880 resultados para Supervised brushing


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The Experimental Project was designated as Research Project No. HR-34, sponsored by the Iowa Highway Research Board and constructed by the Iowa Highway Commission. Construction was supervised cooperatively by Engineers of the Iowa Highway Commission and the Portland Cement Association. The objective of the experiment is to study the behavior of relatively thin portland cement concrete resurfacing courses placed with bond on old concrete pavements. The phase of the problem being studied now, involves only pavements in which the old concrete is structurally sound.

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This issue review examines the funding levels within the community-based corrections, or CBC, district departments compared to the offender populations, risk and supervision levels, and recidivism rates to consider whether current funding allocations are appropriate. The majority of offenders in corrections are supervised by the CBC-district departments.

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L’estudi actualitza les taxes de reincidència dels menors sotmesos a una mesura d’internament o de llibertat vigilada que van ser publicades a la recerca “La reincidència en el delicte en la justícia de menors” finalitzada l’any 2005 i que van iniciar la sèrie. Aquest estudi ja és el sisè del mateix tipus i, en aquest cas, segueix els joves que van finalitzar una mesura de llibertat vigilada o d’internament l’any 2008, i els segueix fins el 31 de desembre de 2011 amb l’objectiu de saber si han comès un nou delicte que hagi estat detectat per la Xarxa d’execució penal, tant de joves com d’adults. S’ha estudiat tota la població de joves desinternats de centres, que per l’any 2008 foren 258 subjectes. En el cas de llibertat vigilada la població que ha finalitzat l’any 2008 ha estat de 967 subjectes. En total la població estudiada ha estat de 1.225 joves. Els resultats en la taxa de reincidència de llibertat vigilada han baixat lleugerament (28,7%) respecte l’any anterior (que era del 29,6%). En internament la taxa de reincidència també ha baixat lleugerament (57,8%) respecte l’any passat (58,7%). L’estudi permet comparar de forma seriada sis anys d’evolució de la taxa de reincidència juvenil després de la posada en marxa de la Llei Orgànica 5/2000, de 12 de gener, reguladora de la responsabilitat penal dels menors (LORPM).

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El estudio actualiza por quinto año las tasas de reincidencia juvenil en las medidas de libertad vigilada e internamiento en Catalunya. En este caso se ha estudiado a la población que finalizó una medida el año 2008 y se les ha seguido hasta el 31 de diciembre de 2011. Los resultados nos dicen que la tasa de reincidencia de libertad vigilada es del 28,7% y la tasa de internamiento es del 57,8%.

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The objective of the present work was to determine the inheritance and stability of transgenes of a transgenic bean line expressing the genes rep-trap-ren from Bean golden mosaic virus and the bar gene. Crosses were done between the transgenic line and four commercial bean cultivars, followed by four backcrosses to the commercial cultivars. Progenies from each cross were evaluated for the presence of the transgenes by brushing the leaves with glufosinate ammonium and by polymerase chain reaction using specific oligonucleotides. Advanced generations were rub-inoculated with an isolate of Bean common mosaic necrosis virus (BCMNV). The transgenes were inherited consistently in a Mendelian pattern in the four crosses studied. The analyzed lines recovered close to 80% of the characteristics of the recurrent parent, as determined by the random amplified DNA markers used, besides maintaining important traits such as resistance to BCMNV. The presence of the transgene did not cause any detectable undesirable effect in the evaluated progenies.

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BACKGROUND: Over the years, somatic care has become increasingly specialized. Furthermore, a rising number of patients requiring somatic care also present with a psychiatric comorbidity. As a consequence, the time and resources needed to care for these patients can interfere with the course of somatic treatment and influence the patient-caregiver relationship. In the light of these observations, the Liaison Psychiatry Unit at the University Hospital in Lausanne (CHUV) has educated its nursing staff in order to strengthen its action within the general care hospital. What has been developed is a reflexive approach through supervision of somatic staff, in order to improve the efficiency of liaison psychiatry interventions with the caregivers in charge of patients. The kind of supervision we have developed is the result of a real partnership with somatic staff. Besides, in order to better understand the complexity of interactions between the two systems involved, the patient's and the caregivers', we use several theoretical references in an integrative manner. PSYCHOANALYTICAL REFERENCE: The psychoanalytical model allows us to better understand the dynamics between the supervisor and the supervised group in order to contain and give meaning to the affects arising in the supervision space. "Containing function" and "transitional phenomena" refer to the experience in which emotions can find a space where they can be taken in and processed in a secure and supportive manner. These concepts, along with that of the "psychic envelope", were initially developed to explain the psychological development of the baby in its early interactions with its mother or its surrogate. In the field of supervision, they allow us to be aware of these complex phenomena and the diverse qualities to which a supervisor needs to resort, such as attention, support and incentive, in order to offer a secure environment. SYSTEMIC REFERENCE: A new perspective of the patient's complexity is revealed by the group's dynamics. The supervisor's attention is mainly focused on the work of affects. However, these are often buried under a defensive shell, serving as a temporary protection, which prevents the caregiver from recognizing his or her own emotions, thereby enhancing the difficulties in the relationship with the patient. Whenever the work of putting emotions into words fail, we use "sculpting", a technique derived from the systemic model. Through the use of this type of analogical language, affects can emerge without constraint or feelings of danger. Through "playing" in that "transitional space", new exchanges appear between group members and allow new behaviors to be conceived. In practice, we ask the supervisee who is presenting a complex situation, to design a spatial representation of his or her understanding of the situation, through the display of characters significant to the situation: the patient, somatic staff members, relatives of the patient, etc. In silence, the supervisee shapes the characters into postures and arranges them in the room. Each sculpted character is identified, named, and positioned, with his or her gaze being set in a specific direction. Finally the sculptor shapes him or herself in his or her own role. When the sculpture is complete and after a few moments of fixation, we ask participants to express themselves about their experience. By means of this physical representation, participants to the sculpture discover perceptions and feelings that were unknown up to then. Hence from this analogical representation a reflection and hypotheses of understanding can arise and be developed within the group. CONCLUSION: Through the use of the concepts of "containing function" and "transitional space" we position ourselves in the scope of the encounter and the dialog. Through the use of the systemic technique of "sculpting" we promote the process of understanding, rather than that of explaining, which would place us in the position of experts. The experience of these encounters has shown us that what we need to focus on is indeed what happens in this transitional space in terms of dynamics and process. The encounter and the sharing of competencies both allow a new understanding of the situation at hand, which has, of course, to be verified in the reality of the patient-caregiver relationship. It is often a source of adjustment for interpersonal skills to recover its containing function in order to enable caregiver to better respond to the patient's needs.

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Although physical activity is recommended in patients on maintenance hemodialysis (MHD), randomized controlled trials testing the effects of exercise in this population have given conflicting results. In general, aerobic exercises mostly failed to produce improvements in physical function, whereas resistance exercises, although less studied, appeared to be more promising. The use of sophisticated materials such as leg press and free weights may preclude widespread application of resistance training in patients on MHD. Simple and cheap elastic bands may thus be an attractive alternative. We tested the feasibility of a supervised intradialytic resistance band exercise training program, and its effects on physical function, in patients on MHD. A total of 11 unselected adult patients on MHD from our center, aged 70 ± 10.7 (mean ± standard deviation) years, including 8 men and 3 women, accepted to follow the program under the supervision of qualified physiotherapists. Thirty-six exercise sessions of moderate intensity (twice a week, mean duration 40 minutes each, during 4.5 to 6 months), mainly involving leg muscles against an elastic resistance, were performed. The exercise program was well tolerated and all patients completed it. Statistically significant improvements were observed in the following tests: Tinetti test, 23.9 ± 3.9 points before versus 25.7 ± 3.5 points after the program (P = .022); the Timed Up and Go test, 12.1 ± 6.6 versus 10 ± 5.8 seconds (P = .0156). Improvements in the 6-minute walk distance and in the one-leg balance tests just failed to reach statistical significance. In this single-center pilot study, an intradialytic resistance band exercise program was feasible, well tolerated, and showed encouraging results on physical function.

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Background: Differences in the distribution of genotypes between individuals of the same ethnicity are an important confounder factor commonly undervalued in typical association studies conducted in radiogenomics. Objective: To evaluate the genotypic distribution of SNPs in a wide set of Spanish prostate cancer patients for determine the homogeneity of the population and to disclose potential bias. Design, Setting, and Participants: A total of 601 prostate cancer patients from Andalusia, Basque Country, Canary and Catalonia were genotyped for 10 SNPs located in 6 different genes associated to DNA repair: XRCC1 (rs25487, rs25489, rs1799782), ERCC2 (rs13181), ERCC1 (rs11615), LIG4 (rs1805388, rs1805386), ATM (rs17503908, rs1800057) and P53 (rs1042522). The SNP genotyping was made in a Biotrove OpenArrayH NT Cycler. Outcome Measurements and Statistical Analysis: Comparisons of genotypic and allelic frequencies among populations, as well as haplotype analyses were determined using the web-based environment SNPator. Principal component analysis was made using the SnpMatrix and XSnpMatrix classes and methods implemented as an R package. Non-supervised hierarchical cluster of SNP was made using MultiExperiment Viewer. Results and Limitations: We observed that genotype distribution of 4 out 10 SNPs was statistically different among the studied populations, showing the greatest differences between Andalusia and Catalonia. These observations were confirmed in cluster analysis, principal component analysis and in the differential distribution of haplotypes among the populations. Because tumor characteristics have not been taken into account, it is possible that some polymorphisms may influence tumor characteristics in the same way that it may pose a risk factor for other disease characteristics. Conclusion: Differences in distribution of genotypes within different populations of the same ethnicity could be an important confounding factor responsible for the lack of validation of SNPs associated with radiation-induced toxicity, especially when extensive meta-analysis with subjects from different countries are carried out.

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Background: In 2004, complementary and alternative medicine (CAM) was offered by physicians in one third of Swiss hospitals. Since then, CAM health policy has considerably changed. This study aims at describing the present supply and use of CAM in hospitals of the French-speaking part of Switzerland, and qualitatively explores the characteristics of this supply. Methods: Between June 2011 and March 2012, a short questionnaire was sent to the medical directors of hospitals (N=46), asking them whether a CAM was offered, where and by whom. Then, a semi-directive interview was conducted with 10 CAM therapists. Results: Among 37 responses (return rate 80%), 19 medical directors indicated that their hospital offered at least one CAM and 18 reported that they did not. Acupuncture was the most frequently proposed CAM, followed by manual therapies, osteopathy and aromatherapy. The disciplines that offered CAM most frequently were rehabilitation, gynaecology- obstetrics, palliative care, psychiatry and anaesthesiology. In eight out of ten interviews, it appeared that the procedures for introducing a CAM in the hospital were not tightly supervised by the hospital but were mainly based on the goodwill of the therapists, rather than clinical/scientific evidence. Conclusion: Hospitals offering CAM in the French-speaking part of Switzerland seems to have risen since 2004. The selection of CAM to be offered in a hospital should be based on the same procedure of evaluation and validation as conventional care, and if their safety and efficiency is evidence-based, they should receive the same structural resources.

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BACKGROUND: New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients. METHOD: Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD. RESULTS: During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0+/-6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin. CONCLUSION: In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program.

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The objective of this work was to evaluate the use of multispectral remote sensing for site-specific nitrogen fertilizer management. Satellite imagery from the advanced spaceborne thermal emission and reflection radiometer (Aster) was acquired in a 23 ha corn-planted area in Iran. For the collection of field samples, a total of 53 pixels were selected by systematic randomized sampling. The total nitrogen content in corn leaf tissues in these pixels was evaluated. To predict corn canopy nitrogen content, different vegetation indices, such as normalized difference vegetation index (NDVI), soil-adjusted vegetation index (Savi), optimized soil-adjusted vegetation index (Osavi), modified chlorophyll absorption ratio index 2 (MCARI2), and modified triangle vegetation index 2 (MTVI2), were investigated. The supervised classification technique using the spectral angle mapper classifier (SAM) was performed to generate a nitrogen fertilization map. The MTVI2 presented the highest correlation (R²=0.87) and is a good predictor of corn canopy nitrogen content in the V13 stage, at 60 days after cultivating. Aster imagery can be used to predict nitrogen status in corn canopy. Classification results indicate three levels of required nitrogen per pixel: low (0-2.5 kg), medium (2.5-3 kg), and high (3-3.3 kg).

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Rehabilitation programs represent an important and valuable tool for patients suffering various diseases. Supervised exercise programs for patients with peripheral arterial diseases have been shown to be efficacious in ameliorating walking performances and quality of life of such patients. With this regards the angiology service of the CHUV in Lausanne has established a multidisciplinary supervised program of vascular rehabilitation. This article describes organisation and characteristics of such a program.

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Puhdastilojen suunnittelussa pyritään saamaan hallittu ja valvottu ilmanpuhtaus luokiteltuun tilaan.Luokittelu tapahtuu puhdastilastandardeilla, lisäksi lääkevalmisteita valmistettavassa tilassa GMP -säädösten mukaisin luokituksin. Puhdastilastandardi ISO 14644 käsittää seitsemän osaa, jossa on käsitelty puhdastilaa koskevia määräyksiä suunnittelusta käyttöön ja testaukseen. GMP-säädökset sisältävät yhdeksän kappaletta, joista kappale 3: 'Tilat ja laitteet' on keskeinen osa lääkeainevalmistuksen puhdastilasuunnittelua. Puhtaan ilman aikaansaamiseksi puhdastilaan merkittävimmät roolit ovat ilmanvaihdolla, puhdastilarakenteilla ja rakennusautomaatiolla. Ilma voidaan tuoda tilaan kolmella eri periaatteella. Ilmaa tuodaan tilaan yhdensuuntaisesti, turbulenttisesti tai sekavirtauksena HEPA -suodattimien kautta, joilla varmistetaan epäpuhtauksien korkea suodatusaste. Ilmapoistetaan rei'itettyjen, korotettujen lattioiden kautta tai tilan alaosassa olevien poistoilmasäleikköjen kautta, josta se johdetaan noin 75-90%:sti kierrätettynä takaisin tilaan. Lääketeollisuudessa rei'itettyjä, korotettuja lattioita eivoida käyttää kontaminaatiovaaran, vuoksi. Tilaan suunniteltuja olosuhteita ylläpidetään rakennusautomaation avulla ja monitorointijärjestelmällä valvotaan tilassa olevan ilman laatua. Kaikki GMP-luokituksen mukaiset puhdastilat tulee validoida. Validointiin kuuluu teknisten järjestelmien kvalifiointi ja koko prosessin validointi. Teknisten järjestel-mien kvalifiointi käsittää suunnitelmien tarkastuksen (DQ), asennus - ja käyttöönotto tarkastukset (IQ), toiminnan testauksen (OQ) ja suorituksen testauksen (PQ). Kvali-fiointi kuuluu yhtenä osa-alueena validointiin. Prosessin validointi on osa yrityksen laadunvarmistusta. Validoinnilla hankitaan dokumentoidut todisteet siitä, että tila tai prosessi todella täyttää annetut vaatimukset. Tässä työssä laadittiin esimerkinomainen kvalifiointisuunnitelma puhdastilan tekni-sille järjestelmille. Suunnitelma sisältää asennus- ja käyttöönoton mukaiset tarkastukset (IQ)ja toiminnan aikaiset testaukset (OQ).

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Introduction Our institution (University hospital) is encouraging physical activities for health through various popular sporting events in the city of Lausanne, the biggest of which is a road race of 2, 4, 10 and 20km. Objective To create an efficient and sustainable training program in preparation of the race for a group of motivated hospital employees without any prior experience with structured training and to identifying the benefits and limitations encountered.. Methods Subjects of various fitness levels were recruited by add and agreed to undergo lab and field testing before a 12-week 3 times/week running program, based on maximal aerobic speed (MAS-30/30 sec intervals), running technique exercises and endurance training. The interval session was the only one supervised. Their goal was the 10km (11 subjects) and the 20km (6 subjects). Results A group of 17 subjects (7 male and 10 female), mean age 36.6±7.3 years, VO2max 44.0±5.5 ml/kg/min, filed test interval MAS 15.1±2.4 km/h started the program. 2 were lost because of injury (while skiing). Adherence to interval sessions was excellent, although 3 weekly training sessions proved to be difficult for most of the subjects. Performance in the race was satisfying for all of them, 6/7 subjects having improved their running time from the previous year, the others participated for the first time and 7/8 completed the race satisfyingly, one DNF-ed because of sinusitis. Repeat MAS field test was available for 6 subjects, who improved by 5.9% (p<0.01). Subjectively, all of the participants were very satisfied with improvement, interaction with colleagues from various professions, and with self achievement and confidence. Conclusions Implementation of a structured training program for recreational or non-athletes can be very successful in creating a better self-confidence, a better working environment inside a hospital facility and obviously in improvement of physical fitness and athletic performance. Above all, it can only encourage health institutions to promote the health of their own employees through physical activity, which can allow people to connect through sports. As a result, subjects in this study tend to encourage other employees to be more active and are hungry for more advice and continued offers for physical activities benefiting both them and the institution through better efficiency at work and less absenteeism common to more active people.

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The Institute of Radiation Physics (IRA) is attached to the Department of Medical Radiology at the Vaud University Hospital Center (CHUV) in Lausanne. The Institute's main tasks are strongly linked to the medical activities of the Department: radiotherapy, radiodiagnostics, interventional radiology and nuclear medicine. The Institute also works in the fields of operational radiation protection, radiation metrology and radioecology. In the case of an accident involving radioactive materials, the emergency services are able to call on the assistance of radiation protection specialists. In order to avoid having to create and maintain a specific structure, both burdensome and rarely needed, Switzerland decided to unite all existing emergency services for such events. Thus, the IRA was invited to participate in this network. The challenge is therefore to integrate a university structure, used to academic collaborations and the scientific approach, to an interventional organization accustomed to strict policies, a military-style command structure and "drilled" procedures. The IRA's solution entails mobilizing existing resources and the expertise developed through professional experience. The main asset of this solution is that it involves the participation of committed collaborators who remain in a familiar environment, and are able to use proven materials and mastered procedures, even if the atmosphere of an accident situation differs greatly from regular laboratory routines. However, this solution requires both a commitment to education and training in emergency situations, and a commitment in terms of discipline by each collaborator in order to be integrated into a response plan supervised by an operational command center.