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Aim To describe the methods and feasibility of the nutritional intervention carried out within the SPRINTT Randomized cotrolled trial. We also illustrate how nutrition interventionists identified participants at risk of malnutrition and the lessons learnt from the nutrition intervention. Findings SPRINTT nutrition intervention was well-received by the majority of the participants. It was mainly carried out using tailored nutrition counselling, but also other means of delivering the intervention were successfully used. Compared with a standard nutrition prescription, an individualized protocol to diagnose malnutrition and follow-up by tailored nutrition counselling helped achieve nutritional targets more effectively in spite of diversity of population in nutritional habits and in some cases reluctance to accept changes. Message The SPRINTT nutrition intervention was feasible and allowed flexibility to the varying needs and cultural differences of this heterogeneous population of frail, older Europeans. It may serve as a model to educate and improve nutrition among community-dwelling older people at risk of mobility limitations. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-020-00438-4., Background The “Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies” (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. Methods SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3–9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0–1.2 g/kg body weight, energy intake of 25–30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. Results Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. Conclusion The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-020-00438-4.

Disc displacements of the temporomandibular joint correspond to a modification in the relationship between mandibular condyle and articular disc of this joint. There are two categories of disc displacements : one ‘‘with reduction’’ and the other ‘‘without reduction’’ ; among disc displacements ‘‘with reduction’’ we can make a difference between partial disc displacement or grade I, and complete disc displacement or grade II. In maximum intercuspal position, for grade I we notice that the condyle is in contact with the posterior band of the disc, whereas for grade II it is posterior to the disc. For both of these grades, when the patient opens the jaw we can observe a reunion between the disc and the condyle. We made a literature review in order to see how and why grade I and grade II disc displacements differ from one another. A number of authors distinguish grade I and grade II as two specific entities, relying on clinical signs and complementary exams. For these authors, this distinction has an interest to decide therapeutic strategies, set prognosis, and enhance accuracy and reliability of epidemiological studies.; Les désunions disco-condyliennes de l’ATM correspondent à une modification de la relation entre le condyle mandibulaire et le disque de l’articulation temporo-mandibulaire. Il y a deux catégories de désunions : les désunions disco-condyliennes ‘‘réductibles’’ et les désunions disco-condyliennes ‘‘non réductibles’’ ; parmi les désunions disco-condyliennes dites ‘‘réductibles’’, on différencie les désunions partielles ou grade I, et les désunions totales ou grade II. En occlusion d’intercuspidie maximale, on observe que pour les grades I le condyle est en contact avec le bourrelet postérieur du disque, alors que pour les grades II il est situé en arrière du disque. En position bouche ouverte, pour ces deux grades, on observe une réunion disco-condylienne. Nous avons réalisé une revue de littérature afin de voir si ces deux types de désunions disco-condyliennes sont différenciés, comment, et dans quel intérêt. En effet un certain nombre d’auteurs distinguent les grades I et les grades II, comme deux entités spécifiques, en s’appuyant sur les signes cliniques et les examens complémentaires. Pour ces auteurs, cette distinction présente un intérêt pour décider de la stratégie thérapeutique, pour déterminer un pronostic, ainsi que pour améliorer la précision et la fiabilité des études épidémiologiques.

Landscape configuration and composition can influence the spatial distribution of species. Cross-scale interactions may exist when multiscale effects interplay to shape species’ distribution patterns. We investigated how the spatial distribution of a semiaquatic mammal, muskrat (Ondatra zibethicus), is influenced by local-scale resource characteristics. We also assessed how fetch, the unobstructed distance wind can travel across water, influences fine-scale habitat use by muskrats. We used 2 years of presence-absence surveys (2015–2016) at 71 wetland sites to evaluate the spatial distribution of muskrats in a lacustrine system in Minnesota, USA. We expected site occupancy and colonization to be positively associated with the amount of Typha x glauca (a rapidly establishing invasive hybrid cattail species) at sites, and negatively associated with fetch impact, water depths, and open water areas. As expected, sites with greater coverage of T. x glauca, shallower water depths, and less open water had greater initial occupancy probabilities. Muskrats were more likely to colonize fetch-impacted sites if there were also greater coverages of T. x glauca present. The distribution and intensity of fetch, dictated by the watershed-scale configuration of upland landscapes, influenced site colonization by muskrats. Our results suggest that this landscape-scale effect is mediated by the amount of T. x glauca present at much finer scales. This cross-scale interaction may facilitate distribution expansions of wetland-obligate species into otherwise unsuitable habitats.

In this work, we present experimental results on the behavior of liquid water at megabar pressure. The experiment was performed using the HIPER (High-Intensity Plasma Experimental Research) laser facility, a uniaxial irradiation chamber of GEKKO XII (GXII) at the Institute of Laser Engineering (ILE), and the PHELIX at GSI (GSI Helmholtz Centre for Heavy Ion Research), a single-beam high-power laser facility, to launch a planar shock into solid multilayered water samples. Equation-of-state data of water (H2O) are obtained in the pressure range 0.50–4.6 Mbar by tuning the laser-drive parameters. The Hugoniot parameters (pressure, density, etc.) and the shock temperature were simultaneously determined by using VISAR and SOP as diagnostic tools and quartz as the standard material for impedance mismatch experiments. Finally, our experimental results are compared with hydrodynamic simulations tested with different equations of state, showing good compatibility with tabulated SESAME tables for water., The authors would like to acknowledge the support of the laser technical team at GEKKO XII (ILE) and PHELIX (GSI). This work received funding from the Euratom Research and Training Program 2014–2018 and 2019-2020 (Grant agreement no. 633053). The involved teams were operated within the framework of the Enabling Research Project ENR-IFE19.CEA-01, Study of Direct Drive and Shock Ignition for IFE: Theory, Simulations, Experiments, Diagnostics Development. JIHT RAS team members were supported by the Ministry of Science and Higher Education of the Russian Federation (State Assignment no. 075-00460-21-00).

Background: The “Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies” (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. Methods: SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3–9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0–1.2 g/kg body weight, energy intake of 25–30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. Results: Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. Conclusion: The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations.

Pediatric CRPS is a painful, disabling and often chronic condition. Its rehabilitation remains long and ambiguous. The objective of this dissertation is to determine the reasons for this complexity and to identify the difficulties as well as the effective coping strategies found by patients through semistructured interviews. Knowledge of the mechanisms of pain, management of emotions, distraction, formulation of objectives and the quality of listening by the therapist are concepts mentioned but only partially understood. Therapeutic education has the potential to optimize these strategies to reduce pain and rehabilitation time while improving patient engagement and strengthening relationships with therapists.; Le SDRC pédiatrique est une affection douloureuse, invalidante et souvent chronique. Sa rééducation demeure longue et ambiguë. L’objectif de ce mémoire est de déterminer les raisons de cette complexité et d’identifier les difficultés ainsi que les stratégies d’adaptation efficaces trouvées par les patients au travers d’entretiens semi-directifs. La connaissance des mécanismes de la douleur, la gestion des émotions, la distraction, la formulation d’objectifs et la qualité de l’écoute du thérapeute sont des notions évoquées mais partiellement comprises. L’éducation thérapeutique possède le potentiel d’optimiser ces stratégies afin de réduire la douleur et le temps de rééducation tout en améliorant l’implication des patients et renforçant leurs relations avec les thérapeutes.

This paper deals with the optimization of the hyperthermia treatment of skin cancer, with gold nanoshells loaded in the tumor. The physical problem involves a one-dimensional bioheat transfer problem, coupled to a radiation problem for the laser propagation within a multi-layered medium that includes several tissues. The corresponding bioheat transfer problem is governed by Pennes' equation, while the laser radiation propagation in the tissues is modelled with the diffusion δ-P1 approximation. The solution of the direct problem was obtained by finite volumes and verified with an analytic solution, as well as with the Matlab function pdepe. The thermal decomposition in the tissues was modelled with an Arrhenius equation, while the objective function was given by a quadratic form involving the difference between the predicted and the desired spatial variation of the thermal damage at a specific final time. Both the Levenberg-Marquardt and the Particle Swarm methods were implemented and provided similar results for the two design variables of interest in this work: the volume fraction of nanoparticles within the tumor and the laser power, by considering a fixed duration of 10 minutes for the treatment. The results obtained in this work also show that more than one treatment session is required for the total eradication of the tumor.

This thesis defines a campaign of experimentation to guide UTACC development from concept to reality. It also applies design methodologies to reduce costs and increase the quality, effectiveness, and speed of UTACC's development. UTACC is a system of systems that teams Marines with unmanned robotic systems to reduce the Marine's cognitive load and enhance mission accomplishment. Bringing UTACC from concept to reality requires extensive experimentation, but prior to this thesis no experimentation plan has existed. A series of UTACC theses have been written starting with a CONOPS. Then theses red-celled the CONOPS, explored Coactive Design methodology, analyzed UAV alternatives, and generated measures of effectiveness and performance for the system. Using information learned from the previous theses, the campaign of experimentation described in this thesis identifies key developmental relationships, associates measures with them, and organizes them in an incremental order. This thesis also emphasizes Coactive Design and Model Driven Software Development to reduce cost and improve the quality and flexibility of the system. The goal of the campaign is to provide a plan to develop a robust, cost-efficient system that Marines can use as a part of their team to increase victory on the battlefield. http://archive.org/details/unmannedtactical1094550577 Captain, United States Marine Corps Approved for public release; distribution is unlimited.

Resume Le cadre legislatif indique que l’accompagnement de la personne handicapee est centre sur son « projet de vie ». Mais qu’en est-il lorsque la personne hospitalisee n’est pas encore en capacite de se projeter pour preparer sa sortie ? Qui sont ces patients en difficulte pour elaborer un projet de sortie et dont la duree de sejour se prolonge ? Les situations complexes des personnes dont l’atteinte corporelle se cumule avec une precarite psychosociale revelent avec acuite ces questionnements. Le cumul constate des situations de precarite et de handicap conduit a observer leur interdependance. Il fait emerger des liens de causalite, il convoque la dialectique entre exclusion et participation sociale, il revele la convergence de processus de souffrances psychiques, sources d’insecurite. Des lors, l’accompagnement en ergotherapie vise la restauration d’un sentiment de securite, comme condition de la capacite a se projeter dans l’avenir. Ainsi, l’activite est envisagee comme le moyen pour la personne de s’approprier le temps et l’espace dans le sens d’un projet de sortie. Cet article, issu d’un memoire soutenu pour l’obtention du DU « strategies de compensation du handicap », plaide pour une meilleure identification de ces situations complexes et pour une definition des moyens a mettre en œuvre dans le respect d’une demarche de reinsertion centree sur « le projet de vie » de la personne. Parallelement, l’etude revele l’enjeu, lie au contexte actuel, des reformes du financement des etablissements de soins de suite. Au regard du cheminement du patient, la duree des sejours comme critere determinant pour la valorisation financiere s’opposerait a l’accomplissement des missions de reinsertion qui incombent aux etablissements de soins de suite.

This paper presents a three-dimensional numerical simulation of a nitriding process applied to an industrial component. The aim of the simulation is to predict the residual stresses and distortions due to volume changes induced by chromium nitride (CrN) and carbides (M23C6 et M4C3) formation. The simulation is performed in two steps. The diffusion of nitrogen and the precipitation of chrome nitride and carbides are first simulated. Then stresses and strains are calculated, assuming an elastic behaviour of the component, and using a volume expansion due to the precipitate concentration. The proposed approach is applied on a gear tooth. Small holes and details were neglected. For symmetry reasons, only half a tooth is taken into account. As the main phenomena take place through the first millimetre from the outer surface, a special attention was paid on meshing. The mesh used for the diffusion and precipitation analysis is composed of 1 130 000 nodes and 1 110 000 elements. For the mechanical analysis, a coarser mesh including only 165 000 nodes and 290 000 elements was used.

International audience; Interactions of short-chain organic acids with hydrated cement phases affect structure durability in the agro-food and nuclear waste industries but can also be used to modify cement properties. Most previous studies have been experimental, performed at fixed concentrations and pH, without quantitatively discriminating among polyacidity effects, or complexation and salt precipitation processes. This paper addresses such issues by thermodynamic equilibrium calculations for acetic, citric, oxalic, succinic acids and a simplified hydrated CEM-I. The thermodynamic constants collected from the literature allow the speciation to be modelled over a wide range of pH and concentrations. Citric and oxalic had a stronger chelating effect than acetic acid, while succinic acid was intermediate. Similarly, Ca-citrate and Ca-oxalate salts were more insoluble than Ca-acetate and Ca-succinate salts. Regarding aluminium complexation, hydroxyls, sulphates, and acid competition was highlighted. The exploration of acid mixtures showed the preponderant effect of oxalate and citrate over acetate and succinate.