The experience of healthcare professionals treating adolescents with eating disorders in psychiatric and pediatric inpatient units for adolescents: A qualitative study.

OBJECTIVES: The recommended treatment for Eating Disorders (EDs) is multidisciplinary and multimodal. Nonetheless, the complex linkage of the different disciplines involved is not necessarily simple. We analyzed the experience of healthcare professionals faced with psychiatric and psychological symptoms in adolescents with EDs in two "multidisciplinary" inpatient units embedded predominantly in different paradigms - one pediatric and one psychiatric. METHODS: Qualitative analysis of 20 healthcare staff members' interviews from different professional backgrounds working in inpatient units for EDs in Montreal (Canada) and Paris (France). RESULTS: The "Complex patients" theme discusses the need for a global approach to the multiplicity of symptoms presented by these patients. "Management and its limits" describes the daily management of psychiatric symptoms in both units. "Psychiatry and Adolescent medicine: from opposition to collaboration" describes the different levels at which these disciplines work together and how this cooperation may be evolving. CONCLUSIONS: The complex entanglement intrinsic in EDs of the patients' somatic, psychosocial, psychiatric, and adolescent problems requires collaboration between disciplines, but the modalities of this collaboration are multiple and evolve non-linearly in specialized treatment units. A multilevel approach must be offered, with the degree of collaboration (multidisciplinary, interdisciplinary and transdisciplinary) appropriate to the complexity of each adolescent's issues.

[Adjustment of healthcare and telemedicine in times of lockdown and COVID-19 pandemic: Feedback from a "Maison des Adolescents" (Teenager's House)]. / Adaptation des soins et télémédecine en période de confinement et de pandémie de COVID-19 : retour d'expérience d'une Maison des Adolescents.

BACKGROUND: The COVID-19 sanitary crisis has imposed a major reorganization of the health care system in France. Lockdown could be a factor in the emergence or deterioration of psychological disorders; it can be even more fragilizing during the specific period of adolescence. The « Maisons des Adolescents ¼ (Teenagers' Houses) had to urgently adjust their practices to provide continuity of care for adolescents suffering from physical or mental disorders. The « Maisons des Adolescents ¼ are pluridisciplinary care centres for adolescents and their families that provide assessments and services for medical, psychological, socio-educational, educational and legal needs. How did care continue for adolescents during lockdown? What adjustments occurred in the « Maisons des Adolescents ¼ during the health crisis? METHODS: This article presents the case of an adolescent who suffered a significant deterioration of her anorexia nervosa during confinement. Through this case, we describe the reorganization of care within the different units (consultations - day hospital - hospitalization unit) of a Parisian « Maison des Adolescents ¼ during the COVID-19 pandemic. FINDINGS: In this service, the rapid implementation of the telemedicine system in the context of the COVID-19 pandemic made possible provision of continuity in care for vulnerable adolescents and families. Based on the existing literature, we discuss the advantages and limitations of telemedicine and the practical issues for the future organization of care for adolescents. PERSPECTIVES: In contrast to pediatric medicine or child psychiatry, there is no protocol describing the application of telemedicine in adolescent medicine and psychiatry. There is an urgent need for further evaluation of the use of telemedicine for this population. This kind of research will improve knowledge about the effectiveness, acceptability and limitations of using a teleconsultation device in adolescent psychiatry in a crisis context. Certain remote care modalities implemented during the sanitary crisis could thus be maintained over time and become routine in the field of adolescent medicine and psychiatry.

[Comorbid major depressive disorder of anorexia nervosa in adolescence: A scoping review of treatment strategies]. / Scoping review des stratégies de prise en charge du trouble dépressif caractérisé comorbide d'une anorexie mentale à l'adolescence.

OBJECTIVES: Psychiatric comorbidities are frequent in anorexia nervosa, with the highest rate of suicidal lethality among psychiatric disorders. Major depressive disorder is one of the most life-threatening comorbidities of anorexia nervosa, exacerbating the risk of suicide, aphagia, and pervasive refusal syndrome. The aim of this study is to conduct a systematic review of studies exploring strategies for the treatment of severe depression in the acute phase of anorexia nervosa in adolescence. METHODS: We conducted a scoping review of the publications dealing with the treatment of depressive comorbidities in adolescents suffering from anorexia nervosa published between 2005 and 2019. An electronic search in Pubmed and Medline for relevant studies used the following keywords adolescent, youth, anorexia nervosa, depress*, suicide*, "melancholic depression", treat*, therapy*, care. Included studies were dealing with 10-18-year-old inpatient or outpatient adolescents presenting an anorexia nervosa complicated by a major depressive disorder. RESULTS: Of 562 studies identified, eight were included in the final sample. Regarding psychiatric treatments, four studies concerned the prescription of antidepressants, one case-study was described a treatment by electroconvulsive therapy and another was dealt with light therapy. Finally, the two last studies evaluated the effect of nutritional treatment on psychiatric symptoms but found no significant direct association between weight gain and improvement of depressive symptoms. DISCUSSION: There is a need to identify faster severe depressive disorders in adolescents with anorexia nervosa in order to provide, along with refeeding, a more intensive treatment of mood symptoms. A multidisciplinary and coordinated approach must be initiated at the beginning of the trouble. There is a need for more systematic studies on the therapeutic approaches of mood disorder comorbidities in adolescents suffering from anorexia nervosa.

Chemical cleaning/disinfection and ageing of organic UF membranes: a review.

Membrane separation processes have become a basic unit operation for process design and product development. These processes are used in a variety of separation and concentration steps, but in all cases, the membranes must be cleaned regularly to remove both organic and inorganic material deposited on the surface and/or into the membrane bulk. Cleaning/disinfection is a vital step in maintaining the permeability and selectivity of the membrane in order to get the plant to its original capacity, to minimize risks of bacteriological contamination, and to make acceptable products. For this purpose, a large number of chemical cleaning/disinfection agents are commercially available. In general, these cleaning/disinfection agents have to improve the membrane flux to a certain extent. However, they can also cause irreversible damages in membrane properties and performances over the long term. Until now, there is considerably less literature dedicated to membrane ageing than to cleaning/disinfection. The knowledge in cleaning/disinfection efficiency has recently been improved. But in order to develop optimized cleaning/disinfection protocols there still remains a challenge to better understand membrane ageing. In order to compensate for the lack of correlated cleaning/disinfection and ageing data from the literature, this paper investigates cleaning/disinfection efficiencies and ageing damages of organic ultrafiltration membranes. The final aim is to provide less detrimental cleaning/disinfection procedures and to propose some guidelines which should have been taken into consideration in term of membrane ageing studies. To carry out this study, this article will detail the background of cleaning/disinfection and aging membrane topics in a first introductive part. In a second part, key factors and endpoints of cleaning/disinfection and aging membranes will be discussed deeply: the membrane role and the cleaning parameters roles, such as water quality, storing conditions, cleaning/disinfection/aging agents/conditions/protocols. The third and last part will be developed the parameters, methods and ways of characterization at our disposal and commonly used to develop and implement membrane cleaning and/or ageing studies.

Retreatment of silicon slurry by membrane processes.

The purpose of the present study is to develop a process to regenerate the polish liquid used in Chemical and Mechanical Polishing (CMP), called "slurry", and more specifically Silicon CMP slurry. Physico-chemical analyses show a considerable dilution of slurry through washing waters used in polishing. Thus, this effluent has been characterised for a better identification of the deviations from the slurry of reference (Point Of Use). Hence, the principle is to regenerate this effluent by membrane processes. The ultrafiltration results obtained at laboratory scale have led to the development of an industrial prototype. An optimal utilisation of this treatment allows completing a two-step process: the reconcentration by ultrafiltration and a chemical adjustment by addition of concentrated slurry. A stable behaviour of the slurry at the different steps of the process has been observed. Polishing results are similar with retreated and POU slurries. Furthermore, the functioning at industrial scale permits to maintain the performances obtained on the laboratory pilot.