Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study.

To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women > or =70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not. INTRODUCTION: As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose. MATERIALS AND METHODS: The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women > or =70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters. RESULTS: From the 7609 women who were included in the study, 7062 women 75.2 +/- 3.1 (SD) years of age were prospectively followed for 2.9 +/- 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s). CONCLUSIONS: In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.

Partial protection and intrathecal invasion of CD8(+) T cells in acute canine distemper virus infection.

Initial non-inflammatory demyelination in canine distemper virus infection (CDV) develops against a background of severe immunosuppression and is therefore, thought to be virus-induced. However, recently we found a marked invasion of T cells throughout the central nervous system (CNS) in dogs with acute distemper despite drastic damage to the immune system. In the present study, this apparent paradox was further investigated by immunophenotyping of lymphocytes, following experimental CDV challenge in vaccinated and non-vaccinated dogs. In contrast to CDV infected, unprotected dogs, vaccinated dogs did not become immunosuppressed and exhibited a strong antiviral immune response following challenge with virulent CDV. In unprotected dogs rapid and drastic lymphopenia was initially due to depletion of T cells. In peripheral blood, CD4(+) T cells were more sensitive and depleted earlier and for a longer time than CD8(+) cells which recovered soon. In the cerebrospinal fluid (CSF) we could observe an increase in the T cell to B cell and CD8(+) to CD4(+) ratios. Thus, partial protection of the CD8(+) cell population could explain why part of the immune function in acute distemper is preserved. As found earlier, T cells invaded the CNS parenchyma in these dogs but also in the protected challenged dogs, which did not develop any CNS disease at all. Since markers of T cell activation were upregulated in both groups of animals, this phenomenon could in part be related to non-specific penetration of activated T cells through the blood brain barrier. However, in diseased animals much larger numbers of T cells were found in the CNS than in the protected dogs, suggesting that massive invasion of T cells in the brain requires CDV expression in the CNS.

Long-term continuous-flow left ventricular assist devices (LVAD) as bridge to heart transplantation.

Heart transplantation (HTx) is the treatment of choice for end-stage heart failure but the limited availability of heart's donors still represents a major issue. So long-term mechanical circulatory support (MCS) has been proposed as an alternative treatment option to assist patients scheduled on HTx waiting list bridging them for a variable time period to cardiac transplantation-the so-called bridge-to-transplantation (BTT) strategy. Nowadays approximately 90% of patients being considered for MCS receive a left ventricular assist device (LVAD). In fact, LVAD experienced several improvements in the last decade and the predominance of continuous-flow over pulsatile-flow technology has been evident since 2008. The aim of the present report is to give an overview of continuous-flow LVAD utilization in the specific setting of the BTT strategy taking into consideration the most representative articles of the scientific literature and focusing the attention on the evolution, clinical outcomes, relevant implications on the HTx strategy and future perspectives of the continuous-flow LVAD technology.

Le renforcement de la loi fédérale sur la protection des données : le cas de la protection de la vie privée dès la conception (privacy by design)

La protection des données est un élément essentiel d'un Etat de droit et une société démocratique, car elle accorde à chaque individu le droit de disposer de ce qui fait partie de sa sphère privée. Actuellement en Suisse, la loi fédérale sur la protection des données (LPD) est en vigueur depuis 1993. En 2010, l'Office fédéral de la justice a supervisé une évaluation de son efficacité : il en résulte que cette dernière a été prouvée, mais tendra à diminuer fortement dans les années à suivre. Pour causes principales : l'évolution des technologies, caractérisée notamment par le développement des moyens de traitement de données toujours plus variés et conséquents, et un manque d'informations des individus par rapport à la protection des données en générale et à leurs droits. Suite à l'évaluation, cinq objectifs de révision ont été formulés par le Conseil fédéral, dont celui d'intégrer la privacy by design ou « protection de la vie privée dès la conception » dans la loi. Ce concept, qui est également repris dans les travaux européens en cours, est développé à l'origine par l'Information and Privacy Commissionner de l'Ontario (Canada), Ann Cavoukian. Le principe général de la privacy by design est que la protection de la vie privée doit être incluse dans les systèmes traitant les données lors de leur conception. Souvent évoquée comme une solution idéale, répondant au problème de l'inadéquation de la loi par la logique de prévention qu'elle promeut, la privacy by design demeure toutefois un souhait dont l'application n'est que peu analysée. Ce travail cherche justement à répondre à la question de la manière de la mettre en oeuvre dans la législation suisse. Se basant sur les textes et la doctrine juridiques et une littérature dans les domaines de l'économie, l'informatique, la politique et la sociologie des données personnelles, il propose tout d'abord une revue générale des principes et définitions des concepts-clés de la protection des données en Suisse et dans le cadre international. Puis, il propose deux possibilités d'intégration de la privacy by design : la première est une solution privée non contraignante qui consiste à promouvoir le concept et faire en sorte que les responsables de traitement décident par eux-mêmes d'intégrer la privacy by design dans leurs projets ; ce procédé est possible grâce au renforcement du processus de certification déjà en cours. La deuxième option est une solution contraignante visant à intégrer le principe directement dans la loi et de prendre les mesures pour le rendre effectif ; ce travail montre que le développement de la figure du conseiller à la protection des données permet d'atteindre cet objectif. Enfin, des considérations générales sur l'application du principe sont abordées, telles que l'influence des développements en cours dans l'Union européenne sur la Suisse par rapport à la protection des données et la limite posée par le principe de territorialité.

Business Model Considerations for Privacy Protection in a Mobile Location Based Context

In this paper we discuss the main privacy issues around mobile business models and we envision new solutions having privacy protection as a main value proposition. We construct a framework to help analyze the situation and assume that a third party is necessary to warrant transactions between mobile users and m-commerce providers. We then use the business model canvas to describe a generic business model pattern for privacy third party services. This pattern is then illustrated in two different variations of a privacy business model, which we call privacy broker and privacy management software. We conclude by giving examples for each business model and by suggesting further directions of investigation

1C.06: Ambulatory pulse pressure is negatively associated with excretions of urinary caffeine and its metabolites

OBJECTIVE: Systolic blood pressure (BP) has been associated with urinary caffeine and its metabolites such as paraxanthine and theophylline. Caffeine and caffeine metabolites could influence arterial pulse pressure (PP) via sympathomimetic effects, smooth muscle relaxation, and phosphodiesterase inhibition. The purpose of this analysis was to explore the association of ambulatory PP with urinary caffeine and its related metabolites in a large population-based sample. DESIGN AND METHOD: Families were randomly selected from the general population of three Swiss cities (2009-2013). Ambulatory BP monitoring was conducted using validated Diasys Integra devices. PP was defined as the difference between the systolic and diastolic ambulatory BP. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 h urine using ultra-high performance liquid chromatography tandem mass spectrometry. Urinary excretions were log-transformed to satisfy regression assumptions. We used linear mixed models to explore the associations of urinary caffeine and caffeine metabolite excretions with 24-hour, day- and night-time PP while adjusting for major confounders. RESULTS: The 836 participants (48.9% men) included in this analysis had mean (±SD) age of 47.8 (±17.5), and mean 24-hour systolic and diastolic BP of 120.1 mmHg (±13.9) and 78.0 (±8.6). Except theobromine, log transformed urinary caffeine and caffeine metabolite excretions were associated negatively with 24-hour, daytime and night-time ambulatory PP. 24-hour, daytime, and night-time ambulatory PP decreased by -0.804 mmHg (SE, 0.209), -0.749 (0.215), and -0.968 (0.243) (all P values <0.005), for each doubling excretion of caffeine. Strong negative associations with night-time ambulatory PP were observed for paraxanthine and theophylline.(Figure is included in full-text article.) CONCLUSIONS: : The negative associations of PP with caffeine, paraxanthine, and theophylline excretions suggest that caffeine and its metabolites do lower BP, possibly by modifying arterial stiffness.