Grande fréquence des prescriptions médicamenteuses à visée cardiovasculaire potentiellement inappropriées dans la population âgée [Potentially inappropriate prescribing cardiovascular medications in the aged population: prospective study in a district hospital centre (France)].

OBJECTIVES: Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria. METHODS: A sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed. RESULTS: Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure. CONCLUSION: Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing commission of treatment that did not fit with patients' comorbidities and/or characteristics.

Duration of untreated psychosis: Impact of the definition of treatment onset on its predictive value over three years of treatment.

BACKGROUND: While reduction of DUP (Duration of Untreated Psychosis) is a key goal in early intervention strategies, the predictive value of DUP on outcome has been questioned. We planned this study in order to explore the impact of three different definition of "treatment initiation" on the predictive value of DUP on outcome in an early psychosis sample. METHODS: 221 early psychosis patients aged 18-35 were followed-up prospectively over 36 months. DUP was measured using three definitions for treatment onset: Initiation of antipsychotic medication (DUP1); engagement in a specialized programme (DUP2) and combination of engagement in a specialized programme and adherence to medication (DUP3). RESULTS: 10% of patients never reached criteria for DUP3 and therefore were never adequately treated over the 36-month period of care. While DUP1 and DUP2 had a limited predictive value on outcome, DUP3, based on a more restrictive definition for treatment onset, was a better predictor of positive and negative symptoms, as well as functional outcome at 12, 24 and 36 months. Globally, DUP3 explained 2 to 5 times more of the variance than DUP1 and DUP2, with effect sizes falling in the medium range according to Cohen. CONCLUSIONS: The limited predictive value of DUP on outcome in previous studies may be linked to problems of definitions that do not take adherence to treatment into account. While they need replication, our results suggest effort to reduce DUP should continue and aim both at early detection and development of engagement strategies.

Cover layers to the growth of trees and shrobs over a sulfide spoil from gold mining

This work was done at a gold mine company in Paracatu, MG, Brazil, and was conducted from March 2000 to November 2005. The substrate (spoil) studied was a phillite rock which contains sulfides such as pyrite and arsenopyrite. This study aimed to evaluate the survival and growth of plant species on different combinations of substrate layers over the spoil. These layers were a cover layer and a sealing layer, both deposited over the spoil. The treatment 1 had saprolite (B1) in the sealing layer (SL) and B1 with liming (B1L) in the cover layer (CL). The treatment 2 had B1 in SL and B1L + soil with liming (SoL) in the CL. The treatment 3 had B1 + SoL in the SL and B1L in the CL. The treatment 4 had B1 + SoL in the SL and B1L + SoL in the CL. The plant species used were Acacia farnesiana, A. holosericea, A. polyphylla, Albizia lebbeck, Clitoria fairchildiana, Flemingia sp., Mimosa artemisiana, M. bimucronata e Enterolobium contortisiliquum. Forty and 57 months after planting, collardiameter, height, and living plants were evaluated. The greatest survival rate was oobservedintreatmentwith B horizon of an Oxisoil in both layers, with 80 %. In general, M. bimucronata and A. farnesiana species showed the highest survival rate. The arsenic-content by Mehlich 3 in the cover layer ranged from 0.00 to 14.69 mg dm- 3 among treatments. The experimental results suggest that layers combinations above the sulfide substrate allow the rapid revegetation of the spoil.

Repercussions of a sleep medicine outreach program

Despite the high prevalence of sleep disorders, many healthcare professionals and lay people have little knowledge of Sleep Medicine. Mindful of such a reality, in 2001 the Sleep Institute of the Associação Fundo de Incentivo à Psicofarmacologia launched a campaign to increase Sleep Medicine awareness. Media features, exhibitions, inserts, and classes were used to reach 2,000,000 people and 55,000 healthcare professionals during the period from 2001 to 2004. To evaluate this program, we compared data for polysomnography referrals to the Institute in 2000 and in 2004. A total of 8805 referrals were evaluated (2000: 2164; 2004: 6641). Over the 4 years of the program, the number of beds increased by 43%; more women were referred (31 vs 37%; P < 0.001), mainly with a diagnostic hypothesis of sleep-disorder breathing (SDB). SDB was the most frequent diagnostic hypothesis in 2000 and 2004. In 2004 there were fewer referrals without a diagnostic hypothesis (27 vs 21%; P < 0.001) and for controlling surgically treated SDB (2.3 vs 1.6%; P < 0.05), and an increase in the following diagnostic hypotheses: non-invasive treatment of SDB (8.3 vs 12.3%; P < 0.001) and insomnia (3.5 vs 6.5%; P < 0.001). Insomnia diagnostic hypothesis was better correlated with SDB on referral documents in 2004 and less with a diagnostic hypothesis of limb movement disturbance. The program helped increase polysomnography referrals, particularly among women. Healthcare professionals appear to have a more developed understanding of sleep disorders.

Effect of oral ingestion of an extract of the herb Uncaria tomentosa on the biodistribution of sodium pertechnetate in rats

The aim of the present study was to determine the effect of the oral ingestion of an extract of the herb Uncaria tomentosa (cat's claw) on the biodistribution of the radiobiocomplex sodium pertechnetate (Na99mTcO4) in rats. The animals (male Wistar rats, 2 months old, 180-220 g), were treated (1 mL) with an U. tomentosa extract (32 mg/mL, N = 5) or 0.9% NaCl solution (control, N = 5) for 7 days. After this period, Na99mTcO4 (3.7 MBq, 0.3 mL) was injected through the ocular plexus and after 10 min the rats were killed, the organs isolated and counted in a well-gamma counter. A significant (P < 0.05) alteration in Na99mTcO4 uptake i) from 0.57 ± 0.008 to 0.39 ± 0.06 %ATI/organ (P < 0.05) and from 0.57 ± 0.17 to 0.39 ± 0.14 %ATI/g (P < 0.05) was observed in the heart, ii) from 0.07 ± 0.02 to 0.19 ± 0.07 %ATI/g in the pancreas, and iii) from 0.07 ± 0.01 to 0.18 ± 0.07 %ATI/g (P < 0.05) in muscle after treatment with this extract. Although these results were obtained with animals, caution is advisable in the interpretation of the nuclear medicine examination when the patient is using this herb. This finding is probably an example of drug interaction with a radiopharmaceutical, a fact that could lead to misdiagnosis of the examination in clinical practice with unexpected consequences for the patient.

Issues in the Transatlantic Trade and Investment Partnership: A critical discourse analysis

Negotiating trade agreements is an important part of government trade policies, economic planning and part of the globally operating trading system of today. European Union and the United States have been active in the formation of trade agreements in global comparison. Now these two economic giants are engaged in negotiations to form their own trade agreement, the so called Transnational Trade and Investment Partnership (TTIP). The purpose of this thesis is to understand the reasons for making a trade agreement between two economic areas and understanding the issues it may include in the case of the TTIP. The TTIP has received a great deal of attention in the media. The opinions towards the partnership have been extreme, and the debate has been heated. The purpose of this study is to introduce the nature of the public discussion regarding the TTIP from Spring 2013 until 2014. The research problem is to find out what are the main issues in the agreement and what are the values influencing them. The study was conducted applying methods of critical discourse analysis to the chosen data. This includes gathering the issues from the data based on the attention each has received in the discussion. The underlying motives for raising different issues were analysed by investigating the authors’ position in the political, economic and social circuits. The perceived economic impacts of the TTIP are also under analysis with the same criteria. Some of the most respected economic newspapers globally were included in the research material as well as papers or reports published by the EU and global organisations. The analysis indicates a clear dichotomy of the attitudes towards the TTIP. Key problems include lack of transparency in the negotiations, the misunderstood investor-state dispute settlement, the constantly expanding regulatory issues and the risk of protectionism. The theory and data does suggest that the removal of tariffs is an effective tool for reaching economic gains in the TTIP and even more effective would be the reducing of non-tariff barriers, such as protectionism. Critics are worried over the rising influence of corporations over governments. The discourse analysis reveals that the supporters of the TTIP have values related to increasing welfare through economic growth. Critics do not deny the economic benefits but raise the question of inequality as a consequence. Overall they represent softer values such as sustainable development and democracy as a counter-attack to the corporate values of efficiency and the maximising of profits.

Comparison between the availability of iron in the presence of vitamin a and β-carotene in foods and medications

The objective of this work was to verify the availability of iron in the presence of vitamin A as components of foods and in combinations with medicines. The iron available was measured in the presence of vitamin A in foods - common bean (B), beef liver (Li) and carrot (C) - and medicines - Fer-In-Sol® (Fer) (Mead Johnson), Arovit® (A) (Roche) and Neutrofer® (N) (Sigma Pharma) - as well as in combinations of both. β-carotene, vitamin A, total iron, heme and non heme iron, percentage of dialyzable iron and amount of dialyzable iron was determined. Vitamin A and β-carotene had a positive effect on the percentage of iron dialysis. Carrot and liver had a better percentage of dialyzable iron than their respective medicine at similar concentrations. Therefore, we can conclude that there has been an influence of vitamin A over the dialysis of iron, being the mixtures containing liver the ones which achieved the highest concentrations of dialyzable iron, and also that, according to the amounts needed to obtain the daily recommended intake of iron, they are good for consumption.

The bridging of pluralistic visions of science and ethics for bioethics - Tibetan medicine as compared with the Western research on longevity and human genetic enhancement

La thèse examine les liens entre la vision pluraliste de la science et l’éthique de la médecine tibétaine et les nouvelles pratiques en médecine occidentale, soit la longévité et la recherche sur la génétique amélioratrice. Elle cherche à cerner l’apport que la médecine tibétaine peut apporter aux recherches occidentales sur la longévité et la génétique humaine amélioratrice. Elle traite donc d’un enjeu social clé et du débat qui s’y rattache. La découverte et la description sont centrales à la méthodologie et informent l’analyse. Nous avons examiné dans un premier temps, les travaux de recherche sur la longévité reliée à la génétique amélioratrice (mémoire et muscles). Nous nous sommes penchés également sur les fondements de la médecine tibétaine en tant que système intégré. Pour ce faire, nous avons traité des notions telles que la santé, l’identité, la perfection et l’immortalité. Notre cadre conceptuel repose sur la théorie bouddhiste de l’interdépendance qui se caractérise par la formulation de catégories qui ensuite sont synthétisées dans l’essence; les deux niveaux d’interprétation de la théorie sont décrits en détail avant de passer à une comparaison avec la notion de complexité occidentale. La médecine tibétaine de fait présente un système où l’éthique et la science sont intégrées et se prête bien à une comparaison avec la vision pluraliste de la science à partir d’une perspective éthique/bioéthique. Les commentaires recueillis auprès des experts nous ont permis de cerner comment la science, l’éthique et l’amélioration de la longévité sont définies au sein des deux paradigmes de l’Est et de l’Ouest. Nos résultats montrent six points qui se dégagent au terme de cette recherche permettent de jeter un pont sur la vision pluraliste de ces paradigmes. Ceux-ci transcendent les points de vue doctrinaux individuels de religions ainsi que du monde scientifique occidental. Plus que tout, ils laissent entrevoir un cadre de références novatrices qui contribuera à la prise de décision à l’égard de questionnements bioéthiques.

Impact of Western Ghats Orography on the Weather and Climate over Southern Peninsular India-A Mesoscale Modelling Study

The thesis gives a general introduction about the topic include India, the spatial and temporal variation of the surface meteorological parameters are dealt in detail. The general pattern of the winds over the region in different seasons and the generation and movements of the thermally and dynamically originated local wind systems of Western Ghats region has been studied. The modification of the prevailing winds over region by the Palghat Gap and its effect on the mouth regions pf the gap is analysed in great depth. The thesis gives the information of climatic elements of the mountain region such as energy budgets, rainfall studies, evaporation and condensation and the variation in the heat fluxes over the region. The impact of orography is studied in a different approach. The type of hypothetical study gives more insight into the control of mountain on the distribution of meteorological parameter over the study region and helps to quantify the impact of the mountain in varying the weather climate of region. The detailed study of the hydro-meteorological aspects of the main river basins of the region also should be included to the climatic studies for the total understanding of the weather and climate over the region.

Dynamic and Thermodynamic Structure of the Monsoon Boundary Layer over India

The objective of the study is to examine the dynamic and thermodynamic structure and the variations that occur in the surface layer during the pre-monsoon, onset and post-monsoon periods over the Indian region. The variations caused during the occurrence of micro and mesoscale systems, structure and variation in the marine boundary layer over the Indian region is also investigated. The drag coefficient computed indirectly also shows variation during various seasons. The thermodynamic structure of the atmosphere shows variation during the various seasons. The onset monsoon causes lowering of the Lifting Condensation Levels. The outcome of the study is expected to provide a better understanding of the structure and variations in the boundary layer over India, which is useful for many applications especially for numerical modeling studies.

Intraseasonal oscillation of total precipitable water over North Indian Ocean and its application in the diagnostic study of coastal rainfall

TRMM Microwave Imager (TMI) is reported to be a useful sensor to measure the atmospheric and oceanic parameters even in cloudy conditions. Vertically integrated specific humidity, Total Precipitable Water (TPW) retrieved from the water vapour absorption channel (22GHz.) along with 10m wind speed and rain rate derived from TMI is used to investigate the moisture variation over North Indian Ocean. Intraseasonal Oscillations (ISO) of TPW during the summer monsoon seasons 1998, 1999, and 2000 over North Indian Ocean is explored using wavelet analysis. The dominant waves in TPW during the monsoon periods and the differences in ISO over Arabian Sea and Bay of Bengal are investigated. The northward propagation of TPW anomaly and its coherence with the coastal rainfall is also studied. For the diagnostic study of heavy rainfall spells over the west coast, the intrusion of TPW over the North Arabian Sea is seen to be a useful tool.

Computational models for the prediction of severe thunderstorms over east indian region

Thunderstorm is one of the most spectacular weather phenomena in the atmosphere. Many parts over the Indian region experience thunderstorms at higher frequency during pre-monsoon months (March- May), when the atmosphere is highly unstable because of high temperatures prevailing at lower levels. Most dominant feature of the weather during the pre-monsoon season over the eastern Indo-Gangetic plain and northeast India is the outburst of severe local convective storms, commonly known as ‘Nor’wester’ or ‘Kalbaishakhi’. The severe thunderstorms associated with thunder, squall line, lightning and hail cause extensive losses in agriculture, damage to structure and also loss of life. The casualty due to lightning associated with thunderstorms in this region is the highest in the world. The highest numbers of aviation hazards are reported during occurrence of these thunderstorms. In India, 72% of tornadoes are associated with this thunderstorm.

Drastic variation in the surface boundary layer parameters over Cochin during the annular solar eclipse: Analysis using sonic anemometer data

Atmospheric surface boundary layer parameters vary anomalously in response to the occurrence of annular solar eclipse on 15th January 2010 over Cochin. It was the longest annular solar eclipse occurred over South India with high intensity. As it occurred during the noon hours, it is considered to be much more significant because of its effects in all the regions of atmosphere including ionosphere. Since the insolation is the main driving factor responsible for the anomalous changes occurred in the surface layer due to annular solar eclipse, occurred on 15th January 2010, that played very important role in understanding dynamics of the atmosphere during the eclipse period because of its coincidence with the noon time. The Sonic anemometer is able to give data of zonal, meridional and vertical wind as well as the air temperature at a temporal resolution of 1 s. Different surface boundary layer parameters and turbulent fluxes were computed by the application of eddy correlation technique using the high resolution station data. The surface boundary layer parameters that are computed using the sonic anemometer data during the period are momentum flux, sensible heat flux, turbulent kinetic energy, frictional velocity (u*), variance of temperature, variances of u, v and w wind. In order to compare the results, a control run has been done using the data of previous day as well as next day. It is noted that over the specified time period of annular solar eclipse, all the above stated surface boundary layer parameters vary anomalously when compared with the control run. From the observations we could note that momentum flux was 0.1 Nm 2 instead of the mean value 0.2 Nm-2 when there was eclipse. Sensible heat flux anomalously decreases to 50 Nm 2 instead of the mean value 200 Nm 2 at the time of solar eclipse. The turbulent kinetic energy decreases to 0.2 m2s 2 from the mean value 1 m2s 2. The frictional velocity value decreases to 0.05 ms 1 instead of the mean value 0.2 ms 1. The present study aimed at understanding the dynamics of surface layer in response to the annular solar eclipse over a tropical coastal station, occurred during the noon hours. Key words: annular solar eclipse, surface boundary layer, sonic anemometer

Adding new components to the knowledge plane GMPLS over WDM networks

A recent study defines a new network plane: the knowledge plane. The incorporation of the knowledge plane over the network allows having more accurate information of the current and future network states. In this paper, the introduction and management of the network reliability information in the knowledge plane is proposed in order to improve the quality of service with protection routing algorithms in GMPLS over WDM networks. Different experiments prove the efficiency and scalability of the proposed scheme in terms of the percentage of resources used to protect the network

A report on the language instruction provided to a group of deaf children

This paper is a summary of a course of language instruction provided to a group of deaf children over the course of one year.