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Effectiveness and Implementation of Adapted Physical Activity Delivery Strategies for Older Adults Living With HIV in Ivory Coast: Protocol for a Type 2 Hybrid Randomized Controlled Trial
No full textInternational audienceBackground: With improved access to antiretroviral treatment, HIV infection has become a chronic disease, and the proportion of people living with HIV aged 50 years or older is increasing. However, the long-term evolution of this disease is associated with an increased risk of comorbidities and functional impairments, which negatively impact the social participation and quality of life of people living with HIV. In resource-limited countries, population aging is a new situation, and significant challenges remain unaddressed to respond to this demographic shift. Strong evidence supports the role of physical activity (PA) in improving health and decreasing functional limitations in many chronic conditions, including HIV. However, there is a lack of information on how to effectively implement this type of nondrug intervention in resource-limited contexts.Objective: This study aims to examine the effectiveness and implementation of 2 strategies to deliver an adapted PA program to older adults living with HIV.Methods: This is a prospective, randomized controlled trial following a type 2 hybrid design, with a dual focus on intervention effectiveness and implementation outcomes. It also includes prior formative research that provides information on the context and guides the implementation. Conducted in Ivory Coast, the study aims to randomize 180 people living with HIV aged 50 years or older, receiving antiretroviral treatment and presenting moderate functional limitations or disabilities into the following three arms: (1) a reference arm receiving a group-based PA program supervised by a coach, (2) an exploratory arm receiving a home-based PA program with remote supervision via phone calls and messaging apps, or (3) a control arm receiving health education sessions. The total follow-up period is planned for 12 months, with an initial 6-month active phase and then a 6-month maintenance phase. The primary effectiveness outcome is the increase in the number of steps in the 6-minute step-up test between baseline and 6 months. The secondary outcomes include changes in performance on other functional tests and improvements in cardiometabolic risk factors. The implementation outcomes include the acceptability, adoption, feasibility, and sustainability of the intervention.Results: This study is funded by ANRS Emerging Infectious Disease, which is also the study sponsor. It received ethical approval from the National Ethical Committee of Ivory Coast (00231 3124/MSHPCMU/CNESVS-km). As of manuscript submission, the baseline formative research has been completed, participants have been randomized, and they have started the PA activity program. Results dissemination will involve civil society and decision-makers through workshops and policy briefs.Conclusions: This study builds on previous research on healthy aging while living with HIV. Its hybrid design allows for a comprehensive evaluation of implementation processes and outcomes alongside effectiveness outcomes
Change in standing acetabular orientation 2 years postoperatively after surgical correction of adult spinal deformity
No full textInternational audienceIntroductionAlthough sagittal alignment is known to influence pelvic position, few studies accurately identify the relationship between sagittal alignment and acetabular orientation. We hypothesized that postoperative PT should be correlated with acetabular change in native hips after surgical correction of adult spinal deformity.The objective of this study was therefore to describe the correlation between the change in pelvic tilt and the change in acetabular orientation two years after surgical correction of adult spinal deformity.Material and methodBased on a retrospective study of a prospective mono center database, 127 acetabuli out of sixty-nine patients were analyzed preoperatively and at two years postoperatively of surgical management of sagittal imbalance by posterior arthrodesis extended to the pelvis. The analysis was based on bi-planar EOS radiographs with 3D reconstructions of the pelvis and spine using SterEOS 3D software.The following specific parameters were analyzed: sacral slope, pelvic tilt, lumbar lordosis, SVA, acetabulum tilt (AT), anteversion (AA) (orientation of the acetabulum in the axial plane), abduction (AAbd) (orientation of the acetabulum in the frontal plane), inclination (AI) (orientation of the acetabulum in the sagittal plane), and anterior acetabulum coverage (ACA).A Pearson correlation was performed between the pre-and postoperative change in acetabular parameters (right and left) and pelvic parameters. Linear regressions were performed to identify the most relevant pelvic and spinal parameters. A subgroup analysis was performed to identify a difference between distal sacral and distal ilium fixations.ResultsAll measured acetabular parameters were significantly different two years after surgery. Changes in AT (p = 0.03), AI (p = 0.03) and ACA (p = 0.05) were significantly greater in the ilium fixation group. Postoperative PT reduction was strongly correlated with the decrease of AT and AA ( = 0.61 and = 0.57, p < 0.001), it was also correlated with the increase of AI and ACA and the decrease of AAbd. The entire cohort linear regression analysis revealed that a 1 ° decrease in PT resulted in a 0.4 ° decrease in AA and a 0.6 ° decrease in AT (R2 = 0.45 and = 0.38).ConclusionOur study highlights the significant influence of the change in sagittal alignment on acetabular orientation in standing position. This correlation explains the increased risk of anterior hip impingement, the change in acetabular load distribution that might lead to early hip osteoarthritis, and the overall change in the subjects' gait pattern
Advancing Diamond Microfabrication by Selective Removal of CVD Diamond Surface using Oxygen Plasma.
No full textBiopolymeric nanogel delivery of doxorubicin induces apoptosis and inhibits growth of colon cancer cells through modulating Bax/Bcl2 ratio, AKT/PTEN, and activating Caspase-3
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Severity of complications is associated with impaired health‐related quality of life in people with type 1 diabetes
No full textInternational audienceAims Health‐related quality of life (HRQoL) assessment is increasingly integrated into type 1 diabetes (T1D) monitoring to promote a holistic approach. To investigate HRQoL in adults with T1D and to assess the impact of the severity of complications on HRQoL. Materials and Methods This is a cross‐sectional analysis of baseline characteristics of adults living with T1D included in Société Francophone du Diabète – Cohorte Diabète de Type 1 (SFDT1), a French longitudinal cohort study. HRQoL was assessed using generic (EuroQol 5‐Dimensions 5‐Level questionnaire [EQ‐5D‐5L]) and diabetes‐specific (Audit of Diabetes‐Dependent Quality of Life) instruments. The severity of diabetes complications was measured using an adapted Diabetes Complication Score Index (DCSI) ranging from 0 to 14. We used multiple imputations to deal with missing data. Results We included 1892 adults, 48% women, with a median (interquartile range [IQR]) age of 38 (28; 51) years. The mean overall EQ‐5D‐5L HRQoL score was 71.1 ± 17.7 (maximum 100), with the following number of participants negatively impacted for each domain: 271 (14%) for mobility, 94 (5%) for self‐care, 378 (19%) for usual activities, 853 (45%) for pain/discomfort and 983 (52%) for anxiety/depression. The median (IQR) DCSI was 1 (0; 2). In multivariable models, a one‐step increase in DCSI was associated with a 1.5% decrease in overall EQ‐5D‐5L HRQoL. DCSI was also inversely associated with all domains of the generic scale except anxiety/depression and 17 domains of the diabetes‐specific scale. Conclusions We observed an inverse association between the severity of complications and overall HRQoL and most of its dimensions. Our results highlight the need to reinforce the prevention of complications to improve the overall well‐being of people with T1D
Evidence for the absence of a relationship between inflammation and cognition in a cohort of 1565 individuals with bipolar spectrum disorders: a Bayesian analysis of network
No full textInternational audiencePrevious studies have reported variable associations between peripheral inflammatory markers and cognitive functioning in individuals with bipolar spectrum disorders (BSD), with some identifying significant links and others finding no relationship. Such inconsistencies raise important questions about the role of inflammation in cognitive impairment among individuals with BSD. This study aims to investigate the relationship between peripheral inflammatory markers and cognitive function in a clinical sample of individuals with BSD using a Bayesian network analysis framework. We analyzed data from a large cohort (n = 1565) focusing on hsCRP and a subsample (n = 249) that included concurrent assessments of additional cytokines including Interleukin-6 and Tumor Necrosis Factor-alpha. A Bayesian approach was utilized to quantify uncertainty regarding the presence or absence of associations between inflammation and cognitive function. Our findings revealed no significant associations between inflammatory markers and cognitive performance in both samples. Strong evidence was found supporting the absence of association, with network analysis indicating distinct clusters for cognitive and inflammatory variables, suggesting they function as independent constructs with limited interactions. In our clinical sample of individuals with BSD, our findings do not support a direct association between some inflammatory markers and cognition, aligning with studies that found minimal or no associations. Our study emphasizes the importance of utilizing Bayesian methods to assess these relationships rigorously and suggests further exploration of individual differences and subgroup effects in future research
La Recherche-projet en design, éléments pour une théorisation
No full textensaama.netCet article est issu du partenariat entre la fondation Bénéteau et le master "Produire autrement" qui s'est déroulé en septembre 2025 à La Rochelle et propose de réfléchir à la notion de projet en design
Early mechanical reperfusion in high-risk pulmonary embolism supported by V-A ECMO: a multicenter international cohort study
No full textInternational audienceAbstract Objectives To explore how early mechanical reperfusion impacts outcomes in high-risk pulmonary embolism (PE) patients supported by veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Methods This retrospective international study included adult patients treated with V-A ECMO for high-risk PE at 39 ECMO centers (2014–2024). Early mechanical reperfusion was defined as catheter-directed therapy or surgical embolectomy within 48 hours of ECMO initiation. Patients dying within 12 hours or receiving delayed reperfusion were excluded. The primary outcome was 90-day mortality, assessed using propensity-matched groups. Measurements and Main Results Among 492 patients on V-A ECMO (median age 53), 69% had cardiac arrest, and 28% received early mechanical reperfusion. After propensity matching, 137 patients were compared in each group. Ninety-day mortality was 32% with early mechanical reperfusion on ECMO versus 39% with ECMO stand-alone (HR 0.68; 95% CI, 0.45–1.03; p = 0.07). Overall, ECMO duration and weaning rates were similar; however, early mechanical reperfusion improved ECMO weaning in patients without prior thrombolysis (sHR 1.56; 95% CI, 1.03–2.36; p = 0.04). Bleeding occurred in 50% of patients, with no significant difference between groups. Conclusion In this large international cohort of patients with high-risk PE on V-A ECMO, early mechanical reperfusion therapy was not associated with a reduction in 90-day mortality or ECMO duration. These findings may support a stepwise, individualized approach favoring initial ECMO stand-alone support, although a certain clinical benefit from early mechanical reperfusion in selected patients cannot be excluded
Cultural Countertransference of Young Clinicians Facing a State of Possession: A Cultural Case Study
No full textInternational audiencePossession states are a well-known but a complex clinical aspect of transcultural psy-chiatry. How do young clinicians react when facing such symptoms? Starting from the case of a Somali patient suffering from possession states, treated in a transcul-tural consultation group, we will attempt to explain the cultural countertransference experienced by young clinicians who witnessed a trance. Using the Cultural Formu-lation Interview, we observed an evolution of the countertransference, and therefore an evolution of the symptom’s understanding and of the patient’s condition. This clinical case thus highlights the necessity to take into account the cultural counter-transference of young clinicians within the transcultural consultation
