Trauma in critically ill children : transfusion and osmotherapy practices

Les accidents sont la cause la plus fréquente de décès chez l’enfant, la plupart du temps à cause d’un traumatisme cranio-cérébrale (TCC) sévère ou d’un choc hémorragique. Malgré cela, la prise en charge de ces patients est souvent basée sur la littérature adulte. Le mannitol et le salin hypertonique (3%) sont des traitements standards dans la gestion de l’hypertension intracrânienne, mais il existe très peu d’évidence sur leur utilité en pédiatrie. Nous avons entrepris une revue rétrospective des traumatismes crâniens sévères admis dans les sept dernières années, pour décrire l’utilisation de ces agents hyperosmolaires et leurs effets sur la pression intracrânienne. Nous avons établi que le salin hypertonique est plus fréquemment utilisé que le mannitol, qu’il ne semble pas y avoir de facteurs associés à l’utilisation de l’un ou l’autre, et que l’effet sur la pression intracrânienne est difficile à évaluer en raison de multiples co-interventions. Il faudra mettre en place un protocole de gestion du patient avec TCC sévère avant d’entreprendre des études prospectives. La transfusion sanguine est employée de façon courante dans la prise en charge du patient traumatisé. De nombreuses études soulignent les effets néfastes des transfusions sanguines suggérant des seuils transfusionnels plus restrictifs. Malgré cela, il n’y a pas de données sur les transfusions chez l’enfant atteint de traumatismes graves. Nous avons donc entrepris une analyse post-hoc d’une grosse étude prospective multicentrique sur les pratiques transfusionnelles des enfants traumatisés. Nous avons conclu que les enfants traumatisés sont transfusés de manière importante avant et après l’admission aux soins intensifs. Un jeune âge, un PELOD élevé et le recours à la ventilation mécanique sont des facteurs associés à recevoir une transfusion sanguine aux soins intensifs. Le facteur le plus prédicteur, demeure le fait de recevoir une transfusion avant l’admission aux soins, élément qui suggère probablement un saignement continu. Il demeure qu’une étude prospective spécifique des patients traumatisés doit être effectuée pour évaluer si une prise en charge basée sur un seuil transfusionnel restrictif serait sécuritaire dans cette population.

Double blind test series

Braille is a communication tool in decline, in America by 80% since 1950, and in the UK to the extent that only 1% of blind people are now thought to read Braille.1, 2 There are a variety of causal factors, including the phasing out of Braille instruction due to the educational mainstreaming of blind children and the resistance to learning Braille by those who lose sight later in life.3Braille is a writing system of raised dots that allows blind people to read and write tactilely. Each Braille character comprises a cell of six potentially raised dots, two dots across and three dots down. It is designed only to communicate the message and does not convey the tonality provided by visual fonts.However, in his book Design Meets Disability, Graham Pullin, observes that: “Braille is interesting and beautiful, as abstract visual and tactile decoration, intriguing and indecipherable to the nonreader ” and continues; “…braille could be decorative for sighted people.”4I assert that the increasing abandonment of Braille frees it from its restrictive constraints, opening it to exploration and experimentation, and that this may result in Braille becoming dynamic expression for the sighted, as well as the partially sighted and blind.Printmaking is well suited for this exploration. Printmaking processes and techniques can result in prints aesthetically compelling to both senses of sight and touch. Established approaches, such as flocking, varnishes, puff-ink, embossing and die cut, combined with experiments in new techniques in laser cutting and 3D printing, create visually and texturally vibrant prints.In this paper I will detail my systematic investigation of sensually expressive printmaking concentrating on the issues surrounding Braille as a printmaking design element paying particular attention to the approaches and techniques used not only in producing its visual style but to those techniques used to keep it integrally tactile.

Vadr går gränsen?

This article introduces a study concerning parents regulations regarding their child’s participation in social activities. The aim of the study is to examine how many pupils who are not allowed to participate in social activities and some educational elements at school, as for example sports and study tours. The ethnicity and gender perspectives are central for the questions. The implicit aim is to compare the situation among boys and girls with immigrant background in relation to boys and girls with Swedish background. The study contains a quantitative survey among 1193 children, 13 to 15 years old, living in a Swedish middle-sized city. The result from the analysis shows that most of the children are allowed to participate in the activities. However, regarding parental consent to participating in activities the results show that children with immigrant background experience restrictions to a larger extent than others. This result concerns in particular girls with immigrant background. Other significant findings in this study indicate that low-educated parents or/and religious parents have more restrictive norms considering pupils participating in social activities, especially for immigrant girls.

Les méthodes d’adaptation du Centre des droits de l’homme "Memorial" aux mesures étatiques russes- Les principes d’action d’une ONG de défense des droits de l’homme russe

En raison du virage semi-autoritaire de l’État russe au début des années 2000, l’adaptation aux mesures contraignantes de l’État, qu’elle soit consciente ou inconsciente, constitue un aspect fondamental du quotidien des ONG de défense des droits de l’homme russes. Cependant, il s’agit d’une question jusqu’ici négligée dans la littérature scientifique. Ainsi, ce mémoire a pour objet d’examiner la démarche d’adaptation d’une ONG particulièrement active sur la scène russe, le Centre des droits de l’homme Memorial, entre 1999 et 2014. La recherche révèle que cette ONG emploie deux méthodes afin de s’adapter aux mesures étatiques et que celles-ci sont, en fait, des principes d’action adoptés par l’organisation au moment de sa création. Le premier principe d’action s’appuie sur la coopération et la solidarité développées par le Centre des droits de l’homme Memorial avec d’autres ONG russes, des ONG internationales et des organisations internationales. En partenariat avec ces organisations, le Centre des droits de l’homme Memorial élabore des activités de recherche et de plaidoyer et mène des missions de surveillance des droits de l’homme. Ce principe d’action renforce considérablement la capacité d’adaptation de l’ONG et favorise l’exercice de son rôle de contrepouvoir. Le second principe d’action se fonde sur la recherche de collaboration constructive avec l’État. Lors d’interactions ponctuelles avec les autorités, l’organisation exerce un rôle d’expert en matière de droits de l’homme et tente de réduire les entraves posées à la société civile. Outre sa propriété adaptative, cette méthode d’adaptation combine deux fonctions inhérentes à la société civile, soit la représentation des intérêts des citoyens auprès des instances étatiques et l’établissement d’un partenariat avec l’État dans le but d’amener ce dernier à adopter des pratiques démocratiques. Ce mémoire montre la capacité du Centre des droits de l’homme Memorial à se mouvoir d’une méthode d’adaptation à l’autre afin de maximiser son action.

Identification et description de différents profils familiaux chez les familles d’adolescentes présentant une anorexie mentale

Méthodologie: Modèle « circomplexe » d’Olson ; Modèle du fonctionnement familial de McMaster

Forma ecclesiae : Per un cattolicesimo di popolo oggi: “per tutti” anche se non “di tutti”

La radicalité du changement culturel provoque une crise de la forma ecclesiae et introduit la question relative à quelle est la forme de l’Église la plus appropriée à l’annonce de l’évangile. L’Église italienne, que le présent travail a l’intention d’assumer en qualité de point de référence particulier, en est également intéressée: contrairement au passé, même le plus récent, la foi chrétienne n’est plus un patrimoine «de tous». La question se pose puisque, au nom de l’évangile, l’action de l’Église ne peut pas disperser, pourtant, le caractère universel de la foi en soi même (son être «pour tous»). Dans un tel scénario, s’enclenche le but que cette thèse se pose de poursuivre sur le plan de la pensée théologique-pastorale: elle veut accompagner l’Église en son être à l’intérieur de cette tension entre l’instance théologique d’une foi qui est «pour tous» et le donné sociologique dont il émerge qu’elle n’est plus «de tous». Beaucoup de projets contemporaines de réforme pastorale ont l’intention de faire face aux transformations de la culture afin d’empêcher tout injustifiée domestication. Cependant, comme cette thèse essaie à le prouver, ils risquent souvent de suggérer une rupture avec le passé récent du corps ecclésial. Pour eux la référence polémique est représentée par cette figure de «catholicisme populaire» avec qui, dans le contexte de la «civilisation paroissiale», l’expérience chrétienne est réussie à s’enraciner dans le tissu social. Dans ces projets, il est – en effet – assimilé d’une manière restrictive à une sorte de «catholicisme de masse», basé seulement sur des processus religieux de socialisation et d’uniformisation de l’expérience. Au contraire, le but de ce travail consiste en un essai de compréhension renouvelée de cette figure de vie chrétienne. Elle n’est retenue seulement selon la particulière forme historique qu’elle a adoptée dans le demain passé, marqué par une situation d’homogénéité culturelle, d’une Église de peuple, mais aussi comme principe opératoire qui désigne la capacité du christianisme de se réaliser en tant qu’élévation et transfiguration des formes anthropologiques de base. Cette perspective dynamique permet de trouver dans le «catholicisme populaire» un principe écclesio-génétique qui exalte l’interaction entre l’initiative ecclésiale et la sensibilité des croyants, et qui, tout en défendant la qualité théologale de l’expérience chrétienne, ne méprise pas la valeur pédagogique de son enracinement religieux. La dynamique qui préside au «catholicisme populaire», grâce à la confrontation avec une étude sur le terrain, conduit à l’individuation de certaines provocations à propos de la structure du corps ecclésial, en ce qui concerne les représentations, les actions, les sujets et les limites qui le caractérisent. Elles sont transposées de manière à envisager une réforme de l’Église qui s’avère applicable pour le présent et qui cherche à garder le caractère universel-non formel de la foi, c’est à dire son «pour tous».

From a traditionally open access fishery to modern restrictions: Portuguese anglers' perceptions about newly implemented recreational fishing regulations

Saltwater recreational fishing (SRF) in Portugal was for a long time an open-access activity, without restrictions of any kind. Restrictions to control the recreational harvest were first implemented in 2006 and were highly criticized by the angler community, for being highly restrictive and lacking scientific support. The present study aimed to obtain socio-economic data on the recreational shore anglers and gauge their perceptions about recreational fishing regulations and the newly implemented restrictions in Portugal. Roving creel surveys were conducted along the south and south-west coasts of Portugal, during pre and post regulation periods (2006-2007). A total of 1298 valid face-to-face interviews were conducted. Logit models were fitted to identify which characteristics influence anglers' perceptions about recreational fishing regulations. The majority of the interviewed anglers was aware and agreed with the existence of recreational fishing regulations. However, most were against the recreational fishing regulations currently in place. The logit models estimates revealed that Portuguese anglers with a higher level of formal education and income are more likely to agree with the existence of recreational fishing regulations. In contrast, anglers who perceive that more limitations and a better enforcement of commercial fishing would improve fishing in the area are less likely to agree with the existence of SRF regulations. The findings from this study will contribute to inform decision-makers about anglers' potential behaviour towards the new and future regulations. Although the existence of fishing regulations is a good starting point for effective management, the lack of acceptance and detailed knowledge of the regulations in place by fishers may result in lack of compliance, and ultimately hinder the success of recreational fishing regulations in Portugal. (C) 2013 Elsevier Ltd. All rights reserved.

Avaliação e controlo da qualidade da água de albufeiras com base em modelos dinâmicos

A problemática relacionada com a modelação da qualidade da água de albufeiras pode ser abordada de diversos pontos de vista. Neste trabalho recorre-se a metodologias de resolução de problemas que emanam da Área Cientifica da Inteligência Artificial, assim como a ferramentas utilizadas na procura de soluções como as Árvores de Decisão, as Redes Neuronais Artificiais e a Aproximação de Vizinhanças. Actualmente os métodos de avaliação da qualidade da água são muito restritivos já que não permitem aferir a qualidade da água em tempo real. O desenvolvimento de modelos de previsão baseados em técnicas de Descoberta de Conhecimento em Bases de Dados, mostrou ser uma alternativa tendo em vista um comportamento pró-activo que pode contribuir decisivamente para diagnosticar, preservar e requalificar as albufeiras. No decurso do trabalho, foi utilizada a aprendizagem não-supervisionada tendo em vista estudar a dinâmica das albufeiras sendo descritos dois comportamentos distintos, relacionados com a época do ano. ABSTRACT: The problems related to the modelling of water quality in reservoirs can be approached from different viewpoints. This work resorts to methods of resolving problems emanating from the Scientific Area of Artificial lntelligence as well as to tools used in the search for solutions such as Decision Trees, Artificial Neural Networks and Nearest-Neighbour Method. Currently, the methods for assessing water quality are very restrictive because they do not indicate the water quality in real time. The development of forecasting models, based on techniques of Knowledge Discovery in Databases, shows to be an alternative in view of a pro-active behavior that may contribute to diagnose, maintain and requalify the water bodies. ln this work. unsupervised learning was used to study the dynamics of reservoirs, being described two distinct behaviors, related to the time of year.

Barn owl feathers as biomonitors of mercury: sources of variation

Given their central role in mercury (Hg) excretion and suitability as reservoirs, bird feathers are useful Hg biomonitors. Nevertheless, the interpretation of Hg concentrations is still questioned as a result of a poor knowledge of feather physiology and mechanisms affecting Hg deposition. Given the constraints of feather availability to ecotoxicological studies, we tested the effect of intraindividual differences in Hg concentrations according to feather type (body vs. flight feathers), position in the wing and size (mass and length) in order to understand how these factors could affect Hg estimates. We measured Hg concentration of 154 feathers from 28 un-moulted barn owls (Tyto alba), collected dead on roadsides. Median Hg concentration was 0.45 (0.076–4.5) mg kg-1 in body feathers, 0.44 (0.040–4.9) mg kg-1 in primary and 0.60 (0.042–4.7) mg kg-1 in secondary feathers, and we found a poor effect of feather type on intra-individual Hg levels. We also found a negative effect of wing feather mass on Hg concentration but not of feather length and of its position in the wing. We hypothesize that differences in feather growth rate may be the main driver of between-feather differences in Hg concentrations, which can have implications in the interpretation of Hg concentrations in feathers. Finally, we recommend that, whenever possible, several feathers from the same individual should be analysed. The five innermost primaries have lowest mean deviations to both betweenfeather and intra-individual mean Hg concentration and thus should be selected under restrictive sampling scenarios.

ANALYSE THE VULNERABILITY IN THE MARANHÃO ILHA, BRAZIL, USING GIS TECHNIQUES AND GEOSPATIAL INFERENCE

Vulnerability and sustainability studies of an area help to assess both its level of exposure and capacity to support possible environmental impacts, and it is of primordial importance for proposals of the Legislation on Zoning, Allotment, Land Use/land cover, aiming to stimulate those areas indicated for urban growth, to discourage growth of overcrowded areas, to detect sections with restrictive use, as well as districts for permanent protection. This paper aims to analyze the vulnerability in the Maranhão Ilha, using GIS techniques, geospatial inference intersected with relevant social-environmental indicators.Estudos de vulnerabilidade e de sustentabilidade de uma área ajudam a avaliar o seu grau de exposição e sua capacidade de suporte a possíveis impactos ambientais, sendo fundamental para propostas de Lei de Zoneamento, Parcelamento, Uso e Ocupação do Solo, tendo por finalidade orientar as áreas onde deverá haver estímulo para o crescimento urbano; contenção da malha urbana; detecção de locais com possibilidade de uso restritivo, bem como locais de proteção permanente. Este trabalho propõe analisar o índice de vulnerabilidade a perda de solo da Ilha do Maranhão com base na metodologia proposta por (CREPANI, et al. 2001) e em técnicas de inferência espacial com apoio na AHP (Análise Hierárquica de Processo).

Modelling and Optimization of Energy Management Strategies for Hybrid Vehicles

In the last decades the automotive sector has seen a technological revolution, due mainly to the more restrictive regulation, the newly introduced technologies and, as last, to the poor resources of fossil fuels remaining on Earth. Promising solution in vehicles’ propulsion are represented by alternative architectures and energy sources, for example fuel-cells and pure electric vehicles. The automotive transition to new and green vehicles is passing through the development of hybrid vehicles, that usually combine positive aspects of each technology. To fully exploit the powerful of hybrid vehicles, however, it is important to manage the powertrain’s degrees of freedom in the smartest way possible, otherwise hybridization would be worthless. To this aim, this dissertation is focused on the development of energy management strategies and predictive control functions. Such algorithms have the goal of increasing the powertrain overall efficiency and contextually increasing the driver safety. Such control algorithms have been applied to an axle-split Plug-in Hybrid Electric Vehicle with a complex architecture that allows more than one driving modes, including the pure electric one. The different energy management strategies investigated are mainly three: the vehicle baseline heuristic controller, in the following mentioned as rule-based controller, a sub-optimal controller that can include also predictive functionalities, referred to as Equivalent Consumption Minimization Strategy, and a vehicle global optimum control technique, called Dynamic Programming, also including the high-voltage battery thermal management. During this project, different modelling approaches have been applied to the powertrain, including Hardware-in-the-loop, and diverse powertrain high-level controllers have been developed and implemented, increasing at each step their complexity. It has been proven the potential of using sophisticated powertrain control techniques, and that the gainable benefits in terms of fuel economy are largely influenced by the chose energy management strategy, even considering the powerful vehicle investigated.

Alterazioni strutturali e funzionali nelle diverse eziologie di amiloidosi cardiaca: analisi dei parametri ecocardiografici ed emodinamici invasivi e loro ruolo prognostico

Background e scopo: Tradizionalmente la cardiomiopatia amiloidotica (CA) è stata considerata una cardiomiopatia restrittiva, ma studi recenti hanno evidenziato il ruolo anche della disfuzione sistolica nella sua fisiopatologia. In questo contesto recente, raramente è stato indagato il profilo emodinamico invasivo. Lo scopo dello studio è stato quello di caratterizzare il profilo emodinamico, strutturale e funzionale della CA nelle tre principali eziologie (amiloidosi da catene leggere (AL), amiloidosi transtiretino-relata (ATTR) mutata (ATTRm) e ‘wild-type’ (ATTRwt)), valutare le differenze del profilo ecocardiografico ed emodinamico nelle fasi diverse di malattia ed esplorare il ruolo prognostico delle principali variabili cliniche e strumentali nella CA. Metodi e risultati: Abbiamo analizzato retrospettivamente i dati di 224 pazienti con CA (AL, n=93; ATTRm, n=66; ATTRwt, n=65). Rispetto all'ATTRwt, i pazienti con AL presentano un minor interessamento morfologico cardiaco, ma dati emodinamici paragonabili, caratterizzati da elevate pressioni di riempimento biventricolari e riduzione della gittata sistolica. L’ATTRm, nonostante il profilo ecocardiografico analogo all’ATTRwt, mostra un quadro emodinamico migliore. Gli indici di funzione diastolica e sistolica longitudinale del ventricolo sinistro (Vsn) sono alterati fin dagli stadi iniziali della malattia, mentre la frazione di eiezione (FEVsn) rimane preservata nella maggior parte dei pazienti, anche nelle fasi avanzate (FEVsn 50 [37-60]%; FEVsn <40% nel 28% dei pazienti NYHA III / IV). All'analisi multivariata, età, NYHA III/I, eziologia AL, frazione di contrazione miocardica (MCF), indice cardiaco (CI) e pressione atriale destra (RAP) sono indipendentemente associati a eventi clinici avversi. Conclusioni Questo studio conferma la complessa fisiopatologia della CA, in cui la disfunzione diastolica è accompagnata da una funzione sistolica longitudinale anormale sin dalle fasi iniziali della malattia. L'AL e l'ATTRwt, nonostante diversi gradi di alterazioni morfologiche, hanno un profilo emodinamico simile; l'ATTRm, invece, presenta un quadro emodinamico migliore. Tra i parametri strumentali, MCF, CI e RAP emergono come predittori significativi di eventi avversi.

Virtual Calibration of CO2 and Pollutant Emissions of a High-Performance PHEV using Model-in-the-Loop Methodology

The study analyses the calibration process of a newly developed high-performance plug-in hybrid electric passenger car powertrain. The complexity of modern powertrains and the more and more restrictive regulations regarding pollutant emissions are the primary challenges for the calibration of a vehicle’s powertrain. In addition, the managers of OEM need to know as earlier as possible if the vehicle under development will meet the target technical features (emission included). This leads to the necessity for advanced calibration methodologies, in order to keep the development of the powertrain robust, time and cost effective. The suggested solution is the virtual calibration, that allows the tuning of control functions of a powertrain before having it built. The aim of this study is to calibrate virtually the hybrid control unit functions in order to optimize the pollutant emissions and the fuel consumption. Starting from the model of the conventional vehicle, the powertrain is then hybridized and integrated with emissions and aftertreatments models. After its validation, the hybrid control unit strategies are optimized using the Model-in-the-Loop testing methodology. The calibration activities will proceed thanks to the implementation of a Hardware-in-the-Loop environment, that will allow to test and calibrate the Engine and Transmission control units effectively, besides in a time and cost saving manner.

Innovative strategies for the mitigation of acrylamide content in different food products

Acrylamide (AA) is an undesirable food toxic compound, classified as 'probably carcinogenic to humans' by the International Agency for Research on Cancer due to its toxic effects, including neurotoxicity, genotoxicity, carcinogenicity and reproductive toxicity. AA is mainly formed during the heat treatment of foods (> 120 °C) by the Maillard reaction, an essential reaction that also allows the desired levels of shelf-life and sensory properties of various food products to be achieved. Over the years, authorities and regulations have become more restrictive regarding the maximum levels of AA permitted in foods and beverages. The latest Commission Regulation (EU) 2017/2158 contains reference levels and measures to reduce AA in several food groups that contribute to the highest dietary intake, making necessary the study of promising AA mitigation strategies. The aim of this PhD research project was to identify, characterise and optimise some AA mitigation strategies in the most at-risk widely consumed foods such as potato, coffee and bakery products. Some AA control strategies were selected and investigated for each food category, also considering the main quality characteristics of the final products. The comprehensive results obtained during the three years of research activity have allowed a deeper knowledge of the traditional and innovative AA mitigation strategies, which can be extremely useful for both the food industry and international authorities. The most promising strategies studied in terms of reduction of AA while maintaining the main quality characteristics of the examined foods were: the application of pulsed electric fields and yeast immersion as pre-treatments of chips for frying; the selection of high roasting degrees for coffee products; the selection of static baking conditions for biscuits; the optimisation of alternative biscuit’ formulations by both the use of chickpea legume flour and of flour from bean with intact cotyledon cell walls.

Transitional Justice as a Post-Revolution Constitutional Arrangement: A Law and Economics Approach

This dissertation addresses the timely questions of transitional justice (TJ) in the aftermath of revolutions against autocratic regimes, dealing with TJ as a constitutional arrangement through the lenses of constitutional economics. After an introductory chapter, chapter 2 deals with why nations rarely adopt meaningful TJ processes in the first place, it then explains the limitations of civil society as the arbiter, facilitator, and enforcer of TJ policies. Chapter 3 tackles the question of which mechanisms to choose? It uses the UN Guidelines on TJ that sets five principal TJ mechanisms. It provides a cost-benefit analysis (CBA) of each mechanism and suggests policy implications accordingly. The CBA inspires chapter 4 analysis, suggesting a tradeoff between restrictive fair trial standards under constitutional laws and justice considerations. The tradeoff explains the suggested efficiency of the balanced TJ approaches that combine trials and amnesties. This approach is used for the case study analysis of TJ in Tunisia after the 2011 revolution in chapter 5. The chapter presents the first index of TJ mechanisms in Tunisia through novel data collected by the author. It shows an ultimate TJ design that ended with a modest harvest in the application. The lack of cooperation between the Tunisian parties, added to the absence of transparency in many TJ measures, threatens any possible positive outcomes of the partial TJ process. It is also alarming regarding constitutional compliance in a system that – until recently - was considered the only democracy in the Arab region. Chapter 6 is a summary