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International audience; Rationale: Elexacaftor-tezacaftor-ivacaftor is a CFTR (cystic fibrosis [CF] transmembrane conductance regulator) modulator combination, developed for patients with CF with at least one Phe508del mutation. Objectives: To evaluate the effects of elexacaftor-tezacaftor- ivacaftor in patients with CF and advanced respiratory disease. Methods: A prospective observational study, including all patients aged ⩾12 years and with a percent-predicted FEV1 (ppFEV1)

3D-FLAIR 1.5-Tesla MRI sequences can detect abnormalities that show as signal hyperintensity in patients with unilateral SSHL. We propose a simple objective method to detect these abnormalities based on the quantitative calculation of affected versus healthy contralateral ear signal intensity ratios. This signal hyperintensity may involve the cochlea, vestibule or the entire inner ear of affected ears. Such abnormalities were found in 45% of patients with SSHL, and hyperintensity was associated with lower initial and final hearing levels, as well as a lower ≥ 10 dB hearing recovery and more vertigo. We put hyperintensity itself forward as a marker of poor prognosis for patients with SSHL.

PURPOSE: Patients with cancer are presumed to be more vulnerable to COVID-19. We evaluated a screening strategy combining chest computed tomography (CT) and reverse-transcription polymerase chain reaction (RT-PCR) for patients treated with radiation therapy at our cancer center located in a COVID-19 French hotspot during the first wave of the pandemic. METHODS AND MATERIALS: Chest CT images were proposed during radiation therapy CT simulation. Images were reviewed by an expert radiologist according to the COVID-19 Reporting and Data System classification. Nasal swabs with RT-PCR assay were initially proposed in cases of suspicious imaging or clinical context and were eventually integrated into the systematic screening. A dedicated radiation therapy workflow was proposed for COVID-19 patients to limit the risk of contamination. RESULTS: From March 18, 2020 to May 1, 2020, 480 patients were screened by chest CT, and 313 patients had both chest CT and RT-PCR (65%). The cumulative incidence of COVID-19 was 5.4% (95% confidence interval [CI], 3.6-7.8; 26 of 480 patients). Diagnosis of COVID-19 was made before radiation therapy for 22 patients (84.6%) and during RT for 4 patients (15.3%). Chest CT directly aided the diagnosis of 7 cases in which the initial RT-PCR was negative or not feasible, out of a total of 480 patients (1.5%) and 517 chest CT acquisitions. Four patients with COVID-19 at the time of the chest CT screening had a false negative CT. Sensitivity and specificity of chest CT screening in patients with both RT-PCR and chest CT testing were estimated at 0.82 (95% CI, 0.60-0.95) and 0.98 (95% CI, 0.96-0.99), respectively. Adaptation of the radiation therapy treatment was made for all patients, with 7 postponed treatments (median: 5 days; interquartile range, 1.5-14.8). CONCLUSIONS: The benefit of systematic use of chest CT screening during CT simulation for patients undergoing radiation therapy during the COVID-19 pandemic seemed limited.

ObjectiveTo evaluate the treatments’ consequences for unilateral hearing loss in children.DesignSystematic review and meta-analysis (CRD42018109417). The MEDLINE, CENTRAL, ISRCTN and ClinicalTrials databases were searched between September 2018 and May 2019. Articles were screened and data were collected independently by two authors following the Cochrane and Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. The risk of bias was evaluated using the Cochrane tool, the Newcastle-Ottawa Scale, the National Institute of Health, USA tool and considering the risk of confounding. In the studies with the lowest risk of bias, a meta-analysis was conducted.InterventionsValidated hearing rehabilitation devices.Patients6–15 years old children with moderate to profound unilateral hearing loss.Main outcome measuresThe primary study outcome was children’s quality of life. Academic performances were studied as an additional outcome.Results731 unique articles were identified from the primary search. Of these, 18 articles met the Population, Intervention, Control, Outcomes and Study design selection criteria. In the eight studies with the lowest risk of bias, two meta-analysis were conducted. There was not enough data on academic results to conduct a meta-analysis. In 73 children included in a fixed effect meta-analysis (two studies), no effect of treatment could be shown (g=−0.20, p=0.39). In 61 children included in a random-effect meta-analysis (six studies), a strong positive effect of hearing treatment on quality of life was demonstrated (g=1.32, pConclusionsThe treatment of unilateral hearing loss seems to improve children’s quality of life. Further research is needed to identify the most effective treatment and its corresponding indications.

International audience; Although subsistence hunting is cross-culturally an activity led and practiced mostly by men, a rich body of literature shows that in many small-scale societies women also engage in hunting in varied and often inconspicuous ways. Using data collected among two contemporary forager-horticulturalist societies facing rapid change (the Tsimane' of Bolivia and the Baka of Cameroon), we compare the technological and social characteristics of hunting trips led by women and men and analyze the specific socioeconomic characteristics that facilitate or constrain women's engagement in hunting. Results from interviews on daily activities with 121 Tsimane' (63 women and 58 men) and 159 Baka (83 women and 76 men) show that Tsimane' and Baka women participate in subsistence hunting, albeit using different techniques and in different social contexts than men. We also found differences in the individual and household socioeconomic profiles of Tsimane' and Baka women who hunt and those who do not hunt. Moreover, the characteristics that differentiate hunter and non-hunter women vary from one society to the other, suggesting that gender roles in relation to hunting are fluid and likely to change, not only across societies, but also as societies change. Keywords Baka (Cameroon). Gender. Small-scale societies. Social-ecological transformations. Tsimane' (Bolivia) Across societies, subsistence hunting is an activity led and practiced mostly by men; nevertheless, a rich body of literature shows that in many small-scale societies women also engage in hunting in many different and sometimes inconspicuous ways, often

Understanding local knowledge about wild edible plants (WEP) is essential for assessing plant services, reducing the risks of knowledge extinction, recognizing the rights of local communities, and improving biodiversity conservation efforts. However, the knowledge of specific groups such as women or children tends to be under-represented in local ecological knowledge (LEK) research. In this study, we explore how knowledge of WEP is distributed across gender and life stages (adults/children) among Betsileo people in the southern highlands of Madagascar. Using data from free listings with 42 adults and 40 children, gender-balanced, we show that knowledge on WEP differs widely across gender and life stage. In addition, we find that children have extended knowledge of WEP while reporting different species than adults. Women’s knowledge specializes in herbaceous species (versus other plant life forms), while men’s knowledge specializes in endemic species (versus native or introduced). Finally, we find that introduced species are more frequently cited by children, while adults cite more endemic species. We discuss the LEK differentiation mechanisms and the implications of acquiring life stage’s knowledge in the highland landscapes of Madagascar. Given our findings, we highlight the importance of considering groups with under-represented knowledge repositories, such as children and women, into future research.

Two new treatments have recently become standard of care for patients with metastatic colorectal cancer (mCRC): encorafenib (BRAF inhibitor) associated with cetuximab (anti-EGFR) in the second or third line of chemotherapy for BRAF V600E tumors, and pembrolizumab (an anti PD-1 immune checkpoint inhibitor) for tumors harboring microsatellite instability (MSI)-high and/or deficient mismatch repair (dMMR). Furthermore, 30% of BRAF V600E mutated mCRC are MSI/dMMR through a sporadic hypermethylation of the promoter of hMLH1. We report here, for the first time, the case of a patient with BRAF V600E, PIK3CA and SMAD4 mutated and dMMR/MSI mCRC, in whom we observed an atypical response pattern under the sequence of pembrolizumab followed by the doublet encorafenib and cetuximab treatment. The patient was progressive after a single cycle of pembrolizumab followed by a rapid complete response after only two months of treatment with encorafenib and cetuximab, discovered during R0 cyto-reduction surgery for peritoneal carcinomatosis. This article is protected by copyright. All rights reserved.

Health professionals not specialized in genetics are expected to take an increasing role in genetic services delivery. This article aims to identify legal and ethical challenges related to a collaborative oncogenetics service model, where non-genetic health professionals provide genetic services to patients. Through a scoping literature review, we identified issues to the provision of hereditary breast and ovarian cancer, or other hereditary adult cancers, genetic testing under this model. Concerns that arose in the literature were informed consent, lack of adherence to best practice guidelines, lack of education of non-genetic health professionals on the provision of genetic services, psychological impacts of genetic testing, continuity of care, the complexity of genetic test results, confidentiality, risks of medical mismanagement, and the associated medical responsibility liabilities. Despite these challenges, there is a growing consensus towards the feasibility of cancer genetic testing being undertaken by non-genetic healthcare professionals in a collaborative oncogenetics service model.

International audience; Patients with cancer are at higher risk of severe coronavirus infectious disease 2019 (COVID-19), but the mechanisms underlying virus–host interactions during cancer therapies remain elusive. When comparing nasopharyngeal swabs from cancer and noncancer patients for RT-qPCR cycle thresholds measuring acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in 1063 patients (58% with cancer), we found that malignant disease favors the magnitude and duration of viral RNA shedding concomitant with prolonged serum elevations of type 1 IFN that anticorrelated with anti-RBD IgG antibodies. Cancer patients with a prolonged SARS-CoV-2 RNA detection exhibited the typical immunopathology of severe COVID-19 at the early phase of infection including circulation of immature neutrophils, depletion of nonconventional monocytes, and a general lymphopenia that, however, was accompanied by a rise in plasmablasts, activated follicular T-helper cells, and non-naive Granzyme B + FasL + , Eomes high TCF-1 high , PD-1 + CD8 + Tc1 cells. Virus-induced lymphopenia worsened cancer-associated lymphocyte loss, and low lymphocyte counts correlated with chronic SARS-CoV-2 RNA shedding, COVID-19 severity, and a higher risk of cancer-related death in the first and second surge of the pandemic. Lymphocyte loss correlated with significant changes in metabolites from the polyamine and biliary salt pathways as well as increased blood DNA from Enterobacteriaceae and Micrococcaceae gut family members in long-term viral carriers. We surmise that cancer therapies may exacerbate the paradoxical association between lymphopenia and COVID-19-related immunopathology, and that the prevention of COVID-19-induced lymphocyte loss may reduce cancer-associated death.

Background The present study evaluated the relative survival benefits associated with enasidenib and current standard of care (SoC) therapies for patients with relapsed/refractory (R/R) acute myeloid leukemia (AML) and an isocitrate dehydrogenase 2 (IDH2) mutation who are ineligible for hematopoietic stem cell transplantation (HSCT). Methods Propensity score matching (PSM) analysis compared survival outcomes observed with enasidenib 100 mg daily in the phase I/II AG221‐C‐001 trial and SoC outcomes obtained from a real‐world chart review of patients in France. Results Before matching, enasidenib (n = 195) was associated with numerically improved overall survival (OS) relative to SoC (n = 80; hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.61–1.11). After matching and adjusting for covariates (n = 78 per group), mortality risk was significantly lower with enasidenib than with SoC (HR, 0.67; 95% CI, 0.47–0.97). The median OS was 9.26 months for enasidenib (95% CI, 7.72–13.24) and 4.76 months for SoC (95% CI, 3.81–8.21). Results remained robust across all sensitivity analyses conducted. Conclusions PSM analyses indicate that enasidenib significantly prolongs survival relative to SoC among patients with R/R AML and an IDH2 mutation who are ineligible for HSCT. Future prospective studies are needed to validate these findings using other data sources and to assess the comparative efficacy of enasidenib for other treatment outcomes., Overall survival was improved with enasidenib compared with SoC. Enasidenib may be an important advance in treatment for patients with R/R acute myeloid leukemia associated with IDH2 mutations who are ineligible for hematopoietic stem cell transplantation.

Unidad de excelencia María de Maeztu CEX2019-000940-M While cross-cultural research on subjective well-being and its multiple drivers is growing, the study of happiness among Indigenous peoples continues to be under-represented in the literature. In this work, we measure life satisfaction through open-ended questionnaires to explore levels and drivers of subjective well-being among 474 adults in three Indigenous societies across the tropics: the Tsimane' in Bolivian lowland Amazonia, the Baka in southeastern Cameroon, and the Punan in Indonesian Borneo. We found that life satisfaction levels in the three studied societies are slightly above neutral, suggesting that most people in the sample consider themselves as moderately happy. We also found that respondents provided explanations mostly when their satisfaction with life was negative, as if moderate happiness was the normal state and explanations were only needed when reporting a different life satisfaction level due to some exceptionally good or bad occurrence. Finally, we also found that issues related to health and-to a lesser extent-social life were the more prominent explanations for life satisfaction. Our research not only highlights the importance to understand, appreciate and respect Indigenous peoples' own perspectives and insights on subjective well-being, but also suggests that the greatest gains in subjective well-being might be achieved by alleviating the factors that tend to make people unhappy.

Introduction The Patient-Generated Subjective Global Assessment (PG-SGA) is currently the standard nutritional assessment tool for patients with cancer. In a retrospective assessment of a prospective cohort, we showed that the Nutritional Risk Index (NRI) seemed to be associated with treatment toxicity and survival in patients with metastatic colorectal cancer (mCRC). Objective The objective of this study was to compare these two nutritional tools (PG-SGA and NRI) on their correlation with chemotherapy-related toxicity and survival in non–pre-treated patients with mCRC. Methods This prospective multicentre observational study enrolled non–pre-treated patients with mCRC. PG-SGA and NRI were performed at the onset of first-line chemotherapy. Treatment-related toxicities were registered according to National Cancer Institute Common Toxicity Criteria Adverse Event version 4.0. Progression-free survival (PFS) and overall survival (OS) were calculated from the start of treatment. Results A total of 168 patients were included from eight French centres. Patients were considered malnourished in 41% of cases according to PG-SGA and 56% of cases according to the NRI. In multivariate analysis, malnutrition according to PG-SGA was significantly associated with chemotherapy-related grade ≥2 clinical toxicities (odds ratio: 3.7; 95% confidence interval [CI]: 1.7–8.4; p = 0.001) and OS (hazard ratio [HR]: 2.6; 95% CI: 1.3–5.3; p = 0.006), but not with PFS (HR: 1.5; 95% CI: 0.8–2.6; p = 0.2). Conversely, malnutrition according to the NRI was not significantly associated with these tolerance and efficacy parameters. Conclusion Although more complex to perform in daily oncology practice, the PG-SGA score appears to be the best nutritional assessment tool because of its strong association with clinically relevant oncological outcomes such as OS and treatment-related toxicities in patients with mCRC.

Objectives Nontuberculous mycobacterial (NTM) lymphadenitis is a rare disease of children under 5 years. Its treatment is not standardized, even a “wait-and-see” approach is shown to be effective in the literature. Here, we discuss the diagnostic and therapeutic strategies employed in our departments. Methods Records of pediatric patients treated for NTM cervical lymphadenitis from 2010 to 2015 in our tertiary center were retrospectively reviewed. Patients underwent cervical echotomography and/or CT scan. Every patient but one had microbiological explorations (NTM polymerase chain reaction [PCR] and culture) on fine needle aspiration of pus and/or adenitis biopsy. Differential diagnoses (tuberculosis, cat scratch disease) were excluded with serologies, chest X-Ray, and PCR on adenitis samples. Patients were classified as “proven diagnosis” (NTM detected), “highly probable” (suggestive clinical and anatomopathological aspect) or “possible” infection (suggestive adenitis alone). Treatments, follow-up and adverse events were reviewed. Results Thirty-one patients were treated for NTM, median age 2.40 years (Interquartile Range IQR = [1.85–3.16]). Twenty-nine patients (96.77%) had an isolated cervico-facial localization. Median follow-up was 8.00 months (IQR = [4.20–13.43]). We found 17 “proven diagnosis” (58.62%), 5 “highly probable” (17.24%) and 7 “possible” infections (24.14%). “Proven” infections were due to: Mycobacterium avium (n = 12, 66.67%) and M. intracellulare (n = 5, 27.78%). All 29 patients received antibiotics, which were effective for 10 (34.48%, group 1); 10 underwent surgical excision for a poor outcome with antibiotics (34.48%, group 2); spontaneous or surgical drainage occurred in 9 on antibiotics (31.03%, group 3). The median times to resolution for group 1, 2 and 3 were respectively 6.33 months, 6.22 months and 9.53 months. Antibiotics treatment was mostly clarithromycin (n = 27, 93.10%) and/or rifampicin (n = 19, 65.52%); 18 patients (62.07%) received both. Median antibiotics duration was 6.23 months (IQR = [5.17–7.46]), with good compliance (79.31%). The observed adverse effects were 3 (13.04%) isolated transient transaminase elevations, 1 case (4.35%) of minor creatinine elevation, and 1 case (4.35%) of transient diarrhea. Surgical drainage caused 1 transient marginal mandibular nerve palsy, resolutive after 1 month. Conclusion Antibiotics in NTM adenitis lead to resolution in 7 months, with good tolerance and compliance. The efficacy of “wait-and-see” attitude in the literature make excision surgery a second line treatment.

Problem Postnatal screening rates to detect type two diabetes following gestational diabetes are low. The quality of communication is an important element to consider in developing targeted strategies that support women in completing recommended follow-up care. Aims To explore the communication perspectives, practices and preferences of women, hospital clinicians and general practitioners, to determine strategies that may promote completion of recommended postnatal GDM follow-up, in Queensland Australia. Method We used an exploratory, three-phase, mixed-methods approach, interpreted through intergroup communication theory. Phase one: convergent interviews explored perspectives of the communication experience in GDM care among new mothers (n = 13), hospital clinicians (n = 13) and general practitioners (n = 16). Phase two: a retrospective chart audit assessed current practice in postnatal discharge summaries of women (n = 86). Phase three: an online survey identified the preferences of general practitioners and hospital clinicians who provide maternity care in Queensland. Triangulation of the findings from the interviews, audit and surveys was used to clarify results and increase the robustness of the findings. Results Three themes: Seeking information, Written hospital discharge summary (discharge summary) and Clarity of follow-up requirements, provide direction for pragmatic strategies to promote follow-up. Practical recommendations include continued discussion about care with women from the point of GDM diagnosis into the postnatal period; discharge summaries that give primacy to diagnosis and ongoing treatment; and provision of explicit directions for recommended testing and timing. Implications This research informs seven practical recommendations to help promote completion of recommended postnatal GDM follow-up.

Problem The reasons for low postnatal screening rates for women with gestational diabetes mellitus are not well understood. Multiple care providers, settings and changes to diagnostic criteria, may contribute to confusion over postnatal care. Quality of communication between clinicians may be an important influence for the completion of postnatal gestational diabetes mellitus follow-up. Aim Describe and analyse communication processes between hospital clinicians (midwives, medical, allied staff) and general practitioners who provide postnatal gestational diabetes mellitus care. Methods Purposive sampling and convergent interviews explored participants’ communication experiences providing gestational diabetes mellitus postnatal follow-up. Data were analysed with Leximancer automated content analysis software; interpretation was undertaken using Communication Accommodation Theory. Setting and participants Clinicians who provided maternity care at a tertiary referral hospital (n = 13) in Queensland, Australia, and general practitioners (n = 16) who provided maternity shared care with that hospital between December 2012 and July 2013. Findings Thematic analysis identified very different perspectives between the experiences of General Practitioners and hospital clinicians; six themes emerged. General practitioners were concerned about themes relating to discharge summaries and follow-up guidelines. In contrast, hospital clinicians were more concerned about themes relating to gestational diabetes mellitus antenatal care and specialist clinics. Two themes, gestational diabetes mellitus women and postnatal checks were shared. Conclusion Gestational diabetes mellitus follow-up is characterised by communication where general practitioners appear to be information seekers whose communication needs are not met by hospital clinicians. Midwives are ideally placed to assist in improving communication and postnatal gestational diabetes mellitus follow-up.

Due to global socio-economical and ecological changes, indigenous societies are exposed to an increased risk of alcohol and substance abuse. Most research on this topic has been done on indigenous communities in Canada, Australia, the US, parts of Europe and New Zealand, leaving indigenous communities in other parts of the world largely unrepresented. This study focuses on alcohol and drug consumption among the Baka: a former hunter-gatherer society in southeastern Cameroon that has been facing drastic socio-ecological changes in the last five decades. During long-term fieldwork we collected ethnographic and empirical data by means of group and individual interviews among four Baka communities. By using a multivariable approach, we describe psychoactive substance use behaviors, its socio-cultural and political context, and consequences. Our findings show that 48% of men, 24% of women and 11% of children between five and 16 years old reported alcohol intake in the past 24 h. The use of Tramadol was also reported, including by children as young as five years old. Psychoactive substances were used for recreational purposes, as painkillers, and energy boosters. Substance abuse was related to health issues, especially problems with fertility, and to several household and social conflicts. Other factors related to substance abuse were Baka's marginalization and sexual exploitation of Baka women and girls. By discussing these matters, we hope to stimulate more research on similar problems in small-scale societies and to invite governments, human rights activists, and other important parties to take action.

In tropical rainforests, access to and availability of natural resources are vital for the dietary diversity and food security of forest-dwelling societies. In the Congo Basin, these are challenged by the increasing exploitation of forests for bushmeat, commercial hardwood, mining, and large-scale agriculture. In this context, a balanced approach is needed between the pressures from forest exploitation, non-timber forest product trade and the livelihood and dietary behavior of rural communities. While there is a general positive association between tree cover and dietary diversity, the complex biocultural interactions between tropical forest food resources and the communities they sustain are still understudied. This research focuses on the knowledge and use of wild food plants by the forest-dwelling Baka people in southeast Cameroon. By using two different sets of methods, namely ex-situ interviews and in-situ surveys, we collected ethnographic and ethnobotanical data in two Baka settlements and explored the diversity of wild edible plants known, the frequency of their consumption, and potential conflicts between local diet and commercial trade in forest resources. Within a single Baka population, we showed that the in-situ walk-in-the-woods method resulted in more detailed information on wild food plant knowledge and use frequency than the ex-situ methods of freelisting and dietary recalls. Our in-situ method yielded 91 wild edible species, much more than the ex-situ freelisting interviews (38 spp.) and dietary recalls (12 spp.). Our results suggest that studies that are based only on ex-situ interviews may underestimate the importance of wild food plants for local communities. We discuss the limitations and strengths of these different methods for investigating the diversity of wild food plant knowledge and uses. Our analysis shows that future studies on wild food plants would profit from a mixed approach that combines in-situ and ex-situ methods.

Intersex individuals face human rights violations, discrimination, and stigmatization worldwide. Diagnosis in infants is uncommon, with between 1 in 2000 and 1 in 4500 infants born with ambiguous external genitalia sufficient to warrant genetic and endocrine studies. However, estimates of the actual proportion of the population falling under the broader umbrella of intersex, including sexual variation at the chromosomal, gonadal, hormonal, or genital level, are as high as 1.7%. As the rise of non-invasive prenatal screening (NIPS) capable of identifying intersex conditions at the fetal stage has increased the potential for prenatal detection, there is an urgent need for attention to the potential ethical challenges that may arise from earlier and more frequent detection. There has been growing attention in recent years to the harms faced by intersex individuals at the hands of the medical community. In the prenatal context, genetic counseling is one avenue by which prospective parents might be helped to understand the full spectrum of intersexuality and form realistic expectations for their children. However, best practices and medical policies to prevent stigmatization and discrimination against intersex individuals remain underdeveloped. There is presently a lack of Canadian-specific guidance or explicit legal protections for intersex individuals to guide health care providers in their relationship with these patients and their families. In this commentary, we argue that this gap calls for increased training for health care providers that incorporates the voices and concerns of the intersex community.

The diagnosis of lung lobe torsion in dogs is usually based on radiological, endoscopic, and CT features. Few ultrasonographic descriptions have been published. The purpose of this multicenter, retrospective, and prospective observational study was to investigate the presence of a hypoechoic area forming a pulmonary band or line at the periphery of the twisted lobe on ultrasonography and assess its significance by comparing it to CT and histological findings. Fifteen dogs with lung lobe torsion confirmed surgically or postmortem were included. All had received ultrasonography and CT examinations; 13 had additional histopathological examination performed. In 14 cases, thoracic ultrasonography revealed a peripheral hypoechoic band, overlying areas of scattered, hyperreflecting interfaces in the affected lobe. On CT, central emphysema was surrounded by a peripheral, soft tissue attenuation band, affecting the periphery in 14 cases. No band was observed in one case, in which the lobe was entirely consolidated. Histological examination yielded a comparable peripheral band, consisting of a thickened visceral pleura with or without hemorrhagic necrosis of the underlying pulmonary parenchyma. This peripheral band may be related to the specific fractal organization of airways and vessels, which plays an important role in lung perfusion and ventilation and makes the lung periphery more prone to ischemia. Our findings suggest that the presence of a peripheral hypoechoic band, associated with central emphysema in a noncollapsed lung lobe on ultrasonography, is suggestive of compromised blood supply and air flow, and lung lobe torsion should therefore be suspected.

International audience; Rationale: Lumacaftor-ivacaftor is a CFTR (cystic fibrosis transmembrane conductance regulator) modulator combination recently approved for patients with cystic fibrosis (CF) homozygous for the Phe508del mutation.Objectives: To evaluate the safety and effectiveness of lumacaftor-ivacaftor in adolescents (≥12 yr) and adults (≥18 yr) in a real-life postapproval setting.Methods: The study was conducted in the 47 CF reference centers in France. All patients who initiated lumacaftor-ivacaftor from January 1 to December 31, 2016, were eligible. Patients were evaluated for lumacaftor-ivacaftor safety and effectiveness over the first year of treatment following the French CF Learning Society's recommendations.Measurements and Main Results: Among the 845 patients (292 adolescents and 553 adults) who initiated lumacaftor-ivacaftor, 18.2% (154 patients) discontinued treatment, often owing to respiratory (48.1%, 74 patients) or nonrespiratory (27.9%, 43 patients) adverse events. In multivariable logistic regression, factors associated with increased rates of discontinuation included adult age group, percent predicted FEV1 (ppFEV1) less than 40%, and numbers of intravenous antibiotic courses during the year before lumacaftor-ivacaftor initiation. Patients with continuous exposure to lumacaftor-ivacaftor showed an absolute increase in ppFEV1 (+3.67%), an increase in body mass index (+0.73 kg/m2), and a decrease in intravenous antibiotic courses by 35%. Patients who discontinued treatment had significant decrease in ppFEV1, without improvement in body mass index or decrease in intravenous antibiotic courses.Conclusions: Lumacaftor-ivacaftor was associated with improvement in lung disease and nutritional status in patients who tolerated treatment. Adults who discontinued lumacaftor-ivacaftor, often owing to adverse events, were found at high risk of clinical deterioration.

Methotrexate-induced pneumonitis is a rare but potentially fatal side effect. It is a diagnosis of exclusion. There are early and late forms and different cell patterns in the bronchoalveolar lavage (BAL).We present a case of acute interstitial lung disease in a 54-year-old patient who had been taking methotrexate for a year and a half for rheumatoid arthritis. After excluding other causes and based on the diagnostic criteria of Searles and McKendry, we could reasonably identify methotrexate as the cause of the lung disease. It was of late onset and the BAL showed neutrophilia and eosinophilia.Methotrexate-induced pneumonitis is a diagnosis of exclusion. A late onset combined with the predominance of neutrophils and eosinophils in BAL is rare in the literature, demonstrating the wide heterogeneity of methotrexate-related interstitial lung disease.

International audience; BACKGROUND:Kodamaea ohmeri is a yeast is frequently mistaken for Candida, which belongs to the same family. This micro-organism has been reported to cause life-threatening infections in humans.CASE PRESENTATION:A 81-year-old woman developed a severe fungemic pulmonary infection due to Kodamaea ohmeri that was identified from bronchoalveolar fluid and blood cultures, which is unusual in immunocompetent patients. Because K. ohmeri was first wrongly identified as Candida albicans, the patient inadequately received caspofungin, which was clinically ineffective, especially as the strain was resistant to echinocandins. Clinical cure was obtained after treatment was switched to voriconazole.CONCLUSIONS:An increasing number of serious infections due to K. ohmeri has been reported in the literature, but the correct identification of this micro-organism remains difficult.

Background Anaplasma ovis is a major cause of small ruminant anaplasmosis, a tick-borne disease mainly affecting small ruminants in tropical and subtropical regions of the world. Due to health and production problems in dairy goat flocks in Corsica, France, and the demonstration of A. ovis infection in some animals, an extensive survey was conducted in the island in spring 2016. The aim of the survey was to determine the prevalence and geographical distribution of A. ovis infections in goats and ticks as well as possible relationships with anaemia and other health indicators. In addition, the genetic diversity of A. ovis was evaluated. Methods Blood and faecal samples were collected in 55 clinically healthy flocks (10 goats per flock) for A. ovis qPCR, haematocrit determination, paratuberculosis ELISA seropositivity and gastrointestinal nematode egg excretion quantification. Ticks were collected, identified and processed for A. ovis DNA detection. Results A high prevalence of A. ovis DNA detection was found at the individual (52.0%) and flock levels (83.6%) with a within-flock prevalence ranging between 0–100%. Rhipicephalus bursa was the only tick species collected on goats (n = 355) and the detection rate of A. ovis DNA in ticks was 20.3%. Anaplasma ovis DNA prevalence was higher in flocks located at an altitude above 168 m, in goats of Corsican/crossbred breed and in goats > 3 years-old. No relationship was found between A. ovis DNA detection at the individual or flock level and haematocrit, paratuberculosis seropositivity or gastrointestinal parasites. Positive A. ovis goat samples were used for amplification of gltA and msp4 genes for species confirmation and strain identification, respectively. Sequence and phylogenetic analysis of these genes confirmed the detection of A. ovis and allowed identification of six different strains of this pathogen (named Corsica 1-6 (COR1-6). While the msp4 sequence of strain COR1 had 100% identity with strains previously reported, COR2 to 6 were found to be novel strains. The strain COR1 was the most represented, corresponding to 94.6% of the msp4 sequences obtained. Conclusions The results showed a relatively high genetic diversity of A. ovis associated with high bacterial prevalence in goats. Electronic supplementary material The online version of this article (10.1186/s13071-018-3269-7) contains supplementary material, which is available to authorized users.

ObjectiveTo quantitatively assess the factors associated with non-beneficial treatments (NBTs) in hospital admissions at the end of life.DesignRetrospective multicentre cohort study.SettingThree large, metropolitan tertiary hospitals in Australia.Participants831 adult patients who died as inpatients following admission to the study hospitals over a 6-month period in 2012.Main outcome measuresOdds ratios (ORs) of NBT derived from logistic regression models.ResultsOverall, 103 (12.4%) admissions involved NBTs. Admissions that involved conflict within a patient’s family (OR 8.9, 95% CI 4.1 to 18.9) or conflict within the medical team (OR 6.5, 95% CI 2.4 to 17.8) had the strongest associations with NBTs in the all subsets regression model. A positive association was observed in older patients, with each 10-year increment in age increasing the likelihood of NBT by approximately 50% (OR 1.5, 95% CI 1.2 to 1.9). There was also a statistically significant hospital effect.ConclusionsThis paper presents the first statistical modelling results to assess the factors associated with NBT in hospital, beyond an intensive care setting. Our findings highlight potential areas for intervention to reduce the likelihood of NBTs.

The dynamics of knowledge transmission and acquisition, or how different aspects of culture are passed from one individual to another and how they are acquired and embodied by individuals, are central to understanding cultural evolution. In small-scale societies, cultural knowledge is largely acquired early in life through observation, imitation, and other forms of social learning embedded in daily experiences. However, little is known about the pathways through which such knowledge is transmitted, especially during middle childhood and adolescence. This study presents new empirical data on cultural knowledge transmission during childhood. Data were collected among the Baka, a forager-farmer society in southeastern Cameroon. We conducted structured interviews with children between 5 and 16 years of age (n = 58 children; 177 interviews, with children being interviewed 1–6 times) about group composition during subsistence activities. Children’s groups were generally diverse, although children tended to perform subsistence activities primarily without adults and with same-sex companions. Group composition varied from one subsistence activity to another, which suggests that the flow of knowledge might also vary according to the activity performed. Analysis of the social composition of children’s subsistence groups shows that vertical and oblique transmission of subsistence-related knowledge might not be predominant during middle childhood and adolescence. Rather, horizontal transmission appears to be the most common knowledge transmission strategy used by Baka children during middle childhood and adolescence, highlighting the importance of other children in the transmission of knowledge. Electronic supplementary material The online version of this article (10.1007/s12110-018-9328-0) contains supplementary material, which is available to authorized users.

In this study, 3,531 Queensland women, who had recently given birth, completed a questionnaire that included questions about their participation in decision making during pregnancy, their ratings of client-centered care, and perceived quality of care. These data tested a version of the Linguistic Model of Patient Participation in Care, adapted to the maternity context. The authors investigated how age and education influenced women's perceptions of their participation and quality of care. Hierarchical multiple regressions revealed that women's perceived ability to make decisions, and the extent of client-centered communication with maternity care providers, were the most influential predictors of participation and perceived quality of care. Participation in care predicted perceived quality of care, but the influence of client-centered communication by a care provider and a woman's confidence in decision making were stronger predictors of perceived quality of care. Age and education level were not important predictors. These findings extend and support the use of Linguistic Model of Patient Participation in Care in the maternity context.

Gaucher disease is a genetic lysosomal storage disorder due to a glucocerebrosidase deficiency. Type 3, including neurological impairment, may have a specific phenotype in the context of the D409H mutation.We report the case of a 22-year-old woman who presented with Gaucher disease. Enzyme replacement therapy by imiglucerase was followed by rapid clinical and biological improvement. However, communication difficulties, which were initially attributed to the language barrier, revealed neurological impairment. After complementary assessment, the diagnosis of type 3 Gaucher disease was suspected. Gene analysis of the glucocerebrosidase showed a homozygous D409H mutation.This mutation results in calcified heart valves, corneal opacities, alteration of oculomotricity and hydrocephalus. The mild manifestation at onset and the late neurological involvement in the medical history make the diagnosis more difficult. This particular clinical phenotype deserves to be known in adult medicine departments.

Objectives: Up to 87% of women are using some form of complementary and alternative medicine (CAM) during their pregnancy, and this study was conducted to investigate the information sources that these women find influential in relation to such use. Design: The study sample was obtained via the Australian Longitudinal Study on Women's Health. This article is based on a substudy of 1835 pregnant women who were surveyed in 2010. The women answered questions about CAM use, pregnancy-related health concerns, and influential information sources in relation to CAM use. Logistic regression models were used to determine the information sources that women reported as influential in their decision making regarding CAM use. Results: Of the respondents (n=1835, 79.2% response rate), 48.1% (n=623) of the pregnant women consulted a CAM practitioner and 91.7% (n=1485) used a CAM product during pregnancy. The results show that, of the women who used CAM, nearly half (48%, n=493) were influenced by their own personal experience of CAM and 43% (n=423) by family and friends. Other popular sources of information were general practitioners 27% (n=263), the media (television, radio, books, magazines, newspapers) 22% (n=220), obstetricians 21% (n=208) and midwives 19% (n=190). Numerous statistically significant associations between influential information sources and pregnancy-related health conditions were identified. Conclusions: Women utilize a wide variety of information sources regarding their CAM use during pregnancy. Nonprofessional sources of information were found to be particularly influential, and maternity health care professionals need to have a nonjudgmental and open discussion with women about their CAM use during pregnancy in order to ensure safe and effective maternal outcomes. © Copyright 2014, Mary Ann Liebert, Inc. 2014.

Objective: Further developments in EEG monitoring necessitate new methods of filtering to eliminate artifacts, without transforming relevant signals. This article presents an automatic filtering of EEG recordings, based on a spatio-temporal method called Adaptive Filtering by Optimal Projection or Dual Adaptive Filtering by Optimal Projection. Evaluation of filtering methods is difficult, and comparisons between methods remain a challenge; here, we present a method to score the visual assessment of the EEG. The aim of this study was to evaluate an automatic filtering method, called Adaptive Filtering by Optimal Projection, improved by Dual Adaptive Filtering by Optimal Projection, of EEG recordings of patients with epilepsy. Methods: Two hundred forty-eight nonfiltered EEG segments of 20 seconds each were selected from 35 EEG recordings of 27 different patients by 3 clinical neurophysiologists based on their content. The reading quality as well as the proportions of artifacts and of cerebral activity removed after filtering were evaluated on a scale of 0 to 4. The mean square difference of amplitude before and after filtering was computed in specific spectral band. Results: The artifacts were largely removed (82% for muscular, 72% for ocular, and 71% for electrode artifacts). The readability was improved on an average by two points for pages containing epileptic seizures, and by one point for those containing alpha rhythms, slow waves, and spikes. After filtering, consistency tests showed a consensus (Spearman correlation [0.69–0.79]) on the removal of the artifact versus loss of information. The spectral analysis showed equivalent results (0.16% mean square difference in the alpha band). Conclusions: Our filtering method is effective in removing artifacts without altering relevant signals. The significance is that we evaluated a new automated method of filtering EEG that is easy to use for both for the analysis of routine EEG and in the field of epilepsy at large.

The objective of this study was to explore the determinants that are related to women's likelihood to consult with a complementary and alternative medicine (CAM) practitioner during pregnancy. Primary data were collected as a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH) in 2010. We completed a cross-sectional survey of 2,445 women from the ALSWH "younger" cohort (n = 8,012), who had identified as being pregnant or had recently given birth in 2009. Independent Poisson backwards stepwise regression models were applied to four CAM practitioner outcome categories: acupuncturist, chiropractor, massage therapist, and naturopath. The survey was completed by 1,835 women (79.2%). The factors associated with women's consultation with a CAM practitioner differed by practitioner groups. A range of demographic factors were related, including employment status, financial status, and level of education. Women's health insurance coverage, health status, and perceptions toward both conventional maternity care and CAM were also associated with their likelihood of consultations with all practitioner groups, but in diverse ways. Determinants for women's consultations with a CAM practitioner varied across practitioner groups. Stakeholders and researchers would benefit from giving attention to specific individual modalities when considering CAM use in maternity care. Copyright © Taylor & Francis Group, LLC.

© 2016 Taylor & Francis. The objective of the authors in this study was to determine if prior visits to a complementary and alternative medicine (CAM) practitioner were associated with CAM use during pregnancy. The study sample comprised the Australian Longitudinal Study on Women’s Health. Women were surveyed prior to pregnancy in 2006, and then again in 2010 if they were pregnant or had recently given birth, and asked a range of questions relating to demographic variables, health status, and use of CAM. A multivariable analysis identified significant covariates associated with visits to specific CAM practitioner modalities during pregnancy. Of the 447 women who consulted a CAM practitioner prior to pregnancy, 62.4% (n = 279) continued this use during pregnancy. Prior use of massage therapy, acupuncture, herbalist/naturopath, or chiropractor was related to use of the same service during pregnancy. Higher income and working full-time were associated with the continued use of massage, while continued visits to a chiropractor were associated with having depressive symptoms, a urinary tract infection, and living in a rural community. Prior use of CAM was highly related to continuing use during pregnancy. Further research is required to elucidate the benefits women attain from a CAM-model of care that they do not get from their conventional maternity care providers alone.

International audience; Importance: Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy.Objective: To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis.Design, setting, and participants: Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included.Interventions: Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis.Main outcomes and measures: Major infection and explantation.Results: Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290).Conclusions and relevance: After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children.

AIMS: The purpose of the Euro Heart Survey Programme of the European Society of Cardiology is to evaluate to which extent clinical practice endorses existing guidelines as well as to identify differences in population profiles, patient management, and outcome across Europe. The current survey focuses on the invasive diagnosis and treatment of patients with established coronary artery disease (CAD). METHODS AND RESULTS: Between November 2001 and March 2002, 7769 consecutive patients undergoing invasive evaluation at 130 hospitals (31 countries) were screened for the presence of one or more coronary stenosis >50% in diameter. Patient demographics and comorbidity, clinical presentation, invasive parameters, treatment options, and procedural techniques were prospectively entered in an electronic database (550 variables+29 per diseased coronary segment). Major adverse cardiac events (MACE) were evaluated at 30 days and 1 year. Out of 5619 patients with angiographically proven coronary stenosis (72% of screened population), 53% presented with stable angina while ST elevation myocardial infarction (STEMI) was the indication for coronary angiography in 16% and non-ST segment elevation myocardial infarction or unstable angina in 30%. Only medical therapy was continued in 21%, whereas mechanical revascularization was performed in the remainder [percutaneous coronary intervention (PCI) in 58% and coronary artery bypass grafting (CABG) in 21%]. Patients referred for PCI were younger, were more active, had a lower risk profile, and had less comorbid conditions. CABG was performed mostly in patients with left main lesions (21%), two- (25%), or three-vessel disease (67%) with 4.1 diseased segments, on average. Single-vessel PCI was performed in 82% of patients with either single- (45%), two- (33%), or three-vessel disease (21%). Stents were used in 75% of attempted lesions, with a large variation between sites. Direct PCI for STEMI was performed in 410 cases, representing 7% of the entire workload in the participating catheterization laboratories. Time delay was within 90 min in 76% of direct PCI cases. In keeping with the recommendations of practice guidelines, the survey identified under-use of adjunctive medication (GP IIb/IIIa receptor blockers, statins, and angiotensin-converting enzyme-inhibitors). Mortality rates at 30 days and 1 year were low in all subgroups. MACE primarily consisted of repeat PCI (12%). CONCLUSION: The current Euro Heart Survey on coronary revascularization was performed in the era of bare metal stenting and provides a global European picture of the invasive approach to patients with CAD. These data will serve as a benchmark for the future evaluation of the impact of drug-eluting stents on the practice of interventional cardiology and bypass surgery.

Background Pregnant women have been identified as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women. Aim To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. Methods The study sample was obtained via the Australian Longitudinal Study on Women's Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. Results Complementary and alternative medicine use was found to be high with 48.1% (n = 623) of pregnant women consulting a CAM practitioner and 52.0% (n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant women's visits to a CAM practitioner. Significant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. Conclusion Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care. © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

In osteoclasts, Src controls podosome organization and bone degradation, which leads to an osteopetrotic phenotype in src−/− mice. Since this phenotype was even more severe in src−/−hck−/− mice, we examined the individual contribution of Hck in bone homeostasis. Compared to wt mice, hck−/− mice exhibited an osteopetrotic phenotype characterized by an increased density of trabecular bone and decreased bone degradation, although osteoclastogenesis was not impaired. Podosome organization and matrix degradation were found to be defective in hck−/− osteoclast precursors (preosteoclast) but were normal in mature hck−/− osteoclasts, probably through compensation by Src, which was specifically overexpressed in mature osteoclasts. As a consequence of podosome defects, the 3-dimensional migration of hck−/− preosteoclasts was strongly affected in vitro. In vivo, this translated by altered bone homing of preosteoclasts in hck−/− mice: in metatarsals of 1-wk-old mice, when bone formation strongly depends on the recruitment of these cells, reduced numbers of osteoclasts and abnormal developing trabecular bone were observed. This phenotype was still detectable in adults. In summmary, Hck is one of the very few effectors of preosteoclast recruitment described to date and thereby plays a critical role in bone remodeling.—Vérollet, C., Gallois, A., Dacquin, R., Lastrucci, C., Pandruvada, S. M. N., Ortega, N., Poincloux, R., Behar, A., Cougoule, C., Lowell, C., Al Saati, T., Jurdic, P., Maridonneau-Parini, I. Hck contributes to bone homeostasis by controlling the recruitment of osteoclast precursors.

Epistaxis constitutes a significant proportion of the Otolaryngologist’s emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis. Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery. Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoidal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors. A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.

Unidad de excelencia María de Maeztu MdM-2015-0552 Researchers have analysed whether school and local knowledge complement or substitute each other, but have paid less attention to whether those two learning models use different cognitive strategies. In this study, we use data collected among three contemporary hunter-gatherer societies with relatively low levels of exposure to schooling yet with high levels of local ecological knowledge to test the association between i) schooling and ii) local ecological knowledge and verbal working memory. Participants include 94 people (24 Baka, 25 Punan, and 45 Tsimane') from whom we collected information on 1) schooling and school related skills (i.e., literacy and numeracy), 2) local knowledge and skills related to hunting and medicinal plants, and 3) working memory. To assess working memory, we applied a multi-trial free recall using words relevant to each cultural setting. People with and without schooling have similar levels of accurate and inaccurate recall, although they differ in their strategies to organize recall: people with schooling have higher results for serial clustering, suggesting better learning with repetition, whereas people without schooling have higher results for semantic clustering, suggesting they organize recall around semantically meaningful categories. Individual levels of local ecological knowledge are not related to accurate recall or organization recall, arguably due to overall high levels of local ecological knowledge. While schooling seems to favour some organization strategies this might come at the expense of some other organization strategies.

Purpose: To evaluate the corneal thickness and curvature of myopic and patients with keratoconus from two countries. Methods: This cross-sectional study was conducted at Cabinet Opale, Fort de France, French West Indies and University Hospital of Bordeaux, France. Corneal thickness and curvature were assessed in 170 keratoconic eyes of 89 residents of the French Caribbean Islands (FCI) and 159 keratoconic eyes of 91 residents of the Aquitaine region of southwest France. A group of age-matched keratoconus-free patients who had been referred for refractive surgery owing to myopia (173 FCI [173 eyes; 87 individuals] and Aquitaine [181 eyes; 93 individuals]) were also assessed. Results: The mean age at keratoconus diagnosis was significantly higher among FCI than Aquitaine residents (p = 0.009). The mean keratometric (Km) reading was statistically higher for keratoconic FCI than Aquitaine patients, at 48.06 versus 46.21 diopters (p = 0.001). This difference was more pronounced among patients aged >40 years than those ≤40 years (p = 0.009). Patients with keratoconus showed no significant difference in mean central corneal thickness and thinnest corneal point values, irrespective of region. Myopic individuals from the FCI, however, had significantly lower mean central corneal thickness and thinnest corneal point measurements than Aquitaine myopics, irrespective of age group (p ≤ 0.0008). Conclusion: The corneas of patients with keratoconus of African-Caribbean and Caucasian origins are of similar thickness. Myopic African-Caribbean patients referred for refractive surgery tend to present with thinner corneas than Caucasians.

Background: People with dementia have a range of needs that are met by informal caregivers. A DVD-based training program was developed using research-based strategies for memory and communication in dementia. The effectiveness of the training on the caregiver experience and the well-being of the person with dementia was evaluated.Methods: A pre-test/post-test controlled trial was undertaken with caregiver–care-recipient dyads living in the community. Measures of the carers’ knowledge of memory and communication strategies, burden, positive perceptions of caregiving, and perceptions of problem behaviors were taken pre- and three months post-intervention. The depression and well-being of the person with dementia were also evaluated. Satisfaction with the training and feedback were measured.Results: Twenty-nine dyads (13 training group, 16 control group) participated. Bonferroni's correction was made to adjust for multiple comparisons, setting α at 0.00385. A significant improvement was found in caregivers’ knowledge for the training group compared to the control group (p = 0.0011). The training group caregivers reported a reduction in the frequency of care recipient disruptive behaviors (p = 0.028) and increased perceptions of positive aspects of caregiving (p = 0.039), both at a level approaching significance. The training group care recipients had increased frequency of verbally communicated depressive behaviors at a level approaching significance (p = 0.0126). The frequency of observed depressive behaviors was not significantly different between groups.Conclusions: This approach to training for caregivers of people with dementia appears promising for its impact on knowledge and the caregiving experience. Further research could monitor the impact of the training on broader measures of depression and well-being, with a larger sample.

The objective of this cross-sectional questionnaire study was to assess associations of a self-report index of sun protection habit strength with sunscreen use in sporting environments and outdoor physical activity. Participants (n = 234) in field hockey, soccer, tennis and surf sports in Queensland, Australia, completed a self-administered survey on sun protection during organized sport, and during general outdoor physical activity during 2005/2006. The sun protection habit strength index was dichotomized into two categories. Multinomial logistic regression analyses assessed the associations of low versus high sun protection habit strength with three categories of sunscreen use (no or rare use; inadequate use; and adequate use). Compared to participants with low sun protection habit strength, those with high sun protection habit strength had significantly greater odds of any sunscreen use during organized sport and during general outdoor physical activity. This association was strongest for adequate sunscreen use in both settings. In conclusion, this study suggests that the measure of sun protection habit strength is a potentially useful assessment tool for future sun protection studies.

Background The acquisition of local knowledge occurs through complex interactions between individual and contextual characteristics: as context changes, so it changes the acquisition of knowledge. Contemporary small-scale societies facing rapid social-ecological change provide a unique opportunity to study the relation between social-ecological changes and the process of acquisition of local knowledge. In this work, we study children’s involvement in subsistence related activities (i.e., hunting and gathering) in a context of social-ecological change and discuss how such involvement might condition the acquisition of local knowledge during childhood. Methods We interviewed 98 children from a hunter-gatherer society, the Baka, living in two different villages in southeastern Cameroon and assessed their involvement in daily activities. Using interviews, we collected self-reported data on the main activities performed during the previous 24 h. We describe the frequency of occurrence of daily activities during middle childhood and adolescence and explore the variation in occurrence according to the sex, the age group, and the village of residency of the child. We also explore variation according to the season in which the activity is conducted and to the predicted potential of the activity for the acquisition of local knowledge. Results Baka children and adolescents engage in subsistence-related activities (i.e., hunting and gathering) and playing more frequently than in other activities (i.e., traditional tales or schooling). Gender differences in children’s subsistence activities emerge at an early age. Engagement in activities also varies with age, with adolescents spending more time in agricultural activities, modern leisure (i.e., going to bars), and socializing than younger children. When conducting similar activities, adolescents use more complex techniques than younger children. Conclusion Subsistence activities, which present a high potential for transmission of local knowledge, continue to be predominant in Baka childhood. However, Baka children also engage in other, non-traditional activities, such as modern forms of leisure, or schooling, with a low potential for the transmission of local knowledge. Baka children’s involvement in non-traditional activities might have unforeseen impacts on the acquisition of local knowledge.

This study examined the ways in which health care providers (general practitioners and specialists) and patients communicate with each other about managing musculoskeletal (MSK) disorders, a major cause of long-term pain and physical disability. In managing their illness, patients must interact closely with health care providers, who play a large role in transferring knowledge to them. In-depth interviews with patients, general practitioners, and specialist rheumatologists in Australia and Canada were analyzed using Leximancer (a text-mining tool). Results indicated that, in their communication, doctors subtly emphasized accepting and adjusting to the illness ("new normal"), whereas patients emphasized pain relief and getting "back to normal." These results suggest that doctors and patients should accommodate in their communication across subtle and often unexpressed differences in the priorities of provider and patient, or they are likely to be at cross purposes and thus less effective.

Purpose: Over and above the risks associated with ageing, older migrants are also at risk of social isolation. The social identity approach, and the Social Identity Model of Identity Change (SIMIC) in particular, provides a theoretical basis from which to understand the factors contributing to social isolation and how this then impacts on older migrants’ capacity to age well in a foreign land. Building on the recognition that migration involves a major life change, we explore this transition qualitatively focusing specifically on social connectedness and adjustment. Methods: In semi-structured interviews with 29 older migrants in Australia, we examined participants’ experiences of migration and perceptions of identity and identity change. We also considered in more detail experiences of the most and least socially isolated individuals to understand adjustment trajectories. Results: We found evidence supporting the key processes described in SIMIC (relating to social identity continuity, social identity gain, and perceived identity compatibility), suggesting that where adjustment was positive it was experienced as a process of successfully adapting to identity change. Conclusion: We emphasise the importance of identity resources as substantial and concrete assets that can enhance the well-being among older adults aging in a foreign land.

Objective.The Effective Consumer Scale (EC-17) comprises 17 items measuring the main skills and behaviors people need to effectively manage their healthcare. We tested the responsiveness of the EC-17.Methods.Participants, in 2 waves of a 6-week Arthritis Self-Management Program (ASMP) from Arthritis Ireland, received a questionnaire at the first and last week of the weekly ASMP. The questionnaire included the EC-17 and 10 other measures for arthritis. Deficits, mean change, and standard deviations were calculated at baseline and Week 6. The EC-17 scores were compared to the Arthritis Self-Efficacy (ASE) and Patient Activation Measure (PAM) scales. Results were presented at OMERACT 9.Results.There is some overlap between the EC-17 and the ASE and PAM; however, most items of greatest deficit in the EC-17 are not covered by those scales. In 327 participants representing both intervention waves (2006 and 2007), the EC-17 was more efficient than the ASE but less efficient than the PAM for detecting improvements after the ASMP, and was moderately correlated with the PAM.Conclusion.The EC-17 appears to measure different skills and attributes than the ASE and PAM. Discussions with participants at OMERACT 9 agreed that it is worthwhile to measure the skills and attributes of an effective consumer, and supported the development of an intervention (such as proposed online decision aids) that would include education in the categories in the EC-17.

OBJECTIVE A1C is widely considered the gold standard for monitoring effective blood glucose levels. Recently, a genome-wide association study reported an association between A1C and rs7072268 within HK1 (encoding hexokinase 1), which catalyzes the first step of glycolysis. HK1 deficiency in erythrocytes (red blood cells [RBCs]) causes severe nonspherocytic hemolytic anemia in both humans and mice. RESEARCH DESIGN AND METHODS The contribution of rs7072268 to A1C and the RBC-related traits was assessed in 6,953 nondiabetic European participants. We additionally analyzed the association with hematologic traits in 5,229 nondiabetic European individuals (in whom A1C was not measured) and 1,924 diabetic patients. Glucose control–related markers other than A1C were analyzed in 18,694 nondiabetic European individuals. A type 2 diabetes case-control study included 7,447 French diabetic patients. RESULTS Our study confirms a strong association between the rs7072268–T allele and increased A1C (β = 0.029%; P = 2.22 × 10−7). Surprisingly, despite adequate study power, rs7072268 showed no association with any other markers of glucose control (fasting- and 2-h post-OGTT–related parameters, n = 18,694). In contrast, rs7072268–T allele decreases hemoglobin levels (n = 13,416; β = −0.054 g/dl; P = 3.74 × 10−6) and hematocrit (n = 11,492; β = −0.13%; P = 2.26 × 10−4), suggesting a proanemic effect. The T allele also increases risk for anemia (836 cases; odds ratio 1.13; P = 0.018). CONCLUSIONS HK1 variation, although strongly associated with A1C, does not seem to be involved in blood glucose control. Since HK1 rs7072268 is associated with reduced hemoglobin levels and favors anemia, we propose that HK1 may influence A1C levels through its anemic effect or its effect on glucose metabolism in RBCs. These findings may have implications for type 2 diabetes diagnosis and clinical management because anemia is a frequent complication of the diabetes state.

OBJECTIVE—We tested whether determination of the ACE insertion/deletion polymorphism is useful for renal and cardiovascular prognoses of type 2 diabetic subjects. RESEARCH DESIGN AND METHODS—The French participants (3,126 of 4,912) in the Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) trial were studied for their prognosis over 4 years according to their ACE insertion/deletion polymorphism. We used two cohorts of French type 2 diabetic patients for replication: a 3-year follow-up study (n = 917; Survie, Diabete de type 2 et Genetique [SURDIAGENE] study) and a case-control study on diabetic nephropathy (n = 1,277; Diabete de type 2, Nephropathie et Genetique [DIAB2NEPHROGENE] study). We investigated the effect of the insertion/deletion polymorphism on the primary outcome in the DIABHYCAR trial (defined as the first of the following events to occur: cardiovascular death, nonfatal myocardial infarction, stroke, heart failure leading to hospital admission, or end-stage renal failure) and its components. RESULTS—In DIABHYCAR, the primary outcome and most of its components were not affected by the ACE insertion/deletion genotype. Only renal outcome was favored by the I allele (P = 0.03). The risk of myocardial infarction was not affected by ACE genotype, but the probability of fatal outcome increased with the number of D alleles (P < 0.03). In SURDIAGENE, the association between the ACE I allele and renal outcome was not replicated. In DIAB2NEPHROGENE, no association was found with nephropathy. CONCLUSIONS—We were not able to demonstrate the manifest usefulness of the ACE insertion/deletion polymorphism for the prognosis of type 2 diabetic subjects.

Background Low levels of serum testosterone, as typically found in women and children, cannot be measured reliably by immunoassays. Our aim was to develop a sensitive assay to quantitate low serum testosterone concentrations using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The results were compared to those obtained with various immunoassay techniques. Methods Serum testosterone levels in 70 women and children were measured using LC-MS/MS and compared with two automated, non-isotopic immunoassays, and three manual, isotopic immunoassays. Serum extraction was required only for LC-MS/MS and one of the isotopic methods. Results Deming regression analysis was used for comparison: the correlation coefficients were between 0.772 and 0.870, and the slopes between 0.972 and 1.365. Using Bland and Altman analysis, all the 5 immunoassays showed a positive mean difference compared with LC-MS/MS: all overestimated the testosterone levels in women and children. Conclusion None of the immunoassays tested proved sufficiently reliable when low testosterone concentrations (≤ 3.47 nmol/L) were measured. In contrast to conventional isotopic and non-isotopic immunoassay techniques, LC-MS/MS allows the precise determination of low testosterone levels. It has adequate sensitivity and is not subject to interference from other steroids that were tested.

Objectives: To explore the relationship between sun protection and physical activity in young adults (18-30 years) involved in four organised sports. Methods: Participants (n=237) in field hockey, soccer, tennis and surf sports completed a self-administered survey on demographic and sun-protective behaviours while playing sport. Differences in sun-protective behaviour were explored by sport and by gender. Results: Sunburn during the previous sporting season was high (69%). There were differences between sports for sunburn, sunscreen use and reapplication of sunscreen. Lifesaving had the highest rates compared with the other three sports. Hats and sunglasses worn by participants varied significantly by sports. A greater proportion of soccer and hockey players indicated they were not allowed to wear a hat or sunglasses during competition. For all sports, competition was played mainly in the open with no shade provision for competitors while they were playing. There were some gender differences within each of the sports. Female soccer and tennis players were more likely to wear sunscreen compared with males. Female hockey players were more likely to wear a hat compared with males. Conclusions: Our findings highlight that there is still room for improvement in sun-protective behaviours; among young adult sport competitors. There is a need for a systematic approach to sun protection in the sporting environments of young adults. Implications: Health promotion efforts to increase physical activity need to be paired with sun protection messages.

Dendritic cells (DC) are the mononuclear cells that initiate adaptive immune responses. Osteoclasts (OC) are the multinucleated giant cells that resorb bone. As previously described for human conventional DC (cDC), we demonstrate that murine cDC, either in vitro generated from Fms-like tyrosine kinase 3 (Flt3)+ bone marrow progenitors or ex vivo purified from spleen, are able to develop into OC in response to M-CSF and receptor activator of NF-kappaB ligand (RANKL) in vitro. This transdifferentiation is driven by the immune environment that controls cDC maturation, cell fusion, tartrate-resistant acid phosphatase (TRAP) and bone resorption activities. Only immature cDC have the capacity to become OC since mature cDC or plasmacytoid DC do not. Additions of the pro-inflammatory cytokines, such as IL-1beta and TNF-alpha, or human rheumatoid synovial fluid, increase murine cDC transdifferentiation into OC, whereas IFN-alpha inhibits it. The adaptive cytokine, IFN-gamma, inhibits cDC fusion while IL-4 increases it. IL-2, IFN-gamma and IL-4 inhibit TRAP and bone resorption activities contrary to IL-10, which enhances both activities. A putative new "immune multinucleated giant cell" unable to resorb bone, which is formed owing to IL-4, is underlined. The future analysis of cDC transdifferentiation into OC in murine models of inflammatory arthritis will give us the quantitative importance of this phenomenon in vivo.

Objective: The aim of this paper was to examine self-efficacy and perceived appropriateness among rural general practitioners (GPs) in regards to screening and intervention for physical, lifestyle and mental health issues. Method: Fifty GPs from 25 practices in eight rural Queensland towns completed a written survey designed for the study. Results: General practitioners rated opportunistic screening or assessment for smoking and for detection of relapse of mental disorders as the most appropriate, with even cardiovascular and diabetes risk falling behind these. Self-efficacy was highest for medical disorders for smoking assessment. It was significantly lower for alcohol, mental health issues, and addressing risks of physical disorder in people with mental disorders. Conclusions: High appropriateness ratings suggest that current strategies to boost self-efficacy of GPs in addressing mental health issues are timely.