Estimation and mapping of uranium content of geological units in France.

In France, natural radiation accounts for most of the population exposure to ionizing radiation. The Institute for Radiological Protection and Nuclear Safety (IRSN) carries out studies to evaluate the variability of natural radioactivity over the French territory. In this framework, the present study consisted in the evaluation of uranium concentrations in bedrocks. The objective was to provide estimate of uranium content of each geological unit defined in the geological map of France (1:1,000,000). The methodology was based on the interpretation of existing geochemical data (results of whole rock sample analysis) and the knowledge of petrology and lithology of the geological units, which allowed obtaining a first estimate of the uranium content of rocks. Then, this first estimate was improved thanks to some additional information. For example, some particular or regional sedimentary rocks which could present uranium contents higher than those generally observed for these lithologies, were identified. Moreover, databases on mining provided information on the location of uranium and coal/lignite mines and thus indicated the location of particular uranium-rich rocks. The geological units, defined from their boundaries extracted from the geological map of France (1:1,000,000), were finally classified into 5 categories based on their mean uranium content. The map obtained provided useful data for establishing the geogenic radon map of France, but also for mapping countrywide exposure to terrestrial radiation and for the evaluation of background levels of natural radioactivity used for impact assessment of anthropogenic activities.

Present-day uplift of the western Alps.

Collisional mountain belts grow as a consequence of continental plate convergence and eventually disappear under the combined effects of gravitational collapse and erosion. Using a decade of GPS data, we show that the western Alps are currently characterized by zero horizontal velocity boundary conditions, offering the opportunity to investigate orogen evolution at the time of cessation of plate convergence. We find no significant horizontal motion within the belt, but GPS and levelling measurements independently show a regional pattern of uplift reaching ~2.5 mm/yr in the northwestern Alps. Unless a low viscosity crustal root under the northwestern Alps locally enhances the vertical response to surface unloading, the summed effects of isostatic responses to erosion and glaciation explain at most 60% of the observed uplift rates. Rock-uplift rates corrected from transient glacial isostatic adjustment contributions likely exceed erosion rates in the northwestern Alps. In the absence of active convergence, the observed surface uplift must result from deep-seated processes.

A survey to assess transfusion medicine education needs for clinicians.

OBJECTIVE: To evaluate the baseline knowledge of attending clinicians, residents and medical students in transfusion medicine (TM) at our institution in order to develop specialty-specific lectures. BACKGROUND: Physicians often receive minimal training in TM. Transfusion practices vary widely among individual physicians and across institutions. This variation leads to increased and unnecessary risk to patients and elevated costs for hospitals--problems that may be addressed through TM education. METHODS: An electronic self-administered survey was developed and administered to attending physicians, house staff and third and fourth year medical students at four hospitals. The survey consisted of 3 sections including background demographics, 14 knowledge assessment (KA) questions and opinions on educational needs. RESULTS: Two hundred and twenty-five surveys were received from physicians and medical students, of which 189 were completed and analysed. The overall mean score on the KA section was 31 · 4 ± 18 · 3% (4 · 4 ± 2 · 6 of 14 questions) correct. Significantly stronger performance was noted in the following categories: participants in the specialties pathology or hematology (adult and pediatric), all fellows and participants who report greater than 5 h of formal TM education in the past 5 years. The majority of participants believed that additional training in TM was needed for themselves as well as other physicians at all training levels. CONCLUSIONS: Additional training in TM would be beneficial to and welcomed by physicians in all training levels in all specialties. Innovative specialty-specific educational programmes need to be developed and tested to ensure efficacy and durability.

Blood transfusion in trauma patients: unresolved questions.

Massive transfusion is an essential part of resuscitation efforts in acute trauma patients. The goal is to quickly correct trauma-induced coagulopathy and replace red blood cell (RBC) mass with the minimal number as well as the appropriate choice of blood components to minimize the possible adverse effects of transfusions. Early trauma induced coagulopathy (ETIC) is present in about 20% of patients upon hospital admission and predicts for decreased survival. The mechanism of ETIC is still being elucidated; however, most theories of ETIC's pathophysiology justify the early use of plasma. Most massive transfusion protocol (MTP) ratios deliver blood products in a ratio of 1:1:1 for RBCs:plasma:platelets, which is supported by the majority of the literature demonstrating improved patient survival with higher ratios (>1 plasma and platelet for every 2 RBCs transfused). Indeed, formula-driven MTPs allow trauma services to react quickly to ETIC and provide coagulation factors and platelets in these ratios without having to wait for the results of coagulation assays while the patient's coagulopathy worsens. New MTPs are being created which are adjusted according to an individual's coagulation laboratory values based on point-of-care laboratory tests, such as thromboelastography. When creating an MTP, product wastage due to inappropriate activation and improper product storage should be considered and closely monitored. Another area of discussion regarding transfusion in trauma includes the potential association of prolonged storage of RBCs and adverse outcomes, which has yet to be confirmed. Significant progress has been made in the transfusion management of trauma patients, but further studies are required to optimize patient care and outcomes.

Mapping of the geogenic radon potential in France to improve radon risk management: methodology and first application to region Bourgogne.

In order to improve regulatory tools for radon risk management in France, a harmonised methodology to derive a single map of the geogenic radon potential has been developed. This approach consists of determining the capacity of the geological units to produce radon and to facilitate its transfer to the atmosphere, based on the interpretation of existing geological data. This approach is firstly based on a classification of the geological units according to their uranium (U) content, to create a radon source potential map. This initial map is then improved by taking into account the main additional parameters, such as fault lines, which control the preferential pathways of radon through the ground and which can increase the radon levels in soils. The implementation of this methodology to the whole French territory is currently in progress. We present here the results obtained in one region (Bourgogne, Massif Central) which displays significant variations of the geogenic radon potential. The map obtained leads to a more precise zoning than the scale of the existing map of radon priority areas currently based solely on administrative boundaries.

The significance of a positive DAT in thalassemia patients.

The DAT is performed for the detection of antibody or complement on the surface of RBCs. Our institution previously performed DATs on all chronically transfused thalassemia patients before each transfusion episode to detect early alloimmunization. The medical records of all thalassemia patients treated at our institution from 2004 to 2007 were reviewed to determine the significance of the high rate of positive DATs (52.5% of 80 patients). The majority of IgG-reactive DATs were associated with a nonreactive eluate (65.4% of 286 eluates performed). A positive DAT was significantly associated with splenectomy (χ² = 15.4; p < 0.001), elevated IgG levels (χ² = 26.8; p < 0.001), HCV (χ² = 20.7; p < 0.001), and warm autoantibody (χ² = 5.87; p = 0.03). Multivariate analysis revealed that only HCV (OR, 5.0; p = 0.037) and elevated IgG levels (OR, 9.0; p = 0.001) were independently associated with a positive DAT. Alloimmunized thalassemic patients were more likely to have a positive DAT than nonalloimmunized patients, but this association was not significant (OR, 2.2; p = 0.11). A positive DAT did not correlate with decreased response to transfusion, RBC survival, hemolysis, or increased transfusion requirements. Only two cases of early alloimmunization were detected by DAT among 288 DAT-positive samples studied during 4 years. This study demonstrated that the routine performance of DATs on pretransfusion specimens in thalassemic patients has limited clinical utility, and the elimination of this test will improve turnaround time and decrease costs.

Heterotopic ossification after lateral epicondylectomy.

Lateral epicondylitis is a common affliction that can be treated nonsurgically. However, surgical treatment is rarely indicated, and results are usually effective in more than 90% of patients. Although complications have been described, ours is the first report of heterotopic ossification after an uncomplicated lateral epicondylectomy.

Leishmania major-infected murine langerhans cell-like dendritic cells from susceptible mice release IL-12 after infection and vaccinate against experimental cutaneous Leishmaniasis.

Leishmania major-infected C57BL / 6 skin-dendritic cells (DC) are activated and release cytokines (including IL-12 p70), and likely initiate protective Th1 immunity in vivo (von Stebut, E. et al., J. Exp. Med. 188: 1547 - 1552). To characterize differences in DC function in mice that are genetically susceptible (BALB / c) and resistant (C57BL / 6) to cutaneous leishmaniasis, we analyzed the effects of L. major on Langerhans cell-like, fetal skin-derived DC (FSDDC) from both strains. BALB / c- and C57BL / 6-FSDDC ingested similar numbers of amastigotes, but did not ingest metacyclic promastigotes. Like C57BL / 6-FSDDC, infection of BALB / c-FSDDC led to up-regulation of MHC class I and II antigens, CD40, CD54, and CD86 within 18 h. L. major-induced BALB / c DC activation also led to the release of TNF-alpha, IL-6 and IL-12 p40 into 18-h supernatants. Infected BALB / c- and C57BL / 6-DC both released small amounts of IL-12 p70 within 72 h. Additional stimulation with IFN-gamma and / or anti-CD40 induced the release of more IL-12 p70 from infected BALB / c-DC than C57BL / 6-DC. Co-culture of control or infected BALB / c- and C57BL / 6-DC with naive syngeneic CD4(+) T cells and soluble anti-CD3 resulted in mixed, IFN-gamma-predominant responses after restimulation with immobilized anti-CD3. Finally, syngeneic L. major-infected DC effectively vaccinated BALB / c mice against cutaneous leishmaniasis. Genetic susceptibility to L. major that results from induction of Th2 predominant immune responses after infection does not appear to reflect failure of skin DC to internalize or respond to parasites, or the inability of BALB / c T cells to mount a Th1 response to DC-associated Leishmania antigens.

Musculoskeletal abnormalities in velocardiofacial syndrome.

This is the first case report detailing the musculoskeletal pathology and treatment ramifications associated with velocardiofacial syndrome. Orthopaedic manifestations include scoliosis, clubfoot, Sprengel's deformity, generalized ligamentous laxity that is especially problematic about the knee, and epiphyseal dysplasia that is most notable in the lateral humeral condyle, lateral femoral condyle, and femoral head.

Patellar ligament reconstruction using allograft patellar ligament: a case report.

This report describes a method of patellar ligament reconstruction. Our patient sustained a rupture of the patellar ligament and had reconstruction with allograft patellar ligament after failed primary repair. At the 2-year follow-up, his range of motion was 0 degrees to 110 degrees and he was able to return to unrestricted standing work.

Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia.

OBJECTIVES: Pathologists differ in their definition of "dysplasia." This study was done to test the hypothesis that experienced oral pathologists are consistent in diagnosing epithelial dysplasia. STUDY DESIGN: Six board-certified oral pathologists examined 120 oral biopsies exhibiting simple hyperkeratosis to severe dysplasia. No clinical information was given, and presence of dysplasia was judged by histomorphology. Examiners' diagnoses were compared with sign-out diagnoses for each case. Months later, each examiner viewed 60 relabeled slides from the original 120. Each diagnosis was compared with the diagnosis in the first round. RESULTS: Exact agreement with the sign-out diagnosis averaged 50.5% (within one histologic grade 90.4%). Examiners agreed exactly with their own diagnoses 50.8% of the time (within one histologic grade 92.4%). Agreement distinguishing dysplasia from no dysplasia compared with original sign-out diagnosis was 81.5%. Agreement with themselves distinguishing dysplasia from no dysplasia was 80.3%. CONCLUSIONS: Accurate reproducible agreement among experienced board-certified oral pathologists diagnosing oral epithelial dysplasia is difficult to achieve.

The data entry conundrum.

Many physicians are not enthusiastic about improving their methods of data entry, but pressure is mounting for us to communicate better with patients, colleagues, and outside parties. We will be unable to handle clinical data management until we have solved the problem of who enters data and how.

Cables.

If you want to control your own computer installation, get the satisfaction of doing your own maintenance, and compensate for an inept or uninformed vendor, the information in this article will help you achieve these ends. Good luck and good cabling!

Atlas of macroseismic maps for French earthquakes with their principal characteristics

The SIRENE macroseismic database has been utilized to draw isoseismal maps for the 140 best-documented French earthquakes, characterized by epicentral intensities of at least V(MSK) and located in all parts of the country. A study of focal depths derived from available local intensity data using an intensity versus distance decay law (Sponheuer) shows that the focal depths of most of the events considered do not exceed about 10 km. Thier distribution correlates fairly well with regional dynamic geology features. A relationship is then computed between magnitude, intensity and focal distance, based on 73 instrumentally recorded earthquakes (Ml between 3.3 and 6.3) and on 217 mean radius values (from 2 to 380 km) for isoseismals of intensity VIII to III (MSK). This relationship is applied to historical earthquakes contained in the database SIRENE which are characterised by their intensity only. These results are used in the evaluation as well deterministic as probabilistic of the seismic hazard on the national territory.(AU)

Tying pay to performance: one critical care unit's approach.

This article describes development and testing of a tool for determining an appropriate reward for staff performance in a critical care area. Outlined is the process of identifying and quantifying appropriate merit increases based on bedside performance as well as participation in other unit, hospital, professional and community activities. Positive results are reported after one- and two-year use.