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The implementation of Industry 4.0 technologies suggests significant impacts on production systems productivity and decision-making process improvements. However, many manufacturers have difficulty determining to what extent these various technologies can reinforce the autonomy of teams and operational systems. This article addresses this issue by proposing a model describing different types of autonomy and the contribution of 4.0 technologies in the various steps of the decision-making processes. The model was confronted with a set of application cases from the literature. It emerges that new technologies' improvements are significant from a decision-making point of view and may eventually favor implementing new modes of autonomy. Decision-makers can rely on the proposed model to better understand the opportunities linked to the fusion of cybernetic, physical, and social spaces made possible by Industry 4.0.

Introduction/Background Several studies suggest that oncological surgery induce an acute inflammatory response, and that it may exacerbate certain mechanisms related to tumor growth and eventual dissemination. We propose to investigates whether the administration of Ketorolac (Taradyl)®, a nonsteroidal anti-inflammatory drug, given intraoperatively during surgery for ovarian, tubal, or peritoneal cancer, influences disease free survival (DFS) and Overall survival (OS). Methodology A Retrospective analysis of all the patients operated at Cliniques Universitaires Saint-Luc; Brussel between 2015 and 2017 for ovarian, fallopian tube or peritoneum cancer. All the patient were included from the UCLouvain Network of Gynaecological Oncology (UNGO), an academic network in Belgium for centralisation of the surgery for ovarian cancer patient. Results Of the 90 patients who met the inclusion criteria, 68% received Ketorolac intraoperatively. Only age was statistically different between the two groups (p Conclusion These results suggest that the intraoperative administration of Ketorolac during surgery for ovarian, tubal or peritoneal cancer has a positive effect on the risk of recurrence and median survival. Disclosure Nothing to disclose.

Samples of Cs2LiYCl6 :Ce (CLYC) scintillator have been characterized using monoenergetic neutron beams in the energy range 4.1–5.5 MeV. Four crystals with dimensions (thickness×diameter) of 1″×1″, 1″×2″, and 2″×2″ were evaluated, including one crystal with natural concentrations of Li isotopes and three that were enriched in 6 Li. The intrinsic efficiency of CLYC for fast-neutron detection has been determined for the natural-Li crystal. These measurements were translated into reaction cross-sections, and show good agreement with available cross-section data for neutron interactions with the 35Cl component of CLYC. Furthermore, it is shown that the charged-particle energy released in the fast-neutron reactions on 35 Cl varies linearly with the energy of the incoming neutron. These results verify the efficacy of CLYC for fast-neutron spectroscopy in a range of applications.

Most children with cystic fibrosis (CF) show persisting steatorrhoea even when treated with pancreatic enzyme. As a low duodenal pH could be responsible for this persisting fat loss, we evaluated the effects of a proton-pump inhibitor (lansoprazole) on both steatorrhoea and growth parameters in 15 CF patients, aged 3.1-22.6 y. Acid steatocrit, anthropometry and dual-energy X-ray absorptiometry were used to evaluate steatorrhoea and the nutritional status before, during and 3 months after stopping lansoprazole treatment (15 mg/d for 3 months). Mean +/- SD acid steatocrit values decreased from 37.1 +/- 8.8% to 28.5 +/- 10.6% (p = 0.02). Significant mean Z-score improvements were found for weight (+0.14; p = 0.02), height (+0.15; p = 0.03), subscapular (+0.61; p = 0.003), supra-iliac (+0.8; p = 0.002) and the sum of the four measured skinfolds (+0.61; p = 0.002). Z-scores deteriorated again after stopping lansoprazole. Fat mass and bone mineral content increased significantly on lansoprazole (p = 0.008 and p = 0.005, respectively). We conclude that lansoprazole as adjuvant therapy significantly improves both steatorrhoea and the nutritional status in CF children who maintain steatorrhoea while on pancreatic enzymes.

We have developed a dynamic gamma-ray emission image reconstruction method called MVIR (Moving Voxel Image Reconstruction) for lane detection in multilane portal monitor systems. MVIR was evaluated for use in the Fixed Site Detection System (FSDS), a prototype three-lane gamma-ray portal monitor system for EZ-pass toll plazas. As a baseline, we compared MVIR with a static emission image reconstruction method in analyzing the same real and simulated data sets. Performance was judged by the distributions of image intensities for source and no-source vehicles over many trials as a function of source strength. We found that MVIR produced significantly better results in all cases. The performance difference was greatest at low count rates, where source/no-source distributions were well separated with the MVIR method, allowing reliable source vehicle identification with a low probability of false positive identifications. Static emission image reconstruction of the same data produced overlapping distributions that made source vehicle identification unreliable. The performance of the static method was acceptable at high count rates. Both algorithms reliably identified two strong sources passing through at nearly the same time.

Objective To describe the epidemiology of Guyana9s road traffic injuries and perform the first geocoding of road traffic injuries in this setting. Methods This was a registry-based retrospective cross-sectional study investigating collisions resulting in serious and fatal injuries. Police reports from two police divisions were used to identify victim, second party (ie, non-victim) and collision characteristics of all serious and fatal collisions between January 2012 and June 2015. Collisions with available location data were geocoded using Geographic Information Systems. Distributions of characteristics were compared for urban and rural areas. Multivariable logistic regression was used to assess variables associated with fatal collisions. Results The study included 751 collisions, resulting in 1002 seriously or fatally injured victims. Fatally injured victims tended to be older, male and either pedestrians or cyclists. Fatal collisions tended to take place in rural areas, occur on weekends and involve speeding. Fifty-three per cent of fatalities occurred due to non-motorised road users being struck by motorised road users, and the most common fatal collision type was between pedestrians and motor vehicles (35%). The distribution of collisions was similar for urban (43.8%) and rural (56.2%) areas. Fatal collisions were more likely to occur in rural settings. Conclusions Road traffic injuries pose a considerable public health burden in Guyana. These results suggest a pattern of high mortality in rural collisions and a disproportionate burden of injuries on vulnerable road users. The spatial distribution of collisions should be considered in order to target interventions and improve road traffic safety.

Perioperative inflammation is now considered not only as a therapeutic target but is also included in new screening strategies, patient stratification, preoperative optimization, especially in cancer, and also in the frail patient at risk of infectious and ischemic complications.

Resume Objectifs Estimer le danger auditif collectif d’une exposition a des bruits industriels. Methodes L’indicateur tardif audio-sonometrique (ITAS) est un score global suggere pour suivre la perte auditive de groupes d’ouvriers exposes a des bruits lesionnels en fonction : du niveau d’exposition quotidienne au bruit, LEX,8h en dB(A) ; du deficit audiometrique individuel a 3 kHz (PAM 3 kHz : en dB) ; de la PAM0 3 kHz ciblee lors de la retraite ; et des classes d’âge quinquennales (ou decennale) entre 50 ans et 59 ans. ITAS = PAM0 − PAM 3 kHz + 10 log (âge − 20) − 10 log (0,23 × LEX,8h − 17,36). Resultats Quand un LEX,8h depasse 80 dB(A) et que la PAM0 3 kHz a ete fixee a 25 dB, une surveillance audiometrique occasionnelle pourrait etre proposee a des travailleurs exposes a des bruits impulsifs dangereux, par exemple si les valeurs mediane et moyenne de l’ITAS devenaient inferieures a 20 pour les hommes et a 23 pour les femmes (valeurs seuils indicatives). Conclusion Ainsi, ce modele exponentiel admet qu’une exposition quotidienne a des bruits impulsifs puisse etre plus nocive pour l’audition que celle a un bruit continu d’energie equivalente durant huit heures.

Treating chronic neuropathic pain remains a challenge, despite the existing therapies. Recent years have seen the emergence of promising new technologies, such as the neurostimulation of the dorsal root ganglion (DRG). In the present article, we review the clinical evidence for the efficacy and safety of DRG neurostimulation in the treatment of chronic pain. While the results from a number of small observational studies are promising, it is not yet possible to conclude on the long-term effectiveness and safety of DRG stimulation and it is too early to recommend its widespread use outside of a research protocol. To improve the level of proof, larger randomized controlled trials are needed. These should include well-described populations, a sufficiently long follow-up and a detailed description of concurrent treatments (pharmacologic and patient integration in a multidisciplinary approach).

This paper presents a sea spray generation function for aerosols produced by bubbles bursting that accounts for the effects of fetch. This is achieved by introducing a fetch-dependent model for the whitecap fraction, which is valid for fetch-limited conditions, i.e. steady-state conditions of the wave field in the whitecap droplet flux derived by Monahan et al. (1986). The aerosol generation fluxes calculated by this method show an enhancement of the aerosol production with increasing fetch. However, the predicted generation fluxes are lower than those calculated by using the classical model for the whitecap fraction proposed by Monahan and O’Muircheartaigh (1980). The results are then compared to aerosol size distributions measured in a Mediterranean coastal site at various fetch lengths. The data confirm the role of fetch, through its influence on marine aerosol generation and subsequent particle dispersion. The aerosol size distributions are divided into "fine" and "coarse" fractions. Submicrometer particles decrease in concentration at larger fetch, while the concentrations of super micron aerosols increase with increasing fetch.Key words. Atmospheric composition and structure (aerosols and particles) Meteorology and atmospheric dynamics (waves and ties) Oceanography: physical (air-sea interactions)

Tetrahydrobiopterin-responsive phenylalanine hydroxylase deficiency in Dutch neonates.Spaapen LJ, Bakker JA, Velter C, Loots W, Rubio-Gonzalbo ME, Forget PP, Dorland L, De Koning TJ, Poll-The BT, Ploos van Amstel HK, Bekhof J, Blau N, Duran M.Department of Biochemical Genetics, Stichting Klinische Genetica Zuid-Oost Nederland, Maastricht. leo.spaapen@gen.unimaas.nlFour neonates with a positive phenylalanine screening test (Phe concentrations between 258 and 1250 micromol/L) were investigated further to differentiate between phenylalanine hydroxylase (PAH) deficiency and variant hyperphenylalaninaemia (HPA) forms. In patients 1 and 2 a tetrahydrobiopterin (BH4) load caused a significant decrease of the plasma Phe levels. A combined phenylalanine/BH4 loading test was performed in patients 2, 3 and 4. In the latter two patients, plasma Phe concentrations completely normalized within 8 h after the BH4 load (20 mg/kg). Basal urinary pterins were normal in all four patients. The activity of dihydropteridine reductase (DHPR) was normal in patients 1, 2 and 3 and 50% of control values in patient 4 (not in the range of DHPR-deficient patients). In patient 3 a subsequent phenylalanine loading test with concomitant analysis of plasma biopterins revealed a normal increase of biopterin, excluding a BH4 biosynthesis defect. Pterins and neurotransmitter metabolites in CSF of patients 1, 3 and 4 were normal. DNA mutations detected in the PAH gene of patients 1-4 were A313T, and L367fsinsC; V190A and R243X; A300S and A403V; R241C and A403V. The results are suggestive for mutant PAH enzymes with decreased affinity for the cofactor BH4.

Acid steatocrit during infancy.Van den Neucker A, Forget P, Veneberg JA, Schutten BJ, van Kreel B.Department of Paediatrics and Chemistry, University Hospital of Maastricht, The Netherlands.The faecal acid steatocrit is an improved steatocrit method for the evaluation of faecal fat. The present study was set up in order to establish reference values during the first year of life. Faecal acid steatocrit values were determined in 58 healthy full term and in 16 healthy prematurely born infants. Very high acid steatocrit results (above 60%) were found in all premature and many formula-fed term infants during the first 6 months of age, thereafter with values below 10%. In 40- to 120-day-old infants acid steatocrit results of human milk-fed infants were significantly lower than those of formula-fed infants (p < 0.01). We conclude that high acid steatocrit results after the age of 6 months are indicative of fat malabsorption, while before this age high values can be due to "physiological steatorrhoea". The acid steatocrit should be useful for the evaluation of milk fat absorption in infants.

Background Intimate partner violence (IPV) is prevalent throughout the world and is a devastating public health problem. Healthcare workers (HCWs) are tasked with treating victims of IPV but may be victims themselves. Guyana is a lower-middle income country in South America. This study sought to determine the knowledge and attitudes of Guyanese HCWs and their perceived barriers to providing care in addition to determining the prevalence of IPV victimization and perpetration among HCWs. Methods HCWs at the only tertiary care hospital in the Guyana completed an anonymous survey that comprised 30 questions relating to IPV. Results The survey was completed by 87.5% of eligible HCWs. Of the respondents, 81.8% were female, 49.9% had ever experienced abuse and 21% admitted to perpetrating violence. Multivariate analysis found that the age groups 31-40 years (OR 2.3, 95% CI 1.1-4.6) and 41-50 years (OR 2.3, 95% CI 1.2-4.7) had higher odds of accepting justification for physical violence, and so did nursing staff (OR 4.3, 95% CI 1.4-13.1). Overall, 29.9% of HCWs accepted justification for physical violence in at least one of the named scenarios. Conclusion This study demonstrates a high prevalence of IPV among HCWs and identifies prevailing attitudes regarding IPV. This knowledge is essential in developing effective, appropriate training programs and identifies a need to address IPV among the healthcare workforce. Language: en

A comparative experimental and FEM study has been carried out, in order to investigate dynamic and constraint aspects of the Charpy test. Standard V-notch Charpy specimens were tested under dynamic and static loading conditions. 2-D plane strain and 3-D models were employed in numerical analysis. In order to incorporate strain-rate effects, an elastic-viscoplastic constitutive equation has been applied, based on actual test data obtained for a low-alloy structural steel. Fully dynamic analysis clearly indicated inertial effects. Modal analysis enabled the confirmation of the origin of the oscillations on the load–displacement curve as beam vibration of the specimen resulting from interaction with the elastic striker.

In mice, immunological adaptation of the gut to microbial and nutritional antigens occurs at weaning in parallel with biochemical and morphological maturation. Because oral administration of spermine to neonatal rats has been shown to induce biochemical and morphological maturation, we investigated whether spermine also affects maturation of the mucosal immune system.Swiss mice 7, 12, and 27 days old were given spermine orally (0.5 mumol/g body weight) during 3 days. Intestinal length was measured, and lactase and sucrase activities were determined. The phenotype of intraepithelial and lamina propria lymphocytes was assessed by FACS analysis using markers for CD3, TCR alpha beta, TCR gamma delta, CD4, CD8 alpha, CD8 beta, CD5, CD18, CD54, and CD49d.Similar to what occurs during natural development, spermine treatment of neonatal mice increased intestinal length, decreased lactase activity, and increased sucrase activity. The percentage of intraepithelial lymphocytes expressing TCR alpha beta, CD4, CD5, and CD54, as well as the levels of expression of these antigens, increased after spermine treatment on day 12, similarly to natural maturation. The increase in expression of CD3, TCR gamma delta, CD18, and CD49d did not reach statistical significance. No effect was observed on CD8 expression. The phenotype of lamina propria lymphocytes was not affected. Spermine administration to 7- and 27-day-old mice had no effect on the phenotype of either intraepithelial or lamina propria lymphocytes.Oral spermine administration to neonatal mice induced, in parallel with biochemical maturation, precocious maturation of the murine intestinal immune system and particularly affected differentiation of the intraepithelial lymphocyte population.

Laser beams provide a highly concentrated energy source that can easily be transmitted and manipulated using fibre optics and other optical cOlnponents such as mirrors. Advantages of laser treatment of componentsinclude: lowdistortion of treated parts; the ability to treat specific areas accurately; flexibility compared with, for example, electron beams; and the ability to conduct treatlnent in air or in inert or reactive gases. Apart fr01n cutting and welding, the first application in the Inaterials field was for heat treatment and involved laser surface hardening in the solid state, based on the heating of a thin sUlface layer that was self quenched by the bulk of the cOlnponent. Numerous further treatments have since been developed that involve melting of the surface layer, with or without addition of material, and more recently purely mechanical processes based on the laser shock phenomenon have emerged. The main laser processes that have already been commercialised or are expected shortlyto b...

Background With the recent growth of fellowships in international emergency medicine, the authors sought to evaluate medical students’ attitudes toward international emergency medicine and to determine the effects these attitudes have on their residency selection. Methods Study design: Cross-sectional survey. Data collection: An anonymous, eight-question online survey was distributed to all members of the American Academy of Emergency Medicine Resident and Student section. This survey was also distributed to fourth-year medical students rotating through the Emergency Department at Los Angeles County and the University of Southern California. Results Ninety-eight surveys were collected, 61 from rotating students and 37 from the AAEM mailing. There were no statistically significant differences in responses between the two groups. Of the respondents, 49.4% of have been exposed to IEM, and 46.9% have participated in international health projects. Ninety-four percent agree that IEM is an exciting career option. Seventy-nine percent said programs with IEM opportunities are more appealing than those without, and 45% said the presence of IEM opportunities would be an important factor in rank list; 53% believe that IEM requires formal public health training, and 63% believe it requires tropical medicine training; 68.3%of respondents speak a language in addition to English. This subset was more likely to have participated in IEM projects previously (p = 0.026) but not more likely to make match choices based on IEM. Conclusions Half of medical students surveyed had prior experience in international health, and most agree that international emergency medicine is an exciting career option. Over two thirds believe that the presence of IEM opportunities will be a factor in their match list decision.

Growth of tumors can accelerate during the peri-operative period. Accordingly, early relapse of cancer occurs in some patients during the first two postoperative years. Temporal and biologic analyses of cancer pathophysiology suggest a link between peri-operative pathophysiological changes and acceleration of tumor growth. Understanding the role of inflammation and its consequences (i.e., immune response, growth factors, dissemination of tumor cells) could lead to define a role of anesthesiologists in reducing cancer recurrence following surgery. We argue for peri-operative pharmacological interventions to reduce cancer relapse, with a focus on non-steroidal anti-inflammatory drugs.

Le traitement de “grenaillage photonique” par choc laser vise à écrouir un matériau et à y introduire des contraintes résiduelles de compression en vue d'améliorer ses propriétés mécaniques. Dans le cas de superalliages aéronautiques à base de nickel, on attend une augmentation de la tenue en fatigue. On traite ici de la déformation induite par le choc grâce à une étude microstructurale fondée sur l'observation des microreliefs de surface dans la zone traitée. Ceux-ci sont interprétés comme le résultat de l'évolution cristallographique du matériau soumis au choc. Les phénomènes de glissement, sont, en particulier, précisément identifiés. Plus généralement, les hétérogénéités de surface dans les différentes parties de l'impact sont expliquées à la lumière de résultats sur la propagation des ondes de détente de surface et sur la création de contraintes résiduelles. Deux superalliages à base de nickel, l'AM1 monocristallin et l'Inconel 718 polycristallin, ont été étudiés.

Introduction: Academic departments of emergency medicine are becoming increasingly involved in assisting with the development of long-term emergency medicine training programs in low and middle-income countries. This article presents our 10-year experience working with local partners to improve emergency medical care education in Guyana. Methods: The Vanderbilt Department of Emergency Medicine has collaborated with the Georgetown Public Hospital Corporation on the development of Emergency Medicine skills followed by the implementation of an emergency medicine residency training program. Residency development included a needs assessment, proposed curriculum, internal and external partnerships, University of Guyana and Ministry of Health approval, and funding. Results: In our experience, we have found that our successful program initiation was due in large part to the pre-existing interest of several local partners and followed by long-term involvement within the country. As a newer specialty without significant local expertise, resident educational needs mandated a locally present full time EM trained attending to serve as the program director. Both external and internal funding was required to achieve this goal. Local educational efforts were best supplemented by robust distance learning. The program was developed to conform to local academic standards and to train the residents to the level of consultant physicians. Despite the best preparations, future challenges remain. Conclusion: While every program has unique challenges, it is likely many of the issues we havefaced are generalizable to other settings and will be useful to other programs considering or currentlyconducting this type of collaborative project. [West J Emerg Med. 2013;14(5):477–481.]

The combination of Pleth Variability Index (PVI) and passive leg raising (PLR)-induced pulse pressure variation may help to diagnose hypovolemia in spontaneously breathing patients. In 44 subjects, PVI and Pulse Pressure (PP) variation after PLR were measured before and after induced hypovolemia (blood gift or hemodialysis session). PVI values were significantly greater after hemodialysis session or blood gift (22% vs 18%, P = 0.03); in contrast PP variation did not change significantly (7% vs 4%, P = 0.49). The accuracy of these parameters or of their combination to identify the "after hypovolemia induction" period was weak. In spontaneous ventilation, PVI value is greater after induced hypovolemia, whereas PP variation does not change significantly. The combination of PVI and PLR does not improve the accuracy of the detection of induced hypovolemia.

Incidence and clinical manifestation of cow's milk protein intolerance (CMPI) were studied in 1158 unselected newborn infants followed prospectively from birth to 1 year of age. No food changes were required in 914 infants who were used as healthy controls. When CMPI was suspected (211 infants), diagnostic dietary interventions according to a standard protocol were performed. After exclusion of lactose intolerance, two positive cow's milk elimination/challenge tests were considered diagnostic of CMPI. Two hundred and eleven symptomatic infants were examined for possible CMPI. A large group of 80 infants improved on a lactose reduced formula. In 87/211 infants CMPI was excluded (sick controls). Finally CMPI was proven in 26 infants. The calculated incidence rate for CMPI was 2.8%. The principal symptoms in infants with CMPI were gastrointestinal, dermatological and respiratory in 50%, 31% and 19% respectively. A positive family history for atopy (first or second degree relatives) was more frequent in either CMPI infants (65%), or sick controls (63%) when compared to either healthy controls (35%) or infants improving on a low lactose formula (51%). Differences between patients with CMPI and sick controls were only found for the presence of atopy in at least 2 first degree relatives [(5/26 in CMPI infants and 4/87 in sick controls (P

OBJECTIVES: To assess the collective hearing hazard entailed by occupational noise exposure. METHODS: The Late Audio-Sonometric Index (LASI) is a global score recommended for following up hearing loss in groups of workers exposed to traumatic noise, combining: daily noise exposure level (L(EX,8h) in dB(A)); individual hearing threshold level at 3kHz (HTL (3kHz) in dB); HTL(0)(3)(kHz) targeted at retirement; and 5 (or 10) years age bracket between 50 and 59 years of age. LASI=HTL(0)(3kHz) - HTL (3kHz)+10 log (age - 20) - 10 log (0.23×L(EX,8h) - 17.36). RESULTS: When L(EX,8h) exceeds 80dB(A) and HTL(0)(3kHz) is at 25dB, occasional audiometric surveillance may be recommended for workers exposed to hazardous impulse noise: e.g., should the median and the mean LASI values fall below 20 for men or 23 for women (indicative threshold values). CONCLUSION: This exponential model thus integrates the fact that daily exposure to impulse noise may be more harmful for hearing than eight hours exposure to continuous noise of equivalent energy. Language: en

The ground wave propagation of VHF radio waves over an inhomogeneous sea surface of variable conductivity and under various sea roughness conditions is studied both theoretically and experimentally. Theoretical simulations predict a high sensitivity of the ground wave attenuation factor upon large variations of the surface conductivity, as can be found in an estuary. This sensitivity can be influenced appreciably by the sea state under high winds in fetch-limited conditions and under a broader range of wind speeds for a fully developed sea. Results from a VHF radar experiment over a river plume with appropriate in situ documentation are reported here. They validate the theoretical expectations on the influence of the conductivity profile on radio wave propagation. Because of the low winds encountered, the wind/wave influence is evident only on the variations of the radar cross-section coefficient (linearly related to Bragg wave spectral energy) in fetch-limited conditions. Also, these variations can be attributed in some cases to the influence of slicks in the river plume. The study suggests that the VHF radar technique may be used for remote sensing of sea surface conductivity.

Department of Pediatrics, University Hospital, Maastricht, The Netherlands.Magnetic resonance cholangiopancreaticography (MRCP) was used to visualize the biliary tract in two children, aged 7 weeks and 10 years, with a choledochal cyst. MRCP was successful in both cases and the findings were confirmed by intraoperative cholangiography.

We report the successful use of nasal intermittent positive pressure ventilation (NIPPV) in the perioperative period of a 51 yr-old woman with a type II spinal muscular atrophy (SMA II). The patient was treated chronically with nocturnal NIPPV at home and scheduled for endoscopic retrograde cholangiopancreatography (ERCP) under general anesthesia. Some criteria of difficult intubation were present (forced mouth opening of 1.5 cm, short neck and thyromental distance of 5 cm). Nasal endotracheal fiberoptic intubation during spontaneous breathing under sedation with propofol was performed. The ERCP procedure was conducted without complications. At the end of the procedure, IPPV was maintained until recovery of respiratory function. After extubation, NIPPV was continued in the recovery room. The patient was discharged from the post-anesthesia care unit 4 hours after the procedure. Management of patients with SMA remains a challenge and clinicians must be aware that the use of NIPPV may be a useful and life-saving tool in the perioperative period for these patients.

The objective of this multicentre, randomised, open-label, general practice (GP) study was to evaluate the efficacy and tolerability of cefprozil (Cefzil(trade mark), Bristol-Myers Squibb) compared with that of cefuroxime axetil (Ceftin((R)), Glaxo Wellcome) in the treatment of adult subjects with acute sinusitis. Typical of the GP setting, diagnosis was made based solely on clinical signs and symptoms of acute disease. Sinus radiography was performed post-randomisation. A total of 381 adolescent and adult patients were randomly assigned to 10 days' treatment with either cefprozil, 500mg orally twice daily (n = 191), or cefuroxime axetil, 250mg orally twice daily (n = 190). Based on predefined criteria, treatments were found to be equally effective in terms of proportions of patients in the per-protocol population that were cured, improved or failed (p = 0.20). Similar results were observed when the evaluation was performed on the subset of patients with radiographic evidence of sinusitis and when the evaluation was based on the investigator's judgement. Similar rates of adverse events were observed in the two treatment groups. In summary, cefprozil 500mg twice daily is as well tolerated and as effective as cefuroxime axetil 250mg twice daily for the treatment of adolescent and adult patients with clinical signs and symptoms of acute sinusitis.

Small bowel permeability was investigated in 87 children with recurrent abdominal pain by measuring the 24-h urinary excretion of orally administered 51Cr-EDTA. The mean excretion was 3.64% +/- 1.49% per 24 h. The difference between the mean urinary excretion in children with recurrent abdominal pain and control children (2.51% +/- 0.70%), was significant (p less than 0.01, two sample t-test). The increased small bowel permeability in children with recurrent abdominal pain might indicate an intestinal etiology for the patients' complaints.

Making use of ({sup 51}Cr)EDTA as a permeability marker, we measured intestinal permeability in a group of 20 children with proven cow's milk intolerance (CMI), a group of 17 children with similar complaints where CMI was excluded (sick controls), and a group of 12 control children. ({sup 51}Cr)EDTA test results (mean +/- SD) were 6.85 +/- 3.64%, 3.42 +/- 0.94%, and 2.61 +/- 0.67% in the group with CMI, the sick control, and the control group, respectively. When compared to both control groups, patients with cow's milk intolerance (CMI) showed a significantly increased small bowel permeability. We conclude that the ({sup 51}Cr)EDTA test can be helpful for the diagnosis of cow's milk intolerance.

Laser shock surface treatment could be envisaged to harden and induce compressive stresses within materials thus improving their fatigue and fretting-fatigue resistance. Both laser beam optical phe...

The performance and operational feasibility of the very high frequency (VHF) COSMER pulsed Doppler radar have been demonstrated in a region dominated by strong tidal currents. The VHF COSMER system was deployed in the Normand Breton Gulf (France) for the EPEL program, supported by the French Navy. Comparisons of ocean radial currents are made between these from COSMER system and these from an in situ instrument. We also made comparisons with currents simulated by the numerical model TELEMAC 2D. This paper presents results of the analysis. Preliminary results of wind direction estimation are also presented, using a cos/sup s/ model.

The signature of the Gulf of Lions (GoL) surface dynamics by SeaWiFS measurements of chlorophyll (Chl) is addressed in this paper. A chain of three nested models based on the MARS-3D code is used to simulate the Northwestern Mediterranean Sea circulation. This modeling network allows to resolve the GoL dynamics taking into account the influence of the general basin circulation (Northern Current). A good qualitative agreement between Chl and modeled salinity fields was generally obtained. From SeaWiFS images and according to the model results, the Rho/spl circ/ne water masses can follow the coasts to the west of the river mouth or can be expelled southward in the western part of the GoL. Along the continental slope, the Northern Current (NC) channels the Rho/spl circ/ne river dispersion plume up to the Catalan coasts. In bloom condition the localization of the oligotrophic vein corresponds accurately to the NC position. Small scale dynamics observed on chlorophyll fields are generally reproduced by the model. However they can be misplaced on MARS-3D results because of the difficulties to simulate these small scale processes and the too coarse resolution of wind forcing. Finally, the quantitative pixel/pixel comparisons between the Chl fields and the computed surface salinity fields show a high scattering due to the misplacement of features. Nevertheless, two clear trends was observed, corresponding to the southwestward and the along coast direction of the Rho/spl circ/ne river plume.

To assess energy requirements and body composition in preoperative children with congenital heart disease (CHD).In 11 infants with CHD (2-8 mo), total daily energy expenditure (TDEE) and total body water (TBW) were measured with doubly labelled water and compared with historic data from healthy controls. Within the patient group, energy expenditure of infants with versus those without congestive heart failure was compared. Subsequently, the data were pooled with literature data in meta-analyses.CHD patients showed increased TBW (mean +/- SD 66 +/- 3 vs 58 +/- 5% of body weight, p0.05) and energy expenditure (381 +/- 42 vs 298 +/- 36 kJ kg(-1) d(-1), p0.001). Meta-analyses showed that CHD infants have 35% increased TDEE (376 vs 278 kJ kg(-1) d(-1) , p0.00001) and 7% higher TBW (p0.0001). Coexistent congestive heart failure (treated with diuretics) had no influence on TDEE (mean difference 14 kJ kg(-1) d(-1) , not significant). In patients with heart failure and growth retardation, an energy balance study showed an average 12% loss of initially ingested energy due to vomiting, increased TDEE and low faecal energy loss, resulting in low energy available for growth, compared with controls (42 +/- 30 vs 96 +/- 61 kJ kg(-1) d(-1) , p0.05).Many infants with CHD require substantially higher energy intake (at least 100 kJ kg(-1) d(-1) extra) owing to increased TDEE, which is not explained by a higher percentage of body water. Coexistent heart failure does not appear to have an additional influence on TDEE. In infants with CHD and growth failure factors other than elevated TDEE, including vomiting, may explain the disturbed energy balance.

The monitoring of neutron induced embrittlement of nuclear power plants is provided using Charpy impact test in the surveillance program. However structural integrity assessments require the fracture toughness. Some empirical formulas have been developed but no direct relationship was found. The aim of our study is to determine the fracture toughness of a Reactor Pressure Vessel steel from instrumented Charpy impact test using local approach to fracture. This non-empirical method has been applied in the brittle domain as well as in the ductile to brittle transition for an A508 C1.3 steel. In the brittle domain, fracture occurs by cleavage and can be modeled with the Beremin model. Fracture toughness has been successfully determined from Charpy impact tests results and the influence of several parameters (mesh design, Beremin model with one or two parameters, number of Charpy impact tests results) on the results was considered. In the ductile to brittle transition, cleavage fracture is preceded by ductile crack growth. Ductile tearing has been accounted for in the simulations with the Rousselier model whereas cleavage fracture is still described with the Beremin model. The determination of fracture toughness from Charpy impact tests gave encouraging results but finite element simulations have to be refined in order to improve predictions.Copyright © 2003 by ASME

Addresses the study of coastal swells by SAR imagery. The principles for the determination of swell parameters from image data are recalled. Then, the author presents results on swell events observed by ERS1 off Arguin Bank (Mauritania). These results are analyzed and compared with estimates from the wave prediction model of Meteofrance and from a model of swell propagation in finite-depth water. The study leads the author to conclude that SAR can be considered as a quasi-operational instrument for swell monitoring, and that scientific applications, in addition to economical applications, can henceforth be envisaged. >

Three methods for mapping swell in the coastal zone from SAR imagery are presented. The first one gives accurate large scale estimates of swell wavenumber and wave height, the second one maps the swell crests and small scale wave height variations, and the last method produces filtered and calibrated images of SAR swell modulation using recursive wavelet transforms. Comparisons of SAR-derived parameters and wave modelling results are shown for three experimental cases. A good agreement is generally found. However imagery artefacts occur when swell shortens and deviates from the range direction as it propagates over varying topography.

Three satellite images, two SAR and one SPOT have been processed using fast Fourier transform analysis in order to provide swell wave length fields in a shallow water area (70 to 10 m water depth) off the Arcachon inlet (France). Three corresponding bathymetries have been obtained assuming conservation of the wave period. These fields compare well with a large scale reference bathymetry for the main features. They are of course more noisy, especially the SPOT bathymetry, but part of the differences corresponds to real structures such as series of humps and hollows perturbing the 40-m isobath revealed on a more detailed bathymetry.

This study compared the acid steatocrit (AS) results of healthy children with those of sick children with and without gastrointestinal involvement. Stool samples of 166 children were investigated, comprising 50 healthy children, 26 asthma patients, and 90 patients with gastrointestinal problems divided into 34 treated cystic fibrosis (CF) patients with exocrine pancreatic insufficiency, 16 untreated coeliac disease (CD) patients and 40 patients with various gastrointestinal problems. The median values (5th-95th percentile) of AS results were 3.3% (0.0-21%) for healthy children, 4.5% (1.8-22.5%) for asthma patients, 24.7% (2.6-68.2%) for treated CF patients with exocrine pancreatic insufficiency, 19.8% (3-77.7%) for untreated CD patients and 5.5% (1.8-29%) for patients with various gastrointestinal diseases.The AS results of treated CF patients with exocrine pancreatic insufficiency and untreated CD patients were similar and significantly higher than those of healthy children and asthma patients. AS can be considered to be a reliable tool in screening for steatorrhoea in paediatric patients.

Femtosecond x-ray and visible pulses were used to probe structural and electronic dynamics during an optically driven, solid-solid phase transition in VO(2). For high interband electronic excitation (approximately 5 x 10(21) cm(-3)), a subpicosecond transformation into the high-T, rutile phase of the material is observed, simultaneous with an insulator-to-metal transition. The fast time scale observed suggests that, in this regime, the structural transition may not be thermally initiated.

SUMMARY. In this prospective open study of 14 children with cystic fibrosis (CF), we evaluated the effect of 1 year adjuvant therapy with lansoprazole, a proton pump inhibitor (PPI), on growth, fecal fat loss, body composition and lung function. Only stable patients with pancreatic insufficiency were included, and their data were compared to those of a large Dutch pediatric normal reference population. During the use of the PPI, mean weight and height did not change significantly, while body mass index improved (P0.05). An immediate significant and persistent reduction of fecal acid steatocrit (P0.05) was demonstrated. Compared to normal Dutch children, the CF patients showed significantly decreased standard deviation scores (SDS) for total body fat (TBF, -0.966) and fat-free mass (FFM, -1.826). Under lansoprazole, TBF improved significantly (P0.05), while mean FFM remained unchanged. A significant improvement in total lung capacity (P0.05), residual volume (P = 0.055), and maximal inspiratory mouth pressure (P = 0.002) was also demonstrated. Hyperinflation tended to decrease during the use of a PPI. Daily recordings of peak expiratory flow (PEF) showed a maximal diurnal variability of 28% of recent best PEF and minimal morning PEF of 72% of recent best PEF, confirming that bronchial hyperresponsiveness is increased in CF. We conclude that adjuvant therapy with lansoprazole in young CF patients with persistent fat malabsorption, decreased fat losses and improved total body fat. Lung hyperinflation decreased, which may partly explain the improvement in inspiratory muscle performance. The simultaneous improvements in body composition and lung hyperinflation suggest a relationship between these two parameters. Further research is necessary to confirm such a relationship and to elucidate the mechanisms involved.

Summary form only given. We present the progress in the optimization of laser produced plasma sources, specifically aimed the 4-5 keV X-ray energy range, using Ti and Ta wire and plane targets. Two table-top Chirped Pulse Amplification (CPA) laser systems were used: the INRS CPA laser (Nd:glass second harmonic @532 nm, 400 fs, 400 mJ, high pulse/pedestal contrast ratio, low repetition rate), and the UCSD CPA laser (Ti:sapphire @800 nm, 30 fs, 100 mJ 20 Hz repetition rate). The spectra of the emitted radiation were analyzed by the combination of a curved Si crystal spectrometer and an X-ray CCD camera arrangement. The PX-1 X-ray streak camera of INRS has also been used to follow the time history of multi-keV X-ray emission with subpicosecond temporal resolution. Comparison of the data collected with the two systems (INRS vs. UCSD) suggests the important role of the pre-pulse in achieving the maximum yield in a particular emission wavelength range. The pulse duration of the excitation pulses also has a strong effect in controlling the hot electron production processes in the rapidly expanding solid density plasma. Preliminary experiments on static absorption spectra of iodine at the L-III edge gave important data (photon statistics, signal-to-noise ratio) for designing future time-resolved EXAFS experiments based on laser produced X-ray sources.

Over a period of 4 years, 88 infants with cow's milk protein intolerance (CMPI) were followed prospectively in order to evaluate the persistence of CMPI and its relationship between either serum IgE levels or RAST results for cow's milk. After exclusion of lactose intolerance, two positive cow's milk elimination challenge tests were considered diagnostic for CMPI. At the age of 1, 2, 3 and 4 years respectively, 85%, 78%, 49% and 33% of the children still were cow's milk intolerant. Initial serum values of IgE greater than or equal to 10 kU/l indicated a late development of tolerance to cow's milk proteins. At the age of 4 years, 90% of infants with initial IgE levels less than 10 kU/l had become tolerant to cow's milk while this was the case for only 47% of infants with initial IgE levels greater than or equal to 10 kU/l. Initial RAST results for cow's milk bore no obvious relationship to outcome.

Elevated NO production mediated by activation of the enzyme iNOS is thought to play a central role in the development of tissue damage observed during septic shock. IFN-gamma, TNF-alpha and IL-10 have been shown to be involved in the regulation of LPS-induced serum levels of the NO-oxidation products nitrate and nitrite. Therefore, in the present study, we investigated the role of endogenous IFN-gamma, TNF-alpha and IL-10 in the regulation of LPS-induced tissue iNOS expression in the major organs. To this end, mice were pre-treated with anti-IFN-gamma, anti-TNF-alpha, anti-IL-10 monoclonal antibodies, or combinations of these, two hours before intraperitoneal LPS-challenge. Immunohistochemical staining for iNOS and determination of iNOS activity indicated that iNOS expression was mainly upregulated in the small intestine, lung and heart, and that IFN-gamma, TNF-alpha as well as IL-10 are involved in the regulation of iNOS expression and enzyme activity. Whereas blocking either IFN-gamma or TNF-alpha did not affect iNOS expression, iNOS enzymatic activity seems to be inhibited. In contrast, blocking both mediators nearly completely prevents iNOS expression after LPS challenge, suggesting that the presence of either IFN-gamma or TNF-alpha is essential for LPS-induced iNOS expression in these organs. Combined treatment of these monoclonal antibodies revealed that whereas on the one hand IL-10 inhibits LPS-induced iNOS expression, on the other hand IL-10 or an IL-10 inducible factor is also involved in the upregulation of iNOS expression after LPS challenge.