networks evolved under different selection rules

Mathematical models of gene regulation are a powerful tool for understanding the complex features of genetic control. While various modeling efforts have been successful at explaining gene expression dynamics, much less is known about how evolution shapes the structure of these networks. An important feature of gene regulatory networks is their stability in response to environmental perturbations. Regulatory systems are thought to have evolved to exist near the transition between stability and instability, in order to have the required stability to environmental fluctuations while also being able to achieve a wide variety of functions (corresponding to different dynamical patterns). We study a simplified model of gene network evolution in which links are added via different selection rules. These growth models are inspired by recent work on `explosive' percolation which shows that when network links are added through competitive rather than random processes, the connectivity phase transition can be significantly delayed, and when it is reached, it appears to be first order (discontinuous, e.g., going from no failure at all to large expected failure) instead of second order (continuous, e.g., going from no failure at all to very small expected failure). We find that by modifying the traditional framework for networks grown via competitive link addition to capture how gene networks evolve to avoid damage propagation, we also see significant delays in the transition that depend on the selection rules, but the transitions always appear continuous rather than `explosive'.

Entropy, chaos, and excited-state quantum phase transitions in the Dicke model

We study nonequilibrium processes in an isolated quantum system-the Dicke model-focusing on the role played by the transition from integrability to chaos and the presence of excited-state quantum phase transitions. We show that both diagonal and entanglement entropies are abruptly increased by the onset of chaos. Also, this increase ends in both cases just after the system crosses the critical energy of the excited-state quantum phase transition. The link between entropy production, the development of chaos, and the excited-state quantum phase transition is more clear for the entanglement entropy.

Nature of the spin-glass phase in dense packings of Ising dipoles with random anisotropy axes

By Monte Carlo simulations, we study the character of the spinglass (SG) phase in dense disordered packings of magnetic nanoparticles (NPs). We focus on NPs which have large uniaxial anisotropies and can be well represented as Ising dipoles. Dipoles are placed on SC lattices and point along randomly oriented axes. From the behaviour of a SG correlation length we determine the transition temperature Tc between the paramagnetic and a SG phase. For temperatures well below Tc we find distributions of the SG overlap parameter q that are strongly sample-dependent and exhibit several spikes. We find that the average width of spikes, and the fraction of samples with spikes higher than a certain threshold does not vary appreciably with the system sizes studied. We compare these results with the ones found previously for 3D site-diluted systems of parallel Ising dipoles and with the behaviour of the Sherrington-Kirkpatrick model.

Insulator-to-metal transition in vanadium supersaturated silicon: variable-range hopping and Kondo effect signatures

We report the observation of the insulator-to-metal transition in crystalline silicon samples supersaturated with vanadium. Ion implantation followed by pulsed laser melting and rapid resolidification produce high quality single-crystalline silicon samples with vanadium concentrations that exceed equilibrium values in more than 5 orders of magnitude. Temperature-dependent analysis of the conductivity and Hall mobility values for temperatures from 10K to 300K indicate that a transition from an insulating to a metallic phase is obtained at a vanadium concentration between 1.1 × 10^(20) and 1.3 × 10^(21) cm^(−3) . Samples in the insulating phase present a variable-range hopping transport mechanism with a Coulomb gap at the Fermi energy level. Electron wave function localization length increases from 61 to 82 nm as the vanadium concentration increases in the films, supporting the theory of impurity band merging from delocalization of levels states. On the metallic phase, electronic transport present a dispersion mechanism related with the Kondo effect, suggesting the presence of local magnetic moments in the vanadium supersaturated silicon material.

Determination of subclinical metabolic disorders in transition dairy cows

Das Gesundheitsmanagement von Milchkühen hat in den vergangenen Jahren auf den landwirtschaftlichen Betrieben an Bedeutung gewonnen. Neben Präventionsmaßnahmen zur Gesunderhaltung der Tiere ist die frühzeitige und systematische Erkennung von Erkrankungen hierbei der Hauptbestandteil. Es zeigt sich vermehrt, dass vor allem Transitkühe verstärkt an Stoffwechselerkrankungen in sowohl klinischer als auch subklinischer Form erkranken. Letztere stellen ein hohes Risiko dar, zum einen weil subklinische Erkrankungen oftmals nur schwer oder gar nicht erkannt werden und zum anderen, weil sie in vielen Fällen die Grundlage für meist schwerwiegendere Folgeerkrankungen sind. In der vorliegenden Studie wird das Thema der Früherkennung von subklinischen Ketosen und der subakuten Pansenazidose behandelt. Verschiedene Methoden wurden unter praktischen Versuchsbedingungen auf ihre Tauglichkeit zur Krankheitserkennung hin geprüft. In einer ersten Studie wurde auf einem konventionellen Milchviehbetrieb ein Ketose-Monitoring bei frischlaktierenden Kühen ab Tag 3 postpartum durchgeführt. Insgesamt 15 Tiere waren an einer subklinischen Ketose erkrankt, was eine Aufkommensrate von 26% in den untersuchten Tieren bedeutete. Die Blutproben von insgesamt 24 Tieren wurden auf ihren IL-6-Gehalt untersucht. Von den untersuchten Tieren waren 14 Tiere erkrankt, 10 Tiere bildeten die gesunde Kontrollgruppe. Interleukin-6 wurde bestimmt, da dem Zytokin IL-6 in anderen Studien in Bezug auf Ketosen eine Rolle zugesprochen wurde. Die erwartete Erhöhung von IL-6 bei erkrankten Tieren konnte nicht festgestellt werden; die erkrankten Kühe zeigten vielmehr die niedrigsten IL-6 Werte der Studiengruppe. Insgesamt waren die IL-6 Konzentrationen auf einem niedrigen Niveau mit 27.2 pg/m l± 10.2. Es zeigte sich, dass die IL-6 Bestimmung im Blut hinsichtlich der Erkennung von subklinischen Ketosen nur eingeschränkt nutzbar ist. Es konnte ausschließlich eine schwache negative Korrelation zwischen Beta- Hydroxybutyrat (BHBA, Goldstandard für den Nachweis einer Ketose) und IL-6 detektiert werden. Zusätzlich zu den Blutanalysen wurde ebenfalls die tägliche Wiederkauaktivität mit dem „DairyCheck“ System bestimmt, welches kontinuierlich die charakteristischen Kaumuskelkontraktionen aufzeichnet und somit die Dauer des Wiederkäuens bestimmt werden kann. Es wurde geprüft, ob sich ketotische Tiere von nicht ketotischen Tieren hinsichtlich der täglichen Wiederkäuzeit unterscheiden. Milchkühe mit einer Ketose kauten im Schnitt 475 min/d ± 56 wieder, nach Genesung 497 min/d ± 48. Sie befanden sich somit im Durchschnitt immer unterhalb der gesunden Kontrollgruppe, welche 521 min/d ± 76 wiederkaute. Eine Korrelation zwischen der Wiederkauzeit und dem BHBA- Gehalt im Blut war nur sehr schwach ausgeprägt, nicht zuletzt da die Tiere generell eine hohe Variabilität in der Wiederkauaktivität zeigten. Bei einer weiteren Studie, ebenfalls auf einem Praxisbetrieb durchgeführt, wurde auf die Erkennung der subakuten Pansensazidose (SARA) fokussiert. Hierbei kam ein drahtloses, kommerziell verfügbares Bolussystem zum Einsatz, welches den pH Wert kontinuierlich im Retikulorumen misst. Es macht die Erkennung einer SARA auch unter Praxisbedingungen ohne invasive Methoden wie der Punktion möglich. Das Bolussystem wurde 24 Milchkühen kurz vor der Abkalbung oral eingegeben, um den pH-Wert während der gesamten Transitphase messen und überwachen zu können. Während in der Trockenstehphase nur vereinzelte SARA Fälle auftraten, erlitt ein Großteil der untersuchten Tiere in der Frühlaktation eine SARA. Auf Grundlage von pH-Werten von laktierenden Milchkühen, wurde zusätzlich eine Sensitivitätsanalyse von verschieden, bereits eingesetzten Nachweismethoden durchgeführt, um die Tauglichkeit für die SARA-Diagnostik zu untersuchen. Es handelte sich hierbei zum einen um einen SARA-Nachweis unter Heranziehung von Einzelwerten, Fress- und Wiederkäuzeiten, sowie ausgewählten Milchinhaltsstoffen und der Milchmenge. Die Analyse ergab, dass nahezu alle Nachweismethoden im Vergleich zur Langzeitmessung nur eingeschränkt zur SARA-Diagnostik nutzbar sind. In einem weiteren Teil der Studie wurde eine Kotfraktionierung bei den gleichen Tieren durchgeführt, um damit SARA-Tiere auch mittels der Kotanalyse erkennen kann. Es konnte gezeigt werden, dass zum einen die Ration einen Einfluss auf die Kotzusammensetzung hat (Trockensteherration versus Ration für Laktierende) zum anderen aber auch, dass eine SARA die Zusammensetzung des Kotes verändert. Hierfür wurden Kotproben ausschließlich von laktierenden Kühen untersucht, sodass der Einfluss der Ration ausgeschlossen werden konnte. Erhöhte Faseranteile im Kot von SARA - Kühen gaben Hinweis auf eine verminderte Verdaulichkeit. Dabei erwies sich vor allem die Hemizellulose als guter Parameter, um auf eine SARA schließen zu können. Die Versuchsbedingungen ließen es ebenfalls zu, die pH-Verläufe der Tiere in der Frühlaktation zu untersuchen. Eine Clusteranalyse von pH-Werten der ersten 12 Tage postpartum zeigte, dass die untersuchten Tiere trotz gleicher Haltungs- und Fütterungsbedingungen unterschiedliche pH-Wert Verläufe entwickelten. So gab es eine Gruppe von Milchkühen, die den pH-Wert stabil halten konnte, während die restlichen pH-Abfälle in verschiedenen Verläufen und Intensitäten aufzeigten. Es konnte ebenfalls aufgezeigt werden, dass Tiere innerhalb der Testherde unterschiedliche Schweregrade der SARA entwickelten. Auch in dieser Studie wurde deutlich, dass Tiere scheinbar unterschiedliche Möglichkeiten haben, auf ihre Umwelt zu reagieren, bzw. suboptimalen Bedingungen entgegenwirken zu können. Zusammengefasst wurden verschiedene Methoden zur Ketose- und SARA- Erkennung geprüft, von denen nur einzelne für die Praxis zu empfehlen sind. Die Variabilität der Tiere, sowohl bei der Ausprägung der Erkrankungen als auch bei den gemessenen Parametern verdeutlicht die Notwendigkeit, diese im Herden- und Gesundheitsmanagement in Zukunft stärker zu berücksichtigen.

The Cratylia Mollis Seed Lectin Induces Membrane Permeability Transition In Isolated Rat Liver Mitochondria And A Cyclosporine A-insensitive Permeability Transition In Trypanosoma Cruzi Mitochondria.

Previous results provided evidence that Cratylia mollis seed lectin (Cramoll 1,4) promotes Trypanosoma cruzi epimastigotes death by necrosis via a mechanism involving plasma membrane permeabilization to Ca(2+) and mitochondrial dysfunction due to matrix Ca(2+) overload. In order to investigate the mechanism of Ca(2+) -induced mitochondrial impairment, experiments were performed analyzing the effects of this lectin on T. cruzi mitochondrial fraction and in isolated rat liver mitochondria (RLM), as a control. Confocal microscopy of T. cruzi whole cell revealed that Cramoll 1,4 binding to the plasma membrane glycoconjugates is followed by its internalization and binding to the mitochondrion. Electrical membrane potential (∆Ψm ) of T. cruzi mitochondrial fraction suspended in a reaction medium containing 10 μM Ca(2+) was significantly decreased by 50 μg/ml Cramoll 1,4 via a mechanism insensitive to cyclosporine A (CsA, membrane permeability transition (MPT) inhibitor), but sensitive to catalase or 125 mM glucose. In RLM suspended in a medium containing 10 μM Ca(2+) this lectin, at 50 μg/ml, induced increase in the rate of hydrogen peroxide release, mitochondrial swelling, and ∆Ψm disruption. All these mitochondrial alterations were sensitive to CsA, catalase, and EGTA. These results indicate that Cramoll 1, 4 leads to inner mitochondrial membrane permeabilization through Ca(2+) dependent mechanisms in both mitochondria. The sensitivity to CsA in RLM characterizes this lectin as a MPT inducer and the lack of CsA effect identifies a CsA-insensitive MPT in T. cruzi mitochondria.

Beam-energy Dependence Of The Directed Flow Of Protons, Antiprotons, And Pions In Au+au Collisions.

Rapidity-odd directed flow (v1) measurements for charged pions, protons, and antiprotons near midrapidity (y=0) are reported in sNN=7.7, 11.5, 19.6, 27, 39, 62.4, and 200 GeV Au+Au collisions as recorded by the STAR detector at the Relativistic Heavy Ion Collider. At intermediate impact parameters, the proton and net-proton slope parameter dv1/dy|y=0 shows a minimum between 11.5 and 19.6 GeV. In addition, the net-proton dv1/dy|y=0 changes sign twice between 7.7 and 39 GeV. The proton and net-proton results qualitatively resemble predictions of a hydrodynamic model with a first-order phase transition from hadronic matter to deconfined matter, and differ from hadronic transport calculations.

Predictive Value Of Phase I Trials For Safety In Later Trials And Final Approved Dose: Analysis Of 61 Approved Cancer Drugs.

Phase I trials use a small number of patients to define a maximum tolerated dose (MTD) and the safety of new agents. We compared data from phase I and registration trials to determine whether early trials predicted later safety and final dose. We searched the U.S. Food and Drug Administration (FDA) website for drugs approved in nonpediatric cancers (January 1990-October 2012). The recommended phase II dose (R2PD) and toxicities from phase I were compared with doses and safety in later trials. In 62 of 85 (73%) matched trials, the dose from the later trial was within 20% of the RP2D. In a multivariable analysis, phase I trials of targeted agents were less predictive of the final approved dose (OR, 0.2 for adopting ± 20% of the RP2D for targeted vs. other classes; P = 0.025). Of the 530 clinically relevant toxicities in later trials, 70% (n = 374) were described in phase I. A significant relationship (P = 0.0032) between increasing the number of patients in phase I (up to 60) and the ability to describe future clinically relevant toxicities was observed. Among 28,505 patients in later trials, the death rate that was related to drug was 1.41%. In conclusion, dosing based on phase I trials was associated with a low toxicity-related death rate in later trials. The ability to predict relevant toxicities correlates with the number of patients on the initial phase I trial. The final dose approved was within 20% of the RP2D in 73% of assessed trials.