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Abstract Background Mobile intensive care units frequently manage unplanned out-of-hospital births (UOHB). Rewarming methods during pre-hospital management of UOHB have not yet been compared. The aim was to compare rewarming methods used during pre-hospital management in a large prospective cohort of UOHB in France. Methods We analysed UOHB from the prospective AIE cohort from 25 prehospital emergency medical services in France. The primary outcome was the change in body temperature from arrival at scene to arrival at hospital. Results From 2011 to 2018, 1854 UOHB were recorded, of whom 520 were analysed. We found that using incubator care was the most effective rewarming method (+ 0.8 °C during transport), followed by the combination of plastic bag, skin-to-skin and cap (+ 0.2 °C). The associations plastic bag + cap and skin-to-skin + cap did not allow the newborn to be warmed up but rather to maintain initial temperature (+ 0.0 °C). The results of the multivariate model were consistent with these observations, with better rewarming with the use of an incubator. We also identified circumstances of increased risk of hypothermia according to classification and regression tree, like premature birth (

Abstract Background The present challenge for patient involvement is the improvement of healthcare efficiency through a deeper consideration of the patient experience. In hospitals, numerous interventions promoting patient involvement are informally implemented by healthcare workers (HCWs). The first aim of this study was to conduct an overview of hospital HCWs’ experiences of the involvement of patients or their representatives. This overview included the involvement of patients in the domains of healthcare provision and support for other patients, healthcare quality and safety improvement, training and research. The second aim was to describe the challenges and conditions for the development of participative interventions by HCWs. Methods We conducted a mixed-methods sequential study at Nantes University Hospital from September 2017 to May 2018. To achieve the first aim, we performed a descriptive analysis of quantitative data collected via a questionnaire survey of 1290 HCWs. To achieve the second aim, we conducted a thematic analysis of qualitative data collected via eight semi-structured interviews with HCWs who reported involving patients or their representatives (family and patient association members) in healthcare. Results Among the 213 survey participants (16.5%), 133 reported a total of 424 participative interventions, mostly in the domains of care quality and safety (37%) and care provision and support (29%). The analysis of the qualitative data evidenced three types of factors determining the implementation of such interventions: the profiles of patients and their representatives, the beliefs and attitudes of HCWs, and organisational factors. While leadership from patients and HCWs was a central element in the development of patient involvement interventions, organisations’ capacities to foster a sustainable partnership culture appeared to be the next challenge to promote the patient-as-partner model in health systems. Our results also highlighted numerous benefits of patient and representative involvement for patients and HCWs. Conclusions The numerous initiatives reported show that patients and patient representatives participate alongside HCWs in hospitals. It is essential to take into account the facilitating and hindering factors of patient involvement in hospital HCWs’ practices for the further development of current initiatives. Additional studies, especially from the point of view of patients, are needed to complement our findings.

Though deformable thermoelectric materials are desirable for integrating thermoelectric devices into wearable electronics, typical thermoelectric materials are too brittle for practical application. Here, the authors report a high-performance elastic composite for stretchable thermoelectric modules.

Author(s): David Leclère [sup.1] , Michael Obersteiner [sup.1] [sup.2] , Mike Barrett [sup.3] , Stuart H. M. Butchart [sup.4] [sup.5] , Abhishek Chaudhary [sup.6] [sup.7] , Adriana De Palma [sup.8] [...], Increased efforts are required to prevent further losses to terrestrial biodiversity and the ecosystem services that it provides.sup.1,2. Ambitious targets have been proposed, such as reversing the declining trends in biodiversity.sup.3; however, just feeding the growing human population will make this a challenge.sup.4. Here we use an ensemble of land-use and biodiversity models to assess whether--and how--humanity can reverse the declines in terrestrial biodiversity caused by habitat conversion, which is a major threat to biodiversity.sup.5. We show that immediate efforts, consistent with the broader sustainability agenda but of unprecedented ambition and coordination, could enable the provision of food for the growing human population while reversing the global terrestrial biodiversity trends caused by habitat conversion. If we decide to increase the extent of land under conservation management, restore degraded land and generalize landscape-level conservation planning, biodiversity trends from habitat conversion could become positive by the mid-twenty-first century on average across models (confidence interval, 2042-2061), but this was not the case for all models. Food prices could increase and, on average across models, almost half (confidence interval, 34-50%) of the future biodiversity losses could not be avoided. However, additionally tackling the drivers of land-use change could avoid conflict with affordable food provision and reduces the environmental effects of the food-provision system. Through further sustainable intensification and trade, reduced food waste and more plant-based human diets, more than two thirds of future biodiversity losses are avoided and the biodiversity trends from habitat conversion are reversed by 2050 for almost all of the models. Although limiting further loss will remain challenging in several biodiversity-rich regions, and other threats--such as climate change--must be addressed to truly reverse the declines in biodiversity, our results show that ambitious conservation efforts and food system transformation are central to an effective post-2020 biodiversity strategy. To promote the recovery of the currently declining global trends in terrestrial biodiversity, increases in both the extent of land under conservation management and the sustainability of the global food system from farm to fork are required.

BackgroundThe use of 18FDG-PET/CT for delineating a gross tumor volume (GTV, also called MTV metabolic tumor volume) in radiotherapy (RT) planning of head neck squamous cell carcinomas (HNSCC) is not included in current recommendations, although its interest for the radiotherapist is of evidence. Because pre-RT PET scans are rarely done simultaneously with dosimetry CT, the validation of a robust image registration tool and of a reproducible MTV delineation method is still required.ObjectiveOur objective was to study a CT-based elastic registration method on dual-time pre-RT 18FDG-PET/CT images to assess the feasibility of PET-based RT planning in patients with HNSCC.MethodsDual-time 18FDG-PET/CT [whole-body examination (wbPET) + 1 dedicated step (headPET)] were selected to simulate a 2-times scenario of pre-RT PET images deformation on dosimetry CT. ER-headPET and RR-headPET images were, respectively, reconstructed after CT-to-CT rigid (RR) and elastic (ER) registrations of the headPET on the wbPET. The MTVs delineation was performed using two methods (40%SUVmax, PET-Edge). The percentage variations of several PET parameters (SUVmax, SUVmean, SUVpeak, MTV, TLG) were calculated between wbPET, ER-headPET, and RR-headPET. Correlation between MTV values was calculated (Deming linear regression). MTVs intersections were assessed by two indices (OF, DICE) and compared together (Wilcoxon test). Additional per-volume analysis was evaluated (Mann-Whitney test). Inter- and intra-observer reproducibilities were evaluated (ICC = intra-class coefficient).Results36 patients (30M/6F; median age = 65 y) were retrospectively included. The changes in SUVmax, SUVmean and SUVpeak values between ER-headPET and RR-headPET images were 0.99). The ER-headPET MTVs had significant higher mean OF and DICE with the wbPET MTVs, for both delineation methods (p ≤ 0.002); and also when lesions had a volume > 5cc (excellent OF = 0.80 with 40%SUVmax). The inter- and intra-observer reproducibilities for MTV delineation were excellent (ICC ≥ 0.8, close to 1 with PET-Edge).ConclusionOur study demonstrated no significant changes in MTV after an elastic deformation of pre-RT 18FDG-PET/CT images acquired in dual-time mode. This opens possibilities for HNSCC radiotherapy planning improvement by transferring GTV-PET on dosimetry CT.

Although fossil evidence suggests that various animal groups were able to move actively through their environment in the early stages of their evolution, virtually no direct information is available on the nature of their muscle systems. The origin of jellyfish swimming, for example, is of great interest to biologists. Exceptionally preserved muscles are described here in benthic peridermal olivooid medusozoans from the basal Cambrian of China (Kuanchuanpu Formation, ca. 535 Ma) that have direct equivalent in modern medusozoans. They consist of circular fibers distributed over the bell surface (subumbrella) and most probably have a myoepithelial origin. This is the oldest record of a muscle system in cnidarians and more generally in animals. This basic system was probably co-opted by early Cambrian jellyfish to develop capacities for jet-propelled swimming within the water column. Additional lines of fossil evidence obtained from ecdysozoans (worms and panarthropods) show that the muscle systems of early animals underwent a rapid diversification through the early Cambrian and increased their capacity to colonize a wide range of habitats both within the water column and sediment at a critical time of their evolutionary radiation.

Achieving sustainable development requires understanding how human behavior and the environment interact across spatial scales. In particular, knowing how to manage tradeoffs between the environment and the economy, or between one spatial scale and another, necessitates a modeling approach that allows these different components to interact. Existing integrated local and global analyses provide key insights, but often fail to capture ‘meso-scale’ phenomena that operate at scales between the local and the global, leading to erroneous predictions and a constrained scope of analysis. Meso-scale phenomena are difficult to model because of their complexity and computational challenges, where adding additional scales can increase model run-time exponentially. These additions, however, are necessary to make models that include sufficient detail for policy-makers to assess tradeoffs. Here, we synthesize research that explicitly includes meso-scale phenomena and assess where further efforts might be fruitful in improving our predictions and expanding the scope of questions that sustainability science can answer. We emphasize five categories of models relevant to sustainability science, including biophysical models, integrated assessment models, land-use change models, earth-economy models and spatial downscaling models. We outline the technical and methodological challenges present in these areas of research and discuss seven directions for future research that will improve coverage of meso-scale effects. Additionally, we provide a specific worked example that shows the challenges present, and possible solutions, for modeling meso-scale phenomena in integrated earth-economy models.