Disfavored in Life, Favored in Death? Later-Life Mortality Differences (Ages 30+) between Migrants and Natives in Antwerp, Rotterdam and Stockholm, 1850-1930

Differences in adult mortality were studied between natives and domestic and international migrants in three Northwestern European cities during different stages of the epidemiological transition. Event history analysis was conducted for mortality risk at ages 30+ using life course data retrieved from three large historical demographic micro-level databases. Results provide ample evidence of healthy migrant effects in Antwerp, Rotterdam, and Stockholm, and the effect was particularly strong among domestic migrants in Rotterdam. The multivariate analyses show that the early life environment, as well as positive selection effects, contributed to the healthy migrant effect: As migration distance increased, mortality risks declined. Being born in the countryside and moving later in life to a city were also associated with lower mortality risks. Although migrants overall had lower mortality risks than natives, we discovered, four vulnerable sub-groups whose mortality risk not only increased, but eventually exceeded that of natives: (1) rural migrants in the period when major epidemics belonged to the past, (2) international migrants who lost their partner, (3) Italian and Italian-speaking Swiss men in Rotterdam, and (4) medium-distance domestic migrant men in Antwerp

Origin of the TTC values for compounds that are genotoxic and/or carcinogenic and an approach for their revaluation

The threshold of toxicological concern (TTC) approach is a resource-effective de minimismethod for the safety assessment of chemicals, based on distributional analysis of the results of a large number of toxicological studies. It is being increasingly used to screen and prioritise substances with low exposure for which there is little or no toxicological information. The first step in the approach is the identification of substances that may be DNA-reactive mutagens, to which the lowest TTC value is applied. This TTC value was based on analysis of the cancer potency database and involved a number of assumptions that no longer reflect the state-of-the-science and some of which were not as transparent as they could have been. Hence, review and updating of the database is proposed, using inclusion and exclusion criteria reflecting current knowledge. A strategy for the selection of appropriate substances for TTC determination, based on consideration of weight of evidence for genotoxicity and carcinogenicity is outlined. Identification of substances that are carcinogenic by a DNA-reactive mutagenicmode of action and those that clearly act by a non-genotoxic mode of action will enable the protectiveness to be determined of both the TTC for DNA-reactive mutagenicityand that applied by default to substances that may be carcinogenic but are unlikely to be DNA-reactive mutagens (i.e. for Cramer class I-III compounds). Critical to the application of the TTC approach to substances that are likely to be DNA-reactive mutagens is the reliability of the software tools used to identify such compounds. Current methods for this task are reviewed and recommendations made for their application

Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe

Purpose: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. Methods: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. Results: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13–15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatme

Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Abstract: Purpose: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. Methods: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. Results: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13–15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatments (MOR = 2.9, p < 0.001); and smaller in 6-month outcome (MOR = 1.2, p = 0.01). Conclusions: Half of contemporary TBI patients at the ICU have mild to moderate head injury. Substantial between-center variations exist in ICU stay and treatment policies, and less so in outcome. It remains unclear whether admission of short-stay patients represents appropriate prudence or inappropriate use of clinical resources

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/)

Investigating the Properties of Folded Parchment – A Preliminary Study = Untersuchung der Eigenschaften von gefaltetem Pergament – eine Vorstudie

Parchment manuscripts form an important part of many historic collections. They are often found folded, with some displaying multiple fold patterns resulting from changing uses over their history. Parchment is a potentially fragile medium and folding can increase its susceptibility to damage, as well as hampering access and display. Treatment to address these issues may involve the relaxation of the folded structure, using humidification or a solvent such as propanol, and gentle pressing or stretching. However, this presents a dilemma – an inappropriately folded manuscript may be more prone to damage, but treatments require invasive interventions. This preliminary study has employed infrared spectroscopy and shrinkage temperature measurements to better understand the properties of folded parchment. It demonstrates that physicochemical changes can be detected at the fold and, to a lesser extent, in adjacent areas, compared to the bulk material, and that monitoring these changes allows the impact of different treatment methods to be assessed. This provides a basis for further research into the effect of both the original folding and of potential treatment methods, to inform conservation decisions and help ensure appropriate, effective, and sympathetic outcomes

Transduction pathways regulating the trophic effects of Saccharomyces boulardii in rat intestinal mucosa.

Abstract Saccharomyces boulardii is a probiotic yeast that is widely prescribed in lyophilized form; it determines several effects in human and rat small intestine including endoluminal secretion of enzymes and of polyamines, stimulation of microvillous enzymes, of sIgA, increased production of the receptor for polymeric immunoglobulins by crypt cells, and enhanced d-glucose uptake. Aim. The objective of this study was to determine the pathway(s) by which these effects generated by the yeast are transduced into mucosal cells. Methods. Litters of six growing Wistar rats each were treated with S. boulardii (50 mug/gram body weight) or with saline between days 30 and 34 postpartum. For each animal, the cytosol was prepared from the whole mucosa after the fat cake was discarded. Several known intestinal substrates were immunoprecipitated and immunoblotted using specific antibodies recognizing the non-, mono-, or diphosphorylated forms of these substrates. The signals were detected using Echochemiluminoscence (ECL) and were measured by optodensitometry. Results. Treatment with S. boulardii markedly enhanced the RAS-GAP-RAF-ERK(1,2) pathway with participation of growth receptor bound 2 protein, SHC, SOS, and CRKII. Unit p85alpha of phosphatidylinositol 3 kinase, tested in its phosphorylated form, was also enhanced by the probiotic compared to control samples. In rats treated with an inhibitor of RAF-1 and of ERK(1,2) (PD098059) the expression of mucosal disaccharidases was inhibited by about 50%. Conclusion. The probiotic S. boulardii generates in vivo mitogen and metabolic signals that are transduced into intestinal mucosal cells, downstream from the apical membrane to the nuclei, using recruitment substrates and serine, threonine, or tyrosine kinases

Interaction of Saccharomyces boulardii With Intestinal Brush Border Membranes: Key to Probiotic Effects?

The probiotic Saccharomyces boulardii exerts beneficial effects in humans, which include trophic effects, anti-inflammatory effects, antisecretory effects, inhibition of toxins, immunostimulatory effects, and resistance to bacterial overgrowth. This short communication discusses the interactions of the probiotic with brush border membrane (BBM) constituents because most of these effects are BBM mediated. The use of bacterial and yeast probiotics has increased dramatically in more and more clinical states, but their exact mechanisms of action remain largely unknown. The present communication focuses on the interactions of a confirmed yeast probiotic (S boulardii) on the constituents of BBMs

Effects of Saccharomyces boulardii on intestinal mucosa.

Saccharomyces boulardii (S. boulardii) is a non-pathogenic biotherapeutic agent, widely prescribed in a lyophilized form in many countries over the world. S. boulardii acts as a shuttle liberating effective enzymes, proteins and trophic factors during its intestinal transit that improve host immune defenses, digestion, and absorption of nutrients. In addition, S. boulardii secretes during its intestinal transit polyamines, mainly spermine and spermidine that regulate gene expression and protein synthesis. In this review, we will focus on the interactions of the yeast with the host intestinal mucosa

Multiple languages, multiple identities? Children’s language characteristics and their ethnic and national identification

An increasing number of ethnolinguistic minority children in European cities grow up multilingual, being proficient in more than one language. Current public and political debates often insinuate that these children’s language behaviour is a reflection of their identification with and integration in society. Though some empirical studies have corroborated this idea, others have contested it, suggesting that a more detailed analysis of the identity-language link is advisable. This quantitative study investigates if and how language practices, language exposure and language proficiencies differentially shape identification with the majority group and the ethnolinguistic minority group among a sample of primary school children (N = 528; ages 10-12) living in Antwerp, Belgium. Our results suggest that identification with these two groups involves separate processes and as such, this study helps to nuance the polarized public and political debate in Belgium about the role of language as an indicator of integration. In addition, the findings suggest that the essentializing of language within formal institutions such as schools, may contribute to the large share of children reporting that they strongly identify with the ethnolinguistic minority group as compared to the number of children strongly identifying with Belgium.status: Published onlin