Search

Since the LACC study in 2018, the use of the uterine manipulator (UM) has been questioned in Oncological surgery. Nowadays, there are few data on UM use in patients eligible for minimally invasive surgery for endometrial cancer. Our objective was to evaluate the practices and modalities of UM use by French onco-gynecologic surgeons in the management of endometrial cancer. We surveyed the practices of 3 French medical societies-affiliated onco-gynecological surgeons with a web questionnaire composed of 16 questions. A total of 165 responses were collected. In the case of minimally invasive hysterectomy for endometrial cancer, the routine use of UM was 42.7%. Of the 40.9% of surgeons who never used UM, 83.6% justified it with the risk of tumor spillage. When UM was used, surgeons mentioned reducing operating time and reducing complications in 67.0% and 59.8% of cases respectively as its main advantages. UM was set up without laparoscopic control in 54.6% of cases. In 47.4% of cases, the medical student was in charge of UM instrumentation. Tubal obliteration at the beginning of the procedure was performed systematically in 35.4% of cases. For 63.5% of UM users, the adjuvant treatment could be modified in case of uterine perforation. This survey confirms the heterogeneity of practices regarding the use of UM in endometrial cancer surgery. Prospective data on the benefit (reduction of surgical complications)/risk (impact on survival) balance are needed to recommend or not the use of this device. [ABSTRACT FROM AUTHOR]

A mother's psychological well-being impacts her own and her infant's health. Challenges to maternal psychological well-being (eg, depression, anxiety) are associated with increased infant emergency department (ED) utilization. It is not known if other maternal psychological factors, such as relational health and past maltreatment during one's own childhood, are also associated with child ED utilization. Examine maternal psychological factors (ie, childhood maltreatment, mental health, and relational health) associated with infant ED utilization in the first year of life. Participants included 120 economically disadvantaged women recruited into a prospective longitudinal study during pregnancy and followed across the first year of their child's life. Mothers reported number of infant ED visits from birth to 1 year (assessed 12-months postpartum), as well as on their own childhood maltreatment, relational health, and mental health (assessed prenatally). Associations between maternal experiences and infant ED utilization were assessed via bivariate correlations and regression analyses. Infants attended on average 0.79 ED visits (range 0–6). Maltreatment during the mother's own childhood, poor relational health, and prenatal mental health symptoms were each associated with greater infant ED visits; maternal age, income, and education were not. In a Poisson regression, childhood sexual abuse was the strongest predictor of infant ED utilization, followed by low acceptance from the mother's father figure and prenatal depression. Prenatal assessment of psychosocial factors may help identify risk for higher ED use. Women with psychosocial risk factors may need additional support establishing supportive primary and behavioral health care before and after birth. [ABSTRACT FROM AUTHOR]

Early postoperative infections due to Serratia marcescens have been reported by both clinicians and microbiologists in our teaching hospital. Here, we present an interlinked clinical, epidemiological, environmental and genomic investigation of this outbreak due to a T-shaped intraoperative probe contaminated by S. marcescens used during peroperative ultrasonography in laparoscopic liver resection. [ABSTRACT FROM AUTHOR]

Background: Existing data on pediatric massive transfusion as part of trauma resuscitation is limited. We report the characteristics of pediatric casualties associated with undergoing massive transfusion at US military treatment facilities during combat operations in Iraq and Afghanistan.Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. We stratified subjects by Centers for Disease Control age groupings: <1, 1-4, 5-9, 10-14, and 15-17 years. We defined a massive transfusion as 40 mL/kg of total blood products or more.Results: From January 2007 through January 2016 there were 3439 pediatric casualties within the registry, of which 543 (15.7%) met criteria for receiving a massive transfusion. The median age of children undergoing massive transfusion was 9 years (IQR 5-12), male (73.4%), injured in Afghanistan (69.9%) and injured by explosives (60.4%). Compared to other pediatric casualties, subjects undergoing massive transfusion had higher composite injury severity scores (median 17 versus 9), higher incidence of tachycardia (86.8% versus 70.9%), increased incidence of hypotension (31.2% versus 7.5%), and decreased survival to hospital discharge (82.6% versus 91.6%). Specific to body regions, casualties undergoing massive transfusion more frequently had serious injuries to the head/neck (30.0% versus 22.8%), the thorax (22.8% versus 9.9%), abdomen (26.8% versus 6.9%), the extremities (42.1% versus 14.6%), while less frequently had serious injuries to the skin (5.3% versus 8.4%). All findings were significant.Conclusions: Further research is needed to better translate the lessons learned from pediatric trauma care in the combat setting into the civilian setting in developed countries.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background and Aims: Pediatric obesity and sleep-disordered breathing (SDB) are associated with cardiometabolic risk (CMR), but the degree of severity at which SDB affects cardiometabolic health is unknown. We assessed the relationship between the CMR and the apnea-hypopnea index (AHI), to identify a threshold of AHI from which an increase in the CMR is observed, in adolescents with obesity. We also compared the clinical, cardiometabolic and sleep characteristics between adolescents presenting a high (CMR+) and low CMR (CMR-), according to the threshold of AHI.Methods and Results: 114 adolescents with obesity were recruited from three institutions specialized in obesity management. Sleep and SDB as assessed by polysomnography, anthropometric parameters, fat mass (FM), glucose and lipid profiles, and blood pressure (BP) were measured at admission. Continuous (MetScoreFM) and dichotomous (metabolic syndrome, MetS) CMR were determined. Associations between MetScoreFM and AHI adjusted for BMI, sex and age were assessed by multivariable analyses. Data of 82 adolescents were analyzed. Multivariable analyses enabled us to identify a threshold of AHI = 2 above which we observed a strong and significant association between CMR and AHI (Cohen's d effect-size = 0.57 [0.11; 1.02] p = 0.02). Adolescents with CMR+ exhibited higher MetScoreFM (p < 0.05), insulin resistance (p < 0.05), systolic BP (p < 0.001), sleep fragmentation (p < 0.01) and intermittent hypoxia than CMR- group (p < 0.0001). MetS was found in 90.9% of adolescents with CMR+, versus 69.4% in the CMR- group (p < 0.05).Conclusions: The identification of a threshold of AHI ≥ 2 corresponding to the cardiometabolic alterations highlights the need for the early management of SDB and obesity in adolescents, to prevent cardiometabolic diseases.Clinical Trials: NCT03466359, NCT02588469 and NCT01358773. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence suggests hyperoxia therapy may be harmful. We describe injury characteristics and survival outcomes for pediatric trauma casualties in Iraq and Afghanistan, stratified by partial pressure of arterial oxygen (PaO2). Secondarily, we performed subgroup analyses for severe traumatic brain injury (TBI) and massive transfusion of blood products (MT).Methods: We utilized Department of Defense Trauma Registry data. We included subjects <18 years. We excluded subjects without an arterial blood gas (ABG). We stratified subjects as hyperoxemia (PaO2 100-300 mmHg) and extreme hyperoxemia (PaO2 >300 mmHg).Results: January 2007-January 2016, 3439 pediatric encounters were in the database. Of those, 1323 had an ABG, with 291 (22%) demonstrating hyperoxemia and 43 (3.3%) extreme hyperoxemia. The median age was 8, most were male (76%) in Afghanistan (69%), and injured by explosive (42%). There were no significant differences in survival between subjects with no hyperoxemia, hyperoxemia, and extreme hyperoxemia (92% vs 87% vs 86%; p = 0.078). Also, there were no significant differences in survival between groups among TBI and MT subjects, and there were no increased odds of survival between groups on multivariable regression analyses.Conclusions: Hyperoxemia was common among hospitalized, wartime pediatric trauma casualties in Iraq and Afghanistan that underwent ABG analysis. Survival to hospital discharge rates were not significantly different between subjects with hyperoxemia and subjects without hyperoxemia. [ABSTRACT FROM AUTHOR]

Sleep disorders are commonplace in our modern societies. Specialized hospital departments are generally overloaded, and sleep assessment is an expensive process in terms of equipment, human resources, and time. Biomarkers would usefully complement current measures in the screening and follow-up of sleep disorders and their daytime repercussions. Among salivary markers, a growing body of literature suggests that salivary α-amylase (sAA) may be a cross-species marker of sleep debt. However, there is no consensus as to the direction of variation in sAA with sleep disorders. Herein, after describing the mechanisms of sAA secretion and its relationship with stress, studies assessing the relationship between sAA and sleep parameters are reviewed. Finally, the influence of confounding factors is discussed, along with methodological considerations, to better understand the fluctuations in sAA and facilitate future studies in the field. [ABSTRACT FROM AUTHOR]

La fiabilité des modèles avec variables latentes est questionnée par différents auteurs : quelle est la nature des propriétés mentales ? Comment intégrer le complexe des processus mentaux avec des variables latentes ? Tous ces débats posent la question de la légitimité des variables latentes comme outils méthodologiques relativement à de nouvelles approches comme les Network analysis. En posant clairement la nature ontologique des propriétés mentales comme propriétés émergentes de processus mentaux, et en posant clairement une théorie de la connaissance pragmatiste et réaliste, notre travail cherche à montrer que les variables latentes sont des outils efficients pour inférer des propriétés mentales. The reliability of models with latent variables is questioned by different authors: what is the ontology of mental properties? How to integrate the complex of mental processes with latent variables? All these debates raise the question of the legitimacy of latent variables as methodological approach comparatively to new approaches such as Network analysis. By clearly posing the ontological nature of mental properties as emergent properties of mental processes, and by clearly posing a theory of pragmatist and realistic knowledge, our work seeks to show that latent variables are efficient approaches for inferring mental properties. [ABSTRACT FROM AUTHOR]

Background: Head injuries frequently occur in combat. Tactical Combat Casualty Care (TCCC) guidelines recommend pre-hospital use of ketamine for analgesia. Yet the use of this medication in patients with head injuries remains controversial, particularly among pediatric patients. We compare survival to hospital discharge rates among pediatric head injury subjects who received prehospital ketamine versus those who did not.Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric (<18 years of age) subjects from January 2007 to January 2016. We performed a sub-analysis of subjects with an abbreviated injury severity score for the head of 3 (serious) or higher and at least one documented Glasgow Coma Score (GCS) ≤13.Results: Of the 3439 pediatric patients within our dataset, 555 subjects met inclusion criteria for head injury - 36 (6.5%) received prehospital ketamine versus 519 (93.5%) who did not. There was no significant difference noted between groups regarding median age (10 versus 8, p = 0.259), percent male gender (72.2% versus 76.3%, p = 0.579), mechanism of injury (p = 0.143), median composite injury scores (22 versus 20, p = 0.082), median ventilator-free days (28 versus 27, p = 0.068), median ICU-free days (27.5 versus 27, p = 0.767), median hospital days (3.5 versus 4, p = 0.876) or survival to discharge (66.7% versus 70.7%, p = 0.607).Conclusions: Within this data set, we were unable to detect any differences in mortality among pediatric head trauma subjects administered ketamine compared to subjects not receiving this medication in the prehospital setting. [ABSTRACT FROM AUTHOR]

Highlights • A GNSS-R airborne campaign organized over Landes Forest. • High correlations observed between GNSS-R observables and forest Above Ground Biomass. • Inversion of GNSS-R observables with a moderate precision of above ground biomass. Abstract The Above-Ground Biomass (AGB) is a key parameter used for the modeling of the carbon cycle. The aim of this study is to make an experimental assessment of the sensitivity of Global Navigation Satellite System (GNSS) reflected signals to forest AGB. This is based on the analysis of the data recorded during several GLORI airborne campaigns in June and July 2015, over the Landes Forest (France). Ground truth measurements of tree height, density and diameter at breast height (DBH), as well as AGB, were carried out for 100 maritime pine forest plots of various ages. The GNSS-R data were used to obtain the right-left (Γ RL) and right-right (Γ RR) reflectivity observables, which are geo-referenced in accordance with the known positions of relevant GPS satellites and the airborne receiver. The correlations between forest AGB and the GNSS-R observables yield the highest sensitivity at high elevation angles (70°-90°). In this case, for (Γ RL) and the reflectivity polarization ratio (PR = Γ RL /Γ RR) estimated with a coherent integration time Tc = 20 ms, the coefficients of determination R2 are equal to 0.67 and 0.51, with a sensitivity of −0.051 dB/[106g (Mg) ha−1], and −0.053 dB/[Mg ha−1], respectively. The relationships between AGB and the observables are confirmed through the use of a 5-fold cross validation approach, with several different coherent integration times. [ABSTRACT FROM AUTHOR]

Historical and present day disturbances have contributed to long-term changes in the extent, composition, and structure of Upper Mississippi River System (UMRS) floodplain forests. Loss of forest habitat, low tree species diversity, a lack of successful regeneration in many areas, and continued declines in forest health over time are serious threats to this ecosystem. Floodplain forest restoration has therefore gained importance as a management goal throughout the UMRS. A key component of the restoration process is assessing the ecological characteristics of remnant, high quality reference sites to identify appropriate targets for forest restoration efforts. In this study, fourteen reference sites were located and established along a ∼1140 km longitudinal stretch of the Upper Mississippi River, lower Illinois River, lower Big Muddy River, and lower Cache River watershed. Biological and abiotic data were sampled from 1000 m 2 permanent plots located at each study site. Overstory floodplain forest communities were generally dominated by silver maple ( Acer saccharinum ) and a variable combination of green ash ( Fraxinus pennsylvanica ), American elm ( Ulmus americana ), cottonwood ( Populus deltoides ), pin oak ( Quercus palustris ), and hackberry ( Celtis occidentalis ). Common understory trees capable of overstory recruitment included silver maple, green ash, American elm, and hackberry. Overstory species richness and diversity were generally high, but species richness and diversity in the understory layer were much lower, a trend that was most pronounced in the northernmost sites. In addition, the scarcity of mast producing and/or shade intolerant species in the understory was evident throughout the study, even at sites where they were present in the overstory. Herbaceous communities were notably variable between study sites. Despite the latitudinal gradient, ordination of the floodplain forest communities revealed substantial compositional overlap between sites. However, patterns in the ordination were significantly correlated with local variability in canopy cover, elevation, soil texture, and several hydrologic parameters. Species richness and diversity generally increased from north to south. Results suggest that regional differences and local characteristics such as microtopographic features should be considered when selecting target restoration conditions and evaluating the suitability of individual species for specific restoration projects. [ABSTRACT FROM AUTHOR]

Background: Military hospital healthcare providers treated children during the recent conflicts in Afghanistan and Iraq. Compared to adults, pediatric patients present unique challenges during trauma resuscitations and have notably been discussed in few research reports. We seek to describe ED interventions performed on pediatric trauma patients in Iraq and Afghanistan.Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients in Iraq and Afghanistan from January 2007 to January 2016. Subjects were grouped based on Centers for Disease Control age categories. We used descriptive statistics.Results: During this period, there were 3388 pediatric encounters that arrived at the ED with signs of life or on-going interventions. Most subjects were male (77.2%), located in Afghanistan (67.9%), injured by explosive (43.2%), and admitted to an intensive care unit (57.8%). Most of those arriving to the ED alive or with on-going interventions survived to hospital discharge (91.6%). The most frequently encountered age group was 5-9years (33.3%) followed by 10-14years (31.5%). The most common interventions were vascular access (86.6%), fluid administration (85.0%), and external warming (44.6%). Intubation was the most frequent airway intervention (18.2%). Packed red blood cells were the most frequently administered blood product (33.8% of subjects).Conclusions: Pediatric subjects accounted for a notable portion of care delivered in theater emergency departments during the study period. Vascular access and fluid administration were the most frequently performed interventions. Pediatric-specific training is needed as a part of deployment medicine operations. [ABSTRACT FROM AUTHOR]

Study Objective: To describe the left lateral extraperitoneal approach to perform complete para-aortic and pelvic lymphadenectomy and transverse total hysterectomy from left to right as a novel approach to treat obese patients with endometrial cancer. Laparoscopic management of obese patients represents a challenge for the gynecologic surgeon. The extraperitoneal approach is technically easier in the obese patient because it naturally creates a bowel-free operative field.Design: A prospective pilot bicentric and descriptive study (Canadian Task Force classification III) evaluating the feasibility and reproducibility of the transverse total hysterectomy and complete lymphadenectomy through left endoscopic extraperitoneal approach in obese patients with endometrial cancer.Setting: A comprehensive cancer center in Toulouse and a teaching university hospital in Madrid.Patients: Sixteen consecutive overweight or obese patients (body mass index > 25 kg/m2) with high-risk endometrial cancer.Interventions: Currently, the left extraperitoneal approach is routinely used to perform complete para-aortic and pelvic lymphadenectomy. It provides direct access to the left ureter and uterine pedicle. This access can be extended to the right side when performing a transverse extrafascial hysterectomy from left to right. The procedure starts from the left extraperitoneal space, where the left uterine artery is sectioned and the vesicovaginal and rectovaginal septa are developed, without opening the peritoneum. Colpotomy is performed from the left to the right side. Once the right ureter is identified, the right uterine artery can be safely transected. Alternatively, the right uterine artery can be sealed and sectioned during the right pelvic lymphadenectomy. At the end of the procedure the peritoneum is opened to complete the surgery.Measurements and Main Results: Between May 2015 and February 2016, 16 consecutive obese patients were successfully treated using this technique. Median patient age was 62 years (range, 44-78), and median body mass index was 32.5 kg/m2 (range, 26-42). In 3 cases the right uterine artery was sealed during the right pelvic lymphadenectomy, in 11 cases after completing vaginal opening, and in 2 cases after peritoneal opening. The median operative time was 137.5 minutes (range, 66-260). The median blood loss was 85 mL (range, 0-260), and no blood transfusion was required in any of our 16 patients. No significant complications occurred.Conclusion: The full extraperitoneal approach represents an interesting alternative strategy for the surgical treatment of obese patients with high-risk endometrial cancer. [ABSTRACT FROM AUTHOR]

Résumé La mesure en psychologie est au cœur d’une discussion importante dans la littérature académique. Notre objectif est de porter une discussion critique sur ce sujet. Nous proposons de repositionner l’objet de la mesure, à savoir les propriétés mentales. À partir d’une ontologie clarifiée, nous considérons qu’une démarche empirique de mesure d’une propriété mentale est possible. Cette démarche doit s’affirmer pragmatique–réaliste. Concrètement, un test doit être renégocié relativement au contexte. La validation d’une mesure quantitative exige la vérification d’un certain nombre de critères. Notre travail pose en conséquence une critique des mesures effectuées usuellement en psychométrie. Measurement in psychology is at the heart of a major debate in the academic literature. We aim to contribute a critical discussion of this issue. We propose to reposition the object of measurement, namely mental properties. On the basis of a clarified ontology, we consider that an empirical approach to measuring a mental property is possible. This approach must be resolutely pragmatic–realist. In practical terms, this means that a test needs to be renegotiated relative to the context. The validation of quantitative measures requires verification of a certain number of criteria. Consequently, our work critically explores measures as they are usually conceived in psychometrics domain. [ABSTRACT FROM AUTHOR]

The production of melanin is a complex process involving biochemical cascades, such as the pro-phenoloxidase (proPO) system, and enzymes, such as phenoloxidases (POs). Different studies have shown a strong correlation between the decrease in PO activities and the occurrence of diseases in bivalve invertebrates, leading to mortalities in the host. Results of these studies suggest that POs could play a fundamental role in defense mechanisms in bivalves. This article reviews the fundamental knowledge on the proPO system in bivalves and the methods used to assess PO activities. Finally, this is the first report on the major findings of laboratory and field studies that indicate that a type of PO in bivalves, the laccase enzyme, is inducible and involved in the 1) immune 2) antioxidant and 3) detoxification roles in bivalves, and might be an ecological potential biomarker of environmental stress. [ABSTRACT FROM AUTHOR]

In this paper, we focus on the problem of robust rolling-stock planning for French passenger trains. First, we characterize robustness and define some indicators for the evaluation of rolling-stock rosters. We take a particular interest in homogenizing turning-times in a roster in order to absorb potential delays. Then, we propose a new approach to solve the problem of robust rolling-stock planning. The SNCF reference tool (PRESTO) calculates a solution to the rolling-stock planning problem. It consists of a multi-step approach to cover demand while minimizing operating costs, and to further add maintenance slots to the roster. We propose an integrated ILP model to add robustness to a roster while maintaining low operating costs compared to PRESTO. We have carried out tests on nine real French regional transport instances, and we use a simulation module to evaluate the results. We observe a significant improvement in robustness indicators while maintaining low operating costs and meeting maintenance requirements. [ABSTRACT FROM AUTHOR]

Background: Vancomycin-resistant Enterococcus raffinosus has rarely been associated with nosocomial infection and outbreaks.Aim: To report the successful control of a nosocomial outbreak of vanA-type vancomycin-resistant E. raffinosus in a surgical intensive care unit.Methods: The investigation of the outbreak is reported with control measures taken. Molecular typing of vancomycin-resistant E. raffinosus isolates was performed by repetitive sequence-based polymerase chain reaction (PCR).Findings: Between September and October 2014, vancomycin-resistant E. raffinosus isolates were isolated from four patients. The index patient had been hospitalized previously in Portugal, and was not found to be colonized by vancomycin-resistant enterococci on screening cultures obtained at admission. However, vancomycin-resistant E. raffinosus was isolated from a bile sample 19 days after hospital admission. All four isolates were resistant to both vancomycin and teicoplanin due to the presence of the vanA gene, while remaining susceptible to daptomycin and linezolid. Repetitive sequence-based PCR confirmed the spread of a single vanA-positive E. raffinosus clone. Infection control measures including direct PCR screening on rectal specimens, contact precautions, and cohorting of patients and personnel led to successful control of the outbreak.Conclusion: This is the first reported outbreak of vanA-type vancomycin-resistant E. raffinosus in France in both clinical and screening specimens among hospitalized patients. The inability of routine selective screening media to detect the vancomycin-resistant E. raffinosus in the index case likely contributed to the outbreak. [ABSTRACT FROM AUTHOR]

Introduction Airway compromise is the second leading cause of preventable death on the battlefield among US military casualties. Airway management is an important component of pediatric trauma care. Yet, intubation is a challenging skill with which many prehospital providers have limited pediatric experience. We compare mortality among pediatric trauma patients undergoing intubation in the prehospital setting versus a fixed-facility emergency department. Methods We queried the Department of Defense Trauma Registry (DODTR) for all pediatric encounters in Iraq and Afghanistan from January 2007 to January 2016. We compared outcomes of pediatric subjects undergoing intubation in the prehospital setting versus the emergency department (ED) setting. Results During this period, there were 3439 pediatric encounters (8.0% of DODTR encounters during this time). Of those, 802 (23.3%) underwent intubation (prehospital = 211, ED = 591). Compared to patients undergoing ED intubation, patients undergoing prehospital intubation had higher median composite injury severity scores (17 versus 16) and lower survival rates (66.8% versus 79.9%, p < 0.001). On univariable logistic regression analysis, prehospital intubation increased mortality odds (OR 1.97, 95% CI 1.39–2.79). After adjusting for confounders, the association between prehospital intubation and death remained significant (OR 2.03, 95% CI 1.35–3.06). Conclusions Pediatric trauma subjects intubated in the prehospital setting had worse outcomes than those intubated in the ED. This finding persisted after controlling for measurable confounders. [ABSTRACT FROM AUTHOR]

Background Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. Methods A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). Results Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), “open” abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. Conclusion Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established. [ABSTRACT FROM AUTHOR]

The advent of multicore and manycore processors, including GPUs, in the customer market encouraged developers to focus on extraction of parallelism. While it is certainly true that parallelism can deliver performance boosts, parallelization is also a very complex and error- prone task, and any applications are still dominated by sequential sections. Micro-architectures have become extremely complex, and they usually do a very good job at executing fast a given sequence of instructions. When they occasionally fail, however, the penalty is severe. Pathological behaviors often have their roots in very low-level details of the micro-architecture, hardly available to the programmer. We argue that the impact of these low-level features on performance has been overlooked, often relegated to experts. We show that a few metrics can be easily defined to help assess the overall performance of an application, and quickly diagnose a problem. Finally, we illustrate our claim with a simple prototype, along with use cases. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Les dispositifs de santé en France comme à l’étranger sont traversés par de fortes tensions. Les causes sont multiples : démographie des professionnels de santé tendue, pathologies non transmissibles et chroniques en recrudescence… La nécessité de développer des modes de prises en charge novateurs plus efficients devient une priorité. Le domaine de l’allergologie est concerné par ces tensions à plusieurs titres : une augmentation constante de la prévalence des pathologies allergiques, une nécessaire formation de médecins spécialistes pouvant prendre en charge la complexité des situations et développer de la recherche, une organisation de la santé nouvelle, alliant médecine hospitalière et de territoire. Des transferts de compétences entre professionnels de santé sont d’ores et déjà mis en place dans certaines spécialités médicales, en réponse aux besoins de santé des populations sur le territoire national et ce, en particulier dans les déserts médicaux. L’exercice infirmier en allergologie nécessite des compétences et une expertise non acquises par le diplôme initial d’infirmier. Les infirmiers qui exercent dans cette discipline peuvent apporter leur contribution au dispositif de santé, dès lors qu’ils ont bénéficié d’une formation académique en appui d’une solide expérience de terrain. À l’instar d’autres pays, les auteurs proposent un programme de formation d’infirmier de pratiques avancées en allergologie, de niveau master, répondant aux besoins de qualité des soins et de sécurité des patients. Health devices in France and abroad are crossed by strong tensions. Causes are multiple: demography of health professionals strained, non-communicable and chronic diseases on the rise. The need to develop ways of more efficient innovative taken loads becomes a priority. The field of allergology is affected by these tensions in several respects: a steady increase in the prevalence of allergic diseases, necessary training of specialists that can handle complex situations and develop research, organization of new health system, combining hospital medicine and territory. Skills mix between health professionals are already implemented in some medical specialties, as a response to the health needs of populations in the country and especially in medical emptiness. The practice of nursing in allergology requires skills not acquired by the initial degree nursing expertise (bachelor). Nurses practicing in allergy can contribute to device health, when they received solid academic training and background, in support of a strong field experience. The authors analyze advanced practice training in different countries and propose a training program for master level in response to the needs of quality of care and patient safety in this area. [ABSTRACT FROM AUTHOR]

Summary Context While photodynamic therapy (PDT) is a promising treatment for peritoneal carcinomatosis, its use is often limited because of the toxicity of photosensitizers. In this study, safety of PDT with hexaminoevulinate (HAL), a second generation photosensitizer, is assessed. Methods PDT of the peritoneal cavity was performed in a rat model of peritoneal carcinomatosis. Rats were treated according to different protocols: with full or half HAL dose, after intraperitoneal or oral administration of HAL, 4 or 8 h after its injection, using red or green light, after protection of the liver or cooling of the abdominal wall. Toxicity was assessed by blood tests quantifying hematocrit, liver and muscular enzymes and by pathological examination of abdominal and intrathoracic organs after treatment. The results were analyzed in the light of quantification of fluorescence and protoporphyrin IX (PPIX) content of the same organs. Results PDT with HAL induced rhabdomyolysis, intestinal necrosis and liver function test anomalies, leading to death in 2 out of 34 rats. The liver and the intestine contained high levels of PPIX (3–5 times more than tumor nodules). Conclusion HAL PDT lacked specificity. However, the strategy associating diagnosis, treatment and evaluation of the results in one single procedure was effective and should be tested with other photosensitizers. [ABSTRACT FROM AUTHOR]

Résumé: La rédaction de certificats médicaux fait partie intégrante de l’exercice médical. Dans un grand nombre de cas, ils ne sont ni nécessaires, ni justifiés. Nous rapportons l’observation d’un patient de 14ans, diagnostiqué allergique au poisson. Avant son départ pour un séjour à l’étranger, l’école demande aux parents de se procurer un certificat médical attestant que l’adolescent est capable de reconnaître la présence de poisson dans la nourriture et de refuser le plat proposé. Le médecin peut-il refuser de rédiger un certificat ? Peut-il établir un certificat à la demande d’un tiers ? Le certificat doit-il revêtir une forme particulière ? Engage-t-il sa responsabilité lors de la délivrance d’un tel document ? [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite a high response rate to front-line therapy, prognosis of epithelial ovarian carcinoma (EOC) remains poor. Approaches that combine Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have been developed recently. The purpose of this study was to assess early and long-term survival in patients treated with this strategy. Patients and methods: A retrospective cohort multicentric study from French centres was performed. All consecutive patients with advanced and recurrent EOC treated with CRS and HIPEC were included. Results: The study included 566 patients from 13 centres who underwent 607 procedures between 1991 and 2010. There were 92 patients with advanced EOC (first-line treatment), and 474 patients with recurrent EOC. A complete cytoreductive surgery was performed in 74.9% of patients. Mortality and grades 3 to 4 morbidity rates were 0.8% and 31.3%, respectively. The median overall survivals were 35.4 months and 45.7 months for advanced and recurrent EOC, respectively. There was no significant difference in overall survival between patients with chemosensitive and with chemoresistant recurrence. Peritoneal Cancer Index (PCI) that evaluated disease extent was the strongest independent prognostic factor for overall and disease-free survival in all groups. Conclusion: For advanced and recurrent EOC, curative therapeutic approach combining optimal CRS and HIPEC should be considered as it may achieve long-term survival in patients with a severe prognosis disease, even in patients with chemoresistant disease. PCI should be used for patient's selection. [Copyright &y& Elsevier]

Résumé: Les défensines sont des protéines de petite taille, riches en ponts disulfure, largement distribuées dans le règne végétal. Elles possèdent toutes un domaine ű knottin Ƈ qui se caractérise par l’existence d’un nœud (entrelac) de ponts disulfure. Ce nœud est constitué d’un pont disulfure qui vient traverser une grande boucle constituée par deux autres ponts disulfure reliés au squelette peptidique. Cette organisation suppose que le pont disulfure traversant soit disposé perpendiculairement par rapport aux deux autres ponts disulfure constituant la boucle. Ce domaine ű knottin Ƈ est relié à une longue queue C-terminale riche en hydroxyproline (défensines à longue chaîne d’environ 110 acides aminés) ou non (défensines à courte chaîne d’environ 50 acides aminés). L’allergène Art v 1 du pollen d’armoise (Artemisia vulgaris) est le prototype des défensines à longue chaîne, tandis que la plupart des défensines de Brassicacées sont des défensines à courte chaîne. À l’exception d’Art v 1 et de l’allergène Amb a 4 du pollen d’ambroisie (Ambrosia artemisiifolia) qui sont des allergènes bien connus, l’allergénicité des autres défensines végétales est loin d’avoir été démontrée. Néanmoins, le fait que les plages électropositives (constituées de lysine et d’arginine) et électronégatives (constituées d’acides aspartique et glutamique) identifiées à la surface d’Art v 1 et d’Amb a 4 se retrouvent dans quelques autres défensines, suggère que d’autres défensines pourraient être allergéniques. Des investigations cliniques et biologiques seront bien sûr nécessaires pour justifier ce statut d’allergène. [ABSTRACT FROM AUTHOR]

Abstract: By overemphasizing the role of overstory trees in forest studies, researchers, managers and policy makers could well ignore an important functional component of the forest ecosystem: the understory. This could be particularly true in forests with relatively open canopies. In maritime pine (Pinus pinaster Ait.) plantation forests in the southwest of France, a considerable amount of the direct radiation is transmitted through the canopy and is available for the growth of understory species. This study focused on five dominant understory species, including three woody species (Calluna vulgaris L., Erica cinerea L. and Cytisus scoparius L.) and two herbaceous perennials species (Molinia caerulea L. (Moench) and Pteridium aquilinum L. Khun). For each species five pine stands with varying amounts of understory were selected to predict biomass for a wide range of values. The number of pine trees and their dimensions were recorded enabling us to estimate the aboveground and root biomass of the pines using allometric relationships. Biometrical measurements of the understory and destructive harvests were carried out in each stand to measure aboveground, coarse and fine root biomass. The results showed that the understory represented an average of 6.8% of total ecosystem aboveground biomass and 27.4% of total ecosystem root biomass, underlining the need for a broader view of this component of the forest ecosystem. Allometric relationships derived from the biometrical data enabled satisfactory predictions of aboveground biomass for all five understory species and for belowground biomass of three species (M. caerulea, P. aquilinum, C. scoparius); allometric relationships failed to predict root biomass for two woody understory species (E. cinerea and C. vulgaris). [Copyright &y& Elsevier]

Abstract: This study evaluated the toxicity of dispersant application which is, in nearshore area, a controversial response technique to oil spill. Through an experimental approach with juveniles of Liza aurata, the toxicity of five exposure conditions was evaluated: (i) a chemically dispersed oil simulating dispersant application; (ii) a single dispersant as an internal control of chemically dispersed oil; (iii) a mechanically dispersed oil simulating natural dispersion of oil; (iv) a water soluble fraction of oil simulating an undispersed and untreated oil slick and (v) uncontaminated seawater as a control exposure condition. The relative concentration of PAHs (polycyclic aromatic hydrocarbons) biliary metabolites showed that the incorporation of these toxic compounds was increased if the oil was dispersed, whether mechanically or chemically. However, toxicity was not observed at the organism level since the aerobic metabolic scope and the critical swimming speed of exposed fish were not impaired. [Copyright &y& Elsevier]

Summary: Ovarian cancer is among the deadliest in women. Current treatment strategies fail to cure many patients owing to the difficulties of eradicating peritoneal implants frequently associated with this pathology. Photodynamic therapy represents a promising treatment as it offers many advantages over alternative strategies: diagnostic properties, specific targeting of abnormal cells, possibility to be combined with other therapies. [Copyright &y& Elsevier]

Dispersant use in nearshore areas is likely to increase the exposure of aquatic organisms to petroleum. To measure the toxicity of this controversial response technique, golden grey mullets (Liza aurata) were exposed to mechanically dispersed oil, chemically dispersed oil, dispersant alone in seawater, water-soluble fraction of oil and to seawater as a control treatment. Several biomarkers were assessed in the gills (enzymatic antioxidant activities, glutathione content, lipid peroxidation) and in the gallbladder (polycylic aromatic hydrocarbons metabolites). The significant differences between chemically dispersed oil and water soluble fraction of oil highlight the environmental risk to disperse an oil slick when containment and recovery can be conducted. The lack of significance between chemically and mechanically dispersed oil suggests that dispersant application is no more toxic than the natural dispersion of the oil slick. The results of this study are of interest in order to establish dispersant use policies in nearshore areas. [Copyright &y& Elsevier]

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Bark beetles are notorious pests of natural and planted forests causing extensive damage. These insects depend on dead or weakened trees but can switch to healthy trees during an outbreak as mass-attacks allow the beetle to overwhelm tree defences. Climatic events like windstorms are known to favour bark beetle outbreaks because they create a large number of breeding sites, i.e., weakened trees and for this reason, windthrown timber is generally preventively harvested and removed. In December 1999, the southwest of France was struck by a devastating windstorm that felled more that 27millionm3of timber. This event offered the opportunity to study large-scale spatial pattern of trees attacked by the bark beetle Ips sexdentatus and its relationship with the spatial location of pine logs that were temporally stored in piles along stand edges during the post-storm process of fallen tree removal. The study was undertaken in a pure maritime pine forest of 1300ha in 2001 and 2002. We developed a landscape approach based on a GIS and a complete inventory of attacked trees. During this study more than 70% of the investigated stands had at least one tree attacked by I. sexdentatus. Spatial aggregation prevailed in stands with attacked trees. Patches of attacked trees were identified using a kernel estimation procedure coupled with randomization tests. Attacked trees formed patches of 500–700m2 on average which displayed a clumped spatial distribution. Log piles stemming from the sanitation removals were mainly distributed along the large access roads and showed an aggregated spatial pattern as well. The spatial relationship between patches of attacked trees and log pile storage areas was analyzed by means of the Ripley’s statistic that revealed a strong association at the scale of the studied forest. Our results indicated that bark beetle attacks were facilitated in the vicinity of areas where pine logs were stored. The spatial extent of this relationship was >1000m. Similar results were obtained in 2001 and 2002 despite differences in the number and spatial distribution of attacked trees. The presence of a strong “facilitation effect” suggests that log piles should be removed quickly in order to prevent outbreaks of bark beetles. [Copyright &y& Elsevier]

Abstract: Bark beetle infestations are often scattered throughout the forest landscape and therefore difficult to accurately and rapidly assess. We tested a roadside sampling technique in a pure maritime pine forest (Pinus pinaster) of ca. 1300ha where bark beetle outbreak foci were observed following a windstorm. The sampling method relied on the count along stand edges of all dying or dead trees sighted within a fixed distance from the road. About 2300 trees attacked by Ips sexdentatus were recorded and located using colour-infrared aerial photography. Accuracy of the infestation map was verified by ground sampling. Piles of cut logs stored along the edge significantly increased the percentage of attacked trees in the neighbouring stand. However, the percentage of attacked trees within the stand edges did not differ with the percentage within the stand interior. It allowed us to use stand edges as sampling units to estimate the mean percentage of attacked trees per stand. At the stand scale, the use of a fixed 10m wide strip along stand edges maximized the detection of attacked trees and minimized the bias of estimated percent of attacked trees. Based on GIS data, various stratified roadside sampling plans with increasing numbers of edges per stand and increasing numbers of stands per forest were simulated by bootstrap resampling. In a forest without any storage of cut logs, systematic roadside surveys underestimated the level of damage. The sampling accuracy increased with the kilometers of edges surveyed. In a forest with piles of cut logs on which bark beetles can breed, the best option was an adaptive sampling plan where at least two additional consecutive edges were observed in stands close to the pile. As compared to systematic sampling plans, adaptive plans were three times less expensive in terms of sampling effort for the same accuracy. Overall, adaptive sampling plans were also more robust as they provided less biased estimates as the proportion of stands with nearby piles increased in simulated forests. [Copyright &y& Elsevier]

Sleep occupies a substantial proportion of life. Sleep modifications parallel brain development during childhood. Sex and gender differences have been reported in brain development and many clinical and psychosocial conditions. This narrative review provides insight into the differences between girls and boys in terms of brain maturation and plasticity related to sleep and sleep characteristics (physiology, sleep duration) during development. [ABSTRACT FROM AUTHOR]

Background The clinical significance of moderate coronary stenosis is a fundamental to the choice of treatment. The gold standard is invasive fractional flow reserve (FFR) studying by quantitative coronary angiography (QCA). The role of 256 slices coronary computed tomography angiography (CCTA) one-beat acquisition is insufficiently studied and may be an important factor to predict the clinical significance of moderate coronary stenosis. Purpose To identify morphological CCTA predictors for the clinical significance of moderate coronary artery stenosis. Methods A total of 61 arteries (43 consecutive patients) underwent CCTA and QCA associated with a lesion-specific FFR measurement were retrospectively analyzed. CCTA was performed on a 256-slices CT one-beat acquisition, three-phase injection protocol by using smart shot dual injector. Stenosis from 50–69% were considered as moderate. FFR ≤ 0.80 was considered as functionally significant. Results The mean age was 67.9 ± 10.1, BMI 27.3 ± 4.4 kg/m 2 and 75% were males. Twenty-nine percent patients (18 arteries) have clinically significant moderate stenosis with FFR ≤ 0.8; 23% ( n = 14) have moderate but not clinically significant stenosis (FFR > 0.80) and 48% ( n = 29) were presented by 30–49% stenosis. All of stenosis < 50% by CCTA were functionally non-significant with FFR > 0.8 ( P < 0.05, 100% negative predictive value (NPV)). As CT-predictors for the clinical significance of moderate coronary stenosis (FFR ≤ 0.8) were revealed: stenosis length ≥ 16 mm (sensitivity (ss) 78%, specificity (sp) 79%, PPV 82%, NPV 73%, P = 0.004) and multiple stenosis in calcified arteries with the stenosis's length ≥ 16 mm (sp 86%, PPV 85%, P = 0.012). Conclusion CCTA plays an important role for noninvasive assessment of clinical significance of moderate coronary stenosis. Moderate stenosis are clinically significant (FFR ≤ 0.8) if their length is more than 16 mm in calcified arteries, particularly in culprit arteries with multiple stenosis. [ABSTRACT FROM AUTHOR]

Introduction: Airway compromise is the second leading cause of preventable death on the battlefield among US military casualties. Airway management is an important component of pediatric trauma care. Yet, intubation is a challenging skill with which many prehospital providers have limited pediatric experience. We compare mortality among pediatric trauma patients undergoing intubation in the prehospital setting versus a fixed-facility emergency department.Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric encounters in Iraq and Afghanistan from January 2007 to January 2016. We compared outcomes of pediatric subjects undergoing intubation in the prehospital setting versus the emergency department (ED) setting.Results: During this period, there were 3439 pediatric encounters (8.0% of DODTR encounters during this time). Of those, 802 (23.3%) underwent intubation (prehospital=211, ED=591). Compared to patients undergoing ED intubation, patients undergoing prehospital intubation had higher median composite injury severity scores (17 versus 16) and lower survival rates (66.8% versus 79.9%, p<0.001). On univariable logistic regression analysis, prehospital intubation increased mortality odds (OR 1.97, 95% CI 1.39-2.79). After adjusting for confounders, the association between prehospital intubation and death remained significant (OR 2.03, 95% CI 1.35-3.06).Conclusions: Pediatric trauma subjects intubated in the prehospital setting had worse outcomes than those intubated in the ED. This finding persisted after controlling for measurable confounders. [ABSTRACT FROM AUTHOR]

Objectives: to investigate whether in-ambulance abciximab initiation, in ST-elevation myocardial infarction (STEMI) patients improves ST segment resolution (STR) after primary percutaneous intervention (PCI). Methods: MISTRAL is a prospective randomized double blind study conducted in 11 centers in France (ClinicalTrial.gov number NCT 00638638). 256 patients with STEMI within 6 hours from symptom onset were allocated to receive Abciximab started either in the Mobile Intensive Care Unit (MICU) or later in the cathlab after diagnostic angiography. Other treatments in the MICU included aspirin 250mg IV, heparin 40 UI/kg IV. Primary endpoint was complete (>70%) ST-segment resolution was adjudicated by an independent centralized ECG-Corelab. Results: mean age was 56±12 years old and 80% of the patients were males. Median delay from symptoms to diagnosis was 90 min and 103 min min from diagnosis to balloon. Complete ST resolution was similar in the early and late groups 21% vs 15% (p = 0.44) before PCI and 70% vs 67% (p = 0.67) 60 min after PCI. Mean residual ST elevation tended to be lower in the early group before PCI 8.1 vs 9.6mm (P = 0.17) but not after PCI 3.0 vs 3.2mm (p = 0.62). In the early group, TIMI 2–3 flow rate before PCI tended to be higher (45 vs 34%, p = 0.095) and distal embolisation rate was lower (8 vs 21%, p = 0.008). TIMI 2–3 flow rate post-PCI, blush score rates, LVEF, biologic infarct size, 30 days MACE were similar in both groups with very low mortality rates (1.7 vs 0.8%). Conclusions: early ambulance vs. routine cathlab administration of abciximab in STEMI did not improve ST resolution post-PCI, final TIMI flow rate, LVEF, infarct size and MACE. Early ambulance abciximab tended to improve TIMI 2–3 flow rates pre-PCI and to reduce slow flow and distal embolisation during procedure. Early abciximab tends to “facilitate” PCI procedure since more arteries are opened at the time of angio (45 vs 34% TIMI2–3) and less embolisation or slow flow occurs during procedure. [Copyright &y& Elsevier]