Performance Tiers within a Competitive Age Group of Young Swimmers Are Characterized by Different Kinetic and Kinematic Behaviors.

The present study aimed to analyze swimmers' in-water kinetic and kinematic behaviors according to different swimming performance tiers within the same age group. An amount of 53 highly trained swimmers (girls and boys: 12.40 ± 0.74 years) were split up into 3 tiers based on their personal best performance (i.e., speed) in the 50 m freestyle event (short-course): lower-tier (1.25 ± 0.08 m·s-1); mid-tier (1.45 ± 0.04 m·s-1); and top-tier (1.60 ± 0.04 m·s-1). The in-water mean peak force was measured during a maximum bout of 25 m front crawl using a differential pressure sensors system (Aquanex system, Swimming Technology Research, Richmond, VA, USA) and defined as a kinetic variable, while speed, stroke rate, stroke length, and stroke index were retrieved and considered as kinematic measures. The top-tier swimmers were taller with a longer arm span and hand surface areas than the low-tier, but similar to the mid-tier. While the mean peak force, speed and efficiency differed among tiers, the stroke rate and stroke length showed mixed findings. Coaches should be aware that young swimmers belonging to the same age group may deliver different performance outcomes due to different kinetic and kinematic behaviors.

Mixing times for two classes of stochastically modeled reaction networks.

The past few decades have seen robust research on questions regarding the existence, form, and properties of stationary distributions of stochastically modeled reaction networks. When a stochastic model admits a stationary distribution an important practical question is: what is the rate of convergence of the distribution of the process to the stationary distribution? With the exception of [1] pertaining to models whose state space is restricted to the non-negative integers, there has been a notable lack of results related to this rate of convergence in the reaction network literature. This paper begins the process of filling that hole in our understanding. In this paper, we characterize this rate of convergence, via the mixing times of the processes, for two classes of stochastically modeled reaction networks. Specifically, by applying a Foster-Lyapunov criteria we establish exponential ergodicity for two classes of reaction networks introduced in [2]. Moreover, we show that for one of the classes the convergence is uniform over the initial state.

Investigating the relationship between interventions, contact patterns, and SARS-CoV-2 transmissibility.

BACKGROUND: After a rapid upsurge of COVID-19 cases in Italy during the fall of 2020, the government introduced a three-tiered restriction system aimed at increasing physical distancing. The Ministry of Health, after periodic epidemiological risk assessments, assigned a tier to each of the 21 Italian regions and autonomous provinces. It is still unclear to what extent these different sets of measures altered the number of daily interactions and the social mixing patterns. METHODS AND FINDINGS: We conducted a survey between July 2020 and March 2021 to monitor changes in social contact patterns among individuals in the metropolitan city of Milan, Italy, which was hardly hit by the second wave of the COVID-19 pandemic. The number of daily contacts during periods characterized by different levels of restrictions was analyzed through negative binomial regression models and age-specific contact matrices were estimated under the different tiers of restrictions. By relying on the empirically estimated mixing patterns, we quantified relative changes in SARS-CoV-2 transmission potential associated with the different tiers. As tighter restrictions were implemented during the fall of 2020, a progressive reduction in the mean number of daily contacts recorded by study participants was observed: from 15.9 % under mild restrictions (yellow tier), to 41.8 % under strong restrictions (red tier). Higher restrictions levels were also found to increase the relative contribution of contacts occurring within the household. The SARS-CoV-2 reproduction number was estimated to decrease by 17.1 % (95 %CI: 1.5-30.1), 25.1 % (95 %CI: 13.0-36.0) and 44.7 % (95 %CI: 33.9-53.0) under the yellow, orange, and red tiers, respectively. CONCLUSIONS: Our results give an important quantification of the expected contribution of different restriction levels in shaping social contacts and decreasing the transmission potential of SARS-CoV-2. These estimates can find an operational use in anticipating the effect that the implementation of these tiered restriction can have on SARS-CoV-2 reproduction number under an evolving epidemiological situation.

Emergence and Embodiment in Economic Modeling.

Exploratory ventures outside the established disciplinary boundaries can yield added insights and explanatory power. Imposing cognitive limitations on human logical reasoning ability (bounded rationality) is a well-known case in point. Extending cognition to parts of body outside the brain, and to environment outside the body is another. In contrast, the present article takes a constructive approach, also in an exploratory spirit. For the sake of exposition, we consider three tiered realms of scientific inquiry: physical or inanimate, biological or animate, and socio-psychological or sentient. In this three-tier framework, we explore the extent of gains in modeling human action within the confines of physical principles such as optimization. In this exercise, concepts of complexity and emergence account for the absence of analytically derivable mapping from micro or finer grain phenomena to macro or coarser grain phenomena. A general notion of embodiment captures the inclusion of a more expansive range of explanatory factors in modeling and understanding a given phenomenon. Emergence and embodiment play complementary roles in exploration of human behavior.

[Involuntary admission to psychiatry at the request of caregivers: The point of view of caregivers]. / Les soins psychiatriques à la demande d'un tiers : le point de vue du tiers.

OBJECTIVES: In France, the family and friends of a patient with a psychiatric disorder can legally be involved in the decision to involuntary admission to psychiatry through care at the request of a third party. This involvement has been questioned in recent years, notably to protect this third party. The main objective of this work was to assess whether providing the third party with information on care without consent when providing care at the request of a third party (SDT) had an impact on the third party's experience. The secondary objectives were to identify other factors that might impact the third party's experience of the SDT, and to assess the impact of the SDT on the relationship between the third party and his or her hospitalized relative, as well as the factors that might influence it. METHODS: The study was based on a questionnaire, constructed after meeting several members of an association of relatives of patients with psychiatric disorders : UNAFAM. This questionnaire questioned the context of hospitalization, the information provided concerning care without consent, the experience of the third party at the time of hospitalization and at a distance, and the impact of hospitalization on the relationship between the third party and his or her hospitalized relative, both at the time of hospitalization and at a distance. This questionnaire was then sent to UNAFAM members in three randomly selected regions. It was specified that it was only intended for people who had already been a third party during SDT. The results were received anonymously. RESULTS: Among the 166 respondents, 85 (51.2 %) had received information about involuntary admission, and there was more frequent relief at the time of hospitalization (P<0.01) and at a distance (P<0.01), and less frequent feelings of violence towards their loved one at a distance from hospitalization (P=0.02) compared to those who had not received information. The negative impact of hospitalization on the relationship between the third party and their hospitalized relative was lower (P=0.04) among third parties who received information. The fact that the doctor was perceived as being mainly responsible for the decision to hospitalize also preserved the third party's experience and relationship with his or her relative. However, third parties who understood their involvement as an administrative necessity reported less frequent relief (P=0.01), and the negative impact of hospitalization on their relationship with their relative was higher (P=0.01). Conversely, the fact that they felt integrated into the care and listened to by the health care team was correlated with a better experience of the situation by the third party, and a lesser negative impact of hospitalization on the relationship between the third party and their relative. CONCLUSIONS: Providing information to the third party about involuntary admission at the time of an SDT could improve his or her experience of the situation and limit the negative impact of hospitalization on his or her relationship with his or her loved one. Although it seems important for the third party to feel that the majority of the decision to hospitalize is made by the physician, including him/her in this decision could improve his/her experience of the situation and limit the negative impact of hospitalization on the relationship between the third party and his/her family member.

[Involuntary Psychiatric Hospitalizations: From request to a call center to hospitalization]. / Admission en soins psychiatriques a la demande d'un tiers : de l'appel au SAMU a l'hospitalisation.

BACKGROUND: Involuntary psychiatric hospitalization (IPH) is a heavy and complex psychiatric exception measure. In the Seine-Saint-Denis department (low medical density), the evaluation of the patient in psychiatric decompensation is the responsibility of the out-of-hours general practitioners (GP) mandated by the call center. Their feeling is the non-achievement of the procedure once the patient arrives at the emergency room. We aimed to evaluate the outcome of patients following a request for IPH from these GP. METHODS: We conducted a retrospective study based on all requests for IPH received during 2016 at the Seine-Saint-Denis emergency medical call center. The characteristics of the call and the patient, as well as the decisions of the regulator and the GP were collected. The decision of hospitalization in the emergency room was sought for patients referred for IPH. RESULTS: Of the 7541 calls for decompensation, 539 were for an IPH. These calls occurred during non-working hours in 55 % of cases. A GP was involved in more than two-thirds of the cases and requested an IPH for 240/304 (79 %) patients. Patients were male in 56 % of cases with an average age of 40 (±16) years. IPH was confirmed for 132 (61 %) patients. This rate did not differ from the 65 % reported in the literature (Z-test, P=0.26). Voluntary hospitalization was performed for 37 (17 %) other patients. DISCUSSION: The IPH rate for patients referred by GP mandated by the call center was comparable to that following the requests of the attending physicians, validating their intervention in this critical context.

O terceiro analítico supervisório: o processo supervisório, o campo supervisório e a transformação contínua / The supervisory analytic third: supervisory process, supervisory field, and the continuous transformation / El tercer analítico de supervisión: el proceso de supervisión, el campo de supervisión y la transformación continua / Le tiers analytique de supervision: processus de supervision, champ de supervision et transformation continue

As autoras propõem a hipótese da existência de um fenômeno que ocorre no processo de supervisão e que nomeiam como o terceiro analítico supervisório. Partem da ideia de que algumas representações sem representação simbólica do aparelho psíquico do paciente - que se mantêm nesse estado durante a sessão de análise - poderiam sofrer algum tipo de transformação durante o processo de supervisão. Fenômenos perceptivos que acontecem no aparelho psíquico do sujeito e no campo analítico, como o trabalho de figurabilidade e a simbolização primária, também podem acontecer numa sessão de supervisão. As autoras mostram que esse processo incide tanto na mente do supervisionando quanto na do supervisor e sucede em três tempos: 1) sessão de análise, 2) sessão de supervisão, e 3) reflexão e narrativa. Começam com uma breve revisão teórica dos conceitos de Darstellbarkeit, figurabilidade psíquica e simbolização primária. Depois, descrevem como se dá a apreensão de representações sem representação simbólica, ou seja, representações não simbolizadas, através do processo supervisório, e então propõem a ideia do terceiro analítico supervisório. Por fim, apresentam alguns exemplos clínicos.

This study proposes the hypothesis on the existence of a phenomenon that occurs in the supervisory process, and that will be named as the supervisory analytic third. It begins with the idea that some representations without symbolic representation of the patient's psychic apparatus, who remains in this state during the analysis session, could suffer some kind of transformation during the supervision process. Perceptive phenomena that occur in the subject's psychic apparatus and in the analytic field, such as the figurability work and primary symbolization, can also occur in a supervision session. The authors show that this process focuses on both the supervisee's and supervisor's minds, and takes place in three moments: 1) analysis session, 2) supervision session, and 3) reflection and intelligibility. The text begins with a brief theoretical review of the concepts of Darstellbarkeit, psychic figurability, and primary symbolization. The second part describes how the representations without symbolic representations, that is, representations that are not symbolized, are apprehended; through the supervisory process, and then proposes the idea of the supervisory analytic third. Finally, some clinical examples are presented.

El artículo propone la hipótesis de la existencia de un fenómeno que se produce en el proceso de supervisión y que se denominará tercer analítico de supervisión. Se parte de la idea de que algunas representaciones sin representación-simbólica del aparato psíquico del paciente - que permanece en este estado durante la sesión de análisis- podrían sufrir algún tipo de transformación durante el proceso de supervisión. Los fenómenos perceptivos que se producen en el aparato psíquico del sujeto y en el campo analítico, como el trabajo de figuración y simbolización primaria, también pueden producirse en una sesión de supervisión. Las autoras muestran que este proceso se centra tanto en la mente del supervisor como en la del supervisando y tiene lugar en tres tiempos: 1) sesión de análisis, 2) sesión de supervisión y 3) reflexión e inteligibilidad. El texto comienza con un breve repaso teórico de los conceptos de Darstellbarkeit, figurabilidad psíquica y simbolización primaria. La segunda parte describe cómo se produce la aprehensión de las representaciones sin representación-simbólica, es decir, de las representaciones no simbolizadas a través del proceso de supervisión y, a continuación, propone la idea del tercero analítico de supervisión. Por último, se presentan algunos ejemplos clínicos.

L'article propose, en tant qu'hypothèse, l'existence d'un phénomène qui a lieu dans le processus de supervision et qui sera nommé le tiers analytique de supervision. Il part de l'idée que certaines représentations sans représentation symbolique de l'appareil psychique du patient - lequel reste dans cet état pendant la séance d'analyse, - pourraient subir quelque type de transformation au cours du processus de supervision. Les phénomènes perceptifs qui se produisent dans l'appareil psychique du sujet et dans le champ analytique, tels que le travail de figurabilité et la symbolisation primaire, peuvent également avoir lieu lors d'une séance de supervision. Les autrices démontrent que ce processus affecte aussi bien la psyché de la personne en supervision que celle du superviseur et se déroule en trois étapes : 1) la séance d'analyse, 2) la séance de supervision et 3) les réflexions et l'intelligibilité. L'article débute par une brève révision théorique des concepts de Darstelbarkeit, de figurabilité psychique et de symbolisation primaire. Dans la deuxième partie on décrit comment l'appréhension des représentations sans représentation-symboliques se déroule-t-elle, c'est-à-dire, les représentations non-symboliques, par l'intermédiaire du processus de supervision, et on propose ensuite l'idée du tiers analytique de supervision. Pour finir, quelques exemples cliniques sont présentés.

[Medico-legal framework for emergency care of a patient with psychiatric conditions]. / Cadre médico-légal des soins en urgence d'un patient à présentation psychiatrique.

The care and referral of patients with psychiatric conditions is a perilous process. It combines the need for care with respect for individual freedom. Knowledge of the different legal frameworks is thus necessary for psychiatric care at the request of a third party, care without request of a third party within the framework of a procedure for imminent danger, and finally for the injunction of psychiatric care on the decision of a State representative. These are necessary prerequisites for practising in an emergency structure.

The technologically-mediated self: reflections on the container and field of telecommunications.

This paper contains reflections on the use of the imagination in technologically-mediated therapy and analysis. As part of the individuation process the psyche is seen as needing to adapt to new technological ways of communicating. The notion of a technologically-mediated self is posited describing a self which can only be apprehended through, and by, the use of telecommunications. This self is seen as identical to the in-person self, a subset, or superset of it. There is a revisioning of our notions of the container and the field in this work performed through technological-mediation. The need to engage the imagination in approaching this kind of work is emphasized in order to create an imaginal play-space in which the body will be deeply affected. Some thoughts on how the process of individuation might look through such analytic work is presented.

Cet article contient des réflexions sur l'utilisation de l'imagination dans la thérapie et l'analyse pratiquées par la médiation de la technologie. En tant que partie intégrante du processus d'individuation, la psyché est considérée comme devant s'adapter à de nouvelles façons de communiquer, basées sur la technologie. La notion d'un soi atteint par la médiation de la technologie est postulée, un soi qui ne peut être appréhendé que par le biais de l'utilisation des télécommunications. Ce soi est considéré comme étant identique au soi dans la personne; un sous-ensemble, ou un sur-ensemble. L'article présente une révision de nos notions de contenant et de champ quand on travaille avec la médiation de la technologie. Il souligne le besoin de mobiliser l'imagination quand on aborde ce genre de travail afin de créer un espace imaginal de jeu dans lequel le corps sera profondément affecté. Il propose quelques pensées sur comment le processus d'individuation pourrait se présenter au travers d'un tel travail analytique.

El presente trabajo contiene reflexiones sobre el uso de la imaginación en terapia y análisis mediado por la tecnología. Como parte del proceso de individuación, la psique necesita adaptarse a nuevos modos tecnológicos de comunicación. Se propone la noción de un self mediado-tecnológicamente, al describir a un self que solamente puede ser aprehendido a través y por el uso de las telecomunicaciones. Este self es considerado como idéntico al self presencial, una parte o una versión mayor del mismo. Se presenta una revisión de nuestras nociones acerca del campo y del espacio de contención en este trabajo realizado a través de la mediación tecnológica. Se enfatiza la necesidad de comprometer a la imaginación al abordar esta forma de trabajo, para crear un espacio de juego-imaginal, en el cual el cuerpo estará profundamente afectado. Se presentan algunas reflexiones acerca de cómo podría mirarse el proceso de individuación a través de dicho trabajo.

An Evidence-Based Strategic Approach to Prevention and Treatment of Dry Eye Disease, a Modern Global Epidemic.

Dry eye disease (DED) is an emerging health concern causing significant visual, psychological, social, and economic impact globally. In contrast to visual rehabilitation undertaken at late stages of DED, measures instituted to prevent its onset, establishment, or progression can alter its natural course and effectively bring down the associated morbidity. This review attempts to present the available literature on preventive strategies of DED at one place, including strategies for risk assessment and mitigation, targeting a wide range of population. A literature search was conducted using PubMed and an extensive literature review on preventive strategies for DED was compiled to put forth a holistic and strategic approach for preventing DED. This can be undertaken at various stages or severity of DED directed at different tiers of the health care system. Conclusion: This review intends to put emphasis on preventive strategies being adopted as an integral part of routine clinical practice by general ophthalmologists and specialists to tackle the burden of DED and improve the quality of the lives of the patients suffering from it.

An In-Depth Analysis of Research Output in Successful Integrated Plastic Surgery Match Applicants and Factors Associated With Matching at Top-Ranked Programs.

OBJECTIVE: With USMLE Step I score reports becoming pass/fail, research output may become a more important factor for applicants in the integrated plastic surgery match. The authors aim to assess the research output of successful applicants and bibliometric variables associated with matching at higher tier programs. DESIGN: A search of peer-reviewed publications up to or during September before the matriculant's match year was performed using PubMed, Google Scholar, and Scopus for each resident. Bibliometric variables were analyzed including those associated with matching at higher tier Doximity reputation/research programs. SETTING: University of Pennsylvania (Philadelphia, Pennsylvania). PARTICIPANTS: Integrated plastic surgery interns for the 2019 to 2020 and 2020 to 2021 academic years (n = 301). RESULTS: Three hundred one matriculants at 73 programs produced a total of 731 manuscripts. The mean number of publications and H-index per applicant was 2.43 ± 3.84 and 1.01 ± 1.30, respectively. The average and maximum journal impact factor was 2.8 ± 1.81 and 4.66 ± 5.59, respectively. H-index, total publications, plastic surgery-related and unrelated publications, and first-author studies were all associated with matching into both a higher ranked reputation and research tier program, respectively (p < 0.05). Highest impact factor publications were associated with matching at top tier research programs only (p < 0.05). Among students from US News Top 40 and non-Top 40 medical schools, total publications and first-author publications remained associated with matching at a higher tier reputation and research program (p < 0.05). However, plastic surgery-related publications were significantly linked to matching into a higher tier program for matriculants from non-Top 40 medical schools only (p < 0.05). CONCLUSIONS: Research productivity, particularly total publications and first-author publications, is associated with an increased likelihood of matching at a higher tier integrated plastic surgery residency. Regardless of their medical school's US News rank, students may gain a competitive edge in the match with increased research output.

[The psychic and relational stakes of sleep]. / Les enjeux psychiques et relationnels du sommeil.

By progressing towards a certain inner security, the child gradually becomes accustomed to the separation and absence he faces during sleep. However, certain anxiety-provoking situations arising from his own history or from the unconscious of the family prevent him from getting into bed and quietly surrendering to sleep. A serene environment with parents trying to be "good enough" and where everyone plays their part will succeed in reassuring the child's fears when it comes to falling asleep.

Economic and Welfare Impacts of Providing Good Life Opportunities to Farm Animals.

Existing animal welfare standards for legislation and food certification programmes are primarily designed to avoid harms to the livestock, with minimal consideration given to their behavioural freedoms. Recent research has shown, however, that animal welfare should not only be evaluated by the absence of negative states but also by the presence of "good life" or positive experiences enjoyed by animals. The objective of the present study is to investigate the scientific validity and on-farm cost implications of utilising potential input-based measures of positive welfare as part of evaluation criteria for farm assurance schemes. Building upon the Farm Animal Welfare Council's concept of good life opportunities, an assessment was undertaken on 49 noncaged laying hen farms across the UK by measuring on-farm resources to facilitate positive experiences alongside commonly measured metrics for welfare outcomes. The financial cost of providing these resources on each enterprise was also estimated using a farm-scale costing tool. The results suggested that 63% of resource needs that facilitate the behaviour opportunities of laying hens are already being provided by these producers, far above legal and commercial requirements. This practice attracts no reward mechanism or direct financial benefit under the current market structure. Additional provision of opportunities was positively associated with behavioural outcomes, but only limited impact was observed on health and productivity measures. Economic modelling indicated that significant room exists to further improve welfare scores on these farms, on average by 97%, without incurring additional costs. Together we argue that these results can be seen as evidence of market failure since producers are providing positive welfare value to society that is not being currently recognised. It is therefore contended that measuring and rewarding the supply of good life opportunities could be a novel policy instrument to create an effective marketplace that appropriately recognises high welfare production.

A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

BACKGROUND: Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place. METHODS: Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting. RESULTS: We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms. CONCLUSIONS: These protocols are intended to assist clinicians in the management of patients with both ICP and brain oxygen monitors but they do not reflect either a standard-of-care or a substitute for thoughtful individualized management. These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference.

Cigarette prices in a complex cigarette tax system: empirical evidence from Indonesia.

BACKGROUND: The complex cigarette tax system in Indonesia has created the opportunity for cigarette producers to avoid tax, which results in affordable cigarette prices. In addition to increasing cigarette tax every year, the government has adopted several policies to increase cigarette prices, such as reducing the number of tiers and applying cigarette tax based on the combined production of affiliated companies (ie, firms with a minimum 10% ownership of another cigarette company, sharing the same boards of commissioners or using input from other tobacco companies, in which a firm has at least 10% ownership). OBJECTIVE: To investigate the effect of cigarette tax, affiliated company rules and changes in the number of tiers on cigarette prices produced in Indonesia. METHOD: Using brand level data from 2005 to 2017, we model cigarette prices as a function of cigarette tax, affiliated company rules, number of tiers, cigarette types and cigarette tax system using random effect and fixed effect estimations. FINDING: We find that a percentage increase in cigarette tax increases cigarette prices by less than 1% for all cigarette types. The implementation of affiliated company rules is effective in increasing cigarette prices for both affiliated and non-affiliated firms. We also find that a fewer number of tiers are associated with a higher cigarette price. Our results suggest that a reduction in the number of tiers will increase the effectiveness of a specific tax system in making cigarettes less affordable.

A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

BACKGROUND: Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based. METHODS: We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists' decision tendencies were the focus of recommendations. RESULTS: We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination. CONCLUSIONS: Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.

[Characteristics of patients who received an indication of involuntary admission, with or without the involvement of a third party, in a Parisian psychiatric emergency unit]. / Caractérisation d'une population de patients hospitalisés sous contrainte en ASPDT/u et ASPPI à partir d'un service d'urgence psychiatrique parisien.

BACKGROUND: The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party. METHODS: An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016. RESULTS: One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder. CONCLUSION: Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.

O Conceito de Empreendimento Econômico Solidário: Por uma Abordagem Gradualista / The Concept of Solidarity Economy Venture: Towards a Gradualist Approach / Le Concept de l'Entreprenariat Économique Solidaire: Pour une Approche Gradualiste / El Concepto de Iniciativas de Economía Solidaria: Hacia una Perspectiva Gradualista

RESUMO O artigo apresenta inicialmente como uma confluência havida nos anos 1990 entre diversos atores sociais no Brasil conduziu a uma unidade política em torno do conceito de empreendimento econômico solidário. Discute a seguir as conveniências e inadequações desse enfoque, essencialmente normativo, para fins acadêmicos, atividade que implica identificar os traços estruturantes de tais organizações e formular critérios de qualificação e diferenciação desse campo de práticas. Propõe, desta maneira, uma modelagem weberiana ideal-típica do conceito, apropriada a análises empíricas desde um prisma teórico predeterminado. Lastreado em estudos precedentes dos autores, o exame do grau de correspondência entre as organizações econômicas concretas e os critérios prescritos pelo modelo permite qualificá-las, relacioná-las a organizações congêneres e comparar a economia solidária com campos de práticas afins, dentre eles o terceiro setor, examinado em suas peculiaridades na última seção do artigo.

ABSTRACT The following article begins by demonstrating how a convergence between various social actors in 1990s Brazil led to a political consensus on the concept of an empreendimento econômico solidário [solidarity economy venture]. It then discusses the advantages and disadvantages of what is essentially a normative focus, for academic purposes, leading us to identify the structural elements of such organizations and to formulate qualification and differentiation criteria in this field of practice. It thus proposes a Weberian ideal-type model for the concept, appropriated for empirical analyses from a pre-determined theoretical prism. Backed by several of the authors' previous studies, an examination of the degree of correspondence between the specific economic organizations and the criteria prescribed by the model allows us to qualify and relate them to peer organizations and to compare the solidarity economy with similar fields of practice, such as the third sector, examining particular features in the final section of the article.

RÉSUMÉ Cet article présente initialement de quelle manière une confluence survenue dans les années 1990 entre divers acteurs sociaux du Brésil a pu conduire à une unité politique autour du concept d'entreprenariat économique solidaire. On discutera ensuite des avantages et des inconvénients de cette approche, essentiellement normative, à des fins académiques, ce qui impliquera l'identification des traits structurants de telles organisations et la formulation des critères de qualification et de différenciation de ce champ de pratiques. On proposera ainsi une modélisation wébérienne idéale-typique du concept, qui s'avère appropriée pour les analyses empiriques sous un prisme théorique prédéterminé. Sur la base de des précédentes études des auteurs, l'examen du degré de correspondance entre les organisations économiques concrètes et les critères prescrits par le modèle permettra de les qualifier, de les mettre en relation avec des organisations similaires et de comparer l'économie solidaire avec des champs de pratique du même ordre, à l'instar du tiers-secteur, dont on examinera les particularités dans la dernière partie de cet article.

RESUMEN El artículo presenta inicialmente la manera en que la confluencia que se produjo en la década de 1990 entre diversos actores sociales en Brasil condujo a una unidad política en torno al concepto de iniciativas económicas solidarias (conocidas en Brasil como empreendimentos econômicos solidários ). A continuación, se debaten las ventajas e inconvenientes de este enfoque, esencialmente normativo, para fines académicos, una actividad que implica identificar los rasgos estructurales de tales organizaciones y formular criterios de calificación y diferenciación de este campo de prácticas. Se propone, de esta manera, una configuración weberiana ideal típica del concepto, apropiada para análisis empíricos realizados desde un prisma teórico predeterminado. Fundamentado en estudios precedentes de los autores, el examen del grado de correspondencia entre las organizaciones económicas concretas y los criterios prescritos por el modelo permite calificarlas, relacionarlas con organizaciones congéneres y comparar la economía solidaria con campos de prácticas afines, entre ellos, el tercer sector, cuyas peculiaridades se examinan en la última sección del artículo.

La promoción de estilos de vida saludable aprovechando los espacios públicos / Promotion of healthy lifestyles taking advantage of public spaces / A promoção de estilos de vida saudáveis aproveitando os espaços públicos / La promotion de modes de vie sains en tirant profit des espaces publics

Resumen Objetivo: Analizar la influencia que tienen el entorno físico y los aspectos sociales de los espacios públicos en la activación física y el bienestar de los ciudadanos, con el fin de identificar oportunidades para diseñar estrategias de mercadotecnia social que fomenten la salud y el bienestar entre los ciudadanos. Materiales y métodos: Se realizó un estudio mixto en dos etapas: observación y análisis de los atributos físicos de la Ruta Recreativa de Saltillo, Coahuila en base al modelo de Servipanoramas; aplicación de encuestas en línea a 168 adultos utilizando las escalas de bienestar percibido y de valoración de las Ciclovías. Resultados: Los hallazgos sugieren que la existencia de espacios públicos apropiados para ejercitarse y convivir con otros resulta atractiva para los participantes en el estudio, quienes señalan que la Ruta Recreativa estudiada ofrece el entorno adecuado para alcanzar sus metas de salud y relacionarse con personas con intereses similares. Conclusiones: Existe un interés de los visitantes a la Ruta Recreativa de Saltillo, Coahuila por alcanzar mejores niveles de salud y bienestar, lo cual puede ser aprovechado por empresas y organismos públicos para diseñar e implementar estrategias e intervenciones de mercadotecnia social orientadas a la promoción de la salud y el cambio de hábitos, utilizando los espacios abiertos que la Ruta Recreativa ofrece y llegar así a un mayor número de ciudadanos.

Abstract Objective: To analyze the influence of physical environment and social aspects of public spaces on the physical activation and well-being of citizens, in order to identify opportunities to design social marketing strategies that promote health and wellbeing among citizens. Materials and methods: A mixed study was carried out in two stages: observation and analysis of the physical attributes of the Saltillo Recreational Route, Coahuila based on the Servipanoramas model; Application of online surveys to 168 adults using the perceived well-being and assessment scales of the Ciclovias. Results: The findings suggest that the existence of appropriate public spaces to exercise and coexist with others is attractive to the participants in the study, who point out that the recreational route studied offers the right environment to reach their health goals and interact with people with similar interests. Conclusions: There is an interest of the visitors to the Recreational Route of Saltillo, Coahuila for achieving better levels of health and well-being, which can be used by companies and public bodies to design and implement strategies and interventions of social marketing oriented to the promotion of Health and change of habits, using the open spaces that the Recreational Route offers and reach a greater number of citizens.

Resumo Objetivo: Analisar a influência que tem o meio físico e os aspetos sociais dos espaços públicos na atividade física e no bem-estar dos cidadaos, com o fim de identificar oportunidades para desenhar estratégias de marketing social que fomentem a saúde e o bem-estar dos cidadaos. Materiais e métodos: Foi realizado um estudo misto em duas etapas: observação e análise dos atributos físicos da "Ruta Recreativa de Saltillo, Coahuila" tendo por base o modelo de Servipanoramas; aplicação de inquéritos a 168 adultos utilizando as escalas de bem-estar percebido e de valorização das ciclovias. Resultados: Foi sugerido que a existencia de espa9os públicos apropriados para fazer exercício e conviver com outras pessoas, resulta atractivo para os participantes no estudo. Estes assinalaram que a rota recreativa estudada oferece o ambiente adequado para alcaçar as suas metas de saúde e relacionar-se com pessoas com intereses similares. Conclusões: Existe un interesse dos visitantes pela "Ruta Recreativa de Saltillo, Coahuila", porque permite alcafar melhores níveis de saúde e de bem-estar. Este facto pode ser aproveitado por empresas e organismos públicos para desenhar e implementar estratégias de marketing social orientadas para a promoção da saúde e para a mudança de hábitos, utilizando os espaços ao ar libre que a rota oferece.

Résumé Objectif: Analyser l'influence de l'environnement physique et des aspects sociaux des espaces publics sur l'activation physique et le bien-etre des citoyens afin d'identifier les possibilités de concevoir des stratégies de marketing social pour promouvoir la santé et le bien-etre parmi les citoyens. Matériels et méthodes: Une étude mixte a été réalisée en deux étapes: observation et analyse des caractéristiques physiques de la Ruta Recreativa de Saltillo (Itinéraire Récréatif de Saltillo), dans l'état de Coahuila, d'apres le modele de Servipanoramas; et application d'enquetes en ligne a168 adultes en utilisant les échelles de bien-etre per9u et d'évaluation des pistes cyclables. Résultats: Les résultats suggerent que l'existence d'espaces publics appropriés pour réaliser des activités physiques et partager du temps avec d'autres personnes est attrayante pour les participants a l'étude. Ceux-ci indiquent que la Ruta Recreativa étudiée offre l'environnement approprié pour atteindre leurs objectifs de santé et interagir avec des personnes ayant des intérets similaires. Conclusions: Il existe un intéret des visiteurs de la Ruta Recreativa de Saltillo, Coahuila, pour améliorer leur santé et leur bien-etre. Les entreprises et les organismes publics peuvent en profiter pour concevoir et mettre en reuvre des stratégies et des interventions de marketing social visant a promouvoir la santé et le changement de comportement en utilisant les espaces ouverts qu'offrent la Ruta Recreativa pour qu'un plus grand nombre de citoyens en bénéficient.

[The eyelid-cheek junction]. / La jonction palpébro-jugale.

The eyelid-cheek junction is a key area which generates many comments: from looking tired to looking good or rested, without forgetting charm, beauty, and a youthful appearance. In spite of many interesting medical and surgical procedures, treating this area is sometimes difficult and results are not always up to our expectations. Standardized blepharoplasty, which has often been improperly used, has shown its limits. Since the latest refinements, lipostructure has revolutionised blepharoplasty and serving as a reference, it has become an established technique. Subperiostal mediofacial lift allows outstanding results at the cost of a certain technical aggressiveness. Aesthetic medicine proposes worthy alternative and/or appropriate complementary solutions. Different procedures we dispose of have been reviewed together with their assets and their limits. A codification of therapeutic indications is proposed. The positioning of the eyelid-cheek clinical junction in relation with the low orbital bone rim influences our strategy in choosing the appropriate technique.