Le Réseau Pédiatrique du Sud et Ouest Francilien a établi un protocole de suivi développemental, largement inspiré des échelles de développement existantes, adapté à la pratique courante de ...consultation. La mallette de consultation décrite ici rassemble une série d’objets et jeux du commerce très simples, qui sont un support pour une exploration qualitative du développement, pour les enfants de moins de quatre ans. Différents domaines sont pris en compte : motricité globale, coordinations oculomanuelles, manipulations et constructions, communication et langage, capacités attentionnelles, comportement relationnel et social. Le temps d’échanges et de jeu entre le pédiatre et l’enfant permet un premier repérage de troubles éventuels : il facilite et affine l’orientation vers un professionnel spécialisé pour une consultation, un bilan normé voire une prise en charge thérapeutique. Ce cadre ludique offre aussi un espace pour les parents, ce qui peut les étayer comme premiers acteurs du développement de leur enfant. Partie intégrante de la consultation développementale, ce temps est complété par l’examen somatique et les dépistages sensoriels. Aujourd’hui réservé aux enfants vulnérables, ce type de consultation pourrait être étendu à tous les enfants.
The South and West Francilien Pediatric Network (Réseau Pédiatrique du Sud et Ouest Francilien RPSOF) has established a protocol for the developmental follow up of infants inspired by the existing developmental scales adapted to the current practice of out patient consultation. The consultation described here collects a set of very simple objects and trade toys that are a support for a qualitative exploration of the development for the infants of less than 4years of age. Different fields are taken into account: global motor skills, hand-eye coordination, manipulation and construction, communication and language, attentional capacity, relational and social behaviour. The time of exchange and play between the paediatrician and the infant allows a first detection of possible problems: the orientation towards a specialized professional for a consultation, a standard check-up or even a therapeutic care becomes easier and clearer. This playful environment also offers a space for the parents, and supports their participation as primary role players in the development of their child. This time, integral part of the consultation, is completed by the somatic examination and sensory screening tests. At present reserved for children identified as being at risk, this type of consultation could be universalised for all infants.
La mortalité avant et après la naissance est élevée chez les jumeaux, confrontant les parents à un deuil très particulier. L’objectif de cette étude était de décrire les réactions des parents lors du ...décès d’un de leurs jumeaux en réanimation néonatale, la façon dont ils avaient investi l’enfant en vie et le rôle des soignants pour les aider.
Dans une étude qualitative sur le devenir des parents après la perte d’un enfant dans 4 services français de réanimation néonatale, des entretiens semi-directifs ont été conduits 3 ans après le décès. Les entretiens ont été enregistrés, retranscrits et analysés (analyse de discours). Parmi les 166 parents ayant participé, 26 avaient perdu un jumeau.
À propos du décès, les parents ont insisté sur la complexité des sentiments éprouvés, simultanés et antinomiques. Le deuil était rendu particulier par la difficulté à pleurer la perte de l’enfant décédé tout en s’occupant de l’enfant en vie. Le refoulement des affects, un risque de superposition des images de chaque enfant dans l’esprit des parents et de confusion dans les places de chacun ont été observés.
Lors de la perte d’un jumeau, les parents sont submergés par la coexistence de sentiments contradictoires. Les soignants doivent pouvoir entendre les parents évoquer des sentiments contradictoires et les soutenir dans la reconnaissance de l’existence et de la perte d’un des enfants et dans l’investissement de l’enfant en vie. Leur rôle est essentiel pour les aider à construire des histoires différentes avec chaque enfant.
The mortality rate both before and after birth is higher in twins. Parents face a particularly difficult mourning experience when confronted with the loss of 1 of their newborn twins. The aim of this article is to describe how parents experience and cope with this situation over the long term, how they describe the loss at the time of the death in a neonatal intensive care unit (NICU), the way they are able to become attached to the surviving twin, and the role that NICU caregivers can play to help them.
This study is part of a larger qualitative study on parental mourning after the loss of a newborn in 4 NICUs in France. Semi-structured research interviews were conducted 3years after the death. The interviews were recorded, transcribed, and anonymized. Discourse analysis was used to extract the data on different themes. Among the 166 participating parents, 26 had lost a newborn twin.
The parents reported their difficulties when faced with simultaneous contradictory events at the time of the death of a twin child in the NICU. Mourning appeared to be more difficult in this particular case: to combine the loss of a deceased child with the care of the surviving newborn was very complicated. The existence of the “co-twin” was described as an essential support for the parents; however, over the long term, this child could not fulfill the feelings of emptiness. The relation with this surviving child was sometimes disturbed by parental anxiety that the accident could recur. Fathers and mothers showed repression of their sadness and despair. The representations of the 2 children in their parents’ mind were sometimes very close or even overlapping and some parents were confused with regards to the place each of them could have. In the NICU, the caregivers should be able to listen to the parents expressing their contradictory feelings, to sustain the acknowledgement of the loss of 1 child, and in becoming attached to the surviving child. Parents need to be reassured about their living child's health.
When faced with the loss of a newborn twin, parents are overwhelmed by the coexistence of contradictory feelings. The role of the medical staff is essential in building separate stories and having different memories for each child.
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► The native film on the alloy surface contains TiO2, Nb2O5, ZrO2, Ta2O5 as was demonstrated by XPS. ► After 2000h, XPS revealed the same oxides and calcium, phosphorous ions ...deposited as hydroxyapatite. ► Impedance data exhibited a passive film with two layers: an inner, barrier and an outer, porous. ► In Ringer and Ringer–Brown solutions, the new alloy presented low corrosion rates.
A new quaternary Ti–20Nb–10Zr–5Ta alloy with β-near microstructure was obtained. Its native passive film composition and its modification and corrosion resistance after 2000 immersion hours in simulated biofluids were studied. The native film on the alloy surface contains TiO2, Nb2O5, ZrO2, Ta2O5 protective oxides as was demonstrated by XPS. After 2000h, XPS revealed the presence of same oxides and calcium, phosphorous ions deposited from physiological solutions as hydroxyapatite. In Ringer and Ringer–Brown solutions, the new alloy presented low corrosion rates. Impedance data exhibited a passive film with two layers: an inner, barrier layer and an outer, porous layer.
Introduction
The quality of life is a multidiimensional and subjective construct, based on the patient’s experience.
Objectives
The objective of this study is to observe if at the HIV - positive ...patient the quality of life in relation to health is a consequence of disease and treatment and if his perception about the disease changes his ability to have a full and useful life.
Methods
We centralized the data coming from a number of 600 patients registered in the Iasi Regional Center, for a period of 12 months. The side effects reported by the patients emerged from discussions with the infectious diseases specialist and the psychologist.
Results
From 600 pacients, 59% of them were male with mean age of 21.1 years old. Approximately 14% of the patiens had stable jobs, the rest were unemployed or had part-time jobs. 38% came from foster care units of from broken homes. The average number of days of hospitalization was 4 days, 25% of them were at their first scheme, 10% in the seventh-eighth scheme. Among the antiretroviral side effects patients complained nausea and vomiting in 85% of cases, lipodystrophy symptoms in 25% of cases, diarrhea in 15% of the cases; regarding the psychological aspects, 65% of patients showed an above level of anxiety, 40% had depressive manifestations, 10% had specific obsessions-compulsions and 10% neurotic and hysterical tendencies.
Conclusions
We need a close collaboration between the infectious diseases specialist and the psychologists in order to enhance the quality of life of the HIV patient.
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•Native passive film (TiO2, Ta2O5, ZrO2) on Ti–15Ta–5Zr alloy surface has a thickness of 8.5nm.•Duplex oxide film formed by inner, compact and by outer porous layer was modelled by ...EIS.•Passive film thickened over time by new depositions from physiological solutions.•After 1500h in acid Ringer solution the brushite was detected by XPS.•In neutral and alkaline Ringer solutions the hydroxyapatite was identified by XPS and SEM.
The native passive film on the new Ti–15Ta–5Zr alloy surface contains the protective TiO2, Ta2O5 and ZrO2 oxides (XPS analysis). The decrease of the corrosion current densities and the increase of the polarisation resistances values signify the thickening of the passive film in time. The duplex oxide film formed by the inner, compact, layer and by the outer, porous layer was modelled; electrical parameters indicated the thickening over time both of the barrier and porous layers. XPS and SEM analyses demonstrated the in time deposition of new layers consisting by brushite in acid Ringer solution and from hydroxyapatite in neutral and alkaline Ringer solutions.
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► EIS spectra for Ti6Al4V1Zr alloy were fitted with one time constant electric equivalent circuit. ► For covered alloy the equivalent circuit contains two time constants. ► ...Resistances of films increased in time revealing the improvement of the alloy protection capacity. ► Surface roughness significantly increased by apatite formation, being favourably to cell adhesion.
A new titanium base Ti–6Al–4V–1Zr alloy covered with hydroxyapatite or bovine serum albumin/hydroxyapatite was characterized in this paper in order to be used as implant material. Following techniques were used: linear polarization, electrochemical impedance spectroscopy, scanning electronic microscopy, Fourier transform infrared spectroscopy and atomic force microscopy. For HA or BSA/HA covered alloy, the electric equivalent circuit contains two time constants (for the passive film and for coatings). The resistance of the protective films increased in time and BSA/HA coating was slightly rougher than HA coating, this situation being favourably to the cell adhesion.
Introduction
HIV infection is currently considered a worldwide pandemic.
Objectives
The objective of this paper is to outline the profile of HIV – positive patients in intensive care units, regarding ...the psycho-emotional and viral parameters.
Methods
We realized a retrospective study for a period of 36 months, evaluating HIV positive patients in intensive care unit in the “Sf. Parascheva” Infectious Diseases Clincal Hospital Iasi, Romania.
Results
From 1
st
of Janury 2011 to 31
st
of December 2013, the HIV/AIDS Regional Centre of Iasi recorded 2649 hospitalizations, of which 18 cases required intensive medical care, 10 males and 8 females. The number of days of hospital admission varied between 4.5 and 32 days in the Intensive Care Unit. Initialy the psychological interview was conducted for 16 of the 18
th
patients, 2 cases were with severely deteriorated health status that didn’t allowed communication. From them, 7 survived and they were evaluated at discharge from IIntensive Care Unit and also monitored long term, that revealed an increase in adherence to Antiretroviral Therapy and a change in lifestyle.
Conclusions
HIV positive patients that requires intensive care showed a marked immunological collapse due to abandonment of the therapy or late detection. In order to fully accomplish the needs of the HIV positive patient, the infectious diseases specialist must collaborate with the psychologist.
In this work, a multi-elementary Ti–10Zr–5Nb–5Ta alloy, with non-toxic alloying elements, was used to develop an accumulative roll bonding, ARB-type procedure in order to improve its structural and ...mechanical properties. The alloy was obtained by cold crucible semi-levitation melting technique and then was ARB deformed following a special route. After three ARB cycles, the total deformation degree per layer is about 86%; the calculated medium layer thickness is about 13 μm. The ARB processed alloy has a low Young’s modulus of 46 GPa, a value very close to the value of the natural cortical bone (about 20 GPa). Data concerning ultimate tensile strength obtained for ARB processed alloy is rather high, suitable to be used as a material for bone substitute. Hardness of the ARB processed alloy is higher than that of the as-cast alloy, ensuring a better behaviour as a implant material. The tensile curve for the as-cast alloy shows an elastoplastic behaviour with a quite linear elastic behaviour and the tensile curve for the ARB processed alloy is quite similar with a strain-hardening elastoplastic body. Corrosion behaviour of the studied alloy revealed the improvement of the main electrochemical parameters, as a result of the positive influence of ARB processing. Lower corrosion and ion release rates for the ARB processed alloy than for the as-cast alloy, due to the favourable effect of ARB thermo-mechanical processing were obtained.
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► New Ti–10Zr–5Nb–5Ta alloy was processed by an accumulative roll bonding (ARB) method. ► After three ARB cycles, total deformation degree/layer is 86%; medium layer thickness is about 13 μm. ► ARB processed alloy has a low Young’s modulus (46 GPa), very close to the value of the natural cortical bone (30 GPa). ► Ultimate tensile strength for ARB processed alloy is high, suitable for a bone implant. ► Improvement of corrosion resistance as result of ARB processing positive influence was obtained.
Ti6Al4V-ELI alloy was plastically deformed at elevated temperatures in the range of
β and
α
+
β fields and was subsequently heat treated; so that five different alloys were obtained. The corrosion ...resistance of these alloys was studied in Ringer solutions of different pH values using the techniques of electrochemical cyclic potentiodynamic polarization, electrochemical impedance spectroscopy and scanning electron microscopy. All alloys exhibited high corrosion resistance in Ringer solutions for 2000 exposure hours. SEM observations indicated the formation of calcium phosphate on the alloy surface. Two electric equivalent circuits with two time or three time constants were fitted.
In this study, a new Ti–25Ta–25Nb (mass%) beta alloy was synthesised by cold crucible semi-levitation melting. This technique made it possible to obtain homogeneous ingots although the elements used ...have very different melting points. After melting, a thermo-mechanical treatment was applied in order to obtain a perfectly recrystallised beta microstructure. For this alloy composition, the tensile tests showed a very low Young’s modulus associated with an important super-elastic behaviour, which contributes to decrease the elastic modulus under stress and to increase the recoverable strain. On the other hand, the corrosion tests, which were carried out in a neutral Ringer solution, indicated a corrosion resistance higher than that of the commercially pure CP Ti alloy. These results show that this new alloy possesses all the characteristics necessary for its long-term use in medical implants.
► New superelastic biomedical Ti alloy synthesised by cold crucible levitation melting. ► Ti-25Ta-25Nb alloy having a very low Young’s modulus at 55 GPa. ► Superelastic recoverable strain evaluated at 0.75%. ► Low corrosion rate for the Ti-25Ta-25Nb alloy in neutral Ringer solution.
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