Ten Years of Valuation of the Local Impact of Atmospheric Pollution: from Scientific Assessments to Political Decisions

This paper focuses on the economic valuation of the impact of local air pollution. Two main issues are considered: 1. The scientific issue: what is estimated, how and why? The main studies from the nineties are presented here. Two strong issues are stressed, with the diversity of valuation methods, on the one hand, and the debates on how to take the long term into account and the discount technique, on the other. 2. The political issue: how the results from the economic field are analysed and used to establish official values for public policies? The methods used in the transport sector in three different European countries (France, Sweden and Switzerland) are studied here.To conclude, we highlight the discrepancy between these two processes and, wherever possible, offer solutions to reach better synergy.Local air pollution ; External costs ; Economic valuation ; Official values ; Public decision ; International comparison

DIATELIC : une expérience de télésurveillance de dialysés à domicile

Colloque avec actes et comité de lecture.Diatélic est un système de télésurveillance de dialysés à domicile par la technique de DPCA (Dialyse Péritonéale Continue Ambulatoire). Il a été développé par le LORIA en coopération avec les médecins de l'ALTIR et un médecin conseil. l'objectif premier de Diatélic est de prévenir les aggravations de santé des patients en détectant au plus tôt les anomalies d'évolutions de certains paramètres. Alors que certains systèmes de télésurveillance détectent les alarmes ou les alertes dès leur occurrence, Diatélic estime l'état des patients pour prévenir les alarmes qui peuvent être causes de mortalité, mais dans tous les cas au moins causes de transports médicalisés et souvent d'hospitalisation à un stade de risque plus élevé et plus onéreux. Ce système est testé techniquement depuis juin 1998 et est actuellement en cours d'expérimentation médicale selon les règles de l'art après avis favorable du CCPPRB de Lorraine. Cet article présente cette expérimentation selon le plan suivant. Nous rappelons (§2) l'historique et les motivations qui ont conduit au développement de ce système. La thérapeutique considérée jusqu'alors, à savoir la Dialyse Péritonéale Continue Ambulatoire, est rapidement présentée (§3), de façon à mettre en évidence les risques encourus et les paramètres à surveiller. Le système est ensuite brièvement décrit (§4) pour illustrer l'importance du système intelligent de détection d'alertes

Prognostic significance of vascular and valvular calcifications in low- and high-gradient aortic stenosis

International audienceAims In low-gradient aortic stenosis (LGAS), the high valvulo-arterial impedance observed despite low valvular gradient suggests a high vascular load. Thoracic aortic calcifications (TACs) and valvular aortic calcifications (VACs) are, respectively, surrogates of aortic load and aortic valvular gradient. The aim of this study was to compare the respective contributions of TAC and VAC on 3-year cardiovascular (CV) mortality following TAVI in LGAS vs. high-gradient aortic stenosis (HGAS) patients. Methods and results A total of 1396 consecutive patients were included. TAC and VAC were measured on the pre-TAVI CT-scan. About 435 (31.2%) patients had LGAS and 961 (68.8%) HGAS. LGAS patients were more prone to have diabetes, coronary artery disease (CAD), atrial fibrillation (AF), and lower left ventricular ejection fraction (LVEF), P<0.05 for all. During the 3 years after TAVI, 245(17.8%) patients experienced CV mortality, 92(21.6%) in LGAS and 153(16.2%) in HGAS patients, P=0.018. Multivariate analysis adjusted for age, gender, diabetes, AF, CAD, LVEF, renal function, vascular access, and aortic regurgitation showed that TAC but not VAC was associated with CV mortality in LGAS, hazard ratio (HR) 1.085 confidence interval (CI) (1.019–1.156), P=0.011, and HR 0.713 CI (0.439–1.8), P=0.235; the opposite was observed in HGAS patients with VAC but not TAC being associated with CV mortality, HR 1.342 CI (1.034–1.742), P=0.027, and HR 1.015 CI (0.955–1.079), P=0.626. Conclusion TAC plays a major prognostic role in LGAS while VAC remains the key in HGAS patients. This confirms that LGAS is a complex vascular and valvular disease

Passive Wrist Stiffness: The Influence of Handedness

Objective: This paper reports on the quantification of passive wrist joint stiffness and investigates the potential influence of handedness and gender on stiffness estimates. Methods: We evaluated the torque-angle relationship during passive wrist movements in 2 degrees of freedom (into flexion-extension and radial-ulnar deviation) in 13 healthy subjects using a wrist robot. Experimental results determined intrasubject differences between dominant and nondominant wrist and intersubject differences between male and female participants. Results: We found differences in the magnitude of passive stiffness of left- and right-hand dominant males and right-hand dominant females suggesting that the dominant hand tends to be stiffer than the nondominant hand. Left-hand stiffness magnitude was found to be 37% higher than the right-hand stiffness magnitude in the left-handed male group and the right-hand stiffness magnitude was 11% and 40% higher in the right-handed male and female groups, respectively. Other joint stiffness features such as the orientation and the anisotropy of wrist stiffness followed the expected pattern from previous studies. Conclusion: The observed difference in wrist stiffness between the dominant and nondominant limb is likely due to biomechanical adaptations to repetitive asymmetric activities (such as squash, tennis, basketball, or activities of daily living such as writing, teeth brushing, etc.). Significance: Understanding and quantifying handedness influence on stiffness may have critical implication for the optimization of surgical and rehabilitative interventions

Télémédecine et Dialyse

National audienceLes données de la littérature font état d'expériences très marginales de télémédecine en dialyse péritonéale (DP). Ces expériences se limitent à la transmission de données et/ou d'images par les nouvelles voies de communication. Cette étude présente une application originale et innovante de la télémédecine dans le domaine de la DP. Le système DIATELIC (Surveillance Interactive et Coopérative des Dialysés) ajoute à l'optimisation de la transmission de données via intra/internet, un système expert élaboré détectant des anomalies d'apparition progressive voire imperceptible. Ce système expert "intelligent" utilise 5 règles d'interprétation simultanée utilisant des données initiales simples: Poids, tension artérielle (TA), TA différentielle, TA orthostatique, Ultrafiltration péritonéale. Ces règles déclenchent des alertes à partir de valeurs fixes pré- établies, mais également à partir des valeurs moyennes mesurées pendant les 15 jours précédents. L'utilisation routinière de ce système, opérationnel depuis plus d'un an, est concluante. Pour le médecin, l'utilisation d'un tel système change radicalement le suivi du malade en DP. L'accès quotidien aux données du malade se rapproche plus d'une surveillance de type hospitalière, et la messagerie intégrée facilite les contacts. Pour le malade, une impression de sécurité est constamment rapportée, le système expert prévenant à la fois le centre et le patient en cas d'anomalie. La télémédecine, en plein développement, représentera probablement un enjeu de santé publique majeur lorsque les études du rapport coût/bénéfice auront démontré son utilité

Telemedicine and dialysis

Colloque avec actes et comité de lecture. internationale.International audienceInformation found in the literature presents only marginal experiences concerning telemedicine in regards to peritoneal dialysis (PD). These experiences are limited to the transmission of data and/or images using new methods of communication. This article presents a new and innovative application of telemedicine in the field of PD and describes its characteristics in comparison to other telemedicine systems. In addition to optimizing the transmission of data via intra/internet, the DIATELIC (Interactive and Cooperative Monitoring of Dialysis Patients) system has an expert system designed to detect anomalies which can appear progressively and imperceptibly. This intelligent expert system uses six rules of interpretation simultaneously using basic initial data: Weight, blood pressure, differential blood pressure, orthostatic blood pressure, peritoneal ultrafiltration. These rules enable the system to give warning signs based on values which are pre-established or calculated using the averages of the previous 15 days. Routine use of this system operational now for over a year is conclusive. For the doctor, this system radically changes the way medical team follow-up on the patient. Daily access to the information concerning the patient resembles more a hospital-like setting and the integrated message service facilitates the contacts. For the patient, the sense of security derived from the expert system which notifies both the center and the patient in case of an anomaly is often mentioned. Telemedicine, which is in full development, will likely represent a major revolution for the public health system when the studies on the cost/benefit ratio reveal its utility

Polymeric nanocapsules prevent oxidation of core-loaded molecules: evidence based on the effects of docosahexaenoic acid and neuroprostane on breast cancer cells proliferation

International audienceBackground:Nanocapsules, as a delivery system, are able to target drugs and other biologically sensitive moleculesto specific cells or organs. This system has been intensively investigated as a way to protect bioactives drugs frominactivation upon interaction with the body and to ensure the release to the target. However, the mechanism ofimproved activity of the nanoencapsulated molecules is far from being understood at the cellular and subcellularlevels. Epidemiological studies suggest that dietary polyunsaturated fatty acids (PUFA) can reduce the morbidityand mortality from breast cancer. This influence could be modulated by the oxidative status of the diet and it hasbeen suggested that the anti-proliferative properties of docosahexaenoic acid (DHA) are enhanced by pro-oxidantagents Methods:The effect of encapsulation of PUFA on breast cancer cell proliferation in different oxidative mediumwas evaluated in vitro. We compared the proliferation of the human breast cancer cell line MDA-MB-231 and ofthe non-cancer human mammary epithelial cell line MCF-10A in different experimental conditions. Results:DHA possessed anti-proliferative properties that were prevented by alpha-tocopherol (an antioxidant) andenhanced by the pro-oxidant hydrogen peroxide that confirmsthat DHA has to be oxidized to exert its anti-proliferativeproperties. We also evaluated the anti-proliferative effects of the 4(RS)-4-F4t-neuroprostane, a bioactive, non-enzymaticoxygenated metabolite of DHA known to play a major role inthe prevention of cardiovascular diseases. DHA-loadednanocapsules was less potent than non-encapsulated DHA while co-encapsulation of DHA with H2O2maintainedthe inhibition of proliferation. The nanocapsules slightly improves the anti-proliferative effect in the case of4(RS)-4-F4t-neuroprostane that is more hydrophilic than DHA. Conclusion:Overall, our findings suggest that the sensitivity of tumor cell lines to DHA involves oxidized metabolites.They also indicate that neuroprostane is a metabolite participating in the growth reducing effect of DHA, but it is not thesole. These results also suggest that NC seek to enhance the stability against degradation, enhance cellular availability,and control the release of bioactive fatty acids following their lipophilicities