Influence des barrières sur la propagation de la déformationle long des surfaces de décollement : étude expérimentale

International audienceA series of small-scale experiments has been done to study the influence of gap and thickness variations along a layer of potential decollement on the fault sequence in a thrust system. It is shown that a local thinning or discontinuity of the decollement layer can become a barrier which localises the deformation, initiates a ramp, and controls the order of fault development above the decollement layer.Une série d'expériences sur modèles réduits a été réalisée afin d'étudier l'influence des lacunes et des variations d'épaisseur d'un niveau de décollement potentiel sur la propagation d'un système chevauchant. Les résultats montrent qu'un amincissement ou une discontinuité de ce niveau crée une barrière qui peut bloquer au moins temporairement le décollement, localiser la déformation, servir de site d'initiation d'une rampe, et déterminer aissi l'ordre d'apparition des rampes suivantes

Assessment of progress towards universal health coverage for people with disabilities in Afghanistan: a multilevel analysis of repeated cross-sectional surveys

Background Since 2002, Afghanistan has made much effort to achieve universal health coverage. According to the UN Sustainable Development Goal 3, target eight, the provision of quality care to all must include usually underserved groups, including people with disabilities. We investigated whether a decade of international investment in the Afghan health system has brought quality health care to this group. Methods We used data from two representative household surveys, one done in 2005 and one in 2013, in 13 provinces of Afghanistan, that included questions about activity limitations and functioning difficulties, socioeconomic factors, perceived availability of health care, and experience with coverage of health-care needs. We used multilevel modelling and tests for interaction to investigate factors associated with differences in perception between timepoints and whether village remoteness affected changes in perception. Findings The 2005 survey included 334 people, and the 2013 survey included 961 people. Mean age, employment, and asset levels of participants with disabilities increased slightly between 2005 and 2013, but the level of education decreased. Formal education and higher asset level were associated with improved availability of health care and positive experience with coverage of health-care needs, whereas being employed was only associated with the latter. Perceived availability of health care and positive experience with coverage of health-care needs significantly worsened in 2013 compared with in 2005 (227 [69%] perceived that services were available in 2005 vs 405 [44%] in 2013, p<0·0001; 255 [78%] perceived a positive experience in 2005 vs 410 [45%] in 2013, p<0·0001). Village remoteness increased in 2013 (no connectivity by paved road 186 [57%] in 2005 vs 797 [87%] in 2013, p<0·0001; mean time to reach health-care facility 64·3 min [SD 167·7] vs 84·4 min [107·7], p<0·0001) and negatively affected perception of health-care availability. Interpretation Perceived availability of health care and experience with health-care coverage have not greatly improved for people with disabilities in Afghanistan, particularly in remote areas. Health policy in Afghanistan will need to address attitudinal, social, and accessibility barriers to health care

Community based system dynamic as an approach for understanding and acting on messy problems: a case study for global mental health intervention in Afghanistan

Background: Afghanistan lacks suitable specialized mental healthcare services despite high prevalence of severe mental health disorders which are aggravated by the conflict and numerous daily stressors. Recent studies have shown that Afghans with mental illness are not only deprived of care but are vulnerable in many other ways. Innovative participatory approaches to the design of mental healthcare policies and programs are needed in such challenging context. Methods: We employed community based system dynamics to examine interactions between multiple factors and actors to examine the problem of persistently low service utilization for people with mental illness. Group model building sessions, designed based on a series of scripts and led by three facilitators, took place with NGO staff members in Mazar-I-Sharif in July 2014 and in Kabul in February 2015. Results: We identified major feedback loops that constitute a hypothesis of how system components interact to generate a persistently low rate of service utilization by people with mental illness. In particular, we found that the interaction of the combined burdens of poverty and cost of treatment interact with cultural and social stigmatizing beliefs, in the context of limited clinical or other treatment support, to perpetuate low access to care for people with mental disorders. These findings indicate that the introduction of mental healthcare services alone will not be sufficient to meaningfully improve the condition of individuals with mental illness if community stigma and poverty are not addressed concurrently. Conclusions: Our model highlights important factors that prevent persons with mental illness from accessing services. Our study demonstrates that group model building methods using community based system dynamics can provide an effective tool to elicit a common vision on a complex problem and identify shared potential strategies for intervention in a development and global health context. Its strength and originality is the leadership role played b

Electric Lifeline Policy in Maine

Concern about the impact of high energy costs on the low-income and elderly citizens underlies Maine’s so-called electric lifeline programs, which modify rates to assist qualified customers with their electric bills. Recently, researchers at the Margaret Chase Smith Policy Center conducted an evaluation of Central Maine Power Company’s electric lifeline policy. This article, based on the findings of that evaluation, examines the many regulatory and social issues that have surfaced during Maine’s lifeline experience

New sedimentological, structural and paleo-thermicity data in the Boucheville Basin (eastern North Pyrenean Zone, France)

International audienceThe Boucheville Basin is one of the easternmost Mesozoic basins of the North Pyrenean Zone (NPZ) that was opened during the Albian extension between the Iberian and European plates. During the extension, a HT/LP metamorphism event affected the Albian basins near the North Pyrenean Fault (NPF). Our aim is to better understand the evolution of the Boucheville Basin during the Albian–Cenomanian lithospheric thinning, which occurred under high thermal conditions. Sedimentological and structural data were collected in the basin and are used to produce synthetic stratigraphic columns of different portions of the basin and to restore selected cross-sections. North–south cross-sections show that the Boucheville Basin is a large and asymmetrical deformed syncline with inverted borders. Synthetic stratigraphic columns show that the sedimentation of the Boucheville Basin starts with carbonate platforms deposited under low bathymetric conditions showing slope deposits and evolves to deep bathymetric conditions of marls deposited without evidence of slopes. Raman spectroscopy on carbonaceous material (RSCM) was made on samples used to construct the sedimentological stratigraphic columns in order to obtain a temperature map of the Albian metamorphism. They reveal homogeneity in the temperatures between 500 and 600 °C. In situ LA–ICP–MS U–Pb dating of titanite grains found in a syn-deformation located in the Albian calcschists provided an age of ca. 97 Ma that gives a time constraint for both the deformation and metamorphism. These data are used collectively to propose a model for the tectono-sedimentary and metamorphic evolution of the Boucheville Basin during the Albian extension

Print information to inform decisions about mammography screening participation in 16 countries with population-based programs

OBJECTIVE: To profile and compare the content and presentation of written communications related to informed decision-making about mammography. METHODS: Materials from 16 screening programs organized at the national or regional level were analyzed according to five major information domains suggested by the international literature. RESULTS: A majority of countries provided information on the program (interval, cost and quality). There was considerable variability in comprehensiveness of elements in the domains, e.g., test characteristics (false positive/negative) and pros and cons of screening. The majority noted the likelihood of recall for further tests, few commented on the risks of additional tests or finding unimportant tumors. The audit also found variation in presentation (words and pictures). CONCLUSIONS: Presentation of comprehensive, but balanced information on screening benefits and risks is complex and daunting. Issues such as framing effects, coupled with debate about screening efficacy are challenging to the design of effective information tools. The objective of increasing screening prevalence at the population level must be balanced with objectively presenting complete and clear information. Additional research is needed on how information (and mode of presentation) impact screening decisions. PRACTICE IMPLICATIONS: Public health officials need to articulate their objectives and review written communication according to important decision-making domains. [Authors]]]> Decision Making ; Informed Consent ; Mammography ; Mass Screening ; Patient Acceptance of Health Care ; Patient Education as Topic oai:serval.unil.ch:BIB_E228BFDB52E0 2022-05-07T01:28:47Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_E228BFDB52E0 Evaluation médico-économique de la thrombolyse de l'accident vasculaire cérébral hyperaigu par le rtPA (Actilyse) http://www.chuv.ch/bdfm/cdsp/MemoireBonvin.pdf Bonvin, Marielle Université de Lausanne, Faculté des hautes études commerciales masterthesis 2003 <![CDATA[L'AVC (accident vasculaire cérébral) représente la troisième cause de mortalité et la première cause de handicap fonctionnel chronique dans la population adulte occidentale. Son fardeau économique compte parmi les plus élevés de toutes les maladies. Ce mémoire a pour objet d'étudier l'impact économique d'une nouvelle procédure d'intervention, la thrombolyse des infarctus cérébraux par le rtPA, sur les coûts du Centre hospitalier universitaire vaudois. [Table des matières] 1. Introduction. 2. Physiopathologie et traitement de l'accident vasculaire cérébral : 2.1 Mécanismes de la coagulation sanguine 2.2 L'athérosclérose. 2.3 L'infarctus cérébral. 2.4 Les traitements de l'AVC. 2.5 La controverse. 2.6 La situation au CHUV. 2.7 Les enjeux économiques. 3. Méthodologie. 4. Tableaux : caractéristiques de l'échantillon et résultats. 5. Discussion. 6. Limites de l'étude. 7. Conclusion

Basement – Cover decoupling and progressive exhumation of metamorphic sediments at hot rifted margin. Insights from the Northeastern Pyrenean analog

International audienceWe compile field data collected along the eastern part of the North Pyrenean Zone (NPZ) to point to a tectonic evolution under peculiar thermal conditions applying to the basin sediments in relation with the opening of the Cretaceous Pyrenean rift. Based on this compilation, we show that when thinning of the continental crust increased , isotherms moved closer to the surface with the result that the brittle-ductile transition propagated upward and reached sediments deposited at the early stage of the basin opening. During the continental breakup, the pre-rift Mesozoic cover was efficiently decoupled from the Paleozoic basement along the Triassic evaporite level and underwent drastic ductile thinning and boudinage. We suggest that the upper Albian and upper Creta-ceous flysches acted as a blanket allowing temperature increase in the mobile pre-rift cover. Finally, we show that continuous spreading of the basin floor triggered the exhumation of the metamorphic, ductily sheared pre-rift cover, thus contributing to the progressive thinning of the sedimentary pile. In a second step, we investigate the detailed geological records of such a hot regime evolution along a reference-section of the eastern NPZ. We propose a balanced restoration from the Mouthoumet basement massif (north) to the Boucheville Albian basin (south). This section shows a north to south increase in the HT Pyrenean imprint from almost no metamorphic recrystallization to more than 600 °C in the pre-and syn-rift sediments. From this reconstruction, we propose a scenario of tectonic thinning involving the exhumation of the pre-rift cover by the activation of various detachment surfaces at different levels in the sedimentary pile. In a third step, examination of the architecture of current distal passive margin domains provides confident comparison between the Pyrenean case and modern analogs. Finally, we propose a general evolutionary model for the pre-rift sequence of the Northeastern Pyrenean rifted margin

Readmissions and the quality of care in patients hospitalized with heart failure

Objectives. Clinical practice guidelines based on the results of randomized clinical trials recommend that patients with heart failure due to left ventricular systolic dysfunction (LVSD) be treated with angiotensin-converting enzyme inhibitors (ACEI) at doses shown to reduce mortality and readmission. This study examined the relationship between ACEI use at discharge and readmission among patients with heart failure due to LVSD. Methods and results. Data were abstracted from the medical records of 2943 randomly selected patients hospitalized for heart failure in 50 hospitals. The outcome of interest was the number of readmissions occurring up to 21 months after discharge. Six-hundred and eleven patients were eligible for analysis. Compared with patients discharged at a recommended ACEI dose, patients not prescribed an ACEI at discharge had an adjusted rate ratio of readmission (RR) of 1.74 [95% confidence interval (CI) 1.22-2.48], while patients prescribed an ACEI at less than a recommended dose had an RR of 1.24 (95% CI 0.91-1.69) (P = 0.005 for the trend). Conclusion. Our results show that ACEI use at discharge in patients with LVSD is associated with decreased rate of readmission. These findings suggest that compliance with the ACEI prescribing recommendations listed in clinical practice guidelines for patients with heart failure due to LVSD confers benefi

External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol.

INTRODUCTION: Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department. METHODS AND ANALYSIS: This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority. ETHICS AND DISSEMINATION: This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT02616419