L’insomnie et son traitement chez les personnes âgées : une nouvelle approche

Les hypothèses avancées actuellement sur l'intervention psychologique pour résoudre les troubles d'induction et de maintien du sommeil n'expliquent qu'en partie le phénomène de l'insomnie, tout particulièrement chez les personnes âgées. Dans cet article, nous analysons les modes de traitement de l'insomnie non basés sur la pharmacologie qui sont présentement offerts, et nous proposons une nouvelle manière de concevoir et de traiter les difficultés d'induction et de maintien du sommeil (DIMS). À base de facteurs cognitifs et estimatifs (traitement d'informations), le modèle est utilisé pour soumettre de nouvelles approches d'intervention. Vu la fréquence des interruptions de sommeil chez les gens âgés et les effets restreints de la pharmacothérapie et de la psychothérapie sur eux, les hypothèses énoncées par le modèle proposé et l'intervention projetée sont examinées en portant une attention toute particulière à la population âgée.Existing hypotheses regarding psychological mediation of disorders in initiating and maintaining sleep only partially explain the phenomenon of insomnia, particularly in aging individuals. In this article we review existing nonpharmacological treatments of insomnia and propose a new way of conceptualizing and treating disorders of initiating and maintaining sleep. The model, based on cognitive and information processing factors, is then used to propose novel approaches to intervention. Because of the prevalence of sleep disruptions in older adults and the limitations of existing pharmacological and psychological treatments with this population, the assumptions of the model and the proposed intervention are explored with particular reference to aging individuals

The influence of body mass index and age on C-peptide at the diagnosis of type 1 diabetes in children who participated in the diabetes prevention trial-type 1

BACKGROUND/OBJECTIVE: The extent of influence of BMI and age on C-peptide at the diagnosis of type 1 diabetes (T1D) is unknown. We thus studied the impact of body mass index Z-scores (BMIZ) and age on C-peptide measures at and soon after the diagnosis of T1D. METHODS: Data from Diabetes Prevention Trial-Type 1 (DPT-1) participants <18.0 years at diagnosis was analyzed. Analyses examined associations of C-peptide measures with BMIZ and age in 2 cohorts: oral glucose tolerance tests (OGTTs) at diagnosis (n = 99) and mixed meal tolerance tests (MMTTs) <6 months after diagnosis (n = 80). Multivariable linear regression was utilized. RESULTS: Fasting and area under the curve (AUC) C-peptide from OGTTs (n = 99) at diagnosis and MMTTs (n = 80) after diagnosis were positively associated with BMIZ and age (P < .001 for all). Associations persisted when BMIZ and age were included as independent variables in regression models (P < .001 for all). BMIZ and age explained 31%-47% of the variance of C-peptide measures. In an example, 2 individuals with identical AUC C-peptide values had an approximate 5-fold difference in values after adjustments for BMIZ and age. The association between fasting glucose and C-peptide decreased markedly when fasting C-peptide values were adjusted (r = 0.30, P < .01 to r = 0.07, n.s.). CONCLUSIONS: C-peptide measures are strongly and independently related to BMIZ and age at and soon after the diagnosis of T1D. Adjustments for BMIZ and age cause substantial changes in C-peptide values, and impact the association between glycemia and C-peptide. Such adjustments can improve assessments of β-cell impairment at diagnosis

Bottleneck Routing Games with Low Price of Anarchy

We study {\em bottleneck routing games} where the social cost is determined by the worst congestion on any edge in the network. In the literature, bottleneck games assume player utility costs determined by the worst congested edge in their paths. However, the Nash equilibria of such games are inefficient since the price of anarchy can be very high and proportional to the size of the network. In order to obtain smaller price of anarchy we introduce {\em exponential bottleneck games} where the utility costs of the players are exponential functions of their congestions. We find that exponential bottleneck games are very efficient and give a poly-log bound on the price of anarchy: $O(\log L \cdot \log |E|)$, where $L$ is the largest path length in the players' strategy sets and $E$ is the set of edges in the graph. By adjusting the exponential utility costs with a logarithm we obtain games whose player costs are almost identical to those in regular bottleneck games, and at the same time have the good price of anarchy of exponential games.Comment: 12 page

Information and Communication Technology for French and English Speaking Postsecondary Students with Disabilities: What are Their Needs and How Well are These Being Met?

This study evaluates how well information and communication technology (ICT) related needs of students with various disabilities are met at school, at home, and in e-learning contexts. Results are based on the POSITIVES Scale, a 26 item ob-jective measure of how well the ICT related needs of these students are met. The sample consists of 131 students from French and 1202 students from English lan-guage universities and junior/community colleges with various disabilities from across Canada. Although the results generally show more favourable than unfa-vourable scores, these are affected by the nature of students’ disabilities and by context: home or school. Generally, both groups had similar views about cir-cumstances where their needs were poorly met and about what worked well. The findings suggest that linguistic and policy considerations have an impact on how well the ICT related needs of students with different disabilities are met in differ-ent parts of Canada

Jejunal Perforation During Percutaneous Nephrolithotrypsy

Colonic and duodenal perforations, albeit rare, are known complications of PCNL; however, to our knowledge, jejunal perforation has never been reported. We report a case of an 83-year-old man, underwent left PCNL for a 2cm stone in the renal pelvis, confirmed to have a jejunal perforation. He was successfully managed conservatively. His diagnostic work up and management will be discussed

Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial

Background The clinical benefit of preventive eradication of unruptured brain arteriovenous malformations remains uncertain. A Randomised trial of Unruptured Brain Arteriovenous malformations (ARUBA) aims to compare the risk of death and symptomatic stroke in patients with an unruptured brain arteriovenous malformation who are allocated to either medical management alone or medical management with interventional therapy. Methods Adult patients (\u3e= 18 years) with an unruptured brain arteriovenous malformation were enrolled into this trial at 39 clinical sites in nine countries. Patients were randomised (by web-based system, in a 1: 1 ratio, with random permuted block design [block size 2, 4, or 6], stratified by clinical site) to medical management with interventional therapy (ie, neurosurgery, embolisation, or stereotactic radiotherapy, alone or in combination) or medical management alone (ie, pharmacological therapy for neurological symptoms as needed). Patients, clinicians, and investigators are aware of treatment assignment. The primary outcome is time to the composite endpoint of death or symptomatic stroke; the primary analysis is by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00389181. Findings Randomisation was started on April 4, 2007, and was stopped on April 15, 2013, when a data and safety monitoring board appointed by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health recommended halting randomisation because of superiority of the medical management group (log-rank Z statistic of 4.10, exceeding the prespecified stopping boundary value of 2.87). At this point, outcome data were available for 223 patients (mean follow-up 33.3 months [SD 19.7]), 114 assigned to interventional therapy and 109 to medical management. The primary endpoint had been reached by 11 (10.1%) patients in the medical management group compared with 35 (30.7%) in the interventional therapy group. The risk of death or stroke was significantly lower in the medical management group than in the interventional therapy group (hazard ratio 0.27, 95% CI 0.14-0.54). No harms were identified, other than a higher number of strokes (45 vs 12,

Epidemiological and clinical characteristics of international travelers with enteric fever and antibiotic resistance profiles of their isolates: A GeoSentinel analysis

Copyright © 2020 American Society for Microbiology. All Rights Reserved. Enteric fever, caused by Salmonella enterica serovar Typhi (S. Typhi) and S. enterica serovar Paratyphi (S. Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site’s national guidelines. A total of 889 travelers (S. Typhi infections, n = 474; S. Paratyphi infections, n = 414; coinfection, n = 1) were included; 114 (13%) were children of (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with S. Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 S. Typhi and 75 S. Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two S. Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. S. Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children

Malicious Bayesian Congestion Games

In this paper, we introduce malicious Bayesian congestion games as an extension to congestion games where players might act in a malicious way. In such a game each player has two types. Either the player is a rational player seeking to minimize her own delay, or - with a certain probability - the player is malicious in which case her only goal is to disturb the other players as much as possible. We show that such games do in general not possess a Bayesian Nash equilibrium in pure strategies (i.e. a pure Bayesian Nash equilibrium). Moreover, given a game, we show that it is NP-complete to decide whether it admits a pure Bayesian Nash equilibrium. This result even holds when resource latency functions are linear, each player is malicious with the same probability, and all strategy sets consist of singleton sets. For a slightly more restricted class of malicious Bayesian congestion games, we provide easy checkable properties that are necessary and sufficient for the existence of a pure Bayesian Nash equilibrium. In the second part of the paper we study the impact of the malicious types on the overall performance of the system (i.e. the social cost). To measure this impact, we use the Price of Malice. We provide (tight) bounds on the Price of Malice for an interesting class of malicious Bayesian congestion games. Moreover, we show that for certain congestion games the advent of malicious types can also be beneficial to the system in the sense that the social cost of the worst case equilibrium decreases. We provide a tight bound on the maximum factor by which this happens.Comment: 18 pages, submitted to WAOA'0