Risk Factors of Inadequate Colposcopy After Large Loop Excision of the Transformation Zone: A Prospective Cohort Study

International audienceObjective: The aim of the study was to identify the risk factors of post-large loop excision of the transformation zone (LLETZ) inadequate colposcopy. Materials and Methods: From December 2013 to July 2014, a total of 157 patients who had a LLETZ performed for the treatment of high-grade intraepithelial lesion with fully visible cervical squamocolumnar junction were included. All procedures were performed using semicircular loops. The use of colposcopy made during each procedure was systematically documented. Dimensions and volume of LLETZ specimens were measured at the time of procedure, before formaldehyde fixation. All participants were invited for a follow-up colposcopy 3 to 6 months after LLETZ. Primary end point was the diagnosis of post-LLETZ inadequate colposcopy, defined by a not fully visible cervical squamocolumnar junction and/or cervical stenosis. Results: Colposcopies were performed in a mean (SD) delay of 136 (88) days and were inadequate in 22 (14%) cases. Factors found to significantly increase the probability of post-LLETZ inadequate colposcopy were a history of previous excisional cervical therapy [adjusted odds ratio (aOR) = 4.29, 95% CI = 1.12-16.37, p = .033] and the thickness of the specimen (aOR = 3.12, 95% CI = 1.02-9.60, p = .047). The use of colpos-copy for the guidance of LLETZ was statistically associated with a decrease in the risk of post-LLETZ inadequate colposcopy (aOR = 0.19, 95% CI = 0.04-0.80, p = .024) as the achievement of negative endocervical margins (aOR = 0.26, 95% CI = 0.08-0.86, p = .027). Conclusions: Although the risk of post-LLETZ inadequate colpos-copy is increased in patients with history of excisional therapy and with the thickness of the excised specimen, it could be reduced with the use of colposcopic guidance and the achievement of negative endocervical margins. L arge loop excision of the transformation zone (LLETZ) is a routine procedure worldwide, because it is the first-line treatment of high-grade intraepithelial lesion (HSIL) of the cervix. Quality criteria for optimal LLETZ include the completeness of excision with the achievement of negative margins, while producing the minimal excised volume and depth of excision to minimize subsequent obstetrical and neonatal morbidity. 1,2 Obtaining negative margins is important, because incomplete excision exposes women to a significant risk of posttreatment residual and/or recurrent disease, particularly when the lesion involves the endo-cervical canal. 3,4 However, this risk remains higher to the general female population, even when negative margins are achieved. Women who had had a LLETZ remain therefore exposed to a 3-to 4-fold increased risk of developing subsequent cervical cancer at least for 20 years. 5-8 Thus, prolonged and careful post-LLETZ follow-up is mandatory, whatsoever the margins status. For the last decade, the value of human papillomavirus testing has been demonstrated in this indication. Although a negative human papillomavirus test has now been admitted as the best test of cure for patients, colposcopy remains needed when this test is found to be positive. 9-12 Although being the key examination in this indication, the accuracy of colposcopy performed after previous excisional therapy of HSIL is however questionable because the healing process might result in changes in the appearance of the transformation zone (TZ). However, the main limitation of post-LLETZ colposcopic examination is the possibility of inadequate colposcopy due to the inability to visualize the entire TZ. Known risk factors for inadequate colposcopy include age, severity of lesion, and estrogen status of the patient. 13 However, inadequate colposcopy is also one of the main adverse effects of excisional therapies of the cervix, including LLETZ. 13 However, data on the precise risk factors for inadequate colposcopy after LLETZ are limited because most studies have focused on the sole risk of cervical stenosis without considering the position and visibility of the squamocolumnar junction. 14-17 This point is however crucial because it is clinically essential to identify how post-LLETZ inadequate colposcopy could be avoided, thus preserving the possibility for the follow-up of these women

Evolutionary Breakpoints in the Gibbon Suggest Association between Cytosine Methylation and Karyotype Evolution

Gibbon species have accumulated an unusually high number of chromosomal changes since diverging from the common hominoid ancestor 15–18 million years ago. The cause of this increased rate of chromosomal rearrangements is not known, nor is it known if genome architecture has a role. To address this question, we analyzed sequences spanning 57 breaks of synteny between northern white-cheeked gibbons (Nomascus l. leucogenys) and humans. We find that the breakpoint regions are enriched in segmental duplications and repeats, with Alu elements being the most abundant. Alus located near the gibbon breakpoints (<150 bp) have a higher CpG content than other Alus. Bisulphite allelic sequencing reveals that these gibbon Alus have a lower average density of methylated cytosine that their human orthologues. The finding of higher CpG content and lower average CpG methylation suggests that the gibbon Alu elements are epigenetically distinct from their human orthologues. The association between undermethylation and chromosomal rearrangement in gibbons suggests a correlation between epigenetic state and structural genome variation in evolution

Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies

Background: The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We established the Advanced Robotic Therapy Integrated Centers (ARTIC) network with the goal of advancing the science and clinical practice of rehabilitation robotics. The investigators hope to exploit variations in practice to learn about current clinical application and outcomes. The aim of this paper is to introduce the ARTIC network to the clinical and research community, present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies. Methods: ARTIC is a pragmatic observational study of clinical care. The database includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat® as part of their treatment. Patient characteristics, diagnosis-specific information, and indicators of impairment severity are collected. Core clinical assessments include the 10-Meter Walk Test and the Goal Attainment Scaling. Data from each Lokomat® training session are automatically collected. Results: At time of analysis, the database contained data collected from 595 patients (cerebral palsy: n = 208; stroke: n = 129; spinal cord injury: n = 93; traumatic brain injury: n = 39; and various other diagnoses: n = 126). At onset, average walking speeds were slow. The training intensity increased from the first to the final therapy session and most patients achieved their goals. Conclusions: The characteristics of the patients matched epidemiological data for the target populations. When patient characteristics differed from epidemiological data, this was mainly due to the selection criteria used to assess eligibility for Lokomat® training. While patients included in randomized controlled interventional trials have to fulfill many inclusion and exclusion criteria, the only selection criteria applying to patients in the ARTIC database are those required for use of the Lokomat®. We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses. Due to the standardization of assessments and the use of a common technology, this network could serve as a basis for researchers interested in specific interventional studies expanding beyond the Lokomat®

Qualité des fumées d'incinération de déchets evaluée par mesure de la cytotoxicité sur cellules de type macrophagique

Our work consists in developing a global bio-assay to evaluate on-line waste incineration stack gas quality. Total stack gases (gas, aerosols, particles) are sampled from the inside of the stack and flow down into an exposure chamber. Alveolar macrophage-like cells from the THP-1 monocyte strain are prepared in culture dishes that allow their contact with an atmosphere. They are maintain in close contact with incineration stack gases in the exposure chamber providing to the cell culture an humidified 37°C-regulated atmosphere, and react to the global stack gas quality. Using the comparison of exposed cells to blank cells kept in clean air, one can attribute a cytotoxicity rate to the gases. Acolorimetric method gives cell viability : yellow tetrazolium MTT salt solution is reduced into a formazan blue salt by only cells. The lower the rate, the better the quality of the stack gases. Our work shows that : testing the bio-assay on simple gases is essential in order its sensitivity to polluants which may be present in the atmosphere ; the cell response in well correlated with NO2, SO2 or HCl concentration ; cells cultured on membranes on which stack gas dusts were collected show high cytotoxicity rates ; hence the stack gas sampling must preserve dusts transported by the gases from the source tested to the reactive cells ; the cytotoxicity index is related to NO, CO, SO2 and HCl concentrations measured in stack gases, even weakly ; in addition, the index seems to be also sensitive to micropollutants which are not measured here. This global bio-assay may be a good complement to the routine controls performed on stack gases, for it can detect pollutants that physical and chemical controls does even not measureNotre objectif est de mettre en place un test qui mesure in situ la toxicité globale des fumées d'incinération de déchets. Pendant une heure, des cellules de type macrophagique sont placées au contact des fumées ; un index de cytotoxicité i.c. est calculé, en comparant la viabilité des cellules exposées a celle de cellules témoins placées à l'air pur. Les fumées sont échantillonnées dans leur totalité (gaz, aérosols, particules). Elles sont conduites vers une chambre d'exposition qui maintient les cellules dans leurs conditions de culture (37°C, humidité à saturation, 5% Co2). Les cellules sont des monocytes de la lignée thp-1. Cultivées sur des membranes qui les maintiennent à l'interface entre leur liquide nutritif et l'atmosphère environnante, elles survivent aux agressions de l'air grâce à leur équipement biochimique antioxydant. Le test de viabilité cellulaire est base sur le changement de couleur du sel de tétrazolium mtt, du jaune au violet, lors de sa réduction par les cellules viables ; ainsi, la sante globale de la population cellulaire est estimée par simple mesure colorimétrique. Les essais menés au laboratoire ou in situ révèlent : Qu’il existe une relation concentration-effet entre l'i.c. et les gaz simplesNO2, SO2 ou HCl, ainsi qu'une réponse du test face aux mélanges complexes de gaz de combustion (fumée de tabac) ; Que les cellules sont très sensibles au contact des particules ; il faut donc tenir compte de l'impact des poussières de fumées en plus de celui des gaz ; Que l'i.c. augmente lors des pics de concentrations relevés dans les fumées, mais qu'il peut aussi croitre alors qu'il n'y en a pas ; cela indique que le test est sensible aux macropolluants comme aux micropolluants. Les tests biologiques ont une grande contribution à apporter aux contrôles de qualité des effluents atmosphériques, car ils détectent la présence de polluants ou de combinaisons de polluants que l'analyse chimique ne mesure pa

Développement de TCSP sur rail et maîtrise de l'étalement urbain. : Possibilités de densification des secteurs à proximité des lignes ferroviaires dans les franges de quatre régions urbaines : Bruxelles, Milan, Paris, et Washington.

La recherche TCSP et étalement urbain Bruxelles, Paris, Milan, Washington s’appuie surquatre monographies. L’analyse porte sur quatre régions urbaines et s’appuie sur l’étude desept corridors ferroviaires. Elle s’est déployée aux trois échelles d’analyse, de la régionurbaine, du corridor ferroviaire et du quartier de gare. Le rapport de recherche comprend deuxvolumes: le premier (rapport intermédiaire de 2011) restitue les résultats de l’étude à échellede la région urbaine; le second porte sur les territoires desservis par les lignes et les quartiersde gares.A l’échelle de la région urbaine (macro), les monographies présentent les dynamiquesterritoriales; le rapport entre l’offre et la demande mobilité et les projets de transport en cours.Les enjeux régionaux en termes de mobilité sont précisés et les situations types, identifiées.L’analyse aboutit à situer les secteurs d’étude dans le contexte géographique, en devenir, del’aire métropolitaine.Une fiche de synthèse présente pour chaque région les principaux découpages institutionnelset statistiques, l’administration du territoire (acteurs, compétences respectives et modesd’interactions) et les chiffres clé sur la population, l’emploi et leur distribution dans l’espacerégional.Le présent rapport constitue le second et dernier volume du rapport de recherche. Il porte surles territoires desservis par les sept lignes étudiées et approfondit l’étude à l’échelle desquartiers de gare. Dans les trois villes européennes, les déplacements à l’échelle des corridorset la relation entre la gare et son environnement sont étudiés précisément, les gares sontclassées suivant une série d’indicateurs relatifs aux caractéristiques transport de la gare eturbaines du quartier de gare; les indicateurs retenus font l’objet d’une analyse statistiquecomparée, dans les trois villes européennes. La monographie sur Washington propose unerelecture des expériences de Transit- oriented development dans le Maryland.Le volume comprend trois parties: la première restitue l’étude territoriale aux échelles« méso » du secteur d’étude et « micro » des quartiers de gares des exemples européens ; laseconde partie concerne l’étude comparée et la dernière partie présente la cartographie desterritoires étudiés. Le cas de Washington est présenté dans son intégralité (l’analyse de larégion urbaine a été ici reprise et complétée).Après avoir rappelé les problématiques du travail réalisé (1. Questionnements), nousprésentons les contextes métropolitains et les projets étudiés (2. Situations et cas d’étude)puis les différents aspects de la démarche (3. Monographies et outils de comparaison)

The role of multiple attachments in intergenerational transmission of child sexual abuse among male victims

International audienc

Results from the Intergovernmental Panel on Climatic Change Photochemical Model Intercomparison (PhotoComp)

Results from the Intergovernmental Panel on Climatic Change (IPCC) tropospheric photochemical model intercomparison (PhotoComp) are presented with a brief discussion of the factors that may contribute to differences in the modeled behaviors of HOx cycling and the accompanying O-3 tendencies. PhotoComp was a tightly controlled model experiment in which the IPCC 1994 assessment sought to determine the consistency among models that are used to predict changes in tropospheric ozone, an important greenhouse gas, Calculated tropospheric photodissociation rates displayed significant differences, with a root-mean-square (rms) error of the reported model results ranging from about +/-6-9% of the mean (for O-3 and NO2) to up to +/-15% (H2O2 and CH2O). Models using multistream methods in radiative transfer calculations showed distinctly higher rates for photodissociation of NO2 and CH2O compared to models using two-stream methods, and this difference accounted for up to one third of the rms error for these two rates, In general, some small but systematic differences between models were noted for the predicted chemical tendencies in cases that did not include reactions of nonmethane hydrocarbons (NMHC). These differences in modeled O-3 tendencies in some cases could be identified, for example, as being due to differences in photodissociation rates, but in others they could not and must be ascribed to unidentified errors. O-3 tendencies showed rms errors of about +/-10% in the moist, surface level cases with NOx concentrations equal to a few tens of parts per trillion by volume. Most of these model to model differences can be traced to differences in the destruction of O-3 due to reaction with HO2. Differences in HO2, in turn, are likely due to (1) inconsistent reaction rates used by the models for the conversion of HO2 to H2O2 and (2) differences in the model-calculated photolysis of H2O2 and CH2O. In the middle tropospheric ''polluted'' scenario with NOx concentrations larger than a few parts per billion by volume, O-3 tendencies showed rms errors of +/-10-30%. These model to model differences most likely stem from differences in the calculated rates of O-3 photolysis to O(D-1), which provides about 80% of the HOx source under these conditions. The introduction of hydrocarbons dramatically increased both the rate of NOx loss and its model to model differences, which, in turn, are reflected in an increased spread of predicted O-3. Including NMHC in the simulation approximately doubled the rms error for O-3 concentration

La desserte ferroviaire des territoires périurbains: Construire la ville autour des gares. Bruxelles/Milan/Paris/Washington

Les faibles densités construites et la dispersion des déplacements posent de nouveaux défis. Quels transports collectifs peuvent répondre à la demande de transport quand la massification des déplacements s’avère impossible ? À quelles conditions le transport ferroviaire peut-il accompagner un développement urbain moins dispersé, plus économe en consommation de sols, d’énergie et affranchi du « système automobile » ?Anne Grillet-Aubert (Paris), Bénédicte Grosjean, Géry Leloutre (Bruxelles), Paola Pucci (Milan), Colas Bazaud, Karen Bowie (Washington) interrogent les projets de développement de transport collectif en site propre dans quatre régions urbaines : deux lignes du RER en cours de réalisation à Bruxelles, l’amélioration du service sur deux voies ferrées au sud de Milan ; le projet de Tram-train Massy-Évry en seconde couronne d’Île-de-France, et aux États-Unis le Corridor Cities Transitway et la Purple line à Washington.Un large panorama de situations territoriales présentées suivant une grille commune d’analyse permet la meilleure compréhension des enjeux, des potentialités et difficultés de mise en œuvre d’un développement urbain orienté vers le rail.Une vaste cartographie homogène et originale restitue les caractéristiques morphologiques des territoires étudiés aux trois échelles de la région urbaine, du territoire desservi par les lignes et des quartiers de gare.info:eu-repo/semantics/published

What Does Hidden Curriculum in Engineering Look Like and How Can It Be Explored?

This work in progress paper describes the initial stages of a project which aims to characterize the mechanisms of hidden curriculum (HC) in engineering and identify methods for exploring this phenomenon. To effectively study the complex nature of HC, this work brings together researchers with a range of expertise (sociology, engineering education, engineering, statistics, policy analysis, curriculum and instruction) to develop a holistic approach to explore HC in engineering. This work describes the process of gathering input from this multidisciplinary team as well as the literature to develop a mixed-method instrument and model to explore the mechanisms behind HC in engineering, a new realm in engineering education. Early findings suggest that HC may require considerations of an individual’s motivation, self-efficacy, and self-advocacy. The paper also discusses the initial stages of a vignette design used to elicit participants’ responses and reactions to the presented scenes. The vignette scenes focus on HC elements present during classroom preparation and instruction in engineering. Preliminary work on these HC elements per scene are also discussed here