Prise en charge des facteurs de risque des maladies cardiovasculaires: qu'est-ce qui a vraiment changé en 15 ans [Management of cardiovascular diseases in adults from 1999 to 2014: what has really changed?].

Every year, a considerable number of clinical guidelines for the management of cardiovascular risk factors are issued. It may give the idea that this area is constantly evolving with regular changes for ambulatory clinical practice, including family medicine. Sometimes important differences between the various recommendations are observed. This led us to wonder about the evolution of recommendations for the management of diabetes, dyslipidemia and high blood pressure over time. This article presents a historical review of US and European recommendations between 1999 and 2014 to highlight what has actually changed.

The economic cost of hospital malnutrition in Europe; a narrative review

Background: Malnutrition among hospitalized patients increases length of stay (LOS) and carries extra hospitalization costs. Objective: To review the impact of malnutrition on hospital LOS and costs in Europe. Methods: PubMed and Google Scholar search. All articles from January 2004 until November 2014 were identified. Reference lists of relevant articles were also manually searched. Results: Ten studies on LOS and nine studies on costs were reviewed. The methods used to assess malnutrition and to calculate costs differed considerably between studies. Malnutrition led to an increased LOS ranging from 2.4 to 7.2 days. Among hospitalized patients, malnutrition led to an additional individual cost ranging between 1640 V and 5829 V. At the national level, the costs of malnutrition ranged between 32.8 million V and 1.2 billion V. Expressed as percentage of national health expenditures, the values ranged between 2.1% and 10%. Conclusions: In Europe, malnutrition leads to an increase in LOS and in hospital costs, both at the individual and the national level. Standardization of methods and results reported is needed to adequately compare results between countries. © 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Privatization and Regulation of Toll Motorways in Europe

The private sector plays an increasing and relevant role in highway funding and management. For that reason, the regulation designed and enforced by public authorities becomes even more important for the social welfare results generated by this process. In this study, we analyze the current trends in highway funding and management paying special attention on the recent process of privatization and its motivations. Since public ownership and regulation are substitutes for government intervention, we check the hypothesis that highways privatization induces more strict regulation. Indeed, we observe that as the private sector increases its size, toll regulation becomes more detailed.

Los efectos de la sociedad en los museos: del boom a la crisis de ideas = The effects of the society in museums: from boom to the ideas crisis

This paper compares different times of museums considering the situation of the past two decades. It reflects on the upswing and down, knowing that partake of the latter and we are in a deep crisis and unsustainable policies dictating contradictory. This situation raises the museums with their own project and creative professionals can better overcome difficulties because they do not suffer crisis of ideas. Some paradoxes are evident as the case of Greece, the place where the museums are repositories of highly relevant cultural values and the same institutions that have enhanced their improvement in the years of the upswing, they currently require, cuts that put them in a position risk. Similarly we can see that policies are applied to thin the identity of museums since they rely on adjustments that do not study each particular case. Alternatively there is the creativity and efforts of managers and professionals in general and cooperative work. It gives details of some of our participatory projects that go in this direction and to be successfully applied

Methods for construction and analysis of computational models in systems biology : applications to the modelling of the heat shock response and the self-assembly of intermediate filaments

Systems biology is a new, emerging and rapidly developing, multidisciplinary research field that aims to study biochemical and biological systems from a holistic perspective, with the goal of providing a comprehensive, system- level understanding of cellular behaviour. In this way, it addresses one of the greatest challenges faced by contemporary biology, which is to compre- hend the function of complex biological systems. Systems biology combines various methods that originate from scientific disciplines such as molecu- lar biology, chemistry, engineering sciences, mathematics, computer science and systems theory. Systems biology, unlike “traditional” biology, focuses on high-level concepts such as: network, component, robustness, efficiency, control, regulation, hierarchical design, synchronization, concurrency, and many others. The very terminology of systems biology is “foreign” to “tra- ditional” biology, marks its drastic shift in the research paradigm and it indicates close linkage of systems biology to computer science. One of the basic tools utilized in systems biology is the mathematical modelling of life processes tightly linked to experimental practice. The stud- ies contained in this thesis revolve around a number of challenges commonly encountered in the computational modelling in systems biology. The re- search comprises of the development and application of a broad range of methods originating in the fields of computer science and mathematics for construction and analysis of computational models in systems biology. In particular, the performed research is setup in the context of two biolog- ical phenomena chosen as modelling case studies: 1) the eukaryotic heat shock response and 2) the in vitro self-assembly of intermediate filaments, one of the main constituents of the cytoskeleton. The range of presented approaches spans from heuristic, through numerical and statistical to ana- lytical methods applied in the effort to formally describe and analyse the two biological processes. We notice however, that although applied to cer- tain case studies, the presented methods are not limited to them and can be utilized in the analysis of other biological mechanisms as well as com- plex systems in general. The full range of developed and applied modelling techniques as well as model analysis methodologies constitutes a rich mod- elling framework. Moreover, the presentation of the developed methods, their application to the two case studies and the discussions concerning their potentials and limitations point to the difficulties and challenges one encounters in computational modelling of biological systems. The problems of model identifiability, model comparison, model refinement, model inte- gration and extension, choice of the proper modelling framework and level of abstraction, or the choice of the proper scope of the model run through this thesis.

Mathematical modeling of electro-rotation spectra of small particles in liquid solutions: Application to human erythrocyte aggregates

Electro-rotation can be used to determine the dielectric properties of cells, as well as to observe dynamic changes in both dielectric and morphological properties. Suspended biological cells and particles respond to alternating-field polarization by moving, deforming or rotating. While in linearly polarized alternating fields the particles are oriented along their axis of highest polarizability, in circularly polarized fields the axis of lowest polarizability aligns perpendicular to the plane of field rotation. Ellipsoidal models for cells are frequently applied, which include, beside sphere-shaped cells, also the limiting cases of rods and disks. Human erythrocyte cells, due to their particular shape, hardly resemble an ellipsoid. The additional effect of rouleaux formation with different numbers of aggregations suggests a model of circular cylinders of variable length. In the present study, the induced dipole moment of short cylinders was calculated and applied to rouleaux of human erythrocytes, which move freely in a suspending conductive medium under the effect of a rotating external field. Electro-rotation torque spectra are calculated for such aggregations of different length. Both the maximum rotation speeds and the peak frequencies of the torque are found to depend clearly on the size of the rouleaux. While the rotation speed grows with rouleaux length, the field frequency nup is lowest for the largest cell aggregations where the torque shows a maximum.

The effects of language complexity in a counterattitudinal appeal to laypeople : an application of the elaboration likelihood model of persuasion to a legal issue

The effects of a complexly worded counterattitudinal appeal on laypeople's attitudes toward a legal issue were examined, using the Elaboration Likelihood Model (ELM) of persuasion as a theoretical framework. This model states that persuasion can result from the elaboration and scrutiny of the message arguments (i.e., central route processing), or can result from less cognitively effortful strategies, such as relying on source characteristics as a cue to message validity (i.e., peripheral route processing). One hundred and sixty-seven undergraduates (85 men and 81 women) listened to eitller a low status or high status source deliver a counterattitudinal speech on a legal issue. The speech was designed to contain strong or weak arguments. These arguments were 'worded in a simple and, therefore, easy to comprehend manner, or in a complex and, therefore, difficult to comprehend manner. Thus, there were three experimental manipulations: argument comprehensibility (easy to comprehend vs. difficult to comprehend), argumel11 strength (weak vs. strong), and source status (low vs. high). After listening to tIle speec.J] participants completed a measure 'of their attitude toward the legal issue, a thought listil1g task, an argument recall task,manipulation checks, measures of motivation to process the message, and measures of mood. As a result of the failure of the argument strength manipulation, only the effects of the comprehel1sibility and source status manipulations were tested. There was, however, some evidence of more central route processing in the easy comprehension condition than in the difficult comprehension condition, as predicted. Significant correlations were found between attitude and favourable and unfavourable thoughts about the legal issue with easy to comprehend arguments; whereas, there was a correlation only between attitude and favourable thoughts 11 toward the issue with difficult to comprehend arguments, suggesting, perhaps, that central route processing, \vhich involves argument scrutiny and elaboration, occurred under conditions of easy comprehension to a greater extent than under conditions of difficult comprehension. The results also revealed, among other findings, several significant effects of gender. Men had more favourable attitudes toward the legal issue than did women, men recalled more arguments from the speech than did women, men were less frustrated while listening to the speech than were ,vomen, and men put more effort into thinking about the message arguments than did women. When the arguments were difficult to comprehend, men had more favourable thoughts and fewer unfavourable thoughts about the legal issue than did women. Men and women may have had different affective responses to the issue of plea bargaining (with women responding more negatively than men), especially in light of a local and controversial plea bargain that occurred around the time of this study. Such pre-existing gender differences may have led to tIle lower frustration, the greater effort, the greater recall, and more positive attitudes for men than for WOlnen. Results· from this study suggest that current cognitive models of persuasion may not be very applicable to controversial issues which elicit strong emotional responses. Finally, these data indicate that affective responses, the controversial and emotional nature ofthe issue, gender and other individual differences are important considerations when experts are attempting to persuade laypeople toward a counterattitudinal position.

Unintended Consequences of Strategies Implemented in Canadian Healthcare Organizations to Reduce Wait Times for Elective Hip and Knee Surgeries

Introduction: En réponse aux exigences du gouvernement fédéral en ce qui concerne les temps d'attente pour les chirurgies électives d’hanche et du genou, les Organismes Canadiens de santé ont adopté des stratégies de gestion pour les listes d'attente. Cependant, il n'existe pas actuellement aucune information disponible concernant les effets imprévus, positive ou négative, de ces stratégies. Méthodologie: Un modèle qui a été construit est tombé en panne la gestion de la chirurgie d’hanche et du genou en différentes étapes, afin d'identifier les effets imprévus possibles pour chaque étape; le modèle a été validé auprès d'un panel d'experts. Cette étude a choisi quatre études de cas en fonction de leur durabilité: un cas qui a été durable, un cas qui a été modérément durable, et deux cas peu probable d'être durable. Dans cette étude qualitative, nous avons mené 31 entretiens semi-structurés entre Novembre 2010 et Juin 2011 avec les gestionnaires, les infirmières, les thérapeutes et les chirurgiens impliqués dans la gestion des stratégies du temps d’attente pour les chirurgies électives d’hanche et du genou. Les quatre cas ont été sélectionnés à partir de trois provinces / régions. Nous avons analysé les conséquences non intentionnelles aux niveaux systémique et organisationnelle en utilisant les stratégies dans chaque contexte. Enregistrements des entrevues ont été transcrits mot à mot et soumis à l'analyse du cadre. Résultats: Les effets négatifs sont la précarité des stratégies en raison du non-récurrente financement, l'anxiété chez les patients qui ne sont pas prêts pour la chirurgie, une redistribution du temps de chirurgie vers l’orthopédie au détriment des autres interventions chirurgicales, tensions entre les chirurgiens et entre les orthopédistes et anesthésistes, et la pression sur le personnel dans le bloc opératoire et postopératoire. Conclusion: La stratégie d’implémentation aux niveaux national et local devrait prendre en compte les conséquences potentielles, positives et négatives. Il y a des conséquences inattendues à chaque niveau de l'organisation des soins de santé. Individuellement et collectivement, ces conséquences peuvent positivement et négativement affecter les résultats. Par conséquent, la planification de la santé doit analyser et prendre en compte les conséquences inattendues en termes de bonnes résultats inattendues, compromis et les conséquences négatives afin d'améliorer les résultats.

Partial nitritation of landfill leachate in a SBR prior to an anammox reactor : operation and modelling

Els lixiviats d'abocadors urbans són aigües residuals altament contaminades, que es caracteritzen per les elevades concentracions d'amoni i el baix contingut de matèria orgànica biodegradable. El tractament dels lixiviats a través dels processos de nitrificació-desnitrificació convencionals és costós a causa de la seva elevada demanda d'oxigen i la necessitat d'addició d'una font de carboni externa. En els darrers anys, la viabilitat del tractament d'aquest tipus d'afluents per un procés combinat de nitritació parcial-anammox ha estat demostrada. Aquesta tesi es centra en el tractament de lixiviats d'abocador a través d'un procés de nitritació parcial en SBR, com un pas preparatori per a un reactor anammox. Els resultats de l'estudi han demostrat la viabilitat d'aquesta tecnologia per al tractament de lixiviats d'abocador. El treball va evolucionar des d'una escala inicial de laboratori, on el procés va ser testat inicialment, a uns exitosos experiments d'operació a llarg termini a escala pilot. Finalment, la tesi també inclou el desenvolupament, calibració i validació d'un model matemàtic del procés, que té com a objectiu augmentar el coneixement del procés.

The Origins of Lactase Persistence in Europe

Lactase persistence (LP) is common among people of European ancestry, but with the exception of some African, Middle Eastern and southern Asian groups, is rare or absent elsewhere in the world. Lactase gene haplotype conservation around a polymorphism strongly associated with LP in Europeans (-13,910 C/T) indicates that the derived allele is recent in origin and has been subject to strong positive selection. Furthermore, ancient DNA work has shown that the -13,910*T (derived) allele was very rare or absent in early Neolithic central Europeans. It is unlikely that LP would provide a selective advantage without a supply of fresh milk, and this has lead to a gene-culture coevolutionary model where lactase persistence is only favoured in cultures practicing dairying, and dairying is more favoured in lactase persistent populations. We have developed a flexible demic computer simulation model to explore the spread of lactase persistence, dairying, other subsistence practices and unlinked genetic markers in Europe and western Asia's geographic space. Using data on -13,910*T allele frequency and farming arrival dates across Europe, and approximate Bayesian computation to estimate parameters of interest, we infer that the -13,910*T allele first underwent selection among dairying farmers around 7,500 years ago in a region between the central Balkans and central Europe, possibly in association with the dissemination of the Neolithic Linearbandkeramik culture over Central Europe. Furthermore, our results suggest that natural selection favouring a lactase persistence allele was not higher in northern latitudes through an increased requirement for dietary vitamin D. Our results provide a coherent and spatially explicit picture of the coevolution of lactase persistence and dairying in Europe.

Analysis of void volumes in proteins and application to stability of the p53 tumour suppressor protein

We have developed a new method for the analysis of voids in proteins (defined as empty cavities not accessible to solvent). This method combines analysis of individual discrete voids with analysis of packing quality. While these are different aspects of the same effect, they have traditionally been analysed using different approaches. The method has been applied to the calculation of total void volume and maximum void size in a non-redundant set of protein domains and has been used to examine correlations between thermal stability and void size. The tumour-suppressor protein p53 has then been compared with the non-redundant data set to determine whether its low thermal stability results from poor packing. We found that p53 has average packing, but the detrimental effects of some previously unexplained mutations to p53 observed in cancer can be explained by the creation of unusually large voids. (C) 2004 Elsevier Ltd. All rights reserved.