Influence of Ablation on Differential Arc Resistance

The influence of ablation on the du/di behavior of an arc in a model gas circuit breaker was examined. Specifically the transition from a state without ablation in the nozzle towards states with ablation was of interest, since prior work indicated that for high currents the voltage becomes constant or du/di gets even positive if ablation is present. Measurements with different blow pressures and rectangular DC currents of varying amplitude were compared, using PMMA-nozzles and dry air as blowing gas. Ablation was measured by weighing the nozzle, scanning the cross section, and using a coordinate measuring machine. The results agreed well, and confirmed that higher pressure shifts the du/di curve towards more favorable values

Volatile anaesthetics and positive pressure ventilation reduce left atrial performance: a transthoracic echocardiographic study in young healthy adults

Background Animal and in vitro studies suggest that volatile anaesthetics affect left atrial (LA) performance. We hypothesized that human LA pump function and dimensions are altered by volatile anaesthetics in vivo. Methods We performed transthoracic echocardiographic (TTE) measurements in 59 healthy subjects (aged 18-48 yr) undergoing minor surgery under general anaesthesia. The unpremedicated patients were randomly assigned to anaesthesia with sevoflurane, desflurane, or isoflurane. TTE examinations were performed at baseline and after induction of anaesthesia and upon placement of a laryngeal mask during spontaneous breathing. After changing to intermittent positive pressure ventilation (IPPV), an additional TTE was performed. The study focused on the velocity-time integral of late peak transmitral inflow velocity (AVTI) and maximum LA volume. Results We found no evidence for relevant differences in the effects of the three volatile anaesthetics. AVTI decreased significantly from 4.1 (1.2) cm at baseline to 3.2 (1.1) cm during spontaneous breathing of 1 minimum alveolar concentration of volatile anaesthetics. AVTI decreased further to 2.8 (1.0) cm after changing to IPPV. The maximum LA volume was 45.4 (18.6) cm3 at baseline and remained unchanged during spontaneous breathing but decreased to 34.5 (16.7) cm3 during IPPV. Other parameters of LA pump function and dimensions decreased similarly. Conclusions Volatile anaesthetics reduced active LA pump function in humans in vivo. Addition of IPPV decreased LA dimensions and further reduced LA pump function. Effects in vivo were less pronounced than previously found in in vitro and animal studies. Further studies are warranted to evaluate the clinical implications of these findings. Clinical trial registration NCT002445

Evaluation of a large-scale health department naloxone distribution program: Per capita naloxone distribution and overdose morality

OBJECTIVES: To report per-capita distribution of take-home naloxone to lay bystanders and evaluate changes in opioid overdose mortality in the county over time. METHODS: Hamilton County Public Health in southwestern Ohio led the program from Oct 2017-Dec 2019. Analyses included all cartons distributed within Hamilton County or in surrounding counties to people who reported a home address within Hamilton County. Per capita distribution was estimated using publicly available census data. Opioid overdose mortality was compared between the period before (Oct 2015-Sep 2017) and during (Oct 2017-Sep 2019) the program. RESULTS: A total of 10,416 cartons were included for analyses, with a total per capita distribution of 1,275 cartons per 100,000 county residents (average annual rate of 588/100,000). Median monthly opioid overdose mortality in the two years before (28 persons, 95% CI 25-31) and during (26, 95% CI 23-28) the program did not differ significantly. CONCLUSIONS: Massive and rapid naloxone distribution to lay bystanders is feasible. Even large-scale take-home naloxone distribution may not substantially reduce opioid overdose mortality rates

DNA-Sequence Variation Among Schistosoma mekongi Populations and Related Taxa; Phylogeography and the Current Distribution of Asian Schistosomiasis

Schistosomiasis is a disease caused by parasitic worms of the genus Schistosoma. In the lower Mekong river, schistosomiasis in humans is called Mekong schistosomiasis and is caused by Schistosoma mekongi. In the past, Mekong schistosomiasis was known only from the lower Mekong river. Here DNA-sequence variation is used to study the relationships and history of populations of S. mekongi. Populations from other rivers are compared and shown to be S. mekongi, thus confirming that this species is not restricted to only a small section of one river. The dates of divergence among populations are also estimated. Prior to this study it was assumed that S. mekongi originated in Yunnan, China, migrated southwards across Laos and into Cambodia, later becoming extinct in Laos (due to conditions unsuitable for transmission). In contrast, the dates estimated here indicate that S. mekongi entered Cambodia from Vietnam, 2.5–1 Ma. The pattern of genetic variation fits better with a more recent, and ongoing, northwards migration from Cambodia into Laos. The implications are that Mekong schistosomiasis is more widespread than once thought and that the human population at risk is up to 10 times greater than originally estimated. There is also an increased possibility of the spread of Mekong schistosomiasis across Laos

Predicting At-Risk Opioid Use Three Months After Ed Visit for Trauma: Results from the AURORA Study

OBJECTIVE: Whether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use. METHODS: Participants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months. RESULTS: Of 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5). CONCLUSIONS: ED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making

Adhérence parentale à un service d’urgences après orientation téléphonique

Background: The Centrale Téléphonique des Médecins de Garde (CTMG) is a 24-hour service call centre which specializes in evaluating, sorting and orientating children and adults with urgent and nonurgent medical problems. Parents’ calls are regulated by nurses. Little is known about parental adherence to referral following triage recommendations. Objectives: To determine parents’ adherence with referral to the emergency department of the Hôpital de l’Enfance de Lausanne (HEL) after being referred by the nurses of the CTMG. Design / Methods: This was a prospective and observational study. From November 4 to December 4 2019, pediatric calls (<15 years old) with urgent orientation (<2 hours) were selected. Non-urgent and life-threatening emergencies were excluded. Children orientation was then verified in the HEL emergency department, as well as their triage score (Australasian Triage Scale, ATS) and their final outcome (discharged home or hospitalised). Results: Parental adherence to the orientation is 76% (343/451). 302/343 (88%) arrived in the emergency department within 2 hours. 169/343 (49%) were given an ATS score of 2, 3 or 4 upon arrival. 35/343 (10%) were hospitalised or needed further investigations. The 3 major call complaints were respiratory (107/451, 24%), gastrointestinal (89/451, 20%) and trauma (78/451, 17%). Median age was 2 years old. 298/451 (66%) children who were referred by CTMG were up to 3 years old or under. Conclusion: Parental adherence to the emergency department is satisfying. This result matches with literature data (63- 83%). Also, the time period of arrival in the emergency department was respected. No cases were under-evaluated by the call centre

Knowledge and acceptance of telemedicine in surgery: a survey

A questionnaire was sent to the chief surgeons at 141 Swiss hospitals to evaluate their knowledge and acceptance of telemedicine in surgery. The response rate was 69%. Ninety-three per cent of all surgical departments used computer technology, 85% regularly used the Web and 88% had an internal hospital network. ISDN lines were used in 58% of the participants' hospitals. While 35% of respondents had participated at least once in networking, only 8% regularly used telemedicine. The opinion was that access to therapeutic advice (87%) was a better use of telemedicine than was obtaining a primary diagnosis (24%), although the majority accepted the principle of making (91%) and receiving (94%) a remote diagnosis. The survey suggested that surgeons are interested in telemedicine and open to its development, although their experience and knowledge are limited. Therefore, telemedicine in surgery may be advanced by creating surgical networks for teleconsultation and tele-education

A51 - Isotopes stables et GC-MS - Transformation de l'acide l-malique 13C par les bacteries lactiques du vin

ISSN: 0365-4877International audienceLes nouvelles recherches sur le theme de la Fermentation Malolactique (FML) s'orientent vers la selection des souches de bacteries pour l'ensemencement des vins. Cette selection passe par l'approfondissement de la connaissance des voies metaboliques de degradation de l'acide 1-malique par les bacteries lactiques au cours de la FML.Pour cela, le devenir de l'acide 1-malique 3.4-13C et l'incorporation de 13C sur le carbone 3 des acides lactique et pyruvique, ont ete suivis au cours de l'incubation en milieu de culture.La methodologie des amas d'ions a ete mise en oeuvre par incubation d'un melange equimoleculaire d'acide 1-malique et 1-malique 3.4-13C, (Ctotale: 22 mM) en milieu de culture (25 ml) pour 4 souches (Lc. oenos B1, B16, 13A1 et Lb. plantarum). La consommation d'acide malique et la production d'acide lactique ont ete mesurees au cours de l'incubation sur des aliquotes (400 μl) prelevees dans chacun des pots, avant incubation (t0) et a t = 5H, 9H, 17H, 24H, 43H et 69H par GC-MS des derives Tms de l'acide malique et de l'acide lactique. Parallelement les facteurs d'enrichissement (FE) ont ete mesures par fragmentometrie de masse sur les ions M * - 15 et M - 15 des acides malique (m/z: 337 et 335) et lactique (m/z: 220 et 219), et de l'acide pyruvique sous forme de derive oxime-Tms (m/z: 248 et 247). Concernant la souche Lc. oenos B1 la production d'acide lactique est symetrique a la consommation de l'acide malique entre 0 et 43H (pente = 0.299 + 0.064 et - 0.254 + 0.041).L'accroissement du facteur d'enrichissement (FE) de l'acide lactique est lineaire entre 0 et 43H puis atteint un plateau pour Lc. oenos, et egalement lineaire entre 0 et 13H puis decroit jusqu'a 69H pour Lb. plantarum, tandis que celui de l'acide malique reste stable, indiquant une consommation identique des molecules non marquees et marquees. Les pentes des droites de correlation de l'evolution du FE de l'acide lactique en fonction du temps montrent des vitesses differentes d'entree du 13C dans l'acide lactique pour chacune des souches, ce parametre pouvant ainsi constituer un critere de differenciation.D'autre part le FE de l'acide pyruvique montre un tres faible accroissement au cours du temps, sauf pour Lb. plantarum (max. = 8%) suggerant que l'acide pyruvique intervient comme intermediaire metabolique dans la transformation de l'acide malique en acide lactique