Postmortem angiography: review of former and current methods.

OBJECTIVE: Postmortem investigations are becoming more and more sophisticated. CT and MRI are already being used in pathology and forensic medicine. In this context, the impact of postmortem angiography increases because of the rapid evaluation of organ-specific vascular patterns, vascular alteration under pathologic and physiologic conditions, and tissue changes induced by artificial and unnatural causes. CONCLUSION: In this article, the advantages and disadvantages of former and current techniques and contrast agents are reviewed.

Senescence in cell oxidative status in two bird species with contrasting life expectancy.

Oxidative stress occurs when the production of reactive oxygen species (ROS) by an organism exceeds its capacity to mitigate the damaging effects of the ROS. Consequently, oxidative stress hypotheses of ageing argue that a decline in fecundity and an increase in the likelihood of death with advancing age reported at the organism level are driven by gradual disruption of the oxidative balance at the cellular level. Here, we measured erythrocyte resistance to oxidative stress in the same individuals over several years in two free-living bird species with contrasting life expectancy, the great tit (known maximum life expectancy is 15.4 years) and the Alpine swift (26 years). In both species, we found evidence for senescence in cell resistance to oxidative stress, with patterns of senescence becoming apparent as subjects get older. In the Alpine swift, there was also evidence for positive selection on cell resistance to oxidative stress, the more resistant subjects being longer lived. The present findings of inter-individual selection and intra-individual deterioration in cell oxidative status at old age in free-living animals support a role for oxidative stress in the ageing of wild animals.

Inversion of crosshole seismic data in heterogenous environments : Comparison of waveform and ray-based approaches

High-resolution tomographic imaging of the shallow subsurface is becoming increasingly important for a wide range of environmental, hydrological and engineering applications. Because of their superior resolution power, their sensitivity to pertinent petrophysical parameters, and their far reaching complementarities, both seismic and georadar crosshole imaging are of particular importance. To date, corresponding approaches have largely relied on asymptotic, ray-based approaches, which only account for a very small part of the observed wavefields, inherently suffer from a limited resolution, and in complex environments may prove to be inadequate. These problems can potentially be alleviated through waveform inversion. We have developed an acoustic waveform inversion approach for crosshole seismic data whose kernel is based on a finite-difference time-domain (FDTD) solution of the 2-D acoustic wave equations. This algorithm is tested on and applied to synthetic data from seismic velocity models of increasing complexity and realism and the results are compared to those obtained using state-of-the-art ray-based traveltime tomography. Regardless of the heterogeneity of the underlying models, the waveform inversion approach has the potential of reliably resolving both the geometry and the acoustic properties of features of the size of less than half a dominant wavelength. Our results do, however, also indicate that, within their inherent resolution limits, ray-based approaches provide an effective and efficient means to obtain satisfactory tomographic reconstructions of the seismic velocity structure in the presence of mild to moderate heterogeneity and in absence of strong scattering. Conversely, the excess effort of waveform inversion provides the greatest benefits for the most heterogeneous, and arguably most realistic, environments where multiple scattering effects tend to be prevalent and ray-based methods lose most of their effectiveness.

Le mouvement peut-il guérir? : histoire de l'engagement des médecins français dans l'élaboration de l'éducation physique (1741-1888)

Résumé : Cette recherche doctorale analyse l'engagement des médecins français autour de l'éducation physique entre 1741 et 1888. Basé sur un travail prosopographique d'identification des médecins qui ont participé à l'élaboration de l'éducation physique, ce travail repose sur une mise en dialogue de leurs prises de position respectives. Pour réaliser cette enquête, nous avons compulsé un large corpus de sources primaires, composé des ouvrages consacrés à la gymnastique médicale mais aussi une très large portion de la production d'imprimés touchant à l'anatomie, l'hygiène, la thérapeutique, la physiologie, l'orthopédie, etc. Le corpus contient également des articles des principaux dictionnaires médicaux de la période et des principales revues médicales du XIXe siècle. Avec une approche critique de l'historiographie et à partir de ce corpus, nous avons travaillé dans le cadre de contextes définis pour saisir au plus près les logiques sociales et scientifiques amenant les médecins auprès de l'éducation physique. Trois conjonctures successives structurent l'engagement médical. Entre 1741 et 1817, la thèse retrace l'émergence d'un questionnement ; les années 1817-1847 constituent un « moment orthopédique » dans la formulation de la gymnastique ; et finalement entre 1847 et 1888, on observe une diversification des voies de légitimation médicale des exercices du corps. Ces trois moments de l'histoire des « discours gymniques médicaux » proposent un certain nombre de convergences : la prégnance de l'orthopédie, une certaine concentration autour de la santé des corps féminins, l'inclusion dans un « projet hygiéniste » ; mais aussi des divergences et des singularités : relatives à la progressive structuration en cours du champ médical, à l'implication progressive du politique (surtout après 1845/1850), aux transformations des pathologies/doctrines médicales « dominantes », ainsi qu'à l'importance plus ou moins forte de l'une ou l'autre des facettes de l'éducation physique (militaire, athlétique, « médicinale » ou pédagogique). Le processus est aussi celui de l'expérimentation de la curation de certaines pathologies (scolioses, affections nerveuses), dans des configurations idéologiques/scientifiques marquées par la « dégénération » (XVIIIe siècle), l'anatomie pathologique (début du XIXe siècle) et plus tard la « dégénérescence » et les affections nerveuses (après 1850). Dans le cadre d'une dynamique d'inspiration « foucaldienne », ces recommandations évoluent d'une anatomopolitique - caractérisée par un essor de discours empreints d'anatomie au XVIIIe siècle - vers une biopolitique - caractérisée par l'engagement de l'Etat qui fait de la gymnastique une discipline d'enseignement, pensée à des fins hygiéniques dans la seconde moitié du XIXe - où le processus réside en fait dans une biologisation progressive des recommandations pratiques. Observée à l'aune de la formulation médicale de l'éducation physique, la biopolitique n'est pas réalisée dans la seconde moitié du XVIIIe, elle se compose lentement aux marges de l'institution scolaire et des gymnastiques pédagogico-militaires pour constituer un projet thérapeutique et hygiénique plus construit après 1850. Abstract : This dissertation analyzes French doctor's involvement in debates and initiatives concerning physical education between 1741 and 1888. Based on a prosopographic inventory of those physicians who participated in the development of physical education, it explores the variety of their discourses with respect to the practice of physical exercises. This investigation relies on a large selection of primary sources: works devoted to medical gymnastic, but also medical treatises related to anatomy, hygiene, therapeutics, physiology, orthopedics, etc. The sources also include articles from the major medical dictionaries and journals of the nineteenth century. These documents are used to explore the socio-scientific mechanisms that underlay physicians' commitment to physical education. Three chronological periods structure medical engagement in the area of physical education. Between 1741 and 1817 the thesis traces the emergence of a questioning; the years 1817 to 1847 represent an « orthopedic moment » in the development of gymnastics; finally between 1847 and 1888, one witnesses a diversification of the legitimation process between medicine and gymnastics. These three moments in the history of « medical and gymnastic discourses » offer a number of similarities: the weight of orthopedics, the ongoing focus on the health of the female body, and the association of these discourses with a « hygienic project ». But differences also distinguish these periods as the medical field became more structured and new medical doctrines became dominant, with the increasing involvement of politics (especially after 1850), and with the changing weight of priorities within physical education (military, athletic, « medical » or pedagogic). Medical discourses centered on the curing of certain diseases (scoliosis or nervous disorders) are analyzed within an ideological configuration marked by the idea of « degeneration » (in the eighteenth century), « pathological anatomy » (in the early nineteenth century) and later « dégénérescence » associated with nervous disorders (after 1850). The dissertation draws on Foucault's historical epistemology to understand how medical recommendations evolve from an anatomopolitics - characterized by a surge in anatomical discourses - toward a biopolitics - characterized by the commitment of the State to introduce gymnastics for hygienic purposes into schools in the second half of the nineteenth century. This process reveals a progressive "biologization" of practical recommendations. The medical discourses about physical education show that Foucault's biopolitical power is not achieved in the second half of the eighteenth century, but develops slowly at the margins of the school system and of pedagogical and military gymnastic, becoming a veritable hygienic and therapeutic project only after 1850.

Aplicação da teoria de Parse no relacionamento enfermeiro-indivíduo

O estudo tem o objetivo de relatar experiências de situações vividas pelas autoras ao aplicarem os fundamentos da teoria de Parse "Human Becoming" e apresentar seus princípios e conceitos visando divulgá-la. Após estudo teórico para a compreensão da teoria, os seus princípios foram aplicados na prática. As autoras constataram que isto implica em mudança de valores e crenças do enfermeiro, transformando sua visão sobre o ser humano e sua saúde, tornando o cuidado mais humanístico. A experiência vivenciada possibilitou amadurecimento pessoal e profissional das autoras.

Devenir charrùa dans l'Uruguay de l'après dictature Entre mémoires fragmentées et « sens du collectif ». Une ethnographie audiovisuelle en collaboration.

Dans cette recherche, je me suis intéressée à la genèse des rapports sociaux construisant un collectif, dans l'articulation être nommé et se nommer. En Uruguay, pays construit sur un imaginaire social dit "sans indiens", mon travail a consisté à essayer de comprendre les conditions historiques, sociales et politiques d'émergence de collectifs de personnes réclamant l'appartenance à une identité autochtone précise, l'identité charrùa. J'ai démontré qu'il s'agit d'un processus en cours, individuel et collectif, qui a des temporalités diverses, qui a néanmoins émergé depuis une vingtaine d'années, dans le contexte de la post-dictature et celui géopolitique de l'autochtonie, dans une articulation local/global. L'analyse dévoile que l'identité charrùa est l'enjeu du rapport social qui est la lutte politique contre l'exclusion. Cette identité accompagne l'état-nation depuis sa fondation. Figure duelle, cette identité contient les traces des violences internes dans un continuum de mémoires fragmentées et entrelacées. Elle est aussi promesse de devenir en tant que modèle identitaire parvenu à l'autonomie et conservant le « sens du collectif ». Anthropologue engagée, me situant dans une perspective décoloniale, j'ai proposé aux personnes avec qui j'ai effectué cette recherche, d'élaborer une ethnographie collaborative, la caméra et les films se situant au coeur du terrain, compris comme espace relationnel de construction d'une connaissance partagée. -- My research is based on the genesis of social relations which build up a collective, structured on being named and be named. My work in Uruguay, country built on a social construct called "without Indians", was to try to understand the historical, social and political conditions of emerging collectives. These claim the belonging of a precise indigenous identity, the charrua identity. I showed that the current process, which is individual and collective, with different temporalities, emerged twenty years ago, in the post-dictatorship context as well as the geopolitical context of indigeneity, in a local/global structure. The analysis reveals that the charrua identity is the stake of the social relation which is political fight against exclusion. This identity accompanies the nation state since its foundation. Dategory dual, this identity keeps the traces of the internal in the continuum of the fragmented and intertwined memories. This is also the becoming promise of an identity model, which reaches autonomy and keeps the "sense of collective". As an involved anthropologist, I worked from a decolonization point of view. I suggested that the people who went through the research with me, should work out a collaborative ethnography, the video camera and the movies being set in the middle of the fieldwork. This one is conceived as a relational space of construction of a shared knowledge.

Managing diabetes in Switzerland : a systemic approach

Executive summaryThe increasing prevalence of chronic diseases is one of the major causes of rising health expenditure, as stated by the WHO. Not only chronic diseases are very costly, but they are by far the leading cause of mortality in the world, representing 60% of all deaths. Diabetes in particular is becoming a major burden of disease. In Switzerland around 5% of the population suffer of type 2 diabetes and 5 to 10% of the annual health care budget is attributable to diabetes. If the predictions of WHO do realise, the prevalence of diabetes will double until 2030 and so is expected the attributable health expenditure.The objective of this thesis is to provide policy recommendations as to slow down the disease progression and its costly complication. We study the factors that influence diabetes dynamics and the interventions that improve health outcomes while decreasing costs according to different time horizon and use systems thinking and system dynamic.Our results show that managing diabetes requires using integrated care interventions that are effective on three fronts: (1) delaying the onset of complications, (2) slowing down the disease progression and (3) accelerating the time to diagnosis of diabetes and its complications. We recommend firstly the implementation of those interventions targeted at changing patients' behaviour which are also less expensive, but require a change in the delivery of care and medical practices. Then policies targeted at an earlier diagnosis of diabetes, its prevention and the diagnosis of complications are to be considered. This sequence of interventions allows saving money, as total costs decrease, even including the costs of interventions and result in longer life expectancy of diabetics in the long term.In diabetes management there is therefore a trade-off between medical costs and patients' benefits on the one hand and between the objectives of obtaining results in the short or long term on the other hand. Decision makers need to deliver acceptable outcomes in the short term. Considering this criterion, the preferred policy may be to focus only on diagnosed diabetics, thus attempting to slow down the progression of their disease, compared to an integrated care approach addressing all the aspects of the disease. Such a policy also yields desirable results in terms of costs and patients' benefits.

The apical localization of transcribing RNA polymerases on supercoiled DNA prevents their rotation around the template.

The interaction of Escherichia coli RNA polymerase with supercoiled DNA was visualized by cryo-electron microscopy of vitrified samples and by classical electron microscopy methods. We observed that when E. coli RNA polymerase binds to a promoter on supercoiled DNA, this promoter becomes located at an apical loop of the interwound DNA molecule. During transcription RNA polymerase shifts the apical loop along the DNA, always remaining at the top of the moving loop. This relationship between RNA polymerase and the supercoiled template precludes circling of the RNA polymerase around the DNA and prevents the growing RNA transcript from becoming entangled with the template DNA.

First-line therapies in inflammatory bowel disease.

Background and Aims: Medical therapy of inflammatory bowel disease (IBD) is becoming more complex, given the increasing choice of drugs to treat Crohn's disease (CD) and ulcerative colitis (UC). We aimed to summarize the current guidelines for first-line treatments in IBD. Methods: An extensive literature search with focus on the guidelines of the European Crohn's and Colitis Organisation for the diagnosis and treatment of CD and UC was performed. First-line treatments were defined as the following drug categories: 5-aminosalicylates, budesonide, systemic steroids, azathioprine, 6-mercaptopurine, methotrexate, infliximab, adalimumab and certolizumab pegol. The following drug categories were not included: cyclosporine and tacrolimus (not yet approved by Swissmedic for IBD treatment). Results: Treatment recommendations for the following clinically frequent situations are presented according to disease severity: ileocecal CD, colonic CD, proximal small bowel CD and perianal CD. For UC the following situations are presented: ulcerative proctitis, left-sided colitis and pancolitis. Conclusions: We provide a summary on the use of first-line therapies for clinically frequent situations in patients with CD and UC.

Pregnancy-induced chromatin remodeling in the breast of postmenopausal women.

Early pregnancy and multiparity are known to reduce the risk of women to develop breast cancer at menopause. Based on the knowledge that the differentiation of the breast induced by the hormones of pregnancy plays a major role in this protection, this work was performed with the purpose of identifying what differentiation-associated molecular changes persist in the breast until menopause. Core needle biopsies (CNB) obtained from the breast of 42 nulliparous (NP) and 71 parous (P) postmenopausal women were analyzed in morphology, immunocytochemistry and gene expression. Whereas in the NP breast, nuclei of epithelial cells were large and euchromatic, in the P breast they were small and hyperchromatic, showing strong methylation of histone 3 at lysine 9 and 27. Transcriptomic analysis performed using Affymetrix HG_U133 oligonucleotide arrays revealed that in CNB of the P breast, there were 267 upregulated probesets that comprised genes controlling chromatin organization, transcription regulation, splicing machinery, mRNA processing and noncoding elements including XIST. We concluded that the differentiation process induced by pregnancy is centered in chromatin remodeling and in the mRNA processing reactome, both of which emerge as important regulatory pathways. These are indicative of a safeguard step that maintains the fidelity of the transcription process, becoming the ultimate mechanism mediating the protection of the breast conferred by full-term pregnancy.

Epidemiological Profile for Iowa, 2002

This statewide profile describes the epidemiology of HIV, AIDS, and other sexually transmitted diseases in Iowa through December, 2002. The report characterizes the distribution of these diseases in terms of geography, race, gender, age, and associated causal factors. This epidemiological profile has been prepared to assist in developing a comprehensive HIV/AIDS Prevention and Care Plan. This description of the HIV epidemic in the state serves to guide prevention and service efforts, to quantify unmet need for prevention and care programs, and to evaluate programs and policies in Iowa. Five key questions are addressed: 1. What are the sociodemographic characteristics of Iowa’s population? 2. What is the epidemiology, including the geographical distribution, of HIV, AIDS, and other sexually transmitted diseases (STDs) in Iowa? 3. Who is at the greatest risk of becoming infected with HIV and other STDs in Iowa? 4. What are the patterns of utilization of HIV services throughout the state? 5. What are the number and characteristics of persons who know they are HIV-positive, but who are not receiving primary medical care?

Trajectòries d'èxit de joves immigrants a l'ensenyament superior i al món professional

L’educació dels immigrants és un tema prioritari a les agendes polítiques de molts països de la OCDE. En molts casos, els governs s’han preocupat especialment de la seva integració al món del treball però creix l’interès en els seus resultats al sistema educatiu i en la revisió de les polítiques adreçades a respondre a les seves necessitats educatives i formatives. La majoria d’aquests estudis es situen a l’esfera de l’educació infantil, primària, secundaria i formació professional, per això resulta pràcticament impossible trobar estudis que analitzin el baix percentatge d’accés d’estudiants immigrants extracomunitaris a la universitat (al voltant de 3,3% en el cas de Catalunya); que contribueixin a entendre els factors que configuren les trajectòries d’èxit escolar i d’integració laboral dels estudiants immigrants que accedeixen i completen els estudis universitaris; que puguin donar pautes per desenvolupar polítiques educatives que millorin els resultats d’aprenentatge dels estudiants immigrants; i que puguin servir com a mirall i incentiu per a altres persones immigrants i, perquè no, també del país. Aquest projecte ha estudiat el conjunt d’elements que condicionen l’accés dels joves immigrants als estudis universitaris, i a l’estatus laboral que els hauria de possibilitar la seva formació universitària. L’estudi ha consistit en una metaanàlisi dels documents existents sobre el tema i en la realització de 8 narratives biogràfiques; quatre de persones cursant diferents estudis a les universitats catalanes i quatre que ja s’han incorporat al món del professional. Aquestes narratives venen acompanyades de 8 vídeos que exploren noves maneres de visibilització d’aquesta població i es transformen en una pràctica d’autoria. Aquest material visual pot servir com a recurs educatiu, en la mida que pugui ser un mirall i un incentiu per a altres persones immigrants i del país. Finalment, presenta un seguit de recomanacions per als responsables de les polítiques i dels centres educatius.

Relation soignant-soigné quand les blogs s'en mêlent [Patient-caregiver relationship: when illness blogs step in].

The use of social media as a communication tool is rapidly growing in the community, and more specifically in patients, through illness blogs. This has been true for several years in North America, but is becoming a reality in Europe as well. We report here the first results of studies on the putative psychological benefits and risks of illness blogs for their authors. We also explore the possible impact of blogging on the patient-caregiver relationship. Social media are expected to have a growing influence in certain areas of health care. Physicians should therefore stay informed about them, take advantage of their benefits, and anticipate their risks.

Iterative image reconstruction techniques: cardiothoracic computed tomography applications.

Iterative image reconstruction algorithms provide significant improvements over traditional filtered back projection in computed tomography (CT). Clinically available through recent advances in modern CT technology, iterative reconstruction enhances image quality through cyclical image calculation, suppressing image noise and artifacts, particularly blooming artifacts. The advantages of iterative reconstruction are apparent in traditionally challenging cases-for example, in obese patients, those with significant artery calcification, or those with coronary artery stents. In addition, as clinical use of CT has grown, so have concerns over ionizing radiation associated with CT examinations. Through noise reduction, iterative reconstruction has been shown to permit radiation dose reduction while preserving diagnostic image quality. This approach is becoming increasingly attractive as the routine use of CT for pediatric and repeated follow-up evaluation grows ever more common. Cardiovascular CT in particular, with its focus on detailed structural and functional analyses, stands to benefit greatly from the promising iterative solutions that are readily available.

Immigració i desafecció política a l'espai local: la instrumentalització política de la immigració a Catalunya i Gran Bretanya

El projecte ha tingut com a objectiu principal abordar la instrumentalització política de la immigració per part de partits polítics de nova extrema dreta. Aquest fenomen, que ha adquirit una gran rellevància a gran part dels països europeus, està adquirint una creixent rellevància en els casos britànic i català a partir de, entre altres coses, l'emergència electoral dels partits Plataforma per Catalunya i British National Party. En aquest sentit, el projecte ha tractat de desenvolupar una recerca que produís un conjunt de dades i coneixements que permetessin abordar de forma fonamentada un fenomen “nou” en el context català i que, fins al moment, ha rebut escassa atenció per part del món acadèmic. Dins d’aquest objectiu cal destacar el fet que la àmplia experiència de l’equip investigador britànic en l’anàlisi de la nova extrema dreta ha permès que els investigadors catalans poguessin desenvolupar la seva recerca recolzant-se i dialogant en la seva contrapart britànica. Els resultats de la recerca són certament novedosos i representaran una important contribució al coneixement d’aquest fenomen. Així, en el marc de la recerca s’han desenvolupat una sèrie d’entrevistes a membres i a votants de PxC, així com una enquesta a votants i una anàlisi agregada sobre el vot al partit. En aquest sentit, cal destacar que és la primera vegada que s’aconsegueixen aquest tipus de dades. Un fet que està fent, i farà, que la seva explotació i divulgació adquireixi una gran rellevància tant en el món acadèmic com en el de les administracions públiques. Finalment, convé ressaltar que el projecte també ha servit per consolidar la relació entre els equips d’investigació britànic i català i per impulsar la inserció de l’equip català en les xarxes europees d’investigació sobre aquesta matèria.