Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Le Burn out des médecins généralistes en Picardie

INTRODUCTION : De nombreuses études témoignent d un degré de burn out (BO) élevé dans la population des médecins généralistes. Le BO est caractérisé par une dépersonnalisation dans la relation à l autre, un épuisement émotionnel et une diminution de l accomplissement personnel. OBJECTIFS : Le but de cette étude était d étudier la prévalence du BO des médecins généralistes (MG) Picards et d évaluer le lien entre BO et densité en médecins généralistes. METHODE : Nous avons réalisé une étude descriptive transversale en 2009 à partir du questionnaire d autoévaluation Maslach Burn out Inventory (MBI). Le questionnaire a été envoyé à un échantillon aléatoire de 840 médecins généralistes. RESULTATS : Le taux de réponses était de 45,8%. D après le MBI, 33,0% des MG répondants entretiennent des attitudes négatives de dépersonnalisation vis à vis de leur patient, 20,3% ont un niveau d épuisement émotionnel élevé, 32,2% ont un score élevé de BO dans la dimension accomplissement personnel. La prévalence du BO est de 56%. Un niveau de BO élevé dans les 3 dimensions est retrouvé chez 6% des MG Picards. Un lien a été mis en évidence entre densité faible en MG et épuisement émotionnel élevé. Toutefois la robustesse de ce résultat a été mise en cause. DISCUSSION : La prévalence du BO des MG en Picardie diffère peu de celle des autres régions pour lesquelles nous disposons d études. L épuisement émotionnel est plus faible que dans les autres régions. Le BO n étant pas lié à la densité médicale, ces résultats sont rassurants pour la qualité de la relation médecin-malade en Picardie. CONCLUSION : Il serait intéressant de prolonger ce travail par une étude qualitative visant à déterminer quels sont d après les médecins eux-mêmes les véritables causes de leur burn out.INTRODUCTION: Many studies show a degree of burn out (BO) in the population of practitioners. The BO is characterised by a depersonalization in relationship to the other, an emotional exhaustion and decreasing completing staff. OBJECTIF: The purpose of this study was to investigate the prevalence of general practitioners (GP) Picards BO and explore the link between BO and density in practitioners. METHODE: We have made a cross-sectional descriptive study during the summer 2009 with the self-assessment questionnaire Maslach Burn out Inventory . It was sent to a sample of 840 family doctors. RESULTS: the response rate was 45,8%. According the MBI, 33,0% of the respondents MG maintain depersonalization negative attitudes towards their patient, 20.3% have a level of high emotional exhaustion, 32,2% have a high score of BO in the personal accomplishment dimension. The prevalence of the BO is 56%. A high level of BO in 3 dimensions is found at 6% of the GP Picards . A link has been highlighted between low density in MG and higher emotional exhaustion. However the robustness of this result has been questioned. DISCUSSION: The prevalence in Picardie differs from the other regions which studies. Emotional exhaustion is lower than in other regions. BO is not related to the medical density, these results are reassuring for the quality of the doctor-patient relationship in Picardie. CONCLUSION : It could be interesting to do a qualitative study to determinate the true reason of BOAMIENS-BU Santé (800212102) / SudocSudocFranceF

Contrôle de la neurogenèse et de la mémoire olfactive chez la souris normale et Tg2576, modèle de la maladie d'Alzheimer (implication du système noradrénergique)

La neurogenèse adulte se déroule principalement au sein du gyrus denté de l hippocampe et du bulbe olfactif (BO), cortex impliqués dans des processus mnésiques et cognitifs auxquels elle a été corrélée. Parallèlement, des signes olfactifs précoces caractérisent certaines maladies dégénératives, dont la maladie d Alzheimer (MA) dans laquelle une atteinte des systèmes neuromodulateurs est aussi décrite. Sur ces bases nous avons évalué les performances de mémoire olfactive, la neurogenèse bulbaire et l état des systèmes neuromodulateurs dans un modèle de MA, les souris Tg2576 (étude 1). Un déficit précoce de mémoire olfactive à court terme (MOCT) a pu être associé à une baisse de la survie des nouveaux neurones granulaires du BO et à une dégénérescence avancée du Locus Coeruleus (LC). Nous avons ensuite étudié le rôle de la noradrénaline (NA) bulbaire dans la MOCT (étude 2). Pour cela nous avons induit une dégénérescence du LC, puis réintroduit la NA localement dans le BO ce qui nous a permis de montrer l importance de la NA bulbaire dans la mise en mémoire des odeurs. Enfin nous avons évalué l influence de l âge sur la neurogenèse bulbaire et sur l apprentissage olfactif (étude 3). Des souris âgées montrent une importante baisse du taux de neurogenèse bulbaire, des signes de dégénérescence du système noradrénergique (SN) et ne réussissent plus à associer une récompense à une odeur, contrairement aux animaux jeunes Ces résultats suggèrent que les pertes cognitives liées au vieillissement pourraient être en partie dues à une altération du SN liée à un déficit de neurogenèse mais que les mécanismes intervenant lors du vieillissement normal et pathologique sont différents.Adult neurogenesis occurring in the dentate gyrus and the olfactory bulb (OB) could be involve in cognitive processes. Moreover, precocious olfactory alterations and changes in neuromodulatory systems are constantly described in Alzheimer disease (AD). We hypothesized that bulbar neurogenesis, in relation with modifications in neuromodulation, could be involved in the development of olfactory signs of AD (Study 1). In a rodent model of the disease, the Tg2576 mice, we showed an early deficit of olfactory short term memory (OSTM) associated with a strong decrease in newborn neurons survival in the OB and a marked degeneration of the Locus Coeruleus (LC). Then, we tested the implication of the bulbar noradrenalin (NA) in the OSTM (Study 2). For that purpose, we beforehand injected the animals with the specific-noradrenergic neurotoxin DSP4 and then, lesioned and control animals were tested in a habituation-discrimination task after bulbar re-injection of saline or NA solutions. We showed that local NA is strongly involved in the modulation of habituation performances and essential to the short term memory of odorants. Finally, we assessed the influence of normal aging on bulbar neurogenesis and olfactory learning. These preliminary results showed that old mice were not able anymore to associate a food-reward with a specific odor. This deficit was associated with an almost suppression of bulbar neurogenesis and with signs of LC degeneration (Study 3). These data suggest that adult neurogenesis and noradrenergic system could be involved in some alterations linked to aging according to different mechanisms during AD or normal aging.LYON1-BU.Sciences (692662101) / SudocSudocFranceF

Contribution à l optimisation du procédé de fabrication d une forme sèche au sein des ateliers de granulation et de compression

Dans le but de diminuer leurs coûts de production, les laboratoires pharmaceutiques se doivent d optimiser leurs procédés de fabrication pour rester compétitifs. L obtention d une forme sèche, telle que les comprimés passe souvent par une étape de granulation humide. Il s agit d un procédé d agglomération et de densification des poudres, dont le but est d améliorer les propriétésd écoulement, et d assurer l homogénéité du mélange, afin de faciliter l étape de compression. L objectif de ce travail est de diminuer les pertes de comprimés, en passant par une meilleure maîtrise du procédé de granulation. Cette thèse présente dans une première partie les techniques de granulation et de séchage au sein d un mélangeur-granulateur-sécheur, puis de compression sur machine industrielle. La deuxième partie portera sur les essais réalisés au sein de l atelier de granulation, en vue de mieux comprendre le procédé, et ainsi de pouvoir l optimiser.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Les patients en arrêt cardio-respiratoire orientés vers le centre d'hémodynamique (prise en charge et devenir au CHU de Nantes)

La mort subite est un problème majeur de santé publique puisque qu'elle est responsable d'environ 50 000 décès par an en France. La principale étiologie en est l'infarctus du myocarde. Nous avons étudié la prise en charge et le devenir à 1 an de 74 patients victimes d'arrêt cardio-circulatoire ayant bénéficié d'une coronarographie en urgence afin de déterminer les facteurs prédictifs d'occlusion coronaire aiguë et de survie dans cette population. Les meilleures chances de survie sont obtenues en cas d'âge inférieur à 59 ans, de mise en œuvre immédiate des gestes de survie, de durée de réanimation courte (inférieure à 25 minutes), d'infarctus du myocarde comme étiologie et de réalisation d une angioplastie. Les facteurs prédictifs d'infarctus sont l'existence d'une douleur thoracique, la présence d'un sus-décalage du segment ST et la constatation de troubles de cinétique segmentaire à l'échographie cardiaque, qui pourrait s'avérer être un examen d'urgence essentiel dans la prise en charge de ces patients.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Application of Road Infrastructure Safety Assessment Methods at Intersections

Traffic safety at intersections is a particularly difficult phenomenon to study, given the fact that accidents occur randomly in time and space thereby making short-term measurement, assessment and comparison difficult. The EU directive 2008/96/EC introduced road infrastructure safety management, which offers a five layer structure for developing safer road infrastructure has been used to develop tools for accident prediction and black spot management analysis which has been applied in this work to assess the safety level of intersections in Norrköping city in Sweden. Accident data history from STRADA (Swedish Traffic Accident Data Acquisition) and the network demand model for Norrköping city were used to model black spots and predict the expected number of accidents at intersections using PTV Visum Safety tool, after STRADA accident classification was restructured and the Swedish accident prediction model (APM) was configured and tested to work within the tool using the model from the Swedish road administration (SRA). The performance of the default (Swiss) and the Swedish APM was compared and identified locations with the high accident records, predicted accident counts and traffic volumes were audited using qualitative assessment checklist from Street-Audit tool. The results from these methods were analysed, validated and compared. This work provides recommendations on the used quantitative and qualitative methods to prevent accident occurrence at the identified locations

3D Modeling of the Movement of Machine using Mortar Method forEdge Finite Elements of Magnetic Vector Potential Formulation

International audienc

Similar discrimination abilities were observed under freely moving and head-restrained conditions.

<p>(<b>A</b>) Schema depicting head-restrained and freely moving paradigms. (<b>B</b>) Discrimination accuracy shown as the average percentage of correct choices, 300 trial blocks from which DT is calculated (filled bars represent head-restrained conditions on a go/no-go task and empty bars represent freely moving conditions on a go/no-go task) for AA vs EB (blue, n = 8 mice, average ± sem), binary mixtures of AA and EB (red, n = 8 mice, average ± sem), cit vs but (green, n = 8 mice, average ± sem) and clove vs cam (brown, n = 8 mice, average ± sem). Dotted line indicates chance level. (<b>C</b>) Stimulus dependent DTs were observed for go/no-go conditioning task under freely moving conditions and were similar to the DTs measured under head-restrained conditions (color codes and number of mice: same as above, all values are expressed as average ± sem).</p

Denoising techniques combined to Monte Carlo simulations for the prediction of high-resolution portal images in radiotherapy treatment verification

International audienceThis work investigates the possibility of combining Monte Carlo (MC) simulations to a denoising algorithm for the accurate prediction of images acquired using amorphous silicon (a-Si) electronic portal imaging devices (EPIDs). An accurate MC model of the Siemens OptiVue1000 EPID was first developed using the penelope code, integrating a non-uniform backscatter modelling. Two already existing denoising algorithms were then applied on simulated portal images, namely the iterative reduction of noise (IRON) method and the locally adaptive Savitzky–Golay (LASG) method. A third denoising method, based on a nonparametric Bayesian framework and called DPGLM (for Dirichlet process generalized linear model) was also developed. Performances of the IRON, LASG and DPGLM methods, in terms of smoothing capabilities and computation time, were compared for portal images computed for different values of the RMS pixel noise (up to 10%) in three different configurations, a heterogeneous phantom irradiated by a non-conformal 15 × 15 cm$^2$ field, a conformal beam from a pelvis treatment plan, and an IMRT beam from a prostate treatment plan. For all configurations, DPGLM outperforms both IRON and LASG by providing better smoothing performances and demonstrating a better robustness with respect to noise. Additionally, no parameter tuning is required by DPGLM, which makes the denoising step very generic and easy to handle for any portal image. Concerning the computation time, the denoising of 1024 × 1024 images takes about 1 h 30 min, 2 h and 5 min using DPGLM, IRON, and LASG, respectively. This paper shows the feasibility to predict within a few hours and with the same resolution as real images accurate portal images, combining MC simulations with the DPGLM denoising algorithm

Go/no-go olfactory conditioning task under head-restrained conditions.

<p>(<b>A</b>) Mouse engaged in a go/no-go operant conditioning task. (<b>B</b>) Schema of rewarded and unrewarded trials. (<b>C</b>) Structure of a single trial. The criterion for a water reward was the total lick of 80 ms in three time bins of 500 ms out of four bins during the 2 s odor presentation, if there was no baseline licking. If mice were licking during the baseline, they had to lick double amount of time during the odor presentation to get the water reward.</p