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"Meunier, Pierre"
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The structures of the film experience : historical assessments and phenomenological expansions
For the first time this volume makes Jean-Pierre Meunier's insightful thoughts on the film experience available for an English-speaking readership. Introduced and commented by specialists in film studies and philosophy, Meunier?s intricate phenomenological descriptions of the spectator?s engagement with fiction films, documentaries and home movies can reach the wide audience they have deserved ever since their publication in French in 1969.
Book
A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention
This study of pooled data from trials of oral vitamin D supplementation examined the incidence of hip and nonvertebral fractures in persons 65 years of age or older. The data suggest that high-dose vitamin D may help prevent hip and nonvertebral fractures.
Approximately 75% of fractures occur in people 65 years of age or older.
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By 2050, the worldwide incidence of hip fractures is expected to increase by 240% among women and 310% among men.
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One strategy to prevent fractures in this population might be universal vitamin D supplementation. However, the results of several study level meta-analyses and one pooled participant-level analysis do not agree. Although one trial-level meta-analysis of double-blind, randomized, controlled trials suggested an 18% reduction in the incidence of hip fracture and a 20% reduction in the incidence of any nonvertebral fracture at a received dose of no less . . .
Journal Article
Oritatami: A Computational Model for Molecular Co-Transcriptional Folding
We introduce and study the computational power of Oritatami, a theoretical model that explores greedy molecular folding, whereby a molecular strand begins to fold before its production is complete. This model is inspired by our recent experimental work demonstrating the construction of shapes at the nanoscale from RNA, where strands of RNA fold into programmable shapes during their transcription from an engineered sequence of synthetic DNA. In the model of Oritatami, we explore the process of folding a single-strand bit by bit in such a way that the final fold emerges as a space-time diagram of computation. One major requirement in order to compute within this model is the ability to program a single sequence to fold into different shapes dependent on the state of the surrounding inputs. Another challenge is to embed all of the computing components within a contiguous strand, and in such a way that different fold patterns of the same strand perform different functions of computation. Here, we introduce general design techniques to solve these challenges in the Oritatami model. Our main result in this direction is the demonstration of a periodic Oritatami system that folds upon itself algorithmically into a prescribed set of shapes, depending on its current local environment, and whose final folding displays the sequence of binary integers from 0 to N = 2 k − 1 with a seed of size O ( k ) . We prove that designing Oritatami is NP-hard in the number of possible local environments for the folding. Nevertheless, we provide an efficient algorithm, linear in the length of the sequence, that solves the Oritatami design problem when the number of local environments is a small fixed constant. This shows that this problem is in fact fixed parameter tractable (FPT) and can thus be solved in practice efficiently. We hope that the numerous structural strategies employed in Oritatami enabling computation will inspire new architectures for computing in RNA that take advantage of the rapid kinetic-folding of RNA.
Journal Article
Long-term follow-up of balloon-expandable valves according to the implantation strategy: insight from the DIRECTAVI trial
Safety and feasibility of transcatheter aortic valve replacement (TAVR) without balloon aortic valvuloplasty (BAV) using the SAPIEN 3 balloon-expandable device has been previously demonstrated. The impact on long-term valve hemodynamic performances and outcomes remains however unknown. We evaluate long-term clinical and hemodynamic results according to the implant strategy (direct TAVR vs BAV pre-TAVR) in patients included in the DIRECTAVI randomized trial (NCT02729519).
Clinical and echocardiographic follow-up until January 2023 was performed for all patients included in the DIRECTAVI trial since 2016 (n = 228). The primary endpoint was incidence of moderate/severe hemodynamic valve deterioration (HVD), according to the Valve Academic Research defined Consortium-3 criteria (increase in mean gradient ≥10 mmHg resulting in a final mean gradient ≥20 mmHg, or new/worsening aortic regurgitation of 1 grade resulting in ≥ moderate aortic regurgitation).
Median follow-up was 3.8 (2.2-4.7) years. Mean age at follow-up was 87 ± 6.7 years. No difference in incidence of HVD in the direct implantation group compared to the BAV group was found (incidence of 1.97 per 100 person-years and 1.45 per 100 person-years, respectively, P = 0.6). Prevalence of predicted prothesis-patient mismatch was low (n = 13 [11.4%] in the direct TAVR group vs n = 15 [13.2%] in BAV group) and similar between both groups (P = .7). Major outcomes including death, stroke, hospitalization for heart failure and pacemaker implantation were similar between both groups, (P = .4, P = .7, P = .3, and P = .3 respectively).
Direct implantation of the balloon-expandable device in TAVR was not associated with an increased risk of moderate/severe HVD or major outcomes up to 6-year follow-up. These results guarantee wide use of direct balloon-expandable valve implantation, when feasible.
NCT05140317.
Journal Article
Cross-sectional study to describe allergic rhinitis flare-ups and associated airways phenotype in house dust mite sensitization
To quantify and describe flare-ups of house dust mite allergic rhinitis (HDM-AR) which had occurred during the last 12 months in a population of adults and children candidate for Allergen ImmunoTherapy (AIT). Next, to identify associated clinical features.
This was an observational, multicenter, cross-sectional study that included patients aged ≥ 5 years with HDM-AR eligible for AIT and without prior AIT for at least 12 months. Flare-ups were all period with impairment of quality of life (QoL) and requiring a change in their usual treatment. Data were collected using medical records and patient questionnaires. Variables associated with the occurrence of ≥ 2 AR flare-ups were identified.
1,701 patients were included (average age: 23 years, 51.5% males, 30.4% children, 17.7% adolescents and 51.9% adults). Severe and persistent AR affected 70.9% of them and 53.7% showed polysensitization. Asthma was associated with AR in 34.4% and was well-controlled in 58.5%. The occurrence of at least one AR flare-up in the year was reported by 77.7%, with an annual rate in the whole population of 2.6 ± 3.9 and a duration of 14.1 ± 17.1 days. Deeply or moderately AR-related degraded QoL was experienced by 39.5% and 64.6%, respectively. The occurrence of ≥ 2 AR flare-ups was reported by 54.5% and was associated with polysensitization, AR intermittence and severity.
AR flare-ups are frequent and impair QoL in HDM-allergic patients, suggesting that it could be considered as therapeutic targets.
Journal Article
Early Canadian Real-World Experience with Brolucizumab in Anti-Vascular Endothelial Growth Factor-Experienced Patients with Neovascular Age-Related Macular Degeneration: A Retrospective Chart Review
Purpose: To assess early real-world outcomes with brolucizumab in Canadian patients with neovascular age-related macular degeneration (nAMD) for which they previously received [greater than or equal to]1 anti-vascular endothelial growth factor (anti-VEGF) agent(s). Patients and Methods: This multisite, real-world, retrospective chart review included data from a consecutive sample of 73 patients who received brolucizumab for nAMD after treatment with [greater than or equal to]1 other anti-VEGF agents. The principal reasons for switching to brolucizumab were to extend the treatment interval (51.6% of patients) and to treat persistent macular fluid (34.2%). The primary outcomes were best-corrected visual acuity (BCVA) and the incidence rates of intraocular inflammation (IOI), retinal vasculitis (RV), and retinal vascular occlusion (RVO). Secondary outcomes included central retinal thickness (CRT), injection interval, and presence of intraretinal and subretinal fluid (IRF and SRF). All parameters were measured at baseline until the last treatment visit between April 27, 2020, and August 31, 2021. Results: Over a mean follow-up of 28 weeks, a nonsignificant mean improvement in BCVA was identified (4.3 [standard deviation (SD) 8.3] letters; P=0.057), with 47.9% experiencing a gain of [greater than or equal to]5 letters. IOI was detected in 3 patients (4.1%), one of whom also developed RV and RVO (1.4%), which is consistent with existing brolucizumab data. Significant reductions were observed in mean CRT (-36.6 [micro]m [SD 56.1 [micro]m]; P=0.0002) and presence of any macular fluid (56.1% [SD 5.6%]; P<0.001), IRF (66.6% [SD 6.3%]; P<0.001), and SRF (62.7% [SD 6.3%]; P<0.001). The mean injection interval increased significantly by 2.1 weeks (SD 2.7; P<0.001). Conclusion: In the first real-world Canadian analysis, brolucizumab was associated with improvements in functional outcomes in treatment-experienced patients, consistent with other real-world studies. The incidence of IOI, RV, and RVO were in line with the post hoc safety analysis of HAWK and HARRIER data. Keywords: best-corrected visual acuity, central retinal thickness, injection interval, intraocular inflammation, retinal vascular occlusion
Journal Article
Estimates of optimal vitamin D status
Vitamin D has captured attention as an important determinant of bone health, but there is no common definition of optimal vitamin D status. Herein, we address the question: What is the optimal circulating level of 25-hydroxyvitamin D [25(OH)D] for the skeleton? The opinions of the authors on the minimum level of serum 25(OH)D that is optimal for fracture prevention varied between 50 and 80 nmol/l. However, for five of the six authors, the minimum desirable 25(OH)D concentration clusters between 70 and 80 nmol/l. The authors recognize that the average older man and woman will need intakes of at least 20 to 25 mcg (800 to 1,000 IU) per day of vitamin D(3 )to reach a serum 25(OH)D level of 75 nmol/l. Based on the available evidence, we believe that if older men and women maintain serum levels of 25(OH)D that are higher than the consensus median threshold of 75 nmol/l, they will be at lower risk of fracture.
Journal Article
Clinical practice during the COVID-19 pandemic: a qualitative study among child and adolescent psychiatrists across the world
Background
The COVID-19 pandemic has directly impacted the field of child and adolescent psychiatry, affecting all aspects of the lives of children and their families and increasing their risk of distress and mental health issues, especially among children with preexisting psychiatric disorders. Child and adolescent psychiatrists (CAPs) across the world have had to adapt their practice, due to lockdown and social distancing measures. This study aimed to explore how CAPs experienced their clinical practice in these singular conditions.
Methods
This exploratory international qualitative study used the Inductive Process to analyse the Structure of lived Experience (IPSE) approach, which is a five-stage inductive process used to explore the lived experience of participants in depth and to analyze their structure of lived experience. This study took place from March through July 2020 through individual in-depth video interviews. The sample size was determined according to the principles of
theoretical sufficiency.
Results
39 CAPs from 26 countries participated (age range 32–70 years; 23 women). Data analysis produced a structure of lived experience comprising three central axes of experience: (1) lost in space, lost in time, describing CAPs’ experience of disorganization of their clinical practice in the dimensions of lived time and lived space, (2) the body—of CAPs and patients—underlining their disconcerting experience of both sensory aspects and the non-embodied encounter during clinical practice, and (3) unpleasant emotions, with angst and loneliness the two main feelings coloring their clinical practice experience.
Conclusions
This analysis of the structure of lived experience of CAPs went beyond the sole context of the pandemic and revealed key aspects of what usually organizes CAP clinical practice. It identified two blind spots or conceptual voids within the child and adolescent psychiatry field: first, the intrinsic therapeutic function of a CAP clinical practice and, second, the important diagnostic and therapeutic function of the embodied encounter during CAP consultations. Beyond the context of COVID-19, further research should investigate these aspects to better define what a CAP does in practice and to increase both attractiveness and recruitment in this specialty.
Journal Article
Simplified TAVR Procedure: How Far Is It Possible to Go?
Increasing operators’ experience and improvement of the technique have resulted in a drastic reduction in complications following transcatheter aortic valve replacement (TAVR) in patients with lower surgical risk. In parallel, the procedure was considerably simplified, with a routine default approach including local anesthesia in the catheterization laboratory, percutaneous femoral approach, radial artery as the secondary access, prosthesis implantation without predilatation, left ventricle wire pacing and early discharge. Thus, the “simplified” TAVR adopted in most centers nowadays is a real revolution of the technique. However, simplified TAVR must be accompanied upstream by a rigorous selection of patients who can benefit from a minimalist procedure in order to guarantee its safety. The minimalist strategy must not become dogmatic and careful pre-, per- and post-procedural evaluation of patients with well-defined protocols guarantee optimal care following TAVR. This review aims to evaluate the benefits and limits of the simplified TAVR procedure in a current and future vision.
Journal Article
Effect of Risedronate on the Risk of Hip Fracture in Elderly Women
Hip fractures cause substantial disability and are associated with a high rate of death among elderly women,
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but there have been few studies of the effects of drug treatment on the risk of hip fracture. Observational studies suggest that estrogen may reduce the risk of hip fracture.
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Alendronate reduced the risk of hip fracture in postmenopausal women with low bone mass at the femoral neck or with previous vertebral fractures, but not in women without those risk factors.
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Numerous risk factors for hip fracture have been identified.
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In general, these risk factors can be categorized as skeletal . . .
Journal Article