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The economic impacts of caring for an older adult may be amplified for employed family and unpaid caregivers. We examine out-of-pocket spending among employed, retired, and unemployed caregivers. Among employed caregivers, we identify correlates of spending and assess whether spending and work productivity loss contribute to financial burden. Analyses use the 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving. We find that employed caregivers incur more out-of-pocket spending on caregiving than retired and unemployed counterparts. Employed caregivers spending more than $500 out-of-pocket provide more hours of care and assist older adults with greater impairment. Among employed family caregivers, caregiver and care recipient Medicaid enrollment, spending, and work productivity loss are associated with financial burden. Findings suggest that caregiving exacerbates economic well-being among employed caregivers, particularly for those with socioeconomic vulnerability.

to study the morbidity operative peri in digestive surgery.It was about a prospective and descriptive survey in the services of digestive surgery and anesthesia resuscitation from February to August 2014. The population of survey was constituted of the whole patients having benefitted an anesthesia for programmed digestive surgery. The statistical test used for the comparison of the qualitative variables was CHI2 with p0,05 considered meaningful.during the period 125 files have been collected. The patients having presented at least an undesirable event were of 86 either 68,8%. These events had occurred in 77.9% of cases during the interview. The middle age was of 47.46±15, 68years with extremes of 18years. and 85 years. Sex ratio was of 1, 55. Patients were classified ASA I in 83.2%. The predominant operative indication was the gastric tumor in 26.4 % of the cases. General anesthesia was practiced in 82.4% of the cases. Anesthesia were achieved in 55.2% of the cases by male nurses' anesthetists and 44,8% by the students in diploma of studies specials(DES).Main recovered undesirable events were of cardiovascular, respiratory and digestive nature (nausea and vomiting). Intervening of the undesirable events was bound to the technique of anesthesia, Anesthetic time length of intervention, used narcotic and to the antecedents of the patients with p0, 05.Factors of avoidable operative morbidity peri are nearly present in all our acts for digestive surgery. The formation of the staff and the setting to disposition of products better tolerated will permit to reduce these factors.Etudier la morbidité péri-opératoire en chirurgie digestive.Il s'agissait d'une étude transversale dans les services de chirurgie digestive et d'anesthésie réanimation de Février à août 2014. La population d'étude était constituée de l'ensemble des patients ayant bénéficié d'une anesthésie pour chirurgie digestive programmée. Le test statistique utilisé pour la comparaison des variables qualitatives a été le CHI2 avec p0,05 considérée comme significative.pendant la période 125 dossiers de patients ont été colligés. Les patients ayant présenté au moins un événement indésirable étaient de 86 soit 68,8 %. Ces événements étaient survenus dans 77,9 % des cas à la phase d'entretien. L'âge moyen était de 47,46±15,68 avec des extrêmes de 18 ans et 85 ans. Le sexe ratio était de 1,55. Les patients étaient classés ASA I dans 83,2 %. L'indication opératoire prédominante était la tumeur gastrique avec 26,4 % des cas. L'anesthésie générale était pratiquée dans 82,4% des cas. L'anesthésies était réalisée dans 55,2 % des cas par les infirmiers anesthésistes et 44,8 % par les étudiants en diplôme d'études spéciales(DES). Les principaux événements indésirables retrouvés étaient de nature cardiovasculaire, respiratoire et digestive. La survenue des événements indésirables était liée à la technique d'anesthésie, au temps anesthésique, à la durée de l'intervention, au narcotique utilisé et aux antécédents des patients avec p0,05.Les facteurs de morbidité évitables péri-opératoire sont quasiment présents dans tous nos actes pour chirurgie digestive. La formation du personnel et la mise à disposition de produits mieux tolérés permettront de réduire ces facteurs.

Background: The Senior Care Services Scale (SCSS) describes hospital provision of older adult services before the passage of the Affordable Care Act. Objectives: Since act passage, (1) update SCSS service groups; and (2) investigate hospital SCSS scores’ relationship to readmission or mortality among Medicare beneficiaries. Methods: Retrospective cohort analysis of older adults ≥65 years ( n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes: Hospital readmission, or death, within 30 and 90 days of discharge. Results: The updated SCSS had three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30 days (RR .94, 95% CI .91–.98), and 90 days (RR .94, 95% CI .91–.97). There was no significant association between Home-Care-and-Hospice and Post-Acute-Community-Care scores and study outcomes. Conclusion: Greater provision of hospital-level senior services may be associated with mortality reduction among Medicare beneficiaries.

Seven years after the declaration of the first epidemic of Ebola virus disease in Guinea, the country faced a new outbreak—between 14 February and 19 June 2021—near the epicentre of the previous epidemic1,2. Here we use next-generation sequencing to generate complete or near-complete genomes of Zaire ebolavirus from samples obtained from 12 different patients. These genomes form a well-supported phylogenetic cluster with genomes from the previous outbreak, which indicates that the new outbreak was not the result of a new spillover event from an animal reservoir. The 2021 lineage shows considerably lower divergence than would be expected during sustained human-to-human transmission, which suggests a persistent infection with reduced replication or a period of latency. The resurgence of Zaire ebolavirus from humans five years after the end of the previous outbreak of Ebola virus disease reinforces the need for long-term medical and social care for patients who survive the disease, to reduce the risk of re-emergence and to prevent further stigmatization. The viral lineage responsible for the February 2021 outbreak of Ebola virus disease in Guinea is nested within a clade that predominantly consists of genomes sampled during the 2013–2016 epidemic, suggesting that the virus might have re-emerged after a long period of latency within a previously infected individual.

Resume Introduction L’utilisation de produits depigmentants a visee cosmetique est largement repandue chez les femmes d’Afrique subsaharienne. De nombreuses complications (cutanees et systemiques) associees a cette pratique ont pourtant ete decrites. La survenue de carcinomes epidermoides a longtemps ete evoquee mais rarement rapportee, puisque seules trois observations ont ete publiees. Nous en decrivons le premier cas observe au Mali. Observation Une femme de 30 ans, sans antecedent pathologique notable, consultait pour une ulceration du cou evoluant depuis 5 ans. Elle utilisait des produits cosmetiques a base d’hydroquinone et de corticoides depuis environ 10 ans. A l’examen clinique, elle avait une large ulceration localisee a la face laterale gauche du cou. Les serologiques des hepatites virales et du VIH etaient negatives. Le diagnostic de carcinome epidermoide etait confirme par l’examen histopathologique. Une exerese chirurgicale de la lesion etait effectuee ; elle etait suivie d’une recidive locale precoce trois mois plus tard, necessitant une reprise chirurgicale. Discussion La prevalence elevee de l’usage des produits cosmetiques depigmentants contraste avec la rarete du carcinome epidermoide sur terrain depigmente. Toutefois, le delai de survenue d’une telle complication et le nombre croissant des cas rapportes doivent inciter les praticiens a promouvoir la prevention par des messages educatifs, l’usage de filtres solaires et la biopsie systematique de toute ulceration chez les femmes employant des produits depigmentants, en particulier lorsqu’il s’agit d’une localisation cervicale.

International audience; This paper proposes methods and tools to support analysis and simulation of propagation of alerts in a city. Environmental modeling and monitoring is now a major framework for application of wireless sensor networks. Sound and visual alerts remain a major way to warn and prevent accidents in social life. This work combines a cellular segmentation of the city, representation of buildings and roads, representation of vehicle paths, and cell behaviour that compute sound wave propagation with respect to space and time. As a first result, there is the possibility to evaluate nuisance from vehicles repetitively travelling their sirens along avenues. Coupling to smart cities sensing systems will allow a better control on traffic lights and management of autonomous intersections. This can help to prevent and reduce noise and accidents. In the context of smarts cities, cooperative sound detection can be associated to the development of new smart cars, and better rescue or police vehicles. High speed simulations with real time opportunities are obtained thanks to code generation for graphic accelerators.; Cet article propose des méthodes et des outils pour la simulation et l'analyse de la propagation des alertes dans le cadre d’une ville intelligente.La modélisation et la surveillance de l'environnement sont désormais un cadre majeur pour les applications des réseaux de capteurs sans fil.Les alertes sonores et visuelles restent un moyen important pour avertir et prévenir les accidents dans a vie sociale.Ce travail combine une segmentation cellulaire de la ville, une représentation des bâtiments et des routes, représentation des trajectoires des véhicules et du comportement des cellules qui calculent la propagation des ondes sonores dans l'espace et le temps.En premier lieu, il est possible d'évaluer de manière répétitive les nuisances des véhicules utilisant leurs sirènes le long des avenues. Le couplage aux systèmes de détection des villes intelligentes permettra un meilleur contrôle de la gestion des feux de circulation et des intersections autonomes. Cela peut aider à prévenir et à réduire le bruit et les accidents. Dans le contexte des villes intelligentes, la détection sonore dynamique peut être associée au développement de nouvelles voitures intelligentes et mieux aider, guider les véhicules de sauvetage ou de police. Des simulations, avec génération de code pour les accélérateurs graphiques, ont été faites grâce à la programmation massivement parallèle sur GPU, avec optimisation du temps.

Introduction Depuis 2012, la chimioprevention du paludisme saisonnier (CPS) a ete adopte au Mali chez les enfants âges de moins de 5 ans avec une reduction significative de l’incidence du paludisme dans cette population. Recemment, un changement du fardeau du paludisme a ete observe chez les grands enfants dans certaines zones d’endemie palustre suite a l’implementation de la CPS chez les petits enfants. Cette etude a ete conduite pour determiner l’effet et l’acceptabilite de la CPS chez les grands enfants en collaboration avec le programme national de lutte conte le paludisme afin d’evaluer la faisabilite d’inclure cette tranche d’âge dans le programme routine de moins de cinq ans. Methodes Dangassa est une zone d’endemie palustre situe a 80 km au sud de Bamako (capitale) et a 4 km le long du fleuve Niger. La transmission du paludisme se fait durant toute l’annee mais est intense 5-6 mois. Une etude non-randomisee a ete effectuee, incluant 350 enfants âges de 5 a 14 ans (175 dans le bras d’intervention versus 175 pour le controle). Les enfants dans le bras d’intervention ont recu cinq tours d’administration de la Sulfadoxine-Pyrimethamine + Amodiaquine a l’intervalle d’un mois du juillet au novembre 2019. Les donnees ont ete collectees sur le taux de couverture de la CPS, de l’utilisation de moustiquaire et le paludisme chaque mois chez tous les enfants des deux bras de juillet au decembre 2019. Les regressions logistique et de Cox ont ete utilisees estimer le taux de reduction du paludisme avec un seuil de signification fixe a 5 %. Resultats La CPS a ete largement accepte par la communaute avec 96,5 % d’avis favorable. En juillet (base), les parametres mesures etaient similaires entre les deux bras excepte l’anemie. En decembre (un mois apres le dernier tour), une reduction de l’infection palustre (OR = 0,22 95 %CI [0,11-0,42]), de l’anemie (OR = 0,14 95 %CI [0,07-0,28]) a ete observee dans le bras d’intervention apres ajustement sur l’âge et l’utilisation de moustiquaire. Chez les enfants ayant une parasitemie negative en juillet, une diminution significative de l’incidence de l’infection palustre a ete observee dans le bras d’intervention. En comparant le delai d’apparition de la premiere infection, 75 % de enfants dans le bras controle etaient deja infectes par le Plasmodium contre 40 % dans le bras d’intervention (Log-rank test p = 0,001) ( Fig. 1 ). Conclusion La CPS est largement acceptee par la communaute, une reduction significative de l’infection palustre a ete observee chez les enfants dans le bras d’intervention.

International audience; Many physical phenomena can be modeled as the propagation of sound or radio waves, the fluids flow, the distribution of gas, the dispersion produced in a river, etc. With the help of the AC we can deduce very realistic situations. In previous work, we simulated the propagation of sound in the city using cellular automata, taking into account the urban parameters. In that works, we used horizontal bars to simulate the presence of obstacles (buildings and others) in the sound propagation environment. These obstacles have been defined with arbitrarily fixed coefficients of resistance. In this paper, we rely on the models and algorithms proposed in previous works, to observe the behavior of our simulations of sound, in a concrete environment of obstacle. For this we use NetGen[1], which is a map processing tool. PickCell allows us to analyze the behavior of sound in a concrete environment; De nombreux phénomènes physiques peuvent être modélisés comme la propagation du son ou des ondes radio, le débit des fluides, la diffusion de gaz, la dispersion produite dans une rivière, etc.A l’aide des Automates cellulaires (CA) nous pouvons produire des situations très réalistes. Dans des travaux antérieurs, nous avons simulé la propagation du son dans la ville en utilisant des automates cellulaires et en tenant compte des paramètres. Dans ce travail, nous avons utilisé des barres horizontales pour simuler la présence d'obstacles (bâtiments et autres) dans l’environnement de propagation du son. Ces obstacles ont été définis avec des coefficients de résistance arbitrairement fixés. Dans cet article, nous allons nous appuyer sur les modèles etalgorithmes proposés dans les travaux précédents, pour observer le comportement de nos simulations sonores, de manière concrète dans l’environnement et ses obstacles. Pour cela, nous utilisons NetGen [1], qui est un outil de traitement de carte. PickCell nous permet d’analyser le comportement du son dans un environnement concret.

International audience

This paper deals with the problem of sound propagation in urban areas. It begins by investigating the propagation of sound in order to determine and extract the physical parameters that direct this propagation. The formalism of cellular automata (CA) is presented, as well as its use for the specification of physical phenomena, with discrete events, such as sound propagation. The use of cellular automata in a smart city context, to model the propagation of sound is presented. The proposed model takes into account buildings and other city obstacles. A CUDA Implementation of this model is described. This implementation is used to simulate sound propagation on shapefile cards. The proposed model makes it possible to determine the sound power in a given location and the geographic area covered by the sound wave.

Women widely use skin-lightening products for cosmetic purposes in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. The occurrence of epidermoid carcinoma has long been reported, but only three cases have been published so far. We report the first case in Mali.A 30-year old woman with no noteworthy medical history was seen at our outpatient center for cervical ulceration that had been present for the last 5 years. She had used cosmetic bleaching cream over a period of around ten years. Physical examination revealed extensive ulceration on the left side of her neck. Blood tests for viral hepatitis and human immunodeficiency virus were negative. The pathological examination of the skin biopsy confirmed the diagnosis of squamous cell carcinoma. After failure of the initial excision with early relapse, multiple surgical ablations were performed 3 months later.The high prevalence of skin-lightening cosmetic use contrasts with the rarity of epidermoid carcinoma in depigmented skin. However, a large chronic ulcer on uncovered parts of the upper body, particularly the neck, should prompt physicians to consider skin cancer. Appropriate preventive measures include the promotion of educational messages for the general population, the use of sun-protection devices, and routine skin biopsy for all women presenting chronic cervical ulceration after long-term use of skin-lightening products.

Introduction La lepre lepromateuse represente la forme anergique de l’infection a Mycobacterium leprae dont l’evolution est habituellement emaillee d’accident immunoallergiques. Le phenomene de Lucio en est une forme inhabituelle. Nous rapportons un cas. Observation M. S, 62 ans, consulte en dermatologie pour des plaies chroniques diffuses. La maladie a debute, deux ans auparavant, par un eclaircissement spontane du visage. Au fur et a mesure que l’eclaircissement progressait, apparaissaient de petites taches rouges qui s’ulceraient secondairement ; initialement localisees aux jambes, s’etendaient aux bras et au thorax. Un antecedent familial de lepre chez une tante paternelle etait note. L’examen physique retrouvait un malade dysphonique, apyretique et maigre (IMC = 17,32 kg/m 2 ). La peau etait recouverte de multiples ulcerations et des croutes par endroit, de taille variable a base infiltree au tronc et aux membres. Une infiltration du lobe des oreilles et un elargissement de la base du nez une muqueuse nasale congestive. L’examen neurologique retrouvait une hypertrophie de plusieurs troncs nerveux peripheriques. Le reste de l’examen clinique etait normal. La bacilloscopie etait positive a 5+ a plusieurs sites. En dehors d’une anemie a 9 gr/dL, le reste du bilan biologique est normal. Le diagnostic de phenomene de Lucio sur lepre lepromateuse etait evoque. L’administration d’une polychimiotherapie (PCT) OMS MB et de thalidomide ont entraine une nette amelioration au bout de 10 jours. Discussion Le phenomene de Lucio est une forme violente d’erytheme noueux lepreux. Elle survient generalement apres traitement chez des malades lepromateux connus. Sa survenue chez un sujet naif de tout traitement anti-lepreux, comme dans notre cas est un fait inhabituel qui doit attirer notre attention.

A new siderophore, N 5, N 6-thiodipropanoyl-bis[ N 1, N 10-bis(2,3-dihydroxy benzoyl-spermidine)]-Fe (III) complex or H 2 LFe has been synthesised. The reaction of the reduced form of this complex with dioxygen has been investigated through electrochemical study and revealed the formation of a new species assumed to be H 2 O 2 . This species has been confirmed by esr spectroscopy using the diamagnetic compound 5-deutero-2,2,5-trimethylpyrrolidine-1-hydroxyl as spin trap. The resulting persistent radical is 5-deutero-2,2,5-trimethylpyrrolidine-1-yloxy (a N =16.58 G, a D =3.49 G).

The maintenance of hydraulic networks, along with the distribution of water, is a primary function of irrigation scheme management. Maintenance normally passes through four stages (planning, implementation, monitoring, and evaluation) which marshal information exchanged between diverse stakeholders. This article shows how the management of such information was computerized on a large irrigation scheme in the Office du Niger in Mali, and the impact this had on the management of maintenance. After analyzing initial procedures and assessing stakeholders' needs, a conceptual model was built based on four components: Operation and Maintenance Unit, annual maintenance plan, maintenance activity, and nomenclature. The software developed on this basis enables one to describe the network and the contractors involved in maintenance operations, record annual maintenance plans and work accomplished each year, and manage the different nomenclatures required in the application of the software. Automated output in the form of tables and graphs facilitates decision-making based on records of past operations. The software was designed and implemented based on the results of an initial experimental phase, which also led to the creation of a data processing unit in charge of managing the information system of the Office du Niger. The whole process enabled a more coherent organization of maintenance operations while addressing problems related to training and staff commitment. Farmer participation, however, remains limited at this stage. Copyright © 2009 John Wiley & Sons, Ltd.

To evaluate the variability of tuberculin skin test (TST), we did a prospective study in the pneumology unit of the teaching hospital at Point G and in the tuberculosis unit of the health district II at Bamako, Mali TST was applied two times to every patient more than 18 years old: at the beginning before the tuberculosis treatment (tst1) and after 2 months (tst2). For all 113 patients followed in both units, 41 were enrolled in this study (36, 2%). The mean age of patients was 37.9 years and 73.2% were male.(sex proportion was 2.72 for male). The different forms of Tuberculosis were: 63.4% of tuberculosis with smear positive(TSP); 7.3% of tuberculosis with smear negative(TSN); and 29,3% of disseminated tuberculosis. 22% of the patients were HIV positive. The tst1 was positive for 58.5% of the patients(11.11% of the HIV positive patients and 78.13% of the HIV negative). The diameter of indurations of the TST increased considerably during the treatment mainly with patients infected by HIV. The TST test can be an indicator of follow op for these patients who had less AFB most of time?

The hope of the World Health Organization (WHO) in the fight against tuberculosis rests today on the implementation of the strategy DOTS. The success of this strategy passes obligatorily by an implication of the parents, neighbors in one word of the population living with the patient; this is why we fixed our objective to study knowledge on the tuberculosis of the people of more than 18 years of the district of Bamako. We carried out a cross-sectional study supplemented by focus-groups in 3 districts of Bamako near the general population (socio-medical personnel, old tuberculous, and helping natural) for the period from the 1st of June to July 15, 2004. Our sample was composed of 246 people for the individual questionnaires and of 47 per 8 meetings of focus group: the sex ratio was 2,5 in favour of the men and 60,2% of our subjects had less than 30 years. In the general population of Bamako 24,8% had a good knowledge, 49,0% an average knowledge and 26,2% a bad knowledge. 48,8 % of those which had a good knowledge were the pupils, students and civils servant. So in general the population had a good knowledge on symptomatology (90,2 %), it on the other hand had the knowledge very limited on the etiology (only 10,6% of the subject knew that tuberculosis is caused by a mycobactery) or on the modes of transmission (cigarettes, soap, meat). The population of Bamako has a very passable level of knowledge on tuberculosis. If this level is good with regard to symptomatology, it is very insufficient on the etiology or on the transmission of the disease. To improve this knowledge one needs a sensitizing supported for television and the radio in the dialects and national languages.

Cervix cancer remains a public health problem in developing countries. These results are an assessment for multicentric study based on visual inspection of the cervix after application of acetiq acid (VIA) and lugol's iodine (VILI). The aim of this study is to determine the feasibility and the impact of this screening in the community health centres "CSCOM" in the district of Bamako. It was a prospective and multicentric study through 8 CSCOM, 3 Reference Centres "CSRéf", Hôpital Gabriel Touré (HGT) and National Institute of Public Health (INRSP) in Bamako. During 28 months, 5016 women aged through 25-49 years were screened. After their consent and questionnaire filling, the patient is comfortably settled for visual test. The repartition of screened patients by health level is: CSCOM (19.24% : 965/5016), CSRéf (48.64% : 2440/5016), HGT (32.12% : 1611/5016). In general, the positivity of tests was: 5.2% (VIA) and 6.8% (VILI). The positive women at the CSCOM level were oriented to the CSRéf or the HGT for the colposcopy, possible biopsy or care. At all 177 biopsies were done, and histological diagnosis were: 67 dysplasias, 3 early invasive carcinomas, 69 invasive carcinomas and 38 inflammatory metaplasic lesions or nonconclusives aspects. Patients with dysplasias or cancers were treated by cryotherapy, loop electrosurgical excision procedure (LEEP), cold-knife conization or surgery. This study showed that screening of cervical cancer by visual inspection is workable at CSCOM level. We wish a large diffusion of the method to the whole of the country.

In the goal of determine the impact of circumcision in transmission of HIV in military area. A retrospective study has been carried out from January 2000 to December 2005 at the infirmary of Genie military garrison about all HIV positive serology registered in that structure. It was a study of circumcised militaries and uncircumcised militaries as control group. Among 1183 militaries, 1102 were men (93.2%). Among these 1102, 57 were HIV positive (5.1%). Among 1102 military, 154 were uncircumcised and among them 20 were HIV positive (12.9 %). Among 948 of circumcised militaries 37 were HIV positive (3.9%). Circumcision reduces the risk of infection by HIV; however it has to be considered as supplement among other prevention methods.

Nine selected out-patient clinics caring for asthma patients in Algeria, Guinea, Ivory Coast, Kenya, Mali, Morocco, Syria, Turkey and Vietnam.Prospective enrolment of consecutive patients considered by the practitioner to have asthma with evaluation of adherence of the practitioner with recommended standard case management, including proportion of patients confirmed to have asthma, proportion in whom severity was correctly graded and proportion in whom treatment with inhaled corticosteroids corresponded to severity grade.Of 499 consecutive patients, 456 (91%) were enrolled and evaluated. The diagnosis was confirmed in 263 (58%). Agreement between the practitioner and the guidelines in assigning grade of severity was moderate overall (kappa = 0.42). It was higher for assignment of grade using symptoms (K = 0.51), but poor for assignment of grade using peak expiratory flow (PEF) rate (kappa = 0.29), with practitioners tending to underestimate the severity. Agreement between the practitioners' assessment of severity and treatment with inhaled corticosteroids was poor (kappa = 0.18), with underutilisation of inhaled corticosteroids.Practitioners caring for asthma patients in this study tended to underutilise the PEF rate in assessing their patients and underutilised treatment of patients with inhaled corticosteroids.

The benzene-Ru(II)-supported trilacunary heteropolytungstates [(RuC6H6)2XW9O34]6- (X = Si, 1; Ge, 2) have been synthesized and characterized by multinuclear solution NMR (183W, 13C, 1H, 29Si), UV-vis and IR spectroscopy, electrochemistry, and elemental analysis. Single-crystal X-ray analysis was carried out on Rb2Na4[(RuC6H6)2SiW9O34].21H2O (RbNa-1), which crystallizes in the triclinic system, space group P, with a = 11.9415(2) A, b = 13.3123(2) A, c = 19.4927(4) A, alpha = 96.6460(10) degrees , beta = 95.1570(10) degrees , gamma = 98.2560(10) degrees , and Z = 2 and on Cs2Na4[(RuC6H6)2GeW9O34].19.5H2O (CsNa-2), which crystallizes also in the triclinic system, space group P, with a = 11.930(4) A, b = 13.353(4) A, c = 19.586(6) A, alpha = 95.982(5) degrees , beta = 95.414(6) degrees , gamma = 98.142(5) degrees , and Z = 2. The novel polyanion structure consists of two (RuC6H6) units linked to a trilacunary (XW9O34) Keggin fragment via Ru-O(W) and Ru-O(X) bonds resulting in an assembly with Cs symmetry. Polyanions 1 and 2 were synthesized by reaction of [RuC6H6Cl2]2 with [A-alpha-XW9O34]10- in aqueous buffer medium (pH 6.0). Both 1 and 2 are stable in solution as indicated by the expected 5-line pattern (2:1:2:2:2) in the 183W NMR and the expected (3C, 1H, and 29Si spectra. Descriptions of the respective electrochemical behaviors of the W centers and the Ru centers in 1 and 2 are given in media where these processes are clearly defined. In a pH = 3 acetate medium, the cyclic voltammetry of the W centers shows the known fingerprint of the trilacunary alpha-[XW9O34]n- (X = Ge, Si) moieties. The presence of the (RuC6H6) substituents imparts a good stability to these fragments in solution. Stepwise oxidation of the Ru centers was suspected in pH = 5 acetate medium, but only the first step was well-separated from a large current composite wave. The stepwise oxidation was finally observed clearly in a DMF-water (90/10 v/v) mixture and shows two well-behaved Ru oxidation processes. A short comparison is made with DMSO-bearing Ru polyoxometalates.

The cost and availability of the medications required for the treatment of asthma may represent potential barriers to effective management.A survey of prices and policies for components of asthma treatment in 1998, in Algeria, Burkina Faso, Ivory Coast, Guinea, Mali, Syria, Turkey and Vietnam.Medications were consistently available in only four of the eight countries studied. The cost of essential medications for standard case management varied by over five times for beclomethasone and by over three times for inhaled salbutamol. In all but two countries, the cost of one year of drugs for treatment of a moderate, persistent case exceeded the monthly salary of a nurse in that country. The essential drugs list included inhaled salbutamol in five of eight countries and beclomethasone in three of eight. The costs of medications were lower where generic preparations were available and, to a lesser extent, where the medications are on the essential drugs list.The cost and availability of medications vary widely, and may represent an important barrier to effective management in some low and middle income countries.

Publisher Summary This chapter discusses two theoretical models (analytical and numerical) elaborated for the determination of the thermal field in the slab that has been compared. It involves determining temperature distribution in a slab destined to produce hot sanitary water. For that purpose, a copper coil is drowned in this slab. The slab is covered by a pane of glass and is insulated on the other sides. The approach consists of undertaking decomposition in Fourier series of the ambience function and in applying the principle of superposition of the different responses to arrive at the response of the slab to any solicitation and to obtain theoretical results that conform to the experimental ones. A two-dimensional numerical model has been developed in the chapter. It uses the implicit method of finite differences of ADI (Alternating Direction Implicit) type of Peaceman and Readford that ensures a large stability during the resolution of a two-dimensional unsteady problem with a large number of knots. Results obtained by applying the FEHT (Finite Element Heat Transfer) software of F. Chart Software have added to the theoretical and experimental ones. The application of the FEHT software permits the representation, among others, of the isothermal lines and the gradients of temperature in the slab.

A new tetra-catecholamide compound N5,N6-thiodipropanoyl-bis[N1,N10-bis(2,3-dihydroxybenzoyl-spermidi ne)] (H8L) has been synthesised as an iron chelator of Fe (III). Cyclic voltammogram of the iron complex H2LFe run under an argon atmosphere shows a quasi-reversible redox process with E0 = -430 mV vs. SCE in CH3OH/H20 (60/40). This value approaches the range of biological reductants and consequently the complex may mimic the release of iron from enterobactin to the agents which are directly involved in cell metabolism.

It has been shown on two examples that STM and AFM techniques can be used to image oxometalates with molecular resolution. The shapes of these molecules are clearly distinguished and their dimensions have been determined. It has even been possible to correlate other results culled from the AFM image of the surface of a single crystal of an oxometalate with those of crystallography. These results served as reference images in the study of the basal plane of HOPG when it is used as a working electrode during the cyclic voltammetry of 10 -3 M H 2 W 12 O 40 6- , in a pH=2 medium, with simultaneous STM monitoring of the surface morphology. A potential-dependent deposition of the oxometalate is superimposed on a strong alteration of the HOPG surface. When the potential domain is extended to include the third redox system of H 2 W 12 O 40 6- , a particularly well-ordered two-dimensional array is observed, the individual entities having the diameter of the oxometalate

The survey of the primary resistances of tuberculosis bacilli to drugs is not only important epidemiologically speaking, but also for its use as a guideline to defining programs, to assessing the quality and the practical development of chemotherapy in a country, to measuring the propensity of the resisting tuberculosis bacilli to infect a given population within some time and to taking the necessary remedial measures. The object of this study has been to compare the rate of initial drugs' resistances of tuberculosis bacilli in Mali between 1980-1982 and 1989-1990. The results, which show a fall in the primary resistances due to drugs and to the combination of antibiotics as well, are being discussed while taking account various factors related to the organization.

This is a descriptive study of 33 cases with recurrent tuberculosis in patients who abandoned their treatment, admitted between March and October 1991 in the Pulmonary Tuberculosis Service of the Hospital Point G. The aim of the study was to identify the reasons for stopping treatment and to propose corrective measures. One third of the patients registered in the study were agricultural workers. Sixteen per cent of those who stopped treatment did so in the first four months of treatment. The duration and the nature of the therapeutic regime had no influence on the attendance of the patients: 42% received a standard regime for twelve months and 45% a short regime for eight months. We thought that the poor motivation of the health personnel to counsel the patients correctly was the principal factor in influencing their attendance. Sixty seven per cent did not know the nature of their disease. The distance factor between home and the place of treatment was another important point which should be improved. Concrete proposals were made to improve the supervision and follow up of tuberculous patients.

We report the results of a retrospective study of 108 cases of pleural empyema collected in the Pneumo-Phthisiology Department of the National Hospital of "Point G" from September 1984 to August 1990. The sex-ratio is 3/1 in favour of males with a mean age of 35.5 years. The pleural empyema represent 2.2% of all patients admitted in the Hospital and 20.2% of liquid effusions of the Pleura observed during the study period. The causal common germ has been placed in a proeminent position in 18 cases (16.7%) including 14 cases of gram-positive germs. Tuberculous aetiology has been proven in 16 cases (27.6%) against 67 cases of bacterial pleuresies (62%). The initial treatment has consisted in an empirical antibiotherapy of a large spectrum associated with repeated washing punctions. A short-term antituberculous chemotherapy (8 months, 2RHZS(6TH)) has been administrated each time the tuberculous aetiology has been proven or strongly presumed. The therapeutic results have been favourable in 85 cases (78.7%) and unfavourable in 23 cases (21%) including 10 deaths (9.2%).

Among accidents likely to complicate pregnancy, and in particular delivery, a ruptured uterus is considered serious. The foetus often dies, and the life of the mother is threatened: treatment has serious after effects on fecundity. This study covers certain aspects of uterus rupture crisis in a highly risk delivery specialization unit. The special purpose of the unit explains the high proportion of ruptures. The special purpose of the unit explains the high proportion of ruptures (11.5%). High multiparity and the lack of insufficiency of supervision during pregnancy and delivery constitute the greatest factors of risk.

Two series of new oxometalate-based materials are described. It is shown that numerous electronic conductors or semiconductor electrodes can be easily electromodified in the presence of various compounds of the oxometalate series. Upon modification, materials usually known to be poor hydrogen cathodes or photocathodes show strikingly high exchange current densities for the h.e.r.. The enhanced kinetics for this process is mainly attributed to the electrodeposited catalysts because it appears as largely independent from the nature of the starting electrode material. The modified surfaces are robust and very durable, and have been characterized by electrochemistry and several complementary physical techniques. The second class of materials is constituted by surfaces which are functionalized by oxometalates entrapped in polymeric matrices. Electronically-conductive as well as non-conductive polymers are suitable for this purpose. It appears that the inclusion of oxometalates generates new polymers which can be interesting by themselves. It is also shown that the entrapped oxometalates retain all their known properties and exhibit enhanced redox catalysis effects. The h.e.r. and the oxygen reduction process are taken as examples. Finally, the catalyst electrodeposited in the first class of materials is also easily obtained in polymeric matrices.

The first wave of three selected heteropolyanions (HPAs) was studied in acidic water by linear sweep voltammetry and voltammetry at a rotating disc electrode. These HPAs are SiW 12 O 4− 40 , PW 12 O 3− 40 and P 2 W 18 O 6− 62 . At a glassy carbon or mercury electrode they all show a one-electron, reversible, diffusion-controlled wave under the appropriate pH conditions. The intensity of the current is directly dependent on the concentration of various alkali salts added to the solution and a good correlation between this intensity and the viscosity of the solution has been established. Different cross-check experiments resulted in the conclusion that SiW 12 O 4− 40 easily reveals that Li + , Na + , H 3 O + are net structure-making ions, while K + , Cl − , ClO − 4 , SO 2− 4 and HSO − 4 are net structure-breaking species; this HPA constitutes an adequate and discriminating probe of concentrated electrolyte solutions as concerns the classification of the relative intensity and direction of the ion-water interactions.