Programmes d’exercices à domicile adaptés à des conditions musculosquelettiques variées : transfert de connaissances

Travail d'intégration réalisé dans le cadre du cours PHT-6113.Introduction/problématique : Les atteintes musculosquelettiques sont fréquentes et entraînent des coûts importants. Plusieurs évidences suggèrent que les programmes d’exercices à domicile (PED) seraient bénéfiques pour certaines pathologies, dont la cervicalgie, la lombalgie, la gonarthrose et le syndrome d’accrochage à l’épaule (SAE). Cependant, il n’existe pas de lignes directrices quant aux conseils et aux exercices à préconiser pour ces atteintes. De plus, il manque d’outils de transfert de ces connaissances sur ces pathologies spécifiquement adressé aux physiothérapeutes. Objectifs : Ce travail vise à A) synthétiser les évidences quant aux interventions à préconiser pour les pathologies mentionnées et B) créer un outil de transfert de connaissances qui informera les physiothérapeutes des interventions à préconiser dans ces atteintes. Description sommaire ou stratégique : Le travail d’un an s’est déroulé en cinq phases soit, 1) la définition du projet, 2) la recension des écrits, 3) les rencontres avec des physiothérapeutes, 4) la synthèse des lignes directrices d’intervention et 5) l’élaboration de l’interface web interactive Google+ comme outil de transfert de connaissances. Principaux sujets abordés : Chaque pathologie soit, la cervicalgie chronique, la lombalgie chronique, la gonarthrose et le SAE, fait l’objet d’un chapitre. Résultats : Le travail résume les interventions pertinentes pour chaque pathologie. Les rencontres ont permis d’identifier les besoins des physiothérapeutes en matière de transfert de connaissance et l’interface web semble être pertinente pour combler ces besoins. Conclusion : Les PED seraient efficaces dans le traitement de plusieurs pathologies musculosquelettiques en physiothérapie. Il manque de consensus quant aux interventions à inclure dans ces PED. Il faudra évaluer l’impact de l’outil de transfert de connaissances sur la pratique des physiothérapeutes

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Observations of Mass Loss from the Transiting Exoplanet HD 209458b

Using the new Cosmic Origins Spectrograph (COS) on the {\it Hubble Space Telescope (HST)}, we obtained moderate-resolution, high signal/noise ultraviolet spectra of HD 209458 and its exoplanet HD 209458b during transit, both orbital quadratures, and secondary eclipse. We compare transit spectra with spectra obtained at non-transit phases to identify spectral features due to the exoplanet's expanding atmosphere. We find that the mean flux decreased by $7.8\pm 1.3$% for the C II 1334.5323\AA\ and 1335.6854\AA\ lines and by $8.2\pm 1.4$% for the Si III 1206.500\AA\ line during transit compared to non-transit times in the velocity interval --50 to +50 km s$^{-1}$. Comparison of the C II and Si III line depths and transit/non-transit line ratios shows deeper absorption features near --10 and +15 km s$^{-1}$ and less certain features near --40 and +30--70 km s$^{-1}$, but future observations are needed to verify this first detection of velocity structure in the expanding atmosphere of an exoplanet. Our results for the C II lines and the non-detection of Si IV 1394.76\AA\ absorption are in agreement with \citet{Vidal-Madjar2004}, but we find absorption during transit in the Si III line contrary to the earlier result. The $8\pm 1$% obscuration of the star during transit is far larger than the 1.5% obscuration by the exoplanet's disk. Absorption during transit at velocities between --50 and +50 km s$^{-1}$ in the C II and Si III lines requires high-velocity ion absorbers, but models that assume that the absorbers are high-temperature thermal ions are inconsistent with the COS spectra. Assuming hydrodynamic model values for the gas temperature and outflow velocity at the limb of the outflow as seen in the C II lines, we find mass-loss rates in the range (8--40)$\times 10^{10}$ g s$^{-1}$.Comment: 25 pages, 4 figures, Astrophysical Journal in pres

Searching for Far-Ultraviolet Auroral/Dayglow Emission from HD209458b

We present recent observations from the HST-Cosmic Origins Spectrograph aimed at characterizing the auroral emission from the extrasolar planet HD209458b. We obtained medium-resolution (R~18-20,000) far-ultraviolet (1150-1700A) spectra at both the Phase 0.25 and Phase 0.75 quadrature positions as well as a stellar baseline measurement at secondary eclipse. This analysis includes a catalog of stellar emission lines and a star-subtracted spectrum of the planet. We present an emission model for planetary H2 emission, and compare this model to the planetary spectrum. No unambiguously identifiable atomic or molecular features are detected, and upper limits are presented for auroral/dayglow line strengths. An orbital velocity cross-correlation analysis finds a statistically significant (3.8 sigma) feature at +15 (+/- 20) km/s in the rest frame of the planet, at 1582 A. This feature is consistent with emission from H2 B-X (2-9) P(4) (lambda_{rest} = 1581.11 A), however the physical mechanism required to excite this transition is unclear. We compare limits on relative line strengths seen in the exoplanet spectrum with models of ultraviolet fluorescence to constrain the atmospheric column density of neutral hydrogen between the star and the planetary surface. These results support models of short period extrasolar giant planets with weak magnetic fields and extended atomic atmospheres.Comment: Accepted to ApJ. 12 pages, 5 figures, 4 table

Antibiotic treatment patterns across Europe in patients with complicated skin and soft-tissue infections due to meticillin-resistant <em>Staphylococcus aureus</em>:a plea for implementation of early switch and early discharge criteria

AbstractThis retrospective observational medical chart review aimed to describe country-specific variations across Europe in real-world meticillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft-tissue infection (cSSTI) treatment patterns, antibiotic stewardship activity, and potential opportunities for early switch (ES) from intravenous (i.v.) to oral formulations and early discharge (ED) from hospital using standardised data collection and criteria and economic implications of these opportunities. Patients were randomly sampled from 12 countries (Austria, Czech Republic, France, Germany, Greece, Ireland, Italy, Poland, Portugal, Slovakia, Spain and the UK), aged ≥18 years, with documented MRSA cSSTI, hospitalised between 1 July 2010 and 30 June 2011, discharged alive by 31 July 2011. Of 1502 patients, 1468 received MRSA-targeted therapy. Intravenous-to-oral switch rates ranged from 2.0% to 20.2%, i.v. length of therapy from 10.1 to 18.6 days and hospital length of stay (LoS) from 15.2 to 25.0 days across Europe. Of 341 sites, 82.9% had antibiotic steering committees, 23.7% had i.v.-to-oral switch antibiotic protocols and 12.9% had ED protocols for MRSA cSSTI. ES and ED eligibility ranged from 12.0% (Slovakia) to 56.3% (Greece) and from 10% (Slovakia) to 48.2% (Portugal), respectively. Potential cost savings per ED-eligible patient ranged from €414 (Slovakia) to €2703 (France). MRSA cSSTI treatment patterns varied widely across countries, but further reductions in i.v. therapy, hospital LoS and associated costs could be realised. These data provide insight into clinical practice patterns across diverse European healthcare systems and identify potential opportunities for local clinicians and policy-makers to improve clinical care and cost-effectiveness of this therapeutic area

Detecting Earth-like Biosignatures on Rocky Exoplanets around Nearby Stars with Ground-based Extremely Large Telescopes

As we begin to discover rocky planets in the habitable zone of nearby stars with missions like TESS and CHEOPS, we will need quick advancements on instrumentation and observational techniques that will enable us to answer key science questions, such as What are the atmospheric characteristics of habitable zone rocky planets? How common are Earth-like biosignatures in rocky planets?} How similar or dissimilar are those planets to Earth? Over the next decade we expect to have discovered several Earth-analog candidates, but we will not have the tools to study the atmospheres of all of them in detail. Ground-based ELTs can identify biosignatures in the spectra of these candidate exo-Earths and understand how the planets' atmospheres compare to the Earth at different epochs. Transit spectroscopy, high-resolution spectroscopy, and reflected-light direct imaging on ELTs can identify multiple biosignatures for habitable zone, rocky planets around M stars at optical to near-infrared wavelengths. Thermal infrared direct imaging can detect habitable zone, rocky planets around AFGK stars, identifying ozone and motivating reflected-light follow-up observations with NASA missions like HabEx/LUVOIR. Therefore, we recommend that the Astro2020 Decadal Survey Committee support: (1) the search for Earth-like biosignatures on rocky planets around nearby stars as a key science case; (2) the construction over the next decade of ground-based Extremely Large Telecopes (ELTs), which will provide the large aperture and spatial resolution necessary to start revealing the atmospheres of Earth-analogues around nearby stars; (3) the development of instrumentation that optimizes the detection of biosignatures; and (4) the generation of accurate line lists for potential biosignature gases, which are needed as model templates to detect those molecules

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