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Atrial fibrillation (AF) is common in the elderly. The treatment of this condition is based on anticoagulation to prevent stroke and systemic arterial embolism. Vitamin K antagonists (VKAs) have long been the only anticoagulants available for the management of AF. Administration is complex and is one of the main causes of iatrogenic disease in the elderly. In the past 10 years, direct-acting oral anticoagulants (DOACs) have emerged, and large randomised trials (RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF) have demonstrated their superiority over VKAs in the management of AF. These trials were conducted on large numbers of patients (n=71,683), including 27,500 patients aged ≥75 years and nearly 8,000 subjects aged >80 years. Results from 11 recent meta-analyses of randomised trials and observational real-world studies of 660,896 elderly patients indicate that DOACs are more effective than VKA-based prophylaxis in preventing stroke (with a reduction in risk ranging from 13% to 26%), and carry a lower risk of cerebral haemorrhaging (50% reduction in risk). The risk of major haemorrhaging appears to be similar to, or lower than that with DOACs relative to VKAs (depending on the dosage, renal function, haemorrhagic site or type of DOAC). Moreover, improved outcomes with DOACs over VKA therapy have been demonstrated based on subgroup analyses in subjects aged over 75, in patients with renal insufficiency (creatinine clearance: 30-50 mL/min) and in those with a history of falls. Analyses indicate that DOACs are a better choice than VKAs in the elderly because elderly patients are at greatest risk of stroke and cerebral haemorrhaging. In summary, DOACs have a better efficacy/tolerance profile than VKAs, which justifies their first-line use in subjects over 75 years of age.

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.L’asthme fait souvent son apparition avant l’âge de six ans. Cependant, il subsiste des incertitudes relativement à quand et comment un enfant d’âge préscolaire ayant des symptômes de type asthmatique peut être diagnostiqué avec cette condition. Ceci retarde le traitement et contribue à la morbidité à court et à long terme. L’Assemblée clinique sur l’asthme de la Société canadienne de thoracologie s’est associée à la Société canadienne de pédiatrie pour créer un groupe de travail conjoint afin de préparer un document de principes sur le diagnostic et la prise en charge de l’asthme chez les enfants d’âge préscolaire. En l’absence de mesures de la fonction pulmonaire, le diagnostic d’asthme devrait être envisagé chez les enfants de un à cinq ans ayant des symptômes de type asthmatique fréquents (≥8 jours/mois) ou des exacerbations récurrentes (≥2) (épisodes accompagnés de signes compatibles). Le diagnostic nécessite une documentation objective des signes cliniques ou un compte rendu parental convaincant de symptômes d’obstruction des voies respiratoires et de réversibilité de l’ obstruction (amélioration suite à un traitement pour l’asthme), ainsi que l’absence de suspicion clinique de tout autre diagnostic. La respiration sifflante, souvent accompagnée de difficultés respiratoires et de toux, est le signe cardinal de l’obstruction des voies respiratoires. La réversibilité à la suite de la prise de médicaments pour l’asthme se définie par l’observation directe par un professionnel de la santé compétent, d’une amélioration après l’administration de ß

National audience; Interactive paper technologies offer new opportunities for supporting the highly individual practices of creative artists, such as contemporary music composers, who express and explore their ideas on both paper and the computer. We introduce PaperComposer, a graphical interface builder that allows users to create a personalized interactive paper interface that they can connect to their own computer-based musical data. We also present an API that facilitates the development of interactive paper components for PaperComposer. We describe one public demonstration of a novel musical interface designed for children and our collaborations with composers to create two novel interactive music interfaces that reflected their individual composition styles.

Frailty in the older population is a clinical syndrome which evaluate a risk level. The Frailty syndrome defines a reduction of the adaptation capacity to a stress. It can be modulated by physical, psychological and social factors. The screening of the frailty syndrome is relevant for older people without disability for basic activities of daily living. The clinical criteria of frailty must be predictive of the risk of functional decline and adverse outcomes, consensual at the international level, and easy to perform in primary care as well as in the clinical researches.

Hermann Schmitz, the author of the text that is presented here in translation, can be regarded as a founding father of research on atmosphere for the German-speaking world. He is however not a founder in the sense of having intentionally laid a foundation stone for a field of research, by publishing a monograph or important essay on the subject of atmospheres, which was subsequently developed and became more differentiated. Rather, his first use of the concept of atmospheres was in a subordin...

Biochemical diagnosis of hereditary metabolic diseases requires the detection and simultaneous identification of a large number of compounds, hence the interest in metabolic profiles. Acylcarnitine profile allows the identification and quantification of more than thirty compounds. As part of the accreditation process for medical biology examinations according to standard NF EN ISO 15189, the group from SFEIM recommends an approach to accredit acylcarnitine profile. Validation parameters and recommendations are discussed in this specific framework.

BACKGROUND & AIMS: This position paper summarizes theoretical and practical aspects of the monitoring of artificial nutrition and metabolism in critically ill patients, thereby completing ESPEN guidelines on intensive care unit (ICU) nutrition. METHODS: Available literature and personal clinical experience on monitoring of nutrition and metabolism was systematically reviewed by the ESPEN group for ICU nutrition guidelines. RESULTS: We did not identify any studies comparing outcomes with monitoring versus not monitoring nutrition therapy. The potential for abnormal values to be associated with harm was clearly recognized. The necessity to create locally adapted standard operating procedures (SOPs) for follow up of enteral and parenteral nutrition is emphasised. Clinical observations, laboratory parameters (including blood glucose, electrolytes, triglycerides, liver tests), and monitoring of energy expenditure and body composition are addressed, focusing on prevention, and early detection of nutrition-related complications. CONCLUSION: Understanding and defining risks and developing local SOPs are critical to reduce specific risks. ispartof: CLINICAL NUTRITION vol:38 issue:2 pages:584-593 ispartof: location:England status: published

La biomasse est une source d’énergie renouvelable qui peut contribuer de manière significative à la réduction de la consommation de combustibles fossiles. L’utilisation de déchets agricoles ou agro-industriels tels que les grignons d’olives est particulièrement pertinente. La gazéification est une technique prometteuse de valorisation énergétique des déchets pour ce type de résidus lignocellulosiques. La technologie est cependant adaptée à un panel relativement limité de combustibles solides ayant des spécifications définies, qui doivent donc être caractérisées correctement. Le but de cette étude était d’analyser et de comparer des grignons d’olives de 3 origines différentes par des techniques complémentaires telles que la spectroscopie infrarouge à transformer de Fourier, la thermogravimétrie couplée à l’analyse calorimétrique différentielle et la pyrolyse suivie d’une chromatographie en phase gazeuse / spectrométrie de masse (Py-CG/SM). Les résultats soulignent la nature complexe des grignons qui sont principalement organiques. En plus des principaux composés organiques (cellulose, hémicelluloses et lignine), la présence de plusieurs constituants organiques mineurs a été montrée. La Py-CG/SM a montré que le gaz produit par pyrolyse contient plusieurs produits de dégradation de la matière lignocellulosique et de l’huile d’olive. L’influence du procédé d’extraction de l’huile d’olive (à deux phases ou à trois phases) a également été mise en évidence. La dégradation thermochimique des grignons suit un mécanisme complexe mais la composition des grignons répond à la plupart des spécifications requises par la gazéification., Biomass is a renewable energy source that can make a significant contribution to reducing fossil fuels consumption. The use of agricultural or agro-industrial waste such as olive mill solid residues is particularly relevant. Gasification is a promising waste-to-energy technique for this type of lignocellulosic residues. The technology however is adapted to a relatively limited panel of solid waste fuels of defined specifications, which must therefore be characterized properly. The purpose of this study was to analyze and compare olive mill solid residues from 3 different origins by complementary techniques such as Fourier transform infrared spectroscopy, thermogravimetry coupled to differential scanning calorimetry and analytical pyrolysis combined with gas chromatography/mass spectrometry (Py-CG/SM). The results underlined the complex nature of the residues, which are mainly organic. In addition to the major compounds (cellulose, hemicelluloses and lignin), the presence of several minor organic constituents was shown. Py-CG/SM showed that the gas produced by pyrolysis contains several degradation products of lignocellulosic material and olive oil. The influence of the olive oil extraction process (two-phase or three-phase) was also highlighted. The thermochemical degradation of olive mill residues follows a complex pathway but the composition of the residues meets most of the requirements parameters for gasification.

ObjectiveTo develop an index to assess the nutritional quality of household food purchases based on food expenditures only.DesignA database of monthly food purchases of a convenience sample of low-income households was used to develop the Healthy Purchase Index (HPI). The HPI is the sum of two sub-scores based on expenditure shares of food categories in total household food expenditure: the purchase diversity sub-score and the purchase quality sub-score. The first was adapted from an existing diversity score. The second integrated those food categories identified as the best predictors of the nutritional quality of purchases based on associations between expenditure shares of food categories and two nutritional quality indicators: the mean adequacy ratio (MAR) and the mean excess ratio (MER). Correlation between the HPI and a score assessing adherence to French dietary guidelines (PNNS-GSmod) was performed as a first validation.Setting/ParticpantsFood purchases of 112 households from deprived neighbourhoods of Marseille (France), participating in the Opticourses and Jassur projects (2012–2015).ResultsThe purchase diversity sub-score reflects the presence in food purchases of five food categories: fruits, vegetables, starches, dairy products, and meat, fish & eggs. The purchase quality sub-score is based on expenditure shares for fruit & vegetables, added fats & seasonings, sweet snacks, cheese, sugary drinks, refined grains and fish, as these were identified as predictors of the nutritional quality of purchases. The HPI was positively associated with the PNNS-GSmod(rs=0·378;PConclusionsThe HPI helps assess the healthiness of household food purchases.

Glucose-regulated protein 78 (GRP78) is a chaperone protein that has a high frequency in tumor cells. Normally it is found in the endoplasmic reticulum to assist in protein folding, but under cellular stress, GRP78 influences proliferative signaling pathways at the cell surface. The increased expression elicits autoantibody production, providing a biomarker of ovarian cancer, as well as other types of cancer. This study aims to determine the epitope recognition of GRP78 autoantibodies isolated from serum of ovarian cancer patients and use the identified antibodies to design new drug delivery systems to specifically target cancer cells. We first confirmed that the membrane GRP78 levels are increased in ovarian cancer cells and positively correlate with proliferation. However, the level of circulating GRP78 autoantibodies did not correlate with membrane GRP78 expression in ovarian cancer cells and was lower, although not significantly, compared to control patients. We then determined the epitope recognition of GRP78 autoantibodies and showed that treatment with paclitaxel-loaded nanoparticles coated with anti-GRP78 antibodies significantly decreased tumor development in chick embryo culture of ovarian cancer cell tumors compared to paclitaxel treatment alone. This evidence suggests that nanoparticle drug delivery systems coupled with antibodies against GRP78 has potential as a powerful therapy against ovarian cancer.

Background: Web-based surveys have become a new and popular method for collecting data, but only a few studies have directly compared postal and Web-based surveys among physicians, and none to our knowledge among general practitioners (GPs). Objective: Our aim is to compare two modes of survey delivery (postal and Web-based) in terms of participation rates, response times, and completeness of questionnaires in a study assessing GPs’ preventive practices. Methods: This randomized study was conducted in Western Switzerland (Geneva and Vaud) and in France (Alsace and Pays de la Loire) in 2015. A random selection of community-based GPs (1000 GPs in Switzerland and 2400 GPs in France) were randomly allocated to receive a questionnaire about preventive care activities either by post (n=700 in Switzerland, n=400 in France) or by email (n=300 in Switzerland, n=2000 in France). Reminder messages were sent once in the postal group and twice in the Web-based group. Any GPs practicing only complementary and alternative medicine were excluded from the study. Results: Among the 3400 contacted GPs, 764 (22.47%, 95% CI 21.07%-23.87%) returned the questionnaire. Compared to the postal group, the participation rate in the Web-based group was more than four times lower (246/2300, 10.70% vs 518/1100, 47.09%, P

The competency-based approach “APC” is considered one of the most appropriate pedagogical approaches for effective learning. However, although it is increasingly recommended by the Moroccan educational system, we realize a reticence of its application. The purpose of this research is to approach the representation of teachers about the “APC” in order to assess the level of its implementation in the Moroccan educational system. Thus, we elaborated a questionnaire. The collection of information by means of this questionnaire was conducted among 300 secondary school teachers performing in the Regional Academy of Education and Training AREF Fes-Boulemane and the number of responses received is only 115. The data obtained show a significant rate of application of this approach in several educational institutions. The reasons for not adopting this approach by some teachers can be categorized into several ranks: working conditions, lack of training (initial and continuous), socio-cultural conditions. The success of education depends heavily on the development of human resources education and training, which begins with an advanced initial training in teachers training centers, continues through self-study and is followed by continuous training., L’approche par compétence « APC » est considérée comme l’une des approches pédagogiques les plus appropriées pour un apprentissage efficace. Cependant, bien qu’elle soit de plus en plus recommandée par le système éducatif marocain, on constate une réticence de son application. La finalité de ce travail est d’approcher les représentations des enseignants sur l’APC et cela afin d’apprécier leur degré d’implication dans sa mise en œuvre dans le système éducatif marocain. Ainsi, nous avons élaboré un questionnaire. La collecte d’informations, au moyen de ce questionnaire, a été faite auprès de 300 professeurs du cycle secondaire exerçant dans l’Académie Régionale d’Éducation et de Formation AREF Fès-Boulemane et le nombre des réponses reçu n’est que 115 seulement. Les données obtenues mettent en évidence un taux significatif d’application de cette approche dans plusieurs établissements d’enseignement. Les causes présentées de la non adoption de cette approche par quelques enseignants peuvent être catégorisés en plusieurs rangs : les conditions de travail, le manque de formation (initiale ou continue), conditions socioculturelles. La réussite de l’enseignement dépend étroitement du développement des ressources humaines de l’éducation et de la formation, qui commence par un perfectionnement de la formation initiale dans des centres de formation des enseignants, continue par l’autoformation et se poursuit par les formations continues.

Improving school management has become a necessity in education systems, given the constraints of current changes. This is why the development of the role of the director is placed as a priority, and this is how we are currently focusing on his continuing education. We seek to ensure that this training contributes to involving the heads of educational establishments in the process of change, and to ensuring a real transition among these actors, so that they voluntarily and effectively engage in innovation in the management of their schools. Moroccan experience shows that following continuous reform processes, decision-makers have become aware of the need to move in a managerial direction, and to consider innovation in school management and the role of the director, as a point of departure to arrive at a performance of the system. Among the tools used to achieve these objectives, continuing education for managers came first. However, the study of the field shows that this training, as conceived and delivered, could not ensure the total commitment of the heads of the educational establishments in the introduction of the desired change., L'amélioration de la gestion scolaire est devenue une nécessité dans les systêmes éducatifs vue les contraintes des changements actuels, c'est pourquoi le développement du rôle du directeur est placé en priorité et c'est ainsi qu'on mise actuellement sur la formation continue de ce dernier. On cherche à ce que cette formation contribue à impliquer les chefs des établissements scolaires dans le processus de changement et à assurer une transition réelle chez ces acteurs pour qu'ils s'engagent volontairement et effectivement dans l'innovation de la gestion de leurs écoles. L'expérience Marocaine montre que suite à des processus continus de réforme, les décideurs sont devenus conscients de la nécessité de s'orienter dans un sens managérial et de considérer l'innovation dans la gestion scolaire et le rôle du directeur comme point de départ pour arriver à une performance du systême. Parmi les outils exploités pour atteindre ces objectifs, la formation continue des directeurs est venue en premier lieu. Cependant l'étude du terrain montre que cette formation comme conçue et dispensée n'a pas pu assurer l'engagement total des chefs des établissements scolaires dans l'introduction du changement voulu.

Background The Internet Addiction Test (IAT) is the most widely used questionnaire to screen for problematic Internet use. Nevertheless, its factorial structure is still debated, which complicates comparisons among existing studies. Most previous studies were performed with students or community samples despite the probability of there being more problematic Internet use among users of specific applications, such as online gaming or gambling. Objective To assess the factorial structure of a modified version of the IAT that addresses specific applications, such as video games and online poker. Methods Two adult samples—one sample of Internet gamers (n=920) and one sample of online poker players (n=214)—were recruited and completed an online version of the modified IAT. Both samples were split into two subsamples. Two principal component analyses (PCAs) followed by two confirmatory factor analyses (CFAs) were run separately. Results The results of principal component analysis indicated that a one-factor model fit the data well across both samples. In consideration of the weakness of some IAT items, a 17-item modified version of the IAT was proposed. Conclusions This study assessed, for the first time, the factorial structure of a modified version of an Internet-administered IAT on a sample of Internet gamers and a sample of online poker players. The scale seems appropriate for the assessment of such online behaviors. Further studies on the modified 17-item IAT version are needed.

International audience; This short paper compares two approaches of the state of the art, to implement Ambient Assisted Living (AAL) systems. By com- paring the two approaches, we aim to show that combining them could lead to an improvement of the offered response of the system. It shows that it could be interesting to develop a proof-of-concept system from a combination of these approaches, as it would improve the state of the art in AAL systems.

Cutaneous neurofibromas are benign dermal tumors composed of spindle cells in a myxoid stroma containing numerous blood vessels. Here we describe 6 cases of solitary cutaneous neurofibroma showing unusually higher density of blood vessels in the stroma when compared to that of classical neurofibromas. We propose this lesion to be a new histopathological variant of neurofibroma and name it angioneurofibroma. © 2014 S. Karger AG, Basel

International university rankings are attracting growing interest among public opinion, universities and nations, which is evident in a global knowledge economy, improving the competitiveness and reputation of universities becomes an end in itself. Their public nature draws attention to concerns for excellence in higher education and seems to produce a spirit of competitiveness among universities and encourages them to perform better. The university charts show more and more the supremacy of the elite universities which are always at the top and which maintain their reputation. This article focuses on the predominant global characteristics that determine the quality and competitiveness of elite universities and suggests some strategies that universities can adopt to improve their competitiveness by drawing on the different indicators selected by the different rankings of universities., Les classements internationaux des universités suscitent un intérêt croissant parmi l'opinion public, les universités et les nations, ce qui est évident dans une économie mondiale du savoir, améliorer la compétitivité et la réputation des universités devient une fin en soi même. Leur caractêre public attire l'attention sur les préoccupations pour l'excellence dans l'enseignement supérieur et semble produire un esprit de compétitivité parmi les universités et les encourage à mieux performer. Les palmarês universitaires montrent de plus en plus la suprématie des universités d'élite qui sont toujours au top et qui maintiennent leur réputation. Le présent article met l'accent sur les caractéristiques globales prédominantes qui déterminent la qualité et la compétitivité des universités d'élite et propose quelques stratégies que les universités peuvent adopter pour améliorer leur compétitivité en s'inspirant des différents indicateurs retenus par les différents classements des universités.

Profitable use of vegetable oil by-products by anaerobic digestion The productions of vegetable oil and methyl esters of vegetable oil lead to the generation of a lot of by-products. The purpose of this work was to study an alternative solution for a profitable use of vegetable oil by-products: anaerobic digestion. The potential for anaerobic digestion of 24 by-products was studied. The results show that most of oil by-products had a good capacity for anaerobic digestion. Then, the effects of the addition of oil by-products on the behavior of one reactor treating a mixture of grass, cow manure and fruit and vegetable waste and another reactor treating household waste were investigated. Most of the by-products tested improved significantly the production of methane indicating that the addition of by-products from oil production could represent a significant financial earning for the digester operators. Discussions are in progress involving oil producers and biogas plant operators to assess the opportunity of supporting the addition of by-products from oil refining in their facilities. A first evaluation of the costs and potential benefits of by-product treatment was performed. These costs should be reviewed in line with the increased development of anaerobic digestion and the expected benefits due to the digestion of by-products.

National audience; Les salles de classes sont de plus en plus équipées de dispositifs informatiques qui permettent aux enseignants de diffuser des ressources multimédia pendant les cours. Nous avons donc d'une part des enseignants encouragés à diffuser des ressources numériques et d'autre part des élèves qui continuent principalement à prendre des notes sur des cahiers papier traditionnels. Cet article présente un prototype de logiciel de prise de notes augmentée (appelé U-Note) qui s'appuie sur la technologie des sty-los numérique Anoto pour tenter de concilier ces deux types de supports.

"This article explores the roots of the American art music tradition in the aesthetics of John Sullivan Dwight (1813-1893), the most influential writer on music in 19th century America. As a Brook Farmer and a former Unitarian minister, Dwight articulated a conception of music simultaneously endowed with deep spiritual content and social import. Steeped in the literary and musical traditions of German Romanticism, especially the works of Schiller and Beethoven, Dwight's musical Transcendentalism echoed many of Emerson's themes and contributed to fashioning the key notions that nurtured the aesthetic tradition in which Charles Ives was raised. His utopian musical anthropology turned music into a form of spiritual experience reorienting our relation to the world and thus foreshadowing the refounding of society."

Cet article a pour objectifs : • de présenter un ensemble de bonnes pratiques qui peuvent être inspirées de l'application de la norme internationale ISO 10006 (2003) : « Systêmes de management de la qualité - Lignes directrices pour le management de la qualité dans les projets », dans l'organisation et la réalisation d'une recherche universitaire, débouchant sur une matrice de 54 éléments, • d'illustrer au travers de huit bonnes pratiques la maniêre de mettre en application sur le terrain une telle approche, • de positionner ces concepts dans la stratégie qualité globale de l'institution universitaire concernée, • de suggérer l'élaboration de 3 nouvelles normes internationales en relation avec les démarches qualité en recherche., The objectives of this article are: - to present a set of good practices which can be inspired by the application of the international standard ISO 10006 (2003): "Quality management systems - Guidelines for quality management in projects", in the organization and carrying out university research, leading to a matrix of 54 elements, - to illustrate through eight good practices the way to apply such an approach in the field, - to position these concepts in the overall quality strategy of the university institution concerned, to suggest the development of 3 new international standards in relation to quality approaches in research.