The problem of over-medicalisation: How AOD disease models perpetuate inequity for young people with multiple disadvantage.

Young people who experience multiple disadvantage have been identified as some of the most marginalised and under-serviced people in the alcohol and other drug (AOD) system. In this paper, we draw on a range of research evidence to argue that one of the challenges in responding appropriately to the needs of these young people are models of care which seek to ameliorate 'illness' rather than promote wellness. While disease approaches have some important benefits, overly-medicalised AOD treatment responses also have negative impacts. We argue that disease models rest on understandings of substance use as an individual enterprise and thereby pay insufficient attention to the material disadvantage that shape young people's substance use, creating feelings of shame, failure and a reluctance to return to care if they continue to use. Additionally we draw on literature that shows how disease models construe young people's substance use as compulsive, perpetuating deficit views of them as irrational and failing to account for the specific meanings that young people themselves give to their substance use. By focusing on clinical solutions rather than material and relational ones, medicalised treatment responses perpetuate inequity: they benefit young people whose resources and normative values align with the treatments offered by disease models, but are much less helpful to those who are under-resourced,. We suggest that alternative approaches can be found in First Nations models of care and youth programs that attend to social, cultural, and material wellbeing, making living well the focus of treatment rather than illness amelioration.

Consumption of Dairy Products and Cognitive Functioning: Findings from the SU.VI.MAX 2 Study.

OBJECTIVES: Research concerning the link between dairy product intake and cognition is scant while experimental studies suggest links through various biological mechanisms. This study's objective was to examine the cross-time associations of total and specific dairy product consumption with cognitive performance in aging adults. We also explored compliance with dairy intake recommendations in France. DESIGN: The study was based on the «Supplémentation en Vitamines et Minéraux Antioxydants¼ randomized trial (SU.VI.MAX, 1994-2002) and the SU.VI.MAX 2 observational follow-up study (2007-2009). SETTING: A general-population cohort in France. PARTICIPANTS: N=3,076 participants included in both the SU.VI.MAX and SU.VI.MAX 2 studies. MEASUREMENTS: Dairy product consumption was estimated using repeated 24h records (1994-1996; mean=10 records, SD=3). Cognitive performance was assessed by neuropsychologists after an average of 13 years post-baseline via a battery of six validated tests. Mean age at the time of the cognitive function evaluation was 65.5 (SD=4.6) years. Principal component analysis revealed factors for verbal memory and working memory. Associations of energy-adjusted dairy product consumption and compliance with the respective dietary guidelines with subsequent cognitive impairment were examined using ANCOVA, providing mean differences (95% confidence intervals, CI) according to tertiles (T), adjusted for confounders including overall dietary patterns. RESULTS: Total dairy product consumption was not associated with cognitive function. However, milk intake was negatively associated with verbal memory performance: mean difference T3 versus T1= -0.99 (-1.83, -0.15). Among women, consuming more than the recommended amount of dairy was negatively associated with working memory performance: excess versus adequate = -1.52 (-2.93, -0.11). CONCLUSION: Our results indicate that dairy products consumption and especially compliance with dietary guidelines regarding dairy product intake are differentially associated with performance in specific cognitive domains after a comprehensive adjustment for lifestyle factors, health status markers and dietary patterns. Further longitudinal research is needed given the limited data available.

Examining the elemental contribution towards the biodegradation of Mg-Zn-Ca ternary metallic glasses.

The Mg-Zn-Ca metallic glass system has been the focus of recent studies as a prospective material for biodegradable implants. To date, the influence each alloying element has on the degradation behaviour of this class of alloy is still not well understood. This study employs electrochemical polarisation and in situ impedance spectroscopy coupled with H2 gas collection in simulated body fluid at 37 °C to elucidate the mechanisms by which a series of custom produced Mg-Zn-Ca metallic glasses degrade compared with high purity Mg. The results show that Mg-Zn-Ca metallic glasses provide significantly more noble corrosion potentials and suppressed hydrogen gas evolution relative to high purity Mg. Furthermore, the role each element has in degradation was investigated systematically by varying the concentration of each alloying element. Testing revealed that the complex nature of dissolution in metallic glasses requires testing beyond solely polarisation and hydrogen gas collection to elucidate degradation behaviour in vitro. Practical limits to which the composition may be adjusted in this ternary alloy system, so as to maintain minimal degradation, have been achieved.

A predictive structural model for bulk metallic glasses.

Great progress has been made in understanding the atomic structure of metallic glasses, but there is still no clear connection between atomic structure and glass-forming ability. Here we give new insights into perhaps the most important question in the field of amorphous metals: how can glass-forming ability be predicted from atomic structure? We give a new approach to modelling metallic glass atomic structures by solving three long-standing problems: we discover a new family of structural defects that discourage glass formation; we impose efficient local packing around all atoms simultaneously; and we enforce structural self-consistency. Fewer than a dozen binary structures satisfy these constraints, but extra degrees of freedom in structures with three or more different atom sizes significantly expand the number of relatively stable, 'bulk' metallic glasses. The present work gives a new approach towards achieving the long-sought goal of a predictive capability for bulk metallic glasses.

Frailty and nutrition: searching for evidence.

Frailty is a geriatric syndrome that predicts disability, morbidity and mortality in the elderly. Poor nutritional status is one of the main risk factors for frailty. Macronutrients and micronutrients deficiencies are associated with frailty. Recent studies suggest that improving nutritional status for macronutrients and micronutrients may reduce the risk of frailty. Specific diets such as the Mediterranean diet rich in anti-oxidants, is currently investigated in the prevention of frailty. The aim of this paper is to summarize the current body of knowledge on the relations between nutrition and frailty, and provide recommendations for future nutritional research on the field of frailty.

Overall and abdominal adiposity in midlife and subsequent cognitive function.

OBJECTIVES: The scientific literature supports a link between midlife adiposity and cognitive function or decline but most studies to-date have investigated only overall adiposity, often omitting important confounders from the analyses. We investigated in a cross-time design the relationships between two different midlife adiposity markers and subsequent cognitive function, testing midlife dietary patterns as a potential confounder of the associations. DESIGN: The study was based on the «Supplémentation en Vitamines et Minéraux Antioxydants¼ randomized trial (SU.VI.MAX, 1994-2002) and the SU.VI.MAX 2 observational follow-up study (2007-2009). SETTING: A general-population cohort in France. PARTICIPANTS: N=2,817 individuals (1,493 men and 1,324 women) included in both the SU.VI.MAX and SU.VI.MAX 2 studies. MEASUREMENTS: The cognitive performance of 2,817 middle-aged adults participating in the SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydant) study was assessed in 2007-2009 using 6 neuropsychological tests. Principal component analysis was used to derive specific cognitive scores. A composite cognitive score was also computed. Body mass index (BMI) and waist circumference (WC) were measured 13 years earlier (1994). Associations between midlife adiposity and cognitive functioning were estimated through covariance analyses. RESULTS: After adjustment for obesity-related cardio-metabolic parameters, higher BMI and larger WC at midlife predicted lower executive function. For example, the adjusted mean difference (95% confidence interval) for 1 SD increase in WC was -0.48 (-0.97, 0.00). Obese participants in midlife showed an adjusted mean difference (95% confidence interval) of -1.68 (-3.15, -0.22) compared with non-obese. Further adjustment for midlife dietary patterns slightly attenuated these associations. No relationships were observed with verbal memory or global cognitive function. CONCLUSION: Midlife overall and abdominal adiposity were similarly associated with lower executive functioning scores. Dietary patterns may partly explain such a relationship, arguing for the importance of controlling for lifestyle confounders in future studies.

[Grief, evolution of new definitions]. / Deuil, évolution conceptuelle et nouvelles définitions.

The concept of pathological grief is a controversial issue. Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Complicated grief is a process that by its length or intensity is considered pathological but not considered as a distinct mental disorder in the present international classifications: ICD-10 and DSM-IV-TR. For some individuals, if intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. This definition evolved with the implementation of a proposed criteria for a persistent complex bereavement disorder in the section of "condition of further study"s of the new DSM-5 after the debate raised by the proposition of several authors to include a distinct mental disorder. We tried to illustrate that complex question with a non exhaustive review and with a case report of a clinical situation of a female that was treated in a crisis center in Geneva, following the sudden death of her husband.

Distortion of the anterior part of the interhemispheric fissure: significance and implications for prenatal diagnosis.

In order to illustrate the significance of a new anatomical finding, distortion of the interhemispheric fissure (DIHF) associated with impacted medial borders of the frontal lobes, we report a retrospective observational study of 13 fetuses in which DIHF was identified on prenatal imaging. In 10 cases there were associated anatomical anomalies, including mainly midline anomalies (syntelencephaly (n=2), lobar holoprosencephaly (n=1), Aicardi syndrome (n=2)), but also schizencephaly (n=1), cortical dysplasia (n=1) and more complex cerebral malformations (n=3), including neural tube defect in two cases. Chromosomal anomaly was identified in two cases, including 6p deletion in a case without associated central nervous system anomalies and a complex mosaicism in one of the cases with syntelencephaly. In two cases, the finding was apparently isolated on both pre- and postnatal imaging, and the children were doing well at follow-up, aged 4 and 5 years. The presence of DIHF on prenatal imaging may help in the diagnosis of cerebral anomalies, especially those involving the midline. If DIHF is apparently isolated on prenatal ultrasound, magnetic resonance imaging is recommended for careful analysis of gyration and midline, especially optic and olfactory structures. Karyotyping is also recommended.

Aliphatic/aromatic systems under irradiation: influence of the irradiation temperature and of the molecular organization.

With the aim of understanding the electronic excitation, charge or reactive species transfers occurring during irradiation, we studied the role of the aromatic content on ethylene/styrene random copolymers (PES) and on cyclohexane/benzene glasses (amorphous organic solids). Radiation-induced modifications were monitored in situ, at the molecular level, using Fourier transform infrared spectroscopy (FTIR). Irradiations were performed under a vacuum, and thanks to in situ measurements, oxidation was avoided. We followed both the C═C bond creation in the aliphatic moiety and the destruction of the aromatic moiety. The influence of the irradiation temperature was investigated by irradiating samples at room temperature and at 11 K. At such a low temperature, long-range migration hardly occurs and its influence is considerably reduced or could even vanish. Therefore, low temperature irradiation gives insight on the relative influence of reactive species transport and electronic excitation and charge transport. We found that the effect of lowering the PES irradiation temperature from room temperature to 11 K is small, indicating a minor role for the reactive species transport. Moreover, the two chosen systems allow the examination of the relative magnitude of intra- and intermolecular transfers. We demonstrate that, under conditions where reactive species are almost frozen, intermolecular transfers are very efficient.

How to design nutritional intervention trials to slow cognitive decline in apparently healthy populations and apply for efficacy claims: a statement from the International Academy on Nutrition and Aging Task Force.

Interventions are crucial as they offer simple and inexpensive public health solutions that will be useful over the long term use. A Task Force on designing trials of nutritional interventions to slow cognitive decline in older adults was held in Toulouse in September 2012. The aim of the Task Force was to bring together leading experts from academia, the food industry and regulatory agencies to determine the best trial designs that would enable us to reach our goal of maintaining or improving cognitive function in apparently healthy aging people. An associated challenge for this Task Force was to determine the type of trials required by the Public Food Agencies for assessing the impact of nutritional compounds in comparison to well established requirements for drug trials. Although the required quality of the study design, rationale and statistical analysis remains the same, the studies designed to show reduction of cognitive decline require a long duration and the objectives of this task force was to determine best design for these trials. Two specific needs were identified to support trials of nutritional interventions: 1- Risk- reduction strategies are needed to tackle the growing burden of cognitive decline that may lead to dementia, 2- Innovative study designs are needed to improve the quality of these studies.

Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes.

BACKGROUND: The prevalence of vitamin D insufficiency is very high in the nursing home (NH) population. Paradoxically, vitamin D insufficiency is rarely treated despite of strong clinical evidence and recommendations for supplementation. This review aims at reporting the current knowledge of vitamin D supplementation in NH and proposing recommendations adapted to the specificities of this institutional setting. DESIGN: Current literature on vitamin D supplementation for NH residents was narratively presented and discussed by the French Group of Geriatrics and Nutrition. RESULT: Vitamin D supplementation is a safe and well-tolerated treatment. Most residents in NH have vitamin D insufficiency, and would benefit from vitamin D supplement. However, only few residents are actually treated. Current specific and personalized protocols for vitamin D supplementation may not be practical for use in NH settings (e.g., assessment of serum vitamin D concentrations before and after supplementation). Therefore, our group proposes a model of intervention based on the systematic supplementation of vitamin D (1,000 IU/day) since the patient's admission to the NH and throughout his/her stay without the need of a preliminary evaluation of the baseline levels. Calcium should be prescribed only in case of poor dietary calcium intake. CONCLUSION: A population-based rather than individual-based approach may probably improve the management of vitamin D insufficiency in the older population living in NH, without increasing the risks of adverse health problems. The clinical relevance and cost effectiveness of this proposal should be assessed under NH real-world conditions to establish its feasibility.

A new electric method for non-invasive continuous monitoring of stroke volume and ventricular volume-time curves.

BACKGROUND: In this paper a new non-invasive, operator-free, continuous ventricular stroke volume monitoring device (Hemodynamic Cardiac Profiler, HCP) is presented, that measures the average stroke volume (SV) for each period of 20 seconds, as well as ventricular volume-time curves for each cardiac cycle, using a new electric method (Ventricular Field Recognition) with six independent electrode pairs distributed over the frontal thoracic skin. In contrast to existing non-invasive electric methods, our method does not use the algorithms of impedance or bioreactance cardiography. Instead, our method is based on specific 2D spatial patterns on the thoracic skin, representing the distribution, over the thorax, of changes in the applied current field caused by cardiac volume changes during the cardiac cycle. Since total heart volume variation during the cardiac cycle is a poor indicator for ventricular stroke volume, our HCP separates atrial filling effects from ventricular filling effects, and retrieves the volume changes of only the ventricles. METHODS: ex-vivo experiments on a post-mortem human heart have been performed to measure the effects of increasing the blood volume inside the ventricles in isolation, leaving the atrial volume invariant (which can not be done in-vivo). These effects have been measured as a specific 2D pattern of voltage changes on the thoracic skin. Furthermore, a working prototype of the HCP has been developed that uses these ex-vivo results in an algorithm to decompose voltage changes, that were measured in-vivo by the HCP on the thoracic skin of a human volunteer, into an atrial component and a ventricular component, in almost real-time (with a delay of maximally 39 seconds). The HCP prototype has been tested in-vivo on 7 human volunteers, using G-suit inflation and deflation to provoke stroke volume changes, and LVot Doppler as a reference technique. RESULTS: The ex-vivo measurements showed that ventricular filling caused a pattern over the thorax quite distinct from that of atrial filling. The in-vivo tests of the HCP with LVot Doppler resulted in a Pearson's correlation of R = 0.892, and Bland-Altman plotting of SV yielded a mean bias of -1.6 ml and 2SD =14.8 ml. CONCLUSIONS: The results indicate that the HCP was able to track the changes in ventricular stroke volume reliably. Furthermore, the HCP produced ventricular volume-time curves that were consistent with the literature, and may be a diagnostic tool as well.

Ca-Mg-Zn bulk metallic glasses as bioresorbable metals.

A series of six unique Ca-based bulk metallic glasses were synthesized and characterized. The glasses were designed to consist solely of the biocompatible elements Ca, Mg and Zn, with the view to their potential use as bioresorbable metals for orthopaedic applications. The alloys had a critical casting thickness of up to 4.5 mm. Mechanical and thermophysical testing revealed a Young's modulus (stiffness) of ∼40 GPa. Glass transition temperatures ranged from 119 to 129°C, above which the alloys can be formed like a thermoplastic polymer. In vitro biocorrosion testing using a combination of polarization and mass loss techniques revealed that the corrosion rate of these alloys is relatively rapid, although, in some cases, it may be tailored through alloy composition.

Irradiation of ethylene/styrene copolymers: evidence of sensitization of the aromatic moiety as counterpart of the radiation protection effect.

Molecules containing aromatics systems are more stable in the presence of ionizing radiations than alkanes. In the same way, introducing aromatic rings into aliphatic compounds increases their stability. The protective effect is nonlocal and likely results from the transfer of energy and species from the aliphatic moiety to the aromatic one. For years, it was commonly assumed that the aromatic moiety, which is very radiation resistant, accommodates the extra energy remaining unaffected. The use of Fourier transform infrared spectroscopy, online with high energy ion beam irradiation of ethylene/styrene random copolymers, allows us to bring experimental evidence that the benzene rings are sensitized by transfer reactions and consequently that this effect is more important in polymers with low benzene ring molar content.

Binder phenotype in mothers affected with autoimmune disorders.

OBJECTIVE: To report four foetal cases of the Binder phenotype associated with maternal autoimmune disorders. PATIENTS AND METHODS: In three mothers with autoimmune diseases, 2D and 3D ultrasonographic measurements were made on four foetuses with the Binder profile, and were compared with postnatal phenotypes. RESULTS: The Binder phenotype can be detected in early pregnancy (14.5 WG). All foetuses had verticalized nasal bones and midfacial hypoplasia. Punctuate calcifications were found in almost all the cases. No specific maternal auto-antibody has been associated with foetal Binder phenotype. CONCLUSION: Since the Binder phenotype can be diagnosed at ultrasound examination during pregnancy, it is important to establish the underlying cause so as to assess the foetal prognosis. This study stresses the importance of systematic checks for maternal autoimmune disease in cases of prenatally diagnosed Binder phenotypes.

Irreducible developmental dysplasia of the hip due to acetabular roof cartilage hypertrophy. Diagnostic sonography in 15 hips.

INTRODUCTION: Irreducible developmental dysplasia of the hip (DDH) in newborns is a rare entity. The different obstacles preventing reduction have been described in the literature. HYPOTHESIS: A clinical form of DDH with hypertrophy of the cartilage of the acetabular roof (acetabular bulge) can be reliably identified on ultrasound and should probably be defined as a separate entity. MATERIALS AND METHODS: For the first time, the authors report their experience, a review of the literature and the radiographic description (ultrasound, arthrography MRI) of irreducible neonatal DDH due to hypertrophy of the cartilage of the acetabular roof (acetabular bulge) in 12 infants (15 hips). RESULTS: Neonatal sonography seems to be sufficient to identify this specific clinical entity without any additional work-up. This sonographic sign could help determine the therapeutic strategy earlier in this severe and complex form of DDH.

Microfluidics for synthetic biology: from design to execution.

With the expanding interest in cellular responses to dynamic environments, microfluidic devices have become important experimental platforms for biological research. Microfluidic "microchemostat" devices enable precise environmental control while capturing high quality, single-cell gene expression data. For studies of population heterogeneity and gene expression noise, these abilities are crucial. Here, we describe the necessary steps for experimental microfluidics using devices created in our lab as examples. First, we discuss the rational design of microchemostats and the tools available to predict their performance. We carefully analyze the critical parts of an example device, focusing on the most important part of any microchemostat: the cell trap. Next, we present a method for generating on-chip dynamic environments using an integrated fluidic junction coupled to linear actuators. Our system relies on the simple modulation of hydrostatic pressure to alter the mixing ratio between two source reservoirs and we detail the software and hardware behind it. To expand the throughput of microchemostat experiments, we describe how to build larger, parallel versions of simpler devices. To analyze the large amounts of data, we discuss methods for automated cell tracking, focusing on the special problems presented by Saccharomyces cerevisiae cells. The manufacturing of microchemostats is described in complete detail: from the photolithographic processing of the wafer to the final bonding of the PDMS chip to glass coverslip. Finally, the procedures for conducting Escherichia coli and S. cerevisiae microchemostat experiments are addressed.

Thirteen-year prospective study between fish consumption, long-chain n-3 fatty acids intakes and cognitive function.

OBJECTIVES: Because of their structural, anti-inflammatory and antithrombic properties, long-chain n-3 fatty acids may be key factors in the aging process. We sought to elucidate the association between intake of long-chain n-3 fatty acids and/or fish and cognitive function evaluated 13 years after dietary assessment. DESIGN: Prospective population-based study. PARTICIPANTS/SETTING: 3,294 adults from the SU.VI.MAX study (Supplementation with Antioxidant Vitamins and Minerals study). MEASUREMENTS/STATISTICAL ANALYSIS: Subjects underwent a standardized clinical examination which included cognitive tests and self-reported cognitive difficulties scale (2007-2009). Poor scores were defined using percentiles as cut-off. Dietary data were assessed through repeated 24-h dietary records. Odd ratio (OR), comparing the fourth (Q4) to the first quartile (Q1), of having a poor score were calculated using adjusted logistic regression. RESULTS: Self-reported cognitive difficulties were less frequent among subjects with higher intakes of total n-3 long chain fatty acids (OR = 0.72, CI 95%=0.56-0.92) and eicosapentaenoic acid (OR Q4 versus Q1 = 0.74, CI 95%=0.58-0.95), even after adjustment for depressive symptoms. A borderline significant association was also found with high fish consumption (OR Q4 versus Q1 = 0.80, CI 95%=0.63-1.01). CONCLUSION: Cognitive complaints, which may be an early indicator of cognitive decline, are less frequent among the elderly who have a high long-chain n-3 acids intake, as assessed 13 years earlier.

[Chronic obstructive pulmonary disease (COPD) in the elderly]. / La bronchopneumopathie chronique obstructive (BPCO) du sujet âgé en huit questions/réponses.

Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by incompletely reversible airflow limitation, measured by a decrease of FEV(1)/FVC ratio. International consensus does not agree on a single threshold for this ratio, which can define airflow obstruction. Although the prevalence of COPD in the elderly population varies according to the definition used, it definitely increases with age and could reach 15% in those over 65 years of age. Therefore, ageing of the population should result in increased prevalence and socioeconomical costs of COPD during coming years. In France, diagnosis of COPD in the elderly is difficult, late and insufficient. Management, which has the same goals as in younger populations, has to be global and coordinated. Some points should be considered with particular attention considering the cumulative risks related on the one hand to COPD and on the other to ageing: pharmacological side-effects, decreased physical and social autonomy, nutritional impairment, comorbidities. Given the lack of specific data in elderly populations, pharmacological indications are generally considered to be the same as in younger populations, but some additional precautionary measures are necessary. Pulmonary rehabilitation seems to be beneficial at any age. Palliative care comes up against important difficulties: an indefinite beginning of the palliative stage in COPD; insufficient palliative care resources; insufficient communication; insufficient utilization of palliative care resources. Global COPD management in elderly requires coordination, best reached in health care network organizations involving medical and/or social professionals.

Pediatric outcome of children with the prenatal diagnosis of isolated septal agenesis.

BACKGROUND: Isolated Septal Agenesis (SA) is a rare disease with clinical outcomes (especially neurological outcomes) that are unknown. The purpose of this study was to evaluate the clinical outcome of these children. METHODS: We conducted a retrospective multicenter study of 17 children with an isolated SA or SA combined with a moderate ventricular dilatation (VD) that was diagnosed antenatally and confirmed by a magnetic resonance imaging (MRI) performed in the antenatal period. RESULTS: Of the 17 children, 14 had normal neurological examinations, 2 had language development delay and visuo-spatial dyspraxia, and 3 of the 17 children had behavioral problems. Eight children had neuropsychological evaluations, and the results were normal in six cases. There were 3 cases of septo-optic dysplasia (SOD) diagnosed postnatally, which highlighted the difficulties in assessing the optic tract and hypothalamic-pituitary region in antenatal imaging. Language delay and behavioral disorders were the main abnormalities at follow-up. CONCLUSION: The discovery of an isolated SA reveals the difficulties of prenatal diagnosis to correlate the neurological and functional prognosis to morphological findings. The prognosis seemed to be good. It appears necessary to improve the diagnostic performance of fetal brain imaging and to follow-up these children prospectively to assess their long-term cognitive-behavioral outcomes.