Perinatal grief following neonatal comfort care for lethal fetal condition

BACKGROUND: The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA). METHODS: This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale. RESULTS: There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25% . CONCLUSION: Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA

Statistical Derivation of Basic Equations of Diffusional Kinetics in Alloys with Application to the Description of Diffusion of Carbon in Austenite

Basic equations of diffusional kinetics in alloys are statistically derived using the master equation approach. To describe diffusional transformations in substitution alloys, we derive the "quasi-equilibrium" kinetic equation which generalizes its earlier versions by taking into account possible "interaction renormalization" effects. For the interstitial alloys Me-X, we derive the explicit expression for the diffusivity D of an interstitial atom X which notably differs from those used in previous phenomenological treatments. This microscopic expression for D is applied to describe the diffusion of carbon in austenite basing on some simple models of carbon-carbon interaction. The results obtained enable us to make certain conclusions about the real form of these interactions, and about the scale of the "transition state entropy" for diffusion of carbon in austenite.Comment: 26 pages, 5 postscript figures, LaTe

Study of Damage Propagation at the Interface Localization-Delocalization Transition of the Confined Ising Model

The propagation of damage in a confined magnetic Ising film, with short range competing magnetic fields ($h$) acting at opposite walls, is studied by means of Monte Carlo simulations. Due to the presence of the fields, the film undergoes a wetting transition at a well defined critical temperature $T_w(h)$. In fact, the competing fields causes the occurrence of an interface between magnetic domains of different orientation. For $T T_w(h)$) such interface is bounded (unbounded) to the walls, while right at $T_w(h)$ the interface is essentially located at the center of the film. It is found that the spatio-temporal spreading of the damage becomes considerably enhanced by the presence of the interface, which act as a ''catalyst'' of the damage causing an enhancement of the total damaged area. The critical points for damage spreading are evaluated by extrapolation to the thermodynamic limit using a finite-size scaling approach. Furthermore, the wetting transition effectively shifts the location of the damage spreading critical points, as compared with the well known critical temperature of the order-disorder transition characteristic of the Ising model. Such a critical points are found to be placed within the non-wet phase.Comment: 22 pages, 13 figures include

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/)

Accessing the meanings of ambiguous word roots in context: Evidence from crossmodal priming

How are morphemes recognized and interpreted during incremental sentence comprehension? We investigated this question in a crossmodal primed lexical decision task employing words that contain semantically ambiguous roots (e.g., ‘bark’; with meanings related to both “dog” and “tree”) but which are disambiguated when affixed by “-ing” (e.g., ‘barking’; related to “dog” only). We aimed to understand whether access to the meaning of the root ‘bark’ would be constrained by lower-level morphological affixation. In our experiment, participants listened to sentences containing an affixed ambiguous root while concurrently performing lexical decisions to a visual target related to the root-only meaning, the affixed meaning, or matched controls. Targets were presented for 80 ms at the recognition point of bark or 500 ms post-recognition. We found that both meanings of the root were activated, despite affixation. Results suggest that a parsing system blind to semantics decomposes morphologically complex words into morphemes before recognition

Ineffective anti PD-1 therapy after BRAF inhibitor failure in advanced melanoma

Abstract Background Anti-PD-1 and BRAF-inhibitors (BRAFi) have been approved as first-line treatments in advanced melanoma. To date, no prospective data are available to give the best sequence of treatment. The objective of this study was to evaluate in real-life the efficacy of anti-PD-1 after BRAFi, ipilimumab, or chemotherapy failure. Methods This was a single institution cohort analysis in patients treated with anti-PD-1 right after BRAFi, ipilimumab, or chemotherapy failure. Melanoma evolution after anti-PD-1 initiation was analyzed in BRAF-mutated and BRAF wild-type patients. The efficacy of treatment was evaluated by Objective Response Rate (ORR), Disease Control Rate (DCR), Progression-Free Survival (PFS), and Overall Survival (OS). Results Seventy-four patients were included: 33 wild-type and 41 BRAF-mutated melanoma. ORR to anti-PD-1 was significantly lower in BRAF-mutated patients (12.2% vs. 45.5%, p = 0.002). After anti-PD-1 initiation, the median PFS and OS was significantly shorter in the BRAF mutated group (2 vs. 5 months and 7 vs. 20 months, p = 0.001). The hazard ratio for disease progression was of 2.3 (95%CI:1.3–3.9; p = 0.003) and 2.5 (95%CI:1.3–4.5; p = 0.005) for death. Thirty-nine percent of BRAF-mutated-patients died within 3 months after anti-PD-1 initiation. Rapid death (≤3 months) was significantly higher in BRAF-mutated patients (55.2% vs. 20.0%, p = 0.014). Discussion This is the largest series of unselected patients treated in real-life with anti-PD-1 as second-or-higher line of treatment. Anti-PD-1 was less effective in BRAF-mutated cases as a majority of patients presented aggressive tumor evolution after BRAFi discontinuation. These data are consistent with previous studies suggesting a negative impact of BRAFi prior to immunotherapy