Military culture relies on hierarchy and obedience, which contradict the implementation and use of collaborative care models. In this commentary, a team of lived experience, clinical and research experts discuss, for the first time, cultural, communication and policy considerations for implementing collaborative care models in military mental healthcare settings.

La technique d’Eye-tracking (ET), basée sur la détection du reflet cornéen généré par une lumière infrarouge, permet l’enregistrement en temps réel des mouvements oculaires d’un individu explorant une image ou son environnement. Cette technique révélant le sens du regard en une succession de saccades et de fixations a permis d’apporter un nouvel éclairage sur la manière dont un individu explore le monde environnant et de mettre en lumière les particularités perceptives dans différentes pathologies, dont les troubles du spectre autistique. Les sujets avec trouble du spectre autistique présentent des atypies perceptives se traduisant notamment par un biais de traitement en faveur de la dimension locale (détails). La majorité des travaux en ET se sont intéressés à la cognition sociale. Certains ont notamment révélé que les stratégies d’exploration des visages au sein d’une scène sociale en milieu naturel étaient différentes chez les sujets TSA et pourraient contribuer aux troubles de cognition sociale et de reconnaissance émotionnelle [1]. Toutefois, cette technique trouve également son intérêt dans l’étude d’autres domaines cognitifs tels que les capacités de catégorisation [2] ou la mémoire. Les personnes avec TSA ont un fonctionnement mnésique atypique [3], résultant notamment de difficultés de sélection et d’intégration d’informations perceptives complexes. Ces difficultés ont été identifiées dès les premières millisecondes d’exploration de l’information à mémoriser [4]. Nous proposons d’illustrer l’apport de cette approche pour la caractérisation des atypies perceptives des personnes avec TSA et leurs répercussions sur le fonctionnement cognitif. Nous aborderons également les perspectives nouvelles d’évaluation neuropsychologique et de remédiation qu’offre cette technique d’ET au clinicien.

Globally, marine turtles are considered threatened throughout their range, and therefore conservation practitioners are increasingly investing resources in marine protected areas to protect key life history stages and critical habitats, including foraging grounds, nesting beaches and inter-nesting areas. Empirical data on the distribution of these habitats and/or the spatial ecology and behaviour of individuals of many marine turtle populations are often lacking, undermining conservation efforts, particularly along the Atlantic coast of Africa. Here we contribute to the knowledge base in this region by describing patterns of habitat use for nine green turtles Chelonia mydas tagged with satellite platform transmitter terminals at a foraging ground in Loango Bay, Republic of the Congo, one of only a few documented mainland foraging grounds for marine turtles in Central Africa. Analyses of these data revealed that core areas of habitat use and occupancy for a wide range of size/age classes were restricted to shallow waters adjacent to Pointe Indienne in Loango Bay, with most individuals showing periods of high fidelity to this area. These data are timely given the Congolese government recently announced its intention to create a marine conservation zone to protect marine turtles in Loango Bay. Despite the small sample size of this study, these data exemplify the need for comprehensive strategies that span national jurisdictions, as we provide the first documented evidence of linkages between green turtle foraging sites in Central Africa (Loango Bay, Republic of the Congo) and Southern Africa (Mussulo Bay, Angola).

When assessing hepatitis B virus (HBV) status in clinical settings, it is unclear whether self-reports on vaccination history and previous HBV-test results have any diagnostic capacity. Of 3997 participants in a multi-centre HBV-screening study in Paris, France, 1090 were asked questions on their last HBV-test result and vaccination history. Discordance between self-reported history compared with infection status (determined by serology) was calculated for participants claiming ‘negative’, ‘effective vaccine’, ‘past infection’, or ‘chronic infection’ HBV-status. Serological testing revealed that 320 (29.4%) were non-immunised, 576 (52.8%) were vaccinated, 173 (15.9%) had resolved the infection and 21 (1.9%) were hepatitis B surface antigen positive. In total 208/426 (48.8%) participants with a self-reported history of ‘negative’ infection had a discordant serological result, in whom 128 (61.5%) were vaccinated and 74 (35.6%) had resolved infections. A total of 153/599 (25.5%) participants self-reporting ‘effective vaccine’ had a discordant serological result, in whom 100 (65.4%) were non-immunised and 50 (32.7%) were resolved infections. Discordance for declaring ‘past’ or ‘chronic infection’ occurred in 9/55 (16.4%) and 3/10 (30.0%) individuals, respectively. In conclusion, self-reported HBV-status based on participant history is partially inadequate for determining serological HBV-status, especially between negative/vaccinated individuals. More adapted patient education about HBV-status might be helpful for certain key populations.

Research demonstrates the importance of nutrition for early brain development. Few studies have examined the effectiveness of multiple micronutrient powders (MNP) on child development. This study examined the impacts of home fortification with MNP on motor and mental development, executive function and memory of children living in Bihar. This two-arm cluster-randomised effectiveness trial selected seventy health sub-centres to receive either MNP and nutrition counselling (intervention) or nutrition counselling alone (control) for 12 months. Front-line health workers delivered the intervention to all households in study communities with a child aged 6–18 months. Data were collected using cross-sectional surveys at baseline and endline by selecting households from intervention (baseline, n 2184; endline, n 2170) and control (baseline, n 2176; endline, n 2122) communities using a two-stage cluster-randomised sampling strategy. Children in the intervention group had a significantly larger improvement from baseline to endline compared with those in the control group on scores for motor and mental development (Cohen’s d, motor=0·12; 95 % CI 0·03, 0·22; mental=0·15; 95 % CI 0·06, 0·25). Greater impacts of MNP on motor and mental development were observed in children from households with higher stimulation scores at baseline compared with those with lower stimulation (Cohen’s d, motor=0·20 v. 0·09; mental=0·22 v. 0·14; Pinteraction<0·05). No significant treatment differences were seen for executive function or memory. Home fortification with MNP through the existing health infrastructure in Bihar was effective in improving motor and mental development and should be considered in combination with other child development interventions such as stimulation.

The next-generation radio telescopes such as LOFAR and SKA will give access to high time-resolution and high instantaneous sensitivity that can be exploited to study slow and fast transients over the whole radio window. The search for radio transients in large datasets also represents a new signal-processing challenge requiring efficient and robust signal reconstruction algorithms. Using sparse representations and the general ‘compressed sensing’ framework, we developed a 2D–1D algorithm based on the primal-dual splitting method. We have performed our sparse 2D–1D reconstruction on three-dimensional data sets containing either simulated or real radio transients, at various levels of SNR and integration times. This report presents a summary of the current level of performance of our method.

Severe longitudinally extensive transverse myelitis (LETM) can cause quadriplegia, marked sensory dysfunction, and respiratory failure. Some patients are unresponsive to conventional immune therapy. We report two cases of severe immune-mediated LETM requiring intensive care admission that failed to respond to high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab. Disease cessation and significant recovery was achieved after cyclophosphamide induction. In patients with severe acute immune-mediated LETM who fail to respond to corticosteroids and plasma exchange, cyclophosphamide induction should be considered. This agent and regimen provides a robust immunosuppressive response and can be induced rapidly. Cyclophosphamide effects and supportive evidence are discussed.

The extensive protein degradation occurring during ensiling decreases the nutritive value of silages, but this might be counteracted by tannins. Therefore, silages from two legume species containing condensed tannins (CT) – sainfoin (SF) and birdsfoot trefoil (two cultivars: birdsfoot trefoil, cv. Bull (BTB) and birdsfoot trefoil, cv. Polom) – were compared for their in vitro ruminal fermentation characteristics. The effect of combining them with two CT-free legume silages (lucerne (LU) and red clover (RC)) was also determined. The supply of duodenally utilisable CP (uCP) in the forages was emphasised. The legumes were each harvested from three field sites. After 24 h of wilting on the field, the legumes were ensiled in laboratory silos for 86 days. Proximate constituents, silage fermentation characteristics, CT content and CP fractions were determined. Subsequently, silage samples and 1 : 1 mixtures of the CT-containing and CT-free silages were incubated for 24 h in batch cultures using ruminal fluid and buffer (1 : 2, v/v). Each treatment was replicated six times in six runs. The effects on pH, ammonia and volatile fatty acid concentrations, protozoal counts, and total gas and methane production were determined. uCP content was calculated by considering the CP in the silage and the ammonia in the incubation fluid from treatments and blanks. Statistical evaluation compared data from single plants alone and together with that from the mixtures. Among treatments, SF silage contained the least CP and the most CT. The non-protein nitrogen content was lower, favouring neutral detergent soluble and insoluble protein fractions, in the SF and RC silages. Absolute uCP content was lowest in SF and SF mixtures, although the ratio to total CP was the highest. In comparison with LU, the ammonia concentration of the incubation fluid was lower for SF, RC and BTB and for the mixture of SF with LU. The total gas and methane production was similar among the treatments, and the total volatile fatty acid production was decreased with the CT-containing legumes. Protozoal count was increased with the mixtures containing LU and either SF or BTB compared with single LU. In conclusion, compared with the other legumes, SF and RC have similar advantages as they show limited proteolysis during ensiling. In addition, SF supplies more uCP relative to total CP. The CT-containing legumes also differed in their effect on ruminal fermentation and ammonia formation, probably because of their different CT contents. Thus, SF and its mixtures appear promising for improving the protein utilisation of ruminants.

Homocysteine (Hcy) is an intermediary sulphur amino acid recognised for pro-oxidative properties in several species which may weaken immune competence in piglets. In this species, there is an acute 10-fold increase of concentrations of plasma Hcy (pHcy) during the first 2 weeks of life. The present experiment aimed to determine if pHcy in piglets can be regulated by oral supplementations of betaine as a methyl group supplier, creatine for reducing the demand for methyl groups, choline with both previous functions and vitamin B6 as enzymic co-factor for Hcy catabolism. A total of seventeen sows (second parity) were fed gestation and lactation diets supplemented with folic acid (10 mg/kg) and vitamin B12 (150 µg/kg). Eight piglets in each litter received daily one of the eight following oral treatments (mg/kg body weight): (1) control (saline); (2) betaine (50); (3) choline (70); (4) creatine (300); (5) pyridoxine (0·2); (6) treatments 2 and 5; (7) treatments 3 and 4; and (8) treatments 2, 3, 4 and 5. According to age, pHcy increased sharply from 2·48 µm at birth to 17·96 µm at 21 d of age (P < 0·01). Concentrations of pHcy tended to be lower (P = 0·09) in treated than in control piglets but the highest and sole pairwise significant decrease (23 %) was observed between treatments 1 and 8 (P = 0·03). Growth from birth to 21 d of age was not influenced by treatments (P > 0·70). Therefore, it appears possible to reduce pHcy concentrations in suckling piglets but a combination of all chosen nutrients is required.

Many diseases with an auto-immune etiology have a skewed sex distribution. In the majority of instances, women are affected more frequently than men. A review of population studies demonstrates that the preponderance of women in multiple sclerosis (MS) is almost constant. We show that this preponderance is further increased in early as well as in late-onset cases, in familial cases as well as in MS twin pairs and that the HLA-DR2 allele, which has been associated with MS in Caucasian populations, is significantly more frequent in women than in men with MS. “Rules” have been established for multifactorial diseases; MS contravenes most of those rules. The skewed sex distribution in MS could be attributed to the known hormonal and gender influences on the immune response, as well as to genetic influences.

Background : A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods : To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results : This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions : The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.

Acute psychological stress is positively associated with a cold/flu. The present randomised, double-blind, placebo-controlled study examined the effect of three potentially probiotic bacteria on the proportion of healthy days over a 6-week period in academically stressed undergraduate students (n 581) who received Lactobacillus helveticus R0052, Bifidobacterium longum ssp. infantis R0033, Bifidobacterium bifidum R0071 or placebo. On each day, participants recorded the intensity (scale: 0 = not experiencing to 3 = very intense) for nine cold/flu symptoms, and a sum of symptom intensity >6 was designated as a day of cold/flu. B. bifidum resulted in a greater proportion of healthy days than placebo (P≤ 0·05). The percentage of participants reporting ≥ 1 d of cold/flu during the 6-week intervention period was significantly lower with B. bifidum than with placebo (P< 0·05). There were no effects of B. infantis or L. helveticus compared with placebo on either outcome. A predictive model accounted for influential characteristics and their interactions on daily reporting of cold/flu episodes. The proportion of participants reporting a cold on any given day was lower at weeks 2 and 3 with B. bifidum and B. infantis than with placebo for the average level of stress and the most commonly reported number of hours of sleep. Daily intake of bifidobacteria provides benefit related to cold/flu outcomes during acute stress.

Cobalamin (CBL), the biologically active form of vitamin B12, and its analogs, are produced by bacteria only if cobalt supply is adequate. The analogs differ generally by the nucleotide moiety of the molecule. In CBL, 5,6-dimethylbenzimidazole (5,6-DMB) is the base in the nucleotide moiety. The present study aimed to determine if a supplement of 5,6-DMB could increase utilization of dietary cobalt for synthesis of CBL and change ruminal fermentation, nutrient digestibility, omasal flow of nutrients and ruminal protozoa counts. Eight ruminally cannulated multiparous Holstein cows (mean±standard deviation=238±21 days in milk and 736±47 kg of BW) were used in a crossover design. Cows were randomly assigned to a daily supplement of a gelatin capsule containing 1.5 g of 5,6-DMB via the rumen cannula or no supplement. Each period lasted 29 days and consisted of 21 days for treatment adaptation and 8 days for data and samples collection. Five corrinoids, CBL and four cobamides were detected in the total mixed ration and the omasal digesta from both treatments. The dietary supplement of 5,6-DMB increased (P=0.02) apparent ruminal synthesis of CBL from 14.6 to 19.6 (s.e.m. 0.8) mg/day but had no effect (P>0.1) on apparent ruminal synthesis of the four analogs. The supplement of 5,6-DMB had no effect (P>0.1) on milk production and composition, or on protozoal count, ruminal pH and concentrations of volatile fatty acids and ammonia nitrogen in rumen content. The supplement had also no effect (P>0.1) on intake, omasal flow and apparent ruminal digestibility of dry matter, organic matter, NDF, ADF and nitrogenous fractions. Plasma concentration of CBL was not affected by treatments (P=0.98). Providing a preformed part of the CBL molecule, that is, 5,6-DMB, increased by 34% the apparent ruminal synthesis of CBL by ruminal bacteria but had no effect on ruminal fermentation or protozoa count and it was not sufficient to increase plasma concentrations of the vitamin. Even though the efficiency of cobalt utilization for apparent synthesis of CBL was increased from 2.0% to 2.7% by the 5,6-DMB supplement, this improved efficiency was still very low. Further research is needed to identify the factors affecting efficiency of utilization of cobalt for synthesis of CBL by the bacterial populations in rumen.

Nonparametric regression is a powerful tool to estimate nonlinear relations between some predictors and a response variable. However, when the number of predictors is high, nonparametric estimators may suffer from the curse of dimensionality. In this chapter, we show how a dimension reduction method (namely Sliced Inverse Regression) can be combined with nonparametric kernel regression to overcome this drawback. The methods are illustrated both on simulated datasets as well as on an astronomy dataset using the R software.

Here we present the installation and successful commissioning of an L'-band Annular Groove Phase Mask (AGPM) coronagraph on VLT/NACO. The AGPM is a vector vortex coronagraph made from diamond subwavelength gratings tuned to the L' band. The vector vortex coronagraph enables high contrast imaging at very small inner working angle (here 0″.09, the diffraction limit of the VLT at L'), potentially being the key to a new parameter space. During technical and science verification runs, we discovered a late-type companion at two beamwidths from an F0V star (Mawet et al. 2013), and imaged the inner regions of β Pictoris down to the previously unexplored projected radius of 1.75 AU. The circumstellar disk was also resolved from ≃ 1″ to 5″ (see J. Milli et al., these proceedings). These results showcase the potential of the NACO L-band AGPM over a wide range of spatial scales.

Despite spending more on health care than every other industrialized country, the U.S. ranks 37th in health outcomes. These differences cannot be explained away with differences in age and income, or even with quality of care. And, the rate of growth in health care spending in the U.S. continues to increase. The share of the Gross Domestic Product (GDP) attributable to health care grew from 9% in 1980 to more than 17% in 2011. Health care costs are projected to account for more than one-fifth of our economy by 2021. Despite spending more and more, the U.S. does not have better health outcomes than other countries. Worse, our increasing spending is largely attributable to preventable conditions. More than 85 cents of every dollar spent on health in the U.S. are spent on the treatment and management of chronic diseases, such as those caused by preventable conditions related to obesity and tobacco use.

The Laboratoire des Sciences du Climat et de l'Environnement (LSCE) research program on prehistoric art conducts chronological studies of parietal representations with their associated archaeological context. This multidisciplinary approach provides chronological arguments about the creation period of parietal representations. This article presents chronological investigations carried out in several decorated caves in France (La Grande Grotte, Labastide, Lascaux, La Tête-du-Lion, Villars) and Spain (La Garma, Nerja, La Pileta, Urdiales). Several types of organic materials, collected from different areas of the caves close to the walls and in connection with parietal art, were dated to determine the periods of human presence in the cave, a presence that may have been related to artistic activities. These new radiocarbon results range from 33,000–29,000 (La Grande Grotte) to 16,000–14,000 cal BP (Urdiales).