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.

Reciprocity to Increase Participation of Compatible Living Donor and Recipient Pairs in Kidney Paired Donation.

Inclusion of compatible living donor and recipient pairs (CPs) in kidney paired donation (KPD) programs could increase living donor transplantation. We introduce the concept of a reciprocity-based strategy in which the recipient of a CP who participates in KPD receives priority for a repeat deceased donor transplant in the event their primary living donor KPD transplant fails, and then we review the practical and ethical considerations of this strategy. The strategy limits prioritization to CPs already committed to living donation, minimizing the risk of unduly influencing donor behavior. The provision of a tangible benefit independent of the CP's actual KPD match avoids many of the practical and ethical challenges with strategies that rely on finding the CP recipient a better-matched kidney that might provide the CP recipient a future benefit to increase KPD participation. Specifically, the strategy avoids the potential to misrepresent the degree of future benefit of a better-matched kidney to the CP recipient and minimizes delays in transplantation related to finding a better-matched kidney. Preliminary estimates suggest the strategy has significant potential to increase the number of living donor transplants. Further evaluation of the acceptance of this strategy by CPs and by waitlisted patients is warranted.

Evaluation of a preemptive strategy for BK polyomavirus-associated nephropathy based on prospective monitoring of BK viremia: a kidney transplantation center experience.

INTRODUCTION: BK polyomavirus-associated nephropathy (BKPVAN) is a major cause of renal failure early after kidney transplantation. The present study reports the preliminary results of prospective monitoring including a preemptive strategy for BKPVAN during the first year after kidney transplantation. METHODS: We monitored BK virus DNA in blood at months 1, 2, 3, 6, 9, and 12 among 92 subjects who received induction therapy (basiliximab or antithymocyte globulin), and maintenance immunosuppression with prednisone, mycophenolate mofetil, and tacrolimus. Patients with two or more consecutive measurements of viral load >10(4) copies/mL were treated with a stepwise approach including dose reduction or discontinuation of mycophenolate mofetil eventually followed by reduction of tacrolimus and introduction of leflunomide. RESULTS: Within 1 year, seven (7%) patients displayed sustained BK viremia at a median of 92 days after transplantation. Among 68 patients who underwent a renal allograft biopsy, seven were diagnosed as BKPVAN at a median of 15 weeks after transplantation. The diagnosis was achieved by a surveillance biopsy in four patients with stable renal function. BKPVAN was preceded by asymptomatic viremia except for two cases in whom BK viremia occurred at 6 or 11 months, after the histological diagnosis. At 12 months, six patients had cleared their viremia. Serum creatinine levels had stabilized in six recipients with BKPVAN estimated renal function was 43.7 ± 16.3 mL/min in patients with viremia and/or BKPVAN versus 61.3 ± 20.1 mL/min among patients who never became viremic (P = .03). None of the patients with viremia and/or BKPVAN lost the allograft. CONCLUSION: BKPVAN may occur early after kidney transplantation, at a low or undetectable viremia or at some weeks after the first positive viremia. Intensive monitoring during the first 4 months after transplantation together with early protocol biopsies or interventions prompted by BK viremia may optimize BKPVAN diagnosis at a subclinical stage, thus avoiding renal dysfunction.

[Comparison of the urinary excretion of biomarkers of exposure to pyrethroids and pyrethrins between residents of urban and rural areas of the province of Quebec, Canada]. / Comparaison de l'excrétion urinaire de biomarqueurs d'exposition aux pyréthrinoïdes et aux pyréthrines chez les résidents de régions urbaine et rurale de la Province de Québec, Canada.

BACKGROUND: Residents of rural (agricultural) areas are often suspected of being exposed to higher levels of pesticides than residents of urban areas. However, only a limited number of studies have specifically evaluated the impact of the geographical area of residence on pyrethroid and pyrethrin exposure in the general population. This study aimed at comparing the levels of biomarkers of exposure between an urban and rural, adult and children, population of the Province of Quebec, Canada. METHODS: A total of 154 urban (Montreal) and 154 rural (Monteregie) participants provided a complete overnight timed-urine collection and filled a self-administered questionnaire. Urine samples were analyzed for pyrethroid and pyrethrin metabolites: cis- and trans-dichloro- and cis-dibromo- vinyldimethylcyclopropane carboxylic acids, phenoxy- and fluorophenoxy-benzoic acids and chrysanthemum dicarboxylic acid. Amounts of metabolites (pmol/12h par kilogram body weight) and their frequency of detection in the two populations were compared and interpreted with the help of the answers gathered by questionnaire. RESULTS: Adults and children from the rural area tended to excrete higher levels of the main urinary metabolites, the cis- and trans-dichlorovinyldimethylcyclopropane carboxylic acids and the phenoxybenzoic acid, than those living in the urban area. When the adults and children were combined, this difference was statistically significant for the phenoxybenzoic acid (p=0.020), marginally significant for the trans-dichlorovinyldimethylcyclopropane carboxylic acid (p=0.053) and nonsignificant for the cis-dichlorovinyldimethylcyclopropane carboxylic acid (p=0.158). The chrysanthemum dicarboxylic acid, the fluorophenoxybenzoic acid and the dibromovinyldimethylcyclopropane carboxylic acid were detected in much lower proportion but, in the case of the fluorophenoxybenzoic acid, the relative frequency of detection was statistically significantly higher (p<0.001) in the rural population. CONCLUSION: The presence of a baseline level of biomarkers in the urban and rural population confirms the ubiquity of pyrethroids and pyrethrins in the environment. However, in the rural adult and infantile population under study, other factors possibly contributed to slightly increase exposure compared to the urban population, namely the use of mosquito repellents and household insecticides as reported by questionnaire.

Reflexiones éticas sobre la medicina personalizada: ¿la alianza entre la ciencia y la medicina, realizada por fin / Réfl exions éthiques sur la médecine personnalisée: l’alliance de la science et de la médecine enfi n réalisée?

La medicina personalizada es la última corriente médica del momento y podría imponerse en la práctica médica a partir del 2010. La medicina personalizada se caracteriza por la utilización de datos derivados principalmente de la genómica, con el fin de escoger terapias hechas a la medida para cada paciente. Si bien las grandes corrientes de pensamiento representan, con frecuencia, una revolución con respecto al modo de pensamiento precedente, se insertan, sin embargo, en un continuum que busca establecer la unión entre ciencia y medicina. Los promotores de la medicina personalizada consideran que se logrará la alianza y, al mismo tiempo, garantizará el devenir de una medicina eficaz y segura. A pesar de las grandes promesas de la medicina personalizada y sus próximas aplicaciones en diferentes especialidades médicas como la cardiología y la oncología, es necesario superar numerosos retos y obstáculos para su aplicación real en clínica. También es importante evaluar de manera ética y crítica esta nueva forma de medicina que pretende ser a la vez más científica y más individualizada. De una parte, la refl exiónética obliga a afrontar los retos generalmente asociados a la genómica y a cuestionar realmente el aporte de nuevos datos científicos a la medicina. De otra parte, esta reflexión también obliga a evaluar la paradoja de la medicina personalizada que intenta fundamentarse sobre datos científi cos sólidos, ciertos y generalizables, con el fin de adaptarse a la situación única e incierta de un paciente.

On site bioremediation of hydrocarbon-contaminated Arctic tundra soils in inoculated biopiles.

There is a need to develop technology to allow the remediation of soil in polar regions that have been contaminated by hydrocarbon fuel spills. Bioremediation is potentially useful for this purpose, but has not been well demonstrated in polar regions. We investigated biopiles for on-site bioremediation of soil contaminated with Arctic diesel fuel in two independent small-scale field experiments at different sites on the Arctic tundra. The results were highly consistent with one another. In biopiles at both sites, extensive hydrocarbon removal occurred after one summer. After 1 year in treatments with optimal conditions, total petroleum hydrocarbons were reduced from 196 to below 10 mg per kg of soil at one site, and from 2,109 to 195 mg per kg of soil at the other site. Addition of ammonium chloride and sodium phosphate greatly stimulated hydrocarbon removal and indicates that biodegradation was the primary mechanism by which this was achieved. Inoculation with cold-adapted, mixed microbial cultures further stimulated hydrocarbon removal during the summer immediately following inoculation. At one site, soil temperature was monitored during the summer season, and a clear plastic cover increased biopile soil temperature, measured as degree-day accumulation, by 30-49%. Our results show that on-site bioremediation of fuel-contaminated soil at Arctic tundra sites is feasible.

Serum concentrations and clearances of folic acid and pyridoxal-5-phosphate during venovenous continuous renal replacement therapy.

OBJECTIVE: To determine to what extent hydrosoluble vitamins are removed by continuous renal replacement therapy (CRRT); to evaluate clearances, removal rates, and evolution of serum concentrations of folic acid and pyridoxal-5'-phosphate (P-5'-P), the active moiety of vitamin B6 during CRRT. DESIGN: A prospective, non-interventional, descriptive study on vitamin losses induced by CRRT. SETTING: Medical and surgical intensive care units in a tertiary university-affiliated hospital. PATIENTS: A total of ten critically ill patients in oligoanuric acute renal failure (five treated by continuous venovenous hemofiltration and five by continuous venovenous hemodiafiltration) with a mean effluent rate of 1801 +/- 468 ml/h. Nutritional support was not modified and additional vitamin supplements were not provided during study periods. MEASUREMENTS AND RESULTS: Concentrations of folic acid and P-5'-P were determined daily during CRRT. Samples for folic acid, P-5'-P, urea, and creatinine were taken simultaneously from the blood at the dialyzer inlet and from the effluent, at CRRT initiation, and daily thereafter over an average of 3.4 +/- 1.2 days. Samples were processed by immunochemiluminescence for folic acid and by radioenzymatic assay for P-5'-P determinations with normal ranges above 6.8 nmol/l and from 11.5 to 179.3 nmol/l, respectively. Marked decreases in serum folic acid and P-5'-P concentrations were noticed over time with mean daily reductions of 12.6 and 13.7%. Serum folic acid concentrations decreased from 42.7 to 16.0 nmol/l and serum P-5'-P decreased from 14.4 to 5.0 nmol/l in the blood coming in to the dialyzer over the study period. Clearances and removal rates were determined from the effluent side. During CRRT, mean (+/- SEM) folic acid and P-5'-P clearances were 20.5 +/- 6.3 ml/min (n = 34) and 13.2 +/- 10.6 ml/min (n = 22), whereas mean urea clearance was 27.1 +/- 5.1 ml/min (n = 26). Folic acid and P-5'-P removal rates were 27.0 +/- 34.2 and 3.4 +/- 2.0 nmol/h, corresponding to mean daily losses of nearly 650 and 80 nmol/day respectively. CONCLUSION: Significant losses of folic acid and P-5'-P (and most likely of other hydrosoluble vitamins) occur during CRRT. Considering that stores of most hydrosoluble vitamins are relatively low in critically ill patients, supplementation should be provided to patients treated similarly.

Characterization of thermotropism in primary roots of maize: Dependence on temperature and temperature gradient, and interaction with gravitropism.

Thermotropism in primary roots of Zea mays L. was studied with respect to gradient strength (°C · cm(--1)), temperature of exposure within a gradient, pre-treatment temperature, and gravitropic stimulation. The magnitude of the response decreased with gradient strength. Maximum thermotropism was independent of gradient strength and pre-treatment temperature. The range of temperature for positive and negative thermotropism did not change with pre-treatment temperature. However, the exact range of temperatures for positive and negative thermotropism varied with gradient strengths. In general, temperatures of exposure lower than 25° C resulted in positive tropic responses while temperatures of exposure of 39° C or more resulted in negative tropic responses. Thermotropism was shown to modify and reverse the normal gravitropic curvature of a horizontal root when thermal gradients were applied opposite the 1 · g vector. It is concluded that root thermotropism is a consequence of thermal sensing and that the curvature of the primary root results from the interaction of the thermal and gravitational sensing systems.

The pattern of secondary root formation in curving roots of Arabidopsis thaliana (L.) Heynh.

A gravitational stimulus was used to induce the curvature of the main root of Arabidopsis thaliana. The number of secondary roots increased on the convex side and decreased on the concave side of any curved main root axes in comparison with straight roots used as the control. The same phenomenon was observed with the curved main roots of plants grown on a clinostat and of mutant plants exhibiting random root orientation. The data suggest that the pattern of lateral root formation is associated with curvature but is independent of the environmental stimuli used to induce curvature.