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

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

Tide and wind coupling in a semienclosed bay driven by coastal upwelling

The Ría de Vigo is a semi-enclosed bay in which tidal residual currents are associated with coastal upwelling events. Both upwelling and downwelling favourable winds generate a bidirectional exchange flow with the shelf – a two-layer circulation with surface waters leaving (entering) the ria and a compensating inflow (outflow) through the bottom layer under upwelling (downwelling) conditions. This vertical circulation changes the vertical density structure inside the ria. In the ria, the tide is mainly semidiurnal (M2, S2 and K2), with some energy in the diurnal band (K1). Our velocity observations show that the vertical structure of the tidal currents in the ria do not exhibit a classic barotropic profile with a bottom boundary layer beneath uniform “free-stream” flow as the tidal bottom boundary layer is affected by stratification. This links tidal circulation to the wind-driven residual circulation, since the latter also greatly helps to control the stratification. We quantify this effect by fitting tidal ellipses to observed velocities through the water column. In addition to this indirect coupling through stratification, there is a direct interaction in which velocities in the upper and bottom layers are best correlated with winds while the mid-water velocities are best correlated with tides. These wind-tide interactions are expected to play a key role in the resuspension and transport of nutrients and phytoplankton in the Ria.CTM2012-3515

Tidal and wind influences on circulation in the southern mouth of the Ría de Vigo (NW Iberian Peninsula)

Tidal and wind influences on the velocity field in the Ría de Vigo were assessed using atmospheric data from two meteorological stations located at Bouzas port and on an oceanic buoy off Silleiro Cape along with oceanic data from an ADCP moored in the Ría for a 72-day period. A two-layer circulation pattern was observed. Near-surface and near-bottom currents are primarily influenced by wind (especially remote winds), separated by an intermediate layer dominated by tidal variability. At subtidal frequencies, residual currents are well correlated with wind variability. Remote wind forcing exhibited a markedly high correlation with surface layer currents, indicating the major role played by wind in the long-term upwelling-modulated circulation of the Ría

Sediment mobilization and seawater warming affect ecophysiology of the clam polititapes rhomboides

Poster.-- Poster.-- VIII International Symposium on Marine Science, Las Palmas de Gran Canaria, 6-8 July 2022High-energy hydrodynamic events associated to currents and waves may disturb bivalve mollusks´ ecophysiology, especially those buried in the the sea bed due to sediment mobilization. Evidences of massive mortality for the clam Polititapes rhomboides (banded carpet shell clam) in Galicia (NW Spain) have been associated to warm water temperatures and high wave magnitudes above climatic averages and the presence of rickettsias (intracellular prokaryotic colonies) in gills (Villalba et al. 1999; Darriba et al. 2019; Villacieros-Robineau et al. 2021)Project PID2019-106008RB-C21 financed by MCIN/AEI/10.13039/501100011033N

Immune and physiological responses of clams (Polititapes rhomboides) under sediment mobilization and seawater warming conditions

Poster.-- 4th Congress of the International Society of Fish & Shellfish Immunology, December 12-15, 2022, Bode, NorwayHigh-energy hydrodynamic events associated with currents and waves may disturb bivalve mollusks' ecophysiology, especially those buried in the sea bed where the bottom boundary layer dynamics may mobilize and resuspend the surface sediments. Evidence of massive mortality for the clam Polititapes rhomboides (banded carpet shell clam) in 2010 in Galicia (NW Spain) has been associated to warm water temperatures and high wave magnitudes above climatic averages and the presence of rickettsias (intracellular prokaryotic colonies) in gills. To monitor in the laboratory the environmental conditions observed in 2010, clams were subjected to intense sediment mobilization (four cycles of sediment remobilization, each followed by a calm period) and seawater warming (from 15°C to 18°C). Immune system, behavioral, and ecophysiological clams' responses were then evaluated. Nitric oxide (NO) production increased synergistically with seawater warming and sediment remobilization. Taking into account the four cycles of sediment remobilization, clams responded by increasing NO production as early as the first cycle in what we could call an acute effect. However, the most striking effect was the increased NO response after a second stimulation (the following sediment remobilization cycles), suggesting that clams achieve a kind of alertness the first time they are exposed to a stimulus through a mechanism possibly related to "trained immunity". Seawater warming and sediment mobilization presented also synergistic effects causing the lowest valve opening amplitude. Besides, sediment remobilization caused abrupt decrease in clearance rates of clams suggesting that reduced valve opening during this stage may have altered filtration processes of phytoplankton uptake. Metabolic rate as oxygen consumption showed a synergistic increase with both abiotic stressors. Considering the NO response and the ecophysiology data we could suggest that clams respond to stress increasing metabolism to obtain energy (ATP) and oxygen consumption by aerobic respiration. ATP production involves the generation of reactive oxygen species (ROS) including NO as by-products. The anti-oxidant system can balance the ROS production but this could be drastically altered (disruption of cytoskeleton and apoptotic cell death) if ROS production is greater and faster than the antioxidant system can regulate, which seems not to be the case for this particular experimentProject PID2019-106008RB-C21 financed by MCIN/AEl/10.13039/501100011033N

The assessment of neuromuscular fatigue during 120 min of simulated soccer exercise

Purpose This investigation examined the development of neuromuscular fatigue during a simulated soccer match incorporating a period of extra time (ET) and the reliability of these responses on repeated test occasions. Methods Ten male amateur football players completed a 120 min soccer match simulation (SMS). Before, at half time (HT), full time (FT), and following a period of ET, twitch responses to supramaximal femoral nerve and transcranial magnetic stimulation (TMS) were obtained from the knee-extensors to measure neuromuscular fatigue. Within 7 days of the first SMS, a second 120 min SMS was performed by eight of the original ten participants to assess the reliability of the fatigue response. Results At HT, FT, and ET, reductions in maximal voluntary force (MVC; −11, −20 and −27%, respectively, P ≤ 0.01), potentiated twitch force (−15, −23 and −23%, respectively, P < 0.05), voluntary activation (FT, −15 and ET, −18%, P ≤ 0.01), and voluntary activation measured with TMS (−11, −15 and −17%, respectively, P ≤ 0.01) were evident. The fatigue response was robust across both trials; the change in MVC at each time point demonstrated a good level of reliability (CV range 6–11%; ICC2,1 0.83–0.94), whilst the responses identified with motor nerve stimulation showed a moderate level of reliability (CV range 5–18%; ICC2,1 0.63–0.89) and the data obtained with motor cortex stimulation showed an excellent level of reliability (CV range 3–6%; ICC2,1 0.90–0.98). Conclusion Simulated soccer exercise induces a significant level of fatigue, which is consistent on repeat tests, and involves both central and peripheral mechanisms