The Experience of Pregnancy Discovery andAcceptance: A Descriptive Study Based on freeHierarchical Evocation by Associative Networks

Women’s childbearing experiences vary with pregnancy intentional nature and outcome. An Associative Network study targeted 129 women pregnant >1 year ago and their experiences at pregnancy start and post-pregnancy. Word-associations formed 15 themes and 5 metathemes. The main pregnancy discovery themes were “Affect” (39%), “Relationships with others” (11%), and “Logistics” (7%). The main post-pregnancy themes were “Affect” (18%), “Relationship with the child” (13%), and “Personal progress” (12%). The overall polarity index was higher in intended vs. unintended pregnancies. Whatever pregnancy outcome, women expressed impressions of constructive experience. Discovering pregnancy and deciding about it led anyway to personal and social progress

Responsiveness of the Motor Function Measure in Patients With Spinal Muscular Atrophy

Abstract Objective: To assess the ability of the Motor Function Measure (MFM) to detect changes in the progression of spinal muscular atrophy (SMA). Design: Observational, retrospective, multicenter cohort study. Setting: Seventeen departments of pediatric physical medicine. Participants: Volunteer patients with SMA (NZ112) aged 5.7 to 59 years with no treatment other than physical therapy and nutritional or respiratory assistance. Interventions: Not applicable. Main Outcome Measures: The distributions of the MFM scores (total score and 3 subscores) were analyzed per SMA subtype. The relationships between scores and age were studied. The slopes of score changes (reflecting MFM responsiveness) were estimated in patients with at least 6 months' follow-up and 2 MFMs. Hypothetical sample sizes for specific effect sizes in clinical trial scenarios are given. Results: In 12 patients with SMA type 2 and 19 with SMA type 3 (mean AE SD follow-up, 25.8AE19mo), there was a moderate inverse relationship between age and the MFM total score. Patients with less than 6 months' follow-up showed little score changes. Patients with longer follow-ups showed a slow deterioration (À0.9 points/y for type 2 and À0.6 points/y for type 3). Substantial responsiveness was obtained with the MFM Dimension 2 subscore (proximal and axial motricity) in patients with SMA type 2 (standardized response mean [SRM]Z1.29), and with the MFM Dimension 1 subscore (standing and transfers) in patients with SMA type 3 aged 10 to 15 years (SRMZ.94). Conclusions: If further confirmed by larger studies, these preliminary results on the relative responsiveness of the MFM in SMA will foster its use in monitoring disease progression in patients who participate in clinical trials

Flexible and structured survival model for a simultaneous estimation of non-linear and non-proportional effects and complex interactions between continuous variables: Performance of this multidimensional penalized spline approach in net survival trend analysis.

Cancer survival trend analyses are essential to describe accurately the way medical practices impact patients' survival according to the year of diagnosis. To this end, survival models should be able to account simultaneously for non-linear and non-proportional effects and for complex interactions between continuous variables. However, in the statistical literature, there is no consensus yet on how to build such models that should be flexible but still provide smooth estimates of survival. In this article, we tackle this challenge by smoothing the complex hypersurface (time since diagnosis, age at diagnosis, year of diagnosis, and mortality hazard) using a multidimensional penalized spline built from the tensor product of the marginal bases of time, age, and year. Considering this penalized survival model as a Poisson model, we assess the performance of this approach in estimating the net survival with a comprehensive simulation study that reflects simple and complex realistic survival trends. The bias was generally small and the root mean squared error was good and often similar to that of the true model that generated the data. This parametric approach offers many advantages and interesting prospects (such as forecasting) that make it an attractive and efficient tool for survival trend analyses

Unexpected Modulation of Recall B and T Cell Responses after Immunization with Rotavirus-like Particles in the Presence of LT-R192G

LT-R192G, a mutant of the thermolabile enterotoxin of E. coli, is a potent adjuvant of immunization. Immune responses are generally analyzed at the end of protocols including at least 2 administrations, but rarely after a prime. To investigate this point, we compared B and T cell responses in mice after one and two intrarectal immunizations with 2/6 rotavirus-like particles (2/6-VLP) and LT-R192G. After a boost, we found, an unexpected lower B cell expansion measured by flow cytometry, despite a secondary antibody response. We then analyzed CD4+CD25+Foxp3+ regulatory T cells (Tregs) and CD4+CD25+Foxp3− helper T cells after in vitro (re)stimulation of mesenteric lymph node cells with the antigen (2/6-VLP), the adjuvant (LT-R192G) or both. 2/6-VLP did not activate CD4+CD25+Foxp3− nor Foxp3+ T cells from non-immunized and 2/6-VLP immunized mice, whereas they did activate both subsets from mice immunized with 2/6-VLP in the presence of adjuvant. LT-R192G dramatically decreased CD4+CD25+Foxp3+ T cells from non-immunized and 2/6-VLP immunized mice but not from mice immunized with 2/6-VLP and adjuvant. Moreover, in this case, LT-R192G increased Foxp3 expression on CD4+CD25+Foxp3+ cells, suggesting specific Treg activation during the recall. Finally, when both 2/6-VLP and LT-R192G were used for restimulation, LT-R192G clearly suppressed both 2/6-VLP-specific CD4+CD25+Foxp3− and Foxp3+ T cells. All together, these results suggest that LT-R192G exerts different effects on CD4+CD25+Foxp3+ T cells, depending on a first or a second contact. The unexpected immunomodulation observed during the recall should be considered in designing vaccination protocols

Comparison of Methods to Correct Survival Estimates and Survival Regression Analysis on a Large HIV African Cohort

The evaluation of HIV treatment programs is generally based on an estimation of survival among patients receiving antiretroviral treatment (ART). In large HIV programs, loss to follow-up (LFU) rates remain high despite active patient tracing, which is likely to bias survival estimates and survival regression analyses

My article has just been rejected!

Unfortunately, articles submitted to journals are rejected more frequently than is desirable. Journals themselves estimate that more than 60% of submitted articles are rejected without review (for top journals, the figure may even be 80%). Thus, whatever an article’s content or quality, an outright rejection should be expected right from the time of submission, and a reaction strategy defined beforehand. Each rejection should be carefully examined and fully understood before attempting any response. Here are some hints for beginners—or for edgy authors

My article has just been rejected!

Unfortunately, articles submitted to journals are rejected more frequently than is desirable. Journals themselves estimate that more than 60% of submitted articles are rejected without review (for top journals, the figure may even be 80%). Thus, whatever an article’s content or quality, an outright rejection should be expected right from the time of submission, and a reaction strategy defined beforehand. Each rejection should be carefully examined and fully understood before attempting any response. Here are some hints for beginners—or for edgy authors

What to tell and never tell a reviewer

The specialized literature abounds in recommendations about the most desirable technical ways of answering reviewers’ comments on a submitted manuscript. However, not all publications mention authors’ and/or reviewers’ feelings or reactions about what they may read or write in their respective reports, and even fewer publications tackle openly what may or may not be said in a set of answers to a reviewer’s comments. In answering reviewers’ comments, authors are often attentive to the technical or rational aspects of the task but might forget some of its relational aspects. In their answers, authors are expected to make every effort to abide by reviewers’ suggestions, including discussing major criticisms, editing the illustrations, or implementing minor corrections; abstain from questioning a reviewer’s competence or willingness to write a good re­view, including full and attentive reading and drafting useful comments; clearly separate their answers to each reviewer; avoid skipping, merging, or reordering reviewers’ comments; and, finally, specify the changes made. Authors are advised to call on facts, logic, and some diplomacy, but never on artifice, concealment, or flattery. Failing to do so erodes the trust between authors and reviewers, whereas integrity is expected and highly valued. The guiding principle should always be honesty