Diagnosis of intra-abdominal injuries can be challenging in multitrauma patients with associated injuries. Our experience and review of the literature

ntroduction. Trauma is the most common cause of death and disability among patients during the first four decades of life. Abdominal trauma is reported to be the 3rd most common injured region. Clinical examination may be unreliable in the evaluation of these patients especially in the presence of associated injuries. Therefore the use of diagnostic tools is essential in the management of the injured patient with abdominal trauma and additional injuries. Patients and Methods. During 1 year period from December 2010 to November 2011 we recorded the patients that presented to the emergency department of our hospital and were found to suffer from intra-abdominal injuries. These patients were divided in two groups depending on whether they had additional comorbid injuries or not. Several parameters were recorded and compared between the two groups, such as mechanism of injury, general status and hemodynamic stability of the patient on presentation, physical examination, use of imaging modalities and concomitant findings, need for surgical intervention and mortality rates. Furthermore the discrepancy between physical findings and final diagnosis after the use of diagnostic adjuncts is reported. Results. We recorded 31 patients with abdominal trauma. 13 (42%) patients were found to suffer from abdominal trauma and associated injuries (Group I), whereas 18 (58%) presented with abdominal trauma alone (Group II). The patients of the first group presented hemodynamic instability in 38% of cases while the patients of the second in 22% of cases. Reduced consciousness was present in 38% in group I versus 17% in group II. Signs of abdominal injury during clinical examination were present in only 15% in group I versus 72% in group II that represented a remarkable difference between the two groups. Conservative treatment was possible in 15% of patients with additional injuries and in 22% of patients with abdominal injury alone. In group I there were two deaths whereas in group II all patients survived. Conclusion. In patients with abdominal trauma, associated injuries seem to add to the severity of injury and indicate a worse prognosis. Clinical examination is unreliable and misleading in the majority of these patients and the use of diagnostic tools cannot be overemphasized.

The Role of College Students' Perceptions of Effort Source on Self-Evaluations of Academic Ability

In the present studies I investigated whether college students’ perceptions of effort source influenced their perceptions of the relation between levels of their own effort and ability in mathematics. In Study 1 (N = 210), I found using hypothetical vignettes that perceptions of task-elicited effort (i.e., effort that arises due to the subjective difficulty or ease of the task) led to perceptions of an inverse relation between one’s effort and ability, and perceptions of self-initiated effort (i.e., effort that arises due to one’s own motivation or lack of motivation) led to perceptions of a positive relation between one’s effort and ability, consistent with my hypotheses and prior research. In Study 2 (N = 160), participants completed an academic task and I used open-ended questions to manipulate their perceptions of effort source. I found that participants in the task-elicited condition endorsed no overall relation between effort and ability, and participants in the self-initiated condition endorsed an overall inverse relation, which is inconsistent with my hypotheses and prior research. Possible explanations for the findings, as well as broader theoretical and educational implications are discussed.

Active Data Collection Techniques to Understand Online Scammers and Cybercriminals

Nigerian scam, also known as advance fee fraud or 419 scam, is a prevalent form of online fraudulent activity that causes financial loss to individuals and businesses. Nigerian scam has evolved from simple non-targeted email messages to more sophisticated scams targeted at users of classifieds, dating and other websites. Even though such scams are observed and reported by users frequently, the community’s understanding of Nigerian scams is limited since the scammers operate “underground”. To better understand the underground Nigerian scam ecosystem and seek effective methods to deter Nigerian scam and cybercrime in general, we conduct a series of active and passive measurement studies. Relying upon the analysis and insight gained from the measurement studies, we make four contributions: (1) we analyze the taxonomy of Nigerian scam and derive long-term trends in scams; (2) we provide an insight on Nigerian scam and cybercrime ecosystems and their underground operation; (3) we propose a payment intervention as a potential deterrent to cybercrime operation in general and evaluate its effectiveness; and (4) we offer active and passive measurement tools and techniques that enable in-depth analysis of cybercrime ecosystems and deterrence on them. We first created and analyze a repository of more than two hundred thousand user-reported scam emails, stretching from 2006 to 2014, from four major scam reporting websites. We select ten most commonly observed scam categories and tag 2,000 scam emails randomly selected from our repository. Based upon the manually tagged dataset, we train a machine learning classifier and cluster all scam emails in the repository. From the clustering result, we find a strong and sustained upward trend for targeted scams and downward trend for non-targeted scams. We then focus on two types of targeted scams: sales scams and rental scams targeted users on Craigslist. We built an automated scam data collection system and gathered large-scale sales scam emails. Using the system we posted honeypot ads on Craigslist and conversed automatically with the scammers. Through the email conversation, the system obtained additional confirmation of likely scam activities and collected additional information such as IP addresses and shipping addresses. Our analysis revealed that around 10 groups were responsible for nearly half of the over 13,000 total scam attempts we received. These groups used IP addresses and shipping addresses in both Nigeria and the U.S. We also crawled rental ads on Craigslist, identified rental scam ads amongst the large number of benign ads and conversed with the potential scammers. Through in-depth analysis of the rental scams, we found seven major scam campaigns employing various operations and monetization methods. We also found that unlike sales scammers, most rental scammers were in the U.S. The large-scale scam data and in-depth analysis provide useful insights on how to design effective deterrence techniques against cybercrime in general. We study underground DDoS-for-hire services, also known as booters, and measure the effectiveness of undermining a payment system of DDoS Services. Our analysis shows that the payment intervention can have the desired effect of limiting cybercriminals’ ability and increasing the risk of accepting payments.

Role of climate on barn owls road-kill likelihood and the effect on population viability in future climate change

Roads represent a new source of mortality due to animal-vehicle risk of collision threatening log-term populations’ viability. Risk of road-kill depends on species sensitivity to roads and their specific life-history traits. The risk of road mortality for each species depends on the characteristics of roads and bioecological characteristics of the species. In this study we intend to know the importance of climatic parameters (temperature and precipitation) together with traffic and life history traits and understand the role of drought in barn owl population viability, also affected by road mortality in three scenarios: high mobility, high population density and the combination of previous scenarios (mixed) (Manuscript). For the first objective we correlated the several parameters (climate, traffic and life history traits). We used the most correlated variables to build a predictive mixed model (GLMM) the influence of the same. Using a population model we evaluated barn owl population viability in all three scenarios. Model revealed precipitation, traffic and dispersal have negative relationship with road-kills, although the relationship was not significant. Scenarios showed different results, high mobility scenario showed greater population depletion, more fluctuations over time and greater risk of extinction. High population density scenario showed a more stable population with lower risk of extinction and mixed scenario showed similar results as first scenario. Climate seems to play an indirect role on barn owl road-kills, it may influence prey availability which influences barn owl reproductive success and activity. Also, high mobility scenario showed a greater negative impact on viability of populations which may affect their ability and resilience to other stochastic events. Future research should take in account climate and how it may influence species life cycles and activity periods for a more complete approach of road-kills. Also it is important to make the best mitigation decisions which might include improving prey quality habitat.

Epidemiology and genetic architecture of blood pressure: a family based study of Generation Scotland

Hypertension is a major risk factor for cardiovascular disease and mortality, and a growing global public health concern, with up to one-third of the world’s population affected. Despite the vast amount of evidence for the benefits of blood pressure (BP) lowering accumulated to date, elevated BP is still the leading risk factor for disease and disability worldwide. It is well established that hypertension and BP are common complex traits, where multiple genetic and environmental factors contribute to BP variation. Furthermore, family and twin studies confirmed the genetic component of BP, with a heritability estimate in the range of 30-50%. Contemporary genomic tools enabling the genotyping of millions of genetic variants across the human genome in an efficient, reliable, and cost-effective manner, has transformed hypertension genetics research. This is accompanied by the presence of international consortia that have offered unprecedentedly large sample sizes for genome-wide association studies (GWASs). While GWAS for hypertension and BP have identified more than 60 loci, variants in these loci are associated with modest effects on BP and in aggregate can explain less than 3% of the variance in BP. The aims of this thesis are to study the genetic and environmental factors that influence BP and hypertension traits in the Scottish population, by performing several genetic epidemiological analyses. In the first part of this thesis, it aims to study the burden of hypertension in the Scottish population, along with assessing the familial aggregation and heritialbity of BP and hypertension traits. In the second part, it aims to validate the association of common SNPs reported in the large GWAS and to estimate the variance explained by these variants. In this thesis, comprehensive genetic epidemiology analyses were performed on Generation Scotland: Scottish Family Health Study (GS:SFHS), one of the largest population-based family design studies. The availability of clinical, biological samples, self-reported information, and medical records for study participants has allowed several assessments to be performed to evaluate factors that influence BP variation in the Scottish population. Of the 20,753 subjects genotyped in the study, a total of 18,470 individuals (grouped into 7,025 extended families) passed the stringent quality control (QC) criteria and were available for all subsequent analysis. Based on the BP-lowering treatment exposure sources, subjects were further classified into two groups. First, subjects with both a self-reported medications (SRMs) history and electronic-prescription records (EPRs; n =12,347); second, all the subjects with at least one medication history source (n =18,470). In the first group, the analysis showed a good concordance between SRMs and EPRs (kappa =71%), indicating that SRMs can be used as a surrogate to assess the exposure to BP-lowering medication in GS:SFHS participants. Although both sources suffer from some limitations, SRMs can be considered the best available source to estimate the drug exposure history in those without EPRs. The prevalence of hypertension was 40.8% with higher prevalence in men (46.3%) compared to women (35.8%). The prevalence of awareness, treatment and controlled hypertension as defined by the study definition were 25.3%, 31.2%, and 54.3%, respectively. These findings are lower than similar reported studies in other populations, with the exception of controlled hypertension prevalence, which can be considered better than other populations. Odds of hypertension were higher in men, obese or overweight individuals, people with a parental history of hypertension, and those living in the most deprived area of Scotland. On the other hand, deprivation was associated with higher odds of treatment, awareness and controlled hypertension, suggesting that people living in the most deprived area may have been receiving better quality of care, or have higher comorbidity levels requiring greater engagement with doctors. These findings highlight the need for further work to improve hypertension management in Scotland. The family design of GS:SFHS has allowed family-based analysis to be performed to assess the familial aggregation and heritability of BP and hypertension traits. The familial correlation of BP traits ranged from 0.07 to 0.20, and from 0.18 to 0.34 for parent-offspring pairs and sibling pairs, respectively. A higher correlation of BP traits was observed among first-degree relatives than other types of relative pairs. A variance-component model that was adjusted for sex, body mass index (BMI), age, and age-squared was used to estimate heritability of BP traits, which ranged from 24% to 32% with pulse pressure (PP) having the lowest estimates. The genetic correlation between BP traits showed a high correlation between systolic (SBP), diastolic (DBP) and mean arterial pressure (MAP) (G: 81% to 94%), but lower correlations with PP (G: 22% to 78%). The sibling recurrence risk ratio (λS) for hypertension and treatment were calculated as 1.60 and 2.04 respectively. These findings confirm the genetic components of BP traits in GS:SFHS, and justify further work to investigate genetic determinants of BP. Genetic variants reported in the recent large GWAS of BP traits were selected for genotyping in GS:SFHS using a custom designed TaqMan® OpenArray®. The genotyping plate included 44 single nucleotide polymorphisms (SNPs) that have been previously reported to be associated with BP or hypertension at genome-wide significance level. A linear mixed model that is adjusted for age, age-squared, sex, and BMI was used to test for the association between the genetic variants and BP traits. Of the 43 variants that passed the QC, 11 variants showed statistically significant association with at least one BP trait. The phenotypic variance explained by these variant for the four BP traits were 1.4%, 1.5%, 1.6%, and 0.8% for SBP, DBP, MAP, and PP, respectively. The association of genetic risk score (GRS) that were constructed from selected variants has showed a positive association with BP level and hypertension prevalence, with an average effect of one mmHg increase with each 0.80 unit increases in the GRS across the different BP traits. The impact of BP-lowering medication on the genetic association study for BP traits has been established, with typical practice of adding a fixed value (i.e. 15/10 mmHg) to the measured BP values to adjust for BP treatment. Using the subset of participants with the two treatment exposure sources (i.e. SRMs and EPRs), the influence of using either source to justify the addition of fixed values in SNP association signal was analysed. BP phenotypes derived from EPRs were considered the true phenotypes, and those derived from SRMs were considered less accurate, with some phenotypic noise. Comparing SNPs association signals between the four BP traits in the two model derived from the different adjustments showed that MAP was the least impacted by the phenotypic noise. This was suggested by identifying the same overlapped significant SNPs for the two models in the case of MAP, while other BP traits had some discrepancy between the two sources

ISO 9000 AND CONTROL OF DOCUMENTS

ISO 9000 is a family of international standards for quality management, applicable to all sizes of company, whether public or private.Management Systems ISO 9000 quality make up the human side, administrative and operating companies. By integrating these three aspects, the organization takes full advantage of all its resources, making results more efficiently, reducing administrative and operating expenses.With globalization and opening markets this has become a competitive advantage by providing further confidence and evidence to all customers, subcontractors, personnel and other stakeholders that the organization is committed to establishing, maintaining and improving levels acceptable quality products and services.Another advantage of quality systems is the clear definition of policies and functions, the staff is utilized according to their ability and focus on real customer needs.It should be mentioned that to achieve these benefits, it is necessary that management of the organization, is committed to the development of its quality system and to allocate financial and human resources to do so. These resources are minimal compared with the benefits you can achieve.

Occupational contact urticaria: lessons from the French National Network for Occupational Disease Vigilance and Prevention (RNV3P)

International audience

Using a Combination of Phylogenetic Comparative and Paleobotanical Methods to Elucidate Patterns of Lineage Selection in Rosales (Plantae: Anthophyta)

An increasing focus in evolutionary biology is on the interplay between mesoscale ecological and evolutionary processes such as population demographics, habitat tolerance, and especially geographic distribution, as potential drivers responsible for patterns of diversification and extinction over geologic time. However, few studies to date connect organismal processes such as survival and reproduction through mesoscale patterns to long-term macroevolutionary trends. In my dissertation, I investigate how mechanism of seed dispersal, mediated through geographic range size, influences diversification rates in the Rosales (Plantae: Anthophyta). In my first chapter, I validate the phylogenetic comparative methods that I use in my second and third chapters. Available state speciation and extinction (SSE) models assumptions about evolution known to be false through fossil data. I show, however, that as long as net diversification rates remain positive – a condition likely true for the Rosales – these violations of SSE’s assumptions do not cause significantly biased results. With SSE methods validated, my second chapter reconstructs three associations that appear to increase diversification rate for Rosalean genera: (1) herbaceous habit; (2) a three-way interaction combining animal dispersal, high within-genus species richness, and geographic range on multiple continents; (3) a four-way interaction combining woody habit with the other three characteristics of (2). I suggest that the three- and four-way interactions represent colonization ability and resulting extinction resistance in the face of late Cenozoic climate change; however, there are other possibilities as well that I hope to investigate in future research. My third chapter reconstructs the phylogeographic history of the Rosales using both non-fossil-assisted SSE methods as well as fossil-informed traditional phylogeographic analysis. Ancestral state reconstructions indicate that the Rosaceae diversified in North America while the other Rosalean families diversified elsewhere, possibly in Eurasia. SSE is able to successfully identify groups of genera that were likely to have been ancestrally widespread, but has poorer taxonomic resolution than methods that use fossil data. In conclusion, these chapters together suggest several potential causal links between organismal, mesoscale, and geologic scale processes, but further work will be needed to test the hypotheses that I raise here.

Solubility and solvation of monosaccharides in ionic liquids

Herein, solubility experimental data for six monosaccharides, viz. D-(+)-glucose, D-(+)-mannose, D-(-)-fructose, D-(+)-galactose, D-(+)-xylose and L-(+)-arabinose, in four ionic liquids (ILs), at temperatures ranging from 288.2 to 348.2 K, were obtained aimed at gathering a better understanding of their solvation ability and molecular-level mechanisms which rule the dissolution process. To ascertain the chemical features that enhance the solubility of monosaccharides, ILs composed of dialkylimidazolium or tetra-alkylphosphonium cations combined with the dicyanamide, dimethylphosphate or chloride anions were investigated. It was found that the ranking of the solubility of monosaccharides depends on the IL; yet, D-(+)-xylose is always the most soluble while D-(-)-fructose is the least soluble monosaccharide. The results obtained show that both the IL cation and the anion play a major role in the solubility of monosaccharides. Finally, from the determination of the respective thermodynamic properties of solution, it was found that enthalpic contributions are dominant in the solubilization process. However, the observed differences in the solubilities of monosaccharides in 1-butyl-3-methylimidazolium dicyanamide are ruled by a change in the entropy of solution.

BLACK, MALE, AND HIGH-ACHIEVING: AN EXAMINATION OF A RISK FACTOR AND CULTURAL RESOURCES FOR BLACK MALE ACADEMIC ACHIEVEMENT

Black boys are confronted with unique educational circumstances. They are often misdiagnosed and misplaced into special education programs (Bush-Daniels, 2008; Patton, 1998; Terman et al., 1996). Additionally, they are less likely to be enrolled in gifted and talented programs, even if their former achievements reflect their aptitude to succeed (Black Alliance for Educational Options, n.d.; Moore & Flowers, 2012). Given these statistics, a considerable emphasis has been placed on the causes and the consequences of low/under achievement for this population. As a result, the experiences of Black males who are achieving have been greatly neglected. Moreover, little is known about the factors that facilitate academic achievement among high-achieving Black boys. In an effort to bring the heterogenic nature of schooling experiences for Black boys to light, the present study examined the influence risk and protective factors had on the academic experiences of high-achieving Black boys. Grounded in the risk and resilience framework and the Integrative Model for the Study of Minority Youth Development, this study explored whether the high-achieving Black high school boys in this sample (n =88) reported experiencing discrimination (i.e. academic-based) and how this academic-based discrimination related to their 1) academic performance (i.e. GPA), 2) perceptions of math ability, and 3) race-based academic self-concept. In addition to exploring how academic-based discrimination was linked to academic achievement, this study examined how cultural resources such as racial socialization messages and racial identity related to academic achievement. Specifically, cultural socialization, preparation for bias, egalitarianism, private regard and public regard were evaluated alongside the three academic outcomes under study. Finally, the study explored whether aspects of racial socialization or racial identity buffered the effects of discrimination on any of the outcomes. Interestingly, the race/ethnicity of the student mattered for how students perceived their math ability. The risk factor academic-based discrimination was linked to academic performance. Cultural resources cultural socialization, preparation for bias, and private regard were linked to various academic outcomes of interest. There was only one significant moderating effect: a high private regard buffered the relationship between academic-based discrimination and race-based academic self-concept. Limitations and implications of this study are discussed.

Counseling Self-Efficacy and the Relational Efficacy Model

Relation-inferred self-efficacy (RISE), a relatively new concept, is defined as a target individual’s beliefs about how an observer, often a relationship partner, perceives the target’s ability to perform certain actions successfully. Along with self-efficacy (i.e., one’s beliefs about his or her own ability) and other-efficacy (i.e., one’s beliefs about his or her partner’s ability), RISE makes up a three part system of interrelated efficacy beliefs known as the relational efficacy model (Lent & Lopez, 2002). Previous research has shown this model to be helpful in understanding how relational dyads, including coach-athlete, advisor-advisee, and romantic partners, contribute to the development of self-efficacy beliefs. The clinical supervision dyad (i.e., supervisor-supervisee), is another context in which relational efficacy beliefs may play an important role. This study investigated the relationship between counseling self-efficacy, RISE, and other-efficacy within the context of clinical supervision. Specifically, it examined whether supervisee perceptions about how their supervisor sees their counseling ability (RISE) related to how supervisees see their own counseling ability (counseling self-efficacy), and what moderates this relationship. The study also sought to discover the degree to which RISE mediated the relationship between supervisor working alliance and counseling self-efficacy. Data were collected from 240 graduate students who were currently enrolled in counseling related fields, working with at least one client, and receiving regular supervision. Results demonstrated that years of experience and RISE predicted counseling self-efficacy and that the relationship between RISE and counseling self-efficacy was, as expected, moderated by other-efficacy. Contrary to expectations, however, counseling experience and level of client difficulty did not moderate the relationship between RISE and counseling self-efficacy. These findings suggest that the relationship between RISE and counseling self-efficacy was stronger when supervisees saw their supervisors as capable therapists. Furthermore, RISE was found to fully mediate the relationship between supervisor working alliance and counseling self-efficacy. Future research directions and implications for training and supervision are discussed.

Beyond human and intellectual capital: Profiling the value of knowledge, skills and experience

The concept of human capital is associated mainly with the Nobel Laureate Gary Becker and, in his usage, has a clear conceptual basis as investment in the costs of formal education. By contrast, this paper suggests that ‘intellectual capital’ is a re-branding of knowledge, skills and experience rather than re-conceptualisation of resource based learning. Becker also chose not to include informal knowledge, skills or experience within his concept of human capital, which remains limited by its constrained premises. This paper submits that both human capital and intellectual capital advocates fail to identify or measure the tacit knowledge and implicit learning which increasingly is recognised as a key to the competitive advantage of organisations. It first focuses on the conceptual basis of claims made for human capital and intellectual capital, outlines limits in their methodology, and contrasts these with insights from theories of tacit knowledge and implicit learning and the central role within them of informal or non-formal skill acquisition. It develops and illustrates instances of interfacing tacit and explicit knowledge before introducing a methodology for profiling the acquisition of knowledge, ability and skills. It does so by introducing the concepts of non-formal learningfrom- work (LfW) and informal learning-from-life (LfL), with evidence from a four country EU case study commissioned within the lifelong learning remit of the Lisbon Agenda.

Gender, Behavioral Assessment of Negative Reinforcement Driven Risk Taking Propensity, and Cigarette Smoking

Cigarette smoking remains the leading preventable cause of death and disability in the United States and most often is initiated during adolescence. An emerging body of research suggests that a negative reinforcement model may explain factors that contribute to tobacco use during adolescence and that negative reinforcement processes may contribute to tobacco use to a greater extent among female adolescents than among male adolescents. However, the extant literature both on the relationship between negative reinforcement processes and adolescent tobacco use as well as on the relationship between gender, negative reinforcement processes, and adolescent tobacco use is limited by the sole reliance on self-report measures of negative reinforcement processes that may contribute to cigarette smoking. The current study aimed to further disentangle the relationships between negative reinforcement based risk taking, gender and tobacco use during older adolescence by utilizing a behavioral analogue measure of negative reinforcement based risk taking, the Maryland Resource for the Behavioral Utilization of the Reinforcement of Negative Stimuli (MRBURNS). Specifically, we examined the relationship between pumps on the MRBURNS, an indicator of risk taking, and smoking status as well as the interaction between MRBURNS pumps and gender for predicting smoking status. Participants included 103 older adolescents (n=51 smokers, 50.5% female, Age (M(SD) = 19.41(1.06)) who all attended one experimental session during which they completed the MRBURNS as well as self-report measures of tobacco use, nicotine dependence, alcohol use, depression, and anxiety. We utilized binary logistic regressions to examine the relationship between MRBURNS pumps and smoking status as well as the interactive effect of MRBURNS pumps and gender for predicting smoking status. Controlling for relevant covariates, pumps on the MRBURNS did not significantly predict smoking status and the interaction between pumps on the MRBURNS and gender also did not significantly predict smoking status. These findings highlight the importance of future research examining various task modifications to the MRBURNS as well as the need for replications of this study with larger, more diverse samples.

Protein disulfide isomerase as a target for besnoitiosis therapy : molecular characterization and studies of its role in infection and host immune response

Tese de Doutoramento em Ciências Veterinárias na especialidade de Sanidade Animal

Identification of patients at risk of poor outcomes following hip or knee arthroplasty

Les arthroplasties totales de la hanche (ATH) et du genou (ATG) sont souvent offertes aux patients atteints de dégénérescence articulaire sévère. Bien qu’efficace chez la majorité des patients, ces interventions mènent à des résultats sous-optimaux dans de nombreux cas. Il demeure difficile d’identifier les patients à risque de résultats sous-optimaux à l’heure actuelle. L’identification de ces patients avant la chirurgie pourrait permettre d’optimiser la gamme de soins et de services offerts et de possiblement améliorer les résultats de leur chirurgie. Ce mémoire a comme objectifs : 1) de réaliser une revue systématique des déterminants associés à la douleur et aux incapacités fonctionnelles rapportées par les patients à moyen-terme suivant ces deux types d’arthroplastie et 2) de développer des modèles de prédiction clinique permettant l’identification des patients à risque de mauvais résultats en terme de douleur et d’incapacités fonctionnelles suivant l’ATH et l’ATG. Une revue systématique de la littérature identifiant les déterminants de la douleur et de la fonction suivant l’ATH et l’ATG a été réalisée dans quatre bases de données jusqu’en avril 2015 et octobre 2014, respectivement. Afin de développer un algorithme de prédiction pouvant identifier les patients à risque de résultats sous-optimaux, nous avons aussi utilisé des données rétrospectives provenant de 265 patients ayant subi une ATH à l’Hôpital Maisonneuve-Rosemont (HMR) de 2004 à 2010. Finalement, des données prospectives sur 141 patients recrutés au moment de leur inclusion sur une liste d’attente pour une ATG dans trois hôpitaux universitaires à Québec, Canada et suivis jusqu’à six mois après la chirurgie ont permis l’élaboration d’une règle de prédiction clinique permettant l’identification des patients à risque de mauvais résultats en terme de douleur et d’incapacités fonctionnelles. Vingt-deux (22) études d’une qualité méthodologique moyenne à excellente ont été incluses dans la revue. Les principaux déterminants de douleur et d’incapacités fonctionnelles après l’ATH incluaient: le niveau préopératoire de douleur et de fonction, un indice de la masse corporelle plus élevé, des comorbidités médicales plus importantes, un état de santé générale diminué, une scolarité plus faible, une arthrose radiographique moins sévère et la présence d’arthrose à la hanche controlatérale. Trente-quatre (34) études évaluant les déterminants de douleur et d’incapacités fonctionnelles après l’ATG avec une qualité méthodologique moyenne à excellente ont été évaluées et les déterminants suivant ont été identifiés: le niveau préopératoire de douleur et de fonction, des comorbidités médicales plus importantes, un état de santé générale diminué, un plus grands niveau d’anxiété et/ou de symptômes dépressifs, la présence de douleur au dos, plus de pensées catastrophiques ou un faible niveau socioéconomique. Pour la création d’une règle de prédiction clinique, un algorithme préliminaire composé de l’âge, du sexe, de l’indice de masse corporelle ainsi que de trois questions du WOMAC préopératoire a permis l’identification des patients à risque de résultats chirurgicaux sous-optimaux (pire quartile du WOMAC postopératoire et percevant leur hanche opérée comme artificielle avec des limitations fonctionnelles mineures ou majeures) à une durée moyenne ±écart type de 446±171 jours après une ATH avec une sensibilité de 75.0% (95% IC: 59.8 – 85.8), une spécificité de 77.8% (95% IC: 71.9 – 82.7) et un rapport de vraisemblance positif de 3.38 (98% IC: 2.49 – 4.57). Une règle de prédiction clinique formée de cinq items du questionnaire WOMAC préopratoire a permis l’identification des patients en attente d’une ATG à risque de mauvais résultats (pire quintile du WOMAC postopératoire) six mois après l’ATG avec une sensibilité de 82.1 % (95% IC: 66.7 – 95.8), une spécificité de 71.7% (95% IC: 62.8 – 79.8) et un rapport de vraisemblance positif de 2.9 (95% IC: 1.8 – 4.7). Les résultats de ce mémoire ont permis d’identifier, à partir de la littérature, une liste de déterminants de douleur et d’incapacités fonctionnelles après l’ATH et l’ATG avec le plus haut niveau d’évidence à ce jour. De plus, deux modèles de prédiction avec de très bonnes capacités prédictives ont été développés afin d’identifier les patients à risque de mauvais résultats chirurgicaux après l’ATH et l’ATG. L’identification de ces patients avant la chirurgie pourrait permettre d’optimiser leur prise en charge et de possiblement améliorer les résultats de leur chirurgie.