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Background and purposeThe FLASH effect has been validated in different preclinical experiments with electrons (eFLASH) and protons (pFLASH) operating at a mean dose rate above 40 Gy/s. However, no systematic intercomparison of the FLASH effect produced by evs. pFLASH has yet been performed and constitutes the aim of the present study.Materials and methodsThe electron eRT6/Oriatron/CHUV/5.5 MeV and proton Gantry1/PSI/170 MeV were used to deliver conventional (0.1 Gy/s eCONV and pCONV) and FLASH (≥100 Gy/s eFLASH and pFLASH) irradiation. Protons were delivered in transmission. Dosimetric and biologic intercomparisons were performed with previously validated models.ResultsDoses measured at Gantry1 were in agreement (± 2.5%) with reference dosimeters calibrated at CHUV/IRA. The neurocognitive capacity of e and pFLASH irradiated mice was indistinguishable from the control while both e and pCONV irradiated cohorts showed cognitive decrements. Complete tumor response was obtained with the two beams and was similar between e and pFLASHvs. e and pCONV. Tumor rejection was similar indicating that T-cell memory response is beam-type and dose-rate independent.ConclusionDespite major differences in the temporal microstructure, this study shows that dosimetric standards can be established. The sparing of brain function and tumor control produced by the two beams were similar, suggesting that the most important physical parameter driving the FLASH effect is the overall time of exposure which should be in the range of hundreds of milliseconds for WBI in mice. In addition, we observed that immunological memory response is similar between electron and proton beams and is independent off the dose rate.

Background Mutations in SCN5A are identified in approximately 20% to 30% of probands affected by Brugada syndrome (BrS). However, in familial studies, the relationship between SCN5A mutations and BrS remains poorly understood. The aim of this study was to investigate the association of SCN5A mutations and BrS in a group of large genotyped families. Methods Families were included if at least 3 family members were carriers of the SCN5A mutation, which was identified in the proband. Families were recruited from 12 tertiary centers in France between 1995 and 2020. Type 1 ST elevation was defined by ≥2 mm J-point elevation with coved ST segment and negative T wave. Results Forty-nine large families composed of 600 members including 304 mutation carriers (51%) were studied. The signature type I ECG was present in 160 mutation carriers (BrS-ECG+; 53%). In 42 families, we found 33 individuals affected by BrS but with a negative genotype (mutation-negative BrS-ECG+). Among them, 5 patients have an ECG suggestive of BrS but without the complete signature type I ECG. Among these 33 mutation-negative BrS-ECG+ individuals, 3 (9%), belonging to 3 different families, had a spontaneous type I ECG, whereas 28 had a type I ECG only after the administration of sodium channel blockers. Three of these 33 individuals (9%) had also experienced syncope. Mutation carriers had, on average, longer PR (190±36 ms vs 154±29 ms, p Conclusions Our results suggest that SCN5A mutations are not directly causal to the occurrence of a BrS-ECG+ and that genetic background may play a powerful role in the pathophysiology of BrS. These findings are consistent with the notion that the pathophysiology of BrS includes various elements beyond mutant sodium channels. Funding Acknowledgement Type of funding sources: None.

The demand for all types of resources (food, freshwater, energy and raw materials) has increased alarmingly due to the continuous techno-economic development of society, bringing about a pressing shortage not only in low-income countries but also in more developed economies. Such is the case for the very wealthy countries in the Gulf Cooperation Council, which are currently struggling with the lack of fresh water supply, or certain countries in Latin America where the contamination of natural water sources poses a major environmental threat. In order to assess this water-energy nexus problem, this paper looks into systems where the production of renewable power is combined with either freshwater production (through desalination) or industrial wastewater treatment for effluent control. Three enabling renewable energy technologies are assessed: solar micro gas turbines, wind turbines and photovoltaic panels. In all cases, off-grid installations are considered. The paper describes the characteristics of these three systems and provides a comparison of technical specifications, yield and costs. Wind and photovoltaic are the standard approach, as already proven by a number of commercial plants, but solar micro gas turbines exhibit additional flexibility (in particular when hybridisation is considered) and have the differential feature of producing not only electric power but also heat. This enables the combination of different types of water treatment technologies in order to increase water production/recovery which, in turn, reduces the environmental impact of the production process associated (either freshwater or other good or service).

BACKGROUND: This study aims to investigate the occurrence of unplanned hospitalizations in older patients with cancer and to determine predictive factors. METHODS: A prospective Belgian multicentre (n = 22), observational cohort study was performed. Patients ≥70 years with a malignant tumor were included. Patients underwent G8 screening followed by geriatric assessment (GA) if abnormal at baseline and were followed for unplanned hospitalizations at approximately three months. Uni- and multivariable regression models were performed to determine predictive factors associated with unplanned hospitalizations in older patients with an abnormal G8. RESULTS: In total, 7763 patients were included in the current analysis of which 2409 (31%) patients with a normal G8 score and 5354 (69%) with an abnormal G8 score. Patients with an abnormal G8 were hospitalized more frequently than patients with a normal G8 (22.9% versus 12.4%; p

Objectives: We aimed to determine the prognostic value of baseline Health-Related Quality Of Life (HRQOL) and geriatric assessment (GA) to predict three-month mortality in older patients with cancer undergoing treatment. Methods: Logistic regressions analysed HRQOL, as measured with the EORTC Global Health Status (GHS) scale, and geriatric information prognostic for early mortality controlling for oncology variables. The assessment was established with the odds ratio (OR), 95% confidence interval (CI) and level of significance set at p < 0.05. Discriminative power was evaluated with area under the curve (AUC). Results: In total, 6769 patients were included in the study, of whom 1259 (18.60%) died at three months. Our model showed higher odds of early death for patients with lower HRQOL (GHS, OR 0.98, 95% CI 0.98-0.99; p < 0.001), a geriatric risk profile (G8 Screening Tool, 1.94, 1.14-3.29; p = 0.014), cognitive decline (Mini Mental State Examination, 1.41, 1.15-1.72; p 0.001), being at risk for malnutrition (Mini Nutritional Assessment-Short Form, 1.54, 1.21-1.98; p = 0.001), fatigue (Visual Analogue Scale for Fatigue, 1.45, 1.16-1.82; p = 0.012) and comorbidities (Charlson Comorbidity index, 1.23, 1.02-1.49: p = 0.033). Additionally, older age, poor ECOG PS and being male increased the odds of early death, although the magnitude differed depending on tumor site and stage, and treatment (all p < 0.05). Predictive accuracy increased with 3.7% when including HRQOL and GA in the model. Conclusion: The results suggest that, in addition to traditional clinical measures, HRQOL and GA provide additional prognostic information for early death, but the odds differ by patient and tumor characteristics. (C) 2020 Elsevier Ltd. All rights reserved.

PURPOSE: Using the EORTC Global Health Status (GHS) scale, we aimed to determine minimal clinically important differences (MCID) in health-related quality of life (HRQOL) changes for older cancer patients with a geriatric risk profile, as defined by the geriatric 8 (G8) health screening tool, undergoing treatment. Simultaneously, we assessed baseline patient characteristics prognostic for HRQOL changes. METHODS: Our analysis included 1424 (G8 ≤ 14) older patients with cancer scheduled to receive chemotherapy (n = 683) or surgery (n = 741). Anchor-based methods, linking the GHS score to clinical indicators, were used to determine MCID between baseline and follow-up at 3 months. A threshold of 0.2 standard deviation (SD) was used to exclude MCID estimates too small for interpretation. Logistic regressions analysed baseline patient characteristics prognostic for HRQOL changes. RESULTS: The 15-item Geriatric Depression Scale (GDS15), Visual Analogue Scale (VAS) for Fatigue and ECOG Performance Status (PS) were selected as clinical anchors. In the surgery group, MCID estimates for improvement and deterioration were ECOG PS (5*, 11*), GDS15 (5*, 2) and VAS Fatigue (3, 9*). In the chemotherapy group, MCID estimates for improvement and deterioration were ECOG PS (8*, 7*), GDS15 (5, 4) and VAS Fatigue (5, 5*). Estimates with * were > 0.2 SD threshold. Patients experiencing pain or malnutrition (surgery group) or fatigue (chemotherapy group) at baseline showed a significantly stable or improved HRQOL (p

BACKGROUND: In the general older population, geriatric assessment (GA)-guided treatment plans can improve overall survival, quality of life and functional status (FS). In GA-related research in geriatric oncology, studies mainly focused on geriatric screening and GA but not on geriatric recommendations, interventions and follow-up. The aim of this study was to investigate the adherence to geriatric recommendations and subsequent actions undertaken in older patients with cancer. PATIENT AND METHODS: A prospective Belgian multicenter (N = 22) cohort study included patients ≥70 years with a malignant tumor upon oncologic treatment decision. Patients with an abnormal result on the geriatric screening (G8 ≤14/17) underwent GA. Geriatric recommendations were formulated based on GA results. At follow-up the adherence to geriatric recommendations was documented including a description of actions undertaken. RESULTS: From November 2012 till February 2015, G8 screening was carried out in 8451 patients, of which 5838 patients had an abnormal result. Geriatric recommendations data were available for 5631 patients. Geriatric recommendations were made for 4459 patients. Geriatric interventions data were available for 4167 patients. A total of 12 384 geriatric recommendations were made. At least one different geriatric recommendation was implemented in 2874 patients. A dietician, social worker and geriatrician intervened most frequently for problems detected on the nutritional, social and functional domain. A total of 7569 actions were undertaken for a total of 5725 geriatric interventions, most frequently nutritional support and supplements, extended home care and psychological support. CONCLUSIONS: This large-scale Belgian study focuses on the adherence to geriatric recommendations and subsequent actions undertaken and contributes to the optimal management of older patients with cancer. We identified the domains for which geriatric recommendations are most frequently made and adhered to, and which referrals to other health care workers and facilities are frequently applied in the multidisciplinary approach of older patients with cancer. ispartof: ANNALS OF ONCOLOGY vol:29 issue:9 pages:1987-1994 ispartof: location:England status: published

cis-Diamminedichloroplatinum(II) (CDDP), which is mostly referred to as cisplatin, is a widely used antineoplastic. The efficacy of cisplatin can be improved by combining it with the vitamin B6 precursor pyridoxine. Here, we evaluated the putative synergistic interaction of CDDP with pyridoxine in the treatment of an orthotopic mouse model of non-small-cell lung cancer (NSCLC). CDDP and pyridoxine exhibited hyperadditive therapeutic effects. However, this synergy was only observed in the context of an intact immune system and disappeared when the otherwise successful drug combination was applied to the same NSCLC cancer implanted in the lungs of athymic mice (which lack T lymphocytes). Immunocompetent mice that had been cured from NSCLC by the combined regimen of CDDP plus pyridoxine became resistant against subcutaneous rechallenge with the same (but not with an unrelated) cancer cell line. In vitro, CDDP and pyridoxine did not only cause synergistic killing of NSCLC cells but also elicited signs of immunogenic cell death including an endoplasmic reticulum stress response and exposure of calreticulin at the surface of the NSCLC cells. NSCLC cells treated with CDDP plus pyridoxine in vitro elicited a protective anticancer immune response upon their injection into immunocompetent mice. Altogether, these results suggest that the combined regimen of cisplatin plus pyridoxine mediates immune-dependent antineoplastic effects against NSCLC.

Background We estimated the vaccine effectiveness (VE) of tetanus-diphtheria-acellular pertussis vaccine (Tdap) for preventing pertussis among adolescents during a statewide outbreak of pertussis in Wisconsin during 2012. Methods We used the population-based Wisconsin Immunization Registry (WIR) to construct a cohort of Wisconsin residents born during 1998-2000 and collect Tdap vaccination histories. Reports of laboratory-confirmed pertussis with onset during 2012 were matched to WIR clients. Incidence rate ratios (IRRs) of pertussis and Tdap VE estimates [(1 - IRR)*100%], by year of Tdap vaccine receipt and brand (Boostrix/Adacel), were estimated using Poisson regression. Results Tdap VE decreased with increasing time since receipt, with VEs of 75.3% (95% confidence interval [CI], 55.2%-86.5%) for receipt during 2012, 68.2% (95% CI, 60.9%-74.1%) for receipt during 2011, 34.5% (95% CI, 19.9%-46.4%) for receipt during 2010, and 11.9% (95% CI, -11.1% to 30.1%) for receipt during 2009/2008; point estimates were higher among Boostrix recipients than among Adacel recipients. Among Tdap recipients, increasing time since receipt was associated with increased risk, and receipt of Boostrix (vs Adacel) was associated with decreased risk of pertussis (adjusted IRR, 0.62 [95% CI, .52-.74]). Conclusions Our results demonstrate waning immunity following vaccination with either Tdap brand. Boostrix was more effective than Adacel in preventing pertussis in our cohort, but these findings may not be generalizable to adolescent cohorts that received different diphtheria-tetanus-acellular pertussis vaccines (DTaP) during childhood and should be further examined in studies that include childhood DTaP history.

Contexte L’utilisation des rayonnements ionisants est indispensable dans le domaine medical. Toutefois, ces rayonnements peuvent presenter un risque pour le patient ainsi que les professionnels de sante. Selon le rapport de l’ASN sur l’etat de la surete nucleaire et de la radioprotection en France en 2015 « 525 ESR ont ete enregistres dont 220 ont concerne la radiotherapie ou la curietherapie, 123 la medecine nucleaire, 100 la scanographie et 22 la radiologie interventionnelle ». Les guides 11 et 16 de l’ASN decrivent le processus de gestion des risques a mettre en place dans les etablissements de sante, base sur le retour d’experience a travers la declaration et l’analyse des evenements significatifs enregistres. Methode La RMP (Risk Management Platform) est utilisee en routine clinique dans les services de radiotherapie et de medecine nucleaire du groupe SENY. Le processus de gestion des risques est integre a la pratique clinique, selon deux methodes. Une methode preventive, grâce a l’outil AMDEC, permettant d’identifier les potentiels modes de defaillance, d’analyser leurs causes et leurs consequences. Les risques les plus importants sont identifies grâce au calcul de leur criticite. Afin de reduire ces risques, des plans d’action sont mis en place. La comparaison de la criticite residuelle a celle esperee permet de confirmer l’efficacite du plan d’action mis en place. Au niveau du Groupe SENY, une mise a jour de l’AMDEC se fait tous les ans. Une methode corrective, basee sur le retour d’experience et la mise en place de CREx (comite de retour d’experience), se base sur les declarations de tous les evenements precurseurs ou indesirables survenus dans les services. La criticite est aussi calculee pour chaque evenement et les plus critiques sont analyses en etudiant la chronologie des faits, les causes et les consequences de ces evenements. Cette analyse est assistee par un outil statistique. Des actions correctives et preventives sont determinees lors des reunions CREx mensuelles avant d’etre mises en place. Conclusion Notre retour d’experience lie a l’utilisation de la plateforme RMP en routine clinique au niveau du Groupe SENY, nous a permis d’assurer une conformite aux guides no 11 et 16 de l’ASN, une gestion des risques en temps reel, une assistance de nos professionnels de sante dans les demarches administratives, declaratives et reglementaires, ainsi qu’une amelioration continue de la qualite et la securite des soins.

Introduction En France, il est recommande de vacciner seulement les jeunes filles contre les infections a HPV, avec 2 exceptions pour les hommes : les immunodeprimes de moins de 20 ans (depuis 2014), et les hommes ayant des relations sexuelles avec des hommes (HSH) de moins de 27 ans (depuis 2016). L’objectif de cette etude etait d’explorer la couverture vaccinale chez les HSH, et de determiner les facteurs associes, notamment la perception et le niveau d’adhesion au vaccin dans cette population, et l’offre vaccinale par les medecins. Materiels et methodes Nous avons diffuse un questionnaire anonyme en ligne destine aux HSH en France sur differents reseaux sociaux entre le 7 octobre 2018 et le 15 janvier 2019. Ce questionnaire explorait notamment des donnees sociodemographiques, le statut vaccinal pour les HPV, et l’offre vaccinale par les medecins. Resultats Le questionnaire a ete complete par 2094 participants (âge 35,4 ± 11 ans). La grande majorite (93,5 %, 1958) declarait avoir des relations sexuelles uniquement avec des hommes ; 342 (16,3 %) utilisaient la prophylaxie pre-exposition (PrEP). La recommandation de vaccination contre les HPV etait connue par 39,2 % des participants (821) ; parmi tous les participants, 7,6 % (159) etaient vaccines. Parmi les 541 participants concernes par la recommandation de vaccination (avoir moins de 27 ans en 2016, et donc etre dans la cible sur la periode 2016–2019), 16,6 % (90) etaient vaccines ; cette proportion etait significativement plus elevee parmi les 43 personnes sous PrEP (48,8 %, 21 vaccines) que chez les 498 autres (13,9 %, 69 vaccines), p Conclusion La couverture vaccinale contre les HPV est faible chez les HSH ayant participe a cette etude (7,6 %), y compris chez les moins de 27 ans concernes par la recommandation de vaccination (16,6 %). Cela semble resulter d’un manque de proposition du vaccin de la part des medecins plutot que d’une opposition a la vaccination.

International audience; Several compositions of metal cored filler wire were manufactured to define the best welding conditions for homogeneous welding, by Gas Metal Arc Welding (GMAW) process, of a modified AISI 444 ferritic stainless steel dedicated to automotive exhaust manifold applications. The patented grade is know under APERAM trade name K44X and has been developed to present improved high temperature fatigue properties. All filler wires investigated contained 19%Cr and 1.8%Mo, equivalent to the base metal K44X chemistry, but various titanium and niobium contents. Chemical analyses and microstructural observations of fusion zones revealed the need of a minimum Ti content of 0.15% to obtain a completely equiaxed grain structure. This structure conferred on the fusion zone a good ductility even in the as-welded state at room temperature. Unfortunately, titanium additions decreased the oxidation resistance at 950°C if no significant Nb complementary alloying was made. The combined high Ti and Nb additions made it possible to obtain for the welded structure, after optimized heat treatment, high temperature tensile strengths and ductility for the fusion zones and assemblies, rather close to those of the base metal. 950°C aging heat treatment was necessary to restore significantly the ductility of the as welded structure. Both fusion zone and base metal presented rather homogenized properties. Finally, with the optimized composition of the cored filler wire - 0.3 Ti minimum (i.e. 0.15% in the fusion zone) and high Nb complementary additions, the properties, including the thermal fatigue strength, of the K44X assemblies are excellent.

Objectives: The aim of this study is to describe a large-scale, Belgian implementation project about geriatric assessment (=GA) in daily oncology practice and to identify barriers and facilitators for implementing GA in this setting. Design / setting / participants: The principal investigator of every participating hospital (n=22) was invited to complete a newly developed questionnaire with closed-and open-ended questions. The closed-ended questions surveyed how GA was implemented. The open-ended questions identified barriers and facilitators for the implementation of GA in daily oncology practice. Descriptive statistics and conventional content analysis were performed as appropriate. Results: Qualifying criteria (e.g. disease status and cancer type) for GA varied substantially between hospitals. Thirteen hospitals (59.1%) succeeded to screen more than half of eligible patients. Most hospitals reported that GA data and follow-up data had been collected in almost all screened patients. Implementing geriatric recommendations and formulating new geriatric recommendations at the time of follow-up are important opportunities for improvement. The majority of identified barriers were organizational, with high workload, lack of time or financial/staffing problems as most cited. The most cited facilitators were all related to collaboration. Conclusion: Interventions to improve the implementation of GA in older patients with cancer need to address a wide range of factors, with organization and collaboration as key elements. All stakeholders, seeking to improve the implementation of GA in older patients with cancer, should consider and address the identified barriers and facilitators.

Resume Objectifs Etudier la faisabilite et evaluer la mesure de la reserve interventriculaire anterieure (IVA) lors de l’echographie cardiaque de stress a la dobutamine pour le diagnostic des stenoses significatives (plus de 70 %) de l’IVA. Methode Etude diagnostique, retrospective, aupres des patients ayant eu une echographie cardiaque a la dobutamine suspecte de coronaropathie ayant donnee lieu a un controle coronarographique avec mesure de la reserve coronaire de l’IVA pendant l’examen en prenant comme seuil pathologique une valeur inferieure a 2. Resultats La mesure de la reserve coronaire a ete faisable dans la moitie des examens echocardiograhiques ( n = 41). Le pic de vitesse diastolique de l’IVA au repos etait a 0,33 m/s en moyenne (SD = 0,20), la vitesse diastolique maximale a l’effort etait de 0,62 m/s en moyenne (SD = 0,20), la reserve moyenne etait a 2,25 (SD = 0,65). Dans les 50 cas ou l’IVA n’a pu etre enregistree, la coronarographie a conclu a une occlusion de cette artere chez cinq patients (10 %). La valeur predictive positive (VPP) d’une reserve IVA basse pour le diagnostic d’une stenose IVA etait de 66,7 % (IC95 % : 38,3–88,2 %) et la valeur predictive negative (VPN) de 65,4 % (IC95 % : 44,3–82,8 %). La presence d’un trouble de la cinetique dans le territoire anterieur avec une reserve IVA basse avait une VPP de 75,0 % (IC95 % : 34,9–96,8 %) pour le diagnostic de stenose IVA et inversement l’absence de trouble de la cinetique avec une reserve IVA normale avait une VPN de 60,6 % (IC95 % : 43,9–77,3 %). Nous n’avons pas mis en evidence de correlation franche entre la reserve coronaire basse et l’existence d’anomalie de cinetique anterieure (coefficient Kappa = 0,51 ; IC95 % : 0,28–0,72). Conclusion La mesure de la reserve coronaire de l’IVA lors de l’echographie dobutamine est faisable mais ameliore peu la performance de l’examen pour la detection des stenoses significatives de l’IVA. La place de cette mesure dans le suivi des patients coronariens reste a preciser.

Resume En 2004, sur proposition de la Mission nationale d’expertise et d’audits hospitaliers (MeaH), trois centres de lutte contre le cancer volontaires (Angers, Lille et Villejuif) ont mis en place un premier chantier securite en radiotherapie. Leurs travaux ont permis d’identifier la necessite de poursuivre l’elaboration d’un referentiel avec l’objectif d’un « juste ecrit », de prendre en compte le facteur humain comme une des quatre familles de facteurs contributifs a un « ecart systeme » et surtout de construire collectivement, au niveau d’un departement de radiotherapie, le comite de retour d’experience (Crex). La formalisation d’un Crex est incontournable dans tout systeme de gestion de la securite (system management mode [SMM] ou manuel de gestion de la securite [MGS]). Le Crex permet a l’ensemble des acteurs d’un departement d’ecouter les evenements du mois (incidents et precurseurs), de selectionner l’evenement qui fera l’objet de la prochaine analyse systemique (Orion©) et surtout de choisir l’action corrective la plus appropriee pour s’assurer de sa bonne mise en œuvre. Cette demarche a ete validee par les professionnels, etendue aux centres de radiotherapie puis reconnue par l’Autorite de surete nucleaire (ASN) comme s’inscrivant dans la demarche de qualite/securite. Le comite de retour d’experience, outil de management interne de la securite, doit cependant etre partage pour etre profitable a tous et non reserve a un cercle local d’inities. La mutualisation des comite de retour d’experience – souhaitee et evoquee des sa creation – est aujourd’hui devenue realite. Plusieurs initiatives ont deja permis d’en mesurer l’interet collectif, d’autres etapes restent a faire et permettront un reel partage collectif de l’experience. Sur cette base, la definition des pratiques de qualite/securite en radiotherapie doit nous permettre de mettre en œuvre a l’echelle 2012 des audits de pratiques cliniques (APC) menes par et pour les professionnels.

Abolishment of anxiolytic-like effects of diazepam occurs during re-exposure to some animal tests of anxiety. We investigated the loss of anxiolytic-like effects of diazepam during Trial 2 on previously undrugged mice, namely one-trial tolerance (OTT). Swiss mice were subjected to 1) Four-Plate Test (FPT) without punishments in Trial 1 or 2) FPT without punishments in both Trials or 3) FPT with spatial modifications in Trial 1 or 4) Elevated Plus Maze (EPM), then 24 h later to FPT, with saline, diazepam (1 mg/kg) or DOI (1 mg/kg). Removing punishments in Trial 1 does not counteract the effect reduction of diazepam in Trial 2, but spatial modifications of the aversive environment. Previous exposure to EPM does not trigger a loss of efficacy of diazepam in FPT. Electric punishments do not trigger OTT to benzodiazepines; whilst knowledge of the environment seems to be responsible for this phenomenon. FPT may be useful to study OTT because punishments potentate OTT in this model of anxiety.

On February 22, 2013, the Advisory Committee on Immunization Practices (ACIP) revised recommendations for vaccination of pregnant women to recommend tetanus-diphtheria-acellular pertussis vaccine (Tdap) during every pregnancy, optimally at 27-36 weeks of gestation, to prevent pertussis among their newborns. Since 2004, influenza vaccination has been recommended for pregnant women in any trimester to prevent influenza and associated complications for mother and newborn. To evaluate vaccination of pregnant women in Wisconsin after the 2013 Tdap recommendation, health insurance claims data for approximately 49% of Wisconsin births were analyzed. The percentage of women who received Tdap during pregnancy increased from 13.8% of women delivering during January 2013 (63.1% of whom received Tdap 2-13 weeks before delivery) to 51.0% of women delivering during March 2014 (90.9% of whom received Tdap 2-13 weeks before delivery). Among women delivering during November 2013-March 2014, 49.4% had received influenza vaccine during pregnancy. After the 2013 recommendation, Tdap vaccination among pregnant women increased but plateaued at rates similar to influenza vaccination rates. Prenatal care providers should implement, evaluate, and improve Tdap and influenza vaccination programs, and strongly recommend that pregnant patients receive these vaccines to prevent severe illness and complications among mothers and infants.

CONTEXT Vaccination coverage rates can be improved through the application of complete and accurate immunization information systems (IISs). OBJECTIVE Evaluate the completeness and accuracy of Wisconsin's IIS, the Wisconsin Immunization Registry (WIR). DESIGN Cross-sectional evaluation, comparing vaccination medical records (MRs) from provider clinics with WIR records. PARTICIPANTS Medical records of patients born during 2009 were randomly selected from 251 Wisconsin clinics associated with the Vaccines for Children Program. MAIN OUTCOME MEASURES Completeness: percentage of patients with client records in the WIR, percentage of patients up-to-date (%UTD) with the 4:3:1:3:3:1:4 vaccination series, and percentage of patients' MR vaccinations matched by administration date (±10 days) and type to vaccinations documented in the WIR. Accuracy: percentages of matched vaccinations with the same administration date, same trade name (TN), and same lot number. RESULTS Of the 1863 selected patient MRs, 98% (n = 1833) had WIR client records and 97% of their 30 899 vaccinations were documented in the WIR. The %UTD was 49.3% using the MR only, 76.5% using the WIR only, and 75.2% as estimated by the National Immunization Survey. Among matched vaccinations, 99% had the same administration date, 96% had the same TN, and 95% had the same lot number. Compared with patients from clinics that entered data into the WIR using data exchange from electronic health records, patients from clinics that entered data using the Web-based user interface were less likely to have client records in the WIR (odds ratio: 0.3; 95% confidence interval: 0.1-0.9) and less likely to have accurate TNs (odds ratio: 0.3; 95% confidence interval: 0.1-0.5). CONCLUSIONS The WIR was complete and accurate among this sample of children born during 2009 and provided a vaccination coverage assessment similar to the National Immunization Survey. Our results provide support for the expectation that meaningful use and other initiatives that increase data exchange from electronic health records to IISs will improve IIS data quality.

Thickness defects on thin strips are caused by the cold rolling process itself or by mechanical trouble at the tandem mill. Dedicated experimental measurements of the related phenomena are reported and a global analysis of their effect on the final product thickness is put forward. Innovative advanced solutions are presented to achieve high thickness performance.

The 3rd octave chatter in cold rolling mills is a major issue for the industrial production of thin sheets with very tight tolerances, like packaging steels for instance. In this context, an experimental and theoretical approach, completed in partnership by Arcelor and VAI, afforded a precise analysis and innovative results, in the following fields : global on-line tandem mill instrumentation and efficient signal treatments implementation ; clear differentiation between brummer (non divergent mode) and chatter (divergent mode) ; modelling of interactions between chatter and technology (analytical and F.E. approaches) ; advanced chatter monitoring and industrial implementation.

Objectif de l’etude La categorisation des maladies prises en charge dans nos services de radiotherapie permet d’adapter les delais de traitement et de definir des priorites en cas de reduction des plages horaires. Ces reductions, programmees ou non, conduisent a une impossibilite d’effectuer la planification recommandee pour les traitements longs en radiotherapie prostatique. Nous avons donc etudie l’etalement et le fractionnement des cancers prostatiques irradies dans notre centre en 2014. Materiel et methode A partir des dossiers de 238 patients, nous avons selectionne ceux des 61 en situation de recidive postoperatoire (51) ou n’ayant pas recu d’hormonotherapie concomitante car atteints d’un cancer de pronostic favorable selon la classification de D’Amico (10). Resultats L’etalement classique prevu de 7,03 semaines en moyenne avec un ecart-type (σ) de 0,9 en fonction de la prescription (64 a 76 Gy) a ete en realite de 8,8 semaines en moyenne (σ = 0,75). L’analyse descriptive de notre population a montre que si on faisait abstraction des semaines de debut et de fin de traitement, le nombre de seances hebdomadaire pour un meme patient varie de trois (10 % ; σ = 0,9) a cinq (33 % ; σ = 1,5). La modalite la plus frequente etant de quatre (56 % ; σ = 1,7). Conclusion Les contraintes machines sont a l’origine de ce faible taux de patients recevant un etalement classique. Considerant nos imperatifs cliniques, techniques, l’etat d’avancee des connaissances et de la recherche actuelle, existe-t-il un autre etalement « ideal » pour les radiotherapies prostatiques que celui en cours actuellement dans nos services, hypo-fractionnement par exemple ?

An approach is required for forming a statistically credible radiated immunity level applicable to Intentional Electromagnetic Interference (IEMI) environments. IEMI and Electromagnetic Pulse (EMP) environments are typically radiated pulsed or transient phenomena, although conducted environments exist they are less common. Whilst new standards and guidance documents are available which provide test methods to generate the required immunity data for IEMI, the vast majority of electronic equipment and systems which are already in use/service are only tested for immunity to relatively benign EM environments provided within Electromagnetic Compatibility (EMC) standards. None of the commonly applied EMC standards directly address radiated transient phenomena, although there are other conducted transient tests which relate back to radiated transients. Comparing the peak radiated fields from IEMI and EMP to the immunity levels in the EMC standards (3 V/m and 10 V/m are common levels) is not only technically flawed since the modulation schemes are very different but also leads to very large estimates of separation distance between IEMI environments and potential victim systems. Primarily based on its broad applicability, frequency content and the transient nature of the test, Electrostatic Discharge (ESD) was selected for investigation to examine the radiated Electric (E) field produced during test for comparison with IEMI and EMP environments. It was found that over 87 % of the E-fields measured were 100 V/m or more, though the radiated waveform was highly variable.

In the Southern Ocean, the formation of deep water and the convective movements are influenced by the high-temporal variability of ice production in the area. The study of these phenomena therefore needs an accurate representation of the atmosphere/ocean interface generally occupied by the ice pack. With this aim in view, a one-dimensional thermodynamic model based on Semtner's approach associated with a horizontal transport component is used to compute the sea ice thickness and extent. A visco-plastic ice rheology reproduces the ridging of the ice pack. Turbulent surface heat and momentum fluxes over ice and open areas are classically computed. The sea ice and leads are connected to the deep ocean through a mixed layer. The heat and salt fluxes between ice and water column are explicitly taken into account. The model is run with a set of climatological data to reproduce the ice formation during a year and the results are compared with available observations. This work is the first step of a coupled ocean circulation/sea ice model developed for the Southern Ocean. (C) 2000 Elsevier Science B.V. All rights reserved.

Research has been performed on Finite Element vibration modelling for a single 4-high industrial stand in a cold rolling mill, in order to assess precisely the vibration modes in the frequency range [0-1000] hertz. The dynamic behaviour of the whole mechanical structure is very useful to analyse the stand vibratory signature in terms of diagnosis, to study the sensitivity of the modal parameters with respect to different configurations (rolling working points, technological features, etc.), as well as to appreciate qualitatively industrial harmful vibration phenomena, like the 3rd octave chatter or the 5th octave surface defects on the final product.

We studied gastro-oesophageal reflux (GOR) with a face mask and laryngeal mask airway (LMA), and the effects of inflation pressure and volume of the LMA cuff on oesophageal pH, in 60 patients. Patients were managed with either a face mask (group I) or LMA inflated to obtain a seal in the anaesthesia circuit at 7 cm H2O (group II) or 15 cm H2O (group III). A pH-sensitive probe with two electrodes, 10 cm apart, was placed in the oesophagus during anaesthesia and recordings were made continuously until patients awakened. There was a significant difference in the incidence of GOR between the face mask (group I) and the LMA (groups II-III) (P < 0.05) in the lower oesophagus but there was no difference in the mid-oesophagus. No correlation was found between pressure and volume inside the cuff and variations in oesophageal pH. We conclude that LMA use was associated with increased reflux in the low oesophagus but oesophageal pH was not influenced by variations in pressure or volume inside the LMA cuff.

We describe a 62-year-old woman with slowly growing usual nodular goitre in whom diffuse giant cell arteritis (GCA) of the thyroid arteries was found upon thyroidectomy, revealing otherwise unsuspected biopsy-proven temporal arteritis. To our knowledge, this association had been previously reported in only three instances. In each case, GCA of the thyroid arteries appeared clinically silent, did not produce significant glandular dysfunction, and was uncovered thanks to a planned thyroidectomy for nodular goitre. These observations highlight that thyroid artery involvement by GCA, even widespread, as in our patient, may be overlooked clinically and may produce little or no thyroid dysfunction.