Simulation 3D electromagnetique et thermomecanique d'une cavite RF

Une etude thermomecanique 3D de l'extremite de lame a l'entree du RFQ d'IPHI a ete menee avec le code I-DEAS. Le but est de comparer les temperatures atteintes, les contraintes et les deformations calculees a partir des densites de puissance RF deposee sur la lame obtenues a partir de deux codes de calcul electromagnetique differents: SOPRANO et MAFI

Surgical management of multilevel lumbar spondylolysis: A case report and review of the literature

AbstractMultilevel lumbar spondylolysis accounts for less than 6% of the cases of lumbar spondylolysis and its treatment, as reported in the literature, has not been consistent. Fewer than ten cases presenting triple lumbar spondylosis have been published. We describe the case of a 33-year-old male presenting bilateral L3, L4, and L5 isthmic lysis with no spondylolisthesis or disc degeneration. The MRI and CT of the lumbar spine were decisive elements in the therapeutic choice and the surgical treatment performed was bilateral L3 and L4 isthmic repair via a combined anterior and posterior L5S1 approach. The clinical and radiological results were good at the last follow-up visit

Gait variability at fast-pace walking speed: A biomarker of mild cognitive impairment?

The interpretation of the increase in stride-to-stride variability of stride time (STV) regarding the evolution of cognitive deficits across the dementia spectrum is matter of debate.The aim of this study was to compare STV at usual and fast-pace walking speeds of MCI patients with that of cognitively healthy individuals (CHI) and Alzheimer\u27s disease (AD) patients with mild dementia, while considering the effects of potential confounders. STV while walking at usual and fast-pace walking speeds was recorded with the GAITRiteA (R) system from 116 older adults (mean age 75.6 +/- 6.5 years; 55.2% female) divided into 3 groups according to their cognitive status (44 CHI, 39 MCI patients and 33 AD patients with mild dementia). The full adjusted multiple linear regression models showed that high STV was associated with slow gait speed at usual-pace walking speed (P=0.002) and with the MCI status at fast-pace walking speed (P=0.015). High STV at fast-pace walking speed was a specific gait disturbance of MCI patients in the sample of studied participants, and thus could be used in the future as a specific biomarker of MCI patients

The Conserved nhaAR Operon Is Drastically Divergent between B2 and Non-B2 Escherichia coli and Is Involved in Extra-Intestinal Virulence

The Escherichia coli species is divided in phylogenetic groups that differ in their virulence and commensal distribution. Strains belonging to the B2 group are involved in extra-intestinal pathologies but also appear to be more prevalent as commensals among human occidental populations. To investigate the genetic specificities of B2 sub-group, we used 128 sequenced genomes and identified genes of the core genome that showed marked difference between B2 and non-B2 genomes. We focused on the gene and its surrounding region with the strongest divergence between B2 and non-B2, the antiporter gene nhaA. This gene is part of the nhaAR operon, which is in the core genome but flanked by mobile regions, and is involved in growth at high pH and high sodium concentrations. Consistently, we found that a panel of non-B2 strains grew faster than B2 at high pH and high sodium concentrations. However, we could not identify differences in expression of the nhaAR operon using fluorescence reporter plasmids. Furthermore, the operon deletion had no differential impact between B2 and non-B2 strains, and did not result in a fitness modification in a murine model of gut colonization. Nevertheless, sequence analysis and experiments in a murine model of septicemia revealed that recombination in nhaA among B2 strains was observed in strains with low virulence. Finally, nhaA and nhaAR operon deletions drastically decreased virulence in one B2 strain. This effect of nhaAR deletion appeared to be stronger than deletion of all pathogenicity islands. Thus, a population genetic approach allowed us to identify an operon in the core genome without strong effect in commensalism but with an important role in extra-intestinal virulence, a landmark of the B2 strains

Early Hospital Discharge of Older Adults Admitted to the Emergency Department: Effect of Different Types of Recommendations Made by a Mobile Geriatric Team

International audienc

Mobile Geriatric Team and Length of Hospital Stay Among Older Inpatients: A Case-Control Pilot Study

International audienc

Screening for elderly patients admitted to the emergency department requiring specialized geriatric care

BACKGROUND: There is a need for a brief geriatric assessment (BGA) tool to screen elderly patients admitted to the Emergency Department (ED) for their risk of a long hospital stay. OBJECTIVE: To examine whether a BGA administered to elderly patients admitted to the ED may predict the risk of a long hospital stay in the geriatric acute care unit. METHODS: This study had a prospective cohort study design, enrolling 424 elderly patients (mean age 84.0 +/- 6.5 years, 31.6% male) who were evaluated in the ED using a BGA composed of the following items: age, gender, number of medications taken daily, history of falls during the past 6 months, Mini-Mental State Examination (MMSE) score, and non-use of home-help services (i.e., living alone without using any formal or informal home services or social help). The length of stay (LOS) was calculated in days. Patients were separated into three groups based on LOS: low (<8 days), intermediate (8-13 days), and high (>13 days). RESULTS: The prevalence of male gender was higher among patients with the longest LOS compared to those with intermediate LOS (p = 0.002). There were more patients with a history of falls in the high LOS group compared to the intermediate LOS group (p = 0.001) and the low LOS group (p < 0.001). The classification tree showed that male patients with an MMSE score <20 who fell with age under 85 years formed the end node with the greatest relative risk (RR) of a long hospital stay (RR = 14.3 with p < 0.001). CONCLUSIONS: The combination of a history of falls, male gender, cognitive impairment, and age under 85 years identified elderly ED patients at high risk of a long hospital stay

Who is at risk of long hospital stay among patients admitted to geriatric acute care unit? Results from a prospective cohort study

1) To confirm that vitamin D deficiency, defined as serum 25-hydroxyvitamin D (25OHD) concentration < 25nmol/L, was associated with long length-of-stay (LOS) among older inpatients admitted to geriatric acute care unit; and 2) to examine which combination of risk factors of longer LOS including vitamin D deficiency best predicted longer LOS.Based on a prospective cohort study with a 25-day follow-up on average, 531 consecutive older inpatients (mean age 85.0 +/- 7.2 years, 59.1% women) admitted to the geriatric acute care unit of Angers University Hospital, France, were included. Linear regression models showed that male gender (P < 0.025), delirium (P < 0.015) and vitamin D deficiency (P < 0.001) were independently associated with a longer LOS. The highest risk of a longer LOS was shown while combining vitamin D deficiency with male gender (Odds ratio (OR)=3.70 with P < 0.001). The risk increased significantly while delirium was associated with these two baseline characteristics (OR=4.76 with P=0.001). Kaplan-Meier distributions of discharge differed significantly between participants who had or not the combination of the 3 criteria (P < 0.007). Vitamin D deficiency, delirium and male gender were significant risk factors for a longer LOS in the studied sample of older inpatients

Association of Depressive Symptoms with Recurrent Falls: A Cross-Sectional Elderly Population Based Study and a Systematic Review

Background: Screening of depressive symptoms is recommended in recurrent fallers. Compared to the 30-item and 15-item Geriatric Depression Scales (GDS), the 4-item GDS is easier to administer and quicker to perform. The association between abnormal 4-item GDS score and recurrent falls has not yet been examined. In addition, while depressive symptoms-related gait instability is well known, the association with recurrent falls has been few studied. Objective: 1) To examine the association between abnormal 4-item GDS score and recurrent falls in community-dwelling older adults using original data from health examination centers (HEC) of French health insurance of Lyon, and 2) to perform a systematic review of studies that examined the association of depressive symptoms with recurrent falls among older adults. Methods: Firstly, based on a cross-sectional design, 2,594 community-dwellers (mean age 72.1 +/- 5.4years; 49.8% women) were recruited in HEC of Lyon, France. The 4-item GDS score (abnormal if score >= 1) and recurrent falls (i.e., 2 or more falls in the past year) were used as main outcomes. Secondly, a systematic English and French Medline literature search was conducted on May 28, 2012 with no limit of date using the following Medical Subject Heading (MeSH) terms "Aged OR aged, 80 and over", "Accidental falls", "Depressive disorder" and "Reccurence". The search also included the reference lists of the retrieved articles. Results: A total of 19.0% (n=494) participants were recurrent fillers in the cross-sectional study. Abnormal 4-item GDS score was more prevalent among recurrent fallers compared to non-recurrent fallers (44.7% versus 25.0%, with P<0.001), and was significantly associated with recurrent falls (Odd ratio (OR)=1.82 with P<0.001 for full model; OR=1.86 with P<0.001 for stepwise backward model). In addition to the current study, the systematic review found only four other studies on this topic, three of them examining the association of depressive symptoms with recurrent falls using 30-item or 15-item GDS. All studies showed a significant association of depressive symptoms with recurrent falls. Conclusions: The current cross-sectional study shows an association between abnormal 4-item GDS score and recurrent falls. This association of depressive symptoms with recurrent falls was confirmed by the systematic review. Based on these results, we suggest that recurrent falls risk assessment should involve a systematic screening of depressive symptoms using the 4-item GDS

Association between vitamin D deficiency and long hospital stay in geriatric acute care unit: results from a pilot cohort study

Finding a biomarker of long length-of-stay (LOS) would provide a simple solution to target frail older inpatients at such risk. The aim of this study was to determine whether serum 25-hydroxyvitamin D (25OHD) deficiency, defined as serum concentration <25 nmol/L, was associated with long LOS among inpatients admitted to a geriatric acute care unit. Three hundred and six older inpatients (mean age 84.6 +/- 6.4 years, 61.8 % women) were consecutively included in this longitudinal prospective cohort study. Patients were separated into two groups according to LOS tertiles: highest tertile (>= 14 days; n = 120) versus the other two tertiles combined (<14 days; n = 186). Serum 25OHD deficiency (58.3 vs. 38.7 %, P = 0.001) and the prevalence of male gender (58.3 vs. 28.5 %, P < 0.001) were higher among inpatients with the highest LOS compared with those with lower LOS. Serum 25OHD deficiency [odds ratio (OR) = 2.22, P = 0.001 for unadjusted model; OR = 1.87, P = 0.012 for fully adjusted model) and male gender (OR = 2.87, P < 0.001 for unadjusted model; OR = 2.64, P = 0.001 for full model) were associated with a high LOS. Vitamin D deficiency and male gender were risk factors for a long LOS in this pilot study. Using these risk factors to identify inpatients at risk of long LOS may be helpful in adapting early care plans, and thus improving inpatients\u27 health and shortening LOS