Suivi cardiaque des patients oncologiques pédiatriques après une chimiothérapie cardiotoxique

1.1 Introduction : Les anthracyclines (comme la doxorubicine) sont communément utilisées pour le traitement des leucémies, lymphomes et autres tumeurs malignes de l'enfant. Leur utilisation est cependant limitée par leur cardiotoxicité. Il est donc important de monitorer les survivants avant, pendant et après le traitement pour détecter précocement une dysfonction cardiaque. 1.2 Objectifs : Ce travail recense tous les patients ayant été traités par anthracycline en oncologie pédiatrique et suivi en cardiologie pédiatrique au CHUV entre 1991 et 2013. Il décrit l'évolution à long terme de ces patients et si leur suivi a été suffisant. 1.3 Méthodologie : Étude rétrospective dans les unités de cardiologie et d'oncologie pédiatrique au CHUV. Création d'une base de données de tous les patients pédiatriques (<16 ans) ayant été traités par anthracyclines et suivi en cardiologique pédiatrique. Elle contient des données démographiques, cardiologiques et oncologiques. Analyses statistiques (descriptives simples, comparatives et régression logistique). 1.4 Résultats : Le risque d'évolution cardiaque anormale est significativement augmenté par un traitement de doxorubicine > 300 mg/m2, la radiothérapie et un traitement simultané de doxorubicine > 300 mg/m2 et radiothérapie. Un traitement par haute dose de doxorubicine augmente significativement les traitements cardiaques. Les sarcomes sont plus souvent traités par hautes doses de doxorubicine, radiothérapie et doxorubicine à haute dose et radiothérapie combinées. Les patients plus âgés sont plus souvent traités par radiothérapie. Dans la catégorie des patients traités par radiothérapie, les sarcomes sont plus traités par haute dose de doxorubicine. 1.5 Conclusion : Il est important de suivre avec beaucoup d'attention et à long terme les patients traités par une dose de doxorubicine >300mg/m2, par radiothérapie, par haute dose de doxorubicine et radiothérapie simultanée et ceux atteints d'un sarcome. Le suivi régulier offert par le CHUV permet de détecter précocement une dysfonction cardiaque et de la prendre en charge

Using behavioral studies to adapt management decisions and reduce negative interactions between humans and baboons in Cape Town, South Africa

Understanding the behavioral ecology of wildlife that experiences negative interactions with humans and the outcome of any wildlife management intervention is essential. In the Cape Peninsula, South Africa, chacma baboons (Papio ursinus) search for anthropogenic food sources in both urban and agricultural areas. In response, the city of Cape Town and private farmers employ “rangers” to keep baboons within the Table Mountain National Park. In this study, we investigated the success of rangers' intervention in keeping baboons in their natural habitat. Based on our findings in year one, we recommended adjustments to the rangers' management strategy in year two. We recommended improved consensus of actions toward baboons (that is, when/where to herd them), and the construction of a baboon-proof fence around one of the farms that provided a corridor to urban areas. During the 2 months following recommendations, these interventions combined resulted in a significant reduction in the time baboons spent in both urban and agricultural land. Our case study illustrates the importance of integrating research findings into ongoing management actions to improve both human livelihoods and baboon conservation through an adaptive management framework. We expect similar approaches to be beneficial in a wide range of species and contexts

Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life : A randomized controlled trial

Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet. We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up. Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen’s d = 0.57, p = 0.010). The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders

Médecine d’urgence [Emergency medicine : update 2019]

At a time when « Smarter medicine » and « Choosing Wisely » campains become increasingly important, emergency medicine is no exception. Many recent studies lead us to reconsider our practices and to change our work-up and treatement strategies, to ultimately use only the ones with a real clinical benefit for emergency departement patients

Ab initio study of the volume dependence of dynamical and thermodynamical properties of silicon

Motivated by the negative thermal expansion observed for silicon between 20 K and 120 K, we present first an ab initio study of the volume dependence of interatomic force constants, phonon frequencies of TA(X) and TA(L) modes, and of the associated mode Gruneisen parameters. The influence of successive nearest neighbors shells is analysed. Analytical formulas, taking into account interactions up to second nearest neighbors, are developped for phonon frequencies of TA(X) and TA(L) modes and the corresponding mode Gruneisen parameters. We also analyze the volume and pressure dependence of various thermodynamic properties (specific heat, bulk modulus, thermal expansion), and point out the effect of the negative mode Gruneisen parameters of the acoustic branches on these properties. Finally, we present the evolution of the mean square atomic displacement and of the atomic temperature factor with the temperature for different volumes, for which the anomalous effects are even greater.Comment: 24 pages, Revtex 3.0, 11 figures, accepted for publication in Phys. Rev.

First Principles Phase Diagram Calculations for the Octahedral-Interstitial System ZrOX_{X}, 0≤X≤1/20 \leq X \leq 1/2

First principles based phase diagram calculations were performed for the octahedral-interstitial solid solution system \alpha ZrOX (\alpha Zr[ ]_(1-X)OX; [ ]=Vacancy; 0 \leq X \leq 1/2). The cluster expansion method was used to do a ground state analysis, and to calculate the phase diagram. The predicted diagram has four ordered ground-states in the range 0 \leq X \leq 1/2, but one of these, at X=5/12, is predicted to disproportionate at T \approx 20K, well below the experimentally investigated range T \approx 420K. Thus, at T \succeq 420K, the first-principles based calculation predicts three ordered phases rather than the four that have been reported by experimentalists

Extreme behavioural shifts by baboons exploiting risky, resource-rich, human-modified environments

Abstract A range of species exploit anthropogenic food resources in behaviour known as ‘raiding’. Such behavioural flexibility is considered a central component of a species’ ability to cope with human-induced environmental changes. Here, we study the behavioural processes by which raiding male chacma baboons (Papio ursinus) exploit the opportunities and mitigate the risks presented by raiding in the suburbs of Cape Town, South Africa. Ecological sampling and interviews conducted with ‘rangers’ (employed to manage the baboons’ space use) revealed that baboons are at risk of being herded out of urban spaces that contain high-energy anthropogenic food sources. Baboon-attached motion/GPS tracking collars showed that raiding male baboons spent almost all of their time at the urban edge, engaging in short, high-activity forays into the urban space. Moreover, activity levels were increased where the likelihood of deterrence by rangers was greater. Overall, these raiding baboons display a time-activity balance that is drastically altered in comparison to individuals living in more remote regions. We suggest our methods can be used to obtain precise estimates of management impact for this and other species in conflict with people