Repositorio Institucional de contenido educativo de la Escuela Latinoamericana de Medicina (ELAM)

Con el propósito de implementar el servicio de repositorio que facilite su gestión, preservación y reutilización de los recursos educativos, así como el establecimiento de políticas de auto archivo y acceso libre en la Escuela Latinoamericana de Medicina. Se ejecutó un proyecto de desarrollo tecnológico para el cual se realizó un estudio descriptivo y transversal, durante los meses septiembre de 2012 a enero del 2013. Se utilizó un grupo de Informantes clave constituido por 13 individuos. Fueron utilizados como métodos el análisis histórico-lógico, el análisis documental, el análisis y la síntesis de la información y la entrevista al grupo de Informantes clave para identificar los requerimientos en cuanto a contenido, formato de archivos y organización del contenido. Como resultados se obtuvo que el repositorio, es creado con Eprints, almacena recursos educativos, en diferentes formatos, proyectos de investigación, informes y presentaciones, además de tesis de maestría y doctorales, organizado por índices de contenido, permite el autoarchivo y establece como modalidad de publicación el depósito semimediado. El servicio está disponible para los usuarios de la Intranet en la dirección electrónica: http://archivoelam.sld.cu. Se concluyó que para el diseño del repositorio se determinó utilizar la aplicación Eprints tiene como modalidad de publicación el depósito semimediado y permite el archivo de recursos educativos, tesis de maestría y doctorales en cualquier formato, organizados por índices, está disponible para usuarios de la Intranet. Palabras Clave: iniciativa de acceso abierto, repositorio, recursos educativos

Outcomes in patients with gunshot wounds to the brain.

Introduction:Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods:We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation. Results:825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation. Conclusion:We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. Level of evidence:Level II

The pharmacist in the face of the booming of the vegetarian and vegan diets

Le nombre de personnes adoptant un régime végétarien ou végétalien ne cesse d’augmenter. Ces régimes restrictifs –allant de la consommation de viande occasionnelle à l’exclusion de tout produit d’origine animale - nécessitent d’avoir des connaissances en nutrition afin d’être équilibrés et de couvrir l’intégralité des besoins nutritionnels journaliers. Dans ce cadre-là, le pharmacien doit pouvoir conseiller ces patients afin de les guider dans leurs choix alimentaires pour limiter le risque de carence.The number of people adopting a vegetarian or vegan diet continues to increase. These restrictive diets - ranging from occasional meat consumption to the exclusion of any animal products - require nutritional knowledge in order to be balanced and to cover all daily nutritional needs. In this context, the pharmacist must be able to advise these patients in order to guide them in their food choices to limit the risk of deficiency

Revêtements polymères stimulables à base de (poly-L-lysine)-g-poly(N-isopropylacrylamide) pour contrôler l’adhésion cellulaire spécifique

Polymer coatings based on the physorption of comb-like polymers, (Poly-L-Lysine)-g-poly(NIsopropylacrylamide)derivatives (PLL-g-PNIPAM), have been developed to reversibly modulate specific cell adhesion on demand.This technique of coating relies on the spontaneous adsorption of PLL on typical anionic substrates used in biology: a simple bath application of substrates in solution of PLLg-PNIPAM affords a stable polymer adlayer with dense and thermoresponsive poly(NIsopropylacrylamide) brushes. Adsorption of comb-like polymers with different strands enables to easily modulate properties of the coatings. We focused on thermoresponsive poly(N-Isopropylacrylamide-co-ligand) brusheswhere ligand is Biotin or a peptide of adhesion.A versatile synthesis of PLL-g-PNIPAM is presented. This synthesis is based on RAFT polymerization of N-acryloxysuccinimide and post-modifications of both the backbone and the polymer ends. Detection of the transition soluble/insoluble in solution and AFM/QCM-d studies of PNIPAM adlayers demonstrate that the critical temperature in adlayers are close to the one in solution. Stability in terms of composition and thickness has been checked after temperature cycles. The study of the adsorption of Avidin-coated particles suggests that these adlayers can expose/mask Biotin, and so regulate specific interaction by simple change in temperature. To optimize the thermal contrast of ligand accessibility, this study includes measurements on mixed adlayers with functionalized/unfunctionalized brushes. Finally, specific adhesion of HeLa cells can be thermally modulated on adlayers presenting repellent brushes and with controlled densities of adhesive peptides (RGD).A local control has been considered on such coatings by using light stimulus. In this context, azobenzene-containing Poly(NIsopropylacrylamide) were synthesized but they shown only a weak light-response.Des revêtements polymères basés sur la physisorption de copolymères en peigne, dérivés du (Poly-L-Lysine)-g-poly(N Isopropylacrylamide) noté PLL-g-PNIPAM, ont été développés afin de contrôler réversiblement l'adhésion cellulaire. La préparation de ces revêtements repose sur l'adsorption spontanée de la poly(lysine) sur la plupart des substrats anioniques usuels en biologie, aisément mis en oeuvre par le non-spécialiste : une simple immersion du substrat dans une solution de PLL-g-PNIPAM donne une monocouche résistante au rinçage et dense en chaines poly(N-Isopropylacrylamide) thermosensibles.L'adsorption de copolymères en peigne dérivés de la PLL et portant des chaînes latérales de natures variées permet d'ajuster à souhait les propriétés du revêtement. Notre attention s'est portée particulièrement sur l'étude de couchesthermosensibles poly(N-Isopropylacrylamide-coligand), où le ligand est soit un groupe biotine, soit un peptide d'adhésion.Une voie de synthèse générique de dérivés PLL-g- PNIPAM est décrite. Elle se fonde sur la polymérisation RAFT du N-acryloxysuccinimide et la post-modification des unités de répétition puis des extrémités de chaînes. Des mesures de la température de transition soluble/insoluble en solution et des caractérisations par AFM et QCM-d de l'extension des chaînes en surface ont permis de démontrer que la transition au sein des revêtements s'opère à une température proche de celle en solution. La stabilité en termes de composition et d'épaisseur des revêtements suite à des cycles de transitions thermiques a été vérifiée. Une étude de l'adsorption de particules décorées par des protéines comme l'avidine a permis de montrer la capacité des couches adsorbée à exposer/masquer la biotine, et à réguler la formation de liaisons spécifiques par simple changement de température. Pour s'assurer de la possibilité d'ajustement du contraste d'accessibilité de ligands, cette étude a été complétée par des mesures sur des couches mixtes contenant des mélanges de chaînes fonctionnelles ou non fonctionnalisées. Enfin, en utilisant un peptide d'adhésion (RGD) comme ligand, il a été montré que l'interaction avec la surface de cellules HeLA peut être réversiblement contrôlée via une variation de température de quelques degrés, moyennant d'optimiser la densité en peptides et la présence de chaînes répulsives en surface.Un control local par stimulation lumineuse a été envisagé. Des poly(N-Isopropylacrylamide) contenant des azobenzenes furent synthétisés mais ne montrent qu'une faible réponse lumineuse

Editorial

Editoria

Analyse isotopique de l'americium par spectrometrie de masse a thermo-ionisation apport d'un nouveau materiau de reference certifie

International audienceDans le combustible nucleaire use, une fois le plutonium retire, l'americium est le premier contributeur de la toxicite a long terme des dechets L'analyse de la composition isotopique et de la concentration a faibles incertitudes est d'un interet primordial pour la gestion des dechets. L'analyse de l'isotope 241Am est egalement importante pour la surete nucleaire car il agit comme une horloge pour la separation du plutonium l'isotope 241Am est un descendant du 241Pu.La Spectrometrie de Masse a Thermo-Ionisation (TIMS) est une technique privilegiee pour realiser ce type de mesures a caractere metrologique sur les actinides. La methode de reference pour l'analyse isotopique est la methode d'evaporation totale. Elle permet de diminuer les quantites analysables, de s'affranchir du fractionnement isotopique, principale source d'incertitudes, et d'augmenter l'exactitude de mesure comparee aux methodes traditionnelles. Neanmoins, l'absence de materiau de reference certifie (MRC) en isotopie et en concentration est un frein pour l'analyse metrologique de l'americium. Afin d'y pallier la CETAMA et le centre commun de recherche de l'Union europeenne (EC-JRC) ont produit un MRC enrichi en isotope 243Am. Une comparaison inter laboratoires a ete organisee afin de verifier la certification de la concentration massique et des rapports isotopiques en americium du MRC. L'objectif de cette etude est d'utiliser les resultats de cette comparaison inter-laboratoire afin de verifier et d'evaluer les performances de la methode d'evaporation totale pour l'analyse de l'americium.Differentes mesures ont ete effectuees sur le MRC recu pour determiner le rapport isotopique 241Am/243Am. L'ecart relatif a la valeur de reference a ete determine inferieur 0,0001 pourcent. L'incertitude de mesure a ete calculee a 0,11 pourcent (k=2). La determination de la teneur en americium a ete realisee par dilution isotopique. L'ecart a la valeur de reference est inferieur a 0,02 pourcent avec une incertitude de mesure egale a 0,81 pourcent (k=2). Cette etude a permis de demontrer les performances du TIMS pour la realisation des analyses isotopiques et de concentration en americium a caractere metrologique

Patterns of injury amongst cruise ship passengers requiring hospitalisation

Background: The number of commercial cruise ship passengers continues to rise and is projected to reach27.2 million passengers worldwide in 2018. Accidental injury aboard these ships can result in serious morbidityand mortality. This study examines the injury mechanisms, patterns, demographics, and outcomesof these injuries which are serious enough to require hospitalisation in order to facilitate administrative,financial, and medical decision making to aid in injury prevention and treatment.Materials and methods: This is a cross-sectional, retrospective, registry-based study of adult patients sustaininginjury while on a cruise ship admitted to a Level I Trauma Centre in the United States over a 2-yearperiod. Data on demographics, injury type and severity, surgical management, hospital charges, length ofstay, mortality, and discharge disposition were recorded.Results: Sixty seven patients were identified and included in the analysis. 70.1% of patients were 65 orolder and a majority were female (59.7%). The most common mechanism of injury was a ground levelfall (79.1%), and the most common injury encountered was a femur fracture (52.2%) which involved theacetabulo-femoral joint in 85.7% of cases. Traumatic brain injuries were uncommon occurring in 7.5% ofcases. There were no fatalities in this series.Conclusions: The most common injuries aboard cruise ships requiring hospitalisation occur in the geriatricpopulation as a result of a ground level fall. Most commonly, the injuries are long bone fractures, withfemur fractures occurring most frequently and accounting for over half of all injuries sustained. Resourcesand protocols for pre-hospital management of cruise ship injuries should prioritise these patients, and fallprevention measures for this demographic should be mandatory aboard all cruise ships

Development of an analysis method of minor uranium isotope ratio measurements using electron multipliers in Thermal Ionization Mass Spectrometry

International audienceA simple analytical procedure was developed to measure with high accuracy the isotope ratio of minor isotope of natural uranium present in small quantities using a thermal ionization mass spectrometer (TIMS). The reduction of quantities used for analysis and the measurement of non-abundant isotopes are of prime interest in the nuclear industry. Indeed it is necessary to reduce the analyst received dose and the effluent released, as well as realizing measurement at trace level. The new generation of TIMS is equipped with a multicollection system of electron multipliers: discrete dynode electron multiplier (SEM) and continuous dynode electron multiplier (MIC), that improve the sensitivity compared to faraday cups. The procedure developed was verified using Certified Reference Material IRMM 052. Results were evaluated relying on NF T 90-210 norm regarding method validation. First, the isotope ratio 234 U/ 238 U was examined by total evaporation using the SEM and MIC to measure 234 U and the faraday cup to measure 238 U. In a second approach, the isotope ratio 235 U/ 238 U was studied by total evaporation using the SEM to measure 235 U and the faraday cup to measure 238 U. The classical method with peak-jumping SEM measurement was also used. Total evaporation method employing only the faraday cup was used to confront the results obtained. The analyzable quantity was reduced from 250 ng to 50 ng for the 235 U/ 238 U isotope ratio and from 1270 ng to 50 ng for the 234 U/ 238 U isotope ratio with acceptable uncertainties thanks to the use of electron multipliers. For all experiments were the accuracy was achieved, the calculated uncertainties were below to 0.28 % for the 235 U/ 238 U isotope ratio and 5 % for the 234 U/ 238 U isotope ratio. I

Development and comparison of two high accuracy methods for uranium concentration in nuclear fuel: ID-TIMS and K-edge densitometry

International audienceThis study compares the two analytical methods for uranium concentration determination with high accuracy in uranium pellet: K-edge densitometer (KED) and the isotope dilution with Thermal Ionisation Mass Spectrometry measurements (ID-TIMS). Both techniques are compared in terms of time, generated radioactive effluent, simplicity, uncertainty estimation and detection limit. ID-TIMS shows lower detection limit and uncertainties than KED. However, the KED analysis time is shorter and generates less effluent. Both techniques were used for metrological analysis of uranium concentration in nuclear materials. The optimization of sample spike mixture isotope ratio for ID-TIMS to decrease uncertainties is also discussed

Development and comparison of high accuracy thermal ionization methods for uranium isotope ratios determination in nuclear fuel

International audienceThis study presents the development and the comparison of high accuracy methods for the uranium isotope determination by thermal ionization mass spectrometry. Two methods for uranium minor isotope ratio determination were compared in term of accuracy, analysable quantity, analysis time and versatility the total evaporation and the classical method with multi-dynamic sequences. The mathematical correction of the abundance sensitivity and the detector calibration within the classical method helps decreasing the uncertainties and the biases compared to the total evaporation method. This comparative study was conducted within the framework of the 2017 Nuclear Material Round Robin participation organized by the International Atomic Energy Agency