Cervical radiculopathy: Efficiency of CT-guided cervical facet joint corticosteroid injection : 47

Purpose: Cervical foraminal injection performed with a direct approach of the foramen may induce serious neurologic complications. Cervical facet joint (CFJ) injections are easier to perform and safe, and may diffuse in the epidural and foraminal spaces. We analyzed the efficiency and tolerance of CT-guided CFJ slow-acting corticosteroid injection in patients with radiculopathy related to disc herniation. Methods and materials: Pilot study included 17 patients presenting typical cervical radiculopathy related to disc herniation without relief of pain after medical treatment (one month duration). CFJ puncture was performed under CT guidance with a lateral approach. CT control of the CFJ opacification was performed after injections of contrast agent (1 ml), followed by slow-acting corticosteroid (25 mg). Main criteria for judgment was pain relief one month later (delta visual analogical scale VAS for 0 to 100 mm). Diffusion of iodinated contrast agent in the foramen was assessed by two radiologists in consensus. Results: Pain relief was significant at one month (delta VAS 22 ± 23 mm, p = 0.001) and 41% (7/17) of patients had pain relief more than 50%. In cases with foraminal diffusion, pain relief more than 50% occured in 5 patients (50%) and only in 2 patients (29%) in cases without foraminal diffusion. No complication occurred. Conclusion: CT-guided CFJ slow-acting corticosteroid injection is safe and provided good results at one month follow-up. It may be considered as an interesting percutaneous treatment in patients suffering from cervical radicular pain related to disc herniation.

Développement d'une méthode microgravimétrique urbaine : intégration dans un SIG et application au projet du M2 lausannois

Résumé La réalisation d'une seconde ligne de métro (M2) dès 2004, passant dans le centre ville de Lausanne, a été l'opportunité de développer une méthodologie concernant des campagnes microgravimétriques dans un environnement urbain perturbé. Les corrections topographiques prennent une dimension particulière dans un tel milieu, car de nombreux objets non géologiques d'origine anthropogénique comme toutes sortes de sous-sols vides viennent perturber les mesures gravimétriques. Les études de génie civil d'avant projet de ce métro nous ont fournis une quantité importante d'informations cadastrales, notamment sur les contours des bâtiments, sur la position prévue du tube du M2, sur des profondeurs de sous-sol au voisinage du tube, mais aussi sur la géologie rencontré le long du corridor du M2 (issue des données lithologiques de forages géotechniques). La planimétrie des sous-sols a été traitée à l'aide des contours des bâtiments dans un SIG (Système d'Information Géographique), alors qu'une enquête de voisinage fut nécessaire pour mesurer la hauteur des sous-sols. Il a été alors possible, à partir d'un MNT (Modèle Numérique de Terrain) existant sur une grille au mètre, de mettre à jour celui ci avec les vides que représentent ces sous-sols. Les cycles de mesures gravimétriques ont été traités dans des bases de données Ac¬cess, pour permettre un plus grand contrôle des données, une plus grande rapidité de traitement, et une correction de relief rétroactive plus facile, notamment lorsque des mises à jour de la topographie ont lieu durant les travaux. Le quartier Caroline (entre le pont Bessières et la place de l'Ours) a été choisi comme zone d'étude. Le choix s'est porté sur ce quartier du fait que, durant ce travail de thèse, nous avions chronologiquement les phases pré et post creusement du tunnel du M2. Cela nous a permis d'effectuer deux campagnes gravimétriques (avant le creu¬sement durant l'été 2005 et après le creusement durant l'été 2007). Ces réitérations nous ont permis de tester notre modélisation du tunnel. En effet, en comparant les mesures des deux campagnes et la réponse gravifique du modèle du tube discrétisé en prismes rectangulaires, nous avons pu valider notre méthode de modélisation. La modélisation que nous avons développée nous permet de construire avec détail la forme de l'objet considéré avec la possibilité de recouper plusieurs fois des interfaces de terrains géologiques et la surface topographique. Ce type de modélisation peut s'appliquer à toutes constructions anthropogéniques de formes linéaires. Abstract The realization of a second underground (M2) in 2004, in downtown Lausanne, was the opportunity to develop a methodology of microgravity in urban environment. Terrain corrections take on special meaning in such environment. Many non-geologic anthropogenic objects like basements act as perturbation of gravity measurements. Civil engineering provided a large amount of cadastral informations, including out¬lines of buildings, M2 tube position, depths of some basements in the vicinity of the M2 corridor, and also on the geology encountered along the M2 corridor (from the lithological data from boreholes). Geometry of basements was deduced from building outlines in a GIS (Geographic Information System). Field investigation was carried out to measure or estimate heights of basements. A DEM (Digital Elevation Model) of the city of Lausanne is updated from voids of basements. Gravity cycles have been processed in Access database, to enable greater control of data, enhance speed processing, and retroactive terrain correction easier, when update of topographic surface are available. Caroline area (between the bridge Saint-Martin and Place de l'Ours) was chosen as the study area. This area was in particular interest because it was before and after digging in this thesis. This allowed us to conduct two gravity surveys (before excavation during summer 2005 and after excavation during summer 2007). These re-occupations enable us to test our modélisation of the tube. Actually, by comparing the difference of measurements between the both surveys and the gravity response of our model (by rectangular prisms), we were able to validate our modeling. The modeling method we developed allows us to construct detailed shape of an object with possibility to cross land geological interfaces and surface topography. This type of modélisation can be applied to all anthropogenic structures.

Valoriser le géopatrimoine par la médiation indirecte et la visualisation des objets géomorphologiques

Résumé: Valoriser le géopatrimoine par la médiation indirecte et la visualisation des objets géomorphologiques Le géopatrimoine regroupe des objets géologiques lato sensu auxquels certaines valeurs sont attribuées, en fonction de leur intérêt pour la science, de leur rareté, de leurs particularités culturelles ou écologiques, etc. Valoriser le géopatrimoine signifie avant tout faire partager cette approche aux non-spécialistes, en expliquant ce qui fait la valeur de ces objets. Cette valorisation peut s'effectuer, entre autres, sous la forme d'une activité touristique et contribuer ainsi au développement régional. Faire comprendre l'origine, la singularité et la valeur des formes du relief implique le recours à une communication éducative, désignée par le terme de médiation. Les implications de la dimension éducative du processus, comme la prise en compte des connaissances et attentes du public, la création d'un environnement favorable à l'apprentissage ou l'attractivité du contenu, sont souvent négligées. Du point de vue conceptuel, un modèle de la médiation indirecte (c'est-à-dire au moyen de supports médiatiques) a été proposé et appliqué au développement empirique de produits de médiation et à leur évaluation. Ce modèle ne garantit pas la réussite de la communication éducative, mais contribue à créer un cadre favorable au processus. De plus, plusieurs lignes directrices pour le choix du type de média et sa mise en forme ont été définies sur la base d'une compilation de résultats de la psychologie cognitive sur l'usage des médias pour l'apprentissage. Des méthodes qualitatives et quantitatives variées ont été mobilisées : enquêtes par questionnaire ex situ et in situ, auprès des visiteurs de géomorphosites de montagne, réalisation de médias interactifs testés ensuite auprès de divers publics (parcours enregistré, pré- et post-questionnaires) et entretiens collectifs. Les résultats obtenus éclairent divers aspects de la problématique. L'étude du public a montré, par exemple, que le géotourisme possède un réel public parmi les visiteurs des sites de montagnes : trois-quarts d'entre eux expriment de l'intérêt pour des explications sur la géologie et l'évolution du paysage. Cette thèse a exploré ces aspects liés au processus d'apprentissage en se focalisant sur les médias visuels, surtout interactifs. La plupart des médias visuels couramment utilisés en géomorphologie ont été considérés. Le développement de versions interactives de ces médias sous forme d'applications web a fourni un aperçu concret des possibilités des nouvelles technologies. Les utilisateurs apprécient en particulier a richesse du contenu, le haut degré d'interactivité et la variété de ces applications. De tels médias incitent à visiter le site naturel et semblent aussi répondre aux intérêts de publics variés. Abstract: Geoheritage promotion through non-personal interpretation and visualisation of geomorphological features Geoheritage concerns all geological features lato sensu to which some values are attributed, according to their scientific interest, their rarity, their cultural or ecological dimensions, etc. Geoheritage promotion implies sharing this point of view with non-specialists, explaining what gives value to those objects. Geotourism is one of the many ways to achieve geoheritage promotion, while contributing also to regional development. In order to make non-specialists understand the origin, the specificity and the value of landforms, educational communication is needed, that is called interpretation (French: médiation). This education dimension has several, and often neglected, implications, like taking into account public's knowledge and expectations, creating a favourable learning environment, attractive design, etc. From the conceptual point of view, a model for non-personal interpretation has been proposed and applied for the empirical development and for the assessment of interpretive products. This model does not guarantee success of educational communication, but help creating a favourable environment for this process. Moreover, some guidelines were defined from a compilation of several results of cognitive psychology on media use for learning. They guide the choice of the kind of media and its design. Several qualitative and quantitative methods were applied: survey questionnaires ex situ and in situ by mountain geomorphosites visitors, interactive medias developed and then tested by different kinds of users (with usertracking, pre- and post-survey questionnaires), group interviews. The results answered different aspects of the research questions. Visitor surveys revealed for example that geotourism could attract many visitors of mountain areas: three quarters of them say they are interested in getting explanations about geology and landscape (in particular its dynamic dimensions). This thesis examined those aspects with a focus on visual medias, both statics and interactive. Most of currently used medias in geomorphology were considered. Interactive versions of those medias were developed in web applications; they gave a concrete overview on the opportunities that new technologies offer. The content richness, the high interaction level and the diversity of the applications are the most liked aspects by the users. Such medias drive to visit the natural site and seem to correspond to the interests of various kinds of publics. Zusammenfassung: Aufwertung des erdwissenschaftlichen Erbes durch mediale Vermittlung und Visualisierung von geomorphologischen Objekten Das erdwissenschaftliche Erbe besteht aus geologischen Gegebenheiten lato sensu, denen entsprechend ihrer Bedeutung für die Wissenschaft, ihrer Seltenheit, ihrer kulturellen oder ökologischen Besonderheiten usw. bestimmte Werte zugeordnet werden. Das erdwissenschaftliche Erbe aufzuwerten bedeutet in erster Linie, diesen Ansatz Nichtspezialisten näher zu bringen, indem ihnen erklärt wird, was den Wert dieser Gegebenheiten ausmacht. Dies kann etwa im Rahmen eines touristischen Angebots geschehen und so die regionale Entwicklung unterstützen. Um Entstehung, Besonderheit und Wert von Geländeformen verständlich zu machen, wird eine pädagogische Kommunikationsform verwendet, die als mediale Vermittlung (franz. médiation) bezeichnet wird. Die Bedeutung der pädagogischen Dimension des Vermittlungsprozesses wie etwa der Einbezug des Wissens und der Erwartungen des Publikums, die Gestaltung eines positiven Lernklimas oder die Attraktivität des Inhalts wird oft vernachlässigt. Auf konzeptueller Ebene wurde ein Modell der indirekten Interpretation erarbeitet (d. h. anhand von Medien), das bei der empirischen Entwicklung der Interpretationsprodukte und ihrer Evaluation Anwendung fand. Dieses Modell garantiert zwar nicht den Erfolg der pädagogischen Kommunikation. Es trägt aber dazu bei, einen für den Prozess günstigen Kontext zu schaffen. Des Weiteren wurden mehrere Richtlinien für die Wahl des Medientyps und dessen Ausgestaltung anhand einer Zusammenstellung von Resultaten der kognitiven Psychologie über den Gebrauch von Medien in Lernprozessen definiert. Es wurden verschiedene qualitative und quantitative Methoden eingesetzt: Befragung mittels Fragebogen der Besucher von geomorphologischen Geotopen im Gebirge - ex situ und in situ -, Erarbeitung von interaktiven Medien, die anschliessend anhand verschiedener Zielgruppen gestestet wurden (Aufnahme des Besuchparcours, Vor- und Nachfragebögen) sowie kollektive Interviews. Die Ergebnisse geben Aufschluss zu verschiedenen Aspekten der Fragestellung. Die Befragung des Publikums hat zum Beispiel deutlich gemacht, dass der Geotourismus unter den Besuchern von Berggebieten tatsächlich auf eine Nachfrage stösst: drei Viertel von ihnen zeigen ein Interesse für Erläuterungen zur Geologie und der Landschaftsentwicklung. Die vorliegende Doktorarbeit hat die genannten Aspekte der Lernprozesse untersucht, wobei der Fokus auf visuellen, insbesondere interaktiven Medien lag. Die meisten gängigen visuellen Medien der Geomorphologie wurden berücksichtigt. Die Entwicklung von interaktiven Versionen dieser Medien in Form von Web-Anwendungen hat die Möglichkeiten der neuen Technologien veranschaulicht. Die Benutzer schätzten insbesondere die Vielfalt des Inhalts, die hohe Interaktivität und die Diversität dieser Anwendungen. Solche Medien laden dazu ein, ein Naturgebiet zu besuchen und scheinen den Interessen der verschiedenen Publikumsgruppen entgegenzukommen.

Trigeminal neuralgia related to megadolichobasilar artery compression: a prospective series of twenty-nine patients treated with gamma knife surgery, with more than one year of follow-up.

BACKGROUND: Trigeminal neuralgia (TN) secondary to megadolichobasilar artery (MBA) compression is considerably difficult to manage surgically. OBJECTIVE: This study aims to evaluate the safety/efficacy of Gamma Knife surgery (GKS) in this special group of patients. METHODS: Between July 1992 and November 2010, 29 patients with >1 year of follow-up presenting with MBA compression were treated with GKS at Timone University Hospital. Radiosurgery was performed using a Gamma Knife (model B, C or Perfexion). A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 9.1 mm (range: 6-18.2 mm) from the emergence. RESULTS: The median follow-up period was 46.1 months (range: 12.9-157.9 months). Initially, all patients (100%) were pain free; the average time to complete pain relief was 13.5 days (range: 0-240 days). Their actuarial probability of remaining pain free without medication at 0.5, 1 and 2 years was 93.1, 79.3 and 75.7%, respectively, and remained stable until 13 years after treatment. The actuarial probability of hypoesthesia onset at 6 months was 4.3%; at 1 year it reached 13% and remained stable until 13 years after treatment. CONCLUSIONS: GKS proved to be reasonably safe and effective on a long-term basis as a first- and/or second-line surgical treatment for TN due to MBA compression.

Data-driven topo-climatic mapping with machine learning methods

Automatic environmental monitoring networks enforced by wireless communication technologies provide large and ever increasing volumes of data nowadays. The use of this information in natural hazard research is an important issue. Particularly useful for risk assessment and decision making are the spatial maps of hazard-related parameters produced from point observations and available auxiliary information. The purpose of this article is to present and explore the appropriate tools to process large amounts of available data and produce predictions at fine spatial scales. These are the algorithms of machine learning, which are aimed at non-parametric robust modelling of non-linear dependencies from empirical data. The computational efficiency of the data-driven methods allows producing the prediction maps in real time which makes them superior to physical models for the operational use in risk assessment and mitigation. Particularly, this situation encounters in spatial prediction of climatic variables (topo-climatic mapping). In complex topographies of the mountainous regions, the meteorological processes are highly influenced by the relief. The article shows how these relations, possibly regionalized and non-linear, can be modelled from data using the information from digital elevation models. The particular illustration of the developed methodology concerns the mapping of temperatures (including the situations of Föhn and temperature inversion) given the measurements taken from the Swiss meteorological monitoring network. The range of the methods used in the study includes data-driven feature selection, support vector algorithms and artificial neural networks.

Assessment of Asphalt Interlayer Designed on Jointed Concrete, InTrans Project 13-475, 2014

Reflective cracking in hot mix asphalt (HMA) overlays has been a common cause of poor pavement performance in Iowa for many years. Reflective cracks commonly occur in HMA overlays when deteriorated portland cement concrete is paved over with HMA. This results in HMA pavement surfaces with poor ride quality and increased transportation maintenance costs. To delay the formation of cracks in HMA overlays, the Iowa Department of Transportation (Iowa DOT) has begun to implement a crack-relief interlayer mix design specification. The crack-relief interlayer is an asphalt-rich, highly flexible HMA that can resist cracking in high strain loading conditions. In this project, the field performance of an HMA overlay using a one inch interlayer was compared to a conventional HMA overlay without an interlayer. Both test sections were constructed on US 169 in Adel, Iowa as part of an Iowa DOT overlay project. The laboratory performance of the interlayer mix design was assessed for resistance to cracking from repeated strains by using the four-point bending beam apparatus. An HMA using a highly polymer modified binder was designed and shown to meet the laboratory performance test criteria. The field performance of the overlay with the interlayer exceeded the performance of the conventional overlay that did not have the interlayer. After one winter season, 29 percent less reflective cracking was measured in the pavement section with the interlayer than the pavement section without the interlayer. The level of cracking severity was also reduced by using the interlayer in the overlay.

La crisi en l'experiència educativa

Situat en una concepció educativa que busca la crisi per créixer humanament, el text fa desfilar els elements que segons l’autora nuen l’experiència educativa amb la realitat present amb la qual conviuen, posant de relleu la configuració d’un quasidiscurs que intenta segrestar la crisi necessària per a l’aprenentatge. No obstant, la reflexió planteja que més enllà de la lògica de relats i pràctiques incapacitadores també hi ha espais, temps i elements, com la humilitat i la indisciplina, que permeten que la potencialitat educativa de la crisi no desaparegui de l’experiència vital de cada criatura.

Typologie des sols sur gypse et végétation associée en Suisse

Soils on gypsum are well known in dry climates, but were very little described in temperate climate, and never in Switzerland. This study aims to describe soils affected by gypsum in temperate climate and to understand their pedogenesis using standard laboratory analyzes performed on ten Swiss soils located on gypsum outcrops. In parallel, phytosociological relevés described the vegetation encountered in gypsiferous grounds. Gypsification process (secondary gypsum enrichment by precipitation) was observed in all soils. It was particularly important in regions where potential evapotranspiration exceed strongly precipitations in summer (central Valais, Chablais under influence of warm wind). Gypsum contents were regularly measured above 20% in deep horizons, and exceeded locally 70%, building a white, indurate horizon. However, the absence of such a gypsic horizon in the top soil hindered the use of gypsosol (according to the Référentiel pédologique, BAIZE & GIRARD 2009), the typical name of soils affected by gypsum, but restricted to dry regions. As all soils had a high content of magnesium carbonates, they were logically classified in the group of DOLOMITOSOLS. However, according to the World Reference Base for Soil Resources (IUSS 2014), five soils can be classified among the Gypsisols, criteria being here less restricting. These soils are characterized by a coarse texture and a particulate brittle structure making a filtering substrate. They allow water to flow easily taking nutrients. They are not retained by clay, which does generally not exceed 1% of the fine material. The saturation of calcium blocks the breakdown of organic matter. Moreover, these soils are often rejuvenated by erosion caused by the rough relief due to gypsum (landslides, sinkholes, cliffs and slopes). Hence, the vegetation is mainly characterized by calcareous and drought tolerant species, with mostly xerothermophilic beech (Cephalanthero-Fagenion) and pine forests (Erico-Pinion sylvestris) in lowlands, or subalpine heathlands (Ericion) and dry calcareous grasslands (Caricion firmae) in higher elevations.

Hemobilia, a rare cause of acute pancreatitis after percutaneous liver biopsy: diagnosis and treatment by endoscopic retrograde cholangiopancreatography.

We here report the case history of a 75-yr-old woman who developed pancreatitis and recurrent symptomatic, cholestasis-induced hemobilia after percutaneous liver biopsy. An endoscopic sphincterotomy with clot extraction led to relief of symptoms. The risk of hemobilia after percutaneous liver biopsy is less than one per 1000 procedures, and only two cases of acute pancreatitis after percutaneous liver biopsy have previously been reported. To our knowledge, this is the first case in which endoscopic retrograde cholangiopancreatography was used to both diagnostic and therapeutic ends.

Candidat à l'échec scolaire incompris et ignoré : l'enfant de migrants = Misunderstood and ignored candidate to the school failure: The child of migrants

Immigration, intégration, précarité, échec scolaire, ignorance du français, délinquance sont des thèmes qui animent régulièrement les débats publics, médiatiques et politiques. Bien que les migrations ont toujours fait partie de l'histoire humaine, elles sont souvent décrites comme un trouble aux identités nationales, elles-mêmes mises à mal par la mondialisation. Cependant, les mécanismes sous-tendant les difficultés rencontrées par certains enfants de migrants demeurent bien moins débattus et considérés que leurs conséquences bruyantes et visibles. Après une réflexion sur l'impact de la migration elle-même sur le sujet et un bref aperçu de l'ethnopsychiatrie, nous allons décrire les difficultés que peut rencontrer l'enfant de migrants, leurs origines et leurs conséquences. Nous nous intéresserons ensuite à la manière dont notre société, nos institutions en tiennent compte ou pas. Nous terminerons notre propos par la mise en relief des besoins thérapeutiques et éducatifs spéciaux de ces enfants et la manière dont ceux-ci sont comblés (ou non). Immigration, social integration, precariousness, language barrier, delinquency are constantly stimulating public, political and media debate. Migrations always were part of the human history but they are often described like a disorder of the national identities, themselves put at evil by globalization. However, the origin of the difficulties that certain children of migrants encounter is often overlooked. Only their disturbing implications are frequently studied. After a brief comment on the impact of the migration and the ethnopsychiatry, we will outline the difficulties sometimes faced by the children of migrants, their origins and consequences. Then we will describe how the society and the institutions take them in account (or not). We finally will delineate the specific needs of those children and how they are meeting (or not).

Table de quelques chartes de l'abbaye de Longpont.

Acquis le 28 novembre 1821 de M. Renard de la Savonnerie, avec 6 autres mss., pour le prix global de 600 francs; cf. B.n.F., département des Manuscrits, Archives Modernes 492ter, registre des acquisitions du département des Manuscrits 1821-1830, f. 41 "Relief de chartes de l'abbaye de Longpont, un vol. 8°"; nouv. acq. fr. 5530.

Lexan Gate Arm, HR-536, 1987

Innovative Rail Ltd. of Cedar Rapids, Iowa produced a new rail/highway crossing gate arm that shows promise in two areas: a. Minimizing arm breakage, and b. Added target value to motorists. The new gate was demonstrated to the Chicago and North Western Transportation Company, and that railroad has requested its use at two crossings on an "experimental basis" to determine if its installation provides relief in those areas. On April 18, 1986, the Department observed a test of the material under field conditions with the Transportation Company. The gate received four mid-center strikes at 5 MPH by a company truck while in the lowered position, and showed no damage. In a fifth mid-center strike at 15 MPH, the gate was visibly damaged at the connection to its raising mechanism, but continued to function though at a 5-10 degree drop. Several pictures of the gate and its saddle mechanism are shown in Appendix A of this report. Innovative Rail established distributorships in the United States and Canada, and has since gone out of business.

Collaborative quality improvement to manage pain in acute care hospitals.

Objective. Collaborative quality improvement programs have been successfully used to manage chronic diseases in adults and acute lung complications in premature infants. Their effectiveness to improve pain management in acute care hospitals is currently unknown. The purpose of this study was to determine whether a collaborative quality improvement program implemented at hospital level could improve pain management and overall pain relief. Design.To assess the effectiveness of the program, we performed a before-after trial comparing patient's self-reported pain management and experience before and after program implementation. We included all adult patients hospitalized for more than 24 hours and discharged either to their home or to a nursing facility, between March 1, 2001 and March 31, 2001 (before program implementation) and between September 15, 2005 and October 15, 2005 (after program implementation). Setting.A teaching hospital of 2,096 beds in Geneva, Switzerland. Patients.All adult patients hospitalized for more than 24 hours and discharged between 1 to 31 March 2001 (before program) and 15 September to 15 October 2005 (after program implementation). Interventions.Implementation of a collaborative quality improvement program using multifaceted interventions (staff education, opinion leaders, patient education, audit, and feedback) to improve pain management at hospital level. Outcome Measures.Patient-reported pain experience, pain management, and overall hospital experience based on the Picker Patient Experience questionnaire, perceived health (SF-36 Health survey). Results.After implementation of the program only 2.3% of the patients reported having no pain relief during their hospital stay (vs 4.5% in 2001, P = 0.05). Among nonsurgical patients, improvements were observed for pain assessment (42.3% vs 27.9% of the patients had pain intensity measured with a visual analog scale, P = 0.012), pain management (staff did everything they could to help in 78.9% vs 67.9% of cases P = 0.003), and pain relief (70.4% vs 57.3% of patients reported full pain relief P = 0.008). In surgical patients, pain assessment also improved (53.7.3% vs 37.6%) as well as pain treatment. More patients received treatments to relieve pain regularly or intermittently after program implementation (95.1% vs 91.9% P = 0.046). Conclusion.Implementation of a collaborative quality improvement program at hospital level improved both pain management and pain relief in patients. Further studies are needed to determine the overall cost-effectiveness of such programs.

Of flies, mice and men: a systematic approach to understanding the early life origins of chronic lung disease.

Despite intensive research efforts, the aetiology of the majority of chronic lung diseases (CLD) in both, children and adults, remains elusive. Current therapeutic options are limited, providing only symptomatic relief, rather than treating the underlying condition, or preventing its development in the first place. Thus, there is a strong and unmet clinical need for the development of both, novel effective therapies and preventative strategies for CLD. Many studies suggest that modifications of prenatal and/or early postnatal lung development will have important implications for future lung function and risk of CLD throughout life. This view represents a fundamental change of current pathophysiological concepts and treatment paradigms, and holds the potential to develop novel preventative and/or therapeutic strategies. However, for the successful development of such approaches, key questions, such as a clear understanding of underlying mechanisms of impaired lung development, the identification and validation of relevant preclinical models to facilitate translational research, and the development of concepts for correction of aberrant development, all need to be solved. Accordingly, a European Science Foundation Exploratory Workshop was held where clinical, translational and basic research scientists from different disciplines met to discuss potential mechanisms of developmental origins of CLD, and to identify major knowledge gaps in order to delineate a roadmap for future integrative research.