Development and validation of the Symptomatic Transdiagnostic Test (S2T).

INTRODUCTION: The categorical approach in psychiatry has received many criticisms. Modern research tends to develop a transdiagnostic approach. However, transdiagnostic works lack an overall understanding and focus mainly on anxiety and depression. The aim of the present study was to develop an easy to use tool to evaluate multiple dimensions opening the way for further research in the transdiagnostic approach. This will allow researchers to quickly assess the efficacy of psychotherapeutic interventions on multiple psychopathological dimensions. METHOD: First, we identified the main symptoms of psychopathology in a sample of mental healthcare workers. Second, we developed the Symptomatic Transdiagnostic Test (S2T) to assess the main symptoms of psychopathology. Third, we evaluated its psychometric properties (exploratory and confirmatory factor analysis, internal consistency) in three non-clinical samples and one clinical sample. RESULTS: The 66-item S2T included eleven factors referring to: i) negative thoughts and mood; ii) psycho-traumatic and maladaptive symptoms; iii) addiction symptoms; iv) disturbed eating behavior; v) disturbed perception and behavior; vi) panic and agoraphobia; vii) emotional lability; viii) dejection; ix) neurodevelopmental manifestations; x) anxiety and xi) psychic hyperactivity. We found a high internal consistency for the general scale (α=0.96) and the subscales. We found a good concurrent validity. As expected, we found higher levels of symptoms within the clinical population as compared to the non-clinical samples, except for addiction symptoms and disrupted eating behavior. We found negative associations between the symptomatic dimensions and psychological skills. CONCLUSION: The S2T is a relevant tool for clinicians and researchers to assess the psychopathological profile. The main psychopathological symptoms are negatively related to the psychological skills.

Assessing low laser damage densities of fused silica optics by means of a functional raster scan protocol.

The knowledge of the laser damage resistance of fused silica optics for their use in high-power lasers is of primary importance for the operation and maintenance of these facilities. Among the control procedures developed, one of the most relevant to date is the raster scan procedure [Lamaignère et al., Rev. Sci. Instrum. 78, 103105 (2007)]. This procedure is used to determine the damage density of optical components as a function of fluence. To date, this procedure takes into account all triggered damage sites, regardless of their size and/or morphology. We have added a step to this procedure, which consists in irradiating again all the damage sites with a series of shots to ascertain their ability to grow. This allows us to estimate the densities of growing damage sites, which are most critical for the safe operation of lasers. This pragmatic approach can be considered a functional test procedure. By applying this procedure to large optical areas, we were then able to measure extremely low damage densities (∼10-4 damage cm-2) over a wide range of fluences [0-18 J cm-2], corresponding to fluences to which the optics are irradiated during the operation of high-power lasers. We can then determine the damage law of a given set of optical components. This reference law makes it possible, on the one hand, to predict the lifetime of the optics. On the other hand, any deviation can then be analyzed with regard to this reference law. Thanks to the determination of confidence intervals, this functional procedure can also be used to delimit the reference law by upper and lower bounds.

Interference filters and their impact on FM-to-AM conversion: a method for investigation and characterization.

High-power nanosecond laser pulses are usually spectrally broadened via temporal phase modulations to tackle the issue of stimulated Brillouin scattering and to achieve optical smoothing of the focal spot. While propagating along the beamline, such pulses can undergo frequency modulation to amplitude modulation (FM-to-AM) conversion. This phenomenon induces modulations of the optical power that can have a strong impact on laser performance. Interference filters are specific FM-to-AM conversion contributors that lead to high-frequency modulations that cannot be measured using conventional means. We propose an indirect method to investigate for such FM-to-AM contributors using spectral measurements. Further analysis of the collected data makes the quantification of the defining parameters of interference filters possible. In turn, we show that it is possible to estimate the range of power modulations induced by interference filters.

[Evolution of the cesarean delivery rate from 37 weeks of gestation among nulliparas or how to evaluate the external validity of a randomized North American trial about induction of labor]. / Évolution du taux de césariennes à partir de 37 semaines d'aménorrhée parmi les nullipares ou comment évaluer la validité externe d'un essai randomisé nord-américain sur le déclenchement artificiel du travail.

OBJECTIVE: To determine the risk of caesarean delivery (CD) when an expectant management is considered for a nulliparous reaching≥37 weeks of gestation (wog). METHODS: This is a prospective study, including all nulliparous women who delivered at≥37 wog a singleton fetus in a cephalic presentation between the first January 2017 and the 31st December 2017 in a French perinatal network (Mypa). For each week of gestation from 37 wog to 41 wog, the rate of CD was determined according the onset of labor (spontaneous or induced). The risk of CD when expectant management was considered at a specific gestational age was calculated by taking all the population who reached this gestational age, minus all women who had an induction of labor or underwent a caesarean delivery before labor. RESULTS: In total, 16,085 women delivered at≥24 wog, and 5498 (34.1%) were nulliparous with a singleton fetus in a cephalic presentation reaching 37SA. The risk of CD increased from 40 wog, whatever the labor was spontaneous or induced (when labor was spontaneous, the risk of CD was stable till 39 wog around 11%, and increased from 14% at 40 wog to 20% at 41 wog; similarly, when labor was induced, the risk of CD was stable till 39 wog around 28%, and increased from 40% at 40 wog to 38% at 41 wog. The risk of CD for a nulliparous reaching>37 Wog when expectant management is considered was stable around 22.3%. CONCLUSION: The risk of CD for a nulliparous reaching≥37SA when expectant management is considered is similar than the one in the United States of America.

A powerful tool for comparing different test procedures to measure the probability and density of laser induced damage on optical materials.

The determination of the laser damage resistance of optics in the nanosecond regime is based on statistical tests and approaches because the response of the components is mainly related to the presence of defects randomly distributed in the optics and is therefore probabilistic in nature. For practical reasons, the tests are mostly carried out with beams of small dimensions (several tens of micrometer), that make it possible to determine a damage probability from which a laser damage threshold is extracted. This threshold is, however, highly correlated with the size of the test beam and the sampling of the test procedure. Some measurements are also made with beams of large dimensions (several millimeters) from which a damage density is determined. However, the relationship between the damage probability and the damage density is not trivial. It is based on assumptions that are difficult to verify because the experimental validations are carried out on different laser installations. In order to study accurately the coherence between these tests with small and large beams, as well as the link between damage probability and damage density, it is necessary to perform measurements on the same laser installation. We propose here, to compare for the first time, the results obtained with the same laser source with a large beam and also with small beams. The small beams are shaped from phase objects specifically implemented to obtain several small beams from a single larger beam. The consistency of the laser damage that results from both sets of measurements is demonstrated here. It validates the assumptions made and the specific mathematical treatment implemented to establish the link between the two approaches. In fine, it also validates and strengthens the approach previously developed from the rasterscan procedure [Lamaignère et al., Rev. Sci. Instrum. 78, 103105 (2007)] used to measure damage densities from the scanning of optics with beams of small dimensions. The reported original work based on phase objects thus makes it possible to replicate small beam tests with a large beam facility. The comparison between the results from the small beams and the results from the large beam experiments definitively makes the link between damage probabilities and damage densities. This also shows that small beam tests are reasonable representative of tests carried out with large beams.

[Impact of organizational factors on the cesarean delivery occurrence in a low-risk population]. / Facteurs organisationnels associés à la réalisation d'une césarienne dans une population à bas risque.

OBJECTIVE: Huge differences in cesarean delivery rate exist between maternities in a same region. In recent years, the cesarean delivery rate has increased in the low-risk population. The objective of this study was to assess the impact of organizational factors on the cesarean delivery occurence in a low-risk population. METHODS: We performed a population-based cohort study in the MYPA perinatal network from 2009 to 2015. A low-risk population was selected, keeping only groups 1 and 3 of the Robson classification. The studied organizational factors included the structural characteristics of maternity (academic or not, public or private, number of annual births, maternal intensive care unit, neonatal intensive care unit, number of delivery rooms) and the organization of the health care team (number of midwives and obstetricians, on call duty, workload and implementation of a morbi-mortality review). We used a logistic multilevel model, based on random center effect, for both univariable and multivariable analysis. RESULTS: Our study population included 64,100 women. The cesarean delivery rate ranged from 5.5 to 11.3 % among the 10 maternities. In univariate analysis, the organizational variables significantly associated with the cesarean delivery rate were maternity status (university hospital, non-university public hospital and private hospital) and the implementation of a morbi-mortality review. However, after adjustment, none of these organizational factors were significantly associated with the cesarean delivery occurence. When multivariate analysis was restricted to the nulliparous subgroup, the private status of maternity was significantly associated with a higher rate of cesarean deliveries (OR=1.39 [1.09-1.76]). Also, the probability of cesarean delivery was higher when the number of births by delivery room increased (OR=1.15 [1.01-1.31]). For the multiparous subgroup, no variable was significantly associated with cesarean delivery occurence. CONCLUSION: In our global low-risk population, no organizational factors appeared to be associated with an increase in cesarean delivery rate. On the other hand, in the low-risk nulliparous population, the private status of the maternity and a high number of births by delivery room were associated with more cesarean deliveries. Increasing the number of delivery rooms could be a way to reduce the number of cesarean deliveries. Future researches should also try to identify specific factors that can reduce differences in cesarean delivery rates between private and public maternities.

Operating environment for awake brain surgery - Choice of tests.

INTRODUCTION: The indication for awake brain surgery depends on a prerequisite, i.e. recognition that the brain area concerned is truly eloquent, and identification of one or more functions that must be preserved. These functions are determined preoperatively in collaboration with the patient, and neuropsychological tests considered to be the most relevant are performed in the operating room according to each team's technical preferences. OPERATING ENVIRONMENT: The neurosurgeon must choose transfer equipment considered to be relevant. Although a minimal technological environment is an option, a surgical team with great human wealth is essential, composed of specialized personnel with complementary skills. CHOICE AND IMPLEMENTATION OF INTRAOPERATIVE TESTS: The choice of intraoperative tests, which can be relatively simple for certain primary functions, can be much more difficult for high-level cognitive functions. No consensus has been reached concerning these tests, which must therefore be selected on an individual basis. Intraoperative testing must be based on preoperative multidisciplinary decisions made jointly by the neurosurgeon, neurologist, speech therapist and neuropsychologist. CONCLUSIONS: Numerous operating tools and technology transfers are available for neurosurgical teams performing awake brain surgery but none - or very few - of them constitutes a mandatory prerequisite. In contrast, the transition from the concept of eloquent brain area to that of brain functions that must be preserved requires highly skilled multidisciplinary human resources. This goal will be more likely achieved in centers highly specialized in functional oncological neurosurgery.

[Awareness and understanding of consent in Alzheimer's disease]. / Conscience et compréhension du consentement dans la maladie d'Alzheimer.

Before a patient can take part in a clinical research, French legislation requires his/her free, express and informed consent. In the same way, the information must be given in a clear, fair and appropriate manner. However, in the context of Alzheimer's disease, one might wonder about the patient's capacity to consent. The goal of our research was to study the capacity to provide informed consent in a group of patients with mild Alzheimer's disease and in a control group, using two specialized clinical vignettes inspired by Marson's studies. The aim of the study was to assess discernment in capacity to consent to a treatment and to determinate the possible links between impaired capacities to consent and cognitive and behavioral impairments involved in Alzheimer's disease. The data collected confirm that the capacity to make and maintain a choice is preserved while the capacities to appreciate the consequences of choosing a treatment, to reason and to understand the treatment situation are already impaired in mild Alzheimer's disease. The impairment of these capacities can be linked to dysexecutive syndrome, apathy and impaired self-awareness. Caregivers and family should take into account the risk of weakened capacities of discernment as soon as possible.

[Deaths due to smallpox vaccination in France 1968-1977 (author's transl)]. / Etude des décès imputés à la vaccination antivariolique en France, de 1968 à 1977.

Between 1968 and 1977 there were 4 113 109 primary smallpox vaccinations in France. There were 30 deaths but no deaths occurred after re-vaccination. The mortality can be analysed as follows: -- proven or probable cases: 1.5 death/million vaccinations; -- proven, probable or possible cases 2.9/million vaccinations; -- proven, probable, possible or doubtful 7.3 cases/million vaccinations. The risk of death is 3 to 4 times greater under the age of one year and an overall death rate of 6/million vaccinations in reasonably accurate.