Female genital mutilation and its prevention: a challenge for paediatricians.

Female genital mutilation (FGM) is defined as an injury of the external female genitalia for cultural or non-therapeutic reasons. FGM is mainly performed in sub-Saharan and Eastern Africa. The western health care systems are confronted with migrants from this cultural background. The aim is to offer information on how to approach this subject. The degree of FGM can vary from excision of the prepuce and clitoris to infibulation. Infections, urinary retention, pain, lesions of neighbouring organs, bleeding, psychological trauma and even death are possible acute complications. The different long-term complications include the risk of reduced fertility and difficulties during labour, which are key arguments against FGM in the migrant community. Paediatricians often have questions on how to approach the subject. With an open, neutral approach and basic knowledge, discussions with parents are constructive. Talking about the newborn, delivery or traditions may be a good starting point. Once they feel accepted, they speak surprisingly openly. FGM is performed out of love for their daughters. We have to be aware of their arguments and fears, but we should also stress the parents' responsibility in taking a health risk for their daughters. It is important to know the family's opinion on FGM. Some may need support, especially against community pressure. As FGM is often performed on newborns or at 4-9 years of age, paediatricians should have an active role in the prevention of FGM, especially as they have repeated close contact with those concerned and medical consequences are the main arguments against FGM.

Three essays on leadership

ABSTRACT Samuel Bendahan, John Antonakis, Christian Zehnder, and François Pralong The relationship between power and immoral decisions has been discussed extensively by scientists and philosophers alike. Although the exercise of power is ubiquitous in social hierarchies, direct evidence on the impact of power on decision making is scarce. We use laboratory experiments to study whether more power leads to corruption. We manipulate power in the context of leader decision-making authority involving monetary stakes. Prior to the experiment, we also gathered extensive data on psychological and endocrinological individual differences. We find that an increase of power caused leaders to be more likely to engage in destructive, selfish behaviour, although the same subjects did not behave in this manner before their level of power was increased. We also show how individual differences affect the initial level of destructive behaviour and the corruption process. WHAT'S RIGHT FOR THE LEFT MAY NOT BE RIGHT FOR THE RIGHT: VALUE CONGRUENCE AND CHARISMA IN POLITICAL LEADERSHIP Samuel Bendahan ABSTRACT Value congruence between leaders and followers is important not only for follower commitment but also as part of the attributions followers make of leaders. I theorized that transformational leadership, which often is referred to as being value driven and having strong moral foundations, has differential effects depending on the values of the follower and whether these values are congruent with what the leader espouses. I designed an experiment to analyze how the political values of followers and leaders can influence followers' attributions regarding leaders. Within the context of political leadership, I found that transformational leaders were seen as more prototypical. Value congruence predicted prototypicality, which was strongly related to follower intentions to vote for the leader. Furthermore, followers with left-wing political values were more influenced by prototypical leaders than were followers with right-wing political values, presumably because of moral overtones of both left-wing ideology and transformational leadership. JUDGING LEADERSHIP POTENTIAL IN AN INTERVIEW: MODERATING EFFECT OF INTERVIEWER INTELLIGENCE ON INTERVIEWER COGNITIVE BUSYNESS, CANDIDATE PERFORMANCE-CUES EFFECTS, AND CANDIDATE ETHNICITY Samuel Bendahan, Philippe Jacquart, and John Antonakis ABSTRACT A large body of literature suggests that interviewers do not accurately rate candidates when using unstructured interviews and evaluation procedures that affect pre-interview expectations; however, the process by which these biases are produced is not well understood. We theorized several reasons for the sub-par performance of the unstructured interview. These factors, which we manipulated in the context of a videotaped interview of a candidate applying for a leadership position, include evaluator cognitive load, pre-interview performance cues regarding the candidate, and the ethnicity of the candidate. We also controlled for the intelligence of the evaluator. We found a significant four-way interaction between the manipulated factors and evaluators' cognitive abilities. The effects of the manipulated factors were all significantly less for evaluators who were high on general intelligence.

Quetiapine dosage in bipolar disorder episodes and mixed states

OBJECTIVE: Although the maximal quetiapine doses in the published studies were restricted to 800 mg/day, higher quetiapine doses are not unusual in clinical practice. The aim of the present study was to evaluate the effectiveness, tolerability and clinical reasons associated to the use of high dosage of quetiapine (>800 mg), when used under routine clinical conditions, in a sample of bipolar disorder and schizoaffective bipolar inpatients. METHODS: Charts of all bipolar and schizoaffective adult inpatients, who had received quetiapine for a mood episode between 1999 and 2005 were retrospectively reviewed. These charts also included the assessment of manic and depressive symptoms on admission and at discharge using the Beck-Rafaelsen Mania Scale (MAS) and the Montgomery Asberg depression rating scale (MADRS), respectively. RESULTS: Data of 50 patients were analyzed. The overall F in repeated measures ANOVA revealed a significant MAS scores reduction between admission and discharge. MAS scores reduction did not differ between the high and low quetiapine groups. Similarly, a significant MADRS reduction was found. Again, no differences between the high and the low dose group were found. Logistic regression analysis of the 50 patients revealed only mixed episodes predicted high quetiapine dosage. CONCLUSIONS: The present study confirms quetiapine efficiency and tolerability in the treatment of bipolar episodes, even in doses > to 800 mg and found a link between quetiapine doses and mixed episodes

Experimentació a distància de la física per a enginyers (EDFE)

El laboratori de física és el lloc que permet apropar la Física i la seva realitat quotidiana, tant la tecnològica com la científica, a l'estudiantat mitjançant experiències i demostracions motivadores. En general, les pràctiques de laboratori se solen realitzar per parelles, encara que no necessàriament, propiciant un treball en equip. Ara bé, pensant en aquelles estudiantes i aquells estudiants que no poden seguir el calendari de sessions presencials establert, per raons justificables, s’ha generat un material docent innovador consistent en la filmació de vídeos d’algunes de les pràctiques que actualment s'estan duent a terme en el laboratori de Física de l'EPSEM. Les filmacions van acompanyades per uns tutorials que permeten introduir la pràctica i il·lustrar tots els conceptes teòrics que hi intervenen i algunes simulacions. A més, també hi ha disponible uns tests d'autoavaluació i d'avaluació que acreditin l'aprenentatge de l'estudiant. L’objectiu és procurar, a partir d’una experimentació virtual, minimitzar la manca d’adquisició d’algunes habilitats pròpies de l’experimentació real al laboratori. Els productes creats han estat inclosos en el web del Departament de Física Aplicada de la UPC a l'EPSEM, on es proporciona tot un conjunt d’eines i informacions pensades per facilitar una millor forma de treballar en un laboratori. En aquest web es poden trobar, les normes generals per a la realització de les pràctiques i per a l’elaboració dels informes preceptius, el guió i l’esquema del muntatge de cada experimentació, així com enllaços a webs relacionats amb la física, que poden resultar molt útils per a l’alumnat. El pas endavant que suposa el material desenvolupat, ampliable en un futur, és sens dubte una alternativa educativa complementaria per garantir una formació més integral de les nostres estudiantes i dels nostres estudiants, en correspondència amb l’esperit de fomentar l'autoaprenentatge que traspua el procés d'integració a l'EEES. Veure: http://www.epsem.upc.edu/~practiquesfisica/

Materials de construcció : de l'aula a l'obra : una experiència d'aprenentatge actiu en un entorn no presencial

L’estudi dels materials de construcció és una part fonamental de la formació de l’estudiantat en l’àmbit de la Enginyeria Civil. En aquest context, una part rellevant de les assignatures de Química de Materials i Materials de Construcció és aquella que fa referència als diversos mètodes d’assaig i procediments que ens permeten analitzar i estudiar les característiques d’un material. Per aquesta raó, és de gran importància que els alumnes puguin disposar d’unes determinades hores en les quals l’aprenentatge es realitza a través de la pràctica en el laboratori dels procediments estudiats a classe i la realització d’un informe posterior en el qual quedin reflectits els coneixements adquirits durant l’activitat en el laboratori. Malauradament, la realització de pràctiques en el laboratori du aparellades una sèrie de limitacions (espai, temps, utilització de reactius perillosos o instrumental sofisticat), que fan que el nombre d’activitats d’aquesta mena sigui necessàriament restringit. D'altra banda, l'estudi dels materials només es completa quan els coneixements adquirits a l'aula i al laboratori surten d'aquests àmbits i es confronten amb les situacions reals amb les quals es pot trobar un enginyer durant l'exercici de la seva professió. L'organització de visites a diverses instal·lacions al llarg del curs cobreix en part aquesta necessitat, tot i alguns inconvenients logístics (grups nombrosos, alumnes de mobilitat reduïda i altres). La finalitat d'aquest projecte ha estat posar en funcionament una dinàmica de treball que permeti a l'estudiantat aprofundir en el coneixement dels materials de construcció i el seu comportament en situacions reals amb les quals es trobarà en l'exercici de la seva professió. Aquesta metodologia es basa en l'ús de materials audiovisuals elaborats sota criteris d'adequació pedagògica i que responen a les demandes professionals del futur enginyer. Les possibilitats ofertes per un entorn virtual d'aprenentatge (tecnologia Moodle) permeten el disseny d'activitats que motivin l’autoaprenentatge de l’alumnat.

Paclitaxel-eluting biodegradable synthetic vascular prostheses: a step towards reduction of neointima formation?

BACKGROUND: Clinical small-caliber vascular prostheses are unsatisfactory. Reasons for failure are early thrombosis and late intimal hyperplasia. We thus prepared biodegradable small-caliber vascular prostheses using electrospun polycaprolactone (PCL) with slow-releasing paclitaxel (PTX), an antiproliferative drug. METHODS AND RESULTS: PCL solutions containing PTX were used to prepare nonwoven nanofibre-based 2-mm ID prostheses. Mechanical morphological properties and drug loading, distribution, and release were studied in vitro. Infrarenal abdominal aortic replacement was carried out with nondrug-loaded and drug-loaded prostheses in 18 rats and followed for 6 months. Patency, stenosis, tissue reaction, and drug effect on endothelialization, vascular remodeling, and neointima formation were studied in vivo. In vitro prostheses showed controlled morphology mimicking extracellular matrix with mechanical properties similar to those of native vessels. PTX-loaded grafts with suitable mechanical properties and controlled drug-release were obtained by factorial design. In vivo, both groups showed 100% patency, no stenosis, and no aneurysmal dilatation. Endothelial coverage and cell ingrowth were significantly reduced at 3 weeks and delayed at 12 and 24 weeks in PTX grafts, but as envisioned, neointima formation was significantly reduced in these grafts at 12 weeks and delayed at 6 months. CONCLUSIONS: Biodegradable, electrospun, nanofibre, polycaprolactone prostheses are promising because in vitro they maintain their mechanical properties (regardless of PTX loading), and in vivo show good patency, reendothelialize, and remodel with autologous cells. PTX loading delays endothelialization and cellular ingrowth. Conversely, it reduces neointima formation until the end point of our study and thus may be an interesting option for small caliber vascular grafts.

Programa d'introducció al dret espanyol per a estudiants d'intercanvi

El projecte "Programa d'introducció al dret espanyol per a estudiants d'intercanvi" s'ha dut a terme a la Facultat de dret de la Universitat de Barcelona des del mes de juny de 2007 al mes de setembre de 2008. Ha consistit en iniciar l’esmentat programa que suposava, pels estudiants d’intercanvi sol·licitants, la consecució d’un Diploma d’Introducció al Dret espanyol, expedit per la Facultat de Dret de la UB, a banda del reconeixement dels crèdits cursats a Barcelona. L’objectiu va ser proposar canvis en el plantejament curricular, en concret la posada en marxa de les assignatures del Diploma: Introducció al Dret Privat, Introducció al Dret públic, Introducció al sistema processal espanyol, i Bases del sistema legal espanyol. Com a tasca prèvia que havia de garnatir l’èxit es va fer una difusió del programa a les universitats d’origen i es va articular un sistema d’acollida als estudiants que es va demostrar molt útil al principi de curs per a informacions diverses, però que després va ser infrautilitzat. Pel que fa a les assignatures, es van plantejar com un anàlisi dels trets fonamentals i diferencials del nostre dret, utilitzant elements de comparació amb els ordenaments dels països dels alumnes, però sense fer un exercici estricte de dret comparat. La taxa de rediment va ser alta – 75% - però es va detectar un problema, la insuficient preparació idomàtica, que depassa l’organització del programa. També es va considerar un repte pedagògic important: la heterogeneïtat dels estudiants tant en la seva formació jurídica prèvia –assignatures cursades en la seva Universitat-, com en relació al sistema legal del país del qual provenien, en relació al sistema espanyol. Per aquest motiu, el plantejament del curs i els materials a utilitzar va dependre en bona mesura del conjunt del grup al qual es va dirigr cada assignatura en concret.

Tibial or hip BMD predict clinical fracture risk equally well: results from a prospective study in 700 elderly Swiss women.

SUMMARY: In a randomly selected cohort of Swiss community-dwelling elderly women prospectively followed up for 2.8 +/- 0.6 years, clinical fractures were assessed twice yearly. Bone mineral density (BMD) measured at tibial diaphysis (T-DIA) and tibial epiphysis (T-EPI) using dual-energy X-ray absorptiometry (DXA) was shown to be a valid alternative to lumbar spine or hip BMD in predicting fractures. INTRODUCTION: A study was carried out to determine whether BMD measurement at the distal tibia sites of T-EPI and T-DIA is predictive of clinical fracture risk. METHODS: In a predefined representative cohort of Swiss community-dwelling elderly women aged 70-80 years included in the prospective, multi-centre Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture risk (SEMOF) study, fracture risk profile was assessed and BMD measured at the lumbar spine (LS), hip (HIP) and tibia (T-DIA and T-EPI) using DXA. Thereafter, clinical fractures were reported in a bi-yearly questionnaire. RESULTS: During 1,786 women-years of follow-up, 68 clinical fragility fractures occurred in 61 women. Older age and previous fracture were identified as risk factors for the present fractures. A decrease of 1 standard deviation in BMD values yielded a 1.5-fold (HIP) to 1.8-fold (T-EPI) significant increase in clinical fragility fracture hazard ratio (adjusted for age and previous fracture). All measured sites had comparable performance for fracture prediction (area under the curve range from 0.63 [LS] to 0.68 [T-EPI]). CONCLUSION: Fracture risk prediction with BMD measurements at T-DIA and T-EPI is a valid alternative to BMD measurements at LS or HIP for patients in whom these sites cannot be accessed for clinical, technical or practical reasons.

Spatial distribution of economic activities: an empirical approach usingself-organizing maps

The aim of this paper is to analyse the colocation patterns of industries and firms. We study the spatial distribution of firms from different industries at a microgeographic level and from this identify the main reasons for this locational behaviour. The empirical application uses data from Mercantile Registers of Spanish firms (manufacturers and services). Inter-sectorial linkages are shown using self-organizing maps. Key words: clusters, microgeographic data, self-organizing maps, firm location JEL classification: R10, R12, R34

Is monetary policy in new members states asymmetric?

Estimated Taylor rules became popular as a description of monetary policy conduct. There are numerous reasons why real monetary policy can be asymmetric and estimated Taylor rule nonlinear. This paper tests whether monetary policy can be described as asymmetric in three new European Union (EU) members (the Czech Republic, Hungary and Poland), which apply an inflation targeting regime. Two different empirical frameworks are

Differential association of drinking motives with alcohol use on weekdays and weekends.

Drinking motives (DM) reflect the reasons why individuals drink alcohol. Weekdays are mainly dedicated to work, whereas weekends are generally associated with spending time with friends during special events or leisure activities; using alcohol on weekdays and weekends may also be related to different DM. This study examined whether DM were differentially associated with drinking volume (DV) on weekdays and weekends. A representative sample of 5,391 young Swiss men completed a questionnaire assessing weekday and weekend DV, as well as their DM, namely, enhancement, social, coping, and conformity motives. Associations of DM with weekday and weekend DV were examined using structural equation models. Each DM was tested individually in a separate model; all associations were positive and generally stronger (except conformity) for weekend rather than for weekday DV. Further specific patterns of association were found when DM were entered into a single model simultaneously. Associations with weekday and with weekend DV were positive for enhancement and coping motives. However, associations were stronger with weekend rather than with weekday DV for enhancement, and stronger with weekday than with weekend DV for coping motives. Associations of social motives were not significant with weekend DV and negative with weekday DV. Conformity motives were negatively associated with weekend DV and positively related to weekday DV. These results suggest that interventions targeting enhancement motives should be particularly effective at decreasing weekend drinking, whereas interventions targeted at coping motives would be particularly effective at reducing alcohol use on weekdays. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Central and Cortical Gray Mater Segmentation of Magnetic Resonance Images of the Fetal Brain

Motivation. The study of human brain development in itsearly stage is today possible thanks to in vivo fetalmagnetic resonance imaging (MRI) techniques. Aquantitative analysis of fetal cortical surfacerepresents a new approach which can be used as a markerof the cerebral maturation (as gyration) and also forstudying central nervous system pathologies [1]. However,this quantitative approach is a major challenge forseveral reasons. First, movement of the fetus inside theamniotic cavity requires very fast MRI sequences tominimize motion artifacts, resulting in a poor spatialresolution and/or lower SNR. Second, due to the ongoingmyelination and cortical maturation, the appearance ofthe developing brain differs very much from thehomogenous tissue types found in adults. Third, due tolow resolution, fetal MR images considerably suffer ofpartial volume (PV) effect, sometimes in large areas.Today extensive efforts are made to deal with thereconstruction of high resolution 3D fetal volumes[2,3,4] to cope with intra-volume motion and low SNR.However, few studies exist related to the automatedsegmentation of MR fetal imaging. [5] and [6] work on thesegmentation of specific areas of the fetal brain such asposterior fossa, brainstem or germinal matrix. Firstattempt for automated brain tissue segmentation has beenpresented in [7] and in our previous work [8]. Bothmethods apply the Expectation-Maximization Markov RandomField (EM-MRF) framework but contrary to [7] we do notneed from any anatomical atlas prior. Data set &Methods. Prenatal MR imaging was performed with a 1-Tsystem (GE Medical Systems, Milwaukee) using single shotfast spin echo (ssFSE) sequences (TR 7000 ms, TE 180 ms,FOV 40 x 40 cm, slice thickness 5.4mm, in plane spatialresolution 1.09mm). Each fetus has 6 axial volumes(around 15 slices per volume), each of them acquired inabout 1 min. Each volume is shifted by 1 mm with respectto the previous one. Gestational age (GA) ranges from 29to 32 weeks. Mother is under sedation. Each volume ismanually segmented to extract fetal brain fromsurrounding maternal tissues. Then, in-homogeneityintensity correction is performed using [9] and linearintensity normalization is performed to have intensityvalues that range from 0 to 255. Note that due tointra-tissue variability of developing brain someintensity variability still remains. For each fetus, ahigh spatial resolution image of isotropic voxel size of1.09 mm is created applying [2] and using B-splines forthe scattered data interpolation [10] (see Fig. 1). Then,basal ganglia (BS) segmentation is performed on thissuper reconstructed volume. Active contour framework witha Level Set (LS) implementation is used. Our LS follows aslightly different formulation from well-known Chan-Vese[11] formulation. In our case, the LS evolves forcing themean of the inside of the curve to be the mean intensityof basal ganglia. Moreover, we add local spatial priorthrough a probabilistic map created by fitting anellipsoid onto the basal ganglia region. Some userinteraction is needed to set the mean intensity of BG(green dots in Fig. 2) and the initial fitting points forthe probabilistic prior map (blue points in Fig. 2). Oncebasal ganglia are removed from the image, brain tissuesegmentation is performed as described in [8]. Results.The case study presented here has 29 weeks of GA. Thehigh resolution reconstructed volume is presented in Fig.1. The steps of BG segmentation are shown in Fig. 2.Overlap in comparison with manual segmentation isquantified by the Dice similarity index (DSI) equal to0.829 (values above 0.7 are considered a very goodagreement). Such BG segmentation has been applied on 3other subjects ranging for 29 to 32 GA and the DSI hasbeen of 0.856, 0.794 and 0.785. Our segmentation of theinner (red and blue contours) and outer cortical surface(green contour) is presented in Fig. 3. Finally, torefine the results we include our WM segmentation in theFreesurfer software [12] and some manual corrections toobtain Fig.4. Discussion. Precise cortical surfaceextraction of fetal brain is needed for quantitativestudies of early human brain development. Our workcombines the well known statistical classificationframework with the active contour segmentation forcentral gray mater extraction. A main advantage of thepresented procedure for fetal brain surface extraction isthat we do not include any spatial prior coming fromanatomical atlases. The results presented here arepreliminary but promising. Our efforts are now in testingsuch approach on a wider range of gestational ages thatwe will include in the final version of this work andstudying as well its generalization to different scannersand different type of MRI sequences. References. [1]Guibaud, Prenatal Diagnosis 29(4) (2009). [2] Rousseau,Acad. Rad. 13(9), 2006, [3] Jiang, IEEE TMI 2007. [4]Warfield IADB, MICCAI 2009. [5] Claude, IEEE Trans. Bio.Eng. 51(4) (2004). [6] Habas, MICCAI (Pt. 1) 2008. [7]Bertelsen, ISMRM 2009 [8] Bach Cuadra, IADB, MICCAI 2009.[9] Styner, IEEE TMI 19(39 (2000). [10] Lee, IEEE Trans.Visual. And Comp. Graph. 3(3), 1997, [11] Chan, IEEETrans. Img. Proc, 10(2), 2001 [12] Freesurfer,http://surfer.nmr.mgh.harvard.edu.

Schistosomiasis vaccine development: progress and prospects

The undisputed, worldwide success of chemotherapy notwithstanding, schistosomiasis continues to defy control efforts in as much rapid reinfection demands repeated treatment, sometimes as often as once a year. There is thus a need for a complementary tool with effect for the longer term, notably a vaccine. International efforts in this direction have been ongoing for several decades but, until the recombinant DNA techniques were introduced, antigen production remained an unsurmountable bottleneck. Although animal experiments have been highly productive and are still much needed, they probably do not reflect the human situation adequately and real progress can not be expected until more is known about human immune responses to schistosome infection. It is well-known that irradiated cercariae consistently produce high levels of protection in experimental animals but, for various reasons, this proof of principle cannot be directly exploited. Research has instead been focussed on the identification and testing of specific schistosome antigens. This work has been quite successful and is already at the stage where clinical trials are called for. Preliminary results from coordinated in vitro laboratory and field epidemiological studies regarding the protective potential of several antigens support the initiation of such trials. A series of meetings, organized earlier this year in Cairo, Egypt, reviewed recent progress, selecteded suitable vaccine candidates and made firm recommendations for future action including pledging support for large-scale production according to good manufacturing practice (GMP) and Phase I trials. Scientists at the American Centers for Disease Control and Prevention (CDC) have drawn up a detailed research plan. The major financial support will come from USAID, Cairo, which has established a scientific advisory group of Egyptian scientists and representatives from current and previous international donors such as WHO, NIAID, the European Union and the Edna McConnell Clark Foundation.

THE HIGH DIAGNOSTIC YIELD OF A GERIATRIC OUTPATIENT CLINIC

Objectives: To determine characteristics of older patients referred to a geriatric outpatient clinic; 2) to determine the prevalence of geriatric syndromes in this population; 3) to identify main recommendations made to referring primary care physicians. Design: Cross-sectional analysis Setting: Outpatient clinic of the service of geriatric medicine at the University of Lausanne Medical Center, Lausanne, Switzerland. Participants: Community-dwelling patients aged 65 and over referred to the clinic. Measurements: Demographics, social, functional and health status data, main diagnoses identified and recommendations made for primary care physicians were collected prospectively. Results: Subjects (N=206, mean age 79.7±7.6 years, 57.3% women, 48.5% living alone, 36.9% receiving formal home care) were referred by primary care physicians (76%), hospitalists (18%), or family members (7%). Main reasons for referral were request for comprehensive assessment, cognitive evaluation, and mobility assessment (45.2%, 26.2%, and 15.5%, respectively). 21.4% of patients are independent in Lawton's Instrumental ADL and 47.1% are independent in Katz's Basic ADL, and 57.3% of patients reported having fallen once or more over the last year. Overall, 76.2% of patients had gait and balance impairment, 72.8% cognitive impairment, 57.3% polypharmacy (≥6 drugs; median 6.5±3.9, IQR 4-8), 54.4% affective disorder, 48.3% osteoporosis, 45.1% urinary incontinence and 33.8% orthostatic hypotension. Polymorbidity (≥6 geriatric syndromes) was present in 58.3% of referred patients. On average, patients received 10.6±4.0 recommendations, including fall prevention interventions (85.2 % of patients: walking aid adaptation in 48.1%, vitamin D prescription in 59.7%, home hazards assessment in 59.2%, and exercise prescription in 53.4%), referral to a memory clinic (45.6%), and treatment modifications (69.9 % of all patients and 81.6% of patients with polypharmacy, mostly psychotropic drugs discontinuation). Conclusions: Polymorbidity was frequent in these older outpatients, with polypharmacy, mobility and cognitive impairments being most prevalent. Outpatient geriatric consultation is a good opportunity to identify geriatric syndromes and propose interventions to prevent or delay functional decline.

Cricotracheal resection for pediatric subglottic stenosis.

Until recently, cricotracheal resection (CTR) has not been commonly accepted as a treatment modality for severe subglottic stenosis in the pediatric age group. The reasons have included the risk of a possible dehiscence at the site of the anastomosis, the likelihood of injury to the recurrent laryngeal nerves, and the interference with normal growth of the larynx. Thirty-eight infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary thyrotracheal anastomosis. Thirty-three patients were tracheotomy-dependent at the time of surgery and 34 were referred cases; 27 were classified as grade III, and 10 as grade IV stenoses according to new Cotton's classification. Nineteen patients were younger than 3 years of age at the time of surgery. The tracheotomy was resected during the surgical procedure in 21 cases. Decannulation was achieved in 36/38 cases after an open procedure. There is one complete restenosis and one good result awaiting decannulation after further surgery for a Pierre Robin syndrome. The authors experienced no lesion of the recurrent laryngeal nerves and no fatality. Thirty-one patients show no exertional dyspnea, three a slight stridor while exercising, and two patients are not decannulated. The postoperative follow-up in longer than 10 years in eight cases. All patients show a normal growth of the larynx and trachea. Compared to laryngotracheoplasties, CTR gives better results for severe subglottic stenosis. This operation should become the treatment of choice for severe (grade III and IV) subglottic stenosis in infants and children.