Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study.

BACKGROUND: The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick Stick, the TQS), combined with knowledge of certain demographic characteristics, may improve the evaluation of tetanus immunity and thus help to avoid inadequate prophylactic measures and reduce costs. OBJECTIVES: To evaluate the contribution of the TQS in the choice of tetanus prophylaxis and to perform a cost-effectiveness analysis. The final aim was to define the place of the TQS in a modified algorithm for assessment of tetanus immunity in the emergency department. METHOD: In this Belgian prospective, double-blind, multicentre study, 611 adult patients with a wound were included; 498 (81.5%) records were valid. The TQS test was performed by a nurse before the vaccination history was taken and the choice of prophylaxis was made, using the official algorithm (Belgian Superior Health Council), by a doctor who was unaware of the TQS result. RESULTS: The prevalence of protective anti-tetanus immunity was 74.1%. Immunity was lower in older patients and in female patients. The TQS was a cost-effective tool for patients presenting with a tetanus-prone wound and considered from the vaccination history to be unprotected. Use of the TQS would have improved management in 56.9% (95% CI 47.7% to 65.7%) of patients by avoiding unnecessary treatments, leading to a reduction in the mean cost per patient (10.58 euros/patient with the TQS versus 11.34 euros/patient without). The benefits of the TQS use were significantly greater in patients <61 years old: unnecessary treatment would have been avoided in 76.9% (95% CI 65.8% to 85.4%) of cases and the mean cost per patient reduced to 8.31 euros. CONCLUSION: In selected patients, the TQS is a cost-effective tool to evaluate tetanus immunity. An algorithm is proposed for ED assessment of tetanus immunity integrating age and the TQS result

Palaeogeographical reconstructions of Lake Maliq (Korça Basin, Albania) between 14,000 BP and 2000 BP

International audienceSince the early 1990s, excavations of a protohistoric lakeside settlement in the Korça basin carried out by a French–Albanian archaeological team have induced geomorphological and palynological studies about the sedimentary records of Lake Maliq. These studies allow us to distinguish a series of centennial-scale high and low lake level events between 4200 and 4000 cal BP (2899–2637 BC/2843–2416 BC) and 2600 cal BP (822–671 BC), probably due to large-scale climate changes (in the Mediterranean basin). In addition, the sediment sequence also gives evidence of a millennial-scale trend of lake level rise. It appears to be an interplay between lake level rises and falls against tectonic subsidence of the basin allowing accommodation space for sediment deposition. The variations of the lake's level and the lake's surface area influenced the development and the abandonment of the nearby lakeside settlements (like the tell of Sovjan). In order to prepare an archaeological survey around the now dried up lake, we made a 3D model of the Holocene deposit from the lake including these lake level results, geomorphological mapping, excavation data, numerous core logs, AMS 14 C dating and SRTM DEM data. The GIS model allowed us to propose four palaeogeographical reconstructions of the extension of Lake Maliq: around 14,000 BP, during the Mesolithic (around 9000 BP – 8781–8542 BC), the Early/Middle Bronze Age transition (around 3800 BP – 2310–2042 BC) and the Iron Age (2600 BP – 822–671 BC). A map of the thickness of the sediments above potential archaeological layers is also proposed

LES VARIATIONS DE L'EXTENSION DU LAC MALIQ (BASSIN DE KORÇË, ALBANIE) EN RELATION AVEC L'OCCUPATION HUMAINE ENTRE 14000 BP ET 2000 BP

International audienceDepuis le début des années 1990, les fouilles archéologiques menées dans le bassin de Korçë, notamment sur le tell de Sovjan, occupé du Néolithique ancien (7990 cal BP, soit 7060 - 6899 av. J.-C.) jusqu’à l’Âge du fer (2600 cal BP, soit 822 - 671 av. J.-C.), ont confirmé l’implantation de populations sédentaires, pratiquant l’agriculture et l’élevage depuis le Néolithique ancien (LAFE 2005 ; LERA 1990 ; LERA et al. 1996 ; TOUCHAIS et al., 2005). Il s’agit de la civilisation dite « culture de Podgorie » (KOBAS 2005 ; KORKUTI 1995 ; PRENDI 1990). La partie nord du bassin de Korçë a été occupée par le lac Maliq, jusqu’à ce qu’il soit asséché par drainage à la fin des années 1950. À cette époque, l’extension du lac variait de 40 km2 à la fin de l’été à 80 km2 (FOUACHE et al. 2001). Du Néolithique ancien à l’Âge du fer, et surtout à la période du Bronze moyen (autour de 3800 cal BP, 2310 - 2042 av. J.-C.), de nombreuses implantations humaines occupaient les rives du lac (fig. 1) comme sur le site de Maliq, le seul site « palaffitique » étudié dans le bassin (PRENDI, 1966) ou Sovjan, un site de rive (TOUCHAIS et alii, 2005).Afin de reconstituer plus précisément la densité de ces sites et d’aboutir à un modèle d’implantation humaine autour du lac Maliq, la Mission franco-albanaise a entrepris des prospections archéologiques systématiques. En préliminaire à ces prospections, des reconstitutions paléogéographiques de l’extension du lac Maliq ont été proposées pour quatre périodes clefs : autour de 14000 BP, le Mésolithique (autour de 9000 cal BP, soit 8781 - 8542 av. J.-C.), le Bronze moyen (autour de 3800 cal BP, soit 2310 - 2042 av. J.-C.) et l’Âge du fer (2600 cal BP, soit 822 - 671 av. J.-C.). Ces reconstitutions ont été réalisées à partir d’un Système d’Information Géographique (SIG) associé à un Modèle Numérique de Terrain (MNT) en trois dimension, incluant des données topographiques, géologiques, paléoenvironnementales et archéologiques.Ces reconstitutions permettent également de discuter de l’influence possible des variations climatiques holocènes sur les fluctuations du niveau du lac Maliq

How to Improve Assessment of Tetanus Immunity in the Emergency Room: A Prospective Cost-Effectiveness, Double Blind Study

peer reviewe

Effect of Trans-Nasal Evaporative Intra-arrest Cooling on Functional Neurologic Outcome in Out-of-Hospital Cardiac Arrest : The PRINCESS Randomized Clinical Trial

© 2019 American Medical Association. All rights reserved.Importance: Therapeutic hypothermia may increase survival with good neurologic outcome after cardiac arrest. Trans-nasal evaporative cooling is a method used to induce cooling, primarily of the brain, during cardiopulmonary resuscitation (ie, intra-arrest). Objective: To determine whether prehospital trans-nasal evaporative intra-arrest cooling improves survival with good neurologic outcome compared with cooling initiated after hospital arrival. Design, Setting, and Participants: The PRINCESS trial was an investigator-initiated, randomized, clinical, international multicenter study with blinded assessment of the outcome, performed by emergency medical services in 7 European countries from July 2010 to January 2018, with final follow-up on April 29, 2018. In total, 677 patients with bystander-witnessed out-of-hospital cardiac arrest were enrolled. Interventions: Patients were randomly assigned to receive trans-nasal evaporative intra-arrest cooling (n = 343) or standard care (n = 334). Patients admitted to the hospital in both groups received systemic therapeutic hypothermia at 32°C to 34°C for 24 hours. Main Outcomes and Measures: The primary outcome was survival with good neurologic outcome, defined as Cerebral Performance Category (CPC) 1-2, at 90 days. Secondary outcomes were survival at 90 days and time to reach core body temperature less than 34°C. Results: Among the 677 randomized patients (median age, 65 years; 172 [25%] women), 671 completed the trial. Median time to core temperature less than 34°C was 105 minutes in the intervention group vs 182 minutes in the control group (P < .001). The number of patients with CPC 1-2 at 90 days was 56 of 337 (16.6%) in the intervention cooling group vs 45 of 334 (13.5%) in the control group (difference, 3.1% [95% CI, -2.3% to 8.5%]; relative risk [RR], 1.23 [95% CI, 0.86-1.72]; P = .25). In the intervention group, 60 of 337 patients (17.8%) were alive at 90 days vs 52 of 334 (15.6%) in the control group (difference, 2.2% [95% CI, -3.4% to 7.9%]; RR, 1.14 [95% CI, 0.81-1.57]; P = .44). Minor nosebleed was the most common device-related adverse event, reported in 45 of 337 patients (13%) in the intervention group. The adverse event rate within 7 days was similar between groups. Conclusions and Relevance: Among patients with out-of-hospital cardiac arrest, trans-nasal evaporative intra-arrest cooling compared with usual care did not result in a statistically significant improvement in survival with good neurologic outcome at 90 days. Trial Registration: ClinicalTrials.gov Identifier: NCT01400373.Peer reviewedFinal Accepted Versio

Activation of mutated TRPA1 ion channel by resveratrol in human prostate cancer associated fibroblasts (CAF)

Previous studies showed the effects of resveratrol (RES) on several cancer cells, including prostate cancer (PCa) cell apoptosis without taking into consideration the impact of the tumor microenvironment (TME). The TME is composed of cancer cells, endothelial cells, blood cells and cancer-associated fibroblasts (CAF), the main source of growth factors. The latter cells might modify in the TME the impact of RES on tumor cells via secreted factors. Recent data clearly show the impact of CAF on cancer cells apoptosis resistance via secreted factors. However, the effects of RES on PCa CAF have not been studied so far. We have investigated here for the first time the effects of RES on the physiology of PCa CAF in the context of TME. Using a prostate cancer CAF cell line and primary cultures of CAF from prostate cancers, we show that RES activates the N-terminal mutated Transient Receptor Potential Ankyrin 1 (TRPA1) channel leading to an increase in intracellular calcium concentration and the expression and secretion of growth factors (HGF and VEGF) without inducing apoptosis in these cells. Interestingly, in the present work, we also show that when the prostate cancer cells were co-cultured with CAF, the RES-induced cancer cell apoptosis was reduced by 40%, an apoptosis reduction canceled in the presence of the TRPA1 channel inhibitors. The present work highlights CAF TRPA1 ion channels as a target for RES and the importance of the channel in the epithelial-stromal crosstalk in the TME leading to resistance to the RES-induced apoptosis

Late Quaternary sea-level change and early human societies in the central and eastern Mediterranean Basin : an interdisciplinary review

This article reviews key data and debates focused on relative sea-level changes since the Last Interglacial (approximately the last 132,000 years) in the Mediterranean Basin, and their implications for past human populations. Geological and geomorphological landscape studies are critical to archaeology. Coastal regions provide a wide range of resources to the populations that inhabit them. Coastal landscapes are increasingly the focus of scholarly discussions from the earliest exploitation of littoral resources and early hominin cognition, to the inundation of the earliest permanently settled fishing villages and eventually, formative centres of urbanisation. In the Mediterranean, these would become hubs of maritime transportation that gave rise to the roots of modern seaborne trade. As such, this article represents an original review of both the geo-scientific and archaeological data that specifically relate to sea-level changes and resulting impacts on both physical and cultural landscapes from the Palaeolithic until the emergence of the Classical periods. Our review highlights that the interdisciplinary links between coastal archaeology, geomorphology and sea-level changes are important to explain environmental impacts on coastal human societies and human migration. We review geological indicators of sea level and outline how archaeological features are commonly used as proxies for measuring past sea levels, both gradual changes and catastrophic events. We argue that coastal archaeologists should, as a part of their analyses, incorporate important sea-level concepts, such as indicative meaning. The interpretation of the indicative meaning of Roman fishtanks, for example, plays a critical role in reconstructions of late Holocene Mediterranean sea levels. We identify avenues for future work, which include the consideration of glacial isostatic adjustment (GIA) in addition to coastal tectonics to explain vertical movements of coastlines, more research on Palaeolithic island colonisation, broadening of Palaeolithic studies to include materials from the entire coastal landscape and not just coastal resources, a focus on rescue of archaeological sites under threat by coastal change, and expansion of underwater archaeological explorations in combination with submarine geomorphology. This article presents a collaborative synthesis of data, some of which have been collected and analysed by the authors, as the MEDFLOOD (MEDiterranean sea-level change and projection for future FLOODing) community, and highlights key sites, data, concepts and ongoing debates

Les ressources hydriques et les aménagements antiques dans le contexte cristallin de l'île de Délos

Desruelles Stéphane. Les ressources hydriques et les aménagements antiques dans le contexte cristallin de l'île de Délos . In: Topoi, volume 11/2, 2001. pp. 551-578