Awareness of human immunodeficiency virus screening guidelines is low in emergency departments of western Switzerland.

Background: Human immunodeficiency virus (HIV) prevalence in Switzerland is 0.4% and 30% of HIV patients are diagnosed with CD4 counts <200 cells/microliter. In 2010, the Swiss Federal Office of Public Health (SFOP) published updated guidelines regarding Physician- Initiated Counseling and Testing (PICT) for HIV. In the new guidelines, when acute HIV infection is suspected or HIV is among the differential diagnoses, an HIV test is performed without risk assessment nor prior counseling, unless the patient specifically refuses it. Counseling and verbal consent are still required when the patient asks for an HIV test or belongs to a high risk group. Whist HIV testing in the emergency departments (ED) is recommended, only 1% of patients are currently screened. Lack of awareness among physicians has been cited in the literature as the first barrier to guideline implementation. Objectives: To test if physicians working in EDs of 5 large teaching hospitals in western Switzerland, admitting 175,000 patients / year, were aware of the updated SFOP guidelines. Methods: A survey was delivered to 167 ED physicians in the summer of 2011. The survey consisted of 26 vignettes designed to test whether physicians would request an HIV test according to the new guidelines and if they knew when the PICT strategy was allowed or counseling required. Finally, physicians were asked the number of HIV tests they had requested in the previous 4 weeks, and if they were aware of the new HIV guidelines. Results are presented as mean and standard deviation, median and interquartile range (IQR), or as proportions; Student's t test was used to compare continuous variables; Results: 143 physicians returned the survey (86%); mean age was 32 ± 8 years, and median postgraduate experience of 6 years (IQR 3-12); 52% were male and 17% were attendings. The percentage of correct responses was 60 ± 13% with no difference between attendings and residents (p = 0.31); 2 of the 3 questions with the lowest scores were failure to recognize situations in which HIV testing was indicated, and the third one a failure to recognize acute HIV infection. 82% of physicians were not aware of the new guidelines. The median number of test requests was 1 (IQR 0-2, range 1-10). Conclusion: ED physicians are not aware of current HIV screening guidelines published by the SFOP, and rarely perform HIV tests. An information campaign is required if ED physicians are expected to play a significant role in the reduction of undiagnosed HIV patients.

Laser Cutting of Austenitic Stainless Steel with a High Quality Laser Beam

The thin disk and fiber lasers are new solid-state laser technologies that offer a combinationof high beam quality and a wavelength that is easily absorbed by metal surfacesand are expected to challenge the CO2 and Nd:YAG lasers in cutting of metals ofthick sections (thickness greater than 2mm). This thesis studied the potential of the disk and fiber lasers for cutting applications and the benefits of their better beam quality. The literature review covered the principles of the disk laser, high power fiber laser, CO2 laser and Nd:YAG laser as well as the principle of laser cutting. The cutting experiments were made with thedisk, fiber and CO2 lasers using nitrogen as an assist gas. The test material was austenitic stainless steel of sheet thickness 1.3mm, 2.3mm, 4.3mm and 6.2mm for the disk and fiber laser cutting experiments and sheet thickness of 1.3mm, 1.85mm, 4.4mm and 6.4mm for the CO2 laser cutting experiments. The experiments focused on the maximum cutting speeds with appropriate cut quality. Kerf width, cutedge perpendicularity and surface roughness were the cut characteristics used to analyze the cut quality. Attempts were made to draw conclusions on the influence of high beam quality on the cutting speed and cut quality. The cutting speeds were enormous for the disk and fiber laser cutting experiments with the 1.3mm and 2.3mm sheet thickness and the cut quality was good. The disk and fiber laser cutting speeds were lower at 4.3mm and 6.2mm sheet thickness but there was still a considerable percentage increase in cutting speeds compared to the CO2 laser cutting speeds at similar sheet thickness. However, the cut quality for 6.2mm thickness was not very good for the disk and fiber laser cutting experiments but could probably be improved by proper selection of cutting parameters.

CO2-laserin soveltaminen WFU-paperin reunan leikkaamiseen

Tämän diplomityön tarkoitus oli selvittää CO2-laserin soveltuvuutta paperin reunan leikkaamiseen ennen liimapuristinta nopealle modernilleWFU-paperikoneelle. Merkittävimmät leikkauskokeet tehtiin leikkaamalla paperirataa todenmukaisissa olosuhteissa koekoneella. Koeleikkauksissa tutkittiin myös päällystettyjen paperilajien CO2-laserleikkausta. Paperin reunan koeleikkauksia suoritettiin leikkauspöytää vasten sekä telaa vasten. Leikkauspöytänä käytettiin korkeapainevesileikkaimelle suunniteltua leikkauspöytää, jota paranneltiin tämän työn yhteydessä paremmin laserleikkaukselle sopivaksi. Telaa vasten suoritetuilla leikkauksilla lasertehon tarve oli suurempi verrattuna pöytää vasten leikkaukseen samalla leikkausnopeudella ja samalla paperilajilla. Laserlaitteiston mitoittaminen oikein pelkkien arkkileikkauskokeiden perusteella ei ollut mahdollista. Myös rullilla tapahtuvia leikkauskokeita tarvittiin. Pöytää vasten tapahtuvaan leikkaamiseen tarvitaan 1000 W laserlaite paperin molemmille reunoille. Tämän tehoiset laserlaitteet riittävät kaikille Changshun PK 1:n paperilajeille niiden lajikohtaiseen maksimiajonopeuteen. Testatuista kolmesta polttovälistä antoi 5" polttoväli parhaat leikkaustulokset. Polttopisteen paikka voi vaihdella ± 0.75 mm paperin pinnasta vaikuttamatta silti merkittävästi lasertehon tarpeeseen. Laserleikatun paperin reuna oli hyvälaatuinen, eikä laserleikkaus aiheuttanut paperille epätoivottuja asioita kuten mustumista.

[12 phot. des Basses-Alpes et des Hautes-Alpes avec commentaires géologiques, don W. Kilian en 1893]

Donateur : Kilian, W. (18..-19..)

Utopie de la littérature : la question littéraire dans l'oeuvre de Theodor W. Adorno

La thèse se propose d'étudier la question de la littérature dans l'oeuvre de Theodor W. Adorno. Elle fait apparaître la fonction utopique que le philosophe allemand attribue à la littérature en tant que celle-ci dessine l'horizon d'une « langue sans terre », ligne de fuite hors de la « Dialektik der Aufklàrung » et de l'autodestruction de la Raison. Tandis que le discours philosophique a sans cesse reproduit dans son appareil conceptuel la violence mythico- rationnelle à l'encontre du singulier non-identique, la langue littéraire semble en mesure d'indiquer la possibilité de parvenir par le concept au-delà du concept, ce qui constitue le désir utopique de la pensée comme dialectique négative. L'enjeu n'est pas seulement épistémique : il est bien éthico-politique, lié à la possibilité d'établir des rapports à l'autre libérés de la contrainte de l'identité.¦Dans les oeuvres littéraires dont il entreprend la lecture - qu'il s'agisse de celles d'Eichendorff, de Hôlderlin, de Proust, de Valéry, de Beckett ou encore de Kafka - Adorno ne cherche cependant pas une figure concrète de l'utopie, mais la trace de « ce qui nous appartient en propre et qui a été laissé en blanc» - aussi bien dans les textes que dans l'Histoire. La littérature porte alors en creux ce possible impossible dont la puissance hante le présent entre ses lignes ; elle est de la réconciliation ( Versôhnung) une image sans image, tout à la fois ressource de la critique radicale des conditions existantes et réserve du désir d'un autre à venir.¦A partir d'une esquisse du geste inaugural de l'utopie de la littérature dans le premier romantisme de Iéna, la thèse expose les enjeux philosophiques, esthétiques et politiques de la littérature dans la pensée adornienne, puis procède - et c'est là le coeur du travail - à une « lecture de lectures », à une traversée des essais qu'Adorno consacra, tout au long de sa vie, aux textes littéraires, pour trouver en ceux-ci les indices de l'utopie à l'oeuvre.

The blood-brain barrier: cellular basis.

Perfusion experiments with horseradish peroxidase have established that the morphological substrate of the blood-brain barrier is represented by microvascular endothelial cells. They are characterized by complexly arranged tight junctions and a very low rate of transcytotic vesicular transport. They express transport enzymes, carrier systems and brain endothelial cell-specific molecules of unknown function not expressed by any other endothelial cell population. These blood-brain barrier properties are not intrinsic to these cells but are inducible by the surrounding brain tissue. Type I astrocytes injected into the anterior eye chamber of the rat or onto the chick chorioallantoic membrane are able to induce a host-derived angiogenesis and some blood-brain barrier properties in endothelial cells of non-neural origin. Recently we have shown that this cellular interaction is due to the secretion of a soluble astrocyte derived factor(s). Astrocytes are also implicated in the maintenance, functional regulation and the repair of the blood-brain barrier. Complex interactions between other constituents of the microenvironment surrounding the endothelial cells, such as the basement membrane, pericytes, nerve endings, microglial cells and the extracellular fluid, take place and are required for the proper functioning of the blood-brain barrier, which in addition is regionally different as reflected by endothelial cell heterogeneity.

A computationally efficient shear deformable beam element for large deformation multibody applications

In this paper, a new two-dimensional shear deformable beam element based on the absolute nodal coordinate formulation is proposed. The nonlinear elastic forces of the beam element are obtained using a continuum mechanics approach without employing a local element coordinate system. In this study, linear polynomials are used to interpolate both the transverse and longitudinal components of the displacement. This is different from other absolute nodal-coordinate-based beam elements where cubic polynomials are used in the longitudinal direction. The accompanying defects of the phenomenon known as shear locking are avoided through the adoption of selective integration within the numerical integration method. The proposed element is verified using several numerical examples, and the results are compared to analytical solutions and the results for an existing shear deformable beam element. It is shown that by using the proposed element, accurate linear and nonlinear static deformations, as well as realistic dynamic behavior, can be achieved with a smaller computational effort than by using existing shear deformable two-dimensional beam elements.

Multiplicação in vitro dos porta-enxertos de Prunus sp. 'Barrier' e 'Cadaman'

Este trabalho foi realizado com o objetivo de estabelecer a melhor concentração de sais do meio MS e da citocinina BAP para a multiplicação dos porta-enxertos de Prunus sp. 'Barrier' e 'Cadaman'. Segmentos nodais foram introduzidos em tubos de ensaio contendo 10 mL de meio de cultura com variações na concentração de sais (MS; ½MS; e 2/3MS) combinadas com cinco concentrações de BAP (0; 1,5; 2,5; 3,5 e 4,5 miM). Utilizou-se um fatorial 2x3x5, distribuído em blocos casualizados, compostos por quatro repetições contendo cinco tubos de ensaio cada uma, sendo inoculado um segmento nodal por tubo. As avaliações foram realizadas após cinco semanas de cultivo em ambiente com intensidade luminosa de 20 miE m-2 s-1, fotoperíodo de 16 horas e temperatura de 24 ± 4ºC. Verificou-se maior número médio de gemas e de brotações para a cultivar Barrier. À medida que se reduziu a concentração de sais do meio de cultura, obteve-se maior número de brotações, porém com menor tamanho. As regressões polinomiais das variáveis número de gemas, brotações por explante e comprimento das brotações apresentaram um ajustamento quadrático para níveis de BAP, atingindo os pontos de máximo 31,2 gemas/explante; 4,6 brotações por explante, e 8,1 mm de comprimento nas concentrações 3,3; 3,1, e 3,1 miM de BAP, respectivamente.

Automated formulation of optimisation models for steel beam structures

Over 70% of the total costs of an end product are consequences of decisions that are made during the design process. A search for optimal cross-sections will often have only a marginal effect on the amount of material used if the geometry of a structure is fixed and if the cross-sectional characteristics of its elements are property designed by conventional methods. In recent years, optimalgeometry has become a central area of research in the automated design of structures. It is generally accepted that no single optimisation algorithm is suitable for all engineering design problems. An appropriate algorithm, therefore, mustbe selected individually for each optimisation situation. Modelling is the mosttime consuming phase in the optimisation of steel and metal structures. In thisresearch, the goal was to develop a method and computer program, which reduces the modelling and optimisation time for structural design. The program needed anoptimisation algorithm that is suitable for various engineering design problems. Because Finite Element modelling is commonly used in the design of steel and metal structures, the interaction between a finite element tool and optimisation tool needed a practical solution. The developed method and computer programs were tested with standard optimisation tests and practical design optimisation cases. Three generations of computer programs are developed. The programs combine anoptimisation problem modelling tool and FE-modelling program using three alternate methdos. The modelling and optimisation was demonstrated in the design of a new boom construction and steel structures of flat and ridge roofs. This thesis demonstrates that the most time consuming modelling time is significantly reduced. Modelling errors are reduced and the results are more reliable. A new selection rule for the evolution algorithm, which eliminates the need for constraint weight factors is tested with optimisation cases of the steel structures that include hundreds of constraints. It is seen that the tested algorithm can be used nearly as a black box without parameter settings and penalty factors of the constraints.