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Blended collaborative care (BCC) can improve quality of life and well-being in patients with chronic heart failure (CHF).However, few of the studies have explicitly explored patients‘ and carers‘ health and treatment preferences before implementing BCC. To the best of our knowledge, this is the first multinational qualitative study on patients’ and carers’ needs regarding a BCC intervention. Across countries, results revealed three contrasting profiles which will serve as a basis for the development of a BCC intervention within the EU-wide study ESCAPE.

The Generalized Aerosol Retrieval from Radiometer and Lidar Combined data algorithm (GARRLiC) and the LIdar-Radiometer Inversion Code (LIRIC) provide the opportunity to study the aerosol vertical distribution by combining ground-based lidar and sun-photometric measurements. Here, we utilize the capabilities of both algorithms for the characterization of Saharan dust and marine particles, along with their mixtures, in the south-eastern Mediterranean during the CHARacterization of Aerosol mixtures of Dust and Marine origin Experiment (CHARADMExp). Three case studies are presented, focusing on dust-dominated, marinedominated and dust-marine mixing conditions. GARRLiC and LIRIC achieve a satisfactory characterization for the dust-dominated case in terms of particle microphysical properties and concentration profiles. The marine-dominated and the mixture cases are more challenging for both algorithms, although GARRLiC manages to provide more detailed microphysical retrievals compared to AERONET, while LIRIC effectively discriminates dust and marine particles in its concentration profile retrievals. The results are also compared with modelled dust and marine concentration profiles and surface in situ measurements. © Author(s) 2017.

This paper presents the control and operation of reel-to-reel tape drives without any tension transducer. First, the tape drive model is validated while operating in the read/write or the velocity mode. Utilizing the coupled nature of the velocity-tension loop and the fact that the system is completely observable, the tension errors are estimated based on the validated model using state estimation techniques. The tension error estimates do not correlate well with the actual tension errors primarily due to the periodic disturbances caused by reel eccentricities during steady running and are not used for feedback purposes. In this paper, the controller design for such transports for the velocity and the position loops are presented. Due to lack of forced air in the tape path in such drives, there is considerable stiction/friction during start-up when the position loop is used. Feed forward currents which are functions of desired tension at the head and tape velocity are used for proper friction compensation. For systems using two tachometers, one for each reel, a linear velocity difference technique is presented which shuts down the drive in case of excessive or low tape tension and thus preserves tape integrity. Finally, test results are presented to illustrate the effectiveness of the design techniques.

The primary purpose of the head servo in the track following tape drives is to track follow as accurately as possible during read/write operations in spite of disturbances such as tape edge movements or tape transients, internal and external vibrations transmitted to the head actuator and signal noise and dropouts. The track following and fine positioning is done using a position error signal (PES). Feedback controller design using proportional-integral-derivative (PID), lead-lag or estimator/controller techniques are used for maintaining accurate track following. This paper assumes that in addition to the PES signal, a head position signal is available for long seek, short seek, and track identification tasks, etc. In this paper, the development of a disturbance observer that supplements the nominal head servo controller in minimizing the effects of the tape transients is presented. The PES and the head position error signals are blended to provide a measure of the tape transient disturbance. This paper presents the theory of the disturbance observer and analyses to show the range of frequencies over which the disturbance observer will be effective. Finally, simulation results are presented for tape transients of various frequencies.

Rare-earth (RE) palladium surface compounds have been studied by LEED and angle-resolved photoemission (ARPE). The compounds were prepared by deposition of pure RE metals (Dy, Ce) on Pd(111) and subsequent annealing. The films reveal a sharp (2 × 2) overstructure in the LEED patterns that point to a surface geometry equivalent to REPd 3 (111). The ARPE data are in good agreement with LCAO band-structure calculations for this compound. Particularly, an experimentally observed shift of the Pd 4d-derived bands to higher binding energies in going from the Dy- to the Ce-based compound is convincingly reflected in the calculations and attributed to the influence of a non-integer occupancy of the Ce 4f states.

This report documents the results of an in-depth evaluation of energy consumption and thermal comfort for two potential net zero-energy homes (NZEHs) in Massachusetts, as well as an indoor air quality (IAQ) evaluation performed in conjunction with Lawrence Berkeley National Laboratory (LBNL).

To compare maternity ward professionals' and patients' views regarding the length of stay in the maternity after a normal delivery and to explore working relationships with ambulatory health professionals.Three surveysGeneral professional agreement on a minimum of 4 days; few contacts with ambulatory health professionals. One third of the women found their length of stay excessive. Most did not appear to gain new skills after 3 days, nor to encounter major difficulties once they returned to their home.and conclusion. It will be essential to organize effective working relationships between the maternity ward and ambulatory health professionals to ensure appropriate follow-up after an earlier discharge from the hospital, in agreement with the capabilities and expectations of a majority of women.

AN UNUSUAL INFECTION: Actinomycosis, uncommon in a pelvic localization, is a severe condition not well known to gynecologists. It is caused by Actinomyces israeli and is closely associated with long-term use of an intrauterine device. In the pelvic localization, the disease generally presents as a pseudoneoplastic formation. DIFFICULT DIAGNOSIS: Diagnosis is generally not established clinically. Pathology provides positive diagnosis. The germ cannot be isolated easily as it does not survive standard bacteriology sampling. Monoclonal antibodies may be helpful.Intravenous penicillin G followed by at least 6 months oral penicillin is generally successful in eradicating the infection. Indications for surgery should be limited to diagnostic procedures (pathology specimen), drainage in case of abscess formation, and removal of an obstacle compressing the digestive or urinary tract.

Actinomycosis is uncommonly observed in a pelvic localization. The presence of an intrauterine device is an important risk factor.A 50-year-old woman presented a tumoral mass in the pelvis with secondary liver involvement. Pathology examination corrected the initial diagnosis of advanced stage pelvic neoplasia to actinomycosis. Rapid improvement was achieved with penicillin.Differential diagnosis is difficult but essential in case of pelvic actinomycosis as misdiagnosis can have disastrous surgical consequences. Medical treatment is indicated. Actinomycosis should be entertained as a possible diagnosis in all cases associating a pelvic tumor and inflammation in women wearing an intrauterine device.

Evaluation (usefulness and safety) of programmed autologous transfusion in obstetrics. SITE. Blood Transfusion Centre, Hôpital Louis-Mourier, F 92700 Colombes.Prospective study of 150 patients for whom blood withdrawal was planned during the last month of pregnancy. Entry criteria were either a risk of haemorrhage or persistent patient request.Two withdrawals were planned during the last month of pregnancy at the out-patient clinic at a one-week interval. The autologous units were transfused per-partum in case of haemorrhage and/or post-partum in case of anaemia.One hundred pregnant women entered the protocol (43 had a risk of haemorrhage). Both preplanned withdrawals were made in 60 of these patients. Per-partum transfusions were necessary in only 7 patients including 4/43 with a risk factor (9%) and 3/57 with no risk factor (5%). Post-partum transfusions were made in 22 other patients. Consequently, 117 of the 160 units collected were not used (73%).Despite good tolerance (5% incidence) due to the known problems in evaluating the risk of haemorrhage and the small percentage of patients without risk factors who were transfused per-partum, we have decided to reserve this protocol for patients with an authentically identified risk of haemorrhage (placenta praevia, cesarean section, uterine scar tissue).

To determine the relationship between bacterial colonization of the amniotic fluid sampled by amniocentesis and premature rupture of the membranes.A prospective multicentric study conducted over a one year period in 6 maternity wards in the suburban area of Paris. Thirty-six women with premature rupture of the membranes were studied.There were 11 patients (30%) with contaminated fluid at the first amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocentesis. Twenty-five patients had sterile fluid. In 7 patients with prolonged rupture for more than one week, repeated amniocenteses were used to follow bacterial colonization. In one patient, Proteus mirabilis in the amniotic fluid was eradicated by adapted antibiotic therapy. In patients with sterile amniotic fluid, there was no secondary colonization. In the 11 cases with colonized liquid, the vaginal swab could only be considered as positive in 4 cases. Amniocentesis was able to discover 7 bacterial colonizations of the amniotic fluid in patients with an indeterminant vaginal swab. Likewise, C-reactive protein levels were raised only in 26% of the cases with a colonized amniotic fluid.

Several authors have found that caesarean section might be a risk factor for post-partum depression, while others consider that mood disturbances are not a specific response to delivery and can be observed in women undergoing hysterectomy. This longitudinal prospective study was carried out in 156 in-patient women at the Maternity department of Louis Mourier hospital, near Paris. These women were divided into three groups: 52 with normal delivery, 63 with caesarean section and 41 with gynecological surgery. Seventeen per cent of the women who had delivered suffered from baby-blues. The figure for anxiety (De Bonis scaleor = 20) was 23% in the 1st group, 41% in the 2nd group and 54% in the 3rd group. The figure for mood disturbances (according to DSM III criteria) was 4% in the 1st group, 16% in the 2nd group and 21% in the 3rd group. There was no significant difference between the 3 groups in figures for anxiety and depression during the first 3 months after delivery or surgery, but anxiety and depression ratings seem to fall faster and more steadily in women who had surgery.

Group B streptococcus (GBS) is an important cause of neonatal infection. Early-onset diseases are due to perinatal contamination. The epidemiology of late-onset infections is poorly known. Maternal colonization may be responsible for some of them. The relationships between neonatal colonization and late disease could be a colonization of the gut. The purpose of this 3 year-prospective study was to analyse the kinetics of gut colonization in neonates and the influence of antibiotherapy. One hundred and nineteen infants less than one month of age were included because of the presence of GBS in their gastric aspirates or GBS infection. Depending on the therapeutic strategy, the infants were separated into 3 groups: 1) amoxicillin plus aminoside greater than or equal to 10 days because of neonatal infection (28 infants), 2) same combination less than or equal to 5 days because a GBS infection was suspected but not confirmed (17 infants), 3) no antibiotics (77 infants). Fecal flora was regularly analysed by differential count. Antibiotics caused rapid disappearance of GBS from the gut. However, the same strain reappeared after stopping the antibiotics at a rate of 13.5%. Without antibiotics, GBS was implanted in 33% of cases. This difference of implantation rate is statistically significant (p less than 0.05). No GBS infection was observed in any infant after a follow-up examination of 6 months to 2 years. Among the clinical and bacteriological factors studied, adhesion only was correlated with the GBS implantation. These results allow to discuss therapeutic abstention in colonized infants without any signs of infection.

Cervico-isthmial incompetence develops in the second trimester of pregnancy. There are problems as to the correct treatment. The authors report four cases where stitches were put in late using the technique of "parachute" cerclage. This made it possible for four live babies to be born. A search of the literature shows that after late cerclage in 60-90% of cases pregnancy continues normally. But it has to be realised that complications do occur and these are mainly chorio-amnionitis which carries a bad prognosis obstetrically and also premature rupture of the membranes. The authors recommend this manoeuvre in spite of the risks because of the benefits that can be obtained. The procedure should only be carried out if there is no cervico-vaginal infection as determined by negative swabs and tocolytic treatment should also be given.

The condition of "megacystis-microcolon" is a very rare condition which can now be diagnosed ante-natally due to ultrasound. The presence of a megacystis (large bladder) with increased levels of amniotic fluid makes it possible to eliminate other ante-natal causes of dilatation of the bladder and in particular when it is found in a female fetus (as it is in 80% of cases). At birth, one finds, apart from the massive dilatation of the bladder with very little effect on the upper urinary tract, a microcolon with complete absence of peristalsis. This last abnormality always leads to a catastrophic short term result because treatment is quite ineffective. Many histological studies have been carried out and these sometimes differ from one another but it is possible to think that the condition is due to pathology of neurogenic origin in the muscle of the bladder and the aetiology of this is unknown. Finally, because there have been a few familial cases, there may be a genetic element in this illness that has such a poor prognosis.

Les auteurs rappellent les caracteristiques principales des reacteurs a haute temperature puis decrivent l'etat actuel de la technologie de la filiere en Republique Federale d'Allemagne. Ils evoquent, dans ce cadre, l'experience du reacteur AVR, la realisation du reacteur THTR de Schmehausen ainsi que les projets HHT et PNP.

The evolution of the mean spinability value of human cervical mucus was studied by means of an automatic device throughout the menstrual cycle and pregnancy and during and after the onset of menopause. The automatic measurement brings to light the major drawbacks presented by manual methods: values previously obtained should be considered as underestimated. The mean spinability value recorded from cyclic mucus exhibits a very significant increase at mid-cycle. Graphical analysis demonstrates that only small differences in the mean spinability value occur as pregnancy proceeds. A progressive and regular decrease in the mean spinability value can be recorded from the very beginning of the menopause. However, the spinability values observed in premenopausal mucus are noticeably higher than those recorded after the onset of the menopause. The numeric data furnished by the automatic measurement are discussed in terms of statistics.

Revue succincte des travaux en Allemagne Federale de developpement du reacteur a lit de boulets pour la fourniture de chaleur a des temperatures allant jusqu'a 900-1000°C. Developpement de la technologie d'utilisation de l'helium chaud produit par ce type de reacteur pour la gazeification a la vapeur du charbon, l'hydrogazeification du lignite et le reformage a la vapeur du methane

Medicated IUDs such as copper IUDs and progesterone-releasing IUDs represent a new development in this form of contraception. All IUDs act by causing an inflammatory reaction at the endometrial level. Techniques of insertion vary from one model to the other; insertion always requires an experienced practitioner, and postabortion or midmenstruation insertions are to be preferred. Pregnancy with IUD in situ is a rare occurrence; the IUD must then be immediately removed. Ectopic pregnancies are about 5-10% of all pregnancies with the device in situ. IUD complications are uterine perforation, mostly done at time of insertion, and pelvic infection which, if untreated, can cause infertility; this is the reason why an IUD is never recommended to a nullipara. Pain and bleeding are the most common side effects. When the strings of the device are not visible, translocation of the device inside the uterine cavity must be suspected. The choice of the wrong type of IUD or a bad insertion can cause spontaneous expulsion of the device. IUD wearers must be regularly seen by a doctor; there is no correlation between IUD use and cervical or endometrial carcinoma.

The authors noted, while carrying out ultrasound examinations, that there was many cases of abruption of oocytes at the beginning of pregnancy. This study was of 42 cases in 3 maternity units of Paris and its suburbs. It shows up how often, in pregnancies complicated bleeding in the first trimester, ultrasound can demonstrate such abruption. Ultrasound pictures can demonstrate the principal characteristics and the outcome of these abruptions, as well as their effect on the continuation of the pregnancy. In this way it establishes a correlation between the anatomy and the pathology and brings to the fore various hypothesis as to the aetiology of these pathological conditions.

The relationship between gynaecological and obstetrical parameters and psychological troubles in pregnancy and after delivery are a matter of much debate. This arises partly because of different methods of studying the conditions and because of epidemiological studies that have been carried out on this subject. This longitudinal prospective study has been carried out on 211 women who were delivered in the maternity department of Louis Mourier Hospital. The figure for anxiety (in the de Bonis scale of greater than or equal to 20) was 13 to 15% at different times in the pregnancy, of depression (in the CESd scale greater than or equal to 16) was between 11 and 14.5%. 34.5% of those women who had delivered suffered from "baby blues", while 20% had symptoms of depression (CESd greater than or equal to 16 in the first week post-partum) and 6% had a quite obvious syndrome of depression (MADRS greater than or equal to 20). Finally, 18 to 24.5% of women had a major episode of depression (according to the DSM III test) in the year following delivery. As far as risk factors were concerned there was a statistically significant correlation between anxiety and depression in pregnancy and induction of labour, as well as difficulties with the third stage of labour and with an Apgar score of less than 9 in the infant. There was poor correlation between "baby blues" and gynaecological and pathological changes except where vaginal delivery was not spontaneous and where large episiotomies were carried out. On the other hand, women who had pathological labours or cesareans or a general anaesthetic for the third stage had more troubles than others in the year following delivery. Finally, women who showed signs of anxiety or depression in pregnancy or had "baby blues" after delivery were less likely to be able to breast feed their children.

Ultrasounds are the best means at present available for observing the placenta. It follows that it is necessary to appreciate the different phases that occur in placental development. Ultrasound will allow us to work out this evolution and to look for abnormalities that may develop. The placenta becomes an entity at about the 12th week of amenorrhoea. Precise localisation of the placenta is possible in the second trimester of pregnancy, but the final site of the placenta is not fixed in the uterus because different segments develop unevenly. All the same, it is necessary to make a prognosis of the risks of an abnormal insertion of the placenta at the end of pregnancy. It is therefore necessary to be precise in localising the placenta. There are several sources of error which have to be avoided: -- difficulty of exact localisation of the internal os of the cervix. -- the existence of thickening of the myometrium, which forms a reserve for uterine stretch.. These thickenings sometimes come at the same places as the placenta and it may be difficult to differentiate one from the other. -- the presence of placental folds. There are several different elements involving prognosis : -- the site of the lower edge of the placenta in relationship to the internal os. -- the site of the upper edge of the placenta in relationship to the fundus of the uterus. This, statistically, is the best index of prognosis, and so we suggest a classification. -- finally the volume of the myometrium between the lower edge of the placenta and the internal os gives an idea and allows us to work out how the lower segment can stretch. Finally, it is by combining all these elements in a study that a better prognosis can be worked out for the final site of the placenta in the uterus. It is only in the third trimester of pregnancy after the lower segment has formed that the final site of the placenta can be confirmed and that a decision can be taken on the way patient should be treated.

The theory behind our work is the following: toxaemia may be due to the accidental passage of fetal proteins into the maternal organism. Particularly suspect are alpha-fetoproteins from the fetal blood or the amniotic fluid. The experiments were carried out on rats by injecting amniotic fluid or fetal serum into the rats by different routes and rhythms and in different doses. Arterial blood pressure readings showed that the levels were consistently higher than those of controls. The study of the kidneys anatomo-pathologically shows the following triad: intense congestion, tubular lesions, connective tissues affected. These lesions are reversible. The discussion concentrates on the similarities and differences between these findings and pathological changes found in kidneys in pregnancy.

The study of a personal series of five pregnancies and the review of 130 cases published enabled us to recall the physiological, clinical and therapeutic sides of the "pregnancy-heart valve prothesis" combination. Maternal mortality remains at 3%; morbidity, essentially in the form of haemorragic or thrombo-embolic accidents, comes to 45%. We insist on the importance of a pregnancy planned and accepted both by the cardiologist and the obstetrician as contraception is a difficult problem with these patients, classical oestroprogestative methods and intra-uterine devices being too much of a risk. An intake of a progestagen in small doses combines efficiency with innocuity.

The evolution of the mean spinability value of human cervical mucus was studied by means of an automatic device throughout the menstrual cycle and pregnancy and during and after the onset of menopause. The automatic measurement brings to light the major drawbacks presented by manual methods: values previously obtained should be considered as underestimated. The mean spinability value recorded from cyclic mucus exhibits a very significant increase at mid-cycle. Graphical analysis demonstrates that only small differences in the mean spinability value occur as pregnancy proceeds. A progressive and regular decrease in the mean spinability value can be recorded from the very beginning of the menopause. However, the spinability values observed in premenopausal mucus are noticeably higher than those recorded after the onset of the menopause. The numeric data furnished by the automatic measurement are discussed in terms of statistics.

The efficacy of nomegestrol acetate in the treatment of menstrual cycle disorders and dysfunctional uterine bleedings was confirmed on 66 cases in this study conducted by three hospital departments. The study also confirmed the perfect clinical tolerance of nomegestrol acetate. One knows that the same is not true with Nortestosterone derivatives which were used up to now in these indications.