Human Factors Issues of Tcas: a Simulation-Based Study

Since its introduction in the 90’s, TCAS II, presented as a straightforward and very reliable technological tool, has significantly reduced the risk of collision. Paradoxically, the introduction of this system has been accompanied with numerous incidents and one major accident in 2002, mainly due to unclear rules, poor air-ground cooperation and poor human decision. In order to investigate these potential human factors issues, a part-task air-ground simulation was conducted: 10 pilots and 10 controllers were involved in the simulations of 4 scenarios containing TCAS occurrences. Data collected included video camera recordings for behavioral analysis, Heart Rate (HR) for stress evaluation, questionnaires and debriefings for perceived risk levels and situational awareness assessment. The observations and errors were analyzed through the CREAM methodology. The debriefings were led through a self-confrontation technique, together with pilots and controllers. Results show that the simulations of TCAS situations were able to produce a significant physiological stress response with significant increase of HR when a resolution happens. Questionnaires and debriefings show that, in most of the observed cases, aircrew, and controllers are not sharing the same mental picture of the involved traffic and the risk of collision. This raises important issues in terms of cooperation between controllers and aircrews in such demanding occurrences. This should allow identifying risky situations and the related generic causes. The results will be discussed, aiming at a potential improvement of the system, in terms of Human Machine Interface, training and consistency of procedures

Dual-energy computed-tomography-based discrimination between basic calcium phosphate and calcium pyrophosphate crystal deposition in vivo.

Dual-energy computed tomography (DECT) is being considered as a non-invasive diagnostic and characterization tool in calcium crystal-associated arthropathies. Our objective was to assess the potential of DECT in distinguishing between basic calcium phosphate (BCP) and calcium pyrophosphate (CPP) crystal deposition in and around joints in vivo. A total of 13 patients with calcific periarthritis and 11 patients with crystal-proven CPPD were recruited prospectively to undergo DECT scans. Samples harvested from BCP and CPP calcification types were analyzed using Raman spectroscopy and validated against synthetic crystals. Regions of interest were placed in BCP and CPP calcifications, and the following DECT attenuation parameters were obtained: CT numbers (HU) at 80 and 140 kV, dual-energy index (DEI), electron density (Rho), and effective atomic number (Z <sub>eff</sub> ). These DECT attenuation parameters were compared and validated against crystal calibration phantoms at two known equal concentrations. Receiver operating characteristic (ROC) curves were plotted to determine the highest accuracy thresholds for DEI and Z <sub>eff</sub> . Raman spectroscopy enabled chemical fingerprinting of BCP and CPP crystals both in vitro and in vivo. DECT was able to distinguish between HA and CPP in crystal calibration phantoms at two known equal concentrations, most notably by DEI (200 mg/cm <sup>3</sup> : 0.037 ± 0 versus 0.034 ± 0, p = 0.008) and Z <sub>eff</sub> (200 mg /cm <sup>3</sup> : 9.4 ± 0 versus 9.3 ± 0, p = 0.01) analysis. Likewise, BCP calcifications had significantly higher DEI (0.041 ± 0.005 versus 0.034 ± 0.005, p = 0.008) and Z <sub>eff</sub> (9.5 ± 0.2 versus 9.3 ± 0.2, p = 0.03) than CPP crystal deposits with comparable CT numbers in patients. With an area under the ROC curve of 0.83 [best threshold value = 0.0 39, sensitivity = 90. 9% (81.8, 97. 7%), specificity = 64.6% (50.0, 64. 6%)], DEI was the best parameter in distinguishing between BCP and CPP crystal depositions. DECT can help distinguish between crystal-proven BCP and CPP calcification types in vivo and, thus, aid in the diagnosis of challenging clinical cases, and in the characterization of CPP and BCP crystal deposition occurring in osteoarthritis

ACCESS AND SECONDARY USE OF DATA COLLECTED IN AN ELECTRONIC MEDICAL CHART: RESULTS OF THE REAL WORLD ROSWITCH STUDY

International audienc

Pattern of demyelination occuring during anti-TNF alpha therapy: a French national survey.

International audienc

Pattern of demyelination occuring during anti-TNF alpha therapy: a French national survey.

International audienc

Benefits of Physical Training in Fibromyalgia and Related Syndromes

OBJECTIVE: To review the published information on physical training for fibromyalgia (FM) and related syndromes. METHODS: A search of Medline literature (via Ovid and PubMed) with the following keywords: FM, chronic fatigue syndrome, therapy, rehabilitation, aerobic, exercise, and cognitive behavioral therapy. The reference lists of articles were examined for additional related articles. RESULTS: Several studies investigated the benefits of graded exercise therapy for patients with FM or related syndromes. Although some systematic reviews have not established an unequivocal benefit of physical training, most authors report a benefit for patients with chronic pain or fatigue. Ideally, such a therapy should be a part of multidisciplinary program. Muscular rehabilitation is reserved for preventing the deconditioning syndrome often reported in patients and the vicious cycle of pain, avoidance and inactivity behaviors, or even kinesiophobia, deconditioning, incapacity and psychological distress. CONCLUSION: This review emphasizes the relevance of graded physical training for treating FM and related syndromes. The development of rehabilitation centers, with experts able to propose a relevant therapy to patients with chronic pain or fatigue, should help alleviate this public health problem

Predictive risk factors of serious infections in patients with rheumatoid arthritis treated with abatacept in common practice: results from the Orencia and Rheumatoid Arthritis (ORA) registry

International audienceObjectives Little data are available regarding the rate and predicting factors of serious infections in patients with rheumatoid arthritis (RA) treated with abatacept (ABA) in daily practice. We therefore addressed this issue using real-life data from the Orencia and Rheumatoid Arthritis (ORA) registry. Methods ORA is an independent 5-year prospective registry promoted by the French Society of Rheumatology that includes patients with RA treated with ABA. At baseline, 3 months, 6 months and every 6 months or at disease relapse, during 5 years, standardised information is prospectively collected by trained clinical nurses. A serious infection was defined as an infection occurring during treatment with ABA or during the 3 months following withdrawal of ABA without any initiation of a new biologic and requiring hospitalisation and/or intravenous antibiotics and/or resulting in death. Results Baseline characteristics and comorbidities: among the 976 patients included with a follow-up of at least 3 months (total follow-up of 1903 patient-years), 78 serious infections occurred in 69 patients (4.1/100 patient-years). Predicting factors of serious infections: on univariate analysis, an older age, history of previous serious or recurrent infections, diabetes and a lower number of previous anti-tumour necrosis factor were associated with a higher risk of serious infections. On multivariate analysis, only age (HR per 10-year increase 1.44, 95% CI 1.17 to 1.76, p=0.001) and history of previous serious or recurrent infections (HR 1.94, 95% CI 1.18 to 3.20, p=0.009) were significantly associated with a higher risk of serious infections. Conclusions In common practice, patients treated with ABA had more comorbidities than in clinical trials and serious infections were slightly more frequently observed. In the ORA registry, predictive risk factors of serious infections include age and history of serious infections