1
|
Fonseca-Romero P, Ahmed SM, Brintz BJ, Vierkant DM, Bard JD, Cohen DM, Festekjian A, Leber AL, Jackson JT, Kanwar N, Larsen C, Selvarangan R, Chapin KC, Pavia AT. Etiologies of bloody diarrhea in children presenting with acute gastroenteritis to US emergency departments. medRxiv 2024:2024.04.03.24305279. [PMID: 38633774 PMCID: PMC11023649 DOI: 10.1101/2024.04.03.24305279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Among 111 children presenting with bloody diarrhea in a multicenter study of molecular testing in US emergency departments, we found viral pathogens in 18%, bacteria in 48%, protozoa in 2%, and no pathogens detected in 38%.
Collapse
Affiliation(s)
- Paola Fonseca-Romero
- Department of Pathology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Sharia M Ahmed
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Ben J Brintz
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - D Matthew Vierkant
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Dien Bard
- Children's Hospital, Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Daniel M Cohen
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Ara Festekjian
- Children's Hospital, Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, US
| | - Amy L Leber
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Chari Larsen
- Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Kimberle C Chapin
- Deepull, Barcelona, Spain
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew T Pavia
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
2
|
Pavia AT, Cohen DM, Leber AL, Daly JA, Jackson JT, Selvarangan R, Kanwar N, Bender JM, Dien Bard J, Festekjian A, Duffy S, Larsen C, Holmberg KM, Bardsley T, Haaland B, Bourzac KM, Stockmann C, Chapin KC, Leung DT. Clinical Impact of Multiplex Molecular Diagnostic Testing in Children With Acute Gastroenteritis Presenting to an Emergency Department: A Multicenter Prospective Study. Clin Infect Dis 2024; 78:573-581. [PMID: 38097379 PMCID: PMC10954335 DOI: 10.1093/cid/ciad710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited. METHODS We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at 5 academic children's hospitals on children presenting to the emergency department with acute gastroenteritis. Caregivers were interviewed on enrollment and 7-10 days after enrollment to determine symptoms, risk factors, subsequent medical visits, and impact on family members. During the pre-intervention period, diagnostic testing was performed at the clinician's discretion . During the intervention period, multiplex molecular testing was performed on all children, with results available to clinicians. The primary outcome was return visits to a healthcare provider within 10 days of enrollment. RESULTS Potential pathogens were identified by clinician-ordered tests in 19 of 571 (3.3%) in the pre-intervention period compared with 434 of 586 (74%) in the intervention period; clinically relevant pathogens were detected in 2.1% and 15%, respectively. In the multivariate model, the intervention was associated with a 21% reduction in the odds of any return visit (odds ratio, 0.79; 95% confidence interval, .70-.90) after adjusting for potential confounders. Appropriate treatment was prescribed in 11.3% compared with 19.6% during the intervention period (P = .22). CONCLUSIONS Routine molecular multiplex testing for all children who presented to the ED with acute gastroenteritis detected more clinically relevant pathogens and led to a 21% decrease in return visits. Additional research is needed to define patients most likely to benefit from testing. Clinical Trials Registration. NCT02248285.
Collapse
Affiliation(s)
- Andrew T Pavia
- Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Daniel M Cohen
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Amy L Leber
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Judy A Daly
- Department of Pathology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Neena Kanwar
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jeffrey M Bender
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Dien Bard
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ara Festekjian
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Susan Duffy
- Department of Emergency Medicine, Hasbro Children's Hospital, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Chari Larsen
- Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Tyler Bardsley
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Christopher Stockmann
- Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kimberle C Chapin
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Daniel T Leung
- Departments of Pediatrics and Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Pathology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
3
|
Larsen C, Larsen HCG, Pedersen CC, Thomsen PN, Tøffner-Clausen J, Tauris TM. Probing supernovae and kicks in post-supernova binaries. Nature 2024; 625:E18-E23. [PMID: 38267684 DOI: 10.1038/s41586-023-06847-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/07/2023] [Indexed: 01/26/2024]
Affiliation(s)
- C Larsen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - H C G Larsen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - C C Pedersen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - P N Thomsen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - J Tøffner-Clausen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - T M Tauris
- Department of Materials and Production, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
4
|
Amdi C, Larsen C, Jensen KMR, Tange EØ, Sato H, Williams AR. Intrauterine growth restriction in piglets modulates postnatal immune function and hepatic transcriptional responses independently of energy intake. Front Physiol 2023; 14:1254958. [PMID: 37916220 PMCID: PMC10617784 DOI: 10.3389/fphys.2023.1254958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction: Insufficient prenatal nutrition can affect fetal development and lead to intrauterine growth restriction (IUGR). The aim of this study was to investigate hepatic transcriptional responses and innate immune function in piglets suffering from IUGR compared to normal-sized piglets at 3 days of age and explore whether the provision of an energy-rich supplement at birth could modulate these parameters. Methods: A total of 68 piglets were included in the study. Peripheral blood mononuclear cells were harvested for LPS stimulation, and organs were harvested post-mortem to quantify relative weights. Liver tissue was utilized for RNA sequencing coupled with gene-set enrichment analysis. Results: IUGR resulted in increased expression of genes such as PDK4 and substantial alterations in transcriptional pathways related to metabolic activity (e.g., citric acid and Krebs cycles), but these changes were equivalent in piglets given an energy-rich supplement or not. Transcriptomic analysis and serum biochemistry suggested altered glucose metabolism and a shift toward oxidation of fatty acids. IUGR piglets also exhibited suppression of genes related to innate immune function (e.g., CXCL12) and pathways related to cell proliferation (e.g., WNT and PDGF signaling). Moreover, they produced less IL-1β in response to LPS stimulation and had lower levels of blood eosinophils than normal-sized piglets. Discussion: Taken together, our results indicate that IUGR results in early-life alterations in metabolism and immunity that may not be easily restored by the provision of exogenous energy supplementation.
Collapse
Affiliation(s)
- C. Amdi
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | |
Collapse
|
5
|
Pavia AT, Cohen DM, Leber AL, Daly JA, Jackson JT, Selvarangan R, Kanwar N, Bender JM, Bard JD, Festekjian A, Duffy S, Larsen C, Holmberg KM, Bardsley T, Haaland B, Bourzac KM, Stockmann C, Chapin KC, Leung DT. Clinical Impact of Multiplex Molecular Diagnostic Testing in Children with Acute Gastroenteritis Presenting to An Emergency Department: A Multicenter Prospective Study. medRxiv 2023:2023.07.27.23293208. [PMID: 37577483 PMCID: PMC10418295 DOI: 10.1101/2023.07.27.23293208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Multiplex molecular diagnostic panels have greatly enhanced detection of gastrointestinal pathogens. However, data on the impact of these tests on clinical and patient-centered outcomes are limited. Methods We conducted a prospective, multicenter, stepped-wedge trial to determine the impact of multiplex molecular testing at five academic children's hospitals in children presenting to the ED with acute gastroenteritis. Caregivers were interviewed on enrollment and again 7-10 days after enrollment to determine symptoms, risk factors, subsequent medical visits, and impact on family members. During the pre-intervention period, diagnostic testing was performed at the discretion of clinicians. During the intervention period, multiplex molecular testing was performed on all children with results available to clinicians. Primary outcome was return visits to a health care provider within 10 days of enrollment. Results Potential pathogens were identified by clinician ordered tests in 19/571 (3.3%) in the pre-intervention period compared to 434/586 (74%) in the intervention period; clinically relevant pathogens were detected in 2.1% and 15% respectively. In the multivariate model adjusting for potential confounders, the intervention was associated with a 21% reduction in the odds of any return visit (OR 0.79; 95% CI 0.70-0.90). Appropriate treatment was prescribed in 11.3% compared to 19.6% during the intervention period(P=0.22). Conclusions Routine molecular multiplex testing for all children presenting to the ED with AGE detected more clinically relevant pathogens and led to a 21% decrease in return visits. Additional research is needed to define patients most likely to benefit from testing.
Collapse
|
6
|
Magua W, Okoh A, Pranav P, Wang J, Karadkhele G, Cole R, Daneshmand M, Gupta D, Larsen C, Morris A. Belatacept-Based Immunosuppression in Heart Transplant Recipients: National Trends with Outcomes from a Single Center. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
7
|
Lyderik K, Madsen J, Larsen C, L. M. Pedersen M, Kjeldsen N, Williams A, Hedemann M, Amdi C. An increased weaning age and liquid feed enhances weight gain compared to piglets fed dry feed pre-weaning. Animal 2023; 17:100801. [PMID: 37121161 DOI: 10.1016/j.animal.2023.100801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Increasing age and providing liquid creep feed could potentially increase the solid feed intake in pre-weaning piglets, which may in turn promote gut maturation and post-weaning feed intake, possibly lessening the severity of the growth-check associated with the suckling-to-weaning transition. Therefore, this study aimed to investigate if feeding dry- versus liquid creep feed (DF vs. LF) and weaning in week 4 or 5 (4W or 5W) could accelerate maturational changes to the small intestines of pre-weaning piglets by increasing digestive and absorptive capacity. In a 2 × 2 factorial study the effect of weaning age (WA) and feeding strategy (FS) on weaning weight, pre-weaning accumulated gain (AG), and average daily gain was measured for 12 923 piglets. A subpopulation of 15 piglets from each treatment group (4WDF, 4WLF, 5WDF and 5WLF; n = 60) were sacrificed to assess the effects of WA and FS on weight of digestive organs, activity of maltase, lactase and sucrase, and gene expression level of sodium-glucose linked transporter 1 (SGLT-1), glucose transporter 2 (GLUT2) and peptide transporter 1 (PepT1) in the proximal part of the small intestine (SI). No interactions were found but average weaning weight was affected by WA (P < 0.001) and FS (P < 0.001), where 5W were heavier than 4W and LF were heavier than DF. Correspondingly, the average daily gain (ADG) was affected by both WA (P = 0.003) and FS (P < 0.001). Only WA affected the relative weight of the digestive organs, where stomach weight, weight of SI and colon weight were heavier in 5W piglets compared to 4W. Lactase activity tended to decrease with age (P = 0.061), but there was no difference in the activity of maltase or sucrase between any of the treatment groups. Similarly, there was no differences in gene expression level of SGLT1, GLUT2 or PepT1 between neither the two ages nor feeding strategies. In conclusion, both WA and FS affect weaning weight and weight gain of piglets in the pre-weaning period.
Collapse
|
8
|
Schmidt L, Larsen C, Louise M, Sylvest R, Koert E. P-497 Men’s attitude towards two fertility education interventions and preferences for future fertility awareness initiatives. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What are men's preferences for communication of fertility information and how to target prevention efforts to promote men to make informed decisions regarding family formation?
Summary answer
Men preferred fertility education interventions to use positive language to create new knowledge, include personal stories as conversation starters, and be provided in different formats.
What is known already
The far majority of men in Denmark wants to become fathers; however, 20% of 50-year-old men are childless compared to 12% among women. Around 40% of men in Denmark have reduced semen quality. Previous studies have found that men have insufficient knowledge about fertility, infertility and associated risk factors, and that men want to receive more information about fertility when they are young. Only few intervention studies have been performed about how to increase men’s and women’s fertility knowledge, and even fewer studies have focused only on men.
Study design, size, duration
Qualitative focus group discussions with 13 men assigned into five focus groups were carried out. Two interventions were introduced; an episode from the podcast “Actually you don’t have to wait that long” about two couples who have become parents in their mid-twenties, and an informational poster developed by The International Fertility Education Initiative was shown during the group discussions. The interviews took place online over Zoom in January 2021. Interviews ranged in average 91 minutes.
Participants/materials, setting, methods
All participants were recruited through Facebook and social networks. The interviewed men were young, childless aged 25-32 in a committed relationship and all residents in Copenhagen, Denmark. Focus group questions were semi-structured and examined the men’s reactions to the podcast and poster and preferences for communication of fertility information. The focus group discussions were recorded, anonymized and transcribed. Data were analyzed using Graneheim and Lundman's method of qualitative content analysis.
Main results and the role of chance
The overall themes were: “Poster: source of information”, “Podcast: report from the lived life” and “Information targeting men”. The men’s reactions to the poster and podcast were categorized into the sub-themes benefits and critiques and suggestions. Benefits of the poster was that it included important knowledge and was relevant to a large target group. Critiques were that it had too much information and lacked the emotional aspect of family formation. They wished for more positive languaging and communication about the fertility information on the poster. The benefit of the podcast was the use of personal stories to highlight the emotional aspect of family formation which was a conversation starter for partners. Critiques were that some men found the personal stories unrelatable and believed it didn’t contribute new knowledge. They suggested to include couples with fertility problems with an expert. According to men, future interventions should focus on how information is communicated. It should be factual, include humor and not be negative or shameful. Different formats to provide fertility information including TV-programs, podcasts, and social media interventions should be used to reach the most men in different ways. They also suggested fertility information should be included in sexual education in school.
Limitations, reasons for caution
All men were residents of the capital city Copenhagen, and men with a short education were underrepresented. Therefore, our results may not represent the opinions of all men aged 25-32 years in Denmark.
Wider implications of the findings
In the future fertility awareness campaigns should be developed in cooperation with the target group together with clinicians, and concurrent intervention studies on the developed methods should be performed. In all probability, a mix of different interventions will be necessary to attain the desired effect to ensure long-lasting fertility awareness.
Trial registration number
Not applicable
Collapse
Affiliation(s)
- L Schmidt
- University of Copenhagen, Department of Public Health , Copenhagen K, Denmark
| | - C Larsen
- University of Copenhagen, Department of Public Health , Copenhagen, Denmark
| | - M Louise
- University of Copenhagen, Department of Public Health , Copenhagen, Denmark
| | - R Sylvest
- Copenhagen University Hospital- Rigshospitalet, Fertility Clinic , Copenhagen, Denmark
| | - E Koert
- University of Copenhagen, Department of Public Health , Copenhagen, Denmark
| |
Collapse
|
9
|
Kelly M, Chiang Y, Corte-Real Houlihan M, Haylock-Vize P, Larsen C, Lilis L, Maki S, Milt KM, Shee J, Spoone L, Warre M. 959 Undertaking Core Surgical Training Less Than Full Time: A Qualitative Study of Experiences. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
The Royal College of Surgeons identifies Less Than Full Time Training (LTFT) as a key factor in attracting excellent candidates at Core level. Previous evaluations of LTFT have, however, focused on ST3 and beyond. This study focuses on Core Surgical Training (CST), to determine how well it is delivering for LTFT trainees.
Method
Participants undertaking any part of CST LTFT were eligible. An electronic, self-administered questionnaire was accessed by participants.
Results
There were 11 participants. The majority (55%) rated the information available, which often related to more senior trainees, as poor. A third reported it ‘very difficult’ to arrange a LTFT training post. A significant proportion felt their access to operative experience was decreased and 45% reported feeling less confident. Positive aspects were improved work-life balance and being able to maintain a surgical career with a family. Suggestions for improvements included normalising LTFT in surgery to reduce stigma, having dedicated LTFT TPDs, clear pathways, and longer rotations.
Conclusions
Training LTFT offers many benefits – not least, increasing workforce diversity. However, for many, training LTFT at Core level produces additional stress, work and stigma. If the surgical community is serious about maintaining an excellent, diverse workforce, these issues should be tackled sooner rather than later.
Collapse
Affiliation(s)
- M Kelly
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Y Chiang
- Croydon University Hospital NHS Trust, London, United Kingdom
| | | | | | - C Larsen
- Northumbria Healthcare Foundation Trust, North Tyneside, United Kingdom
| | - L Lilis
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - S Maki
- The Hillingdon Hospital NHS Trust, London, United Kingdom
| | - K M Milt
- NHS Lothian, Edinburgh, United Kingdom
| | - J Shee
- South Devon and Torbay Foundation Trust, Torbay, United Kingdom
| | - L Spoone
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - M Warre
- Lister Hospital, East and North Herts NHS Trust, Stevenage, United Kingdom
| |
Collapse
|
10
|
Larsen C, Lynegaard JC, Pedersen AØ, Kjeldsen NJ, Hansen CF, Nielsen JP, Amdi C. A reduced CP level without medicinal zinc oxide does not alter the intestinal morphology in weaned pigs 24 days post-weaning. Animal 2021; 15:100188. [PMID: 33610517 DOI: 10.1016/j.animal.2021.100188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 01/20/2023] Open
Abstract
The use of medicinal zinc oxide (ZnO) to prevent diarrhoea post-weaning will be banned in the EU from 2022. Therefore, new alternatives are needed to avoid an increase in diarrhoea and higher antibiotic use. A low dietary CP level has shown to lower the frequency of diarrhoea in pigs, due to lower microbial protein fermentation in the colon as well as improved conditions in the small intestine after weaning. The objective of this study was to examine the effect of decreased CP levels post-weaning as an alternative to medicinal ZnO on gut morphology and histopathology. Five hundred and sixty pigs were randomly assigned into one of six groups receiving a two-phase diet from 5.5 to 15 kg: positive control group (PC) with medicinal ZnO and standard levels of protein (19.1-18.4% CP), negative control group (NC) without medicinal ZnO and standard levels of protein (19.1-18.4% CP). The remaining four low protein groups were a low-standard (LS) CP level (16.6-18.4% CP), a low-low (LL) CP level (16.6-16.2% CP), a very low-high (VLH) CP level (14-19.3% CP) and a very low-medium (VLM) CP level (14-17.4% CP). Individual BW was recorded at day 0, 10 and 24 post-weaning, and all antibiotic treatments were recorded. Tissue samples from the small intestine (mid-jejunum) for morphological and histopathologic analysis, organ weights, blood and urine samples were collected at day 10 and 24 post-weaning from a total of 90 sacrificed weaners. The results demonstrated no differences in intestinal morphology between groups, but the histopathology showed a damaged brush border score in VLM and VLH pigs . In addition, a lower blood urea nitrogen in VLM pigs at 24 days was found. The LL and VLM pigs had a significantly decreased average daily gain in the overall trial period compared to PC and NC pigs. Conclusively, intestinal brush border was damaged by the very low protein diet at 24 days post-weaning, but intestinal morphology was unaffected by dietary strategy.
Collapse
Affiliation(s)
- C Larsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, DK-1870 Frederiksberg C, Copenhagen, Denmark
| | - J C Lynegaard
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, DK-1870 Frederiksberg C, Copenhagen, Denmark.
| | - A Ø Pedersen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, DK-1870 Frederiksberg C, Copenhagen, Denmark
| | - N J Kjeldsen
- Pig Research Centre, Danish Agriculture and Food Council, SEGES, Axeltorv 3, DK-1609 Copenhagen, Denmark
| | - C F Hansen
- Pig Research Centre, Danish Agriculture and Food Council, SEGES, Axeltorv 3, DK-1609 Copenhagen, Denmark
| | - J P Nielsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, DK-1870 Frederiksberg C, Copenhagen, Denmark
| | - C Amdi
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Grønnegårdsvej 2, DK-1870 Frederiksberg C, Copenhagen, Denmark
| |
Collapse
|
11
|
Galli E, Smiseth O, Aalen J, Duchenne J, Larsen C, Sade E, Hubert A, Anilkumar S, Penicka M, Hernandez A, Leclercq C, Voigt JU, Donal E. Better diastolic function in CRT candidates is associated with improved survival after CRT implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The relationship between diastolic dysfunction (DD) and outcome after CRT is debated.
Purpose
Purpose of this study was to evaluate the role of DD in predicting all-cause mortality in heart failure patients undergoing CRT.
Methods
One-hundred ninety-three patients (age: 67±11 years, QRS width: 167±21 ms, LVEF 28±8%) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging. A reduction of LV end-systolic volume >15% at 6-month follow-up (FU) identified CRT-responders and was observed in 132 (68%) patients.
Results
During a median 35 months FU, 29 (15%) patients died. Through multivariable analysis, coronary artery disease, NYHA functional class and grade I DD were shown to be independent predictors of prognosis (Table 1). Grade I DD was associated with a longer survival rate in both responders and non responders (Figure 1). Non responders with grade II-III DD had the worse outcome (HR 12.5 [3.56–44.04], p<0.0001).
Conclusions
Better diastolic function at baseline is associated with an improved survival after CRT implantation, independently of CRT-response.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- E Galli
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - J Aalen
- University of Oslo, Oslo, Norway
| | | | - C Larsen
- University of Oslo, Oslo, Norway
| | - E Sade
- Baskent University, Ankara, Turkey
| | - A Hubert
- Hospital Pontchaillou of Rennes, Rennes, France
| | - S Anilkumar
- Hamad Medical Corporation Heart Hospital, Doha, Qatar
| | - M Penicka
- Cardiovascular Research Center Aalst, Aalst, Belgium
| | - A Hernandez
- Laboratory Signal Processing and Image, Rennes, France
| | - C Leclercq
- Hospital Pontchaillou of Rennes, Rennes, France
| | | | - E Donal
- Hospital Pontchaillou of Rennes, Rennes, France
| |
Collapse
|
12
|
Galli E, Aalen J, Duchenne J, Larsen C, Hubert A, Saade E, Le Rolle V, Leclercq C, Smiseth O, Voigt JU, Donal E. 557 Left ventricular diastolic function is a predictor of volumetric response to cardiac resynchronization therapy. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Conflicting data exist about the effects of cardiac resynchronization therapy (CRT) on diastolic function (DF). Aims of the study are: 1) to assess diastolic patterns in patients undergoing CRT; 2) to evaluate the role of DF in predicting CRT-response.
Methods
193 patients (age: 67 ± 11 ms, QRS width: 167 ± 21 ms, LVEF 28 ± 8%) were prospectively included in this multicentric study. 2D-standard echocardiography was performed before CRT and at 6-month follow-up (FU). DF was assessed according to recommendations from grade I to III. In case of data in the "grey zone", DF was defined as "indeterminate". A reduction of left ventricular (LV) end-systolic volume >15% at FU identified CRT-responders (CRT-R).
Results
At 6-month FU, 132 patients (68%) were CRT-R. Figure 1 shows DF parameters in the overall population, CRT-R, and CRT-non responders (CRT-NR) before and after CRT. At multivariable analysis, grade I diastolic dysfunction at baseline was a significant independent predictor of CRT response (OR 3.02, p = 0.001) (Table 1). The addition of grade I diastolic dysfunction to a model including clinical (sex, NYHA class, ischemic cardiomyopathy) and echocardiographic parameters (LV size), significantly increase the model power for the prediction of CRT-response (χ2: 29 vs 44, p = 0.001).
Conclusions
Before CRT, DF parameters are significantly altered in CRT-NR with respect to CRT-R. Moreover, CRT-NR experience a significant deterioration of DF after CRT. In our population, grade I diastolic function at baseline was a significant independent predictor of positive response to CRT.
Table 1 Univariable analysis Multivariable analysis Age 1.01 (0.99-1.05) 0.25 Males 0.36 (0.17-0.76) 0.008 0.57 (0.22-1.47) 0.25 CAD 0.21 (0.11-0.40) <0.001 0.31 (0.15-0.65) 0.002 NYHA 0.52 (0.31-0.88) 0.01 0.57 (0.22-1.47) 0.25 QRS 1.01 (0.99-1.02) 0.44 LVEDV 0.99 (0.99-1.00) 0.003 0.98 (0.97-1.01) 0.18 LVESV 0.99 (0.98-0.99) 0.005 1.01 (0.99-1.03) 0.28 LVEF 1.00 (0.97-1.05) 0.63 Grade I DD 4.13 (2.16-7.91) <0.0001 3.02 (1.26-7.23) 0.001 Grade II DD 0.57 (0.40-0.80) 0.001 0.87 (0.35-2.19) 0.79 Grade III DD 0.76 (0.58-1.02) 0.06
Abstract 557 Figure.
Collapse
Affiliation(s)
- E Galli
- University Hospital of Rennes, Rennes, France
| | - J Aalen
- University of Oslo, Oslo, Norway
| | | | - C Larsen
- University of Oslo, Oslo, Norway
| | - A Hubert
- University Hospital of Rennes, Rennes, France
| | - E Saade
- Baskent University, Ankara, Turkey
| | - V Le Rolle
- University Hospital of Rennes, Rennes, France
| | - C Leclercq
- University Hospital of Rennes, Rennes, France
| | | | | | - E Donal
- University Hospital of Rennes, Rennes, France
| |
Collapse
|
13
|
Brouard C, Saboni L, Gautier A, Chevaliez S, Rahib D, Richard J, Larsen C, Pillonel J, Lydié N, Lot F. Prévalence des hépatites B et C à partir d’un auto-prélèvement de sang à domicile et dépistage en population générale métropolitaine en 2016. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Larsen C, Richard C, West D. DO DEMENTIA CAREGIVERS HAVE WORSE HEALTH OUTCOMES AS COMPARED TO NON-CAREGIVERS IN A NATIONAL SAMPLE? Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - D West
- University of South Carolina
| |
Collapse
|
15
|
Duijm N, Svensberg K, Larsen C, Sporrong S. "It's about training; it's about being committed and practice it". Interviews with Danish pharmacy students about their Communication Skills Training. Res Social Adm Pharm 2018. [DOI: 10.1016/j.sapharm.2018.05.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Pol S, Haour G, Fontaine H, Dorival C, Petrov-Sanchez V, Bourliere M, Capeau J, Carrieri P, Larrey D, Larsen C, Marcellin P, Pawlostky JM, Nahon P, Zoulim F, Cacoub P, de Ledinghen V, Mathurin P, Negro F, Pageaux GP, Yazdanpanah Y, Wittkop L, Zarski JP, Carrat F. The negative impact of HBV/HCV coinfection on cirrhosis and its consequences. Aliment Pharmacol Ther 2017; 46:1054-1060. [PMID: 28994127 DOI: 10.1111/apt.14352] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/09/2017] [Accepted: 09/10/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV)/hepatitis C virus (HCV) confection has been rarely studied in nonasian series. AIM To compare the characteristics of HBV/HCV coinfected patients to those of HBV- or HCV-monoinfected patients in the ANRS CO22 HEPATHER cohort study. PATIENTS AND METHODS Of the 20 936 included patients, 95 had HBV/HCV coinfection (hepatitis B surface antigen, anti-HCV antibody and HCV RNA positive) and were matched with 375 HBV- and 380 HCV-monoinfected patients on age, gender and time since HBV or HCV diagnosis. RESULTS F3-F4 fibrosis was more frequent in coinfected patients (58%) than in HBV- (32%, P < .0001), but similar in HCV-monoinfected patients (52%, P = .3142). Decompensated cirrhosis was more frequent in coinfected patients (11%) than in HBV- (2%, P = .0002) or HCV- (4%, P = .0275) monoinfected patients. Past excessive alcohol use was more frequent in coinfected patients (26%) than in HBV (12%, P = .0011), but similar in HCV monoinfected patients (32%, P = .2868). Coinfected patients had a higher proportion with arterial hypertension (42%) than HBV- (26%) or HCV-monoinfected patients (25%) (P < .003). Multivariable analysis confirmed the association between F3-F4 fibrosis and HCV infection in HBV-infected patients (OR = 3.84, 95% CI 1.99-7.43) and the association between decompensated cirrhosis and coinfection in HBV infected (OR = 5.58, 95% CI 1.42-22.0) or HCV infected patients (OR = 3.02, 95% CI 1.22-7.44). CONCLUSIONS HCV coinfection harmfully affects liver fibrosis in HBV patients, while decompensated cirrhosis is increased in coinfected patients compared with HBV- or HCV-monoinfected patients. HCV treatment is as safe and effective in coinfected as monoinfected patients and should be considered following the same rules as HCV monoinfected patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - P Nahon
- Bondy, France.,Saint-Denis, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Ajao M, Rudnicki M, Larsen C, Goggins E, Cox M, Mushinski A, Manoucheri E, Cohen S, Einarsson J. Does 3D Laparoscopy Improve Vaginal Cuff Suture Time? a Randomized Controlled Trial. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Smith T, Ye X, Stockmann C, Cohen D, Leber A, Daly J, Jackson J, Selvarangan R, Kanwar N, Bender J, Bard JD, Festekjian A, Duffy S, Larsen C, Baca T, Holmberg K, Bourzac K, Chapin KC, Pavia A, Leung D. Clinical Predictors of Shigella and Campylobacter Infection in Children in the United States. Open Forum Infect Dis 2017. [PMCID: PMC5631326 DOI: 10.1093/ofid/ofx163.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Infectious gastroenteritis is a major cause of morbidity and mortality among children worldwide. While most episodes are self-limiting, for select pathogens such as Shigella and Campylobacter, etiological diagnosis may allow effective antimicrobial therapy and aid public health interventions. Unfortunately, clinical predictors of such pathogens are not well established and are based on small studies using bacterial culture for identification. Methods We used prospectively collected data from a multi-center study of pediatric gastroenteritis employing multi-pathogen molecular diagnostics to determine clinical predictors associated with 1) Shigella and 2) Shigella or Campylobacter infection. We used machine learning algorithms for clinical predictor identification, then performed logistic regression on features extracted plus pre-selected variables of interest. Results Of 993 children enrolled with acute diarrhea, we detected Shigella spp. in 56 (5.6%) and Campylobacter spp. in 24 (2.4%). Compared with children who had neither pathogen detected (of whom, >70% had ≥1 potential pathogen identified), bloody diarrhea (odds ratio 4.0), headache (OR 2.2), fever (OR 7.1), summer (OR 3.3), and sick contact with GI illness (OR 2.2), were positively associated with Shigella, and out-of-state travel (OR 0.3) and vomiting and/or nausea (OR 0.4) were negatively associated (Table). For Shigella or Campylobacter, predictors were similar but season was no longer significantly associated with infection. Conclusion These results can create prediction models and assist clinicians with identifying patients who would benefit from diagnostic testing and earlier antibiotic treatment. This may curtail unnecessary antibiotic use, and help to direct and target appropriate use of stool diagnostics. Disclosures A. Leber, BioFIre Diagnostics: Research Contractor and Scientific Advisor, Research support, Speaker honorarium and Travel expenses J. Daly, Biofire: Grant Investigator, Grant recipient R. Selvarangan, BioFire Diagnostics: Board Member and Investigator, Consulting fee and Research grant Luminex Diagnostics: Investigator, Research grant J. Dien Bard, BioFire: Consultant and Investigator, Research grant and Speaker honorarium K. Holmberg, BioFire Diagnostics: Employee, Salary K. Bourzac, BioFire Diagnostics: Employee, Salary K. C. Chapin, BioFire Diagnstics: Investigator, Research support A. Pavia, BioFire Diagnostics: Grant Investigator, Research grant
Collapse
Affiliation(s)
| | | | - Chris Stockmann
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - Daniel Cohen
- Pediatrics, Section of Emergency Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Amy Leber
- Department of Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio
| | - Judy Daly
- Primary Children’s Hospital, Salt Lake City, Utah
| | - Jami Jackson
- Children’s Mercy Hospital, Kansas City, Missouri
| | | | - Neena Kanwar
- Children’s Mercy Hospital, Kansas City, Missouri
| | - Jeffery Bender
- Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California
| | - Jennifer Dien Bard
- Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Ara Festekjian
- Children’s Hospital Los Angeles, Los Angeles, California
| | | | - Chari Larsen
- Pediatrics, University of Utah, Salt Lake City, Utah
| | - Tanya Baca
- University of Utah, Salt Lake City, Utah
| | | | | | - Kimberle C Chapin
- Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Andrew Pavia
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - Daniel Leung
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah
| |
Collapse
|
19
|
Jensen G, Jones L, Kutzke M, Lange L, Larsen C, Klamm M, Jelen N. OUTCOMES OF A MOBILE, NURSE-LED INTERPROFESSIONAL COLLABORATIVE TEAM IN UNDERSERVED RURAL AMERICA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - L. Jones
- Sanford Health, Sioux Falls, South Dakota
| | - M. Kutzke
- Sanford Health, Sioux Falls, South Dakota
| | - L. Lange
- Sanford Health, Sioux Falls, South Dakota
| | - C. Larsen
- Sanford Health, Sioux Falls, South Dakota
| | - M. Klamm
- Sanford Health, Sioux Falls, South Dakota
| | - N. Jelen
- Sanford Health, Sioux Falls, South Dakota
| |
Collapse
|
20
|
Stockmann C, Cohen D, Leber A, Daly J, Jackson J, Selvarangan R, Kanwar N, Bender JM, Bard JD, Festekjian A, Duffy S, Larsen C, Baca T, Holmberg K, Bourzac K, Chapin KC, Pavia A. Implementation of a Molecular Diagnostic Test for Pediatric Acute Gastroenteritis: The FilmArray Gastrointestinal Panel IMPACT Study. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chris Stockmann
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| | - Daniel Cohen
- Pediatrics, Section of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy Leber
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Judy Daly
- Microbiology, Primary Children's Medical Center, Salt Lake City, Utah
| | - Jami Jackson
- Children's Mercy Hospital, Kansas City, Missouri
| | | | - Neena Kanwar
- Children's Mercy Hospital, Kansas City, Missouri
| | | | - Jennifer Dien Bard
- Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Ara Festekjian
- Children's Hospital Los Angeles, Los Angeles, California
| | - Susan Duffy
- Rhode Island Hospital, Providence, Rhode Island
| | - Chari Larsen
- Pediatrics, University of Utah, Salt Lake City, Utah
| | - Tanya Baca
- University of Utah, Salt Lake City, Utah
| | | | | | - Kimberle C. Chapin
- Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, Rhode Island
| | - Andrew Pavia
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
21
|
Kuhlmann E, Lauxen O, Larsen C. Regional health workforce monitoring as governance innovation: a German model to coordinate sectoral demand, skill mix and mobility. Hum Resour Health 2016; 14:71. [PMID: 27894307 PMCID: PMC5127055 DOI: 10.1186/s12960-016-0170-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 11/22/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND As health workforce policy is gaining momentum, data sources and monitoring systems have significantly improved in the European Union and internationally. Yet data remain poorly connected to policy-making and implementation and often do not adequately support integrated approaches. This brings the importance of governance and the need for innovation into play. CASE The present case study introduces a regional health workforce monitor in the German Federal State of Rhineland-Palatinate and seeks to explore the capacity of monitoring to innovate health workforce governance. The monitor applies an approach from the European Network on Regional Labour Market Monitoring to the health workforce. The novel aspect of this model is an integrated, procedural approach that promotes a 'learning system' of governance based on three interconnected pillars: mixed methods and bottom-up data collection, strong stakeholder involvement with complex communication tools and shared decision- and policy-making. Selected empirical examples illustrate the approach and the tools focusing on two aspects: the connection between sectoral, occupational and mobility data to analyse skill/qualification mixes and the supply-demand matches and the connection between monitoring and stakeholder-driven policy. CONCLUSION Regional health workforce monitoring can promote effective governance in high-income countries like Germany with overall high density of health workers but maldistribution of staff and skills. The regional stakeholder networks are cost-effective and easily accessible and might therefore be appealing also to low- and middle-income countries.
Collapse
Affiliation(s)
- E. Kuhlmann
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
- Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - O. Lauxen
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
| | - C. Larsen
- Institute for Economics, Labour and Culture, Goethe University Frankfurt, Frankfurt, Germany
| |
Collapse
|
22
|
Kuhlmann E, Lauxen O, Larsen C. Integrating skill-mix and mobility in regional health workforce monitoring and governance. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw164.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Abstract
Guided by ultrasonography percutaneous needle biopsy of skeletal muscle was performed in 24 patients, using the one hand held Biopty system and a 2 mm Tru-Cut needle. The specimens were graded with regard to diagnostic quality and utility and almost all specimens (96%) were of highest quality. The use of ultrasonography was helpful in selecting a suitable area for the biopsy and vascular structures could be avoided. The procedure was well tolerated and easy to perform, and no complications were recorded.
Collapse
Affiliation(s)
- S. Lindequist
- Departments of Diagnostic Radiology and Pathology, Odense University Hospital, Odense, Denmark
| | - C. Larsen
- Departments of Diagnostic Radiology and Pathology, Odense University Hospital, Odense, Denmark
| | - H. Daa Schrøder
- Departments of Diagnostic Radiology and Pathology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
24
|
Pyndt Jørgensen B, Krych L, Pedersen TB, Plath N, Redrobe JP, Hansen AK, Nielsen DS, Pedersen CS, Larsen C, Sørensen DB. Investigating the long-term effect of subchronic phencyclidine-treatment on novel object recognition and the association between the gut microbiota and behavior in the animal model of schizophrenia. Physiol Behav 2014; 141:32-9. [PMID: 25545766 DOI: 10.1016/j.physbeh.2014.12.042] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/22/2014] [Accepted: 12/24/2014] [Indexed: 12/26/2022]
Abstract
Subchronic phencyclidine (subPCP) treatment induces schizophrenic-like behavior in rodents, including cognitive deficits and increased locomotor sensitivity towards acute administration of PCP. Evidence is accumulating that the gut microbiota (GM) influences behavior through modulation of the microbiota-gut-brain axis, and hence, part of the variation within this animal model may derive from variation in the GM. The aims of this study was to investigate first, the duration of subPCP-induced cognitive impairment in the novel object recognition test, and second, the possible effect of subchronic PCP-treatment on the GM, and the association between the GM and the behavioral parameters. The association was further investigated by antibiotic reduction of the GM. Male Lister Hooded rats were dosed twice daily i.p. with either 5mg/kg PCP or sterile isotonic saline for seven days followed by a seven-day washout period. Rats were tested in the novel object recognition and the locomotor activity assays immediately after, three weeks after, or six weeks after washout, and the fecal GM was analyzed by high throughput sequencing. Antibiotic- and control-treated rats were tested in the same manner following washout. In conclusion, subPCP-treatment impaired novel object recognition up to three weeks after washout, whereas locomotor sensitivity was increased for at least six weeks after washout. Differences in the core gut microbiome immediately after washout suggested subPCP treatment to alter the GM. GM profiles correlated to memory performance. Administration of ampicillin abolished the subPCP-induced memory deficit. It thus seems reasonable to speculate that the GM influences memory performance, contributing to variation within the model.
Collapse
Affiliation(s)
- B Pyndt Jørgensen
- Section of Experimental Animal Models, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Thorvaldsensvej 57, 1871 Frederiksberg C., Denmark.
| | - L Krych
- Department of Food Science, Faculty of Science, University of Copenhagen, Denmark
| | - T B Pedersen
- Nonclinical Safety Research, H. Lundbeck A/S, Valby, Denmark
| | - N Plath
- Synaptic Transmission, H. Lundbeck A/S, Valby, Denmark
| | - J P Redrobe
- Synaptic Transmission, H. Lundbeck A/S, Valby, Denmark
| | - A K Hansen
- Section of Experimental Animal Models, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Thorvaldsensvej 57, 1871 Frederiksberg C., Denmark
| | - D S Nielsen
- Department of Food Science, Faculty of Science, University of Copenhagen, Denmark
| | - C S Pedersen
- Synaptic Transmission, H. Lundbeck A/S, Valby, Denmark
| | - C Larsen
- Section of Experimental Animal Models, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Thorvaldsensvej 57, 1871 Frederiksberg C., Denmark
| | - D B Sørensen
- Section of Experimental Animal Models, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Thorvaldsensvej 57, 1871 Frederiksberg C., Denmark
| |
Collapse
|
25
|
|
26
|
Abstract
Gain-switching is an alternative pulsing technique of fiber lasers, which is power scalable and has a low complexity. From a linear stability analysis of rate equations the relaxation oscillation period is derived and from it, the pulse duration is defined. Good agreement between the measured pulse duration and the theoretical prediction is found over a wide range of parameters. In particular we investigate the influence of an often present length of passive fiber in the cavity and show that it introduces a finite minimum in the achievable pulse duration. This minimum pulse duration is shown to occur at longer active fibers length with increased passive length of fiber in the cavity. The peak power is observed to depend linearly on the absorbed pump power and be independent of the passive fiber length. Given these conclusions, the pulse energy, duration, and peak power can be estimated with good precision.
Collapse
|
27
|
Kuhlmann E, Larsen C. How to staff the future long-term healthcare workforce? A need for integrative European health human resources policy. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
28
|
|
29
|
Larsen C, Giesberts M, Nyga S, Fitzau O, Jungbluth B, Hoffmann HD, Bang O. Gain-switched all-fiber laser with narrow bandwidth. Opt Express 2013; 21:12302-12308. [PMID: 23736448 DOI: 10.1364/oe.21.012302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Gain-switching of a CW fiber laser is a simple and cost-effective approach to generate pulses using an all-fiber system. We report on the construction of a narrow bandwidth (below 0.1 nm) gain-switched fiber laser and optimize the pulse energy and pulse duration under this constraint. The extracted pulse energy is 20 μJ in a duration of 135 ns at 7 kHz. The bandwidth increases for a higher pump pulse energy and repetition rate, and this sets the limit of the output pulse energy. A single power amplifier is added to raise the peak power to the kW-level and the pulse energy to 230 μJ while keeping the bandwidth below 0.1 nm. This allows frequency doubling in a periodically poled lithium tantalate crystal with a reasonable conversion efficiency.
Collapse
Affiliation(s)
- C Larsen
- DTU Fotonik, Department of Photonics Engineering, Technical University of Denmark, 2800 Kgs Lyngby, Denmark.
| | | | | | | | | | | | | |
Collapse
|
30
|
Sørensen ST, Møller U, Larsen C, Moselund PM, Jakobsen C, Johansen J, Andersen TV, Thomsen CL, Bang O. Deep-blue supercontinnum sources with optimum taper profiles--verification of GAM. Opt Express 2012; 20:10635-10645. [PMID: 22565689 DOI: 10.1364/oe.20.010635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We use an asymmetric 2 m draw-tower photonic crystal fiber taper to demonstrate that the taper profile needs careful optimisation if you want to develop a supercontinuum light source with as much power as possible in the blue edge of the spectrum. In particular we show, that for a given taper length, the downtapering should be as long as possible. We argue how this may be explained by the concept of group-acceleration mismatch (GAM) and we confirm the results using conventional symmetrical short tapers made on a taper station, which have varying downtapering lengths.
Collapse
Affiliation(s)
- S T Sørensen
- DTU Fotonik, Department of Photonics Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark.
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Pedersen M, Vallentin S, Larsen C, Pohl Z, Vinten G, Elezaj D, Ryberg M, Danø H, Behrens C, Sjöström D. PO-0947 DIFFERENCES IN RTT AND PHYSICIAN DELINEATION OF BREAST CANCER AND HOW IT AFFECTS THE TREATMENT PLAN. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Larsen C, Soerensen J, Grantcharov T, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder T, Ottesen B. O507 Impact of virtual reality training in laparoscopic gynaecology. Int J Gynaecol Obstet 2011. [DOI: 10.1016/s0020-7292(09)60880-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Larsen C, Noordegraaf D, Skovgaard PMW, Hansen KP, Mattsson KE, Bang O. Gain-switched CW fiber laser for improved supercontinuum generation in a PCF. Opt Express 2011; 19:14883-14891. [PMID: 21934849 DOI: 10.1364/oe.19.014883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We demonstrate supercontinuum generation in a PCF pumped by a gain-switched high-power continuous wave (CW) fiber laser. The pulses generated by gain-switching have a peak power of more than 700 W, a duration around 200 ns, and a repetition rate of 200 kHz giving a high average power of almost 30 W. By coupling such a pulse train into a commercial nonlinear photonic crystal fiber, a supercontinuum is generated with a spectrum spanning from 500 to 2250 nm, a total output power of 12 W, and an infrared flatness of 6 dB over a bandwidth of more than 1000 nm with a power density above 5 dBm/nm (3 mW/nm). This is considerably broader than when operating the same system under CW conditions. The presented approach is attractive due to the high power, power scalability, and reduced system complexity compared to picosecond-pumped supercontinuum sources.
Collapse
Affiliation(s)
- C Larsen
- DTU Fotonik—Department of Photonics Engineering, Technical University of Denmark, 2800 Kgs Lyngby, Denmark.
| | | | | | | | | | | |
Collapse
|
34
|
Kuhlmann E, Burau V, Larsen C, Lewandowski R, Lionis C, Repullo J. Medicine and management in European healthcare systems: how do they matter in the control of clinical practice? Int J Clin Pract 2011; 65:722-4. [PMID: 21518159 DOI: 10.1111/j.1742-1241.2011.02665.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- E Kuhlmann
- Department of Social and Policy Sciences, University of Bath, Bath, UK.
| | | | | | | | | | | |
Collapse
|
35
|
Bendorf A, Kerridge I, Pussell B, Donadio C, Hesham A, Grassi G, Kanaki A, Barsotti M, Hertig A, Dubois-Xu YC, Buob D, Noel C, Rondeau E, Hazzan M, Dahle DO, Mjoen G, Marz W, Holme I, Fellstrom B, Jardine A, Holdaas H, Vincenti F, Larsen C, Alberu J, Duro Garcia V, Rostaing L, Rice K, Schnitzler M, Xing J, Agarwal M, Charpentier B. Transplantation / Clinical studies. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Affiliation(s)
- C Murphy
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Crespo M, Collado S, Mir M, Hurtado S, Cao H, Barbosa F, Serra C, Hidalgo C, Faura A, Garcia de Lomas J, Montero M, Horcajada JP, Puig JM, Pascual J, Ulusal Okyay G, Uludag K, Sozen H, Arman D, Dalgic A, Guz G, Fraile P, Garcia-Cosmes P, Rosado C, Gonzalez C, Tabernero JM, Costa C, Saldan A, Astegiano S, Terlizzi ME, Messina M, Bergallo M, Segoloni G, Cavallo R, Schwarz A, Grosshennig A, Heim A, Broecker V, Haller H, Linnenweber S, Liborio AB, Mendoza TR, Esmeraldo RM, Oliveira MLMB, Nogueira Paes FJV, Silva Junior GB, Daher EF, Hodgson K, Baharani J, Fenton A, Baharani J, Mjoen G, Hartmann A, Reisaeter A, Midtvedt K, Dahle DO, Holdaas H, Shabir S, Lukacik P, Bevins A, Basnayake K, Bental A, Hughes RG, Cockwell P, Burrows R, Hutchison CA, Varma P, Kumar A, Hooda A, Badwal S, Barrios C, Mir M, Crespo M, Fumado L, Frances A, Puig JM, Horcajada JP, Arango O, Pascual J, Pawlik A, Chudek J, Kolonko A, Wilk J, Jalowiecki P, Wiecek A, Teplan V, Kralova-Lesna I, Mahrova A, Racek J, tollova M, Maggisano V, Caracciolo V, Solazzo A, Montanari M, Della Grotta F, Nakazawa D, Nishio S, Nakagaki T, Ishikawa Y, Ito M, Shibazaki S, Shimoda N, Miura M, Morita K, Nonomura K, Koike T, Locsey L, Seres I, Sztanek F, Harangi M, Padra J, Asztalos L, Paragh G, Rodriguez-Reimundes E, Soler-Pujol G, Diaz CH, Davalos-Michel M, Vilches AR, Laham G, Mjoen G, Stavem K, Midtvedt K, Norby G, Holdaas H, Tutal E, Canver B, Can S, Sezer S, Colak T, Kolonko A, Chudek J, Wiecek A, Paschoalin R, Barros X, Duran C, Torregrosa JV, Crespo M, Mir M, Barrios C, Faura A, Tellez E, Marin M, Puig JM, Pascual J, Smalcelj R, Smalcelj A, Claes K, Petit T, Bammens B, Kuypers D, Naesens M, Vanrenterghem Y, Evenepoel P, Gerhart MK, Colbus S, Seiler S, Grun O, Fliser D, Heine GH, Vincenti F, Grinyo J, Larsen C, Medina Pestana J, Vanrenterghem Y, Dong Y, Thomas D, Charpentier B, Luna E, Martinez R, Cerezo I, Ferreira F, Cubero J, Villa J, Martinez C, Garcia C, Rodrigo E, Santos L, Pinera C, Quintela E, Ruiz JC, Fernandez-Fresnedo G, Palomar R, Gomez-Alamillo C, Martin de Francisco AL, Arias M, Grinyo J, Nainan G, del Carmen Rial M, Steinberg S, Vincenti F, Dong Y, Thomas D, Kamar N, Durrbach A, Grinyo J, Vanrenterghem Y, Becker T, Florman S, Lang P, del Carmen Rial M, Schnitzler M, Duan T, Block A, Medina Pestana J, Sawosz M, Cieciura T, Durlik M, Perkowska A, Sikora P, Beck B, De Mauri A, Brambilla M, Stratta P, Chiarinotti D, De Leo M, Attou S, Arzour H, Boudrifa N, Mekhlouf N, Gaouar A, Merazga S, Kalem K, Haddoum F. Transplantation: clinical studies. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
38
|
Huggel C, Salzmann N, Allen S, Caplan-Auerbach J, Fischer L, Haeberli W, Larsen C, Schneider D, Wessels R. Recent and future warm extreme events and high-mountain slope stability. Philos Trans A Math Phys Eng Sci 2010; 368:2435-2459. [PMID: 20403836 DOI: 10.1098/rsta.2010.0078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The number of large slope failures in some high-mountain regions such as the European Alps has increased during the past two to three decades. There is concern that recent climate change is driving this increase in slope failures, thus possibly further exacerbating the hazard in the future. Although the effects of a gradual temperature rise on glaciers and permafrost have been extensively studied, the impacts of short-term, unusually warm temperature increases on slope stability in high mountains remain largely unexplored. We describe several large slope failures in rock and ice in recent years in Alaska, New Zealand and the European Alps, and analyse weather patterns in the days and weeks before the failures. Although we did not find one general temperature pattern, all the failures were preceded by unusually warm periods; some happened immediately after temperatures suddenly dropped to freezing. We assessed the frequency of warm extremes in the future by analysing eight regional climate models from the recently completed European Union programme ENSEMBLES for the central Swiss Alps. The models show an increase in the higher frequency of high-temperature events for the period 2001-2050 compared with a 1951-2000 reference period. Warm events lasting 5, 10 and 30 days are projected to increase by about 1.5-4 times by 2050 and in some models by up to 10 times. Warm extremes can trigger large landslides in temperature-sensitive high mountains by enhancing the production of water by melt of snow and ice, and by rapid thaw. Although these processes reduce slope strength, they must be considered within the local geological, glaciological and topographic context of a slope.
Collapse
Affiliation(s)
- C Huggel
- Department of Geography, University of Zurich, Switzerland.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Trevitt J, Kawa K, Jalali A, Larsen C. Differential effects of adenosine antagonists in two models of parkinsonian tremor. Pharmacol Biochem Behav 2009; 94:24-9. [DOI: 10.1016/j.pbb.2009.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 07/02/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
|
40
|
Aunsholt N, Larsen C. The Arterial Oxygen Extraction Tension and Oxygen Compensation Factor during Acetate and Bicarbonate Dialysis. Blood Purif 2008. [DOI: 10.1159/000170063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
41
|
Shen L, Kuppachi S, Agarwal A, Turgeon N, Tso P, Newell K, Pearson T, Larsen C, Kirk A. INFLUENCE OF DONOR TYPE ON ELDERLY KIDNEY TRANSPLANT SURVIVAL AND ALLOGRAFT FUNCTION. Transplantation 2008. [DOI: 10.1097/01.tp.0000332432.68459.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
|
43
|
Larsen C, Pialoux G, Salmon D, Antona D, Le Strat Y, Piroth L, Pol S, Rosenthal E, Neau D, Semaille C, Delarocque Astagneau E. Prevalence of hepatitis C and hepatitis B infection in the HIV-infected population of France, 2004. Euro Surveill 2008. [DOI: 10.2807/ese.13.22.18888-en] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Our objective was to estimate the prevalence of HCV and HBV co-infection among HIV-infected adults in France and describe the epidemiological characteristics of co-infected patients and their clinical management. A one-day national cross-sectional survey was conducted in 2004. A random and proportional probability sample design was used, based on the number of AIDS cases reported since 1999 by hospital wards. Weighted estimations were computed. HIV-infected adults (out/in-patients) were included after consent. Data were collected on demographic criteria, HIV, HCV and HBV infections, as well as on antiviral therapies. Overall, 1849 HIV-infected patients were included. The prevalence of anti-HCV or HCV RNA positivity (HCV co-infection) was 24.3% [95% confidence interval (CI): 21.3-27.6] and varied from 3.1% in men who had sex with men to 92.8% in injecting drug users (IDUs). The prevalence of positive HCV RNA was 17.0% [95% CI:14.7-19.4]. The prevalence of HBs antigen (Ag) or HBV DNA positivity was 7.0% [95% CI: 5.9-8.1] and varied with the continent of birth from 2.1% in Northern Africa to 10.8% in sub-Saharan Africa. The prevalence of HIV-HCV-HBV co-infection was 1.6% [95% CI: 1.0-2.4], mostly IDUs (83.3%). A severe liver disease (cirrhosis or hepatocellular carcinoma) was diagnosed in 24.7% of the positive HCV RNA patients.This study confirmed the burden of HCV infection in French HIV-infected patients and described for the first time in France the epidemiological characteristics of HIV-HBV co-infection. Furthermore, it stresses the severity of liver disease related to HCV in HIV-infected population.
Collapse
Affiliation(s)
- C Larsen
- Department of Infectious Diseases, National institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - G Pialoux
- Department of Infectious Diseases, APHP-Tenon University Hospital, Paris, France
| | - D Salmon
- Department of Internal Medicine, APHP-Cochin University Hospital, Paris, France
| | - D Antona
- Department of Infectious Diseases, National institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - Y Le Strat
- Department of Infectious Diseases, National institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - L Piroth
- Department of Infectious Diseases, Le Bocage University Hospital, Dijon, France
| | - S Pol
- Department of Hepatology, APHP-Cochin University Hospital, Paris, France
| | - E Rosenthal
- Department of Internal Medicine, L’Archet-1 University Hospital, Nice, France
| | - D Neau
- Department of Infectious Diseases, Pellegrin University Hospital, Bordeaux, France
| | - C Semaille
- Department of Infectious Diseases, National institute for Public Health Surveillance (InVS), Saint-Maurice, France
| | - E Delarocque Astagneau
- Department of Infectious Diseases, National institute for Public Health Surveillance (InVS), Saint-Maurice, France
| |
Collapse
|
44
|
Larsen C, Pialoux G, Salmon D, Antona D, Le Strat Y, Piroth L, Pol S, Rosenthal E, Neau D, Semaille C, Delarocque Astagneau E. Prevalence of hepatitis C and hepatitis B infection in the HIV-infected population of France, 2004. Euro Surveill 2008; 13:18888. [PMID: 18761958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Our objective was to estimate the prevalence of HCV and HBV co-infection among HIV-infected adults in France and describe the epidemiological characteristics of co-infected patients and their clinical management. A one-day national cross-sectional survey was conducted in 2004. A random and proportional probability sample design was used, based on the number of AIDS cases reported since 1999 by hospital wards. Weighted estimations were computed. HIV-infected adults (out/in-patients) were included after consent. Data were collected on demographic criteria, HIV, HCV and HBV infections, as well as on antiviral therapies. Overall, 1849 HIV-infected patients were included. The prevalence of anti-HCV or HCV RNA positivity (HCV co-infection) was 24.3% [95% confidence interval (CI): 21.3-27.6] and varied from 3.1% in men who had sex with men to 92.8% in injecting drug users (IDUs). The prevalence of positive HCV RNA was 17.0% [95% CI:14.7-19.4]. The prevalence of HBs antigen (Ag) or HBV DNA positivity was 7.0% [95% CI: 5.9-8.1] and varied with the continent of birth from 2.1% in Northern Africa to 10.8% in sub-Saharan Africa. The prevalence of HIV-HCV-HBV co-infection was 1.6% [95% CI: 1.0-2.4], mostly IDUs (83.3%). A severe liver disease (cirrhosis or hepatocellular carcinoma) was diagnosed in 24.7% of the positive HCV RNA patients. This study confirmed the burden of HCV infection in French HIV-infected patients and described for the first time in France the epidemiological characteristics of HIV-HBV co-infection. Furthermore, it stresses the severity of liver disease related to HCV in HIV-infected population.
Collapse
Affiliation(s)
- C Larsen
- Department of Infectious Diseases, National institute for Public Health Surveillance, Saint-Maurice, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Gangappa S, Larsen C, Pearson T. Erratum. Am J Transplant 2007. [DOI: 10.1111/j.1600-6143.2006.01776.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
46
|
Bray RA, Nolen JDL, Larsen C, Pearson T, Newell KA, Kokko K, Guasch A, Tso P, Mendel JB, Gebel HM. Transplanting the highly sensitized patient: The emory algorithm. Am J Transplant 2006; 6:2307-15. [PMID: 16939516 DOI: 10.1111/j.1600-6143.2006.01521.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Renal transplant patients sensitized to HLA antigens comprise nearly one-third of the UNOS wait-list and receive 14% of deceased donor (DD) transplants, a rate half that of unsensitized patients. Between 1999 and 2003, we performed 492 adult renal transplants from DD; 120 patients (approximately 25%) had a panel reactive antibody (PRA) of >30%, with nearly half (n = 58) having a PRA of >80%. Our approach is based upon high-resolution solid-phase HLA antibody analysis to identify class I/II antibodies and a 'virtual crossmatch' to predict compatible donor/recipient combinations. Recipients are excluded from the United Network for Organ Sharing match run if donors possess unacceptable antigens. Thus, when sensitized patients appear on the match run, they have a high probability of a negative final crossmatch. Here, we describe our 5-year experience with this approach. Five-year graft survival ranged from 66% to 70% among unsensitized (n = 272), moderately sensitized (PRA < 30%, n = 100) and highly sensitized (>30% PRA; n = 120) patients, equal to the average national graft survival (65.7%). The application of this approach (the Emory Algorithm) provides a logical and systematic approach to improve the access of sensitized patients to DD organs and promote more equitable allocation to a highly disadvantaged group of patients awaiting renal transplantation.
Collapse
Affiliation(s)
- R A Bray
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Siegel PB, Blair M, Gross WB, Meldrum B, Larsen C, Boa-Amponsem K, Emmerson DA. Poult Performance as Influenced by Age of Dam, Genetic Line, and Dietary Vitamin E. Poult Sci 2006; 85:939-42. [PMID: 16673775 DOI: 10.1093/ps/85.5.939] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An experiment was conducted to measure the effects of age of dam, genetic line, and dietary levels of vitamin E on growth and immunocompetence of poults. Age of dam was defined as younger (in early egg production) and older (past peak production); line consisted of a commercial sire and dam line; and dietary vitamin E was supplemented into the diet at 10 and 300 IU/kg of feed. Traits measured included body, liver, gizzard, and yolk sac weights at hatch; BW and feed conversion to 9, 28, and 42 d; response to SRBC, Phaseolus vulgaris agglutinin-P, and Escherichia coli administered at 28 d of age; and response to a cold stress on d 5 posthatch. Differences among genetic lines were evident with growth greater for poults from the sire than from the dam line. Performance of poults from older dams was generally superior to that of poults from younger dams. The higher level of vitamin E resulted in a greater than 7-fold increase in blood plasma vitamin E and reduced mortality. There were interactions among the main effects in which the fitness of poults from younger dams was enhanced by the higher level of vitamin E and the effect of breeder age differed among genetic lines.
Collapse
Affiliation(s)
- P B Siegel
- Department of Animal and Poultry Sciences, Virginia Tech, Blacksburg 24061, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Larsen C, Salmon D, Pialoux G, Antona D, Piroth L, Pol S, Le Strat Y, Rosenthal E, Neau D, Delarocque-Astagneau E, Desenclos J. P.418 Prevalence of hepatitis C virus (HCV) and hepatitis B virus (HBV) infection among HIV infected persons (France, 2004). J Clin Virol 2006. [DOI: 10.1016/s1386-6532(06)80591-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
49
|
Puro V, De Carli G, Cicalini S, Soldani F, Balslev U, Begovac J, Boaventura L, Campins Marti M, Hernández Navarrete MJ, Kammerlander R, Larsen C, Lot F, Lunding S, Marcus U, Payne L, Pereira AA, Thomas T, Ippolito G. European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill 2005; 10:11-12. [DOI: 10.2807/esm.10.10.00573-en] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up.
Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted.
Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination
The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days).
In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.
Collapse
Affiliation(s)
- V Puro
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - G De Carli
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - S Cicalini
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - F Soldani
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| | - U Balslev
- Department of Infectious Diseases, Hvidovre Hospital; Copenhagen, Denmark
| | - J Begovac
- Dr. Fran Mihaljevic University Hospital for Infectious Diseases; Zagreb, Croatia
| | - L Boaventura
- Servicio de Doenças Infecciosas, Hospital de Santa Maria; Lisbon, Portugal
| | - M Campins Marti
- Hospital Vall d’Hebron, Servicio de Medicina Preventiva; Barcelona, Spain
| | | | - R Kammerlander
- Office Fédéral de la Santé Publique, Division Epidémiologie et Maladies Infectieuses, Berne, Switzerland
| | - C Larsen
- Institut de Veille Sanitaire, Département des Maladies Infectieuses, Saint-Maurice, France
| | - F Lot
- Institut de Veille Sanitaire, Département des Maladies Infectieuses, Saint-Maurice, France
| | - S Lunding
- Department of Infectious Diseases, Rigshospitalet; Copenhagen, Denmark
| | - U Marcus
- Robert Koch Institut, Infektionsepidemiologie AIDS/STD; Berlin, Germany
| | - L Payne
- Public Health Laboratory Service, Communicable Disease Surveillance Centre, HIV and STI Division; London, UK
| | - A A Pereira
- Servicio de Doenças Infecciosas, Hospital de Santa Maria; Lisbon, Portugal
| | - T Thomas
- Public Health Laboratory Service, Communicable Disease Surveillance Centre, HIV and STI Division; London, UK
| | - G Ippolito
- Istituto Nazionale per le Malattie Infettive “Lazzaro Spallanzani”, IRCCS; Rome, Italy
| |
Collapse
|
50
|
Puro V, De Carli G, Cicalini S, Soldani F, Balslev U, Begovac J, Boaventura L, Campins Martí M, Hernández Navarrete MJ, Kammerlander R, Larsen C, Lot F, Lunding S, Marcus U, Payne L, Pereira AA, Thomas T, Ippolito G. European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill 2005; 10:260-4. [PMID: 16282641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Exposure prevention is the primary strategy to reduce the risk of occupational bloodborne pathogen infections in healthcare workers (HCW). HCWs should be made aware of the medicolegal and clinical relevance of reporting an exposure, and have ready access to expert consultants to receive appropriate counselling, treatment and follow-up. Vaccination against hepatitis B virus (HBV), and demonstration of immunisation before employment are strongly recommended. HCWs with postvaccinal anti-HBs levels, 1-2 months after vaccine completion, >or=10 mIU/mL are considered as responders. Responders are protected against HBV infection: booster doses of vaccine or periodic antibody concentration testing are not recommended. Alternative strategies to overcome non-response should be adopted. Isolated anti-HBc positive HCWs should be tested for anti-HBc IgM and HBV-DNA: if negative, anti-HBs response to vaccination can distinguish between infection (anti-HBs >or=50 mUI/ml 30 days after 1st vaccination: anamnestic response) and false positive results(anti-HBs >or=10 mUI/ml 30 days after 3rd vaccination: primary response); true positive subjects have resistance to re-infection. and do not need vaccination The management of an occupational exposure to HBV differs according to the susceptibility of the exposed HCW and the serostatus of the source. When indicated, post-exposure prophylaxis with HBV vaccine, hepatitis B immunoglobulin or both must be started as soon as possible (within 1-7 days). In the absence of prophylaxis against hepatitis C virus (HCV) infection, follow-up management of HCV exposures depends on whether antiviral treatment during the acute phase is chosen. Test the HCW for HCV-Ab at baseline and after 6 months; up to 12 for HIV-HCV co-infected sources. If treatment is recommended, perform ALT (amino alanine transferase) activity at baseline and monthly for 4 months after exposure, and qualitative HCV-RNA when an increase is detected.
Collapse
Affiliation(s)
- V Puro
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|