INSTALLATION OF THE LHC EXPERIMENTAL INSERTIONS

The installation of the LHC experimental insertions, and particularly the installation of the Low-Beta quadrupoles, raises many technical challenges due to the stringent alignment specifications and to the difficulty of access in very confined areas. The compact layout with many lattice elements, vacuum components, beam control instrumentation and the presence of shielding does not allow for any improvisation in the installation procedure. This paper reviews all the constraints that need to be taken into account when installing the experimental insertions. It describes the chronological sequence of installation and discusses the technical solutions that have been adopted

Comparison of Treatment Effect Estimates for Pharmacological Randomized Controlled Trials Enrolling Older Adults Only and Those including Adults: A Meta-Epidemiological Study

Context Older adults are underrepresented in clinical research. To assess therapeutic efficacy in older patients, some randomized controlled trials (RCTs) include older adults only. Objective To compare treatment effects between RCTs including older adults only (elderly RCTs) and RCTs including all adults (adult RCTs) by a meta-epidemiological approach. Methods All systematic reviews published in the Cochrane Library (Issue 4, 2011) were screened. Eligible studies were meta-analyses of binary outcomes of pharmacologic treatment including at least one elderly RCT and at least one adult RCT. For each meta-analysis, we compared summary odds ratios for elderly RCTs and adult RCTs by calculating a ratio of odds ratios (ROR). A summary ROR was estimated across all meta-analyses. Results We selected 55 meta-analyses including 524 RCTs (17% elderly RCTs). The treatment effects differed beyond that expected by chance for 7 (13%) meta-analyses, showing more favourable treatment effects in elderly RCTs in 5 cases and in adult RCTs in 2 cases. The summary ROR was 0.91 (95% CI, 0.77–1.08, p = 0.28), with substantial heterogeneity (I2 = 51% and τ2 = 0.14). Sensitivity and subgroup analyses by type-of-age RCT (elderly RCTs vs RCTs excluding older adults and vs RCTs of mixed-age adults), type of outcome (mortality or other) and type of comparator (placebo or active drug) yielded similar results. Conclusions The efficacy of pharmacologic treatments did not significantly differ, on average, between RCTs including older adults only and RCTs of all adults. However, clinically important discrepancies may occur and should be considered when generalizing evidence from all adults to older adults

Influence of trial sample size on treatment effect estimates: meta-epidemiological study

Objective To assess the influence of trial sample size on treatment effect estimates within meta-analyses. Design Meta-epidemiological study. Data sources 93 meta-analyses (735 randomised controlled trials) assessing therapeutic interventions with binary outcomes, published in the 10 leading journals of each medical subject category of the Journal Citation Reports or in the Cochrane Database of Systematic Reviews. Data extraction Sample size, outcome data, and risk of bias extracted from each trial. Data synthesis Trials within each meta-analysis were sorted by their sample size: using quarters within each meta-analysis (from quarter 1 with 25% of the smallest trials, to quarter 4 with 25% of the largest trials), and using size groups across meta-analyses (ranging from <50 to ≥1000 patients). Treatment effects were compared within each meta-analysis between quarters or between size groups by average ratios of odds ratios (where a ratio of odds ratios less than 1 indicates larger effects in smaller trials). Results Treatment effect estimates were significantly larger in smaller trials, regardless of sample size. Compared with quarter 4 (which included the largest trials), treatment effects were, on average, 32% larger in trials in quarter 1 (which included the smallest trials; ratio of odds ratios 0.68, 95% confidence interval 0.57 to 0.82), 17% larger in trials in quarter 2 (0.83, 0.75 to 0.91), and 12% larger in trials in quarter 3 (0.88, 0.82 to 0.95). Similar results were obtained when comparing treatment effect estimates between different size groups. Compared with trials of 1000 patients or more, treatment effects were, on average, 48% larger in trials with fewer than 50 patients (0.52, 0.41 to 0.66) and 10% larger in trials with 500-999 patients (0.90, 0.82 to 1.00). Conclusions Treatment effect estimates differed within meta-analyses solely based on trial sample size, with stronger effect estimates seen in small to moderately sized trials than in the largest trials

Príncipe de Asturias. Alfonso XII

Siglo XIX. Cart

Meta-Analysis of a Complex Network of Non-Pharmacological Interventions: The Example of Femoral Neck Fracture

Background Surgical interventions raise specific methodological issues in network meta-analysis (NMA). They are usually multi-component interventions resulting in complex networks of randomized controlled trials (RCTs), with multiple groups and sparse connections. Purpose To illustrate the applicability of the NMA in a complex network of surgical interventions and to prioritize the available interventions according to a clinically relevant outcome. Methods We considered RCTs of treatments for femoral neck fracture in adults. We searched CENTRAL, MEDLINE, EMBASE and ClinicalTrials.gov up to November 2015. Two reviewers independently selected trials, extracted data and used the Cochrane Collaboration’s tool for assessing the risk of bias. A group of orthopedic surgeons grouped similar but not identical interventions under the same node. We synthesized the network using a Bayesian network meta-analysis model. We derived posterior odds ratios (ORs) and 95% credible intervals (95% CrIs) for all possible pairwise comparisons. The primary outcome was all-cause revision surgery. Results Data from 27 trials were combined, for 4,186 participants (72% women, mean age 80 years, 95% displaced fractures). The median follow-up was 2 years. With hemiarthroplasty (HA) and total hip arthroplasty (THA) as a comparison, risk of surgical revision was significantly higher with the treatments unthreaded cervical osteosynthesis (OR 8.0 [95% CrI 3.6–15.5] and 5.9 [2.4–12.0], respectively), screw (9.4 [6.0–16.5] and 6.7 [3.9–13.6]) and plate (12.5 [5.8–23.8] and 7.8 [3.8–19.4]). Conclusions In older women with displaced femoral neck fractures, arthroplasty (HA and THA) is the most effective treatment in terms of risk of revision surgery

Design of the 70 mm twin aperture superconducting quadrupole for the LHC dump insertion

The LHC dump insertion features a pair of superconducting quadrupoles located on either side of a 340 m long straight section. Two horizontally deflecting kickers, located in between the quadrupole pairs, and a septum in the centre of the insertion, vertically deflect the two counter-rotating beams past the quadrupoles on the downstream sides, and into the dump areas. Due to the layout, the optical ß function in the quadrupoles is around 640 m, the largest around the LHC at injection. The quadrupoles must therefore have enlarged aperture and specially designed cryostats to allow for the safe passage of both the circulating and ejected beams. In this paper we present the design of the twin aperture dump quadrupole based on the 70 mm four layer coil proposed for the LHC low-ß quadrupoles. In preparation for model construction, we report on improvements of the coil design and a study of the retaining structures

Automatic classification of registered clinical trials towards the Global Burden of Diseases taxonomy of diseases and injuries

Includes details on the implementation of MetaMap and IntraMap, prioritization rules, the test set of clinical trials and the classification of the external test set according to the 171 GBD categories. Dataset S1: Expert-based enrichment database for the classification according to the 28 GBD categories. Manual classification of 503 UMLS concepts that could not be mapped to any of the 28 GBD categories. Dataset S2: Expert-based enrichment database for the classification according to the 171 GBD categories. Manual classification of 655 UMLS concepts that could not be mapped to any of the 171 GBD categories, among which 108 could be projected to candidate GBD categories. Table S1: Excluded residual GBD categories for the grouping of the GBD cause list in 171 GBD categories. A grouping of 193 GBD categories was defined during the GBD 2010 study to inform policy makers about the main health problems per country. From these 193 GBD categories, we excluded the 22 residual categories listed in the Table. We developed a classifier for the remaining 171 GBD categories. Among these residual categories, the unique excluded categories in the grouping of 28 GBD categories were “Other infectious diseases” and “Other endocrine, nutritional, blood, and immune disorders”. Table S2: Per-category evaluation of performance of the classifier for the 171 GBD categories plus the “No GBD” category. Number of trials per GBD category from the test set of 2,763 clinical trials. Sensitivities, specificities (in %) and likelihood ratios for each of the 171 GBD categories plus the “No GBD” category for the classifier using the Word Sense Disambiguation server, the expert-based enrichment database and the priority to the health condition field. Table S3: Performance of the 8 versions of the classifier for the 171 GBD categories. Exact-matching and weighted averaged sensitivities and specificities for 8 versions of the classifier for the 171 GBD categories. Exact-matching corresponds to the proportion (in %) of trials for which the automatic GBD classification is correct. Exact-matching was estimated over all trials (N = 2,763), trials concerning a unique GBD category (N = 2,092), trials concerning 2 or more GBD categories (N = 187), and trials not relevant for the GBD (N = 484). The weighted averaged sensitivity and specificity corresponds to the weighted average across GBD categories of the sensitivities and specificities for each GBD category plus the “No GBD” category (in %). The 8 versions correspond to the combinations of the use or not of the Word Sense Disambiguation server during the text annotation, the expert-based enrichment database, and the priority to the health condition field as a prioritization rule. Table S4: Per-category evaluation of the performance of the baseline for the 28 GBD categories plus the “No GBD” category. Number of trials per GBD category from the test set of 2,763 clinical trials. Sensitivities and specificities (in %) of the 28 GBD categories plus the “No GBD” category for the classification of clinical trial records towards GBD categories without using the UMLS knowledge source but based on the recognition in free text of the names of diseases defining in each GBD category only. For the baseline a clinical trial records was classified with a GBD category if at least one of the 291 disease names from the GBD cause list defining that GBD category appeared verbatim in the condition field, the public or scientific titles, separately, or in at least one of these three text fields. (DOCX 84 kb

BD2I : Normes sur l'identification de 274 images d'objets et leur mise en relation chez l'enfant français de 3 à 8 ans

The data base BD2I provides the first French norms for children of 274 pictures of objects (150 from Snodgarss and Vanderwart, 1980). Correct picture identification and naming, and identification of taxonomic and thematic associations were evaluated between 3 and 8 years. Verbal justification and strength of the associations were assessed between 4 and 8 years. All norms were collected from 80 children by age. Visual similarity was judged by 40 adults. These normative data are necessary because children are less efficient than adults in naming and also because their representations of objects relations differ from those of adults