How financial cutbacks affect job quality and care of the elderly

Based on case studies in 12 nursing homes in the United Kingdom, the authors illustrate how financial cutbacks affect job quality and the quality of care. The dimensions of job quality that suffered most were those directly related to the ability of workers to provide care: reductions in staffing, longer working hours, and work intensification. Cuts to labor costs eroded the quality of workers’ jobs in all 12 homes but with two differential outcomes: in seven homes, care quality was maintained, and in five homes, it deteriorated. Care quality was maintained in homes where a patient-centered care approach and remaining job quality allowed workers to develop work-arounds to protect residents from spillover effects. Care quality declined in homes where custodial approaches to care and low job quality did not provide workers the time or resources to protect residents or to maintain prior levels of care. A tipping point was reached, leading to a spillover into impoverished care

Epilepsy with migrating focal seizures

To report new sporadic cases and 1 family with epilepsy of infancy with migrating focal seizures (EIMFSs) due to KCNT1 gain-of-function and to assess therapies' efficacy including quinidine. We reviewed the clinical, EEG, and molecular data of 17 new patients with EIMFS and KCNT1 mutations, in collaboration with the network of the French reference center for rare epilepsies. The mean seizure onset age was 1 month (range: 1 hour to 4 months), and all children had focal motor seizures with autonomic signs and migrating ictal pattern on EEG. Three children also had infantile spasms and hypsarrhythmia. The identified KCNT1 variants clustered as "hot spots" on the C-terminal domain, and all mutations occurred de novo except the p.R398Q mutation inherited from the father with nocturnal frontal lobe epilepsy, present in 2 paternal uncles, one being asymptomatic and the other with single tonic-clonic seizure. In 1 patient with EIMFS, we identified the p.R1106Q mutation associated with Brugada syndrome and saw no abnormality in cardiac rhythm. Quinidine was well tolerated when administered to 2 and 4-year-old patients but did not reduce seizure frequency. The majority of the KCNT1 mutations appear to cluster in hot spots essential for the channel activity. A same mutation can be linked to a spectrum of conditions ranging from EMFSI to asymptomatic carrier, even in the same family. None of the antiepileptic therapies displayed clinical efficacy, including quinidine in 2 patients

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Bilan et perspectives de la gestion de la variabilité génétique des ovins laitiers en France

Management of genetic diversity is a major concern in animal breeding, especially as genomic selection starting in French dairy sheep will reduce generation interval and increase genetic progress. Hence, it appeared important to assess the evolution of genetic diversity over the last decades using pedigree information to better monitor the breeding schemes. The results obtained in the Lacaune (LL) and Ref-Faced Manech breed (MTR) are satisfying: respectively + 0.29 and + 0.42 % of inbreeding increase per generation over 2000-2009, even though it is still possible to better balance elite families in MTR. On the contrary, results from Basco-Bearnaise (BB) and Black-Faced Manech breeds (MTN) underline a less efficient management of genetic diversity: respectively + 0.74 and + 1.02 % of inbreeding increase per generation over 2000-2009. This situation results from the too small number of sires of ram families (PAB) compared to the number allowed by the size of the nucleus of selection BB and MTN. This is a consequence of an imbalanced use of PAB families due to the very short duration of the AI period (fresh semen) and the lower AI fertility in these two breeds. Studies were carried out with the managers of breeding societies. This was done in order to increase the number of PAB families and to provide at each step of selection, the indicators of genetic variability allowing a more balanced management of these PAB families. Corse breed pedigrees are not extensive enough to allow a relevant pedigree analysis. Studies are on-going in these five breeds to assess genetic variability based on SNP (Single Nucleotid Polymorphism) from the 18,500 genotypes available with genomic selection

Analyse de la longévité fonctionnelle dans les races ovines laitières françaises

International audienceDuring the past few decades, selection objectives have strongly evolved in the French dairy sheep sector to include functional and health traits in addition to production traits. To face new challenges ofsustainability, actors of breeding organizations for small ruminants are now considering selecting traits for robustness. As part of the CASDAR RUSTIC project, a genetic analysis of functional longevity was carried out, considering this trait reflects the ability of ewes to delay their culling for other criteria than production level. Among several indicators of functional longevity, we have chosen to study the Length of Productive Life, which is the number of days between the first lambing of the ewe and its culling. We have therefore implemented a survival analysis using the Survival Kit developed by V. Ducrocq. Only rams with at least 20 uncensored daughters were selected for this study. The heritability obtained ranged from 0.06 and 0.17: these values are of the same order of magnitude as in cattle. Estimated breeding values (EBV) were also calculated and validated by comparing the survival curves of extreme rams on the longevity index. An analysis showed the accuracy of EBV is very dependent on the number of girls whose careers are uncensored and that 30 to 40 daughters uncensored are necessary to reach an accuracy of 0.7. These first results are encouraging, however, this study should be continued, especially to study genetic correlations with the other characters in selection and to integrate functional longevity in selection objectives.Au cours des dernières décennies, les objectifs de sélection ont fortement évolué dans les filières ovines laitières françaises pour intégrer des caractères fonctionnels et de santé en plus des caractères deproduction. Pour répondre aux enjeux de durabilité, les acteurs des schémas de sélection des petits ruminants envisagent désormais de sélectionner des caractères de robustesse. Dans le cadre du projet CASDAR RUSTIC, une analyse génétique de la longévité fonctionnelle, qui traduit la capacité des animaux à retarder leur réforme pour des critères autres que le seul niveau de production, a été réalisée. Parmi plusieurs critères de longévité fonctionnelle, nous avons choisi d’étudier la Durée de Vie Productive qui est le nombre de jour entre la première mise-bas de la brebis et sa date de sortie. Nous avons pour cela mis en œuvre une analyse de survie en utilisant le Kit de Survie développé par V. Ducrocq. Seuls les béliers ayant au moins 20 filles non censurées ont été retenus pour cette étude. Les héritabilités obtenues sont du même ordre de grandeur qu’en bovins et se situent entre 0,06 et 0,17. Des index ont également été calculés puis validés en comparant les courbes de survies de béliers extrêmes sur l’index longévité. Une analyse des CD a montré que la précision des index est très dépendante du nombre de filles dont la carrière est complète et qu’il en faut au moins 30 à 40 pour atteindre un CD de 0,7. Ces premiers résultats sont assez encourageants mais nécessitent d’être encore approfondis, notamment du point de vue de la précision et des corrélations génétiques avec les autres caractères en sélection. Il s’agira ensuite de s’interroger sur la méthodologie à suivre pour intégrer ce caractère dans les objectifs de sélection dans le cadre des évaluations génomiques en routine

Analyse de la longévité fonctionnelle dans les races ovines laitières françaises

International audienceDuring the past few decades, selection objectives have strongly evolved in the French dairy sheep sector to include functional and health traits in addition to production traits. To face new challenges ofsustainability, actors of breeding organizations for small ruminants are now considering selecting traits for robustness. As part of the CASDAR RUSTIC project, a genetic analysis of functional longevity was carried out, considering this trait reflects the ability of ewes to delay their culling for other criteria than production level. Among several indicators of functional longevity, we have chosen to study the Length of Productive Life, which is the number of days between the first lambing of the ewe and its culling. We have therefore implemented a survival analysis using the Survival Kit developed by V. Ducrocq. Only rams with at least 20 uncensored daughters were selected for this study. The heritability obtained ranged from 0.06 and 0.17: these values are of the same order of magnitude as in cattle. Estimated breeding values (EBV) were also calculated and validated by comparing the survival curves of extreme rams on the longevity index. An analysis showed the accuracy of EBV is very dependent on the number of girls whose careers are uncensored and that 30 to 40 daughters uncensored are necessary to reach an accuracy of 0.7. These first results are encouraging, however, this study should be continued, especially to study genetic correlations with the other characters in selection and to integrate functional longevity in selection objectives.Au cours des dernières décennies, les objectifs de sélection ont fortement évolué dans les filières ovines laitières françaises pour intégrer des caractères fonctionnels et de santé en plus des caractères deproduction. Pour répondre aux enjeux de durabilité, les acteurs des schémas de sélection des petits ruminants envisagent désormais de sélectionner des caractères de robustesse. Dans le cadre du projet CASDAR RUSTIC, une analyse génétique de la longévité fonctionnelle, qui traduit la capacité des animaux à retarder leur réforme pour des critères autres que le seul niveau de production, a été réalisée. Parmi plusieurs critères de longévité fonctionnelle, nous avons choisi d’étudier la Durée de Vie Productive qui est le nombre de jour entre la première mise-bas de la brebis et sa date de sortie. Nous avons pour cela mis en œuvre une analyse de survie en utilisant le Kit de Survie développé par V. Ducrocq. Seuls les béliers ayant au moins 20 filles non censurées ont été retenus pour cette étude. Les héritabilités obtenues sont du même ordre de grandeur qu’en bovins et se situent entre 0,06 et 0,17. Des index ont également été calculés puis validés en comparant les courbes de survies de béliers extrêmes sur l’index longévité. Une analyse des CD a montré que la précision des index est très dépendante du nombre de filles dont la carrière est complète et qu’il en faut au moins 30 à 40 pour atteindre un CD de 0,7. Ces premiers résultats sont assez encourageants mais nécessitent d’être encore approfondis, notamment du point de vue de la précision et des corrélations génétiques avec les autres caractères en sélection. Il s’agira ensuite de s’interroger sur la méthodologie à suivre pour intégrer ce caractère dans les objectifs de sélection dans le cadre des évaluations génomiques en routine

Concours des Prix du Ministre de l'éducation. Enseignement collégial

"Concours des Prix du Ministre de l'éducation. Enseignement collégial"Bibliogr.: p. 355-357Index: p. 359-38

Caractérisation des environnements de production et de nouveaux phénotypes pour améliorer la sélection et l’adaptation des ovins et caprins dans des environnements variés

The overall sustainability and innovative capacity of the sheep and goat sector in Europe have to be improved to cope with current and future economic, environmental and societal challenges. Innovations in genetic resource management and breeding for sheep and goat populations will be explored in the iSAGE European project (WP5) in order to help the industry to cope with such future challenges. In France, genetic evaluation for small ruminants is performed in a large variability and poorly characterized environments. In this regard, we will consider multi-generation data from existing French breeding programs and experimental field studies. Effects of herd for traits under genetic selection will be investigated in commercial farms in order to better characterize the production environment, particularly using meteorological data but also feeding, breeding system and economic criteria. Such characterization will enable to follow-up trends in animal performances according to weather changes. This work could also contribute to characterize farm typologies to which a set of sustainability indicators will be tested. Then, contrasted environments will be identified and genotype by environment interactions studies will be carried out aiming to improve genetic selection efficiency in a variety of environments. In addition to existing data, we will explore new phenotypes considered as key functional traits for robustness and for which stakeholders are particularly interested. These new phenotypes will be also explored in combination with feed efficiency in experimental facilities under contrasted environments or under feed shortage challenges. Genetic and genomic studies will be performed for new phenotypes used to assess individual robustness. The total merit indices will be revisited from the technical and economic point of view in order to evaluate economic weights of each trait in the "breeding goal", for diversified production systems.En France, l’évaluation génétique des petits ruminants estime simultanément la valeur génétique des reproducteurs ainsi que les effets d’environnement dont le plus important est l’effet troupeau. Cette évaluation est réalisée dans des environnements variés et mal caractérisés faisant l’hypothèse d’absence d’interaction GxE. Pour tester cette hypothèse et disséquer les composantes des effets troupeaux, les environnements de production seront caractérisés à partir des données collectées en fermes (disponibles dans les systèmes nationaux d’information génétique ou collectées ponctuellement) décrivant les systèmes d’élevages et des données météorologiques. La discrimination des types d’environnements de production établis par la typologie des élevages permettra d’analyser les interactions GxE pour différentes races ovines et caprines en France.Par ailleurs, l’adaptation des petits ruminants à ces environnements variés et changeants implique entre autre leur efficacité d’utilisation des ressources et leur capacité biologique à mobiliser et reconstituer leurs réserves énergétiques sous forme de lipides. Des travaux expérimentaux seront conduits pour étudier les mécanismes biologiques et le déterminisme génétique de la dynamique des réserves corporelles en lien avec l’efficacité alimentaire. Cette approche permettra d’identifier de nouveaux phénotypes pour l’amélioration génétique de la robustesse des petits ruminants

Infarct size-reducing effect of heat stress and α(1) adrenoceptors in rats

1. Noradrenaline (NA), which is abundantly released during heat stress (HS), is known to induce both delayed cardioprotection and heat stress protein (HSP) 72 expression by the mediation of α(1) adrenoceptors. Therefore, we have investigated the implication of α(1) adrenoceptors in HS-induced resistance to myocardial infarction, in the isolated rat heart model. 2. Rats were pretreated with prazosin (1 mg kg(−1), i.p., Praz) or 5-methylurapidil (3 mg kg(−1), i.v, 5MU) or chloroethylclonidine (3 mg kg(−1), i.v., CEC) or vehicle (V) in order to selectively antagonize α(1), α(1A) and α(1B) adrenoceptors. They were then either heat stressed (42°C for 15 min) or sham anaesthetized. Twenty-four hours later, their hearts were isolated, retrogradely perfused, and subjected to a 30 min occlusion of the left coronary artery followed by 120 min of reperfusion. 3. Infarct-to-risk ratio was significantly reduced in HS+V (15.4±1.8%) compared to Sham+V (35.7±1.3%) hearts. This effect was abolished in Praz-treated (29.1±1.6% in HS+Praz vs 34.1±4.0% in Sham+Praz), 5MU-treated (34.5±2.2% in HS+5MU vs 31.2±2.0% in Sham+5MU) and CEC-treated (33.4±3.0% in HS+CEC vs 32.4±1.3% in Sham+CEC) groups. Western blot analysis of myocardial HSP72 showed an HS-induced increase of this protein, which was not modified by Praz, 5MU and CEC pretreatments. 4. We conclude that both α(1A) and α(1B) adrenoceptor subtypes appear to play a role in the heat stress-induced cardioprotection, independently of the HSP72 level. Further investigations are required to elucidate the precise role of HSPs in this adaptative response