Développement et utilisation d'un questionnaire d'évaluation de la transition de l'adolescent atteint du syndrome de Klinefelter

1.1.Introduction Le but de cette étude est de développer un programme de suivi et de transition structuré pour les enfants adolescents et jeunes adultes atteints d'un syndrome de Klinefelter (KS), afin de les guider avec leur entourage dans la transition des soins pédiatriques à ceux pour adultes. Il existe peu de littérature concertant cette thématique. Cette étude devrait donc aider à la prise en charge de ces patients à l'aide d'un protocole standardisé. 1.2.Objectifs 1.2.1. Evaluation de la prise en charge médicale et du traitement des enfants, adolescents et jeunes adultes ayant été suivis à l'HEL (Hôpital de l'Enfance de Lausanne) et au CHUV pour un syndrome de Klinefelter. 1.2.2. Evaluation du vécu de la transition des soins pédiatriques aux soins adultes ainsi que la qualité de vie actuelle des patients. 1.2.3. Elaboration d'un programme structuré de transition pour le patient avec syndrome de Klinefelter 1.3.Méthode Etude sur les bases de données existantes à l'HEL et au CHUV des patients suivis pour un syndrome de Klinefelter ? Elaboration et évaluation d'un questionnaire destiné à des jeunes adultes ayant été suivis à l'HEL ou au CHUV, âgés de 16 à 40 ans, afin d'évaluer leur vécu de la transition ainsi que le suivi médical actuel ? Utilisation d'un 2ème questionnaire, WHOQOL-BREF, évaluant la qualité de vie de ces patients ? Elaboration d'un programme structuré de transition 1.4.Résultats ? Anthropométrie de la cohorte pédiatrique ? Bonne prise en charge pédiatrique mais suivi insuffisant ? Nécessité d'une prise en charge multidisciplinaire ? Rédaction d'un document de référence pour le suivi de ces patients 1.5.Conclusion Les sujets étudiés dans notre cohorte présentent les signes cliniques classiques d'un KS, mais avec une expression variable. En effet, ils présentent pour la plupart une grande taille avec disproportion modérée. La gynécomastie n'est pas aussi fréquente dans notre cohorte que décrite. Nous constatons qu'il existe une bonne prise en charge pédiatrique de ces patients avec un suivi régulier, un ralentissement de la croissance et une bonne évolution de leur puberté. Notre étude montre que 78.6% des patients développent un hypogonadisme hypergonadotrope en moyenne à 15-16 ans, nécessitant un traitement substitutif par testostérone. Selon nos données le meilleur moment de prise en charge de la fertilité devrait avoir lieu probablement entre 14-15 ans, où nous observons une légère augmentation du volume testiculaire à travers notre cohorte. En absence de spermogramme fait chez nos patients, nous n'avons pas de données suffisantes. Concernant le suivi à long terme des patients, il est insuffisant. En effet seulement 50% de la cohorte pédiatrique a été redirigé vers un spécialiste pour adulte. Nous avons été surpris de constater que seulement 40% des patients, qui ont répondu au questionnaire, sont traités à ce jour. Il est donc nécessaire d'anticiper la transition des soins pédiatriques aux soins adultes. La qualité de vie de ces patients est relativement bonne, Cependant à travers les retours du questionnaire nous avons pu constater une large variation des réponses allant d'un extrême à l'autre, Il est donc nécessaire d'avoir une prise en charge multidisciplinaire et personnalisé pour chaque patient. Ces données nous ont permis d'élaborer un protocole de transition qui s'insère dans le programme de transition du CEMjA

Novel Phases in the Field Induced Spin Density Wave State in (TMTSF)_2PF_6

Magnetoresistance measurements on the quasi one-dimensional organic conductor (TMTSF)_2PF_6 performed in magnetic fields B up to 16T, temperatures T down to 0.12K and under pressures P up to 14kbar have revealed new phases on its P-B-T phase diagram. We found a new boundary which subdivides the field induced spin density wave (FISDW) phase diagram into two regions. We showed that a low-temperature region of the FISDW diagram is characterized by a hysteresis behavior typical for the first order transitions, as observed in a number of studies. In contrast to the common believe, in high temperature region of the FISDW phase diagram, the hysteresis and, hence, the first order transitions were found to disappear. Nevertheless, sharp changes in the resistivity slope are observed both in the low and high temperature domains indicating that the cascade of transitions between different subphases exists over all range of the FISDW state. We also found that the temperature dependence of the resistance (at a constant B) changes sign at about the same boundary. We compare these results with recent theoretical models.Comment: LaTex, 4 pages, 4 figure

Machine learning algorithms distinguish discrete digital emotional fingerprints for web pages related to back pain

Back pain is the leading cause of disability worldwide. Its emergence relates not only to the musculoskeletal degeneration biological substrate but also to psychosocial factors; emotional components play a pivotal role. In modern society, people are significantly informed by the Internet; in turn, they contribute social validation to a “successful” digital information subset in a dynamic interplay. The Affective component of medical pages has not been previously investigated, a significant gap in knowledge since they represent a critical biopsychosocial feature. We tested the hypothesis that successful pages related to spine pathology embed a consistent emotional pattern, allowing discrimination from a control group. The pool of web pages related to spine or hip/knee pathology was automatically selected by relevance and popularity and submitted to automated sentiment analysis to generate emotional patterns. Machine Learning (ML) algorithms were trained to predict page original topics from patterns with binary classification. ML showed high discrimination accuracy; disgust emerged as a discriminating emotion. The findings suggest that the digital affective “successful content” (collective consciousness) integrates patients’ biopsychosocial ecosystem, with potential implications for the emergence of chronic pain, and the endorsement of health-relevant specific behaviors. Awareness of such effects raises practical and ethical issues for health information providers

Paramagnetic Intrinsic Meissner Effect in Layered Superconductors

Free energy of a layered superconductor with $\xi_{\perp} < d$ is calculated in a parallel magnetic field by means of the Gor'kov equations, where $\xi_{\perp}$ is a coherence length perpendicular to the layers and $d$ is an inter-layer distance. The free energy is shown to differ from that in the textbook Lawrence-Doniach model at high fields, where the Meissner currents are found to create an unexpected positive magnetic moment due to shrinking of the Cooper pairs "sizes" by a magnetic field. This paramagnetic intrinsic Meissner effect in a bulk is suggested to detect by measuring in-plane torque, the upper critical field, and magnetization in layered organic and high-T$_c$ superconductors as well as in superconducting superlattices.Comment: Submitted to Physical Review Letters on February 21st 200

Head Position in Stroke Trial (HeadPoST)- sitting-up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomised controlled trial

Background Positioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0°) compared with sitting-up (≥30°) head positioning in the first 24 hours of hospital admission for patients with acute stroke. Methods/Design We plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0°) or sitting-up (≥30°) head position as a ‘business as usual’ stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (α 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period. Discussion HeadPoST is a large international clinical trial in which we will rigorously evaluate the effects of different head positioning in patients with acute stroke. Trial registration ClinicalTrials.gov identifier: NCT02162017 (date of registration: 27 April 2014); ANZCTR identifier: ACTRN12614000483651 (date of registration: 9 May 2014). Protocol version and date: version 2.2, 19 June 2014

Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses

AIMS/HYPOTHESIS: Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. METHODS: Data were sourced from MEDLINE and All EBM (Evidence Based Medicine) databases from inception to July 2018. Observational studies, investigating the effect of age at diabetes diagnosis on macrovascular and microvascular diabetes complications in adults with type 2 diabetes were selected according to pre-specified criteria. Two investigators independently extracted data and evaluated all studies. If data were not reported in a comparable format, data were obtained from authors, presented as minimally adjusted ORs (and 95% CIs) per 1 year increase in age at diabetes diagnosis, adjusted for current age for each outcome of interest. The study protocol was recorded with PROSPERO International Prospective Register of Systematic Reviews (CRD42016043593). RESULTS: Data from 26 observational studies comprising 1,325,493 individuals from 30 countries were included. Random-effects meta-analyses with inverse variance weighting were used to obtain the pooled ORs. Age at diabetes diagnosis was inversely associated with risk of all-cause mortality and macrovascular and microvascular disease (all p < 0.001). Each 1 year increase in age at diabetes diagnosis was associated with a 4%, 3% and 5% decreased risk of all-cause mortality, macrovascular disease and microvascular disease, respectively, adjusted for current age. The effects were consistent for the individual components of the composite outcomes (all p < 0.001). CONCLUSIONS/INTERPRETATION: Younger, rather than older, age at diabetes diagnosis was associated with higher risk of mortality and vascular disease. Early and sustained interventions to delay type 2 diabetes onset and improve blood glucose levels and cardiovascular risk profiles of those already diagnosed are essential to reduce morbidity and mortality. Graphical abstract

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions

Instances and connectors : issues for a second generation process language

This work is supported by UK EPSRC grants GR/L34433 and GR/L32699Over the past decade a variety of process languages have been defined, used and evaluated. It is now possible to consider second generation languages based on this experience. Rather than develop a second generation wish list this position paper explores two issues: instances and connectors. Instances relate to the relationship between a process model as a description and the, possibly multiple, enacting instances which are created from it. Connectors refers to the issue of concurrency control and achieving a higher level of abstraction in how parts of a model interact. We believe that these issues are key to developing systems which can effectively support business processes, and that they have not received sufficient attention within the process modelling community. Through exploring these issues we also illustrate our approach to designing a second generation process language.Postprin

Interaction of enamel matrix proteins with human periodontal ligament cells

Dorothy Hodgkin Postgraduate Award for research studies (jointly funded by the Engineering and Physical Sciences Research Council, UK, and by Institut Straumann) and the Research Discretionary Funds of the Periodontology Unit, UCL Eastman Dental Institute. Financial support was also provided by the NIHR Comprehensive Biomedical Research Centre and by the WCU Program of the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No. R31-10069)