Search

Objective: This project aimed to train nurses on an oncology unit in hypnotic communication to reduce treatment-related pain and anxiety in their patients. A pilot study was conducted to assess changes in hypnotic communication behaviors associated with the training. Methods: Nurses were recruited and their interactions during a simulated patient admission for treatment (before and after training) were recorded. Hypnotic communication skills were assessed by independent reviewers using a training checklist listing different hypnotic communication techniques and a validated assessment scale (Sainte-Justine Hypnotic Communication Assessment Scale, SJ-HCAS). Results: Seven nurses were evaluated. Wilcoxon paired-sample tests (pre–post) reported significant improvement with large effect sizes in the total score of the training grid (P = 0.034, r = 0.832) and significant improvement with large effect sizes in the relational (P = 0.018, r = 0.930) and total (P = 0.021, r = 0.903) scores of the SJ-HCAS. Conclusion: This pilot study shows promising results regarding the effectiveness of hypnotic communication training for nurses. These acquired skills could translate into improved treatment experience with patients and could be transferred to other professionals and settings in the health care system.

The control of somatropin products according to the monographs of the European Pharmacopoeia (Ph. Eur.) requires a system suitability preparation for the test for related proteins by liquid chromatography. A preparation consisting in a mixture of somatropin and desamidosomatropin, such as the Ph. Eur. Somatropin/desamidosomatropin resolution mixture Chemical Reference Substance (CRS), is to be used to ascertain adequate resolution of the chromatographic setup. Due to low stocks, the Biological Standardisation Programme (BSP) of the Council of Europe and the European Union ran a study to establish a new batch of this system suitability CRS. A freeze-dried candidate batch (cCRS2) was produced and tested at the European Directorate for the Quality of Medicines and HealthCare (EDQM, Council of Europe). The resolution between the peaks due to somatropin and desamidosomatropin was 1.7 and the symmetry factor for the somatropin peak was 1.2. The mean percentage area of the desamidosomatropin peak was 14.6 %. These results showed that cCRS2 is suitable for its intended purpose. Based on these data, in May 2020 the Ph. Eur. Commission established the candidate batch as Ph. Eur. Soma-tropin/desamidosomatropin resolution mixture CRS batch 2.

Young people are often the intended audience for health and social programs, yet they rarely participate in the decision-making processes that determine how these programs are designed, implemented, or evaluated. Failing to meaningfully engage young people, well-intended adults may miss opportunities to create relevant and effective programs and policies for youth. This article describes a youth-led health assessment conducted with researchers from an academic medical center accountable care organization and stakeholders from a local community center. We explain the process of recruiting and engaging youth in this project, along with health concerns they identified in their communities via a survey, including mental and sexual health, food access, and community safety, as well as recommendations the youth researchers developed for improving health and tackling inequities. Our findings show that youth participation fosters a deeper sense of empowerment and leadership potential. Policy makers and other health leaders should consider engaging young people as they make decisions about health care delivery.

Significance We identified a group of DNA repair genes directly induced by EZH2 and repressed by EZH2 inhibitors. Expression of these genes predicts the response of wild-type EZH2-harboring solid tumors to EZH2 inhibitors. Most importantly, our findings lay the foundation for the development of a combination therapy that combines EZH2 inhibitors and DNA damaging agents or drugs that block DNA repair for the treatment of castration-resistant prostate cancer and other solid tumors., Drugs that block the activity of the methyltransferase EZH2 are in clinical development for the treatment of non-Hodgkin lymphomas harboring EZH2 gain-of-function mutations that enhance its polycomb repressive function. We have previously reported that EZH2 can act as a transcriptional activator in castration-resistant prostate cancer (CRPC). Now we show that EZH2 inhibitors can also block the transactivation activity of EZH2 and inhibit the growth of CRPC cells. Gene expression and epigenomics profiling of cells treated with EZH2 inhibitors demonstrated that in addition to derepressing gene expression, these compounds also robustly down-regulate a set of DNA damage repair (DDR) genes, especially those involved in the base excision repair (BER) pathway. Methylation of the pioneer factor FOXA1 by EZH2 contributes to the activation of these genes, and interaction with the transcriptional coactivator P300 via the transactivation domain on EZH2 directly turns on the transcription. In addition, CRISPR-Cas9–mediated knockout screens in the presence of EZH2 inhibitors identified these BER genes as the determinants that underlie the growth-inhibitory effect of EZH2 inhibitors. Interrogation of public data from diverse types of solid tumors expressing wild-type EZH2 demonstrated that expression of DDR genes is significantly correlated with EZH2 dependency and cellular sensitivity to EZH2 inhibitors. Consistent with these findings, treatment of CRPC cells with EZH2 inhibitors dramatically enhances their sensitivity to genotoxic stress. These studies reveal a previously unappreciated mechanism of action of EZH2 inhibitors and provide a mechanistic basis for potential combination cancer therapies.

In Burkina Faso, Burundi and Niger, the policy to remove user fees for primary care was carried out through significant adjustments in public financial management (PFM). The paper analyzes the PFM adjustments by stage of the budget cycle and describes their importance for health financing. The three countries shifted from input-based to program-based allocation for primary care facility compensation, allowed service providers autonomy to access and manage the funds, and established budget performance monitoring frameworks related to outputs. These PFM changes, in turn, enabled key improvements in health financing, namely, more direct funding of primary care facilities from general budget revenue, and payments to those service providers based on outputs and drawn from noncontributory entitlements. The paper draws on these experiences to provide key lessons on the PFM enabling conditions needed to expand health coverage through public financing mechanisms.

Primary venous aneurysms are rare and usually asymptomatic. Venous aneurysms are manifested more frequently in the lower extremities than in the upper extremities. Primary venous aneurysms of the upper extremities are more often reported as aesthetically displeasing bulges or incidental findings. Here, we report the rare case of an axillary primary venous aneurysm in a pediatric patient who presented with syncope and massive pulmonary embolism and highlight the management. Keywords: Venous aneurysm, Axillary aneurysm, Pediatric, Peripheral aneurysm

Genetically modified (GM) sugarcane is being developed for use in commercial production in several countries. Regulatory approval is required before these cultivars can be released and grown. Part of the approval process is to understand and assess the potential for environmental harm that might result from introduction of a GM organism. A key piece of biological information to assist in this analysis is to determine if and over what distance transgenes could be transferred by pollen from the GM plants and passed onto the next generation of sugarcane seeds. This is not known for sugarcane. Consequently, a field experiment was designed and conducted in Australia to determine the level of pollination between sugarcane cultivars (Saccharum spp. hybrids), and the distance over which it occurs, by placing non-GM flowering plants of cultivar in the centre of a field of non-GM cultivar . Mature inflorescences of the pollen receptor () were collected in eight directions up to 200 m from the centre of the field. Parentage of the seeds from the mother plants germinating in controlled conditions was determined by molecular markers. At a distance of 1 m in all directions from the pollen source, relatively high levels of hybridisation were found, though this was highest (100%) in the upwind direction. The level of hybridisation decreased in the shape of an exponential decay curve but detectable levels of hybridisation still occurred at 200 m downwind from the pollen source. The high level of cross- pollination at close distance was confirmed in a second experiment. The potential for pollen to travel several hundred metres and effect pollination and the subsequent production of sugarcane seeds means that containment of a transgene by distance cannot be assumed for sugarcane. The potential for cross- pollination of sugarcane plants or of compatible, sympatric relatives will be dependent upon local conditions. The risk of harm as a result of pollen carrying a transgene subsequently pollinating and producing seed will have to be evaluated against the likelihood of germination and survival of the seed and the nature and effects of the transgene.

Black spot (caused by the fungal pathogen Diplocarpon rosae) is the most severe disease of roses in the outdoor landscape. Most cultivars are susceptible to this disease and its control requires repeated fungicide treatments. New rules on pesticide use encourage breeders to develop roses with a high resistance level to black spot. Growing genetically resistant rose cultivars is an alternative to chemical control of the disease. Resistance durability depends on the kind of resistance, the plant genetic background, the spatial and temporal deployment of resistances, the integration of resistances in cultural systems, and the dynamic of pathogen adaptation. To date, both dominant resistance genes and partial resistance loci have been described particularly in the genetic background of Rosa multiflora. In this study, a genotype closely related to the wild rose Rosa wichurana was examined to identify new resistance genes. Two progenies, connected by the resistant male parent, were scored for black spot resistance after natural infections in field over three and two years in three and one French locations for HW (Rosa hybrida ‘H190’ × hybrid of Rosa wichurana) and OW (Rosa chinensis ‘Old Blush’ × hybrid of Rosa wichurana) progenies, respectively. Genetic maps based on microsatellite and SNP markers were developed for HW and OW progenies, respectively. One common quantitative trait locus (QTL) was localized on linkage group 3 (LG3) of the male maps; it was revealed in the two progenies for several years and in different locations. Another QTL was identified but only in the HW progeny: it was mapped on LG5. The effectiveness of these QTLs should be confirmed against a wide range of pathogen isolates. To provide tools to study the genetic diversity of D. rosae, we sequenced two strains using Illumina paired-end sequencing technology and developed polymorphic microsatellite markers. The genome size of the two strains was estimated to 31 and 34 Mb. A set of 31 polymorphic markers was obtained. 70 monoconidial strains of D. rosae isolated from leaves of Rosa spp. with black spot symptoms were obtained from various locations in Europe and Asia. The analysis of this Eurasian pathogen collection revealed a strong genetic differentiation between pathogen populations collected from wild roses and those collected from gardens. To screen the resistance level of rose genotypes against pathogen diversity, we inoculated rooted cuttings with monoconidial strains of the pathogen under greenhouse conditions. Disease symptoms were scored 10 and 28 days post inoculation (dpi). This pathological test showed a range of resistance levels in rose against the diverse pathogen isolates collected in France and identified genotypes interesting for breeding.

Study question What are the factors that could predict the number of embryos to be transferred in order to diminish risk of multiple pregnancies? Summary answer Single embryo transfer (SET) is advisable for What is known already Multiple pregnancies are associated to increased maternal and perinatal complications. Risks associated to multiple implantations are significantly reduced with SET policy. However, while SET is more assertive with a lesser negative impact in younger patients ( Study design, size, duration A retrospective study from the national French data registry provided and approved by the Agence de la Biomédecine was performed. A total of 196530 fresh and 68913 frozen cycles from women aged 18–43 year-old were included (2014–2017). Risk factors assessed included women’s age, number of attempts, number of oocytes, fertilization rate, embryo stage, number of embryos transferred, number of supernumerary embryos frozen. Secondary infertility, oocyte donor, oocyte freezing, PGT, freeze-all and IVM cycles were excluded. Participants/materials, setting, methods Cumulative cycles derived from 65% of ICSI, 32% of IVF and 3,2% IVF/ICSI. The distribution of patients age at oocyte retrieval was 60% < 35, 21% < 38, 11% < 40, and 8% ≥ 40 years old. Multivariable logistic regression was conducted to calculate adjusted odds ratios with 95% confidence intervals for live birth chance and multiple live birth risk associated with each risk factor. Main results and the role of chance The chances of obtaining a cumulative live birth decreases with increased patients age (OR 0.71 for 35–38 years and 0.47 for 38–40 years, p 18, p 40% (OR 1.29, p 1, OR 13.08 for >2, and OR 16.92 for >6, p 2 embryos, p In case of live birth, the risks of multiple births when two embryos were transferred decreases in patients aged >38 years (OR 0.50, p 60% (OR 1.30, p 1.30, p Limitations, reasons for caution This study is limited in only providing a risk-benefit balance for multiples on the choice of transferring one or two embryos. Clinical data such as stimulation protocols and doses of gonadotropins were not considered in this evaluation. Wider implications of the findings: This study provides help to develop a strategy for the medical staff in the decision making for the number of embryos to be transferred. It may also serve as a patient’s information aid and help to improve their chances of achieving a health singleton if pregnant. Trial registration number Not applicable

Socioeconomic factors, such as insurance status, have been shown to affect outcomes for patients following emergency injuries. Dual-eligible beneficiaries, receiving both Medicare and Medicaid, constitute an especially vulnerable population. There is limited data addressing whether dual-eligible beneficiaries with hemorrhagic stroke display unique characteristics and outcomes compared to patients with Medicare, Medicaid, or private insurance.We conducted a retrospective analysis of 10-years of National Inpatient Sample data. Using ICD-9-CM codes, we identified adult patients with known insurance status who were emergently hospitalized for intracranial hemorrhage; epidural, subdural, subarachnoid, and intracerebral hemorrhages were included. Patient characteristics including whether they underwent surgical intervention were collected. Multivariable logistic regression was used to adjust for confounders. Primary clinical outcomes of interest included mortality (in-hospital), complications (any), and favorable discharge (home/home with services).Among 410,621 patients, dual-eligible (6.8%) patients were on average older (mean age = 73yrs) compared to Medicaid (46yrs), private insurance (67yrs), or no-charge (47yrs) patients. Caucasian race was highest among Medicare patients (83%) while African-American race was highest among Medicaid (22%). Among all patients, 5.3% underwent operative intervention. Dual-eligibles had significantly higher odds of in-hospital mortality compared to no-charge (adjusted odds ratio (aOR) = 1.61, 95% CI = [1.04 - 2.49]), but no significant difference between Medicare and Medicaid although dual-eligibles. Dual-eligibles had significantly increased odds of complications compared to Medicaid (aOR = 1.23, 95% CI = [1.11 - 1.37]) and privately insured patients (aOR = 1.19, 95% CI = [1.11 - 1.28]), both p 0.001, and lower odds of favorable discharge compared to all other groups, all p 0.001. Dual-eligibles underwent a shorter length of stay, an 18% decrease, compared to Medicaid patients (β-Coefficient = 0.82, 95% CI = [0.78 - 0.86], p 0.001), and inflation adjusted admission costs that were 24% lower compared to Medicaid patients (β-Coefficient = 0.76, 95% CI = [0.73 - 0.80], p 0.001), amounting to a $3,684 decrease in cost.Dual-eligible beneficiaries experience unique health disparities from lower odds of favorable discharge to increased odds of complications and in-hospital mortality compared to other insured and uninsured groups. Adverse outcomes among dual-eligible beneficiaries highlight the need to uncover and address unknown sources of disparities to improve emergency treatment of hemorrhagic stroke in this population.

ObjectivesTo examine factors associated with COVID-19 vaccine receipt among healthcare workers, including healthcare worker job type, race, and gender, as well as the role of vaccine confidence in decisions to vaccinate, and to better understand specific concerns related to COVID-19 vaccination among healthcare workers.DesignCross-sectional anonymous survey among front-line, support service, and administrative healthcare workers.SettingTwo large integrated healthcare systems (one private and one public) in New York City during the initial rollout of the COVID-19 vaccine among healthcare workers.Participants1,933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers, and administrative staff.Main Outcome MeasuresThe primary outcome was COVID-19 vaccine receipt during the initial rollout of the vaccine among healthcare workers.ResultsAmong 1,933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among Black (58%) compared with White (91%) healthcare workers; and lower among Hispanic (69%) compared with non-Hispanic (84%) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine. Across all participants, 27% expressed concern about being experimented on with the COVID-19 vaccine. In a multivariable analysis, concern about being experimented on with the COVID-19 vaccine, concerns about COVID-19 vaccine safety, lack of influenza vaccine receipt, disagreeing that COVID-19 vaccination is important to protect family members, and Black race were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members, and patients.ConclusionsOur data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects, or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers’ decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting Black and Hispanic workers. Further research is urgently needed in developing strategies with healthcare workers to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.SUMMARY BOXESWhat is already known?High uptake of effective COVID-19 vaccines among healthcare workers is critical to pandemic response.In studies of potential COVID-19 vaccine acceptance prior to COVID-19 vaccine availability, people who identified as Black were less likely to indicate they would accept the vaccine.Understanding reasons why some healthcare workers chose not to get the COVID-19 vaccine will help us develop interventions to improve COVID-19 vaccine confidence among healthcare workers and in their communities.What this study addsWe demonstrate high receipt of COVID-19 vaccines in the initial rollout among healthcare workers.Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers’ decisions to vaccinate.We observed substantially lower rates of receipt among Black and Hispanic healthcare workers, independent of differences in vaccine-related beliefs. A quarter of healthcare workers expressed concerns about being experimented on. These results suggest systemic racism may be a critical barrier to equitable vaccination.Our results highlight that healthcare workers of all types, including those with non-patient-facing roles, play an important role as sources of COVID-19 vaccine information in their communities.

We define a generalisation of the Edge-Reinforced Random Walk (ERRW) introduced by Coppersmith and Diaconis in 1986, called *-Edge-Reinforced Random Walk (*-ERRW), which can be seen as an extension of the r-dependent ERRW introduced by Bacallado (2011). Similarly as for the ERRW, it has a continuous-time counterpart, called *-Vertex-Reinforced Jump Process (*-VRJP), which itself generalises the Vertex- Reinforced Jump Process proposed by Werner in 2000 and initially studied by Davis and Volkov (2002, 2004). Under some assumptions on the initial weights, the *-ERRW is partially exchangeable in the sense of Diaconis and Freedman (1980), and thus it is a random walk in a random environment: we compute the law of that environment., 17 pages

Additional file 2. Gating strategy. (a) Total lymphocytes were selected in whole blood after erythrocyte lysis and staining, based on their morphological properties. Subpopulations of T lymphocytes and NK lymphocytes were determined based on the surface markers as follows: CD3+ for T cells, CD3+CD4+ for T-helper (CD45RA+ for naive, CD45RA- for memory and HLA-DR+ for activated), CD3+CD8+ for T-cytotoxic (CD45RA+ for naive, CD45RA- for memory and HLA-DR+ for activated), CD56+CD3- for NK. (b) CXCR4 and CD26 expression was assessed on T subpopulations by calculating the ratio of their mean fluorescence intensity (MFI) to the MFI of their isotype counterparts

Additional file 1. Table SI: Multivariable linear regression aimed at explaining the T-helper count as outcome variable in the 36 HHT patients. The explanatory variables tested were: CXCR4 MFI on T-helper lymphocytes, age and requirement of IV treatment for iron-deficiency anemia. Due to non-linearity in CXCR4 MFI on T-helper lymphocytes, this variable was divided in two classes (> 4.48 vs ��� 4.48) for analysis.

Background We investigated the association between socioclinical, inflammatory, and metabolic markers and weight gain in people with human immunodeficiency virus (HIV) on combination antiretroviral therapy (cART). Methods Individuals from the COPANA cohort of normal weight (body mass index [BMI], 18.5–24.9 [ calculated as weight in kilograms divided by height in meters squared) at cART initiation who achieved virological suppression (viral load, Results After 36 months of cART, 32 of 158 people with HIV (20%) became overweight or obese (21% female; 65% born in France and 23% born in sub-Saharan Africa; median BMI at cART initiation, 22 [interquartile range, 21–23]). After adjustment, higher BMI, originating from sub-Saharan Africa, living in a couple, and higher soluble tumor necrosis factor receptor 2 and lower adiponectin concentrations at cART initiation were associated with becoming overweight or obese. Conclusion Weight gain on cART is multifactorial. Special attention should be given to migrants from sub-Saharan Africa. Monocyte activation and adipocyte dysfunction at cART initiation affect weight regulation.

Young people are often the intended audience for health and social programs, yet they rarely participate in the decision-making processes that determine how these programs are designed, implemented, or evaluated. Failing to meaningfully engage young people, well-intended adults may miss opportunities to create relevant and effective programs and policies for youth. This article describes a youth-led health assessment conducted with researchers from an academic medical center accountable care organization and stakeholders from a local community center. We explain the process of recruiting and engaging youth in this project, along with health concerns they identified in their communities via a survey, including mental and sexual health, food access, and community safety, as well as recommendations the youth researchers developed for improving health and tackling inequities. Our findings show that youth participation fosters a deeper sense of empowerment and leadership potential. Policy makers and other health leaders should consider engaging young people as they make decisions about health care delivery.

SummaryDrugs that block the activity of the methyltransferase EZH2 are in clinical development for the treatment of non-Hodgkin lymphomas harboring gain-of-function EZH2 mutations that enhance its polycomb repressive function. In contrast, in castration-resistant prostate cancer (CRPC) we have previously reported that EZH2 plays a non-canonical role as a transcriptional activator. In this setting, we now show that EZH2 inhibitors can also block the non-canonical activity of EZH2 and inhibit the growth of CRPC cells. Gene expression and epigenomic profiling of cells treated with EZH2 inhibitors demonstrated that rather than de-repressing tumor suppressor genes silenced by PRC2, EZH2 inhibitors downregulate a set of DNA repair genes that are directly regulated by EZH2. In addition, genome-wide CRISPR/Cas9-mediated loss-of-function screens in the presence of EZH2 inhibitors identified these DNA repair genes to underlie the growth-inhibitory function of these compounds. Interrogation of public data from diverse solid tumor types expressing wild-type EZH2 showed that expression of DNA damage repair genes is significantly correlated with cellular sensitivity to EZH2 inhibitors. Consistent with these findings, treatment of CRPC cells with EZH2 inhibitors dramatically enhanced their sensitivity to genotoxic stress. These studies reveal a previously unappreciated mechanism of action of EZH2 inhibitors and provide a mechanistic basis for potential new combination cancer therapies.

Background Although aortoiliac occlusive disease (AIOD) is preferentially treated endovascularly, some patients are still better served with an aortobifemoral bypass (ABF). For those patients, surgical treatment options include both standard open operations as well as laparoscopic ABF (LapABF). Several European centers perform LapABF with favorable results instead of open surgery, but this has not been widely embraced in the United States. We reviewed our ten-year experience with LapABF, evolving from a completely laparoscopic to a standardized laparoscopic-assisted approach. Methods A retrospective review of all laparoscopic aortic operations performed at a single US academic institution from 2005 to 2015 was completed. Demographics, co-morbidities, intraoperative parameters and clinical outcomes were recorded. Patients were excluded from consideration for laparoscopic surgery if they had previous aortic surgery, aneurysmal disease or gastrointestinal pathology (e.g. diverticulitis or an enteric stoma). Results Thirty men and sixteen women were treated, (n=46) with a mean age of 55.7 (range 38-75 years). All operations were performed by a single surgeon. LapABF was successfully completed in 95.6%. A completely laparoscopic approach was undertaken in eight patients and a laparoscopic-assisted approach was used in the remaining 38 patients. Mean follow-up was 46 months (range 1 to 131). The indication for operation was claudication (n=35, 76%), rest pain (n=8, 17%) or tissue loss (n=3, 7%). Twenty-one limbs had a history of a prior failed aortoiliac endovascular intervention (23%). Median length of stay was 6 days (range 2-30). Within 30 days there were two myocardial infarctions (4.3%), one transient ischemic attack (2.2%) and one death (2.2%). Re-intervention was performed in 12 patients over the course of the study period (26.1%). Primary, primary-assisted and secondary patency was 79.4%, 93.9% and 94.9% at 60 months, respectively. Overall mortality was 17% with a mean duration of follow-up of 60 months (range 1-116). Multivariable analysis revealed coronary artery disease (CAD; P=0.03) conferred a sixteen-fold risk for death during long-term follow-up. Conclusions In this large US series of LapABF, we observed acceptable long-term patency, short length of stay and minimal morbidity. We suggest that this standardized approach for laparoscopic-assisted ABF is a viable option for patients with AIOD not suitable for endovascular therapy. The use of laparoscopic-assisted ABF affords practitioners the benefits of a completely laparoscopic approach while reducing the duration and complexity of the operation. Given the rate of re-interventions in the early era practitioners should be aware of the learning curve with this approach.

Addressing racial disparities within the surgical workforce is vital to provide quality care to all patients; inclusion is critical to do so. Inclusion signifies a move beyond numerical representation; tangible goals include reducing attrition and maximizing career development. The aims of this review were to (1) test whether there are academically published interventions or frameworks addressing inclusion in the surgical workforce and (2) characterize these interventions or frameworks. This review adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three electronic databases (Medline, PubMed, Web of Science) were queried. Peer-reviewed full-text English-language articles focused on interventions or frameworks to achieve inclusion in the surgical workforce were considered. The initial search yielded 2243 papers; 15 met inclusion criteria. The published literature regarding interventions to achieve inclusion was sparse; the most common reasons for exclusion of full texts were papers not focused on interventions (42%; n = 51) or purely focused on diversity and representation (36%; n = 42). The most common field represented was broadly academic surgery (4/15; 47%), with seven other subspecialties represented. A small minority received funding (3/15; 20%). Common themes included systematic reform of recruitment policies and practices, increased access to targeted mentorship, gaining leadership support, and increased avenues for underrepresented faculty advancement. While limited, promising work has been undertaken through national collaboration and model institutional work. Future considerations may include incentivizing academic publication of inclusion work, increasing access to funding, and rewarding these efforts in career advancement.

Functional gene approaches have been used to better understand the roles of microbes in driving forest soil nitrogen (N) cycling rates and bioavailability. Ammonia oxidation is a rate limiting step in nitrification, and is a key area for understanding environmental constraints on N availability in forests. We studied how increasing temperature affects the role of ammonia oxidizing archaea (AOA) and bacteria (AOB) in soil N cycling and availability by using a highly constrained natural mean annual temperature (MAT) elevation gradient in a tropical montane wet forest. We found that net nitrate (NO3- ) bioavailability is positively related to MAT (r2 = 0.79, P = 0.0033), and AOA DNA abundance is positively related to both NO3- availability (r2 = 0.34, P = 0.0071) and MAT (r2 = 0.34, P

Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP. © 2020 British Journal of Anaesthesia

International audience; A procedure was developed for in vitro propagation of Rosa genotypes along with an efficient de novo shoot organogenesis (DNSO) method. We tested, on one genotype (hybrid of Rosa wichurana), the effects of MS basal medium complemented with two growth regulators to achieve either shoot elongation or shoot multiplication of plants. These media were complemented with carbohydrate concentrations from different sources. Then, the impacts of various carbohydrates (fructose, glucose, maltose, sorbitol, sucrose) on the growth and development of several rose genotypes during donor plant subculturing were studied on SMM. The results showed high variability in growth and development between genotypes. Contrary to other members of the Rosaceae family, no correlation was found between the shoot size and number when the amount of sorbitol was increased.Murashige and Skoog medium supplemented with 3.0 mg L-1 BAP and containing fructose or glucose at 30 g L-1 was chosen to induce leaf explants for the DNSO experiments. MS basal medium complemented with TDZ/IBA at three ratios and the same range of carbohydrate sources were tested for DNSO. Significant genotypic variations with regard to the percentage of regeneration was demonstrated with six genotypes. For two genotypes, a hybrid of Rosa wichurana and Rosa 'White Pet', we defined the conditions required to obtain 100% DNSO. For Rosa chinensis 'Old blush' and the rootstock genotype Rosa 'Natal Briar', we obtained 74 and 87.5% DNSO and only 56.67% and 37.5% for Rosa GUY SAVOY (R) ('Delstrimen') and Rosa Felicite et Perpetue' respectively. This adventitious shoot regeneration method may be used for large-scale shoot propagation and genetic engineering studies in Rosa.Keywords

Sugarcane root systems are poorly studied and understood due to the perennial nature, tall stature, and the long cropping cycle. Whilst some field studies gave insights into sugarcane root traits, there is no detailed description of root and root system traits available. The objectives of our work were to establish a baseline of sugarcane root trait values that will serve for future studies, and to characterise the degree of root system resilience when restricting tiller number. We first conducted an initial screening for root trait diversity on a collection of twenty cultivars representative of sugarcane breeding from 1930 to now. Then we investigated the effect of reduced tillering, via manual de-tillering, on the plant root and root system traits of five varieties grown under optimal conditions in a glasshouse for 1700 °Cd. In addition to establishing baseline means and variation for sugarcane root trait values that could serve as a reference for crop models, we demonstrated that the sugarcane root mass fraction was extremely resilient to drastic reduction in tiller number. Restricted plants were effectively maintaining their root system configuration (opening angle) by dramatically increasing the number of nodal roots produced per tiller as well as maximizing total root length by increasing the specific root length. Using this knowledge of sugarcane root traits in combination with the specific agronomic constraints for sugarcane will now underpin the development of a root system ideotype for sugarcane to enable targeted root trait selection for improving crop productivity.

Introduction The pharmacotoxicology department (PTD) of the University Hospital of Lyon is a unique organization in France, gathering three regulatory vigilances: addictovigilance (AV), pharmacovigilance (PV), and poison control (PCC) centers. Since May 2018, requests for each center are handled by one single help desk. The aim was to improve answers’ efficiency and quality through an interdisciplinary approach. Our objective was to assess the requester's satisfaction on the provided answers. Material and methods A retrospective satisfaction survey was carried out over a three-week-period on a representative part of the incoming requests (20% of PCC requests, 100% of PV and AV requests). These requests came either from patient himself, parents or relatives, or healthcare professional. The survey was proposed to the requesters by phone or email depending on how requests were received. An online questionnaire on framaform.org website was filled out using an identification number which ensures case anonymization. Results Among the 1135 received requests, 38.5% of the submitted questionnaires were completed (n = 123/319), mainly by non-healthcare professionals (76.4%). These requests mostly concerned PC (74.8%) and PV (24.4%) centers, and 63.4% of requesters contacted PTD for the first time. Contact details for the PTD were considered to be easily accessible for 87% of the requesters. The given information was assessed as very clear by 99.2% of the requesters. Moreover, 97.6% of them were fully satisfied with the provided medical and treatment advice. Regarding quality of processing and time to answer, the large majority of requesters was satisfied (99.2% and 95.1%, respectively). Discussion/Conclusion This PTD survey shows positive results with an excellent overall requesters’ satisfaction. Despite the low rate of participation, these results underline the added value of such multidisciplinary and coordinated approach, encouraging us to pursue this functioning model.

Metrological non-destructive characterization of intense ( α , n) neutron sources (emission rate between 107 and 3 × 108 s−1 into 4 π sr solid angle) is a challenge for nuclear applications. In this article, we will present the design, development and in situ validation of two measurement cells especially dedicated to this characterization. The main goal consists in determining the absolute neutron emission rate of this type of neutron sources with relative uncertainties less than 5% (k=1). Another purpose is related to the qualitative and quantitative analysis of fission products present in irradiated neutron sources. Because of experimental constraints, acquisitions were carried out underwater which required a full remote control of the measurement cells. Neutron emission rate is assessed using three different non-destructive techniques: (i) global neutron counting, (ii) neutron activation using gold dosimeters and (iii) gamma-ray spectrometry. We will successively present the design step and associated constraints, main characteristics of measurement cells and associated laboratory characterization as well as experimental results obtained during the final in situ measurement campaign. The latter shows an excellent agreement regarding the neutron emission rate values provided by the three different non-destructive techniques and a relative combined standard uncertainty less than 5% (k=1) for the investigated neutron sources.

Plant root systems play many key roles including nutrient and water uptake, interface with soil microorganisms and resistance to lodging. As for other crops, large and systematic studies of sugarcane root systems have always been hampered by the opaque and solid nature of the soil. In recent years, methods for efficient extraction of DNA from soil and for species-specific DNA amplification have been developed. Such tools could have potential to greatly improve root phenotyping and health diagnostic capability in sugarcane. In this paper, we present a fast, specific and efficient method for the quantification of sugarcane live root cells in soil samples. Previous studies were typically based on mass and length, so we established a calibration to convert root DNA quantity to live root mass. This diagnostic was validated on field samples and used to investigate the fate of the root system after harvest prior to regrowth of the ratoon crop. Two weeks after harvest, the sugarcane roots from the previous crop were still viable. This raises the question of the role that the root system of the harvested crop plays in the performance of the next crop and demonstrates how this test can be used to answer research questions.

The emission probabilities of γ rays produced in the

A significant proportion of patients with locally advanced hypopharyngeal cancer could not be managed by larynx-sparing therapy. T4 stage is one of the main predictive factors of oncologic and functional outcomes.To analyze the therapeutic management of patients with locally advanced hypopharyngeal cancer in clinical practice and to report oncologic and functional outcomes.This was a retrospective study of all patients treated for a locally advanced hypopharyngeal squamous cell carcinoma between 2001 and 2012 at our institution.A total of 100 patients were included in this study. Induction chemotherapy (CT) followed by radiotherapy (RT) ± CT, primary RT + CT, and primary total pharyngolaryngectomy (TPL) comprised the initial therapeutic management for 54, 24, and 20 patients, respectively. Two patients received only supportive care. Overall survival (OS) and cause-specific survival (SS) were 50% and 60% at 3 years, respectively. In the group of patients referred for induction CT, the 3-year OS and SS were 58% and 70%, respectively. In multivariate analysis, T stage (p = 0.05) and ASA score (p = 0.02) were significant predictive factors of OS. T4 tumor stage had a pejorative impact on swallowing function after therapy (p = 0.006). The rate of patients alive, disease-free, and with a functional larynx at 2 years was 23%.

Aging time and storage conditions of silica stabilized gold nanoparticles impact the mechanism of nanoparticle-rattle structure formation. These differences are evaluated using electron microscopy and localized surface plasmon resonance spectroscopy coupled with modelling of gold nanosphere sensitivity to their local dielectric environment. Sample aging is revealed to impact the overall silica density and subsequent void formation in these structures. In all samples, voids formed near the metal cores and increased in size, which could be quantified using modelling. All in all, these results suggest that optimal silica membrane formation likely depends on initial silica density, which is directly related to sample age and storage conditions. As a result, these considerations as well as dielectric modelling could be exploited for future synthesis and use of these materials in surface enhanced spectroscopy and catalytic applications.

I cancri dell’ipofaringe insorgono, il piu delle volte, tra i 50 e i 70 anni, con, ancora, una larga preponderanza maschile. Si tratta, il piu delle volte, di carcinomi epidermoidi legati all’intossicazione alcolica e tabagica. Il bilancio comprende una valutazione clinica minuziosa, delle indagini endoscopiche e degli esami di diagnostica per immagini, il cui principale obiettivo consiste nel definire le estensioni e, quindi, lo stadio del tumore. Esso deve anche fare il punto sullo stato nutrizionale e sulle comorbilita del paziente che determinano grandemente le possibilita terapeutiche successive. Alcuni pazienti ben selezionati, che presentano un tumore di stadio precoce, possono trarre beneficio da una chirurgia faringolaringea parziale per via esterna o endoscopica. Tuttavia, per la maggior parte, i tumori dell’ipofaringe sono diagnosticati a uno stadio localmente avanzato e richiedono, sul piano chirurgico, una faringolaringectomia totale. In funzione dell’estensione del tumore e dello stato generale del paziente, puo, allora, essere proposto un protocollo di conservazione laringea, che lascia ampio spazio alla chemioterapia, in induzione o in associazione concomitante con la radioterapia. La prognosi di questi cancri rimane oggi particolarmente infausta, in particolare a causa della frequenza delle metastasi linfonodali e viscerali. I progressi futuri verranno probabilmente dall’integrazione delle terapie molecolari mirate ai vari stadi del trattamento della malattia.

Reaction kinetics is an axiomatic topic in chemistry that is often addressed as early as the high school course and serves as the foundation for more sophisticated conversations in college-level organic, physical, and biological chemistry courses. Despite the fundamental nature of reaction kinetics, students can struggle with transforming their corpuscular reaction concepts into mathematical rate models. Here, we describe an approach to teaching rate laws at the introductory college level that draws upon model-based reasoning as the pedagogical underpinning. Collision theory, graphical analysis of kinetics plots, and transformations between concentration/time and rate/concentration representations are used to facilitate the growth in understanding about rate laws and reaction mechanisms. The learning outcome expected by the conclusion of the instructional sequence is the ability to collect and analyze kinetic data to determine reaction orders and rate laws using mathematical concepts familiar to students ...

B. Vallet *, Y. Blanloeil , B. Cholley , G. Orliaguet , S. Pierre , B. Tavernier a a Pole d’anesthesie reanimation, hopital Huriez, CHRU de Lille, rue Polonovski, 59037 Lille cedex, France b Service d’anesthesie-reanimation chirurgicale, hopital G.-et-R.-Laennec, CHU de Nantes, 44093 Nantes cedex 1, France c Service d’anesthesie-reanimation, hopital europeen Georges-Pompidou, 20, rue Leblanc, 75908 Paris cedex 15, France d Service d’anesthesie-reanimation, hopital universitaire Necker–Enfants-Malades, universite Paris Descartes, Assistance publique–Hopitaux de Paris, 149, rue de Sevres, 75743 Paris cedex 15, France e Institut Claudius-Regaud, 20–24, rue du Pont-Saint-Pierre, 31052 Toulouse Cedex, France

High-resolution alpha-particle spectrometry was performed to determine the main alpha-particle emission probabilities in the decay of

Air Traffic Management (ATM) ensures the safety of flights by optimizing flows and maintaining separation between aircraft. Many ATM applications involve some aircraft trajectory optimization in order to improve the performance of the overall system. Trajectories are objects belonging to spaces with infinite dimensions. Widely used approaches are based on discretization, sampling trajectories at some regular points, and then using appropriate representations to reduce the dimension of the search space. We propose an approach in which trajectories in a two-dimensional space are designed with the help of convex hull generation. By using static as well as moving obstacles for which the position and the size are controlled by artificial evolution, we propose a new algorithm for efficient trajectory planning in Terminal Maneuvering Areas.

International audience; Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients. METHODS: All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection. RESULTS: Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR. CONCLUSIONS: HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.

Between the 24th of June and the 6th of July 2005, nine men came to Fort-de-France emergency department (Martinique, French West Indies) with more or less pronounced pulmonary symptoms associated in two cases with skin lesions. Three weeks before these nine men performed work in a deserted house. The diagnosis of histoplasmosis was based on pulmonary sample mycological analysis (direct examination and culture), molecular biology and serological tests. Interrogatory and environmental investigations on the presumed place of exposition to H. capsulatum var. capsulatum spores allowed confirming how and where contamination took place.

Background The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation. Methods A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals. Results Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals. Conclusion Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).