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Resume Les 2 et 3 juin 2021, une panne telephonique nationale affecte le fonctionnement des numeros d’urgence. L’analyse de l’activite des CRRA15 des huit SAMU d’Ile-de-France a montre (par rapport aux periodes de reference) une baisse du nombre d’appels au SAMU centre 15 et une diminution des dossiers de regulation medicale pendant la panne, suivie d’une augmentation 2 heures plus tard. Parallelement, il n’a pas ete observe de variation du nombre de sorties des SMUR, ni du nombre de patients accueillis dans les services d’urgences hospitaliers. Le faible impact observe peut etre explique par la nature partielle de la panne, mais aussi par la mise en place rapide par l’ARSIF et l’AP-HP d’une information destinee au public et d’une solution de contournement de la panne.

L’épidémie de COVID 19 a nécessité un renforcement en moyens techniques comme en personnel dans le cadre des activités de régulation médicale mais aussi pour les interventions pré hospitalières non médicalisées ou des SMUR. Ce renforcement a été adapté à l’évolution de l’activité. Au SAMU de Paris, l’activité a imposé le doublement des postes de régulation dès la deuxième semaine de mars afin de répondre à la fois aux appels habituels mais aussi à la demande liée au COVID. Des étudiants en médecine de diplôme de formation approfondie en sciences médicales (DFASM) de 1re, 2e et 3e années volontaires ont été mobilisés pour venir renforcer la régulation médicale et assurer les réponses au sein d’une salle supplémentaire installée pour répondre aux appels COVID. Seuls, les étudiants en médecine du 2ème cycle ont donc été intégrés à cette organisation, ils bénéficiant à leur arrivée d’une formation adaptée à leur niveau d’étude et aux fonctions à accomplir au sein de la régulation médicale et aussi tout au long de leur activité d’un encadrement par un médecin sénior de l’aide médicale d’urgence et /ou de la permanence des soins ambulatoires. Cette activité était donc sécurisée par des médecins séniors comme dans tout stage hospitalier. Cette organisation a contribué notamment à Paris, à la réponse à l’afflux des appels au SAMU. Ce renfort a ensuite été maintenu, aussi bien dans le cadre de la crise que dans l’activité quotidienne et dans le déploiement du Service d’Accès aux Soins (SAS).

Resume L’enseignement RMAT est une initiation courte a la prise en charge des victimes d’attentats terroristes pour les etudiants en medecine. Cet enseignement comporte aussi des notions d’organisation medicale en cas d’accident catastrophique ou de situation sanitaire exceptionnelle. Les auteurs rapportent le contenu, le deroulement et les modalites pratiques de cette formation originale qui a ete apprecie et a repondu aux attentes des etudiants du deuxieme cycle des etudes medicales dans un domaine qui n’est pas classiquement enseigne a ce stade de leurs etudes.

Residues obtained from hydrothermal liquefaction of municipality waste (MSWR) and coffee waste (CR) were blended with coal and charred at 1000 °C. Co-gasification experiments were conducted on the coal, MSWR, CR, and their respective blended chars using a thermogravimetric analyser. The reactivities of the char samples decreased in the order: MSWR > CR > MSWR-coal blend > CR-coal blend > coal. RPM was found to best predict the reaction profile of the coal, and the blended chars, except for the MSWR and CR chars, which fitted satisfactorily upon the application of the MRPM. The activation energies obtained using the RPM, MRPM, and the different reactivity models showed that the MSWR, CR, and the blend chars have lower activation energies when compared to the feed coal char. Although the MSWR and CR exhibited catalytic influence on the coal char during co-gasification, the synergistic effect was inhibitory with all determined SE

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 8 mai 2015

Purpose This retrospective study investigated 3-dimensional (3D) imaging with intraoperative Cone-Beam Computed Tomography (CBCT) in Mandibular Angle Fractures (MAF) treated by open reduction. The aim of this study was to demonstrate the image quality of intraoperative CBCT in this region and the benefit for the patients. Methods 83 patients with 86 MAF were included in this study. 8 patients were female and 75 male. Patient age ranged from 11 to 68 years (average age 26.8 years). All patients were examined with the mobile CBCT scanner ARCADIS Orbic 3D (Siemens Medical Solutions, Erlangen, Germany) directly after surgical treatment of the MAF. Results As a direct result of intraoperative CBCT four patients (5%) underwent intraoperative revision. The intraoperative acquisition of the data sets was uncomplicated and in all cases it was possible to effectively visualise and assess the MAF in 3D quality. Conclusion The results showed that intraoperative CBCT is a reliable imaging technique for real-time intraoperative assessment of treated MAF. Use of the mobile 3D CBCT scanner is easy to integrate into routine practice and offers the advantage that immediate revision surgery can be performed.

Gut dysfunction is suspected to play a major role in the pathophysiology of post-resuscitation disease through an increase in intestinal permeability and endotoxin release. However this dysfunction often remains occult and is poorly investigated. The aim of this pilot study was to explore intestinal failure biomarkers in post-cardiac arrest patients and to correlate them with endotoxemia.Following resuscitation after cardiac arrest, 21 patients were prospectively studied. Urinary intestinal fatty acid-binding protein (IFABP), which marks intestinal permeability, plasma citrulline, which reflects the functional enterocyte mass, and whole blood endotoxin were measured at admission, days 1-3 and 6. We explored the kinetics of release and the relationship between IFABP, citrulline and endotoxin values.IFABP was extremely high at admission and normalized at D3 (6668 pg/mL vs 39 pg/mL, p=0.01). Lowest median of citrulline (N=20-40 μmol/L) was attained at D2 (11 μmol/L at D2 vs 24 μmol/L at admission, p=0.01) and tended to normalize at D6 (21 μmol/L). During ICU stay, 86% of patients presented a detectable endotoxemia. Highest endotoxin level was positively correlated with highest IFABP level (R(2)=0.31, p=0.01) and was inversely correlated with lowest plasma citrulline levels (R(2)=0.55, p0.001). Endotoxin levels increased between admission and D2 in patients with post-resuscitation shock, whereas it decreases in patients with no shock (median +0.33 EU vs -0.19 EU, p=0.03). Highest endotoxin level was positively correlated with D3 SOFA score (R(2)=0.45, p=0.004).Biomarkers of intestinal injury are altered after cardiac arrest and are associated with endotoxemia. This could worsen post-resuscitation shock and organ failure.

Objective Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms. Design A descriptive study of barriers to intervention delivery in a controlled trial. Settings The study was conducted in six nursing homes in Maryland. Participants Participants were 89 agitated nursing home residents with dementia. Intervention Personalized interventions were developed using the Treatment Routes for Exploring Agitation decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined. Measurements Barriers to Intervention Delivery Assessment, activities of daily living, cognitive functioning, depressed affect, pain, observed agitation, and observed affect. Results Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, whereas higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment. Conclusion Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery.

Background Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy. Objective The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement. Methods Participants were 193 residents of 7 Maryland nursing with a diagnosis of dementia. Stimulus engagement was assessed via the Observational Measure of Engagement, measuring duration, attention, and attitude to the stimulus. Twenty-five stimuli were presented, which were categorized as live human social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. Results All stimuli elicited significantly greater engagement in comparison to the control stimulus. In the multivariate model, music significantly increased engagement duration, whereas all other stimuli significantly increased duration, attention, and attitude. Significant environmental variables in the multivariate model that increased engagement were: use of the long introduction with modeling (relative to minimal introduction), any level of sound (especially moderate sound), and the presence of between 2 and 24 people in the room. Significant personal attributes included Mini-Mental State Examination scores, activities of daily living performance and clarity of speech, which were positively associated with higher engagement scores. Conclusions Results are consistent with the Comprehensive Process Model of Engagement. Personal attributes, environmental factors, and stimulus characteristics all contribute to the level and nature of engagement, with a secondary finding being that exposure to any stimulus elicits engagement in persons with dementia.

Objective To assess nursing home physicians’ and social workers’ perceptions of the new Maryland Patient Plan of Care Form (PPOC). Design Mailed survey. Setting Nursing homes in Maryland. Participants Thirty-seven physicians and 60 social workers. Measurements Views of physicians and social workers were assessed through quantitative questions about the use of the PPOC form and qualitative questions about barriers in completing the form and recommendations to improve the form. Results The majority (79.2%) of physicians and social workers reported that completing the PPOC is somewhat of a major burden. An overwhelming majority (85.6%) reported that social workers are completing the form, while close to half of the physicians and a quarter of the social work respondents say that physicians are involved in completing the form. Moreover, significantly more social workers (63.3%) than physicians (36.7%) believe the form would be more useful as a physician’s order ( X 2 = 5.287; d f = 1; P = .021). Both physicians and social workers identify barriers to completing the form and offer recommendations to improve the form. Conclusions Despite legislation requiring physicians to sign the PPOC, it is not a physician’s order, thus shifting the burden of completing the PPOC to social workers. We conclude that most physicians and social workers view the PPOC as burdensome and do not feel that it is useful, but whether it is having an effect on patient care preferences merits further investigation.

We have studied the chemical modification and functionalization of the surface of hydrogenated amorphous silicon (a-Si:H) and silicon suboxides (a-SiO x :H) for the purpose of selective cell adhesion. The preparation of hydrophobic/hydrophilic contrast on the amorphous surfaces has been investigated systematically as a function of the oxygen content by contact angle measurements. Successful functionalization of a-Si:H by hydrosilylation with methyl acrylate is reported and analyzed by thermal desorption studies as well as enzyme linked immunosorbent assays using RGD-peptide derivatives.

Resume La mise en place d’une assistance circulatoire de type circulation extracorporelle (CEC) chez un patient en arret cardiaque refractaire doit etre effectuee le plus precocement possible, afin d’optimiser son pronostic en particulier sur le plan neurologique. Mais dans le meme temps, la reanimation cardiopulmonaire specialisee doit etre poursuivie, afin de ne pas compromettre les chances de reprise d’une activite cardiaque spontanee. Nous rapportons le cas d’un patient en arret cardiaque refractaire pris en charge dans le metropolitain parisien, et dont le transfert jusqu’a l’hopital a ete effectue dans la rame de metro elle-meme. Ce mode de transport original a permis de continuer de maniere optimale la reanimation specialisee durant le transfert du patient, et ainsi d’obtenir une reprise d’activite cardiocirculatoire spontanee avant son arrivee dans le service receveur.

A prospective cohort study was conducted to examine predictors of mortality in the nursing home. Participants were 399 long-term nursing home residents, who were followed up for 11 years at the end of which 380 had died, 16 were still alive, 2 were discharged with unknown status, and 1 was alive when discharged. The median duration from baseline to death was 2.75 years. For cognitively intact residents, male gender, larger number of medical diagnoses, and manifestations of physically nonaggressive agitated behaviors (e.g., restlessness, pacing) were significant predictors. For cognitively impaired residents, the significant predictors were older age, impaired activities of daily living, and screaming behavior at a high frequency. Cognitive impairment is important both in predicting death in this population and in understanding the impact of other predictors. The impact of agitated behaviors, quality of social relations, and appetite on mortality highlights issues of quality of life at the end of life.

The friction and wear behavior of sliding bearings made from high temperature thermoplastics was investigated to determine the possibility of dry sliding applications. A test apparatus for plain bearing testing was designed and built to enable load, speed, and temperature to be controlled and temperature, friction and wear to be continuously monitored. Bulk material bearings (polyaryletherketone-based composites and neat polybenzimidazole) and metal-thermoplastic compound bearings with a sliding layer of polyetheretherketone were investigated. Their suitability for dry sliding bearing applications was assessed using the values of friction coefficient, wear rate and friction induced temperature. In general, the operating performance is mainly influenced by the operating conditions and the precise construction of the bearing. A fiber reinforcement of the thermoplastic matrix is necessary at high loads, whereas it is unnecessary at low loads. A further increase of the operational limits is made possible by improving the heat conduction from the contact area, as comparison with results of pin-on-disk investigations indicates. The materials tested provide operation of dry sliding bearings to temperatures over 200°C.

A prospective study of vision-related outcomes of cataract surgery as well as cognitive functioning, activities of daily living (ADL) functioning, and depressed affect was conducted with 19 nursing home residents scheduled for cataract surgery. Also studied were 22 candidates for cataract surgery who decided against it. Comparison of both groups at baseline revealed that residents who chose cataract surgery were less cognitively and ADL impaired. Analysis after cataract surgery showed that visual acuity improved significantly at 4 months and was maintained at 1 year after surgery.

Chronic pain patients and the physicians who treat them may have differing assessments of pain and the affect of treatment on their pain. The use of the Subject’s Global Assessment (SGA) and Physician’s Global Assessment (PGA) in clinical trials allows patients and physicians to assess pain with a standardized questionnaire during treatment. A phase-3 withdrawal study assessing 12-hour extended-release hydrocodone/ acetaminophen (HC/APAP CR) treatment in chronic low-back pain (CLBP) consisted of the following periods: Washout/Screening, 3-week Active-Drug Open-Label (OL), 12-week Double-Blind (DB), in which subjects were randomized to placebo, 1 or 2 tablets HC/APAP CR twice daily, and Taper/Follow-up. Primary endpoint results and study design details are reported elsewhere. Subject’s (SGA) and physician’s (PGA) global assessment of Back Pain Status are reported here. Subjects’ assessment of their Back Pain Status was evaluated using a 5-point categorical scale (ranges: very good to very poor). Physician’s assessment of subject’s back pain was evaluated based on a 5-point categorical scale (ranges: very mild to very severe). Both measures were evaluated at the OL-baseline, DB-baseline, week-2, week-6, and week-12 visits. At weeks 2, 6 and 12, statistically significantly greater proportions of subjects in the HC/APAP CR 2-tablet group assessed their CLBP favorably on the SGA compared with subjects in the placebo group. Additionally, statistically significantly greater proportions of subjects in the HC/APAP CR 1-tablet group assessed their CLBP favorably, at weeks 6 and 12, on the SGA compared with subjects in the placebo group. Similarly the distribution of PGA scores at weeks 2, 6, and 12, was statistically significantly superior for each HC/APAP CR treatment group compared to the placebo treatment group. Global assessments of CLBP status, as rated by both subjects and physicians, were more favorable in the both HC/APAP CR groups compared with the placebo group. Funded by Abbott Laboratories.

We recorded steady-state (4.19 and 8.41 Hz) VEPs in 17 Parkinson's Disease (PD) patients and 18 control observers using on-off temporal modulation of a 2.3 c/deg sinusoidal grating. With 4.19 Hz, 20 out of 33 PD patient eyes had abnormal VEPs. However, only 8 of 33 eyes were abnormal with 8.41 Hz. "Routine" (counterphase) transient VEPs revealed delayed VEPs for only 7 out of 24 eyes of the patients. These findings suggest an "input" temporal frequency-dependent abnormality in the foveal pathway.

Heart morphology in the small freshwater teleost, Japanese Medaka, (oryzias latipes) was studied by light and electron microscopy. Particular attention was directed to the three heart layers, epicardium, myocardium, and endocardium in the atrial and ventricular portions of the organ. The trabeculae originate and insert into the myocardial wall forming many complex anastomoses and interdigitations. The entire ventricle is trabeculated giving the chamber a “spongy” appearance; the atrium is less extensively trabeculated. The epicardial layer forms an outer covering over the organ and is composed of simple squamous epithelial cells. The myocardial cells of the trabeculae have small diameters but extend for considerable distances. The myofibrils usually are located peripherally, while the nucleus, mitochondria, and other cellular organelles are located centrally. The myofibrils exhibit a typical vertebrate structure with distinct A-bands, I-bands, and Z-lines; H-zones are discernible but appear less prominent than in higher vertebrates. Intercalated disks have fasciae adherentes and maculae adherentes (desmosomes) as component parts. Although a distinct T-system is absent, prominent subsarcolemmal cisternae are located in the I-band areas and there is a moderately well-developed sarcoplasmic reticulum. The endocardium is composed of a continuous layer of cells that appear to be metabolically very active. Filling the cytoplasm of these cells are large numbers of rough endoplasmic reticulum cisternae and associated mitochondria, vesicles containing amorphous material, and large round bodies with consistencies varying from dense to amorphous to filamentous.