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To assess the efficacy and safety of topiramate in treating binge eating disorder (BED), using a systematic review and meta-analysis of the available randomized clinical trials (RCTs).
The RCTs assessing topiramate vs placebo with or without adjunctive psychotherapy in BED were reviewed using a systematic search in the PubMed, Web of Science, PsycINFO, Cochrane Database of Systematic Review, and ClinicalTrials.gov search Websites, from inception to November 2019. Main outcomes were the changes in binge frequency, quality of life, and weight, respectively. Effect estimates were pooled using random-effect models and presented as risk ratios (RRs) or mean differences (MDs) and their 95% confidence interval (95% CI). Data extraction was performed by two independent reviewers.
Three studies were eligible for inclusion, involving 528 BED patients. Topiramate was found to be significantly more efficacious than placebo in reducing: (a) the number of binge episodes per week (MD = −1.31; 95% CI = −2.58 to −0.03; I2 = 94%); (b) the number of binge days per week (MD = −0.98; 95% CI = −1.80 to −0.16; I2 = 94%); and (c) weight (MD = −4.91 kg; 95% CI = −6.42 to −3.41; I2 = 10%). However, participants in the topiramate groups withdrew significantly more frequently for safety reasons, relative to placebo participants (RR = 1.90; 95% CI = 1.13-3.18, I2 = 0%).
Preliminary findings support a possible efficacy of topiramate for the treatment of BED, even if safety concerns could limit the practical use of this treatment in BED subjects.
To assess evolutionary processes in deep time, it is essential to understand the roles of development and environment, both recorded through the morphological variability of fossil assemblages. Thanks to their great abundance and the high temporal resolution of their fossil record, conodont elements are ideal to address this issue. In this paper, we present the first quantitative study of a Carnian–Norian (Late Triassic) assemblage of closely related P1 conodont elements. Using geometric morphometrics (landmarks, sliding landmarks, and elliptic Fourier analysis), we explore the main axes of phenotypic variation and relate them to classically used taxonomic characters. We show that some important taxonomic features follow laws of covariation, hence highlighting developmental constraints. Furthermore, the intraspecific variation within all considered species, either Carnian or Norian forms, is similarly restricted, emphasizing, for the first time in conodont P1 elements, a common line of least resistance to evolution, which means that similar intrinsic (developmental) factors were acting on these taxa and likely biased the evolutionary trajectories of all these taxa in a similar way. Because the evolution between Carnian and Norian forms is known to have followed a trajectory that is significantly different from the line of least resistance, strong extrinsic pressures, such as environmental disturbances, were probably at play around the Carnian/Norian boundary to counteract the effects of these intrinsic, developmental constraints.
Major depressive disorder (MDD) is underdiagnosed and undertreated in schizophrenia, and has been strongly associated with impaired quality of life.
To determine the prevalence and associated factors of MDD and unremitted MDD in schizophrenia, to compare treated and non-treated MDD.
Participants were included in the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment. MDD was defined by a Calgary score ≥6. Non-remitted MDD was defined by current antidepressant treatment (unchanged for >8 weeks) and current Calgary score ≥6.
613 patients were included and 175 (28.5%) were identified with current MDD. MDD has been significantly associated with respectively paranoid delusion (odds ratio 1.8; P = 0.01), avolition (odds ratio 1.8; P = 0.02), blunted affect (odds ratio 1.7; P = 0.04) and benzodiazepine consumption (odds ratio 1.8; P = 0.02). Antidepressants were associated with lower depressive symptoms score (5.4 v. 9.5; P < 0.0001); however, 44.1% of treated patients remained in non-remittance MDD. Nonremitters were found to have more paranoid delusion (odds ratio 2.3; P = 0.009) and more current alcohol misuse disorder (odds ratio 4.8; P = 0.04). No antidepressant class or specific antipsychotic were associated with higher or lower response to antidepressant treatment. MDD was associated with Metabolic syndrome (31.4 v. 20.2%; P = 0.006) but not with increased C-reactive protein.
Antidepressant administration is associated with lower depressive symptom level in patients with schizophrenia and MDD. Paranoid delusions and alcohol misuse disorder should be specifically explored and treated in cases of non-remission under treatment. MetS may play a role in MDD onset and/or maintenance in patients with schizophrenia.
It remains unclear whether ST-elevation myocardial infarction (STEMI) patients transported by ambulance over long distances are at risk for clinical adverse events. We sought to determine the frequency of clinical adverse events in a rural population of STEMI patients and to evaluate the impact of transport time on the occurrence of these events in the presence of basic life support paramedics.
We performed a health records review of 880 consecutive STEMI patients transported to a percutaneous coronary intervention centre. Patients had continuous electrocardiogram and vital sign monitoring during transport. A classification of clinically important and minor adverse events was established based on a literature search and expert consensus. A multivariate ordinal logistic regression model was used to study the association between transport time (0-14, 15-29, ≥30 minutes) and the occurrence of overall clinical adverse events.
Clinically important and minor events were experienced by 18.5% and 12.2% of STEMI patients, respectively. The most frequent clinically important events observed were severe hypotension (6.1%) and ventricular tachycardia/ventricular fibrillation (5.1%). Transport time was not associated with a higher risk of experiencing clinical adverse events (p=0.19), but advanced age was associated with adverse events (p=0.03). No deaths were recorded during prehospital transport.
In our study of rural STEMI patients, clinical adverse events were common (30.7%). However, transport time was not associated with the occurrence of adverse clinical events in these patients.
This paper presents the characterization and modeling process of MASMOS structures by means of a classical compact three-port electrical non-linear model approach. From DC and S-parameters measurements, a large signal model (LSM) has been developed for two different MASMOS structures. The proposed LSM and associated modeling approach have been validated through load pull measurements with different harmonic load conditions. Then, generic multi-tone measurements have been carried out making use of an innovative test bench to quantify linearity performances of MASMOS structures. The model is used in a power amplifiers design flow for LTE applications and is expected to allow a significant reduction of simulation time, compared with technological-oriented model as BSIM3.
This paper presents performances achieved with InAlGaN/GaN HEMTs with 0.15 µm gate length on SiC substrate. Technology Computer Aided Design simulations were used to optimize the heterostructure. Special attention was paid to the design of the buffer structure. I-V measurements with DC and pulsed bias voltages were performed. CW measurements at millimeter waves were also carried out and are detailed in the following sections. The technology, optimized for power applications up to 45 GHz, demonstrates a current gain cut-off frequency FT of 70 GHz and a maximum available gain cut-off frequency FMAG of 140 GHz. CW Load-pull power measurements at 30 GHz enable to achieve a maximum PAE of 41% associated with an output power density of 3.5 W/mm when biased at VDS = 20 V. These devices, with an improved buffer structure show, reduced recovery time in pulsed operating conditions. These improved characteristics should have a positive impact for pulsed or modulated signal applications.
Background: Individuals with Parkinson’s disease (PD) often present with visual symptoms (e.g., difficulty in reading, double vision) that can also be found in convergence insufficiency (CI). Our objective was to estimate the prevalence of CI-type visual symptomatology in individuals with PD, in comparison with controls. Methods: Participants ≥50 years with (n=300) and without (n=300) PD were recruited. They were administered the Convergence Insufficiency Symptom Survey (CISS–15) over the phone. A score of ≥21 on the CISS–15, considered positive for CI-type symptomatology, served as the cutoff. Data from individuals (n=87 with, n=94 without PD) who were approached but who reported having a known oculovisual condition were analysed separately. Student’s t test and chi-square at the 0.05 level were employed for statistical significance. Results: A total of 29.3% of participants with versus 7.3% without PD presented with a score of ≥21 on the CISS–15 (p=0.001). Of the participants having a known oculovisual condition, 39.1% with versus 19.1% without PD presented with a score of ≥21 on the CISS–15 (p=0.01). Conclusions: The prevalence of CI-type visual symptoms is higher in individuals with versus without PD whether or not they have a coexisting oculovisual condition. These results suggest that PD per se places individuals with the disease at greater risk of visual symptomatology. These results further underline the importance of providing regular eye exams for individuals with PD.
Despite numerous medical, pharmacological and surgical approaches for chronic low back pain (LBP), many patients continue to complain of severe disabling pain. Peripheral nerve field stimulation (PNfS), alone or combined with spinal cord stimulation, is a neuromodulation procedure that have been recently developed and implemented in our hospital. We conducted a Health Technology Assessment (HTA) to determine if PNfS may be considered as a standard of practice in the management of intractable LBP and failed back surgery syndrome (FBSS).
An interdisciplinary group of experts was involved in the project. A systematic review (SR) was performed in several databases and grey literature to identify clinical practice guidelines, SR and observational studies published through September 2016. A survey was conducted among other chronic pain centers in Canada to document PNfS use in LBP and FBSS treatment.
Data on effectiveness and safety of PNfS in chronic LBP treatment were scarce. Short-term results (3-12 months) from small sample and low quality studies suggest that PNfS, alone or combined with spinal cord stimulation, is associated with pain intensity and opioid use reductions. Effects on functional status and quality of life remain undetermined. Most frequent adverse events reported with PNfS devices are lead migrations, discomfort or pain and surgical site infections. No other Canadian pain centers were found to use PNfS in chronic LBP or FBSS.
PNfS is potentially a beneficial treatment option for patients with chronic low back pain or FBSS. However, the value of this innovative treatment remains unknown. Among factors to be clarified are target population (any chronic low back pain or FBSS), use of PNfS alone or combined with spinal cord stimulation, long-term effects, and comparison with conventional medical management. PNfS use in chronic LBP has to be assessed through a rigorous framework before its introduction as a standard medical practice.
Background: The prevalence of sleep disturbances among patients with Parkinson’s disease (PD) is estimated to occur in 37% to 98% of patients. Sleep disturbances have been associated with a reduced quality of life for patients with PD. The objective of this study was to assess the impact of rasagiline treatment on the severity of sleep disturbances among patients with idiopathic PD. Methods: In this open-label, multicentre study, 110 adult patients with idiopathic PD were treated with rasagiline either as monotherapy or as adjunct therapy. The primary endpoint was the change in severity of sleep disturbances, assessed with the PD Sleep Scale from baseline to month 2. Exploratory endpoints included change in daytime sleepiness, assessed with the Epworth Sleep Scale, treatment satisfaction measured with the Treatment Satisfaction Questionnaire for Medication, patient’s overall improvement or deterioration over time measured with the Clinical Global Impression of Improvement, tolerability, and safety. Findings: Patients treated with rasagiline as mono- or adjunct therapy showed a statistically significant improvement in sleep quality after 2 months. There was no change in daytime sleepiness. Overall, patients were satisfied with rasagiline treatment with a mean Treatment Satisfaction Questionnaire for Medication [standard deviation] total score at month 2 of 68% [16.1]. At the end of study, 64 patients (65.9%) were judged, by the investigator, as being at least minimally improved from baseline on the Clinical Global Impression of Improvement. Rasagiline was safe and well-tolerated. Interpretation: Rasagiline as mono- or adjunct-therapy may improve sleep experience in patients with PD in the short term.
We investigated whether convenience sampling is a suitable method to generate a sample of older drivers representative of the older-Canadian driver population. Using equivalence testing, we compared a large convenience sample of older drivers (Candrive II prospective cohort study) to a similarly aged population of older Canadian drivers. The Candrive sample consists of 928 community-dwelling older drivers from seven metropolitan areas of Canada. The population data was obtained from the Canadian Community Health Survey – Healthy Aging (CCHS-HA), which is a representative sample of older Canadians. The data for drivers aged 70 and older were extracted from the CCHS-HA database, for a total of 3,899 older Canadian drivers. Two samples were demonstrated as equivalent on socio-demographic, health, and driving variables that we compared, but not on driving frequency. We conclude that convenience sampling used in the Candrive study created a fairly representative sample of Canadian older drivers, with a few exceptions.
This paper presents an original characterization method of trapping phenomena in gallium nitride high electron mobility transistors (GaN HEMTs). This method is based on the frequency dispersion of the output-admittance that is characterized by low-frequency S-parameter measurements. As microwave performances of GaN HEMTs are significantly affected by trapping effects, trap characterization is essential for this power technology. The proposed measurement setup and the trap characterization method allow us to determine the activation energy Ea and the capture cross-section σn of the identified traps. Three original characterizations are presented here to investigate the particular effects of bias, ageing, and light, respectively. These measurements are illustrated through different technologies such as AlGaN/GaN and InAlN/GaN HEMTs with non-intentionally doped or carbon doped GaN buffer layers. The extracted trap signatures are intended to provide an efficient feedback to the technology developments
A study of the electrical performances of AlInN/GaN High Electron Mobility Transistors (HEMTs) on SiC substrates is presented in this paper. Four different wafers with different technological and epitaxial processes were characterized. Thanks to intensive characterizations as pulsed-IV, [S]-parameters, and load-pull measurements from S to Ku bands, it is demonstrated here that AlInN/GaN HEMTs show excellent power performances and constitute a particularly interesting alternative to AlGaN/GaN HEMTs, especially for high-frequency applications beyond the X band. The measured transistors with 250 nm gate lengths from different wafers delivered in continuous wave (cw): 10.8 W/mm with 60% associated power added efficiency (PAE) at 3,5 GHz, 6.6 W/mm with 39% associated PAE at 10.24 GHz, and 4.2 W/mm with 43% associated PAE at 18 GHz.
The present paper presents an overview of the AlGaN/GaN-based circuits realized over the years. Two technological processes with 0.25 and 0.7 μm gate length allowed one to address applications from L- to Ku-bands. Depending on the process development and frequency of the operation, results on hybrid or MMIC technology are presented. GaN technology is evaluated through the realization of high-power amplifiers, robust low-noise amplifiers, or power switches to prepare the next generation of Tx-Rx modules.
The temperature evolution over the past 40 years in the Bay of Biscay (North-East Atlantic) is investigated from an in situ data analysis, completed with a satellite SST (Sea Surface Temperature) analysis over the last 20 years. The in situ dataset is an interannual version of the
BoByClim climatology, covering the Bay of Biscay area with a 10-km horizontal resolution and a 5-m vertical step. The satellite dataset is the European COastral Sea Operational Observing and Forcast System Program (ECOOP) daily analysis, covering the IBIROOS (Iberian-Biscay-Irish Sea) area with a 4-km resolution. The study area (43°N-50°N/12°W-1°W) extends over the intersection of the domains covered by these two analyses.
In the 0–200 m layer of this domain, a heat budget has been computed from an
ocean circulation model over the period 1965-2004. Heat is essentially
imported from the west by the North Atlantic Drift, then exported southward and northward, or transferred downward into deeper layers. The annual average of air-sea flux is weak, with a zero isoline crossing the domain from the northwest to the southeast. Ocean and atmosphere, forming a coupled system, have comparable contributions and may both result in a heat sink or
source. At the interannual scale, variability is mainly controlled by the
air-sea flux, with a secondary contribution from oceanic transport. A strong
warming of $\sim $0.2 °C/decade for the period 1965-2004 is apparent from
the surface down to the 200-m depth. The decadal evolution is consistent
with several analyses over the North Atlantic. Meanwhile, warming is
approximately twice faster than in the whole basin. This trend is not
steady, as a cooling period occurred until the early 1970's, and the
temperature increase has been significantly stronger during the last 20
years ($\sim $0.3 °C/decade between 0 and 100 m, from 1986 to 2005). The
trend and the interannual variability are maximal over the northern part of
the shelf. The typical duration of interannual anomalies is two years and
their penetration depth is ~100 m, although they occasionally exceed
200 m. The interseasonal anomalies are also stronger within the mixed layer
(root-mean-square, RMS = 0.6 °C at the surface) than below (RMS = 0.3 °C at 100 m). Their geographic distribution is radically different between
the surface and the deep levels. A seasonal dependence of the warming rate
is evident in the upper layer, as the temperature trend is stronger in summer than in winter (by a factor of 2 at the surface). Some of the potential implications for the ecosystem are discussed, particularly in terms of species distribution and dynamics of species exploited by fisheries.
Le problème de planification de techniciens et d'interventions pour les télécommunications (TIST pour
Technicians and Interventions Scheduling Problem for
Telecommunications) comprend la planification d'interventions et l'affectation d'équipes de techniciens à ces interventions. Chaque intervention est caractérisée, entre autres, par une priorité. L'objectif de ce problème est de séquencer les interventions en tenant compte de leur priorité tout en satisfaisant un ensemble de contraintes comme l'ordre d'exécution de certaines interventions et le nombre minimum de techniciens d'un niveau de compétence donné à affecter à chaque intervention. La résolution de ce problème est centrée sur un algorithme GRASP (Greedy Randomized Adaptive Search Procedure) caractérisé par une mise à jour dynamique des critères de choix des interventions. Pour évaluer la qualité des résultats obtenus par cette approche heuristique, nous présentons également un calcul de bornes inférieures.
Thanks to its physical characteristics, Ultra-wideband (UWB) is one of the most promising technologies for indoor pedestrian navigation. UWB radio localisation systems however experience multipath phenomena that decrease the precision and the reliability of the user's location. To cope with complex indoor environments, UWB radio signals are coupled with inertial measurements from Micro Electro Mechanical Sensors (MEMS) in an extended Kalman filter. Improved performances of the filter are presented and compared with reference trajectories and with pure inertial solutions. Only specific selection methods enable this improvement by detecting and removing outliers in the raw localisation data.
Les prothèses de hanche en biocéramique sont résistantes à l'usure mais, du fait de leur fragilité intrinsèque, sont susceptibles de se rompre. Le phénomène de décoaptation, séparation de faible amplitude de la tête et de la cupule, a été mis en évidence lors de la marche, et le choc mécanique en résultant peut fortement augmenter les risques de rupture. Un modèle par éléments-finis a été développé et les résultats ont été exploités afin de simuler l'évolution de la probabilité de rupture de cupules en zircone au cours du temps. Les résultats s'accordent bien avec l'expérience, même si des améliorations sont nécessaires afin de prendre en compte l'érosion des surfaces de contact.