Caractéristiques des patients adressés à une équipe mobile de soins palliatifs par le service des urgences d'un hôpital tertiaire

Contexte : Le service des urgences représente la porte d'entrée dans l'hôpital pour de nombreux patients, dont ceux relevant de soins palliatifs. Parmi ces patients palliatifs, la proportion de patients âges est en constante augmentation. Cependant, il existe peu de données dans la littérature sur les patients admis dans un service d'urgence relevant de soins palliatifs spécialises. Objectif : L'objectif principal de cette étude est de permettre la caractérisation des patients du service des urgences d'un hôpital tertiaire pour lesquels le recours à une équipe spécialisée de soins palliatifs est nécessaire. Méthodologie : Nous avons réalisé une étude rétrospective descriptive, incluant 94 patients, sur une période de deux ans, du 1er janvier 2012 au 31 décembre 2013. Les variables étudiées étaient (i) les caractéristiques sociodémographiques et cliniques des patients (âge, sexe, pathologie principale) ; (ii) la trajectoire des patients (nombre de passages au service des urgences durant l'année précédant l'hospitalisation, devenir des patients après la prise en charge au service des urgences, délai entre l'admission au service des urgences et la prise en charge par l'EMSPi, nombre de consultations par patient réalisées par l'EMSPi) ; (iii) les motifs de prise en charge (motifs d'admission au service des urgences, motifs de recours à l'EMSPi) et les problématiques identifiées par l'EMSPi. Afin d'apprécier l'influence de l'âge sur les différentes variables, une catégorisation selon l'âge a été réalisée avec comme valeur de séparation la moyenne d'âge des patients. Résultats : Les patients étaient en majorité des hommes (52.1%), avaient une moyenne d'âge de 69 ans et présentaient principalement une pathologie cancéreuse (85.1%). La majorité d'entre eux restaient hospitalisés (89.4%) et deux tiers avaient été admis au moins une fois au service des urgences dans l'année précédant l'hospitalisation de référence. La prise en charge par l'EMSPi était précoce puisque dans 79.3% des cas, les patients étaient vus par l'EMSPi le jour de l'admission ou le lendemain. 89.0% des patients avaient bénéficié d'une seule consultation de l'EMSPi. Les trois principaux motifs d'admission au service des urgences étaient la baisse de l'état général (30.6%), la douleur (15.7%) et la dyspnée (13.0%). Pour les motifs de recours à l'EMSPi, l'orientation (41.6%), la douleur (22.8%) et l'évaluation globale (17.8%) étaient retrouvés. Les problématiques les plus fréquemment identifiées par l'EMSPi lors de son évaluation étaient l'orientation (26.6%), la douleur (23.4%) et la dyspnée (14.9%). Il n'y avait pas de différence significative dans les deux groupes de tranche d'âge, excepté pour l'orientation, plus fréquemment identifiée comme motif de recours à l'EMSPi chez les patients de plus de 69 ans. 3 Conclusion : Cette étude met en évidence un taux élevé d'hospitalisation chez les patients palliatifs admis au service des urgences et ayant besoin d'un recours à une équipe spécialisée de soins palliatifs. La principale problématique posée par ces patients, en dehors du contrôle des symptômes, est leur orientation dans le système de soins. Ce problème est plus marqué pour les patients âgés. Des études complémentaires seront nécessaires pour explorer plus précisément le profil de ces patients, afin de permettre leur identification précoce au service des urgences

Effects of nitrogen on benthic diatom assemblages in high-elevation Central and Eastern Alpine lakes.

We explored patterns of benthic-diatom composition across 62 high-elevation Alpine lakes spanning a wide range of nitrogen (N) concentrations due to atmospheric deposition and background variation in lake and watershed characteristics (e.g., land cover, bedrock geology, lake depth, and elevation). Our goals were to (i) assess the effect of lake-water N concentration on benthic-diatom composition during late summer or fall conditions and (ii) identify policy- relevant response thresholds. The analyses were carried out on an existing data set of diatom and water-chemistry data (EMERGE set), integrated with new data. Multivariate and correlation analyses revealed associations between pH, N concentration, and benthic-diatom composition, but the effects of pH and N were confounded. However, partial correlation analysis allowed us to identify ‘N-responsive diatoms’, i.e., diatom taxa with non-spurious association with N. Focusing on these taxa, we detected a decline in the abundance of taxa preferring low N concentrations and an increase in the abundance of taxa preferring high N concentrations starting at NO 3 concentrations of approximately 5 μmol L -1 . We interpreted this shift as an effect of watershed N saturation due to atmospheric N deposition. Based on the results, we suggest a concentration threshold of 5 μmol NO 3 L -1 during late-summer or fall to prevent change in benthic diatoms in high-elevation Alpine lakes affected by N deposition

Two-kink bound states in the magnetically perturbed Potts field theory at T<Tc

The q-state Potts field theory with $2\le q\le 4$ in the low-temperature phase is considered in presence of a weak magnetic field h. In absence of the magnetic field, the theory is integrable, but not free at q>2: its elementary excitations - the kinks - interact at small distances, and their interaction can be characterized by the factorizable scattering matrix which was found by Chim and Zamolodchikov. The magnetic field induces the long-range attraction between kinks causing their confinement into the bound-states. We calculate the masses of the two-kink bound states in the leading order in |h| -> 0 expressing them in terms of the scattering matrix of kinks at h=0.Comment: 20 pages, no figures, v2: one section and references adde

AUTOMATIC ASSESSMENT OF LAKE STATUS USING AN OPEN SOURCE APPROACH: LAKE LUGANO'S CASE STUDY

Abstract. Climate change and human activities are increasingly threatening water resources. In particular sub-alpine lakes are fundamental not only for tourism or other economical activities, but also as a source of water. In this context, there is a strong need to monitor such resources to understand, study and react to known and unknown impacts, so that appropriate mitigation actions can be taken. Unfortunately, although monitoring data already exist for many of these lakes, the information is archived in different formats and servers undermining the full exploitation of data and preventing a more efficient data management. The aim of this work is to improve this situation by implementing a system that integrates and standardizes data coming from different sources. In addition, the system integrates web based tools that estimate lake state indicators using open source software and standard. Thanks to this system, it will be possible to exploit the data potential more fully. This paper focuses on the achievements reached by the research carried out on Lake Lugano in the context of the project SIMILE after two years of work

Monopoles, abelian projection, and gauge invariance

A direct connection is proved between the Non-Abelian Bianchi Identities(NABI), and the abelian Bianchi identities for the 't Hooft tensor. As a consequence the existence of a non-zero magnetic current is related to the violation of the NABI's and is a gauge-invariant property. The construction allows to show that not all abelian projections can be used to expose monopoles in lattice configurations: each field configuration with non-zero magnetic charge identifies its natural projection, up to gauge transformations which tend to unity at large distances. It is shown that the so-called maximal-abelian gauge is a legitimate choice. It is also proved, starting from the NABI, that monopole condensation is a physical gauge invariant phenomenon, independent of the choice of the abelian projection.Comment: 9 pages, no figur

Radiopacity of Sodium Zirconium Cyclosilicate in Computed Tomography: a case of a patient with Hyperkalemia and kidney disease

Sodium Zirconium Cyclosilicate (SZC) is commonly used for treating hyperkalemia because it sequesters gastrointestinal potassium ions, thereby reducing serum potassium levels. However, a less-discussed aspect of SZC is its radiopacity on x-ray-based imaging techniques. The European Medicines Agency (EMA) has only vaguely addressed this issue. Radiopaque substances like SZC can interfere with diagnostic imaging, creating challenges for clinicians and radiologists. We present the case of a 34-year-old Italian male to illustrate these concerns

Bound state dynamics in the long-range spin- ½ XXZ model

Experimental platforms based on trapped ions, cold molecules, and Rydberg atoms have made possible the investigation of highly nonlocal spin-1/2 Hamiltonians with long-range couplings. Here, we study the effects of such nonlocal couplings in the long-range spin-1/2 XXZ Heisenberg Hamiltonian. We calculate explicitly the two-spin energy spectrum, which describes all possible energetic configurations of two spins pointing in a specific direction embedded in a background of spins with opposite orientation. For fast decay of the spin-spin couplings, we find that the two-spin energy spectrum is characterized by well-defined discrete values, corresponding to bound states, separated by a set of continuum states describing the scattering region. In the deep long-range regime instead, the bound states disappear as they get incorporated by the scattering region. The presence of two-spin bound states results to be crucial to determine both two- and many-spin dynamics. On one hand, radically different two-spin spreadings can be observed by tuning the decay of the spin couplings. On the other hand, two-spin bound states enable the dynamical stabilization of effective antiferromagnetic states in the presence of ferromagnetic couplings. Finally, we propose a novel scheme based on a trapped-ion quantum simulator to experimentally realize the long-range XXZ model and to study its out-of-equilibrium properties

The dynamics of university units as a multi-level process. Credibility cycles and resource dependencies

This paper presents an analysis of resource acquisition and profile development of institutional units within universities. We conceptualize resource acquisition as a two level nested process, where units compete for external resources based on their credibility, but at the same time are granted faculty positions from the larger units (department) to which they belong. Our model implies that the growth of university units is constrained by the decisions of their parent department on the allocation of professorial positions, which represent the critical resource for most units’ activities. In our field of study this allocation is largely based on educational activities, and therefore, units with high scientific credibility are not necessarily able to grow, despite an increasing reliance on external funds. Our paper therefore sheds light on the implications that the dual funding system of European universities has for the development of units, while taking into account the interaction between institutional funding and third-party funding

Relational arenas in a regional Higher Education system: Insights from an empirical analysis

Extant indicators on research and higher education do not consider the complex relational structure in which universities are embedded and that influences their performance on one side, and the impact of policies on the other. This article investigates the overall pattern of universities' relational arenas in a Regional environment by considering their two main domains of activity, namely research and teaching. We study their structure, determinants, and existing interactions, in order to understand the possible consequences for policy making and management, and to identify synthetic indicators to represent the