Étude comparative du fonctionnement dans la communauté des jeunes adultes schizophrènes et de leurs pairs sans psychopathologie

La schizophrénie est un trouble mental qui touche environ un pour cent de la population et dont les symptômes et troubles associés affectent la capacité des individus à fonctionner dans la communauté. Dans la dernière décennie, des services spécialisés dans la détection et l’intervention précoce dès le premier épisode psychotique ont été implantés dans plusieurs pays. Or, ces services ont surtout ciblé, jusqu’ici, la réduction des symptômes et de la demande de soins. Les difficultés fonctionnelles des jeunes adultes schizophrènes justifient que les services qui leur sont destinés misent également sur la réadaptation et l’amélioration du fonctionnement dans la communauté. Les besoins, priorités et préférences de cette population, ainsi que l’impact des particularités développementales du jeune âge adulte sur leur fonctionnement, sont méconnus. Cette étude propose de documenter le fonctionnement dans la communauté des jeunes adultes schizophrènes au stade du premier épisode psychotique et de le comparer à celui de leurs pairs sans psychopathologie. L’utilisation d’un modèle théorique de réadaptation, le modèle de Compétence, permet de conceptualiser le fonctionnement sous l’angle de la relation personne-environnement. Ce projet s’inscrit dans une approche de recherche synthétique ; le devis préconisé est une étude de cas multiples avec l’utilisation de méthodes mixtes (qualitatives et quantitatives), selon un modèle concurrent de triangulation (Creswell & Plano Clark, 2007). Les résultats mettent en lumière des différences entre les deux groupes dans les domaines des relations sociales et conjugales, du cheminement académique et de l’indépendance résidentielle et financière. Les données qualitatives, analysées selon le modèle de la théorisation ancrée (Glaser & Strauss, 1967), permettent de comprendre les processus sociaux impliqués dans l’accomplissement des tâches développementales au jeune âge adulte, ainsi que les conditions personnelles et systémiques sous-jacentes. Les résultats soulignent l’importance d’adapter les services résidentiels aux particularités développementales, de favoriser le soutien aux études et d’inclure les amis et les pairs dans la réadaptation des personnes touchées. Cette thèse permet à la fois d’identifier les besoins et priorités de cette population, de donner une voix aux jeunes adultes schizophrènes dans l’élaboration des services qui leur sont destinés et d’examiner les enjeux méthodologiques reliés à l’utilisation d’un devis mixte en recherche clinique.

Active Microwave Imaging for Breast Cancer Detection

Active microwave imaging is explored as an imaging modality for early detection of breast cancer. When exposed to microwaves, breast tumor exhibits electrical properties that are significantly different from that of healthy breast tissues. The two approaches of active microwave imaging — confocal microwave technique with measured reflected signals and microwave tomographic imaging with measured scattered signals are addressed here. Normal and malignant breast tissue samples of same person are subjected to study within 30 minutes of mastectomy. Corn syrup is used as coupling medium, as its dielectric parameters show good match with that of the normal breast tissue samples. As bandwidth of the transmitter is an important aspect in the time domain confocal microwave imaging approach, wideband bowtie antenna having 2:1 VSWR bandwidth of 46% is designed for the transmission and reception of microwave signals. Same antenna is used for microwave tomographic imaging too at the frequency of 3000 MHz. Experimentally obtained time domain results are substantiated by finite difference time domain (FDTD) analysis. 2-D tomographic images are reconstructed with the collected scattered data using distorted Born iterative method. Variations of dielectric permittivity in breast samples are distinguishable from the obtained permittivity profiles.

Serum proteomic abnormality predating screen detection of ovarian cancer

Ovarian cancer is characterized by vague, non-specific symptoms, advanced stage at diagnosis and poor overall survival. A nested case control study was undertaken on stored serial serum samples from women who developed ovarian cancer and healthy controls (matched for serum processing and storage conditions as well as attributes such as age) in a pilot randomized controlled trial of ovarian cancer screening. The unique feature of this study is that the women were screened for up to 7 years. The serum samples underwent prefractionation using a reversed-phase batch extraction protocol prior to MALDI-TOF MS data acquisition. Our exploratory analysis shows that combining a single MS peak with CA125 allows statistically significant discrimination at the 5% level between cases and controls up to 12 months in advance of the original diagnosis of ovarian cancer. Such combinations work much better than a single peak or CA125 alone. This paper demonstrates that mass spectra from the low molecular weight serum proteome carry information useful for early detection of ovarian cancer. The next step is to identify the specific biomarkers that make early detection possible.

Symposium on 'nutrition interventions in high-risk groups' - CVD risk in South Asians: the importance of defining adiposity and influence of dietary polyunsaturated fat

The prevalence of the metabolic syndrome (MetS), CVD and type 2 diabetes (T2D) is known to be higher in populations from the Indian subcontinent compared with the general UK population. While identification of this increased risk is crucial to allow for effective treatment, there is controversy over the applicability of diagnostic criteria, and particularly measures of adiposity in ethnic minorities. Diagnostic cut-offs for BMI and waist circumference have been largely derived from predominantly white Caucasian populations and, therefore, have been inappropriate and not transferable to Asian groups. Many Asian populations, particularly South Asians, have a higher total and central adiposity for a similar body weight compared with matched Caucasians and greater CVD risk associated with a lower BMI. Although the causes of CVD and T2D are multi-factorial, diet is thought to make a substantial contribution to the development of these diseases. Low dietary intakes and tissue levels of long-chain (LC) n-3 PUFA in South Asian populations have been linked to high-risk abnormalities in the MetS. Conversely, increasing the dietary intake of LC n-3 PUFA in South Asians has proved an effective strategy for correcting such abnormalities as dyslipidaemia in the MetS. Appropriate diagnostic criteria that include a modified definition of adiposity must be in place to facilitate the early detection and thus targeted treatment of increased risk in ethnic minorities.

It is always on your mind: experiences and perceptions of falling of older people and their carers and the potential of a mobile falls detection device

Background. Falls and fear of falling present a major risk to older people as both can affect their quality of life and independence. Mobile assistive technologies (AT) fall detection devices may maximise the potential for older people to live independently for as long as possible within their own homes by facilitating early detection of falls. Aims. To explore the experiences and perceptions of older people and their carers as to the potential of a mobile falls detection AT device. Methods. Nine focus groups with 47 participants including both older people with a range of health conditions and their carers. Interviews were audio recorded, transcribed verbatim, and thematically analysed. Results. Four key themes were identified relating to participants’ experiences and perceptions of falling and the potential impact of a mobile falls detector: cause of falling, falling as everyday vulnerability, the environmental context of falling, and regaining confidence and independence by having a mobile falls detector. Conclusion. The perceived benefits of a mobile falls detector may differ between older people and their carers. The experience of falling has to be taken into account when designing mobile assistive technology devices as these may influence perceptions of such devices and how older people utilise them.

Detection of citrus canker in citrus plants using laser induced fluorescence spectroscopy

Citrus canker is a serious disease caused by Xanthomonas citri subsp. citri bacteria, which infects citrus plants (Citrus spp.) leading to a large economic loss in citrus production worldwide. In Brazil citrus canker control is done by an official eradication campaign, therefore early detection of such disease is important to prevent greater economic losses. However, detection is difficult and so far it has been done by visual inspection of each tree. Suspicious leaves from citrus plants in the field are sent to the laboratory to confirm the infection by laboratory analysis, which is a time consuming. Our goal was to develop a new optical technique to detect and diagnose citrus canker in citrus plants with a portable field spectrometer unit. In this paper, we review two experiments on laser induced fluorescence spectroscopy (LIF) applied to detect citrus canker. We also present new data to show that the length of time a leaf has been detached is an important variable in our studies. Our results show that LIF has the potential to be applied to citrus plants.

Solid phase microextraction, mass spectrometry and metabolomic approaches for detection of potential urinary cancer biomarkers: a powerful strategy for breast cancer diagnosis

A sensitive assay to identify volatile organic metabolites (VOMs) as biomarkers that can accurately diagnose the onset of breast cancer using non-invasively collected clinical specimens is ideal for early detection. Therefore the aim of this study was to establish the urinary metabolomic profile of breast cancer patients and healthy individuals (control group) and to explore the VOMs as potential biomarkers in breast cancer diagnosis at early stage. Solid-phase microextraction (SPME) using CAR/PDMS sorbent combined with gas chromatography–mass spectrometry was applied to obtain metabolomic information patterns of 26 breast cancer patients and 21 healthy individuals (controls). A total of seventy-nine VOMs, belonging to distinct chemical classes, were detected and identified in control and breast cancer groups. Ketones and sulfur compounds were the chemical classes with highest contribution for both groups. Results showed that excretion values of 6 VOMs among the total of 79 detected were found to be statistically different (p < 0.05). A significant increase in the peak area of (−)-4-carene, 3-heptanone, 1,2,4-trimethylbenzene, 2-methoxythiophene and phenol, in VOMs of cancer patients relatively to controls was observed. Statiscally significant lower abundances of dimethyl disulfide were found in cancer patients. Bioanalytical data were submitted to multivariate statistics [principal component analysis (PCA)], in order to visualize clusters of cases and to detect the VOMs that are able to differentiate cancer patients from healthy individuals. Very good discrimination within breast cancer and control groups was achieved. Nevertheless, a deep study using a larger number of patients must be carried out to confirm the results.

Detection of Toxoplasma gondii in the reproductive system of male goats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Role of the clinical pharmacist in detection of drug therapy problemas in critically impatients: experience report

This is an experience report on clinical pharmacy in New York, United States of America, in a teaching hospital, describing the results of drug therapy monitoring in critically ill patients, as well as interventions to solve or prevent identified drug therapy problems. The cross-sectional study was conducted by the clinical staff at the Surgical Intensive Care Unit during August 20th to 24th, 2012. Blood counts, serum levels of certain antibiotics, microbiological cultures and their antibiotic susceptibility, possible drug interactions, dosage of each drug prescribed and the compatibility between the route of administration and pharmaceutical form were assessed daily through review of electronic medical records. Twenty seven patients were followed up and 16 drug therapy problems were identified: Unnecessary drug therapy (seven), adverse drug reaction (four), needs additional drug therapy (two), noncompliance (two) and dosage too low (one). After evaluation, the drug therapy problems and their pharmaceutical interventions were reported to clinical pharmaceutical responsible for the Surgical ICU, as well as the multidisciplinary team. Further, the clinical outcomes were monitored and interventions were classified as to its acceptance. Data demonstrate that clinical pharmacists can contribute to the security and proper use of medications, as the trigger tools for intensive monitoring helps in early detection of drug therapy problems and patient safety.

Proteomics-driven approach for the detection of breast cancer biomarkers

Breast cancer (BC) is the most often diagnosed cancer entity of women worldwide. No molecular biomarkers are usable in the clinical routine for the early detection of BC. Proteomics is one of the dynamic tools for the successful examination of changes on the protein level. In this thesis different proteomics-based investigations were performed for the detection of protein and autoantibody biomarkers in serum samples of BC and healthy (CTRL) subjects. First, protein levels of candidates from previous profiling studies were investigated via antibody-microarray platform. Three proteins were found in distinct levels in both groups: secretoglobin family 1D member 1, alpha-2 macroglobulin and inter-alpha-trypsin inhibitor heavy chain family member 4. The second part was dedicated to the de novo exploration of potentially immunogenic tumor antigens (TA’s) with immunoprecipitation and Western immunoblotting followed by identification over mass spectrometry. Autoantibody levels were verified in individual serum profiling via the protein microarray platform. Two autoantibody’ cohorts (anti-Histone 2B and anti-Recoverin) were found in different levels in both groups. The findings of this PhD thesis underline deregulated serum protein and autoantibody levels in the presence of BC. Further investigations are needed to confirm the results in an independent study population.

Relevance of the pig stomach for the detection of dietary factors and gut maturation and control

In this thesis two approaches were applied to achieve a double general objective. The first chapter was dedicated to the study of the distribution of the expression of genes of several bitter and fat receptor in several gastrointestinal tracts. A set of 7 genes for bitter taste and for 3 genes for fat taste was amplified with real-time PCR from mRNA extracted from 5 gastrointestinal segments of weaned pigs. The presence of gene expression for several chemosensing receptors for bitter and fat taste in different compartments of the stomach confirms that this organ should be considered a player for the early detection of bolus composition. In the second chapter we investigated in young pigs the distribution of butyrate-sensing olfactory receptor (OR51E1) receptor along the GIT, its relation with some endocrine markers, its variation with age, and after interventions affecting the gut environment and intestinal microbiota in piglets and in different tissues. Our results indicate that OR51E1 is strictly related to the normal GIT enteroendocrine activity. In the third chapter we investigated the differential gene expression between oxyntic and pyloric mucosa in seven starter pigs. The obtained data indicate that there is significant differential gene exression between oxintic of the young pig and pyloric mucosa and further functional studies are needed to confirm their physiological importance. In the last chapter, thymol, that has been proposed as an oral alternative to antibiotics in the feed of pigs and broilers, was introduced directly into the stomach of 8 weaned pigs and sampled for gastric oxyntic and pyloric mucosa. The analysis of the whole transcript expression shoes that the stimulation of gastric proliferative activity and the control of digestive activity by thymol can influence positively gastric maturation and function in the weaned pigs.

Endocarditis due to Tropheryma whipplei: rapid detection, limited genetic diversity, and long-term clinical outcome in a local experience

The characteristic features of Whipple's disease include abdominal pain, diarrhoea, wasting, and arthralgias, with the causative agent, Tropheryma whipplei, being detected mainly in intestinal biopsies. PCR technology has led to the identification of T. whipplei in specimens from various other locations, including the central nervous system and the heart. T. whipplei is now recognized as one of the causes of culture-negative endocarditis, and endocarditis can be the only manifestation of the infection with T. whipplei. Although it is considered a rare disease, the true incidence of endocarditis due to T. whipplei is not clearly established. With the increasing use of molecular methods, it is likely that T. whipplei will be more frequently identified. Questions also remain about the genetic variability of T. whipplei strains, optimal diagnostic procedures and therapeutic options. In the present study, we provide clinical data on four new patients with documented endocarditis due to T. whipplei in the context of the available published literature. There was no clinical involvement of the gastrointestinal tract. Genetic analysis of the T. whipplei strains with DNA isolated from the excised heart valves revealed little to no genetic variability. In a selected case, we describe acridine orange staining for early detection of the disease, prompting early adaptation of the antibiotic therapy. We provide long-term follow-up data on the patients. In our hands, an initial 2-week course of intravenous antibiotics followed by cotrimoxazole for at least 1 year was a suitable treatment option for T. whipplei endocarditis.

A multiplex real-time PCR assay for rapid detection and differentiation of 25 bacterial and fungal pathogens from whole blood samples

Early detection of bloodstream infections (BSI) is crucial in the clinical setting. Blood culture remains the gold standard for diagnosing BSI. Molecular diagnostic tools can contribute to a more rapid diagnosis in septic patients. Here, a multiplex real-time PCR-based assay for rapid detection of 25 clinically important pathogens directly from whole blood in <6 h is presented. Minimal analytical sensitivity was determined by hit rate analysis from 20 independent experiments. At a concentration of 3 CFU/ml a hit rate of 50% was obtained for E. aerogenes and 100% for S. marcescens, E. coli, P. mirabilis, P. aeruginosa, and A. fumigatus. The hit rate for C. glabrata was 75% at 30 CFU/ml. Comparing PCR identification results with conventional microbiology for 1,548 clinical isolates yielded an overall specificity of 98.8%. The analytical specificity in 102 healthy blood donors was 100%. Although further evaluation is warranted, our assay holds promise for more rapid pathogen identification in clinical sepsis.

Inventory of veterinary syndromic surveillance initiatives in Europe (Triple-S project): current situation and perspectives.

Within the current context that favours the emergence of new diseases, syndromic surveillance (SyS) appears increasingly more relevant tool for the early detection of unexpected health events. The Triple-S project (Syndromic Surveillance Systems in Europe), co-financed by the European Commission, was launched in September 2010 for a three year period to promote both human and animal health SyS in European countries. Objectives of the project included performing an inventory of current and planned European animal health SyS systems and promoting knowledge transfer between SyS experts. This study presents and discusses the results of the Triple-S inventory of European veterinary SyS initiatives. European SyS systems were identified through an active process based on a questionnaire sent to animal health experts involved in SyS in Europe. Results were analyzed through a descriptive analysis and a multiple factor analysis (MFA) in order to establish a typology of the European SyS initiatives. Twenty seven European SyS systems were identified from twelve countries, at different levels of development, from project phase to active systems. Results of this inventory showed a real interest of European countries for SyS but also highlighted the novelty of this field. This survey highlighted the diversity of SyS systems in Europe in terms of objectives, population targeted, data providers, indicators monitored. For most SyS initiatives, statistical analysis of surveillance results was identified as a limitation in using the data. MFA results distinguished two types of systems. The first one belonged to the private sector, focused on companion animals and had reached a higher degree of achievement. The second one was based on mandatory collected data, targeted livestock species and is still in an early project phase. The exchange of knowledge between human and animal health sectors was considered useful to enhance SyS. In the same way that SyS is complementary to traditional surveillance, synergies between human and animal health SyS could be an added value, most notably to enhance timeliness, sensitivity and help interpreting non-specific signals.

Improving the clinical prediction of psychosis by combining ultra-high risk criteria and cognitive basic symptoms

OBJECTIVE Cognitive impairments are regarded as a core component of schizophrenia. However, the cognitive dimension of psychosis is hardly considered by ultra-high risk (UHR) criteria. Therefore, we studied whether the combination of symptomatic UHR criteria and the basic symptom criterion "cognitive disturbances" (COGDIS) is superior in predicting first-episode psychosis. METHOD In a naturalistic 48-month follow-up study, the conversion rate to first-episode psychosis was studied in 246 outpatients of an early detection of psychosis service (FETZ); thereby, the association between conversion, and the combined and singular use of UHR criteria and COGDIS was compared. RESULTS Patients that met UHR criteria and COGDIS (n=127) at baseline had a significantly higher risk of conversion (hr=0.66 at month 48) and a shorter time to conversion than patients that met only UHR criteria (n=37; hr=0.28) or only COGDIS (n=30; hr=0.23). Furthermore, the risk of conversion was higher for the combined criteria than for UHR criteria (n=164; hr=0.56 at month 48) and COGDIS (n=158; hr=0.56 at month 48) when considered irrespective of each other. CONCLUSIONS Our findings support the merits of considering both COGDIS and UHR criteria in the early detection of persons who are at high risk of developing a first psychotic episode within 48months. Applying both sets of criteria improves sensitivity and individual risk estimation, and may thereby support the development of stage-targeted interventions. Moreover, since the combined approach enables the identification of considerably more homogeneous at-risk samples, it should support both preventive and basic research.