Anesthésie locale par tumescence [Tumescent local anesthesia].

Tumescent anesthesia is a local anesthesia produced by the infiltration of a large volume of very dilute anesthetic solution into the subcutaneous tissue. Many surgical procedures (liposuction, facelift, varicose vein surgery, etc.), which were previously performed under general or locoregional anesthesia, can now be achieved with local tumescent anesthesia. This type of anesthesia has many advantages: reduction of both anesthetic risks and surgical complications (bleeding, hematoma), prolonged anesthesia reducing the need for postoperative analgesia, and costs reduction because all these surgical procedures can be performed on an outpatient basis.

Local heating of human skin causes hyperemia without mediation by muscarinic cholinergic receptors or prostanoids.

RESUME Les changements locaux de la température à la surface de la peau humaine ont une influence importante sur sa perfusion. La chaleur augmente localement le flux sanguin cutané, mais les mécanismes et les médiateurs de cette réponse (réponse thermique d'hyperémie) sont incomplètement élucidés. Dans la présente étude, nous avons examiné la relation possible entre la réponse thermique d'hyperémie, les récepteurs cholinergiques muscariniques et la production des prostaglandines vasodilatatrices. Chez 13 sujets de sexe masculin en bonne santé âgés entre 20 et 30 ans, une chambre métallique (contenant de l'eau) dont la température peut être contrôlée, a été placée sur la face palmaire de leur avant-bras et utilisée pour augmenter la température de surface de 34 à 41°C. L'hyperémie cutanée consécutive a été enregistrée par l'intermédiaire d'un scanner laser-Doppler. Dans une expérience, chacun des 8 sujets a reçu un bolus i.v. de glycopyrolate (agent antimuscarinique) (4 µg/kg) lors d'une visite et de NaCl 0,9% lors de l'autre visite. La réponse thermique d'hyperémie a été déterminée dans l'heure suivant les injections. Les glycopyrolate a efficacement empêché la vasodilation des micro-vaisseaux cutanés induite par iontophorèse d'acétylcholine mais n'a pas influencé la réponse thermique d'hyperémie. Dans une deuxième expérience entreprise avec 5 autres sujets 1 g d'aspirine (inhibiteur de la cyclooxygénase) administrée oralement a totalement supprimé la vasodilatation induite dans la peau par le courant anodique, sans modifier la réponse thermique d'hyperémie. La présente étude confirme l'absence de stimulation des récepteurs muscariniques et la production de prostaglandines vaso-dilatatrices dans la vasodilatation induite chez l'homme par réchauffement local de la peau de l'avant-bras. ABSTRACT Local changes in surface temperature have a powerful influence on the perfusion of human skin. Heating increases local skin blood flow (SkBF), but the mechanisms and mediators of this response (thermal hyperemia response) are incompletely elucidated. In the present study, we examined the possible dependence of the thermal hyperemia response on stimulation of muscarinic cholinergic receptors and on production of vasodilator prostanoids. In 13 male healthy subjects aged 20 - 30 years, a temperature- controlled chamber was positioned on the volar face of one forearm and used to raise surface temperature from 34to41°C. The time-course of the resulting thermal hyperemia response was recorded with a laser-Doppler imager. In one experiment, each of 8 subjects received an i.v. bolus of the antimuscarinic agent glycopyrrolate (4µg/kg) on one visit and saline on the other. The thermal hyperemia response was determined within the hour following the injections. Glycopyrrolate effectively inhibited the skin vasodilation induced by iontophoresis of acetylcholine, but did not influence the thermal hyperemia response. In a second experiment conducted in 5 other subjects, 1 gram of the cyclooxygenase inhibitor aspirin administered orally totally abolished the vasodilation induced in the skin by anodal current, but also failed to modify the thermal hyperemia response. The present study excludes the stimulation of muscarinic receptors and the production of vasodilator prostaglandins as essential and nonredundant mechanisms for the vasodilation induced by local heating in human forearm skin.

Ecoetiqueta de serveis i aprofitament dels recursos hídrics i energètics als establiments hotelers de Sitges

Aquest projecte té com a objectiu l’estudi de l’estat ambiental dels hotels del municipi de Sitges i l’estudi d’aprofitament dels recursos hídrics i energètics característics d’aquesta zona del Mediterrani per hotels de 4 i 5 estrelles. Sitges és un municipi que al període estival dobla la població, i que amb una superfície de 43,85 Km2 conta amb 35 hotels i apart pensions, hostals i càmpings, per tant, el turisme és l’activitat més important a Sitges. Per desenvolupar aquest projecte s’ha realitzat una enquesta senzilla sobre qualitat ambiental per conèixer el comportament ambiental dels diferents hotels. En aquest estudi han participat 15 dels 35 hotels del municipi, ja que el 49% d’aquests romanen tancats des d’Octubre fins a Març i dels 18 hotels restants 15 han accedit a formar part d’aquest estudi. A través d’una prova pilot s’ha avaluat la implantació del Distintiu de Garantia de Qualitat Ambiental a l’hotel Antemare i a l’hotel Sunway Playa Golf, aquests dos hotels pertanyen a la categoria de quatre estrelles, categoria que reuneix més nombre d’hotels i el tant per cent d’ocupació és major en comparació amb les altres categories. El DGQA és una ecoetiqueta de serveis que atorga la Generalitat de Catalunya a partir de la revisió de l’establiment per mitjà d’un tècnic autoritzat. S’ha analitzat l’aprofitament dels recursos local com, les aigües pluvials i la radiació solar en els hotels de 4 i 5 estrelles per obtenir l’autosuficiència individual dels 9 hotels objecte d’estudi. Els resultats obtinguts en aquest estudi reflecteixen la possibilitat de millorar l’estat ambiental dels establiments hotelers, duent a terme alguns criteris bàsics com, la recollida selectiva i una major implantació d’energies renovables, així com també la utilització d’aquestes per assolir un cert nivell d’autosuficiència energètica i hídrica. La prova pilot mostra que els dos hotels estudiats estan molt a prop d’aconseguir el DGQA, els vectors on s’haurien de fer millores són, informació ambiental, energia, aigua i residus.

Local and global consistency properties for student placement

In the context of resource allocation on the basis of priorities, Ergin (2002) identifies a necessary and sufficient condition on the priority structure such that the student-optimal stable mechanism satisfies a consistency principle. Ergin (2002) formulates consistency as a local property based on a fixed population of agents and fixed resources -- we refer to this condition as local consistency and to his condition on the priority structure as local acyclicity. We identify a related but stronger necessary and sufficient condition (unit acyclicity) on the priority structure such that the student-optimal stable mechanism satisfies a more standard global consistency property. Next, we provide necessary and sufficient conditions for the student-optimal stable mechanism to satisfy converse consistency principles. We identify a necessary and sufficient condition (local shift-freeness) on the priority structure such that the student-optimal stable mechanism satisfies local converse consistency. Interestingly, local acyclicity implies local shift-freeness and hence the student-optimal stable mechanism more frequently satisfies local converse consistency than local consistency. Finally, in order for the student-optimal stable mechanism to be globally conversely consistent, one again has to impose unit acyclicity on the priority structure. Hence, unit acyclicity is a necessary and sufficient condition on the priority structure for the student-optimal stable mechanism to satisfy global consistency or global converse consistency.

Local-global splitting for spatiotemporal-adaptive multiscale methods

We present a novel spatiotemporal-adaptive Multiscale Finite Volume (MsFV) method, which is based on the natural idea that the global coarse-scale problem has longer characteristic time than the local fine-scale problems. As a consequence, the global problem can be solved with larger time steps than the local problems. In contrast to the pressure-transport splitting usually employed in the standard MsFV approach, we propose to start directly with a local-global splitting that allows to locally retain the original degree of coupling. This is crucial for highly non-linear systems or in the presence of physical instabilities. To obtain an accurate and efficient algorithm, we devise new adaptive criteria for global update that are based on changes of coarse-scale quantities rather than on fine-scale quantities, as it is routinely done before in the adaptive MsFV method. By means of a complexity analysis we show that the adaptive approach gives a noticeable speed-up with respect to the standard MsFV algorithm. In particular, it is efficient in case of large upscaling factors, which is important for multiphysics problems. Based on the observation that local time stepping acts as a smoother, we devise a self-correcting algorithm which incorporates the information from previous times to improve the quality of the multiscale approximation. We present results of multiphase flow simulations both for Darcy-scale and multiphysics (hybrid) problems, in which a local pore-scale description is combined with a global Darcy-like description. The novel spatiotemporal-adaptive multiscale method based on the local-global splitting is not limited to porous media flow problems, but it can be extended to any system described by a set of conservation equations.

El largo ciclo electoral de Plataforma per Catalunya: del ámbito local a la implantación nacional (2003-2011)

El partido anti-inmigración Plataforma per Catalunya (PxC) ha experimentado un progresivo crecimiento en la franja temporal que va desde su primera participación electoral en 2003 hasta las municipales de 2011. En dicho periodo temporal ha pasado de ser una formación presente exclusivamente en el ámbito local, y con un apoyo fuertemente concentrado en ciertos municipios de Cataluña, a recibir votos y tener secciones locales consolidadas en gran parte del territorio catalán. El texto trata de ofrecer claves interpretativas para entender tanto los éxitos como las debilidades de PxC a lo largo del ciclo electoral 2003-2011. Partiendo de la base de que actualmente existe en España una demanda electoral suficiente para el éxito de una formación como PxC, este trabajo se centra en el análisis de la estrategia política y electoral desarrollada por el partido para aprovechar dicha demanda, y en su interacción con el contexto social y político de la Cataluña de la primera década del siglo XXI.

Fixed rings and strictures in Eosinophilic Esophagitis develop due to continuing inflammation over time

Background and Aims: Two distinct e ndoscopic phenotypes of E osinophilic Esophagitis (EoE) h ave been identified: t he inflammatory (IP) a nd the stenosing (SP) p henotype. I t is not known whether these EoE-associated phenotypes are reflective of different phases during disease course. We aimed to assess the phenotype a t initial EoE p resentation and d iagnosis and to evaluate if SP increases over time. Methods: R etrospective a nalysis of t he Swiss EoE Database (SEED) extended b y a review of p atients charts, endoscopy and pathology records. Results: F orty-four E oE p atients were a nalyzed (33 males, mean age at index visit 41 ± 14 years, all Caucasians). Median follow-up t ime was 3.1 years (IQR 1-4, r ange 1 -18 years). Median diagnostic delay w as 5 y ears (IQR 2-16, range 0-34 years). A t first diagnosis, 3 2% ( 14/44) o f EoE patients h ad already presented w ith a stenosis. T he mean d iameter o f the stenoses w as 1 0 ± 2 mm, and the mean length was 2 .8 ± 2 .9 cm. Peak e osinophil count d id n ot c hange over t ime (48 ± 39 eos/HPF at index visit vs. 59 ± 41 eos/HPF at end of follow-up, n=44). The risk of the presence of a stenosis at index visit was 0% f or a d isease duration of 0 -4 y ears, 37% f or a d isease duration between 5-10 years and 67% f or a d isease duration >10 years (p = 0.0035, trend test). Conclusions: T he frequency of e sophageal stenoses i s proportional to the disease duration, whereas the inflammatory activity does n ot s ignificantly c hange over t ime. O ur f indings underscore the necessity to reduce diagnostic delay in EoE and to control the underlying inflammatory processes to prevent esophageal remodeling.

Screening for health impacts in Local Area Planning in Donegal County Council (2004)

In 2004 an interagency team consisting of members the North Western Health Board and Donegal County Council commissioned the IPH to conduct a HIA screening exercise on planning policy in Donegal. This involved an overview of literature, analysis of policy documents, contact with Planning Officers and observation of public consultation meetings. Following completion of the final report, the intention is to produce a user-friendly template to enable planners to incorporate a health dimension into their decision making.

Briefing Paper on Health Inequalities for Elected Members of Local Government (ROI)

The social and economic circumstances in which people live strongly influence their chances to be healthy.  Factors such as housing, transport, environment, education and employment are just some of the functions of local government that influence health. IPH, in partnership with CAN and Nexus developed a briefing paper to support elected members of local government to ensure that the decision in which they are involved have a positive impact on health, especially the health of vulnerable groups.  It provides councillors with information to assist in contributing to a better quality of life for constituents with healthier decision making in areas such as safer environments, increased education opportunities, better housing stock and improved public transport availability.

IPH Submission to Department of the Environment, Heritage and Local Government Climate Change Response Bill 2010

The main purpose of the Clmate Change Bill is to provide for the adoption of a national policy for reducing greenhouse gas (GHG) emissions; to support this through the making of mitigation and adaptation action plans; and to make provision for emission reduction targets to support the objective of transition to a low carbon, climate resilient and environmentally sustainable economy.The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland.IPH has a keen interest in the effects of climate change on health. In September 2010 the IPH published a paper – Climate Change and Health: A platform for action - to inform policy-makers and the public about the health benefits in reducing greenhouse gas emissions. This paper followed a seminar with international speakers, opened by Minister Gormley, on the same topic in February 2010. 

IPH response to Department of the Environment, Heritage and Local Government and the Department for Regional Development Spatial Strategies

The remit of the Institute of Public Health in Ireland (IPH) is to promote cooperation for public health between Northern Ireland and the Republic of Ireland in the areas of research and information, capacity building and policy advice. Our approach is to support Departments of Health and their agencies in both jurisdictions, and maximise the benefits of all-island cooperation to achieve practical benefits for people in Northern Ireland and the Republic of Ireland. As an all-island body, the Institute of Public Health in Ireland particularly welcomes that the Framework for Collaboration has been co-produced by the Department for Regional Development and the Department of the Environment, Heritage and Local Government. In addition the Institute of Public Health welcomes a more holistic approach to spatial planning that takes into account the environment and sustainable economic development. A clean environment and a more equitable distribution of prosperity have associated health benefits, as outlined in the IPH’s Active travel – healthy lives (2011) and Health impacts of the built environment- a review (2006).

IPH response to DSD Urban Regeneration and Community Development Policy Framework Consultation

The Urban Regeneration and Community Development Policy Framework for Northern Ireland sets out for DSD and its partners, clear priorities for urban regeneration and community development programmes, both before and after the operational responsibility for these is transferred to councils under the reform of local government. Four policy objectives have been developed, which will focus on the underlying structural problems in urban areas and also help strengthen community development throughout Northern Ireland. The policy objectives are as follows: Policy Objective 1 – To tackle area-based deprivation: Policy Objective 2 – To strengthen the competitiveness of our towns and cities: Policy Objective 3 – To improve linkages between areas of need and areas of opportunity: and Policy Objective 4 –To develop more cohesive and engaged communities. Key points from IPH response Urban regeneration and community development provide a basis for addressing the social determinants of health and reducing inequalities in health. This policy framework presents an opportunity for coherence and complementarity with ‘Fit and Well - Changing Lives’ as part of government’s overall approach to tackling health inequalities. It is now well established that a focus on early years’ interventions and family support services yields significant returns, so prioritising action in these areas is essential. Defined action plans on child poverty are essential if this policy framework is to make a real and lasting difference in deprived urban areas. Development of the environmental infrastructure to improve health in deprived areas should be supported by well-planned monitoring and evaluation. Linking the policy framework to economic development and local community plans will enhance effectiveness in the areas of education, job creation, commercial investment and access to services, which in turn are critical for the economic growth and stability of urban communities. Community profile data and health intelligence (as available through IPH Health Well) could usefully inform central and local government in terms of resource allocation and targeted service delivery.

Submission to the Department of Environment, Heritage and Local Government: Sustainable Residential Development in Urban Areas

The Institute of Public Health in Ireland is an all-island body which aims to improve health in Ireland by working to combat health inequalities and influence public policies in favour of health. The Institute promotes co-operation in research, training, information and policy in order to contribute to policies which tackle inequalities in health.   Over the past ten years the Institute has worked closely with the Department of Health and Children and the Department of Health, Social Services and Public Safety in Northern Ireland to build capacity for public health across the island of Ireland.   The Institute takes the view that health is determined by policies, plans and programmes in many sectors outside the health sector as well as being dependent on access to and availability of first class health services. The importance of other sectors is encapsulated in a social determinants of health perspective which recognises that health is largely shaped and influenced by the physical, social, economic and cultural environments in which people live, work and play. Figure 1 illustrates these multi-dimensional impacts on health and also serves to highlight the clear and inextricable links between health and sustainable development. Factors that impact on long-term sustainability will thus also impact on health.