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This study investigates the joint impact of facade geometry and associated sunlight patterns on occupant subjective perception and physiological responses through a novel experimental method coupling physically-based simulations shown in virtual reality with a wearable biometric device. A total of 72 subjects participated in a study combining three facade configurations of an equal aperture ratio with different scenarios of space use (a social or working context). The facade variations –a non-uniform distribution of openings (“Irregular”), a uniform distribution of openings (“Regular”) and venetian blinds (“Blinds”)– were applied to an interior scene with clear sky and direct sun penetration. Subjective evaluations (how pleasant, interesting, and exciting the space was perceived) and physiological responses (heart rate and skin conductance) were collected during exposure to facade variations, while a neutral scene was used to record baseline physiological responses. Results revealed that facade and sunlight pattern geometry significantly influenced subjective responses for both context scenarios, while subsequent analyses showed differences mostly between the Irregular and Regular conditions, with the former being evaluated more positively. Facade and sunlight pattern geometry affected heart rate responses, but not skin conductance responses. In particular, participants showed a larger decrease in heart rate while exposed to the Irregular condition compared to the Blinds. Context scenarios influenced evaluations of interest and excitement. Findings are particularly relevant for applications in architecture and lighting, demonstrating that facade elements and their interaction with light can influence occupant subjective and physiological responses, and showcasing the potential of the presented method for investigating human perception.

A small number of psychiatric inpatients displays a large proportion of Violent Behaviors (VB). These can have a major impact on both victims and patients themselves. This study explored personal, situational and institutional risk factors and their combined effects, which could lead to repetitive VB (three or more assaults). Data from 4518 patients, aged 18 to 65, admitted to an acute psychiatric care facility, were included in the analysis. VB, defined as physical aggressions against another person, were assessed by the Staff Observation Aggression Scale-Revised. 414 VB were reported during the study period, involving 199 patients. 0.75 % of all patients were repetitively violent and committed 43% of all VB. Factors that were linked to repetitive VB were living in sheltered housing before hospitalization, suffering from schizophrenia with substance abuse comorbidity, cumulating hospitalization days and some situational factors, like the fact of being in nursing offices and pharmacies. When all personal, situational and institutional factors were considered together, the combined effects of length of stay and living in sheltered housing increased the risk of repetitive VB. We have identified a small group of vulnerable patients for whom new modalities of inter-institutional networking should be developed to prevent repetitive VB.

Traitement du diverticule de Zenker par diverticulopexie C. Brigand, K. Bajcz, H. Elamrani, S. Dan, S. Rohr C. Meyer Introduction : Le diverticule de Zenker est une pathologie rare, dont le traitement de reference est chirurgical, sans qu’il y ait de consensus sur la technique. Differentes options sont envisageables : chirurgie ouverte avec resection ou pexie, associees a une myotomie du muscle cricopharynge, et traitement endoscopique avec diverticulostomie œsophagienne. Le but de l’etude est une analyse retrospective de la morbidite et des recidives apres diverticulopexie par rapport a la diverticulectomie. Patients et methode : Trente-six patients operes entre 1988 et 2006, ont ete inclus dans cette etude. Sept patients ont eu une diverticulectomie sans myotomie, 11 une resection avec myotomie et 18 une diverticulopexie avec myotomie. Resultats : Dans le groupe diverticulectomie sans myotomie sont survenues 1 fistule et 1 recidive, de meme que dans le groupe diverticulectomie avec myotomie. Aucune complication n’est survenue dans le groupe diverticulopexie. La realimentation a ete plus precoce et la duree d’hospitalisation plus courte apres diverticulopexie. Conclusion : La myotomie cricopharyngee associee a une diverticulopexie est une technique fiable, efficace et reproductible pour les diverticules de taille moyenne. La diverticulectomie serait plutot a reserver aux diverticules de plus de 5 cm. La technique de diverticulostomie trans-orale doit encore etre amelioree avant d’etre diffusee.

Resume But de l'etude. – Etudier l'efficacite a long terme du traitement laparoscopique du reflux gastro-œsophagien. Patients et methodes. – Entre le 1er janvier 1992 et le 31 decembre 1996, 161 patients etaient operes pour un reflux gastro-œsophagien (RGO) par une fundoplicature laparoscopique complete ou partielle ; les techniques utilisees etaient la fundoplicature complete de Nissen-Rossetti (123 cas) ou de Nissen (26 cas) et la fundoplicature partielle de type Toupet (12 cas) ; le recul minimal etait de cinq ans. Cent quarante et un patients ont ete suivis a trois mois, deux ans et cinq ans ; il y avait quatre deces de causes non reliees a la chirurgie et 16 perdus de vue (10 %). Une pHmetrie et une manometrie ont ete realisees en preoperatoire et a trois mois de distance. A deux ans et a cinq ans la reevaluation etait realisee par un questionnaire telephonique. Resultats. – La mortalite postoperatoire etait nulle, la morbidite de 1,2 % et le taux de conversion de 5 %. La dysphagie postoperatoire etait de 23,4 % a trois mois et de 12 % a cinq ans. Les recidives a cinq ans etaient de 12 %. Conclusion. – Le taux global de satisfaction subjective etait de 91,4 % a cinq ans. L'intervention de Nissen-Rossetti enregistre les meilleurs resultats a cinq ans, en terme de dysphagie postoperatoire et de recidive.

INTRODUCTION Zenker's diverticulum is an unusual condition. Its treatment requires surgery but there is no consensus regarding the various operative techniques. Through an open cervical approach, the diverticulum can be either resected or suspended with or without a concurrent myotomy of the cricopharyngeus muscle. An innovative option is endoscopic trans-oral stapled esophago-diverticulostomy. PATIENTS and method: We retrospectively reviewed a consecutive series of 36 patients operated on between 1988 and 2006. Median age was 77.5 years and M/F sex ratio was 1.4. Through an open neck approach, diverticulectomy without cricopharyngeal myotomy was performed in 7 patients, diverticulectomy with myotomy in 11, and diverticulopexy with myotomy in 18. RESULTS Morbidity rate was 13.8%. One fistula and one recurrence occurred in both diverticulectomy groups with and without myotomy. There was no morbidity after suspension diverticulopexy which also allowed earlier oral feeding (1 vs. 6 days) and shortened hospitalization (6 vs. 13.5 days). CONCLUSION Diverticulopexy with cricopharyngeus myotomy is an effective, reliable, and reproducible technique for the correction of Zenker's diverticula smaller than 5 cm. Diverticulectomy should be reserved for larger diverticula. Technical improvements of transoral stapled diverticulostomy are still required before it can be promoted as an alternative therapy.