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Early phases of product development are critical for next phases and impact the product definition. During bid process, suppliers generate offers for a customer that must both meet customer's requirements and be realizable in terms of technical aspects, costs and due date. Our aim is to propose a methodology for implementing a generic bid model, composed of context parameters, customer's requirements, the product i.e. technical solution, its delivery process, and associated risks. Key Performance Indicators allow to evaluate different solutions. The bid model is exploited with two different approaches. First, we use Constraint Satisfaction Problems to formalize expert knowledge and identify variables/constraints and relations. Second, we use case database to reuse past experiences. This model and the methodology are applied with a company developing harbour cranes. An initialisation phase allows to define existing bid process. Then, the generic model is adapted through a specialisation phase, using specific knowledge from company's experts. Finally, the specific model is implemented and tested in an implementation phase. Future work will be focused on a software tool development.
The aim of this study is to review evidence on the cost-effectiveness of exercise-based interventions in the treatment of chronic conditions a decade after the publication of Roine et al. in 2009 (Roine E, Roine RP, Räsänen P, et al. Int J Technol Assess Health Care. 2009;25:427–454).
We carried out a review of published articles in PUBMED and JSTOR between January 1, 2008, and December 31, 2016. Full economic evaluations of exercise programs targeting patients with a chronic condition were eligible for inclusion. Data on program, design, and economic characteristics were extracted using a predefined extraction form. The quality of the economic evaluations was appraised using the adjusted Consensus Health Economic Criteria List.
A total of 426 articles were identified and thirty-seven studies were selected. Eleven studies dealt with musculoskeletal and rheumatologic disorders, ten with cardiovascular diseases, six with neurological disorders, three with mental illnesses, three with cancers, and four with diabetes, respiratory diseases, or pelvic organ prolapse. In total, 60 percent of exercise programs were dominant or cost-effective. For musculoskeletal and rheumatologic disorders, 72 percent of programs were dominant or cost-effective while this was the case for 57 percent of programs for cardiovascular diseases using a nonsurgical comparator.
There is clear evidence in favor of exercise-based programs for the treatment of musculoskeletal and rheumatologic disorders and, to a lesser extent, for the treatment of cardiovascular diseases. More research is needed to evaluate the cost-effectiveness of physical activity in the treatment of neurological disorders, mental illnesses, cancers, respiratory diseases, and diabetes/obesity.
The objective of this study was to determine how clinicians make use of the modern multiplex PCR assays (MPAs) to manage patients hospitalized for community-acquired pneumonia (CAP). We studied the use of MPAs in 1648 patients hospitalized for CAP over a 3-year period at the moment of the setup of the new PCR assay. We observed that the use of MPAs for the identification of multiple respiratory pathogens marks a radical change in the investigation of CAP etiology. Surprisingly, the contribution of MPAs to the medical decision-making process varies drastically according to the units of care.
Hip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.
To assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.
A historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.
A total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.
The hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.
Infect Control Hosp Epidemiol 2015;36(10):1198–1207
Background: A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods: To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results: This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions: The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.
To determine whether the fibula free flap is the most frequently used osteocutaneous flap for mandible reconstruction, and whether it provides quality of life, depression and anxiety advantages.
A systematic review of the public Medline database was conducted. Thirteen patients who underwent mandibular reconstruction at our hospital centre completed questionnaires to evaluate quality of life, depression and anxiety outcomes.
The most frequently used free flaps are those of the fibula (n = 982), radial forearm (n = 201), iliac crest (n = 113), subscapular system (n = 50) and rib–serratus (n = 7). In our patient population, there was a trend towards a better quality of life in those with a fibula free flap. However, patients in this group were significantly younger than patients with other flap types (p = 0.025). Patients with a subscapular system free flap were more depressed (p = 0.031); however, they had large through-and-through defects.
The flap used most frequently in the literature is the fibula free flap. Comparative quality of life data are lacking, and homogeneous populations should be used to reach significant conclusions.
The solid-state phase transitions of bismuth(III) oxide (Bi2O3) nanoparticles were investigated by complementary methods such as differential scanning calorimetry, differential thermal analysis with combined thermogravimetry and mass spectrometry, and high-temperature x-ray diffraction as compacted nanopowder. At room temperature the particles resided in the β-phase, which is usually a metastable high-temperature phase of bulk Bi2O3. The complementary experimental methods were linked and a nanophase (tetragonal β-phase) → bulk-phase (monoclinic α-phase) transition was identified which was preceded by crystal growth and evaporation of O and C containing species. It was also shown that the atmosphere (more precisely its absolute pressure) has an influence on the transition behavior. An interpretation was proposed that successfully explains all observations from this work and from literature: A sudden destabilization takes place around 735 K due to the loss of the stabilizing, carbonized surface. This leads to the observed transformation to the bulk-phase. But if the particles are smaller than a certain, critical size in the nanorange and are not allowed to grow, they remain in the nanophase until they melt.
Surgical site infection (SSI) surveillance represents a key method of nosocomial infection control programs worldwide. However, most SSI surveillance systems are considered to be poorly cost effective regarding human and economic resources required for data collection and patient follow up. This study aims to assess the efficacy of using hospital discharge databases (HDDs) as a routine surveillance system for detecting hip or knee arthroplasty–related infections (HKAIs).
A case-control study was conducted among patients hospitalized in the Centre region of France between 2008 and 2010. HKAI cases were extracted from the HDD with various algorithms based on the International Classification of Diseases, Tenth Revision, and procedure codes. The control subjects were patients with hip or knee arthroplasty (HKA) without infection selected at random from the HDD during the study period. The gold standard was medical chart review. Sensitivity (Se), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the efficacy of the surveillance system.
Among 18,265 hospital stays for HKA, corresponding to 17,388 patients, medical reports were checked for 1,010 hospital stays (989 patients). We identified 530 cases in total (incidence rate, 1% [95% confidence interval (CI), 0.4%–1.6%), and 333 cases were detected by routine surveillance. As compared with 480 controls, Se was 98%, Spe was 71%, PPV was 63%, and NPV was 99%. Using a more specific case definition, based on a sample of 681 hospital stays, Se was 97%, Spe was 95%, PPV was 87%, and NPV was 98%.
This study demonstrates the potential of HDD as a tool for routine SSI surveillance after low-risk surgery, under conditions of having an appropriate algorithm for selecting infections.
New rigid rods amphiphilic molecules based on phenyl ethynylenes oligomers with hydrophilic side chains were synthesized by step by step method. The two most interesting products, the pentamer and the heptamer are enough amphiphilic to give stable Langmuir films that are able to be deposited as LB film on substrates as hydro-philic glass, ITO or hydrophilic silicon. A good transfer ratio of 1 is observed only by lifting, which suggests a Z type deposited film. A multilayer deposition can be carried out to 36 layers. The well structured films of 3.7 nm thick which are observed by X ray reflectivity suggest a rearragement in Y–type bilayer. By AFM, the observed irregular surface with steps of 3.7 and 1.8 nm high or multiples is coherent with a self-rearrangement of the single deposited layer to a double layer during the drying phase. The heptamer and pentamer show large stokes-shifts with a high photoluminescence emission peak at 516 and 504 nm respectively. LED properties were demonstrated using the ITO/oligoPY/ LiF-Al sandwich yielding photon emission at 516 nm for the heptamer. The electroluminescent device yields in the range of 10−3%. The demonstration of electroluminescence in a LB film of molecules aligned parallel to the substrate is very interesting because it confirms the possibility to tailor conduction and emission properties of the devices using a layer by layer deposition technique.
There is currently a great interest in the preparation of nanostructured magnetic films possessing well-defined structures and controlled properties. Recent progresses in colloidal nanocrystals synthesis and processing have led to new methods for producing films and superstructures made with these materials. Hybrid films have been prepared by organizing functionalized magnetite nanoparticles in large patterns using the Langmuir Blodgett technique. Magnetite nanoparticles with an average particle diameter of 39nm have been prepared and then coated with amphiphilic molecules. The resulting decorated particles, with a hydrophobic outer layer, have proven suitable for being processed by the LB technique. The microstructure and the compacity of the nanoparticle arrays appear to depend on the nature of the organic moiety used to decorate the nanoparticles (carboxylate or phosphonate end-capped stilbene derivatives).
The synthesis of multipodes based on substituted ferrocene groups and the results of the investigations of the liquid-crystalline phase properties of these materials, determined by optical polarising microscopy DSC and X-ray diffraction studies as central cores is reported.
The fluoroisopropoxide ligand (HFIP) has allowed the synthesis of
mixed-metal homoleptic Ba2Y and CuBa alkoxides. However, although
these species are all volatile, their poor thermal stability precludes their
use as CVD precursors. Their properties have thus been optimized by
introduction of 2,2,6,6-tetramethylheptane-3,5-dione (thdH) in the metal
coordination sphere. Compounds such as
Y2Ba(μ-HFIP)4(thd)4, the first volatile
Y-Ba species reported so far, as well as
YCu(HFIP)2(thd)3 have been obtained. These
heterometallic ϐdiketonatoalkoxides have been characterized by a variety of
techniques including X-ray diffraction, mass spectrometry, vapor pressure
measurements and thermogravimetric analysis. Preliminary data on thermal
decomposition experiments are given.
A review of microwave techniques for measuring both complex permittivity and complex permeability of materials is given. It includes both resonant and reflection transmission methods for which limitations are discussed.
The use of a circular waveguide radiating into a multi-layered media allows the characterization of heterogeneous and fluid subtances. Many microwave measurement devices, based on reflection coefficient measurements, are subjected to air gap problems that introduce some inaccuracy in the determination of the unknown complex permittivity of the materials. Our purpose is to try and take the air gap into account in these measurements.
LC-NANOP is an ESF EUROCORES SONS Collaborative Research Project that is addressing an innovative approach to self-organized nanostructures by combination of a variety of organic, inorganic and metal scaffolds with the unique self-organization properties of liquid crystals to obtain liquid crystal nano-particles. LC-NANOP is concerned with the synthesis, analysis, characterization, modeling and physico-chemical properties of super- and supra-molecular systems which are formed from a nano-particle as a central scaffold, surrounded by a layer of liquid crystal. The self-organization properties of the liquid crystal coating is the driving force leading to the self-assembly of the nano-particles into secondary or tertiary hierarchical structures, with emphasis on the systematic variation of nano-particle size, chirality, shape and functionality. This bottom-up approach to nano-structuring is very powerful as it combines the extraordinary variety of morphologies that liquid crystals present with the combination of functional entities, relevant for chemical, biological, optoelectronic, and photonic tasks, etc, to create ordered nano-structures that can be controlled by external stimuli.