49 research outputs found
L'Ăconomie de communion : devoirs moraux et responsabilitĂ© sociale axĂ©e sur le relationnel dans l'entreprise
Au sein de lâĂ©conomie libĂ©rale, est nĂ© un modĂšle dâentreprise conjuguant altruisme et recherche du profit : lâĂconomie de Communion. Ă travers sa responsabilitĂ© sociale, cette entreprise adopte des stratĂ©gies particuliĂšres de gestion qui tentent de replacer lâhomme au centre de lâactivitĂ© de lâentreprise. Lâobjectif du mĂ©moire est de prĂ©senter lâĂconomie de Communion, son but et les diffĂ©rents axes qui la soutiennent, ainsi que sa comprĂ©hension de lâinteraction du monde des affaires avec lâĂ©thique, la morale et le droit. Ă la lumiĂšre des expĂ©riences vĂ©cues par 811 entreprises, cet agir Ă©conomique rend compte de lâefficacitĂ© de son mode de gestion au niveau de lâoptimisation de la performance entrepreneuriale. LâĂconomie de Communion met en exergue notamment une approche oĂč la dynamique Ă©conomique repose sur la solidaritĂ© et la fraternitĂ©.Within the liberal economy, a business model was born combining altruism and profit-seeking: the Economy of Communion. Through its social responsibility, this model adopts specific management strategies that try to put people at the center of the firm's activities. The aim of the paper is to present the Economy of Communion, its purpose and the various axes that support it, as well as its understanding of the interaction of the business world with ethics, values and law. In the light of the experience of 811 firms, the Economic of Communion acknowledges the efficiency of its management mode in terms of optimizing entrepreneurial performance. It emphasizes in particular an approach where economic dynamics are based on solidarity and fraternity
Angiopoietine-like 2 : un facteur circulant pro-oxydant et pro-inflammatoire qui contribue au dĂ©veloppement de lâathĂ©rosclĂ©rose
LâathĂ©rosclĂ©rose est une maladie vasculaire inflammatoire chronique qui se dĂ©veloppe progressivement au cours de la vie. Les mĂ©canismes impliquĂ©s sont complexes et la recherche de nouveaux candidats impliquĂ©s dans l'athĂ©rogĂ©nĂšse est toujours d'actualitĂ©. LâAngiopoietine-like 2 (Angptl2) est une protĂ©ine relativement peu connue, aux propriĂ©tĂ©s pro-angiogĂ©niques et pro-inflammatoires, qui appartient par homologie Ă la grande famille des angiopoietines, mais dont le rĂ©cepteur n'est pas encore clairement identifiĂ©. Les situations pathologiques dans lesquelles lâAngptl2 jouerait un rĂŽle crucial sont diverses, mais sa contribution molĂ©culaire dans le dĂ©veloppement de lâathĂ©rosclĂ©rose est inconnue. Par differential display, nous avons initialement identifiĂ© l'Angptl2 comme Ă©tant surexprimĂ©e dans des cellules endothĂ©liales sĂ©nescentes, isolĂ©es et cultivĂ©es Ă partir d'artĂšres mammaires internes de patients athĂ©rosclĂ©rotiques ayant subi un pontage coronarien. Cette dĂ©couverte a Ă©tĂ© la Ă base de mon projet, et mes objectifs ont Ă©tĂ© 1) de dĂ©terminer l'implication de lâAngptl2 vasculaire en prĂ©sence de facteurs de risques tels que le tabagisme et la dyslipidĂ©mie, 2) de produire et de purifier une protĂ©ine recombinante fonctionnelle de lâAngptl2 afin d'identifier in vitro de nouvelles propriĂ©tĂ©s cellulaires de l'Angptl2 et 3) d'Ă©tudier in vivo le potentiel pro-athĂ©rogĂ©nique de l'Angptl2 recombinante dans un modĂšle murin de dyslipidĂ©mie sĂ©vĂšre.
Nous avons montrĂ© que lâAngptl2 est sĂ©crĂ©tĂ©e prĂ©fĂ©rentiellement dans des conditions pro-oxydantes et pro-inflammatoires, avec une augmentation de son expression endothĂ©liale de lâordre de 6 fois chez des patients coronariens fumeurs atteints de maladie pulmonaire obstructive chronique. Suite Ă ces rĂ©sultats, nous avons Ă©mis lâhypothĂšse que lâAngptl2, en plus de ses fonctions pro-inflammatoires connues, possĂšde des propriĂ©tĂ©s pro-oxydantes. Nous avons dĂ©montrĂ© que lâAngptl2 recombinante stimule en effet la production de radicaux libres dans des HUVEC en culture, via lâinhibition partielle de la voie cytoprotectrice antioxydante Nrf2/HO-1 et potentiellement via l'activation de kinase intracellulaire de type p38.
A l'aide de souris dyslipidĂ©miques LDLr-/-; hApoB-100+/+, nous avons dĂ©montrĂ© que le niveau dâAngptl2 plasmatique, vasculaire et dans les plaques athĂ©romateuses, augmente parallĂšlement avec le dĂ©veloppement de lâathĂ©rosclĂ©rose. De plus, une stimulation avec lâAngptl2 recombinante engendre chez ces souris une rĂ©ponse inflammatoire Ă©valuĂ©e par lâexpression endothĂ©liale de cytokines et de molĂ©cules d'adhĂ©sion et par lâinfiltration de leucocytes sur lâendothĂ©lium vasculaire. Finalement, lâadministration intraveineuse de la protĂ©ine recombinante dâAngptl2 pendant quatre semaines Ă des souris LDLr-/-; hApoB-100+/+ augmente de 10 fois l'expansion de la plaque athĂ©rosclĂ©rotique et double leur taux de cholestĂ©rol circulant. Nous avons aussi montrĂ© que chez des patients athĂ©rosclĂ©rotiques, l'Angptl2 plasmatique est 6 fois plus Ă©levĂ©e que chez des sujets sains du mĂȘme Ăąge.
Nos Ă©tudes semblent donc dĂ©finir lâAngptl2 comme un facteur contribuant directement au dĂ©veloppement de l'athĂ©rosclĂ©rose en favorisant la sĂ©nescence, lâinflammation et lâoxydation des cellules endothĂ©liales. Ces propriĂ©tĂ©s pourraient globalement dĂ©finir l'Angptl2, non seulement comme un nouveau biomarqueur circulant de lâathĂ©rosclĂ©rose, mais Ă©galement comme l'un de ses promoteurs.Atherosclerosis is a chronic vascular inflammatory disease that develops gradually during life. While the control mechanisms of this disease are complex and variable, research continues to identify new protein candidates involved in atherogenesis. Angiopoietin-like2 (Angptl2) is a relatively unknown protein, recently shown to display angiogenic and pro-inflammatory properties. Based upon structural homology, Angptl2 is a member of the angiopoietin family; however, the Angptl2 receptor has not yet been clearly identified. The reported pathological situations in which Angptl2 may play a crucial role are multiple, but its molecular contribution in the development of atherosclerosis remains unknown. By differential display, we initially identified Angptl2 as being overexpressed in senescent endothelial cells, isolated and cultivated from internal mammary arteries of atherosclerotic patients undergoing coronary bypass. This observation was at the basis of my project. My specific objectives were 1) to determine the abundance of vascular Angptl2 in the presence of risk factors such as smoking and dyslipidemia, 2) to produce and purify a functional recombinant human Angptl2 protein in order to examine its effects on cellular function in vitro, and 3) to study the pro-atherogenic potential of Angptl2 in vivo using a mouse model of severe dyslipidemia.
We showed that Angptl2 is preferentially secreted under pro-oxidant and pro-inflammatory conditions, with a 6-fold increase in endothelial Angptl2 expression in smoker coronary patients with chronic obstructive pulmonary disease. Based on these results, we hypothesized that, in addition to its known pro-inflammatory functions, Angptl2 has pro-oxidant properties. Accordingly, we demonstrated that recombinant Angptl2 stimulates the production of free radicals by HUVEC, an action exerted, at least in part, by the inhibition of the cytoprotective antioxidant pathway, Nrf2/HO-1, and potentially via the activation of the intracellular p38 MAPK pathway.
In dyslipidemic LDLr-/-; hApoB-100+/+ mice, we showed that the levels of endogenous Angptl2 in plasma, vascular tissue and atherosclerotic lesions increase in parallel with the development of atherosclerosis. In addition, stimulation with recombinant Angptl2 induces an inflammatory response, as assessed by the expression of cytokines and adhesion molecules and by infiltration of leukocytes into the vascular endothelium. Furthermore, intravenous infusion of purified recombinant Angptl2 for four weeks promoted a 10-fold increase in the formation of atherosclerotic plaques in LDLr-/-; hApoB-100+/+ mice and doubled their circulating cholesterol levels. Finally, we also demonstrated that plasma Angptl2 is 6-fold higher in atherosclerotic patients than in age-matched healthy subjects.
These studies therefore strongly suggest that Angptl2 could directly contribute to the development of atherosclerosis by promoting senescence, inflammation and oxidation in endothelial cells. Such properties indicate that Angptl2 may be both a new biomarker of atherosclerosis, as well as one of its contributors
Simulation of a Sensitive Mid-infrared (MIR) D-Shaped Optical Fiber Water Pollutant Sensor
In this work, an efficient optical sensor is proposed for the sensitive detection of various pollutants in water. The suggested optical sensor is based on an indium fluoride (InF3) glass fabricated as a D-shaped optical fiber. The polished surface of the D-shaped fiber is coated with a gold grating to induce the surface plasmon resonance (SPR). The SPR depends on the optical properties of the polluted water analyte in physical contact with the grating. The proposed optical SPR fiber sensor operates within the mid-infrared (MIR) range (3000â4500 nm) to detect any slight change in the water refractive index (RI) due to any pollutants. The full vectorial finite element method (FVFEM) is utilized to calculate the modal properties of the reported sensor. High sensor sensitivity of 17,834 nm/RIU (refractive index units) is achieved for the detection of dissolution of nitric acid (HNO3) in water at a concentration of 14% v/v (volume/volume). Additionally, the reported sensor detects the dissolution of hydrogen peroxide (H2O2) in water investigated at concentrations of 15% v/v and 30% v/v, with sensitivities of 12,308 nm/RIU and 17,143 nm/RIU, respectively. Further, suspending polystyrene beads of diameter 0.1 ÎŒm in the water at a concentration of 10% v/v gives a maximum sensitivity of 5333 nm/RIU. Therefore, the proposed sensor provides a promising approach for the detection of water pollutants in the MIR wavelength regime, rather than the weaker response in the near infrared
Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis
BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London
Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study
Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.
Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.
Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05â2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001).
Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96â1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme
Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial
BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22â754 patients were assessed for elegibility. Of 15â873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme
Elevated International Normalized Ratio values in a patient receiving warfarin and ceftaroline
PURPOSE: The case of a patient whose International Normalized Ratio (INR) became elevated due to a probable interaction between ceftaroline and warfarin is reported.
SUMMARY: A 65-year-old African-American man developed an INR of \u3e18.0 after completing 12 days of ceftaroline therapy for the treatment of cellulitis while taking warfarin therapy. The patient was on warfarin due to his history of deep vein thrombosis of a lower extremity and pulmonary embolism, and his INR was consistently therapeutic for approximately 2 years before ceftaroline therapy. The patient reported no known drug allergies, had no history of adverse drug reactions, and had no recent changes in medications or diet. Phytonadione was administered, and the patient\u27s INR began to decrease, returning to a therapeutic range of 2.30 after approximately 48 hours, at which time warfarin was restarted. After six days of hospitalization, the patient was discharged on his previous regimen of warfarin 7.5 mg orally once daily, with a therapeutic INR of 2.11. His cellulitis had resolved, so no further antibiotic therapy was warranted. To determine the likelihood of the drug interaction between warfarin and ceftaroline in this patient, the Drug Interaction Probability Scale of Horn and colleagues was applied and yielded a score of 6, indicating a probable likelihood of an interaction. Rechallenge was not attempted, as the patient\u27s cellulitis had resolved and there were no evident signs or symptoms of infection.
CONCLUSION: A 65-year-old man experienced an increase in INR values after the addition of ceftaroline to his medication regimen
Statut bucco-dentaire au sein dâune population gĂ©riatrique libanaise : Ă©tude pilote
According to the World Health Organization (WHO), oral health status represents an indicator of the physical and psychological general state of a person, especially among the elderly. Many epidemiological studies have studied oral health among the geriatric population. In Lebanon, the lack of publications related to this subject encouraged us to realize a pilot study in order to evaluate oral health status among a Lebanese geriatric sample from low socioeconomic class. This study was conducted in a volunteer associational center (âResto du Coeurâ), by the Department of ediatric and community dentistry, in collaboration with the Department of prosthodontics of the Faculty of Dental Medicine, at Saint-Joseph University, Lebanon. This activity included the oral health evaluation of 51 geriatric persons along with educational oral health promotion.The oral exam of the participants showed a high prevalence of edentulism, a poor oral hygiene as well as multiple periodontal and dental problems