Impact of a fracture liaison service on patient management after an osteoporotic fracture: the CHUV FLS.

In 2008, the Centre Hospitalier Universitaire Vaudois (CHUV, Lausanne, Switzerland) initiated a Fracture Liaison Service (FLS). All patients hospitalised for a low trauma fracture are identified by the FLS. Inpatients then choose to be managed by either the FLS team or their general practitioner (GP). In this study we compared the management between the FLS team and the GP in terms of diagnosis of osteoporosis, treatment, refracture rates and mortality after FLS recording. Results are compared with the management of osteoporosis before the creation of the FLS, as reported in the survey study Osteocare. A total of 606 patients were included (80% women); 55% chose management by the FLS and 45% their GP. The mean age was 78.5, and hip was the main fracture site (44%). The percentage of patients having dual X-ray absorptiometry to diagnose osteoporosis was significantly higher in the FLS group than the GP group (72 vs 26.5%, p <0.01). This percentage was 31.4% in the Osteocare study. Overall, 50.3% of patients in the FLS group had osteoporosis versus 57.5% in the GP group (p <0.05). This percentage was 46.0% in the Osteocare study. Use of osteoporosis medication was higher in the FLS group (FLS 100% of the patients, GP 44.1%, p <0.001) and had increased since the Osteocare study (21.6%). One-year nonvertebral refracture rate was higher in GP group than in the FLS patients (5.1 vs 3.0%, p <0.05), whereas more vertebral fractures were identified in the FLS group, owing to protocol-driven regular clinical and vertebral fracture assessment (VFA) evaluations (number of evaluations 8 vs 0, p <0.01). Unadjusted mortality was higher in GP group than in the FLS group at one and five years (6.93 vs 2.11% and 33.58 vs. 15.96%, p <0.04). After adjustment by age and fracture site, these results were not significant. With FLS management, diagnosis and treatment of osteoporosis were more frequent than with GP management; new nonvertebral fractures were less frequent. Moreover, both forms of management had increased relative to rates reported in a 2004-2006 nationwide survey Osteocare, before FLS creation

Pointwise regularity of parameterized affine zipper fractal curves

We study the pointwise regularity of zipper fractal curves generated by affine mappings. Under the assumption of dominated splitting of index-1, we calculate the Hausdorff dimension of the level sets of the pointwise Hölder exponent for a subinterval of the spectrum. We give an equivalent characterization for the existence of regular pointwise Hölder exponent for Lebesgue almost every point. In this case, we extend the multifractal analysis to the full spectrum. In particular, we apply our results for the de Rham’s curve

(2010)"

Exponential stability and stabilization of sampled-data systems with time-varying perio

A novel stability analysis of linear systems under asynchronous samplings

International audienceThis article proposes a novel approach to assess stability of continuous linear systems with sampled-data inputs. The method, which is based on the discrete-time Lyapunov theorem, provides easy tractable stability conditions for the continuous-time model. Su±cient conditions for asymptotic and exponential stability are provided dealing with synchronous and asynchronous samplings and uncertain systems. An additional stability analysis is provided for the cases of multiple sampling periods and packet losses. Several examples show the effciency of the method

Stabilization of time-delay systems through linear differential equations using a descriptor representation

In this article, a new method to assess stability and to design static state feedback controller for linear time-delay systems is introduced. The method based on linear differential equations allows considering explicit Lyapunov-Krasovskii functionals with non constant matrix parameters. The stability conditions considering constant delays are delay-dependent and expressed using easy computable linear matrix inequalities. An example is introduced to show the efficiency of the stabilization criteria.QC 20120210</p