Pasarela en Le Havre Francia

The longitudinal profile of this is a cubic parabola with a 6 m rise and a length of 105 m. Essentially this footbridge consists of a metal pier —that supports two unequal spans— situated at 3/10 of the length so as to utilize the pier of an old bridge; it has the shape of a capital A, the posts of which are pyramids with triangular section and which are formed by sheet plates joined together by welding. The spans, however, consist of: two lateral metal welded beams; a series of bridge ties also of metal, at a distance of 2.50 m from each other and joined to the beams by means of bolts; and resting upon these, a 10 cm thick reinforced concrete slab, protected by a greatly adhesive covering due to the strong slope of the accesses. The suspended solution does not allow any greater thickness of the footbridge and thus the views of the harbour are hardly obstructed. Its assymmetric shape along with the slender form of the pier contributes to making its location in the centre of the city very suitable.El perfil longitudinal de esta pasarela es el de una parábola cúbica con 6 m de flecha y 105 m de longitud. Esencialmente está constituida por una pila metálica —que soporta dos tramos desiguales— situada a 3/10 de la longitud con el fin de reutilizar, para su cimentación, la pila de un antiguo puente; tiene la forma de una gran A, cuyos montantes son pirámides de sección triangular formados por palastros soldados entre sí. Los tramos, a su vez, están formados por: dos vigas laterales metálicas, soldadas; una serie de traviesas, también metálicas, distanciadas 2,50 m y unidas a las vigas mediante bulones; y, apoyando sobre estas últimas, una losa de hormigón armado de 10 cm de espesor, protegida por un revestimiento de gran adherencia motivado por la fuerte pendiente de los accesos. La solución suspendida ha permitido dar un espesor muy pequeño a la pasarela, con lo que apenas se obstaculizan las perspectivas de la dársena. Su forma asimétrica, unida a la gran esbeltez de la pila, la hacen muy adecuada a su emplazamiento en pleno centro de la ciudad

A Large Repertoire of Parasite Epitopes Matched by a Large Repertoire of Host Immune Receptors in an Invertebrate Host/Parasite Model

For many decades, invertebrate immunity was believed to be non-adaptive, poorly specific, relying exclusively on sometimes multiple but germ-line encoded innate receptors and effectors. But recent studies performed in different invertebrate species have shaken this paradigm by providing evidence for various types of somatic adaptations at the level of putative immune receptors leading to an enlarged repertoire of recognition molecules. Fibrinogen Related Proteins (FREPs) from the mollusc Biomphalaria glabrata are an example of these putative immune receptors. They are known to be involved in reactions against trematode parasites. Following not yet well understood somatic mechanisms, the FREP repertoire varies considerably from one snail to another, showing a trend towards an individualization of the putative immune repertoire almost comparable to that described from vertebrate adaptive immune system. Nevertheless, their antigenic targets remain unknown. In this study, we show that a specific set of these highly variable FREPs from B. glabrata forms complexes with similarly highly polymorphic and individually variable mucin molecules from its specific trematode parasite S. mansoni (Schistosoma mansoni Polymorphic Mucins: SmPoMucs). This is the first evidence of the interaction between diversified immune receptors and antigenic variant in an invertebrate host/pathogen model. The same order of magnitude in the diversity of the parasite epitopes and the one of the FREP suggests co-evolutionary dynamics between host and parasite regarding this set of determinants that could explain population features like the compatibility polymorphism observed in B. glabrata/S. mansoni interaction. In addition, we identified a third partner associated with the FREPs/SmPoMucs in the immune complex: a Thioester containing Protein (TEP) belonging to a molecular category that plays a role in phagocytosis or encapsulation following recognition. The presence of this last partner in this immune complex argues in favor of the involvement of the formed complex in parasite recognition and elimination from the host

Detection of health deterioration in a COVID-19 patient at home: the potential of ambient sensor systems

The COVID-19 pandemic created increased interest in monitoring patients at home to allow timely recognition of health deteriorations. Hospital care is particularly demanding in these patients because of the necessity for isolation to avoid further spread of the disease. Therefore, home care is a preferred treatment setting for these patients. This is, to our knowledge, the first report indicating the potential of an affordable, contactless, and unobtrusive ambient sensor system for the detection of signs of health deterioration in a patient with COVID-19 by a caregiver from a distance. Prospective data acquisition and correlation of the data with clinical events were obtained from an 81-year-old senior with COVID-19 before and, in particular, over a period of 10 days prior to hospitalization. Clinical signs included weakness, increased respiration rate, sleep disturbances, and confusion. The visualization of a combination of this information on a dedicated dashboard allowed the caregiver to recognize a serious health deterioration that required a lifesaving hospitalization. The potential of such ambient sensor systems to detect signs of serious health deterioration in patients with COVID-19 opens new opportunities for use in asymptomatic or oligosymptomatic patients who live alone and are sent back to their homes for isolation in quarantine after diagnosis

MP2RAGE provides new clinically-compatible correlates of mild cognitive deficits in relapsing-remitting multiple sclerosis

Despite that cognitive impairment is a known early feature present in multiple sclerosis (MS) patients, the biological substrate of cognitive deficits in MS remains elusive. In this study, we assessed whether T1 relaxometry, as obtained in clinically acceptable scan times by the recent Magnetization Prepared 2 Rapid Acquisition Gradient Echoes (MP2RAGE) sequence, may help identifying the structural correlate of cognitive deficits in relapsing-remitting MS patients (RRMS). Twenty-nine healthy controls (HC) and forty-nine RRMS patients underwent high-resolution 3T magnetic resonance imaging to obtain optimal cortical lesion (CL) and white matter lesion (WML) count/volume and T1 relaxation times. T1 z scores were then obtained between T1 relaxation times in lesion and the corresponding HC tissue. Patient cognitive performance was tested using the Brief Repeatable Battery of Neuro-psychological Tests. Multivariate analysis was applied to assess the contribution of MRI variables (T1 z scores, lesion count/volume) to cognition in patients and Bonferroni correction was applied for multiple comparison. T1 z scores were higher in WML (p<0.001) and CL-I (p<0.01) than in the corresponding normal-appearing tissue in patients, indicating relative microstructural loss. (1) T1 z scores in CL-I (p=0.01) and the number of CL-II (p=0.04) were predictors of long-term memory; (2) T1 z scores in CL-I (β=0.3; p=0.03) were independent determinants of long-term memory storage, and (3) lesion volume did not significantly influenced cognitive performances in patients. Our study supports evidence that T1 relaxometry from MP2RAGE provides information about microstructural properties in CL and WML and improves correlation with cognition in RRMS patients, compared to conventional measures of disease burden

A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity.

BACKGROUND: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. MAIN BODY: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. CONCLUSION: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR&nbsp;=&nbsp;2.05, 95%CI&nbsp;=&nbsp;1.39–3.02, p&nbsp;&lt;&nbsp;0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR&nbsp;=&nbsp;0.42, 95%CI&nbsp;=&nbsp;0.18–0.99, p&nbsp;=&nbsp;0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

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/)

Pasarela en Le Havre Francia

The longitudinal profile of this is a cubic parabola with a 6 m rise and a length of 105 m. &#13; Essentially this footbridge consists of a metal pier —that supports two unequal spans— situated at 3/10 of the length so as to utilize the pier of an old bridge; it has the shape of a capital A, the posts of which are pyramids with triangular section and which are formed by sheet plates joined together by welding. &#13; The spans, however, consist of: two lateral metal welded beams; a series of bridge ties also of metal, at a distance of 2.50 m from each other and joined to the beams by means of bolts; and resting upon these, a 10 cm thick reinforced concrete slab, protected by a greatly adhesive covering due to the strong slope of the accesses.&#13; The suspended solution does not allow any greater thickness of the footbridge and thus the views of the harbour are hardly obstructed. Its assymmetric shape along with the slender form of the pier contributes to making its location in the centre of the city very suitable.<br><br>El perfil longitudinal de esta pasarela es el de una parábola cúbica con 6 m de flecha y 105 m de longitud. &#13; Esencialmente está constituida por una pila metálica —que soporta dos tramos desiguales— situada a 3/10 de la longitud con el fin de reutilizar, para su cimentación, la pila de un antiguo puente; tiene la forma de una gran A, cuyos montantes son pirámides de sección triangular formados por palastros soldados entre sí. &#13; Los tramos, a su vez, están formados por: dos vigas laterales metálicas, soldadas; una serie de traviesas, también metálicas, distanciadas 2,50 m y unidas a las vigas mediante bulones; y, apoyando sobre estas últimas, una losa de hormigón armado de 10 cm de espesor, protegida por un revestimiento de gran adherencia motivado por la fuerte pendiente de los accesos. &#13; La solución suspendida ha permitido dar un espesor muy pequeño a la pasarela, con lo que apenas se obstaculizan las perspectivas de la dársena. &#13; Su forma asimétrica, unida a la gran esbeltez de la pila, la hacen muy adecuada a su emplazamiento en pleno centro de la ciudad

Potential of Ambient Sensor Systems for Early Detection of Health Problems in Older Adults

Background: Home monitoring sensor systems are increasingly used to monitor seniors in their apartments for detection of emergency situations. The aim of this study was to deliver a proof-of-concept for the use of multimodal sensor systems with pervasive computing technology for the detection of clinically relevant health problems over longer time periods. Methods: Data were collected with a longitudinal home monitoring study in Switzerland (StrongAge Cohort Study) in a cohort of 24 old and oldest-old, community-dwelling adults over a period of 1 to 2 years. Physical activity in the apartment, toilet visits, refrigerator use, and entrance door openings were quantified using a commercially available passive infrared motion sensing system (Domosafety S.A., Switzerland). Heart rate, respiration rate, and sleep quality were recorded with the commercially available EMFIT QS bed sensor device (Emfit Ltd., Finland). Vital signs and contextual data were collected using a wearable sensor on the upper arm (Everion, Biovotion, Switzerland). Sensor data were correlated with health-related data collected from the weekly visits of the seniors by health professionals, including information about physical, psychological, cognitive, and behavior status, health problems, diseases, medication, and medical diagnoses. Results: Twenty of the 24 recruited participants (age 88.9 ± 7.5 years, 79% females) completed the study; two participants had to stop their study participation because of severe health deterioration, whereas two participants died during the course of the study. A history of chronic disease was present in 12/24 seniors, including heart failure, heart rhythm disturbances, pulmonary embolism, severe insulin-dependent diabetes, and Parkinson's disease. In total, 242,232 person-hours were recorded. During the monitoring period, 963 health status records were reported and repeated clinical assessments of aging-relevant indicators and outcomes were performed. Several episodes of health deterioration, including heart failure worsening and heart rhythm disturbances, could be captured by sensor signals from different sources. Conclusions: Our results indicate that monitoring of seniors with a multimodal sensor and pervasive computing system over longer time periods is feasible and well-accepted, with a great potential for detection of health deterioration. Further studies are necessary to evaluate the full range of the clinical potential of these findings