In vivo assessment of the mechanical properties of the child cortical bone using quantitative computed tomography

The mechanical properties of the rib cortical bone are extremely rare on children due to difficulties to obtain specimens to perform conventional tests. Some recent studies used cadaveric bones or bone tissues collected during surgery but are limited by the number of samples that could be collected. A non-invasive technique could be extremely valuable to overcome this limitation. It has been shown that a relationship exists between the mechanical properties (apparent Young’s modulus and ultimate strength) and the bone mineral density (assessed using Quantitative Computed Tomography, QCT), for the femur and recently by our group for the adult ribs ex vivo. Thus the aim of this study was to assess the mechanical properties of the child rib cortical bone using both QCT images in vivo and the previous relationship between bone mineral density and mechanical properties of the rib cortical bone. Twenty-eight children were included in this study. Seven age-groups have been considered (1, 1.5, 3, 6, 10, 15, 18 years old). The QCT images were prescribed for various thoracic pathologies at the pediatric hospital in Lyon. A calibration phantom was added to the clinical protocol without any modifications for the patient. The protocol was approved by the ethical committee. A 3D reconstruction of each thorax was performed using the QCT images. A custom software was then used to obtain cross-sections to the rib midline. The mean bone mineral density was then computed by averaging the Hounsfield Units in a specific cross-section and by converting the mean value (Hounsfield Units) in bone mineral density using the calibration phantom. This bone mineral density was assessed for the 6th rib of each subject. Our relationship between the bone mineral density and the mechanical properties of the rib cortical bone was used to derive the mechanical properties of the child ribs in vivo. The results give values for the apparent Young’s modulus and the ultimate strength. The mechanical properties increase along growth. As an example the apparent Young’s modulus in the lateral region ranges from 7 GPa +/-3 at 1 year old up to 13 GPa +/- 2 at 18 years old. These data are in agreement with the few previous values obtained from child tissues. This methodology opens the way to in vivo measurement of the mechanical properties of the child cortical bone based on calibrated QCT images

Investigating the need for therapeutic drug monitoring of imipenem in critically ill patients: Are we getting it right?

Background. The drug levels and clearances of imipenem in critically ill patients are not comprehensively described in current literature, yet it is vital that adequate levels be achieved for therapeutic success.Objectives. To determine the proportion of critically ill patients treated with imipenem/cilastatin with sub-therapeutic imipenem plasma levels, and to compare the clinical outcomes of those patients with therapeutic levels with those who had sub-therapeutic levels.Methods. Trough imipenem plasma levels of 68 critically ill patients from a surgical intensive care unit were measured using a validated high-performance liquid chromatography method. Imipenem trough levels were compared with the minimum inhibitory concentration (MIC) of the causative bacterial agents, based on a target value of 100% time above MIC (¦T >MIC).Results. The proportion of participants with sub-therapeutic imipenem levels was 22% (95% confidence interval (CI) 13% - 34%). The 14- and 28-day mortality rates in the sub-therapeutic group were 33% and 40%, respectively, compared with 19% (p=0.293) and 26% (p=0.346), respectively, in the therapeutic group. Sub-therapeutic imipenem plasma levels are associated with adjusted hazard ratio of 1.47 (95% CI 0.55 - 3.91).Conclusions. The lower proportion of critically ill patients with sub-therapeutic imipenem plasma levels in this study compared with previous studies may be attributed to the practice of higher dosages and the administration method of extended infusions of imipenem/cilastatin in our setting. The results demonstrate a trend of higher mortality in patients with sub-therapeutic imipenem levels, although the results were not statistically significant at this sample size.

Investigating the need for therapeutic drug monitoring of imipenem in critically ill patients: Are we getting it right?

Background. The drug levels and clearances of imipenem in critically ill patients are not comprehensively described in current literature, yet it is vital that adequate levels be achieved for therapeutic success. Objectives. To determine the proportion of critically ill patients treated with imipenem/cilastatin with sub-therapeutic imipenem plasma levels, and to compare the clinical outcomes of those patients with therapeutic levels with those who had sub-therapeutic levels. Methods. Trough imipenem plasma levels of 68 critically ill patients from a surgical intensive care unit were measured using a validated high-performance liquid chromatography method. Imipenem trough levels were compared with the minimum inhibitory concentration (MIC) of the causative bacterial agents, based on a target value of 100% time above MIC (ƒT >MIC). Results. The proportion of participants with sub-therapeutic imipenem levels was 22% (95% confidence interval (CI) 13% - 34%). The 14- and 28-day mortality rates in the sub-therapeutic group were 33% and 40%, respectively, compared with 19% (p=0.293) and 26% (p=0.346), respectively, in the therapeutic group. Sub-therapeutic imipenem plasma levels are associated with adjusted hazard ratio of 1.47 (95% CI 0.55 - 3.91). Conclusions. The lower proportion of critically ill patients with sub-therapeutic imipenem plasma levels in this study compared with previous studies may be attributed to the practice of higher dosages and the administration method of extended infusions of imipenem/ cilastatin in our setting. The results demonstrate a trend of higher mortality in patients with sub-therapeutic imipenem levels, although the results were not statistically significant at this sample size

Comparison of Two Self-organization and Hierarchical Routing Protocols for Ad Hoc Networks

International audienceIn this article, we compare two self-organization and hierarchical routing protocols for ad hoc networks. These two protocols apply the reverse approach from the classical one, since they use a reactive routing protocol inside the clusters and a proactive routing protocol between the clusters. We compare them regarding the cluster organization they provide and the routing that is then performed over it. This study gives an idea of the impact of the use of recursiveness and of the partition of the DHT on self-organization and hierarchical routing in ad hoc networks

Genetic diversity and population structure of Angiostrongylus vasorum parasites within and between local urban foxes (Vulpes Vulpes)

Angiostrongylus vasorum is a nematode parasite of the pulmonary arteries and heart that infects domestic and wild canids. Dogs (Canis familiaris) and red foxes (Vulpes vulpes) are the most commonly affected definitive hosts. Recent studies suggest that angiostrongylosis is an emerging disease, and that red foxes may play an important role in the epidemiology of the parasite. Genetic analyses of parasites collected from dogs and foxes throughout Europe have shown that the same parasite haplotypes are commonly shared between different host species. However, the extent of genetic diversity within local A. vasorum populations and individual hosts is unknown. The objective of the present study was to assess the occurrence of genetic diversity among A. vasorum (a) recovered from different foxes within the Greater London area (a localised population, single worm per fox dataset); and (b) hosted within single foxes (multiple worms per fox dataset). During 2016, A. vasorum worms were collected from foxes culled for other purposes in London. DNA was extracted from each parasite and a partial fragment of the mitochondrial cytochrome oxidase subunit 1 (mtCOI) gene was amplified and sequenced. Sequences from the single worm dataset were compared with those published elsewhere. Combined, 19 haplotypes were described of which 15 were identified from foxes found in London, indicating that considerable genetic diversity can be detected within a local geographic area. Analysis of the multiple worm dataset identified 22 haplotypes defining worms recovered from just six foxes, emphasising the relevance of wild canines as reservoirs of genetic diversity. This is the first study to explore the genetic complexity of individual fox-hosted A. vasorum population

Complex population dynamics as a competition between multiple time-scale phenomena

The role of the selection pressure and mutation amplitude on the behavior of a single-species population evolving on a two-dimensional lattice, in a periodically changing environment, is studied both analytically and numerically. The mean-field level of description allows to highlight the delicate interplay between the different time-scale processes in the resulting complex dynamics of the system. We clarify the influence of the amplitude and period of the environmental changes on the critical value of the selection pressure corresponding to a phase-transition "extinct-alive" of the population. However, the intrinsic stochasticity and the dynamically-built in correlations among the individuals, as well as the role of the mutation-induced variety in population's evolution are not appropriately accounted for. A more refined level of description, which is an individual-based one, has to be considered. The inherent fluctuations do not destroy the phase transition "extinct-alive", and the mutation amplitude is strongly influencing the value of the critical selection pressure. The phase diagram in the plane of the population's parameters -- selection and mutation is discussed as a function of the environmental variation characteristics. The differences between a smooth variation of the environment and an abrupt, catastrophic change are also addressesd.Comment: 15 pages, 12 figures. Accepted for publication in Phys. Rev.

The Affective Impact of Financial Skewness on Neural Activity and Choice

Few finance theories consider the influence of “skewness” (or large and asymmetric but unlikely outcomes) on financial choice. We investigated the impact of skewed gambles on subjects' neural activity, self-reported affective responses, and subsequent preferences using functional magnetic resonance imaging (FMRI). Neurally, skewed gambles elicited more anterior insula activation than symmetric gambles equated for expected value and variance, and positively skewed gambles also specifically elicited more nucleus accumbens (NAcc) activation than negatively skewed gambles. Affectively, positively skewed gambles elicited more positive arousal and negatively skewed gambles elicited more negative arousal than symmetric gambles equated for expected value and variance. Subjects also preferred positively skewed gambles more, but negatively skewed gambles less than symmetric gambles of equal expected value. Individual differences in both NAcc activity and positive arousal predicted preferences for positively skewed gambles. These findings support an anticipatory affect account in which statistical properties of gambles—including skewness—can influence neural activity, affective responses, and ultimately, choice

‘Real-world’ health care priority setting using explicit decision criteria: a systematic review of the literature

BACKGROUND: Health care decision making requires making resource allocation decisions among programs, services, and technologies that all compete for a finite resource pool. Methods of priority setting that use explicitly defined criteria can aid health care decision makers in arriving at funding decisions in a transparent and systematic way. The purpose of this paper is to review the published literature and examine the use of criteria-based methods in ‘real-world’ health care allocation decisions. METHODS: A systematic review of the published literature was conducted to find examples of ‘real-world’ priority setting exercises that used explicit criteria to guide decision-making. RESULTS: We found thirty-three examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the ‘real-world’ trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen. CONCLUSIONS: Health care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-015-0814-3) contains supplementary material, which is available to authorized users