Nouveautés dans la stratégie thérapeutique de la diverticulite sigmoïdienne [Current treatment strategies for sigmoid diverticulitis]

Treatment of colonic diverticular disease has evolved over the past years. Most episodes are simple and can be successfully treated with antibiotics alone. For complicated diverticulitis, a strong trend is developing towards less invasive therapies including interventional radiology and laparoscopic lavage in an effort to avoid the morbidity and discomfort of a diverting colostomy. Based on a better understanding of the natural history of the disease, the indication to prophylactic colectomy after a few episodes of simple diverticulitis has been seriously challenged. For those patients who need a colectomy, single port laparoscopy, NOTES and transanal specimen extraction are being proposed. However larger studies are needed to confirm the hypothetical advantages of these evolving techniques.

Western Iowa Missouri River Flooding -- Geo-Infrastructure Damage Assessment, Repair and Mitigation Strategies, TR-638, 2013

The 2011 Missouri River flooding caused significant damage to many geo-infrastructure systems including levees, bridge abutments/foundations, paved and unpaved roadways, culverts, and embankment slopes in western Iowa. The flooding resulted in closures of several interchanges along Interstate 29 and of more than 100 miles of secondary roads in western Iowa, causing severe inconvenience to residents and losses to local businesses. The main goals of this research project were to assist county and city engineers by deploying and using advanced technologies to rapidly assess the damage to geo-infrastructure and develop effective repair and mitigation strategies and solutions for use during future flood events in Iowa. The research team visited selected sites in western Iowa to conduct field reconnaissance, in situ testing on bridge abutment backfills that were affected by floods, flooded and non-flooded secondary roadways, and culverts. In situ testing was conducted shortly after the flood waters receded, and several months after flooding to evaluate recovery and performance. Tests included falling weight deflectometer, dynamic cone penetrometer, three-dimensional (3D) laser scanning, ground penetrating radar, and hand auger soil sampling. Field results indicated significant differences in roadway support characteristics between flooded and non-flooded areas. Support characteristics in some flooded areas recovered over time, while others did not. Voids were detected in culvert and bridge abutment backfill materials shortly after flooding and several months after flooding. A catalog of field assessment techniques and 20 potential repair/mitigation solutions are provided in this report. A flow chart relating the damages observed, assessment techniques, and potential repair/mitigation solutions is provided. These options are discussed for paved/unpaved roads, culverts, and bridge abutments, and are applicable for both primary and secondary roadways.

Surface-dependent strategies and energy flux in benthic marine communities or, why corals do not exist in the Mediterranean

Most structure-building organisms in rocky benthic communities are surface-dependent because their energy inputs depend mainly on the surface they expose to water. Two photosynthetic strategies, divided into calcareous and non calcareous algae, strict suspension-feeders and photosynthetic suspension feeders (e.g. hermatypic corals) are the four main strategies evolutively acquired by benthic organisms. Competition between those strategies occur in relation to productivity of the different species, in such a way that, for given environmental conditions, species with a higher growth (P/B ratio) would dominate. At a worldwide scale, littoral marine benthos can he considered to fit into the four fields defined by two main axes: the first, relates to productivity and relies atrophic and oligotrophic waters and the second is defined by the degree of environmental variability or seasonality (from high to low). Coral reefs (marine ecosystems dominated by photosynthetic suspension feeders) develop in the space of oligotrophic areas with low variability, while kelp beds (marine ecosystem dominated by large, non calcareous algae) are to be found only in eutrophic places with a high variability. The space of eutrophic waters with a low variability do not has specially adapted, high structured, benthic marine ecosystems, and in these conditions opportunistic algae and animals predominate. Finally, photophilic mediterranean benthos -devoid of kelps and without hermatypic corals- typifies the field of oligotrophic areas with high variability; in its more genuine aspect, Mediterranean benthos is represented by small algae with a high percentage of calcareous thallii. In all cases strict suspension-feeders compete successfully with photosynthetic organisms only in situations of low irradiances or very high inputs of POM. In its turn, Mediterranean rocky benthos, in spite of its relative uniformity, is geographically organized along the same axes. The Gulf of Lions and the insular bottoms (Balearic Islands, for example) would correspond to the extremes of eutrophic-high variability areas and oligotrophic-low variability areas, respectively. Irradiance, nutrient and POM concentration, and hydrodynamism are the three variables which mainly affect the distribution of the different surface-dependent strategies, and thus, these parameters are of paramount interest for understanding the trophic structure of Mediterranean benthic communities. In environments non limited by light, nutrient availability, defined as the product between nutrient -POM concentration and hydrodynamism, states the dominance of calcareous versus non calcareous algae. Calcareous algae dominate in oligotrophic waters while non-calcareous algae dominate in moderately eutrophic waters. In light-limited environments, passive suspension feeders (octocorallaria, gorgonians) become dominant species if POM availability is enhanced by a high hydrodynamism (strong currents); in waters with a low charge of POM organisms of other groups, mainly active suspension feeders, predominate (sponges, bryozoans, scleractiniarians). In any case, there always exists a very variable bathymetric zone, depending on light attenuation and nutrient-POM availability, where encrusting calcareous algae strongly compete with suspension feeders (coralligenous).

Identification of SPLUNC1's ENaC-inhibitory domain yields novel strategies to treat sodium hyperabsorption in cystic fibrosis airways.

The epithelial sodium channel (ENaC) is responsible for Na+ and fluid absorption across colon, kidney, and airway epithelia. We have previously identified SPLUNC1 as an autocrine inhibitor of ENaC. We have now located the ENaC inhibitory domain of SPLUNC1 to SPLUNC1's N terminus, and a peptide corresponding to this domain, G22-A39, inhibited ENaC activity to a similar degree as full-length SPLUNC1 (∼2.5 fold). However, G22-A39 had no effect on the structurally related acid-sensing ion channels, indicating specificity for ENaC. G22-A39 preferentially bound to the β-ENaC subunit in a glycosylation-dependent manner. ENaC hyperactivity is contributory to cystic fibrosis (CF) lung disease. Addition of G22-A39 to CF human bronchial epithelial cultures (HBECs) resulted in an increase in airway surface liquid height from 4.2±0.6 to 7.9±0.6 μm, comparable to heights seen in normal HBECs, even in the presence of neutrophil elastase. Our data also indicate that the ENaC inhibitory domain of SPLUNC1 may be cleaved away from the main molecule by neutrophil elastase, which suggests that it may still be active during inflammation or neutrophilia. Furthermore, the robust inhibition of ENaC by the G22-A39 peptide suggests that this peptide may be suitable for treating CF lung disease.

A detailed urinary excretion time course study of captan and folpet biomarkers in workers for the estimation of dose, main route-of-entry and most appropriate sampling and analysis strategies

Captan and folpet are two fungicides largely used in agriculture, but biomonitoring data are mostly limited to measurements of captan metabolite concentrations in spot urine samples of workers, which complicate interpretation of results in terms of internal dose estimation, daily variations according to tasks performed, and most plausible routes of exposure. This study aimed at performing repeated biological measurements of exposure to captan and folpet in field workers (i) to better assess internal dose along with main routes-of-entry according to tasks and (ii) to establish most appropriate sampling and analysis strategies. The detailed urinary excretion time courses of specific and non-specific biomarkers of exposure to captan and folpet were established in tree farmers (n = 2) and grape growers (n = 3) over a typical workweek (seven consecutive days), including spraying and harvest activities. The impact of the expression of urinary measurements [excretion rate values adjusted or not for creatinine or cumulative amounts over given time periods (8, 12, and 24 h)] was evaluated. Absorbed doses and main routes-of-entry were then estimated from the 24-h cumulative urinary amounts through the use of a kinetic model. The time courses showed that exposure levels were higher during spraying than harvest activities. Model simulations also suggest a limited absorption in the studied workers and an exposure mostly through the dermal route. It further pointed out the advantage of expressing biomarker values in terms of body weight-adjusted amounts in repeated 24-h urine collections as compared to concentrations or excretion rates in spot samples, without the necessity for creatinine corrections.

Application in the STRATHE trial of a score system to compare the efficacy and the tolerability of different therapeutic strategies in the management of hypertension

A score system integrating the evolution of efficacy and tolerability over time was applied to a subpopulation of the STRATHE trial, a trial performed according to a parallel group design, with a double-blind, random allocation to either a fixed-dose combination strategy (perindopril/indapamide 2 mg/0.625 mg, with the possibility to increase the dose to 3 mg/0.935 mg, and 4 mg/1.250 mg if needed, n = 118), a sequential monotherapy approach (atenolol 50 mg, followed by losartan 50 mg and amlodipine 5 mg if needed, n = 108), or a stepped-care strategy (valsartan 40 mg, followed by valsartan 80 mg and valsartan 80 mg+ hydrochlorothiazide 12.5 mg if needed, n = 103). The aim was to lower blood pressure below 140/90 mmHg within a 9-month period. The treatment could be adjusted after 3 and 6 months. Only patients in whom the study protocol was strictly applied were included in this analysis. At completion of the trial the total score averaged 13.1 +/- 70.5 (mean +/- SD) using the fixed-dose combination strategy, compared with -7.2 +/- 81.0 using the sequential monotherapy approach and -17.5 +/- 76.4 using the stepped-care strategy. In conclusion, the use of a score system allows the comparison of antihypertensive therapeutic strategies, taking into account at the same time efficacy and tolerability. In the STRATHE trial the best results were observed with the fixed-dose combination containing low doses of an angiotensin enzyme converting inhibitor (perindopril) and a diuretic (indapamide).

Optimal dividend strategies for a compound Poisson risk process under transaction costs and power utility

We characterize the value function of maximizing the total discounted utility of dividend payments for a compound Poisson insurance risk model when strictly positive transaction costs are included, leading to an impulse control problem. We illustrate that well known simple strategies can be optimal in the case of exponential claim amounts. Finally we develop a numerical procedure to deal with general claim amount distributions.

En torno a los efectos de la edad en el aprendizaje escolar de una lengua extrangera

The purpose of this article is to treat a currently much debated issue, the effects of age on second language learning. To do so, we contrast data collected by our research team from over one thousand seven hundred young and adult learners with four popular beliefs or generalizations, which, while deeply rooted in this society, are not always corroborated by our data.Two of these generalizations about Second Language Acquisition (languages spoken in the social context) seem to be widely accepted: a) older children, adolescents and adults are quicker and more efficient at the first stages of learning than are younger learners; b) in a natural context children with an early start are more liable to attain higher levels of proficiency. However, in the context of Foreign Language Acquisition, the context in which we collect the data, this second generalization is difficult to verify due to the low number of instructional hours (a maximum of some 800 hours) and the lower levels of language exposure time provided. The design of our research project has allowed us to study differences observed with respect to the age of onset (ranging from 2 to 18+), but in this article we focus on students who began English instruction at the age of 8 (LOGSE Educational System) and those who began at the age of 11 (EGB). We have collected data from both groups after a period of 200 (Time 1) and 416 instructional hours (Time 2), and we are currently collecting data after a period of 726 instructional hours (Time 3). We have designed and administered a variety of tests: tests on English production and reception, both oral and written, and within both academic and communicative oriented approaches, on the learners' L1 (Spanish and Catalan), as well as a questionnaire eliciting personal and sociolinguistic information. The questions we address and the relevant empirical evidence are as follows: 1. "For young children, learning languages is a game. They enjoy it more than adults."Our data demonstrate that the situation is not quite so. Firstly, both at the levels of Primary and Secondary education (ranging from 70.5% in 11-year-olds to 89% in 14-year-olds) students have a positive attitude towards learning English. Secondly, there is a difference between the two groups with respect to the factors they cite as responsible for their motivation to learn English: the younger students cite intrinsic factors, such as the games they play, the methodology used and the teacher, whereas the older students cite extrinsic factors, such as the role of their knowledge of English in the achievement of their future professional goals. 2 ."Young children have more resources to learn languages." Here our data suggest just the opposite. The ability to employ learning strategies (actions or steps used) increases with age. Older learners' strategies are more varied and cognitively more complex. In contrast, younger learners depend more on their interlocutor and external resources and therefore have a lower level of autonomy in their learning. 3. "Young children don't talk much but understand a lot"This third generalization does seem to be confirmed, at least to a certain extent, by our data in relation to the analysis of differences due to the age factor and productive use of the target language. As seen above, the comparably slower progress of the younger learners is confirmed. Our analysis of interpersonal receptive abilities demonstrates as well the advantage of the older learners. Nevertheless, with respect to passive receptive activities (for example, simple recognition of words or sentences) no great differences are observed. Statistical analyses suggest that in this test, in contrast to the others analyzed, the dominance of the subjects' L1s (reflecting a cognitive capacity that grows with age) has no significant influence on the learning process. 4. "The sooner they begin, the better their results will be in written language"This is not either completely confirmed in our research. First of all, we perceive that certain compensatory strategies disappear only with age, but not with the number of instructional hours. Secondly, given an identical number of instructional hours, the older subjects obtain better results. With respect to our analysis of data from subjects of the same age (12 years old) but with a different number of instructional hours (200 and 416 respectively, as they began at the ages of 11 and 8), we observe that those who began earlier excel only in the area of lexical fluency. In conclusion, the superior rate of older learners appears to be due to their higher level of cognitive development, a factor which allows them to benefit more from formal or explicit instruction in the school context. Younger learners, however, do not benefit from the quantity and quality of linguistic exposure typical of a natural acquisition context in which they would be allowed to make use of implicit learning abilities. It seems clear, then, that the initiative in this country to begin foreign language instruction earlier will have positive effects only if it occurs in combination with either higher levels of exposure time to the foreign language, or, alternatively, with its use as the language of instruction in other areas of the curriculum.

Melanic color-dependent anti-predator behavior strategies in barn owl nestlings

The arms race between predators and prey has led to morphological and behavioral adaptations. Different antipredator strategies can coexist within a population if each strategy is the result of a trade-off with competing demands. Antipredator behavior can be associated with morphological traits, like color patterns, either because in the context of sexual selection, coloration signals the ability to avoid predators or because coloration is a naturally selected trait useful in avoiding predators. Because in the barn owl (Tyto alba), heritable eumelanic plumage coloration is associated with the glucocorticoid-dependent response to stress, we tested whether antipredator behavior is also related to this trait. Compared with small-spotted nestlings, individuals displaying larger black spots hissed more intensely in the presence of humans, feigned death longer, had a lower breathing rate under stress, and were more docile when handled. Cross-fostering experiments showed that the covariation between the spot size and the duration of feigning death was inherited from the biological mother, whereas covariation between spot size and docility was inherited from the biological father. Our results confirm that melanin-based coloration is associated with suites of behavioral traits, which are under both genetic and environmental influence. Coloration can thus evolve as a direct or indirect response to predation, but it can also be a signal of antipredator strategies to potential mates.

Catch-up growth strategies differ between body structures: interactions between age and structure-specific growth in wild nestling Alpine swifts

1. Little is known on the occurrence and magnitude of faster than normal (catch-up) growth in response to periods of undernutrition in the wild, and the extent to which different body structures compensate and over what timescales is poorly understood. 2. We investigated catch-up growth in nestling Alpine Swifts, Apus melba, by comparing nestling growth trajectories in response to a naturally occurring 1-week period of inclement weather and undernutrition with growth of nestlings reared in a good year. 3. In response to undernutrition, nestlings exhibited a hierarchy of tissues preservation and compensation, with body mass being restored quickly after the end of the period of undernutrition, acceleration of skeletal growth occurring later in development, and compensation in wing length occurring mostly due to a prolongation of growth and delayed fledging. 4. The effect of undernutrition and subsequent catch-up growth was age-dependent, with older nestlings being more resilient to undernutrition, and in turn having less need to compensate later in the development. 5. This shows that young in a free-living bird population can compensate in body mass and body size for a naturally occurring period of undernutrition, and that the timing and extent of compensation varies with age and between body structures.