The Olfactory Cleft Endoscopy Scale: a multi-institutional validation study in chronic rhinosinusitis.

BACKGROUND: Olfactory dysfunction (OD) associated with chronic rhinosinusitis (CRS) remains quite challenging. Instruments to precisely assess olfactory cleft anatomy and their association with olfaction are needed. METHODS: The olfactory cleft endoscopy scale (OCES) was used to assess the olfactory cleft in healthy control subjects and a cohort of patients with CRS. Psychophysical and psychosocial olfactory function were assessed and correlations with OCES scores were measured. RESULTS: Control subjects and subjects with CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP) were enrol- led. OCES correlated with both psychophysical and psychosocial olfaction, as measured by threshold, discrimination and identi- fication (TDI) scores and Questionnaire on Olfactory Disorders (QOD-NS) scores for all case and control subjects combined. OCES improved in both CRS groups postoperatively with the highest correlation seen in postoperative olfaction in CRSwNP patients. CRS patients who achieve near perfect OCES and sinus endoscopy scores after surgery have olfactory metrics that are indistin- guishable from controls regardless of polyp status. CONCLUSIONS: The OCES is a valid olfactory-specific measure that demonstrates strong validity and provides complimentary infor- mation to traditional sinus endoscopy to aid in our understanding of OD associated with CRS.

Lack of impact of radiologic septal measurements upon patient symptoms and performance of septoplasty during endoscopic sinus surgery.

BACKGROUND: Recent literature suggests that concurrent septoplasty during endoscopic sinus surgery (ESS) improves patient outcomes, however, the underlying indications for performing concurrent septoplasty are unknown. The objective of this study was to investigate the relationship between objective radiologic measures of nasal septal deviation with preoperative patient symptomatology and measures of CRS disease severity. We also sought to understand the association of objective radiologic measurements with surgeon performance of concurrent septoplasty during ESS. METHODOLOGY: Seventy-four patients with CRS undergoing ESS were prospectively enrolled. Angles of septal deviation, intranasal areas and volumes were assessed on preoperative computed tomography (CT) scans and correlated with a robust battery of patient reported outcomes measures (PROMs), objective measures of CRS severity including olfaction scores, radiologic and endoscopic staging, and performance of septoplasty. RESULTS: Intranasal areas and volumes demonstrated only weak linear associations with patient-reported nasal congestion, however, angles of septal deviation alone did not correlate with congestion or any other PROM measure. Meanwhile, radiologic septal-related measurements did not correlate with objective measures of CRS disease severity or the performance of a concurrent septoplasty. CONCLUSIONS: Though prior studies demonstrate improved patient outcomes in the setting of concurrent septoplasty during ESS, this study failed to establish an association between preoperative radiologic septal-related measurements and patient symptomatology or surgeon decision to perform septoplasty. Although objective factors to identify patients most likely to benefit from concurrent septoplasty remain unidentified, the potential improvement of surgical recommendations and patient outcomes makes this an important area of continued investigation.

Investigations of the MGy dose level radiation effects on the photometric budget of a radiation-hardened CMOS-based camera.

We studied the impact of ionizing radiation at high dose levels (megagray, MGy) on the photometric budget of a radiation-resistant complementary metal oxide semi-conductor (CMOS)-based camera. This is achieved by measuring the radiation-induced degradation of each subpart, namely its illumination system, its optical system, and its CMOS image sensor. The acquired experimental results allow performing a rather realistic simulation of the radiation effects at the system level. Thanks to appropriate mitigation techniques, limited image darkening and color change are obtained at MGy dose levels. The presented results confirm the feasibility of a CMOS-based camera able to resist to MGy dose level of ionizing radiations with an acceptable degradation of the image quality, opening the way to its implementation in the most challenging harsh environments.

Vaccine banks for controlling dog-mediated rabies.

The World Organisation for Animal Health (OIE) regional vaccine banks are established for priority diseases, following a business model that depends largely on financial support from donors (with vaccine also purchased directly by individual countries and international organisations that have been granted access by the OIE to the mechanism), and is based on the concept of starting small and scaling up. The OIE vaccine bank for rabies was established in 2012 with a first production order of just 50,000 doses, but as of 31 December 2016, after five years, the OIE had ordered almost 16 million doses of rabies vaccines for deliveries in 24 countries. It was set up on the basis of OIE internationally recognised procurement procedures and the outcome of an international call for tender. Vaccine manufacturers are contracted to produce and supply high-quality vaccine on demand, but they also keep vaccines available at any moment so that they can deliver small quantities of vaccines for emergencies.

L'Organisation mondiale de la santé animale (OIE) a mis en place des banques de vaccins régionales pour certaines maladies prioritaires, suivant un modèle économique fortement axé sur le soutien financier des donateurs (avec la possibilité également pour les pays individuels et les organisations internationales d'acquérir directement des vaccins dès lors que l'OIE leur a donné accès au dispositif) ; le principe opérationnel de ces banques est celui d'un démarrage modeste suivi d'une montée en puissance progressive. La banque de vaccins de l'OIE contre la rage a été lancée en 2012 avec une première commande pour une production de 50 000 doses. Au 31 décembre 2016, soit après cinq ans d'existence de la banque, le total des commandes de l'OIE s'élevait à près de 16 millions de doses de vaccin contre la rage distribuées dans 24 pays. La mise en place de la banque de vaccins s'inscrit dans les procédures de passation des marchés de l'OIE reconnues au plan international et a fait l'objet d'un appel d'offres international. Le cahier des charges des fabricants de vaccin porte tant sur la production et fourniture à la demande de vaccins de qualité que sur le maintien d'un stock permanent de petites quantités de vaccin pouvant être livrées à tout moment en cas d'urgence.

Los bancos de vacunas regionales de la Organización Mundial de Sanidad Animal (OIE), creados para responder a las enfermedades prioritarias, responden a un modelo económico que depende en gran medida del apoyo financiero de donantes (y también la compra directa de vacunas por parte de países u organizaciones internacionales a los que la OIE ha dado acceso al mecanismo) y reposa en la idea de empezar a pequeña escala e ir ampliando la magnitud de las operaciones. El banco de vacunas antirrábicas de la OIE, creado en 2012, empezó a funcionar con una producción del orden de apenas 50 000 dosis, pero a 31 de diciembre de 2016, cinco años después, la OIE había encargado casi 16 millones de dosis de vacuna para entregarlas a 24 países. Fue establecido conforme a los procedimientos de compra de la OIE, reconocidos a escala internacional, y a los resultados de un proceso internacional de licitación. Los fabricantes de vacunas firman un contrato para producir y entregar vacunas de gran calidad previo pedido, pero también tienen una reserva de vacunas disponibles para poder entregar en todo momento pequeñas cantidades de vacuna en respuesta a situaciones de emergencia.

Real time monitoring of water level and temperature in storage fuel pools through optical fibre sensors.

We present an innovative architecture of a Rayleigh-based optical fibre sensor for the monitoring of water level and temperature inside storage nuclear fuel pools. This sensor, able to withstand the harsh constraints encountered under accidental conditions such as those pointed-out during the Fukushima-Daiichi event (temperature up to 100 °C and radiation dose level up to ~20 kGy), exploits the Optical Frequency Domain Reflectometry technique to remotely monitor a radiation resistant silica-based optical fibre i.e. its sensing probe. We validate the efficiency and the robustness of water level measurements, which are extrapolated from the temperature profile along the fibre length, in a dedicated test bench allowing the simulation of the environmental operating and accidental conditions. The conceived prototype ensures an easy, practical and no invasive integration into existing nuclear facilities. The obtained results represent a significant breakthrough and comfort the ability of the developed system to overcome both operating and accidental constraints providing the distributed profiles of the water level (0-to-5 m) and temperature (20-to-100 °C) with a resolution that in accidental condition is better than 3 cm and of ~0.5 °C respectively. These new sensors will be able, as safeguards, to contribute and reinforce the safety in existing and future nuclear power plants.

Asthma quality of life and control after sinus surgery in patients with chronic rhinosinusitis.

BACKGROUND: Patients with chronic rhinosinusitis (CRS) often have comorbid asthma. Prior studies have not examined the impact of CRS or endoscopic sinus surgery (ESS) upon asthma quality of life (QOL) and asthma control using validated outcome metrics. METHODS: Patients with CRS, both with and without polyps, and comorbid asthma completed the Mini Asthma QOL Questionnaire (miniAQLQ) and Asthma Control Test (ACT) at baseline and 6 months postoperatively as part of a multi-institutional, prospective study. RESULTS: Baseline metrics were available on 86 patients. Patients undergoing ESS reported improved miniAQLQ [0.5 (SD ±1.1), 95% CI: 0.2-0.7; P = 0.002] and ACT scores [1.3 (±4.1), 95% CI: 0.2-2.4; P = 0.025]. Uncontrolled baseline asthma (ACT < 20) was present in 51% of patients undergoing ESS. In uncontrolled patients, ESS resulted in a minimal clinically important difference 57% of the time for miniAQLQ scores (≥0.5 points) and 50% of the time for ACT scores (≥3.0 points). After adjustment with linear regression, baseline miniAQLQ scores were worse in patients with comorbid allergy (P = 0.045) and chronic obstructive pulmonary disease (COPD; P = 0.015). Adjusted baseline ACT scores were worse in patients with COPD (P = 0.004). Covariates associated with changes in miniAQLQ scores after ESS were pre-operative corticosteroid dependency (P = 0.011) and change in total SNOT-22 score (P = 0.010). Covariate associated with significantly less improvement in ACT scores was obstructive sleep apnea (P = 0.016). CONCLUSIONS: Patients with CRS often present with uncontrolled asthma, and ESS improves both miniAQLQ and ACT. Approximately half of patients with uncontrolled asthma improve after ESS, yet there are few CRS-specific factors associated with asthma QOL or control or ESS outcomes.

Biomaterials and Fabrication to Optimise Scaffold Properties for Musculoskeletal Tissue Engineering.

Tissue engineering has emerged as a promising scientific field potentially yielding in vitro developed tissue to replace degenerative or injured tissues in vivo, thus avoiding the donor site morbidity associated with reconstructive surgery. Integral to the process is the role of scaffolds and the biomaterials used to form them. This review explores the concept of scaffold based tissue engineering and design considerations. The scaffold needs to have certain mechanical and architectural properties, it needs to be biocompatible and biodegradable, and allow combination with bioactive molecules. We also discuss scaffolding techniques, different biomaterial options and fabrication technologies, and future areas of development.

Radiation effects on optical frequency domain reflectometry fiber-based sensor.

We investigate the radiation effects on germanosilicate optical fiber acting as the sensing element of optical frequency domain reflectometry devices. Thanks to a new setup permitting to control temperature during irradiation, we evaluate the changes induced by 10 keV x rays on their Rayleigh response up to 1 MGy in a temperature range from -40°C up to 75°C. Irradiation at fixed temperature points out that its measure is reliable during both irradiation and the recovery process. Mixed temperature and radiation measurements show that changing irradiation temperature leads to an error in distributed measurements that depends on the calibration procedure. These results demonstrate that Rayleigh-based optical fiber sensors are very promising for integration in harsh environments.

Vulnerability of OFDR-based distributed sensors to high γ-ray doses.

Vulnerability of Optical Frequency Domain Reflectometry (OFDR) based sensors to high γ-ray doses (up to 10 MGy) is evaluated with a specific issue of a radiation-hardened temperature and strain monitoring system for nuclear industry. For this, we characterize the main radiation effects that are expected to degrade the sensor performances in such applicative domain: the radiation-induced attenuation (RIA), the possible evolution with the dose of the Rayleigh scattering phenomenon as well as its dependence on temperature and strain. This preliminary investigation is done after the irradiation and for five different optical fiber types covering the range from radiation-hardened fibers to highly radiation sensitive ones. Our results show that at these high dose levels the scattering mechanism at the basis of the used technique for the monitoring is unaffected (changes below 5%), authorizing acceptable precision on the temperature or strain measurements. RIA has to be considered as it limits the sensing range. From our vulnerability study, the OFDR sensors appear as promising candidates for nuclear industry even at doses as high as 10 MGy.

[Consequences of increasing and ageing population of Basse-Normandie on gynecology and obstetrics activity]. / Effet de l'augmentation et du vieillissement de la population de Basse-Normandie sur l'activité de gynécologie-obstétrique.

INTRODUCTION: In Basse-Normandie, the population over 65 years old will expend more rapidly between 2007 and 2042 (+11.6%) than the rest of the French population (+9.2%). The same population of Basse-Normandie will get old in the 15 years to come. The impact of these demographic changes over the activity in the gynecology-obstetrics field is not clearly identified. Although we cannot predict the technical and scientific developments in the next 15 years, we are presenting a model allowing to hypothesize about changes of gynecology and obstetrics according to population's aging. MATERIALS AND METHODS: We have established a projection model for the realizable surgical acts in obstetrics and gynecology in accordance with the aging of the population in Basse-Normandie. The study was realized based on the acts concerning the cesarean sections (C-section), tubal sterilization, hysteroscopy and hysterectomy as well as ovarectomy and breast surgery. For each activity branch, the codes of the Classification commune des actes médicaux (CCAM) were selected and then removed from the Programme médicalisé des systèmes d'information (PMSI) database. We have used and adapted the Omphale model of the National Statistics and Economical Studies Institute and we have applied it for the period of 2009-2025. RESULTS: Our projection model has permeated to show a 5.5% regression of the C-section acts, a 2% incretion of the hysterectomies and hysteroscopies, 7.7% of ovarectomies as well as a 9.8% augmentation of the breast surgeries. However, we predict a 11.8% diminution of the sterilizations by tubal implants. Globally, the activity in obstetrics and gynecology will remain constant with an insignificant augmentation of 46 acts (0.01%). CONCLUSION: In Basse-Normandie, the surgical activity in gynecology-obstetrics will moderately increase in the next 15 years. This constant activity signifies that there is no need to form more residents than the number of practitioner to retire. The interest of this model is that it is applicable at a national level and it permits to confront the demographic data and the projections of different activities.

Neonatal clinical screening of the hip in the diagnosis of developmental dysplasia of the hip: a 15-year prospective longitudinal observational study.

Over a 15-year prospective period, 201 infants with a clinically unstable hip at neonatal screening were subsequently reviewed in a 'one stop' clinic where they were assessed clinically and sonographically. Their mean age was 1.62 weeks (95% confidence interval (CI) 1.35 to 1.89). Clinical neonatal hip screening revealed a sensitivity of 62% (mean, 62.6 95%CI 50.9 to 74.3), specificity of 99.8% (mean, 99.8, 95% CI 99.7 to 99.8) and positive predictive value (PPV) of 24% (mean, 26.2, 95% CI 19.3 to 33.0). Static and dynamic sonography for Graf type IV dysplastic hips had a 15-year sensitivity of 77% (mean, 75.8 95% CI 66.9 to 84.6), specificity of 99.8% (mean, 99.8, 95% CI 99.8 to 99.8) and a PPV of 49% (mean, 55.1, 95% CI 41.6 to 68.5). There were 36 infants with an irreducible dislocation of the hip (0.57 per 1000 live births), including six that failed to resolve with neonatal splintage. Most clinically unstable hips referred to a specialist clinic are female and stabilise spontaneously. Most irreducible dislocations are not identified from this neonatal instability group. There may be a small subgroup of females with instability of the hip which may be at risk of progression to irreducibility despite early treatment in a Pavlik harness. A controlled study is required to assess the value of neonatal clinical screening programmes.

[Early detection of COPD in occupational medicine in the Alpes-Maritimes]. / Détection précoce de la BPCO en milieu professionnel dans les Alpes-Maritimes.

INTRODUCTION: This study evaluated a standardized procedure aiming at early detection of COPD in a consecutive population of employees visiting occupational medicine. METHODS: A total of 2818 employees were included by 22 occupational physicians in 5 centers. Respiratory symptoms, smoking status, occupational exposures and socioprofessional categories were collected. Subjects with at least one symptom and/or risk factor underwent spirometry. RESULTS: In this population aged 39±12 years, 2603 patients were free of known asthma or COPD. The presence of at least one symptom was observed in 23.6 % of employees and was significantly associated with smoking status, occupational exposure to organic dust, gas fumes and vapors, and agriculture (P<0.0001). Airflow obstruction (FEV1/FVC < 0.70) was detected in 1.7 % of 1605 employees who underwent spirometry. With the inclusion of known COPD subjects (n=22), the prevalence reached 2.38 %. COPD was significantly associated with smoking intensity. Information on subsequent diagnosis was obtained in only two cases. The quality of spirometry was inadequate in 30 % of cases. Thirty-three percent of detected COPD subjects did not report any respiratory symptoms. CONCLUSION: The strategy used in this study (specific questionnaire plus spirometry) allowed detection of a few cases of previously undiagnosed COPD. Occupational physicians need specific training in spirometry and a better follow-up of care pathways is required to obtain diagnostic confirmation.

[Gynaecology and obstetrics in Basse-Normandy: demographic perspectives in 15 years]. / Gynécologie-obstétrique et gynécologie médicale en Basse-Normandie: perspectives démographiques à 15ans.

OBJECTIVES: The French population is growing and ageing. In this context, it is important to consider the future of gynecologists and obstetricians in Basse-Normandie. The aim of this study was to perform an overview of the demographics of practitioners and estimate the retirements. We also try to project the need of trainees for the next years. MATERIALS AND METHODS: We conducted a demographic and workload survey among 142 practitioners and 35 trainees. We detailed retirements and arrivals of this population. RESULTS: By 2025, nearly two-thirds of practitioners in 2012 will retire, including 100% of medical gynecologists. Otherwise, there will be a lack of 1 to 2 practitioners per year. We also noted the tendance of feminization (86%) and the wish of a multi-practice in public hospital (86%). CONCLUSION: A reflection about the health planning will be necessary in order to answer the demographics difficulty in the region. We will have to take into account the future retirements and also the specific situations in each area.

Radiation tolerant fiber Bragg gratings for high temperature monitoring at MGy dose levels.

We report a method for fabricating fiber Bragg gratings (FBG) resistant to very severe environments mixing high radiation doses (up to 3 MGy) and high temperatures (up to 230°C). Such FBGs have been written in two types of radiation resistant optical fibers (pure-silica and fluorine-doped cores) by exposures to a 800 nm femtosecond IR laser at power exceeding 500 mW and then subjected to a thermal annealing treatment of 15 min at 750°C. Under radiation, our study reveals that the radiation induced Bragg wavelength shift (BWS) at a 3 MGy dose is strongly reduced compared to responses of FBGs written with nonoptimized conditions. The BWS remains lower than 10 pm for temperatures of irradiation ranging from 25°C to 230°C without noticeable decrease of the FBG peak amplitude. For an applicative point of view, this radiation induced BWS corresponds to an additional error on the temperature measurements lower than 1.5°C, opening the way to the development of radiation-tolerant multi-point temperature sensors for nuclear industry.

Methodology for the evaluation of vascular surgery manpower in France.

OBJECTIVES: The French population is growing and ageing. It is expected to increase by 2.7% by 2020, and the number of individuals over 65 years of age is expected to increase by 3.3 million, a 33% increase, between 2005 and 2020. As the number of vascular surgery procedures is closely associated with the age of a population, it is anticipated that there will be a significant increase in the workload of vascular surgeons. STUDY DESIGN: A model is presented to predict changes in vascular surgery activity according to population ageing, including other parameters that could affect workload evolution. METHODS: Three types of arterial procedures were studied: infrarenal abdominal aortic aneurysm (AAA) surgery, peripheral arterial occlusive disease (PAOD) procedures and carotid artery (CEA) procedures. Data were selected and extracted from the national PMSI (Medical Information System Program) database. Data obtained from 2000 were used to predict data based on an ageing population for 2008. From this model, a weighted index was defined for each group by comparing expected and observed workloads. RESULTS: According to the model, over this 8-year period, there was an overall increase in vascular procedures of 52.2%, with an increase of 89% in PAOD procedures. Between 2000 and 2009, the total increase was 58.0%, with 3.9% for AAA procedures, 101.7% for PAOD procedures and 13.2% for CEA procedures. The weighted model based on an ageing population and corrected by a weighted factor predicted this increase. CONCLUSION: This weighted model is able to predict the workload of vascular surgeons over the coming years. An ageing population and other factors could result in a significant increase in demand for vascular surgical services.

Economic analysis and costing of animal health: a literature review of methods and importance.

Myriads of data, a host of methods, but no single universal indicator. The Performance of Veterinary Services (PVS) Gap Analysis helps to quantify the needs of national Veterinary Services. In a world of scarce public financial resources and heightened transparency and accountability, official Veterinary Services (national Veterinary Authorities) must be able to justify their needs in economic and budgetary terms to their line minister, national parliament and the public at large, or in negotiations with donors. Animal health and Veterinary Service activities are a global public good. It is the responsibility of governments to maintain animal health systems, including networks for the surveillance and control of animal diseases to ensure the early detection of suspected animal disease outbreaks, a rapid response and, where possible, eradication of animal disease outbreaks 'at source'. The establishment of animal health systems is a core responsibility of the State, and it requires the use of public funds, although it does not preclude public-private partnerships and strategies for ensuring complementarity between the partners concerned. The PVS Gap Analysis mission of the World Organisation for Animal Health (OIE) is a method for analysing and quantifying disparities between a baseline situation (determined by PVS Evaluation using the OIE PVS Tool) and the target levels set by the country itself in accordance with its priorities. An added advantage is that the method can be used for training and awareness raising.

A pathway to insulin independence in newborns and infants with diabetes.

Permanent neonatal diabetes was previously assumed to require insulin injection or infusion for life. Recently, permanent neonatal diabetes resulting from mutations in the two protein subunits of the adenosine triphosphate-sensitive potassium channel (Kir6.2 and SUR1) has proven to be successfully treatable with high doses of sulfonylureas rather than insulin. Many patients with these mutations first develop hyperglycemia in the nursery or intensive care unit. The awareness of the neonatolgist of this entity can have dramatic effects on the long-term care and quality of life of these patients and their families. In this study, we present the experience of our center, highlighting aspects relevant to neonatal diagnosis and treatment.

The effects of acute tryptophan depletion on mood in patients with Parkinson's disease and the healthy elderly.

Reduced serotonergic tone may be a compensatory adaptation to reduced dopaminergic activity in Parkinson's disease (PD) and may result in vulnerability to depression. To test this hypothesis this study examined the effects of serotonin depletion, using the technique of acute tryptophan depletion (ATD) in PD. The effects of ATD were investigated in a double-blind, placebo-controlled, counterbalanced, cross-over, randomised design, in 20 patients with PD and 32 healthy controls matched for age, gender and pre-morbid IQ. The primary outcome was change in scores on a modified Montgomery-Asberg Depression Rating Scale (MADRS). ATD resulted in a small but statistically significant increase in score on the MADRS, but there was no effect specific to the PD group. The results do not support the hypothesis that low serotonergic tone results in vulnerability to depression in PD and are in accord with an earlier study using the same technique in PD.

Effects of acute tryptophan depletion on neuropsychological and motor function in Parkinson's disease.

Interactions between the 5-HT system and the dopaminergic system and cholinergic system may be important in determining cognitive function and motor function in Parkinson's disease (PD). Previous studies have shown effects of reducing serotonin function, by acute tryptophan depletion (ATD), on neuropsychological function. In particular, an adverse effect on verbal memory has been demonstrated. This study compared with the effects of ATD on cognitive and motor function in PD and healthy control subjects. The effects of ATD were investigated in a double-blind, placebo-controlled, counterbalanced, cross-over, randomised design in 20 patients with PD and 35 healthy controls matched for age, gender and premorbid IQ. There was a differential group effect of ATD on global cognitive function whereby the mean score on the modified mini mental state examination during ATD was lower than placebo in PD but higher in controls. There was a similar pattern of effects on verbal recognition. In a visual recognition task, ATD improved performance in the PD but not in the control group. In terms of psychomotor speed, there was also a group-specific effect with reduced latency of response during ATD in the PD group but increased latency in the control group. ATD has subtle neuropsychological effects, which differ significantly between PD and healthy control subjects. This suggests that the dopaminergic and cholinergic deficit of PD significantly modulates the effects of serotonin depletion, resulting in positive effects in some domains. Further investigation on the effects of specific serotonin antagonists may be merited in PD.