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Background Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The post-intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families. Objectives To report on engagement with non-critical care providers and survivors during the 2012 Society of Critical Care Medicine post-intensive care syndrome stakeholder conference. Task groups developed strategies and resources required for raising awareness and education, understanding and addressing barriers to clinical practice, and identifying research gaps and resources, aimed at improving patient and family outcomes. Participants Representatives from 21 professional associations or health systems involved in the provision of both critical care and rehabilitation of ICU survivors in the United States and ICU survivors and family members. Design Stakeholder consensus meeting. Researchers presented summaries on morbidities for survivors and their families, whereas survivors presented their own experiences. Meeting outcomes Future steps were planned regarding 1) recognizing, preventing, and treating post-intensive care syndrome, 2) building strategies for institutional capacity to support and partner with survivors and families, and 3) understanding and addressing barriers to practice. There was recognition of the need for systematic and frequent assessment for post-intensive care syndrome across the continuum of care, including explicit "functional reconciliation" (assessing gaps between a patient's pre-ICU and current functional ability at all intra- and interinstitutional transitions of care). Future post-intensive care syndrome research topic areas were identified across the continuum of recovery: characterization of at-risk patients (including recognizing risk factors, mechanisms of injury, and optimal screening instruments), prevention and treatment interventions, and outcomes research for patients and families. Conclusions Raising awareness of post-intensive care syndrome for the public and both critical care and non-critical care clinicians will inform a more coordinated approach to treatment and support during recovery after critical illness. Continued conceptual development and engagement with additional stakeholders is required.

Objective. The aim of the present 18-month retrospective study was to assess the association between a continuous long-term treatment with risperidone long-acting injectable (RLAI) of at least 12 months and in-patient care of patients suffering of schizophrenia or schizoaffective disorder. Furthermore we wanted to assess the cost-effectiveness of a long-term treatment with RLAI. Methods. In a mirror-image design, data of 119 patients with schizophrenia and schizoaffective disorder who were switched to RLAI treatment were analyzed retrospectively. Hospitalization rates, the duration of inpatient treatment and the overall treatment costs were assessed 12 and 18 months after switching to RLAI and compared to the equivalent time preceding the switch. Results. After 12 and 18 months of RLAI treatment, the mean reduction of inpatient care was 27.4 and 38.4 days per patient, respectively, compared to the equivalent time period prior to switching to RLAI (Wilcoxon P0.001). The overall savings in drug and institutional-care costs were 21.1 and 21.9%, respectively. Conclusions. Patients receiving RLAI for at least 12 months showed a reduction in inpatient days and lower overall treatment costs.

International audience

International audience; « Dire : Macbeth c'est l'ambition, c'est ne dire rien. Macbeth, c'est la faim. Quelle faim ? la faim du monstre toujours possible dans l'homme. Certaines âmes ont des dents. N'éveillez pas leur faim. » (Hugo, William Shakespeare, 221)

International audience

A statistical method to merge SAXS profiles using Gaussian processes is presented., Small-angle X-ray scattering (SAXS) is an experimental technique that allows structural information on biomolecules in solution to be gathered. High-quality SAXS profiles have typically been obtained by manual merging of scattering profiles from different concentrations and exposure times. This procedure is very subjective and results vary from user to user. Up to now, no robust automatic procedure has been published to perform this step, preventing the application of SAXS to high-throughput projects. Here, SAXS Merge, a fully automated statistical method for merging SAXS profiles using Gaussian processes, is presented. This method requires only the buffer-subtracted SAXS profiles in a specific order. At the heart of its formulation is non-linear interpolation using Gaussian processes, which provides a statement of the problem that accounts for correlation in the data.

Gas microstrip detectors have been previously developed by the particle physics community, where their robustness, compactness and high counting speed have been recognised. These features are particularly attractive to synchrotron radiation use. In this paper, we describe a gas microstrip detector employing multi-element readout and specifically developed for high count rate fluorescence EXAFS at soft X-ray energies below 4 keV.

A retrospective analysis of the phenomenon of industrialization allows one to sort out a Mediterranean type characterized by the coexistence of industrial districts and growth poles and by an emergence, still very limited, of high-tech centers. The issue of location factors of industrial activities confirms the marginal relevance of determinist interpretations in the Mediterranean Basin where «industrial miracles» have flourished since the 19th century. The idiographic perspective on industry was superseded by nomothetic aspirations characterized by recourse to quantitative analysis and taking into account the logic and spatial representation of actors. The systematic perspective henceforth gained a foothold to interpret the attractiveness, no longer of places, but of territories of reception. The concept of industry was then substituted by that of productive system in order to better understand the relationship between industrialization and development. The notion of the industrial transition is validated by geographical observation and instrumentalized by state actors who are responsible for territorial development. Exogenous initiatives, initially criticized, is joined today by endogenous forces to guide local productive systems and assure their continuity., L'analyse rétrospective de l'approche du fait industriel permet de dégager un type méditerranéen d'industrialisation caractérisé par la coexistence de districts industriels et de pôles de croissance, et par une émergence, encore très ponctuelle, d'espaces technopolitains. La problématique des facteurs de localisation des activités industrielles confirme la faible pertinence de la méthode d'interprétation déterministe, dans un Bassin méditerranéen où ont fleuri, dès le XIXe siècle, les «miracles industriels». À la démarche idiographique succède l'ambition nomothétique caractérisée par le recours à l'analyse quantitative, la prise en compte des acteurs, de leurs représentations spatiales et de leurs logiques. La perspective systémique s'impose désormais pour interpréter l'attractivité non plus des lieux mais des territoires d'accueil. Au concept d'industrie se substitue celui de système productif, plus opératoire pour comprendre la relation entre industrialisation et développement. La thèse de la transition industrielle est validée par l'observation géographique et instrumentalisée par les acteurs étatiques pour développer les territoires. Les initiatives exogènes, d'abord critiquées, se combinent aujourd'hui aux forces endogènes pour copiloter les systèmes productifs locaux et assurer leur reproduction durable., Spill Christiane. L'approche géographique du fait industriel dans la revue Méditerranée. In: Méditerranée, tome 97, 3-4-2001. 40 ans de géographie méditérranéenne, sous la direction de Roland Courtot . pp. 11-24.

We have investigated diffusion and thermal diffusion properties of light-absorbing colloidal polyorganosiloxane microgels containing tiny nanometer-sized gold clusters dispersed in toluene. Transient holographic gratings allow for very subtle perturbations in the linear regime where Soret feedback is negligible. Gold-doped colloids of different size and crosslink ratios show different Soret coefficients but identical thermal diffusion coefficients D(T). Undoped colloids tend to aggregate, but a consistent interpretation is obtained if an identical D(T) is assumed for the doped, the undoped, and the aggregated particles. Previously reported Soret feedback measurements on similar systems incidentally yielded comparable Soret coefficients. We show, however, that they suffer from strong convective perturbations.

The high overall throughput wide angle X-ray scattering (HOTWAXS) gas detector system, aimed at X-ray diffraction (XRD) and wide angle X-ray scattering (WAXS) applications has been a successful user facility on stations 2.1 and 9.3 at the Daresbury SRS offering high-speed data acquisition. The facility has been duplicated on station I22 of the Diamond light source. The energy range covered by stations I22 and 9.3 is very similar varying from 6 to 30 keV, well above the energy range conventionally covered by gas detectors. Here, we report studies of the options for successful operation of HOTWAXS at the upper end of this energy range, made possible by this particular design.

Doris Lessing, bom in Persia in 1919, spent most of her first thirty years in Southern Rhodesia, now known as Zimbabwe, in the district of Banket, a couple of hundred miles south from the Zambesi. She published her first novel, The Grass is Singing, in 1950, while Winter in July, a collection of seven short stories published in 1964, constitutes one of her few African collections as such, her other stories being either combined with stories of London or later redistributed by her publishers. Lessing's whole African work reflects a willingness to find a solution to come to terms with the profond continental crack, echoed by a cultural one, that inexorably separates Europe and Africa, as well as their respective sets of values. This aspect is particularly striking in Lessing's treatment of the earth and the landscape., Née en Perse en 1919, Doris Lessing a passé la majeure partie de ses trente premières années en Rhodésie du Sud, l'actuel Zimbabwe, dans le secteur de Banket à quelques trois cents kilomètres du Zambèze. Elle a publié son premier roman, traduit sous le titre Vaincue par la brousse, en 1950, tandis que L'hiver en juillet, un recueil de sept nouvelles paru en 1964, constitue véritablement l'un de ses rares recueils africains à proprement parler, ses autres histoires se trouvant mêlées aux nouvelles londoniennes ou ayant ultérieurement été redistribuées par ses éditeurs. Toute l'œuvre africaine de Lessing reflète cette même volonté de surmonter la profonde fêlure continentale, doublée d'une fêlure culturelle, qui sépare irrévocablement l'Europe et l'Afrique ainsi que leurs valeurs respectives. Cet aspect est particulièrement frappant dans l'approche que Lessing offre de la terre et des paysages., Spill Frédérique. Terre et paysage dans les œuvres africaines de Doris Lessing. In: Travaux de l'Institut Géographique de Reims, vol. 25, n°99-100, 1998. Afrique du Sud : Espaces et Littératures, sous la direction de François-Xavier Fauvelle-Aymar et Philippe Guillaume. pp. 27-37.

In a recent article (J. Comput. Chem. 2013, 34, 132-140), convective Replica-Exchange (convective-RE) has been presented as an alternative to the standard even-odd transition scheme. Computations on systems of various complexity have shown that convective-RE may increase the number of replica round-trips in temperature space with respect to the standard exchange scheme, leading to a more effective sampling of energy basins. Moreover, it has been shown that the method may prevent the formation of bottlenecks in the diffusive walk of replicas through the space of temperature states. By using an ideal temperature-RE model and a classical harmonic-oscillator RE scheme, we study the performances of convective-RE when ergodicity is not broken and convergence of acceptance probabilities is attained. In this dynamic regime, the round-trip ratio between convective and standard-RE is at maximum ~1.5, a value much smaller than that observed in non-ergodic simulations. For large acceptance probabilities, the standard-RE outperforms convective-RE. Our observations suggest that convective-RE can safely be used in either ergodic or non ergodic regimes; however, convective-RE is advantageous only when bottlenecks occur in the state-space diffusion of replicas, or when acceptance probabilities are globally low. We also show that decoupling of the state-space dynamics of the stick replica from the dynamics of the remaining replicas improves the efficiency of convective-RE at low acceptance probability regimes., 8 pages, 5 figures

To study out-patients' perception of an Integrated Care compliance program.Survey of patients enrolled in the Integrated Care program "Münchner Modell" in Munich, Germany.N = 121 patients participated in the survey. Overall patients were very satisfied with the Integrated Care program. They reported improvements in several areas of life.The study highlights the aspects of routine patient care that still need to be improved and shows how these deficits can be addressed by Integrated Care programs.

A variety of monoalkyl, dialkyl as well as trialkyl P-compounds, containing ethyl, isopropyl, and tertiarybutyl rest groups have been synthesized and used for the growth of InP bulk epitaxial layers by low pressure metalorganic vapour phase epitaxy. Almost uncompensated, n-type InP-layers (1.0/spl middot/10/sup 15/ cm/sup -3/ 59600 cm/sup -2/ V/sup -1/ s/sup -1/ at 77 K) are realized using the not specifically purified precursor ditertiarybutyl phosphine ((C/sub 4/H/sub 9/)/sub 2/-P-H, DitBuPH) in combination with commercial TMIn. Layer quality has been investigated by means of optical and scanning electron microscopy (SEM), temperature-dependent van der Pauw-Hall as well as photoluminescence (PL) measurements. All results are compared with those obtained by using PH/sub 3/ as P-source.

The risk factors for systemic fungal infections were analysed retrospectively in 186 orthotopic liver transplant procedures performed in 152 patients between June 1985 and January 1993. The total incidence of systemic fungal infections was 16.5% (25/152). The incidence of disseminated candidiasis, aspergillosis, and combined candidiasis and aspergillosis was 6.5% (n = 10), 7.2% (n = 11) and 2.6% (n = 4), respectively. Mortality associated with systemic fungal infections was 80% (20 of 25 patients). There were ten cases of disseminated candidiasis, with 4 patients surviving, and 11 cases of invasive aspergillosis, with 1 patient surviving. All patients with combined systemic fungal infection died. To identify perioperative risk factors, 39 variables were used to compare patients with systemic fungal infections versus those without fungal infections. Fourteen variables were significantly associated with systemic fungal infections by univariate analysis. A consecutive logistic regression analysis revealed that the amount of fresh frozen plasma transfused due to poor initial function of the allograft and acute renal failure requiring hemofiltration were independently significant risk factors for systemic fungal infections. There was no statistical correlation between systemic fungal infections and the underlying liver disease, previous long-term corticosteroids and the postoperative immunosuppressive therapy. Risk factors identified in this study should be considered in the postoperative care of the individual liver transplant recipient. In our study a poor initial function of the hepatic allograft substantially increased the risk of systemic fungal infection.

Models invoking the chemical master equation are used in many areas of science, and, hence, their simulation is of interest to many researchers. The complexity of the problems at hand often requires considerable computational power, so a large number of algorithms have been developed to speed up simulations. However, a drawback of many of these algorithms is that their implementation is more complicated than, for instance, the Gillespie algorithm, which is widely used to simulate the chemical master equation, and can be implemented with a few lines of code. Here, we present an algorithm which does not modify the way in which the master equation is solved, but instead modifies the transition rates, and can thus be implemented with a few lines of code. It works for all models in which reversible reactions occur by replacing such reversible reactions with effective net reactions. Examples of such systems include reaction-diffusion systems, in which diffusion is modelled by a random walk. The random movement of particles between neighbouring sites is then replaced with a net random flux. Furthermore, as we modify the transition rates of the model, rather than its implementation on a computer, our method can be combined with existing algorithms that were designed to speed up simulations of the stochastic master equation. By focusing on some specific models, we show how our algorithm can significantly speed up model simulations while maintaining essential features of the original model., 23 pages, 7 pages supplementary information, 8 figures, 8 supplementary figures, accepted for publication in The Journal of Chemical Physics

The development and testing of the SuPerior Rate for INTER (SPRINTER) detector is described. Based on a Microstrip Gas Chamber (MSGC) the aim of the project was to produce a matched pair of high counting rate detectors capable of replacing the existing 3He tubes currently used on the INTER reflectometer of the ISIS spallation neutron source. The detector system is described and the results from the first neutron beam tests carried out on an ISIS neutron reflectometer are also shown.

The Gaseous Electron Multiplier (GEM) technology promises to deliver 3He based neutron detectors for a wide range of applications for the spallation neutron source ISIS. These devices offer a high rate capability and when used in conjunction CF4 as a quench gas they offer the potential of a sub mm resolution 2D detector for thermal neutron detection. The operation of these devices at elevated CF4 pressures (necessary for reducing the proton range) however has proved to be somewhat challenging. A program of work was undertaken at RAL to determine whether these devices are appropriate for deployment on the ISIS instruments.

The objective of this thesis is to examine the role of municipal government with regard to disaster planning for individuals with access and functional needs. Oftentimes, a heavy reliance on county and higher levels of government occurs. The purpose herein is to identify why municipalities should create innovative policy solutions for their jurisdictions as part of a collaborative, synthesized approach within their counties. As the first responders in a major disaster, both municipal and county governments play the critical local role within Homeland Security. Conclusively, recommendations are made regarding application for supplementing and integrating planning and preparedness efforts for the best possible outcome. http://archive.org/details/effectivemunicip1094517463 Emergency Manager, Pompano Beach Fire Rescue, Pompano Beach, Florida Approved for public release; distribution is unlimited.

Replica-exchange is a powerful simulation method for sampling the basins of a rugged energy landscape. The replica-exchange method's sampling is efficient because it allows replicas to perform round trips in temperature space, thereby visiting both low and high temperatures in the same simulation. However, replicas have a diffusive walk in temperature space, and the round trip rate decreases significantly with the system size. These drawbacks make convergence of the simulation even more difficult than it already is when bigger systems are tackled. Here, we present a simple modification of the exchange method. In this method, one of the replicas steadily raises or lowers its temperature. We tested the convective replica-exchange method on three systems of varying complexity: the alanine dipeptide in implicit solvent, the GB1 β-hairpin in explicit solvent and the Aβ25–35 homotrimer in a coarse grained representation. For the highly frustrated Aβ25–35 homotrimer, the proposed “convective” replica-exchange method is twice as fast as the standard method. It discovered 24 out of 27 free-energy basins in less than 500 ns. It also prevented the formation of groups of replicas that usually form on either side of an exchange bottleneck, leading to a more efficient sampling of new energy basins than in the standard method. © 2012 Wiley Periodicals, Inc.

The development and testing of the Off Specular MicrOstrip Neutron Detector (OSMOND) is described. Based on a Microstrip Gas Chamber the aim of the project was to produce a high counting rate detector capable of replacing the existing rate limited scintillator detectors currently in use on the CRISP reflectometer for off specular reflectometry experiments. The detector system is described together with results of neutron beam tests carried out at the ISIS spallation neutron source.