Longitudinal Effects of Medical Comorbidities on Functional Outcome and Life Satisfaction After Traumatic Brain Injury: An Individual Growth Curve Analysis of NIDILRR Traumatic Brain Injury Model System Data

Objective: To explore associations of specific physical and neuropsychiatric medical conditions to motor and cognitive functioning and life satisfaction over the first 10 years following traumatic brain injury (TBI). Setting: Telephone follow-up through six TBI Model System centers. Participants: 404 individuals or proxies with TBI enrolled in the TBI Model System longitudinal study participating in 10 year follow-up. Design: Individual growth curve analysis. Main Measures: FIM™ Motor and Cognitive subscales, Life Satisfaction Scales, Medical and Mental Health Co-Morbidities Interview. Results: Hypertension, diabetes, cancers, rheumatoid arthritis, and anxiety negatively affected the trajectory of motor functioning over time. Diabetes, cancers, chronic bronchitis, anxiety, and depression negatively impacted cognitive functioning. Numerous neuropsychiatric conditions (sleep disorder, alcoholism, drug addiction, anxiety, panic attacks, PTSD, depression, bipolar disorder), as well as hypertension, liver disease, and cancers diminished life satisfaction. Other medical conditions had a negative effect on functioning and satisfaction at specific follow-up periods. Conclusion: Natural recovery after TBI may include delayed onset of functional decline or early recovery followed by progressive deterioration and is negatively affected by medical comorbidities. Results contribute to the growing evidence that TBI is most appropriately treated as a chronic medical condition complicated by a variety of comorbid conditions

Prevalence of Medical and Psychiatric Comorbidities Following Traumatic Brain Injury

Objective: To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to, or up to 10 years following, traumatic brain injury (TBI) requiring acute rehabilitation. Design: Retrospective cohort. Setting: Six TBI Model Systems centers. Participants: 404 participants in the TBI Model System National Database who experienced TBI 10 years prior. Interventions: Not applicable. Main Outcome Measure: Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity. Results: At 10 years post-injury, the most common comorbidities developing post-injury, in order, were: back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those less than 50 years, diabetes (OR = 3.54; p = 0.0016), high blood cholesterol (OR = 2.04; p = 0.0092), osteoarthritis (OR = 2.02; p = 0.0454), and hypertension (OR = 1.84; p = 0.0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; p = 0.0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders. Conclusions: People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span

Peanut‐induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry

Background Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. Results 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). Conclusions The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Réformer le système fiscal au Liban : une équation impossible?

The major issues discussed in this thesis revolve mainly around the proposition of critical political, economic, and cultural reforms that might affect the tax compliance of the Lebanese taxpayers. After the shadow economy in Lebanon has been estimated and after the bribe's impact on tax evasion and economic growth has been analyzed, optimal institutions were suggested to confront tax evasion. This thesis consists of three chapters. Chapter 1 estimates the shadow economy in Lebanon by applying the monetary approach. The shadow economy was estimated at 36.61% of the GDP in 2018. Also, it was revealed that the tax evasion's share of the shadow economy hit 30.04% in 2018. It must be noted that shadow economy forecasts were presented for the year 2020. This chapter also presents the multiples factors amplifying this phenomenon in Lebanon and proposes several elements that can limit its growth. For instance, it was shown that the control of the tax evasion might increase the GDP and reduce the shadow economy. Chapter 2 introduces the bribe paid by the tax evaders to corrupted tax auditors, in a capital accumulation model to study its impact on the tax evasion decision and the economic growth. It was shown that the fiscal policy adopted by the government is the key factor defining the taxpayer behavior not the bribe. Moreover, it was proven that the bribe reduces both the individuals' capital accumulation and the government's public resources. This fact will lead to smaller economic growth, depending on capital accumulation. Besides, it was demonstrated that a productive government's budget is a significant factor in the economic growth for a high tax rate. However, the individuals' capitals are the guiding factor of economic growth for a low tax rate. Chapter 3 suggests an optimal aspect of the institutional design that might reduce fiscal fraud in Lebanon. It was revealed that optimal institutional design results in a higher tax collection and an increase in the state's income. Due to this fact, the introduction of changes in the institutional design is needed to improve the financial condition of the state and to respond to the Lebanese taxpayers, who demand competent and transparent institutions that are able to be inclusive. Public provisions, political institutions, tax system, and laws are essential instruments for the regulation of taxpayer behavior. Within this context, this chapter gives concrete proposals to enhance Lebanese taxpayers' compliance. It shows that a well-developed legal framework that controls the general authorities creates an ideal environment for economic and social progress. A "one man, one vote" electoral law, coupled with structural reforms of independent judicial and supervisory bodies, will support the improvement of the general authorities' performance. Therefore, taxpayers will trust the government and establish new cultural fundamentals that induce them to fulfill their obligations toward tax authorities and raise their level of compliance.Cette thèse porte principalement sur la proposition de réformes politiques, économiques et culturelles cruciales visant à influencer la conformité fiscale des contribuables Libanais. Outre l'estimation de l'économie de l'ombre au Liban et l'analyse de l'effet des pots-de-vin sur la fraude fiscale et la croissance économique, des institutions optimales ont été suggérées afin de confronter la fraude fiscale. Ces sujets, objets de cette thèse, sont reformulés dans les trois chapitres détaillés ci-après. Le premier chapitre évalue l'économie de l'ombre au Liban tout en mettant en œuvre une approche monétaire. Il convient de noter que l'économie de l'ombre a été appréciée à 36.61 % du Produit Intérieur Brut (PIB) en 2018. Il a également été révélé que la part de l'évasion fiscale dans l'économie de l'ombre avait atteint 30.04% en 2018. En ce qui concerne l'année 2020, des prévisions se rapportant à l'économie de l'ombre seront présentées. Ce chapitre introduit les facteurs multiples qui accentuent ce phénomène au Liban et suggère de nombreux éléments clés qui pourraient limiter sa croissance. Par exemple, il a été montré que le contrôle de la fraude fiscale pourrait accroitre le PIB et diminuer l'économie de l'ombre. Le deuxième chapitre aborde le pot-de-vin versé par les fraudeurs fiscaux aux contrôleurs fiscaux corrompus dans le cadre d'un modèle d'accumulation de capital; ceci a pour objectif d'étudier l'effet du pot-de-vin sur la décision de fraude fiscale et la croissance économique. Il a été démontré que la politique fiscale adoptée par le gouvernement est le facteur clé définissant le comportement des contribuables et non le pot-de-vin. De plus, il a été prouvé que le pot-de-vin réduit l'accumulation de capital des individus ainsi que les ressources publiques du gouvernement. Ce fait entrainera une croissance économique plus faible en fonction de l'accumulation du capital. En outre, il fut démontré qu'un budget gouvernemental productif constitue un facteur important dans la croissance économique quant au taux d'imposition élevé. Cependant, les capitaux des particuliers représentent le critère déterminant dans la croissance économique en ce qui concerne le faible taux d'imposition. Le troisième chapitre propose un aspect optimal de la conception institutionnelle qui pourrait réduire la fraude fiscale au Liban. Il s'est avéré que la conception institutionnelle optimale entraîne une perception d'impôts plus élevée et une augmentation des revenus de l'Etat. Pour cette raison, la mise en place de changements dans la conception institutionnelle est requise afin d'améliorer la situation financière de l'Etat ; de même celle-ci est nécessaire pour répondre aux contribuables Libanais qui réclament des institutions compétentes et transparentes, capables d'être inclusives. Également, les dispositions publiques, les institutions politiques, le système de taxation, ainsi que les lois sont des instruments essentiels pour la régulation du comportement des contribuables. De plus, ce chapitre fournit des propositions concrètes visant à optimiser la conformité des contribuables Libanais. Celui-ci montre qu'un cadre juridique bien développé contrôlant les autorités générales crée un environnement idéal qui puisse contribuer au progrès économique et le développement social. De même, la loi électorale "un homme, un vote" - combinée avec des réformes structurelles des organes judiciaires et des autorités de contrôle - favorisera l'amélioration de la performance des autorités générales. Par conséquent, les contribuables feront confiance au gouvernement et établiront de nouveaux fondamentaux culturels qui les incitent à remplir leurs obligations envers les autorités fiscales et à augmenter leur niveau de conformité