Severity of Retrognathia and Glossoptosis Does Not Predict Respiratory and Feeding Disorders in Pierre Robin Sequence

Pierre Robin sequence (PRS) may lead to life-threatening respiratory and feeding disorders. With the aim to analyse the association of the severities of retrognathia and glossoptosis with those of respiratory and feeding disorders, we retrospectively studied a series of 50 infants with retrognathia, glossoptosis, cleft palate, and airway obstruction. The patients were managed from birth to at least 6 years of age by a single pediatric team at the Armand Trousseau Hospital in Paris within a 12 years period (2000–2012). Retrognathia and glossoptosis were graded in the neonatal period according to a specific clinical examination. Ventilation assistance was required for 32/50 (64%) patients, and enteral feeding for 41/50 (82%). The grades of retrognathia and glossoptosis and the severity of respiratory disorders did not differ between patients with isolated PRS and syndromic PRS. Severe respiratory disorders were more common and long-lasting feeding (>12 months) was more frequently required in patients with syndromic PRS compared with isolated PRS (42 vs. 13%, p = 0.04 and 42 vs. 4%, p < 0.01 respectively). Using univariate analysis, neurological impairments and laryngomalacia were associated with severe respiratory disorders [Odds ratio (OR) 5.0, 95% CI 1.3–19.6; and OR 14.6, 95% CI 1.3–161.4; p < 0.05] as well as with long-lasting feeding (>12 months) disorders (OR 18.6, 95% CI 3.9–89.2 and OR 20.4, 95% CI 3,4–122.8; p < 10−2). Syndromic SPR status was also associated with severe respiratory disorders (OR 4.9, 95% CI 1–32.5; p < 0.05). Using multivariate analysis, only syndromic PRS status was predictive for severe respiratory disorders (adjusted OR 8, 95% CI 1.47–44.57; p < 0.05); and only neurological impairments remained a significant risk for long lasting feeding disorders (>12 months) (adjusted OR 21.72, 95% CI 3.4–138.63; p < 10−2). The grades of retrognathia and glossoptosis were not predictive factors for the severity of respiratory and feeding disorders.Conclusion: In children with PRS, the severity of clinical conditions may not correlate with anatomic variables but rather with laryngeal abnormalities, neurological impairement and syndromic PRS status

Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality:

BACKGROUND: The birth of a child with a cleft lip, whether or not in association with a cleft palate, is a traumatic event for parents. This prospective, multidisciplinary and multi-centre study aims to explore the perceptions and feelings of parents in the year following the birth of their child, and to analyse parent-child relationships. Four inclusion centres have been selected, differing as to the date of the first surgical intervention, between birth and six months. The aim is to compare results, also distinguishing the subgroups of parents who were given the diagnosis in utero and those who were not. METHODS/DESIGN: The main hypothesis is that the longer the time-lapse before the first surgical intervention, the more likely are the psychological perceptions of the parents to affect the harmonious development of their child. Parents and children are seen twice, when the child is 4 months (T0) and when the child is one year old (T1). At these two times, the psychological state of the child and his/her relational abilities are assessed by a specially trained professional, and self-administered questionnaires measuring factors liable to affect child-parent relationships are issued to the parents. The Alarme Detresse BeBe score for the child and the Parenting Stress Index score for the parents, measured when the child reaches one year, will be used as the main criteria to compare children with early surgery to children with late surgery, and those where the diagnosis was obtained prior to birth with those receiving it at birth. DISCUSSION: The mental and psychological dimensions relating to the abnormality and its correction will be analysed for the parents (the importance of prenatal diagnosis, relational development with the child, self-image, quality of life) and also, for the first time, for the child (distress, withdrawal). In an ethical perspective, the different time lapses until surgery in the different protocols and their effects will be analysed, so as to serve as a reference for improving the quality of information during the waiting period, and the quality of support provided for parents and children by the healthcare team before the first surgical intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00993993

Essays on economic uncertainty

These essays propose different measures of economic uncertainty and evaluate its impact at the microeconomic and macroeconomic level. The first essay in Chapter 2 proposes a measure of macroeconomic uncertainty that allows to distinguish its vari-ous components. Metrics of Knightian uncertainty and risk are proposed, and their respective impact on a number of economic aggregates is evaluated. Chapter 3 extends the classical approach to measuring uncertainty – a mean squared error-based quantity –to entropy methods in econometrics. Several information-theoretic measures of uncertainty are motivated, derived, and estimated on two data sets: the Survey of Professional Forecasters used in Chapter 2, to show that the conclusions hold with this different approach; and the Survey of Economic Expectations, to show how information theoretic measures of uncertainty can help study different situations not afforded by the mean-squared error approach. Chapter 4 studies uncertainty from the point of view of forecasting and propose a measure of forecasting uncertainty to study how business cycles can affect this particular dimension of Knightian uncertainty. Chapter 5 considers the question of the efficacy of fiscal policy in periods of uncertainty, and does so in a way that accounts for the comovements of economic uncertainty with recessions through an conditional adjustment to the classical smooth-transition state dependent models. Chapter 6 concludes.Aquesta tesi proposa diferents mesures d’incertesa econòmica i avalua el seu impacte a nivell microeconòmic i macroeconòmic. El primer assaig, al Capítol 2, proposa una mesura de la incertesa macroeconòmica que permet distingir entre les seves múltiples components. Es proposen mètriques d’incertesa i risc de Knight, i se n’avaluen els seus respectius impactes sobre diverses magnituds econòmiques. En el Capítol 3 s’amplia l’enfocament clàssic per la mesura de la incertesa – l’error quadràtic mig – als mètodes d’entropia en econometria. Les diverses mesures d’incertesa que fan servir la teoría la informació estan motivades, derivades i estimades en dos conjunts de dades: el Survey of Professional Forecasters, que s’utilitza al Capítol 2 per demostrar que les conclusions es mantenen amb aquest nou enfocament; i el Survey of Economic Expectations, que es fa servir per mostrar com aquestes mesures d’informació poden ajudar a estudiar situacions diferents que els mètodes classics amb error quadràtic mig. El Capítol 4 estudia la incertesa des del punt de vista de la predicció i proposa una mesura d’incertesa de previsió per estudiar com els cicles econòmics poden afectar aquesta dimensió particular de la incertesa knightiana. El Capítol 5 examina la qüestió de l’eficàcia de la política fiscal en períodes d’incertesa, i ho fa de manera que ajusta per als moviments de la incertesa econòmica amb les recessions. També es proposa una nova classe de models depenents de l’estat que inclou condicionalitat. El Capítol 6 conté les conclusions.Esta tesis propone diferentes medidas de incertidumbre económica y evalúa su impacto a nivel microeconómico y macroeconómico. El primer ensayo en el Capítulo 2 propone una medida de la incertidumbre macroeconómica que permite distinguir entre sus diversos componentes. Se proponen métricas de incertidumbre y riesgo de Knight, y se evalúan sus respectivos impactos sobre diversas cantidades económicas. El Capítulo 3 amplía el enfoque clásico para medir la incertidumbre - del error cuadrático medio -, a los métodos de entropía en econometría. Varias medidas de incertidumbre que utilizan la teoría de la información están motivadas, derivadas y estimadas en dos conjuntos de datos: el Survey of Professional Forecasters que se utiliza en el Capítulo 2 para demostrar que las conclusiones se mantienen con este nuevo enfoque y el Survey of Economic Expectations, para mostrar cómo estas medidas de información pueden ayudar a estudiar situaciones diferentes de las que los métodos clásicos con error cuadrático medio permiten. El Capítulo 4 estudia la incertidumbre desde el punto de vista de la predicción y propone una medida de incertidumbre de previsión para estudiar cómo los ciclos económicos pueden afectar a esta dimensión particular de la incertidumbre knightiana. El Capítulo 5 examina la cuestión de la eficacia de la política fiscal en períodos de incertidumbre, y lo hace de una manera que tiene en cuenta los movimientos de la incertidumbre económica con las recesiones. Además, se propone una nueva clase de modelos dependientes del estado que incluye condicionalidad. El Capítulo 6 concluye la tesis

Essays on economic uncertainty

These essays propose different measures of economic uncertainty and evaluate its impact at the microeconomic and macroeconomic level. The first essay in Chapter 2 proposes a measure of macroeconomic uncertainty that allows to distinguish its vari-ous components. Metrics of Knightian uncertainty and risk are proposed, and their respective impact on a number of economic aggregates is evaluated. Chapter 3 extends the classical approach to measuring uncertainty – a mean squared error-based quantity –to entropy methods in econometrics. Several information-theoretic measures of uncertainty are motivated, derived, and estimated on two data sets: the Survey of Professional Forecasters used in Chapter 2, to show that the conclusions hold with this different approach; and the Survey of Economic Expectations, to show how information theoretic measures of uncertainty can help study different situations not afforded by the mean-squared error approach. Chapter 4 studies uncertainty from the point of view of forecasting and propose a measure of forecasting uncertainty to study how business cycles can affect this particular dimension of Knightian uncertainty. Chapter 5 considers the question of the efficacy of fiscal policy in periods of uncertainty, and does so in a way that accounts for the comovements of economic uncertainty with recessions through an conditional adjustment to the classical smooth-transition state dependent models. Chapter 6 concludes.Aquesta tesi proposa diferents mesures d’incertesa econòmica i avalua el seu impacte a nivell microeconòmic i macroeconòmic. El primer assaig, al Capítol 2, proposa una mesura de la incertesa macroeconòmica que permet distingir entre les seves múltiples components. Es proposen mètriques d’incertesa i risc de Knight, i se n’avaluen els seus respectius impactes sobre diverses magnituds econòmiques. En el Capítol 3 s’amplia l’enfocament clàssic per la mesura de la incertesa – l’error quadràtic mig – als mètodes d’entropia en econometria. Les diverses mesures d’incertesa que fan servir la teoría la informació estan motivades, derivades i estimades en dos conjunts de dades: el Survey of Professional Forecasters, que s’utilitza al Capítol 2 per demostrar que les conclusions es mantenen amb aquest nou enfocament; i el Survey of Economic Expectations, que es fa servir per mostrar com aquestes mesures d’informació poden ajudar a estudiar situacions diferents que els mètodes classics amb error quadràtic mig. El Capítol 4 estudia la incertesa des del punt de vista de la predicció i proposa una mesura d’incertesa de previsió per estudiar com els cicles econòmics poden afectar aquesta dimensió particular de la incertesa knightiana. El Capítol 5 examina la qüestió de l’eficàcia de la política fiscal en períodes d’incertesa, i ho fa de manera que ajusta per als moviments de la incertesa econòmica amb les recessions. També es proposa una nova classe de models depenents de l’estat que inclou condicionalitat. El Capítol 6 conté les conclusions.Esta tesis propone diferentes medidas de incertidumbre económica y evalúa su impacto a nivel microeconómico y macroeconómico. El primer ensayo en el Capítulo 2 propone una medida de la incertidumbre macroeconómica que permite distinguir entre sus diversos componentes. Se proponen métricas de incertidumbre y riesgo de Knight, y se evalúan sus respectivos impactos sobre diversas cantidades económicas. El Capítulo 3 amplía el enfoque clásico para medir la incertidumbre - del error cuadrático medio -, a los métodos de entropía en econometría. Varias medidas de incertidumbre que utilizan la teoría de la información están motivadas, derivadas y estimadas en dos conjuntos de datos: el Survey of Professional Forecasters que se utiliza en el Capítulo 2 para demostrar que las conclusiones se mantienen con este nuevo enfoque y el Survey of Economic Expectations, para mostrar cómo estas medidas de información pueden ayudar a estudiar situaciones diferentes de las que los métodos clásicos con error cuadrático medio permiten. El Capítulo 4 estudia la incertidumbre desde el punto de vista de la predicción y propone una medida de incertidumbre de previsión para estudiar cómo los ciclos económicos pueden afectar a esta dimensión particular de la incertidumbre knightiana. El Capítulo 5 examina la cuestión de la eficacia de la política fiscal en períodos de incertidumbre, y lo hace de una manera que tiene en cuenta los movimientos de la incertidumbre económica con las recesiones. Además, se propone una nueva clase de modelos dependientes del estado que incluye condicionalidad. El Capítulo 6 concluye la tesis

Implementing tests for forecast evaluation in the presence of instabilities

In this article, we review methodologies to fix the size distortions of tests for forecast evaluation in the presence of instabilities. The methodologies implement tests for relative and absolute forecast evaluation that are robust to instabilities. We also introduce the giacross and rosssekh commands, which implement these procedures in Stata

Prise en charge chirurgicale des fentes palatines dans le syndrome de Pierre Robin, dans le service de chirurgie maxillo-faciale et plastique de l'hôpital Trousseau, entre 1985 et 2000 (à propos de 83 cas)

Le syndrome de Pierre Robin associe trois malformations anatomiques à des troubles fonctionnels de sévérité variable (trois stades). Les différentes hypothèses étiopathogéniques sur les différentes formes de Robin, et les principes actuels du traitement sont exposés. Ce travail réalise l'étude rétrospective de 83 patients, suivis et opérés de fente palatine à l'hôpital Trousseau, entre 1985 et 2000. La gravité et la forme du syndrome, ainsi que les malformations anatomiques sont analysées. Les patients ont porté une orthèse palatine jusqu'au geste opératoire. La fermeture de la fente a été réalisée précocement (3-6 mois), par la technique de Malek. Les résultats locaux et généraux montrent l'intérêt d'une chirurgie précoce dans l'amélioration des troubles fonctionnels, notamment alimentaires. L'orthèse ne semble pas rétrécir la fente. Sur le plan orthophonique, les résultats sont jugés satisfaisants dans 80 % des casThe Pierre Robin syndrome refers to a combination of three anatomic malformations and functional problems of variable severity (three groups). The different etiopathogenic hypothesis and the actual type of treatment are exposed. The results of a retrospective study on 83 patients treated and operated of cleft palate in hôpital Trousseau, between 1985 and 2000, are analysed. Patients have worn a palatal orthesis until the operating date. The cleft palate repair was performed young (3-6 months) by the technique of Malek. Local and general results demonstrate the interest of an early closure for the improvement of the functional difficulties, especially feeding problems. The orthesis doesn't seem to shrink the cleft.The orthoponic results are satisfactory in 80 % of casesPARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Implementing tests for forecast evaluation in the presence of instabilities

In this article, we review methodologies to fix the size distortions of tests for forecast evaluation in the presence of instabilities. The methodologies implement tests for relative and absolute forecast evaluation that are robust to instabilities. We also introduce the giacross and rosssekh commands, which implement these procedures in Stata

From lead-free piezoelectric KNN nanopowders towards ceramics and printed layers : sintering strategies for an eco-efficient manufacturing process.

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