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The inadequacy of mental health and developmental services for children is a widely recognized and growing problem. Although a variety of solutions have been proposed, none has been generally successful or feasible. This research describes models of colocation that have evolved in primary care settings in Massachusetts and reports on pediatricians’ and their colocated colleagues’ impressions of their benefits and challenges. Pediatricians in 18 practices that included a colocated mental health/developmental specialist (MH/DS) were identified through a survey administered through the state American Academy of Pediatrics Chapter, and interviewed. Practices varied widely in the professional expertise/training and roles of the MH/DSs, communication among providers, and financial arrangements. The majority of pediatricians and MH/DSs reported being pleased with their colocated arrangements, despite the costs rarely being supported by billing revenues. This study suggests that further development of such systems hold promise to meet the growing need for accessible pediatric mental and developmental health care.

Resume Introduction Le Western Ontario Shoulder Instability Index (WOSI) est un auto-questionnaire specifique mesurant l’impact fonctionnel des patients atteints d’instabilite chronique scapulo-humerale. Dans sa version originale en anglais, il est valide, fiable et sensible au changement. L’objectif de notre etude a ete d’effectuer une adaptation linguistique et culturelle de la version originale anglaise du WOSI en francais, et d’evaluer les qualites metrologiques de cette version chez des patients atteints d’instabilite chronique scapulo-humerale. Materiels et methodes Le WOSI a ete traduit et adapte linguistiquement et culturellement en francais (WOSI-Fr) selon les recommandations actuelles. Les qualites metrologiques du WOSI-Fr ont ete analysees dans les groupes suivants : patients avec instabilite chronique d’epaule non operee (GNO), patients avec instabilite chronique d’epaule operee (GO), patients instables (GTot = GNO + GO) et sujets temoins (GTem) ; par l’analyse de la validite de construit par la comparaison du WOSI-Fr aux scores de Rowe, Walch-Duplay, QuickDASH et a l’EVA douleur, et par l’analyse de la fiabilite par la reproductibilite et la consistance interne. Resultats La version WOSI-Fr a ete etablie puis acceptee par un groupe d’expert (n = 7). Il existait une correlation significative entre le WOSI et les differents scores algo-fonctionnels pour GTot, pour GO et pour GNO (sauf avec EVA douleur et QuickDASH pour GNO). La reproductibilite (n = 27) etait bonne : la valeur de l’ICC pour le score total etait de 0,88 (IC95 % : 0,47–0,98), variant de 0,80 a 0,94 selon les 4 domaines du WOSI-Fr et de 0,70 a 0,94 pour les differents items separement. Pour GTot, le Cronbach alpha etait de 0,953, la SEM et la MDC etaient respectivement 120,2 (5,7 %) et 333 (15,9 %). Conclusion La version francaise du WOSI (WOSI-Fr) est disponible, adaptee culturellement et linguistiquement, valide et fiable. Nous suggerons son utilisation dans le suivi des patients atteints d’instabilite de l’epaule. Type d’etude Etude prospective. Niveau d’evidence scientifique 2.

Anxiety disorders are the most common psychiatric disorder of childhood, and are associated with high risk for development of future psychopathology. Yet, pediatric anxiety disorders continue to be...

KM3NeT is a research infrastructure being installed in the deep Mediterranean Sea. It will house a neutrino telescope comprising hundreds of networked moorings — detection units or strings — equipped with optical instrumentation to detect the Cherenkov radiation generated by charged particles from neutrino-induced collisions in its vicinity. In comparison to moorings typically used for oceanography, several key features of the KM3NeT string are different: the instrumentation is contained in transparent and thus unprotected glass spheres; two thin Dyneema® ropes are used as strength members; and a thin delicate backbone tube with fibre-optics and copper wires for data and power transmission, respectively, runs along the full length of the mooring. Also, compared to other neutrino telescopes such as ANTARES in the Mediterranean Sea and GVD in Lake Baikal, the KM3NeT strings are more slender to minimise the amount of material used for support of the optical sensors. Moreover, the rate of deploying a large number of strings in a period of a few years is unprecedented. For all these reasons, for the installation of the KM3NeT strings, a custom-made, fast deployment method was designed. Despite the length of several hundreds of metres, the slim design of the string allows it to be compacted into a small, re-usable spherical launching vehicle instead of deploying the mooring weight down from a surface vessel. After being lowered to the seafloor, the string unfurls to its full length with the buoyant launching vehicle rolling along the two ropes. The design of the vehicle, the loading with a string, and its underwater self-unrolling are detailed in this paper. © 2020 The Author(s). Published by IOP Publishing Ltd on behalf of Sissa Medialab. Original content from this work may be used under the terms of the Creative Commons Attribution 4.0 licence. Any further distribution of this work must maintain attribution to the author(s) and the title of the work, journal citation and DOI.

BACKGROUND AND OBJECTIVES:Pediatric surveillance of young children depends on providers’ assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment.METHODS:We analyzed responses to the developmental screening form of the Survey of Well-being of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC).RESULTS:A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P < .01), social determinants of health (P < .01), Medicaid (P < .01), male sex (P < .01), and child race (P < .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that “most children pass” and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should “act early.” An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided.CONCLUSIONS:Detailed normative data on individual developmental milestones can help clinicians guide caregivers’ expectations for milestone attainment, thereby offering greater specificity to CDC guidelines.

The increasing demands from micro-power applications call for the development of the electrode materials for Li-ion microbatteries using thin-film technology. Porous Olivine-type LiFePO4 (LFP) and NASICON-type Li3Fe2(PO4)3 have been successfully fabricated by radio frequency (RF) sputtering and post-annealing treatments of LFP thin films. The microstructures of the LFP films were characterized by X-ray diffraction and scanning electron microscopy. The electrochemical performances of the LFP films were evaluated by cyclic voltammetry and galvanostatic charge-discharge measurements. The deposited and annealed thin film electrodes were tested as cathodes for Li-ion microbatteries. It was found that the electrochemical performance of the deposited films depends strongly on the annealing temperature. The films annealed at 500 °C showed an operating voltage of the porous LFP film about 3.45 V vs. Li/Li+ with an areal capacity of 17.9 µAh cm−2 µm−1 at C/5 rate after 100 cycles. Porous NASICON-type Li3Fe2(PO4)3 obtained after annealing at 700 °C delivers the most stable capacity of 22.1 µAh cm−2 µm−1 over 100 cycles at C/5 rate, with an operating voltage of 2.8 V vs. Li/Li+. The post-annealing treatment of sputtered LFP at 700 °C showed a drastic increase in the electrochemical reactivity of the thin film cathodes vs. Li+, leading to areal capacity ~9 times higher than as-deposited film (~27 vs. ~3 µAh cm−2 µm−1) at C/10 rate.

International audience; BackgroundNETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry.Patients and methodsPatients’ characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497).ResultsAmong the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li–Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P

The positive effects of adapted physical activity (PA) in patients with chronic illness are scientifically recognized, and PA promotion is part and parcel of public policy. In this context, one task in public health research consists in improving knowledge of PA practice in persons with chronic illnesses. As a complement to studies evaluating the importance of various determinants of PA practice, qualitative research is called for. In this framework, the present article will propose a theoretical analytical framework for study of PA in chronic illness. It will be built around two key concepts, namely the "standards of life" drawn from the notion of health in the philosophy of Georges Canguilhem and the "illness trajectory" drawn from the interactionist sociology of Anselm Strauss. We will attempt to improve understanding of the important yet frangible "labor" of patients at work in transformation of their habits and life standards involving PA professionals.

This deliverable report presents the outcomes of the four co-creation workshops and the final consolidation workshop. These workshops were organised at SK, Lyngby, ZZ and HUG between June 2016 to Oct 2016 to create initial product-service-systems (PSS) based on the challenges and opportunities identified from the earlier defined personas and experience mapping at each local testbed. To accomplish this task, a co-creation method was developed based on the Value Design Method to support multi stakeholder ideation when creating PSS. In total, 72 ideas were created and 13 concepts were chosen for further development. Both REACH Engine concepts as well as REACH touchpoint concepts were created. At the consolidation workshop, each testbed was able to make concrete decisions on what the next step was and which concept to start with. These results will provide along with the analyses conducted in T1.3 useful input for WP1.4, and the upcoming development oriented WPs (WPs 2-5). More specifically, the resulting concepts will be used to define functional requirements and specifications in WP1.4, and to subsequently specify the related technical systems and data gathering, engineering and analysis structure.

Pediatric anxiety disorders are highly prevalent, but tend to go undetected as pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of child anxiety disorders. The novel training was completed in a group-based format or via an online, asynchronous training program. Pediatric residents from 2 residency programs (n = 63) participated and completed pre- and posttraining surveys evaluating attitudes about previous training, knowledge about child anxiety, perceived evaluation skills, and responses to clinical vignettes. Most residents (81%) reported they did not receive enough prior training in the presentation of anxiety disorders in young children. Residents’ knowledge and perceived evaluation skills increased posttraining. On the vignette-based assessment, residents demonstrated increased sensitivity with regard to interference, diagnosis, and referral urgency. Despite some challenges with participation, results provide preliminary evidence that brief training programs could be an effective way to improve resident education.

BACKGROUND: Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality. METHODS: Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a “snowball” method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts. RESULTS: Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections. CONCLUSIONS: Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States’ legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers.

BackgroundTuberculosis (TB) poses a global health crisis requiring robust international and country-level action. Adopting and implementing TB policies from the World Health Organization (WHO) is essential to meeting global targets for reducing TB burden. However, many high TB burden countries lag in implementing WHO recommendations. Assessing the progress of implementation at national level can identify key gaps that must be addressed to expand and improve TB care.MethodsIn 2016/2017, Médecins Sans Frontières and the Stop TB Partnership conducted a survey on adoption and implementation of 47 WHO TB policies in the national TB programs of 29 countries. Here we analyze a subset of 23 key policies in diagnosis, models of care, treatment, prevention, and drug regulation to provide a snapshot of national TB policy adoption and implementation. We examine progress since an analogous 2015 survey of 23 of the same countries.ResultsAt the time of the survey, many countries had not yet aligned their national guidelines with all WHO recommendations, although some progress was seen since 2015. For diagnosis, about half of surveyed countries had adopted the WHO-recommended initial rapid test (Xpert MTB/RIF). A majority of countries had adopted decentralized models of care, although one-third of them still required hospitalization for drug-resistant (DR-)TB. Recommended use of the newer drugs bedaquiline (registered in only 6 high-burden TB countries) and delamanid (not registered in any high-burden country) was adopted by 23 and 18 countries, respectively, but short-course (9-month) and newer pediatric regimens by only 13 and 14 countries, respectively. Guidelines in all countries included preventive treatment of latent TB infection for child TB contacts and people living with HIV/AIDS, but only four extended this to adult contacts.ConclusionTo reach global TB targets, greater political will is needed to rapidly adopt and implement internationally recognized care guidelines.KEY MESSAGESWhat is already known?Countries may be slow to adopt and implement updated World Health Organization (WHO) Tuberculosis (TB) testing, treatment, and prevention recommendations.Implementing updated TB guidelines from WHO is a fundamental first step to honoring international commitments, made through the United Nations (UN) Sustainable Development Goals (SDGs) and UN High-Level Meeting on TB Political Declaration, to end TB by 2030.What are the new findings?Of 29 mostly high TB burden countries, none had fully aligned their national guidelines with WHO recommendations, although some progress has been made since 2015.A lack of alignment with WHO recommendations was found across all policy areas surveyed, including prevention, diagnosis, treatment, models of care and drug regulation, particularly regarding uptake of newer, faster, more effective approaches.What do the new findings imply?To reach global TB targets, greater political will is needed to adopt and implement internationally recognized care guidelines more rapidly, and specifically, to keep up with the latest recommendations.Periodic surveys of progress at the national level are a valuable way to identify specific areas where countries or regions have fallen behind and that require specific policy and/or programmatic attention.

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings.

Resume But Elaborer une collection biologique reunissant des echantillons de qualite optimale pour inciter la recherche fondamentale sur les maladies trophoblastiques gestationnelles (MTG). Materiel et methodes Trois axes prioritaires de recherche ont ete definis afin d’optimiser la nature, les conditions de prelevement et de stockage des echantillons biologiques de patientes atteintes de MTG au sein d’une biobanque dediee : la comprehension de la physiopathologie des MTG, le developpement de nouveaux outils diagnostiques et l’identification de nouvelles cibles therapeutiques. Le protocole d’inclusion de chaque patiente a ete elabore a la lumiere d’une revue extensive de la litterature et d’echanges avec de nombreux experts internationaux en recherche sur les MTG. Resultats Cette biobanque rassemble ainsi pour chaque patiente des echantillons tissulaires (frais, conserves en RNALater® et fixes en formol), sanguins (serum, plasma, ARN sanguin et lymphocytes sanguins), urinaires (surnageants) ainsi que des cultures cellulaires selectives de cytotrophoblastes villeux. Les echantillons sont collectes prospectivement et sont associes a de nombreuses donnees cliniques et biologiques dont la decroissance de l’hormone chorionique gonadotropique sanguine en cas de mole hydatiforme. Conclusion La qualite des echantillons et des donnees cliniques constituant cette biobanque ouvre la possibilite de nombreux projets de recherche dans le cadre de collaborations scientifiques nationales et internationales.

Malignant peripheral nerve sheath tumours are extremely rare and can be associated with neurofibramatosis type 1. Their prognosis is poor and surgery remains the mainstay of therapy and should be the first line of treatment. Radiotherapy and chemotherapy are second line treatment and their effectiveness remains to demonstrate. The diagnosis is clinical, radiological, histological and immunohistochemical. Malignant peripheral nerve sheath tumours have a potential of local tumour recurrence very high and can metastasize. They often occur in extremity of the members but also rarely into brain. We report two cases of intracerebral nerve sheath tumour. The first was a 68-year-old woman who was admitted with progressive symptoms of headache and diplopia. A left frontotemporal malignant peripheral nerve sheath tumours was diagnosed and was treated by surgery and irradiation. Ten months later, she presented a local recurrence and spine bone's metastases were treated by vertebroplasty and irradiation. The patient died 15 months after the diagnosis. The second case was a 47-year-old woman who was referred because headache and vomiting symptoms. A right frontal malignant peripheral nerve sheath tumours was diagnosed and treated by surgery and irradiation. After that, the patient had three local recurrence operated and pulmonary and cranial bone's metastases. She was still alive after 20 months. We propose a literature review with 25 cases of intracerebral nerve sheath tumour identified, including the two current cases.

OBJECTIVES: To examine elevated neonatal inflammatory and neurotrophic proteins from children born extremely preterm in relation to later childhood brain Magnetic Resonance Imaging volumes and cognition. STUDY DESIGN: We measured circulating inflammation-related proteins and neurotrophic proteins on postnatal days 1, 7, and 14 in 166 children at 10 years of age (73 males; 93 females). Top quartile levels on ≥2 days for ≥3 inflammation-related proteins and for ≥4 neurotrophic proteins defined exposure. We examined associations among protein levels, brain Magnetic Resonance Imaging volumes, and cognition with multiple linear and logistic regressions. RESULTS: Analyses were adjusted for gestational age at birth and sex. Children with ≥3 elevated inflammation-related proteins had smaller grey matter, brain stem/cerebellar, and total brain volumes than those without elevated inflammation-related proteins, adjusted for neurotrophic proteins. When adjusted for inflammation-related proteins, children with ≥4 neurotrophic proteins, compared with children with no neurotrophic proteins, had larger grey matter and total brain volumes. Higher grey matter, white matter, and cerebellum and brainstem volumes were significantly correlated with higher IQ. Grey and white matter volumes were correlated with each other (r = −0.18; P = .021), and cerebellum and brainstem was highly correlated with grey matter (r = 0.55; P < .001) and white matter (r = 0.29; P < .001). Adjusting for other brain compartments, cerebellum and brainstem was associated with IQ (P = .016), but the association with white matter was marginally significant (P = .051). Grey matter was not associated with IQ. After adjusting for brain volumes, elevated inflammation-related proteins remained significantly associated with a lower IQ, and elevated neurotrophic proteins remained associated with a higher IQ. CONCLUSIONS: Newborn inflammatory and neurotrophin protein levels are associated with later brain volumes and cognition, but their effects on cognition are not entirely explained by altered brain volumes.

KM3NeT will be a network of deep-sea neutrino telescopes in the Mediterranean Sea. The KM3NeT/ARCA detector, to be installed at the Capo Passero site (Italy), is optimised for the detection of high-energy neutrinos of cosmic origin. Thanks to its geographical location on the Northern hemisphere, KM3NeT/ARCA can observe upgoing neutrinos from most of the Galactic Plane, including the Galactic Centre. Given its effective area and excellent pointing resolution, KM3NeT/ARCA will measure or significantly constrain the neutrino flux from potential astrophysical neutrino sources. At the same time, it will test flux predictions based on gamma-ray measurements and the assumption that the gamma-ray flux is of hadronic origin. Assuming this scenario, discovery potentials and sensitivities for a selected list of Galactic sources and to generic point sources with an E −2 spectrum are presented. These spectra are assumed to be time independent. The results indicate that an observation with 3σ significance is possible in about six years of operation for the most intense sources, such as Supernovae Remnants RX J1713.7-3946 and Vela Jr. If no signal will be found during this time, the fraction of the gamma-ray flux coming from hadronic processes can be constrained to be below 50% for these two objects. © 2019 The Authors

Summary We present how a comprehensive geological study helped in the understanding the distribution of the heterogeneity in the example of a nodular facies. The result of an in-house workflow based on core CT-scan information provided quantification of the heterogeneities. These results are used to show that oil can still flow, even when logs indicate high water saturation values. The results anticipated by the method were confirmed by well tests.

Background. Integration of autism screening into primary care practice in Saudi Arabia is not well established. Objectives. To evaluate the feasibility and effectiveness of implementing the Arabic Modified Checklist for Autism in Toddlers (M-CHAT) in a primary care practice at John Hopkins Aramco Healthcare Center in Saudi Arabia. Method. The Arabic version of M-CHAT was distributed to caregivers of 1207 toddlers (16-32 months) from January to December 2014. Feasibility was assessed by measuring the proportion of visits with M-CHAT completed, and reports of workflow challenges and provider satisfaction. The effectiveness of screening was evaluated based on the number of referrals for autism evaluation and autism identification rates. Results. Total M-CHAT completion rate was 89% (1078 out of 1207 child-specific visits). Those identified as low risk (n = 951; 88%) were reassured and followed routinely. Those screening positive (n = 127; 12%) were referred for diagnostic assessment. Twelve (1% of toddlers screened) were diagnosed with autism at a mean age of 24 months. In addition, positive M-CHAT detected speech delay and social anxiety. Providers acknowledged their satisfaction with the M-CHAT implementation process; the main challenge was communicating to families the importance of screening. Referrals for diagnostic evaluations increased from 23 to 43 cases in the first year, and 35 in the second year. Conclusion. Implementation of the autism screening using the Arabic M-CHAT is feasible and effective in a primary care setting in Saudi Arabia. Sustaining the implementation of developmental screening in practice requires staff engagement and systematic monitoring of the impact of change.

Objective Autism screening is recommended by the American Academy of Pediatrics and the Centers for Disease Control and Prevention at ages 18 and 24 months. Popular screening tests have been validated for the age range of 16 to 30 months. However, only a minority of children with autism spectrum disorder (ASD) are identified by age 3 years, and many are not identified until after they enter school. Thus, we aimed to measure the sensitivity and specificity of 2 available screening tests for ASDs in children older than 30 months. Methods We assessed the sensitivity and specificity of 2 ASD screening tools administered to parents of children who were referred to a developmental clinic between the ages of 16 and 48 months: the Modified Checklist for Autism in Toddlers (M-CHAT) and the Parent's Observations of Social Interactions (POSI), which is a component of a comprehensive screening instrument called, the Survey of Well-being of Young Children. Results Both the M-CHAT and the POSI had acceptable sensitivity (≥75%) among children across the age range studied. Their specificity was limited by the fact that the study was conducted in a developmental referral clinic. Conclusion Two readily available screening tools, the POSI and the M-CHAT, have acceptable sensitivity in evaluating risk for autism in children at least to age 48 months. Further research should investigate their sensitivity and specificity when used in primary care settings.

To determine whether a yoga based self-management program improves the overall self-rated pain, disability, anxiety and depression. A total of 28 patients with different chronic pain conditions were treated with yoga therapy for 6-weeks in addition to pharmacological treatment. All the participants were seen by trained yoga therapist once a week and given self-managed yoga schedule to follow at home twice a day for 15 Min's at least. Baseline levels for pain intensity, disability, anxiety and depression were recorded. After the 6-weeks patients were assessed again to measure the change. The primary outcome was self-rated pain measured through Visual Analogue scale (VAS). Secondary outcome measures related to pain disability assessed with Pain disability Index (PDI), anxiety and depression through Hospital Anxiety Depression Scale (HADS). Twenty-six patients completed the 6-weeks intervention period. One patient had significant improvement at 4-weeks of period and didn't want to change yoga schedule given, fearing any changes would make the pain worse again. One patient was moved out of city. Significant change was reported in self rated pain intensity (p

RésuméIntroductionLa ventilation non invasive (VNI) représente le traitement de choix dans l’insuffisance respiratoire aiguë (IRA), mais cette technique est souvent initiée en service de médecine.MéthodesCette étude rétrospective a tenté d’évaluer l’évolution de l’IRA traitée par VNI en service de pneumologie et de mettre en évidence des critères prédictifs d’échec. Tous les sujets étaient traités sur 4 lits dédiés à la VNI. L’échec de la VNI était défini par la nécessité d’une intubation et le transfert du patient en réanimation ou le décès.RésultatsParmi 105 admissions avec IRA, 49 ont nécessité le recours à la VNI. Ces admissions étaient divisées en 2 groupes : avec PaCO245mmHg (39). The overall failure rate of NIV and overall in-hospital mortality rate were 26.5% and 17% respectively. On multivariate analysis, SAPS II and respiratory acidosis with a pH less than 7.30 were significantly associated with failure of NIV.ConclusionsNIV is practicable and is effective in the management of mild to moderate ARF on a respiratory ward. However, patients with respiratory acidosis and a pH less than 7.30 are at risk of NIV failure.

Objective Children whose parents do not speak English experience significant disparities in the identification of developmental delays and disorders; however, little is known about the availability and validity of translations of developmental screeners. The goal was to create a map of the scientific evidence regarding translations of the 9 Academy of Pediatrics-recommended screening instruments into languages other than English. Methods The authors conducted a systematic search of Medline and PsycINFO, references of identified articles, publishers' Web sites, and official manuals. Through evidence mapping, a new methodology supported by AHRQ and the Cochrane Collaboration, the authors documented the extent and distribution of published evidence supporting translations of developmental screeners. Data extraction focused on 3 steps of the translation and validation process: (1) translation methods used, (2) collection of normative data in the target language, and (3) evidence for reliability and validity. Results The authors identified 63 distinct translations among the 9 screeners, of which 44 had supporting evidence published in peer-reviewed sources. Of the 63 translations, 35 had at least some published evidence regarding translation methods used, 28 involving normative data, and 32 regarding reliability and/or construct validity. One-third of the translations found were of the Denver Developmental Screening Test. Specific methods used varied greatly across screeners, as did the level of detail with which results were reported. Conclusion Few developmental screeners have been translated into many languages. Evidence map of the authors demonstrates considerable variation in both the amount and the comprehensiveness of information available about translated instruments. Informal guidelines exist for conducting translation of psychometric instruments but not for documentation of this process. The authors propose that uniform guidelines be established for reporting translation research in peer-reviewed journals, similar to those for clinical trials and studies of diagnostic accuracy.

Resume But de l’etude Les outils d’evaluation permettant d’objectiver le niveau de controle de l’asthme etant nombreux, il est important de valider pour chacun d’entre eux leur pertinence. Nous proposons dans cette etude prospective de comparer des methodes cliniques, fonctionnelles et biologiques pour le suivi d’enfants asthmatiques connus. Methode Cent trois enfants asthmatiques âges de 5 a 18 ans suivis en consultation ont ete inclus. Chaque patient a beneficie d’un examen clinique complet, d’un test de controle de l’asthme (TCA), d’une exploration fonctionnelle respiratoire (EFR), d’une mesure de la fraction expiree en monoxyde d’azote (FeNO) et d’une prise de sang avec hemogramme et dosage de la proteine cationique des eosinophiles (ECP). Resultats Le TCA est correle significativement avec le pourcentage de patients ayant une obstruction bronchique : 18,2 % si TCA Conclusion L’evaluation objective du controle de l’asthme reste difficile et plusieurs marqueurs semblent etre necessaires. L’EFR associe au TCA permet de reperer les patients insuffisamment stabilises et la determination de la FeNO peut etre utile surtout pour le suivi individuel de l’enfant. Par contre, l’interet de l’ECP semble limite.

SummaryBackground Decreased sleep duration and altered sleep quality are risk factors for obesity in youth. Structured exercise training has been shown to increase sleep duration and improve sleep quality. Objectives This study aimed at evaluating the impact of exercise training for improving sleep duration, sleep quality and physical activity in obese adolescents (OB). Methods Twenty OB (age: 14.5 ± 1.5 years; body mass index: 34.0 ± 4.7 kg m−2) and 20 healthy-weight adolescents (HW) completed an overnight polysomnography and wore an accelerometer (SenseWear Bodymedia) for 7 days. OB participated in a 12-week supervised exercise-training programme consisting of 180 min of exercise weekly. Exercise training was a combination of aerobic exercise and resistance training. Results Sleep duration was greater in HW compared with OB (P

Introduction Cognitive change in people at risk of Alzheimer's disease (AD) such as subjective memory complainers is highly variable across individuals. Methods We used latent class growth modeling to identify distinct classes of nonlinear trajectories of cognitive change over 2 years follow-up from 265 subjective memory complainers individuals (age 70 years and older) of the INSIGHT-preAD cohort. We determined the effect of cortical amyloid load, hippocampus and basal forebrain volumes, and education on the cognitive trajectory classes. Results Latent class growth modeling identified distinct nonlinear cognitive trajectories. Education was associated with higher performing trajectories, whereas global amyloid load and basal forebrain atrophy were associated with lower performing trajectories. Discussion Distinct classes of cognitive trajectories were associated with risk and protective factors of AD. These associations support the notion that the identified cognitive trajectories reflect different risk for AD that may be useful for selecting high-risk individuals for intervention trials.

The association of hand preference (left, mixed, and right) with cognitive, academic, motor, and behavioral function was evaluated in 864 extremely preterm children at 10 years of age. Left-handed and right-handed children performed similarly but mixed-handed children had greater odds of functional deficits across domains than right-handed children.

An 8-year 8-month-old biological female who self-identifies as a boy, Ricardo is brought by his mother for a well-child check to his new pediatrician. Ricardo and his mother report that he is doing well, but have concerns about the upcoming changes associated with puberty. Ricardo states that he is particularly afraid of developing breasts. His mother asks about obtaining a referral to a specialist who can provide "hormone therapy" to delay puberty.Ricardo was adopted from Costa Rica at the age of 2 as a healthy girl named "Angela." From the age of 3, he displayed clear preference for male gender-associated clothes, toys, and games. At age 5, his mother sought care for hyperactivity and sleep problems. He was diagnosed with attention-deficit hyperactivity disorder and sleep onset disorder at age 6, and his symptoms have been well controlled with Adderall and melatonin.Ricardo lives with his parents who are accepting and supportive of his gender preference. He sees a therapist who has experience with gender dysphoria. For the past years, he has attended school as male, with the confidential support of administrators at his elementary school.

BACKGROUND Exercise training has been shown to improve cardiometabolic health in obese adolescents. OBJECTIVES Evaluate the impact of a 12-week exercise-training programme (without caloric restriction) on obese adolescents' cardiometabolic and vascular risk profiles. METHODS We measured systemic markers of oxidation, inflammation, metabolic variables and endothelial function in 20 obese adolescents (OB) (age: 14.5 ± 1.5 years; body mass index: 34.0 ± 4.7 kg m(-2) ) and 20 age- and gender-matched normal-weight adolescents (NW). Body composition was assessed by magnetic resonance imagery. Peak aerobic capacity and maximal fat oxidation were evaluated during specific incremental exercise tests. OB participated in a 12-week exercise-training programme. RESULTS OB presented lower peak aerobic capacity (24.2 ± 5.9 vs. 39.8 ± 8.3 mL kg(-1) min(-1) , P

Ni silicides used as contacts in source/drain and gate of advanced CMOS devices were analyzed by atom probe tomography (APT) at atomic scale. These measurements were performed on 45 nm nMOS after standard self-aligned silicide (salicide) process using Ni(5 at.% Pt) alloy. After the first annealing (RTA1), δ-Ni 2 Si was the only phase formed on gate and source/drain while, after the second annealing (RTA2), two different Ni silicides have been formed: NiSi on the gate and δ-Ni 2 Si on the source and drain. This difference between source/drain and gate regions in nMOS devices has been related to the Si substrate nature (poly or mono-crystalline) and to the size of the contact. In fact, NiSi seems to have difficulties to nucleate in the narrow source/drain contact on mono-crystalline Si. The results have been compared to analysis performed on 28 nm nMOS where the Pt concentration is higher (10 at.% Pt). In this case, θ-Ni 2 Si is the first phase to form after RTA1 and NiSi is then formed at the same time on source (or drain) and gate after RTA2. The absence of the formation of NiSi from δ-Ni 2 Si/Si(1 0 0) interface compared to θ-Ni 2 Si/Si(1 0 0) interface could be related to the difference of the interface energies. The redistributions of As and Pt in different silicides and interfaces were measured and discussed. In particular, it has been evidenced that Pt redistributions obtained on both 45 and 28 nm MOS transistors correspond to respective Pt distributions measured on blanket wafers.