515 resultados para Consentement éclairé


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Title on added t.p. in Arabic: Kitāb Musābaqat al-barq wa-al-ghamām fī suʻāt al-ḥamām.

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Clair de lune.--Un coup d'état.--Le loup.--L'enfant.--Conte de Noél.--La reine Hortense.--Le pardon.--La légende du Mont-Saint-Michel.--Une veuve.--Mademoiselle Cocotte.--Les bijoux.--Apparition.--La porte.--Le père.--Moiron.--Nos lettres.--La nuit (cauchemar).

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Mode of access: Internet.

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Introduction : Les nourrissons, vu la grande compliance de leur cage thoracique, doivent maintenir activement leur volume pulmonaire de fin d’expiration (VPFE). Ceci se fait par interruption précoce de l’expiration, et par le freinage expiratoire au niveau laryngé et par la persistance de la contraction des muscles inspiratoires. Chez les nourrissons ventilés mécaniquement, notre équipe a montré que le diaphragme est activé jusqu’à la fin de l’expiration (activité tonique). Il n’est pas clair si cette activité tonique diaphragmatique compense pour l’absence de freinage laryngé liée à l’intubation endotrachéale. Objectif : Notre objectif est de déterminer si l’activité tonique diaphragmatique persiste après l’extubation chez les nourrissons et si elle peut être observée chez les enfants plus âgés. Méthode : Ceci est une étude observationnelle longitudinale prospective de patients âgés de 1 semaine à 18 ans admis aux soins intensifs pédiatriques (SIP), ventilés mécaniquement pour >24 heures et avec consentement parental. L’activité électrique du diaphragme (AEdi) a été enregistrée à l’aide d’une sonde nasogastrique spécifique à 4 moments durant le séjour aux SIP : en phase aigüe, pré et post-extubation et au congé. L’AEdi a été analysée de façon semi-automatique. L’AEdi tonique a été définie comme l’AEdi durant le dernier quartile de l’expiration. Résultats : 55 patients avec un âge médian de 10 mois (écart interquartile: 1-48) ont été étudiés. Chez les nourrissons (<1an, n=28), l’AEdi tonique en pourcentage de l’activité inspiratoire était de 48% (30-56) en phase aigüe, 38% (25-44) pré-extubation, 28% (17-42) post-extubation et 33% (22-43) au congé des SIP (p<0.05, ANOVA, avec différence significative entre enregistrements 1 et 3-4). Aucun changement significatif n’a été observé pré et post-extubation. L’AEdi tonique chez les patients plus âgés (>1an, n=27) était négligeable en phases de respiration normale (0.6mcv). Par contre, une AEdi tonique significative (>1mcv et >10%) a été observée à au moins un moment durant le séjour de 10 (37%) patients. La bronchiolite est le seul facteur indépendant associé à l’activité tonique diaphragmatique. Conclusion : Chez les nourrissons, l’AEdi tonique persiste après l’extubation et elle peut être réactivée dans certaines situations pathologiques chez les enfants plus âgés. Elle semble être un indicateur de l’effort du patient pour maintenir son VPFE. D’autres études devraient être menées afin de déterminer si la surveillance de l’AEdi tonique pourrait faciliter la détection de situations de ventilation inappropriée.

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Introduction : Les nourrissons, vu la grande compliance de leur cage thoracique, doivent maintenir activement leur volume pulmonaire de fin d’expiration (VPFE). Ceci se fait par interruption précoce de l’expiration, et par le freinage expiratoire au niveau laryngé et par la persistance de la contraction des muscles inspiratoires. Chez les nourrissons ventilés mécaniquement, notre équipe a montré que le diaphragme est activé jusqu’à la fin de l’expiration (activité tonique). Il n’est pas clair si cette activité tonique diaphragmatique compense pour l’absence de freinage laryngé liée à l’intubation endotrachéale. Objectif : Notre objectif est de déterminer si l’activité tonique diaphragmatique persiste après l’extubation chez les nourrissons et si elle peut être observée chez les enfants plus âgés. Méthode : Ceci est une étude observationnelle longitudinale prospective de patients âgés de 1 semaine à 18 ans admis aux soins intensifs pédiatriques (SIP), ventilés mécaniquement pour >24 heures et avec consentement parental. L’activité électrique du diaphragme (AEdi) a été enregistrée à l’aide d’une sonde nasogastrique spécifique à 4 moments durant le séjour aux SIP : en phase aigüe, pré et post-extubation et au congé. L’AEdi a été analysée de façon semi-automatique. L’AEdi tonique a été définie comme l’AEdi durant le dernier quartile de l’expiration. Résultats : 55 patients avec un âge médian de 10 mois (écart interquartile: 1-48) ont été étudiés. Chez les nourrissons (<1an, n=28), l’AEdi tonique en pourcentage de l’activité inspiratoire était de 48% (30-56) en phase aigüe, 38% (25-44) pré-extubation, 28% (17-42) post-extubation et 33% (22-43) au congé des SIP (p<0.05, ANOVA, avec différence significative entre enregistrements 1 et 3-4). Aucun changement significatif n’a été observé pré et post-extubation. L’AEdi tonique chez les patients plus âgés (>1an, n=27) était négligeable en phases de respiration normale (0.6mcv). Par contre, une AEdi tonique significative (>1mcv et >10%) a été observée à au moins un moment durant le séjour de 10 (37%) patients. La bronchiolite est le seul facteur indépendant associé à l’activité tonique diaphragmatique. Conclusion : Chez les nourrissons, l’AEdi tonique persiste après l’extubation et elle peut être réactivée dans certaines situations pathologiques chez les enfants plus âgés. Elle semble être un indicateur de l’effort du patient pour maintenir son VPFE. D’autres études devraient être menées afin de déterminer si la surveillance de l’AEdi tonique pourrait faciliter la détection de situations de ventilation inappropriée.

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Bayesian Belief Networks (BBNs) are emerging as valuable tools for investigating complex ecological problems. In a BBN, the important variables in a problem are identified and causal relationships are represented graphically. Underpinning this is the probabilistic framework in which variables can take on a finite range of mutually exclusive states. Associated with each variable is a conditional probability table (CPT), showing the probability of a variable attaining each of its possible states conditioned on all possible combinations of it parents. Whilst the variables (nodes) are connected, the CPT attached to each node can be quantified independently. This allows each variable to be populated with the best data available, including expert opinion, simulation results or observed data. It also allows the information to be easily updated as better data become available ----- ----- This paper reports on the process of developing a BBN to better understand the initial rapid growth phase (initiation) of a marine cyanobacterium, Lyngbya majuscula, in Moreton Bay, Queensland. Anecdotal evidence suggests that Lyngbya blooms in this region have increased in severity and extent over the past decade. Lyngbya has been associated with acute dermatitis and a range of other health problems in humans. Blooms have been linked to ecosystem degradation and have also damaged commercial and recreational fisheries. However, the causes of blooms are as yet poorly understood.

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Banana bunchy top is regarded as the most important viral disease of banana, causing significant yield losses worldwide. The disease is caused by Banana bunchy top virus (BBTV), which is a circular ssDNA virus belonging to the genus Babuvirus in the family Nanoviridae. There are currently few effective control strategies for this and other ssDNA viruses. “In Plant Activation” (InPAct) is a novel technology being developed at QUT for ssDNA virus-activated suicide gene expression. The technology exploits the rolling circle replication mechanism of ssDNA viruses and is based on a unique “split” gene design such that suicide gene expression is only activated in the presence of the viral Rep. This PhD project aimed to develop a BBTV-based InPAct system as a suicide gene strategy to control BBTV. The BBTV-based InPAct vector design requires a BBTV intergenic region (IR) to be embedded within an intron in the gene expression cassette. To ensure that the BBTV IR would not interfere with intron splicing, a TEST vector was initially generated that contained the entire BBTV IR embedded within an intron in a β-glucuronidase (GUS) expression vector. Transient GUS assays in banana embryogenic cell suspensions indicated that cryptic intron splice sites were present within the IR. Transcript analysis revealed two cryptic intron splice sites in the Domain III sequence of the CR-M within the IR. Removal of the CR-M from the TEST vector resulted in an enhancement of GUS expression suggesting that the cryptic intron splice sites had been removed. An InPAct GUS vector was subsequently generated that contained the modified BBTV IR, with the CR-M (minus Domain III) repositioned within the InPAct cassette. Using transient histochemical and fluorometric GUS assays in banana embryogenic cells, the InPAct GUS vector was shown to be activated in the presence of the BBTV Rep. However, the presence of both BBTV Rep and Clink was shown to have a deleterious effect on GUS expression suggesting that these proteins were cytotoxic at the levels expressed. Analysis of replication of the InPAct vectors by Southern hybridisation revealed low levels of InPAct cassette-based episomal DNA released from the vector through the nicking/ligation activity of BBTV Rep. However, Rep-mediated episomal replicons, indicative of rolling circle replication of the released circularised cassettes, were not observed. The inability of the InPAct cassette to be replicated was further investigated. To examine whether the absence of Domain III of the CR-M was responsible, a suite of modified BBTV-based InPAct GUS vectors was constructed that contained the CR-M with the inclusion of Domain III, the CR-M with the inclusion of Domain III and additional upstream IR sequence, or no CR-M. Analysis of replication by Southern hybridisation revealed that neither the presence of Domain III, nor the entire CR-M, had an effect on replication levels. Since the InPAct cassette was significantly larger than the native BBTV genomic components (approximately 1 kb), the effect of InPAct cassette size on replication was also investigated. A suite of size variant BBTV-based vectors was constructed that increased the size of a replication competent cassette to 1.1 kbp through to 2.1 kbp.. Analysis of replication by Southern hybridisation revealed that an increase in vector size above approximately 1.5 - 1.7 kbp resulted in a decrease in replication. Following the demonstration of Rep-mediated release, circularisation and expression from the InPAct GUS vector, an InPAct vector was generated in which the uidA reporter gene was replaced with the ribonuclease-encoding suicide gene, barnase. Initially, a TEST vector was generated to assess the cytotoxicity of Barnase on banana cells. Although transient assays revealed a Barnase-induced cytotoxic effect in banana cells, the expression levels were sub-optimal. An InPAct BARNASE vector was generated and tested for BBTV Rep-activated Barnase expression using transient assays in banana embryogenic cells. High levels of background expression from the InPAct BARNASE vector made it difficult to accurately assess Rep-activated Barnase expression. Analysis of replication by Southern hybridisation revealed low levels of InPAct cassette-based episomal DNA released from the vector but no Rep-mediated episomal replicons indicative of rolling circle replication of the released circularised cassettes were again observed. Despite the inability of the InPAct vectors to replicate to enable high level gene expression, the InPAct BARNASE vector was assessed in planta for BBTV Rep-mediated activation of Barnase expression. Eleven lines of transgenic InPAct BARNASE banana plants were generated by Agrobacterium-mediated transformation and were challenged with viruliferous Pentalonia nigronervosa. At least one clonal plant in each line developed bunchy top symptoms and infection was confirmed by PCR. No localised lesions were observed on any plants, nor was there any localised GUS expression in the one InPAct GUS line challenged with viruliferous aphids. The results presented in this thesis are the first study towards the development of a BBTV-based InPAct system as a Rep-activatable suicide gene expression system to control BBTV. Although further optimisation of the vectors is necessary, the preliminary results suggest that this approach has the potential to be an effective control strategy for BBTV. The use of iterons within the InPAct vectors that are recognised by Reps from different ssDNA plant viruses may provide a broad-spectrum resistance strategy against multiple ssDNA plant viruses. Further, this technology holds great promise as a platform technology for the molecular farming of high-value proteins in vitro or in vivo through expression of the ssDNA virus Rep protein.

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Substance misuse is common in early psychosis, and impacts negatively on outcomes. Little is known about effective interventions for this population. We report a pilot study of brief intervention for substance misuse in early psychosis (Start Over and Survive: SOS), comparing it with Standard Care (SC). Twenty-five in-patients aged 18-35 years with early psychosis and current misuse of non-opioid drugs were allocated randomly to conditions. Substance use and related problems were assessed at baseline, 6 weeks and 3, 6 and 12 months. Final assessments were blind to condition. All 13 SOS participants who proceeded to motivational interviewing reported less substance use at 6 months, compared with 58% (7/12) in SC alone. Effects were well maintained to 12 months. However, more SOS participants lived with a relative or partner, and this also was associated with better outcomes. Engagement remained challenging: 39% (16/41) declined participation and 38% (5/13) in SOS only received rapport building. Further research will increase sample size, and address both engagement and potential confounds.

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Over the last decade, brief intervention for alcohol problems has become a well-validated and accepted treatment, with bried interventions frequently showing equivalence in terms of outcome to more extended treatments (Bien et al, 1993). A recent review of this studies found that heavy drinkers who received interventions of less than 1 h were almost twice as likely to moderate their drinking over the following 6-12 months as did those not receiving intervention (Wilk etal, 1997).Some studies have used motivational interviewing (MI) strategies (Monti et al, 1999); others have simply given information ajnd advice to reduce drinking (Fleming et al, 1997). Leaflets or information on strategies to assist in the attempt or follow-up sessions are sometimes provided (Fleming et al, 1997). In general practice research, provision of one or more follow-up sessions increases the reliability of intake reductions across studies (Poikolainen, 1999).