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Background and Objectives: In 2017, our French 1671-bed university hospital opened a 12-bed unit for very short stays, post-emergency (unit of transitory admission in geriatric [UTAG] area), dedicated to frail patients older than 75 years requiring short-term care. We sought to investigate whether this new organization's shortened length of stay (LOS) was associated or not with a higher rate of readmission., Methods: We conducted a retrospective descriptive study based on the daily activity of the UTAG over 6 months including all patients consecutively hospitalized in the unit via the computerized medical file of the hospital. The data collected included the Rockwood score, the primary diagnoses, the LOS and any 1-month readmission., Results: From August 2019 to January 2020, 646 older adult patients were hospitalized in the UTAG. Two-thirds of the hospitalized patients were women; the mean age of this population was 86.7 ± 6.2 years. The main causes of hospitalization were infectious pathologies (19.8%), falls and their consequences (17.3%), and cardiac pathologies (17.2%). The mean LOS was of 2.7 ± 2.0. Seventy readmissions were observed in the month after discharge. One-month readmissions were more frequent when patients had presented with acute heart failure and among nursing home residents., Conclusion: The creation of the UTAG reduced LOS and so contributed to decreased iatrogenic disabilities without putting patients at increased risk of readmission. The development of cardiac and geriatric dedicated outpatient pathways and a community-based geriatric mobile team intervening in nursing homes could optimize the care of frail older adult patients and avoid readmissions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

In-situ oxygen three-isotope analyses of chondrules and isolated olivine grains in the Paris (CM) chondrite were conducted by secondary ion mass spectrometry (SIMS). Multiple analyses of olivine and/or pyroxene in each chondrule show indistinguishable Δ 17 O values, except for minor occurrences of relict olivine grains (and one low-Ca pyroxene). A mean Δ 17 O value of these homogeneous multiple analyses was obtained for each chondrule, which represent oxygen isotope ratios of the chondrule melt. The Δ 17 O values of individual chondrules range from -7‰ to -2‰ and generally increase with decreasing Mg# of olivine and pyroxene in individual chondrules. Most type I (FeO-poor) chondrules have high Mg# (~99) and variable Δ 17 O values from -7.0‰ to -3.3‰. Other type I chondrules (Mg# ≤97), type II (FeO-rich) chondrules, and two isolated FeO-rich olivine grains have host Δ 17 O values from -3‰ to -2‰. Eight chondrules contain relict grains that are either 16 O-rich or 16 O-poor relative to their host chondrule and show a wide range of Δ 17 O values from -13‰ to 0‰. The results from chondrules in the Paris meteorite are similar to those in Murchison (CM). Collectively, the Δ 17 O values of chondrules in CM chondrites continuously increase from -7‰ to -2‰ with decreasing Mg# from 99 to 37. The majority of type I chondrules (Mg# >98) show Δ 17 O values from -6‰ to -4‰, while the majority of and type II chondrules (Mg# 60-70) show Δ 17 O values of -2.5‰. The covariation of Δ 17 O versus Mg# observed among chondrules in CM chondrites may suggest that most chondrules in carbonaceous chondrites formed in a single large region across the snow line where the contribution of 16 O-poor ice to chondrule precursors and dust enrichment factors varied significantly.

Dynamic models of the protoplanetary disk indicate there should be large-scale material transport in and out of the inner Solar System, but direct evidence for such transport is scarce. Here we show that the ε 50 Ti-ε 54 Cr-Δ 17 O systematics of large individual chondrules, which typically formed 2 to 3 My after the formation of the first solids in the Solar System, indicate certain meteorites (CV and CK chondrites) that formed in the outer Solar System accreted an assortment of both inner and outer Solar System materials, as well as material previously unidentified through the analysis of bulk meteorites. Mixing with primordial refractory components reveals a "missing reservoir" that bridges the gap between inner and outer Solar System materials. We also observe chondrules with positive ε 50 Ti and ε 54 Cr plot with a constant offset below the primitive chondrule mineral line (PCM), indicating that they are on the slope ∼1.0 in the oxygen three-isotope diagram. In contrast, chondrules with negative ε 50 Ti and ε 54 Cr increasingly deviate above from PCM line with increasing δ 18 O, suggesting that they are on a mixing trend with an ordinary chondrite-like isotope reservoir. Furthermore, the Δ 17 O-Mg# systematics of these chondrules indicate they formed in environments characterized by distinct abundances of dust and H 2 O ice. We posit that large-scale outward transport of nominally inner Solar System materials most likely occurred along the midplane associated with a viscously evolving disk and that CV and CK chondrules formed in local regions of enhanced gas pressure and dust density created by the formation of Jupiter., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

We performed in situ oxygen three-isotope measurements of chondrule olivine, pyroxenes, and plagioclase from the newly described CV Red chondrite NWA 8613. Additionally, oxygen isotope ratios of plagioclase in chondrules from the Kaba CV3 OxB chondrite were determined to enable comparisons of isotope ratios and degree of alteration of chondrules in both CV lithologies. NWA 8613 was affected by only mild thermal metamorphism. The majority of oxygen isotope ratios of olivine and pyroxenes plot along a slope-1 line in the oxygen three-isotope diagram, except for a type II and a remolten barred olivine chondrule. When isotopic relict olivine is excluded, olivine, low- and high-Ca pyroxenes are indistinguishable regarding Δ 17 O values. Conversely, plagioclase in chondrules from NWA 8613 and Kaba plot along mass-dependent fractionation lines. Oxygen isotopic disequilibrium between phenocrysts and plagioclase was caused probably by exchange of plagioclase with 16 O-poor fluids on the CV parent body. Based on an existing oxygen isotope mass balance model, possible dust enrichment and ice enhancement factors were estimated. Type I chondrules from NWA 8613 possibly formed at moderately high dust enrichment factors (50× to 150× CI dust relative to Solar abundances); estimates for water ice in the chondrule precursors range from 0.2 to 0.6× the nominal amount of ice in dust of CI composition. Findings agree with results from an earlier study on oxygen isotopes in chondrules of the Kaba CV chondrite, providing further evidence for a relatively dry and only moderately high dust-enriched disk in the CV chondrule-forming region.

The 26 Al- 26 Mg ages of FeO-rich (type II) chondrules from Acfer 094, one of the least thermally metamorphosed carbonaceous chondrites, were determined by SIMS analysis of plagioclase and olivine/pyroxene using a radio frequency (RF) plasma oxygen ion source. In combination with preexisting 26 Al- 26 Mg ages of FeO-poor (type I) chondrules, the maximum range of formation ages recorded in chondrules from a single meteorite is determined to help provide constraints on models of material transport in the proto-planetary disk. We also report new SIMS oxygen three-isotope analyses of type II chondrules in Acfer 094. All but one of the plagioclase analyses show resolvable excesses in 26 Mg and isochron regressions yield initial 26 Al/ 27 Al ratios of type II chondrules that range from (3.62 ± 0.86) × 10 -6 to (9.3 ± 1.1) × 10 -6 , which translates to formation ages between 2.71 -0.22 / +0.28 Ma and 1.75 -0.11 / +0.12 Ma after CAI. This overall range is indistinguishable from that determined for type I chondrules in Acfer 094. The initial 26 Al/ 27 Al ratio of the oldest type II chondrule is resolved from that of all other type II chondrules in Acfer 094. Importantly, the oldest type I chondrule and the oldest type II chondrule in Acfer 094 possess within analytical error indistinguishable initial 26 Al/ 27 Al ratios and Δ 17 O values of ~0‰. Ages and oxygen isotope ratios clearly set these two chondrules apart from all other chondrules in Acfer 094. It is therefore conceivable that the formation region of these two chondrules differs from that of other chondrules and in turn suggests that Acfer 094 contains two distinct chondrule generations.

What Is Known and Objective: Behavioural disorders are difficult to manage in elderly demented patients because of the lack of appropriate drugs or difficulties surrounding the route of administration. The tolerability of Midazolam is well described in the emergency management of agitation for young patients, when administered intramuscularly or intravenously. However, very little data are available on the use of oral Midazolam for this indication and in the elderly population., Methods: A literature review was conducted, and studies were included if involving adults, receiving Midazolam, alone or in combination, whatever the route, dosage or indication and if they reported adverse events related to the use of Midazolam., Results and Discussion: Forty-one articles were included. Eleven different adverse events were identified from the studies. Hypotension and desaturation were the two most frequent adverse events reported. Adverse reactions appear to be more common in older patients but also when Midazolam was used in combination with other drugs. The frequency of these adverse effects was lower than those reported for neuroleptic drugs., What Is New and Conclusion: The oral route appears to be appropriate to provide a rapid and well-tolerated response. Further studies will be needed to confirm the good tolerance of oral Midazolam in the management of acute agitation in elderly demented patients., (© 2019 John Wiley & Sons Ltd.)

High-precision oxygen three-isotope measurements of olivine and pyroxene were performed on 29 chondrules in the Murchison CM2 chondrite by secondary ion mass spectrometry (SIMS). The oxygen isotope ratios of analyzed chondrules all plot very close to the primitive chondrule minerals (PCM) line. In each of 24 chondrules, the olivine and/or pyroxene grains analyzed show indistinguishable oxygen isotope ratios. Exceptions are minor occurrences of isotopically distinguished relict olivine grains, which were found in nine chondrules. The isotope homogeneity of these phenocrysts is consistent with a co-magmatic crystallization of olivine and pyroxene from the final chondrule melts and a significant oxygen isotope exchange between the ambient gas and the melts. Homogeneous type I chondrules with Mg#'s of 98.9-99.5 have host chondrule Δ 17 O values ranging from -6.0‰ to -4.1‰, with one exception (Δ 17 O: -1.2‰; Mg#: 99.6). Homogeneous chondrules with Mg#'s <96, including four type II chondrules (Mg# ~65-70), have Δ 17 O values of around -2.5%. Five type I chondrules (Mg# ≥99) have internally heterogeneous oxygen isotope ratios with Δ 17 O values ranging from -6.5% to -4.0%, similar to those of host chondrule values. These heterogeneous chondrules have granular or porphyritic textures, convoluted outlines, and contain numerous metal grains dispersed within fine-grained silicates. This is consistent with a low degree of melting of the chondrule precursors, possibly because of a low temperature of the melting event and/or a shorter duration of melting. The Δ 17 O values of relict olivine grains in nine chondrules range from -17.9% to -3.4%, while most of them overlap the range of the host chondrule values. Similar to those reported from multiple carbonaceous chondrites (Acfer 094, Y-82094, CO, CR, and CV), the Δ 17 O ~-5% and high Mg# (≥99) chondrules, which might derive from a reduced reservoir with limited dust enrichments (~50× Solar System), dominate the population of chondrules in Murchison. Other chondrules in Murchison formed in more oxidizing environment (Mg#<96) with higher Δ 17 O values of -2.5%, in agreement with the low Mg# chondrules in Acfer 094 and CO chondrites and some chondrules in CV and CR chondrites. They might form in environments containing the same anhydrous precursors as for the Δ 17 O ~-5% and Mg# ~99 chondrules, but enriched in 16 O-poor H2O ice (~0.3-0.4× the CI dust; Δ 17 0>0%) and at dust enrichments of ~300-2000×. Regarding the Mg# and oxygen isotope ratios, the chondrule populations sampled by CM and CO chondrites are similar and indistinguishable. The similarity of these 16 O-rich components in CO and CM chondrites is also supported by the common Fe/Mn ratio of olivine in type II chondrules. Although they accreted similar high-temperature silicates, CO chondrites are anhydrous compared to CM chondrites, suggesting they derived from different parent bodies formed inside and outside the snow line, respectively. If chondrules in CO and CM chondrites formed at the same disk locations but the CM parent body accreted later than the CO parent body, the snow line might have crossed the the common chondrule-forming region towards the Sun between the time of the CO and CM parent bodies accretion.

Oxygen three-isotope analysis by secondary ion mass spectrometry of chondrule olivine and pyroxene in combination with electron microprobe analysis were carried out to investigate 24 FeO-poor (type I) and 2 FeO-rich (type II) chondrules from the Kaba (CV) chondrite. The Mg#'s of olivine and pyroxene in individual chondrules are uniform, which confirms that Kaba is one of the least thermally metamorphosed CV3 chondrites. The majority of chondrules in Kaba contain olivine and pyroxene that show indistinguishable Δ 17 O values (= δ 17 O - 0.52 × δ 18 O) within analytical uncertainties, as revealed by multiple spot analyses of individual chondrules. One third of chondrules contain olivine relict grains that are either 16 O-rich or 16 O-poor relative to other indistinguishable olivine and/or pyroxene analyses in the same chondrules. Excluding those isotopically recognized relicts, the mean oxygen isotope ratios (δ 18 O, δ 17 O, and Δ 17 O) of individual chondrules are calculated, which are interpreted to represent those of the final chondrule melt. Most of these isotope ratios plot on or slightly below the primitive chondrule mineral (PCM) line on the oxygen three-isotope diagram, except for the pyroxene-rich type II chondrule that plots above the PCM and on the terrestrial fractionation line. The Δ 17 O values of type I chondrules range from ~ -8‰ to ~ -4‰; the pyroxene-rich type II chondrule yields ~0‰, the olivine-rich type II chondrule ~ -2‰. In contrast to the ungrouped carbonaceous chondrite Acfer 094, the Yamato 81020 CO3, and the Allende CV3 chondrite, type I chondrules in Kaba only possess Δ 17 O values below -3‰ and a pronounced bimodal distribution of Δ 17 O values, as evident for those other chondrites, was not observed for Kaba. Investigation of the Mg#-Δ 17 O relationship revealed that Δ 17 O values tend to increase with decreasing Mg#'s, similar to those observed for CR chondrites though data from Kaba cluster at the high Mg# (>98) and the low Δ 17 O end (-6‰ and -4‰). A mass balance model involving 16 O-rich anhydrous dust (Δ 17 O = -8‰) and 16 O-poor water ice (Δ 17 O = +2‰) in the chondrule precursors suggests that type I chondrules in Kaba would have formed in a moderately high dust enriched protoplanetary disk at relatively dry conditions (~50-100× dust enrichment compared to Solar abundance gas and less than 0.6× ice enhancement relative to CI chondritic dust). The olivine-rich type II chondrule probably formed in a disk with higher dust enrichment (~2000× Solar).

In order to explore the link between comet 81P/Wild 2 and materials in primitive meteorites, seven particles 5 to 15 μm in diameter from comet 81P/Wild 2 have been analyzed for their oxygen isotope ratios using a secondary ion mass spectrometer. Most particles are single minerals consisting of olivine or pyroxene with Mg# higher than 85, which are relatively minor in 81P/Wild 2 particles (~1/3 of the 16 O-poor cluster). Four particles extracted from Track 149 are 16 O-poor and show Δ 17 O (= δ 17 O - 0.52 × δ 18 O) values from -2% 0 to +1% 0 , similar to previous studies, while one enstatite (En 99 ) particle shows lower Δ 17 O value of -7±4%o (2σ). This compositional range has not been reported among 16 O-poor particles in 81P/Wild 2, but is commonly observed among chondrules in carbonaceous chondrites and in particular in CR chondrites. The distribution in Δ 17 O indicates that 16 O-poor 81P/Wild 2 particles are most similar to chondrules (and their fragments) in the CR chondrites and Tagish Lake-like WIS91600 chondrite chondrule silicate grains, which indicates that they likely come from a reservoir with similar dust/ice ratios as CR chondrites and WIS91600. However, differences in the Mg# distribution imply that the 81P/Wild 2 reservoir was comparatively more oxidized, with a higher dust enrichment. Two nearly pure enstatite grains from track 172 are significantly enriched in 16 O, with δ 18 O values of -51.2 ± 1.5% 0 (2σ) and -43.0 ± 1.3% (2σ), respectively, and Δ 17 O values of -22.3 ± 1.9% (2σ) and -21.3 ± 2.3% 0 (2σ), respectively. They are the first 16 O-rich pyroxenes found among 81P/Wild 2 particles, with similar Δ 17 O values to those of 16 O-rich low-iron, manganese-enriched (LIME) olivine and CAI (calcium and aluminum-rich inclusions) -like particles from 81P/Wild 2. The major element and oxygen isotopic compositions of the pyroxenes are similar to those of enstatite in amoeboid olivine aggregates (AOAs) in primitive chondrites, in which 16 O-rich pyroxenes have previously been found, and thus suggest a condensation origin.

Objectives: To assess the usefulness of histopathologic examination in forensic autopsies., Material and Methods: All consecutive pathological reports and slides from forensic autopsies performed in our department since 2006 have been reviewed., Results: Four hundred forensic necropsies were reviewed. In only 150 cases (38%), pathologists had data about manner of death and gross autopsy findings. Major diagnoses, related to death, and unsuspected by forensic pathologists, were discovered in 83 cases (21%): in 48 cases (12%) gross examination of the heart, lungs and liver showed gross diagnoses missed by the forensic pathologists, and in only 35 cases (9%) microscopic examination revealed a major unsuspected diagnosis (in brain, heart, lungs, liver, kidney and pancreas specimens). In 213 cases (53%), histopathologic examination confirmed gross autopsy findings and allowed to date some wounds. In 104 cases (26%), microscopic examination was not contributory., Conclusion: Microscopic examination revealed major diagnoses in less than 10% of forensic autopsies. Its effectiveness is limited for homicides and suicides. Systematic microscopic examination of numerous organs is often useless and should be limited to cases with no anatomic causes of death. Our study emphasizes the need for a better communication between forensic pathologists and histopathologists, and for a better training of some forensic pathologists for gross examination., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

A 43-year-old man presented at the emergency medical unit with chest pain. The results of a clinical examination were normal, apart from sternum pain (without radiation) on palpation. The patient had no respiratory problems and the pain was relieved by paracetamol. The electrocardiogram, laboratory tests and chest X-ray were normal. However, the man was found dead the next morning. In the autopsy, we noted the presence of haemopericardium, aortic dissection (starting from the vessel's origin and extended to the aortic arch and on through the diaphragm), polycystic kidney disease and liver cysts. In adult autosomal dominant polycystic kidney disease (ADPKD) patients, the main causes of death are ruptured intracerebral aneurysms, coronary artery disease, congestive heart failure, valvular heart disease and ruptured abdominal aortic aneurysms. Aortic dissection is considered to be rare cause of sudden death in ADPKD sufferers. ADPKD can have serious consequences for the vascular system. The families of confirmed ADPKD sufferers must be informed and screened as early as possible, in order to prevent renal and cardiovascular complications.

Ambulatory anaesthesia is an anesthesia allowing the return of the patient home the same day. Even if the ambulatory hospitalization can, in theory, be applied to a prisoner as to every patient, caution is essential in such approach. Every anaesthetist reanimator doctor practicing in public hospitals may give care to patient prisoners while he is far from dominating all features of the prison world and while he must put down his therapeutic indications. The ambulatory anaesthesia in prison environment does not guarantee full security for the patient. Procedures could be set up between hospital complexes, caretakers practicing within penal middle (Unit of Consultation and Ambulatory Care [UCAC]) the prison service and hospital, the prefecture, to identify possible ambulatory interventions for a patient prisoner and to set up all guarantees of patient follow-up care in his return in prison environment. The development of interregional secure hospital units (ISHU) within teaching hospitals, allows an easier realization of interventions to the prisoners, but exists only in seven teaching hospitals in France., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)