Construction guidée de graphes de transducteurs pour l'extraction d'évènements spatio-temporellement localisés

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294 Implementation time of a lipid lowering therapy in patients with dyslipidemia: results of Prysme study

Despite the availability of specific guidelines, the management of dyslipidemia in practice is not optimal.Objective and methodologyPRYSME, a non-interventional multicentre study carried out with 1226 general practitioners, aimed to describe the implementation time of a lipid lowering treatment according to cardiovascular risk level (primary objective) and to identify its determinants. Were eligible patients treated for a dyslipidemia diagnosed less than 2 years ago. Demographic and clinical characteristics and circumstances of diagnosis and treatment initiation were collected.Results3268 patients were included (mean age: 57 years old, males: 64%). 26% were obese and 45% overweight. Only 12% had no cardiovascular risk factors (CRF) at the time of dyslipidemia diagnosis. The most frequent CRF were arterial hypertension (50%), smoking (43%), family history of premature coronary heart disease (28%), HDL-c <0.4g/l (20%) whereas 15% of the patients had a personal history of cardiovascular disease. Dietary programs were initially implemented for 98% of the patients. More than 90% were treated with a statin. The implementation time of the treatment (evaluated according to the biological confirmation of dyslipidemia), according to the initial number of CRF, was as following:0 CRF1 CRF2 CRF≥ 3 CRFSecondary preventionTotal[-3;0] months34.3%28.6%27.1%29.3%49.1%33.1%]0;3] months23.1%26.2%26.4%24.0%21.9%23.9%> 3 months42.6%45.3%46.5%46.8%29.0%43.0%Chi-2 test : P<0.001The main determinant of an early implementation of a lipid lowering therapy (≤ 3 months) was secondary prevention (OR=1.8). The number of CRF had no significant impact.ConclusionThis study underlines the lack of awareness towards cardiovascular risk factors in the management of dyslipidemia, particularly while considering the implementation time of a lipid lowering therapy

Baseline morning cortisol level as a predictor of pituitary-adrenal reserve: a comparison across three assays

The short ACTH stimulation test (250 μg) is the dynamic test most frequently used to assess adrenal function. It is possible that a single basal cortisol could be used to predict the dynamic response, but research has been hampered by the use of different assays and thresholds. OBJECTIVE: To propose a morning baseline cortisol criterion of three of the most commonly used modern cortisol immunoassays - Advia Centaur (Siemens), Architect (Abbott) and the Roche Modular System (Roche) - that could predict adrenal sufficiency. DESIGN: Observational, retrospective cross-sectional study at two centres. PATIENTS AND MEASUREMENTS: Retrospective analysis of the results of 1019 Short Synacthen tests (SSTs) with the Advia Centaur, 449 SSTs with the Architect and 2050 SSTs with the Roche Modular System assay. Serum cortisol levels were measured prior to injection of 250 μg Synacthen and after 30 min. Overall, we were able to collate data from a total of 3518 SSTs in 3571 patients. RESULTS: Using receiver-operator curve analysis, baseline cortisol levels for predicting passing the SST with 100% specificity were 358 nmol/l for Siemens, 336 nmol/l for Abbott and 506 nmol/l for Roche. Utilizing these criteria, 589, 158 and 578 SSTs, respectively, for Siemens, Abbott and Roche immunoassays could have been avoided. CONCLUSIONS: We have defined assay-specific morning cortisol levels that are able to predict the integrity of the hypothalamo-pituitary-adrenal axis. We propose that this represents a valid tool for the initial assessment of adrenal function and has the potential to obviate the need for dynamic testing in a significant number of patients

Exploring variations in childhood stunting in Nigeria using league table, control chart and spatial analysis

Background: Stunting, linear growth retardation is the best measure of child health inequalities as it captures multiple dimensions of children’s health, development and environment where they live. The developmental priorities and socially acceptable health norms and practices in various regions and states within Nigeria remains disaggregated and with this, comes the challenge of being able to ascertain which of the regions and states identifies with either high or low childhood stunting to further investigate the risk factors and make recommendations for action oriented policy decisions. Methods: We used data from the birth histories included in the 2008 Nigeria Demographic and Health Survey (DHS) to estimate childhood stunting. Stunting was defined as height for age below minus two standard deviations from the median height for age of the standard World Health Organization reference population. We plotted control charts of the proportion of childhood stunting for the 37 states (including federal capital, Abuja) in Nigeria. The Local Indicators of Spatial Association (LISA) were used as a measure of the overall clustering and is assessed by a test of a null hypothesis. Results: Childhood stunting is high in Nigeria with an average of about 39%. The percentage of children with stunting ranged from 11.5% in Anambra state to as high as 60% in Kebbi State. Ranking of states with respect to childhood stunting is as follows: Anambra and Lagos states had the least numbers with 11.5% and 16.8% respectively while Yobe, Zamfara, Katsina, Plateau and Kebbi had the highest (with more than 50% of their underfives having stunted growth). Conclusions: Childhood stunting is high in Nigeria and varied significantly across the states. The northern states have a higher proportion than the southern states. There is an urgent need for studies to explore factors that may be responsible for these special cause variations in childhood stunting in Nigeria

Bone mineral density and fracture risk with long-term use of inhaled corticosteroids in patients with asthma: systematic review and meta-analysis

Objectives: We aimed to assess the association between long-term use of inhaled corticosteroids (ICS) and bone adverse effects in patients with asthma. Design: Systematic review and meta-analysis of fracture risk and changes in bone mineral density with long-term ICS use in asthma. Methods: We initially searched MEDLINE and EMBASE in July 2013, and performed an updated PubMed search in December 2014. We selected randomised controlled trials (RCTs) and controlled observational studies of any ICS (duration at least 12 months) compared to non-ICS use in patients with asthma. We conducted meta-analysis of ORs for fractures, and mean differences in bone mineral density. Heterogeneity was assessed using the I2 statistic. Results: We included 18 studies (7 RCTs and 11 observational studies) in the systematic review. Meta-analysis of observational studies did not demonstrate any significant association between ICS and fractures in children (pooled OR 1.02, 95% CI 0.94 to 1.10, two studies), or adults (pooled OR 1.09, 95% CI 0.45 to 2.62, four studies). Three RCTs and three observational studies in children reported on bone mineral density at the lumbar spine, and our meta-analysis did not show significant reductions with ICS use. Three RCTs and four observational studies in adults reported on ICS use and bone mineral density at the lumbar spine and femur, with no significant reductions found in the meta-analysis compared to control. Conclusions ICS use for ≥12 months in adults or children with asthma was not significantly associated with harmful effects on fractures or bone mineral density

Stress transmission in wet granular materials

We analyze stress transmission in wet granular media in the pendular state by means of three-dimensional molecular dynamics simulations. We show that the tensile action of capillary bonds induces a self-stressed particle network organized in two percolating "phases" of positive and negative particle pressures. Various statistical descriptors of the microstructure and bond force network are used to characterize this partition. Two basic properties emerge: 1) The highest particle pressure is located in the bulk of each phase; 2) The lowest pressure level occurs at the interface between the two phases, involving also the largest connectivity of the particles via tensile and compressive bonds. When a confining pressure is applied, the number of tensile bonds falls off and the negative phase breaks into aggregates and isolated sites

The SWEET-HOME Project: Audio Technology in Smart Homes to improve Well-being and Reliance

International audienceThe SWEET-HOME project aims at providing audio-based interaction technology that lets the user have full control over their home environment, at detecting distress situations and at easing the social inclusion of the elderly and frail population. This paper presents an overview of the project focusing on the implemented techniques for speech and sound recognition as context-aware decision making with uncertainty. A user experiment in a smart home demonstrates the interest of this audio-based technology