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Acute calcium deposit (ACD) in the hand and wrist is a cause of acute pain due to crystal-induced soft-tissue inflammation. There are no standard management guidelines for this condition, which is frequently treated with non-steroidal anti-inflammatory drugs (NSAIDs), with variable efficacy, some patients presenting symptoms for several months. We retrospectively analyzed the results of all patients treated with anakinra for hand or wrist ACD in our department in 2020. We extracted data on treatment duration, pain, range of motion, skin erythema, hypervascularization, edema, and X-ray findings. Ten patients were treated for hand or wrist ACD with anakinra 100 mg per day for a mean 2.7 days. We observed rapid and significant improvement in pain, range of motion, local erythema and edema from day 2 and a decrease in skin temperature from day 3. Calcifications significantly decreased in size or disappeared in the majority of the patients. There were no adverse events or recurrences at 1 year's follow-up. Anakinra was associated with significant clinical improvement after only two days' treatment and may be considered to treat patients with hand or wrist ACD, especially in case of contraindications to NSAIDs or glucocorticoids. Further controlled studies are needed to confirm the present observations.

There has been an increased demand for traceable calibrations at infrasonic frequencies in support of geophysical monitoring applications, an example being the Comprehensive Nuclear-Test-Ban Treaty Organization, which provides global international coverage for a nuclear testing ban, and requires the International Monitoring System. In this paper, a new laser pistonphone design is presented with the objective of establishing primary standards for sound pressure at very low frequencies down to 10 mHz. The piston is a modified accessorized loudspeaker driver whose diameter is equal to the diameter of the front pistonphone cavity. The volume velocity of the piston is measured through a laser interferometer and the current version was designed to have an upper frequency limit of 20 Hz, to overlap with the closed coupler reciprocity method of calibration. Particular attention has been given to the sealing to avoid pressure leakage loss. The dimensions of the front cavity were designed to allow the calibration of a large variety of sensors, including microphones, barometers, manometers and microbarometers. Examples of calibrations for several sensors are presented and also an uncertainty budget for the Brüel & Kjær type 4160 laboratory standard microphones, commonly used for primary calibrations. Finally, the metrological performance of the laser pistonphone is demonstrated by comparing the calibration results with those obtained with alternative methods.

Distribution is an integral part of the supply chain of a product. The role of distribution greatly determines the distribution of a product to reach consumers. An efficient process is needed that can ensure that the product reaches consumers widely and at the lowest possible cost. A business should have an efficient distribution channel, so that the business can dominate the market. The purpose of this study was to determine the system of cooperation between roa fishing fishermen and smoked roa fish processors in Kinabuhutan Village and to determine the amount of marketing efficiency at each raw material supply node in Kinabuhutan Village. The population in this study were roa fishers, fish processors, middlemen and retailers. Data were collected using purposive sampling. The data collected in the form of primary data and secondary data. Primary data collection techniques with observation and interviews. The data obtained were analyzed using quantitative descriptive analysis and qualitative descriptive analysis. Based on the results of the study, there are five main components or actors in supply chain analysis, namely fishermen, smoked roa fish processors, middlemen, retailers and final consumers. In addition, there are 3 types of flow in the supply chain, namely product flow, financial flow and information flow. The flow of smoked roa fish products flows from upstream to downstream or from fishermen to final consumers. Meanwhile, financial flows flow from downstream (downstream) to upstream (upstream) or from consumers to fishermen and the flow of information is a flow that flows from two directions, namely from upstream to downstream (downstream) or from fishermen to consumers and from downstream. (downstream) to upstream (upstream) or from consumers to fishermen. From the results of the analysis, it is also known that the marketing of smoked roa fish products is very efficient because all nodes have an efficiency value < 1, but the most efficient is at the fishermen's node because the value is equal to 0.

The generation of an optimal schedule of elective surgery cases for a hospital surgery services unit is a well-known problem in the operations research field. The complexity of the problem is greatly compounded when uncertainties in the parameters are considered and is an issue that has been addressed in few works in the literature. Uncertainties appear in surgery durations and the availability of downstream resources such as surgical intensive care units (SICU), presenting large deviations from their expected value and impacting in the performance of the scheduling process. The technique presented here addresses the uncertainties in the optimal scheduling of a given set of elective surgery cases by means of simulated-based optimization. The main advantage of this approach over previous works is that detailed systems’ simulations can be constructed without losing computational performance, thus improving the robustness of the scheduling solution.

Background Attention deficit hyperactivity disorder (ADHD) is a common co-morbidity that affects up to 44% of children with Down syndrome (DS). There is a need for reliable, good quality research on the use of methylphenidate within this population. The objective of this study is to report our experience regarding the management of ADHD in these children using methylphenidate. Methods This study is a retrospective observation of 21 children with DS, followed at Jerome Lejeune Institute between 2000 and 2018. The diagnosis of ADHD was made using the Diagnostic and Statistical Manual of Mental Disorders criteria. Efficacy was measured as response or non-response on two main symptoms: attention/concentration and hyperactivity/impulsivity. Safety was evaluated by the presence or absence of side effects. Results Sixteen out of the 21 children (76%) showed improvement with methylphenidate. The average age of treatment onset in responding children was 8 years and 10 months versus 6 years and 3 months in non-responders (P = 0.05). Average dose/weight was significantly different in responders and non-responders (0.82 vs. 0.54 mg/kg/day, respectively; P = 0.03). Twelve children out of 21 (57%) experienced side effects; only three experienced side effects severe enough to require treatment interruption. Most common side effects were loss of appetite and difficulties in falling asleep. Conclusion Methylphenidate was effective and safe in treating ADHD in 76% of cases in children with DS, with few serious side effects to report. Early diagnosis of ADHD is important to improve the quality of life, learning, inclusion and socialisation of children with DS.

BackgroundAcute calcium deposits (ACD) of hydroxyapatite in hand and wrist are a rare cause of acute pain due to crystal-induced soft tissue inflammation. There are no standard management guidelines for this condition, which is frequently treated with non-steroid anti-inflammatory drugs or steroid infiltrations with variable efficacy, some patients presenting symptoms for several months1. Anakinra, an interleukin-1 receptor antagonist, showed non-inferiority compared to usual care in the treatment of acute gout arthritis in a randomized controlled study2 and demonstrated effectiveness in comorbid patients with recurrent crystal-related arthritis. Due to our local experience with anakinra to treat calcific periarthritis3, we started using anakinra in the treatment of selected patients with ACD in hand and wrist with severe pain.ObjectivesTo report our experience with anakinra to treat ACD in hand and wrist in terms of efficacy and safety.MethodsWe retrospectively included all patients treated with anakinra for ACD in hand or wrist in our department in 2020. We extracted data on treatment duration, pain, range of motion, skin erythema, hypervascularization, oedema and X-ray findings when available.ResultsTen patients (mean age 45, SD 11) were treated for ACD in hand or wrist with anakinra 100 mg per day for a mean duration of 2.7 days. We observed a fast and significant improvement of pain at rest on a 0-10 VAS scale (mean pain reduction at day 2 (SD): -3.9 (2.8), p=0.01). All patients were free of pain at rest after day 6 and at motion after day 21. Range of motion significantly improved at day 2 (+41° (24), mean (SD), p=0.03). We observed local erythema and oedema improvement from day 2 and a decrease in skin temperature from day 3. Calcifications decreased in size or disappeared in the majority of the patients. We did not observe any adverse events. Patients did not report recurrence after phone contact, 12 months after treatment.ConclusionAnakinra was associated with a significant clinical improvement after only two days of treatment of ACD in hand or wrist and may be considered to treat patients with this condition, especially those with contraindication to NSAIDs or glucocorticoids. Further controlled studies are needed to confirm our observations.References[1]Nikci V, Doumas C. Calcium deposits in the hand and wrist. J Am Acad Orthop Surg. 2015, 23: 87-94.[2]Janssen CA, Oude Voshaar MAH, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019 Jan 2.[3]Zufferey P, Valcov R, Thomas M, et al. Efficacy of anakinra in acute hydroxyapatite calcification-induced joint pain: A retrospective study of 23 cases. Joint Bone Spine. 2019, 86: 83-8.Figure 1:Graph 1. Box plot of pain at rest (0-10 VAS scale) and range of motion (ROM) at day 0, 1, 2, 3, 7 and 21 after treatment with anakinra 100 mg per day.Disclosure of InterestsNone declared

Background: Diagnosis of monogenic diabetes has important clinical implications for treatment and health expenditure. However, its prevalence remains to be specified in many countries, particularly from South Europe, North Africa and Middle-East, where non-autoimmune diabetes in young adults is increasing dramatically. Aims: To identify cases of monogenic diabetes in young adults from Mediterranean countries and assess the specificities between countries. Methods: We conducted a transnational multicenter study based on exome sequencing in 204 unrelated patients with diabetes (age-at-diagnosis: 26.1 ± 9.1 years). Rare coding variants in 35 targeted genes were evaluated for pathogenicity. Data were analyzed using one-way ANOVA, chi-squared test and factor analysis of mixed data. Results: Forty pathogenic or likely pathogenic variants, 14 of which novel, were identified in 36 patients yielding a genetic diagnosis rate of 17.6%. The majority of cases were due to GCK, HNF1A, ABCC8 and HNF4A variants. We observed highly variable diagnosis rates according to countries, with association to genetic ancestry. Lower body mass index and HbA1c at study inclusion, and less frequent insulin treatment were hallmarks of pathogenic variant carriers. Treatment changes following genetic diagnosis have been made in several patients. Conclusions: Our data from patients in several Mediterranean countries highlight a broad clinical and genetic spectrum of diabetes, showing the relevance of wide genetic testing for personalized care of early-onset diabetes. © 2020 Elsevier B.V.

The application of nanosecond pulsed electric fields (nsPEFs) could be an effective therapeutic strategy for peritoneal metastasis (PM) from colorectal cancer (CRC). The aim of this study was to evaluate in vitro the sensitivity of CT-26 CRC cells to nsPEFs in combination with chemotherapeutic agents, and to observe the subsequent in vivo histologic response.In vitro cellular assays were performed to assess the effects of exposure to 1, 10, 100, 500 and 1000 10 ns pulses in a cuvette or bi-electrode system at 10 and 200 Hz. nsPEF treatment was applied alone or in combination with oxaliplatin and mitomycin. Cell death was detected by flow cytometry, and permeabilization and intracellular calcium levels by fluorescent confocal microscopy after treatment. A mouse model of PM was used to investigate the effects of in vivo exposure to pulses delivered using a bi-electrode system; morphological changes in mitochondria were assessed by electron microscopy. Fibrosis was measured by multiphoton microscopy, while the histological response (HR; hematoxylin-eosin-safran stain), proliferation (KI67, DAPI), and expression of immunological factors (CD3, CD4, CD8) were evaluated by classic histology.10 ns PEFs exerted a dose-dependent effect on CT-26 cells in vitro and in vivo, by inducing cell death and altering mitochondrial morphology after plasma membrane permeabilization. In vivo results indicated a specific CD8+ T cell immune response, together with a strong HR according to the Peritoneal Regression Grading Score (PRGS).The effects of nsPEFs on CT-26 were confirmed in a mouse model of CRC with PM.

To specify whether an association exists between pre-hospital body temperature collected by the emergency medical services (EMS) call centre, and intensive care unit (ICU) admission of patients with septic shock. An observational study based on data collected by the EMS of Paris. All septic shocks were included. Among, the 140 calls concerning septic shock, 22 patients (16%) were admitted to ICU. The mean core temperature was 37.4±1.6°C for ICU and 38.6±1.1°C (p

Objective: to provide evidence based clinical recommendations for the diagnosis and therapy of the acute stage of ischemic cerebrovascular accident in EsSalud. Materials and methods: a group for producing the guideline was conveyed, including specialized physicians and methodologists. The group prepared 8 clinical questions to be answered by the guideline. Systematic searches of previous reviews were performed, and – when it was deemed necessary – primary studies in Medline and the Cochrane Controlled Registry of Trials for 2018 were reviewed. Evidence was selected aiming to respond each one of the proposed clinical questions. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work sessions, the group used GRADE methodology for reviewing the evidence and generated recommendations, good clinical practice items, and designed flow charts for both diagnosis and therapy. Finally, the guide was approved with the decree N° 128-IETSI-ESSALUD-2019. Results: this clinical practice guideline focused in 8 clinical questions, which were divided into four topics: screening, diagnosis, therapy, support and rehabilitation. On the basis of these questions, 28 recommendations were formulated (8 strong and 20 conditional), 38 items for good clinical practice, 1 implementation note, and 2 flow charts. Conclusion: this paper summarizes both evidence based methodology and conclusions from a new clinical practice guide for diagnosis and therapy of the acute stage of a cerebrovascular accident in EsSalud.

Resume But de l’etude Les recommandations de l’European Resuscitation Council (octobre 2015), reaffirment l’importance du guidage telephonique de la reanimation cardiopulmonaire. L’objectif de cette etude est d’evaluer si un guidage telephonique systematique de la reanimation cardiopulmonaire jusqu’a l’arrivee des secours augmente le taux de charge des assistants de regulation medicale au SAMU 78. Patients et methode Il s’agit d’une etude observationnelle, descriptive, prospective, de la gestion des suspicions d’arret cardiaque. Le critere d’inclusion etait la suspicion d’arret cardiaque lors d’un appel. Le critere de jugement principal est le taux de charge moyen sur les tranches horaires sur lesquelles ont ete gerees des suspicions d’arret cardiaque. Resultats Du 1er au 31 mars 2016, sur 121 appels pour suspicion d’arret cardiaque, un guidage telephonique aurait ete realisable pour 24 d’entre eux. Un guidage telephonique systematique de la reanimation cardiopulmonaire jusqu’a l’arrivee des secours augmente le taux de charge horaire de 2 %, (intervalle de confiance a 95 % : [1,72 ; 2,3], p Conclusion Un protocole de guidage telephonique de la reanimation cardiopulmonaire au sein du SAMU 78 augmenterait significativement le taux de charge des assistants de regulation medicale, mais la difference est faible et peu pertinente sur le plan pratique. Ce resultat nous permet d’envisager la mise en place de la procedure de guidage telephonique sans attendre un retentissement majeur sur la qualite globale du SAMU 78.

Resume Introduction La prescription du dosage de la troponine s’est multipliee en medecine generale tandis que les recommandations confirment la non indication de l’utilisation des marqueurs cardiaques en medecine ambulatoire hormis quelques situations bien particulieres. Les objectifs de ce travail etaient de preciser les indications retenues par les medecins generalistes d’Ile-de-France les poussant a pratiquer un dosage de la troponine en ville, le nombre de medecins generalistes possedant un ECG et la conduite adoptee devant un resultat de troponine positif. Materiels et methodes Nous avons mene une etude observationnelle prospective du 10 octobre 2016 au 1er septembre 2017 base sur un questionnaire envoye par mail a 612 medecins generalistes d’Ile-de-France. Le critere de jugement principal etait les indications des prescriptions du dosage ambulatoire de troponine par les medecins generalistes d’Ile-de-France. Resultats Cent quarante medecins ont participe a l’enquete (24 %). Quatre-vingt-trois (59 %) ne pratiquaient aucun dosage de troponine et 15 (11 %) ne retenaient comme seule indication qu’une faible suspicion de syndrome coronarien aigu (SCA) avec une douleur thoracique de plus de 72 heures. Au total, 70 % des medecins respectaient les recommandations. Parmi les 30 % restants, les indications retenues etaient les patients asymptomatiques avec des facteurs de risques cardiovasculaires (1 %), une faible suspicion de SCA avec douleur thoracique depuis moins de 24 heures (19 %), une forte suspicion de SCA (24 %) et des modifications ECG (9 %). Soixante-deux medecins generalistes ont declare posseder un ECG (44 %). En cas de dosage positif, le SAMU est l’interlocuteur privilegie pour 138 medecins (99 %). Conclusions La majeure partie des medecins generalistes d’Ile-de-France suivent les recommandations par rapport au dosage de la troponine en medecine ambulatoire avec comme interlocuteur privilegie le SAMU en cas de resultat positif. Le nombre de medecins generalistes possedant un ECG est faible pouvant expliquer en partie ce recours au dosage de la troponine en cas de doute.

An acoustic pressure sensor is described that uses a small volume of ionized gas (microplasma) as a sensing element to estimate the sound-pressure fluctuations. This type of sensor uses electric discharge between a point and a plane to create the ionized gas useful for electroacoustic conversion. Depending on the polarity of the point (in this case negative), the applied voltage, and the distance between the electrodes (millimetric or micrometric), the electric discharge has specific operating modes and hysteretic behaviors that are described herein. The interaction of a sound wave with the volume of ionized gas causes a variation in the electric current of the microdischarge. The electroacoustic model and the expression of the sensitivity to the sound pressure, existing for the millimetric discharges (Trichel impulse regime), are briefly recalled. An empirical expression of the acoustic pressure sensitivity of millimetric and micrometric discharges is proposed. An experimental setup is developed using a waveguide. It enables the comparison of the value of the sound pressure deduced from plasma sensors to the one of a reference microphone (using a calibration method by comparison). The sensitivity to the sound pressure of these microplasma sensors is of the order of 0.4 nA/Pa.An acoustic pressure sensor is described that uses a small volume of ionized gas (microplasma) as a sensing element to estimate the sound-pressure fluctuations. This type of sensor uses electric discharge between a point and a plane to create the ionized gas useful for electroacoustic conversion. Depending on the polarity of the point (in this case negative), the applied voltage, and the distance between the electrodes (millimetric or micrometric), the electric discharge has specific operating modes and hysteretic behaviors that are described herein. The interaction of a sound wave with the volume of ionized gas causes a variation in the electric current of the microdischarge. The electroacoustic model and the expression of the sensitivity to the sound pressure, existing for the millimetric discharges (Trichel impulse regime), are briefly recalled. An empirical expression of the acoustic pressure sensitivity of millimetric and micrometric discharges is proposed. An experimental setup is developed using a ...

International audience; Background Diagnosis and treatment of colorectal peritoneal metastases at an early stage, before the onset of signs, could improve patient survival. We aimed to compare the survival benefit of systematic second-look surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC), with surveillance, in patients at high risk of developing colorectal peritoneal metastases. Methods We did an open-label, randomised, phase 3 study in 23 hospitals in France. Eligible patients were aged 18-70 years and had a primary colorectal cancer with synchronous and localised colorectal peritoneal metastases removed during tumour resection, resected ovarian metastases, or a perforated tumour. Patients were randomly assigned (1:1) to surveillance or second-look surgery plus oxaliplatin-HIPEC (oxaliplatin 460 mg/m(2), or oxaliplatin 300 mg/m(2) plus irinotecan 200 mg/m(2), plus intravenous fluorouracil 400 mg/m(2)), or mitomycin-HIPEC (mitomycin 35 mg/m(2)) alone in case of neuropathy, after 6 months of adjuvant systemic chemotherapy with no signs of disease recurrence. Randomisation was done via a web-based system, with stratification by treatment centre, nodal status, and risk factors for colorectal peritoneal metastases. Second-look surgery consisted of a complete exploration of the abdominal cavity via xyphopubic incision, and resection of all peritoneal implants if resectable. Surveillance after resection of colorectal cancer was done according to the French Guidelines. The primary outcome was 3-year disease free survival, defined as the time from randomisation to peritoneal or distant disease recurrence, or death from any cause, whichever occurred first, analysed by intention to treat. Surgical complications were assessed in the second look surgery group only. This study was registered at ClinicalTrials.gov, NCT01226394. Findings Between June 11, 2010, and March 31, 2015, 150 patients were recruited and randomly assigned to a treatment group (75 per group). After a median follow-up of 50.8 months (IQR 47.0-54.8), 3-year disease-free survival was 53% (95% CI 41-64) in the surveillance group versus 44% (33-56) in the second-look surgery group (hazard ratio 0.97, 95% CI 0.61-1.56). No treatment-related deaths were reported. 29 (41%) of 71 patients in the second-look surgery group had grade 3-4 complications. The most common grade 3-4 complications were intra-abdominal adverse events (haemorrhage, digestive leakage) in 12 (23%) of 71 patients and haematological adverse events in 13 (18%) of 71 patients. Interpretation Systematic second-look surgery plus oxaliplatin-HIPEC did not improve disease-free survival compared with standard surveillance. Currently, essential surveillance of patients at high risk of developing colorectal peritoneal metastases appears to be adequate and effective in terms of survival outcomes. Copryright (C) 2020 Elsevier Ltd. All rights reserved.

International audience; This article presents the design and development of an event-triggered control strategy to solve the problem of leader-following consensus and formation problem for a group of UAVs carrying a suspended load individually. In this work, the vehicles exchange information through a network, which is represented by a directed and strongly connected graph. Then, employing a decentralized control law, each UAV decides when it has to send a new value to its neighbors. The stability of the complete system is carried out, and numerical results show the advantages wrt information exchange between UAVs, as well as excellent performance in the angular stabilization and the minimum swing for the suspended load.

Purpose: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. Patients and methods: From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). Results: All groups (NA: n Z 42; ADJ: n Z 16; PO: n Z 16; NoC: n Z 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P Z 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P Z 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07e4.94; P Z 0.033). Conclusion: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.

Les equipes prenant en charge un patient suspect de virose Ebola sont tenues au port d’equipements de protection individuelle (EPI) susceptibles d’entraver la dexterite des operateurs. L’objectif principal est d’etudier l’impact des EPI Ebola sur la difficulte et le delai de realisation des gestes d’urgence. Cette etude observationnelle monocentrique croisee incluait 22 medecins urgentistes, reanimateurs ou infirmiers — anesthesistes volontaires devant realiser cinq ateliers sur mannequin avec ou sans port d’EPI Ebola selon une sequence predeterminee: voie veineuse peripherique (VVP), catheter intraosseux (KTIO), intubation avec et sans Eschmann ou apres pose de LMA-Fastrach™. Le critere de jugement principal etait le delai de realisation des gestes techniques avec et sans port d’EPI. Le port de l’EPI n’augmente pas le taux d’echec de chaque geste technique mais augmente significativement les delais d’intubation simple (29 vs 36 secondes; p < 0,01), d’intubation avec Eschmann (38 vs 45 secondes; p = 0,03) et l’intubation au LMA-Fastrach™(39 vs 45 secondes; p < 0,001). Le port d’EPI Ebola augmentait la difficulte ressentie pour la pose d’abords vasculaires sans augmenter le taux d’echec ni modifier les delais de pose de VVP. Le recours au KTIO etait plus rapide que la pose de VVP sans (67 vs 88 secondes; p = 0,02) et avec tenue (78 vs 101 secondes; p < 0,01). Le port de l’EPI n’entraine qu’un impact modere sur la dexterite des gestes techniques en situation d’urgence. Ces resultats doivent etre confortes par des etudes cliniques.

Resume Introduction La simulation en tant que moyen d’enseignement pratique pour les internes en chirurgie doit etre evaluee de facon objective et doit permettre de mettre en valeur l’acquisition de performance de l’etudiant. Les objectifs de cet article sont la publication de nos grilles d’evaluation et leur validation, ainsi que la mesure de satisfaction des etudiants. Methode Une plateforme d’enseignement pratique sur modele porcin a ete creee en 2009 pour 7 centres hospitaliers universitaires francais. Trois fois par an, 31 internes du DESC de chirurgie viscerale effectuaient 5 exercices chronometres : placement des trocarts (trocarts), test de convergence des instruments (convergence), nœuds intracorporels (nœuds), derouler l’intestin grele pour trouver une lesion (deroule) et realiser un surjet de fermeture du peritoine (surjet). L’evaluation etait realisee de facon prospective par 2 experts sur des grilles (HuFEG) specialement concues et validees pour ces exercices. Le temps, les scores des echelles d’evaluation, l’interet et la satisfaction des internes ont ete analyses. Resultats Les donnees pour 31 internes entre mai 2011 et mars 2012 ont ete analysees. Les echelles d’evaluation etaient statistiquement valides et correlees (K > 0,69) pour chaque exercice. Les temps realises par les internes les plus experimentes etaient significativement plus court dans tous les exercices sauf le deroule du grele (p = 0,2). Apres 4 sessions, les temps etaient significativement ameliores avec une meilleure qualite (moins de fautes et scores moyens eleves [> 88 %]), independamment de l’experience de l’interne. Parmi les apprenants, 92 % etaient satisfaits, 86 % pensaient que ces sessions amelioraient leurs qualites techniques et 74 % pensaient que cela avait un impact favorable sur leur pratique clinique. Conclusion Cette etude montre que l’amelioration des techniques chirurgicales par simulation est plebiscitee par les internes et que nos grilles HuFEG sont valides.

Objectives The use of chest physiotherapy (CP) has not, to date, been shown to be effective in the care of infants hospitalized for bronchiolitis. However, it has not yet been studied in outpatient settings. The aim of our study was to examine the short-term benefit of CP with the increased exhalation technique (IET) on the respiratory conditions of nonhospitalized infants. Methods Our research consisted of a multicenter, randomized, controlled, single-blind study of infants under 1 year old. A decrease in the severity score of the infants' respiratory condition was compared between two groups: one receiving CP and one without CP. Eighty-two infants were randomized: 41 in the CP group and 41 in the control group. Blinded assessors determined the Wang Clinical Severity Score at inclusion (T0) and 30 minutes later (T1) for each group. Results Improvement in the severity score was observed for 29 infants (70.7%) in the group receiving CP, compared with 4 infants (9.76%) in the control group (p Conclusion For outpatient care of infants with bronchiolitis, the results of this study suggest that CP with IET leads to a short-term improvement of mucus airway obstruction parameters.

Boalemo's waters contain a variety of marine fish that have high economic value such as tuna, fish and mouse grouper. Realizing the potential of fishery owned, Fish Auction Place (TPI) which organizes fish sale with auction system is a place where Boalemo fishermen sell their fish catch.The purpose of this study is to determine the general condition of women in households of fishermen who work at Tilamuta Fishing Place (TPI), Boalemo Regency and what are the roles of women in the household economy of fishermen who are active in the Fish Auction Site (TPI) Tilamuta, Kabupaten Boalemo.The method used in this study used census method. Technique of data collecting is done by observation, interview, and literature study.From the result of the research, most of the respondents have elementary school (SD) education as many as 14 people (70%), productive age of respondent (15-45 years) as many as 18 people (90%) and 4 families %). The role of hunting women fishermen to meet the needs of family life consists of: Domestic role; 1) cooking, respondents doing cooking activities between 2-3 times in one day; 2) Washing clothes, respondents generally wash clothes 2 to 3 times and washed clothes are all family members; 3) Cleaning and tidying the house, in one day only done between 2 to 3 times; 4) Taking care of the children, respondents no longer prepare children's clothes and no longer deliver to school because the distance of school from home is close enough; 5) Helping the husband, the respondent to prepare the equipment to go to husband husband, market the catch of husband. Social Role: 1) Majelis Ta'lim, attending meetings 1-2 times a month, benefiting respondents; 2) Arisan, respondents do lott arisan 2 - 3 times a month, used to cover household needs; 3) Dasawisma and PKK, respondents have attended the meeting; 4) Kube, respondents have participated about 3 years, the result is used for family expenditure.Productive Role: 1) Laborers, who work as laborers 3 to 4 days a week, earned wages ranging from Rp500,000 - Rp1,000,000; 2) Private employees / civil servants, there is 1 person (5%) with gajin only about> Rp1.000.000, -; 3) washcloth, there are 3 people (15%) about Rp1.000.000,-; 3) Tukas cuci, terdapat 3 orang (15%) sekitar

The muographic imaging of volcanoes relies on the measured transmittance of the atmospheric muon flux through the target. An important bias affecting the result comes from background contamination mimicking a higher transmittance. The MU-RAY and TOMUVOL collaborations measured independently in 2013 the atmospheric muon flux transmitted through the Puy de Dome volcano using their early prototype detectors, based on plastic scintillators and on Glass Resistive Plate Chambers, respectively. These detectors had three (MU-RAY) or four (TOMUVOL) detection layers of 1 m2 each, tens (MU-RAY) or hundreds (TOMUVOL) of nanosecond time resolution, a few millimeter position resolution, an energy threshold of few hundreds MeV, and no particle identification capabilities. The prototypes were deployed about 1.3 km away from the summit, where they measured, behind rock depths larger than 1000 m, remnant fluxes of 1.83±0.50(syst)±0.07(stat) m−2 d−1 deg−2 (MU-RAY) and 1.95±0.16(syst)±0.05(stat) m−2 d−1 deg−2 (TOMUVOL), that roughly correspond to the expected flux of high-energy atmospheric muons crossing 600 meters water equivalent (mwe) at 18° elevation. This implies that imaging depths larger than 500 mwe from 1 km away using such prototype detectors suffer from an overwhelming background. These measurements confirm that a new generation of detectors with higher momentum threshold, time-of-flight measurement, and/or particle identification is needed. The MU-RAY and TOMUVOL collaborations expect shortly to operate improved detectors, suitable for a robust muographic imaging of kilometer-scale volcanoes.

Penelitian ini bertujuan untuk mengetahui peran, kegiatan ekonomi produktif dan kegiatan sosial wanita dalam keluarga nelayan di Kelurahan Tumumpa II Kecamatan Tuminting Kota Manado. Peran wanita dalam meningkatkan perekonomian keluarga nelayan di Kelurahan Tumumpa II Kota Manado sangatlah nyata. Baik secara langsung maupun tidak langsung wanita nelayan atau istri nelayan di Kelurahan Tumumpa II telah ikut andil dalam menopang perekonomian keluarga. Peran istri dalam menopang ekonomi keluarga adalah 88,6% dari wanita responden dengan berbagai macam usaha sedangkan ada sekitaran 11,4 % dari wanita responden yang memilih untuk tidak bekerja tetapi mengurus dan mengolah pendapatan keluarga saja. Istri nelayan yang ada di Kelurahan Tumumpa II juga masih aktif dalam kegiatan-kegiatan sosial kemasyarakatan berupa pelatihan keterampilan ataupun penyuluhan-penyuluhan yang diadakan oleh ibu-ibu PKK di Kelurahan Tumumpa II, arisan, rukun ibadah dan pengajian ibu-ibu.Kata kunci: Peranan Wanita, Perekonomian dan Keluarga Nelayan.

Sektor kelautan dan perikanan memiliki potensi besar sebagai sektor unggulan dan penggerak utama pembangunan perekonomian daerah menuju Sulawesi Utara yang maju, mandiri dan sejahtera. Hal ini disebabkan karena sektor ini memiliki keunggulan komparatif dibanding sektor lainnya berupa ketersediaan sumberdaya alam yang sangat besar dan mempunyai potensi ekonomi yang luar biasa, yang mampu menghasilkan produk dan jasa dengan daya saing tinggi, sepanjang dapat mengelolanya dengan tepat. Menurut Kementerian Kelautan dan Perikanan (KKP), ketersediaan sumberdaya alam yang ada di daratan semakin terbatas, khususnya yang berbasiskan lahan, sejalan dengan bertambahnya penduduk dan berkembangnya kegiatan ekonomi sebagai dampak dari pelaksanaan pembangunan. Tujuan penelitin untuk mengetahui bagaimana pengambilan keputusan dari persediaan es balok dan untuk mengidentifikasi hal apa saja yang mepengaruhi keputusan persediaan es balok di Pelabuhan Perikanan Pantai (PPP) Tumumpa Kota Manado. Metode yang digunakan dalam penelitian ini yaitu metode survei dan metode partisipatif. Data yang dikumpulkan berupa data primer dan data sekunder serta analisis data yang digunakan yaitu analisis deskriptif kualitatif dan analisis deskriptif kuantitatif. Pelabuhan perikanan adalah pelabuhan khusus yang dipergunakan sebagai pangkalan kegiatan penangkapan ikan dan dilengkapi dengan berbagai fasilitas sejak ikan didaratkan sampai didistribusikan. Pelabuhan Perikanan Pantai (PPP) terletak di Kelurahan Tumumpa II Kecamatan Tuminting Kota Manado mempunyai letak geografis 1°31’21” LU dan 124°50’28” BT, dengan jarak lokasi dari pusat kota kurang lebih 7 km. Lokasi seluas 4 (empat) Ha di bangun sejak tahun 1993 yang di kenal dengan nama Pangkalan Pendaratan Ikan (PPI) dengan dana bantuan luar negeri (BLN-OECF INP-22) untuk kegiatan awal seperti survei, penahan tanah dan pengerukan. Pelabuhan Perikanan Pantai (PPP) Tumumpa merupakan salah satu fasilitas penunjang yang di sediakan unit pelaksana teknis dinas (UPTD) balai pengembangan dan pembinaan penangkapan ikan (BP3I), berdasarkan surat keputusan peraturan daerah (PERDA) Provinsi Sulawesi Utara Nomor 3 Tahun 2008 tentang organisasi dan tata kerja Dinas Kelauan dan Perikanan dipimpin oleh seorang kepala balai yang dalam pelaksanaan tugasnya bertanggung jawab kepada Kepala Dinas Kelautan dan Perikanan Provinsi Sulawesi Utara. Dalam kegiatan penjualan es balok, pabrik es balok yang ada di Pelabuhan Perikanan Pantai (PPP) Tumumpa hanya dapat menjual es per balok di karenakan belum mempunyai mesin penghancur es, es balok yang akan di jual kepada nelayan dengan berukuran 80 kg per balok dan dijual seharga Rp 23.000,-/balok. Kata Kunci : es balok, pengambilan keputusan, metode survey

International audience; This paper presents the development of a collaborative event-based control applied to the problem of formation of a group of VTOL-UAVs (Vertical Takeoff and Landing, Unmanned Aerial Vehicles). Each VTOL-UAV decides, based on the difference of its current state (linear position and velocity) and its latest broadcast state, when it has to send a new value to its neighbours. The asymptotic convergence to average consensus or desired formation is depicted via a real-time implementation.

Background The peritoneal cancer index (PCI) is a comparative prognostic factor for colorectal peritoneal metastasis (CRPM). The ability of laparoscopy to determine the PCI in consideration of cytoreductive surgery remains undetermined, and this study was designed to compare it with laparotomy. Methods A prospective multicentre study was conducted for patients with no known CRPM, but at risk of peritoneal disease. Surgery began with laparoscopic exploration followed by open exploration to determine the PCI. Concordance between laparoscopic and open assessment was evaluated for the diagnosis of CRPM and for the PCI. Results Among 50 patients evaluated, CRPM recurrence was found in 29 (58 per cent) and 34 (68 per cent) at laparoscopic and open surgery respectively. Laparoscopy was feasible in 88 per cent (44 of 50) and deemed satisfactory by the surgeon in 52 per cent (26 of 50). Among the 25 evaluable patients with satisfactory laparoscopy, there was concordance of 96 per cent (24 of 25 patients) and 38 per cent (10 of 25) for laparoscopic and open assessment of CRPM and the PCI respectively. Where there were discrepancies, it was laparoscopy that underestimated the PCI. Conclusion Laparoscopy may underestimate the extent of CRPM.

KKP telah menetapkan antara lain menerapkan prinsip-prinsip pengelolaan sumberdaya kelautan dan perikanan yang bertanggung jawab, berdaya saing, dan berkelanjutan. Salah satu langkah operasional yang perlu dilakukan adalah mengembangkan budidaya rumput laut. Tujuan penelitian ini untuk mengetahui strategi agrobisnis budidaya rumput laut di Desa Buku Utara Kecamatan Belang Kabupaten Minahasa Tenggara Provinsi Sulawesi Utara. Metode penelitian yang digunakan adalah studi kasus, dengan cara mempelajari/mendalami suatu kasus tertentu dengan mengumpulkan beragam sumber informasi (Raco, 2010). Data dikumpulkan adalah data primer dan data sekunder. Analisis data hasil penelitian dibedakan dalam dua macam, yaitu analisis kuantitatif dan analisis kualitatif (Fathoni, 2006). Hasil penelitian bahwa rumput laut jenis Eucheuma cottonii yang dibudidayakan, secara geografis perairan memiliki tingkat keterlindungan arus yang baik dan tingkat kadar garam bagus. Penggunaan metode rawai (long line) yang paling baik, karena dasar perairan yang tidak cocok dengan metode lain. Penyediaan benih sudah dipisahkan ± 500 kg bibit dalam satu kali penanaman, untuk penanaman sampai pemanenan rumput laut yaitu 45 hari, sedangkan pemasaran dari Dinas Kelautan dan Perikanan Provinsi membeli langsung di lokasi pembudidaya rumput laut. Keuntungan yang diperoleh dari usaha budidaya rumput yaitu Operation Profit (OP) = Rp 106.160.000,- dan Keuntungan π = Rp 101.688.000,-, dengan jangka waktu pengembalian kuarang lebih 3 tahun 4 bulan.

Tujuan dari penelitian ini untuk mengetahui proses budidaya udang vaname dan untuk mengetahui analisis finansial dari usaha budidaya udang vaname di Balai Pelatihan dan Penyuluhan Perikanan (BPPP) Aertembaga Kota Bitung Provinsi Sulawesi Utara. Jenis penelitian yang digunakan adalah studi kasus. Stake (2006) mengatakan studi kasus sebagai metode penelitian yang memiliki tujuan penting dalam meneliti dan mengungkap keunikan serta kekhasan karakteristik yang terdapat dalam kasus yang diteliti, dimana kasus tersebut menjadi penyebab mengapa penelitian dilakukan. Proses budidaya udang vaname terdiri dari beberapa tahap yakni penjemuran kolam, pencucian kolam, pemberian kaporit, pemberian probiotik, proses pemeliharaan, pemberian pakan, panen, dan penanganan pasca panen. Harga udang vaname di BPPP Aertembaga yaitu Rp. 75.000 / Kg dengan hasil udang yang di panen sebanyak 800 kg. Total keuntungan dari usaha budidaya udang vaname dalam 1 periode sebesar Rp.120.000.000. Total cost selama 1 periode sebesar Rp. 65.448.000 dan Total keuntungan / Net Profit sebesar Rp. 65.448.000. Sehingga Profit Rate atau tingkat keuntungan yang diperoleh sebesar 83,35% dan Benefit Cost Ratio (BCR) adalah 1,83 dengan jangka waktu pengembalian 1,7 tahun. BEP Penjualan menunjukkan bahwa titik impas dari usaha budidaya udang vaname di BPPP Aertembaga adalah Rp. 17.745.461 dan BEP satuan yang didapat yaitu 236,60 kg. Berdasarkan hasil analisis finansialnya ternyata usaha budidaya udang vaname di BPPP Aertembaga layak untuk dikembangkan.

This study aims to review knowing the state of the District Sales Manager village Sinuian Remboken And find out if the fish farming in net cages step feasible OR feasible for the review run. The basic method basis Of Research Singer Namely Studies CASE, data retrieval is done Operates census where respondents Its taken is 100% of a population of Fishermen fish of tilapia in the village Sinuian, data collected is data primary data the collected with how to observe and secondary data in the form evidence, notes OR statements of historical Yang has arranged hearts archives for review analyzing fish farming with analysis methods operating profit data such as net income, the rate of profit, benefit cost ratio, profitability, break-even point, the payback period, net present value, internal rate and returns. Based on the analysis in the financial, fish farming in net cages step in the Village Sinuian eligible to run because the value of a positive operating profit, profit rate of fish farming reached 57.23%, 92.22% profitability, the value of the benefit cost ratio> 1 namely 1.57; BEP or break-even point is BEP sales of Rp. 24,562,016 and BEP 982.48kg unit further investment return rate of tilapia fish farming are 1 year 1 month, with a 92.09% IRR, NPV 329,059,572.14. Keywords : cage nets step, financial analysis, tilapia Abstrak Penelitian ini bertujuan untuk Mengetahui keadaan umum Desa Sinuian Kecamatan Remboken dan mengetahui apakah usaha budidaya ikan di karamba jaring tancap layak atau tidak layak untuk dijalankan. Metode dasar dari penelitian ini yaitu studi kasus, pengambilan data dilakukan secara sensus dimana responden yang diambil adalah 100% dari populasi nelayan pembudidaya ikan nila di Desa Sinuian, data yang dikumpulkan adalah data primer yaitu data yang terkumpul dengan cara observasi dan data sekunder berupa bukti, catatan atau laporan historis yang telah tersusun dalam arsip untuk menganalisis usaha budidaya ikan dengan metode analisis data seperti operating profit, net profit, profit rate, benefit cost ratio, rentabilitas, break event point, payback period, net present value, dan internal rate of return. Berdasarkan hasil analisis secara finansial, usaha budidaya ikan di karamba jaring tancap di Desa Sinuian layak untuk dijalankan karena nilai operating profit positif, profit rate dari usaha budidaya ikan ini mencapai 57,23%, rentabilitas 92,22%, nilai benefit cost ratio >1 yaitu 1,57; BEP atau titik impas yaitu BEP penjualan Rp. 24,562,016dan BEP satuan 982.48kg selanjutnya tingkat pengembalian investasi dari usaha budidaya ikan nila ini adalah 1 tahun 1 bulan, dengan IRR 92,09%, NPV 329,059,572.14. Kata Kunci : Karamba jaring tancap, analisis finansial, ikan nila

International audience; This paper presents the development of a collaborative event-based control applied to the problem of consensus and formation of a group of VTOL-UAVs (Vertical Takeoff and Landing, Unmanned Aerial Vehicles). Each VTOL-UAV decides, based on the difference of its current state (linear position and velocity) and its latest broadcast state, when it has to send a new value to its neighbors. The asymptotic convergence to average consensus or desired formation is depicted via numerical simulations.