L’objectif est de dresser un état des lieux de l’accidentologie des sports de montagne : mieux connaître l’ampleur du phénomène accidentel, les profils des victimes, les circonstances propices à ...l’occurrence de ces accidents, ainsi que la mortalité générée.
L’importance supposée de l’accidentalité sportive en montagne nécessite un diagnostic élaboré sur des bases rigoureuses, car les enjeux soulevés sont multiples, en termes de santé publique, de prévention et de prise en charge des victimes d’accidents.
L’état de l’art présenté résulte du recensement et du croisement des données produites, en France essentiellement, mais aussi à l’étranger, sur les accidents sportifs en montagne. Il est agrémenté d’une revue de littérature internationale et ambitionne in fine l’identification de zones d’ombre constitutives de pistes d’amélioration de l’accidentologie. C’est en effet en prenant appui sur une connaissance affinée du déroulement des accidents sportifs en montagne que l’on pourra progresser en termes de mesures, de discours et de pratiques préventifs.
Les synthèses ponctuant chaque partie des résultats mettent en exergue des éléments peu connus (comme l’exposition particulièrement forte des pratiques de randonnée hors-sentier), voire contre-intuitifs (comme le fait que les accidents en montagne concernent davantage des sportifs confirmés que des novices). Le caractère éclaté des sources, combiné à la complexité des phénomènes observés, doit cependant inciter à la prudence à propos des interprétations formulées. En raison de la fragmentation des sources, l’étude des accidents sportifs en montagne semble en tout état de cause perfectible ; de nombreuses données existent, fournissant d’intéressants éléments de cadrage, mais les connaissances se révèlent actuellement dispersées et parfois incomplètes, du fait notamment de méthodologies hétérogènes ne permettant pas toujours de disposer d’une vision d’ensemble.
This papers aims to provide a large overview of accidents related to sporting activities in the mountain areas. The situation review presented here in results from the collection and cross-referencing of existing data, mainly in France but also abroad, concerning sporting accidents in the mountains. It intends to improve our knowledge of the scope of the phenomenon, victim profiles and the explanatory factors and contexts that favor accident occurrence.
The supposed importance of mountain sport accidentality, sometimes the subject of rather alarmist interpretations, must be analyzed meticulously, since the implications are many, both in terms of public health, prevention and the treatment of victims.
This situation review aims to get as much as possible from the existing data, while identify any shady areas that may constitute improvement areas for accidentology.
In spite of numerous initiatives, or perhaps because of the fragmentation of sources, there appears to be room for improvement regarding the study of sporting accidents in the mountains; a multitude of data exists, providing interesting framing elements, but current knowledge remains dispersed and sometimes incomplete, due in particular to heterogeneous methodologies that do not always provide an overall vision. Prevention should be based on detailed knowledge of the frequency of accidents, their circumstances and risk factors, which represent the pillars of accidentology, in the sense of the scientific study of accidents. The prevention of risks related to mountain sports requires more detailed knowledge of the accident mechanisms. Such progress will enable us to make progress in terms of preventive measures, information and practices.
CD44 is a transmembrane glycoprotein involved in numerous cellular functions, including cell adhesion and extracellular matrix interactions. It is known to be functionally diverse, with alternative ...splice variants increasingly implicated as a marker for tumor-initiating stem cells associated with poor prognosis. Here, we evaluate CD44 as a potential marker of long-term breast cancer outcomes. Tissue specimens from patients treated on the National Cancer Institute 79-C-0111 randomized trial of breast conservation versus mastectomy between 1979 and 1987 were collected, and immunohistochemistry was performed using the standard isoform of CD44. Specimens were correlated with patient characteristics and outcomes. Survival analysis was performed using the log rank test. Fifty-one patients had evaluable tumor sections and available long-term clinical follow up data at a median follow up of 25.7 years. Significant predictors of OS were tumor size (median OFS 25.4 years for ≤2 cm vs. 7.5 years for >2 cm,
p
= 0.001), nodal status (median OS 17.2 years for node-negative patients vs. 6.7 years for node positive patients,
p
= 0.017), and CD44 expression (median OS 18.9 years for CD44 positive patients vs. 8.6 years for CD44 negative patients,
p
= 0.049). There was a trend toward increased PFS for patients with CD44 positive tumors (median PFS 17.9 vs. 4.3 years,
p
= 0.17), but this did not reach statistical significance. These findings illustrate the potential utility of CD44 as a prognostic marker for early stage breast cancer. Subgroup analysis in patients with lymph node involvement revealed CD44 positivity to be most strongly associated with increased survival, suggesting a potential role of CD44 in decision making for axillary management. As there is increasing interest in CD44 as a therapeutic target in ongoing clinical trials, the results of this study suggest additional investigation regarding the role CD44 in breast cancer is warranted.
Our purpose was to determine if total body irradiation (TBI) with lung dose reduction protects against subsequent radiation-induced deterioration in pulmonary function. Between July 1997 and August ...2004, 181 consecutive patients with hematologic malignancies received fractionated TBI before allogeneic peripheral blood stem cell transplant. The first 89 patients were treated to a total dose of 13.6 Gy. Thereafter, total body dose was decreased to 12 Gy with lung dose reduction to 9 or 6 Gy. All patients underwent pulmonary function test evaluation before treatment, 90 days post-treatment, then annually. Median follow-up was 24.0 months. Eighty-nine patients were treated with lung shielding, and 92 without. At 1-year post transplant, there was a small but significant difference in lung volume measurements between patients with lung shielding and those without. This was not observed at the 2-year time point. When stratified by good (>100% predicted) or poor (</=100% predicted) baseline lung function, patients with poor function demonstrated protection at 1 year with lung shielding, while those with good initial lung function did not. TBI with or without lung dose reduction has a small but statistically significant effect on pulmonary function measured at 1 year but not 2 years post irradiation.
Here, using data from the NEMO-3 experiment, we have measured the two-neutrino double beta decay (2νββ) half-life of 82Se as T2ν1/2=9.39±0.17( stat )±0.58( syst )×1019 y under the single-state ...dominance hypothesis for this nuclear transition.
Abstract Using data from the NEMO-3 experiment, we have measured the two-neutrino double beta decay ($$2\nu \beta \beta $$ 2νββ ) half-life of $$^{82}$$ 82 Se as $$T_{\smash {1/2}}^{2\nu } \!=\! ...\left 9.39 \pm 0.17\left( \text{ stat }\right) \pm 0.58\left( \text{ syst }\right) \right \times 10^{19}$$ T1/22ν=9.39±0.17stat±0.58syst×1019 y under the single-state dominance hypothesis for this nuclear transition. The corresponding nuclear matrix element is $$\left| M^{2\nu }\right| = 0.0498 \pm 0.0016$$ M2ν=0.0498±0.0016 . In addition, a search for neutrinoless double beta decay ($$0\nu \beta \beta $$ 0νββ ) using 0.93 kg of $$^{82}$$ 82 Se observed for a total of 5.25 y has been conducted and no evidence for a signal has been found. The resulting half-life limit of $$T_{1/2}^{0\nu } > 2.5 \times 10^{23} \,\text{ y } \,(90\%\,\text{ C.L. })$$ T1/20ν>2.5×1023y(90%C.L.) for the light neutrino exchange mechanism leads to a constraint on the effective Majorana neutrino mass of $$\langle m_{\nu } \rangle < \left( 1.2{-}3.0\right) \,\text{ eV }$$ ⟨mν⟩<1.2-3.0eV , where the range reflects $$0\nu \beta \beta $$ 0νββ nuclear matrix element values from different calculations. Furthermore, constraints on lepton number violating parameters for other $$0\nu \beta \beta $$ 0νββ mechanisms, such as right-handed currents, majoron emission and R-parity violating supersymmetry modes have been set.
The NEMO-3 experiment measured the half-life of the 2νββ decay and searched for the 0νββ decay of Cd116. Using 410 g of Cd116 installed in the detector with an exposure of 5.26 y, (4968±74) events ...corresponding to the 2νββ decay of Cd116 to the ground state of Sn116 have been observed with a signal to background ratio of about 12. The half-life of the 2νββ decay has been measured to be T1/22ν=2.74±0.04(stat)±0.18(syst)×1019 y. No events have been observed above the expected background while searching for 0νββ decay. The corresponding limit on the half-life is determined to be T1/20ν≥1.0×1023 y at the 90% C.L. which corresponds to an upper limit on the effective Majorana neutrino mass of ⟨mν⟩≤1.4–2.5 eV depending on the nuclear matrix elements considered. Limits on other mechanisms generating 0νββ decay such as the exchange of R-parity violating supersymmetric particles, right-handed currents and majoron emission are also obtained.
Climate change is predicted to have particularly challenging impacts throughout the Arctic. For instance, there is a great probability of sea ice melting, leading to increased vessel traffic and oil ...pollution. Eight major nation-states have vested concerns in the potential opening of Arctic sea routes. They each have pledged to take protective action through the Arctic Council. However, there is still a need to develop an international institution to simultaneously address Arctic marine pollution and protect the needs of these states. This article seeks to design a legally binding regime for oil pollution control in the Arctic. In creating this new regime, we shall utilize several shared design elements of historically effective international regimes and take advantage of the legal innovations of these agreements. Our new regime, entitled the Arctic Shipping and Environmental Management Agreement (ASEMA), will take into account both the economic and environmental interests of the parties involved.
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