Therapeutisches Drug-Monitoring in der Psychiatrie : Kurze Zusammenfassung des neuen Konsensuspapiers der Arbeitsgruppe TDM der AGNP [Therapeutic drug monitoring in psychiatry : A brief summary of the new consensus paper by the task force on TDM of the AGNP].

In October 2011 the Task Force Therapeutic Drug Monitoring of the Association for Neuropsychopharmacology and Pharmacopsychiatry (AGNP) published an update (Pharmacopsychiatry 2011, 44: 195-235) of the first version of the consensus paper on therapeutic drug monitoring (TDM) published in 2004. This article summarizes the essential statements to make them accessible to a wider readership in German speaking countries.

Compte définitif des recettes et des dépenses (Gouvernement général de l'Afrique équatoriale française, Territoire de l'Oubangui-Chari)

Etat de collection : 1925. 1926. 1951

HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass.

BACKGROUND: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery among whom it is associated with poor outcomes, prolonged hospital stays and increased mortality. Statin drugs can produce more than one effect independent of their lipid lowering effect, and may improve kidney injury through inhibition of postoperative inflammatory responses. OBJECTIVES: This review aimed to look at the evidence supporting the benefits of perioperative statins for AKI prevention in hospitalised adults after surgery who require cardiac bypass. The main objectives were to 1) determine whether use of statins was associated with preventing AKI development; 2) determine whether use of statins was associated with reductions in in-hospital mortality; 3) determine whether use of statins was associated with reduced need for RRT; and 4) determine any adverse effects associated with the use of statins. SEARCH METHODS: We searched the Cochrane Renal Group's Specialised Register to 13 January 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared administration of statin therapy with placebo or standard clinical care in adult patients undergoing surgery requiring cardiopulmonary bypass and reporting AKI, serum creatinine (SCr) or need for renal replacement therapy (RRT) as an outcome were eligible for inclusion. All forms and dosages of statins in conjunction with any duration of pre-operative therapy were considered for inclusion in this review. DATA COLLECTION AND ANALYSIS: All authors extracted data independently and assessments were cross-checked by a second author. Likewise, assessment of study risk of bias was initially conducted by one author and then by a second author to ensure accuracy. Disagreements were arbitrated among authors until consensus was reached. Authors from two of the included studies provided additional data surrounding post-operative SCr as well as need for RRT. Meta-analyses were used to assess the outcomes of AKI, SCr and mortality rate. Data for the outcomes of RRT and adverse effects were not pooled. Adverse effects taken into account were those reported by the authors of included studies. MAIN RESULTS: We included seven studies (662 participants) in this review. All except one study was assessed as being at high risk of bias. Three studies assessed atorvastatin, three assessed simvastatin and one investigated rosuvastatin. All studies collected data during the immediate perioperative period only; data collection to hospital discharge and postoperative biochemical data collection ranged from 24 hours to 7 days. Overall, pre-operative statin treatment was not associated with a reduction in postoperative AKI, need for RRT, or mortality. Only two studies (195 participants) reported postoperative SCr level. In those studies, patients allocated to receive statins had lower postoperative SCr concentrations compared with those allocated to no drug treatment/placebo (MD 21.2 µmol/L, 95% CI -31.1 to -11.1). Adverse effects were adequately reported in only one study; no difference was found between the statin group compared to placebo. AUTHORS' CONCLUSIONS: Analysis of currently available data did not suggest that preoperative statin use is associated with decreased incidence of AKI in adults after surgery who required cardiac bypass. Although a significant reduction in SCr was seen postoperatively in people treated with statins, this result was driven by results from a single study, where SCr was considered as a secondary outcome. The results of the meta-analysis should be interpreted with caution; few studies were included in subgroup analyses, and significant differences in methodology exist among the included studies. Large high quality RCTs are required to establish the safety and efficacy of statins to prevent AKI after cardiac surgery.

Dictionnaire du bas-langage ou des Manières de parler usitées parmi le peuple : ouvrage dans lequel on a réuni les expressions proverbiales... les sobriquets... les barbarismes... ([Reprod.])

Collection : Archives de la linguistique française ; 195

Riittääkö aika, riittävätkö rahat? - tutkimus verkko-opetuksen työmääristä ja -kustannuksista

Verkko-opetustakäsittelevässä materiaalissa pohditaan usein verkko-opetuksesta opiskelijalle aiheutuvia kustannuksia, kun taas verkko-opetuksen toteuttajaosapuolelle aiheutuvat kustannukset jäävät vähemmälle huomiolle tai kokonaan huomiotta. Tämän tutkimuksen tarkoituksena on selvittää verkko-opetuksen toteuttajaosapuolelle (esim. opettaja, työryhmä, yliopisto tms. organisaatio) aiheutuvia työmääriä ja niistä syntyviä kustannuksia. Tutkimusaineistona käytetään Lappeenrannan teknillisessä yliopistossa toteutettuja verkkokursseja tekniikan, kauppatieteen, kielten opetuksen sekä yleisten oppimista tukevien kurssien osalta.Tutkimuksessa etsitään vastauksia seuraaviin kysymyksiin: kuinka eri tyyppisten verkkokurssien kustannuksetkertyvät ja mitkä tekijät aiheuttavat kustannuksia. Tutkimuksen tärkeimpinä tuloksina voidaan esittää, että: 1. Tutkittujen verkkokurssien hinnat näyttäisivät työkustannusten osalta jäävän alle 1000 ¤:n, samoin kokonaistyömäärät jäävät alle 50 työpäivän. 2.Runsaasti työtä vaatineissa verkkokursseissa on enimmäkseen panostettu kurssin ulkoasun suunnitteluun ja materiaalituotantoon. Sen sijaan esim. opiskelijoiden ohjauksessa ei havaittu merkittävämpää panostusta kuin muissakaan tapauksissa. 3. Karkeasti tulkiten voidaan sanoa, että jo pienellä panostuksella voidaan saada aikaan uudistuksia, jotka hyödyttävät opettajaa ja tehostavat hänen ajankäyttöään. Tämä voi tapahtua myös päinvastoin, eli opettaja voi panostaa hyvinkin paljon verkko-opetukseen saavuttamatta kuitenkaan tavoittelemaansa hyötyä. Tutkimuksen painopiste on verkkokurssien vaatimien työmäärien sekä -kustannusten selvittämisessä sekä analysoinnissa. Raportissa muistutetaan, että kustannustehokkuusajattelun rinnalla tulee kuitenkin pitää mielessä koulutuksen laatuun liittyvät näkökulmat. Kursseja suunniteltaessa on syytä muistaa, etteivät alhaiset kokonaiskustannukset ole ainoa tavoitetila, vaan että tasapaino koulutuksen kustannusten ja laadun kanssa on säilytettävä.

Crescimento e absorção de nutrientes por mudas de gravioleira

O conhecimento da absorção e acumulação de nutrientes nas diferentes fases de desenvolvimento da planta, identificando as épocas em que os nutrientes são exigidos em maiores quantidades, é fundamental no manejo da adubação, visando a máxima eficiência. Com este objetivo desenvolveu-se um experimento no viveiro de produção de mudas frutíferas da Embrapa Agroindústria Tropical, em Pacajus - CE. Mudas de gravioleira, tipo Morada, foram cultivadas em sacola de polietileno, contendo 5 dm³ da mistura solo superficial:solo organo mineral na proporção 3:1 (v/v). Os tratamentos constituíram-se de treze épocas de avaliações: 15, 30, 45, 60, 75, 90, 105, 120, 135, 150, 165, 180 e 195 dias após a repicagem das mudas. Em cada época e inteiramente ao acaso, foram amostradas cinco plantas para avaliar o crescimento e a absorção de nutrientes. As plantas apresentaram crescimento inicial lento, produzindo apenas 27% da matéria seca total até aos 105 dias, e os 73% restante, foram produzidos até aos 195 dias. A absorção de nutrientes acompanhou a produção de matéria seca e apresentou a seguinte ordem decrescente para os macronutrientes: K>N>Ca>Mg>P e para os micronutrientes Fe>Zn>Mn>Cu.

La Milícia Nacional de Lleida al Trienni Liberal

En aquest treball d'investigació dedicat a la Milícia Nacional de la ciutat de Lleida durant el Trienni Liberal s'ha pretés estudiar la seva implantació, l'evolució, la dinàmica interna i la composició socioprofessional dels seus membres. La Milícia a l'inici del període liberal va tenir dificultats per formar-se. Aquest fet ens va indicar que no hi havia molt individus amb tendència liberal i que la major part de la població treballava en l'àmbit agrari, o sigui, no hi havia gaire comerç i els individus dedicats a les professionals liberals o no eren molts quantitativament o no tenien massa poder polític i econòmic. Tot i que la consolidació i l'actuació del bàndol reialista va potenciar l'organització de la Milícia a la ciutat lleidatana. Per aturar l'avanç dels seguidors absolutistes, l'abril de l'any 1821 es va crear una nova milícia, aquesta vegada de caire voluntari. La Milícia Local va triomfar perquè la seva principal característica residia en el voluntarietat. Les persones que es van apuntar ho van fer per motius derivats de les seves pròpies conviccions polítiques. Finalment apuntar que la Milícia Nacional a Lleida a les darreries del règim liberal va aconseguir mantenir el poder constitucional fins l'arribada dels Cent Mil Fills de Sant Lluis.

La Guerra del francès a Lleida (1808-1814)

Este estudio histórico está dedicado a analizar la ocupación del territorio ilerdense por las tropas francesas, la repercusión y la reacción negativa que provocó en la población de Lleida, sobre todo se hará hincapié en el “Motín del Femeret”, un intento de subversión del poder fáctico tradicional por parte de una muchedumbre enfurecida ante la indolencia de las autoridades locales. También se examinará la organización de la resistencia interior de la ciudad para evitar ser conquistada, su asedio ulterior por parte de los soldados galos, la posterior conquista de Lleida por el ejército napoleónico en el año 1810 y la brutal represión que ejercieron sobre sus habitantes, causando notables daños tanto materiales como personales. Asimismo se hará referencia al gobierno francés del barón Henriod (1810-1812) como también al mandato de Alban de Villeneuve (1812-1814). Además se expondrá la reconquista a principios del año 1814 y finalmente se hará referencia a las consecuencias demográficas, económicas y sociales que produjo la Guerra de la Independencia en la ciudad de Lleida.

What to consider for applying backfilling on non-dedicated environments

The resource utilization level in open laboratories of several universities has been shown to be very low. Our aim is to take advantage of those idle resources for parallel computation without disturbing the local load. In order to provide a system that lets us execute parallel applications in such a non-dedicated cluster, we use an integral scheduling system that considers both Space and Time sharing concerns. For dealing with the Time Sharing (TS) aspect, we use a technique based on the communication-driven coscheduling principle. This kind of TS system has some implications on the Space Sharing (SS) system, that force us to modify the way job scheduling is traditionally done. In this paper, we analyze the relation between the TS and the SS systems in a non-dedicated cluster. As a consequence of this analysis, we propose a new technique, termed 3DBackfilling. This proposal implements the well known SS technique of backfilling, but applied to an environment with a MultiProgramming Level (MPL) of the parallel applications that is greater than one. Besides, 3DBackfilling considers the requirements of the local workload running on each node. Our proposal was evaluated in a PVM/MPI Linux cluster, and it was compared with several more traditional SS policies applied to non-dedicated environments.

Valoración social de las propiedades estéticas de los hayedos en Cataluña

Se aplican métodos ensayados en otros países (Scenic Beauty Estimation Method, SBE) para la determinación de las cualidades estéticas de masas forestales de interés recreativo a parcelas en diversas localizaciones del haya en Cataluña, abarcando diferencias significativas en estación, origen, edad y forma de masa. Las valoraciones se refieren a las cualidades estéticas de los rodales de haya vistos desde el interior del bosque, es decir, tal como son apreciados por parte de los visitantes de los montes. Las valoraciones se obtienen a través de paneles de observadores en sesiones fotográficas, se transforman a una escala común y se relacionan mediante análisis de regresión a las variables dasométricas tomadas en las parcelas de inventario. El desarrollo de modelos estadísticos que describen preferencias sociales permite medir la aportación de las diferentes variables dasométricas a la mejora estética de las masas de haya, y puede servir como guía en la ordenación de hayedos en que el uso público sea predominante o muy importante.

Is the relationship between major depressive disorder and self-reported alcohol use disorder an artificial one ?

AIMS: Many studies have suggested a close relationship between alcohol use disorder (AUD) and major depressive disorder (MDD). This study aimed to test whether the relationship between self-reported AUD and MDD was artificially strengthened by the diagnosis of MDD. This association was tested comparing relationships between alcohol use and AUD for depressive people and non-depressive people. METHODS: As part of the Cohort Study on Substance Use Risk Factors, 4352 male Swiss alcohol users in their early twenties answered questions concerning their alcohol use, AUD and MDD at two time points. Generalized linear models for cross-sectional and longitudinal associations were calculated. RESULTS: For cross-sectional associations, depressive participants reported a higher number of AUD symptoms (β = 0.743, P < 0.001) than non-depressive participants. Moreover, there was an interaction (β = -0.204, P = 0.001): the relationship between alcohol use and AUD was weaker for depressive participants rather than non-depressive participants. For longitudinal associations, there were almost no significant relationships between MDD at baseline and AUD at follow-up, but the interaction was still significant (β = -0.249, P < 0.001). CONCLUSION: MDD thus appeared to be a confounding variable in the relationship between alcohol use and AUD, and self-reported measures of AUD seemed to be overestimated by depressive people. This result brings into question the accuracy of self-reported measures of substance use disorders. Furthermore, it adds to the emerging debate about the usefulness of substance use disorder as a concept, when heavy substance use itself appears to be a sensitive and reliable indicator.

Alterações em atributos químicos de um solo submetido à adubação e cultivado com videira 'Niagara Rosada'

Com o objetivo de avaliar alterações em atributos químicos do solo, causadas pela adubação com NPK em videira 'Niagara Rosada', coletaram-se amostras de solo provenientes de um experimento de campo executado em Louveira (SP), durante quatro ciclos de produção. O delineamento experimental foi em blocos ao acaso, no esquema fatorial fracionado 1/2(4³), com tratamentos constituídos pelas combinações de doses de N (0; 65; 130 e 195 kg/ha de N), P (0; 60; 120 e 180 kg/ha de P2O5) e K (0; 45; 90 e 135 kg/ha de K2O) aplicados em cada ciclo de produção. As doses de N, P e K foram aplicadas em forma fracionada, empregando-se como fontes NH4NO3, superfosfato triplo e KCl, respectivamente. Na implantação do experimento, em agosto de 2005, e após quatro safras, em novembro de 2008, foram coletadas amostras de solo de 0 a 20 cm e de 20 a 40 cm de profundidade, determinando-se valores de pH (CaCl2), o teor de matéria orgânica, P, K, Ca, Mg, H+Al e calculada a soma de bases, CTC e saturação por bases. Avaliaram-se, também, a produtividade e as características físicas dos cachos e das bagas. A adubação nitrogenada em videira determinou incrementos significativos na acidez do solo. Doses baixas de P e K foram suficientes para manter o teor de P e de K do solo no mesmo nível da amostragem inicial, após quatro ciclos de produção. A produtividade e as características físicas dos cachos não foram influenciadas pela adubação com N, P e K. A adubação com N, P e K em vinhedos com alta disponibilidade de nutrientes no solo, condição comum na região de Louveira e Jundiaí, implica prejuízo econômico ao produtor, eleva os teores de nutrientes no solo acima das necessidades da cultura, podendo, ainda, aumentar o risco de contaminação ambiental.

Single acquisition electrical property mapping based on relative coil sensitivities: A proof-of-concept demonstration.

PURPOSE: All methods presented to date to map both conductivity and permittivity rely on multiple acquisitions to compute quantitatively the magnitude of radiofrequency transmit fields, B1+. In this work, we propose a method to compute both conductivity and permittivity based solely on relative receive coil sensitivities ( B1-) that can be obtained in one single measurement without the need to neither explicitly perform transmit/receive phase separation nor make assumptions regarding those phases. THEORY AND METHODS: To demonstrate the validity and the noise sensitivity of our method we used electromagnetic finite differences simulations of a 16-channel transceiver array. To experimentally validate our methodology at 7 Tesla, multi compartment phantom data was acquired using a standard 32-channel receive coil system and two-dimensional (2D) and 3D gradient echo acquisition. The reconstructed electric properties were correlated to those measured using dielectric probes. RESULTS: The method was demonstrated both in simulations and in phantom data with correlations to both the modeled and bench measurements being close to identity. The noise properties were modeled and understood. CONCLUSION: The proposed methodology allows to quantitatively determine the electrical properties of a sample using any MR contrast, with the only constraint being the need to have 4 or more receive coils and high SNR. Magn Reson Med, 2014. © 2014 Wiley Periodicals, Inc.

The health promotion model and rare disease patients : a mixed methods study examining adherence to treatment in men with congenital hypogonadotropic hypogonadism

Rare diseases are typically chronic medical conditions of genetic etiology characterized by low prevalence and high complexity. Patients living with rare diseases face numerous physical, psychosocial and economic challenges that place them in the realm of health disparities. Congenital hypogonadotropic hypogonadism (CHH) is a rare endocrine disorder characterized by absent puberty and infertility. Little is known about the psychosocial impact of CHH on patients or their adherence to available treatments. This project aimed to examine the relationship between illness perceptions, depressive symptoms and adherence to treatment in men with CHH using the nursing-sensitive Health Promotion Model (HPM). A community based participatory research (CBPR) framework was employed as a model for empowering patients and overcoming health inequities. The study design used a sequential, explanatory mixed-methods approach. To reach dispersed CHH men, we used web-based recruitment and data collection (online survey). Subsequently, three patient focus groups were conducted to provide explanatory insights into the online survey (i.e. barriers to adherence, challenges of CHH, and coping/support) The online survey (n=101) revealed that CHH men struggle with adherence and often have long gaps in care (40% >1 year). They experience negative psychosocial consequences because of CHH and exhibit significantly increased rates of depression (p<0.001). Focus group participants (n=26) identified healthcare system, interpersonal, and personal factors as barriers to adherence. Further, CHH impacts quality of life and impedes psychosexual development in these men. The CHH men are active internet users who rely on the web forcrowdsourcing solutions and peer-to-peer support. Moreover, they are receptive to web-based interventions to address unmet health needs. This thesis contributes to nursing knowledge in several ways. First, it demonstrates the utility of the HPM as a valuable theoretical construct for understanding medication adherence and for assessing rare disease patients. Second, these data identify a range of unmet health needs that are targets for patient-centered interventions. Third, leveraging technology (high-tech) effectively extended the reach of nursing care while the CBPR approach and focus groups (high-touch) served as concurrent nursing interventions facilitating patient empowerment in overcoming health disparities. Last, these findings hold promise for developing e-health interventions to bridge identified shortfalls in care and activating patients for enhanced self- care and wellness -- Les maladies rares sont généralement de maladies chroniques d'étiologie génétique caractérisées par une faible prévalence et une haute complexité de traitement. Les patients atteints de maladies rares sont confrontés à de nombreux défis physiques, psychosociaux et économiques qui les placent dans une posture de disparité et d'inégalités en santé. L'hypogonadisme hypogonadotrope congénital (CHH) est un trouble endocrinien rare caractérisé par l'absence de puberté et l'infertilité. On sait peu de choses sur l'impact psychosocial du CHH sur les patients ou leur adhésion aux traitements disponibles. Ce projet vise à examiner la relation entre la perception de la maladie, les symptômes dépressifs et l'observance du traitement chez les hommes souffrant de CHH. Cette étude est modélisée à l'aide du modèle de la Promotion de la santé de Pender (HPM). Le cadre de l'approche communautaire de recherche participative (CBPR) a aussi été utilisé. La conception de l'étude a reposé sur une approche mixte séquentielle. Pour atteindre les hommes souffrant de CHH, un recrutement et une collecte de données ont été organisées électroniquement. Par la suite, trois groupes de discussion ont été menées avec des patients experts impliqués au sein d'organisations reliés aux maladies rares. Ils ont été invités à discuter certains éléments additionnels dont, les obstacles à l'adhésion au traitement, les défis généraux de vivre avec un CHH, et l'adaptation à la maladie en tenant compte du soutien disponible. Le sondage en ligne (n = 101) a révélé que les hommes souffrant de CHH ont souvent de longues périodes en rupture de soins (40% > 1 an). Ils vivent des conséquences psychosociales négatives en raison du CHH et présentent une augmentation significative des taux de dépression (p <0,001). Les participants aux groupes de discussion (n = 26) identifient dans l'ordre, les systèmes de soins de santé, les relations interpersonnelles, et des facteurs personnels comme des obstacles à l'adhésion. En outre, selon les participants, le CHH impacte négativement sur leur qualité de vie générale et entrave leur développement psychosexuel. Les hommes souffrant de CHH se considèrent être des utilisateurs actifs d'internet et comptent sur le web pour trouver des solutions pour trouver des ressources et y recherchent le soutien de leurs pairs (peer-to-peer support). En outre, ils se disent réceptifs à des interventions qui sont basées sur le web pour répondre aux besoins de santé non satisfaits. Cette thèse contribue à la connaissance des soins infirmiers de plusieurs façons. Tout d'abord, elle démontre l'utilité de la HPM comme une construction théorique utile pour comprendre l'adhésion aux traitements et pour l'évaluation des éléments de promotion de santé qui concernent les patients atteints de maladies rares. Deuxièmement, ces données identifient une gamme de besoins de santé non satisfaits qui sont des cibles pour des interventions infirmières centrées sur le patient. Troisièmement, méthodologiquement parlant, cette étude démontre que les méthodes mixtes sont appropriées aux études en soins infirmiers car elles allient les nouvelles technologies qui peuvent effectivement étendre la portée des soins infirmiers (« high-tech »), et l'approche CBPR par des groupes de discussion (« high-touch ») qui ont facilité la compréhension des difficultés que doivent surmonter les hommes souffrant de CHH pour diminuer les disparités en santé et augmenter leur responsabilisation dans la gestion de la maladie rare. Enfin, ces résultats sont prometteurs pour développer des interventions e-santé susceptibles de combler les lacunes dans les soins et l'autonomisation de patients pour une meilleure emprise sur les auto-soins et le bien-être.