Disaster Response in the United States of America: An Analysis of the Bureaucratic and Political History of a Failing System

Disaster Response in the United States is plagued by bureaucratic and political obstacles. This paper analyzes the complete history of disaster response in the United States from the 19th century to the present. Specific attention is given to the establishment of FEMA and the Department of Homeland Security. The conclusion offers one possible suggestion to improve American disaster response

Unit-cell for dual-circular polarisation reflectarrays

International audience—A new unit-cell composed of two layers for dual-CP reflectarrays is proposed for the first time with the unique capability to reflect independently and simultaneously the two incident circular polarisations at the same frequency. The experimental results demonstrate that this unit-cell exhibits a 3.8% bandwidth around 8.4 GHz for a phase resolution better than 1.92 bits in LHCP and in RHCP. As a first step towards a reflectarray in dual-CP, this innovative unit-cell is studied in an array configuration. To increase the value of the maximum incidence angle up to 30°, a matching dielectric layer is placed over the cell

Troubles musculo-squelettiques : rôles des médecins-conseils et relations interprofessionnelles

INTRODUCTION: Musculoskeletal disorders (MSD) were responsible for 9.7 million days of sick leave in 2010 in France. They are also a leading cause of occupational exclusion. The objective was to study the role of medical advisers (Mas) in the care of patients with MSD and their interactions with general practitioners (GPs) and occupational health physicians (OPs). METHODS: We performed a qualitative study with semi-structured interviews with medical advisers from the Brittany region. Semistructured interviews were double-coded and were submitted to thematic analysis. RESULTS: Nine interviews were conducted with MAs from the general regime, agricultural regime, and independent workers regime. MAs described an increase in MSD, especially with complex forms. They explained that their activity was not limited to control, but that they also had an important role in limiting occupational exclusion. It is important to anticipate difficulties related to return to work in this setting. They reported contrasted but necessary relations with GPs who are at the centre of care. Return to work may require negotiation with OPs. CONCLUSION: Relations between MAs and GPs are partly based on control of prescriptions, which can create a climate of suspicion. Emphasizing the fight against occupational exclusion can provide new light on the role of MAs. Improving relations between MAs and GPs can be achieved by a better understanding of their respective roles

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

<p>Abstract</p> <p>Background</p> <p>The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).</p> <p>Methods</p> <p>All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.</p> <p>Results</p> <p>The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.</p> <p>Conclusion</p> <p>These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.</p

Hypnotherapy and insomnia: A narrative review of the literature

International audienceINTRODUCTION: Hypnotherapy is increasingly used in general medicine in France to manage health problems such as insomnia. There is some evidence to support the efficacy of hypnosis in treating insomnia but this evidence is based on methodologies of various strengths. This review aims to explore the methodological elements employed in hypnotherapy research to manage insomnia. METHOD: We performed a narrative review of the literature using systematic review methods focusing on treating insomnia with hypnosis. PubMed, Psycinfo, BASE and Cochrane databases and Google scholar were searched. RESULTS: Overall, 25 studies were included consisting of 10 case studies, 11 randomised, controlled trials and 4 pre and post intervention studies. The study designs, intervention, control and comparators were heterogeneous, as were the hypnosis definitions and techniques. Also, detailed descriptions of the hypnosis techniques were lacking. Most studies used non-quantifiable measurement criteria and sample numbers were too small to show significance or be representative. No double-blind study was found. CONCLUSION: Our results indicate that the current research concerning the efficacy of hypnosis to relieve insomnia is lacking in key methodological elements. The evaluation research process requires robust methodology. We propose applying the IDEAL framework, which recommends research steps to evaluate non-pharmacological and other complex therapies to evaluate the efficacy of hypnosis to manage insomnia

A Dual-Band Dual-Circular-Polarization Antenna for Ka-Band Satellite Communications

A novel Ka-band dual-band dual-circularly-polarized antenna array is presented in this letter. A dual-band antenna with left-hand circular polarization for the Ka-band downlink frequencies and right-hand circular polarization for the Ka-band uplink frequencies is realized with compact annular ring slots. By applying the sequential rotation technique, a 2 × 2 subarray with good performance is obtained. This letter describes the design process and presents simulation and measurement results

Treatment of snake envenomations by a new polyvalent antivenom composed of highly purified F(ab')2 : results of a clinical trial in northern Cameroon

A clinical trail was conducted in 2 health centers in northern Cameroon to assess the safety and efficacy of a new polyvalent antivenom composed of higly purified and pasteurized F(ab')2 (FAV-Africa). Forty-six patients with objective signs of envenomation, including 67% with hemorrhage, were included in the study. Each patient received at least 20 ml of FAV-Africa by direct, slow intravenous injection ; 172 10-ml ampules were administered. All patients were clinically cured after treatment. Two patients (4.3%) showed minor immediate adverse events that may have been related to FAV-Africa (induration, light-headedness) ; no other treatment-related adverse event occurred. No patient had serum sickness. This trial confirms the safety of FAV-Africa administered by intravenous injection and its efficacy in the treatment of snake envenomations in sub-Sahara Africa. (Résumé d'auteur