Opportunistic testing for urogenital infection with Chlamydia trachomatis in south-western Switzerland, 2012 : a feasibility study

The feasibility of opportunistic screening of urogenital infections with Chlamydia trachomatis was assessed in a cross-sectional study in 2012, in two cantons of south-western Switzerland: Vaud and Valais. Sexually active persons younger than 30 years, not tested for C. trachomatis in the last three months, were invited for free C. trachomatis testing by PCR in urine or self-applied vaginal swabs. Of 2,461 consenting participants, 1,899 (77%) were women and all but six (0.3%) submitted a sample. Forty-seven per cent of female and 25% of male participants were younger than 20 years. Overall, 134 (5.5%) of 2,455 tested participants had a positive result and were followed up. Seven per cent of all candidates for screening were not invited, 10% of invited candidates were not eligible, 15% of the eligible candidates declined participation, 5% of tested participants testing positive were not treated, 29% of those treated were not retested after six months and 9% of those retested were positive for C. trachomatis. Opportunistic C. trachomatis testing proved technically feasible and acceptable, at least if free of charge. Men and peripheral rural regions were more difficult to reach. Efforts to increase testing and decrease dropout at all stages of the screening procedure are necessary.

En voyage pour Monseigneur. Ambassadeurs, officiers et messagers à la cour de Savoie (1391-1465)

Résumé Amédée VIII, premier comte de Savoie à accéder au titre ducal en 1416, est bien connu pour avoir édicté les Statuta Sabaudie en 1430, pour être devenu ermite à Ripaille près de Thonon en 1434 et, enfin, pour avoir été élu antipape en 1439 sous le nom de Félix V. Mais ce sont surtout ses capacités de fin diplomate qui émergent de l'historiographie. Amédée VIII a en effet su rester en dehors de la guerre de Cent Ans en arbitrant les différentes parties entre 1407 et 1435, puis en continuant son oeuvre d'intermédiaire en Italie jusqu'en 1438. Loin d'être désintéressée, cette activité diplomatique a été utilisée à bon escient pour les propres intérêts du duché. Cette importante activité diplomatique s'est traduite par un nombre élevé d'ambassades envoyées auprès des protagonistes des différents conflits. La politique matrimoniale d'Amédée VIII, visant à un potentiel agrandissement du duché, a généré un tout aussi considérable va-et-vient. Néanmoins, les acteurs des négociations, qu'il s'agisse d'ambassadeurs, d'officiers ou de messagers, ainsi que les modalités pratiques et matérielles de leurs missions, ont totalement été négligés, les historiens s'étant surtout attelés à reconstituer les événements politiques et à vanter l'habileté diplomatique d'Amédée VIII. En étudiant l'exceptionnelle série de comptes conservée aux Archives d'Etat de Turin, les documents émanant des notaires ducaux ou de la Chambre, ainsi que les recueils d'instructions, il résulte qu'Amédée VIII a organisé les voyages de ses officiers au niveau législatif, administratif, financier et pratique, afin d'en faire un instrument de pouvoir et de gouvernement maîtrisé et performant. L'enjeu est en effet fondamental: au niveau international, les ambassadeurs permanents n'existant pas encore, chaque négociation est tributaire d'un voyage pour faire valoir ses droits, protéger ou élargir ses frontières, négocier un mariage, s'assurer une aide militaire ou signer un traité de paix. Les Statuta Sabaudiae sont ainsi les premiers édits savoyards conservés à évoquer les ambassadeurs. La création de dossiers diplomatiques organisés autour des négociations avec un Etat, notamment Milan, met aussi en lumière cette nécessité de contrôler l'intense activité diplomatique déployée par Amédée VIII. La bonne gestion de la diplomatie passe donc également par un important effort de classification de la documentation qu'elle génère en de véritables archives diplomatiques. De même, il ressort très clairement que la diplomatie d'Amédée VIII s'appuie sur une utilisation particulièrement ciblée de ses officiers. Le duc utilise ainsi au mieux les compétences de chacun, qu'il soit question d'ambassadeurs devant traiter de négociations capitales ou de simples chevaucheurs. Dans le cas des légats, c'est principalement dans l'entourage direct du prince qu'ils sont choisis, parmi les conseillers ou les officiers. Ils bénéficient de la confiance de leur seigneur et sont en plus au fait de la situation politique environnante. Les ambassades savoyardes sont d'ailleurs principalement composées d'après un modèle alliant le prestige de la noblesse aux capacités juridiques. Dans ce sens, les légations unissant un officier noble à un juriste sont monnaie courante. Le premier pourra briller au sein de la cour par sa maîtrise du cérémonial, tandis que le second veillera aux problèmes liés au droit et à la rédaction des actes. Amédée VIII pratique également une diplomatie de continuité en envoyant régulièrement les mêmes ambassadeurs auprès d'un seigneur. Ce procédé tend à instaurer un climat de confiance entre les deux parties, le souvenir personnel étant un facteur parfois fondamental lors de négociations. Il donne en outre aux envoyés du duc l'avantage de suivre un même dossier sur une longue période et, ainsi, d'en maîtriser les moindres aspects. Au fil des missions naissent ainsi de véritables spécialistes d'un Etat ou d'affaires particulières. Ces derniers ne sont toutefois pas cantonnés à gérer un seul type de négociation, bien que l'on puisse définir des traits particuliers. Devenu pape, Amédée VIII gardera néanmoins, jusqu'à sa mort en 1451, une influence prépondérante sur son fils Louis dépourvu de son sens aigu de la diplomatie. Le principat de Louis ne peut donc être envisagé séparément de celui de son père. Louis conservera d'ailleurs les supports établis par Amédée VIII pour son appareil diplomatique. Le nouveau duc devra cependant affronter de lourds déboires financiers et une grande instabilité du personnel administratif qui déboucheront in fine sur un refus du voyage diplomatique de la part de certains officiers, remettant ainsi en cause le service du prince.

La dependència econòmica des estudiants : comparació entre dues universitats públiques

Com a estudiants tenim moltes obligacions i la universitat ens absorbeix gran part del temps. És freqüent que en nosaltres sorgeixin inquietuds sobre quina seria la nostra situació si estiguéssim en una altra universitat o context que ens donés més marge d’autonomia i poguéssim, per exemple, dedicar part del nostre temps a treballar i obtenir ingressos. Per tant, la nostra percepció és que la majoria d’estudiants universitaris ho podem ser perquè darrere tenim una família que ens dóna suport en l’aspecte econòmic. Estudiar, entre altres coses, representa una inversió. Una inversió de temps el cost d’oportunitat de la qual és igual al total d’ingressos que podríem obtenir durant els anys que duren els estudis. No obstant, aquest elevat cost d’oportunitat es veu recompensat un cop acabats els estudis en forma d’una remuneració superior a aquest. Però, ha d’implicar sempre això? És obligatori renunciar a uns ingressos per tal de poder-se formar? La societat està interessada en que estudiem, però, dóna recursos per a que ho fem? Quines són les opcions que tenim els estudiants per a poder assolir una certa independència econòmica? Quin paper hi juga la universitat? En quin grau influeix el model d’universitat en el grau de dependència?Estudiem en una universitat, la UPF, la filosofia de la qual és que els estudiants han de ser-ho a temps complert, evitant que treballin mentre cursen la carrera:“Els plans d’estudis, dissenyats a partir de […], l’alta exigència acadèmica i de superació personal, la dedicació completa…” (www.upf.edu)La qualitat dels estudis es relaciona directament amb la dedicació absoluta. És difícil objectar el fet que quant més temps es dedica als estudis, millors són els resultats. No obstant i desgraciadament, no tothom pot permetre’s el luxe de invertir el cent per cent del seu temps als estudis i no treballar. El Pacte Internacional pels Drets Econòmics, Socials i Culturals de la ONU ratificat el 1966 i que va entrar en vigor l’any 1976, defensa, a l’article 13, el dret de tota persona a l’educació: “La enseñanza primaria debe ser obligatoria y accesible a todos gratuitamente"; “La enseñanza secundaria, en sus diferentes formas, incluso la enseñanza secundaria técnica y profesional, debe ser generalizada y hacerse accesible a todos, por cuantos medios sean apropiados, y en particular por la implantación progresiva de la enseñanza gratuita" “La enseñanza superior debe hacerse igualmente accesible a todos, sobre la base de la capacidad de cada uno, por cuantos medios sean apropiados, y en particular por la implantación progresiva de la enseñanza gratuita"En aquest treball hem volgut estudiar quins factors influeixen i de quina manera en la independència econòmica que pot assolir un estudiant. Hem volgut donar un fort èmfasi a l’àmbit universitari a l’hora de fer el treball ja que com a estudiants ens trobem en ple procés formatiu i aquesta té un pes rellevant en les nostres vides quotidianes, sobretot en matèria de temps i dedicació.

Clinical consequences of imatinib plasma concentrations variability in hemato-oncologic patients

Background: Imatinib has revolutionized the treatment of chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST). Considering the large inter-individual differences in the function of the systems involved in its disposition, exposure to imatinib can be expected to vary widely among patients. This observational study aimed at describing imatinib pharmacokinetic variability and its relationship with various biological covariates, especially plasma alpha1-acid glycoprotein (AGP), and at exploring the concentration-response relationship in patients. Methods: A population pharmacokinetic model (NONMEM) including 321 plasma samples from 59 patients was built up and used to derive individual post-hoc Bayesian estimates of drug exposure (AUC; area under curve). Associations between AUC and therapeutic response or tolerability were explored by ordered logistic regression. Influence of the target genotype (i.e. KIT mutation profile) on response was also assessed in GIST patients. Results: A one-compartment model with first-order absorption appropriately described the data, with an average oral clearance of 14.3 L/h (CL) and volume of distribution of 347 L (Vd). A large inter-individual variability remained unexplained, both on CL (36%) and Vd (63%), but AGP levels proved to have a marked impact on total imatinib disposition. Moreover, both total and free AUC correlated with the occurrence and number of side effects (e.g. OR 2.9±0.6 for a 2-fold free AUC increase; p<0.001). Furthermore, in GIST patients, higher free AUC predicted a higher probability of therapeutic response (OR 1.9±0.5; p<0.05), notably in patients with tumor harboring an exon 9 mutation or wild-type KIT, known to decrease tumor sensitivity towards imatinib. Conclusion: The large pharmacokinetic variability, associated to the pharmacokinetic-pharmacodynamic relationship uncovered are arguments to further investigate the usefulness of individualizing imatinib prescription based on TDM. For this type of drug, it should ideally take into consideration either circulating AGP concentrations or free drug levels, as well as KIT genotype for GIST.

Long-term outcome after cognitive and behavioral regression in non-lesional epilepsy with CSWS

Purpose: To present the long-term outcome (LTO) of 10 adolescents and young adults with documented cognitive and behavioral regression as children due to non-lesional focal, mainly frontal epilepsy with continuous spike-waves during slow wave sleep (CSWS). Method: Past medical and EEG data of all patients were reviewed and neuropsychological tests exploring main cognitive functions were administered. Result: After a mean duration of follow-up of 15.6 years (range 8-23 years), none of the 10 patients had recovered fully, but four regained borderline to normal intelligence and were almost independent. Patients with prolonged global intellectual regression had the worst outcome, whereas those with more specific and short-lived deficits recovered best. The marked behavioral disorders that were so disturbing during the active period (AP) resolved in all but one patient. Executive functions were neither severely nor homogenously affected. Three patients with a frontal syndrome during the AP disclosed only mild residual executive and social cognition deficits. The main cognitive gains occurred shortly after the AP, but qualitative improvements continued to occur. LTO correlated best with duration of CSWS. Conclusion: Our findings emphasize that cognitive recovery after cessation of CSWS depends on the severity and duration of the initial regression. None of our patients had major executive and social cognition deficits with preserved intelligence as reported in adults with destructive lesions of the frontal lobes during childhood. Early recognition of epilepsy with CSWS and rapid introduction of effective therapy are crucial for a best possible outcome.

Does lipid oxidation differ in gynoid and android obese women?

This study was performed to investigate whether body fat distribution influences resting metabolic rate and lipid oxidation in obese individuals. Eighty-nine obese women were divided in two groups (android obese, n = 36, BMI = 31.1 +/- 4.5 kg/m2 (mean +/- s.d.); gynoid obese, n = 53, BMI = 29.9 +/- 4.5 kg/m2 on the basis of their waist/hip ratio (0.86 +/- 0.05 vs 0.75 +/- 0.04 respectively). Body weight, per cent body fat and fat-free mass were similar in the two groups. Moreover, resting metabolic rate and respiratory quotient were also identical in android and gynoid obese women, indicating that there was no intergroup difference in the absolute level of lipid oxidation. If, like most other android obese women, they had higher rates of lipolysis and plasma FFA concentrations, the failure of android obese individuals to exhibit a higher lipid oxidation than gynoid obese women may partly explain their increased risk to develop metabolic complications.

Growing at the production frontier. European aggregate growth, 1870-1914

The view of a 1870-1913 expanding European economy providing increasing welfare to everybody has been challenged by many, then and now. We focus on the amazing growth that was experienced, its diffusion and its sources, in the context of the permanent competition among European nation states. During 1870-193 the globalized European economy reached a silver age . GDP growth was quite rapid (2.15% per annum) and diffused all over Europe. Even discounting the high rates of population growth (1.06%), per capita growth was left at a respectable 1.08%. Income per capita was rising in every country, and the rates of improvement were quite similar. This was a major achievement after two generations of highly localized growth, both geographically and socially. Growth was based on the increased use of labour and capital, but a good part of growth (73 per cent for the weighted average of the best documented European countries) came out of total factor productivity efficiency gains resulting from not well specified ultimate sources of growth. This proportion suggests that the European economy was growing at full capacity at its production frontier. It would have been very difficult to improve its performance. Within Europe, convergence was limited, and it only was in motion after 1900. What happened was more the end of the era of big divergence rather than an era of convergence.

Alterations of bone microarchitecture in young patients with inflammatory bowel diseases are associated with fracture risk during growth

Aims: Inflammatory bowel diseases (IBD) appearing during childhood and adolescence compromise peak bone mass acquisition and increase fracture risk. The structural determinants of bone fragility in IBD however remain unknown. Methods: We investigated volumetric bone mineral density (vBMD), trabecular and cortical bone microstructure at distal radius and tibia by high-resolution pQCT (XtremeCT, Scanco, Switzerland), aBMD at distal radius, hip and spine and vertebral fracture assessment (VFA) by DXA in 107 young patients (mean age 22.8 yrs, range 12.2-33.7 yrs; 62 females and 45 males) with Crohn's disease (n=75), ulcerative colitis (n=25), undetermined colitis (n=2), and no definitive diagnosis (n=5), and in 389 healthy young individuals. Results: Mean disease duration was 6.1 yrs, 89/107 IBD patients received corticosteroids, 83 other immunomodulators, and 59 vitamin D. Clinical fractures were reported by 38 patients (mean age at 1st fracture, 12.6 yrs), the vast majority of the forearm, arm or hand; 5 had vertebral crush fractures (Grade 1 or 2) and 11 had multiple fractures. As compared to healthy controls (matched 2:1 for age, sex, height and fracture history), the 102 patients with established IBD had similar weight but significantly lower aBMD at all sites, lower trabecular (Tb) BV/TV and number, and greater Tb separation and inhomogeneous Tb distribution (1/SD TbN) at both distal radius and tibia, lower tibia cortical thickness (CTh), but no differences in cortical vBMD nor bone perimeter. Among IBD's, aBMD was not associated with fractures (by logistic regression adjusted for age, age square, sex, height, weight and protein intake). However, radius and tibia Tb BV/TV, thickness and SD 1/TbN, as well as radius Tb separation and perimeter, were significantly associated with fracture risk (fully adjusted as above), whereas cortical vBMD and CTh were not. After adjustment for aBMD at radius, respectively at femur neck, radius SD 1/TbN and tibia BV/TV, TbTh and perimeter remained independently associated with fracture risk. Conclusions: Young subjects with IBD have low bone mass and poor bone microarchitecture compared to healthy controls. Alterations of bone microarchitecture, particularly in the trabecular bone compartment, are specifically associated with increased fracture risk during growth.

Increasing Students Vocabulary in Efl Class

After reviewing the literature, this work tries to show the importance of teaching vocabulary fõr students’ literacy skills, especially, reading comprehension. Many researchers suggest that the greatest amount of vocabulary growth occurs through incidental word learning in wide reading, and, research indicates that vocabulary instruction is an important vehicle for vocabulary learning. (Anderson& Nagy, as cited in Harmon, 1992, p.306). Word knowledge is one of the best ways of successful reading and comprehension. “Reading enhancement correlates with reader’s vocabulary” (Im, 1994, p.12). Therefore, today’s language teachers and researchers have realized the important role of vocabulary in reading comprehension. A survey carried out on 10th, 11th and 12th grade students, regarding their reading comprehension, shows that unknown words is one of the factors which influences their ability to read and comprehend a passage. It also shows that students feel the need to be instructed on strategy when encountering new words and consequently improving their vocabulary. This inhibits their understanding of a reading selection. As a result it is crucial that teachers equip students with methodological tools to be employed when they encounter unknown words. There are a lot systematic approaches for discerning which skills and words a teacher should focus on and meaningful classroom activities to reinforce the words and strategies that teachers can use to help students increase their word knowledge. Finally research indicates that developing students’ vocabulary correlates with success in all areas of curriculum (Edger, 1999, p.14). The success of vocabulary development depends on students’ active process of learning and strategies used by teachers.

Immunonutrition in gastrointestinal surgery.

Background: Patients undergoing major gastrointestinal surgery are at increased risk of developing complications. The use of immunonutrition (IN) in such patients is not widespread because the available data are heterogeneous, and some show contradictory results with regard to complications, mortality and length of hospital stay. Methods: Randomized controlled trials (RCTs) published between January 1985 and September 2009 that assessed the clinical impact of perioperative enteral IN in major gastrointestinal elective surgery were included in a meta-analysis. Results: Twenty-one RCTs enrolling a total of 2730 patients were included in the meta-analysis. Twelve were considered as high-quality studies. The included studies showed significant heterogeneity with respect to patients, control groups, timing and duration of IN, which limited group analysis. IN significantly reduced overall complications when used before surgery (odds ratio (OR) 0.48, 95 per cent confidence interval (c.i.) 0.34 to 0.69), both before and after operation (OR 0.39, 0.28 to 0.54) or after surgery (OR 0.46, 0.25 to 0.84). For these three timings of IN administration, ORs of postoperative infection were 0.36 (0.24 to 0.56), 0.41 (0.28 to 0.58) and 0.53 (0.40 to 0.71) respectively. Use of IN led to a shorter hospital stay: mean difference -2.12 (95 per cent c.i. -2.97 to -1.26) days. Beneficial effects of IN were confirmed when low-quality trials were excluded. Perioperative IN had no influence on mortality (OR 0.90, 0.46 to 1.76). Conclusion: Perioperative enteral IN decreases morbidity and hospital stay but not mortality after major gastrointestinal surgery; its routine use can be recommended.

Preparation with fasting and acipimox increases myocardial glucose uptake in mice during cardiac 18F-FDG microPET

Purpose: Cardiac 18F-FDG PET is considered as the gold standard to assess myocardial metabolism and infarct size. The myocardial demand for glucose can be influenced by fasting and/or following pharmacological preparation. In the rat, it has been previously shown that fasting combined with preconditioning with acipimox, a nicotinic acid derivate and lipidlowering agent, increased dramatically 18F-FDG uptake in the myocardium. Strategies aimed at reducing infarct scar are evaluated in a variety of mouse models. PET would particularly useful for assessing cardiac viability in the mouse. However, prior knowledge of the best preparation protocol is a prerequisite for accurate measurement of glucose uptake in mice. Therefore, we studied the effect of different protocols on 18F-FDG uptake in the mouse heart.Methods: Mice (n = 15) were separated into three treatment groups according to preconditioning and underwent a 18FDG PET scan. Group 1: No preconditioning (n = 3); Group 2: Overnight fasting (n = 8); and Group 3: Overnight fasting and acipimox (25mg/kg SC) (n = 4). MicroPET images were processed with PMOD to determine 18F-FDG mean standard uptake value (SUV) at 30 min for the whole left ventricle (LV) and for each region of the 17-segments AHA model. For comparisons, we used Mann-Whitney test and multilevel mixed-effects linear regression (Stata 11.0).Results: In total, 27 microPET were performed successfully in 15 animals. Overnight fasting led to a dramatic increase in LV-SUV compared to mice without preconditioning (8.6±0.7g/mL vs. 3.7±1.1g/mL, P<0.001). In addition, LV-SUV was slightly but not significantly higher in animals treated with acipimox compared to animals with overnight fasting alone (10.2±0.5 g/mL, P = 0.06). Fastening increased segmental SUV by 5.1±0.5g/mL as compared to free-feeding mice (from 3.7±0.8g/mL to 8.8±0.4g/mL, P<0.001); segmental-SUV also significantly increased after administration of acipimox (from 8.8±0.4g/mL to 10.1±0.4g/mL, P<0.001).Conclusion: Overnight fasting led to myocardial glucose deprivation and increases 18F-FDG myocardial uptake. Additional administration of acipimox enhances myocardial 18F-FDG uptake, at least at the segmental level. Thus, preconditioning with acipimox may provide better image quality that may help for assessing segmental myocardial metabolism.

My older sibling was drunk - younger siblings' drunkenness in relation to parental monitoring and the parent-adolescent relationship.

This study explored the links between having older siblings who get drunk, satisfaction with the parent-adolescent relationship, parental monitoring, and adolescents' risky drinking. Regression models were conducted based on a national representative sample of 3725 8th to 10th graders in Switzerland (mean age 15.0, SD = .93) who indicated having older siblings. Results showed that both parental factors and older siblings' drinking behaviour shape younger siblings' frequency of risky drinking. Parental monitoring showed a linear dose-response relationship, and siblings' influence had an additive effect. There was a non-linear interaction effect between parent-adolescent relationship and older sibling's drunkenness. The findings suggest that, apart from avoiding an increasingly unsatisfactory relationship with their children, parental monitoring appears to be important in preventing risky drinking by their younger children, even if the older sibling drinks in such a way. However, a satisfying relationship with parents does not seem to be sufficient to counterbalance older siblings' influence.