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

Cluster number counts dependence on dark energy inhomogeneities and coupling to dark matter

Cluster number counts can be used to test dark energy models. We investigate dark energy candidates which are coupled to dark matter. We analyze the cluster number counts dependence on the amount of dark matter coupled to dark energy. Further more, we study how dark energy inhomogeneities affect cluster abundances. It is shown that increasing the coupling reduces significantly the cluster number counts, and that dark energy inhomogeneities increases cluster abundances. Wiggles in cluster number counts are shown to be a specific signature of coupled dark energy models. Future observations will possibly detect such oscillations and discriminate among the different dark energy models.Comment: 9 pages, 8 figures. Further extensions on section on discriminating models with future surveys. Accepted for publication in Mon. Not. Roy. Astro. So

Hydrodynamic Interaction between an Accretion Flow and a Strong Wind around a Black Hole

In 2015, space heating and domestic hot water production accounted for around 40% of the Swiss final energy consumption. Reaching the goals of the 2050 energy strategy will require significantly reducing this share despite the growing building stock. Renewables are numerous but subject to spatial–temporal constraints. Territorial planning of energy distribution systems enabling the integration of renewables requires having a spatial–temporal characterization of the energy demand. This paper presents two bottom-up statistical extrapolation models for the estimation of the geo-dependent heat and electricity demand of the Swiss building stock. The heat demand is estimated by means of a statistical bottom-up model applied at the building level. At the municipality level, the electricity load curve is estimated by combining socio-economic indicators with average consumption per activity and/or electric device. This approach also allows to break down the estimated electricity demand according to activity type (e.g., households, various industry, and service activities) and appliance type (e.g., lighting, motor force, fridges). The total estimated aggregated demand is 94 TWh for heat and 58 TWh for electricity, which represent a deviation of 2.9 and 0.5%, respectively compared to the national energy consumption statistics. In addition, comparisons between estimated and measured electric load curves are done to validate the proposed approach. Finally, these models are used to build a geo-referred database of heat and electricity demand for the entire Swiss territory. As an application of the heat demand model, a realistic saving potential is estimated for the existing building stock; this potential could be achieved through by a deep retrofit program. One advantage of the statistical bottom-up model approach is that it allows to simulate a building stock that replicates the diversity of building demand. This point is important in order to correctly account for the mismatch between gross and net energy saving potential, often called performance gap. The impact of this performance gap is substantial since the estimated net saving potential is only half of the gross one

Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group

IntroductionSeclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers.MethodsWithin a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure.ResultsFor the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient’s transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint.DiscussionS/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures

A randomized controlled trial of home visits by neighborhood mentor mothers to improve children's nutrition in South Africa

Malnourished children and babies with birth weights under 2500 g are at high risk for negative outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve nutritional outcomes for young children in South Africa. One “mentor mother” was recruited from each of 37 neighborhoods in Cape Town, South Africa. Mentor mothers were trained to conduct home visits to weigh children under six years old and to support mothers to problem-solve life challenges, especially around nutrition. Households with underweight children were assigned randomly on a 2:1 ratio to the Philani program (n = 500) or to a standard care condition (n = 179); selection effects occurred and children in the intervention households weighed less at recruitment. Children were evaluated over a one-year period (n = 679 at recruitment and n = 638 with at least one follow-up; 94%). Longitudinal random effects models indicated that, over 12 months, the children in the intervention condition gained significantly more weight than children in the control condition. Mentor mothers who are positive peer deviants may be a viable strategy that is efficacious and can build community, and the use of mentor mothers for other problems in South Africa is discussed

Dietary soy and meat proteins induce distinct physiological and gene expression changes in rats

This study reports on a comprehensive comparison of the effects of soy and meat proteins given at the recommended level on physiological markers of metabolic syndrome and the hepatic transcriptome. Male rats were fed semi-synthetic diets for 1 wk that differed only regarding protein source, with casein serving as reference. Body weight gain and adipose tissue mass were significantly reduced by soy but not meat proteins. The insulin resistance index was improved by soy, and to a lesser extent by meat proteins. Liver triacylglycerol contents were reduced by both protein sources, which coincided with increased plasma triacylglycerol concentrations. Both soy and meat proteins changed plasma amino acid patterns. The expression of 1571 and 1369 genes were altered by soy and meat proteins respectively. Functional classification revealed that lipid, energy and amino acid metabolic pathways, as well as insulin signaling pathways were regulated differently by soy and meat proteins. Several transcriptional regulators, including NFE2L2, ATF4, Srebf1 and Rictor were identified as potential key upstream regulators. These results suggest that soy and meat proteins induce distinct physiological and gene expression responses in rats and provide novel evidence and suggestions for the health effects of different protein sources in human diets

Mindfulness-based interventions for young offenders: a scoping review

Youth offending is a problem worldwide. Young people in the criminal justice system have frequently experienced adverse childhood circumstances, mental health problems, difficulties regulating emotions and poor quality of life. Mindfulness-based interventions can help people manage problems resulting from these experiences, but their usefulness for youth offending populations is not clear. This review evaluated existing evidence for mindfulness-based interventions among such populations. To be included, each study used an intervention with at least one of the three core components of mindfulness-based stress reduction (breath awareness, body awareness, mindful movement) that was delivered to young people in prison or community rehabilitation programs. No restrictions were placed on methods used. Thirteen studies were included: three randomized controlled trials, one controlled trial, three pre-post study designs, three mixed-methods approaches and three qualitative studies. Pooled numbers (n = 842) comprised 99% males aged between 14 and 23. Interventions varied so it was not possible to identify an optimal approach in terms of content, dose or intensity. Studies found some improvement in various measures of mental health, self-regulation, problematic behaviour, substance use, quality of life and criminal propensity. In those studies measuring mindfulness, changes did not reach statistical significance. Qualitative studies reported participants feeling less stressed, better able to concentrate, manage emotions and behaviour, improved social skills and that the interventions were acceptable. Generally low study quality limits the generalizability of these findings. Greater clarity on intervention components and robust mixed-methods evaluation would improve clarity of reporting and better guide future youth offending prevention programs

Micronutrient Deficits Are Still Public Health Issues among Women and Young Children in Vietnam

Background: The 2000 Vietnamese National Nutrition Survey showed that the population’s dietary intake had improved since 1987. However, inequalities were found in food consumption between socioeconomic groups. As no national data exist on the prevalence of micronutrient deficiencies, a survey was conducted in 2010 to assess the micronutrient status of randomly selected 1526 women of reproductive age and 586 children aged 6–75 mo. Principal Findings: In women, according to international thresholds, prevalence of zinc deficiency (ZnD, 67.262.6%) and vitamin B12 deficiency (11.761.7%) represented public health problems, whereas prevalence of anemia (11.661.0%) and iron deficiency (ID, 13.761.1%) were considered low, and folate (,3%) and vitamin A (VAD,,2%) deficiencies were considered negligible. However, many women had marginal folate (25.1%) and vitamin A status (13.6%). Moreover, overweight (BMI$23 kg/m 2 for Asian population) or underweight occurred in 20 % of women respectively highlighting the double burden of malnutrition. In children, a similar pattern was observed for ZnD (51.963.5%), anemia (9.161.4%) and ID (12.961.5%) whereas prevalence of marginal vitamin A status was also high (47.362.2%). There was a significant effect of age on anemia and ID prevalence, with the youngest age group (6–17 mo) having the highest risk for anemia, ID, ZnD and marginal vitamin A status as compared to other groups. Moreover, the poorest groups of population had a higher risk for zinc, anemia and ID

Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice

Producción CientíficaThere is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral prophylaxis or preemptive therapy) were applied according to institutional protocols at each site. The impact on the 12-month incidence of CMV disease was assessed by Cox regression. Asymptomatic CMV infection, acute rejection, graft function, non-CMV infection, graft loss, and all-cause mortality were also analyzed (secondary outcomes). Models were adjusted for a propensity score (PS) analysis for receiving antiviral prophylaxis. Overall, 190 patients (49.1%) received preemptive therapy, 185 (47.8%) antiviral prophylaxis, and 12 (3.1%) no specific intervention. Twelve-month cumulative incidences of CMV disease and asymptomatic infection were 3.6% and 39.3%, respectively. Patients on prophylaxis had lower incidence of CMV disease [PS-adjusted HR (aHR): 0.10; 95% confidence interval (CI): 0.01–0.79] and asymptomatic infection (aHR: 0.46; 95% CI: 0.29–0.72) than those managed preemptively, with no significant differences according to the duration of prophylaxis. All cases of CMV disease in the prophylaxis group occurred after prophylaxis discontinuation. There were no differences in any of the secondary outcomes. In conclusion, antiviral prophylaxis was associated with a lower occurrence of CMV disease in CMV R+ KT recipients, although such benefit should be balanced with the risk of late-onset disease

IFNAR1-Signalling Obstructs ICOS-mediated Humoral Immunity during Non-lethal Blood-Stage Plasmodium Infection

Funding: This work was funded by a Career Development Fellowship (1028634) and a project grant (GRNT1028641) awarded to AHa by the Australian National Health & Medical Research Council (NHMRC). IS was supported by The University of Queensland Centennial and IPRS Scholarships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD