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Introduction 30-day readmission rate is considered an adverse outcome reflecting suboptimal quality of care during index hospitalisation for community-acquired pneumonia (CAP). However, potentially avoidable readmission would be a more relevant metric than all-cause readmission for tracking quality of hospital care for CAP. The objectives of this study are (1) to estimate potentially avoidable 30-day readmission rate and (2) to develop a risk prediction model intended to identify potentially avoidable readmissions for CAP.Methods and analysis The study population consists of consecutive patients admitted in two hospitals from the community or nursing home setting with pneumonia. To qualify for inclusion, patients must have a primary or secondary discharge diagnosis code of pneumonia. Data sources include routinely collected administrative claims data as part of diagnosis-related group prospective payment system and structured chart reviews. The main outcome measure is potentially avoidable readmission within 30 days of discharge from index hospitalisation. The likelihood that a readmission is potentially avoidable will be quantified using latent class analysis based on independent structured reviews performed by four panellists. We will use a two-stage approach to develop a claims data-based model intended to identify potentially avoidable readmissions. The first stage implies deriving a clinical model based on data collected through retrospective chart review only. In the second stage, the predictors comprising the medical record model will be translated into International Classification of Diseases, 10th revision discharge diagnosis codes in order to obtain a claim data-based risk model.The study sample consists of 1150 hospital stays with a diagnosis of CAP. 30-day index hospital readmission rate is 17.5%.Ethics and dissemination The protocol was reviewed by the Comité de Protection des Personnes Sud Est V (IRB#6705). Efforts will be made to release the primary study results within 6 months of data collection completion.Trial registration number ClinicalTrials.gov Registry (NCT02833259).

Angiogenesis is defined as the formation of new capillaries by sprouting from the pre-existing microvasculature. It occurs in physiological and pathological processes particularly in tumor growth and metastasis. α1, α2, α3, and α6 NC1 domains from type IV collagen were reported to inhibit tumor angiogenesis. We previously demonstrated that the α4 NC1 domain from type IV collagen, named Tetrastatin, inhibited tumor growth in a mouse melanoma model. The inhibitory activity was located in a 13 amino acid sequence named QS-13. In the present paper, we demonstrate that QS-13 decreases VEGF-induced-angiogenesis in vivo using the Matrigel plug model. Fluorescence molecular tomography allows the measurement of a 65% decrease in Matrigel plug angiogenesis following QS-13 administration. The results are confirmed by CD31 microvessel density analysis on Matrigel plug slices. QS-13 peptide decreases Human Umbilical Vein Endothelial Cells (HUVEC) migration and pseudotube formation in vitro. Relevant QS-13 conformations were obtained from molecular dynamics simulations and docking. A putative interaction of QS-13 with α5β1 integrin was investigated. The interaction was confirmed by affinity chromatography, solid phase assay, and surface plasmon resonance. QS-13 binding site on α5β1 integrin is located in close vicinity to the RGD binding site, as demonstrated by competition assays. Collectively, our results suggest that QS-13 exhibits a mighty anti-angiogenic activity that could be used in cancer treatment and other pathologies with excessive angiogenesis such as hemangioma, psoriasis or diabetes.

Objectives Polyhandicap (PLH), defined by a combination of profound intellectual impairment and serious motor deficits, is a severe condition with complex disabilities. In France, care of the large majority of PLH individuals is managed in specialised rehabilitation centres or residential facilities, but some of PLH individuals are cared for at home. The aims of this study were to assess the self-perceived burden among informal caregivers of PLH individuals and to identify potential determinants of this burden.Design Cross-sectional study (Neuropaediatric Department, Trousseau Hospital, Paris, France).Settings PLH children were recruited from a specialised paediatric/neurological department.Participants The selection criteria of caregivers were age above 18 years and being the PLH individual’s next of kin.Outcomes measures From March 2015 to December 2016, data were collected from the caregivers, including sociodemographical data, health status, psycho-behavioural data (quality of life, mood disorders and coping) and self-perceived burden. In addition, the health status of the PLH individual was collected. Relationships between the burden scores and potential determinants were tested (correlations coefficients, Mann-Whitney tests, generalised estimating equations models).Results Eighty-four children were eligible; 77 families returned their questionnaire. The informal caregivers of PLH children experienced a high level of perceived burden (scores ranged from 55±20 to 81±12). Eighty per cent of them had more than 5 hours of daily caregiving and 51% of them had to get up more than twice during the night. The main factors associated with caregiver burden were age, financial issues, health status, daily care and coping strategies. The patients’ health status was not associated with caregiver burden.Conclusions Some of the caregiver burden determinants might be modifiable. These findings should help healthcare workers and health-decision makers implement specific and appropriate interventions.Trial registration number NCT02400528.

Before the selection or the evaluation of geomorphosites, processes, most of the time spontaneous, contribute to a progressive heritage designation of landforms, which means a consideration of landforms, close or distant, as objective part of the heritage of individuals and societies. The heritage dimension begins with conditions of appropriation, which precede conditions of preservation and transmission of knowledge. These conditions of appropriation improve at different times and with different durations. The appropriation of landforms, with the prospect of a heritage designation, is then usually handled according to immaterial, or mainly immaterial conditions: by naming the memorable landforms (toponymy), the description of landforms (to identify them) and their representation (at first on maps). It is also handled according to material, or mainly material, conditions which leave, for their part, traces in the landscape, by the religious or commemorative uses of some landforms, by the conquest and by the economic exploitation, essentially touristic. It comes along with land use regulations which are the most important degree of heritage appropriation.

Broadband, multi-functional and parallel-processing devices are often built on coupled oscillators or arrays of resonators. Different length scales and applications determine the dominating coupling mechanism of the device. In this paper we investigate the effects of interactive fluid coupling between members of a one-dimensional array wherein only one member is actuated. We are specifically interested in studying the influence of non-neighbouring members in small-size arrays comprising of three and five members for different Reynolds numbers and gap widths between members. Our model and analysis is based on the Navier–Stokes equation for incompressible flow which is solved using a boundary integral technique resulting in the hydrodynamic coupling matrix through which added mass and damping effects are inferred. Results clearly suggest that non-neighbouring members play a significant role for most typical array configurations and therefore cannot be ignored. In particular, arrays with more than three members must account for the behaviour of such a device with all member interactions. Thus, predicting the performance of most new and emerging technologies such as sensors and biomedical devices is determined by array effects rather than local, nearest neighbour influences.

This paper presents a numerical method to address function estimation problems in inverse heat transfer problems using parameter estimation approach without prior information on the functional form of the variable to be estimated. Using an inverse analysis, the functional form of a time-dependent heat transfer coefficient is estimated efficiently and accurately. The functional form of the heat transfer coefficient is assumed unknown and the inverse heat transfer problem should be treated using a function estimation approach by solving sensitivity and adjoint problems during the minimization process. Based on proposing a new sensitivity matrix, however, the functional form can be estimated in an accurate and very efficient manner using a parameter estimation approach without the need for solving the sensitivity and adjoint problems and imposing extra computational cost, mathematical complexity, and implementation efforts. In the proposed sensitivity analysis scheme, all sensitivity coefficients can be computed in only one direct problem solution at each iteration. In this inverse heat transfer problem, the body shape is irregular and meshed using a body-fitted grid generation method. The direct heat conduction problem is solved using the finite-difference method. The steepest-descent method is used as a minimization algorithm to minimize the defined objective function and the termination of the minimization process is carried out based on the discrepancy principle. A test case with three different functional forms and two different measurement errors is considered to show the accuracy and efficiency of the used inverse analysis.

The relief of Reunion Island is typical of tropical oceanic islands due to the volcanic phenomena responsible for its construction and climatic conditions, which generate particularly powerful erosion processes. It has geomorphological potential, which has contributed to the creation of a National Park, the establishment of Natural Areas of Geological Interest (called ZNIG) that take into account geomorphology as much as geology and the designation of part of the island as a UNESCO World Heritage Site. It benefits from many visitors who come to the island to discover its relief. This methodological article presents a selection of geomorphosites, i.e. sites suitable for popularizing geomorphology in the field, based on dynamic criteria and an integrated analysis of the relief. First, four large geomorphological groups are identified and then around twelve geomorphotypes, which are used to determine as many sets of geomorphosites.

Hydrogen storage is a promising technology for storage of renewable energy resources. Despite its high energy density potential, the development of hydrogen storage has been impeded, mainly due to its significant cost. Although its cost is governed mainly by electrical energy expense, especially for hydrogen produced with alkaline water electrolysis, it is also driven by the value of the cell tension. The most common means of electrolyzer improvement is the use of an electrocatalyst, which reduces the energy required for electrochemical reaction to take place. Another efficient means of electrolyzer improvement is to use the Computational Fluid Dynamics (CFD)-assisted design that allows the comprehension of the phenomena occurring in the electrolyzer and also the improvement in the electrolyzer’s efficiency. The designed two-phase hydrodynamics model of this study has been compared with the experimental results of velocity profiles measured using Laser Doppler Velocimetry (LDV) method. The simulated results were in good agreement with the experimental data in the literature. Under the good fit with experimental values, it is efficient to introduce a new physical bubble transfer phenomenon description called “bubble diffusion”.

Background: The understanding of the pathogenesis of cytomegalovirus (CMV)-induced fetal brain lesions is limited. We aimed to quantify adaptive and innate immune cells and CMV-infected cells in fetal brains with various degrees of brain damage. Methods: In total, 26 archived embedded fetal brains were studied, of which 21 were CMV-infected and classified in severely affected (n = 13) and moderately affected (n = 8), and 5 were uninfected controls. The respective magnitude of infected cells, immune cells (CD8+, B cells, plasma cells, NK cells, and macrophages), and expression of immune checkpoint receptors (PD-1/PD-L1 and LAG-3) were measured by immunochemistry and quantified by quantitative imaging analysis. Results: Quantities of CD8+, plasma cells, NK cells, macrophages, and HCMV+ cells and expression of PD-1/PD-L1 and LAG-3 were significantly higher in severely affected than in moderately affected brains (all p values < 0.05). A strong link between higher number of stained cells for HCMV/CD8 and PD-1 and severity of brain lesions was found by component analysis. Conclusions: The higher expression of CD8, PD-1, and LAG-3 in severely affected brains could reflect immune exhaustion of cerebral T cells. These exhausted T cells could be ineffective in controlling viral multiplication itself, leading to more severe brain lesions. The study of the functionality of brain leucocytes ex vivo is needed to confirm this hypothesis.

The present paper aims to analyze trends over time in prevalence of cerebral palsy of post-neonatal origin, to investigate whether changes are similar according to severity and to describe the disability profile by etiology. Post-neonatal cases, birth years 1976 to 1998, were identified from the Surveillance of Cerebral Palsy in Europe collaboration (19 population-based registries). A recognized causal event occurring between 28 days and 24 months of age was considered to define the cases. Trends in prevalence were explored using graphical methods (Lowess and Cusum control chart) and modeled with negative binomial regressions. Over the study period, 404 cases were identified as post-neonatal cases (5.5% of the total). Mean prevalence rate was 1.20 per 10,000 live births (95% CI [1.08-1.31]). A significant downward trend was observed (p = 0.001), with an accentuated decrease in the 1990s. The prevalence of severe cases which account for around one third of the total also significantly decreased over time (p less than 0.001). In 46% of cases, an infectious aetiology was reported; the corresponding prevalence significantly decreased since 1989. No significant decrease was observed for the rate of cases due to a vascular episode or of traumatic origin. Our results emphasize the need of large population-based surveillance systems to reliably monitor trends in prevalence in rare subgroups of children like those with acquired cerebral palsy. The decrease of the overall prevalence as well as those of the most severe cases may be partly due to public health actions targeted to prevent such events. (Contains 2 figures and 2 tables.)

Video game characters are used as protagonists in contemporary literature to allow the authors to raise the issue of individual and social identities in today’s world, where virtual communications are more and more important. On one hand, video game is only a pretext for some authors of youth literature to talk about how identity is constructed and why we need to respect each other’s differences. On the other hand, some contemporary authors represent video game characters to question the positive or negative influence virtual worlds have on the identity by linking it to immersion and identification.