Impact d'une école de l'asthme sur la consommation en soins et la qualité de vie des enfants de 4 à 12 ans et de leurs parents

L'article a été réalisé en collaboration avec Marie-Elise Verga, infirmière de recherche au DMCP, il a été publié dans les Archives de Pédiatrie, une revue française d'importance pour la profession en novembre 2013. L'impact factor de la revue est de 0.36. Ce travail est centré sur l'évaluation de l'impact d'une école de l'asthme chez l'enfant. L'asthme est la maladie chronique la plus fréquente chez l'enfant, sa prévalence est en augmentation dans le monde depuis plusieurs années. Son impact sur la vie des enfants atteints et de leur famille est important en termes d'absentéisme et de limitation dans les activités de la vie quotidienne. Selon différentes études, la connaissance de la maladie serait un pilier pour l'amélioration de son contrôle. Associée à des compétences personnelles et une médication optimale, elle diminuerait les absences scolaires, la survenue des crises et augmenterait la compliance au traitement. L'Ecole de l'Asthme de l'Hôpital de l'Enfance à Lausanne a été mise en place dans ce but, afin d'offrir, par une équipe pluridisciplinaire, des séances d'éducation thérapeutique tant aux enfants qu'à leur famille. Notre étude exploratoire a pour but d'évaluer l'effet de l'Ecole de l'Asthme sur la consommation en soins et la qualité de vie des enfants de 4 à 12 ans et de leurs parents. 27 enfants ont été inclus durant une année. La qualité de vie a été évaluée chez les enfants et leurs parents au moyen du Paediatric Asthma Quality of Life Questionnaire à l'inclusion et 6 mois plus tard. La consommation en soins a été évaluée sur une période d'un an avant et après l'Ecole de l'asthme par un questionnaire envoyé aux pédiatres. Il s'agit de la première étude de ce genre en Suisse et il y en a très peu à l'étranger. Elle démontre clairement une diminution de la consommation en soins que ce soit les rendez- vous chez le pédiatre, les consultations aux urgences et les hospitalisations. Une amélioration de la qualité de vie retrouvée tant chez les enfants que leurs parents a aussi été observée lors de notre étude. En donnant aux enfants et à leur famille des moyens de mieux gérer la maladie à domicile, l'Ecole de l'Asthme contribue à un meilleur contrôle de cette maladie. Ces premières conclusions valident l'importance d'évaluer cette prise en charge par des études prospectives randomisées. Il existe plusieurs perspectives à développer dans le prolongement de cette étude par exemple inclure des patients non francophones, sachant que les migrants représentent une part importante des consultations en urgences et que leur maladie asthmatique est souvent mal contrôlée. Il faudrait affiner les résultats en comparant nos résultats à ceux d'un groupe contrôle ou d'un groupe avec un enseignement individualisé. Un suivi sur 5 ans permettrait de voir l'impact à long terme. Le côté financier devrait être évalué afin de vérifier la diminution des coûts supposée en rapport à la diminution de la consommation en soins

The food supply of the future

Citation: Broquet, Prudence Dell. The food supply of the future. Senior thesis, Kansas State Agricultural College, 1900.Morse Department of Special CollectionsIntroduction: According to the hypothesis of Malthus, the population tends to increase in geometrical ratio, while the reproduction of food goes on by arithmetical ratio consequently there could not be enough food to supply the population, and death must come to the ones who were crowded out or who were least fitted to survive. But Malthus was a young man just returned from college when he wrote this book, and after discussing the question with his father around their fireside, and being severely attacked by the critics, he reconsidered the subject, and in a few years wrote another book, which exactly disputed the doctrine of the first. He did not say that he had disputed the arguments in the first work and what seems remarkable is that people did not find it out for several hundred years. Ricardo and others wrote of the diminishing returns of land; but this theory has as yet no apparent foundation, either in science or experience. Every year since these theories have been presented there has been a constant gain in the means of subsistence in proportion to the ratio of population. Modern science has proved that land is a mere instrument for the conversion of certain elements of nutrition from one form to another. The supply of energy which can thus be converted is immeasurable. Soil is not necessary for plant growth. Vegetation may be produced in water, with the proper temperature, certain elements of plant food in very small quantities, and the air will supply all other materials which are necessary to its perfect development. Its store is inexhaustible. Nature need not be depended on, for it has often been demonstrated that irrigation can make fertile otherwise barren regions, as Egypt, which would be a desert were it not for the annual overflow of the Nile. Irrigation in the United States may be accomplished by placing dams in the mountains and hills, which will hold the water that falls in winter till it is needed in spring and summer. By this means the dry part of the United States, where almost nothing is now raised, could be made to feed as dense a population as Italy or Spain

Caractérisation hydraulique d'un massif calcaire fissuré de Franche-Comté (France)

Un site expérimental représentatif du milieu calcaire fissuré a été étudié dans le Jurassique supérieur de la vallée de la Loue. Un forage carotté de trente mètres a été réalisé et étudié par différentes techniques de laboratoire (porosité, perméabilité, vitesse ultrasonique, quantification de la fissuration) et de terrain (essais hydrauliques par injection entre obturateurs, diagraphies soniques, densité). Le massif rocheux concerné a été exploré en surface à partir de la sismique réfraction.Les principaux résultats obtenus permettent de relier les paramètres hydrauliques à la fissuration du massif calcaire. On constate une mauvaise relation entre les mesures de laboratoire et de terrain par suite d'un effet d'échelle, les investigations étant faites sur des volumes variant de quelques centimètres cubes à plusieurs mètres cubes. En effet, la matrice homogène et isotrope est perturbée par des fissures (fermées ou ouvertes). Le milieu continu représenté par la matrice et observé au laboratoire s'avère discontinu sur le terrain. L'indice le obtenu à partir de la diagraphie sonique paraît intéressant, mais doit être utilisé avec prudence et après correction dans les zones à argilosité reconnue, en effet dans ces zones on constate que pour des valeurs supérieures à 10 de l'indice lc brut, aucun écoulement n'a été mis en évidence par essai hydraulique. Un abaque de correction C (lc) a donc été établi qui tient compte de la teneur en argile et qui permet de proposer un indice corrige le -C (lc) plus fiable.An experimental site in fissured calcareous media has been analysed in the upper jurassic of the Loue valley. A tore of some 30 metres has been drilled and analysed by different laboratory techniques (porosity, permeahility, ultrasonic speed, quantification ol the fissuration) and in the field (hydraulic injection tests between shutters, sonic and density diagraphics data). The rock volumes have been explored at the surface by the refraction sesmic method.ln the tore the fissures are distributed according to four families :- subvertical stylolitic fractures, the horizontal pealo; of which denote the maximum compressive direction of the original tectonic stresses,- mineralized crevices with calcitic filling, closed fissures,- opened fractures which induced the hydraulical quality of limestones.The total porosity of the limestones is characterized by homogeneous values (front 2 to 6 %) and three differents familles of porosity o and the average diameter dm (0.00310 0.27µm) of the accessible apertures in the matrix :- family 1 : 0.003 µm < dm < 0.018 µm, 1.05 % < ø < 2.14 % in relation with intergranular spacing in the cementic phase. The clay in the basal part of the tore indures a great reduction of this kind of porosity,- family 2 : 0.044 µm < dm < 0.11 µm, 0.49 % < ø < 4.39 % in liaison with intergranular spacing between the carbonatic figurative elements (biociasts, Iithoclasts, oolithes and microorganisms),- family 3 : 0.14 µm < dm < 0.27 µm, 0.28 % < ø < 3.13 % in relation with the increasing of the sizes of the figurative elements.A good agreement between permeability k and porosity ø is observed (k=3.4 10-5 - ø4-96 in darcy units).Three diagraphic investigations has been carried out with gamma-gamma measurements (bulk density), with gamma-ray measurements (clay content) and with acoustic compensated measurements (sonic waves speed). The bulk density log is uniform (2.5 to 2.7 g/cm3), the gamma-ray log is increasing down the hole (21 to 29 m) whereas the clay content rises.The acoustic log records the total wave signal chat can be traduced by two computed logs :- speed propagation of the S waves (Vs speed) and P waves (Vp speed) with ihe ratio Vp/Vs,- Poisson coefficients and Young modulus.The principal results suggest the existence of a liaison between hydraulic parameters and the fissuration of the calcareous formation where three levels of fracturation are observed (from 11 to 12 m, from 16 to 18 m and from 19 to 20m).The permeability values of the limestone matrix cores ara relatively homogeneous (1 to 19 10-5 darcy) with a decrease in the 23 to 27 m section of the bore-hole where a clayed cernent is detected. The hydraulic conductivity of the fractured zone, as determined by means of hydraulic injection tests between shutters leads to values of 1.10-6 to 8.10-6 m/s (# 0.1 to 0.8 darcy). Five zones have been choses for the hydraulic tests in liaison with different parts of the bore hole. The high values ot permeability k are in accordance with the high le index values of the open fractured zones.A tirst local calibration function is proposed :lc=7.13 Log k + 51A pour relation connects the laboratory and field results because the elementary volume is increasing from cubic centimeters to some cubic matera. The homogeneity and the isotropy of matrix is disturbed hy the fissures (shut or open).The matrix medium is continuous on the laboratory scate and discontinuous in the field. The ultra-sonic investigation confirms the liaison between the high values of the sonic P waves speed and the principal regional direction ot tectonical stress. The total acoustic recording yields the knowledge of the S and P waves speeds of in correlation with subvertical fractures when the speed value variations are numerus.Three fracture zones are distinguished between 11 to 12 m, 17 to 18 m and 19 to 20 m. The lc index obtained from the sonic log must be used cautiously aller correction in the true clayed zones. In these zones the values of the le index are above 10 without waler flowing in the bore hale alter hydraulic testing. We propose the use of a corrective chart C (lc) to correct for the clay effect and a new corrected index lc - C (lc) is more reliable.An adjusted statistical graphical chart is proposed with the following expression : C (lc) = ß • Xα with α= 1.84 and ß = 0.088 (valid only for limestones) and X : lite clay index obtained from the gamma-ray measurements. The le index values histogram localizes the permeable zones of limestones with hydreulically active open fractures.Measurement of the speed variation of P sesmic waves on the bottom of the quarry by the means of the refraction method leads to a good agreement between the maximum speed anisotropy direction and the major fracture direction (N 120°-N 140°) which is perpendicular to the minimum anisotropy sesmic speed direction (N 40° -N 50°). The open fractures direction measured on the core is adjoining about N 135°-N 145° when the direction of maximum anisotropy in the quarry is near N 140°

Noninvasive population genetics: a review of sample source, diet, fragment length and microsatellite motif effects on amplification success and genotyping error rates

Noninvasive population genetics has found many applications in ecology and conservation biology. However, the technical difficulties inherent to the analysis of low quantities of DNA generally tend to limit the efficiency of this approach. The nature of samples and loci used in noninvasive population genetics are important factors that may help increasing the potential success of case studies. Here we reviewed the effects of the source of DNA (hair vs. faeces), the diet of focal species, the length of mitochondrial DNA fragments, and the length and repeat motif of nuclear microsatellite loci on genotyping success (amplification success and rate of allelic dropout). Locus-specific effects appeared to have the greatest impact, amplification success decreasing with both mitochondrial and microsatellite fragments' length, while error rates increase with amplicons' length. Dinucleotides showed best amplification success and lower error rates compared to longer repeat units. Genotyping success did not differ between hair- versus faeces-extracted DNA, and success in faeces-based analyses was not consistently influenced by the diet of focal species. While the great remaining variability among studies implies that other unidentified parameters are acting, results show that the careful choice of genetic markers may allow optimizing the success of noninvasive approache

Buccal swabs allow efficient and reliable microsatellite genotyping in amphibians

Buccal swabs have recently been used as a minimally invasive sampling method in genetic studies of wild populations, including amphibian species. Yet it is not known to date what is the level of reliability for microsatellite genotypes obtained using such samples. Allelic dropout and false alleles may affect the genotyping derived from buccal samples. Here we quantified the success of microsatellite amplification and the rates of genotyping errors using buccal swabs in two amphibian species, the Alpine newt Triturus alpestris and the Green tree frog Hyla arborea, and we estimated two important parameters for downstream analyses, namely the number of repetitions required to achieve typing reliability and the probability of identity among genotypes. Amplification success was high, and only one locus tested required two to three repetitions to achieve reliable genotypes, showing that buccal swabbing is a very efficient approach allowing good quality DNA retrieval. This sampling method which allows avoiding the controversial toe-clipping will likely prove very useful in the context of amphibian conservatio

Comportement dynamique des dalles de roulement des ponts en béton sollicités par le trafic routier

The management of a network of existing road bridges involves interventions in order to maintain safety and the priority of these interventions is often determined by safety criteria. During the evaluation of safety, the dynamic effect of traffic actions is considered using equivalent static loads determined by multiplying the effect calculated using traffic load models by a dynamic amplification factor. During the evaluation of a deck slab, the application of inappropriate dynamic amplification factors could have significant financial implications, all the more since the local dynamic effects of overloaded trucks are determinant for this type of structural element. Dynamic amplification factors defined in codes have usually been derived from the measurement of global traffic action effects in the main structural elements of bridges. Unfortunately, local dynamic effects in deck slabs have not been studied in detail until now. A better understanding of the dynamic behaviour of deck slabs will lead to the definition of more accurate dynamic amplification factors and avoid the use of values that are too conservative. The behaviour of deck slabs of six typical Swiss highway bridges has been simulated in order to study their dynamic response during the passage of trucks. The structural arrangement of the deck slab was different for each of the six bridges. A parametric study was based on the simulation of various scenarios involving the passage of trucks for various combinations of speed, path and road surface roughness. Deck slab response was obtained by numerical simulation based on models of the bridge, truck and road surface. This system was resolved using a prediction - correction algorithm that considers the dynamic interaction between a bridge and trucks. Dynamic amplification factors were subsequently calculated from strains and deflections obtained from independent static and dynamic simulations. The simulation of numerous scenarios enabled the evaluation of the influence of different parameters on the dynamic response of a deck slab: The road surface roughness was found to be one of the most important parameters, with an increase in roughness leading to an increase in dynamic amplification factors. An overloaded truck produces a lower dynamic amplification factor in a deck slab than an empty truck. The truck speed influences the dynamic interaction, but a clear relationship between speed and dynamic amplification factor could not be identified. The maximum dynamic amplification factor does not vary significantly from one point to another over a deck slab in a girder bridge. The structural arrangement of a deck slab in a girder bridge has little influence on dynamic amplification factors. Overall, the different deck slabs on the girder bridges studied were all equally sensitive to the dynamic effects of road traffic. In many cases considered for the framed slab bridge, the maximum dynamic amplification factor was found to occur over the supports. For such bridges, the sensitivity of the deck slab to the dynamic effects of road traffic is not uniform. Finally, two approaches to evaluating deck slabs of existing road bridges are proposed. The first approach is only applicable in certain situations and involves a simplified evaluation using an updated traffic load model and a dynamic amplification factor. In situations where a simplified evaluation is not applicable, the second approach is to evaluate a deck slab using numerical or experimental analyses

Genetic isolation by distance and landscape connectivity in the American marten ( Martes americana )

Empirical studies of landscape connectivity are limited by the difficulty of directly measuring animal movement. ‘Indirect' approaches involving genetic analyses provide a complementary tool to ‘direct' methods such as capture-recapture or radio-tracking. Here the effect of landscape on dispersal was investigated in a forest-dwelling species, the American marten (Martes americana) using the genetic model of isolation by distance (IBD). This model assumes isotropic dispersal in a homogeneous environment and is characterized by increasing genetic differentiation among individuals separated by increasing geographic distances. The effect of landscape features on this genetic pattern was used to test for a departure from spatially homogeneous dispersal. This study was conducted on two populations in homogeneous vs. heterogeneous habitat in a harvested boreal forest in Ontario (Canada). A pattern of IBD was evidenced in the homogeneous landscape whereas no such pattern was found in the near-by harvested forest. To test whether landscape structure may be accountable for this difference, we used effective distances that take into account the effect of landscape features on marten movement instead of Euclidean distances in the model of isolation by distance. Effective distances computed using least-cost modeling were better correlated to genetic distances in both landscapes, thereby showing that the interaction between landscape features and dispersal in Martes americana may be detected through individual-based analyses of spatial genetic structure. However, the simplifying assumptions of genetic models and the low proportions in genetic differentiation explained by these models may limit their utility in quantifying the effect of landscape structur

Noninvasive population genetics: a review of sample source, diet, fragment length and microsatellite motif effects on amplification success and genotyping error rates

International audienceNoninvasive population genetics has found many applications in ecology and conservation biology. However, the technical difficulties inherent to the analysis of low quantities of DNA generally tend to limit the efficiency of this approach. The nature of samples and loci used in noninvasive population genetics are important factors that may help increasing the potential success of case studies. Here we reviewed the effects of the source of DNA (hair vs. faeces), the diet of focal species, the length of mitochondrial DNA fragments, and the length and repeat motif of nuclear microsatellite loci on genotyping success (amplification success and rate of allelic dropout). Locus-specific effects appeared to have the greatest impact, amplification success decreasing with both mitochondrial and microsatellite fragments' length, while error rates increase with amplicons' length. Dinucleotides showed best amplification success and lower error rates compared to longer repeat units. Genotyping success did not differ between hair- versus faeces-extracted DNA, and success in faeces-based analyses was not consistently influenced by the diet of focal species. While the great remaining variability among studies implies that other unidentified parameters are acting, results show that the careful choice of genetic markers may allow optimizing the success of noninvasive approaches