Chronic wounds consultation by telemedicine between a rehabilitation healthcare center and nursing home or home

Saint-Hélier Rehabilitation Center (pôle MPR Saint-Hélier), located in Rennes, has been selected for a regional telemedicine project in 2014 about chronic wounds.AimTo make care access easier for heavy disabilities patients in nursing homes or at home with chronic wounds.MethodThe members of TLM Pl@ies chronic team are specialist doctors and nurses for wounds. On request, the occupational therapist or dietician involve in the consultation (multidisciplinary approach). A secure videoconference (web) is used.ResultsSince July 2014, over 100 teleconsultations have been done. Targeted population is constituted by patients:– whose access to care is decreased due to moving difficulties;– of which the health care team is crossing difficulties in the care process (wound care but also disability, nutrition..).Seventy percent of requests come from the nursing home, 30% from homes (pressure ulcers stages 3 and 4, arterial ulcers, venous or mixed). Middle age: 78 years (20–101 years). Only 3 patients refused. Time to organize the teleconsultation is on average 13 days. Consultations last on average 25 minutes. In 30% of cases the teleconsultation is extended by a real live training time for the nurse at home guided by the TLM Pl@ies chroniques team. We evaluate professional satisfaction and technical satisfaction. Without teleconsultation, in 77% of cases transportation request for consultation would be made, in 5% hospitalization. In 18% no request would be done.Discussion/conclusionThese first results, encouraging, confirms the interest of specialized consultations in medico-social settings, and telemedicine can be an effective solution

Debris avalanches on the western flank of Piton des Neiges shield volcano (Reunion Island)

Les faciès bréchiques reconnus à terre dans la région littorale de Saint-Gilles, sur le flanc ouest du volcan Piton des Neiges, sont clairement identifiés comme des dépôts d’avalanche de débris. Leur étude pétrographique, texturale et structurale permet de montrer, grâce à la présence de coulées autochtones interstratifiées, qu’au moins quatre glissements successifs se sont produits. Le premier est de grande ampleur puisqu’il affecte la zone centrale hydrothermalisée du volcan. Il est proposé que ce premier glissement, favorisé par la présence de matériaux ayant subi une importante altération hydrothermale, crée une zone d’instabilité qui influe sur le comportement ultérieur du Piton des Neiges. Dans ce même secteur, les glissements postérieurs concernent uniquement des domaines plus superficiels, mettant en jeu des matériaux non hydrothermalisés et vacuolaires. La bréchification des formations, et en particulier la désagrégation progressive des “blocs” durant le transport de l’avalanche de débris, implique une vitesse de progression élevée. Dans la zone du Cap La Houssaye, l’abrasion et la striation des formations laviques situées sous les unités bréchiques, ainsi que les phénomènes de tassement observés, sont interprétés comme des figures d’arrêt de l’avalanche

Cambios temporales en los transportes y la distribución de las masas de agua a lo largo de la sección 20º W de CAIBOX (Atlántico NE)

24 páginas, 3 tablas, 7 figuras[EN] The CAIBOX cruise was conducted from 25 July to 14 August 2009. Three consecutive transects (zonal, meridional, and transverse) formed a closed box to the west of the Strait of Gibraltar. This study aimed to analyze the thermohaline properties, volume transports, and water mass distributions (percentages) along the meridional section (30–41.5º N, 20º W). We identified the main geostrophic current (Azores Current) and its associated volume transport and interannual changes. Data from previous cruises (AZORES I, A16N, CLIVAR, OACES, and CHAOS) with similar tracks were employed to compare with the CAIBOX meridional section. All but one (CHAOS) were summer cruises. We estimated a mean transport for the Azores Current at 20º W of 9.3 ± 2.6 Sv. There appears to be an inverse relation between the position of this current and its associated transport, with relatively high (low) transports when the current is located roughly south (north) of 35º N. Regarding water masses, an increase of 14.4% was found for Mediterranean Water compared with the 1993, 1998, and 2003 cruises; however, Labrador Sea Water decreased its contribution and southward spreading between 1998 and 2009[ES] Entre el 25 de julio y el 14 de agosto de 2009 se llevó a cabo la campaña CAIBOX, que constó de tres transectos consecutivos (zonal, occidental y transversal) conformando una caja cerrada al oeste del estrecho de Gibraltar. El objetivo principal del presente trabajo fue el estudio de las propiedades termohalinas, los transportes (en términos de volumen) y la distribución de las masas de agua (en porcentajes) a lo largo de la sección occidental (30–41.5º N, 20º W). Se identificó la corriente geostrófica principal (Corriente de las Azores), el transporte asociado a ella y sus cambios interanuales. Adicionalmente se consideraron los datos de cinco campañas anteriores (AZORES I, A16N, CLIVAR, OACES y CHAOS) con secciones similares a las de la campaña CAIBOX. Todas excepto una (CHAOS) fueron campañas estivales. El transporte medio para la Corriente de las Azores a 20º W se estimó en 9.3 ± 2.6 Sv. Parece existir cierta relación inversa entre la posición de dicha corriente y su transporte asociado, con transportes relativamente altos (bajos) cuando la corriente se sitúa al sur (norte) de 35º N. En cuanto a las masas de agua, se observa un incremento de 14.4% del Agua Mediterránea en comparación con las campañas de 1993, 1998 y 2003; sin embargo, el Agua de Labrador ha disminuido su contribución y su propagación hacia el sur entre 1998 y 2009.An important part of the data presented in this paper was obtained through the CAIBEX project: Shelf-ocean Exchanges in the Canaries-Iberia Large Marine Ecosystem (CTM2007-66408-C02/MAR), supported by the Spanish Ministry of Education and Science. The first author, LIC, was funded by a FPU predoctoral fellowship from the National Human Resources Formation Program, within the framework of the 2008–2011 National Scientific Research, Development and Technological Innovation Plan of the Spanish Ministry of Education. The fourth author, NVR, was supported by the Isabel Barreto Program (IN840E) from the Xunta de Galicia.Peer reviewe

Medicosocial outcome after admission in post-intensive care unit at PRM St-Hélier, Rennes

IntroductionPost-Intensive Care Units (PICU) are PRM structures aiming to start the appropriated rehabilitative care as early as possible even though persistent complex medical issues.ObjectiveTo assess medicosocial outcomes of patients away from their admission in PICU.MethodsA retrospective descriptive study that included 81 consecutive patients (mean age 51 years) admitted from 2008 to 2012 in the PICU of Pôle St-Helier Rennes based on called semi-structured interviews between March 2014 and March 2015. Exhaustive data (only 4 lost, 5%) by the patient himself and/or a member of family on autonomy, place of life, structures since the release and reintegration, of patients for 85% of them brain damaged.ResultsThere is 29% (21/77) of death (post-exit life: 1,6 years±1.18). Eighty percent live at home (46/56) of which only 5 without family environment, 10% (5/56) in medicosocial structures (foster or nursing homes…), 10% in hospital (hospital at home, persistent vegetative units…). Fourteen percent (8/56) are completely autonomous and work, all with adaptations. Twenty-three percent (13/56) had a significant dependence for activities of daily life and instrumental ones. Forty percent (22/56) have no hobby. Use of different downstream structures, long-term readaptative monitoring, legal and families’ feelings were also analyzed.Discussion and ConclusionMedical and social outcome of patients in the aftermath of a stay in PICU is disparate, depending on the pathology involved, but also the pre-social situation that seems to be the main predictor of returning home. Most patients have regained a relatively large autonomy for the daily life activities but are embarrassed to complex instrumental activities impeding social inclusion. These results are consistent with those of the literature on head trauma patients but no other study has focused for the moment on the specific population of patients admitted to the PICU. We see the value of such early rehabilitative care units with a real impact on the subsequent independence and opportunities back home

The travel demands of an elite rugby sevens team: Effects on objective and subjective sleep parameters

Purpose: To explore the effects of travel related to international rugby sevens competition on sleep patterns. Methods: Seventeen international male rugby sevens players participated in this study. Sleep assessments were performed daily during two separate Sevens World Series competition legs (Oceania and America). The duration of each competition leg was subdivided into key periods (pre-tour, pre-competition, tournament 1 and 2, relocation and post-tour) lasting 2 to 7 nights. Linear mixed models in combination with magnitude-based decision were used to assess 1) the difference between pre-season and key periods and 2) the effect of travel direction (eastward or westward). Results: Shorter total sleep time (hh:mm) was observed during tournament 2 (mean ± SD, 06:16 ± 01:08), relocation (06:09 ± 01:09) and pre-tour week (06:34 ± 01:24) compared with pre-season (06:52 ± 01:00). Worse sleep quality (AU) was observed during tournament 1 (6.1 ± 65 2.0) and 2 (5.7 ± 1.2) as well as during the relocation week (6.3 ± 1.5) than during pre-season (6.5 ± 1.8). When traveling eastward compared with westward, earlier fall asleep time was observed during tournament 1 (ES -0.57, 90%CI [-1.12 to -0.01]), relocation week (-0.70 [-1.11 to -0.28]), and post-tour (-0.57 [-0.95 to -0.18]). However, possibly trivial and unclear differences were observed during pre-competition week (0.15 [-0.15 to 0.45]) and tournament 2 (0.81 [-0.29 to 1.91]). Conclusion: Sleep patterns of elite rugby sevens players are robust to the effects of long-haul travel and jet lag. However, staff should consider promoting sleep during the tournament and 73 relocation week

Spatial and temporal variability in coccolithophore abundance and distribution in the NW Iberian coastal upwelling system

A systematic investigation of the spatial and temporal variability in coccolithophore abundance and distribution through the water column of the NW Iberian coastal up-welling system was performed. From July 2011 to June 2012, monthly sampling at various water depths was conducted at two parallel stations located at 42 degrees N. Total coccosphere abundance was higher at the outer-shelf station, where warmer, nutrient-depleted waters favoured coccolithophore rather than phytoplanktonic diatom blooms, which are known to dominate the inner-shelf location. In seasonal terms, higher coccosphere and coccolith abundances were registered at both stations during upwelling seasons, coinciding with high irradiance levels. This was typically in conjunction with stratified, nutrient-poor conditions (i.e. relaxing upwelling conditions). However, it also occurred during some upwelling events of colder, nutrient-rich subsurface waters onto the continental shelf. Minimum abundances were generally found during downwelling periods, with unexpectedly high coccolith abundance registered in subsurface waters at the inner-shelf station. This finding can only be explained if strong storms during these downwelling periods favoured resuspension processes, thus remobilizing deposited coccoliths from surface sediments, and hence hampering the identification of autochthonous coccolithophore community structure. At both locations, the major coccolithophore assemblages were dominated by Emiliania huxleyi, small Gephyrocapsa group, Gephyrocapsa oceanica, Florisphaera profunda, Syracosphaera spp., Coronosphaera mediterranea, and Calcidiscus leptoporus. Ecological preferences of the different taxa were assessed by exploring the relationships between environmental conditions and temporal and vertical variability in coccosphere abundance. These findings provide relevant information for the use of fossil coccolith assemblages in marine sediment records, in order to infer past environmental conditions, of particular importance for Paleoceanography. Both E. huxleyi and the small Gephyrocapsa group are proposed as proxies for the upwelling regime with a distinct affinity for different stages of the upwelling event: E. huxleyi was associated with warmer, nutrient-poor and more stable water column (i.e. upwelling relaxation stage) while the small Gephyrocapsa group was linked to colder waters and higher nutrient availability (i.e. early stages of the upwelling event), similarly to G. oceanica. Conversely, F. profunda is suggested as a proxy for the downwelling regime and low-productivity conditions. The assemblage composed by Syracosphaera pulchra, Coronosphaera mediterranea, and Rhabdosphaera clavigera may be a useful indicator of the presence of subtropical waters conveyed northward by the Iberian Poleward Current. Finally, C. leptoporus is proposed as an indicator of warmer, saltier, and oligotrophic waters during the downwelling/winter regime.EXCAPA project - Xunta de Galicia [10MDS402013PR]; CALIBERIA project (Fundacao para a Ciencia e a Tecnologia - Portugal) [PTDC/MAR/102045/2008]; CALIBERIA project [COMPETE/FEDER-FCOMP-01-0124-FEDER-010599, BI/PTDC/MAR/102045/2008/2010-016, BI/PTDC/MAR/102045/2008/2010-022, BI/PTDC/MAR/102045/2008/2011-027]; Ministerio de Economia y Competitividad [CGL2015-68459-P]; Ministry of Education of Spain [AP2010-2559]; ETH Zurich Postdoctoral Fellowship from the Swiss Federal Institute of Technology in Zurich (ETHZ); Xunta de Galicia (Spain); FCT [SFRH/BPD/111433/2015]; Plurianual/Estrategico project [UID/Multi/04326/2013]info:eu-repo/semantics/publishedVersio