1000 resultados para 146-891A
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Comprend : [Pl. en reg. p.46 :] Goriot mangeait machinalement. Jamais il n'avait semblé plus absorbé. [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.78 :] "Madame, je ne suis encore qu'un pauvre diable d'étudiant..." dit Eugène à la duchesse. [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.107 :] "Expliquons-nous..." dit Vautrin en prenant Eugène par le bras. [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.133 :] Le marquis présenta l'étudiant à Mme Nucingen... [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.146 :] En sortant du cours Cuvier, Bianchon aperçut Mlle Michonneau et Poiret causant avec un monsieur qu'il sembla reconaître... [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.151 :] "Suis-je à votre goût?..." dit Mme de Nucingen en se levant et montrant sa robe de cachemire blanc à dessins. [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.229 :] Mme de Nucingen se jeta dans les bras de son père, et couvrit de baisers son visage épanoui... [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.254 :] Le Père Goriot s'élança entre ses deux filles pour les embpêcher de continuer cet échange de reproches. [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.272 :] "Je tremblais que vous ne vinssiez pas..." dit Mme de Beauséant à Rastignac. [Cote : Res p Y2 159/Microfilm R 122341] ; [Pl. en reg. p.300 :] "Mon père est mort!... " cria la comtesse en tombant évanouie. [Cote : Res p Y2 159/Microfilm R 122341]
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To evaluate primary care physicians' attitude towards implementation of rotavirus (RV) immunisation into the Swiss immunisation schedule, an eight-question internet-based questionnaire was sent to the 3799 subscribers of InfoVac, a nationwide web-based expert network on immunisation issues, which reaches >95% of paediatricians and smaller proportions of other primary care physicians. Five demographic variables were also inquired. Descriptive statistics and multivariate analyses for the main outcome "acceptance of routine RV immunisation" and other variables were performed. Diffusion of innovation theory was used for data assessment. Nine-hundred seventy-seven questionnaires were returned (26%). Fifty percent of participants were paediatricians. Routine RV immunisation was supported by 146 participants (15%; so called early adopters), dismissed by 620 (64%), leaving 211 (21%) undecided. However, when asked whether they would recommend RV vaccination to parents if it were officially recommended by the federal authorities and reimbursed, 467 (48.5%; so called early majority) agreed to recommend RV immunisation. Multivariate analysis revealed that physicians who would immunise their own child (OR: 5.1; 95% CI: 4.1-6.3), hospital-based physicians (OR: 1.6; 95% CI: 1.1-2.3) and physicians from the French (OR: 1.6; 95% CI: 1.2-2.3) and Italian speaking areas of Switzerland (OR: 2.5; 95% CI: 1.1-5.8) were more likely to support RV immunisation. Diffusion of innovation theory predicts a >80% implementation if approximately 50% of a given population support an innovation. Introduction of RV immunisation in Switzerland is likely to be successful, if (i) the federal authorities issue an official recommendation and (ii) costs are covered by basic health care insurance.
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Soil can be either source or sink of methane (CH4), depending on the balance between methanogenesis and methanotrophy, which are determined by pedological, climatic and management factors. The objective of this study was to assess the impact of drainage of a highland Haplic Histosol on CH4 fluxes. Field research was carried out in Ponta Grossa (Paraná, Brazil) based on the measurement of CH4 fluxes by the static chamber method in natural and drained Histosol, over one year (17 sampling events). The natural Histosol showed net CH4 eflux, with rates varying from 238 µg m-2 h-1 CH4, in cool/cold periods, to 2,850 µg m-2 h-1 CH4, in warm/hot periods, resulting a cumulative emission of 116 kg ha-1 yr-1 CH4. In the opposite, the drained Histosol showed net influx of CH4 (-39 to -146 µg m-2 h-1), which resulted in a net consumption of 9 kg ha-1 yr-1 CH4. The main driving factors of CH4 consumption in the drained soil were the lowering of the water-table (on average -57 cm, vs -7 cm in natural soil) and the lower water content in the 0-10 cm layer (average of 5.5 kg kg-1, vs 9.9 kg kg-1 in natural soil). Although waterlogged Histosols of highland areas are regarded as CH4 sources, they fulfill fundamental functions in the ecosystem, such as the accumulation of organic carbon (581 Mg ha-1 C to a depth of 1 m) and water (8.6 million L ha-1 = 860 mm to a depth of 1 m). For this reason, these soils must not be drained as an alternative to mitigate CH4 emission, but effectively preserved.
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Introduction: Non-operative management (NOM) of blunt splenic injuries in hemodynamically stable patients is nowadays considered the standard treatment. Material and Methods: The aim was to clarify the criteria used for primary operative management (OM) and planned NOM. Furthermore, the study aimed to identify risk factors for failure of NOM. All adult patients with blunt splenic injuries treated from 2000-2008 were reviewed and a logistic regression analysis employed. Results: There were 206 patients (146 men, 70.9%). Mean age was 38.2 ± 19.1 years. The mean Injury Severity Score (ISS) was 30.9 ± 11.6. The American Association for the Surgery of Trauma (AAST) classification of the splenic injury was: grade I, n = 43 (20.9%); grade II, n = 52 (25.2%); grade III, n = 60 (29.1%), grade IV, n = 42 (20.4%) and grade V, n = 9 (4.4%). 47 patients (22.8%) required immediate surgery (OM). More than 5 units of red cell transfusions (odds ratio [OR] 13.72, P < 0.001), a Glasgow Coma Scale < 11 (OR 9.88, P = 0.009) and age ? 55 years (OR 3.29, P = 0.038) were associated with primary OM. 159 patients (77.2%) qualified for a non-surgical approach (NOM), which was successful in 89.9% (143/159). The overall splenic salvage rate amounted to 69.4% (143/206). Multiple logistic regression analysis found age ? 40 years to be the only factor significantly and independently related to the failure of NOM (OR 13.58, P = 0.001). Conclusion: Advanced age is associated with an increased failure rate of NOM in patients with blunt splenic injuries.
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Hygiene practices in neonatal units require the use of disinfecting solutions containing ethanol or isopropanol. Newly disinfected hands or soaked swabs introduced inside the incubators may emit vapours leading to alcohol exposures to the neonates. Alcohol emissions from hands and other occasional sources (e.g. soaked disinfecting swabs) lead to measurable levels of vapours inside incubators. Average isopropanol and ethanol concentrations ranging from 33.1 to 171.4 mg/m(3) (13.8 to 71.4 ppm) and from 23.5 to more than 146 mg/m3 (9.8 to > 6 ppm) respectively were measured inside occupied incubators (n = 11, measurement time about 230 min) in a neonatal unit of the Centre Hospitalier Universitaire Vaudois in Lausanne during regular activity. Exposure concentrations in a wide range of possible situations were then investigated by modeling using the one-box dispersion model. Theoretical modeling suggested typical isopropanol peaks and average concentrations ranging between 10(2) and 10(3) mg/m(3) (4.10(1) to 4.10(2)ppm), and 10(1) to 10(2) mg/m(3) (4 to 4.10(1) ppm), respectively. Based on our results we suggest several preventive measures to reduce the neonates' exposures to solvent vapours.
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Coma after cardiac arrest (CA) is an important cause of admission to the ICU. Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). TTM and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of clinical examination. In the early ICU phase, patients' good recovery may often be indistinguishable (based on neurologic examination alone) from patients who eventually will have a poor prognosis. Prognostication of post-CA coma, therefore, has evolved toward a multimodal approach that combines neurologic examination with EEG and evoked potentials. Blood biomarkers (eg, neuron-specific enolase [NSE] and soluble 100-β protein) are useful complements for coma prognostication; however, results vary among commercial laboratory assays, and applying one single cutoff level (eg, > 33 μg/L for NSE) for poor prognostication is not recommended. Neuroimaging, mainly diffusion MRI, is emerging as a promising tool for prognostication, but its precise role needs further study before it can be widely used. This multimodal approach might reduce false-positive rates of poor prognosis, thereby providing optimal prognostication of comatose CA survivors. The aim of this review is to summarize studies and the principal tools presently available for outcome prediction and to describe a practical approach to the multimodal prognostication of coma after CA, with a particular focus on neuromonitoring tools. We also propose an algorithm for the optimal use of such multimodal tools during the early ICU phase of post-CA coma.
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A high-resolution U-Pb zircon geochronological study of plutonic units along the south Peruvian margin between 17 degrees and 18 degrees S allows the integration of the geochemical, geodynamic and tectonic evolution of this part of the Andean margin. This study focuses on the composite Jurassic-early Cretaceous Ilo Batholith that was emplaced along the southern Peruvian coast during two episodes of intrusive magmatism; a first period between 173 and 152 Ma (with a peak in magmatic activity between roughly 168 and 162 Ma) and a second period between 110 and 106 Ma. Emplacement of the Jurassic part of the composite Ilo Batholith shortly post-dated the accumulation of the volcanosedimentary succession it intruded (Chocolate formation), which allows to estimate a subsidence rate for this unit of similar to 3.5 km/Ma. The emplacement of the main peak of Jurassic plutonism of the Ilo Batholith was also closely coeval with widespread and repeated slumping (during deposition of the Cachios Formation) in the back-arc region, suggesting a common causal link between these phenomena, which is discussed in the context of an observed 100 km trenchward arc migration at similar to 175 Ma, and the relation with extensional tectonics that prevailed along the Central Andean margin during Pangaea break-up. (C) 2012 Elsevier B.V. All rights reserved.
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A sociologia funcionalista das profissões distingue dois tipos muito diferentes de atividades de trabalho: as profissões e as ocupações (ambas no sentido que os ingleses lhes dão). Como apenas as primeiras (a dos médicos, advogados, engenheiros, professores...) são consideradas escolhas e áreas autônomas que permitem a construção de uma carreira, as segundas (que constituem a maioria) acabam sendo desvalorizadas. Os sociólogos interacionistas (como os de Chicago: Hughes, Becker, Strauss etc.) e críticos (marxianos, weberianos etc.) contestam essa posição e consideram que todas as atividades de trabalho poderiam se tornar "profissionais" (no sentido francês), desde que resultassem de uma socialização que permitisse a aquisição de competências e o reconhecimento (inclusive monetário) de todos os que exercem e compartilham uma mesma atividade. A comparação da socialização de clínicos gerais e de auxiliares de enfermagem na França ilustra esta tese, ao tomar o trabalho como um processo de construção e de reconhecimento de si.
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Os professores enfrentam dificuldades geralmente agrupadas sob a denominação vaga de "mal-estar docente". O artigo descreve e analisa, à luz de uma sociologia pragmática, como eles procedem diante da introdução de novas normas de trabalho. Utilizando a resistência, ajustes, astúcias e diversas estratégias, tentam construir o sentido do ofício e sua própria dignidade e, ao mesmo tempo, "salvar a pele". A pesquisa etnográfica, suporte do artigo, mostra que a gestão das dificuldades está na essência do ofício.
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Com este texto, pretende analisar-se a influência das políticas educativas nos contextos e no trabalho do professor. A partir de um conjunto de informações empíricas, recolhidas no decurso de dois projectos de investigação, foi possível descrever as modalidades através das quais os professores gerem o seu sofrimento profissional. Por outro lado, estes mesmos dados também permitiram caracterizar um conjunto de "ideologias profissionais defensivas", discernindo-se, igualmente, as tensões existentes entre as figuras dos jovens e dos alunos que frequentavam um determinado conjunto de escolas secundárias em Portugal. Com base na reinterpretação dessa mesma informação empírica, serão ainda analisados os efeitos que assumem as actuais políticas educativas no reforço da alienação e da exploração do trabalho docente.