Towards an integrated blood pressure self-monitoring solution for stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial

BACKGROUND

Optimising blood pressure (BP) control is one of the most important modifiable risk factors in preventing subsequent stroke where the risk increases by one-third for every 10 mmHg rise in systolic BP. This study evaluated the feasibility and potential effectiveness of blood pressure self-monitoring with planned medication titration, to inform a definitive trial of the intervention, in patients with a previous stroke or transient ischaemic attack (TIA).

METHODS

Patients with a history of stroke/TIA and sub-optimal BP control were invited to take part in a mixed methods feasibility study for a randomised controlled trial. Those meeting the inclusion criteria with systolic BP >130 mmHg were randomised to a self-monitoring intervention group or usual care group. The intervention involved self-monitoring BP twice a day for 3 days within a 7-day period, every month, following text message reminders. Treatment escalation, based on a pre-agreed plan by the general practitioner (GP) and patient, was initiated according to the results of these readings. Semi-structured interviews were carried out with patients and clinicians and analysed thematically.

RESULTS

Of those identified, 47% (32/68) attended for assessment. Of those assessed, 15 were eligible for recruitment and were consented and randomised to the intervention or control group on a 2:1 basis. Of those randomised, 93% (14/15) completed the study and there were no adverse events. Systolic BP was lower in the intervention group at 3 months. Participants found the intervention acceptable and easy to use. GPs found it easy to incorporate into their practice activity without increasing workload.

CONCLUSIONS

TASMIN5S, an integrated blood pressure self-monitoring intervention in patients with a previous stroke/TIA, is feasible and safe to deliver in primary care. A pre-agreed three-step medication titration plan was easily implemented, increased patient involvement in their care, and had no adverse effects. This feasibility study provides important information to inform a definitive trial to determine the potential effectiveness of the intervention in patients post-stroke or TIA.

TRIAL REGISTRATION

ISRCTN57946500 . Registered on 12/08/2019.

3-year incidence and predictors of metabolic syndrome in schizophrenia in the national FACE-SZ cohort

AIMS

Metabolic Syndrome (MetS) is a major health epidemic of Western countries and patients with schizophrenia is a particularly vulnerable population due to lifestyle, mental illness and treatment factors. However, we lack prospective data to guide prevention. The aim of our study is then to determine MetS incidence and predictors in schizophrenia.

METHOD

Participants were recruited in 10 expert centers at a national level and followed-up for 3 years. MetS was defined according to the International Diabetes Federation criteria. Inverse probability weighting methods were used to correct for attrition bias.

RESULTS

Among the 512 participants followed-up for 3 years, 77.9% had at least one metabolic disturbance. 27.5% were identified with MetS at baseline and excluded from the analyses. Among the rest of participants (N = 371, mean aged 31.2 (SD = 9.1) years, with mean illness duration of 10.0 (SD = 7.6) years and 273 (73.6%) men), MetS incidence was 20.8% at 3 years and raised to 23.6% in tobacco smokers, 29.4% in participants receiving antidepressant prescription at baseline and 42.0% for those with 2 disturbed metabolic disturbances at baseline. Our multivariate analyses confirmed tobacco smoking and antidepressant consumption as independent predictors of MetS onset (adjusted odds ratios (aOR) = 3.82 [1.27-11.45], p = 0.016, and aOR = 3.50 [1.26-9.70], p = 0.0158). Antidepressant prescription predicted more specifically increased lipid disturbances and paroxetine was associated with the highest risk of MetS onset.

CONCLUSION

These results are an alarm call to prioritize MetS prevention and research in schizophrenia. We have listed interventions that should be actively promoted in clinical practice.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Supporting decision making on public health and social measures in response to COVID-19- The PHSM calibration tool

 

Public health and social measures (PHSM) are preventative measures taken by individuals, communities and government institutions at national and local levels to prevent and reduce transmission of an infectious disease - in this instance SARS-CoV-2. The decision to introduce, adapt or lift PHSM should be based primarily on a situational assessment of the intensity of transmission of SARS-CoV-2 and the capacity of the health system to respond to subsequent increases in hospital admissions, but must also consider the effects these measures may have on the general welfare of society and individuals. The WHO Regional Office for Europe developed an online public health and social measures (PHSM) calibration tool to assist Member States in decision-making relating to PHSM implementation during the COVID-19 pandemic. The tool, designed to be used primarily by policy-makers in national and local government authorities, provides guidance based on a situational-level assessment framework that is determined by the level of community transmission and the overall capacity of health systems and public health services within a country or region to respond. By using a combination of country-reported and user-input data, the tool automatically generates a situational assessment and corresponding PHSM guidance for users, summarized in a downloadable report.

Reference

https://phsm.euro.who.int/calibrationTool

Estimating the prevalence of congenital disaccharidase deficiencies using allele frequencies from gnomAD

BACKGROUND

There are currently three known congenital disaccharidase deficiencies: congenital lactase deficiency (CLD), congenital sucrase-isomaltase deficiency (CSD), and congenital trehalase deficiency (CTD). No congenital deficiency has been described for maltase-glucoamylase (MGAM).

METHODS

A literature search was performed in PubMed for the pathogenic variants CLD, CSD, and CTD and the articles retrieved were analyzed to estimate the prevalence of congenital disaccharidase deficiencies.

RESULTS

Based on reported variants, the estimated prevalence was 1.3 per 10⁶ births (95% CI: 1.1-1.7) for CLD, and 31.4 per 10⁶ births (95% CI: 28.3-34.8) for CSD. Using data on previously reported variants and variants predicted to be loss-of-function in gnomAD, the overall estimated prevalence was 2.3 per 10⁶ births (95% CI: 1.9-2.9) for CLD, 57.6 per 10⁶ births (95% CI:52.5-63.2) for CSD, and 9.2 per 10⁶ births (95% CI: 2.5-3.7) for CTD.

CONCLUSION

The prevalence of CSD was found to be relatively high, while for other congenital disaccharidase deficiencies, the estimated prevalence was very low.

The impact of parent history of severe mental illness on schizophrenia outcomes: results from the real-world FACE-SZ cohort

Parent history of severe mental illness (PHSMI) may have long-term consequences in adult offspring due to genetic and early environmental factors in preliminary studies. To compare the outcomes associated in subjects with PHSMI to those in patients without PHSMI. The participants with schizophrenia and schizoaffective disorders were recruited in the ongoing FACE-SZ cohort at a national level (10 expert centers) and evaluated with a 1-day-long standardized battery of clinician-rated scales and patient-reported outcomes. PHSMI was defined as history of schizophrenia or bipolar disorders in at least one parent and was included as explanatory variable in multivariate models. Of the 724 included patients, 78 (10.7%) subjects were classified in the PHSMI group. In multivariate analyses, PHSMI patients had a better insight into schizophrenia and the need for treatment and reported more often childhood trauma history compared to patients without PHSMI. More specifically, those with paternal history of SMI reported more severe outcomes (increased childhood physical and emotional abuses, comorbid major depression and psychiatric hospitalizations). PHSMI is associated with increased risk of childhood trauma, major depressive disorder and psychiatric hospitalization and better insight in individuals with schizophrenia. Specific public health prevention programs for parents with SMI should be developed to help protect children from pejorative psychiatric outcomes. PHSMI may also explain in part the association between better insight and increased depression in schizophrenia.

Applying the behaviour change wheel to develop a smartphone application 'stay-active' to increase physical activity in women with gestational diabetes

BACKGROUND

Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population.

METHODS

The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active's development.

RESULTS

We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages.

CONCLUSION

The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.

Enhanced Automatic Segmentation for Superficial White Matter Fiber Bundles for Probabilistic Tractography Datasets

This paper presents an enhanced algorithm for automatic segmentation of superficial white matter (SWM) bundles from probabilistic dMRI tractography datasets, based on a multi-subject bundle atlas. Previous segmentation methods use the maximum Euclidean distance between corresponding points of the subject fibers and the atlas centroids. However, this scheme might include noisy fibers. Here, we propose a three step approach to discard noisy fibers improving the identification of fibers. The first step applies a fiber clustering and the segmentation is performed between the centroids of the clusters and the atlas centroids. This step removes outliers and enables a better identification of fibers with similar shapes. The second step applies a fiber filter based on two different fiber similarities. One is the Symmetrized Segment-Path Distance (SSPD) over 2D ISOMAP and the other is an adapted version of SSPD for 3D space. The last step eliminates noisy fibers by removing those that connect regions that are far from the main atlas bundle connections. We perform an experimental evaluation using ten subjects of the Human Connectome (HCP) database. The evaluation only considers the bundles connecting precentral and postcentral gyri, with a total of seven bundles per hemisphere. For comparison, the bundles of the ten subjects were manually segmented. Bundles segmented with our method were evaluated in terms of similarity to manually segmented bundles and the final number of fibers. The results show that our approach obtains bundles with a higher similarity score than the state-of-the-art method and maintains a similar number of fibers.Clinical relevance-Many brain pathologies or disorders can occur in specific regions of the SWM automatic segmentation of reliable SWM bundles would help applications to clinical research.

A-03 The Brain–Body Connection in Aging Neurological Populations: Examining the Impact of Exercise and Sedentary Behavior on Brain Structure and Cognitive Functioning in Older Adults with Multiple Sclerosis

Objective

Advancements in treatments for multiple sclerosis (MS) have led to an increase in the number of older adults living with the disease. Exercise has been shown to be remarkably beneficial for “healthy aging,” while sedentary behavior has proved to have more deleterious effects. Despite evidence for the impact of these factors, their influence on older adults with MS is largely unknown. The current study utilizes volumetric measures and graph theory to investigate the relationship between physical activity/sedentary behavior, structural brain indices, and cognition in older adults with MS.

Method

Twenty-seven older adults (55+) with MS were scanned during a structural MRI protocol and cognitively evaluated using the Multiple Sclerosis Functional Composite and Symbol Digit Modalities Test. Graph theory metrics were calculated to examine white matter network properties. FreeSurfer was used to calculate volumes for subcortical structures. Exercise was quantified as the ‘days per week engaged in moderate activity,’ while sedentary behavior was measured as ‘hours per day sitting.’

Results

Multiple regression interaction analyses were conducted. Results showed an exercise by age interaction, such that exercise protected against the negative effects of age on thalamic volume and assortivity. Hours sitting per day was shown to add to the negative effects of aging on structural networks even after controlling for exercise. Lastly, exercise was observed to be protective against age-related cognitive decline in this sample.

Conclusions

This is one of the first studies to examine exercise/sedentariness and brain indices in older adults with MS, pointing to possible brain altering and protective interventions for this group.

COVID-19 pandemic in France: health emergency experiences from the field

Aim

This paper describes the situation regarding COVID‐19 emergency in France as of early May 2020, the main policies to fight this virus, and the roles and responsibilities of nurses regarding their work at this time, as well as the challenges facing the profession.

Background

Europe continues to be affected by the COVID‐19 pandemic. At the time of writing France was the fourth country with the highest number of detected cases and cumulative deaths.

Sources of evidence

Websites of the World Health Organization, French Government, French Agency of Public Health, French National Council of Nurses and ClinicalTrials.gov database, as well as the experiences of the authors.

Discussion

The history of the development of the pandemic in France helps explain the establishment of the state of health emergency and containment of the population. Many decisions made had undesirable repercussions, particularly in terms of intra‐family violence, mental health disorders and the renunciation of care. Hospitals and primary care services, with significant investment by nurses, played a key role in the care of persons with and without COVID‐19.

Conclusion

France has suffered a very high toll in terms of COVID‐19 morbidity and mortality, and effects on its people, health systems and health professionals, including nurses.

Implications for nursing practice

Nurses are recognized for their social usefulness in France. However, it is important to consider the collateral effects of this crisis on nurses and nursing and to integrate the health emergency nursing skills established during the pandemic into the standard field of nursing competence.

Implications for nursing policy

The nursing profession has expectations of a reflection on and revision of nursing skills as well as of its valorization in the French healthcare system, notably carried out by the French National Council Order of Nurses.

A new look at an old test: Normative data of the symbol digit modalities test -Oral version

BACKGROUND

The Symbol Digit Modalities Tests (SDMT) is the most sensitive measure to multiple sclerosis (MS)-related cognitive dysfunction. However, existing normative data has been under scrutiny. Specifically, they are outdated, do not take into account gender, and are poorly stratified by education. More importantly, there exists no oral only version norms, which is typical administration among individuals with MS.

OBJECTIVE

The present investigation aimed to develop updated normative data of the oral version SDMT in which age, gender, and education were taken into consideration.

METHODS

A total of 675 healthy individuals, stratified by age, gender, and education completed the oral version SDMT.

RESULTS

Significant effects were found for age, gender, and education, consistent with previous contentions. Specifically, performance on the SDMT tends to decline with age, with the most noticeable decline beginning in the third decade of life and continuing into the sixth decade. Women, in general perform better than men, with an average of 5.1 more points. Finally, education effects were apparent among those aged 25-54.

CONCLUSION

Based on these findings, updated normative data are provided. Utilization of these updated norms will result in a much needed and more accurate assessment of processing speed for individuals with MS.

The effect of the number of fibers in tractography reconstruction of white matter bundles

The study of white matter (WM) through diffusion Magnetic Resonance Imaging (dMRI) is crucial to obtain a better understanding of human brain connections and functions, at a macroscopic level. A large number of works have focused on long range brain connections, while recently, several studies have also analyzed superficial WM connectivity. In recent years, with the massive use of HCP database, and its processing with known softwares like DSI Studio and MRtrix, it is necessary to evaluate the influence of tractography parameters on the reconstruction of fiber bundles and further analyses. We study the effect of the number of fibers, for whole brain tractography, on the reconstruction of deep and superficial WM bundles based on their segmentation using multi-subject bundle atlases. For DSI Studio (deterministic algorithm), a value of 1M fibers could reconstruct most of deep white matter (DWM) bundles, while a value of 1.5M was required for superficial white matter (SWM) bundles. In the case of MRtrix (probabilistic algorithm), a value of 3M fibers was found to be suitable for the study of both kinds of fibers. Furthermore, we found the tracking of SWM bundles to be more sensitive to several parameters than DWM, for DSI Studio.

MICI-MINOTS: Linguistic and metric validation of a pediatric questionnaire on knowledge about inflammatory bowel disease

BACKGROUND

Therapeutic education is an essential part of the treatment of chronic diseases, such as inflammatory bowel disease (IBD). The IBD-KID, developed in Canada in English, assesses children's and adolescents' acquired knowledge about their condition and has been validated in Canadian and Australian populations. However, there is no pediatric questionnaire in French to assess patients' knowledge about IBD.

OBJECTIVE

To report the linguistic validation process and metric validity of the MICI-MINOTS, the French version of the IBD-KID.

METHOD

The translation process consisted of three consecutive steps: forward-backward translation, acceptability testing, and cognitive interviews. The IBD-KID consists of 23 questions, but a 24th question about immunomodulatory therapy was added in the MICI-MINOTS. Psychometric testing was conducted with five groups: children with IBD, their parents, children in a control group, their parents, and health workers recruited from the Timone Pediatric Hospital and the Saint-Sébastien Maternal and Child Protection Center, Marseille, France. A total of 15 individuals completed the tool twice, with a 15-day interval. Internal consistency, reliability, external validity, reproducibility, and sensitivity to change were tested.

RESULTS

A total of 38 children with IBD (sex: 20 boys, 18 girls; age: 13.90 [±2.88] years; 25 with Crohn's disease), 20 children in the control group, 58 parents (every child was included with one parent), and 62 health workers were included in the analysis. Intraclass correlation was 0.94 (95% confidence interval 0.83-0.98) for test-retest assessment. Readability using the Scolarius score corresponded to elementary school level. Among the children with IBD, 89.5% answered all 24 questions. For 23 questions, the mean score of children with IBD was higher than among children in the control group: 9.58 (±3.01) versus 5.47 (±3.56), respectively (P<0.01). Parents of children with IBD scored higher than parents of children in the control group: 10.63 (±3.16) versus 8.4 (±3.07), respectively (P=0.012). In the health workers' group, pediatric residents (17.82±3.46) scored higher than nurses 11.75 (±3.4) and ward clerks (8.67±2.40; P<0.01). Patients' knowledge score was significantly related to their parents' knowledge score (r=0.402, P=0.012) for 23 questions.

CONCLUSION

The French version of the IBD-KID showed satisfactory psychometric properties to assess knowledge about the disease in French-speaking children.

Ocean deoxygenation and zooplankton: Very small oxygen differences matter

Oxygen minimum zones (OMZs), large midwater regions of very low oxygen, are expected to expand as a result of climate change. While oxygen is known to be important in structuring midwater ecosystems, a precise and mechanistic understanding of the effects of oxygen on zooplankton is lacking. Zooplankton are important components of midwater food webs and biogeochemical cycles. Here, we show that, in the eastern tropical North Pacific OMZ, previously undescribed submesoscale oxygen variability has a direct effect on the distribution of many major zooplankton groups. Despite extraordinary hypoxia tolerance, many zooplankton live near their physiological limits and respond to slight (≤1%) changes in oxygen. Ocean oxygen loss (deoxygenation) may, thus, elicit major unanticipated changes to midwater ecosystem structure and function.

Beyond the expected: Identifying broad research priorities of researchers and the cystic fibrosis community

The Cystic Fibrosis Foundation (CFF) supports research programs aimed at improving care and building a successful drug development pipeline. To ensure its research agenda meets the needs of the community it serves, the CFF sought community input into clinical research prioritization for topics not well-known as already being addressed by CFF-funded research. In 2018, clinical researchers, adults with CF, and family members were surveyed about a broad range of research topics that are perceived to receive less attention. We compared responses from researchers (n = 19) and community members (n = 135) and found groups aligned on their top three research priorities: 1) respiratory microorganism detection and treatment, 2) mental health, and 3) reducing treatment burden. We also explored whether or not those priorities align with the CFF research portfolio. Cognizance of researcher and community priorities can help inform clinical research endeavors to improve the health and well-being of people affected by CF.

Hirudin als Antikoagulans zur Untersuchung der Thrombozytenfunktion

Hirudin ist ein spezifischer Thrombinhemmer, der jetzt auch in rekombinanter Form verfügbar ist. Hirudin wird zur Zeit als Antithrombotikum entwickelt; es hat aber auch einige Vorteile als Reagens und Antikoagulans im Vergleich zu Zitrat oder Heparin. Die Thrombozytenaktivierung in vitro und die Wechselwirkungen zwischen Thrombozyten und plasmatischer Gerinnung bei Verminderung von Ca++ unterscheiden sich deutlich von den Reaktionen in Gegenwart eines physiologischen Gehalts an Ca++.

In hirudinisierten Blutproben war die Thrombinund die Adrenalin-induzierte Aggregation im Vergleich zu Zitratblut deutlich gehemmt. Außerdem waren in Hirudin-PRP die Thrombozytenhaftneigung und die Thrombozytenausbreitung im Vergleich zu Zitrat-PRP deutlich vermindert. Die Thrombozytenzahl in Hirudin-PRP lag stets etwas höher als im parallel gewonnenen Zitrat-PRP. Wahrscheinlich hemmt Natriumzitrat die teilweise Thrombin-abhängige Plättchenvoraktivierung an den Wänden der Entnahmegefäße weniger stark als Hirudin.

Die Wirkung von Antithrombotika auf die Thrombozytenfunktion kann in vitro und wahrscheinlich auch ex vitro mit großer Sensitivität erfaßt werden, wenn für derartige Untersuchungen Hirudin als Antikoagulans verwendet wird.

Influence of Venus and Mars in the cognitive sky of schizophrenia. Results from the first-step national FACE-SZ cohort

OBJECTIVES

Sex differences can yield important clues regarding illness pathophysiology and its treatment. Schizophrenia (SZ) has a lower incidence rate, and a better prognosis, in women versus men. The present study investigated the cognitive profiles of both sexes in a large multi-centre sample of community-dwelling SZ patients.

METHOD

544 community-dwelling stable SZ subjects (141 women and 403 men; mean age 34.5±12.1 and 31.6±8.7years, respectively) were tested with a comprehensive battery of neuropsychological tests.

RESULTS

Although community-dwelling SZ men had more risk factors for impaired cognition (including first-generation antipsychotics administration and comorbid addictive disorders), women had lower scores on a wide range of cognitive functions, including current and premorbid intellectual functioning, working memory, semantic memory, non-verbal abstract thinking and aspects of visual exploration. However, women scored higher in tests of processing speed and verbal learning, as well as having a lower verbal learning bias. No sex difference were evident for visuospatial learning abilities, cued verbal recall, sustained attention and tests of executive functions, including cognitive flexibility, verbal abstract thinking, verbal fluency and planning abilities.

CONCLUSION

Sex differences are evident in the cognitive profiles of SZ patients. The impact on daily functioning and prognosis, as well as longitudinal trajectory, should be further investigated in the FACE-SZ follow-up study. Sex differences in cognition have implications for precision-medicine determined therapeutic strategies.

LIMITS

Given the restricted age range of the sample, future research will have to determine cognitive profiles across gender in late onset SZ.

Creation of a whole brain short association bundle atlas using a hybrid approach

The Human brain connection map is far from being complete. In particular the study of the superficial white matter (SWM) is an unachieved task. Its description is essential for the understanding of human brain function and the study of pathogenesis triggered by abnormal connectivity. In this work we expanded a previously developed method for the automatic creation of a whole brain SWM bundle atlas. The method is based on a hybrid approach. First a cortical parcellation is used to extract fibers connecting two regions. Then an intra-and inter-subject hierarchical clustering are applied to find well-defined SWM bundles reproducible across subjects. In addition to the fronto-parietal and insula regions of the left hemisphere, the analysis was extended to the temporal and occipital lobes, including all their internal regions, for both hemispheres. Validation steps are performed in order to test the robustness of the method and the reproducibility of the obtained bundles. First the method was applied to two independent groups of subjects, in order to discard bundles without match across the two independent atlases. Then, the resulting intersection atlas was projected on a third independent group of subjects in order to filter out bundles without reproducible and reliable projection. The final multi-subject U-fiber atlas is composed of 100 bundles in total, 50 per hemisphere, from which 35 are common to both hemispheres. The atlas can be used in clinical studies for segmentation of the SWM bundles in new subjects, and measure DW values or complement functional data.

Short association bundle atlas based on inter-subject clustering from HARDI data

This paper is focused on the study of short brain association fibers. We present an automatic method to identify short bundles of the superficial white matter based on inter-subject hierarchical clustering. Our method finds clusters of similar fibers, belonging to the different subjects, according to a distance measure between fibers. First, the algorithm obtains representative bundles and subsequently we perform an automatic labeling based on the anatomy, of the most stable connections. The analysis was applied to two independent groups of 37 subjects. Results between the two groups were compared, in order to keep reproducible connections for the atlas creation. The method was applied using linear and non-linear registration, where the non-linear registration showed significantly better results. A final atlas with 35 bundles in the left hemisphere and 27 in the right hemisphere from the whole brain was obtained. Finally results were validated using the atlas to segment 26 new subjects from another HARDI database.

Partnered pharmacist charting on admission in the General Medical and Emergency Short-stay Unit - a cluster-randomised controlled trial in patients with complex medication regimens

WHAT IS KNOWN AND OBJECTIVE

Patients admitted to general medical units and emergency short-stay units are often complex with multiple comorbidities, polypharmacy and at risk for drug-related problems associated with increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of a partnered pharmacist charting model completed at the time of admission to prevent medication errors.

METHODS

We conducted an unblinded cluster randomized controlled trial comparing partnered pharmacist charting to standard medical charting among patients admitted to general medical units and emergency short-stay units with complex medication regimens or polypharmacy. This trial was conducted at an adult major referral hospital in metropolitan Melbourne, Australia, with an annual emergency department attendance of approximately 60 000 patients. The evaluation included patients' medication charts written in the period of 16 March 2015 to 27 July 2015. Patients randomized to the intervention were managed using the partnered pharmacist charting model. The primary outcome variable was a medication error identified by an independent assessor within 24 h of admission, who was not part of the patient's admission process.

RESULTS

Of the 473 patients who received standard medical staff charting during the study period, 372 (78·7%) had at least one medication error identified compared to 15 patients (3·7%) on the partnered pharmacist charting arm (P < 0·001). The relative risk of an error with standard medical charting was 21·4 (95% CI: 13·0-35·0) with a number needed to treat (NNT) to prevent one error of 1·3 (95% CI: 1·3-1·4), and the relative risk of a high or extreme risk error with standard medical charting was 150·9 (95% CI: 21·2-1072·9) with a NNT to prevent one high or extreme error of 2·7 (95% CI 2·4-3·1).

WHAT IS NEW AND CONCLUSION

Partnering between medical staff and pharmacists to jointly chart initial medications on admission significantly reduced inpatient medication errors (including errors of high and extreme risk) among general medical and emergency short-stay patients with complex medication regimens or polypharmacy.

Akathisia: prevalence and risk factors in a community-dwelling sample of patients with schizophrenia. Results from the FACE-SZ dataset

The main objective of this study was to determine the prevalence of akathisia in a community-dwelling sample of patients with schizophrenia, and to determine the effects of treatments and the clinical variables associated with akathisia. 372 patients with schizophrenia or schizoaffective disorder were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with validated scales. Akathisia was measured with the Barnes Akathisia Scale (BAS). Ongoing psychotropic treatment was recorded. The global prevalence of akathisia (as defined by a score of 2 or more on the global akathisia subscale of the BAS) in our sample was 18.5%. Patients who received antipsychotic polytherapy were at higher risk of akathisia and this result remained significant (adjusted odd ratio=2.04, p=.025) after controlling the influence of age, gender, level of education, level of psychotic symptoms, substance use comorbidities, current administration of antidepressant, anticholinergic drugs, benzodiazepines, and daily-administered antipsychotic dose. The combination of second-generation antipsychotics was associated with a 3-fold risk of akathisia compared to second-generation antipsychotics used in monotherapy. Our results indicate that antipsychotic polytherapy should be at best avoided and suggest that monotherapy should be recommended in cases of akathisia. Long-term administration of benzodiazepines or anticholinergic drugs does not seem to be advisable in cases of akathisia, given the potential side effects of these medications.

Metabolic syndrome, abdominal obesity and hyperuricemia in schizophrenia: Results from the FACE-SZ cohort

OBJECTIVE

Abdominal obesity was suggested to be a better predictor than Metabolic Syndrome (MetS) for cardiovascular mortality, however this is has not been extensively studied in schizophrenia. Hyperuricemia (HU) was also suggested to be both an independent risk factor for greater somatic comorbidity and a global metabolic stress marker in patients with schizophrenia. The aim of this study was to estimate the prevalence of MetS, abdominal obesity and HU, to examine the association between metabolic parameters with HU in a cohort of French patients with schizophrenia or schizo-affective disorder (SZ), and to estimate the prevalence rates of treatment of cardio-vascular risk factors.

METHOD

240 SZ patients (age=31.4years, male gender 74.3%) were systematically included. Metabolic syndrome was defined according to the International Diabetes Federation and HU if serum uric acid level was above 360μmol/L.

RESULTS

MetS, abdominal obesity and HU were found respectively in 24.2%, 21.3% and 19.6% of patients. In terms of risk factors, multiple logistic regression showed that after taking into account the potential confounders, the risk for HU was higher in males (OR=5.9, IC95 [1.7-21.4]) and in subjects with high waist circumference (OR=3.1, IC95 [1.1-8.3]) or hypertriglyceridemia (OR=4.9, IC95 [1.9-13]). No association with hypertension, low HDL cholesterol or high fasting glucose was observed. Only 10% of patients with hypertension received a specific treatment, 18% for high fasting glucose and 8% for dyslipidemia.

CONCLUSIONS

The prevalence of MetS, abdominal obesity and hyperuricemia is elevated in French patients with schizophrenia, all of which are considerably under-diagnosed and undertreated. HU is strongly associated with abdominal obesity but not with psychiatric symptomatology.

Automatic segmentation of short association bundles using a new multi-subject atlas of the left hemisphere fronto-parietal brain connections

Human brain connection map is far from being complete. In particular the study of the superficial white matter (SWM) is an unachieved task. Its description is essential for the understanding of human brain function and the study of the pathogenesis associated to it. In this work we developed a method for the automatic creation of a SWM bundle multi-subject atlas. The atlas generation method is based on a cortical parcellation for the extraction of fibers connecting two different gyri. Then, an intra-subject fiber clustering is applied, in order to divide each bundle into sub-bundles with similar shape. After that, a two-step inter-subject fiber clustering is used in order to find the correspondence between the sub-bundles across the subjects, fuse similar clusters and discard the outliers. The method was applied to 40 subjects of a high quality HARDI database, focused on the left hemisphere fronto-parietal and insula brain regions. We obtained an atlas composed of 44 bundles connecting 22 pair of ROIs. Then the atlas was used to automatically segment 39 new subjects from the database.

Information technologies in public health management: a database on biocides to improve quality of life

BACKGROUND

Biocides for prolonging the shelf life of a large variety of materials have been extensively used over the last decades. It has estimated that the worldwide biocide consumption to be about 12.4 billion dollars in 2011, and is expected to increase in 2012. As biocides are substances we get in contact with in our everyday lives, access to this type of information is of paramount importance in order to ensure an appropriate living environment. Consequently, a database where information may be quickly processed, sorted, and easily accessed, according to different search criteria, is the most desirable solution. The main aim of this work was to design and implement a relational database with complete information about biocides used in public health management to improve the quality of life.

METHODS

Design and implementation of a relational database for biocides, by using the software "phpMyAdmin".

RESULTS

A database, which allows for an efficient collection, storage, and management of information including chemical properties and applications of a large quantity of biocides, as well as its adequate dissemination into the public health environment.

CONCLUSION

The information contained in the database herein presented promotes an adequate use of biocides, by means of information technologies, which in consequence may help achieve important improvement in our quality of life.

Hysteresis-free operation of suspended carbon nanotube transistors

Single-walled carbon nanotubes offer high sensitivity and very low power consumption when used as field-effect transistors in nanosensors. Suspending nanotubes between pairs of contacts, rather than attaching them to a surface, has many advantages in chemical, optical or displacement sensing applications, as well as for resonant electromechanical systems. Suspended nanotubes can be integrated into devices after nanotube growth, but contamination caused by the accompanying additional process steps can change device properties. Ultraclean suspended nanotubes can also be grown between existing device contacts, but high growth temperatures limit the choice of metals that can be used as contacts. Moreover, when operated in ambient conditions, devices fabricated by either the post- or pre-growth approach typically exhibit gate hysteresis, which makes device behaviour less reproducible. Here, we report the operation of nanotube transistors in a humid atmosphere without hysteresis. Suspended, individual and ultraclean nanotubes are grown directly between unmetallized device contacts, onto which palladium is then evaporated through self-aligned on-chip shadow masks. This yields pairs of needle-shaped source/drain contacts that have been theoretically shown to allow high nanotube-gate coupling and low gate voltages. This process paves the way for creating ultrasensitive nanosensors based on pristine suspended nanotubes.

Pulsed gate sweep strategies for hysteresis reduction in carbon nanotube transistors for low concentration NO(2) gas detection

Carbon-nanotube-based field effect transistors (CNFETs) have been employed as highly sensitive chemical sensors. Often used as the sensor output signal, the gate threshold voltage (V(th)) is subject to concentration-dependent shifts upon exposure to target analytes. However, an unambiguous determination of the intrinsic V(th) is usually hampered by substantial hysteresis in CNFET gate characteristics. In this study we show that short gate voltage (V(gd)) pulses can be used for hysteresis reduction in CNFETs as chemical sensors, in particular for NO(2) detection. In the pulsed operation regime, even small shifts of V(th) upon sub-ppm NO(2) exposure remain resolvable. Furthermore, the hysteretic behaviour is systematically investigated by varying the pulse waveforms and timing parameters. Finally, we use an adapted hysteresis model for pulsed V(gd) and employ it to discuss the measurement data.

Long term investigations of carbon nanotube transistors encapsulated by atomic-layer-deposited Al(2)O(3) for sensor applications

Single-walled carbon nanotube field-effect transistors (CNFETs) are promising functional structures in future micro- or nanoelectronic systems and sensor applications. Research on the fundamental device concepts includes the investigation of the conditions for stable long term CNFET operation. CNFET operation in ambient air leads to on-state current degradation and fluctuating signals due to the well-known sensitivity of the electronic properties of the CNT to many environmental condition changes. It is the goal of device and sensor research to understand various kinds of sensor-environment interactions and to overcome the environmental sensitivity. Here, we show that the encapsulation of CNFETs by a thermal atomic-layer-deposited (ALD) aluminium oxide (Al(2)O(3)) layer of approximately 100 nm leads to stable device operation for 260 days and reduces their sensitivity to the environment. The characteristics of CNFETs prior to and after Al(2)O(3) encapsulation are comparatively investigated. It is found that encapsulation improves the stability of the CNFET characteristics with respect to the gate threshold voltage, hysteresis width and the on-state current, while 1/f noise is lowered by up to a factor of 7. Finally, CNFETs embedded in a dielectric membrane are employed as pressure sensors to demonstrate sensor operation of CNFETs encapsulated by ALD as piezoresistive transducers.

Electron shuttle instability for nano electromechanical mass sensing

We discuss the potential use of the electromechanical shuttle instability in suspended nanostructures (e.g., nanotubes or nanowires) for nanomechanical sensing. The tunneling-assisted (shuttle-like) electron transport mechanism is addressed from a mechanical and electromechanical point of view, showing strong dependencies on the fundamental frequency, the mechanical restoring and damping force, and the electromechanical charging of the suspended nanostructure. We propose to use these nonlinear dependencies to sense minute mass (and tension) changes. Therefore, we introduce a conceptual sensing device and investigate its operation in the frame of a simple model system. Finally, we discuss different measurement techniques and report on high sensitivities (e.g., 1 nA/zeptogram (zg), or 1 mV/zg depending on the measurement technique) and potential resolutions in the range of 10 zg (10(-23) kg).

Fecal tumor necrosis factor-alpha and calprotectin as differential diagnostic markers for severe diarrhea of small infants

OBJECTIVE

The etiology of early-onset diarrhea of neonates and small infants that persists despite bowel rest is heterogeneous. Two different categories of disorders presenting with diarrhea in the first weeks of life can be distinguished: constitutive intestinal epithelial disorders (microvillus atrophy [MVA] or epithelial dysplasia [ED]) and immune-inflammatory disorders, (autoimmune enteropathy [AIE] or inflammatory colitis [IC]). We aimed to evaluate in a prospective manner the use of fecal inflammatory markers in the differential diagnosis of severe persistent diarrhea.

MATERIAL AND PATIENTS

Twenty-five patients (17 males) were enrolled in this study (median age 8 months). Fourteen children had a constitutive enterocyte disorder (group 1: MVA = 8, ED = 6), and 11 patients had an immuno-inflammatory disease (group 2: AIE = 5, IC = 6). Stool samples were collected at the time of diagnosis and stored at -80 degrees until tumor necrosis factor (TNF)-alpha and calprotectin were measured by enzyme-linked immunoadsorbent assay.

RESULTS

No significant differences in age at onset of diarrhea or in stool volumes were observed between both groups. In group 1, fecal TNF-alpha was undetectable/normal in 14 of 14 children, whereas group 2 showed dramatically elevated TNF-alpha levels (mean 3,104, range 237-18,078 pg/g) in 8 of 11 patients. Similarly, calprotectin levels were undetectable/normal in 14 of 14 patients in group 1 and highly raised in 11 of 11 patients in group 2 (median 1,145, range 375-3,095 mug/g), P < 0.01. Under therapy, these inflammatory parameters normalized.

CONCLUSIONS

Determination of fecal inflammatory markers is a simple method helping to distinguish constitutive from immuno-inflammatory etiologies of severe persistent diarrhea. These data also suggest that constitutive enterocyte disorders are not accompanied by an inflammatory mucosal reaction.