Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Fungal Metabarcoding Data for Two Grapevine Varieties (Regent and <i>Vitis vinifera</i> ‘Cabernet-Sauvignon’) Inoculated with Powdery Mildew (<i>Erysiphe necator</i>) Under Drought Conditions

The increasing needs of humanity for food supply, the need to reduce fertilizer and pesticide use to protect human and environmental health, and the threats of climate change and disease emergence all provide incentives to use microorganisms to promote crop growth and health (Busby et al. 2017; D'Hondt et al. 2021; Toju et al. 2018). One of the challenges currently facing us is discovering and identifying microbial strains or consortia capable of alleviating biotic and abiotic stresses, and integrating them into crop management (Berg et al. 2017; Poudel et al. 2016). Addressing this challenge is crucial in the case of European cultivated grapevine (Vitis vinifera L.) because this emblematic crop is a very heavy user of phytosanitary products (mainly copper, sulfur and synthetic chemical fungicides targeting leaf diseases). Strengthening microbial biocontrol of grapevine leaf diseases by stimulating the microbiota naturally present in vineyards or by inoculating new microorganisms (Bartoli et al. 2020) could reduce viticulture reliance on chemical fungicides. However, this nature-based solution (Maes and Jacobs 2017) will only be effective and sustainable if microbial antagonisms are resilient to microclimatic and climatic variations and associated changes in vine physiology. This is why vine-pathogen-microbiota interactions should be studied under a range of abiotic conditions. Powdery mildew is one of the grapevine leaf diseases for which the use of chemical fungicides must be reduced. It is caused by the ascomycete fungus Erysiphe necatorCultivating the grapevine without pesticides : towards agroecological wine-producing socio-ecosystem

Towards social environmental justice ?

The original handle to Cadmus, the EUI research repository : http://hdl.handle.net/1814/20018This Working Paper is the result of a workshop held at the European University Institute in November 2010. At the heart of it lies a reflection on the potentialities of a new legal concept : social environmental justice. Building on the longstanding tradition of social justice and the more recent trend of environmental (or ecological) justice, our aim was to discuss how these two different dimensions of 'justice' overlap and could be reconciled in an all-encompassing notion. Moreover, we discussed the need for such a new concept in the light of the contemporary challenges of climate change and economic globalisation and focused especially on the concept's added value compared to the already existing notion of sustainable development. In addition to that, we explored the practical value of social environmental justice especially in the context of legal practice. This publication is a mirror of the different normative approaches (more social, more environmental, more holistic) one can adopt in dealing with problems such as climate change and globalization. Finally, it suggests different legal paths (Human rights, Private International Law, European Law) that could be taken in order to address these issues. Table of Contents : Social environmental justice : from the concept to reality / Antoine Duval and Marie-Ange Moreau -- Social environmental justice : the need for a new concept / Marie-Ange Moreau -- Sustainable development without social justice? / Dominic Roux and Marie-Claude Desjardins -- Sustainable development... without 'ecological' justice? / Sophie Lavallée -- Realising social environmental justice : human rights, sustainable development and possible ways forwards / Emmanuela Orlando -- Corporations and social environmental justice : the role of private international law / Claire Staath and Benedict Wray -- International human rights in an environmental horizon / Francesco Francion

Towards social environmental justice ?

The original handle to Cadmus, the EUI research repository : http://hdl.handle.net/1814/20018This Working Paper is the result of a workshop held at the European University Institute in November 2010. At the heart of it lies a reflection on the potentialities of a new legal concept : social environmental justice. Building on the longstanding tradition of social justice and the more recent trend of environmental (or ecological) justice, our aim was to discuss how these two different dimensions of 'justice' overlap and could be reconciled in an all-encompassing notion. Moreover, we discussed the need for such a new concept in the light of the contemporary challenges of climate change and economic globalisation and focused especially on the concept's added value compared to the already existing notion of sustainable development. In addition to that, we explored the practical value of social environmental justice especially in the context of legal practice. This publication is a mirror of the different normative approaches (more social, more environmental, more holistic) one can adopt in dealing with problems such as climate change and globalization. Finally, it suggests different legal paths (Human rights, Private International Law, European Law) that could be taken in order to address these issues. Table of Contents : Social environmental justice : from the concept to reality / Antoine Duval and Marie-Ange Moreau -- Social environmental justice : the need for a new concept / Marie-Ange Moreau -- Sustainable development without social justice? / Dominic Roux and Marie-Claude Desjardins -- Sustainable development... without 'ecological' justice? / Sophie Lavallée -- Realising social environmental justice : human rights, sustainable development and possible ways forwards / Emmanuela Orlando -- Corporations and social environmental justice : the role of private international law / Claire Staath and Benedict Wray -- International human rights in an environmental horizon / Francesco Francion

Dynamical prefrontal population coding during defensive behaviours

Coping with threatening situations requires both identifying stimuli that predict danger and selecting adaptive behavioural responses to survive1. The dorsomedial prefrontal cortex (dmPFC) is a critical structure that is involved in the regulation of threat-related behaviour2,3,4. However, it is unclear how threat-predicting stimuli and defensive behaviours are associated within prefrontal networks to successfully drive adaptive responses. Here we used a combination of extracellular recordings, neuronal decoding approaches, pharmacological and optogenetic manipulations to show that, in mice, threat representations and the initiation of avoidance behaviour are dynamically encoded in the overall population activity of dmPFC neurons. Our data indicate that although dmPFC population activity at stimulus onset encodes sustained threat representations driven by the amygdala, it does not predict action outcome. By contrast, transient dmPFC population activity before the initiation of action reliably predicts avoided from non-avoided trials. Accordingly, optogenetic inhibition of prefrontal activity constrained the selection of adaptive defensive responses in a time-dependent manner. These results reveal that the adaptive selection of defensive responses relies on a dynamic process of information linking threats with defensive actions, unfolding within prefrontal networks.Rôle de la signalisation dopaminergique dans l'amygdale étendue dans le contrôle de la peur généralisée.Role des projections inhibitrices provenant du cortex préfrontal dans l'expression de la peur conditionnéeInnovations instrumentales et procédurales en psychopathologie expérimentale chez le rongeu

Assessing inter- and intraspecific variability of xylem vulnerability to embolism in oaks

The genus Quercus comprises important species in forestry not only for their productive value but also for their ability to withstand drought. Hence an evaluation of inter- and intraspecific variation in drought tolerance is important for selecting the best adapted species and provenances for future afforestation. However, the presence of long vessels makes it difficult to assess xylem vulnerability to embolism in these species. Thanks to the development of a flow centrifuge equipped with a large rotor, we quantified (i) the between species variability of embolism resistance in four native and two exotic species of oaks in Europe and (ii) the within species variability in Quercus petraea. Embolism resistance varied significantly between species, with the pressure inducing 50% loss of hydraulic conductivity (P-50) ranging between -7.0 and -4.2 MPa. Species native to the Mediterranean region were more resistant than pan-European species. In contrast, intraspecific variability in embolism resistance in Q. petraea was low within provenances and null between provenances. A positive correlation between P-50 and vessel diameter among the six oak species indicates that the more embolism resistant species had narrower xylem vessels and a higher amount of hydraulic bridges between vessels. However, this tradeoff between hydraulic efficiency and safety was not observed between Q. petraea provenances

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease