Does Reverse Causality Underlie the Temporal Relationship between Depression and Crohn's Disease?

Background: Studies suggest that there is a temporal relationship between depression and Crohn's disease (CD) activity. However, these studies assumed a unidirectional relationship and did not examine the possibility of reverse causality and the risk of a spurious association due to the overlap of symptoms underlying the depression-CD relationship. We evaluated the existence of reverse causality reflected in a possible bidirectional relationship between patient-reported CD activity and an affective-cognitive dimension of depression. Methods: We studied 3307 adult volunteers with a self-reported diagnosis of CD who completed a baseline survey that included demographics, CD activity, and an affective-cognitive index of depression. Crohn's disease status and the affective-cognitive index of depression were also measured 6 and 12 months after the baseline evaluation. We used structural equation models to evaluate whether the effect of depression on future CD activity is stronger than the effect of CD activity on future depression. We calculated the likelihood that each of these hypotheses is supported by the data and calculated the likelihood ratio to provide a relative measure of which hypothesis best accounts for the data. Results: The results of the informative hypothesis testing showed the most support for the hypothesis stating that an affective-cognitive dimension of depression is a stronger predictor of patient-reported CD activity than the converse. Conclusions: The hypothesis that an affective-cognitive dimension of depression predicts patient-reported exacerbation of CD is 218 times more likely to account for the data than the converse

Microlensing as a probe of the Galactic structure; 20 years of microlensing optical depth studies

Microlensing is now a very popular observational astronomical technique. The investigations accessible through this effect range from the dark matter problem to the search for extra-solar planets. In this review, the techniques to search for microlensing effects and to determine optical depths through the monitoring of large samples of stars will be described. The consequences of the published results on the knowledge of the Milky-Way structure and its dark matter component will be discussed. The difficulties and limitations of the ongoing programs and the perspectives of the microlensing optical depth technique as a probe of the Galaxy structure will also be detailed.Comment: Accepted for publication in General Relativity and Gravitation. General Relativity and Gravitation in press (2010) 0

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. CRD42015020558

Observation of the baryonic decay B \uaf 0 \u2192 \u39bc+ p \uaf K-K+

We report the observation of the baryonic decay B\uaf0\u2192\u39bc+p\uafK-K+ using a data sample of 471 7106 BB\uaf pairs produced in e+e- annihilations at s=10.58GeV. This data sample was recorded with the BABAR detector at the PEP-II storage ring at SLAC. We find B(B\uaf0\u2192\u39bc+p\uafK-K+)=(2.5\ub10.4(stat)\ub10.2(syst)\ub10.6B(\u39bc+)) 710-5, where the uncertainties are statistical, systematic, and due to the uncertainty of the \u39bc+\u2192pK-\u3c0+ branching fraction, respectively. The result has a significance corresponding to 5.0 standard deviations, including all uncertainties. For the resonant decay B\uaf0\u2192\u39bc+p\uaf\u3c6, we determine the upper limit B(B\uaf0\u2192\u39bc+p\uaf\u3c6)<1.2 710-5 at 90% confidence level

Search for Darkonium in e+e- Collisions

Collider searches for dark sectors, new particles interacting only feebly with ordinary matter, have largely focused on identifying signatures of new mediators, leaving much of dark sector structures unexplored. In particular, the existence of dark matter bound states (darkonia) remains to be investigated. This possibility could arise in a simple model in which a dark photon (A0 ) is light enough to generate an attractive force between dark fermions. We report herein a search for a JPC ¼ 1−− darkonium state, the ϒD, produced in the reaction eþe− → γϒD, ϒD → A0 A0 A0 , where the dark photons subsequently decay into pairs of leptons or pions, using 514 fb−1 of data collected with the BABAR detector. No significant signal is observed, and we set bounds on the γ − A0 kinetic mixing as a function of the dark sector coupling constant for 0.001 < mA0 < 3.16 GeV and 0.05 < mϒD < 9.5 GeV.publishedVersio

Primary healthcare solo practices: homogeneous or heterogeneous?

Contains fulltext : 138974.pdf (publisher's version ) (Open Access)Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics. The objective of this paper is to identify different forms of solo practice and to determine the extent to which they are associated with patient experience of care. Methods. Two surveys were carried out in two regions of Quebec in 2010: a telephone survey of 9180 respondents from the general population and a postal survey of 606 primary healthcare (PHC) practices. Data from the two surveys were linked through the respondent's usual source of care. A taxonomy of solo practices was constructed (n = 213), using cluster analysis techniques. Bivariate and multilevel analyses were used to determine the relationship of the taxonomy with patient experience of care. Results. Four models were derived from the taxonomy. Practices in the "resourceful networked" model contrast with those of the "resourceless isolated" model to the extent that the experience of care reported by their patients is more favorable. Conclusion. Solo practice is not a homogeneous group. The four models identified have different organizational features and their patients' experience of care also differs. Some models seem to offer a better organizational potential in the context of current reforms

Etude comparative sur les performances et l'ergonomie de nébuliseurs dans la mucoviscidose

National audienceThis study had, as its aim, to lest twelve nebulizers (6 jet, 6 ultrasonic) which are used in the treatment of cystic fibrosis. Devices were connected to a respirator in order to mimic the Ventilation of a child and of an adult suffering from cystis fibrosis. Three medications : tobramycine, colistine and amiloride were nebulised. The volume of the recommended solution varied between 1.5 and 13 ml according to the manufacturer. During a Session of ten minutes the ultrasonic nebulizer delivered an inhaled volume which was significantly greater than the jet (2.72+-0.98 ml vs 1.22+-0.59 ml, p <0.0001) for the three drugs. Regarding granulometry, the fraction of particles between 0.5 and 5 um, was higher with ultrasonic than with pneumatic nebulizer for tobramycine (67.1+-10.7 vs 55.5+-]1.5 %. p <0.001) and amiloride (66.4+-S1.2 % vs 58. l +-15%, p <0.05 %). The Variation of concentration due to nebulisation were independent of the type of apparatus but influenced by the drug since concentration was increased for tobramycine (+10.5+-18.6 %) and amiloride (+13.4+-8/9 %). In summary the effective fraction resulting from the inhalable fraction, from granulometry and from changes in concentration was significantly greater for ultrasonic than for jet nebrulizer (17.3+-6.7 % vs 9.7+-9.6 %, p <0.001). This study underlines the great variability of the performance of aerosols generators and therefore the need for an accurate evaluation of nebulizer performances in order to prescribe the best nebulizer/drug association in clinical practice.Cette étude avait pour but de tester douze appareils d'aérosols (six pneumatiques, six ultrasoniques) utilisés dans le traitement de la mucoviscidose. Les appareils étaient connectés à un respirateur afin de simuler la ventilation d'un enfant et d'un adulte atteints de mucoviscidose. Trois médicaments : tobramycine, colistine, amiloride étaient nébulisés. Les volumes de solution préconisés variaient entre 1,5 et 13 ml selon les fabricants. Au cours d'une séance de 10 min, les nébuliseurs ultrasoniques délivrent un volume inhalable significativement plus important que les pneumatiques (2.72+-0.98 ml vs l.22-t0,59 ml, p <0.0001) pour les trois médicaments. La fraction déposable, c'est-à-dire avec une granulométrie comprise entre 0,5 et 5 µm, est plus élevée avec les ultrasoniques qu'avec les pneumatiques pour la tobramycine (67.1+-10,7 % vs 55.5+-11.5 %, p <0,001) et l'amiloride (66.4+-9.2 % vs 58.1+-15 %, p <0,05 %). Les variations de concentration dues à la nébulisation sont indépendantes du type d'appareil, mais influencées par le médicament : augmentation de concentration pour la tobramycine (+!0,5+-I8,6 %) et l'amiloride (+13,4+-8,9 %). Au total, la fraction efficace qui résulte à la fois de la fraction inhalable, de sa granulométrie et des variations de concentration est significativement supérieure pour les ultrasoniques que pour les pneumatiques (17.3+-6,7 % vs 9,7+-9.6 %, p <0,001). Cette étude souligne la grande variabilité des performances des appareils d'aérosols, ainsi que la nécessite d'avoir des tests fiables avant l'utilisation en clinique afin de prescrire la meilleure combinaison appareil/médicament