Perforated peptic ulcer disease in transferred patients is associated with significant increase in length of stay

BACKGROUND

Perforated peptic ulcer disease (PPUD) has a prevalence of 0.004-0.014% with mortality of 23.5% (Tarasconi et al. in World J Emerg Surg 15(PG-3):3, 2020). In this single center study, we examined the impact associated with patient transfer from outside facilities to our center for definitive surgical intervention (exploratory laparotomy).

METHODS

Using EPIC report workbench, we identified 27 patients between 2018 and 2021 undergoing exploratory laparotomy with a concurrent diagnosis of peptic ulcer disease, nine of which were transferred to our institution for care. We queried this population for markers of disease severity including mortality, length of stay, intensive care unit (ICU) length of stay, and readmission rates. Manual chart reviews were performed to examine these outcomes in more detail and identify patients who had been transferred to our facility for surgery from an outside hospital.

RESULTS

A total of 27 patients were identified undergoing exploratory laparotomy for definitive treatment of PPUD. The majority of patients queried underwent level A operations, the most urgent level of activation. In our institution, a Level A operation needs to go to the operating room within one hour of arrival to the hospital. Average mortality for this patient population was 14.8%. The readmission rate was 40.1%, and average length of ICU stay post-operatively was 16 days, with 83% of non-transfer patients requiring ICU admission and 100% of transfer patients requiring ICU admission, although this was not found to be statistically significant. Average length of hospital stay was 27 days overall. For non-transfer patients and transfer patients, LOS was 20 days and 41 days, respectively, which was statistically significant by one-sided t-test (p = 0.05).

CONCLUSION

Patients transferred for definitive care of PPUD in a population otherwise notable for high mortality and high readmission rates: their average length of stay compared to non-transfer patients was over twice the length, which was statistically significant. Transferred patients also had higher rates of ICU care requirement although this was not statistically significant. Further inquiry to identify modifiable variables to facilitate the care of transferred patients is warranted, especially in the context of improving quality metrics known to enhance patient outcomes, satisfaction, and value.

A longitudinal comparison of emotional, behavioral and attention problems in autistic and typically developing children

BACKGROUND

Mental health problems are elevated in autistic individuals but there is limited evidence on the developmental course of problems across childhood. We compare the level and growth of anxious-depressed, behavioral and attention problems in an autistic and typically developing (TD) cohort.

METHODS

Latent growth curve models were applied to repeated parent-report Child Behavior Checklist data from age 2-10 years in an inception cohort of autistic children (Pathways, N = 397; 84% boys) and a general population TD cohort (Wirral Child Health and Development Study; WCHADS; N = 884, 49% boys). Percentile plots were generated to quantify the differences between autistic and TD children.

RESULTS

Autistic children showed elevated levels of mental health problems, but this was substantially reduced by accounting for IQ and sex differences between the autistic and TD samples. There was small differences in growth patterns; anxious-depressed problems were particularly elevated at preschool and attention problems at late childhood. Higher family income predicted lower base-level on all three dimensions, but steeper increase of anxious-depressed problems. Higher IQ predicted lower level of attention problems and faster decline over childhood. Female sex predicted higher level of anxious-depressed and faster decline in behavioral problems. Social-affect autism symptom severity predicted elevated level of attention problems. Autistic girls' problems were particularly elevated relative to their same-sex non-autistic peers.

CONCLUSIONS

Autistic children, and especially girls, show elevated mental health problems compared to TD children and there are some differences in predictors. Assessment of mental health should be integrated into clinical practice for autistic children.

REALMS: Resilient exploration and lunar mapping system

Space resource utilisation is opening a new space era. The scientific proof of the presence of water ice on the south pole of the Moon, the recent advances in oxygen extraction from lunar regolith, and its use as a material to build shelters are positioning the Moon, again, at the centre of important space programs. These worldwide programs, led by ARTEMIS, expect robotics to be the disrupting technology enabling humankind’s next giant leap. However, Moon robots require a high level of autonomy to perform lunar exploration tasks more efficiently without being constantly controlled from Earth. Furthermore, having more than one robotic system will increase the resilience and robustness of the global system, improving its success rate, as well as providing additional redundancy. This paper introduces the Resilient Exploration and Lunar Mapping System, developed with a scalable architecture for semi-autonomous lunar mapping. It leverages Visual Simultaneous Localization and Mapping techniques on multiple rovers to map large lunar environments. Several resilience mechanisms are implemented, such as two-agent redundancy, delay invariant communications, a multi-master architecture different control modes. This study presents the experimental results of REALMS with two robots and its potential to be scaled to a larger number of robots, increasing the map coverage and system redundancy. The system’s performance is verified and validated in a lunar analogue facility, and a larger lunar environment during the European Space Agency (ESA)-European Space Resources Innovation Centre Space Resources Challenge. The results of the different experiments show the efficiency of REALMS and the benefits of using semi-autonomous systems.

SAT0229 PROTEOMIC ANALYSIS REVEALS ASSOCIATION BETWEEN IMMUNE-METABOLIC BIOMARKERS AND CLINICAL SYMPTOMS IN SICCA PATIENTS

Background:

Sjögren’s syndrome (SS) is a systemic autoimmune disease whose main characteristic is involvement of the exocrine glandular system. Thus, its most common clinical manifestation is eye and mouth dryness which, alongside fatigue and pain, contributes to poor health-related quality of life (HRQoL). A growing body of evidence recognises the adipose tissue as an active endocrine organ secreting bioactive mediators involved in metabolic and inflammatory disorders. A relationship between obesity and symptoms in SS has not yet been elucidated.

Objectives:

To explore potential associations between obesity-related immune-metabolic biomarkers and clinical symptoms in SS and sicca patients.

Methods:

Proteomics analysis of 184 cardio-immuno-metabolic proteins was assessed on sera from 53 SS (50 females (F), 3 males (M); mean age 54 years) and 60 sicca (56 F, 4 M; mean age 57 years) patients. Participants were enrolled in the Birmingham Optimising Assessment in Sjögren`s Syndrome (OASIS) cohort and examinations included the EULAR SS Patient Reported Index (ESSPRI), Schirmer’s test, unstimulated whole saliva, minor labial salivary gland biopsy, EuroQoL-5 dimension (EQ-5D) tool, immunological parameters, body max index (BMI) and Hb1Ac. Participants with SS fulfilled 2016 ACR/EULAR criteria. Non-SS sicca patients were anti-Ro antibody negative, displayed objective oral and/or ocular dryness, and did not have a physician diagnosis for SS. Linear regression analysis and univariate models were performed to identify the key predictors of symptoms.

Results:

HRQoL as measured as EQ-5D utility values, symptoms as assessed by ESSPRI, and BMI did not differ between the SS and sicca group. However, strong correlations between BMI (or fat or fat-free mass) and EQ-5D and ESSPRI scores were found in the sicca but not in the SS group. Among several proteins investigated, ADM, TNFRSF13B, FGF23, IL10RB, CD5, CD40, IL1RA, TNRSFN9, TNFRSF10A, TNFRSF11A, TRAILR2, GAL9, SPON2, ACE2, LEP, CD4, IL12B, SLAMF1, PD-L1 positively correlated with symptoms in the sicca group (R ≥ 0.3; Holm’s adjusted P ≤ 0.05). Adrenomedullin (ADM) showed the strongest correlation with ESSPRI (R = 0.56; P < 0.0001); age (R = 0.45; P = 0.0003); BMI (R = 0.43, P = 0.0008); Ocular Surface Disease Index (R = 0.32, P = 0.03); EQ-5D utility value (R = -0.45, P = 0.001) and VAS patient (R = -0.41, P = 0.008). There was no association between ADM and gender, Schirmer`s test, disease and symptom duration (P > 0.05). ADM was independently associated with ESSPRI scores in non-SS sicca patients when corrected for BMI, age, HbA1c, depression and anxiety scores. None of the above mentioned proteins correlated with clinical symptoms in the SS group.

Conclusion:

The study suggests that obesity-related immune-metabolic factors may play a role in regulating the symptoms in non-SS sicca patients. ADM appears to be a strong independent predictor of symptoms in these patients but not in SS.

Disclosure of Interests:

Valentina Pucino: None declared, Jason D. Turner: None declared, Florian Kollert Employee of: Novartis, Saaeha Rauz: None declared, Andrea Richard: None declared, Jon Higham: None declared, Ana Poveda-Gallego: None declared, Simon J. Bowman Consultant of: Astrazeneca, Biogen, BMS, Celgene, Medimmune, MTPharma, Novartis, Ono, UCB, xtlbio, Glapagos, Speakers bureau: Novartis, Francesca Barone: None declared, Benjamin Fisher: None declared

SAT0215 HISTORY OF TONSILLECTOMY IS ASSOCIATED WITH GLANDULAR INFLAMMATION IN SJÖGREN’S SYNDROME

Background:

The palatine tonsils are secondary lymphoid-organs that serve as the first line of defense against pathogens. Whether history of tonsillectomy (TE) is associated with the phenotype of Sjögren`s syndrome (SjS) has not been investigated to date.

Objectives:

To test whether TE is linked to SjS phenotype and disease activity scores.

Methods:

A total of 183 patients from the Optimising Assessment in Sjögren`s Syndrome (OASIS) cohort with SjS or non-SjS sicca syndrome were analysed. Patients with SjS fulfilled 2016 ACR/EULAR classification for primary SjS; sicca patients had objective and/or subjective dryness, but were anti-Ro/SSA negative and had no physician diagnosis of SjS. One SjS patient who had TE around the time of symptom onset was excluded.

Results:

Of the total cohort, 116 were diagnosed with SjS (86.2% SSA/Ro positive) and 67 with non-SjS sicca syndrome. Overall, 29% (53/183) had TE; 24.1% of the SjS patients (28/116) and 37.3% of the sicca patients (25/67). The prevalence of TE was higher in sicca than in SjS (p=0.043). The median age at TE was 8 (range 3-50) years and did not differ between SjS and sicca patients (p=0.629). Neither age at first symptoms (p=0.093) nor disease duration (p=0.623) were associated with TE in patients with SjS. SjS patients with TE showed a higher average histological focus score (2.1 (1.2-2.8) vs. 1.3 (0.0-4.3); p=0.049), and were more likely to have activity in the glandular (53.6 vs. 20.5%; p=0.001) and constitutional (39.3 vs. 14.9%, p=0.014) domains of the ESSDAI, and lower levels of IgG (12.2 (7.8-35.6) vs. 15.6 (5.7-56.4) g/l; p=0.012) and IgA (2.3 (0.9-6.6) vs. 2.9 (0.7-9.4) g/l; p=0.032). Whereas there was no difference in EQ5D utility values (p=0.718), VAS global health was significantly lower in the patients with SjS who had TE (58 (10-78) vs. 70 (10-97); p=0.021). There was no association between the status of TE and autoantibodies (SSA, SSB, RF), lachrymal and salivary glands function (Schirmer`s test, unstimulated saliva flow), complement (C3, C4), serum levels of free light chains, β2-microglobulin, ESSPRI, or total ESSDAI (all p-values >0.1). Of 181 patients, 12.7% (23/283) had appendectomy (AE); 10.5% (12/114) of the SjS patients and 16.4 %(11/67) of the sicca patients (p=0.258). With the exception of lower unstimulated salivary flow (0.086 (0.01-0.43) vs. 0.11 (0.0-1.3) ml/min; p=0.026) in SjS patients with AE, there were no differences in disease phenotype between SjS patients with and without AE (all p-values >0.1).

Conclusion:

History of TE in SjS is associated with higher average focus scores and with glandular swelling. It could be speculated that the absence of palatine tonsils is compensated by enhanced lymphocytic infiltrates in the salivary glands. Further research is required to determine if TE is a risk factor for both SjS and non-SjS sicca and to determine the role of the tonsils in the generation of hypergammaglobulinaemia in SjS.

Disclosure of Interests:

Florian Kollert Employee of: Novartis, Valentina Pucino: None declared, Saaeha Rauz: None declared, Andrea Richard: None declared, Jon Higham: None declared, Ana Povedo-Gallego: None declared, Rachel M. Brown: None declared, Timothy Bates: None declared, Simon J. Bowman Consultant of: Astrazeneca, Biogen, BMS, Celgene, Medimmune, MTPharma, Novartis, Ono, UCB, xtlbio, Glapagos, Speakers bureau: Novartis, Francesca Barone: None declared, Benjamin Fisher: None declared

Is body weight dissatisfaction associated with depression?

Introduction

Body image dissatisfaction is a risk factor for depression. Research has focused on female adolescents; yet little is known about sex and age differences.

Objectives/aims

The aim of our study was to evaluate the association of body weight dissatisfaction, a component of body image, with depression overall, and for different sex and age-groups independent of body weight.

Methods

We analyzed data of 15,975 individuals from the cross-sectional 2012 Swiss Health Survey. Participants were asked about their weight satisfaction. Patient Health Questionnaire (PHQ-9) was used to ascertain depression. Age was stratified in three groups (≥ 18-29; ≥ 30-59; ≥ 60 years). Body mass index (BMI) was self-reported and categorized into normal weight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25.0-29.9 kg/m2), and obesity (BMI: ≥ 30 kg/m2). The association between weight dissatisfaction and depression was assessed with logistic regression analyses and adjusted for known confounders (including BMI).

Results

Weight dissatisfaction was associated with depression in the overall group (OR: 2.04, 95% CI: 1.66-2.50) and in men (1.85, 1.34-2.56) and women (2.25, 1.71-2.96) separately, independent of body weight (multivariable adjusted). Stratification by age groups revealed associations of weight dissatisfaction with depression in young (1.78, 1.16-2.74), middle-aged (2.1, 1.61-2.74) and old individuals (2.34, 1.30-4.23) independent of BMI. A sub-analysis in the overall group revealed statistically significant positive associations of weight dissatisfaction with depression in underweight, normal weight, overweight and obese individuals.

Conclusion

Body weight dissatisfaction is associated with depression in men, women, young, middle-aged and old individuals independent of BMI.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Loneliness is adversely associated with lifestyle and physical and mental health

Introduction

Loneliness is a common emotional distress experience and there is increasing evidence of associations with unhealthy lifestyle and adverse health-related factors. Little is known about age and sex as potential effect modifiers, and about the prevalence of loneliness.

Objective/aims

To assess the associations of loneliness with behavioral, physical and mental health factors, taking sex and age into account and to examine the prevalence of loneliness in individuals aged 15+ years.

Methods

Data from 20,007 participants of the cross-sectional population-based Swiss Health Survey 2012 were analyzed. The association of loneliness with lifestyle and health-related factors were assessed with logistic regression analyses. Wald tests were used to test for age and sex differences.

Results

Loneliness was reported by 64.1% of individuals, and was associated with smoking (OR 1.13, 95% CI 1.05–1.23), physical inactivity (1.20, 1.10–1.31), non-adherence to the 5-a-day recommendation for fruit and vegetable consumption (1.21, 1.07–1.37), and more visits to a physician within the last year (1.29, 1.17–1.42). Loneliness was also associated with high cholesterol levels (1.31, 1.18–1.45), diabetes (1.40, 1.16–1.67), self-reported chronic diseases (1.41, 1.30–1.54), impaired self-perceived health (1.94, 1.74–2.16), moderate and high psychological distress (3.74, 3.37–4.16), and depression (2.78, 2.22–3.48). Age modulated the associations in BMI, smoking, visiting a physician within the past year, and self-perceived health. Sex did generally not modulate the associations.

Conclusion

Loneliness is associated with unhealthy lifestyle, and poorer physical and mental health. Associations were modulated by age, but not sex. Further longitudinal studies are needed to elucidate the causal relationships of these associations.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Amendment of soil by biochars and activated carbons to reduce chlordecone bioavailability in piglets

Chlordecone (Kepone or CLD) is a highly persistent pesticide formerly used in French West Indies. Nowadays high levels of this pesticide are still found in soils which represent a subsequent source of contamination for outdoor-reared animals. In that context, sequestering matrices like biochars or activated carbons (ACs) are believed to efficiently decrease the bioavailability of such compounds when added to contaminated soils. The present study intends to test the respective efficiency of soil amendment strategies using commercial ACs or biochars (obtained by a 500 °C or 700 °C pyrolysis of 4 distinct type of wood). This study involved three experimental steps. The first one characterized specific surface areas of biochars and ACs. The second one assessed CLD-availability of contaminated artificial soils (50 μg g^-1 of Dry Matter) amended with 5% of biochar or AC (mass basis). The third one assessed CLD bioavailability of those artificial soils through an in vivo assay. To limit ethically the number of animals, selections of the most promising media were performed between each experimental steps. Forty four castrated male 40-day-old piglets were exposed during 10 day by amended artificial soils according to their group (n = 4). Only treatment groups exposed through amended soil with AC presented a significant decrease of concentrations of CLD in liver and adipose tissue in comparison with the control group (p < 0.001). A non-significant decrease was obtained by amending artificial soil with biochars. This decrease was particularly high for a coconut shell activated carbon were relative bioavailability was found lower than 3.2% for both tissues. This study leads to conclude that AC introduced in CLD contaminated soil should strongly reduce CLD bioavailability.

Potent suppression of HIV-1 cell attachment by Kudzu root extract

There is a constant need to improve antiretrovirals against HIV since therapy is limited by cost, side effects and the emergence of drug resistance. Kudzu is a climbing vine from which the root extract (Pueraria lobata), rich in isoflavones and saponins, has long been used in traditional Chinese medicine for a variety of purposes, from weight loss to alcoholism prevention. Here we show that Kudzu root extract significantly inhibits HIV-1 entry into cell lines, primary human CD4⁺T lymphocytes and macrophages, without cell-associated toxicity. Specifically, Kudzu inhibits the initial attachment of the viral particle to the cell surface, a mechanism that depends on the envelope glycoprotein gp120 but is independent from the HIV-1 cell receptor CD4 and co-receptors CXCR4/CCR5. This activity seems selective to lentiviruses since Kudzu inhibits HIV-2 and simian immunodeficiency virus, but does not interfere with Hepatitis C, Influenza, Zika Brazil and adenovirus infection. Importantly, depending on the dose, Kudzu can act synergistically or additively with the current antiretroviral cocktails against HIV-1 and can block   viruses resistant to the fusion inhibitor Enfuvirtide. Together our results highlight Kudzu's root extract value as a supplement to current antiretroviral therapy against HIV.

Abnormal cerebellar processing of the neck proprioceptive information drives dysfunctions in cervical dystonia

The cerebellum can influence the responsiveness of the primary motor cortex (M1) to undergo spike timing-dependent plastic changes through a complex mechanism involving multiple relays in the cerebello-thalamo-cortical pathway. Previous TMS studies showed that cerebellar cortex excitation can block the increase in M1 excitability induced by a paired-associative stimulation (PAS), while cerebellar cortex inhibition would enhance it. Since cerebellum is known to be affected in many types of dystonia, this bidirectional modulation was assessed in 22 patients with cervical dystonia and 23 healthy controls. Exactly opposite effects were found in patients: cerebellar inhibition suppressed the effects of PAS, while cerebellar excitation enhanced them. Another experiment comparing healthy subjects maintaining the head straight with subjects maintaining the head turned as the patients found that turning the head is enough to invert the cerebellar modulation of M1 plasticity. A third control experiment in healthy subjects showed that proprioceptive perturbation of the sterno-cleido-mastoid muscle had the same effects as turning the head. We discuss these finding in the light of the recent model of a mesencephalic head integrator. We also suggest that abnormal cerebellar processing of the neck proprioceptive information drives dysfunctions of the integrator in cervical dystonia.

Mineralization and Preservation of an extremotolerant Bacterium Isolated from an Early Mars Analog Environment

The artificial mineralization of a polyresistant bacterial strain isolated from an acidic, oligotrophic lake was carried out to better understand microbial (i) early mineralization and (ii) potential for further fossilisation. Mineralization was conducted in mineral matrixes commonly found on Mars and Early-Earth, silica and gypsum, for 6 months. Samples were analyzed using microbiological (survival rates), morphological (electron microscopy), biochemical (GC-MS, Microarray immunoassay, Rock-Eval) and spectroscopic (EDX, FTIR, RAMAN spectroscopy) methods. We also investigated the impact of physiological status on mineralization and long-term fossilisation by exposing cells or not to Mars-related stresses (desiccation and radiation). Bacterial populations remained viable after 6 months although the kinetics of mineralization and cell-mineral interactions depended on the nature of minerals. Detection of biosignatures strongly depended on analytical methods, successful with FTIR and EDX but not with RAMAN and immunoassays. Neither influence of stress exposure, nor qualitative and quantitative changes of detected molecules were observed as a function of mineralization time and matrix. Rock-Eval analysis suggests that potential for preservation on geological times may be possible only with moderate diagenetic and metamorphic conditions. The implications of our results for microfossil preservation in the geological record of Earth as well as on Mars are discussed.

Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study

Essentials Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients. We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients). At three months, the cumulative incidence of clinically relevant bleeding was 9.8%. Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.

SUMMARY

Background The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown. Objectives Our primary aim was to assess the bleeding risk of patients in a real-world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding. Patients/Methods In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non-major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis. Results The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3-11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2-1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months. Conclusions Decisions regarding the use of thromboprophylaxis in palliative care patients should take into account the high risk of bleeding in these patients.

Direct Evidence of Octupole Deformation in Neutron-Rich ^{144}Ba

The neutron-rich nucleus ^{144}Ba (t_{1/2}=11.5  s) is expected to exhibit some of the strongest octupole correlations among nuclei with mass numbers A less than 200. Until now, indirect evidence for such strong correlations has been inferred from observations such as enhanced E1 transitions and interleaving positive- and negative-parity levels in the ground-state band. In this experiment, the octupole strength was measured directly by sub-barrier, multistep Coulomb excitation of a post-accelerated 650-MeV ^{144}Ba beam on a 1.0-mg/cm^{2} ^{208}Pb target. The measured value of the matrix element, ⟨3_{1}^{-}∥M(E3)∥0_{1}^{+}⟩=0.65(+17/-23) eb^{3/2}, corresponds to a reduced B(E3) transition probability of 48(+25/-34)  W.u. This result represents an unambiguous determination of the octupole collectivity, is larger than any available theoretical prediction, and is consistent with octupole deformation.

Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center

Objective.

To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).

Design.

Diagnostic accuracy study.

Setting.

A 425-bed university hospital.

Subjects.

A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.

Methods.

An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.

Results.

Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.

Conclusion.

The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.

Infect Control Hosp Epidemiol2014;35(6):685–691

Constraints on Mimas' interior from Cassini ISS libration measurements

Like our Moon, the majority of the solar system's satellites are locked in a 1:1 spin-orbit resonance; on average, these satellites show the same face toward the planet at a constant rotation rate equal to the satellite's orbital rate. In addition to the uniform rotational motion, physical librations (oscillations about an equilibrium) also occur. The librations may contain signatures of the satellite's internal properties. Using stereophotogrammetry on Cassini Image Science Subsystem (ISS) images, we measured longitudinal physical forced librations of Saturn's moon Mimas. Our measurements confirm all the libration amplitudes calculated from the orbital dynamics, with one exception. This amplitude depends mainly on Mimas' internal structure and has an observed value of twice the predicted one, assuming hydrostatic equilibrium. After considering various possible interior models of Mimas, we argue that the satellite has either a large nonhydrostatic interior, or a hydrostatic one with an internal ocean beneath a thick icy shell.

Accuracy of electronic surveillance of catheter-associated urinary tract infection at an academic medical center

OBJECTIVE

To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).

DESIGN

Diagnostic accuracy study.

SETTING

A 425-bed university hospital.

SUBJECTS

A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.

METHODS

An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.

RESULTS

Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.

CONCLUSION

The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.

Racial variation in sex steroid hormone concentration in black and white men: a meta-analysis

Sex steroid hormones are associated with chronic diseases and mortality with risk associations that differ between racial and ethnic groups. However, it is currently unclear whether sex steroid hormone levels differ between black and white men. The aim of this study was to assess racial variation in circulating testosterone, free testosterone, sex hormone-binding globulin (SHBG) and estradiol levels in men. We searched PubMed for articles comparing circulating hormones in black and white men. A meta-analysis was performed using weighted mean differences (WMD) to compare hormones levels between black and white men. Fifteen eligible studies were identified; three did not report adjusted means. After age adjustment, free testosterone levels were significantly higher in black than in white men (WMD = 4.07 pg/mL, 95% CI 1.26, 6.88). Depending on the free testosterone concentration in white men, this WMD translates into a racial difference ranging from 2.5 to 4.9%. Total testosterone (WMD = 0.10 ng/mL, 95% CI -0.02, 0.22), estradiol (WMD = 0.67 pg/mL, 95% CI -0.04, 1.38) and SHBG (WMD = -0.45 nmol/L, 95% CI -1.75, 0.85) concentrations did not differ comparing blacks with whites. After adjustment for age, black men have a modestly but significantly 2.5 to 4.9% higher free testosterone level than white men. Based on previous studies on effects of sex steroid hormones on risk of chronic diseases or mortality, this modest difference is unlikely to explain racial differences in disease risk.

External fluorescence retention of calcein-marked juvenile brown trout Salmo trutta raised in natural and artificial environments

The fluorescence retention and intensity of juvenile brown trout Salmo trutta marked during their first summer were monitored in a hatchery and in four natural streams. A handheld detector was used for direct examination. In the hatchery, three marking treatments (T) were compared: 3·5 min in a 0·5% calcein solution (T0·5-3·5), 7 min in a 0·5% calcein solution (T0·5-7) and 3·5 min in a 1% calcein solution (T1-3·5). The fish were raised indoors for 11 months and then outdoors until 18 months. The fluorescence retention rate was 100% in all treatments at 11 months, although T1-3·5 showed the highest mean fluorescence intensity, followed by T0·5-7 and T0·5-3·5. The fluorescence intensity was not correlated with the final total length (L(T)) of the fish in two treatments, although it significantly decreased with increasing L(T) in T1-3·5. At 18 months, <30% of the fish were still slightly fluorescent, suggesting a negative effect of sunlight exposure. In stream studies, the fluorescence intensity did not significantly differ according to final L(T); an overall mean ± s.d. retention rate of 70·7 ± 26·6% was measured at 12 months with a decrease to 48·6 ± 24·6% at 24 months. Significant differences amongst streams and within reaches of the same stream were observed. Because of a significant positive effect of the shading index on the fluorescence intensity, the use of calcein should be restricted to streams unexposed to direct sunlight. Consequently, the marking method would be reliable for 1 year monitoring studies in shaded streams.

Time-resolved characterization of primary emissions from residential wood combustion appliances

Primary emissions from a log wood burner and a pellet boiler were characterized by online measurements of the organic aerosol (OA) using a high-resolution time-of-flight aerosol mass spectrometer (HR-TOF-AMS) and of black carbon (BC). The OA and BC concentrations measured during the burning cycle of the log wood burner, batch wise fueled with wood logs, were highly variable and generally dominated by BC. The emissions of the pellet burner had, besides inorganic material, a high fraction of OA and a minor contribution of BC. However, during artificially induced poor burning BC was the dominating species with ∼80% of the measured mass. The elemental O:C ratio of the OA was generally found in the range of 0.2-0.5 during the startup phase or after reloading of the log wood burner. During the burnout or smoldering phase, O:C ratios increased up to 1.6-1.7, which is similar to the ratios found for the pellet boiler during stable burning conditions and higher than the O:C ratios observed for highly aged ambient OA. The organic emissions of both burners have a very similar H:C ratio at a given O:C ratio and therefore fall on the same line in the Van Krevelen diagram.

Pelioid hepatocellular carcinoma in an adult Eurasian badger (Meles meles)

A mass was identified within the left lateral lobe of the liver of a 10-year-old Eurasian badger (Meles meles). The mass was friable and multilobulated, with blood-filled spaces between the lobules. Microscopically, the lesion consisted of sheets and trabeculae of neoplastic hepatocytes often forming cystic spaces containing erythrocytes, fibrin and necrotic debris. The histological appearance was consistent with hepatocellular carcinoma (HCC). Immunohistochemically, the neoplastic cells expressed cytokeratin 18 but not von Willebrand factor. Multiple intranuclear (amphophilic or acidophilic) inclusion bodies were observed in hepatocytes at the junction between the tumour and normal hepatic tissue. HCCs have also been reported in other domestic and wild animals. As hepadnavirus infection has been associated with HCC in woodchucks, further histochemical and transmission electron microscopical studies were performed; however, these demonstrated that the inclusions consisted of lipid droplets and not viral particles. To our knowledge, this is the first report of a naturally occurring HCC in a Eurasian badger.

[Fetal ultrasonography and Doppler in isolated congenital heart block]

Isolated congenital heart block is linked to transplacental passage of maternal anti-SSA/Ro and/or anti-SSB/La antibodies that may be related to a connective tissue disease. Ultrasonography and Doppler are essential to screen fetus at risk. They allow the diagnosis of first- and second-degree blocks which are probably preliminary stages in conducting tissue's injury. In these situations, a maternal treatment by fluorinated steroids can be proposed because of its possible effect on partial blocks. However, these early signs of nodal injury can be lacking: some fetus present a complete heart block without previously detected less advanced block. Moreover, the significance of first-degree block is unclear since it could reverse spontaneously. Other markers of nodal injury would be valuable. In case of complete congenital heart block, ultrasonography is useful to detect congestive heart failure and help the obstetrical management when unfavorable prognostic signs occur.

Formulation and characterization of polyphenol-loaded lipid nanocapsules

The purpose of this study was to design and characterize two flavonoid-loaded lipid nanocapsules (LNC) by applying the phase inversion process, and to enhance their apparent solubility and/or the stability. The flavonoid-loaded LNC were characterized by particle size, encapsulation efficiency, drug leakage rates, stability and spectroscopic studies. It was observed that quercetin-loaded LNC30 (3%) and LNC60 (2%) carried a particle size of 30.3 and 55.1 nm, respectively and significant higher entrapment efficiency. Encapsulation of quercetin (QC) in LNC enabled us to increase its apparent aqueous solubility by a factor of 100. And in view of calculations and results, it seems most probable that QC is arranged at this LNC interface between the oil phase and the hydrophilic polyethylene glycol moieties of the surfactant. In addition, colloidal suspensions proved to be stable in term of encapsulation for at least 10 weeks and QC was not oxidised. With simple chemical modification of (-)-epigallocatechin-3-gallate or (-)-EGCG, it was possible to reach very high encapsulation rates (95%). Thus we obtained stable colloidal suspensions of (-)-EGCG in water over 4 weeks while free (-)-EGCG solubilised in water exhibited 100% degradation within 4h. The initial problems (solubility and stability) of these flavonoids were resolved thanks to drug-loaded LNC.

Electronic and mechanical coupling of carbon nanotubes: a tunable resonant Raman study of systems with known structures

We report on the first tunable resonant Raman scattering study performed on suspended isolated and coupled single-wall carbon nanotubes, unambiguously identified by electron diffraction. Besides the confirmation of the relation between the structural properties, the radial breathing frequency and the optical resonances for isolated metallic nanotubes, we evidence that interacting nanotubes experience drastic modifications of their resonance fingerprints. We first demonstrate a degeneracy lifting of an electronic level in a bundle of identical zigzag nanotubes. We then show the existence of a strong energy transfer mediated by a mechanical coupling between two nonidentical bundled nanotubes.

Diagnostics hardening for harsh environment in Laser Megajoule (invited)

The diagnostic designs for the Laser Megajoule (LMJ) will require components to operate in environments far more severe than those encountered in present facilities. This harsh environment will be induced by fluxes of neutrons, gamma rays, energetic ions, electromagnetic radiations, and, in some cases, debris and shrapnel, at levels several orders of magnitude higher than those experienced today on existing facilities. The lessons learned about the vulnerabilities of present diagnostic parts fielded mainly on OMEGA for many years, have been very useful guide for the design of future LMJ diagnostics. The present and future LMJ diagnostic designs including this vulnerability approach and their main mitigation techniques will be presented together with the main characteristics of the LMJ facility that provide for diagnostic protection.

A versatile high-resolution x-ray imager (HRXI) for laser-plasma experiments on OMEGA

A high-resolution x-ray imager (HRXI) devoted to laser-plasma experiments combines two state-of-the-art technologies developed in France: a high-resolution x-ray microscope and a high-speed x-ray streak camera. The resulting streaked imager achieves spatial and temporal resolutions of approximately 5 microm and approximately 10 ps, respectively. The HXRI has recorded enhanced spatial and temporal resolution radiographs of indirectly driven targets on OMEGA. This paper describes the main features of the instrument and details the activation process on OMEGA (particularly the alignment). Recent results obtained on joint CEA/LLE radiographic OMEGA experiments will also be presented.

Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women

BACKGROUND

Chloasma, or melasma, is a pigmentary disorder that can affect between 50% and 70% of pregnant women. During pregnancy, chloasma does not require any particular treatment beside the use of an effective sunscreen and avoiding the use of any photosensitizing products or inappropriate skin care routine. However, there exist very few studies related to the benefits of sunscreens to prevent this dermatosis.

OBJECTIVE

The aim of this study was to assess the role of a broad-spectrum sunscreen in the prevention and treatment of chloasma in pregnant women.

METHODS

We tested the effectiveness and tolerance of a sunscreen composition (SPF 50+, UVA-PF 28) during a 12-month clinical trial on 200 parturients.

RESULTS

The 'excellent' tolerance of the sunscreen under evaluation was confirmed. Out of 185 patients who completed the study, only five new cases of chloasma were noted, an occurrence of 2.7%, which is much lower than the 53% previously observed in an usual condition study (same investigators, same geographical area and same time frame). In addition, the clinical effectiveness of the evaluated sunscreen was judged 'excellent' by the majority of parturients and by the research dermatologists during all the consultations. It is also worth noting that at 6 months, a clinical improvement was observed in 8 out of 12 volunteers who were affected by a pre-existing chloasma observed during their inclusion visit. Colorimetric measurements showed that, at the end of their pregnancy, the parturients' skin was, on average, significantly lightened (increase of parameter L* in 38% cases) and less pigmented (reduction of parameter b* in 50% cases); thus, resulting in a significantly lighter skin colour (increase of ITA degrees in 69% cases) compared to their inclusion visit.

CONCLUSIONS

This study clearly demonstrates the effectiveness of the well-tolerated broad-spectrum sunscreen evaluated, in the prevention of the development of chloasma in pregnant women.

[Effectiveness of a health network in secondary prevention among coronary patients]

OBJECTIVE

To improve the secondary prevention, particularly hypertension management among coronary patients.

METHODS

In 2004-2005, out of 175 coronary patients having taken part in a cycle of the Educoeur center of the health network Rivarance, 131 (75%) aged between 32-79 years of age (an average of 61 years with 11% women, 52% hypertensive, 24% smokers, 10% diabetics and 72% with unbalanced dyslipidemia (LDL>1g/l)) were re-examined within 12 months and were compared with a French cohort of the EuroAspire II study (365 patients - Lancet 2001). 56% were treated by angioplasty, 24% by coronary bypass and 20% by medical treatment. The 4-week ambulatory educational program consisted of a physical education with 22 meetings of cardiac rehabilitation (ergo cycle, carpet, segmentary muscular work, steps and balneotherapy) and a therapeutic and dietetic education (18 courses and cooking workshops, supermarket visits and self BP measurement). These 131 patients were re-examined 3, 6 and 12 months after by the paramedical team. The GP and nurses were taught recommendations on CV risk factors management. The patients were followed by a computerized medical file. BP (average of 3 measurements by OMRON M4), total cholesterol (CT), weight, physical activity (insufficient if less than 3 walks of 30 min per week), smoking and drugs intake were analyzed on J0 then at one year and were compared with the French results of EuroAspire II. [table: see text]

CONCLUSION

The education and the follow-up of the patient in a network of health improve CV risk factors and particularly hypertension management of these coronary patients but this decreases with time.