Femtosecond Resolution of the Nonballistic Electron Energy Transport in Warm Dense Copper

The ultrafast electron energy transport is investigated in laser-heated warm dense copper in a high flux regime (2.5±0.7×10^{13}  W/cm^{2} absorbed). The dynamics of the electron temperature is retrieved from femtosecond time-resolved x-ray absorption near-edge spectroscopy near the Cu L3 edge. A characteristic time of ∼1  ps is observed for the increase in the average temperature in a 100 nm thick sample. Data are well reproduced by two-temperature hydrodynamic simulations, which support energy transport dominated by thermal conduction rather than ballistic electrons.

Clinical, Economic, and Organizational Impact of the Clinical Pharmacist in an Orthopedic and Trauma Surgery Department

AIM

The aim of this study was to evaluate the clinical, economic, and organizational impact of clinical pharmacist services added to an adult orthopedic and trauma surgery unit in a university hospital.

METHODS

This was a prospective, observational study performed from January to February 2017. All pharmacists' interventions were documented, and their clinical, economic, and organizational impact and the probability of adverse drug events (ADEs) were assessed using the clinical, economic and organizational scale three-dimensional scale. An expert panel composed of three clinical pharmacists, one surgeon and one anesthetist classified the pharmacist intervention. The potential clinical impact was determined through a consensus by the expert panel. Cost avoidance was calculated for serious ADEs with a major impact by avoiding an additional cost of €4912 per event and taking into account the probability of ADE occurrence.

RESULTS

The pharmacists performed 1014 interventions for 28 days with a 95.3% acceptance rate by prescribers. Thirty-nine interventions were rated to have a major clinical impact (3.8%). The organizational impact was estimated favorable for 856 (84.4%) pharmacist interventions. Cost avoidance was estimated at €24,364, and the indirect costs benefit was estimated at €11,864 during the study. The cost-benefit ratio of the clinical pharmacist intervention was €1.94 in savings for every €1 invested.

CONCLUSIONS

Clinical pharmacist services in an orthopedic and trauma surgery department have the potential to improve patient outcomes and avoid healthcare costs. Furthermore, the presence of a pharmacist in surgical units allows for communication between the unit and the pharmacy, which produces better fluidity and improves the quality of care.

Ultrafast Thermal Melting in Nonequilibrium Warm Dense Copper

The ultrafast dynamics of the loss of crystalline periodicity is investigated in femtosecond laser heated warm dense copper, by the original use of x-ray absorption near-edge specific structures just above the L3 edge. The characteristic time is observed near 1 ps, for specific energy density ranging from 1 to 5  MJ/kg, using ps-resolution x-ray absorption spectroscopy. The overall experimental data are well reproduced with two-temperature hydrodynamic simulations, supporting a thermal phase transition.

Collaboration between cardiologist and clinical pharmacist on prescription quality: What is the potential clinical impact for cardiology patients?

OBJECTIVES

The aim of this study was to determine the effect of pharmacists' interventions (PI) on the potential clinical impact of medication errors, including the lack of therapeutic optimisation of patients with cardiologic diseases, such as heart failure and acute coronary syndrome).

METHODS

This was an observational, prospective study conducted in the cardiology department of a French university hospital centre for a duration of 9 months. All prescriptions were analysed and PI were registered for clinical rating by pharmacists and cardiologist.

RESULTS

A total of 532 PI cases were recorded in 339 patients, with a mean of 1.57 (±1.04) PI. The PI acceptance rate was 98.1%. "Dose adjustment" and "introduction therapy" were the most common interventions and represented 38.0% and 32.9%, respectively, of all PI. Statins were the most frequently involved drugs (18.1%), followed by ACE (Angiotensin Converting Enzyme) inhibitors (10.9%) and antiplatelet agents (9.3%). Moreover, 13.8% of PI potentially avoided a severe or very severe clinical impact (n = 71) and 38.6% had a significant impact altering the quality of life (n = 198). There was no significant difference between the average score performed by the clinical pharmacist included in the cardiology team and the one obtained by the cardiologist (P = .797). In contrast, a significant difference was observed for the average score established by the pharmacist localised in central pharmacy versus the rating of the cardiologist (P < .001).

CONCLUSIONS

The collaboration between clinical pharmacists and cardiologists in the medical units seems to be beneficial to the quality of prescriptions, including the implementation of recommendations. The good rate of PI acceptance and the similar rating with the cardiologist show that there is a change in perspective of the pharmacist, being closer to the clinical reality.

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents

Background: Differences in weight status by socioeconomic position occur during adolescence and is known as weight social gradient (WSG). The PRALIMAP (Promotion de l'ALIMentation et de l'Activité Physique) trial highlighted that a universal intervention was effective in reducing overweight and obesity prevalence among adolescents. However, its ability to reduce the WSG is unclear. This study aimed to evaluate the impact of the PRALIMAP intervention on the WSG among adolescents. Methods: Data were obtained from 3504 adolescents who participated in the school-based PRALIMAP trial between 2006 and 2009. The PRALIMAP study consisted of three interventional strategies: educational, environmental, screening and care. Weight status was assessed by body mass index (BMI) z-score and overweight and obesity prevalence. The "indice de position sociale des élèves" was used to measure adolescents' socioeconomic status. Linear regression and hierarchical models were used to assess the WSG and its evolution, respectively. Results: Among all adolescents (14-18 years old), significant WSG was identified at baseline: BMI z-score (β = -0.06; p < 0.0001), overweight and obesity prevalence (β = -2.86; p < 0.0001). Overall, the intervention conferred no significant reduction in the WSG: BMI z-score (β = -0.01 [-0.02 to 0.01], p = 0.48), overweight and obesity prevalence (β = -0.01 [-0.07 to 0.05], p = 0.73). Similar results were observed for adolescents whatever the interventional strategy they benefited from in the PRALIMAP trial. Conclusions: This study provided no evidence that the PRALIMAP universal intervention was effective in reducing the socioeconomic inequalities in weight status among adolescents. Different interventions that account for social differences should be considered to tackle these inequalities.

Two-channel high-resolution quasi-monochromatic X-ray imager for Al and Ti plasma

High-resolution, high-sensitivity X-ray imaging is a real challenge in high-energy density plasma experiments. We present an improved design of the Fresnel ultra high-resolution imager instrument. Using an Ultra-High-Intensity (UHI) laser to generate hot and dense plasma in a small volume of an Al-Ti mixed target provides simultaneous imaging of both Al and Ti X-ray emission. Specifically, the Al He_β (or Ly_β) and the Ti He_α lines are imaged with a resolution of (2.7 ± 0.3) μm and (5.5 ± 0.3) μm, respectively. It features two transmission Fresnel phase zone plates fabricated on the same substrate, each associated with a multilayer mirror for spectral selection. Their spatial resolution has been measured on the PTB synchrotron radiation facility laboratory at BESSY II and on the EQUINOX laser facility. Results obtained on an UHI experiment highlight the difference of emission zone sizes between Al and Ti lines and the versatility of this instrument.

Probing warm dense matter using femtosecond X-ray absorption spectroscopy with a laser-produced betatron source

Exploring and understanding ultrafast processes at the atomic level is a scientific challenge. Femtosecond X-ray absorption spectroscopy (XAS) arises as an essential experimental probing method, as it can simultaneously reveal both electronic and atomic structures, and thus potentially unravel their nonequilibrium dynamic interplay which is at the origin of most of the ultrafast mechanisms. However, despite considerable efforts, there is still no femtosecond X-ray source suitable for routine experiments. Here we show that betatron radiation from relativistic laser−plasma interaction combines ideal features for femtosecond XAS. It has been used to investigate the nonequilibrium dynamics of a copper sample brought at extreme conditions of temperature and pressure by a femtosecond laser pulse. We measured a rise-time of the electron temperature below 100 fs. This experiment demonstrates the great potential of the table-top betatron source which makes possible the investigation of unexplored ultrafast processes in manifold fields of research.

Understanding the ultrafast dynamics of materials under extreme conditions is challenging. Here the authors use a femtosecond betatron X-ray source to investigate the solid to dense plasma phase transition in copper using XAS with unprecedented time resolution.

Patterns of invasive mechanical ventilation in patients with severe blunt chest trauma and lung contusion: A French multicentric evaluation of practices

Introduction

This study investigated invasive mechanical ventilation modalities used in severe blunt chest trauma patients with pulmonary contusion. Occurrence, risk factors, and outcomes of early onset acute respiratory distress syndrome were also evaluated.

Methods

We performed a retrospective multicenter observational study including 115 adult patients hospitalized in six level 1 trauma intensive care units between April and September of 2014. Independent predictors of early onset acute respiratory distress syndrome were determined by multiple logistic regression analysis based on clinical characteristics and initial management.

Results

Protective ventilation principles were highly implemented, even prophylactically before acute respiratory distress syndrome occurrence. Early onset acute respiratory distress syndrome appeared to be associated with lung contusion of >20% of total lung volume and early onset pneumonia.

Conclusions

Predictors of early onset acute respiratory distress syndrome could help with identifying high-risk populations, potentially improving case management through specific protocol development for these patients.

Impact of a pharmacist-led medication review on hospital readmission in a pediatric and elderly population: study protocol for a randomized open-label controlled trial

BACKGROUND

Early hospital readmission of patients after discharge is a public health problem. One major cause of hospital readmission is dysfunctions in integrated pathways between community and hospital care that can cause adverse drug events. Furthermore, the French ENEIS 2 study showed that 1.3% of hospital stays originated from serious adverse drug events in 2009. Pharmacy-led medication reviews at hospital transitions are an effective means of decreasing medication discrepancies when conducted at admission or discharge. However, it is difficult to assess the true impact of pharmacist-led medication reviews in specific high-risk populations, such as pediatric and geriatric populations. In such a context, it is important to demonstrate the effectiveness of medication reconciliation as part of a standardized medication review process-in pediatric and elderly populations-on all-cause readmissions in a large randomized controlled clinical trial. The aim of this study is to assess the impact of the pharmacist-led medication review on the rate of readmissions and/or death after hospital discharge and patient treatment satisfaction.

METHODS/DESIGN

The study is a randomized controlled clinical trial. A total of 1400 hospitalized patients will be randomized in two groups: (1) the experimental group (group receiving a pharmacist-led medication review) and (2) the control group (group receiving usual care). The pharmacist-led medication review process includes medication reconciliation, treatment review and medication liaison service. The primary endpoint will be the rate of readmissions and/or death at 30 days following initial hospitalization discharge. The secondary endpoints will be the rate of hospital readmission, the rate of emergency department visits, the rate of mortality, the number of consultations and patient treatment satisfaction at 30 days following initial hospitalization discharge.

DISCUSSION

A randomized controlled trial provides the most extensive evidence on the impact of pharmacist-led medication reviews on early hospital readmission for extreme age populations.

TRIAL REGISTRATION

Current Controlled Trials, NCT02734017 . Registered on 4 May 2016.

High-resolution quasi-monochromatic X-ray imaging using a Fresnel phase zone plate and a multilayer mirror

High-resolution, high-sensitivity X-ray imaging is a real challenge in laser plasma diagnostic to attain reliable data in high-energy density plasma experiments. In this context, ultra-high-intensity lasers generate hot and dense plasma but only in a small volume. An experiment has been performed at the LULI2000 laser facility to diagnose such plasma conditions from thermal spectroscopic data. To image the emission zone plasma's Al He_β, a Fresnel-lens-based X-ray imager has been developed. It features a 846 μm-diameter Fresnel Phase Zone Plate (FPZP) and a Pd/B₄C multilayer mirror (thickness d = 5.1 nm). This association can be used between 1500 eV and 2100 eV. The FPZP's efficiency was measured on a synchrotron facility (SOLEIL) and its spatial resolution in a laser facility (EQUINOX). The mirror reflectivity was measured on the synchrotron facility BESSY II. With experimental conditions, the system resolution reaches 3.8 ± 0.6 μm with an adequate efficiency in the 1800 eV-1900 eV energy range with a solid angle of 9 × 10^-6 sr. Consequently, a FPZP is an excellent optics setup for high-resolution quasi-monochromatic X-ray imaging and provides a good collection angle. Bragg-Fresnel lenses, based on the principle of FPZP and mirrors, are currently designed for an X-ray imager at the Laser MégaJoule facility.

Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis

AIMS

The aim of this meta-analysis is to examine the impact of in-hospital pharmacist-led medication reviews in paediatric and adult patients.

METHODS

Relevant studies were identified from the Medline and Cochrane Library databases. Studies were included if they met the following criteria (without any language or date restrictions): design: randomized controlled trial; intervention: in-hospital pharmacist-led medication review (experimental group) vs. usual care (control group); participants: paediatric or adult population. The primary outcome was all-cause readmissions and/or emergency department (ED) visits at different time points. The secondary outcomes were all-cause readmissions, all-cause ED visits, drug-related readmissions, mortality, length of hospital stay, adherence and quality of life. We calculated the relative risk (RR) or mean differences (MD) with 95% confidence intervals (CIs) for each study. We used fixed and/or random effects models. Heterogeneity was assessed using the I² statistic.

RESULTS

We systematically reviewed 19 randomized controlled trials (4805 participants). The readmission rates did not differ between the experimental group and the control group (RR = 0.97, 95% CI 0.89; 1.05, p = 0.470). The secondary outcomes did not differ between the two groups, except for in drug-related readmissions, which were lower in the experimental group (RR = 0.25, 95% CI 0.14; 0.45, p < 0.001), and all-cause ED visits (RR = 0.70, 95% CI 0.59; 0.85 p = 0.001).

CONCLUSION

The low-quality evidence in this analysis suggests an impact of pharmacist-led medication reviews on drug-related readmissions and all-cause ED visits. Few studies reported on adherence and quality of life. More high-quality randomized clinical trials are needed to assess the impact of pharmacist-led medication reviews on patient-relevant outcomes, including adherence and quality of life.

Ultrafast short-range disordering of femtosecond-laser-heated warm dense aluminum

We have probed, with time-resolved x-ray absorption near-edge spectroscopy (XANES), a femtosecond-laser-heated aluminum foil with fluences up to 1  J/cm2. The spectra reveal a loss of the short-range order in a few picoseconds. This time scale is compared with the electron-ion equilibration time, calculated with a two-temperature model. Hydrodynamic simulations shed light on complex features that affect the foil dynamics, including progressive density change from solid to liquid (∼10  ps). In this density range, quantum molecular dynamics simulations indicate that XANES is a relevant probe of the ionic temperature.

Picosecond short-range disordering in isochorically heated aluminum at solid density

Using ultrafast x-ray probing, we experimentally observed a progressive loss of ordering within solid-density aluminum as the temperature raises from 300 K to >10{4} K. The Al sample was isochorically heated by a short ( approximately ps), laser-accelerated proton beam and probed by a short broadband x-ray source around the Al K edge. The loss of short-range ordering is detected through the progressive smoothing of the time-resolved x-ray absorption near-edge spectroscopy (XANES) structure. The results are compared with two different theoretical models of warm dense matter and allow us to put an upper bound on the onset of ion lattice disorder within the heated solid-density medium of approximately 10 ps.

Ensuring financial access to emergency obstetric care: three years of experience with Obstetric Risk Insurance in Nouakchott, Mauritania

INTRODUCTION

The high cost of emergency obstetric care (EmOC) is a catastrophic health expenditure for households, causing delay in seeking and providing care in poor countries.

METHODS

In Nouakchott, the Ministry of Health instituted Obstetric Risk Insurance to allow obstetric risk sharing among all pregnant women on a voluntary basis. The fixed premium (US$21.60) entitles women to an obstetric package including EmOC and hospital care as well as post-natal care. The poorest are enrolled at no charge, addressing the problem of equity.

RESULTS

95% of pregnant women in the catchment area (48.3% of the city's deliveries) enrolled. Utilization rates increased over the 3-year period of implementation causing quality of care to decline. Basic and comprehensive EmOC are now provided 24/7. The program has generated US$382,320 in revenues, more than twice as much as current user fees. All recurrent costs other than salaries are covered.

CONCLUSION

This innovative sustainable financing scheme guarantees access to obstetric care to all women at an affordable cost.

Electronic structure and equation of state data of warm dense gold

Equation of state data and electrical resistivity of warm dense gold were measured in the internal energy range 8 - 12 MJ/kg. Experimental results were compared with quantum molecular dynamics simulations. The theoretical results match well the experimental data, allowing a detailed interpretation of the theoretical thermodynamic properties and frequency-dependent conductivities.

Picosecond time-resolved X-ray absorption spectroscopy of ultrafast aluminum plasmas

We have used point-projection K-shell absorption spectroscopy to infer the ionization and recombination dynamics of transient aluminum plasmas. Two femtosecond beams of the 100 TW laser at the LULI facility were used to produce an aluminum plasma on a thin aluminum foil (83 or 50 nm), and a picosecond x-ray backlighter source. The short-pulse backlighter probed the aluminum plasma at different times by adjusting the delay between the two femtosecond driving beams. Absorption x-ray spectra at early times are characteristic of a dense and rather homogeneous plasma. Collisional-radiative atomic physics coupled with hydrodynamic simulations reproduce fairly well the measured average ionization as a function of time.

Aluminum equation-of-state data in the warm dense matter regime

Isochore measurements were performed in the warm dense matter regime. Pressure and internal energy variation of aluminum plasma (density 0.1 g/cm(3) and 0.3 g/cm(3)) are measured using a homogeneous and thermally equilibrated media produced inside an isochoric plasma closed vessel in the internal energy range 20-50 MJ/kg. These data are compared to detailed calculations obtained from ab initio quantum molecular dynamics, average atom model within the framework of the density functional theory, and standard theories. A dispersion between theoretical isochore equation of state is found in the studied experimental thermodynamic regime.

Combined pressure and electrical-resistivity measurements of warm dense aluminum and titanium plasmas

Electrical resistivity, pressure, and internal energy variation of warm dense correlated titanium (density 0.2 g/cm(3)) and aluminum (density 0.1 g/cm(3)) plasmas are measured using a homogeneous and thermally equilibrated media produced inside an isochoric closed-vessel plasma. These data are compared to detailed calculations based on the density functional theory. In the studied temperature range (15,000-30,000 K), it appears that both exchange-correlation and ion-ion interaction treatments are of great importance to calculate accurate theoretical values.

[The delivery record: a help to make the right decision]

The delivery record is a key document for risk assessment and proper decision making at the right time during delivery. If it is exhaustive or badly presented, health workers see it as an administrative constraint, not as a help. The authors recall some principles regarding its form and contents. Its different parts are reviewed: administrative data, medical history, antenatal care, admission clinical examination, partograph, delivery, newborn, recent post-partum and exit examinations. An example of a delivery record used in Nouakchott is presented.

Study of the ion-distribution dynamics of an aluminum laser-produced plasma with picosecond resolution

The ion-distribution dynamics of an expanding aluminum plasma produced by a nanosecond laser pulse at moderate intensity (10(13) W cm(-2)) is studied by point-projection x-ray absorption spectroscopy with unprecedented, picosecond, time resolution. We show that the ionic populations measured as a function of distance to the target and at different probing times differ markedly from those predicted by widely accepted collisional radiative models coupled to hydrodynamic simulations. We discuss the effects of radiation, conduction, and expansion cooling on the spatiotemporal ionic distribution evolution.

[Evaluation of the nutritional status of children less than 5 years of age in Moundou, Chad: correlations with morbidity and hospital mortality]

The purpose of this study carried out in the pediatric ward of the regional hospital in Moundou, Chad, between June 1992 and May 1993 was to assess the prevalence of protein-energy malnutrition in children under 5 years of age and its relationship with various diseases and in-hospital mortality. A total of 1050 children ranging in age from 1 to 59 months were hospitalized in the ward during the study period and included in the study. Nutritional status was assessed using weight-for-height (W/H) and height-for-age (H/A) charts. Diarrhea, dehydratation, malaria, anemia, acute respiratory infection, and meningitis accounted for 85.5% of the underlying diseases and for 76% of deaths. At entry into study the prevalence of malnutrition was 63.1% (W/H < -2 Z-score) including 37% with severe malnutrition (W/H < -3 Z-score) and 16.1% with stunted growth (H/A < -2 Z-score). Malnutrition was more prevalent in children under than over 2 years of age (80% vs. 42.7% respectively). The same trend was observed with regard to severe malnutrition. The prevalence of malnutrition was highest in children with acute respiratory infections or diarrhea (61.3% and 89.8% respectively). Mortality was significantly higher in severely malnourished children and malnourished children with respiratory infection especially at ages under 1 year. Death was attributed to malnutrition in 30% of cases. Better low cost nutritional care is currently feasible. The most cost efficient methods of fighting against this problem are prevention and education especially concerning breast feeding.