Ambulances et SMUR en cas d'urgences vitales au cabinet médical: implications pour la formation et l'équipement du médecin de premier recours

Introduction: Tout praticien est confronté quotidiennement à des urgences. Parmi celles-ci, les urgences vitales peuvent avoir des conséquences majeures pour le patient et pour le praticien. Le but de cette analyse est de déterminer la fréquence de survenue des urgences vitales au cabinet médical qui motivent l'intervention d'une ambulance, avec ou sans médicalisation par un SMUR (Service Mobile d'Urgence et de Réanimation) et d'en évaluer des conséquences en terme de mise en place de procédures, d'équipements ainsi que de formations post-graduée ou continue spécifiques. Matériel et méthode: Etude rétrospective des fiches d'intervention pré-hospitalière des services d'ambulances et des missions des SMUR du canton de Vaud (650'000 habitants) entre 2003 et 2006 pour les missions dont la prise en charge d'un patient a eu lieu dans le cadre d'un cabinet médical. Résultats: Entre 2003 et 2006, 2'224 interventions avec ambulances ont eu lieu dans un des 1'655 cabinet médical vaudois (= 2,3% de l'ensemble des missions) et, dans >90% des cas, dans un délai de 20 minutes. Parmi les interventions, on relève les urgences suivantes (n =, % des interventions): cardio-vasculaires: 755 (= 33,9%), dont 17 arrêts cardio-respiratoires (ACR); respiratoires: 165 (= 7,4%); neurologiques: 138 (= 6,2%); psychiatriques: 129 (= 5,8%); traumatologiques: 475 (= 21,4%), dont 261 (= 54,9%) concernent les extrémités; diverses: 205 (= 9,5%); autres: 359 (= 16,1%). Sur ces interventions, 634 (= 28,5%) ont bénéficié d'une médicalisation par un SMUR, dont 440 (= 70% des missions SMUR au cabinet) pour des urgences cardio-vasculaires. Il y a eu 6 cas de décès au cabinet. Discussion: Les urgences cardio-vasculaires au cabinet représentent un tiers des interventions faisant appel à une ambulance, mais plus des deux tiers des interventions nécessitant une médicalisation, soit plus que pour les autres sites d'interventions médicalisées dans la communauté (46%). Conclusions: Les urgences vitales au cabinet médical ne sont pas négligeable, peuvent avoir des conséquences lourdes (ACR, décès) et perturber significativement son fonctionnement. Dès lors, une formation appropriée tant pour le médecin que pour son personnel, ainsi qu'un équipement adéquat (par ex. salle équipée avec défibrillateur, appareil d'aérosol, attelles pour les extrémités) devraient être encouragés et généralisés auprès du corps médical.

Contexts and typologies in the analysis of welfare state legitimacy : a social psychological approach to political opinion formation

This dissertation analyses public opinion towards the welfare state across 29 European countries. Based on an interdisciplinary approach combining social psychological, sociological, and public opinion approaches to political opinion formation, it investigates how social position and shared beliefs shape perceived legitimacy of welfare institutions, and how social contexts impact on the processes of opinion formation. Drawing on social representations theory, as well as socialization and self-interest approaches, the dissertation analyses the role of social position in lay support for institutional solidarity. Normative beliefs-defined as preferred views regarding the organisation of social relations-mediate the effect of social position on welfare support. In addition, drawing on public opinion literature, the dissertation analyses opinion formation as a function of country-level structural (e.g., level of social spending, unemployment) and ideological factors (e.g., level of meritocracy). The dissertation comprises two theoretical and four empirical chapters. Three of the empirical chapters use data from the European Social Survey 2008. Using multilevel and typological approaches, the dissertation contributes to welfare attitude literature by showing that normative beliefs, such as distrust or egalitarianism, function as underlying mechanisms that link social position to policy attitudes (Chapter 3), and that characteristics of the national contexts influence the processes of political opinion formation (Chapters 3 and 4). Chapter 5 proposes and predicts a typology of the relationship between attitudes towards solidarity and attitudes towards control, reflecting the two central domains of government intervention. Finally, Chapter 6 examines welfare support in the realm of action and social protest, using data from a survey on Spanish Indigados activists. The findings of this dissertation inform contemporary debates about welfare state legitimacy and retrenchment. - Cette thèse avait pour but d'analyser l'opinion publique envers l'Etat social dans 29 pays européens. Basée sur une approche interdisciplinaire qui combine des perspectives psycho-sociales, sociologiques et d'opinion publique sur la formation d'opinion politique, la thèse étudie comment la position sociale et les croyances partagées façonnent la légitimité perçue des institutions de l'Etat social, et comment les contextes sociaux influencent les processus de formation d'opinion. Basée sur la théorie des représentations sociales, ainsi qu'une approche de socialisation et d'intérêt propre, cette thèse analyse le rôle des positions sociales dans le soutien envers la solidarité institutionnelle. Les croyances normatives-définies comme les visions préférées de l'organisation des rapports sociaux-médiatisent l'effet de la position sociale sur le soutien pour l'Etat social. De plus, s'inspirant de la littérature sur l'opinion publique, la thèse analyse la formation d'opinion en fonction des facteurs structurels (ex. le taux de dépenses sociales, le chômage) et idéologiques (ex. le degré de méritocratie). Cette thèse est composée de deux chapitres théoriques et quatre chapitres empiriques. Trois chapitres empiriques utilisent des données provenant de l'enquête European Social Survey 2008. Appliquant des approches multi-niveux et typoloqiques, la thèse contribue à la littérature sur les attitudes envers l'Etat social en montrant que les croyances normatives, telles que la méfiance ou l'égalitarisme, fonctionnent comme des mécanismes sous-jacents qui relient la position sociale aux attitudes politiques (Chapitre 3), et que les caractéristiques des contextes nationaux influencent les processus de formation d'opinion politique (Chapitres 3 et 4). Le chapitre 5 propose et prédit une typologie sur le rapport entre les attitudes envers la solidarité et celles envers le contrôle, renvoyant à deux domaines centraux de régulation étatique. Enfin, le chapitre 6 examine le soutien à l'Etat social dans le domaine de l'action protestataire, utilisant des données d'une enquête menée auprès des militants espagnols du mouvement des Indignés. Les résultats de cette thèse apportent des éléments qui éclairent les débats contemporains sur la légitimité de l'Etat social et son démantèlement.

Semiclassical back reaction in the formation of a straight cosmic string

We derive the back reaction on the gravitational field of a straight cosmic string during its formation due to the gravitational coupling of the string to quantum matter fields. A very simple model of string formation is considered. The gravitational field of the string is computed in the linear approximation. The vacuum expectation value of the stress tensor of a massless scalar quantum field coupled to the string gravitational field is computed to one loop order. Finally, the back-reaction effect is obtained by solving perturbatively the semiclassical Einsteins equations.

New constraints on a light spinless particle coupled to photons

We obtain new stringent constraints on a light spinless particle f coupled only to photons at low energies, considering its effects on the extragalactic photon background, the black-body spectrum of the cosmic microwave background radiation and the cosmological abundance of deuterium.

Correlations between black holes formed in cosmic string breaking

An analysis of cosmic string breaking with the formation of black holes attached to the ends reveals a remarkable feature: the black holes can be correlated or uncorrelated. We find that, as a consequence, the number-of-states enhancement factor in the action governing the formation of uncorrelated black holes is twice the one for a correlated pair. We argue that when an uncorrelated pair forms at the ends of the string, the physics involved is more analogous to thermal nucleation than to particle-antiparticle creation. Also, we analyze the process of intercommuting strings induced by black hole annihilation and merging. Finally, we discuss the consequences for grand unified strings. The process whereby uncorrelated black holes are formed yields a rate which significantly improves over those previously considered, but still not enough to modify string cosmology. 1995 The American Physical Society.

Motion of a classical charged particle

The Lorentz-Dirac equation is not an unavoidable consequence of solely linear and angular momenta conservation for a point charge. It also requires an additional assumption concerning the elementary character of the charge. We here use a less restrictive elementarity assumption for a spinless charge and derive a system of conservation equations that are not properly the equation of motion because, as it contains an extra scalar variable, the future evolution of the charge is not determined. We show that a supplementary constitutive relation can be added so that the motion is determined and free from the troubles that are customary in the Lorentz-Dirac equation, i.e., preacceleration and runaways.

Particle and string fluid interpretation for the scalar sector of Kaluza-Klein theories

The scalar sector of the effective low-energy six-dimensional Kaluza-Klein theory is seen to represent an anisotropic fluid composed of two perfect fluids if the extra space metric has a Euclidean signature, or a perfect fluid of geometric strings if it has an indefinite signature. The Einstein field equations with such fluids can be explicitly integrated when the four-dimensional space-time has two commuting Killing vectors.

Particle creation due to cosmological contraction of extra dimensions

Particle production in a cosmological spacetime with extra dimensions is discussed. A five-dimensional cosmological model with a three-dimensional space expanding isotropically like in a radiative Friedmann-Robertson-Walker model and an internal space contracting to a constant small size is considered. The parameters of the model are adjusted so that time variations in internal space are compatible with present limits on time variations of the fundamental constants. By requiring that the energy density of the particles produced be less than the critical density at the radiation era we set restrictions on two more parameters: namely, the initial time of application of the semiclassical approach and the relative sizes between the internal space and the horizon of the ordinary Universe at this time. Whereas the production of massless particles allows a large range of variation to these parameters, the production of massive particles sets severe constraints on them, since, if they are overproduced, their energy density might very soon dominate the Universe and make cosmological dimensional reduction by extradimensional contraction unlikely.

Particle creation in a colliding plane wave spacetime: Wave packet quantization

We use wave packet mode quantization to compute the creation of massless scalar quantum particles in a colliding plane wave spacetime. The background spacetime represents the collision of two gravitational shock waves followed by trailing gravitational radiation which focus into a Killing-Cauchy horizon. The use of wave packet modes simplifies the problem of mode propagation through the different spacetime regions which was previously studied with the use of monochromatic modes. It is found that the number of particles created in a given wave packet mode has a thermal spectrum with a temperature which is inversely proportional to the focusing time of the plane waves and which depends on the mode trajectory.

Mechanisms of synchronization and pattern formation in a lattice of pulse-coupled oscillators

We analyze the physical mechanisms leading either to synchronization or to the formation of spatiotemporal patterns in a lattice model of pulse-coupled oscillators. In order to make the system tractable from a mathematical point of view we study a one-dimensional ring with unidirectional coupling. In such a situation, exact results concerning the stability of the fixed of the dynamic evolution of the lattice can be obtained. Furthermore, we show that this stability is the responsible for the different behaviors.

Onsager symmetry principle for a particle moving through a fluid not in equilibrium

We have shown that the mobility tensor for a particle moving through an arbitrary homogeneous stationary flow satisfies generalized Onsager symmetry relations in which the time-reversal transformation should also be applied to the external forces that keep the system in the stationary state. It is then found that the lift forces, responsible for the motion of the particle in a direction perpendicular to its velocity, have different parity than the drag forces.