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Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period.Pediatric-onset IBD (17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification.1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/10In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

Resume Objectifs Les objectifs de cette etude etaient d’evaluer les resultats carcinologiques et fonctionnels de la laryngectomie ou pharyngo-laryngectomie totale (PLT) premiere pour cancer du larynx ou de l’hypopharynx avec extension tumorale extra-laryngee (T4), ainsi que de determiner les facteurs predictifs de ces resultats. Materiel et methodes Analyse retrospective des dossiers informatises de tous les patients ayant beneficie d’une (P)LT premiere pour un carcinome epidermoide du larynx ou de l’hypopharynx de stade T4 dans notre institution entre 2000 et 2014. Les facteurs predictifs des resultats carcinologiques et fonctionnels ont ete recherches en analyse univariee et multivariee. Resultats Au total, 63 patients (58 hommes et 5 femmes) d’âge moyen egal a 68,8 ± 9,7 ans ont ete inclus dans cette etude. Les survies globale et specifique etaient de 69 % et 80 % a 3 ans et de 56 % et 69 % a 5 ans respectivement. En analyse multivariee, le sexe feminin ( p p = 0,006) et la presence d’emboles vasculaires ( p = 0,006) avaient un impact significatif pejoratif sur la survie globale. Six mois apres la fin du traitement, 90 % des patients avaient retrouve une alimentation orale autonome et 83 % de ceux appareilles d’une prothese phonatoire avaient recupere une voix intelligible. Conclusion La (P)LT premiere reste le traitement de reference des cancers de stade T4 du larynx et de l’hypopharynx. Elle permet d’obtenir des resultats carcinologiques et fonctionnels satisfaisants.

Objective To analyze postoperative course, oncologic and functional results and prognostic factors of transoral-transcervical oropharyngeal cancer surgery without mandibulotomy, associated to radial forearm free-flap reconstruction. Material and methods Retrospective analysis of computerized medical records of all patients who underwent this type of surgery in our institution between 2004 and 2014. Predictive factors of oncologic and functional results were investigated on univariate and multivariate analyses. Results Forty-four patients (37 male, 7 female; mean age, 62.3 ± 9.3 years) were included. Three-year overall, disease-specific and recurrence-free survival was 90%, 92% and 79%, respectively. Functional scores were satisfactory (normal or slight impairment) for feeding, speech and oral opening functions in 86%, 93% and 100% of cases, respectively. ASA score ≥ III had significantly negative impact on overall survival (P = 0.005) and on feeding (P = 0.01) and speech (P = 0.01). Conclusion Transoral-transcervical oropharyngeal cancer surgery without mandibulotomy provided excellent oncologic and functional outcomes; it is an advantageous alternative to the conventional conservative transmandibular oropharyngectomy.

Objective Children with autism spectrum disorder (ASD) may benefit from medication to treat a diverse array of behaviors and health conditions common in this population including co-occurring conditions associated with ASD, such as attention-deficit/hyperactivity disorder (ADHD) and anxiety. However, prescribing guidelines are lacking and research providing national estimates of medication use in youth with ASD is scant. We examined a nationally representative sample of children and youth ages 6 to 17 with a current diagnosis of ASD to estimate the prevalence and correlates of psychotropic medication. Methods This study used data from the 2016 and 2017 National Survey of Children's Health. We estimated unadjusted prevalence rates and used multivariable logistic regression to estimate the odds of medication use in children and youth across 3 groups: those with ASD-only, those with ASD and ADHD, and those with ADHD-only. Results Two thirds of children ages 6 to 11 and three quarters of youth ages 12 to 17 with ASD and ADHD were taking medication, similar to children (73%) and youth with ADHD-only (70%) and more than children (13%) and youth with ASD-only (22%). There were no correlates of medication use that were consistent across group and medication type. Youth with ASD and ADHD were more likely to be taking medication for emotion, concentration, or behavior than youth with ADHD-only, and nearly half took ASD-specific medication. Conclusions This study adds to the literature on medication use in children and youth with ASD, presenting recent, nationally representative estimates of high prevalence of psychotropic drug use among children with ASD and ADHD.

We report on further development of terahertz systems for measuring the thicknesses of multiple films for noncontact control in art science. Analysis of time-domain data is described and the results of measurements made on ancient real painting realized on a copper substrate are presented. We also show X-Ray images and show that we can clearly differentiate the pigments and some sketches are surprisingly revealed under the painting by terahertz imaging.

In this publication, we present comparative study of the last developments of frequency modulated continuous wave (FMCW) systems in the terahertz frequency range including GaAs based systems and SiGe integrated systems.

Background Cell-seeded biomaterial scaffolds have been proposed as a future option for reconstruction of bone tissue. The ability to generate larger, functional volumes of bone has been a challenge that may be addressed through the use of perfusion bioreactors. In this study, the authors investigated use of a tubular perfusion bioreactor system for the growth and differentiation of bone marrow stromal (mesenchymal stem) cells seeded onto fibrin, a highly angiogenic biomaterial. Methods Cells were encapsulated within fibrin beads and cultured either within a tubular perfusion bioreactor system or statically for up to 14 days. Scaffolds were analyzed for osteogenic differentiation. A rodent cranial defect model (8-mm diameter) was used to assess the bone regeneration of scaffolds cultured in the bioreactor, statically, or used immediately after formation. Immunohistochemistry was used to visualize CD31 vessel density. Micro-computed tomographic imaging was used to visualize mineral formation within the defect volume. Results Tubular perfusion bioreactor system-cultured samples showed significantly greater osteodifferentiation, indicated by an increase in VEGF expression and mineral deposition, compared with statically cultured samples. Increased expression of OPN, RUNX2, VEGF, and CD90 was seen over time in both culture methods. After implantation, bioreactor samples exhibited greater bone formation and vessel density compared with all other groups. Analysis of micro-computed tomographic images showed full union formation through the greatest diameter of the defect in all bioreactor samples and the highest levels of mineralized volume after 8 weeks. Conclusion Mesenchymal stem cells encapsulated in fibrin beads and cultured in the tubular perfusion bioreactor system resulted in increased vascularization and mineralized tissue formation in vivo relative to static culture.

Characteristics of teens on the autism spectrum have been changing over the past decade, driving the need for updated statistics to provide a current picture of the population. This report presents updated statistics on indicators of demographics, disability, education, and health. For many of the indicators, we highlight the experiences of low income and minority youth, examining differences in functioning, health, and experiences by household income and race/ethnicity.

This study used nationally representative data to describe the prevalence and correlates of work experiences among high school students with autism who received special education. Four in tenstudents with autism experienced any type of work (community-based, school-sponsored, paid or unpaid) within a given year—significantly fewer than peers with and without disabilities. Rates of paid work among students with autism were comparable to students with intellectual disability (ID)but half the rate of non-special education peers. Among youth with autism, significant correlates of having work experiences included being white, parent participation in transition planning, and functional skills including navigation. Fostering a variety of early work experiences should be a key goal of disability employment policy at federal and state levels.

Water heating is a leading cause of household energy consumption and, given its capacitive nature, has been the focus of research on demand side management and grid peak load management. Despite all the existing literature on energy for water heating, very little is known about an inextricably linked key determinant of it - demand for hot water and consumption patterns thereof. Moreover, even though water heating energy demand profiles have been investigated in the past, little is known about the different energy profiles for the days of the week, and regional variance of such profiles. This paper measures and reports actual hot water demand acquired through a novel smart metering solution. The different profiles for the days of the week are evaluated, in addition to weekdays and weekend days. Finally, differences between units in peri-rural Mkhondo and the urban Western Cape are compared in terms of water demand, energy demand, and efficiency (energy in vs. energy out). The results show a striking similarity to previous work, with the exception that scheduling has led to energy demand leading water consumption. The results also show that daily routines vary significantly, and also between regions. Surprisingly, the efficiencies and consumption patterns between the regions are also stark, with the urban Western Cape using 20 % more water on an average day, and with 70.2 % efficiency vs. 45.8 % in Mkhondo.

Recent advances in smart grid technology enable new approaches to address the problem of load control for domestic water heating. Since water heaters store energy, they are well-suited to load management. However, existing approaches have focused on the electrical supply side, ignoring the obvious link between the user and the grid: individual hot water consumption patterns. This paper proposes a load spreading approach in which water heaters compete for access to the heating medium. The proposed smart grid solution takes grid load limits, real-time temperature measurements, water usage patterns, individual user comfort, and heater meta-data into consideration. The scheduler only turns on the heaters with the highest level of need, but limits the number of on heaters to ensure that the grid load stays below a set limit for a set time. The method is evaluated by simulation against various heater set temperature levels, and for various load limits, and compared with ripple control and actual consumption measured in a field trial of 34 water heaters. The proposed algorithm reduces the load from 62 kW to 20, 30, 40, and 50 kW (vs. 106 kW for full ripple control). The resulting number of unwanted cold events is fewer than for ripple control, and only slightly more than no control, while reducing the total energy by 14% from a user-optimised natural experiment.

The exquisite synchronicity of sea urchin development provides a reliable model for studying maternal proteins in the haploid egg as well as those involved in egg activation, fertilization and early development. Sea urchin eggs are released by the millions, enabling the quantitative evaluation of maternally stored and newly synthesized proteins over a range of time (seconds to hours post fertilization). During this window of development exist many hallmark and unique biochemical interactions that can be investigated for the purpose of characterizing profiles of kinases and other signaling proteins, manipulated using pharmacology to test sufficiency and necessity, for identification of post translational modifications, and for capturing protein-protein interactions. Coupled with the fact that sea urchin eggs and embryos are transparent, this synchronicity also results in large populations of cells that can be evaluated for newly synthesized protein localization and identification through use of the Click-iT technology. We provide basic protocols for these approaches and direct readers to the appropriate literature for variations and examples.

Cognitive-behavioral approaches have been successfully modified to treat anxiety in cognitively able children and early adolescents on the autism spectrum; however, very few studies have examined modified programs for anxiety and depression in older adolescents and young adults. This key developmental period of emerging adulthood may be a particularly challenging time for individuals on the spectrum due to a number of factors, including the development of psychiatric disorders. Anxiety disorders and depression, which often co-occur with ASD, can impede coping and resilience and thus may be particularly important targets for intervention. Given the limited research on CBT for emerging adults on the autism spectrum, the present article is largely conceptual in nature. We provide an overview of the factors contributing to vulnerability during the transition to adulthood and the limited research regarding the prevalence and psychosocial treatment of anxiety and depression in adults with ASD. Drawing from clinical experience and the literature, we then highlight the unique challenges of adapting CBT for cognitively able emerging adults on the autism spectrum relative to children and adolescents. Potential modifications are offered, but further research will be needed to establish an empirically supported approach.

The importance of vascularization in the field of bone tissue engineering has been established by previous studies. The present work proposes a novel poly(propylene fumarate) (PPF)/fibrin composite scaffold for the development of vascularized neobone tissue. The effect of prevascularization (i.e., in vitro pre-culture prior to implantation) with human mesenchymal stem cells (hMSCs) and human umbilical vein endothelial cells (HUVECs) on in vivo vascularization of scaffolds was determined. Five conditions were studied: no pre-culture (NP), 1 week pre-culture (1P), 2 week pre-culture (2P), 3 week pre-culture (3P), and scaffolds without cells (control, C). Scaffolds were implanted subcutaneously in a severe combined immunodeficiency (SCID) mouse model for 9 days. During in vitro studies, CD31 staining showed a significant increase in vascular network area over 3 weeks of culture. Vascular density was significantly higher in vivo when comparing the NP and 3P groups. Immunohistochemical staining of human CD-31 expression indicated spreading of vascular networks with increasing pre-culture time. These vascular networks were perfused with mouse blood indicated by perfused lectin staining in human CD-31 positive vessels. Our results demonstrate that in vitro prevascularization supports in vivo vascularization in PPF/fibrin scaffolds.

In 2013/2014 (Year 1) and 2014/2015 (Year 2) at Ashley Dene, Canterbury, New Zealand, sheep grazing dryland lucerne monocultures were supplemented with barley grain. In neither year did barley grain supplementation improve lamb growth rates. In 2013/2014 total liveweight (LWt) production of lambs was 782 ± 11.5 kg LWt/ha between 3/9/2014 and 3/2/2015 when pastures were destocked. However, ewes with continuous access to barley grain gained 12.4 kg LWt/ha over the lactation period compared with those without access to grain that lost 14.0 kg LWt/ha. In 2014/2015 (Year 2), liveweight production of lambs totalled 408 ± 1.0 kg LWt/ha from those with no access to grain and 382 ± 1.0 kg LWt/ ha from those with grain supplementation. Upon restocking with weaned lambs, each lamb with access to grain gained 154 ± 9.8 g/d which was less than those without grain access (188 ± 9.7 g/d). Sheep ingested 25-83 g/d of grain with ad lib feeding. These results support previous literature that suggests liveweight responses from grain supplementation of sheep are inconsistent. Keywords: alfalfa, Medicago sativa, Hordeum vulgare, feed conversion efficiency

Employment outcomes for transition-age youth with autism spectrum disorder (TAY-ASD) following Vocational Rehabilitation (VR) services declined between 2002 and 2011; although a few states showed significant progress. We examined inter-state variation in VR service use and outcomes among TAY-ASD in 2014-2016, finding significant differences in the percentage of TAY-ASD who received VR services, entered VR services during secondary school, had timely development of an employment plan, and were employed at VR exit. Inter-state differences remained significant after adjusting for the influence of individual-level demographics and state-level unemployment and fiscal capacity, suggesting other factors influence variation. Future research should monitor whether changes in the VR program, via the 2014 Workforce Innovation and Opportunity Act, move the needle on VR outcomes for TAY-ASD.

We report on further development of terahertz systems for measuring the thicknesses of multiple films for noncontact control in heritage science. We provide the analysis of time-domain data regarding to the measurements conducted on an ancient painting. The piece of art is made of a varnish layer deposited on the painting. The substrate is a copper plate. We specially focus on the dielectric characterization of the varnish layer. THz-images are also reported here.

Art conservation terahertz (THz) diagnostics is an increasing field since THz imaging systems are commercially available. Since most of these experiment are done using femtosecond laser base time domain systems, we present in this paper how we can use frequency modulated continuous wave system to evaluate painting during restoration process.

International audience; There is a growing need for evaluation tools allowing the quantification of the outcome after voice surgeries. Since the end of the 1990s, multiple unfruitful attempts have been made to reach a consensus, including the Dejonckere protocol for the European Laryngological Society in 2001. This suggested to perform objective and quantifiable measures in the following domains: perception, acoustic, aerodynamic, self-evaluation by the patient and videolaryngostroboscopy. But in a PubMed® search with the keywords “Voice Assessment” and “Voice Outcome” since 2001 retrieving 452 articles, only 33 of them were using methods taking into account the first four dimensions proposed by Dejonckere. To elaborate a new and simpler protocol, we chose to focus on unilateral vocal fold paralyses (UVFP), which represents a homogeneous disease in terms of physiology. This protocol was elaborated on the basis of a review of the literature and of the database and experience of the IFOS panel members. In summary, our group recommends the use and implementation of the ELS “basic protocol” with some minor modifications. Voice audio recordings are an indispensable prerequisite, and may even have medico-legal implications. We recommend the systematic use of the Voice Handicap Index (VHI). Perceptual analysis must be performed by using Hirano's GRB scale and voice breathiness has to be prioritized. Currently, acoustic analysis remains optional given the lack of data to support clinical usefulness. Aerodynamic studies should include at a minimum an evaluation of the Maximum Phonation Time, calculated in seconds following multiple trials in order to obtain a recording representing the patient's best possible glottis closure.

Employment outcomes for transition-age youth with autism spectrum disorder (TAY-ASD) following Vocational Rehabilitation (VR) services declined between 2002 and 2011; although a few states showed significant progress. We examined inter-state variation in VR service use and outcomes among TAY-ASD in 2014-2016, finding significant differences in the percentage of TAY-ASD who received VR services, entered VR services during secondary school, had timely development of an employment plan, and were employed at VR exit. Inter-state differences remained significant after adjusting for the influence of individual-level demographics and state-level unemployment and fiscal capacity, suggesting other factors influence variation. Future research should monitor whether changes in the VR program, via the 2014 Workforce Innovation and Opportunity Act, move the needle on VR outcomes for TAY-ASD.

The resource-constraint energy sector faces an insatiable demand for energy, which necessitates improvements in efficiency. One key sector that has potential for savings is residential water heating, which makes up 32% of household energy. Previous studies have proven that with effective scheduling up to 29% savings can be achieved for a nominal consumption pattern. The model that was used to estimate the savings, calculates the energy usage for a given hot water consumption pattern and given heating schedule for a horizontally mounted water heater. This two-node model is used to aid user-informed scheduling and auto- scheduling, but was developed as a black-box model, validating the energy and not the internal temperatures, which could be misleading. This paper evaluates the accuracy of the model by performing temperature measurements inside the horizontal electric water heater. Moreover, two aspects neglected by the model are investigated: The node state transfer usage threshold, and the inter-nodal thermal resistance. The results show that the model significantly underestimates the stratification that occurs naturally. This underestimation also severely affects the modelled energy consumption and hides limitations of the model, preferring a lower threshold and higher inter-nodal resistance. The results also show that Legionella growth in the EWH could be a concern despite a high set point.

The interaction of wakes generated by a fan with the outlet guide vanes occurring at the blade-passing frequency and its harmonics is mainly responsible for aeroengine tonal noise emission in approach conditions. Conventional rotor–stator interaction models assume axisymmetric rows and quasi-annular ducts. However, the stator of new engines is characterized by nonidentical vanes (so-called heterogeneous outlet guide vane) and integrates two internal bifurcations up to the nacelle outlet. These new technologies invalidate the existing tools adopted by engine manufacturers at the design stage. For this reason, hybrid methodologies based on a three-dimensional unsteady Reynolds-averaged Navier–Stokes simulation considering the complete geometry of a modern Snecma engine model are investigated in this paper. Unsteady Reynolds-averaged Navier–Stokes simulation output data are postprocessed using different integral methods to assess the impact of the heterogeneity on angular mode distribution (compared to an id...

A subset of bacterial pathogens, including the zoonotic Brucella species, are highly resistant against polymyxin antibiotics. Bacterial polymyxin resistance has been attributed primarily to the modification of lipopolysaccharide; however, it is unknown what additional mechanisms mediate high-level resistance against this class of drugs. This work identified a role for the Brucella melitensis gene bveA ( BMEII0681 ), encoding a predicted esterase, in the resistance of B. melitensis to polymyxin B. Characterization of the enzymatic activity of BveA demonstrated that it is a phospholipase A1 with specificity for phosphatidylethanolamine (PE). Further, lipidomic analysis of B. melitensis revealed an excess of PE lipids in the bacterial membranes isolated from the bveA mutant. These results suggest that by lowering the PE content of the cell envelope, BveA increases the resistance of B. melitensis to polymyxin B. BveA was required for survival and replication of B. melitensis in macrophages and for persistent infection in mice. BveA family esterases are encoded in the genomes of the alphaproteobacterial species that coexist with the polymyxin-producing bacteria in the rhizosphere, suggesting that maintenance of a low PE content in the bacterial cell envelope may be a shared persistence strategy for association with plant and mammalian hosts.

Many adults with autism have a difficult time achieving employment, continued education, and independent living. This report explores the experiences of adults with ASD who used services funded through state Developmental Disability (DD) agencies in 2014-15. We learn more about their characteristics, the quality of their lives, the opportunities they have to participate in their communities, their ability to exercise choice in their lives, and their access to needed services.

Paintings of individuals or collections undergo aging over time. The work of art restorers consists of repairing these defects using techniques that respect the history of the work. Ultraviolet, infrared and visible light and X-rays are well known techniques for analyzing these defects, but Terahertz is also increasingly used. Several works have shown that it is possible to detect hidden layers and various defects via terahertz pulses. In a previous work, we have shown that it is possible to use terahertz radiation to detect defects in the context of a restoration of a painting with a speed increase compared to time domain imaging.

Studying the phenomenon of cellular senescence has been hindered by the lack of senescence-specific markers. As such, detection of proteins informally associated with senescence accompanies the use of senescence-associated β-galactosidase as a collection of semiselective markers to monitor the presence of senescent cells. To identify novel biomarkers of senescence, we immunized BALB/c mice with senescent mouse lung fibroblasts and screened for antibodies that recognized senescence-associated cell-surface antigens by FACS analysis and a newly developed cell-based ELISA. The majority of antibodies that we isolated, cloned, and sequenced belonged to the IgM isotype of the innate immune system. In-depth characterization of one of these monoclonal, polyreactive natural antibodies, the IgM clone 9H4, revealed its ability to recognize the intermediate filament vimentin. By using 9H4, we observed that senescent primary human fibroblasts express vimentin on their cell surface, and MS analysis revealed a posttranslational modification on cysteine 328 (C328) by the oxidative adduct malondialdehyde (MDA). Moreover, elevated levels of secreted MDA-modified vimentin were detected in the plasma of aged senescence-accelerated mouse prone 8 mice, which are known to have deregulated reactive oxygen species metabolism and accelerated aging. Based on these findings, we hypothesize that humoral innate immunity may recognize senescent cells by the presence of membrane-bound MDA-vimentin, presumably as part of a senescence eradication mechanism that may become impaired with age and result in senescent cell accumulation.

International audience; Art painting diagnostic is commonly performed using electromagnetic waves at wavelengths from terahertz to X-ray. These former techniques are essential in conservation and art history research, but they could be also very useful for restoring artwork. While most studies use time domain imaging technique, in this study, a painting has been investigated using both time domain imaging (TDI) and frequency-modulated continuous wave (FMCW) system in the millimeter frequency range. By applying these systems to a painting of the eighteenth century, we detect and analyze the structure of some defects. This study underlines the differences between FMCW and TDI. We present the advantages and disadvantages of each technique on a real artwork.

In practice cattle may be slaughtered at different combinations of age and weight. As each of these factors could affect meat quality traits, the present work aimed to identify which combination can be expected to increase overall meat quality of m. rectus abdominis of Charolais heifers. Totally, 40 heifers were slaughtered either at 26 +/- 1 or at 36 +/- 1 months of age. Young heifers were sampled at two different carcass weights (349 +/- 12 and 394 +/- 8 kg). Old heifers were also sampled at two different carcass weights (397 +/- 6 and 451 +/- 9 kg). The m. rectus abdominis was excised 24 h postmortem to determine metabolic enzyme activities, myosin heavy-chain isoform proportions, lipid contents, collagen content and collagen solubility. Shear force measurements were evaluated on raw and broiled meat after 14 days of ageing. Meat quality traits scored between 0 and 10 by sensory analysis. Increasing slaughter age from 26 to 36 months had no impact on either raw/broiled shear force (0.31

Poly (lactic-co-glycolic acid) (PLGA)-based materials are widely investigated for drug delivery and tissue engineering applications. Despite their popularity the genotoxic potential of PLGA has not been investigated. In this study, the comet assay, a sensitive assay for DNA damage, was used to evaluate potential genotoxicity in model cell types exposed to PLGA microspheres. Human umbilical vein endothelial cells (HUVECs) and mesenchymal stem cells (MSCs) cells were exposed to PLGA microspheres (0.4-6 mg/mL) and DNA damage assessed at 24 h, 4 days, and 7 days. DNA damage was not identified after 24 h. However, after 4 and 7 days of exposure to 2 and 6 mg/mL of PLGA microspheres a significant elevation of DNA damage in both cell types was observed. The PLGA microspheres did not exhibit any cytotoxic effects on the cells under the conditions tested. Our results suggest that PLGA may have a genotoxic effect on cells. A broader investigation of the PLGA genotoxic profile in biological systems is needed. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 284-291, 2017.

Evaluer et ameliorer le delai de realisation de la TDM cerebrale initiale des patients traites par anticoagulants et victimes d’un traumatisme crânien. Nous avons realise une evaluation des pratiques professionnelles. Elle s’est deroulee en trois phases : une periode d’audit clinique, puis une phase de formation, avant la reevaluation. Les patients de plus de 18 ans traites par anticoagulants et victimes d’un traumatisme crânien etaient inclus. Nous avons mesure le delai entre la prise en charge par l’infirmiere organisatrice de l’accueil et la realisation de la TDM cerebrale sans injection. La phase de formation a consiste en une presentation des recommandations de la SFMU. Un algorithme de prise en charge a egalement ete edite. A la phase « avant », 40 patients etaient inclus entre le 5 mars et le 25 avril 2013. Quarante et un patients ont ete inclus entre le 16 juillet et le 22 aout 2013 lors de la phase « apres ». La proportion de patients ayant beneficie d’une TDM en moins d’une heure est passee de 40 % (n = 16) a 71 % (n = 29) [p = 0,007]. La mediane de delai etait amelioree, passant de 89 minutes (IQR : 35–125) a 43 minutes (IQR : 26–66) [p = 0,01]. Nous avons ameliore la proportion de patients sans saignement intracrânien a la TDM initiale, ayant beneficie d’une TDM de controle a 24 heures du traumatisme. Elle passait de 21 (7/34) a 65 % (24/37) (p < 0,001). A l’issue d’une periode de formation, nous avons ameliore la prise en charge des patients traites par anticoagulants victimes d’un traumatisme crânien.

The effect of grazing date and time of spraying with a glyphosate/atrazine herbicide combination on a threeyear- old lucerne stand was studied on-farm in Central Otago. Total annual dry matter (DM) yield was highest in the weedy unsprayed control (14.8 t DM/ha) and lowest in the crop sprayed on 18 September (10.1 t DM/ ha). However, lucerne DM yield was highest from the 3 July and 22 August spray treatments (11.4 ± 0.39 t DM/ ha) and lowest in the unsprayed control at 7.7 t DM/ha. Phytotoxicity symptoms of glyphosate on the lucerne tended to be limited to crops sprayed on 18 September. To maximise yield, a winter clean-up grazing (June) followed by a winter herbicide application (July/August) when lucerne was approximately 3 cm high and with

Objectives The aims of this study were to assess oncologic and functional outcome in primary total laryngectomy or pharyngolaryngectomy (TL/TL/TPL) for laryngeal or hypopharyngeal cancer with extra-laryngeal extension (T4) and to determine the predictive factors of these results. Material and methods A retrospective analysis was performed on the computerized medical records of all patients undergoing primary TL/TPL for T4 larynx or hypopharynx squamous cell carcinoma between 2000 and 2014 at our institution. Predictive factors of oncologic and functional outcome were investigated on univariate and multivariate analysis. Results Sixty-three patients (58 men, 5 women; mean age, 68.8 ± 9.7 years) were included. Overall and disease-specific survivals were 69% and 80% at 3 years, and 56% and 69% at 5 years, respectively. On multivariate analysis, gender (female, P P = 0.006) and vascular embolism ( P = 0.006) had significant pejorative impact on overall survival. Six months after end of treatment, 90% of patients had recovered independent oral feeding and 83% of those with tracheoesophageal voice prostheses had recovered an intelligible voice. Conclusion Primary TL/TPL remains the gold standard treatment for T4 larynx or hypopharynx cancer. It provides satisfactory oncologic and functional outcomes.

BACKGROUND AND PURPOSE: Despite a recent resurgence, intravoxel incoherent motion MRI faces practical challenges, including limited SNR and demanding acquisition and postprocessing requirements. A simplified approach using linear fitting of a subset of higher b-values has seen success in other organ systems. We sought to validate this method for evaluation of brain pathology by comparing perfusion measurements using simplified linear fitting to conventional biexponential fitting. MATERIALS AND METHODS: Forty-nine patients with gliomas and 17 with acute strokes underwent 3T MRI, including DWI with 16 b-values (range, 0–900 s/mm(2)). Conventional intravoxel incoherent motion was performed using nonlinear fitting of the standard biexponential equation. Simplified intravoxel incoherent motion was performed using linear fitting of the log-normalized signal curves for subsets of b-values >200 s/mm(2). Comparisons between ROIs (tumors, strokes, contralateral brain) and between models (biexponential and simplified linear) were performed by using 2-way ANOVA. The root mean square error and coefficient of determination (R(2)) were computed for the simplified model, with biexponential fitting as the reference standard. RESULTS: Perfusion maps using simplified linear fitting were qualitatively similar to conventional biexponential fitting. The perfusion fraction was elevated in high-grade (n = 33) compared to low-grade (n = 16) gliomas and was reduced in strokes compared to the contralateral brain (P < .001 for both main effects). Decreasing the number of b-values used for linear fitting resulted in reduced accuracy (higher root mean square error and lower R(2)) compared with full biexponential fitting. CONCLUSIONS: Intravoxel incoherent motion perfusion imaging of common brain pathology can be performed by using simplified linear fitting, with preservation of clinically relevant perfusion information.

The potent phagocytic and microbicidal activities of neutrophils and macrophages are among the first lines of defense against bacterial infections. Yet Staphylococcus aureus is often resistant to innate immune defense mechanisms, especially when organized as a biofilm. To investigate how S. aureus biofilms respond to macrophages and neutrophils, gene expression patterns were profiled using Affymetrix microarrays. The addition of macrophages to S. aureus static biofilms led to a global suppression of the biofilm transcriptome with a wide variety of genes downregulated. Notably, genes involved in metabolism, cell wall synthesis/structure, and transcription/translation/replication were among the most highly downregulated, which was most dramatic at 1 h compared to 24 h following macrophage addition to biofilms. Unexpectedly, few genes were enhanced in biofilms after macrophage challenge. Unlike coculture with macrophages, coculture of S. aureus static biofilms with neutrophils did not greatly influence the biofilm transcriptome. Collectively, these experiments demonstrate that S. aureus biofilms differentially modify their gene expression patterns depending on the leukocyte subset encountered.

A conducting drop in partial wetting regime, placed on the lower electrode of a parallel-plate capacitor and surrounded by a dielectric fluid, is considered. The drop, initially flattened by gravity, is elongated by the electrostatic force and possibly lifts-off when a uniform DC electric field is applied. The electrostatic force and the lift-off condition were calculated in two previous articles, respectively, for undeformable and for slightly deformable drops in the absence of gravity (zero Eotvos number). In this paper, numerical models are put to work to study accurately the complex lift-off process resulting from the competition between gravitational, electrical and capillary forces. Large deformations of the drop surface at any value of the Eotvos number may be addressed by such a numerical procedure. Computational results allow assessing the accuracy and limits of previous analytical and asymptotic relations.

Background Developmental disorders, including autism spectrum disorders (ASDs), are increasing in prevalence. Early identification is necessary for early intervention, which is critical for reducing challenges and lifetime costs, especially for ASDs. Because not all children have equal access to developmental and autism screening through primary care settings, nontraditional methods are needed to reach underserved populations. Purpose In this proof-of-concept study, the 2-1-1 Los Angeles County Developmental Screening Project (2-1-1 LA Project) provided developmental and autism screening by telephone in a population of low-income and racially and ethnically diverse children. Methods Aggregate data were reviewed for 2845 children who were screened for developmental delays using the Parents' Evaluation of Developmental Status (PEDS) instrument and/or autism using the Modified Checklist for Autism in Toddlers (M-CHAT) instrument between September 1, 2009, and October 31, 2011. Results Data analysis was conducted December 2011 through February 2012. A majority of children (56%) screened with the PEDS had a moderate to high risk of developmental delays, including 28.2% classified as high-risk, which indicates need for further evaluation. Among 1605 children screened with the M-CHAT, 21.2% had an elevated risk of ASDs. Follow-up care coordination was provided for 2625 children to facilitate completion of referrals for diagnostic evaluation, early childhood education, and other developmental or behavioral needs. Conclusions The project's approach enhanced access to screenings and referral uptake in a population of children that may have difficulty accessing primary care. Findings suggest the potential of nontraditional developmental screening models.

Background Callers to 2-1-1 have greater need for and lesser use of cancer control services than other Americans. Integrating cancer risk assessment and referrals to preventive services into 2-1-1 systems is both feasible and acceptable to callers. Purpose To determine whether callers will act on these referrals. Methods In a randomized trial, 2-1-1 callers ( n =1200) received standard service and those with at least one cancer risk factor or need for screening were assigned to receive verbal referrals only, verbal referrals + a tailored reminder mailed to their home, or verbal referrals + a telephone health coach/navigator. All data were collected from June 2010 to March 2012 and analyzed in March and April 2012. Results At 1-month follow-up, callers in the navigator condition were more likely to report having contacted a cancer control referral than those receiving tailored reminders or verbal referrals only (34% vs 24% vs 18%, respectively; n =772, p Conclusions Given the extensive reach of 2-1-1s and the elevated risk profile of their callers, even modest response rates could have meaningful impact on population health if proactive health referrals were implemented nationally.