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Asthma patients are under-represented among patients with COVID-19. Their behavior during lockdown and associated restrictions is unknown, as well as whether it was influenced by coexistent cardiovascular conditions. We conducted a cross-sectional survey in May 2020, in France, nested in ComPaRe, an e-cohort of adults with chronic diseases. A self-administered questionnaire was mailed to 10,859 people; 3701 fully completed questionnaires. The prevalence of self-reported asthma was 7%. Patients were classified in 4 categories: asthma with (n = 106) or without (n = 149) cardiovascular disease and other diseases with (n = 1186) or without (n = 2260) cardiovascular disease. Adherence to movement restrictions during the lockdown was very strong: 89% of participants reported a frequency of outings of "less than once per week" and "once or twice per week" for errands and no family-related outings during the lockdown. This proportion and frequency of outings were similar whatever the chronic disease (p = 0.122). Most patients (96%) reported a high feeling of security during the lockdown, but 95% felt anxious or depressed, with no difference by disease. As compared with patients with controlled asthma, those with uncontrolled asthma more frequently reported complaints related to deteriorated medical follow-up, waived care, anxiety or depression. Behaviors during the lockdown in France among the asthma population did not differ from patients with other chronic diseases in this cohort, which strengthens hypotheses for specific disease-related susceptibility to explain the low representation of asthmatics among COVID-19 cases. Special attention should be paid to the subgroup of patients with uncontrolled asthma during lockdowns. [ABSTRACT FROM AUTHOR]

Objective: In asthma, treatment effectiveness is strongly influenced by the quality of inhaler use. New devices such as Spiromax® have been specifically developed to improve ease of use. It is crucial to determine whether switching to such a device improves inhaler technique and clinical outcomes, and to identify factors associated with handling errors. Methods: This observational study assessed inhaler device handling errors in 1435 asthma patients recruited via 135 participating physicians in France, before and after switching therapy from the Symbicort Turbuhaler® or Seretide® Diskus® to DuoResp® Spiromax®. Patients received training in the use of their new device at baseline and were re-assessed after three months. Results: After three months of use, 67% of patients were using the DuoResp® Spiromax® with no handling errors, and 88% with no critical errors. The presence of comorbidities was associated with handling errors overall. Concurrent illness potentially affecting device handling and previous training were associated with critical device handling errors. Most patients (85.4%) preferred DuoResp® Spiromax® over their previous device. Levels of inadequately controlled or uncontrolled asthma were reduced from baseline among patients using DuoResp® Spiromax® (8.6% versus 64.6%), and were higher in patients with critical handling errors. Conclusions: Effective patient education, correct inhaler technique, treatment adherence and devices associated with high patient satisfaction are interrelated factors key to the successful delivery of inhaled asthma therapy. Inhaler technique and patient device satisfaction should be routinely assessed in treated patients with uncontrolled asthma. Supplemental data for this article can be accessed at . [ABSTRACT FROM AUTHOR]

The rapid growth of anthropogenic activities in recent decades has resulted in the appearance of numerous new chemical compounds in the environment, known as "emerging pollutants" (EPs) or "contaminants of emerging concern" (CECs). Although partially or not yet regulated or monitored, there is growing research interest in these EPs among the scientific community because of their bioaccumulation, persistence, and adverse effects. Among these, endocrine disruptors, pesticides, and pharmaceuticals can have harmful impacts on human health and the ecosystem. Conventional wastewater treatment technologies are not effective in removing these contaminants, allowing them to be released into the receiving environment. In order to improve the understanding of emerging pollutants, this review discusses the source, occurrence, and impacts of bisphenol A, atrazine, amoxicillin, and paracetamol as model molecules of emerging environmental pollutants, an issue that remains underrepresented in Morocco. Then, treatment methods for EPs are reviewed, including adsorption, advanced oxidation processes, biodegradation, and hybrid treatment. It is proposed that adsorption and photocatalysis can be used as simple, effective, and environmentally friendly technologies for their removal. Thus, we summarize some of the adsorbent and photocatalyst materials applied in recent work to control these pollutants. Towards the end of this paper, the development of inexpensive and locally available (Morocco) materials to remove these compounds from wastewater is considered. [ABSTRACT FROM AUTHOR]

The co-occurrence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) in the same patient, named the overlap syndrome (OS), was first described in 1985. Although the American Thoracic Society underlined the limited knowledge of OS, stated research priorities for this condition, and recommended a "screening" strategy to identify OSA in COPD patients with chronic stable hypercapnia, research studies on OS remain scarce. This review aims to summarize the current knowledge and perspectives related to OSA in COPD patients. OS prevalence is 1.0–3.6% in the general population, 3–66% in COPD patients, and 7–55% in OSA patients. OS patients may have worse sleep quality than those with OSA or COPD alone. Scoring hypopneas may be difficult in COPD patients; desaturation episodes may have origins in these patients, namely upper airway obstruction, hypoventilation during paradoxical sleep, ventilation/perfusion mismatches, and obesity. The apnea–hypopnea index is similar in OSA and OS patients. Desaturations may be greater and more prolonged in OS patients than in patients with COPD or OSA alone. Low body mass index, hyperinflation, and less collapsible airways reduce the risk of OSA in COPD patients. OSA is a risk factor for pulmonary hypertension in COPD patients. Whether OS increases mortality and morbidity risks compared to COPD or OSA alone remains to be confirmed. No guidelines currently recommend specific approaches to the treatment of OSA in patients with COPD. [ABSTRACT FROM AUTHOR]

Background: Triple therapy with inhaled corticosteroids/long-acting muscarinic antagonists/long-acting β2-agonists (ICS/LAMA/LABA) is recommended for patients with chronic obstructive pulmonary disease (COPD) with continued symptoms or exacerbations, despite treatment with LAMA/LABA or ICS/LABA. The pulmonary, extrathoracic, and regional lung deposition patterns of a radiolabeled ICS/LAMA/LABA triple fixed-dose combination budesonide/glycopyrrolate/formoterol fumarate (BGF 320/18/9.6 μg), delivered via a single Aerosphere metered dose inhaler (MDI) were previously assessed in healthy volunteers and showed good deposition to the central and peripheral airways (whole lung deposition: 37.7%). Here, we report the findings assessing BGF in patients with moderate-to-very severe COPD.Methods: This phase I, single-dose, open-label gamma scintigraphy imaging study (NCT03906045) was conducted in patients with moderate-to-very severe COPD. Patients received two actuations of BGF MDI (160/9/4.8 μg per actuation) radiolabeled with technetium‑99‑pertechnetate, not exceeding 5 MBq per actuation. Immediately following each inhalation, patients performed a breath-hold of up to 10 s, then exhaled into an exhalation filter. Gamma scintigraphy imaging of the anterior and posterior views of the lungs and stomach, and a lateral head and neck view, were performed immediately after exhalation. The primary objective of the study was to assess the pulmonary deposition of BGF. Secondary objectives assessed the deposited dose of radiolabeled BGF in the oropharyngeal and stomach regions, on the actuator, and on the exhalation filter in addition to regional airway deposition patterns in the lungs.Results: The mean BGF emitted dose deposited in the lungs was 32.1% (standard deviation [SD] 15.6) in patients with moderate-to-very severe COPD, 35.2% (SD 12.8) in patients with moderate COPD, and 28.7% (SD 18.4) in patients with severe/very severe COPD. Overall, the mean normalized outer/inner ratio was 0.55 (SD 0.19), while the standardized central/peripheral ratio was 2.21 (SD 1.64).Conclusions: Radiolabeled BGF 320/18/9.6 μg was efficiently delivered and deposited throughout the entire lung, including large and small airways, in patients with moderate-to-very severe COPD, with similar deposition in patients with moderate COPD and patients with severe/very severe COPD.Trial Registration: ClinicalTrials.gov, NCT03906045. Registered 8 April 2019, https://clinicaltrials.gov/ct2/show/NCT03906045. [ABSTRACT FROM AUTHOR]

Background: The observation that COPD is an independent risk factor for cardiovascular disease (CVDs) comes from comparisons between smokers with COPD and smokers without COPD. The mechanisms that explain increased risk of CVD in patients with COPD are still unclear.Objectives: The goal of this study was to assess systemic arterial stiffness (a predictor of CVD mortality) and to evaluate its determinants in a group of patients with mild to moderate COPD secondary to organic dust exposure, tobacco smoking, or both.Methods: Systemic arterial stiffness was assessed by using aortic pulse wave velocity (aPWV). Measurements were made in 142 patients with COPD and 155 healthy control subjects matched for age, sex, BMI, and tobacco smoking, exposed to tobacco smoking (n = 56/70 for COPD/control subjects, respectively), organic dusts (n = 44/48), or both (n = 42/37).Results: aPWV was higher in COPD than in healthy controls in subjects exposed to tobacco smoking and to both organic dusts and tobacco smoking. By contrast, among never smokers exposed to organic dusts, patients with COPD and matched control subjects had similar aPWV. Multivariate analysis of the 142 patients with COPD (exposed to tobacco smoking and/or to organic dusts) showed that tobacco smoking was associated with high aPWV. Moreover, soluble suppression of tumorigenicity 2, a marker of major cardiovascular events, was correlated with aPWV in these patients.Conclusions: Analysis of an unselected group of patients with COPD with different causes suggests that: (1) COPD by itself is not sufficient to explain increased aPWV; and (2) tobacco smoking is a risk factor for elevated aPWV in COPD. [ABSTRACT FROM AUTHOR]

Spasticity after spinal cord injury has considerable quality of life implications, impacts on rehabilitation efforts and necessitates long-term multi-disciplinary pharmacological and non-pharmacological management. The potassium chloride co-transporter (KCC2) plays a central role in intracellular chloride homeostasis and the inhibitory function of mature neurons. Animal studies consistently have demonstrated a downregulation of KCC2 activity after spinal cord transection, causing a shift from the inhibitory action of gamma-aminobutyric acid and glycine to an excitatory effect. Furosemide, a recognized KCC2 antagonist in animals, blocks the formation of inhibitory post-synaptic potentials in spinal motoneurons without affecting excitatory post-synaptic potentials. Based on observations in animals studies, we hypothesized that furosemide may be used to unmask KCC2 downregulation after spinal cord injury in humans, which contributes to reflex hyperexcitability. We have shown previously that furosemide reduces both pre-synaptic and post-synaptic inhibition in healthy subjects without altering monosynaptic excitatory transmission. These findings provide evidence that furosemide may be used in humans to evaluate inhibitory synapses in the spinal cord. In this present study, we show that furosemide fails to modulate both pre- and post-synaptic inhibitions relayed to soleus spinal motor neurons in persons with spinal cord injury. The lack of furosemide effect after spinal cord injury suggests KCC2 dysfunction in humans, resulting in reduced inhibitory synaptic transmission in spinal neurons. Our findings suggest that KCC2 dysfunction may be an important etiological factor in hyperreflexia after spinal cord injury. These observations may pave the way to novel therapeutic strategies against spasticity centered on chloride homeostasis. [ABSTRACT FROM AUTHOR]

Introduction: Giant-cell granuloma (GCG) is a benign tumor occurring almost exclusively in the jaws. These lesions remain rare but can sometime have an aggressive behavior. In this article, we will describe and follow two cases of GCG. Observations: The first case is a referred female patient, who presents a mandibular swelling. Its clinical and radiological aspects lead us to do a biopsy, with a histological result of GCG. The second case is a patient with a terminal kidney failure, referred for a buccal swelling in the upper left jaw. The cone-beam computed tomography X-ray shows a compartmentalized lesion with blurry limits. An excisional biopsy is performed and the histological diagnosis is a GCG. Discussion: Although the first patient suffers from no systemic disease, the second one presents a terminal kidney failure resulting in a chronic hyperparathyroidism. Hyperparathyroidism can activate osteoclastic resorption and create bone lesions such as brown tumors. Conclusion: The slow and asymptomatic growth of these lesions often result in a late diagnosis. It should be kept in mind as a differential diagnosis when dealing with an osteolytic lesion of the jaws with no clear etiology, especially if hyperparathyroidism or kidney failure is associated. [ABSTRACT FROM AUTHOR]

Background: The COPD "frequent exacerbator" phenotype is usually defined by at least two treated exacerbations per year and is associated with a huge impact on patient health. However, existence of this phenotype and corresponding thresholds still need to be formally confirmed by statistical methods analyzing exacerbation profiles with no specific a priori hypothesis. The aim of this study was to confirm the existence of the frequent exacerbator phenotype with an innovative unbiased statistical analysis of prospectively recorded exacerbations.Methods: Data from patients with COPD from the French cohort in Exacerbations of COPD Patients (EXACO) were analyzed using the KmL method designed to cluster longitudinal data and receiver operating characteristic (ROC) curve analysis to determine the best threshold to allocate patients to identified clusters. Univariate and multivariate analyses were performed to study characteristics associated with different clusters.Results: Two clusters of patients were identified based on exacerbation frequency over time, with 2.89 exacerbations per year on average in the first cluster (n = 348) and 0.71 on average in the second cluster (n = 116). The best threshold to distinguish these clusters was two moderate to severe exacerbations per year. Frequent exacerbators had more airflow limitation, symptoms, and health-related quality of life impairment. A simple clinical score was derived to help identify patients at risk of exacerbations.Conclusions: These analyses confirmed the existence and clinical relevance of a frequent exacerbator subgroup of patients with COPD and the currently used threshold to define this phenotype. [ABSTRACT FROM AUTHOR]

The number of pharmacological treatments available for COPD has increased markedly in the last years, mostly corresponding to new agents, combinations and devices within know pharmacological classes. Hierarchizing these options is not straightforward since expected effects are limited by the intrinsically fixed character of the underlying lung damage. In addition, all options have not been directly compared face-to-face. Therefore, guidelines derive from some level of subjective interpretation of the available evidence. Determining which magnitude of change can be taken as clinically relevant is complex although crucial to define long-term strategies. Similarly, estimating not only the possible benefits but also the risks of treatments at the individual level is of major importance to guide choices. In the future biomarkers may be of help in that respect. They will hopefully emerge from progresses in systems biology and medicine. Before then, prescriptions should be restricted to the appropriate treatment indications, as established by high level studies and formalized by guidelines. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines are ubiquitous and are developed to provide recommendations for the management of many diseases, including chronic obstructive pulmonary disease. The development of these guidelines is burdensome, demanding a significant investment of time and money. In Europe, the majority of countries develop their own national guidelines, despite the potential for overlap or duplication of effort. A concerted effort and consolidation of resources between countries may alleviate the resource-intensity of maintaining individual national guidelines. Despite significant resource investment into the development and maintenance of clinical practice guidelines, their implementation is suboptimal. Effective strategies of guideline dissemination must be given more consideration, to ensure adequate implementation and improved patient care management in the future. [ABSTRACT FROM AUTHOR]

Steel slag filters, if well designed and operated, may upgrade phosphorus removal in small wastewater treatment plants such as stabilization ponds and constructed wetlands. The main objective of this study was to develop a systemic modelling approach to describe changes in the hydraulic performances and internal hydrodynamics of steel slag filters under real dynamic operating conditions. The experimental retention time distribution curves (RTD curves) determined from tracer experiments performed at different times during the first year of operation of two field-scale steel slag filters were analyzed through a three stage process. First, a statistical analysis of the RTD curves was performed to determine statistical parameters of the retention time distribution. Second, classical tanks in series (TIS) and plug flow with dispersion (PFD) models were used to obtain a first evaluation of the dispersion and mixing regime. Finally, a multi-flow path TIS model, based on the assumption of several flow paths with different hydraulic properties, is proposed to accurately describe the internal hydrodynamics. Overall, the results of this study indicate that higher CaO content, round shape, and larger grain size distribution of steel slag may promote plug-like flow rather than dispersion. The results of the multi-flow path TIS model suggest that the internal hydrodynamics of steel slag filters can be primarily described by two main flow paths: (i) a faster main flow path showing higher plug flow, followed by (ii) a slower secondary flow path showing higher dispersion. The results also showed that internal hydrodynamics may change over time as a consequence of physical-chemical phenomena occurring in the filter, including accumulation of precipitates, slag hydration and carbonation, and particle segregation. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare energy expenditure (EE) predicted by accelerometery (EEAcc) with indirect calorimetry (EEMETA) in individuals with hemiparesis. Methods: Twenty-four participants (12 with stroke and 12 healthy controls) performed a six-minute walk test (6MWT) during which EEMETA was measured using a portable indirect calorimetry system and EEACC was calculated using Bouten's equation (1993) with data from a three-axis accelerometer positioned between L3 and L4. Results: The median EEMETA was 9.85 [8.18;11.89] W·kg−1 in the stroke group and 5.0 [4.56;5.46] W·kg−1 in the control group. The median EEACC was 8.57 [7.86;11.24] W·kg−1 in the control group and 8.2 [7.05;9.56] W·kg−1 in the stroke group. The EEACC and EEMETA were not significantly correlated in either the control (p = 0.8) or the stroke groups (p = 0.06). The Bland–Altman method showed a mean difference of 1.77 ± 3.65 W·kg−1 between the EEACC and EEMETA in the stroke group and −2.08 ± 1.59 W·kg−1 in the controls. Conclusions: The accuracy of the predicted EE, based on the accelerometer and the equations proposed by Bouten et al., was low in individuals with hemiparesis and impaired gait. This combination (sensor and Bouten's equation) is not yet suitable for use as a stand-alone measure in clinical practice for the evaluation of hemiparetic patients. [ABSTRACT FROM AUTHOR]

Purpose:To determine whether activation of the frequency of use and automatic learning parameters of word prediction software has an impact on text input speed. Methods:Forty-five participants with cervical spinal cord injury between C4 and C8 Asia A or B accepted to participate to this study. Participants were separated in two groups: a high lesion group for participants with lesion level is at or above C5 Asia AIS A or B and a low lesion group for participants with lesion is between C6 and C8 Asia AIS A or B. A single evaluation session was carried out for each participant. Text input speed was evaluated during three copying tasks: • without word prediction software (WITHOUT condition) • with automatic learning of words and frequency of use deactivated (NOT_ACTIV condition) • with automatic learning of words and frequency of use activated (ACTIV condition) Results:Text input speed was significantly higher in the WITHOUT than the NOT_ACTIV (p< 0.001) or ACTIV conditions (p = 0.02) for participants with low lesions. Text input speed was significantly higher in the ACTIV than in the NOT_ACTIV (p = 0.002) or WITHOUT (p < 0.001) conditions for participants with high lesions. Conclusions:Use of word prediction software with the activation of frequency of use and automatic learning increased text input speed in participants with high-level tetraplegia. For participants with low-level tetraplegia, the use of word prediction software with frequency of use and automatic learning activated only decreased the number of errors.Implications in rehabilitation  Access to technology can be difficult for persons with disabilities such as cervical spinal cord injury (SCI). Several methods have been developed to increase text input speed such as word prediction software.This study show that parameter of word prediction software (frequency of use) affected text input speed in persons with cervical SCI and differed according to the level of the lesion.• For persons with high-level lesion, our results suggest that this parameter must be activated so that text input speed is increased.• For persons with low lesion group, this parameter must be activated so that the numbers of errors are decreased.• In all cases, the activation of the parameter of frequency of use is essential in order to improve the efficiency of the word prediction software.• Health-related professionals should use these results in their clinical practice for better results and therefore better patients ‘satisfaction. [ABSTRACT FROM AUTHOR]

This correspondence comments on the correlation between measured and simulated charge collection in two diode structures presented in [1]. In [1], results from pulsed-laser-induced charge deposition via two-photon absorption revealed reasonable correlation between experimental data and simulations in some aspects but showed lack of correlation in terms of the measured and predicted magnitudes of the collected charge. The source of this poor agreement has recently been determined, and is attributed to an incorrect pulse energy calibration used for those experiments. With the proper energy calibration applied, the agreement between simulation and experiment is nearly quantitative for all observables in both devices. These results significantly strengthen the validity of the nonlinear optical beam propagation method numerical approach for accurately predicting pulsed-laser-induced charge deposition. [ABSTRACT FROM PUBLISHER]

This article reports on discussions at the 2015 workshop cosponsored by the International Pharmaceutical Aerosol Consortium on Regulation and Science (IPAC-RS) and the International Society for Aerosols in Medicine (ISAM), entitled 'Regulatory and Patient Considerations for Inhalation Device Design, Development and Use.' Key topics addressed at the workshop and presented here include patient-focused device design for orally inhaled products (OIPs), instructions for use (IFU), human factors, regulatory considerations in the United States and Europe, development of generic inhalers, quality-by-design, and change management of OIP devices. Workshop participants also identified several areas for further consideration and emphasized the need for increased focus on the patient to create therapeutic products (inclusive of device design, IFU, education, training) that support adherence with an individual patient's treatment regimen. Advances in patient-centric product development will require engagement and collaboration by industry, regulators, patients, physicians, and other stakeholders. The article includes summaries of presented talks as well as of panel and audience discussions. [ABSTRACT FROM AUTHOR]

The propagation of Analog Single Event Transients (ASETs) to multiple outputs of Bipolar Junction Transistor (BJTs) Integrated Circuits (ICs) is reported for the first time. The results demonstrate that ASETs can appear at several outputs of a BJT amplifier or comparator as a result of a single ion or single laser pulse strike at a single physical location on the chip of a large-scale integrated BJT analog circuit. This is independent of interconnect cross-talk or charge-sharing effects. Laser experiments, together with SPICE simulations and analysis of the ASET’s propagation in the s-domain are used to explain how multiple-output transients (MOTs) are generated and propagate in the device. This study demonstrates that both the charge collection associated with an ASET and the ASET’s shape, commonly used to characterize the propagation of SETs in devices and systems, are unable to explain quantitatively how MOTs propagate through an integrated analog circuit. The analysis methodology adopted here involves combining the Fourier transform of the propagating signal and the current-source transfer function in the s-domain. This approach reveals the mechanisms involved in the transient signal propagation from its point of generation to one or more outputs without the signal following a continuous interconnect path. [ABSTRACT FROM PUBLISHER]

Carrier injection by single-photon absorption using ultraviolet optical pulses is used to investigate single-event transients in pristine and proton-irradiated AlGaN/GaN HEMTs. High-precision spatial mapping of defects and traps in AlGaN/GaN HEMT devices identify regions of enhanced SET signals, or “hot spots” that are ascribed to the presence of lattice defects that modify the electric field in the structure. The resulting transient shape and amplitude depend strongly on the specific location of the injected carriers, and vary with changes in gate and drain bias. Proton irradiation significantly alters transient signal shapes, increases the integrated collected charge, and increases density of defects and traps. [ABSTRACT FROM PUBLISHER]

Pressurized metered-dose inhalers (pMDIs) are sometimes viewed as old-fashioned and as having been superseded by dry powder inhalers (DPIs). Here, we review the technological advances that characterize modern pMDIs, and consider how they can influence the effectiveness of drug delivery for patients with asthma and chronic obstructive pulmonary disease. Compared with old chlorofluorocarbon (CFC)-based inhalers, many hydrofluoroalkane (HFA)-driven pMDIs have more favorable plume characteristics such as a reduced velocity and a higher fine particle fraction; together, these advances have resulted in the development of pMDIs with reduced oropharyngeal deposition and increased lung deposition. In addition, the plume from many HFApMDIs is warmer, which may facilitate their use by patients; moreover, devices are equipped with dose counters, which improves their reliability. As well as reviewing the technological advances of pMDIs, we also discuss the importance of individualizing inhaler therapies to each patient by accounting for their personal preferences and natural breathing patterns. Because pMDIs and DPIs differ considerably in their handling characteristics, matching the right inhaler to the right patient is key to ensuring effective therapy and good compliance. Finally, the majority of patients can be trained successfully in the correct use of their pMDI; training and regular monitoring of inhalation technique are essential prerequisites for effective therapy. While the 'ideal inhaler' may not exist, pMDIs are an effective device option suitable for many patients. pMDIs, together with other types of devices, offer opportunities for the effective individualization of treatments. [ABSTRACT FROM AUTHOR]

Introduction: Data from different healthcare systems on relative cost-effectiveness of asthma step-up therapy strategies are required to inform decision-makers and clinicians. Our objective was to compare cost-effectiveness from the United Kingdom National Health Service perspective of three step-up strategies for patients with asthma uncontrolled by inhaled corticosteroid (ICS) monotherapy. Methods: This was a historical matched cohort cost-effectiveness analysis of anonymized medical records for patients with asthma of age 12-80 years. We conducted two-way comparisons of step-up therapy using increased dose (≥50%) of extrafine-particle ICS or add-on long-acting β-agonist (LABA) via fixed-dose combination (FDC) ICS/LABA inhaler or via separate inhaler. The incremental cost-effectiveness ratio (ICER) was calculated using asthma-related direct costs during one outcome year and a composite measure of risk-domain asthma control (no asthma-related hospital attendance, acute oral corticosteroids, or consultation for lower respiratory tract infection). Results: Patients prescribed ICS dose step-up ( n = 3036) had significantly lower baseline-adjusted, mean asthma-related healthcare costs during the outcome year than those prescribed FDC ICS/LABA ( n = 3036; mean difference, £124/year). ICS dose step-up had 56% probability of being less costly and marginally less effective (a trade-off), with ICER of £51,449 per additional patient controlled with FDC; and ICS dose step-up had 44% probability of being the preferred treatment strategy (less costly and more effective). In a second comparison, ICS step-up ( n = 3232) had 100% probability of being cheaper and more effective than adding LABA to ICS via separate inhalers ( n = 6464). Conclusion: For asthma step-up therapy, increasing ICS dose using extrafine-particle ICS is significantly less costly from the payer perspective and marginally (non-significantly) less effective than FDC ICS/LABA therapy containing standard fine-particle ICS. These findings apply primarily to the UK healthcare system but warrant consideration when developing guidelines in settings with strong economic constraints. Trial Registration: ClinicalTrials.gov identifier: NCT01697722. Funding: Teva Pharmaceuticals Limited, Petach Tikva, Israel. [ABSTRACT FROM AUTHOR]

Background: The Timed Up and Go (TUG) test is widely used to assess locomotion in patients with stroke and is considered to predict the risk of falls. The analysis of locomotor trajectories during the TUG appears pertinent in stroke patients. The aims of this study were i) to analyze locomotor trajectories in patients with stroke during the walking and turning sub-tasks of the TUG, and to compare them with healthy subjects, ii) to determine whether trajectory parameters provide additional information to that provided by the conventional measure (performance time), iii) to compare the trajectory parameters of fallers and non-fallers with stroke and of patients with right and left hemisphere stroke, and iv) to evaluate correlations between trajectory parameters and Berg Balance Scale scores. Methods: 29 patients with stroke (mean age 54.2±12.2 years, 18 men, 8 fallers) and 25 healthy subjects (mean age 51.6±8.7 years, 11 men) underwent three-dimensional analysis of the TUG. The trajectory of the center of mass was analyzed by calculation of the global trajectory length, Hausdorff distance and Dynamic Time Warping. The parameters were compared with a reference trajectory during the total task and each sub-task (Go, Turn, Return) of the TUG. Results: Values of trajectory parameters were significantly higher for the stroke group during the total TUG and the Go and Turn sub-tasks (p<0.05). Moreover, logistic regression indicated that these parameters better discriminated stroke patients and healthy subjects than the conventional timed performance during the Go sub-task. In addition, fallers were distinguished by higher Dynamic Time Warping during the Go (p<0.05). There were no differences between patients with right and left hemisphere stroke. Discussion and Conclusion: The trajectories of the stroke patients were longer and more deviated during the turn and the preceding phase. Trajectory parameters provided additional information to timed performance of this locomotor task. Focusing rehabilitation programs on lead-up to turn and turning could be relevant for stroke patients since the Turn was related to the balance and the phase preceding the turn seemed to distinguish fallers. [ABSTRACT FROM AUTHOR]

Objective: Current asthma guidelines recommend use of inhaled corticosteroids (ICS) in patients with persistent disease. This study was designed to investigate (1) the proportion of patients prescribed ICS-containing maintenance treatment who achieve asthma control, (2) determinants of control and (3) how physicians adapt treatment to the level of control.Methods: General practitioners (GPs) and chest physicians (CPs) in France recruited patients consulting for asthma and prescribed an ICS. Over a 2-year follow-up period, asthma symptoms in the previous 3 months and treatments prescribed were documented at each visit. Variables independently associated with asthma control were determined by multiple logistic regression.Results: Data were available for 924 patients recruited by GPs and 455 recruited by CPs. Asthma control was acceptable in only 24% of patients at inclusion, and in 33.6% at the last follow-up visit. Five factors were independently associated with asthma control: age (or time since diagnosis), gender, smoking status, allergic aetiology of asthma and treatment. Most patients (56.3%) were prescribed the same ICS dose regimen at the end of follow-up as at inclusion. The intensity of controller therapy had been increased in only 12.2% of patients unacceptably controlled at inclusion.Conclusions: Asthma was unacceptably controlled in most patients receiving ICS-containing maintenance treatment and remained so during follow-up. Despite this, treatment adaptations by GPs and CPs were very infrequent. This unsatisfactory situation may be improved by adopting a more dynamic approach to tailoring controller therapy to the needs of the patient. [ABSTRACT FROM AUTHOR]

Carrier-density distributions generated via two-photon absorption from pulsed laser excitation are simulated using nonlinear-optical beam propagation software. These simulated carrier-density distributions are used to calculate depth profiles of the integrated collected charge using a rectangular-parallel-piped approach for two silicon diodes of different structure. Using a set of proposed correlation metrics, the resulting simulated charge collection profiles are found to exhibit good agreement with measured transient charge-collection data for most, but not all of the metrics. The physical phenomena underlying the correlation metrics are discussed in detail. The remaining discrepancies that exist between the simulated and experimental results are addressed and their potential causes are detailed. [ABSTRACT FROM PUBLISHER]

Charge-collection experiments and simulations designed to quantify the effects of reflections from metallization during through-wafer TPA testing are presented. The results reveal a strong dependence on metal line width and metal line position inside the SiO2 overlayer. The charge-collection enhancement is largest for the widest metal lines and the metal lines closest to the Si/SiO2 interface. The charge-collection enhancement is also dependent on incident laser pulse energy, an effect that is a consequence of higher-order optical nonlinearities induced by the ultrashort optical pulses. However, for the lines further away from the Si/SiO2 interface, variations in laser pulse energies affect the charge-collection enhancement to a lesser degree. Z-scan measurements reveal that the peak charge collection occurs when the axial position of the laser focal point is inside the Si substrate. There is a downward trend in peak collected-charge enhancement with the increase in laser pulse energies for the metal lines further away from the Si/SiO2 interface. Metallization enhances the collected charge by same amount regardless of the applied bias voltage. For thinner metal lines and laser pulse energies lower than 1 nJ, the collected charge enhancement due to metallization is negligible. [ABSTRACT FROM PUBLISHER]

Circuit parameters and configuration are very important when studying the synergistic effects total dose/SET. We explore a method combining dynamic parameter measurement and spectrum analysis which lead to a better understanding of this complex phenomenon. In this paper symbolic circuit analysis is used to obtain the relationship between input, output and noise injection due to photocurrent generation in the form of a rational function using symbolic variables in the complex frequency domain. This simulation technique was able to predict the impact of (i) total dose level, (ii) circuit parameters, and (iii) the injected energy on the ASET shapes. Basic mechanisms as field collapse and collection efficiency were also predicted and assessed. [ABSTRACT FROM PUBLISHER]

In this work, a multi-objective dynamic optimization of the operating strategy of a small-size wastewater treatment plant is carried out. In-situ incineration of the excess sludge produced for electricity production is investigated in order to reduce the operating costs. The trade-offs between the treatment quality and the operating costs are characterized. Compared to the literature, emphasis is put on a more rigorous formulation of the problem and an accurate modeling of the underlying phenomena so as to get physically relevant solutions. Thus, from a mathematical perspective, the problem is formulated so that the solution is less sensitive to the – arbitrarily chosen – plant initial conditions. Modeling of physical phenomena e.g. the detrimental effect of the concentration of suspended solids in the mixed liquor, on oxygen transfer rate, has been included in the model. Several constraints are added to the problem so as to maintain the optimal solutions within the limits of validity of the mathematical model. The results provided a clear picture about the trade-offs between the treatment quality and the exploitation costs. Sludge incineration was shown to be of a high energetic profit, but it does not allow the plant to be electrically autonomous. [ABSTRACT FROM AUTHOR]

A pulsed-laser dosimetry approach for two-photon absorption (TPA) single-event effects (SEE) measurements is presented. Development and implementation of three online beam monitors is described. The beam monitors permit characterization of the primary laser beam parameters of interest: the pulse energy delivered to the device under test, the pulse duration, and the focused laser spot size. A direct consequence of this methodology is the ability to monitor continuously the operating point of the TPA SEE pulsed-laser beamline and to make the necessary adjustments when parameters drift, either during an experiment or between experiments. [ABSTRACT FROM PUBLISHER]

Purpose: In the management of adults with cerebral palsy (CP), one of the goals is to monitor and prevent spasticity-related deteriorations in gait. Botulinum Toxin Injections (BTI) are commonly used to treat this spasticity in these patients. The purpose of this study was to evaluate (i) the effect of multi-site BTI on gait patterns in adults with CP and (ii) to determine if these modifications could be detected by the Gait Deviation Index (GDI). Method: Spontaneous-velocity gait was recorded using 3D gait analysis before and 1 month after multi-site BTI in lower limb muscles. Spatiotemporal parameters (STP), kinematic parameters (KP) and the GDI were computed. Results: Post BTI, stride length, peak hip flexion and peak knee flexion during Swing Phase (SW) were significantly increased while the GDI was not significantly modified. Conclusion: A single multi-site BTI improved STP and KP of adults with CP but the GDI was not sensitive enough to detect these changes. [ABSTRACT FROM AUTHOR]

Background: The use of a severity score to help orientation decisions could improve the efficiency of care for acute exacerbations of COPD (AECOPD). We previously developed a score ('2008 score', based on age, dyspnea grade at steady state and number of clinical signs of severity) predicting in-hospital mortality in patients with AECOPD visiting emergency departments (EDs). External validity of this score remained to be assessed. Objectives: To test the predictive properties of the '2008 score' in a population of patients hospitalized in medical respiratory wards for AECOPD, and determine whether a new score specifically derived from this population would differ from the previous score in terms of components or predictive performance. Methods: Data from a cohort study in 1824 patients hospitalized in a medical ward for an AECOPD were analyzed. Patients were categorized using the 2008 score and its predictive characteristics for in-hospital mortality rates were assessed. A new score was developed using multivariate logistic regression modeling in a randomly selected derivation population sample followed by testing in the remaining population (validation sample). Robustness of results was assessed by case-by-case validation. Results: The 2008 score was characterized by a c-statistic at 0.77, a sensitivity of 69% and a specificity of 76% for prediction of in-hospital mortality. The new score comprised the same variables plus major cardiac comorbidities and was characterized by a c-statistic of 0.78, a sensitivity of 77% and specificity of 66%. Conclusions: A score using simple clinical variables has robust properties for predicting the risk of in-hospital death in patients hospitalized for AECOPD. Adding cardiac comorbidities to the original score increased its sensitivity while decreasing its specificity. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of this study was to assess the effects of neuromuscular fatigue on stretch reflex-related torque and electromyographic activity of spastic knee extensor muscles in hemiplegic patients. The second aim was to characterize the time course of quadriceps muscle fatigue during repetitive concentric contractions. Methods: Eighteen patients performed passive, isometric and concentric isokinetic evaluations before and after a fatigue protocol using an isokinetic dynamometer. Voluntary strength and spasticity were evaluated following the simultaneous recording of torque and electromyographic activity of rectus femoris (RF), vastus lateralis (VL) and biceps femoris (BF). Results: Isometric knee extension torque and the root mean square (RMS) value of VL decreased in the fatigued state. During the fatigue protocol, the normalized peak torque decreased whereas the RMS of RF and BF increased between the first five and last five contractions. There was a linear decrease in the neuromuscular efficiency-repetitions relationships for RF and VL. The peak resistive torque and the normalized RMS of RF and VL during passive stretching movements were not modified by the fatigue protocol for any stretch velocity. Discussion: This study showed that localized quadriceps muscle fatigue caused a decrease in voluntary strength which did not modify spasticity intensity. Changes in the distribution of muscle fiber type, with a greater number of slow fibers on the paretic side, may explain why the stretch reflex was not affected by fatigue. [Copyright &y& Elsevier]

The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients. [ABSTRACT FROM AUTHOR]

Highlights: [•] This study assessed for the first time the gait pattern of adults with CP. [•] It showed that five different gait patterns can be identified. [•] Each gait pattern identified was related to specific kinematic parameters. [•] These specific kinematic parameters can be easily checked in clinical practice. [•] Results may permit to follow changes throughout growth, aging or after treatments. [ABSTRACT FROM AUTHOR]

This research examined the prevalence of morning symptoms and their relationship with health status, exacerbations and daily activity in patients with chronic obstructive pulmonary disease (COPD). Data on 1489 patients were analysed from a European and USA sample. Results were tested for significance ( p < 0.05) using Mann-Whitney and regression modelling accounting for age, gender, body mass index, comorbidities, symptom severity, smoking status and medication adherence. Morning symptoms were experienced by 39.8% of patients. Controlling for potential confounders, morning symptoms were significantly associated with higher COPD assessment test scores ( p < 0.001) and exacerbation frequency ( p < 0.001), more frequent worsening of symptoms without consulting a Health Care Professional ( p = 0.008), and increased impact on normal daily activities ( p = 0.007); and in the working population, a significantly greater impact on getting up and ready for the day ( p < 0.001) and significantly more days off work per year ( p < 0.001). Our research concluded that in patients with COPD, morning symptoms are associated with poorer health status, impaired daily activities and increased risk of exacerbation in affected patients compared with those patients without morning symptoms. Improved control of patients' morning symptoms may lead to substantial reduction in COPD impact and frequency of exacerbations, and enable patients to increase daily activities, particularly early morning activities. This could, in turn, enable working patients with COPD to be more productive in the workplace. [ABSTRACT FROM AUTHOR]

Highlights: [•] Effects of tDCS on diaphragm's corticospinal pathways are documented by this study. [•] Anodal or cathodal tDCS reduced excitability of diaphragm's corticospinal pathways. [•] Effects of tDCS on the diaphragm differ from those on the limb muscles. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) symptoms in the morning, including dyspnea and sputum production, affect patients' quality of life and limit their ability to carry out even simple morning activities. It is now emerging that these symptoms are associated with increased risk of exacerbations and work absenteeism, suggesting that they have a more profound impact on patients than previously thought. The development of validated patient-reported outcome (PRO) questionnaires to capture patients' experience of COPD symptoms in the morning is, therefore, vital for establishing effective and comprehensive management strategies. Although it is well established that long-acting bronchodilators are effective in improving COPD symptoms, the limited available data on their impact on morning symptoms and activities have been obtained with non-validated PRO questionnaires. In this review, we discuss the impact of COPD symptoms in the morning and available tools used to evaluate them, and highlight specific gaps that need to be addressed to develop standardized instruments able to meet regulatory requirement. We also present available evidence on the effect of pharmacological therapies on morning symptoms. [ABSTRACT FROM AUTHOR]

The impact of the positive feedback loop on analog single event transient (ASET) shapes was investigated for a comparator-with-hysteresis circuit. Simulation based on previous developed ASET simulation tool is used to model the impact of the power supply voltage, the input voltage level and the injected energy. Simulation results show that these kinds of circuits are sensitive to flip-flop effects. This phenomenon occurs if the input voltage is in the hysteresis band range. In this case, simulations show that the ASET can latch the output into a non-desired state by changing the state of the circuit on his transfer characteristic curves. Laser experiments were conducted and show that the simulation outputs are in agreement with the experimental collected data. [ABSTRACT FROM AUTHOR]

The impact of the positive feedback loop on analog single event transient (ASET) shapes was investigated for a comparator-with-hysteresis circuit. Simulation based on previous developed ASET simulation tool is used to model the impact of the power supply voltage, the input voltage level and the injected energy. Simulation results show that these kinds of circuits are sensitive to flip-flop effects. This phenomenon occurs if the input voltage is in the hysteresis band range. In this case, simulations show that the ASET can latch the output into a non-desired state by changing the state of the circuit on his transfer characteristic curves. Laser experiments were conducted and show that the simulation outputs are in agreement with the experimental collected data. [ABSTRACT FROM PUBLISHER]

In addition to changes in spatio-temporal and kinematic parameters, patients with stroke exhibit fear of falling as well as fatigability during gait. These changes could compromise interpretation of data from gait analysis. The aim of this study was to determine if the gait of hemiplegic patients changes significantly over successive gait trials. Forty two stroke patients and twenty healthy subjects performed 9 gait trials during a gait analysis session. The mean and variability of spatio-temporal and kinematic joint parameters were analyzed during 3 groups of consecutive gait trials (1–3, 4–6 and 7–9). Principal component analysis was used to reduce the number of variables from the joint kinematic waveforms and to identify the parts of the gait cycle which changed during the gait analysis session. The results showed that i) spontaneous gait velocity and the other spatio-temporal parameters significantly increased, and ii) gait variability decreased, over the last 6 gait trials compared to the first 3, for hemiplegic patients but not healthy subjects. Principal component analysis revealed changes in the sagittal waveforms of the hip, knee and ankle for hemiplegic patients after the first 3 gait trials. These results suggest that at the beginning of the gait analysis session, stroke patients exhibited phase of adaptation,characterized by a “cautious gait” but no fatigue was observed. [ABSTRACT FROM AUTHOR]

Introduction: Few data are available about pediatric cardiovascular disease (CVD) in the Horn of Africa. The objective of this study was to describe the spectrum of CVD in children in Djibouti. Methods: Clinical features and management of Djiboutian children between 1 month-old and 15 year-old with CVD were prospectively recorded over a two-year period in Bouffard Military Hospital in Djibouti (January 2009- December 2010). Results: Clinical examination and echocardiography were performed on 156 patients: 32 of them (20 %) had CVD. Three (10%) of them had Down's syndrome. The median age was 5 years (male 53%). Congenital heart disease was observed in 27 (84%) patients and dilated cardiomyopathy (DCM) in 5 (16%) patients including 2 patients with rheumatic valvular disease. Ventricular septal defect was frequent (28%). Other abnormalities were atrial septal defect (13%), Tetralogy of Fallot (9%), pulmonary stenosis (6%) and 3 other patients had multiple congenital anomalies condition. Surgical management was required in 22 (69%) patients and was performed on 15 (47%) cases. During follow up (mean 11.3 ± 6.8 months), 5 (16%) patients died. Absence of surgery was associated with significant mortality (p > 0.05) but age, sex and mean follow up were not. Conclusion: Pediatric CVD is at least as common in this Djiboutian community as in other African cohorts. The absence of surgery was a major mortality risk factor. DCM was frequent in this study. Much work remains to be done to discover the size and nature of genetic and environmental contributions to these various forms of heart diseases in the Horn of Africa. [ABSTRACT FROM AUTHOR]

Analog Single Event Transients (ASETs) in two different shunt voltage references used in power management systems are investigated. Little has been published regarding how the dynamic parameter changes induced by external circuit design, such as time constant, damping coefficient or natural frequency affect ASET shapes. Modifications of the dynamic parameters of the circuit are measured by step response measurement. A correlation between dynamic parameters and ASET laser testing results is proposed. This study establishes the correlation between the dynamic parameters of a shunt voltage reference and ASET parameters such as pulse duration, and positive and negative amplitude. [ABSTRACT FROM AUTHOR]

Abstract: Adequate grip force modulation is critical to manual dexterity and often impaired in hemiparetic stroke patients. Previous studies in hemiparetic patients suggest that aspects of grip force control may be differently affected by the lesion. We developed a visuomotor power grip force-tracking task allowing quantification of tracking error, force variability and release duration. We investigated force control in 24 chronic stroke patients with varying severity of hemiparesis and in healthy control subjects. Force tracking was performed at 10, 20, and 30% maximal voluntary contraction (MVC). Control subjects were also tested at absolute force levels similar to those of the patients. Patients tracking with their paretic hand at similar relative (%MVC) grip force levels showed increased error, force variability and release duration, but surprisingly, there was no difference in tracking error or variability between patients and control subjects performing at similar absolute force levels. Furthermore, patients improved their tracking performance across repeated blocks similar to control subjects. Release duration, however, was increased (also in the non-paretic hand), was force-independent and did not correlate with MVC strength. Of the three performance measures, only release duration explained some of the variance in arm and hand function (Frenchay Arm Test score), independent of MVC strength. The findings show (i) that hemiparetic stroke patients preserve the ability to modulate (generate and maintain) power grip force within their limited force range and (ii) that MVC grip strength and duration of grip release are differently affected and are two complementary predictors of arm function after stroke. [Copyright &y& Elsevier]

Following stroke, control of both the contralesional (paretic) and ipsilesional (less affected) arms is altered. The purpose of this study was to analyse the consequences of stroke on joint rotations of both shoulder girdles, that is, glenohumeral (GH) and scapula motion. Because of hemispheric specialization, we hypothesized that changes would relate to the side of hemisphere damage. Nine stroke patients with left, and 9 with right hemisphere damage (LHD and RHD) and 9 healthy subjects were included. Reaching movements to targets positioned close, far and high in three directions were recorded using an electromagnetic system. Initial and final postures of the scapula, GH and elbow joint were evaluated. Inter-joint rotations throughout the movements were analysed using principal component analysis (PCA). The main finding was that initial and final postures of the contralesional and ipsilesional shoulders differed depending on the side of brain lesion. On the contralesional side, there was less scapula protraction and GH lateral rotation for both groups. Scapula tilt was less anterior in LHD patients, and GH elevation was greater in RHD patients. On the ipsilesional side, GH lateral rotation was reduced in both groups, and scapula protraction was reduced only for LHD patients. PCA confirmed that postures of both shoulders of the LHD group were substantially different to the healthy subjects, while only the contralesional arm of the RHD subjects differed. These results add to existing knowledge of hemispheric specialization, suggesting that the left hemisphere plays a greater role in bilateral joint postures than the right hemisphere. [ABSTRACT FROM AUTHOR]

The Synergistic effect between Total Ionizing Dose (TID) and Analog Transient Radiation Effects in Electronics (ATREE) in an operational amplifier (LM124) is investigated. A predictive methodology, based on a previously developed ATREEs simulation tool, is used to model the synergistic phenomena. This phenomenon is simulated for the first time and the duration of the ATREEs' is found to be identical to those measured experimentally. ATREEs induced by high dose-rate X-ray pulses are investigated using a flash X-ray facility. The ATREEs induced in the LM124 operational amplifier configured in three different bias configurations are investigated and simulated. [ABSTRACT FROM PUBLISHER]

Introduction: An association between HIV infection and chronic obstructive pulmonary disease (COPD) has been observed in several studies. Objective and methods: we conducted a review of the literature linking HIV infection to COPD, focusing on clinical and epidemiological data published before and during widespread highly active antiretroviral therapy (HAART). Results: Interactions between HIV infection and COPD appear to be influenced by multiple factors. In particular, the bronchopulmonary tract can be damaged by HIV infection, the immunodeficiency it induces, and the resulting increase in the risk of pulmonary infections. In addition, the prevalence of smoking and intravenous drug use is higher in HIV-infected populations, also increasing the risk of COPD. Before the advent of HAART, respiratory tract infections probably played a major role. Since the late 1990s and the widespread use of HAART, the frequency of opportunistic infections has fallen but new complications have emerged as life expectancy has increased. Conclusion: given the high prevalence of smoking among HIV-infected patients, COPD may contribute significantly to morbidity and mortality in this setting. [ABSTRACT FROM AUTHOR]

The Synergistic effect between TID and ATREEs (Analog Transient Radiation Effects on Electronics) in an operational amplifier (opamp) (LM124) is investigated for three different bias configurations. An accelerated irradiation technique is used to study these synergistic effects. The impact of TID on ATREEs is found to be identical regardless of whether the irradiation is performed at low dose rate or whether the dose rate is switched from high to low using the Dose Rate Switching (DRS) technique. The correlation between the deviations of the opamp's electrical parameters and the changes of ATREE widths is clearly established. [ABSTRACT FROM AUTHOR]

Analog Transient Radiation Effects in Electronics (ATREE) induced by high dose-rate X-ray pulses are investigated using a flash X-ray facility. The ATREEs induced in a LM124 operational amplifier configured in three different bias configurations are investigated. A predictive methodology, based upon a previously developed ASET simulation tool, is used to model the ATREE phenomena. A semiempirical physical model is used to perform the correlation between the duration of the parasitic pulse signal induced in the LM124 and an equivalent value of the high dose-rate X-ray pulse level. [ABSTRACT FROM AUTHOR]

A high level model is developed using circuit analysis to predict the synergy effect observed on a three stages operational amplifier. This model makes possible to explain and to predict the analog single event transients propagation in circuitry. The effect of total ionizing dose is taken into account by varying the model parameters using the monitoring of the usual supply current induced degradation of the operational amplifier. [ABSTRACT FROM AUTHOR]

Many studies have investigated the changes of spinal neuronal networks in patients with cortico-subcortical or spinal lesions occurring during adulthood. In contrast, little is known about modifications of transmission within spinal networks implied in motor control for patients suffering from perinatal lesions. In the present series of experiments, we have investigated, in adult patients with cerebral palsy who suffered cerebral damage in the perinatal period, the efficacy of transmission within four spinal networks known for exhibiting pathophysiological changes following a central nervous system lesion occurring in adulthood. These are presynaptic Ia inhibition, post-activation depression, disynaptic reciprocal Ia inhibition and propriospinally-mediated Group I and Group II facilitations. In 28 patients with cerebral palsy and 35 age-matched healthy subjects we were able to show that: (i) disynaptic reciprocal Ia inhibition is intact in patients with cerebral palsy; (ii) both presynaptic Ia inhibition and post-activation depression are impaired in patients with cerebral palsy; and (iii) propriospinally-mediated Group I facilitation is undamaged in patients with cerebral palsy, whereas Group II facilitation is strongly enhanced. Only diminished post-activation depression was highly correlated to the severity of spasticity. Differences in the spinal transmission between patients with cerebral palsy and patients who suffered neuronal damage in adulthood are discussed. [ABSTRACT FROM PUBLISHER]