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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

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.

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

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

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

Obstructive Sleep Apnea (OSA) in children, which has a multifactorial origin, can lead, if not treated, to severe medical complications, growth disturbances, behavioural changes and reduced quality of life. Nowadays, it is underdiagnosed whereas early screening, diagnosis and interdisciplinary treatment are essential. Furthermore, many families and health professionals do not often know where to go when there is suspicion of OSA for a child. Orthodontists are uniquely positioned to screen, to refer to the appropriate specialist and to treat, if needed, patients who may be at high risk for OSA. The authors describe the synergistic means to screen, diagnose and treat paediatric OSA in a collaborative and interactive approach between ENT, orthodontists, pneumo-allergologists, sleep physicians, endocrinologists, orofacial myo-functional therapists and speech therapists. These means which are clinically illustrated in this paper fit the guidelines which have been recently published as white papers by official professional specialists organisations involved in paediatric OSA treatment (AAPD, AAO, FFO, SFORL, SFRMS…). The development of multidisciplinary teams gathering specialists who are conscious about the mutual benefits of the specialties involved in paediatric OSA should contribute to optimize the child treatment care pathway and the short, mid and long term outcomes.

International audience; Objectives: This paper aims to provide physicians with knowledge about the motivational processes surrounding exercise and diet for patients with type 2 diabetes and to offer patient support measures to favor self-management. To respond to this objective, the links between two kind of motivators (i.e., promotion and prevention foci), the Selection, Optimization and Compensation (SOC) self-management strategy, and adherence to exercise and diet of patients with type 2 diabetes were investigated for the first time in the literature.Method: A cross-sectional study was conducted with 491 French volunteer participants with type 2 diabetes diagnosed for at least 3 months (Age = 61.66 ± 9.63; BMI = 29.8 ± 5.9). Participants completed an online self-report survey measuring SOC strategy, promotion and prevention foci, and adherence to exercise and diet.Results: The main results of path and bootstrapping analysis demonstrated that promotion focus was positively related with SOC strategy (β = .69, p < .001) whereas prevention focus was not (β = −.01, ns.). On the other hand, SOC strategy was positively related with exercise (β = .20, p < .05), general diet (β = .49, p < .001), fruit and vegetable consumption (β = .27, p < .001), and spacing of carbohydrates (β = .40, p < .001), and mediated the positive link between promotion focus and these behaviors (bootstrapped 95% CI: [.11; .40], [.52; .81], [.22; .54], [.37; .70], respectively).Conclusion: This paper addresses a gap in previous research by evidencing a motivator that promotes self-management for exercise and diet among patients with type 2 diabetes. Our results suggest that physicians should privilege an interaction with patients oriented toward promotional motivation so as to favor their patients’ self-management regarding exercise and diet.

The SFBC Working Group on critical care testing describes in this paper the SFBC recommendations for the determination of maximal turnaround times (TAT) for laboratory medicine examination in emergency conditions. The table presented in a previous paper was updated, taken into account the clinical situations, as well as the emergency response capabilities of the medical laboratory. These new French recommendations must to be based to each local situation in a clinical-biological context between the physicians and the specialist in Lab Medicine.

Public health research differs from clinical epidemiological research in that its focus is primarily on the population level social and structural determinants of individual health and the interventions that might ameliorate them, rather than having a primary focus on individual-level risks. It is typically concerned with the proximal and distal causes of health problems, and their location within complex systems, more than with single exposures. Thus, epidemiological terms and concepts may have very different implications when used in the context of population health. This paper considers some key differences in relation to terms like 'population', 'baseline', 'control group' 'outcome' and 'adverse effects'. Even the concept of an 'intervention' often needs careful handling. The paper concludes that there is a need for an expanded, and more realistic use of these terms in the population health intervention research context.

In response to our social science and humanities colleagues’ paper, Rethinking Assumptions about Cancer Survivorship (Ristovski-Slijepcevic & Bell. [2014]. CONJ, 24(3), p. 166), we offer a nursing disciplinary perspective on some of the dominant messages purported to underpin cancer survivorship. We illuminate points of disjuncture within their paper, using nursing’s disciplinary lens to describe and explain the complexities inherent in the cancer survivorship experience and its implications for clinical practice. Opportunities for collaboration with our social science and humanities colleagues are outlined to foster synergistic knowledge development that will, ultimately, improve the care of those living with, through, and beyond cancer.

This paper attempts to go deeper into the topic of social competency of physicians who provide primary care to populations living in poverty in Montreal. Adaptability as well as the ability to tailor practices according to patient expectations, needs and capabilities were found to be important in the development of the concept of social competency. The case of paternalism is used to demonstrate how a historically and socially contested medical approach is readapted by players in certain contexts in order to better meet patient expectations. This paper presents data collected in a qualitative study comprising 25 semi-supervised interviews with physicians recognized by their peers as having developed exemplary practices in Montreal's impoverished neighbourhoods.

Whichever perspective you take on the “if a tree falls in the forest” question, it is certainly true that the easier a journal is to search and access, the more its content is likely to influence thinking, research and policy. With this in mind, I am happy to announce that the National Library of Medicine (NLM) recently decided to index Healthcare Policy/Politiques de Sante in its Medline database. While the journal has been indexed in the Library's PubMed Central – and CINAHL, CSA (Cambridge), Ulrich's, Embase, IndexCopernicus and Scopus, and is a partner of HINARI – for some time, this decision marks a step change in the ability to search for and access key information from the journal's articles. Citations from indexed articles, the Medical Subject Heading terms used by NLM staff to index the articles and the articles' abstracts will now be searchable in Medline. This will be true of past papers as well as future ones, as the NLM retrospectively adds previous issues of the journal to its database. Our ability to achieve this milestone is due, in large part, to the work of our strong team of volunteer editors and peer reviewers. Central to the process are the journal's editors (see page 6) who guide the path of papers through all stages of the review and publication process. I would particularly like to thank Dr. Pat Martens, who has recently concluded her role as the journal's Data Matters editor. Throughout her tenure, her insightful and helpful contributions have been much appreciated by authors, reviewers and colleagues on the editorial panel alike. Thanks are also due to our peer reviewers. We depend on their breadth of expertise, thoughtful comments and guidance, and generous contributions to improving research and policy debate to ensure the quality and relevance of the papers that we publish in the journal's pages. This year's issues had a broader range of reviewers than ever before, including experts from around the world (see page 100). I would like to take this opportunity to thank them all for their essential assistance. Would you consider becoming a reviewer to help advance scholarship and evidence-informed discussion in health policy? If so, please register for our database of potential reviewers at http://www.longwoods.com/reviewer-registration/healthcare-policy. This tool helps our editors to match papers that we send out for comment with the expertise and interests of reviewers.

To become indexed in MEDLINE has been a goal of the Canadian Journal of Hospital Pharmacy (CJHP) for as long as those of us on the Editorial Board can remember. We believe that the benefits of achieving indexing in MEDLINE are enormous. First, indexing will provide more exposure for the work of authors who publish in the CJHP. That is, authors’ articles will be more widely disseminated and more readily available to other clinicians and scientists around the world, who can then incorporate this new knowledge into their practice or build on the published work. Second, indexing will lead to more high-quality submissions. I have heard from more than a few of my academic colleagues who work in a “publish or perish” environment that they do not submit papers to the CJHP because “it is not indexed”. Once we achieve indexing status, however, authors will receive more recognition, more citations, and higher impact for their published papers and therefore will be more likely to submit their high-quality work to CJHP. Third, indexing is expected to improve the value of the Journal not only for authors but also for readers, subscribers, advertisers, and its owner, the Canadian Society of Hospital Pharmacists (CSHP), for all the reasons described above. If you have searched PubMed recently, you may have noticed that you are already able to retrieve citations of articles published in the CJHP. This is because the Journal was successful in its 2010 application for archiving in PubMed Central (PMC), the US National Institutes of Health’s free digital archive of biomedical and life sciences journal literature (www.ncbi.nlm.nih.gov/pmc/). PMC is part of the larger PubMed service, which also includes MEDLINE, the primary international online bibliographic citation database of biomedical and life sciences journal literature. PubMed now includes a link to the material that CJHP has available on the PMC site. This is great news, but PMC archiving is only one step toward indexing. That is, at the PubMed site, CJHP citations are denoted as “PubMed – in process” or “PubMed”. Only after the CJHP is indexed by the National Library of Medicine (NLM) will it say “PubMed – indexed for MEDLINE”. Currently, about 5000 journal titles are indexed in MEDLINE. The Director of the NLM decides whether or not to index a journal, on the basis of considerations of both scientific quality and policy. Specifically, the NLM’s Literature Selection Technical Review Committee (LSTRC) reviews and assesses the quality of journals, while NLM’s Board of Regents determines the mix of types of journals to be indexed, according to considerations of program relevance. In fact, our Journal was indexed in MEDLINE over the period 1975 to 1997. While the specific reasons for halting our indexing are unknown, the NLM has been known to drop currently indexed journals to accommodate new ones. In 2004, the CJHP submitted an application for indexing that was unsuccessful. Although we would have been allowed to reapply after a minimum of 3 years, the Editorial Board believed it best to hold off until we were more confident of success. As such, we have been “beefing up” the Journal, while carefully examining the NLM’s criteria for indexing and scrutinizing what it took for other journals to achieve indexing status. I would like to take this opportunity to describe some of the additional changes we are planning for the CJHP and to explain why we are advocating these changes and why we believe we can be successful in our effort to achieve indexing status. In planning for our next application for indexing (in early 2015), we have adopted the following primary goals: (1) to improve the CJHP’s scope and coverage, making the Journal more internationally relevant; (2) to continue improving the quality of the CJHP’s review articles, clinical research papers, case reports, and editorials; (3) to further improve the LSTRC’s perception of the strength and credibility of the CJHP’s Editorial Board and the Journal’s editorial independence; (4) to

There is an extensive literature discussing the care: "cure dilemma". This usually puts forward the position that it is doctors who do the curing and nurses who do the caring. Patients are rarely included in the discussion. This paper considers some of this literature and examines whether this separation of functions is a valid one, the part of lay carers in the process, and the perspective of patients. It focuses particularly on cancer because this is an area where the issues seem particularly pertinent. The paper concludes by proposing an alternative and integrated conception which includes patients, nurses and doctors in a cognitive-phenomenological model of coping. It is suggested that this model moves forward from the previous limitations of the care : cure approach and enables more fruitful research and education of practitioners to be undertaken.

Writing the history of children’experiences in exile entails exploring how children refugees have written about these experiences themselves. It is obviously a challenge to find contemporary texts by refugee children, but even when we do, we are faced with a number of methodological issues. This paper attempts to present and tackle some of those, through the study of fifteen biographical notebooks written around 1940-1941 by Spanish refugee children who lived at La Rouvière in France, in a colony created and run by the American Quakers Friends Service Committee (AFSC). These notebooks form a homogeneous, standardized series, with similar cover and title pages, and a similar structure. They were most certainly composed at the same time, and written as part of the children’s schoolwork in the colony. As much as these children’s experiences, opinions and sentiments, they thus reveal the adult requirements guiding and imposed upon children’s writings. This paper suggests a method for reading such heavily formatted children’s productions as palimpsests, i.e. as the final result of layers of writings applied on top of one another. Each layer constitutes a different narrative about refugee children: the story-writing of humanitarian aid, the Quaker tale of child relief and, finally, the narratives of children’s experiences. Écrire l’histoire des expériences enfantines de l’exil suppose de s’intéresser à la manière dont les enfants réfugiés eux-même ont pu écrire sur leurs propres expériences. Or, si la recherche de tels textes, contemporains des faits, représente manifestement un défi, leur découverte nous confronte à des problèmes méthodologiques non moins aigus. Nous tentons ici d’en présenter et d’en aborder quelques-uns, à travers l’étude de quinze cahiers biographiques écrits vers 1940-1941 par des enfants réfugiés espagnols qui vivaient à La Rouvière, en France, dans une colonié créée et gérée par les Quakers de l’American Friends Service Committee (AFSC). Ces cahiers forment une série homogène, standardisée, aux pages de couverture et de titre identiques, et à la structure narrative similaire. Ils ont très certainement été rédigés au même moment, dans le cadre du travail scolaire à la colonie. Tout autant que les expériences, les opinions et les sentiments de ces enfants, il nous révèlent donc les exigences adultes qui guidèrent et s’imposèrent aux écritures enfantines. Dans cet article, nous proposons de lire ces textes comme des palimpsestes, c’est-à-dire comme le résultat final d’une succession de couches d’écritures posées les unes sur les autres. Chaque couche constitue une narration distincte autour des enfants réfugiés : la mise en récit de l’aide humanitaire, la fable Quaker de l’aide à l’enfance et, en dernière instance, les écritures des expériences enfantines. Escribir la historia de las experiencias de los niños en el exilio conlleva explorar las formas en las que los propios niños han escrito sobre sus experiencias. Si ya es de por sí difícil encontrar textos contemporáneos escritos por niños refugiados, una vez localizados, estos plantean una seria de problemas metodológicos. Este artículo tiene como objectivo tratar algunas de estas cuestiones a través del análisis de quince cuadernos autobiográficos escritos en torno a 1940-1941 por niños refugiados españoles durante su estancia en La Rouviere, una colonia a cargo del American Quakers Friends Service Committee (ASFC) en Francia. Los cuadernos forman parte de una serie homogénea y estandarizada, con cubiertas, títulos y páginas parecidas, y estructurados de forma similar. Es casi seguro que fueron escritos en la misma éepoca y que formaron parte del trabajo escolar de los niños durante su estancia en la colonia. Al mismo tiempo que reflejan las experiencias, opiniones y sentimientos de los niños, los cuadernos dejan entrever como los requeriemientos de los adultos se yuxtaponen a los escritos infantiles. El artículo propone como método de aproximación a este material infantil tan fuertemente formateado el palimpsesto, lo que nos haría interpretar los escritos como el resultado final de varias capas narrativas yuxtapuestas. Cada capa constituiría una narrativa diferente sobre los niños refugiados: en primer lugar, el discurso de la ayuda humanitaria; en segundo lugar, la historia cuáquera de socorro infantil y, finalmente, las narrativas de las experiencias de los niños.

This systematic review aims to compare conventional corticotomy with minimally-invasive protocols (MIP). Electronic database, in MEDLINE and CENTRAL, and hand search were performed. Randomized controlled trials (RCTs) and randomized split-mouth designed studies (RSMSs) were selected for inclusion, reporting either the use of a corticotomy procedure or a MIP. The main outcomes were the rate/velocity of tooth movement, type of tooth movement observed, loss of anchorage, periodontal indexes, inflammatory mediators, root resorption, patient's pain experience, impact on the quality of life, and satisfaction. Twenty-two papers were included for the qualitative synthesis, from which ten RCTs and twelve RSMSs. Eighteen of them compared a conventional orthodontic treatment without and with a surgical adjunctive procedure, two with conventional corticotomy and sixteen with a MIP (piezocision, micro-osteoperforations (MOPs) or interseptal bone reduction). Four trials compared a surgical procedure to another one. Corticotomy, piezocision and MOPs are likely to accelerate tooth movement, in decreasing order. Pain is reported to be higher in experimental groups only on the first day after surgery. Patient satisfaction is high after surgical procedures. Loss of anchorage, periodontal indexes, or root resorption occurrence show no differences between groups. Corticotomy stands as the gold-standard procedure for surgically-assisted orthodontics, but piezocision appears as a good compromise solution as well as MOPs, in a lesser extent. MIP are known to accelerate tooth movement only during the first three months.

For high-precision mechanisms such as machine tools or gas-turbine engines, which operate at extreme conditions, it is particularly important to accurately predict the behavior of the included bearing. This prediction includes, among other things, its load distribution, stiffness, and power dissipation. Although shaft speeds tend to increase, rings and shaft walls are becoming thinner due to size and weight constraints. Thus, bearing behavior is no longer independent of the housing and ring stiffness. This paper focuses on the problem of elastic ring deformation and certain behaviors of high-speed intershaft cylindrical roller bearings such as heat dissipation, contact pressure, and risk of bearing failure due to scuffing. The paper presents an analytical method to account for the structural deformation of the rings based on Roark's formulas. The elastic deformation of thin cylindrical rings has been introduced in the set of displacement and load equations that describes the bearing equilibrium. A correla...

In order to better understand the dynamics involved in emergency food aid programs, this paper analyzes the case of Kinshasa (1992–1995). The interaction between local health personnel engaged in the programme and the—potential, legitimate, and unintended—beneficiaries of the aid is central to this paper. The classical concepts of moral hazard and adverse selection, often cited in the current literature on target poverty programs, only partly capture the reality of the situation on the ground. An intervention such as a food aid program should be judged on its capacity to open up spaces of action and negotiation to actors who traditionally occupy only marginal places in them.

At the beginning of the year (in this case, also the millennium), one is tempted either to look back or to look forward, even perhaps to make resolutions for the future. The unpredictability of the future and the uselessness of resolutions (re-solutions?) lead me to look back. The year 2000 was a good one for the Canadian Respiratory Journal, with increases in the number, quality and sources of submitted papers. Inevitably, there was also an increase in the number of rejected submissions; I offer to the authors the consolation that their papers went through a review process that I feel is truly ‘peer review’ and the hope that the quality of the work is thereby enhanced. In the face of many criticisms of peer review, I am especially concerned that the review process remains fair, and, as Editor-in-Chief, I believe that my main function is to provide a judgment that is as unbiased as I can make it. Obviously, I am deeply indebted to my reviewers, and I take this opportunity to thank them for their generous and unrewarded work. The names of the reviewers for 2000 were listed in the November/December issue of the Journal; almost without exception, they provided reviews that were timely, intelligent and constructively critical. Because of the time involved, I do not usually acknowledge them or send revised manuscripts back for their opinion; I apologize for both of these sins of omission but hope that any reader who feels that we have fallen down in this regard will blow a whistle. A sad event in June 2000 for the group in Hamilton, Ontario, was the death of a respected colleague – Dr Leo Kahana. I first knew of Dr Kahana before I arrived in Canada through an important study that he carried out in Montreal, Quebec (1). More than 25 years ago, he went to Hamilton as director of the local chest clinic and became the main consultant for tuberculosis. Later, when the provincial chest clinic was phased out, he also played a major role in the organization of the undergraduate teaching program at McMaster University, Hamilton. After the finding of a radiological abnormality in the autumn of 1999, Dr Kahana bore the investigation and treatment of a nonsmall cell lung carcinoma with quiet fortitude, and wrote an affecting short paper on his experiences as a patient (2). The paper should be required reading for everyone who looks after patients with lung cancer; less than a half-hour spent reading – followed by at least an equal amount of time spent reading between the lines – will provide the reader with invaluable insights. I will not list the insights that came to my mind as I read Dr Kahana’s paper, for this may detract from its value. There are few conditions other than cancer in which, from the patient’s viewpoint, experience falls short of expectation. Too seldom, patients tell us directly when their expectations have not been met or where we have fallen short in our professionalism. Who else but doctors as patients are capable of doing this? Through the years, a small number of papers have appeared in the literature that are written by doctors relating their experiences as patients. Usually, editors accept the papers without peer review, realizing that when it comes to personal experiences, with the pain, disability and anxiety that go with them, there can be no appropriate peer review. It is the clear and authentic expression of these experiences that makes such papers so valuable and, of course, so sad. One can only hope that readers learn the important lessons that our brave colleagues have spent their scarce time trying to impart to us. However, maybe we have to go through such experiences ourselves before we can appreciate fully what the person ‘on the other side of the desk’ is going through – another sad thought. Dr Leo Kahana has left us a valuable legacy, one that I hope will be widely read and internally digested.

Phenylketonuria is the most common inborn error of metabolism and causes irreversible mental retardation if left untreated. Its newborn screening was made possible by the technique of blood collection on filter paper developed by Robert Guthrie. Neonatal PKU screening began in France in the early 1970s. It was initially carried out by a bacteriological method, then by fluorometry, and finally, since 2020, by tandem mass spectrometry. More than 35 million newborns have been screened to date. This resulted in the diagnosis of more than 3,500 children with PKU or mild hyperphenylalaninemia. The management of these children has improved over time, in particular thanks to the techniques of biochemistry and molecular genetics which lead to an accurate diagnosis and the arrival of drug treatment by sapropterin. Thanks to this screening, which allows for early management, the prognosis of PKU has been transformed and, although neurological or behavioral problems may arise, these patients are living normally today., La phénylcétonurie (PCU) est la plus fréquente des erreurs innées du métabolisme et entraîne un retard mental irréversible en l’absence de traitement. Son dépistage néonatal a été rendu possible grâce à la technique de recueil de sang sur papier buvard mise au point par Robert Guthrie. Le dépistage néonatal de la PCU a débuté en France au début des années 1970. Il a été initialement réalisé par une technique bactériologique, puis fluorimétrique et, enfin, depuis 2020 par spectrométrie de masse en tandem. Plus de 35 millions de nouveau-nés ont été dépistés à ce jour, ce qui a permis de diagnostiquer plus de 3 500 enfants porteurs de PCU ou hyperphénylalaninémie modérée. La prise en charge de ces enfants a évolué avec le temps, en particulier grâce aux techniques de biochimie et de génétique moléculaire qui permettent un diagnostic précis et grâce à l’arrivée d’un traitement médicamenteux par saproptérine. Grâce à ce dépistage, qui permet une prise en charge précoce, le pronostic de la PCU a été transformé et, même s’il peut survenir des problèmes neurologiques ou comportementaux, ces patients ont une vie normale aujourd’hui.

Background Bayesian methods, with the predictive probability (PredP), allow multiple interim analyses with interim posterior probability (PostP) computation, without the need to correct for multiple looks at the data. The objective of this paper was to illustrate the use of PredP by simulating a sequential analysis of a clinical trial. Methods We used data from the Laryngobloc trial that planned to include 480 patients to demonstrate the equivalence of success between a laryngoscopy performed with the Laryngobloc® device and a control device. A crossover Bayesian design was used. The success rates of the two laryngoscopy devices were compared. Interim analyses, computed from random numbers of subjects, were simulated. Results The PostP of equivalence rapidly reached the predefined bound of 0.95. The PredP computed with an equivalence margin of 10% reached the efficacy bound between 352 and 409 of the 480 included patients. If a frequentist analysis had been made on the basis of 217 out of 480 subjects, the study would have been prematurely stopped for equivalence. The PredP indicated that this result was nonetheless unstable and that the equivalence was, thus far, not guaranteed. Conclusions Based on these interim analyses, we can conclude with a sufficiently high probability that the equivalence would have been met on the primary outcome before the predetermined end of this particular trial. If a Bayesian approach using PredP had been used, it would have allowed an early termination of the trial by reducing the calculated sample size by 15–20%.

En juillet 2002, l’annonce des résultats de l’étude WHI, remettait en question l’innocuité de l’hormonothérapie substitutive. L’objectif de cette recherche qualitative comparative, réalisée auprès de 28 cliniciens, est de comprendre leurs réactions aux « nouvelles » informations concernant les risques associés à l’hormonothérapie. Nous nous sommes également attachés à comprendre comment cette évolution des connaissances entourant l’hormonothérapie avait transformé le déroulement des consultations de ménopause et à voir dans quelle mesure elle a entraîné une renégociation de la confiance. La controverse entourant la publication de l’étude WHI fournit ainsi l’occasion de mieux cerner le rôle que joue le traitement hormonal au sein de la relation médecin-patient et constitue également une opportunité d’interroger la thèse de Giddens sur la portée réflexive du risque. In July 2002, the Women’s Health Initiative study raised important questions about hormonal replacement therapy (HRT). This paper, based upon a qualitative and comparative study involving 28 MDs, in France and Quebec, explores their reaction to this controversy. We have tried to understand how the publication of the WHI results has influenced the menopause consultation and whether it has resulted in a renegociation of trust within the medical encounter. This controversy is an opportunity to better understand the role prescription drugs play within the doctor-patient relationship and to question Giddens’ thesis on the reflexive nature of risk.

This paper describes the setting up of an emergency foot and mouth disease vaccine production Unit in Botswana. No major problems were experienced in producing effective vaccines against SAT 1, SAT 2 and SAT 3 types of FMD virus. The vaccines which were produced were tested in cattle, and in general the bovine Potency values were high. In the field, the vaccines were successful in eliminating outbreaks of the disease in Botswana, and in some of the neighbouring countries. Mention is made of the establishment of a permanent Vaccine Institute capable of producing 21 million doses per year.Cet article décrit la création au Botswana d'une Unité de production de vaccin anti-aphteux à utiliser en cas d'urgence. Aucun problème majeur ne s'est présenté pour la production de vaccins efficaces contre les types SAT 1, SAT 2 et SAT 3 du virus aphteux. Les vaccins produits ont été contrôlés sur bovins; d'une manière générale, les valeurs de la Puissance bovine étaient élevées. Sur le terrain, la qualité des vaccins a fait ses preuves : des foyers de la maladie ont été éliminés au Botswana et dans certains pays limitrophes. Mention est faite de la construction d'un Institut vaccinal permanent d'une capacité de production de 21 millions de doses par an.

Background Demographic changes require an adaptation of the geriatric care offer, which is readily oriented towards the community and including the development of out-of-hospital mobile geriatric team (MGT). Although psychiatric disorders of older persons require a comprehensive, integrative and multidisciplinary approach, geriatrics and old age psychiatry mobile units often work in parallel without concertation for the management of complex pathologies. The aim of this paper is to present the organisation and the results of a out-of-hospital MGT with a geriatrician and old age psychiatrists (OAP) in a same unit. Method Data were collected during the first-year (2018) of the out-of-hospital MGT of Tours University hospital. After initial geriatric assessment and when old age psychiatry (OAP) intervention was needed, referral mode and justification, patient's characteristics and recommendations made by the team were collected. Results During the study period, 151 patients were assessed, 53% (n=80) had out-of-medical follow-up or difficulties to access to healthcare; 40% (n=60) had behavioural and psychological symptoms of dementia (BPSD), 30% (n=45) falls, 15% (n=23) social problems, 10% (n=15) alteration of overall health status and 5% (n=7) drug conciliation; 40% (n=60) benefited from an OAP evaluation; 100% (n=60) had out of medical follow-up, 83% (n=50) had severe BPSD, 17% (n=10) psychological symptom with psychiatric condition, 10% (n=6) misused psychotropic medications in charge of general comorbidities decompensation; 32% (n=19) had geriatric, OAP consultations and 33% (n=20) were in denial of care; 23% (n=14) with severe BPSD had a second OAP consultation. Discussion Relationship between geriatrician and OAP in the same MGT enables to deliver comprehensive care, including organic, psychiatric and cognitive comorbidities and collaborative assessment of iatrogenicity. A strengthened relationship with general practitioners is a possible option for these frail older patients, out-of-medical follow-up allowing their reintegration in the geriatric healthcare system.

Serum proteins and urinary proteins electrophoresis are useful biological tests. They are often prescribed for the screening of monoclonal gammopathys and also during follow-up for treatment response. This test can be accredited according to standard NF ISO 15189 since laboratories use analysers and adapted reagents, but there are numerous protocols for the method validation. This paper present the results of a survey proposed in 2019 to biologists by CNBH and SFBC. The aim of this survey is to give biologists a choice among several protocols that have been positively evaluated by COFRAC.

Recommendations for visits or environment restrictions, and sometimes for food are usually well described for inpatient within HSCT unit procedures where those measures are less precise and detailed for outpatient from the discharge to the immune reconstitution achievement. The present paper main objective is to define risk patient groups depending on time, immune-suppressive drugs as well as graft-versus-host disease and immune reconstitution. We define here 3 risk patient groups and propose measures about house cleaning, pets, schools, social activities, hygiene, foods, sexual life and siblings.

International audience; Neuropathic pain is defined as pain caused by a lesion or a disease affecting the somatosensory nervous system. Development of neuropathic pain is induced by many pathophysiological mechanisms affecting pain pathways. Neuropathic pain has diverse origins, making its management difficult, hence, many patients with neuropathic pain do not receive appropriate treatment. In 2015, a revision of the Neuropathic Pain Special Interest Group's (NeuPSIG) previous recommendations, based on a systematic review and meta-analysis, evaluated the efficacy of systemic and topical treatments of neuropathic pain. Treatments lines were established using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), which allows to rate the quality of evidence and the strength of recommendations. First line treatments are gabapentin and pregabalin, noradrenalin and serotonin reuptake inhibitors and tricyclic antidepressants. Capsaicin and lidocaine patches are second line treatments, tramadol and strong opioids are third line treatments. This work also highlighted molecules with inconclusive recommendations or non-recommended pharmacological treatments based on a low quality of evidence, a lack of efficacy or a bad safety profile. The objective of this paper is to present the different treatments and to detail their mechanisms of action.

A recent paper shows that cancer patients using complementary therapies in addition to conventional treatment have distinctly worse outcomes. Analysis of the data shows that they are much more likely to refuse one component of conventional treatment: this explains the negative effects of recourse to complementary approaches and underlines the need for great caution in approving their use while ensuring correct adherence to the anti-tumour treatment.

Introduction Several regions in Canada have recently experienced sharp increases in opioid overdoses and related hospitalizations and deaths. This paper describes opioid-related mortality and disability from opioid use disorder in Canada from 1990 to 2014 using data from the Global Burden of Disease (GBD) study. Methods We used data from the GBD study to describe temporal trends (1990–2014) in opioid-related mortality and disability from opioid use disorder using common metrics: disability-adjusted life years (DALY), deaths, years of life lost (YLL) and years lived with disability (YLD). We also compared age-standardized YLL and DALY rates per 100 000 population between Canada, the USA and other regions. Results The age-standardized opioid-related DALY rate in Canada was 355.5 per 100 000 population in 2014, which was higher than the global rate of 193.2, but lower than the rate of 767.9 in the United States. Between 1990 and 2014, the age-standardized opioid-related YLL rate in Canada increased by 142.2%, while globally this rate decreased by 10.1%. In comparison with YLL, YLD accounted for a larger proportion of the overall opioid-related burden across all age groups. Health loss was greater for males than females, and highest among those aged 25 to 29 years. Conclusion The health burden associated with opioid-related mortality and disability from opioid use disorder in Canada is significant and has increased dramatically from 1990 to 2014. These data point to a need for public health action including enhanced monitoring of a range of opioid-related harms.

Nous rapportons un cas de péritonite chyleuse (PC) médicamenteuse secondaire à la lercanidipine survenant chez un patient en dialyse péritonéale continue ambulatoire (DPCA). Il s’agit d’un homme de 22 ans ayant une insuffisance rénale chronique sur néphropathie indéterminée traitée par DPCA. Le patient a présenté un liquide de drainage trouble au démarrage de la dialyse péritonéale (DP). L’arrêt de la lercanidipine a permis un éclaircissement du dialysat effluent sans récidive. La PC médicamenteuse secondaire à la lercanidipine est une complication rare en DP. C’est une forme bénigne de péritonite non infectieuse qui prête souvent à confusion avec les péritonites infectieuses. Les causes les plus fréquentes des PC sont infectieuses, obstructives et les néoplasies abdominales. Dans cet article nous discutons les étiologies des PC, de la physiopathologie et de la conduite diagnostique à tenir devant une PC secondaire à la lercanidipine. Abstract We report a case of lercanidipin-induced chylous peritonitis (CP) occurring in a patient undergoing continuous ambulatory peritoneal dialysis (CAPD), a 22-year-old male with chronic renal failure with indeterminate nephropathy.. The patient presented a turbid drainage fluid at the start of peritoneal dialysis (PD). The chyloperitoneum resolved after stopping lercanidipin without recurrence. Lercanidipin induced-chyloperitoneum is a rare complication in PD. It is a benign form of non-infectious peritonitis that can be confused with an infectious peritonitis. The most common causes of CP are infectious, obstructive and abdominal malignancy. This paper discusses the possible causes of CP, the physiopathology and the management of lercanidipin-induced chyloperitoneum., Bulletin de la Dialyse à Domicile, Vol. 1 No 1 (2018): Bulletin de la Dialyse à Domicile

Le statut acido-basique des patients en dialyse péritonéale est influencé par de multiples facteurs. L’acidose métabolique est une anomalie fréquente dans l’insuffisance rénale chronique et le traitement dialytique permet d’apporter des substances alcalines permettant le maintien d’une balance acide-base normale. Le présent travail rapporte la prévalence des troubles acido-basiques chez les patients en dialyse péritonéale et leurs associations avec les paramètres cliniques et biologiques. Il s’agit d’une étude rétrospective transversale ayant inclus l’ensemble des patients en DP enregistrés dans la base de données du RDPLF. Une acidose métabolique est retrouvée chez 20,4% des patients alors que 27,8% des patients présentaient une alcalose métabolique. Il existe une relation significative entre l’âge, l’apport protidique estimé par le nPNA et le taux de la réserve alcaline plaidant en faveur de l’influence des apports alimentaires dans le maintien d’une acidose métabolique. Une fonction rénale résiduelle faible est associée à une plus faible probabilité d’être en alcalose métabolique. Les résultats de cette étude pourraient permettre un choix individualisé du tampon du dialysat dans le but d’obtenir en permanence un statut acido-basique stable chez les patients en dialyse péritonéale. Abstract Acid-base status of patients on peritoneal dialysis is influenced by multiple factors. Metabolic acidosis is a common feature of chronic renal failure and dialysis treatment provides alkali in the dialysate in order to maintain a normal acid-base balance. This paper reports the prevalence of acid-base disorders in peritoneal dialysis patients and their associations with clinical and laboratory parameters. This is a cross-sectional retrospective study that included all PD patients registered in the RDPLF database. Metabolic acidosis was found in 20.4% of patients while 27.8% of patients had metabolic alkalosis. There is a significant relationship between age, protein intake estimated by nPNA and the level of alkaline reserve pleading in favor of the influence of dietary intakes in the maintenance of metabolic acidosis. Low residual renal function is associated with a lower probability of being in metabolic alkalosis. These results could allow an individual choice of the dialysate buffer in order to permanently obtain stable acid-base status in patients on peritoneal dialysis., Bulletin de la Dialyse à Domicile, Vol. 1 No 1 (2018): Bulletin de la Dialyse à Domicile

First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia.Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables.Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability.CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points.Le diabète touche en plus grande proportion et à un plus jeune âge la population des Premières Nations et des Métis que le reste de la population canadienne. Cet article vise principalement à évaluer l’efficacité et les scores de risque de CANRISK (Questionnaire canadien sur le risque de diabète, un outil de dépistage du diabète destiné aux Canadiens de 40 ans et plus) pour détecter la dysglycémie chez les participants issus des Premières Nations et d’origine métisse en incluant les moins de 40 ans. L’objectif secondaire de cette étude est de déterminer si une modification des seuils relatifs au tour de taille (TT) et à l’indice de masse corporelle (IMC) améliore la valeur prédictive de modèles de régression logistique lorsque les variables du questionnaire CANRISK sont utilisées pour prédire la dysglycémie.Nous avons recueilli auprès de 1479 participants métis et des Premières Nations des données provenant d’un questionnaire CANRISK autoadministré, de mesures anthropométriques et de résultats d’épreuve standard d’hyperglycémie provoquée par voie orale (HGPO). Nous avons calculé la sensibilité et la spécificité des scores CANRISK en appliquant les seuils usuels de classification des risques. Une régression logistique a été effectuée en utilisant des seuils tenant compte de l’origine ethnique pour l’IMC et le TT pour prédire la dysglycémie à l’aide des variables CANRISK.Appliqué aux résultats de l’épreuve d’HGPO, le score seuil CANRISK à 33 points a conduit à une sensibilité et une spécificité de l’outil CANRISK de respectivement 68 % et 63 % chez les 40 ans et plus, et de respectivement 27 % et 87 % chez les moins de 40 ans. L’utilisation d’un seuil inférieur, à 21 points, a fait monter à 77 % la sensibilité chez les moins de 40 ans, avec une spécificité de 44 %. Malgré la faible spécificité correspondant à ce seuil, l’augmentation de la sensibilité montre son importance à identifier les personnes à risque au sein de cette population. Après modification des seuils d’IMC et de TT, les modèles de régression logistique ont présenté une valeur prédictive comparable.L’utilisation du questionnaire CANRISK s’est révélée efficace comme première étape de dépistage du diabète chez les membres des Premières Nations et les Métis d’un large éventail d’âge au Canada, dans la mesure où le seuil CANRISK a été adapté aux moins de 40 ans, et sans que l’on constate d’amélioration différentielle en modifiant les seuils d’IMC et de TT.

Neonatal Arterial Ischemic Stroke (NAIS) affects 6-17 newborns on 100 000-birth term neonates, most of these children keeping long-term motor and cognitive impairments. Based on a literature review, the objectives of this paper are to describe motor and cognitive outcomes after a NAIS and to propose a consensual monitoring of these children to improve their management. About 30 % of children after a NAIS will develop a unilateral cerebral palsy requiring a management by a team with expertise in physical medicine and rehabilitation. Unlike adults, especially after a left NAIS, children will not present aphasia but between 50 and 90 % will present disorders of speech and language in expression and/or reception. After NAIS, the global intellectual efficiency is usually preserved except when the size of the lesion is very important or when severe epilepsy occurs. Several studies are also in favor of vulnerability in visuospatial functions. To quantify impairments, activity limitations and participation restrictions resulting from this NAIS, early and at least yearly evaluations with reliable tools must be carried out systematically until puberty. A multidisciplinary team with a longitudinal follow-up, in all the different developmental dimensions, must conduct these evaluations in term of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation. Consequences on family functioning need to be evaluate in order to help children and family coping with this event.

Summary Introduction The international ICALIC initiative aims at developing a new indirect calorimeter according to the needs of the clinicians and researchers in the field of clinical nutrition and metabolism. The project initially focuses on validating the calorimeter for use in mechanically ventilated acutely ill adult patient. However, standard methods to validate the accuracy of calorimeters have not yet been established. This paper describes the procedures for the in-vitro tests to validate the accuracy of the new indirect calorimeter, and defines the ranges for the parameters to be evaluated in each test to optimize the validation for clinical and research calorimetry measurements. Methods Two in-vitro tests have been defined to validate the accuracy of the gas analyzers and the overall function of the new calorimeter. 1) Gas composition analysis allows validating the accuracy of O2 and CO2 analyzers. Reference gas of known O2 (or CO2) concentration is diluted by pure nitrogen gas to achieve predefined O2 (or CO2) concentration, to be measured by the indirect calorimeter. O2 and CO2 concentrations to be tested were determined according to their expected ranges of concentrations during calorimetry measurements. 2) Gas exchange simulator analysis validates O2 consumption (VO2) and CO2 production (VCO2) measurements. CO2 gas injection into artificial breath gas provided by the mechanical ventilator simulates VCO2. Resulting dilution of O2 concentration in the expiratory air is analyzed by the calorimeter as VO2. CO2 gas of identical concentration to the fraction of inspired O2 (FiO2) is used to simulate identical VO2 and VCO2. Indirect calorimetry results from publications were analyzed to determine the VO2 and VCO2 values to be tested for the validation. Results O2 concentration in respiratory air is highest at inspiration, and can decrease to 15% during expiration. CO2 concentration can be as high as 5% in expired air. To validate analyzers for measurements of FiO2 up to 70%, ranges of O2 and CO2 concentrations to be tested were defined as 15–70% and 0.5–5.0%, respectively. The mean VO2 in 426 adult mechanically ventilated patients was 270 ml/min, with 2 standard deviation (SD) ranges of 150–391 ml/min. Thus, VO2 and VCO2 to be simulated for the validation were defined as 150, 250, and 400 ml/min. Conclusion The procedures for the in-vitro tests of the new indirect calorimeter and the ranges for the parameters to be evaluated in each test have been defined to optimize the validation of accuracy for clinical and research indirect calorimetry measurements. The combined methods will be used to validate the accuracy of the new indirect calorimeter developed by the ICALIC initiative, and should become the standard method to validate the accuracy of any future indirect calorimeters.

OBJECTIVERobot-guided pedicle screw placement is an established technique for the placement of pedicle screws. However, most studies have focused on degenerative disease. In this paper, the authors focus on metastatic spinal disease, which is associated with osteolysis. The associated lack of dense bone may potentially affect the automatic recognition accuracy of radiography-based surgical assistance systems. The aim of the present study is to compare the accuracy of the SpineAssist robot system with conventional fluoroscopy-guided pedicle screw placement for thoracolumbar metastatic spinal disease.METHODSSeventy patients with metastatic spinal disease who required instrumentation were included in this retrospective matched-cohort study. All 70 patients underwent surgery performed by the same team of experienced surgeons. The decision to use robot-assisted or fluoroscopy-guided pedicle screw placement was based the availability of the robot system. In patients who underwent surgery with robot guidance, pedicle screws were inserted after preoperative planning and intraoperative fluoroscopic matching. In the “conventional” group, anatomical landmarks and anteroposterior and lateral fluoroscopy guided placement of the pedicle screws. The primary outcome measure was the accuracy of screw placement on the Gertzbein-Robbins scale. Grades A and B (< 2-mm pedicle breach) were considered clinically acceptable, and all other grades indicated misplacement. Secondary outcome measures included an intergroup comparison of direction of screw misplacement, surgical site infection, and radiation exposure.RESULTSA total of 406 screws were placed at 206 levels. Sixty-one (29.6%) surgically treated levels were in the upper thoracic spine (T1–6), 74 (35.9%) were in the lower thoracic spine, and the remaining 71 (34.4%) were in the lumbosacral region. In the robot-assisted group (Group I; n = 35, 192 screws), trajectories were Grade A or B in 162 (84.4%) of screws. The misplacement rate was 15.6% (30 of 192 screws). In the conventional group (Group II; n = 35, 214 screws), 83.6% (179 of 214) of screw trajectories were acceptable, with a misplacement rate of 16.4% (35 of 214). There was no difference in screw accuracy between the groups (chi-square, 2-tailed Fisher’s exact, p = 0.89). One screw misplacement in the fluoroscopy group required a second surgery (0.5%), but no revisions were required in the robot group. There was no difference in surgical site infections between the 2 groups (Group I, 5 patients [14.3%]; Group II, 8 patients [22.9%]) or in the duration of surgery between the 2 groups (Group I, 226.1 ± 78.8 minutes; Group II, 264.1 ± 124.3 minutes; p = 0.13). There was also no difference in radiation time between the groups (Group I, 138.2 ± 73.0 seconds; Group II, 126.5 ± 95.6 seconds; p = 0.61), but the radiation intensity was higher in the robot group (Group I, 2.8 ± 0.2 mAs; Group II, 2.0 ± 0.6 mAs; p < 0.01).CONCLUSIONSPedicle screw placement for metastatic disease in the thoracolumbar spine can be performed effectively and safely using robot-guided assistance. Based on this retrospective analysis, accuracy, radiation time, and postoperative infection rates are comparable to those of the conventional technique.

Chronic lymphocytic leukemia (CLL) is the most common hematologic malignancy in France. Much progress has been made in recent years in understanding the pathophysiology of the disease, the definition of diagnostic criteria (>5 G/L of clonal B-lymphocytes), identification of prognostic criteria, including a better understanding of fragile patients, high risk patients and even more recently by the emergence of new highly effective drugs, doing discuss their place in the wide therapeutic panel we have. The treatment of patients with CLL is indicated in patients with progressive stage A, stage B or stage C. The new drugs currently available include not only the new generation of anti-CD20 monoclonal antibodies, type I (ofatumumab) or type II (obinutuzumab), Bcl-2 inhibitors (GDC-0199/ABT-199) and now the new small molecules available orally, including Bruton tyrosine kinase inhibitor (BTK) and phosphor-inositide 3-kinase (PI3K) inhibitor. The role of the biologist in monitoring a patient treated for CLL is essential, the latter to make the diagnosis of CLL, the search for prognostic factors (Binet stage, lymphocyte doubling time, looking for a 17p deletion or TP53 mutations, study of mutational profile of heavy chain genes of immunoglobulins IGHV) and biological monitoring of the different treatments. We will study in this paper the results obtained with these drugs, insisting today more than ever on the need to set up a clinical and biological complementarity to allow optimal medical management of patients with CLL. The mechanisms of actions are discussed, as well as the response criteria we should use to evaluate the effectiveness of these treatments in clinical practice.

Because nursing interventions are typically complex and dynamic, evaluating their impact upon care and care systems is a notoriously daunting challenge. Nursing organizations seeking to evaluate the impact of their efforts are frequently frustrated by the gap between the evaluation research ideal and their available resources. In this paper, we describe a practical and manageable process developed to address such an evaluation challenge. Using a three-step inquiry approach, supported by modest organizational funding and a realistic level of voluntary member time, we were able to generate a meaningful understanding of intersecting outcomes arising from the implementation of CANO/ACIO's National Strategy for Chemotherapy Administration. On the basis of our experience, we see considerable merit in both process and outcomes of this form of targeted evaluation.

Iron deficiency, due to blood loss or malabsorption, is commonly observed in geriatric practice. In elderly people, association of inflammatory diseases to iron loss makes diagnosis of absolute iron deficiency sometimes difficult. In case of inflammation, the interpretation of usual biomarkers of iron deficiency (serum ferritin, transferrin saturation, serum iron) may be difficult. The recent discovery of the role of hepcidine in the iron homeostasis, in physiological and pathological situation, contributes to better understanding of the iron regulation. The aim of this short paper is to underline some specificities of elderly iron physiology, to explain hepcidine's role in physiological and pathological situations and to propose a diagnostic approach for a better interpretation of usual biomarkers, in order to differentiate absolute iron deficiency and functional iron deficiency.

The methods for causality assessment of adverse drug reactions were developed in the 1970s and 1980s, alongside the development of pharmacovigilance. The French method is one of the earlier of these, following on from the pioneering works by Irey and Karch and Lasagna. Initially published in 1978, it was updated in 1985, and again in 2011. The main alterations to the original method are presented in tables annexed to this paper. The successive versions improved the presentation, provided more formalised definitions of the criteria for assessing causality, while at the same time ensuring the method remained easy to use. Causality assessment enables the causal link between a drug and the occurrence of an adverse reaction to be formalised and explained. It contributes to diagnosis, and to determining the action to be taken in case of an adverse drug reaction. It can contribute to the quality and the relevance of the data stored in pharmacovigilance databases.

We report in this paper the case of female patient, hypertriglyceridemia associated with milky serum and hyperglycemia have been the alarm signal of a lupus-associated pancreatitis, the confirmation of this entity was done with elevated rate of serum lipase activity. It is about a 33 years age female. She has as unique antecedent a lupus diagnosed on January of the same. The patient was admitted on august 2013 for another episode of lupus associated to the lower lamb edema with a rate of C3 at 0.4 g/L (0.82-1,93) and C4 at 0.05 g/L (0.15-0.57). One day after the beginning of the corticotherapy, the patient presented hyperthermia, ataxis and behavior troubles, epigastric and articular pains and vomiting. Biochemical tests found hyperglycemia at 38.9 mmol/L (3.9-6.1), dyslipidemia with hypertriglyceridemia at 15.7 mmol/L (0.3-1.7) and total cholesterol rate at 5.2 mmol/L (

The mild cognitive impairment (MCI) is described as an intermediate state of cognitive impairment whereby individuals present with mild clinical symptoms but with nearly normal daily living activities. These subjects do not meet the clinical criteria for dementia, yet their cognitive functioning is below what we would expect for age and education in healthy people. In the other hand, older adults are at risk for sleep disorders including obstructive sleep apnea syndrome, restless legs syndrome, REM sleep behavioral disorder and chronic insomnia, which could have an impact on cognitive functioning and are exclusion criteria for the MCI diagnosis. Moreover, REM sleep behavioral disorder represents a risk factor for the development of neurodegenerative diseases. In subjects more 65 years of age the association between chronic insomnia and cognitive changes is still debated. The main aim of this paper is to focus on identification of sleep disorders in the context of cognitive disturbances among professionals working with the elderly.

Besides the main biochemical characteristics of anti TSH-receptor antibodies, this paper points out the optimal conditions for their assays and the interpretation of results.

Artificial intelligence (IA) is the subject of much research, but also many fantasies. It aims to reproduce human intelligence in its learning capacity, knowledge storage and computation. In 2014, the Defense Advanced Research Projects Agency (DARPA) started the restoring active memory (RAM) program that attempt to develop implantable technology to bridge gaps in the injured brain and restore normal memory function to people with memory loss caused by injury or disease. In another IA's field, computational ontologies (a formal and shared conceptualization) try to model knowledge in order to represent a structured and unambiguous meaning of the concepts of a target domain. The aim of these structures is to ensure a consensual understanding of their meaning and a univariant use (the same concept is used by all to categorize the same individuals). The first representations of knowledge in the AI's domain are largely based on model tests of semantic memory. This one, as a component of long-term memory is the memory of words, ideas, concepts. It is the only declarative memory system that resists so remarkably to the effects of age. In contrast, non-specific cognitive changes may decrease the performance of elderly in various events and instead report difficulties of access to semantic representations that affect the semantics stock itself. Some dementias, like semantic dementia and Alzheimer's disease, are linked to alteration of semantic memory. We propose in this paper, using the computational ontologies model, a formal and relatively thin modeling, in the service of neuropsychology: 1) for the practitioner with decision support systems, 2) for the patient as cognitive prosthesis outsourced, and 3) for the researcher to study semantic memory.

Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper.

This paper describes a knowledge transfer experiment that has been conducted since September 2012 in Argenteuil (Val d'Oise, France). This experiment is part of an interventional research project called DeCL/C: "Knowledge translation on social and spatial inequalities: a tool to raise local awareness and mobilization to lessen cancer screening participation rate disparities': The project is carried out by health geographers from Paris Ouest University (UPO) and the National Association of Cities for Public Health (Elus, Sante Publique et Territoires, ESPT). It encompasses two main components: intervention designed to implement a knowledge co-production and transfer process among researchers, stakeholders and decision makers at various levels. This knowledge concerns social and spatial determinants of inequalities of access to breast cancer screening programmes in cities. The research is multidisciplinary (geography, sociology, political science, epistemology) and is designed to measure the impact of this knowledge co-production and transfer in terms of actions in the targeted cities (six cities in the Paris region) as well as the reduction of inequalities of access to breast cancer screening programmes. This article, based on knowledge transfer literature and an empirical experiment in Argenteuil, describes the ongoing knowledge transfer process. It also highlights Argenteuil stakeholders' and decision makers' interest in action and research. The analysis of the knowledge co-production, sharing and ownership process by local actors a e both "strategic" and "profound'

Hugo, the eleven year old protagonist of Appelfeld’s novel Blooms of Darkness (first published in Hebrew in 2006) ‘likes to listen to words’, their sounds often evokes an image in his mind. When the Nazis begin to liquidate the Ghetto, his mother smuggles him out, and leaves him at the care of her childhood friend, Mariana, a Ukrainian prostitute. When his mother turns to leave and kisses him for the last time, Hugo cannot pronounce the word ‘mother’. Language is suppressed, and with it, all of Hugo’s memories of pre-war years and of his parents. It is replaced by silences, and a new functional lexis. “Now it isn’t words that speak to him, but silence,” Appelfeld writes. “This is a difficult language, but as soon as one adopts it, no other language will ever be as effective.” In a much earlier short story, ‘Kitty’ (first published in Hebrew in the collection In the Fertile Valley, 1963), Appelfeld introduces his readers to a young Jewish girl who is hiding from the Nazis in a convent. Kitty is about the same age as Hugo, and she too is surrounded by silence and her muteness allows her to create a parallel reality. In this paper I will look closely on language, silence and the inability to use language as they are linked with the coming of age of Appelfeld’s young protagonists who find themselves in the most unspeakable reality. Hugo, le héros de onze ans du roman d’Appelfeld Pirḥe ha-afela (« Fleurs de ténèbres », publié en hébreu en 2006, traduit en français sous le titre La chambre de Mariana) « aime écouter les mots », leurs sons font souvent naître des images dans son esprit. Quand les nazis commencent à liquider le Ghetto, sa mère le confie à son amie d’enfance, Mariana, une prostituée ukrainienne. Quand elle l’embrasse pour la dernière fois, il n’arrive pas à prononcer le mot « maman ». Le langage disparaît et, avec lui, tous ses souvenirs d’enfance. Il est remplacé par le silence et par un nouveau lexique fonctionnel : « Maintenant, ce ne sont pas les mots qui lui parlent, mais le silence. » Appelfeld écrit : « C’est une langue difficile, mais une fois qu’on l’adopte, aucune autre langue n’est aussi efficace. »Dans une nouvelle écrite longtemps auparavant, « Kitty » (publiée en hébreu dans le recueil, Ba-gay ha-poreh, « Dans la vallée fertile », 1963 ; trad. française F. Rameau-Le Davay in Anthologie de la prose israélienne, textes choisis et présentés par M. Hadas-Lebel, Paris, Albin Michel, coll. « Présences du judaïsme », 1980), Appelfeld présente aux lecteurs une jeune fille juive cachée dans un couvent. Kitty a le même âge que Hugo et, comme Hugo, elle est entourée par le silence et sa mutité lui permet de créer une réalité parallèle. Cet article se propose d’examiner le langage, le silence et l’incapacité d’employer le langage dans leur rapport à la maturité des jeunes protagonistes qui se retrouvent dans une réalité insoutenable. הוגו בן האחת עשרה, גיבור הרומן "פרחי האפלה" (2006), אוהב להקשיב למילים. הן יוצרות תמונות בעיני רוחו. כשהנאצים מתחילים לחסל את תושבי הגטו, אמו מבריחה אותו לחברת ילדותה, מריאנה, זונה אוקראינית. ברגע הפרידה הוא אינו מצליח לבטא את המילה אמא. השפה נעלמת ועמה כל זיכרונות הילדות והבית של הוגו, את מקומם תופשת הדממה. בסיפור הרבה יותר מוקדם, "קיטי" (1963), הגיבורה, בת גילו של הוגו, מסתתרת מפני הנאצים במינזר. גם היא מוקפת בדממה, מה שמאפשר לה ליצור עולם מקביל. מאמר זה עוסק בקשר שבין שתיקתם של הילדים ביצירת אפלפלד ובין המציאות אותה הם חיים.