Multiplex quantitative PCR for single-reaction genetically modified (GM) plant detection and identification of false-positive GM plants linked to Cauliflower mosaic virus (CaMV) infection.

BACKGROUND:Most genetically modified (GM) plants contain a promoter, P35S, from the plant virus, Cauliflower mosaic virus (CaMV), and many have a terminator, TNOS, derived from the bacterium, Agrobacterium tumefaciens. Assays designed to detect GM plants often target the P35S and/or TNOS DNA sequences. However, because the P35S promoter is derived from CaMV, these detection assays can yield false-positives from non-GM plants infected by this naturally-occurring virus. RESULTS:Here we report the development of an assay designed to distinguish CaMV-infected plants from GM plants in a single multiplexed quantitative PCR (qPCR) reaction. Following initial testing and optimization via PCR and singleplex-to-multiplex qPCR on both plasmid and plant DNA, TaqMan qPCR probes with different fluorescence wavelengths were designed to target actin (a positive-control plant gene), P35S, P3 (a CaMV-specific gene), and TNOS. We tested the specificity of our quadruplex qPCR assay using different DNA extracts from organic watercress and both organic and GM canola, all with and without CaMV infection, and by using commercial and industrial samples. The limit of detection (LOD) of each target was determined to be 1% for actin, 0.001% for P35S, and 0.01% for both P3 and TNOS. CONCLUSIONS:This assay was able to distinguish CaMV-infected plants from GM plants in a single multiplexed qPCR reaction for all samples tested in this study, suggesting that this protocol is broadly applicable and readily transferrable to any interested parties with a qPCR platform

How did episiotomy rates change from 2007 to 2014? Population-based study in France

International audienceBACKGROUND: Since the 2000s, selective episiotomy has been systematically recommended worldwide. In France, the recommended episiotomy rate in vaginal deliveries is less than 30%. The aims of this study were to describe the evolution of episiotomy rates between 2007 and 2014, especially for vaginal deliveries without instrumental assistance and to assess individual characteristics and birth environment factors associated with episiotomy.METHODS: This population-based study included all hospital discharge abstracts for all deliveries in France from 2007 to 2014. The use of episiotomy in vaginal deliveries was identified by one code in the French Common Classification of Medical Procedures. The episiotomy rate per department and its evolution is described from 2007 to 2014. A mixed model was used to assess associations with episiotomy for non-operative vaginal deliveries and the risk factors related to the women's characteristics and the birth environment.RESULTS: There were approximately 540,000 non-operative vaginal deliveries per year, in the study period. The national episiotomy rate for vaginal deliveries overall significantly decreased from 26.7% in 2007 to 19.9% in 2014. For non-operative deliveries, this rate fell from 21.1% to 14.1%. For the latter, the use of episiotomy was significantly associated with breech vaginal delivery (aOR = 1.27 [1.23-1.30]), epidural analgesia (aOR = 1.45 [1.43-1.47]), non-reassuring fetal heart rate (aOR = 1.47 [1.47-1.49]), and giving birth for the first time (aOR = 3.85 [3.84-4.00]).CONCLUSIONS: The episiotomy rate decreased throughout France, for vaginal deliveries overall and for non-operative vaginal deliveries. This decrease is probably due to proactive changes in practices to restrict the number of episiotomies, which should be performed only if beneficial to the mother and the infant

Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data

Background: Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. Aim: Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. Design: Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database Results: 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academic medical centers, intensive care unit admissions ranged from 12% to 67.4%; hospital palliative care admissions, from 2% to 30.6%. Across local authorities, for intensive care unit days and hospital palliative care admissions, the ratios between the values at the third and the first quartile were 2.4 and 1.5. The odds of admission for hospital palliative care or to an intensive care unit for more than 7 days were more than twice as high among people ⩽85 years (aOR = 2.11 (1.84–2.43) and aOR = 2.59 (2.12–3.17), respectively). The odds of admission for hospital palliative care were about 25% lower ( p = 0.04) among decedents living in local authorities with the lowest levels of education than those with the highest levels. Conclusion: The variation we document in end-of-life and hospital palliative care across different categories of hospitals and 95 local authorities raises important questions as to what constitutes appropriate hospital use and intensity at the end-of-life. </jats:sec

Soins ambulatoires et facteurs associés à la réhospitalisation précoce des sujets âgés (65+) après un infarctus du myocarde : étude observationnelle à partir des données nationales de l’Échantillon généraliste de bénéficiaires (EGB)

International audienceÉtat de la questionLes réhospitalisations précoces (RHP), dans les 30jours suivant la sortie d’hospitalisation, sont fréquentes chez les sujets âgés, notamment après un infarctus du myocarde (IDM). Elles augmentent la morbi-mortalité et les dépenses de santé. Il a été démontré qu’une meilleure organisation de la sortie d’hospitalisation réduit significativement le risque de RHP. Néanmoins, il n’existe aucune recommandation sur le suivi ambulatoire en sortie d’hospitalisation. L’objectif de l’étude était d’analyser les soins ambulatoires post-hospitaliers et les facteurs associés à la RHP des sujets âgés après un IDM.Matériel et méthodesÉtude observationnelle rétrospective à partir des données nationales de l’Échantillon généraliste de bénéficiaires (EGB). Tous les patients ≥65 ans, hospitalisés pour un IDM entre 2011 et 2013 étaient inclus. Les patients hospitalisés pour un IDM dans l’année précédente, ou décédés pendant l’hospitalisation initiale ou dans les 30jours suivant la sortie étaient exclus. Le critère de jugement principal était la première réhospitalisation, toutes causes, dans les 30jours suivant la sortie du court-séjour. Des données socio-démographiques, médicales et de soins ambulatoires étaient recueillies. Les déterminants de la RHP étaient identifiés via des modèles de régression logistique.RésultatsParmi les 624 patients éligibles, 137 étaient réhospitalisés dans les 30jours (22 %). L’âge moyen était de 79,2 ans, avec une prédominance masculine (57 %). Le délai moyen de réhospitalisation était de 11,9jours. En analyse multivariée, la fibrillation atriale (OR=1,81 [1,12–2,91]), l’insuffisance rénale chronique (OR=1,90 [1,01–3,57]) et la délivrance d’un antiagrégant plaquettaire ou anticoagulant dans les sept jours suivant la sortie (OR=0,57 [0,38–0,83]) étaient significativement associés à la RHP.ConclusionCette étude, réalisée sur un échantillon représentatif de la population française, confirme le haut risque de RHP chez les sujets âgés en post-IDM. Des interventions ciblées sur les comorbidités et les traitements paraissent nécessaires pour réduire ces RHP

Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data

International audienceBackground: Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. Aim: Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. Design: Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database Results: 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academic medical centers, intensive care unit admissions ranged from 12% to 67.4%; hospital palliative care admissions, from 2% to 30.6%. Across local authorities, for intensive care unit days and hospital palliative care admissions, the ratios between the values at the third and the first quartile were 2.4 and 1.5. The odds of admission for hospital palliative care or to an intensive care unit for more than 7 days were more than twice as high among people ⩽85 years (aOR = 2.11 (1.84–2.43) and aOR = 2.59 (2.12–3.17), respectively). The odds of admission for hospital palliative care were about 25% lower (p = 0.04) among decedents living in local authorities with the lowest levels of education than those with the highest levels. Conclusion: The variation we document in end-of-life and hospital palliative care across different categories of hospitals and 95 local authorities raises important questions as to what constitutes appropriate hospital use and intensity at the end-of-life