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Sonia Grzelak,1,2 Mélanie Bérubé,1,2 Marc-Aurèle Gagnon,1 Caroline Côté,1,2 Valérie Turcotte,3 Stéphane Pelet,4 Étienne Belzile4 1Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada; 2Faculty of Nursing, Laval University, Quebec City, QC, Canada; 3Nursing Department, CIUSSS du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada; 4Department of Orthopedic Surgery, CHU de Québec-Université Laval (Hôpital de l’Enfant-Jésus), Quebec City, QC, CanadaCorrespondence: Sonia GrzelakPopulation Health and Optimal Practices Research Unit, Laval University Research Center (Hôpital de l’Enfant-Jésus), 1401, 18 e rue, Quebec City, QC, G1V 1Z4, Canada, Tel +1 418 649-0252, ext 66600, Fax +1 418-649-5733, Email sonia.grzelak.1@ulaval.caPurpose: To examine 1) pain management strategies within the care trajectory of orthopaedic trauma patients and patients’ perception of their effectiveness, 2) adverse effects (AEs) associated with pharmacological treatments, particularly opioids and cannabis, and 3) patients’ perceptions of strategies that should be applied after an orthopaedic trauma and support that they should obtain from health professionals for their use.Patients and Methods: This study was conducted with orthopaedic trauma patients in a level 1 trauma center. A convergent mixed-methods design was used. Data on pain experience, pain management strategies used and AEs were collected with self-administered questionnaires at hospital discharge (T1) and at 3 months after injury (T2). Patients’ preferences about the pain management strategies used, the required support and AEs were further examined through semi-structured individual interviews at the same time measures. Descriptive statistics and thematic analyses were performed.Results: Seventy-one patients were recruited and 30 individual interviews were undertaken. Pharmacological pain management strategies used at T1 and T2 were mainly opioids (95.8%; 20.8%) and acetaminophen (91.5%; 37.5%). The most frequently applied non-pharmacological strategies were sleep (95.6%) and physical positioning (89.7%) at T1 and massage (46.3%) and relaxation (32.5%) at T2. Findings from quantitative and qualitative analyses highlighted that non-pharmacological strategies, such as comfort, massage, distraction, and physical therapy, were perceived as the most effective by participants. Most common AEs related to opioids were dry mouth (78.8%) and fatigue (66.1%) at T1 and insomnia (30.0%) and fatigue (20.0%) at T2. Dry mouth (28.6%) and drowsiness (14.3%) were the most reported AEs by patients using recreational cannabis. An important need for information at hospital discharge and for a personalized follow-up was identified by participants during interviews.Conclusion: Despite its AEs, we found that opioids are still the leading pain management strategy after an orthopaedic trauma and that more efforts are needed to implement non-pharmacological strategies. Cannabis was taken for recreational purposes but patients also used it for pain relief. Support from health professionals is needed to promote the adequate use of these strategies.Keywords: orthopaedic trauma, pain, pharmacological strategies, non-pharmacological strategies, opioids, cannabis

Telemedicine emerged as an alternative care delivery system used to offer effective long-term management to patients with chronic, inflammatory conditions such as psoriatic disease. Teledermatology can provide reliable clinical information through thorough history-taking and virtual evaluations that include patient-provided images and disease activity assessment tools that may help accurately diagnose and manage patients with psoriasis. The integration of validated screening tools for psoriatic arthritis and effective teledermatology practices may improve access to specialists, thus avoiding preventable delays in the diagnosis and treatment of patients with psoriatic arthritis. Although the provision of telehealthcare should not completely replace high quality, in-person dermatologic or rheumatologic visits, the convenience and collaborative nature of teledermatology may lead to expanded access and expedited care in the appropriate setting, whether it be in a virtual or in-person visit.

Background: Little is known about the quality and impact of Canadian-produced research relative to that of other developed nations. The purpose of this study was to determine the contribution of Canadian authors to the orthopedic literature globally and nationally as well as Canada's research productivity in orthopedics. We hypothesized that Canada ranks among the most impactful countries in terms of orthopedic research productivity. Methods: We performed a bibliometric analysis to identify articles published between 2001 and 2020 in the category of orthopedics. We identified Canada's global rank in terms of overall productivity and assessed the contributions of individual Canadian authors. We also examined the quality of publications as determined by category normalized citation impact (CNCI) and publication in the top quartile of journals (%Q1) in terms of impact factor. In addition, we calculated the percentage of Canadian publications that were in orthopedics. Results: We identified 10821 orthopedic publications from 2001 to 2020. Canada placed sixth globally in terms of productivity in orthopedic research. The annual productivity of Canadian orthopedic researchers increased over the study period by a factor of 3.2. In terms of research quality, with a %Q1 of 36.5% and a CNCI of 1.22, Canada outperformed Asian countries and the United States; the latter country had a %Q1 of 35.3% and a CNCI of 1.14 over the study period. Conclusion: The body of Canadian orthopedic literature has grown consistently over the past 20 years. Despite the overall leadership of the United States and other developed nations such as China and Japan, Canada ranks among the most influential countries in terms of the quality and quantity of orthopedic research. Contexte: On en sait peu sur la qualité et les retombées de la recherche menée au Canada par rapport à celles des autres pays industrialisés. Cette étude avait pour but de déterminer la contribution des auteurs canadiens à la littérature mondiale et nationale en orthopédie, et la productivité en recherche dans ce domaine au Canada. Selon notre hypothèse, le Canada se classe parmi les pays ayant le plus d'impact pour ce qui est de la productivité en recherche orthopédique. Méthodes: Nous avons procédé à une analyse bibliométrique pour recenser les articles en orthopédie publiés entre 2001 et 2020. Nous avons vérifié le classement mondial du Canada au plan de la productivité globale et évalué les contributions canadiennes individuelles. Nous avons aussi mesuré la qualité des publications à partir de l'impact normalisé des citations selon la discipline (INCD) et les publications se situant dans le quartile supérieur des revues (%Q1) pour le facteur d'impact. Nous avons aussi calculé le pourcentage des publications canadiennes concernant l'orthopédie. Résultats: Nous avons recensé 10821 publications en orthopédie entre 2001 et 2020. Le Canada s'est classé sixième au monde au plan de la productivité en recherche orthopédique. La productivité annuelle des chercheurs canadiens en orthopédie a augmenté au cours de la période de l'étude selon un facteur de 3,2. Au plan de la qualité de la recherche, avec un indice %Q1 de 36,5% et un INCD de 1,22, le Canada s'est mieux classé que les pays asiatiques et les Etats-Unis, ce dernier ayant obtenu un indice %Q1 de 35,3% et un INCD de 1,14 pour la période de l'étude. Conclusion: Au cours des 20 dernières années, le corpus canadien de littérature orthopédique a régulièrement augmenté. Malgré le leadership global exercé par les Etats-Unis et les autres pays industrialisés, comme la Chine et le Japon, le Canada se classe parmi les pays ayant le plus d'influence aux plans quantitatif et qualitatif en recherche orthopédique., Abibliometric analysis is both a quantitative and a qualitative review of the scientific literature. A number of factors have been described to assess academic productivity using this model, in terms [...]

On présente quelques généralités sur la constitution et les buts du groupe ORLON, groupe d'étude de la géochimie organique des sédiments marins profonds qui comprend, outre l'IFP, les compagnies CFP, Elf-RE et SNPA et un certain nombre de laboratoires universitaires et du CNRS (Paris VI, Bordeaux, Strasbourg, Nancy, Perpignan, Aix-Marseille). Un premier compte rendu de la mission ORLON 1974 en mer de Norvège insiste sur les quatre premières mondiales réalisées à son occasion - utilisation du carottier par gravité Reineck long (12 m) par mer profonde (jusqu'à 2000 m); - dosage du carbone organique à bord par appareil automatique LECO ; - lyophilisation à bord de grandes quantités de sédiments ; - cultures et numération bactériennes à bord sur prélèvements le long d'une carotte longue (jusqu'à 13,5 m). Some general information is given on the formation and aims of the ORLON Group, a group for studying the organic geochemistry of deep marine sediments and, in addition to IFP, including CFP, Elf-RE and SNPA as well as various university and CNRS laboratories (Paris VI, Bordeaux, Strasbourg, Nancy, Perpignan and Aix-Marseille). An initial report on the 1974 ORLON Mission in the Norwegion Sea emphosizes the four world firsts it achieved - using a Reineck gravity core drill 12 m long under deep water (up to 2,000 m); - shipboard organic carbon titration with a LECO automatic apparatus; - shipboard freeze drying of large amounts of sediments; - shipboard bacterial culture and counting in samples taken from a long core sample (up to 13.5).

Quatre articles distincts traitent, le premier des généralités sur la mission ORGON 4, le second du cadre géographique et géologique général, ainsi que de la description des carottes prélevées, le troisième de la biochimie des eaux et le dernier de la microbiologie. Plusieurs milieux ont été rencontrés et étudiés, qui vont de la lagune (Ghubbet el Kharab) à la fosse tectonique profonde (fosse d'Alula-Fartak). Deux radiales, l'une en mer d'Arabie, l'autre dans le golfe d'Oman, permettent de suivre l'évolution des caractères depuis les zones côtières jusqu'à la plaine abyssale. L'implantation des sites de carottage avait été étudiée de manière à éviter les zones à apport détritique important (cône de l'Indus) : les résultats rapportés indiquent que ce but a été certainement atteint et en particulier que la matière organique des sédiments est massivement d'origine marine autochtone (planctonique). L'étude des eaux a retrouvé un résultat antérieurement acquis, à savoir l'existence dans les profondeurs moyennes (800 à 1800 m) d'une zone à minimum de teneur en oxygène très marqué (équivalent à 1 ml/1), correspondant à des milieux de sédimentation a caractère réducteur net et à teneur en matièe organique relativement importante. De façon plus générale, les teneurs en carbone organique des sédiments prélevés à ORGON 4 sont les plus élevées de toutes celles mesurées dans les missions ORGON, à la fois en moyenne et pour les valeurs maximales ; ceci est certainement lié à la productivité primaire exceptionnelle des eaux sus-jacentes. Les études microbiologiques n'ont pas retrouvé les phénomènes spectaculaires d'ORGON 3 : niveaux à microflore exceptionnellement importante encadrés de niveaux stériles dans les profondeurs des carottes. Néanmoins, des tendances vers l'acquisition de ce caractère existent dans certains niveaux. Il faut signaler qu'un essai d'étude plus exhaustive des populations microbiennes a été tenté, par mises en culture sous pression correspondant à la pression de fond, pour essayer de déceler une éventuelle présence de formes barophiles. Four separate articles deal with: 1) general comments on the ORGON 4 mission, 2) the geographic setting and the general geology as well as a description of the tore samples taken, 3) the biochemistry of the waters, and 4) microbiology. Several environments were encountered and investigated, ranging from a lagoon (Ghubbet el Kharab) to a deep fault trough (Alula-Fartak trough). Two radials, one in the Arabian Sea and the other in the Gulf of Oman, were used to follow the evolution of their characteristics from coastal zones down to the abyssal plain. The location of core-sampling sites was studied so as to avoid zones with extensive detrital influx (Indus cone). The results given indicate that this goal has certainly been attained and, in particular, that the organic matter in the sediments is massively of autochthonous marine origin (planktonic). An analysis of the waters came up with the same result that had previously been found, i. e. the existence in medium depths (800 to 1800 m) of a very pronounced minimum-oxygen-content zone (= 1 ml /I) corresponding to sedimentation environments with a clearcut reducing nature and a relatively high organic matter content. More generally, the organic carbon contents of the sediment samples taken during ORGON 4 are the highest of all those measured in the ORGON missions, for both mean and maximum values. This is certainly linked to the exceptional primary productivity of the underlying waters. Microbiological analyses did not find the spectacular phenomena found in ORGON 3, i. e. layers with exceptionally abundant microflora interbedded with sterile layers in the depth of the cores. Nonetheless, there were tendencies to acquire such a nature in some levels. Mention should be made of an attempt to make a more exhaustive investigation of microbial populations by culture under a pressure corresponding to sea bottom pressure, in an effort to detect any eventual presence of barophilic forms.

Trois articles distincts traitent, le premier des généralités sur la mission ORLON, les deux autres des résultats obtenus à la mer dans les domaines de la microbiologie et de la biochimie des eaux. En microbiologie, une opposition existe entre le bassin de Cariaco d'une part, milieu anoxique riche en microflore et spécialement en bactéries sulfato-réductrices, et d'autre part la plaine du Demerara et le cône de l'Amazone, où les eaux ont des teneurs médiocres en microflore et les sédiments des teneurs si faibles qu'elles sont inférieures aux teneurs des eaux (phénomène qui n'existe jamais dans les milieux côtiers ou peu profonds). On met en évidence une relation directe entre teneurs en microflore et vitesse de sédimentation, qui permet d'avoir une vision cohérente des résultats obtenus tant à ORLON I qu'à ORLON 2. Dans le domaine de la biochimie des eaux, on a étudié outre l'eau sus-jacente au sédiment, les eaux interstitielles de 95 niveaux sédimentaires des carottes. L'utilisation d'un dispositif spécial de découpage des carottes prélevées à l'aide du carottier Reineck court a permis une étude fine des paramètres physiques (pH, Eh) et des constituants chimiques (O, dissous, S-- dissous, PO---, NH4 et alcalinité) des eaux interstitielles. L'influence des conditions régnant dans la Cariaco Trench sur la minéralisation de la matière organique a été étudiée au cours de l'enfouissement. Les mesures effectuées dans la mer du Demerara et sur le cône fossile de l'Amazone soulignent l'influence des conditions ambiantes et la pauvreté en matériel organique des régions océaniques profondes. Les dépôts côtiers de l'Amazone et du Para ont également été étudiés. Three separate articles are given. The first deals with general comments on the ORLON cruise, and the other two give the findings obtained on board ship in the fields of microbiology and biochemisiry of water. In microbiology, there is an opposition between the Cariaco Basin, which is on anoxic environment rich in microflora and especially in sulfate-reducing bacteria, and the Demerara Plain and Amazon Fan where the water contains only mediocre amounts of microflora and the sediments contain even fewer amounts thon the water (a phenomenon that never exists in coastal or shallow water). A direct relationship is revealed between the microflore content and the rate of sedimentation, thus giving a coherent picture of the findings obtained by both ORLON I and ORLON 2. In the field of the biochemisiry of the water, in addition ta the water overlying the sediments, an analysis was also made of the interstitial water from 95 sedimentary levels of the cores. The use of a special core cutter on cores token with a short Reineck corer enabled a thorough analysis to be made of the physical parometers (pH, Eh) and the chemical constituents (dissolved Oz, dissolved 5--, PO4--, NH4 and alkalinity) of the interstitiel water.

L'évaluation quantitative des produits mobiles formés lors de l'évolution géochimique de la matière organique est nécessaire parce qu'on ne peut jamais retrouver ces produits en place dans. la roche où ils ont pris naissance. Ils ont, en effet, pu migrer durant l'histoire géologique, et de toute manière une fraction, importante et non connue, se perd lors de la prise des échantillons puis de leur conservation avant analyse. La connaissance de l'analyse d'un état E et d'un état plus évolué E' ne suffit pas pour reconstituer les quantités de produits formés. La pyrolyse type Rock-Eval sur kérogènes, avec détermination du carbone résiduel, permet par contre, à partir d'une hypothèse raisonnable, de calculer les hydrocarbures produits. L'analyse élémentaire permet d'y ajouter CO2, H2O, H2S et N2 (considérés comme seuls produits à côté des hydrocarbures). Une analyse chromatographique sommaire supplémentaire permet d'estimer la composition globale des hydrocarbures. Dans le cas des roches, on propose des techniques de correction de l'effet de matrice pratiquement utilisables et qui permettent de retrouver les résultats précédents, au prix d'une incertitude accrue. The mobile products formed during the geochemical evolution of organic matter must be quantitatively evaluated because these products can never be found in place in the rock where they were formed. Indeed, they may have migrated during geological history, and in any case a large and unknown fraction gets lost when samples are taken and then stored before being analysed. Knowing the elemental analysis of a state E and of a more evolved state E' does not suffice for recreating the amounts of products formed. On the other hand Rock-Eval type pyrolysis of kerogens, including the determination of the residual carbon, can be used to compute the hydrocarbons produced, on the basis of a reasonable hypothesis. Elemental analysis then enables the evaluation of CO2, H2O, H2S and N2 (considered as the only products in addition to hydrocarbons). A summary chromatographic analysis can be used to estimate the overall hydrocarbon composition. In the case of rocks, techniques are proposed for correc-ting for the matrix effect. These practical and usable techniques reproduce the above results in exchange for increased uncertainty.

L'extraction en Soxhlet est inappllcable lorsque les échantillons de roche sont de trop petite taille. A l'occasion de la mise au point du protocole d'extraction correspondant, on examine l'influence d'un certain nombre de conditions opératoires sur le rendement d'extraction : température, durée nature et quantité du solvant, présence de lumière, présence d'air, procédé d'extraction. Pour les hydrocarbures, tant saturés qu'aromatiques, le facteur essentiel est l'agitation du milieu d'extraction ; la nature du solvant n'est pas critique, à condition de ne pas choisir un très mauvais solvant des hydrocarbures : l'extractibilité est en effet plus fonction du pouvoir désorbant vis-à-vis de la roche que du pouvoir solvant proprement dit. Pour les résines et asphalténes, l'interprétation des résultats est délicate, car la frontière n'est pas nette entre produits simplement dissous, produits de solvolyse et, produits de néoformation par interaction solvant-matière organique-matière minérale. II n'existe donc pas de protocole d'extraction recommandable dans l'absolu. Tout dépend des exigences analytiques et aussi pratiques du laboratoire; à l'Institut Français du Pétrole (IFP) le protocole retenu est l'extraction en bécher avec agitation magnétique pendant 20 min dans le chroroforme à 50 °C (approximativement); on donne aussi le protocole d'évaporation du solvant et de récupération de l'extrait, qui doit être étudié soigneusement étant donné les faibles quantités mises en jeu. A Soxhlet extractor cannot be used with rock samples that are too small in size. With the development of on extraction procédure for such cases, this article examines the influence of various operating conditions on extraction yield, i. e. temperature, duration, nature and amount of solvent, presence of light, présence of air and extraction process. For both saturated and aromatic hydrocarbons, the essential factor is the stirring of the extraction medium. The nature of the solvent is not critical provided that a very poor solvent for hydrocabbues is not chosen. Extractability actually depends more on the desorbing power vis-à-vis the rock thon the solving power. For resins and asphaltenes, interpreting the results is a delicote job because there is no clearcut boundary between simply dissolved products, solvolysis products and neoformation products produced by solvent/organic motter/mineral motter interaction. Hence there is no ultimately recommendable extraction procedure. Everything depends on the analytical requirements as well as on laboratory practices. The procedure retained et Institut Français du Pétrole (IFP) is a beaker extraction process with magnetic stirring for 20 min in chloroform at 50 'C (approximately). The procedure for evaporation of the solvent and recovery of the extract is also described and should be studied carefully on account of the small amounts.

Sept articles distincts traitent, le premier des généralités sur la mission ORLON 3, le second du cadre géologique général, les cinq autres des résultats obtenus à la mer dans les domaines de l'interprétation des profils d'échosondeur, de la descrip-tion des carottes, de l'examen de la matière organique figurée, de l'étude des gaz occlus et enfin de la microbiologie. Les profils d'échosondeur permettent de préciser la topographie des fonds, qui apparaissent comme entaillés de canyons. Ils permettent aussi de déceler les glissements sédimentaires qui apparaissent comme un processus normal de mise en place des sédiments dans la région étudiée. La description immédiate des carottes a permis, en particulier, de mettre en évidence des niveaux turbiditiques à éléments bioclastiques subsistant sous la lysocline, ce qui, entre autres, confirme les considérations précédentes. L'examen de la matière organique figurée fait soupçonner l'importance de l'apport détritique éolien, ce qui est une nouveauté. L'étude des gaz occlus oppose nettement la région Nord (radiale de Nouadhibou), au Sud (région des fleuves côtiers et du canyon de Kayar). Dans cette dernière, les gaz ne contiennent pratiquement que du méthane comme hydrocarbure ; les teneurs sontirrégulièrement réparties et ne montrent aucune corrélation, ni avec la teneur en carbone organique, ni avec la richesse microbienne des niveaux. Au Nord, le méthane est un peu moins prédominant (l'éthane représente quelques centièmes du méthane, les homologues supérieurs sont à l'état de traces). S'il n'y a pas corrélation avec la richesse microbienne, il y en a par contre avec la teneur en carbone organique et les teneurs s'accroîssent régulièrement en profondeur pour atteindre le double des teneurs mesurées au Sud. L'interprétation de ces données n'est pas évidente. La microbiologie a mis en évidence un phénomène déjà entrevu aux précédentes missions ORLON. A la pauvreté générale en bactéries des sédiments étudiés, jointe à la disparition totale de ces bactéries très rapidement dans la profondeur des carottes, se superpose ici, dans des niveaux profonds différents suivant les carottes, une microflore très abondante et active (non sporulée). L'importance géologique de cette découverte ne saurait être sous-estimée. Seven separate articles will be published on the ORLON 3 mission.The first will deal with general aspects, the second with the general geological setting and the other five with the results obtained at sea in the fields of interpreting echosounder profiles, describing tore samples, observing parriculote organic motter, examining entrapped gas and investigating microbiology. Echosounder profiles describe the topography of the sea bed which appears to be slashed by canyons. They also detect sedimentary sliding which appears as a normal process of sediment deposition in the region being investigated. The im.nediate description of core samples in particular revealed turbidite levels with bioclastic elements subsisting under the lysocline, thus confirming the preceding considerations among others. An examination of the figured elements in the organic matter suggests the importance of eolian detrital influx, which is something new. An analysis of the entrappeci gas gives rise ta clearcut opposition between the northern region (radial of Nouadhibou) and the southern region (a region of coastal rivers and the Kayar canyon). In the latter region, the gas contains almost nothing other thon methane as a hydrocarbon. The amounts of methane in the gas are irregularly distributed and show no correlation either with the organic carbon contents or with the microbial richness of the levels. In the north the methane is slightly less predominant (ethane represents a few hundredths of methane, and the upper homo-logous series have merely traces). Although there is no correlation witb the microbial richness, there is nonetheless one with the organic carbon content which increases regularly at depth to attain double the amounts measured in the south. The interpretation of such data is not obvious.Microbiology revealed a phenomenon thot had already been glimpsed during preceding ORLON missions. In addition ta the general bacterial poverty of the sediments analyzed, combined with the total disappearance of such bacteria very quickly as depth increases in the cores, is here superimposed the presence of some discrete levels, at depths depending on the cores, where thrives a very abundant and active (unsporulated) microflora.

La répartition des zones pétrolières dans le monde étudiée pour sept grandes périodes allant du Cambrien à l'Actuel montre des relations avec l'histoire géolo-gique globale. Les zones pétrolières paléozoïques, situées essentiellement en Amérique du Nord et en Europe, correspondent le plus souvent à un environnement de plate-forme stable. Les zones pétrolières mésozoïques situées souvent au-dessus de ceintures orogéniques antérieures intéressent particulièrement le domaine mésogéen. Au Tertiaire, les zones pétrolières sont situées dans les mêmes régions qu'au Mésozoïque, mais elles correspondent plus souvent à des fosses tardi - et post-tectoniques associées aux ceintures orogéniques. Au total. les régions mésogéennes renferment 69 % des réserves prouvées initiales d'huile et de gaz du monde. Généralement, les réserves d'hydrocarbures décroissent quand l'âge des réservoirs et des roches-mères augmente, conséquence de la diagenèse, de l'évolution thermique et surtout de la dysmigration. Les phénomènes migratoires sont le plus souvent orientés vers le haut de la série stratigraphique. Les courbes de réserves en fonction de l'âge font apparaître trois maxima correspondant en gros aux orogénèses hercynienne, laramide et alpine et reflétant chaque fois une extension du domaine sédimentaire. La prolificité exceptionnelle du Crétacé semble faire intervenir, en outre, des facteurs allant dans le sens d'une plus grande productivité primaire (transgression globale) et d'une meilleure conservation de la matière organique (tendance à l'anoxie). Les réserves potentielles non découvertes pourraient être du même ordre de grandeur que les réserves connues. Le modèle américain suggère qu'une partie importante des réserves potentielles est située dans des régions déja productrices, sous forme de champs de petite taille. The distribution of petroleum zones in the world has been studied for seven major periods from the Cambrian to the present times so as to determine the relationships, between this distribution and global geological history. The Paleozoic petroleum zones, mainly located in North América and Europe, are mostly related to stable platform environments. The Mesozoic petroleum zones, often located above former orogenic belts, are especially related to the Mesogean realm. The Tertiary petroleum zones are located in the same areas as the Mesozoic ones, but they are more often related to fore-deeps and intramontane deeps of orogenic belts. On the whole, the Mesogean areas contain 69% of the proven ultimate reserves of oil and gas in the world. Hydrocarbon reserves generally decrease as the age of the reservoir and source rock increases on account of diagenesis, thermal evolution and especially dysmigration. The migration processes are generally directed towards the higher parts of the stratigraphic series. There are three maxima of reserves versus age in approximate correlation to the Hercynien, Laramide and Alpine orogeneses. They are primarily related to increases in the sedimentary areas. The exceptional richness of the Cretaceous seems to be the consequence of additional factors increasing the primary production of organic matter (global transgression) and improving its preservation (anoxia). Undiscovered potential reserves might be on the same order of magnitude as the identified ones. The American model suggests that a large shore of the potential reserves is located in already productive areas and will consist of small fields.

Abstract Background In Switzerland, general practitioners (GPs) manage most of the patients receiving methadone maintenance treatment (MMT). Methods Using a cross-sectional postal survey of GPs who treat MMT patients and GPs who do not, we studied the difficulties encountered in the out-patient management of drug-addicted patients. We sent a questionnaire to every GP with MMT patients (556) in the French-speaking part of Switzerland (1,757,000 inhabitants). We sent another shorter questionnaire to primary care physicians without MMT patients living in the Swiss Canton of Vaud. Results The response rate was 63.3%. The highest methadone dose given by GPs to MMT patients averaged 120.4 mg/day. When asked about help they would like to be given, GPs with MMT patients primarily mentioned the importance of receiving adequate fees for the care they provide. Secondly, they mentioned the importance of better training, better knowledge of psychiatric pathologies, and discussion groups on practical cases. GPs without MMT patients refuse to treat these patients mostly for emotional and relational reasons. Conclusion GPs encounter financial, relational and emotional difficulties with MMT patients. They desire better fees for services and better training.

Importance: Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. Objective: Identify the patient who would benefit most from a palliative care approach instead of a surgery. Design: Exploratory-matched retrospective cohort study between 2015 and 2021. Setting: Single Level 1 Trauma Center. Participants: There were 2240 hip fracture patients admitted to our institution between 2015 and 2021. Patients over 65 years old with intertrochanteric or femoral neck fractures could be included. A total of 129 patients opted for palliative care (Palliative Group = PG). This cohort was compared to a matched cohort (for age, sex and fracture type) who underwent surgery but died within three months of the procedure (Surgery Deceased Group = SDG) and another matched cohort who survived more than three months (Surgery Alive Group = SAG) following surgery. Main outcomes and measures: Medical charts were reviewed for patient demographics, autonomy level, level of care, neurocognitive disorders (NCD), fracture type, in-hospital data and outpatient death within three months of admission. Analysis was performed through univariate and multivariate models with SAS OnDemand for Academics (alpha 0.05). Results: Patients in the PG (n = 129) were 88.2 ± 7.2 years old, 71.3% were females, and 61.2% had a femoral neck fracture. Patients in the SDG (n = 95) and SAG (n = 107) were well matched. The PG differed from the SDG (n = 95) and SAG (n = 107) regarding NCD (85.3% vs. 57.9% vs. 36.4%, p < 0.01) and the presence of Behavioral and psychological symptoms of dementia (BPSD) (19.4% vs. 5.3% vs. 3.7%, p < 0.01). There were more known heart failure (24.2% vs. 16.3%, p < 0.01) and Chronic Obstructive Pulmonary Disease (COPD) in the SDG group than in the PG group (26.6 vs. 14.7%, p = 0.02). Patients in the SAG have a significant lower rate of NCD (OR 2,7 (95%CI 1,5–5,0)), heart failure (OR 5,7 (95%CI 1,9–16,4)) and COPD (OR 2,8 (95%CI 1,2–6,3)) than other groups. Prefracture mobility, autonomy and living situation significantly differed between the groups. Median survival was six days in PG and 17 days in SDG. All groups lost autonomy and mobility. There were more complications in the SDG group than in the PG group. The end-of-care trajectory was death or hospice for most patients in the PG and SDG groups. More than 30% of the SAG group could not return home at discharge. Conclusion: The presence of an NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic treatment of femoroacetabular impingement has increased in popularity since the early 2000s when it was first described, although only a few midterm follow-up studies have been published. Purpose: To describe the outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement at a mean 12-year follow-up and to determine the risk factors for failure. Study Design: Case-control study; Level of evidence, 3. Methods: The Non-Arthritic Hip Score (NAHS) and a radiographic evaluation were completed preoperatively and at midterm follow-up. Participants were divided into 2 groups according to their clinical evolution. The success group consisted of patients whose NAHS at the final follow-up was above the established Patient Acceptable Symptom State (PASS) threshold of 81.9, whereas patients who underwent a second surgical intervention or did not reach the PASS threshold at final follow-up were assigned to the failure group. These groups were compared to identify preoperative differences in demographic, pathological, and surgical factors. Results: A total of 95 hips were included, after 23 were lost to follow-up (80.5% follow-up). At a mean follow-up of 12.1 years (range, 9.2-16.0 years), 9 hips required total hip arthroplasty (9.5%), 5 required revision hip arthroscopy (5.3%), 29 did not achieve the NAHS PASS threshold (30.5%), and 52 achieved the NAHS PASS threshold (54.7%). The mean NAHS was 82.4 at final follow-up compared with 66.9 preoperatively (mean difference = 15.5; P <.001). Higher mean body mass index (24.9 vs 23.0; P =.030), older age (30.0 vs 27.2; P =.035), and inferior preoperative lateral joint space width (3.9 vs 4.4; P =.019) were associated with inferior prognosis in the failure group versus success group. Osteoarthritis progression was observed in 69.2% of the failure group and in 34.8% of the success group (P =.082). Labral ossification was observed in 78.3% of all patients, and its lateral projection length was statistically associated with failure (P =.015). Conclusion: At a mean 12-year follow-up, hip arthroscopy for femoroacetabular impingement led to significant clinical improvement, with 55% PASS achievement. In total, 31% of patients were below the PASS threshold, 5% had revision arthroscopy, and only 9% had conversion to total hip arthroplasty for a 45% global failure rate. Increased body mass index, older age, and smaller preoperative lateral joint space width were significant negative prognostic factors. Postoperative degenerative changes were highly prevalent and demonstrated association with failure. [ABSTRACT FROM AUTHOR]