Evaluation of three pedestrian phasing with audible pedestrian signals configurations in Quebec City (Canada): an exploratory study of blind or visually impaired persons' sense of safety, preferences, and expectations.

PURPOSE: This exploratory study aimed to evaluate the preferences, expectations, and sense of safety of blind or visually impaired persons regarding three types of pedestrian phasing with audible pedestrian signals configurations that exist in Quebec City (Canada). These include: 1) exclusive phasing with non-directional audible pedestrian signals; 2) exclusive phasing with directional audible pedestrian signals; and 3) concurrent phasing with directional audible pedestrian signals. METHODS: Thirty-two blind or visually impaired persons were asked to complete a survey. Their preferences and expectations regarding audible pedestrian signals were documented through a series of simulations. Their sense of safety regarding the three existing configurations were also documented. Subsequently, semi-directed, individual interviews with 11 of the individuals who had completed the survey were conducted to build off the collected information. RESULTS: No formal consensus regarding many of the issues discussed were established as participants' responses varied too significantly. However, findings suggest that the exclusive phasing with directional audible pedestrian signals configuration is perceived to be the safest option by the participants. CONCLUSION: This study may have practical implications on the design of intersections (e.g., selection of a type of pedestrian phasing with audible pedestrian signal) and the training of blind or visually impaired pedestrians.IMPLICATIONS FOR REHABILITATIONThe addition of audible pedestrian signals to pedestrian signals heightens the sense of safety of blind or visually impaired persons.This study may have practical implications on the design of intersections with audible pedestrian signals and the selection of a type of audible pedestrian signals based on intersection characteristics.Since many participants reported a lower sense of safety when faced with concurrent phasing, it is recommended that more intensive orientation and mobility interventions be provided to blind or visually impaired pedestrians who use this type of traffic signals.Educating road users about blind or visually impaired pedestrians appears also essential.

Observing the Suppression of Superconductivity in RbEuFe_{4}As_{4} by Correlated Magnetic Fluctuations.

In this Letter, we describe quantitative magnetic imaging of superconducting vortices in RbEuFe_{4}As_{4} in order to investigate the unique interplay between the magnetic and superconducting sublattices. Our scanning Hall microscopy data reveal a pronounced suppression of the superfluid density near the magnetic ordering temperature in good qualitative agreement with a recently developed model describing the suppression of superconductivity by correlated magnetic fluctuations. These results indicate a pronounced exchange interaction between the superconducting and magnetic subsystems in RbEuFe_{4}As_{4}, with important implications for future investigations of physical phenomena arising from the interplay between them.

Dynamic cystocolpoproctography is superior to functional pelvic MRI in the diagnosis of posterior pelvic floor disorders: results of a prospective study.

AIM: The accuracy of dynamic cystocolpoproctography (DCP) and dynamic MRI were compared in diagnosing posterior pelvic floor disorders. METHOD: Fifty consecutive female patients (mean age 51 years) complaining of posterior compartment pelvic floor disorder and referred to a tertiary centre entered the prospective study. The Institutional Review Board stated that informed consent from the patients was not necessary for this study. Patients underwent a DCP and a supine functional MRI by two different radiologists. Assessment of radiological examinations was prospective and blind. All patients underwent surgery that led to the final diagnosis. Agreement between the operative diagnosis and the diagnoses following DCP and MRI was assessed using the weighted kappa statistic. A matched-pairs McNemar's test was applied to demonstrate whether or not one radiological method was superior to the other. RESULTS: Full-thickness rectal prolapse was best diagnosed by clinical examination. Internal rectal prolapse and peritoneocele were best diagnosed by DCP. A better agreement with the operative diagnosis, which is not true superiority, was observed for DCP compared with functional pelvic MRI for full-thickness rectal prolapse, internal rectal prolapse and peritoneocele. There was no significant difference between DCP and functional pelvic MRI in the diagnosis of internal rectal prolapse (P = 0.125) or peritoneocele (P = 0.10). CONCLUSION: As full-thickness rectal prolapse, internal rectal prolapse and peritoneocele might be missed by functional pelvic MRI, there should still be a place for DCP in particular cases where the clinical diagnosis is not clear in women with symptomatic posterior pelvic floor disorders.

Economic and health-related quality-of-life (HRQoL) comparison of lopinavir/ritonavir (LPV/r) and atazanavir plus ritonavir (ATV+RTV) based regimens for antiretroviral therapy (ART)-naïve and -experienced United Kingdom patients in 2011.

BACKGROUND: Using a United Kingdom (UK)-based National Health Services perspective for 2011 this study first estimated the cost-effectiveness and budget impact implications for lopinavir/ritonavir (LPV/r) vs atazanavir plus ritonavir (ATV+RTV) treatment of antiretroviral therapy (ART)-naïve patients and secondly examined the long-term health-related quality-of-life (HRQoL) and economic implications for LPV/r vs ATV+RTV treatment of ART-experienced patients. METHODS: A previously published Markov model that integrates epidemiological data of human immunodeficiency virus (HIV) with predictors of coronary heart disease (CHD) was modified under a clearly specified set of assumptions to reflect viral load (VL) suppression profiles and other differences for these two regimens, applying results from the CASTLE study in ART-naïve patients and using data from BMS-045 in ART-experienced patients. ART costs were referenced to current (2011) pricing guidelines in the UK. Medical care costs reflected UK treatment patterns and relevant drug pricing. Costs and outcomes were discounted at 3.5% per year. Costs are expressed in British pounds (£) and life expectancy in quality-adjusted life years (QALYs). RESULTS: In the ART-naïve subjects, the model predicted a marginal improved life expectancy of 0.031 QALYs (11 days) for the ATV+RTV regimen as a result of predicted CHD outcomes based on lower increases in cholesterol levels compared with the LPV/r regimen. The model demonstrated cost savings with the LPV/r regimen. The total lifetime cost savings was £4070 per patient for the LPV/r regimen. LPV/r saved £2133 and £3409 per patient at 5 and 10 years, respectively. Referenced to LPV/r, the incremental cost-effectiveness ratio (ICER) for ATV+RTV was £149,270/QALY. For ART-experienced patients VL suppression differences favored LPV/r, while CHD risk associated with elevated total cholesterol marginally favored ATV+RTV, resulting in a net improvement in life expectancy of 0.31 QALYs (106 days) for LPV/r. Five-year costs were £5538 per patient greater for ATV+RTV, with a discounted lifetime saving of £1445 per LPV/r patient. LPV/r was modestly dominant economically, producing better outcomes and cost savings. LIMITATIONS: The limitations of this study include uncertainty related to how well the model's assumptions capture current practice, as well as the validity of the model parameters used. This study was limited to using aggregated data in the public domain from the two clinical trials. Thus, some of the model parameters may reflect limitations due to trial design and data aggregation bias. This study has attempted to illuminate the effect of these limitations by presenting the results of the comprehensive sensitivity analysis. CONCLUSIONS: Based on 2011 costs of HIV in the UK and the published efficacy data from the CASTLE and BMS-045 studies, ATV+RTV-based regimens are not expected to be a cost-effective use of resources for ART-naïve patients similar to patients in the CASTLE study, nor for ART-experienced patients based on the only published comparison of ATV+RTV and LPV/r.

[Quality score in pathological report of prostate biopsies improve professional practice]. / La mention systématique d'un indice de qualité dans les comptes rendus de biopsies prostatiques influence les pratiques professionnelles.

OBJECTIVE: Evaluate the influence on professional practices of a systematic indication of a quality score (IGap) in the conclusion of the pathologic reports (CRFS) of prostatic biopsies (PB). MATERIALS AND METHOD: Prospective study carried over 339 consecutive 10 core extended standardized PB performed by two urologists over a period of 22 months. The CRFS were computerized. The conclusion included an IGap ranking from 0 to 1, automatically computed from three criteria: the average length of the PB, the number of PB with identified capsules or periprostatic tissues and the average number of fragments per PB. The quality was best when the index is close to 1. A quarterly monitoring of the average of IGap was performed for the two urologists. The student t test was used to compare the averages. RESULTS: The average of IGap of the urologists A and B was, respectively, of 0.57 (s=0.1; n=184) and 0.66 (s=0.1; n=155): p<0.001. At quarter 1, the averages of IGap of the urologists A and B are, wads of respectively, of 0.47 (s=0.14; n=25) and 0.7 (s=0.12; n=14) (p<0.001). The significant difference of the average of IGap of the urologists A and B observed on quarter 1 progressively decline to disappear from the quarter 4. CONCLUSIONS: At equivalent protocols, the urologists do not necessarily perform PB of comparable quality. A systematic indication of an IGap in the pathological reports of PB seems to prompt the urologists to modify their practices toward an improvement of the score.

[Length of needle and size of prostatic biopsies influence identification of capsular and extracapsular elements]. / La longueur des biopsies prostatiques conditionne l'identification des éléments capsulaires et périprostatiques.

OBJECTIVE: To evaluate the influence of the length of prostate biopsies (PB) on identification of prostatic capsule and periprostatic tissue. MATERIALS AND METHOD: A prospective study was carried out in one center by two urologists during 22 months on 339 consecutive protocols of standardized ten-needle PB (PSA<10ng/ml regardless of digital rectal examination). Pathologic reports were standardized. The conclusion of the pathologic report included the average length of the ten-needle PB (Lm) and the number of prostatic core biopsies on which pathologist identified prostatic capsule and periprostatic tissue (BCI). Protocols of PB were spread in 16 groups depending on the value of Lm in millimeter: [0-1], [1-2], [2-3]... [15-16]. Relationship between Lm's and BCI's was evaluated using the linear regression and the correlation coefficient (r). RESULTS: Average Lm=10.7 (2.1-15.7; s=2.3) (n=339). Average BCI=6.6 (0-10; s=2.3) (n=339). The value of IGap increased when the value of Lm increased (r=0.89). CONCLUSIONS: The pathologists better identify the capsule of the prostate and the periprostatic tissue when the PB's are of large size. PB's of small size are of poor quality either for samplings of the prostatic gland or samplings of the capsule and the periprostatic tissues.

[Development of a pathological quality score of prostate biopsies]. / Elaboration d'un indice de qualité anatomopathologique des biopsies prostatiques.

OBJECTIVES: Develop a score allowing the pathologist to objectively report on the overall quality of extended standardized prostatic biopsy (EPB). METHODS: A prospective study was carried out on 339 consecutive protocols of 10 core EPB (PSA<10 ng/ml). Reports are standardized and computerized. The conclusion of the reports includes an estimate of the overall quality of the EPB based on three items to classify the protocols in three groups: protocol of "good" quality (group 1), "medium" quality (group 2) and "poor" quality (group 3). The score (IGap) is automatically computed from three objective criteria also shown on the conclusion of the report: the average length of the 10 biopsies (LM), the number of biopsies on which capsular elements can be identified (BCI) and the average number of fragment per biopsy (Fm). The IGap index rank from 0 to 1. The average IGap of the three groups is computed using the t-test. RESULTS: The average IGaps of the groups 1, 2 and 3 are respectively of 0,65 (0,37-0,89 ; n=250), 0,52 (0,36-0,71 ; n=69) and 0,43 (0,22-0,6 ; n=20), (p<0,001). CONCLUSION: IGap is a pertinent score reporting objectively of the overall quality of EPB. An IGap close to one indicates a good quality of EPB. An IGap close to zero indicate a poor quality of EPB.

MRI/TRUS data fusion for brachytherapy.

BACKGROUND: Prostate brachytherapy consists in placing radioactive seeds for tumour destruction under transrectal ultrasound imaging (TRUS) control. It requires prostate delineation from the images for dose planning. Because ultrasound imaging is patient- and operator-dependent, we have proposed to fuse MRI data to TRUS data to make image processing more reliable. The technical accuracy of this approach has already been evaluated. METHODS: We present work in progress concerning the evaluation of the approach from the dosimetry viewpoint. The objective is to determine what impact this system may have on the treatment of the patient. Dose planning is performed from initial TRUS prostate contours and evaluated on contours modified by data fusion. RESULTS: For the eight patients included, we demonstrate that TRUS prostate volume is most often underestimated and that dose is overestimated in a correlated way. However, dose constraints are still verified for those eight patients. CONCLUSIONS: This confirms our initial hypothesis.

Severity assessment of acute pulmonary embolism: evaluation using helical CT.

The objective was to evaluate the helical CT (HCT) criteria that could indicate severe pulmonary embolism (PE). In a retrospective study, 81 patients (mean age 62 years) with clinical suspicion of PE explored by HCT were studied. The patients were separated into three different groups according to clinical severity and treatment decisions: group SPE included patients with severe PE based on clinical data who were treated by fibrinolysis or embolectomy ( n=20); group NSPE included patients with non-severe PE who received heparin ( n=30); and group WPE included patients without PE ( n=31). For each patient we calculated a vascular obstruction index based on the site of obstruction and the degree of occlusion in the pulmonary artery. We noted the HCT signs, i.e., cardiac and pulmonary artery dimensions, that could indicate acute cor pulmonale. According to multivariate analysis, factors significantly correlated with the severity of PE were: the vascular obstruction index (group SPE: 54%; group NSPE: 24%; p<0.001); the maximum minor axis of the left ventricle (group SPE: 30.2 mm; group NSPE: 40.4 mm; p<0.001); the diameter of the central pulmonary artery (group SPE: 32.4 mm; group NSPE: 28.3 mm; p<0.001); the maximum minor axis of the right ventricle (group SPE: 47.5 mm; group NSPE: 42.7 mm; p=0.029); the right ventricle/left ventricle minor axis ratio (group SPE: 1.63; group NSPE: 1.09; p<0.0001). Our data suggest that hemodynamic severity of PE can be assessed on HCT scans by measuring four main criteria: the vascular obstruction index; the minimum diameter of the left ventricle; the RV:LV ratio; and the diameter of the central pulmonary artery.

[Tetralogy of Fallot, congenital coronary aneurysms with the histology of periarteritis nodosa: nosologic problems]. / Tétralogie de Fallot, Anévrysmes coronariens congénitaux avec histologie de périartérite noueuse: problèmes nosologiques.

Coronary lesions of periarteritis nodosa are detected in a newborn suffering from a Fallot's tetrad. The authors remind us of the present concept of infantile P.A.N. similar to adults' and of the notion of Kawasaki's syndrom that is almost the same as the infant's serious P.A.N. The reported case, original in many a detail, seems to represent the later expression monosymptomatic of Kawasaki's syndrom as if this one had been amputated at that stage of the greater part of its elements and then, casually developed in utero upon a congenital cardiopathy.