Comparison of transhiatal laparoscopy versus blind closed-chest cervicotomy and laparotomy for esophagectomy in children.

BACKGROUND: Esophageal replacement for caustic stenosis in children poses a challenging surgical problem. Blind removal of the injured esophagus without thoracotomy through a left cervical and transhiatal approach followed by an orthotopic esophageal replacement using either the colon or the stomach is a difficult procedure and can be dangerous in children. We performed our first total laparoscopic transhiatal esophagectomy in February 2007. We aim to compare this new technique to the previously applied method of blind closed-chest esophagectomy through a cervicotomy and laparotomy. METHODS: We analyzed the surgery and follow-up of 40 children operated upon for extensive irreversible caustic burns of the esophagus. The first 20 esophageal replacements were performed following a blind dissection of the mediastinum through a cervical incision and a laparotomy for esophagectomy (Group I). The last 20 esophageal replacements were performed after laparoscopic transhiatal dissection in the mediastinum and cervicotomy in the neck for esophagectomy (Group II). All operations were performed under the supervision of the same senior surgeon. RESULTS: Average age at the time of surgery was the same in both groups. Total esophagectomy was achieved in 45.0% of cases in Group I versus in 90.0% of cases in Group II. Colon was used in 80.0% of cases in Group I and in 90.0% in Group II. The mean duration of surgery was one hour longer in the laparoscopy group. One vascular injury was reported in the blind laparotomy group. Pneumothorax was more frequent in Group II without significant consequences besides drainage. Average time of extubation was about the same in both groups (1.8days). CONCLUSION: Laparoscopic transhiatal esophagectomy for caustic burns before esophageal replacement in children is safe and effective. It could avoid vascular and bronchial mediastinal injuries as the dissection is performed under direct visual control. The routine use of laparoscopic assistance by a senior surgeon improves the safety of esophageal dissection and reduces life-threatening complications.

Carrières militantes partisanes en contexte autoritaire

La désaffection des citoyens à l'égard des partis politiques en contexte autoritaire semble se prolonger au niveau de la recherche. Pourtant, l'observation du phénomène partisan dans de tels contextes soulève plusieurs énigmes. A partir du cas du Maroc, un des rares pays de la région qui connaît depuis son indépendance un pluralisme partisan limité mais néanmoins complexe, nous nous sommes posés trois questions en particulier : 1) Si les partis politiques suscitent tant de méfiance en contexte autoritaire, qu'est-ce qui caractérise ceux qui s'engagent en leur sein ? 2) Comment en vient-on à s'y engager ? 3) Selon quels processus individuels, organisationnels, collectifs les carrières militantes partisanes se transforment-elles dans un régime autoritaire ? Pour saisir, d'une part, les caractéristiques et les lignes de partage qui structurent l'espace partisan marocain en termes de valeurs, de sociographie, de socialisations, de bassins de recrutement, d'autre part, les intrications entre trajectoires individuelles, organisationnelles et collectives, nous avons recouru en parallèle à des méthodes ethnographiques et à la constitution d'une base de données sur 4127 congressistes nationaux de dix organisations politiques marocaines, sondées entre 2008 et 2012. La sélection des organisations politiques a reposé sur des critères historiques et idéologiques, sur des dynamiques de crise, de fragmentation ou d'unification, tout en étant contrainte par les aléas du calendrier de l'organisation des congrès nationaux et des événements de 2011. L'échantillon comporte des partis « administratifs », des partis de gouvernement, d'opposition parlementaire, d'opposition non parlementaire ; avec une diversité d'orientations : nationaliste, berbériste, islamiste, de gauche gouvernementale, de gauche radicale, d'extrême-gauche. En outre, pour interroger les spécificités du fait partisan au regard de ses marges, nous avons intégré dans notre échantillon une organisation altermondialiste promouvant « la politique autrement » et observé les mobilisations de 2011 et de 2012. La concrétisation de cette recherche a été possible grâce à plusieurs contributions : - Les congressistes et nos « alliés » au sein des organisations enquêtées - Université de Lausanne : subsides de démarrage, avant l'obtention du financement du FNRS - M-F. Oliva : gestion du fonds - M. Naoui : traduction vers l'arabe de la première version du questionnaire - l'équipe des enquêteurs constituée notamment par des doctorant.e.s du CM2S (Casablanca) et de l'Université de Mohammedia - H. Rabah: gestion logistique des enquêtes - M. Jeghllaly : participation à la collecte des données, co-responsabilité des enquêtes menées dans deux congrès, traduction et codage des réponses aux questions ouvertes et semi-ouvertes - V. Monney, G. Patthey : gestion administrative et constitution de la base de donnés au début du projet - Y. Boughaba, P. Diaz, F. Friedli, A. Lutz, M. Mouton, S. Ridet-de-Beausacq : saisie des données - N. Khattabi et K. Taifouri : saisie des réponses en arabe - P. Blanchard : stratégie méthodologique, formation méthodologique de l'équipe suisse, supervision de la saisie et du codage, conception et réalisation de la base de données et des documents de codage, traitements statistiques multivariés et séquentiels - J. P. Müller : formation méthodologique complémentaire de la requérante - A. Bennani, M. Catusse, J.G. Contamin, O. Fillieule, F. Haegel, F. Johshua, D. Ksikes, M. Offerlé, F. Passy : soutiens et conseils précieux à un moment ou à un autre de l'enquête.

Investigation of the Loss of Prestress in Prestressed Concrete Beams due to Steam Curing, HR-62, 1961

Mass production of prestressed concrete beams is facilitated by the accelerated curing of the concrete. The ·method most commonly used for this purpose is steam curing at atmospheric pressure. This requires concrete temperatures as high as 150°F. during the curing period. Prestressing facilities in Iowa are located out of doors. This means that during the winter season the forms are set and the steel cables are stressed at temperatures as low as 0°F. The thermal expansion of the prestressing cables should result in a reduction of the stress which was placed in them at the lower temperature. If the stress is reduced in the cables, then the amount of prestress ultimately transferred to the concrete may be less than the amount for which the beam was designed. Research project HR-62 was undertaken to measure and explain the difference between the initial stress placed in the cables and the actual stress which is eventually transferred to the concrete. The project was assigned to the Materials Department Laboratory under the general supervision of the Testing Engineer, Mr. James W. Johnson. A small stress bed complete with steam curing facilities was set up in the laboratory, and prestressed concrete beams were fabricated under closely controlled conditions. Measurements were made to determine the initial stress in the steel and the final stress in the concrete. The results of these tests indicate that there is a general loss of prestressing force in excess of that caused by elastic shortening of the concrete. The exact amount of the loss and the identification of the factors involved could not be determined from this limited investigation.

Alternatives to Guardianship and Conservatorship for Adults in Iowa, Revised 2007

Independence, respect, and equality are values important to all people. These values help define the concepts of autonomy (independence and freedom) and self-determination (the right to make decisions for one’s self). Because these rights are so valued in our society and are something that most of us would value for ourselves, the “least restrictive alternative” should always be considered before taking away a person’s civil and legal rights to make decisions for him or herself. The least restrictive alternative is an option, which allows a person to keep as much autonomy, and self-determination as possible while providing only the level of protection and supervision that is necessary. Some examples may include: representative payee for certain government benefit checks, joint bank accounts or advance directives for health care.

How to prescribe nutritional support using computers.

As other intensive care unit (ICU) therapies, nutritional support has become more complex requiring tight supervision and monitoring. It has repeatedly been shown that despite awareness of guidelines and prescription of the recommended amounts of energy (25 kcal/kg), underfeeding remains a prominent problem worldwide. In patients with prolonged stays, overfeeding has also become an issue. This lack of fit between prescription and delivery is largely caused by the lack of visibility of the nutritional results to nurses and clinicians. Computerized systems have brought major improvements, mainly through the customization of nutrition relevant variables in a single place, making them visible. Another important point is the possibility to change the ICU time constant to days and weeks which is the delay relevant for nutritional changes to appear, instead of minutes and hours which are more relevant for critical care.

Quelles applications raisonnables pour l'anticoagulation régionale au citrate en épuration extrarénale [What reasonable applications for regional citrate anticoagulation in renal replacement therapy?].

Regional citrate anticoagulation of the extracorporeal circuits (CRA) experienced considerable growth over the past decade. This development is partly explained by the significant progresses made in the field of bioengineering. These allow a secure administration of citrate, while an increasing availability of ionized calcium measurement at the bedside allows reactivity in monitoring the treatment. An increasing severity of the medical condition of patients requiring blood purification treatment gives more contrast to the profile of patient who may benefit from a CRA. If some methods of renal replacement therapy are well suited to this mode of anticoagulation, others are, to date, only at the stage of development and are applied under close medical supervision.

Producció de biopolímers amb cultius bacterians mixtes. Comparació de tres reactors discontinus seqüencials (SBR) amb diferents condicions operacionals

La producció de biopolímers (polihidroxialcanoats (PHA) i substàncies polimèriques extracel·lulars (EPS)) a nivell industrial, resulta una nova àrea d’investigació que recull diverses disciplines, entre elles les Ciències Ambientals. Aquest projecte final de carrera amb el títol: “Producció de biopolímers amb cultius bacterians mixtes”, s’ha desenvolupat sota la supervisió de la directora de projecte Dra. María Eugenia Suárez Ojeda del Departament d’Enginyeria Química de la Universitat Autònoma de Barcelona (UAB) i s’ha dut a terme per l’estudiant Jordi Pérez i Forner de la Llicenciatura de Ciències Ambientals, Facultat de Ciències de la UAB, en el Departament d’Enginyeria Química de la mateixa universitat. L’objectiu d’aquest projecte ha estat produir biopolímers simultàniament amb l’eliminació de fòsfor i matèria orgànica en aigües residuals per obtenir un residu final amb un alt valor afegit. Aquests biopolímers reuneixen les característiques necessàries per a poder competir amb els plàstics convencionals i així, reduir l’elevat consum del petroli i la generació de residus no biodegradables. En aquest projecte s’ha dut a terme la posta en marxa d’un reactor discontinu seqüencial (SBR) per a l’acumulació de biopolímers amb cultius bacterians mixtes. Diferents investigadors han estudiat que aquests tipus de cultius bacterians arriben a nivells de fins el 53-97% [Pijuan et al., 2009] de contingut de biopolímers a la biomassa, sometent als microorganismes a diferents situacions d’estrés ja sigui per dèficit de nutrients o per variacions en les fases de feast-famine (festí-fam). Durant el projecte, s’ha realitzat el monitoratge del reactor alimentat amb una aigua sintètica, elaborada en el laboratori, amb les característiques d’un aigua residual provinent de la industria làctica. S’ha sotmès als microorganismes a diferents condicions operacionals, una d’elles amb limitació de fòsfor com a nutrient i una tercera condició amb una variació a les fases feast-famine. D’altra banda, com a segon objectiu, s’ha analitzat el contingut de biopolímers a la biomassa de dos SBRs més, del grup de recerca Bio-GLS del Departament d’Enginyeria Química de la UAB, alimentats amb diferents fonts de carboni, glicerol i àcids grassos de cadena llarga (AGCLL), per observar les influències que té el tipus de substrat en l’acumulació de biopolímers. Els resultats obtinguts en la primera part d’aquest projecte han estat similars als resultats d’altres investigadors [Pijuan et al., 2009; Guerrero et al., 2012]. S’ha determinat que sotmetre als microorganismes a situacions d’estrés té un efecte directe pel que fa a l’acumulació de biopolímers. També s’ha observat com al mateix temps que acumulaven aquests compostos, els microorganismes desenvolupaven la seva tasca de depurar l’aigua residual, obtenint al final del cicle una aigua amb un baix contingut en matèria orgànica i altres contaminants com amoni i fòsfor, en aquest cas. En la segona part del projecte, s’ha observat com el tipus de substrat té un efecte directe pel que fa a l’acumulació de biopolímers i també a l’activitat metabòlica dels microorganismes. Per tant, s’ha conclòs que la producció de biopolímers mitjançant la depuració d’aigües residuals es una via d’investigació molt prometedora pel que fa als resultats obtinguts. Alhora que es tracta un residu, s’obté una producte residual amb un alt valor afegit que pot ser utilitzat per la producció de bioplàstics 100% biodegradables.

Online teaching of inflammatory skin pathology by a French-speaking International University Network

INTRODUCTION: Developments in technology, web-based teaching and whole slide imaging have broadened the teaching horizon in anatomic pathology. Creating online learning material including many types of media such as radiologic images, whole slides, videos, clinical and macroscopic photographs, is now accessible to most universities. Unfortunately, a major limiting factor to maintain and update the learning material is the amount of resources needed. In this perspective, a French-national university network was initiated in 2011 to build joint online teaching modules consisting of clinical cases and tests. The network has since expanded internationally to Québec, Switzerland and Ivory Coast. METHOD: One of the first steps of the project was to build a learning module on inflammatory skin pathology for interns and residents in pathology and dermatology. A pathology resident from Québec spent 6 weeks in France and Switzerland to develop the contents and build the module on an e-learning Moodle platform under the supervision of two dermatopathologists. The learning module contains text, interactive clinical cases, tests with feedback, virtual slides, images and clinical photographs. For that module, the virtual slides are decentralized in 2 universities (Bordeaux and Paris 7). Each university is responsible of its own slide scanning, image storage and online display with virtual slide viewers. RESULTS: The module on inflammatory skin pathology includes more than 50 web pages with French original content, tests and clinical cases, links to over 45 virtual images and more than 50 microscopic and clinical photographs. The whole learning module is being revised by four dermatopathologists and two senior pathologists. It will be accessible to interns and residents in the spring of 2014. The experience and knowledge gained from that work will be transferred to the next international resident whose work will be aimed at creating lung and breast pathology learning modules. CONCLUSION: The challenges of sustaining a project of this scope are numerous. The technical aspect of whole-slide imaging and storage needs to be developed by each university or group. The content needs to be regularly updated and its accuracy reviewed by experts in each individual domain. The learning modules also need to be promoted within the academic community to ensure maximal benefit for trainees. A collateral benefit of the project was the establishment of international partnerships between French-speaking universities and pathologists with the common goal of promoting pathology education through the use of multi-media technology including whole slide imaging.

Issue review : community-based corrections funding.

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.

Self Instructional Math, HR-324, 1995

The Self Instructional Math course book is designed to provide a basic math knowledge for those involved in the planning, design, and construction of highways. It was developed in a manner to allow the student to take the course with minimal supervision and at times that the work schedule allows. The first version of the course was developed in the early 1970's and due to its popularity was revised in the early 1990's to reflect changes in the highway construction math needs. The anticipated move to metric (System International) measurements by the highway industry has necessitated the need to change the math course problem values to metric units. The course includes the latest in Iowa DOT policy information relative to the selection and use of metric values for highway design, and construction. Each unit of the book contains instructional information, section quizzes and a comprehensive examination. All problem values are expressed in metric rather than dual (english and SI) units. The appendix contains useful conversion factors to assist the reader in making the change to metric.

Awareness of HIV Testing Guidelines Is Low among Swiss Emergency Doctors: A Survey of Five Teaching Hospitals in French-Speaking Switzerland.

BACKGROUND: In Switzerland, 30% of HIV-infected individuals are diagnosed late. To optimize HIV testing, the Swiss Federal Office of Public Health (FOPH) updated 'Provider Induced Counseling and Testing' (PICT) recommendations in 2010. These permit doctors to test patients if HIV infection is suspected, without explicit consent or pre-test counseling; patients should nonetheless be informed that testing will be performed. We examined awareness of these updated recommendations among emergency department (ED) doctors. METHODS: We conducted a questionnaire-based survey among 167 ED doctors at five teaching hospitals in French-Speaking Switzerland between 1(st) May and 31(st) July 2011. For 25 clinical scenarios, participants had to state whether HIV testing was indicated or whether patient consent or pre-test counseling was required. We asked how many HIV tests participants had requested in the previous month, and whether they were aware of the FOPH testing recommendations. RESULTS: 144/167 doctors (88%) returned the questionnaire. Median postgraduate experience was 6.5 years (interquartile range [IQR] 3; 12). Mean percentage of correct answers was 59 ± 11%, senior doctors scoring higher (P=0.001). Lowest-scoring questions pertained to acute HIV infection and scenarios where patient consent was not required. Median number of test requests was 1 (IQR 0-2, range 0-10). Only 26/144 (18%) of participants were aware of the updated FOPH recommendations. Those aware had higher scores (P=0.001) but did not perform more HIV tests. CONCLUSIONS: Swiss ED doctors are not aware of the national HIV testing recommendations and rarely perform HIV tests. Improved recommendation dissemination and adherence is required if ED doctors are to contribute to earlier HIV diagnoses.

Tuomioistuinten valvonnan kehityksestä ja nykytilasta

English summary: Development and current status of the supervision of courts (s.1278)

Religious coping in schizophrenia patients : spiritual support in medical care and pastoral counselling

Following an introduction focusing on the role of religion in the treatment of psychosis, the first part of this paper describes an initial study in which the role of spirituality and religiosity was assessed in 115 patients with schizophrenia in Geneva (Switzerland) and 126 in Trois-Rivières (Quebec). These themes have been shown to be highly prevalent for these patients, though their clinicians are often unaware of this prevalence. The following part of the paper presents a second study where religious supervision was offered to clinicians in Geneva. Comparison between forty patients who received spiritual assessment and opportunities to work on religious topics with their clinicians was made with thirty patients without religious intervention. In the supervisory sessions, six different types of religious interventions were suggested. Outcomes at three months show that patients of the intervention group maintain their interest for help in religious matters while clinicians' interest in integrating religious topics in discussions with their patients has decreased. The third and main part of the paper is devoted to an analysis of the suggested interventions from the viewpoint of the study of religions. Five aspects of religion are distinguished, and explanations of the reasons some of them are easier to manage for clinicians are proposed. The paper concludes with proposals for the education of clinicians to help them to differentiate different kinds of religious coping and to recognize when it could be helpful to refer the patient to a pastoral counsellor.

Moodleando en posgrado: uso del campus virtual y evaluación continuada

[spa] La adaptación al EEES ha implicado una reestructuración de los estudios universitarios promoviendo, entre otros, el uso de una evaluación continuada de los aprendizajes y de herramientas docentes virtuales en los nuevos grados. Estos cambios también pueden aplicarse en el posgrado, aunque hasta el momento, son pocas las experiencias al respecto. El presente trabajo muestra la opinión y los resultados obtenidos de los estudiantes de una asignatura de posgrado de un Máster Oficial Universitario URV-UB en el que se llevó a cabo evaluación continuada y se utilizó el Campus Virtual (CV) como herramienta de aprendizaje y participación activa. La aplicación del proyecto (2007PID/UB-14) se llevó a cabo en 4 fases: elaboración del aula, diseño de encuestas dirigidas a los estudiantes para obtener su opinión sobre la evaluación continuada y sus conocimientos en el uso de plataformas virtuales de forma previa al curso, gestión diaria del aula y seguimiento de las actividades propuestas y finalmente, evaluación del proyecto a través de indicadores cualitativos y cuantitativos derivados de las encuestas y de la propia aplicación virtual. Al inicio del curso la mayoría (93,75%) de los estudiantes prefería evaluación continuada y al final de éste el 100% estuvieron de acuerdo con el tipo de evaluación realizado. Respecto al CV, los estudiantes realizaron todas las actividades de autoevaluación voluntarias. La puntuación sobre la utilidad de todos los recursos del aula del CV fue muy elevada, siendo máxima la obtenida por los ejercicios de autoevaluación. En global, los estudiantes otorgaron al aula una puntuación de 8,1 sobre 10.