Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Purpose of Review: We aim to summarize recent insights and provide an up-to-date overview on the role of intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS). Recent Findings: In the largest randomized controlled trial (RCT) of patients with CS after acute myocardial infarction

Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes

In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation

Women’s beliefs about medicines and adherence to pharmacotherapy in pregnancy: Opportunities for community pharmacists?

Background During pregnancy women might weigh benefits of treatment against potential risks to the unborn child. However, non-adherence to necessary treatment can adversely affect both mother and child. To optimize pregnant women’s beliefs and medication adherence, community pharmacists are ideally positioned to play an important role in primary care. Objective This narrative review aimed to summarize the evidence on 1) pregnant women’s beliefs, 2) medication adherence in pregnancy, and 3) community pharmacists’ counselling during pregnancy. Method Three search strategies were used in Medline and Embase to find original studies evaluating women’s beliefs, medication adherence and community pharmacists’ counselling during pregnancy. All original descriptive and analytic epidemiological studies performed in Europe, North America and Australia, written in English and published from 2000 onwards were included. Results We included 14 studies reporting on women’s beliefs, 11 studies on medication adherence and 9 on community pharmacists’ counselling during pregnancy. Women are more reluctant to use medicines during pregnancy and tend to overestimate the teratogenic risk of medicines. Risk perception varies with type of medicine, level of health literacy, education level and occupation. Furthermore, low medication adherence during pregnancy is common. Finally, limited evidence showed current community pharmacists’ counselling is insufficient. Barriers hindering pharmacists are insufficient knowledge and limited access to reliable information. Conclusion Concerns about medication use and non-adherence are widespread among pregnant women. Community pharmacists’ counselling during pregnancy is insufficient. Further education, training and research are required to support community pharmacists in fulfilling all the opportunities they have when counselling pregnant women

Study of doubly strange systems using stored antiprotons

Bound nuclear systems with two units of strangeness are still poorly known despite their importance for many strong interaction phenomena. Stored antiprotons beams in the GeV range represent an unparalleled factory for various hyperon-antihyperon pairs. Their outstanding large production probability in antiproton collisions will open the floodgates for a series of new studies of systems which contain two or even more units of strangeness at the P‾ANDA experiment at FAIR. For the first time, high resolution γ-spectroscopy of doubly strange ΛΛ-hypernuclei will be performed, thus complementing measurements of ground state decays of ΛΛ-hypernuclei at J-PARC or possible decays of particle unstable hypernuclei in heavy ion reactions. High resolution spectroscopy of multistrange Ξ−-atoms will be feasible and even the production of Ω−-atoms will be within reach. The latter might open the door to the |S|=3 world in strangeness nuclear physics, by the study of the hadronic Ω−-nucleus interaction. For the first time it will be possible to study the behavior of Ξ‾+ in nuclear systems under well controlled conditions

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Inventariserend veldonderzoek en definitieve opgraving op Solleveld in Monster (gemeente Westland)

Lit.opg

Self-constraining of low-energy rivers explains low channel mobility and tortuous planforms

Meandering rivers are abundant on Earth, from the largest rivers to the smallest tributaries. The classical view of meandering rivers is a sinuous planform with rounded bends, which grow and migrate until they are cut-off. However, many low-energy meandering rivers have planforms that are much more complex than this classical view due to the heterogeneity of their alluvium, and show relatively limited channel migration. Based on a detailed palaeogeographic study of the Dommel River in The Netherlands, it is inferred that low-energy meandering rivers may develop tortuous planforms with sharp bends, owing to self-formed deposits that increasingly constrain the channel mobility. This mechanism is corroborated by data from 47 meandering river reaches of varied scale from around the world, which show that erosion-resistant floodplain deposits are preserved in the river banks when the river energy is below a critical threshold. The term ‘self-constraining’ is proposed for low-energy rivers where an increase in bank stability over time results in progressive tortuous planforms and reduced mobility. A conceptual model, based on the dataset, shows that the increase in bank stability over time also increases the energy required to break out of the tendency to self-constrain. Self-constraining thereby enhances the resilience of the system to bank erosion, while an unexpected increase in bank erosion may occur if river energy exceeds the critical threshold. This study provides a novel explanation for the evolution of low-energy river planforms and dynamics, and provides new insights on their responses to climate changes

Self-constraining of low-energy rivers explains low channel mobility and tortuous planforms

Meandering rivers are abundant on Earth, from the largest rivers to the smallest tributaries. The classical view of meandering rivers is a sinuous planform with rounded bends, which grow and migrate until they are cut-off. However, many low-energy meandering rivers have planforms that are much more complex than this classical view due to the heterogeneity of their alluvium, and show relatively limited channel migration. Based on a detailed palaeogeographic study of the Dommel River in The Netherlands, it is inferred that low-energy meandering rivers may develop tortuous planforms with sharp bends, owing to self-formed deposits that increasingly constrain the channel mobility. This mechanism is corroborated by data from 47 meandering river reaches of varied scale from around the world, which show that erosion-resistant floodplain deposits are preserved in the river banks when the river energy is below a critical threshold. The term ‘self-constraining’ is proposed for low-energy rivers where an increase in bank stability over time results in progressive tortuous planforms and reduced mobility. A conceptual model, based on the dataset, shows that the increase in bank stability over time also increases the energy required to break out of the tendency to self-constrain. Self-constraining thereby enhances the resilience of the system to bank erosion, while an unexpected increase in bank erosion may occur if river energy exceeds the critical threshold. This study provides a novel explanation for the evolution of low-energy river planforms and dynamics, and provides new insights on their responses to climate changes