Programme de prise en charge des maladies chroniques : quels bénéfices dans l'asthme? : revue Cochrane pour le praticien

L'asthme impose un fardeau important sur les patients et les systèmes de soins. Les programmes de prise en charge des maladies chroniques (chronic disease management) ont pour but d'améliorer la qualité et l'efficacité des soins et du suivi des patients. Ils se composent d'une série d'interventions centrées sur les besoins des patients, encouragent la coordination et l'intégration des soins fournis par différents professionnels de la santé et mettent l'accent sur l'éducation du patient et l'autogestion de sa maladie. L'objectif de cette revue était d'évaluer l'efficacité de tels programmes chez l'adulte asthmatique.

Au sortir de l'hôpital, comment renforcer la continuité de la prise en charge médicale [Discharge from hospital: how to improve continuity of medical care?].

Early readmission is the major success indicator of the transition between hospital and home. Patients admitted with heart failure reach a 20% rate. Potentially avoidable readmissions, defined as unpredictable and related to a known condition during index hospitalization, represent the improvement margin. For these latter, implementation of specific interventions can be effective. Complex interventions on transition, including several modalities and seeking to encourage patient autonomy seem more effective than others. We describe two models: a pragmatic one developed in a regional hospital, and a more complex one developed in a university hospital during the LEAR-HF study. In both cases, it is imperative to work on "medical liability": should it extend beyond discharge up to the threshold of the private practice?

ÉVALUATION DE LA PÉNIBILITÉ DE LA PRISE EN CHARGE DES PATIENTS SOUFFRANT DE TROUBLES PSYCHIQUES EN MILIEU PÉNITENTIAIRE

Contexte: Les Établissements de la Plaine de l'Orbe accueillent des patients souffrant de troubles psychiques sévères et incarcérés sous le coup d'une mesure pénale ou y purgeant une peine. Dans le cadre d'une étude des besoins, l'équipe du Service de Médecine et Psychiatrie Pénitentiaire (SMPP) souhaite développer un outil permettant d'évaluer la pénibilité de la prise en charge de ces patients difficiles. Il y a en effet dans ce contexte, une nécessité d'améliorer l'offre de soins qui est actuellement limitée. Ceci dans la perspective de l'ouverture en 2016 d'un Etablissement de Réinsertion Sécurisée (ERS) sur le site de Cery et de la création d'un Centre de Soins aux Etablissements de la Plaine de l'Orbe à l'horizon 2018. Objectifs: Déterminer les différents critères définissant la pénibilité Élaborer un outil pratique, facilement utilisable en clinique permettant d'évaluer la pénibilité d'un patient ou d'une cohorte L'outil devra avoir une utilité à un niveau individuel (meilleure représentation des problématiques d'un patient, évolutivité de la situation) ainsi que sur une cohorte de patients (aide à l'évaluation des ressources nécessaires ou à l'évaluation de la charge de travail pour une équipe)

Short-term heparin kinetics during catheter ablation of atrial fibrillation

CONTEXTE: L'ablation percutanée par cathéter de la fibrillation auriculaire (AC-FA) est une option de traitement pour les patients souffrant de fibrillation auriculaire (FA) symptomatique réfractaire au traitement médicamenteux. L'AC-FA comporte un risque de complications thromboemboliques qui a été réduit par l'utilisation de l'héparine non fractionnée (HNF) intraveineuse durant la procédure. L'administration optimale de l'HNF ainsi que sa cinétique ne sont pas bien établies et nécessitent d'être déterminées avec précision. MÉTHODES ET RÉSULTATS: Cette étude a inclus 102 patients consécutifs atteints de FA symptomatique, réfractaire au traitement médicamenteux, référés pour une AC-FA. L'âge moyen était de 61 ± 10 ans. Après une ponction transseptale de la fosse ovale, une injection intraveineuse de HNF ajustée au poids (100 U / kg) a été administré. Une augmentation significative du temps de coagulation activé (ACT) a été observée passant d'une valeur de base moyenne de 100 ± 27 secondes, à 355 ± 94 secondes à 10 minutes (T10) et à 375 ± 90 secondes à 20 minutes (T20). 24 patients n'ont pas atteint la valeur visée d'ACT > 300 secondes à T10 et plus de la moitié de ce collectif est resté avec les valeurs d'ACT infrathérapeutiques à T20. Ce sous-ensemble de patients avait des caractéristiques cliniques similaires et avait reçu des doses similaires d'HNF, mais s'était plus fréquemment fait prescrire de la vitamine Kl pré-procédurale que le reste de la population de l'étude. CONCLUSION: Au cours d'une intervention standard, l'HNF montre, de manière inattendue, une cinétique d'anticoagulation lente dans une proportion significative des procédures et ceci jusqu'à 20 minutes après l'administration. Ces résultats soutiennent l'importance d'une administration d'HNF avant la ponction transseptale ou tout cathétérisme gauche avec des mesures précoces et répétées d'ACT afin d'identifier les patients avec une cinétique retardée. Ils sont en ligne avec les directives récentes proposant d'effectuer l'AC-FA sous anticoagulation thérapeutique.

Modeling reaction kinetics and mass transfer in ozonation in water solutions

This dissertation is based on four articles dealing with modeling of ozonation. The literature part of this considers some models for hydrodynamics in bubble column simulation. A literature review of methods for obtaining mass transfer coefficients is presented. The methods presented to obtain mass transfer are general models and can be applied to any gas-liquid system. Ozonation reaction models and methods for obtaining stoichiometric coefficients and reaction rate coefficients for ozonation reactions are discussed in the final section of the literature part. In the first article, ozone gas-liquid mass transfer into water in a bubble column was investigated for different pH values. A more general method for estimation of mass transfer and Henry’s coefficient was developed from the Beltrán method. The ozone volumetric mass transfer coefficient and the Henry’s coefficient were determined simultaneously by parameter estimation using a nonlinear optimization method. A minor dependence of the Henry’s law constant on pH was detected at the pH range 4 - 9. In the second article, a new method using the axial dispersion model for estimation of ozone self-decomposition kinetics in a semi-batch bubble column reactor was developed. The reaction rate coefficients for literature equations of ozone decomposition and the gas phase dispersion coefficient were estimated and compared with the literature data. The reaction order in the pH range 7-10 with respect to ozone 1.12 and 0.51 the hydroxyl ion were obtained, which is in good agreement with literature. The model parameters were determined by parameter estimation using a nonlinear optimization method. Sensitivity analysis was conducted using object function method to obtain information about the reliability and identifiability of the estimated parameters. In the third article, the reaction rate coefficients and the stoichiometric coefficients in the reaction of ozone with the model component p-nitrophenol were estimated at low pH of water using nonlinear optimization. A novel method for estimation of multireaction model parameters in ozonation was developed. In this method the concentration of unknown intermediate compounds is presented as a residual COD (chemical oxygen demand) calculated from the measured COD and the theoretical COD for the known species. The decomposition rate of p-nitrophenol on the pathway producing hydroquinone was found to be about two times faster than the p-nitrophenol decomposition rate on the pathway producing 4- nitrocatechol. In the fourth article, the reaction kinetics of p-nitrophenol ozonation was studied in a bubble column at pH 2. Using the new reaction kinetic model presented in the previous article, the reaction kinetic parameters, rate coefficients, and stoichiometric coefficients as well as the mass transfer coefficient were estimated with nonlinear estimation. The decomposition rate of pnitrophenol was found to be equal both on the pathway producing hydroquinone and on the path way producing 4-nitrocathecol. Comparison of the rate coefficients with the case at initial pH 5 indicates that the p-nitrophenol degradation producing 4- nitrocathecol is more selective towards molecular ozone than the reaction producing hydroquinone. The identifiability and reliability of the estimated parameters were analyzed with the Marcov chain Monte Carlo (MCMC) method. @All rights reserved. No part of the publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the author.

Garvey-Kelson relations for nuclear charge radii

The Garvey-Kelson relations (GKRs) are algebraic expressions originally developed to predict nuclear masses. In this letter we show that the GKRs provide a fruitful framework for the prediction of other physical observables that also display a slowly-varying dynamics. Based on this concept, we extend the GKRs to the study of nuclear charge radii. The GKRs are tested on 455 out of the approximately 800 nuclei whose charge radius is experimentally known. We find a rms deviation between the GK predictions and the experimental values of only 0.01 fm. This should be contrasted against some of the most successful microscopic models that yield rms deviations almost three times as large. Predictions -with reliable uncertainties- are provided for 116 nuclei whose charge radius is presently unknown.

Reaction Kinetics and Viscosity Modelling in the Fusion Syntheses of Ca- and Ca/Mg-resinates

Rosin is a natural product from pine forests and it is used as a raw material in resinate syntheses. Resinates are polyvalent metal salts of rosin acids and especially Ca- and Ca/Mg- resinates find wide application in the printing ink industry. In this thesis, analytical methods were applied to increase general knowledge of resinate chemistry and the reaction kinetics was studied in order to model the non linear solution viscosity increase during resinate syntheses by the fusion method. Solution viscosity in toluene is an important quality factor for resinates to be used in printing inks. The concept of critical resinate concentration, c crit, was introduced to define an abrupt change in viscosity dependence on resinate concentration in the solution. The concept was then used to explain the non-inear solution viscosity increase during resinate syntheses. A semi empirical model with two estimated parameters was derived for the viscosity increase on the basis of apparent reaction kinetics. The model was used to control the viscosity and to predict the total reaction time of the resinate process. The kinetic data from the complex reaction media was obtained by acid value titration and by FTIR spectroscopic analyses using a conventional calibration method to measure the resinate concentration and the concentration of free rosin acids. A multivariate calibration method was successfully applied to make partial least square (PLS) models for monitoring acid value and solution viscosity in both mid-infrared (MIR) and near infrared (NIR) regions during the syntheses. The calibration models can be used for on line resinate process monitoring. In kinetic studies, two main reaction steps were observed during the syntheses. First a fast irreversible resination reaction occurs at 235 °C and then a slow thermal decarboxylation of rosin acids starts to take place at 265 °C. Rosin oil is formed during the decarboxylation reaction step causing significant mass loss as the rosin oil evaporates from the system while the viscosity increases to the target level. The mass balance of the syntheses was determined based on the resinate concentration increase during the decarboxylation reaction step. A mechanistic study of the decarboxylation reaction was based on the observation that resinate molecules are partly solvated by rosin acids during the syntheses. Different decarboxylation mechanisms were proposed for the free and solvating rosin acids. The deduced kinetic model supported the analytical data of the syntheses in a wide resinate concentration region, over a wide range of viscosity values and at different reaction temperatures. In addition, the application of the kinetic model to the modified resinate syntheses gave a good fit. A novel synthesis method with the addition of decarboxylated rosin (i.e. rosin oil) to the reaction mixture was introduced. The conversion of rosin acid to resinate was increased to the level necessary to obtain the target viscosity for the product at 235 °C. Due to a lower reaction temperature than in traditional fusion synthesis at 265 °C, thermal decarboxylation is avoided. As a consequence, the mass yield of the resinate syntheses can be increased from ca. 70% to almost 100% by recycling the added rosin oil.

Lysine-based surfactants in nanovesicle formulations: the role of cationic charge position and hydrophobicity in in vitro cytotoxicity and intracellular delivery

Understanding nanomaterial interactions within cells is of increasing importance for assessing their toxicity and cellular transport. Here, we developed nanovesicles containing bioactive cationic lysine-based amphiphiles, and assessed whether these cationic compounds increase the likelihood of intracellular delivery and modulate toxicity. We found different cytotoxic responses among the formulations, depending on surfactant, cell line and endpoint assayed. The induction of mitochondrial dysfunction, oxidative stress and apoptosis were the general mechanisms underlying cytotoxicity. Fluorescence microscopy analysis demonstrated that nanovesicles were internalized by HeLa cells, and evidenced that their ability to release endocytosed materials into cell cytoplasm depends on the structural parameters of amphiphiles. The cationic charge position and hydrophobicity of surfactants determine the nanovesicle interactions within the cell and, thus, the resulting toxicity and intracellular behavior after cell uptake of the nanomaterial. The insights into some toxicity mechanisms of these new nanomaterials contribute to reducing the uncertainty surrounding their potential health hazards.

Estudo do efeito do tratamento superficial por moagem sobre as propriedades das partículas de uma liga de hidreto metálico

This work reports results of studies on the electrochemical and structural properties of a Ti/Zr-based metal hydride alloy covered by Ni and LaNi4,7Sn0,3 powder additives by ball milling. The effect of this treatment is investigated for the activation time, hydrogen storage capacity and equilibrium pressure, cycling stability and the hydration/dehydration kinetics. Charge and discharge cycles show a significant decrease of the activation time due to an increase of the active area caused by the milling treatment, independent of the additive. However, other results have evidenced little effect of the milling surface treatment on the charge storage capacity, hydrogen equilibrium pressure, and hydration/dehydration kinetics, for both the Ni and LaNi4,7Sn0,3 covered materials.

Study and modeling of the desintegration kinetics of coated paper

The disintegration of recovered paper is the first operation in the preparation of recycled pulp. It is known that the defibering process follows a first order kinetics from which it is possible to obtain the disintegration kinetic constant (KD) by means of different ways. The disintegration constant can be obtained from the Somerville index results (%lsv and from the dissipated energy per volume unit (Ss). The %slv is related to the quantity of non-defibrated paper, as a measure of the non-disintegrated fiber residual (percentage of flakes), which is expressed in disintegration time units. In this work, disintegration kinetics from recycled coated paper has been evaluated, working at 20 revise rotor speed and for different fiber consistency (6, 8, 10, 12 and 14%). The results showed that the values of experimental disintegration kinetic constant, Ko, through the analysis of Somerville index, as function of time. Increased, the disintegration time was drastically reduced. The calculation of the disintegration kinetic constant (modelled Ko), extracted from the Rayleigh’s dissipation function, showed a good correlation with the experimental values using the evolution of the Somerville index or with the dissipated energy

Reversed phase HPLC determination of tamoxifen in dog plasma and its pharmaco-kinetics after a single oral dose administration

The analytical method developed to evaluate tamoxifen in dog plasma samples was precise, accurate, robust and linear in the range of 5-200 ng/mL. The limits of detection and quantification were 0.981 ng/mL and 2.97 ng/mL, respectively. Besides, the intra-day precision and accuracy variations were 8.78 and 10.16%, respectively. Tamoxifen concentrations were analyzed by combined reversed phase liquid chromatography and UV detection (lambda=280 nm). The study was conducted using an open randomized 2-period crossover balanced design with a 1-week washout period between the doses. This simple, rapid and selective method is suitable for pharmacokinetic, bioavailability and bioequivalence studies.

Photometric procedure for quantitative analysis of Aflatoxin B1 in peanuts by thin-layer chromatography using charge coupled device detector

A photometric procedure was developed for determination of aflatoxin B1 in peanuts by TLC-CCD technique. The quantification and detection limit were 1.2 μg kg-1 and 0.4 ng per spot, respectively, with mean recovery of 98%. The CCD camera is sufficiently sensitive to detect small changes in spots fluorescence intensity and the results for performance confirmed the efficiency of the method. Another important property of CCD detector is its linearity for a wide range of luminous stimulus determined by analysis of five-point calibration curves using the intensity of AFB1 fluorescence versus AFB1 concentration (0.8 to 4.8 ng per spot). The method was applied to the analysis of thirty nine peanut samples and aflatoxin B1 levels ranged from 16 to 115 μg kg-1. The TLC-CCD and the photometric procedure developed in this study demonstrated to be a simple and efficient tool for quantitative analyses of AFB1 in peanut samples.