Prévention des infections chez les voyageurs immunosupprimés [Prevention of infection in immunocompromised travelers].

Every year there are more immunocompromised patients with a better quality of life and, therefore, that travel more frequently. While traveling, patients may be exposed to several infections, such as traveler's diarrhea or malaria, which can be associated with a high rate of complications in this population. An appropriate strategy for the prevention of travel-related infections is essential, including education about hygiene measures, vaccinations and prescription of a tailored antimicrobial prophylaxis/stand-by treatment, according to the type of immunosuppression. Potential drug interactions, particularly between antimalaric and immunosuppressive drugs, must also be considered for decision taking. Collaboration between the general practitioner and the travel medicine and infectious diseases specialists is highly recommended to improve the management of these patients.

Surgical safety and hospital volume across a wide range of interventions

OBJECTIVES:: For certain major operations, inpatient mortality risk is lower in high-volume hospitals than those in low-volume hospitals. Extending the analysis to a broader range of interventions and outcomes is necessary before adopting policies based on minimum volume thresholds. METHODS:: Using the United States 2004 Nationwide Inpatient Sample, we assessed the effect of intervention-specific and overall hospital volume on surgical complications, potentially avoidable reoperations, and deaths across 1.4 million interventions in 353 hospitals. Outcome variations across hospitals were analyzed through a 3-level hierarchical logistic regression model (patients, surgical interventions, and hospitals), which took into account interventions on multiple organs, 144 intervention categories, and structural hospital characteristics. Discriminative performance and calibration were good. RESULTS:: Hospitals with more experience in a given intervention had similar reoperation rates but lower mortality and complication rates: odds ratio per volume deciles 0.93 and 0.97. However, the benefit was limited to heart surgery and a small number of other operations. Risks were higher for hospitals that performed more interventions overall: odds ratio per 1000 for each event was approximately 1.02. Even after adjustment for specific volume, mortality varied substantially across both high- and low-volume hospitals. CONCLUSION:: Although the link between specific volume and certain inpatient outcomes suggests that specialization might help improve surgical safety, the variable magnitude of this link and the heterogeneity of hospital effect do not support the systematic use of volume-based referrals. It may be more efficient to monitor risk-adjusted postoperative outcomes and to investigate facilities with worse than expected outcomes.

Adubação com potássio e nitrogênio em três cíclos de produção da bananeira cv. prata-anã

O nitrogênio, depois do potássio, é o elemento mais exigido pela bananeira. O desbalanço entre N e K afeta a produção e a qualidade do fruto de banana. O objetivo deste trabalho foi avaliar a influência das adubações com nitrogênio e potássio na produção da bananeira c.v. Prata-Anã (grupo genômico AAB). O experimento foi realizado em Latossolo Vermelho-Amarelo na região do Semi-árido do Norte de Minas Gerais e irrigado por microaspersão. Estudaram-se cinco doses de N (0; 200; 400; 800 e 1600 kg ha-1ano-1) e cinco doses de K2O (0; 200; 400; 800 e 1600 kg ha-1ano-1), em esquema fatorial (5x5), durante o 2º, 3º e 4º ciclos de produção. A aplicação de doses crescentes de N elevou o teor de Mn nas folhas acima da faixa adequada, promovendo queda na produção de banana no 2º e 3º ciclos. Portanto, infere-se que o teor de Mn nas folhas atingiu nível tóxico. Houve efeito do K sobre a produção de banana apenas no 4º ciclo. A produção máxima de banana no 4º ciclo foi obtida com a aplicação de 962,5 kg de K2O ha-1ano-1. Não ocorreu interação significativa entre N e K.

Caracterização tecnológica de jabuticabas 'Sabará' provenientes de diferentes regiões de cultivo

Características fisico-químicas de jabuticabas 'sabará', provenientes de 10 diferentes regiões de cultivo localizadas no Estado de São Paulo, foram analisadas de agosto a setembro de 2001 para determinação de sua qualidade. De cada local de cultivo foram colhidos 3 kg de frutos. Diferenças significativas foram observadas em todas as características avaliadas. A média de peso por fruto variou de 3,56 a 7,40g, e os frutos oriundos de pomar situado na cidade de Casa Branca - SP foram os que apresentaram os maiores pesos. As médias do índice de formato e do fruto e do diâmetro oscilaram de 0,962 a 0,990 e de 2,45 a 1,73 cm, respectivamente. A coloração dos frutos foi mais roxa-escura do que roxa. A firmeza dos frutos variou de firme a mole, e os frutos colhidos em pomares situados nas regiões de Casa Branca - SP, Pedregulho - SP e Miguelópolis -SP apresentaram-se mais firmes, sugerindo um maior potencial de conservação pós-colheita. O teor de sólidos solúveis totais variou de 11,6 a 17,9, o pH de 2,91 a 3,70 sendo maiores em jabuticabas colhidas em pomares situados nas cidades de Guaíra-SP e Ituverava-SP. A acidez total titulável, expressa em g de ácido cítrico por 100g, variou de 0,888 a 1,625, os teores de vitamina C variaram de 14,86 a 24,67 mg de ácido ascórbico por 100g, e os de carboidrato solúvel de 0,91 a 11,39g de glicose por 100g, respectivamente. Os resultados levam a concluir que as jabuticabas provenientes de pomares situados na cidade de Casa Branca-SP apresentaram melhor qualidade, sendo adequadas tanto para a indústria como para o consumo de fruta fresca e com maior potencial de conservação pós-colheita.

Decreasing educational differences in mortality over 40 years: evidence from the Turin Longitudinal Study (Italy)

BACKGROUND: Recent studies suggest that inequalities in premature mortality have continued to rise over the last decade in most European countries, but not in southern European countries. METHODS: In this study, we assess long-term trends (1971-2011) in absolute and relative educational inequalities in all-cause and cause-specific mortality in the Turin Longitudinal Study (Turin, Italy), a record-linkage study including all individuals resident in Turin in the 1971, 1981, 1991 and 2001 censuses, and aged 30-99 years (more than 2 million people). We examined mortality for all causes, cardiovascular disease (CVD), all cancers and specific cancers (lung, breast), as well as smoking and alcohol-related mortality. RESULTS: Overall mortality substantially decreased in all educational groups over the study period, although cancer rates only slightly declined. Absolute inequalities decreased for both genders (SII=962/694 in men/women in 1972-1976 and SII=531/259 in 2007-2011, p<0.01). Among men, absolute inequalities for CVD and alcohol-related causes declined (p<0.05), while remaining stable for other causes of death. Among women, declines in absolute inequalities were observed for CVD, smoking and alcohol-related causes and lung cancer (p<0.05). Relative inequalities in all-cause mortality remained stable for men and decreased for women (RII=1.92/2.03 in men/women in 1972-1976 and RII=2.15/1.32 in 2007-2011). Among men, relative inequalities increased for smoking-related causes, while among women they decreased for all cancers, CVD, smoking-related causes and lung cancer (p<0.05). CONCLUSIONS: Absolute inequalities in mortality strongly declined over the study period in both genders. Relative educational inequalities in mortality were generally stable among men; while they tended to narrow among women. In general, this study supports the hypothesis that educational inequalities in mortality have decreased in southern European countries.

Safety of human immunisation with a live-attenuated Mycobacterium tuberculosis vaccine: a randomised, double-blind, controlled phase I trial.

BACKGROUND: Tuberculosis remains one of the world's deadliest transmissible diseases despite widespread use of the BCG vaccine. MTBVAC is a new live tuberculosis vaccine based on genetically attenuated Mycobacterium tuberculosis that expresses most antigens present in human isolates of M tuberculosis. We aimed to compare the safety of MTBVAC with BCG in healthy adult volunteers. METHODS: We did this single-centre, randomised, double-blind, controlled phase 1 study at the Centre Hospitalier Universitaire Vaudois (CHUV; Lausanne, Switzerland). Volunteers were eligible for inclusion if they were aged 18-45 years, clinically healthy, HIV-negative and tuberculosis-negative, and had no history of active tuberculosis, chemoprophylaxis for tuberculosis, or BCG vaccination. Volunteers fulfilling the inclusion criteria were randomly assigned to three cohorts in a dose-escalation manner. Randomisation was done centrally by the CHUV Pharmacy and treatments were masked from the study team and volunteers. As participants were recruited within each cohort, they were randomly assigned 3:1 to receive MTBVAC or BCG. Of the participants allocated MTBVAC, those in the first cohort received 5 × 10(3) colony forming units (CFU) MTBVAC, those in the second cohort received 5 × 10(4) CFU MTBVAC, and those in the third cohort received 5 × 10(5) CFU MTBVAC. In all cohorts, participants assigned to receive BCG were given 5 × 10(5) CFU BCG. Each participant received a single intradermal injection of their assigned vaccine in 0·1 mL sterile water in their non-dominant arm. The primary outcome was safety in all vaccinated participants. Secondary outcomes included whole blood cell-mediated immune response to live MTBVAC and BCG, and interferon γ release assays (IGRA) of peripheral blood mononuclear cells. This trial is registered with ClinicalTrials.gov, number NCT02013245. FINDINGS: Between Jan 23, 2013, and Nov 6, 2013, we enrolled 36 volunteers into three cohorts, each of which consisted of nine participants who received MTBVAC and three who received BCG. 34 volunteers completed the trial. The safety of vaccination with MTBVAC at all doses was similar to that of BCG, and vaccination did not induce any serious adverse events. All individuals were IGRA negative at the end of follow-up (day 210). After whole blood stimulation with live MTBVAC or BCG, MTBVAC was at least as immunogenic as BCG. At the same dose as BCG (5×10(5) CFU), although no statistical significance could be achieved, there were more responders in the MTBVAC group than in the BCG group, with a greater frequency of polyfunctional CD4+ central memory T cells. INTERPRETATION: To our knowledge, MTBVAC is the first live-attenuated M tuberculosis vaccine to reach clinical assessment, showing similar safety to BCG. MTBVAC seemed to be at least as immunogenic as BCG, but the study was not powered to investigate this outcome. Further plans to use more immunogenicity endpoints in a larger number of volunteers (adults and adolescents) are underway, with the aim to thoroughly characterise and potentially distinguish immunogenicity between MTBVAC and BCG in tuberculosis-endemic countries. Combined with an excellent safety profile, these data support advanced clinical development in high-burden tuberculosis endemic countries. FUNDING: Biofabri and Bill & Melinda Gates Foundation through the TuBerculosis Vaccine Initiative (TBVI).

Gibberellic acid signaling is required for ambient temperature-mediated induction of flowering in Arabidopsis thaliana.

Distinct molecular mechanisms integrate changes in ambient temperature into the genetic pathways that govern flowering time in Arabidopsis thaliana. Temperature-dependent eviction of the histone variant H2A.Z from nucleosomes has been suggested to facilitate the expression of FT by PIF4 at elevated ambient temperatures. Here we show that, in addition to PIF4, PIF3 and PIF5, but not PIF1 and PIF6, can promote flowering when expressed specifically in phloem companion cells (PCC), where they can induce FT and its close paralog, TSF. However, despite their strong potential to promote flowering, genetic analyses suggest that the PIF genes seem to have only a minor role in adjusting flowering in response to photoperiod or high ambient temperature. In addition, loss of PIF function only partially suppressed the early flowering phenotype and FT expression of the arp6 mutant, which is defective in H2A.Z deposition. In contrast, the chemical inhibition of gibberellic acid (GA) biosynthesis resulted in a strong attenuation of early flowering and FT expression in arp6. Furthermore, GA was able to induce flowering at low temperature (15°C) independently of FT, TSF, and the PIF genes, probably directly at the shoot apical meristem. Together, our results suggest that the timing of the floral transition in response to ambient temperature is more complex than previously thought and that GA signaling might play a crucial role in this process.

Oxochloroalkoxide of the Cerium (IV) and Titanium (IV) as oxides precursor

The Cerium (IV) and Titanium (IV) oxides mixture (CeO2-3TiO2) was prepared by thermal treatment of the oxochloroisopropoxide of Cerium (IV) and Titanium (IV). The chemical route utilizing the Cerium (III) chloride alcoholic complex and Titanium (IV) isopropoxide is presented. The compound Ce5Ti15Cl16O30 (iOPr)4(OH-Et)15 was characterized by elemental analysis, FTIR and TG/DTG. The X-ray diffraction patterns of the oxides resulting from the thermal decomposition of the precursor at 1000 °C for 36 h indicated the formation of cubic cerianite (a = 5.417Å) and tetragonal rutile (a = 4.592Å) and (c = 2.962 Å), with apparent crystallite sizes around 38 and 55nm, respectively.

L'Univers

1869/12/20 (Numéro 962).

Hannele

Soitinnus: lauluääni, piano.

Induction Motor Drive Energy Efficiency - Simulation and Analysis

A coupled system simulator, based on analytical circuit equations and a finite element method (FEM) model of the motor has been developed and it is used to analyse a frequency-converterfed industrial squirrel-cage induction motor. Two control systems that emulate the behaviour of commercial direct-torque-controlled (DTC) and vector-controlled industrial frequency converters have been studied, implemented in the simulation software and verified by extensive laboratory tests. Numerous factors that affect the operation of a variable speed drive (VSD) and its energy efficiency have been investigated, and their significance in the simulation of the VSD results has been studied. The dependency of the frequency converter, induction motor and system losses on the switching frequency is investigated by simulations and measurements at different speeds for both the vector control and the DTC. Intensive laboratory measurements have been carried out to verify the simulation results.

Bag-of-Features Approach to Unsupervised Visual Object Categorisation

The large and growing number of digital images is making manual image search laborious. Only a fraction of the images contain metadata that can be used to search for a particular type of image. Thus, the main research question of this thesis is whether it is possible to learn visual object categories directly from images. Computers process images as long lists of pixels that do not have a clear connection to high-level semantics which could be used in the image search. There are various methods introduced in the literature to extract low-level image features and also approaches to connect these low-level features with high-level semantics. One of these approaches is called Bag-of-Features which is studied in the thesis. In the Bag-of-Features approach, the images are described using a visual codebook. The codebook is built from the descriptions of the image patches using clustering. The images are described by matching descriptions of image patches with the visual codebook and computing the number of matches for each code. In this thesis, unsupervised visual object categorisation using the Bag-of-Features approach is studied. The goal is to find groups of similar images, e.g., images that contain an object from the same category. The standard Bag-of-Features approach is improved by using spatial information and visual saliency. It was found that the performance of the visual object categorisation can be improved by using spatial information of local features to verify the matches. However, this process is computationally heavy, and thus, the number of images must be limited in the spatial matching, for example, by using the Bag-of-Features method as in this study. Different approaches for saliency detection are studied and a new method based on the Hessian-Affine local feature detector is proposed. The new method achieves comparable results with current state-of-the-art. The visual object categorisation performance was improved by using foreground segmentation based on saliency information, especially when the background could be considered as clutter.

Influência do índice de massa corporal na incontinência urinária feminina

OBJETIVOS: avaliar e comparar os efeitos do índice de massa corporal (IMC) sobre severidade da incontinência urinária (IU) feminina por meio do questionário de qualidade de vida King's Health Questionnaire (KHQ), variáveis do estudo urodinâmico e dados da anamnese. MÉTODOS: estudo clínico transversal. Foram selecionados 65 pacientes com incontinência urinária de esforço (IUE) que foram divididas em três grupos: Grupo I (IMC entre 18 e 25 kg/m²); Grupo II (IMC entre 25 e 30 kg/m²) e Grupo III (IMC>30 kg/m²). Os domínios do KHQ foram comparados entre esses grupos. Além disso, alguns dados da anamnese e do estudo urodinâmico (presença de noctúria, enurese, urgência e urge-incontinência) foram também relacionados ao IMC calculando-se o OR (Odds Ratio). O IMC, na presença e na ausência de contrações não inibidas do detrusor, bem como no VLPP (valsalva leak point pressure) <60 ou >60 cmH2O foi avaliado. Por fim, foram realizados testes de correlação do IMC com os nove domínios do KHQ a fim de se evidenciar alguma associação. RESULTADOS: o KHQ foi incapaz de registrar, em qualquer um de seus domínios, deterioração da qualidade de vida das mulheres com IU na medida em que ocorreu elevação do IMC. Encontramos OR para a presença de enurese em relação ao IMC de 1,003 [IC: 0,897-1,121], valor p=0,962. Para a noctúria, o OR foi de 1,049 (IC: 0,933-1,18), valor p=0,425. O valor de OR=0,975 (IC: 0,826-1,151), valor p=0,762 foi encontrado para a urgência. No que se refere à urge-incontinência, encontrou-se OR=0,978 (IC: 0,85-1,126), valor p=0,76. Estudou-se o IMC nos grupos com e sem contrações não-inibidas do músculo detrusor e foram encontradas, respectivamente, medianas de 26,4±4,8 e 28,3±5,7 kg/m² (p=0,6). De forma semelhante, as medianas do IMC nos grupos com VLPP<60 e>60 cmH2O foram, respectivamente, de 29,6±4,1 e 27,7±5,7 kg/m² (p=0,2). Finalmente, não tivemos êxito em demonstrar associação do IMC com qualquer um dos nove domínios do KHQ por meio da correlação de Spearman. CONCLUSÃO: não houve associação dos escores do KHQ com o IMC. Também não houve correlação entre os parâmetros clínicos da anamnese e do estudo urodinâmico com o IMC.

Pukkilan liikenneturvallisuussuunitelma

Pukkilan liikenneturvallisuussuunnitelma laadittiin Pukkilan ja Mäntsälän kuntien sekä Uudenmaan ELY-keskuksen yhteistyönä. Suunnitelman laatimisen aikana kerättiin myös kuntalaisten näkemyksiä ja kokemuksia Mäntsälän liikenteestä ja liikkumisesta. Liikenneturvallisuussuunnitelma sisältää turvallisen ja kestävän liikkumisen periaatteet, vision ja tavoitteet sekä toimenpiteet turvallisen ja kestävän liikkumisen edistämiseksi ja parantamiseksi Pukkilassa. Liikenteen aiheuttamat onnettomuuskustannukset ovat yhteiskunnalle vuosittain noin 2–3 miljardin euron suuruiset. Kunnille aiheutuvat kustannukset ovat näistä noin 15–20 %. Laskelmaan sisältyvät sekä onnettomuuksien aineelliset vahingot että uhrien hyvinvoinnille aiheutuneet aineettomat menetykset. Pukkilassa on tapahtunut viimeisen viiden vuoden aikana keskimäärin 1,4 loukkaantumiseen johtanutta ja 4,2 omaisuusvahinkoon johtanutta liikenneonnettomuutta. Näiden laskennalliset kustannukset ovat olleet kunnalle noin 0,8 miljoonaa euroa. Pukkilalaisten liikkumistottumuksia, mielipiteitä ja liikenneturvallisuusongelmia kartoitettiin keväällä 2013 tehdyllä asukaskyselyllä. Liikenneturvallisuustilannetta selvitettiin lisäksi Pukkilan kunnan alueella vuosina 2007–2011 tapahtuneiden liikenneonnettomuuksien analyyseillä ja maastokäynneillä tehdyillä ongelmakohtien kartoituksilla. Lisäksi käytiin läpi ELY-keskukseen ja kunnalle tulleet liikenneturvallisuusaloitteet. Pukkilan liikenteen toimintaympäristön, liikenneturvallisuusongelmien sekä kuntalaisten liikkumistottumusten analysoinnin sekä valtakunnallisten ja Uudenmaan ELY-keskuksen liikenneturvallisuustavoitteiden pohjalta Pukkilaan määritettiin liikenneturvallisuusvisio sekä määrälliset ja toiminnalliset liikenneturvallisuustavoitteet. Pukkilan liikenneturvallisuusvision mukaan kunta tarjoaa tulevina vuosina turvallisen ja terveellisen elinympäristön, jossa ihmiset voivat liikkua monipuolisesti eri kulkutapoja hyödyntäen. Kenenkään ei tarvitse kuolla eikä loukkaantua vakavasti Pukkilan liikenteessä. Lisäksi liikkuminen koetaan turvalliseksi Pukkilassa ja se kehittyy kestävämpään suuntaan kuntalaisten viisaiden liikkumisvalintojen myötä. Fyysisen liikenneympäristön liikenneturvallisuuden parantamiseksi tehtiin toimenpide-esitykset yhteensä 41 kohteeseen. Toimenpiteet kohdistuvat Pukkilan keskusta-alueelle sekä haja-asutusalueille. Toimenpiteet jaettiin kiireellisyysluokittain kolmeen luokkaan ja niissä painotettiin nopeasti ja suhteellisen edullisesti toteutettavia toimenpiteitä. Toimenpiteistä on esitetty raportissa lyhyet yleiskuvaukset ja raportin liitteinä tarkemmat, helposti päivitettävissä olevat toimenpidekartat ja -taulukot. Toteuttamisohjelmaan sisältyvien toimenpiteiden kustannusarvio on noin 2,6 miljoonaa euroa. Kunnan itse tekemä hallintokuntakohtainen liikenneturvallisuustyön toimintasuunnitelma sisältää liikenneturvallisuuskasvatuksen, -tiedotuksen ja -valistuksen toimenpiteet tuleville vuosille. Toimenpiteitä kohdistetaan kaikille ikäryhmille sisällyttäen liikenneturvallisuustyö kuntien palveluihin ja osaksi hallintokuntien jokapäiväistä työtä. Liikenneturvallisuussuunnitelman toteuttamista seurataan kaupungin liikenneturvallisuustyöryhmässä, jonka kokoonpano muodostettiin työn aikana. Ryhmään kuuluvat kunnan eri hallintokuntien edustajien lisäksi Liikenneturvan, poliisin ja Uudenmaan ELY-keskuksen edustajat.

Mapping cancer, cardiovascular and malaria research in Brazil

This paper presents performance indicators for the Brazilian cancer, cardiovascular and malaria research areas from 1981 to 1995. The data show an increasing number of papers since 1981 and author numbers indicate a continuous growth of the scientific community and suggest an expected impact of scientific activity on biomedical education. The data also characterize cardiovascular research as a well-established area and cancer research as a faster growing consolidating field. The 1989-1994 share of Brazilian articles among world publications shows a growing trend for the cancer (1.61) and cardiovascular (1.59) areas, and a decrease for the malaria area (0.89). The burden of the three diseases on society is contrasted by the small number of consolidated Brazilian research groups, and a questionable balance of thematic activity, especially with regard to malaria. Brazilian periodicals play an important role in increasing the international visibility of science produced in the country. Cancer and cardiovascular research is strongly concentrated in the Southeastern and in Southern regions of Brazil, especially in São Paulo (at least one address from São Paulo in 64.5% of the 962 cancer articles and in 66.9% of the 2250 cardiovascular articles, the second state being Rio de Janeiro with at least one address in 14.1 and 11% of those articles, respectively). Malaria research (468 articles) is more evenly distributed across the country, following the pattern of the endemic distribution of the disease. Surveying these national indicator trends can be useful to establish policies in the decision process about health sciences, medical education and public health.