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International audience; In Virtual Reality (VR), the Sense of Embodiment (SoE) corresponds to the feeling of controlling and owning a virtual body, usually referred to as an avatar. The SoE is generally divided into three components: the Sense of Agency (SoA) which characterises the level of control of the user over the avatar, the Sense of Self-Location (SoSL) which is the feeling to be located in the avatar and the Sense of Body-Ownership (SoBO) that represents the attribution of the virtual body to the user. While previous studies showed that the SoE can be manipulated by disturbing either the SoA, the SoBO or the SoSL, the relationships and interactions between these three components still remain unclear. In this paper, we aim at extending the understanding of the SoE and the interactions between its components by 1) experimentally manipulating them in VR via a biased visual feedback, and 2) understanding if each sub-component can be selectively altered or not. To do so, we designed a within-subject experiment where 47 right-handed participants had to perform movements of their right-hand under different experimental conditions impacting the sub-components of embodiment: the SoA was modified by impacting the control of the avatar with visual biased feedback, the SoBO was altered by modifying the realism of the virtual right hand (anthropomorphic cartoon hand or non-anthropomorphic stick ``fingers'') and the SoSL was controlled via the user's point of view (first or third person). After each trial, participants rated their level of agency, ownership and self-location on a 7-item Likert scale. Results' analysis revealed that the three components could not be selectively altered in this experiment. Nevertheless, these preliminary results pave the way to further studies.

Correction to: World J Surg https://doi.org/10.1007/s00268-021-06099-z

Covid-19 has placed an unprecedented demand on healthcare systems worldwide. A positive safety culture is associated with improved patient safety and, in turn, with patient outcomes. To date, no study has evaluated the impact of Covid-19 on safety culture. The Safety Attitudes Questionnaire (SAQ) was used to investigate safety culture at a large UK healthcare trust during Covid-19. Findings were compared with baseline data from 2017. Incident reporting from the year preceding the pandemic was also examined. SAQ scores of doctors and &ldquo, other clinical staff&rdquo, were relatively higher than the nursing group. During Covid-19, on univariate regression analysis, female gender, age 40&ndash, 49 years, non-White ethnicity, and nursing job role were all associated with lower SAQ scores. Training and support for redeployment were associated with higher SAQ scores. On multivariate analysis, non-disclosed gender (&minus, 0.13), non-disclosed ethnicity (&minus, 0.11), nursing role (&minus, 0.15), and support (0.29) persisted to a level of significance. A significant decrease (p &lt, 0.003) was seen in error reporting after the onset of the Covid-19 pandemic. This is the first study to investigate SAQ during Covid-19. Differences in SAQ scores were observed during Covid-19 between professional groups when compared to baseline. Reductions in incident reporting were also seen. These changes may reflect perception of risk, changes in volume or nature of work. High-quality support for redeployed staff may be associated with improved safety perception during future pandemics.

Background The coronavirus disease (COVID-19) pandemic has led to rapid acceleration in the deployment of new digital technologies to improve both accessibility to and quality of care, and to protect staff. Mixed-reality (MR) technology is the latest iteration of telemedicine innovation; it is a logical next step in the move toward the provision of digitally supported clinical care and medical education. This technology has the potential to revolutionize care both during and after the COVID-19 pandemic. Objective This pilot project sought to deploy the HoloLens2 MR device to support the delivery of remote care in COVID-19 hospital environments. Methods A prospective, observational, nested cohort evaluation of the HoloLens2 was undertaken across three distinct clinical clusters in a teaching hospital in the United Kingdom. Data pertaining to staff exposure to high-risk COVID-19 environments and personal protective equipment (PPE) use by clinical staff (N=28) were collected, and assessments of acceptability and feasibility were conducted. Results The deployment of the HoloLens2 led to a 51.5% reduction in time exposed to harm for staff looking after COVID-19 patients (3.32 vs 1.63 hours/day/staff member; P=.002), and an 83.1% reduction in the amount of PPE used (178 vs 30 items/round/day; P=.02). This represents 222.98 hours of reduced staff exposure to COVID-19, and 3100 fewer PPE items used each week across the three clusters evaluated. The majority of staff using the device agreed it was easy to set up and comfortable to wear, improved the quality of care and decision making, and led to better teamwork and communication. In total, 89.3% (25/28) of users felt that their clinical team was safer when using the HoloLens2. Conclusions New technologies have a role in minimizing exposure to nosocomial infection, optimizing the use of PPE, and enhancing aspects of care. Deploying such technologies at pace requires context-specific information security, infection control, user experience, and workflow integration to be addressed at the outset and led by clinical end-users. The deployment of new telemedicine technology must be supported with objective evidence for its safety and effectiveness to ensure maximum impact.

RATIONALECOVID-19 poses a unique challenge; caring for patients with a novel, infectious disease whilst protecting staff. Some interventions used to give oxygen therapy are aerosol generating procedures. Staff delivering such interventions require PPE and are exposed to a significant viral load resulting in sick days and even death. We aim to reduce this risk using an augmented-reality communication device: The HoloLens by Microsoft.OBJECTIVESIn a tertiary centre in London we aim to implement HoloLens technology, allowing other medical staff to remotely join the consulting clinician when in a high-risk patient area delivering oxygen therapy. The study primary outcome was to reduce the exposure to staff and demonstrate non-inferiority staff satisfaction when compared to not using the device. Our secondary outcome was to reduce extrapolated PPE costs when using the device.METHODSOur study was conducted in March and April 2020, within a respiratory unit delivering aerosolising oxygen therapies (High flow nasal oxygen, Continuous positive airway pressure and non-invasive ventilation) to patients with suspected or confirmed COVID-19 infection.MEASUREMENTSSelf-reported questionnaires to assess satisfaction in key areas of patient care. An infrared people counting device was also used to assess staff in and out of the unit.MAIN RESULTSMean self-reported time in the high-risk zone was less when using HoloLens (2.69 hours) compared to usual practice (3.96 hours) although this difference was not statistically significant (p = 0.3657). HoloLens showed non-inferiority when compared to usual practice in staff satisfaction score for all domains. Furthermore, mean staff satisfaction score encouragingly improved when using HoloLens. Self-reported PPE counts from this study showed 12 staff members changing PPE 25.8 times per shift, almost double the 13.5 times in the HoloLens count.CONCLUSIONSWe have demonstrated HoloLens can reduce the number of staff exposed to aerosol generating areas in a novel infectious disease. Our results show it did not impair communication, medical staff availability or end of life care. HoloLens technology may also reduce the use of PPE, which has equipment availability and cost benefits. This study provides grounding for further use of the HoloLens device by bringing a bedside experience to experts remote to the situation.

BACKGROUND: SSMD are used to enhance transparency, improve quality and facilitate patient choice. The use of SSMD is controversial, but patients' views on such data are largely unknown. OBJECTIVES: The aim of this study was therefore to explore the views of patients and to identify their priorities for outcome reporting in vascular surgery. METHODS: A prospective questionnaire study of 165 patients receiving care in a single academic vascular unit was performed. Data on patients' current understanding and use of SSMD, together with future priorities were collected. RESULTS: Of the 165 patients 80% were unaware of SSMD. 72% thought they should be made aware of the data, although 63% thought they were likely to misinterpret the results. The majority recognized the utility of SSMD to inform treatment (60%) and surgeon (53%) choice. The majority prioritize the patient-surgeon relationship (90%) and past experiences of care (71%) when making treatment decisions. A significant majority (66% vs 49%; P < 0.005) would favour hospital-level to surgeon-level data. The main patient priorities for future outcome reporting were waiting list length (56%), the quality of hospital facilities (55%), and patient satisfaction (54%). CONCLUSIONS: The aims of SSMD reporting are not currently being met, and both patients and healthcare professionals have shared concerns over the nature and usefulness of the data. Patients express a preference for hospital-level outcomes and prioritize the experience of receiving care over outcomes when making treatment decisions. Future outcome reporting should include patient-directed hospital-level metrics that are readily accessible and understood by all.

Health information technology can transform and enhance the quality and safety of care, but it may also introduce new risks. This study analysed 130 healthcare regulator inspection reports and organisational digital maturity scores in order to characterise the impact of health information technology on quality and safety from a regulatory perspective. Although digital maturity and the positive use of health information technology are significantly associated with overall organisational quality, the negative effects of health information technology are frequently and more commonly identified by regulators. The poor usability of technology, lack of easy access to systems and data and the incorrect use of health information technology are the most commonly identified areas adversely affecting quality and safety. There is a need to understand the full risks and benefits of health information technology from the perspective of all stakeholders, including patients, end-users, providers and regulators in order to best inform future practice and regulation.

Objectives: This study investigated the views of healthcare professionals (HCPs) as end-users of mobile technologies to inform the requirements for a successful move towards a mobile first culture of work within secondary care. Many HCPs already used mobile devices to support their day-to-day practice and so transitioning to an organisational led mobile way of working is both needed and timely.Materials and Methods: In-depth focus groups and interviews at a UK academic hospital were conducted with HCPs (nurses, doctors, and allied health professionals). The interviews elicited views from HCPs about the use of mobile technologies in their clinical work and discussed their experiences of previous technology deployments.Results: Thirty-four HCPs participated. Three themes were identified: integrating mobile working in hospital care; addressing data governance and accountability for mobile working; and handling the pace of change. The acceptance of mobile working is determined by whether it enhances, rather than hinders clinical practice whilst holding end-user’s confidence; measuring the impact of the administrative burden on workload, changes to professional accountability and safeguarding patient data are serious issues that need consideration; and the pace of change needs to work for all stakeholders.Discussion and Conclusions: The benefits of adopting mobile technologies are well recognised, however, technical and policy related factors identified by professional end-users require answers in order to successfully integrate mobile working into current practice. Adopting a mobile first approach to work is timely and achievable, but can only be delivered on a foundation of positive end-user engagement and strong organisational leadership.

Objectives Effective communication is critical to the safe delivery of care but is characterized by outdated technologies. Mobile technology has the potential to transform communication and teamwork but the evidence is currently uncertain. The objective of this systematic review was to summarize the quality and breadth of evidence for the impact of mobile technologies on communication and teamwork in hospitals. Materials and Methods Electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL Plus, HMIC, Cochrane Library, and National Institute of Health Research Health Technology Assessment) were searched for English language publications reporting communication- or teamwork-related outcomes from mobile technologies in the hospital setting between 2007 and 2017. Results We identified 38 publications originating from 30 studies. Only 11% were of high quality and none met best practice guidelines for mobile-technology-based trials. The studies reported a heterogenous range of quantitative, qualitative, and mixed-methods outcomes. There is a lack of high-quality evidence, but nonetheless mobile technology can lead to improvements in workflow, strengthen the quality and efficiency of communication, and enhance accessibility and interteam relationships. Discussion This review describes the potential benefits that mobile technology can deliver and that mobile technology is ubiquitous among healthcare professionals. Crucially, it highlights the paucity of high-quality evidence for its effectiveness and identifies common barriers to widespread uptake. Limitations include the limited number of participants and a wide variability in methods and reported outcomes. Conclusion Evidence suggests that mobile technology has the potential to significantly improve communication and teamwork in hospital provided key organizational, technological, and security challenges are tackled and better evidence delivered.

The NHS must reduce its vulnerability and build resilience against future cyber attacks The global WannaCry ransomware attack has had a disproportionate effect on the UK healthcare sector, highlighting the poor state of cybersecurity in the NHS and the failure to recognise it as a fundamental matter for patient safety. WannaCry is trojan malware designed to extort money by holding files to ransom. It exploits a known vulnerability in the Windows operating system that was initially identified and patched by Microsoft in March 2017, with a further patch released after the event.12 The attack is widely reported to have used system exploits released by the hacker group the Shadow Brokers but originating from the US National Security Agency. Once a computer is infected the malware creates encrypted copies of files before deleting the originals; the only way to retrieve affected data is to pay the bitcoin ransom. Computer systems across more than 150 countries have been infected, and only the fortuitous intervention …

Musicians and musically untrained individuals have been shown to differ in a variety of functional brain processes such as auditory analysis and sensorimotor interaction. At the same time, internally operating forward models are assumed to enable the organism to discriminate the sensory outcomes of self-initiated actions from other sensory events by deriving predictions from efference copies of motor commands about forthcoming sensory consequences. As a consequence, sensory responses to stimuli that are triggered by a self-initiated motor act are suppressed relative to the same but externally initiated stimuli, a phenomenon referred to as motor-induced suppression (MIS) of sensory cortical feedback. Moreover, MIS in the auditory domain has been shown to be modulated by the predictability of certain properties such as frequency or stimulus onset. The present study compares auditory processing of predictable and unpredictable self-initiated 0-delay speech sounds and piano tones between musicians and musical laymen by means of an event-related potential (ERP) and topographic pattern analysis (TPA) [microstate analysis or evoked potential (EP) mapping] approach. As in previous research on the topic of MIS, the amplitudes of the auditory event-related potential (AEP) N1 component were significantly attenuated for predictable and unpredictable speech sounds in both experimental groups to a comparable extent. On the other hand, AEP N1 amplitudes were enhanced for unpredictable self-initiated piano tones in both experimental groups similarly and MIS did not develop for predictable self-initiated piano tones at all. The more refined EP mapping revealed that the microstate exhibiting a typical auditory N1-like topography was significantly shorter in musicians when speech sounds and piano tones were self-initiated and predictable. In contrast, non-musicians only exhibited shorter auditory N1-like microstate durations in response to self-initiated and predictable piano tones. Taken together, our findings suggest that besides the known effect of MIS, internally operating forward models also facilitate early acoustic analysis of complex tones by means of faster processing time as indicated by shorter auditory N1-like microstate durations in the first ~200 ms after stimulus onset. In addition, musicians seem to profit from this facilitation also during the analysis of speech sounds as indicated by comparable auditory N1-like microstate duration patterns between speech and piano conditions. In contrast, non-musicians did not show such an effect.

International audience; The effect of an osmotic stress resulting from high glucose or NaCl concentrations on the morphology and intracellular volume of Hansenula anomala was examined by scanning electronic microscopy and changes in the intracellular volume accessible to tritiated water, respectively. No noticeable change in the cell morphology was observed, with the cells remaining ellipsoidal. An increase in the contribution of compatible solutes, such as arabitol, glycerol and trehalose, to the cell volume, was not sufficient to counterbalance the decrease in the volume accessible to tritiated water for increasing water stress, leading to a decrease in cell volume. For a given morphology, a decrease in the cell volume allowed the cell to maximize the surface to ratio volume for a better distribution of the external osmotic pressure. It also allowed maximization of the compatible solute concentration (for a given amount of accumulated compounds), leading to an increase in the internal osmotic potential to counterbalance the osmotic potential of the surrounding medium. However, the accumulation of compatible solutes in the cell did not allow any adjustment of the osmotic potential of cells in high-osmolarity medium, especially in the case of NaCl as the osmoticum, thereby confirming the higher stress effect of salt relative to glucose.

We present a 74-year-old woman who developed a portal vein thrombosis following an elective total knee replacement. She had atrial fibrillation for which she was taking warfarin for anticoagulation. Seven days prior to surgery, she was instructed to discontinue warfarin and replace it with prophylactic low-molecular-weight heparin. On postoperative day 1, routine blood tests revealed deranged hepatic synthetic function, despite standard anticoagulation management. Doppler ultrasonography confirmed a portal vein thrombosis. She was treated with therapeutic doses of low-molecular-weight heparin until her international normalised ratio reached therapeutic levels. Her liver function results had normalised 2 weeks later. Portal vein thrombosis is a potentially fatal complication that is reversible if identified and treated early.

International audience; Continuous cultures of Hansenula anomala were carried out in media at low water activity, resulting from NaCl addition. Three dilution rates were compared and it was shown that a clear steady state was only recorded for the lowest dilution rate tested (0.03 h−1), leading to a biomass concentration of 4.3 g L−1. At 0.06 h−1 dilution rate, steady state was maintained for no more than 20 h and a clear wash-out was observed at 0.12 h−1. The experimental ratio ethanol on glycerol produced at steady state (D = 0.03 h−1) was similar to that previously recorded in batch culture in similar conditions after 30 h of growth, 7.8 and 7.9, respectively. The comparison of continuous culture to repeated batch culture was clearly in favour of the continuous culture, which led to significantly higher glycerol and ethanol production rates, 4.5 and 4 times higher than those recorded in repeated batch culture, respectively, even if significant amounts of glucose remained in the bleeding of the bioreactor.

Past research has shown that musical training induces changes in the processing of supra-segmental aspects of speech, such as pitch and prosody. The aim of the present study was to determine whether musical expertise also leads to an altered neurophysiological processing of sub-segmental information available in the speech signal, in particular the voice-onset-time. Using high-density EEG-recordings we analyzed the neurophysiological responses to voiced and unvoiced consonant-vowel-syllables and noise-analogs in 26 German speaking adult musicians and non-musicians. From the EEG the N1 amplitude of the event-related potential and two microstates from the topographical EEG analysis (one around the N1 amplitude and one immediately preceding the N1 microstate) were calculated to the different stimuli. Similar to earlier studies the N1 amplitude was different to voiced and unvoiced stimuli in non-musicians with larger amplitudes to voiced stimuli. The more refined microstate analysis revealed that the microstate within the N1 time window was shorter to unvoiced stimuli in non-musicians. For musicians there was no difference for the N1 amplitudes and the corresponding microstates between voiced and unvoiced stimuli. In addition, there was a longer very early microstate preceding the microstate at the N1 time window to non-speech stimuli only in musicians. Taken together, our findings suggest that musicians process unvoiced stimuli (irrespective whether these stimuli are speech or non-speech stimuli) differently than controls. We propose that musicians utilize the same network to analyze unvoiced stimuli as for the analysis of voiced stimuli. As a further explanation it is also possible that musicians devote more neurophysiological resources into the analysis of unvoiced segments.

International audience; The Kribi-Campo sub-basin is composed of an Early to Mid Cretaceous series from West Africa's Atlantic coast and is located in southern Cameroon in the Central African equatorial rain forest. It is the smallest coastal basin in Cameroon and forms the southern part of the Douala/Kribi-Campo basin known as Douala basin (s.l.). Until now, no detailed sedimentological studies have been carried out on the outcrops of this basin located in the Campo area. The aim of this study was to characterise the depositional environments, vertical evolution and tectonic context of these Lower Cretaceous series in order to make a comparison with adjacent basins and replace them in the geodynamic context. Facies analysis of the Lower Mundeck Formation (Lower Cretaceous) indicates the presence of four major, interfigered facies associations, that are inferred to represent elements of an alluvial to lacustrine­ fan delta system. The clast lithologies suggest proximity of relief supplying coarse-grained sediment during the deposition of the Lower Mundeck Formation at Campo. The general dip and direction of the bedding is approximately 10 ­12 NW, which also corresponds to the orientation of the foliations in the underlying metamorphic basement. The main sedimentary succession is characterised by a major retrogradational/progradational cycle of Late Aptian age, evaluated at about 3 Ma, with a well-developed progradational trend characterised by fluctuations of the recognised depositional environments. Fluctuations in lake level and sediment supply were possibly controlled by active faults at the basin margin, although climatic changes may have also played a role. The consistently W­WNW palaeoflow of sediments suggests that the palaeorelief was located to the east and could be oriented in a NNE­SSW direction, downthrown to the west. Local outcrops dated as Albian, both north and south of the main outcrop, display some marine influence. These deposits are cut by 040­060 faults parallel to the oceanic transform. Similarly, the Lower Mundeck Formation of the Campo outcrops is considered to be associated mainly with the early drift period of Late Aptian­Albian age. This study is also the first step of knowledge of these African margin deposits, to realise in the future the correlations between outcrops and offshore data.

Lacustrine and alluvial fan facies from the Lower Mundeck Formation (Barremian ?–Aptian) cropping out in the southern part of the Kribi-Campo sub-basin (Cameroon) have been characterised for their oil potential, using both Rock-Eval pyrolysis and palynofacies analyses. The shaly facies show good potential as oil-prone source rock, with TOC content around 4.4% and some intervals with an optimum potential to yield 45 kg hydrocarbons/t of rock. Along the studied outcrops, these organic-rich facies represent approximately a third of the total thickness. Although the studied samples come out from immature thin organic-rich beds within sand dominated beds, it is reasonable to think that these oil-prone facies increase in thickness and maturity in the offshore area, making this part of the southern margin of Cameroon of special interest for petroleum exploration.

Recent reports have indicated that 48–72 h of fasting, Type 1 diabetes and high-protein feeding induce gluconeogenesis in the small intestine of adult rats in vivo. Since this would (i) represent a dramatic revision of the prevailing view that only the liver and the kidneys are gluconeogenic and (ii) have major consequences in the metabolism, nutrition and diabetes fields, we have thoroughly re-examined this question in the situation reported to induce the highest rate of gluconeogenesis. For this, metabolically viable small intestinal segments from 72 h-fasted adult rats were incubated with [3-13C]glutamine as substrate. After incubation, substrate utilization and product accumulation were measured by enzymatic and NMR spectroscopic methods. Although the segments utilized [13C]glutamine at high rates and accumulated 13C-labelled products linearly for 30 min in vitro, no substantial glucose synthesis could be detected. This was not due to the re-utilization of [13C]glucose initially synthesized from [13C]glutamine. Arteriovenous metabolite concentration difference measurements across the portal vein-drained viscera of 72 h-fasted Wistar and Sprague–Dawley rats clearly indicated that glutamine, the main if not the only gluconeogenic precursor taken up, could not give rise to detectable glucose production in vivo. Therefore we challenge the view that the small intestine of the adult rat is a gluconeogenic organ.