Femmes et tabagisme: spécificités épidémiologiques et cliniques [Women and tobacco: epidemiological and clinical specificities]

Cigarette smoking amongst women is a major issue in daily clinical practice and in public health. Tobacco is the cause of gender specific diseases. From a psychosocial point of view, female smokers tend to be emotionally vulnerable and relationship sensitive. The risk of weight gain and depression must be anticipated and assessed throughout the smoking cessation process. Professionals involved in smoking cessation must be aware of these somatic and psychosocial specificities in order to be able to offer efficient smoking cessation treatments. Public health strategies must also be developed worldwide to control the expected dramatic impact of the female tobacco epidemic.

Le projet "SYNAPSY": un point de rencontre entre clinique et neurosciences [The "SYNAPSY" project: where psychiatrists and neuroscientists meet].

The National Center of Competence in Research project "SYNAPSY" aims at identifying certain mechanisms of psychiatric and cognitive disorders, in order to improve the understanding and the genesis of such pathologies, and to promote the development of better diagnostic tools and of new therapeutic approaches. It provides an excellent opportunity for clinical psychiatrists and neuroscientists to develop a synergic mode of collaboration. On the basis of questions stemming from clinical practice and in the frame of patients cohorts, various research projects in neuroscience should lead to progresses that may have a considerable impact on clinical practice.

From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest.

OBJECTIVES: Therapeutic hypothermia has been recommended for postcardiac arrest coma due to ventricular fibrillation. However, no studies have evaluated whether therapeutic hypothermia could be effectively implemented in intensive care practice and whether it would improve the outcome of all comatose patients with cardiac arrest, including those with shock or with cardiac arrest due to nonventricular fibrillation rhythms. DESIGN: Retrospective study. SETTING: Fourteen-bed medical intensive care unit in a university hospital. PATIENTS: Patients were 109 comatose patients with out-of-hospital cardiac arrest due to ventricular fibrillation and nonventricular fibrillation rhythms (asystole/pulseless electrical activity). INTERVENTIONS: We analyzed 55 consecutive patients (June 2002 to December 2004) treated with therapeutic hypothermia (to a central target temperature of 33 degrees C, using external cooling). Fifty-four consecutive patients (June 1999 to May 2002) treated with standard resuscitation served as controls. Efficacy, safety, and outcome at hospital discharge were assessed. Good outcome was defined as Glasgow-Pittsburgh Cerebral Performance category 1 or 2. MEASUREMENTS AND MAIN RESULTS: In patients treated with therapeutic hypothermia, the median time to reach the target temperature was 5 hrs, with a progressive reduction over the 18 months of data collection. Therapeutic hypothermia had a major positive impact on the outcome of patients with cardiac arrest due to ventricular fibrillation (good outcome in 24 of 43 patients [55.8%] of the therapeutic hypothermia group vs. 11 of 43 patients [25.6%] of the standard resuscitation group, p = .004). The benefit of therapeutic hypothermia was also maintained in patients with shock (good outcome in five of 17 patients of the therapeutic hypothermia group vs. zero of 14 of the standard resuscitation group, p = .027). The outcome after cardiac arrest due to nonventricular fibrillation rhythms was poor and did not differ significantly between the two groups. Therapeutic hypothermia was of particular benefit in patients with short duration of cardiac arrest (<30 mins). CONCLUSIONS: Therapeutic hypothermia for the treatment of postcardiac arrest coma can be successfully implemented in intensive care practice with a major benefit on patient outcome, which appeared to be related to the type and the duration of initial cardiac arrest and seemed maintained in patients with shock.

Host and viral genetic correlates of clinical definitions of HIV-1 disease progression.

Background: Various patterns of HIV-1 disease progression are described in clinical practice and in research. There is a need to assess the specificity of commonly used definitions of long term non-progressor (LTNP) elite controllers (LTNP-EC), viremic controllers (LTNP-VC), and viremic non controllers (LTNP-NC), as well as of chronic progressors (P) and rapid progressors (RP). Methodology and Principal Findings: We re-evaluated the HIV-1 clinical definitions, summarized in Table 1, using the information provided by a selected number of host genetic markers and viral factors. There is a continuous decrease of protective factors and an accumulation of risk factors from LTNP-EC to RP. Statistical differences in frequency of protective HLA-B alleles (p-0.01), HLA-C rs9264942 (p-0.06), and protective CCR5/CCR2 haplotypes (p-0.02) across groups, and the presence of viruses with an ancestral genotype in the "viral dating" (i.e., nucleotide sequences with low viral divergence from the most recent common ancestor) support the differences among principal clinical groups of HIV-1 infected individuals. Conclusions: A combination of host genetic and viral factors supports current clinical definitions that discriminate among patterns of HIV-1 progression. The study also emphasizes the need to apply a standardized and accepted set of clinical definitions for the purpose of disease stratification and research.

The burnout syndrome and associated personality disturbances. The study in three graduate programs in Dentistry at the University of Barcelona

Objective: Determine the presence of"burnout" syndrome and characteristic personality patterns in the students and faculty of three graduate programs in Dentistry at the University of Barcelona: Department of Oral Surgery and Implantology, Department of Orthodontics and Department of Integrated Dentistry. Materials and Methods: The study was carried out in 78 dentists. The level of"burnout" was evaluated using the Maslach Burnout Inventory, socio-demographic variables and, finally, the personality test. Results: Oral surgeons constituted the group of highlevel"burnout". The profile of an individual with a propensity to"burn out" is a single man, with a median age of 27, that is in the first years of the graduate program and that combines studies with 30 hours of clinical practice and/or other work (p<0,05). Narcissistic and borderline are the types of personality most frequently found in the individuals that present"burnout" syndrome (p<0,05). Conclusions: In general, no high levels of"burnout" were registered in the studied population, only 2-3%, if applying strict definition of"burnout", and 10% if these criteria were amplified. We believe it is necessary to identify the individuals with a tendency towards"burnout", in order to establish preventive measures and avoid future negative behaviour at work as well as at the personal level.

La importància de l’educació emocional al parvulari. Anàlisi d’una pràctica educativa

En aquest treball, es presenta un marc teòric que té per finalitat mostrar la importància de l’educació emocional a parvulari. Es realitza un petit recorregut per els orígens del concepte, el context en que apareix i les dimensions. Posteriorment, s’ha realitzat l’anàlisi d’una pràctica educativa real (estudi d’un cas), concretament a l’aula de 5 anys, durant 9 setmanes amb l’objectiu d’identificar i relacionar els referents teòrics amb la pràctica educativa. L’objectiu principal del treball ha estat posar en relació les teories dels diferents autors amb la vida quotidiana d’una aula, poder analitzar la presència de l’educació emocional i poder reflexionar en profunditat sobre la tasca docent. S’ha investigat la consciència que té el professorat sobre la importància d’aquest treball amb els alumnes, les estratègies metodològiques utilitzades per el treball emocional, quines dimensions i moments són més presents en el dia a dia, i finalment, observar la formalitat o informalitat de la pràctica de l’educació emocional i analitzar-ne la seva eficàcia. Totes les dades s’han recollit a partir d’una pauta d’observació basada en els referents teòrics i finalment s’ha realit

Concrete Pavement Mixture Design and Analysis (MDA): An Innovative Approach To Proportioning Concrete Mixtures, TPF-5(205), 2015

Mixture proportioning is routinely a matter of using a recipe based on a previously produced concrete, rather than adjusting the proportions based on the needs of the mixture and the locally available materials. As budgets grow tighter and increasing attention is being paid to sustainability metrics, greater attention is beginning to be focused on making mixtures that are more efficient in their usage of materials yet do not compromise engineering performance. Therefore, a performance-based mixture proportioning method is needed to provide the desired concrete properties for a given project specification. The proposed method should be user friendly, easy to apply in practice, and flexible in terms of allowing a wide range of material selection. The objective of this study is to further develop an innovative performance-based mixture proportioning method by analyzing the relationships between the selected mix characteristics and their corresponding effects on tested properties. The proposed method will provide step-by-step instructions to guide the selection of required aggregate and paste systems based on the performance requirements. Although the provided guidance in this report is primarily for concrete pavements, the same approach can be applied to other concrete applications as well.

Bridge Rail and Approach Railing for Low-Volume Roads in Iowa, TR-592, 2010

Bridge rail and approach guardrails provide safety to drivers by shielding more hazardous objects and redirecting vehicles to the roadway. However, guardrail can increase both the initial cost and maintenance cost of a bridge, while adding another object that may be struck by vehicles. Most existing low volume road (LVR) bridges in the state of Iowa are currently indicated to not possess bridge rail meeting “current acceptable standards”. The primary objective of the research summarized in this report was to provide the nations bridge and approach rail state of practice and perform a state wide crash analysis on bridge rails and approach guardrails on LVR bridges in Iowa. In support of this objective, the criteria and guidelines used by other bridge owners were investigated, non-standard and innovative bridge and approach guardrails for LVR’s were investigated, and descriptive, statistical and economical analyses were performed on a state wide crash analysis. The state wide crash analysis found the overall number of crashes at/on the more than 17,000+ inventoried and non-inventoried LVR bridges in Iowa was fewer than 350 crashes over an eight year period, representing less than 0.1% of the statewide reportable crashes. In other words, LVR bridge crashes are fairly rare events. The majority of these crashes occurred on bridges with a traffic volume less than 100 vpd and width less than 24 ft. Similarly, the majority of the LVR bridges possess similar characteristics. Crash rates were highest for bridges with lower traffic volumes, narrower widths, and negative relative bridge widths (relative bridge width is defined as: bridge width minus roadway width). Crash rate did not appear to be effected by bridge length. Statistical analysis confirmed that the frequency of vehicle crashes was higher on bridges with a lower width compared to the roadway width. The frequency of crashes appeared to not be impacted by weather conditions, but crashes may be over represented at night or in dark conditions. Statistical analysis revealed that crashes that occurred on dark roadways were more likely to result in major injury or fatality. These findings potentially highlight the importance of appropriate delineation and signing. System wide, benefit-cost (B/C) analyses yielded very low B/C ratios for statewide bridge rail improvements. This finding is consistent with the aforementioned recommendation to address specific sites where safety concerns exist.

Ink dating using thermal desorption and gas chromatography / mass spectrometry: comparison of results obtained in two laboratories

Recent ink dating methods focused mainly on changes in solvent amounts occurring over time. A promising method was developed at the Landeskriminalamt of Munich using thermal desorption (TD) followed by gas chromatography / mass spectrometry (GC/MS) analysis. Sequential extractions of the phenoxyethanol present in ballpoint pen ink entries were carried out at two different temperatures. This method is applied in forensic practice and is currently implemented in several laboratories participating to the InCID group (International Collaboration on Ink Dating). However, harmonization of the method between the laboratories proved to be a particularly sensitive and time consuming task. The main aim of this work was therefore to implement the TD-GC/MS method at the Bundeskriminalamt (Wiesbaden, Germany) in order to evaluate if results were comparable to those obtained in Munich. At first validation criteria such as limits of reliable measurements, linearity and repeatability were determined. Samples were prepared in three different laboratories using the same inks and analyzed using two TDS-GC/MS instruments (one in Munich and one in Wiesbaden). The inter- and intra-laboratory variability of the ageing parameter was determined and ageing curves were compared. While inks stored in similar conditions yielded comparable ageing curves, it was observed that significantly different storage conditions had an influence on the resulting ageing curves. Finally, interpretation models, such as thresholds and trend tests, were evaluated and discussed in view of the obtained results. Trend tests were considered more suitable than threshold models. As both approaches showed limitations, an alternative model, based on the slopes of the ageing curves, was also proposed.

Clinicopathological features of eyelid skin tumors. A retrospective study of 5504 cases and review of literature.

Eyelid tumors are the most common neoplasm in daily ophthalmology practice and encompass a wide variety of benign and malignant tumors. In this retrospective study, we report the clinical and histological features of 5504 eyelid skin tumors diagnosed at the Laboratory of Ophthalmopathology of the Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland, between January 1989 and December 2007. Benign tumors largely predominated over malignant ones, representing 84% of cases in this series, and the 5 most frequent subtypes were squamous cell papilloma (26%), seborrheic keratosis (21%), melanocytic nevus (20%), hidrocystoma (8%), and xanthoma/xanthelasma (6%). Basal cell carcinoma was the most frequent malignant tumor (86%), followed by squamous cell carcinoma (7%) and sebaceous carcinoma (3%). For several tumor subtypes, there was a poor correlation between clinical and histological diagnosis, stressing the numerous pitfalls in the diagnosis of eyelid tumors. We further discuss our results with reference to previously published series.

Development of a Transportation and Land Use Public Policy Education Program for Iowa, 2000

This literature review serves as a foundation for a transportation and land use public policy education program for Iowa. The objective of the review is to summarize relevant research findings, to review the state of practice and policies of other state and local governments, and to explore land use trends both within the state of Iowa and the nation as a whole. Much of what we learned has been incorporated into the course materials. Because we expect to identify more useful sources throughout the project, this literature review should be considered a work in progress.

Neural substrates of social emotion regulation: a FMRI study on imitation and expressive suppression to dynamic facial signals.

Emotion regulation is crucial for successfully engaging in social interactions. Yet, little is known about the neural mechanisms controlling behavioral responses to emotional expressions perceived in the face of other people, which constitute a key element of interpersonal communication. Here, we investigated brain systems involved in social emotion perception and regulation, using functional magnetic resonance imaging (fMRI) in 20 healthy participants. The latter saw dynamic facial expressions of either happiness or sadness, and were asked to either imitate the expression or to suppress any expression on their own face (in addition to a gender judgment control task). fMRI results revealed higher activity in regions associated with emotion (e.g., the insula), motor function (e.g., motor cortex), and theory of mind (e.g., [pre]cuneus) during imitation. Activity in dorsal cingulate cortex was also increased during imitation, possibly reflecting greater action monitoring or conflict with own feeling states. In addition, premotor regions were more strongly activated during both imitation and suppression, suggesting a recruitment of motor control for both the production and inhibition of emotion expressions. Expressive suppression (eSUP) produced increases in dorsolateral and lateral prefrontal cortex typically related to cognitive control. These results suggest that voluntary imitation and eSUP modulate brain responses to emotional signals perceived from faces, by up- and down-regulating activity in distributed subcortical and cortical networks that are particularly involved in emotion, action monitoring, and cognitive control.

Bone mineral density (BMD), micro-architecture estimation (TBS) and vertebral fracture assessment (VFA) extracted from a single DXA device in combination with clinical risk factors improve significantly the identification of women at high risk of fracture.

Osteoporosis (OP) is a systemic skeletal disease characterized by a low bone mineral density (BMD) and a micro-architectural (MA) deterioration. Clinical risk factors (CRF) are often used as a MA approximation. MA is yet evaluable in daily practice by the trabecular bone score (TBS) measure. TBS is very simple to obtain, by reanalyzing a lumbar DXA-scan. TBS has proven to have diagnosis and prognosis values, partially independent of CRF and BMD. The aim of the OsteoLaus cohort is to combine in daily practice the CRF and the information given by DXA (BMD, TBS and vertebral fracture assessment (VFA)) to better identify women at high fracture risk. The OsteoLaus cohort (1400 women 50 to 80 years living in Lausanne, Switzerland) started in 2010. This study is derived from the cohort COLAUS who started in Lausanne in 2003. The main goal of COLAUS is to obtain information on the epidemiology and genetic determinants of cardiovascular risk in 6700 men and women. CRF for OP, bone ultrasound of the heel, lumbar spine and hip BMD, VFA by DXA and MA evaluation by TBS are recorded in OsteoLaus. Preliminary results are reported. We included 631 women: mean age 67.4 ± 6.7 years, BMI 26.1 ± 4.6, mean lumbar spine BMD 0.943 ± 0.168 (T-score − 1.4 SD), and TBS 1.271 ± 0.103. As expected, correlation between BMD and site matched TBS is low (r2 = 0.16). Prevalence of VFx grade 2/3, major OP Fx and all OP Fx is 8.4%, 17.0% and 26.0% respectively. Age- and BMI-adjusted ORs (per SD decrease) are 1.8 (1.2-2.5), 1.6 (1.2-2.1), and 1.3 (1.1-1.6) for BMD for the different categories of fractures and 2.0 (1.4-3.0), 1.9 (1.4-2.5), and 1.4 (1.1-1.7) for TBS respectively. Only 32 to 37% of women with OP Fx have a BMD < − 2.5 SD or a TBS < 1.200. If we combine a BMD < − 2.5 SD or a TBS < 1.200, 54 to 60% of women with an osteoporotic Fx are identified. As in the already published studies, these preliminary results confirm the partial independence between BMD and TBS. More importantly, a combination of TBS subsequent to BMD increases significantly the identification of women with prevalent OP Fx which would have been misclassified by BMD alone. For the first time we are able to have complementary information about fracture (VFA), density (BMD), micro- and macro architecture (TBS and HAS) from a simple, low ionizing radiation and cheap device: DXA. Such complementary information is very useful for the patient in the daily practice and moreover will likely have an impact on cost effectiveness analysis.

Safety of a new algorithm for the management of childhood illness (Almanach) to improve quality of care and rational use of drugs

Introduction New evidence from randomized controlled and etiology of fever studies, the availability of reliable RDT for malaria, and novel technologies call for revision of the IMCI strategy. We developed a new algorithm based on (i) a systematic review of published studies assessing the safety and appropriateness of RDT and antibiotic prescription, (ii) results from a clinical and microbiological investigation of febrile children aged <5 years, (iii) international expert IMCI opinions. The aim of this study was to assess the safety of the new algorithm among patients in urban and rural areas of Tanzania.Materials and Methods The design was a controlled noninferiority study. Enrolled children aged 2-59 months with any illness were managed either by a study clinician using the new Almanach algorithm (two intervention health facilities), or clinicians using standard practice, including RDT (two control HF). At day 7 and day 14, all patients were reassessed. Patients who were ill in between or not cured at day 14 were followed until recovery or death. Primary outcome was rate of complications, secondary outcome rate of antibiotic prescriptions.Results 1062 children were recruited. Main diagnoses were URTI 26%, pneumonia 19% and gastroenteritis (9.4%). 98% (531/541) were cured at D14 in the Almanach arm and 99.6% (519/521) in controls. Rate of secondary hospitalization was 0.2% in each. One death occurred in controls. None of the complications was due to withdrawal of antibiotics or antimalarials at day 0. Rate of antibiotic use was 19% in the Almanach arm and 84% in controls.Conclusion Evidence suggests that the new algorithm, primarily aimed at the rational use of drugs, is as safe as standard practice and leads to a drastic reduction of antibiotic use. The Almanach is currently being tested for clinician adherence to proposed procedures when used on paper or a mobile phone

Malaria chemoprophylaxis recommendations for immigrants to Europe, visiting relatives and friends--a Delphi method study.

BACKGROUND: Numbers of travellers visiting friends and relatives (VFRs) from Europe to malaria endemic countries are increasing and include long-term and second generation immigrants, who represent the major burden of malaria cases imported back into Europe. Most recommendations for malaria chemoprophylaxis lack a solid evidence base, and often fail to address the cultural, social and economic needs of VFRs. METHODS: European travel medicine experts, who are members of TropNetEurop, completed a sequential series of questionnaires according to the Delphi method. This technique aims at evaluating and developing a consensus through repeated iterations of questionnaires. The questionnaires in this study included questions about professional experience with VFRs, controversial issues in malaria prophylaxis, and 16 scenarios exploring indications for prescribing and choice of chemoprophylaxis. RESULTS: The experience of participants was rather diverse as was their selection of chemoprophylaxis regimen. A significant consensus was observed in only seven of 16 scenarios. The analysis revealed a wide variation in prescribing choices with preferences grouped by region of practice and increased prescribing seen in Northern Europe compared to Central Europe. CONCLUSIONS: Improving the evidence base on efficacy, adherence to chemoprophylaxis and risk of malaria and encouraging discussion among experts, using techniques such as the Delphi method, may reduce the variability in prescription in European travel clinics.