Facteurs influençant le retour au travail après transplantation chez 61 patients rénaux ou hépatiques

Enjeux La réussite d'une transplantation rénale ou hépatique intègre non seulement le succès de l'acte chirurgical et sa prise en charge médicale post-greffe, mais également pour le patient greffé l'assurance d'une nouvelle qualité de vie dont le retour au travail fait partie. Le retour au travail après greffe est cependant généralement peu étudié dans la littérature et peu discuté semble-t-il au niveau médical que ce soit avant ou après greffe, quand bien même d'un point de vue médico-socio-économique il s'agit d'un sujet important compte tenu des coûts liés à un arrêt de travail prolongé ou à une rente pour incapacité de travail. Contexte Après une greffe réussie, il n'existe théoriquement plus de facteur limitant et peu de contre-indications médicales liées à la greffe pour empêcher une reprise progressive de l'activité professionnelle. Or en réalité le taux de retour au travail après greffe est généralement faible, variant entre 30 et 60% selon la littérature. Ceci a incité l'auteur de cette présente étude à essayer d'en connaître les raisons. Ainsi, l'hypothèse a été que certains facteurs professionnels (« en activité professionnelle ou non avant greffe », « être diplômé ou non»), individuels («âge», «genre», «type d'organe greffé») ou médicaux (« complications médicales aiguës de moins de 6 mois post greffe ») influencent négativement ou positivement le retour au travail des patients greffés. L'étude a porté sur un petit collectif volontaire de patients greffés rénaux et hépatiques opérés entre 1993 et 2003 et suivis depuis lors au centre de transplantation d'organes (CTO) du CHUV. Il leur a été administré en face à face un questionnaire médical spécialement conçu pour l'étude. Conclusion L'étude montre que le taux de retour au travail après greffe rénale ou hépatique s'élève à 39% et qu'il existe effectivement des facteurs pouvant influencer le retour au travail après greffe. Ainsi, être « âgé de moins de 45 ans », être « au bénéfice d'une formation (diplôme) » et « travailler les deux ans précédent la greffe » sont des facteurs significatifs de retour au travail après greffe. Perspective Gage de qualité de vie, le retour au travail après greffe doit être encouragé et favorisé quand il se peut, en s'aidant des facteurs connus qui l'influencent positivement ou négativement. Pour cela, il est indispensable qu'au stade pré greffe déjà s'instaure un dialogue sur le sujet entre patients en attente de greffe et personnel médico-social, afin de mettre en oeuvre le plus précocement possible les mesures socio-professionnelles adéquates comme cela se fait déjà en Allemagne ou aux Etats-Unis par exemple.

An epidemiologic study to determine the prevalence of the HLA-B*5701 allele among HIV-positive patients in Europe.

OBJECTIVES: HLA-B*5701 is a major histocompatibility complex class I allele associated with an immunologically-mediated hypersensitivity reaction to abacavir. The objectives of this study were to evaluate HLA-B*5701 prevalence among European, HIV-1-infected patients and to compare the local and central laboratory screening results. METHODS: Data were combined from six multicentre, prospective studies involving 10 European countries in which HIV-1-infected patients (irrespective of treatment experience or previous HLA-B*5701 screening), >or=18 years of age, were evaluated for HLA-B*5701 carriage, determined by the central and local laboratory methods. RESULTS: A total of 9720 patients from 272 centres were included in the analysis. The overall estimate of HLA-B*5701 prevalence in Europe was 4.98%, with country-specific estimates ranging from 1.53 to 7.75%. HLA-B*5701 prevalence was highest in the self-reported white population (6.49%) and lowest in the black population (0.39%). Local laboratory results had a high specificity (99.9%) and sensitivity (99.2%) when compared with the central laboratory results. CONCLUSION: This study supports data from previous studies regarding the prevalence of HLA-B*5701 in the HIV population and the variation of HLA-B*5701 prevalence between different racial groups. The high specificity and sensitivity of local laboratory results, suggests that clinicians can be confident in using local laboratories for pretreatment HLA-B*5701 screening. However, it is essential that local laboratories participate in HLA-B*5701-specific quality assurance programs to maintain 100% sensitivity. In HIV-infected patients, pretreatment HLA-B*5701 screening may allow more informed decisions regarding abacavir use and has the potential to significantly reduce the frequency of abacavir-related hypersensitivity reactions and costs associated with managing these reactions.

New perspectives in the use of ink evidence in forensic science: Part III: Operational applications and evaluation.

The research reported in this series of article aimed at (1) automating the search of questioned ink specimens in ink reference collections and (2) at evaluating the strength of ink evidence in a transparent and balanced manner. These aims require that ink samples are analysed in an accurate and reproducible way and that they are compared in an objective and automated way. This latter requirement is due to the large number of comparisons that are necessary in both scenarios. A research programme was designed to (a) develop a standard methodology for analysing ink samples in a reproducible way, (b) comparing automatically and objectively ink samples and (c) evaluate the proposed methodology in forensic contexts. This report focuses on the last of the three stages of the research programme. The calibration and acquisition process and the mathematical comparison algorithms were described in previous papers [C. Neumann, P. Margot, New perspectives in the use of ink evidence in forensic science-Part I: Development of a quality assurance process for forensic ink analysis by HPTLC, Forensic Sci. Int. 185 (2009) 29-37; C. Neumann, P. Margot, New perspectives in the use of ink evidence in forensic science-Part II: Development and testing of mathematical algorithms for the automatic comparison of ink samples analysed by HPTLC, Forensic Sci. Int. 185 (2009) 38-50]. In this paper, the benefits and challenges of the proposed concepts are tested in two forensic contexts: (1) ink identification and (2) ink evidential value assessment. The results show that different algorithms are better suited for different tasks. This research shows that it is possible to build digital ink libraries using the most commonly used ink analytical technique, i.e. high-performance thin layer chromatography, despite its reputation of lacking reproducibility. More importantly, it is possible to assign evidential value to ink evidence in a transparent way using a probabilistic model. It is therefore possible to move away from the traditional subjective approach, which is entirely based on experts' opinion, and which is usually not very informative. While there is room for the improvement, this report demonstrates the significant gains obtained over the traditional subjective approach for the search of ink specimens in ink databases, and the interpretation of their evidential value.

Embankment Quality Phase IV: Application to Unsuitable Soils, TR-492, 2007

The Quality Management Earthwork (QM-E) special provision was implemented on a pilot project to evaluate quality control (QC) and quality assurance (QA) testing in predominately unsuitable soils. Control limits implemented on this pilot project included the following: 95% relative compaction, moisture content not exceeding +/- 2% of optimum moisture content, soil strength not exceeding a dynamic cone penetrometer (DCP) index of 70 mm/blow, vertical uniformity not exceeding a variation in DCP index of 40 mm/blow, and lift thickness not exceeding depth determined through construction of control strips. Four-point moving averages were used to allow for some variability in the measured parameter values. Management of the QC/QA data proved to be one of the most challenging aspects of the pilot project. Implementing use of the G-RAD data collection system has considerable potential to reduce the time required to develop and maintain QC/QA records for projects using the QM-E special provision. In many cases, results of a single Proctor test were used to establish control limits that were used for several months without retesting. While the data collected for the pilot project indicated that the DCP index control limits could be set more tightly, there is not enough evidence to support making a change. In situ borings, sampling, and testing in natural unsuitable cut material and compacted fill material revealed that the compacted fill had similar strength characteristics to that of the natural cut material after less than three months from the start of construction.

Identification of Practices, Design, Construction, and Repair Using Trenchless Technology, TR-570, 2010

Trenchless technologies are methods used for the construction and rehabilitation of underground utility pipes. These methods are growing increasingly popular due to their versatility and their potential to lower project costs. However, the use of trenchless technologies in Iowa and their effects on surrounding soil and nearby structures has not been adequately documented. Surveys of and interviews with professionals working in trenchless-related industries in Iowa were conducted, and the results were analyzed and compared to survey results from the United States as a whole. The surveys focused on method familiarity, pavement distress observed, reliability of trenchless methods, and future improvements. Results indicate that the frequency of pavement distress or other trenchless-related issues are an ongoing problem in the industry. Inadequate soil information and quality control/quality assurance (QC/QA) are partially to blame. Fieldwork involving the observation of trenchless construction projects was undertaken with the purpose of documenting current practices and applications of trenchless technology in the United States and Iowa. Field tests were performed in which push-in pressure cells were used to measure the soil stresses induced by trenchless construction methods. A program of laboratory soil testing was carried out in conjunction with the field testing. Soil testing showed that the installations were made in sandy clay or well-graded sand with silt and gravel. Pipes were installed primarily using horizontal directional drilling with pipe diameters from 3 to 12 inches. Pressure cell monitoring was conducted during the following construction phases: pilot bore, pre-reaming, and combined pipe pulling and reaming. The greatest increase in lateral earth pressure was 5.6 psi and was detected 2.1 feet from the centerline of the bore during a pilot hole operation in sandy lean clay. Measurements from 1.0 to 2.5 psi were common. Comparisons were made between field measurements and analytical and finite element calculation methods.

Investigation of Electromagnetic Gauges for Determination of In-Place Density of HMA Pavements, TR-576, 2009

This study evaluated the use of electromagnetic gauges to determine the adjusted densities of HMA pavements. Field measurements were taken with two electromagnetic gauges, the Pavement Quality Indicator (PQI) 301 and the Pavetracker Plus 2701B. Seven projects were included in the study with 3 to 5 consecutive paving days. For each day/lot 20 randomly selected locations were tested along with seven core locations. The analysis of PaveTracker and PQI density consisted of determining which factors are statistically significant, and core density residuals and a regression analysis of core as a function of PaveTracker and PQI readings. The following key conclusions can be stated: 1. Core density, traffic and binder content were all found to be significant for both electromagnetic gauges studied, 2. Core density residuals are normally distributed and centered at zero for both electromagnetic gauges, 3. For PaveTracker readings, statistically one third of the lots do not have an intercept that is zero and two thirds of the lots do not rule out a scaler correction factor of zero, 4. For PQI readings, statistically the 95% confidence interval rules out the intercept being zero for all seven projects and six of the seven projects do not rule out the scaler correction factor being zero, 5. The PQI 301 gauge should not be used for quality control or quality assurance, and 6. The Pavetracker 2701B gauge can be used for quality control but not quality assurance. This study has found that with the limited sample size, the adjusted density equations for both electromagnetic gauges were determined to be inadequate. The PaveTracker Plus 2701B was determined to be better than the PQI 301. The PaveTracker 2701B could still be applicable for quality assurance if the number of core locations per day is reduced and supplemented with additional PaveTracker 2701B readings. Further research should be done to determine the minimum number of core locations to calibrate the gauges each day/lot and the number of additional PaveTracker 2701B readings required.

Embankment Quality: Phase III, TR-401, 2002

This report describes test results from a full-scale embankment pilot study conducted in Iowa. The intent of the pilot project was to field test and refine the proposed soil classification system and construction specifications developed in Phase II of this research and to evaluate the feasibility of implementing a contractor quality control (QC) and Iowa DOT quality assurance (QA) program for earthwork grading in the future. One of the primary questions for Phase III is “Was embankment quality improved?” The project involved a “quality conscious” contractor, well-qualified and experienced Iowa Department of Transportation field personnel, a good QC consultant technician, and some of our best soils in the state. If the answer to the above question is “yes” for this project, it would unquestionably be “yes” for other projects as well. The answer is yes, the quality was improved, even for this project, as evidenced by dynamic cone penetrometer test data and the amount of disking required to reduce the moisture content to within acceptable control limits (approximately 29% of soils by volume required disking). Perhaps as important is that we know what quality we have. Increased QC/QA field testing, however, increases construction costs, as expected. The quality management-earthwork program resulted in an additional $0.03 per cubic meter, or 1.6%, of the total construction costs. Disking added about $0.04 per cubic meter, or 1.7%, to the total project costs. In our opinion this is a nominal cost increase to improve quality. It is envisioned that future contractor innovations have the potential for negating this increase. The Phase III results show that the new soil classification system and the proposed field test methods worked well during the Iowa Department of Transportation soils design phase and during the construction phase. Recommendations are provided for future implementation of the results of this study by city, county, and state agencies.

Field Evaluation of Compaction Monitoring Technology: Phase I, 2004

This Phase I report describes a preliminary evaluation of a new compaction monitoring system developed by Caterpillar, Inc. (CAT), for use as a quality control and quality assurance (QC/QA) tool during earthwork construction operations. The CAT compaction monitoring system consists of an instrumented roller with sensors to monitor machine power output in response to changes in soil machine interaction and is fitted with a global positioning system (GPS) to monitor roller location in real time. Three pilot tests were conducted using CAT’s compaction monitoring technology. Two of the sites were located in Peoria, Illinois, at the Caterpillar facilities. The third project was an actual earthwork grading project in West Des Moines, Iowa. Typical construction operations for all tests included the following steps: (1) aerate/till existing soil; (2) moisture condition soil with water truck (if too dry); (3) remix; (4) blade to level surface; and (5) compact soil using the CAT CP-533E roller instrumented with the compaction monitoring sensors and display screen. Test strips varied in loose lift thickness, water content, and length. The results of the study show that it is possible to evaluate soil compaction with relatively good accuracy using machine energy as an indicator, with the advantage of 100% coverage with results in real time. Additional field trials are necessary, however, to expand the range of correlations to other soil types, different roller configurations, roller speeds, lift thicknesses, and water contents. Further, with increased use of this technology, new QC/QA guidelines will need to be developed with a framework in statistical analysis. Results from Phase I revealed that the CAT compaction monitoring method has a high level of promise for use as a QC/QA tool but that additional testing is necessary in order to prove its validity under a wide range of field conditions. The Phase II work plan involves establishing a Technical Advisor Committee, developing a better understanding of the algorithms used, performing further testing in a controlled environment, testing on project sites in the Midwest, and developing QC/QA procedures.

Iowa’s Title V Maternal and Child Health (MCH) Annual Report, 2014

Title V of the Social Security Act is the longest-standing public health legislation in American history. Enacted in 1935, Title V is a federal-state partnership that promotes and improves maternal and child health (MCH). According to each state’s unique needs, Title V supports a spectrum of services, from infrastructure building services like quality assurance and policy development, to gap-filling direct health care services. Title V resources are directed towards MCH priority populations: pregnant women, mothers, infants, women of reproductive years, children and adolescents and children and youth with special health care needs.

09007-004 Upper Buffalo Creek Watershed Final Report

The main channel of Upper Buffalo Creek has been identified on Iowa's 303(d) List of Impaired Waters as having a biological impairment (i.e., greater than 50% decrease in mussel species) due to habitat modification, stream alteration, nutrients, and/or siltation. The Buchanan County SWCD has identified this as a priority watershed because mussel population decreases have been well documented to be directly associated with decreases in ecological value, recreational value, and overall water quality. The presence of a diverse and reproducing mussel population indicates that a healthy aquatic ecosystem is intact, which means good fishing, good water quality for wildlife, and assurance that water is safe for recreation. Dan Cohen, Buchanan Conservation Board Director, stated that "should water quality conditions improve, and fishing holes and habitat be enhanced, there is no doubt that many people would take advantage of the renewed recreational opportunities". This watershed contains two "threatened" species of mussels and five "sensitive" species of fish. The District feels that a watershed project will assist in implementing conservation practices that will greatly improve water quality and enhance biological and recreational venues.

Ruin and related quantities in some advanced insurance risk models

Risk theory has been a very active research area over the last decades. The main objectives of the theory are to find adequate stochastic processes which can model the surplus of a (non-life) insurance company and to analyze the risk related quantities such as ruin time, ruin probability, expected discounted penalty function and expected discounted dividend/tax payments. The study of these ruin related quantities provides crucial information for actuaries and decision makers. This thesis consists of the study of four different insurance risk models which are essentially related. The ruin and related quantities are investigated by using different techniques, resulting in explicit or asymptotic expressions for the ruin time, the ruin probability, the expected discounted penalty function and the expected discounted tax payments. - La recherche en théorie du risque a été très dynamique au cours des dernières décennies. D'un point de vue théorique, les principaux objectifs sont de trouver des processus stochastiques adéquats permettant de modéliser le surplus d'une compagnie d'assurance non vie et d'analyser les mesures de risque, notamment le temps de ruine, la probabilité de ruine, l'espérance de la valeur actuelle de la fonction de pénalité et l'espérance de la valeur actuelle des dividendes et taxes. L'étude de ces mesures associées à la ruine fournit des informations cruciales pour les actuaires et les décideurs. Cette thèse consiste en l'étude des quatre différents modèles de risque d'assurance qui sont essentiellement liés. La ruine et les mesures qui y sont associées sont examinées à l'aide de différentes techniques, ce qui permet d'induire des expressions explicites ou asymptotiques du temps de ruine, de la probabilité de ruine, de l'espérance de la valeur actuelle de la fonction de pénalité et l'espérance de la valeur actuelle des dividendes et taxes.

Iowa’s Title V Block Grant Executive Summary, 2013

Title V of the Social Security Act is the longest-standing public health legislation in American history. Enacted in 1935, Title V is a federal-state partnership that promotes and improves maternal and child health (MCH). According to each state’s unique needs, Title V supports a spectrum of services, from infrastructure building services like quality assurance and policy development, to gap-filling direct health care services. Title V resources are directed towards MCH priority populations: pregnant women, mothers, infants, women of reproductive years, children and adolescents and children and youth with special health care needs.

The clinical use of quantitative ultrasound (QUS) in the detection and management of osteoporosis

For the detection and management of osteoporosis and osteoporosis-related fractures, quantitative ultrasound (QUS) is emerging as a relatively low-cost and readily accessible alternative to dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD) in certain circumstances. The following is a brief, but thorough review of the existing literature with respect to the use of QUS in 6 settings: 1) assessing fragility fracture risk; 2) diagnosing osteoporosis; 3) initiating osteoporosis treatment; 4) monitoring osteoporosis treatment; 5) osteoporosis case finding; and 6) quality assurance and control. Many QUS devices exist that are quite different with respect to the parameters they measure and the strength of empirical evidence supporting their use. In general, heel QUS appears to be most tested and most effective. Overall, some, but not all, heel QUS devices are effective assessing fracture risk in some, but not all, populations, the evidence being strongest for Caucasian females over 55 years old. Otherwise, the evidence is fair with respect to certain devices allowing for the accurate diagnosis of likelihood of osteoporosis, and generally fair to poor in terms of QUS use when initiating or monitoring osteoporosis treatment. A reasonable protocol is proposed herein for case-finding purposes, which relies on a combined assessment of clinical risk factors (CR.F) and heel QUS. Finally, several recommendations are made for quality assurance and control.