Clostridioides difficile Infection, Still a Long Way to Go.

Clostridioides difficile is an increasingly common pathogen both within and outside the hospital and is responsible for a large clinical spectrum from asymptomatic carriage to complicated infection associated with a high mortality. While diagnostic methods have considerably progressed over the years, the optimal diagnostic algorithm is still debated and there is no single diagnostic test that can be used as a standalone test. More importantly, the heterogeneity in diagnostic practices between centers along with the lack of robust surveillance systems in all countries and an important degree of underdiagnosis due to lack of clinical suspicion in the community, hinder a more accurate evaluation of the burden of disease. Our improved understanding of the physiopathology of CDI has allowed some significant progress in the treatment of CDI, including a broader use of fidaxomicine, the use of fecal microbiota transplantation for multiples recurrences and newer approaches including antibodies, vaccines and new molecules, already developed or in the pipeline. However, the management of CDI recurrences and severe infections remain challenging and the main question remains: how to best target these often expensive treatments to the right population. In this review we discuss current diagnostic approaches, treatment and potential prevention strategies, with a special focus on recent advances in the field as well as areas of uncertainty and unmet needs and how to address them

How does social constructivism as displayed in contemporary educational settings in England compare with the Grossetestian view of the development of human knowledge?

There are some obvious differences between education in medieval and present day England, which are set in the wider context of far-reaching cultural changes. The pace and heterogeneity of life in complex, diverse, multi-cultural liberal democracies seems to be a far cry from widely held assumptions about the simplicity and homogeneity of medieval Latin Europe. Maybe we ‘no longer’ have a single source of Truth, but rather different truths and alternative facts? In this chapter we explore how social constructivism is enacted in modern education and how it differs from approaches that were popular in the medieval world. We compare and contrast Grosseteste’s account of acquiring knowledge to the theory of social constructivism, according to which knowledge is developed neither by accident nor by illumination. We consider the role of the teacher, the context, the student, and the educational environment with a view to ‘re-defining’ the source of ultimate knowledge, the role of the teacher, the student and their educational environment

Prevalence of disordered eating in elite female athletes in team sports in Greece

The purpose of the study was to assess a) the prevalence of disordered eating (DE) in elite female team sports players compared to non-athletes and b) to compare DE prevalence in elite female players in basketball, volleyball and water polo. One hundred and seventy-five females were recruited (age 23.10 ± 5.4, BMI 21.85 ± 2.3 kg/m2), 53 were elite basketball players, 42 were elite volleyball players, 34 were elite water polo players and 46 were non-athletes. Participants completed the Eating Disorders Questionnaire (EDE-Q) and a physical activity questionnaire. The EDE-Q incorporates 36 statements which relate to the occurrence and frequency of key behaviours of eating disorders, under the following four subscales: Restraint, eating concern, shape concern and weight concern and a global score of disordered eating. No differences were found in the EDE-Q subscale score and global score between athletes and non-athletes. Only 6.2% of the total number of participants exhibited DE using the global score >2.3. Water polo players had significantly higher scores in the ‘eating concern’ subscale and in the frequency of key behavioural features of DE such as binge eating episodes and objective and subjective bulimic episodes, compared to volleyball and basketball players. In conclusion, team sport elite female players do not exhibit greater prevalence of DE compared to non-athletes. Water polo, a sport that emphasizes leanness and control of body weight for international distinctions, is associated with a higher tendency to exhibit DE, when compared to other team sports

Association of maternal urinary fluoride concentrations during pregnancy with size at birth and the potential mediation effect by maternal thyroid hormones: The Swedish NICE birth cohort

Background: Observational studies have indicated that elevated maternal fluoride exposure during pregnancy may impair child neurodevelopment but a potential impact on birth outcomes is understudied. Objectives: To evaluate the impact of gestational fluoride exposure on birth outcomes (birth size and gestational age at birth) and to assess the potential mediating role of maternal thyroid hormones. Methods: We studied 583 mother-child dyads in the NICE cohort in northern Sweden. Maternal fluoride exposure was assessed by measuring urinary concentrations at late pregnancy (median: 29th gestational week) using an ion selective electrode. Plasma levels of free and total thyroxine (fT4, tT4) and triiodothyronine (fT3, tT3), and thyroid stimulating hormone (TSH) were measured with electrochemiluminescence immunoassays. The infant\u27s weight, length, head circumference, and gestational age at birth were extracted from hospital records. Results: Median urinary fluoride concentration was 0.71 mg/L (5th-95th percentile 0.31–1.9 mg/L; specific gravity adjusted). In multivariable-adjusted regression models, every 1 mg/L increase of maternal urinary fluoride was associated with a mean increase in birth weight by 84 g (95%CI: 30, 138), length by 0.41 cm (95%CI: 0.18, 0.65), head circumference by 0.3 cm (95%CI: 0.1, 0.4), and with increased odds of being born large for gestational age (OR = 1.39, 95%CI: 1.03, 1.89). Every 1 mg/L increase of maternal urinary fluoride was also associated with a mean increase of the plasma fT3:fT4 ratio (B = 0.007, 95%CI: 0.000, 0.014), but not with the hormones or TSH. In mediation analyses, the maternal fT3:fT4 ratio did not explain the urinary fluoride-birth size relationships. Discussion: Gestational urinary fluoride concentrations were associated with increased size at birth and even with increased odds of being born large for gestational age. The fluoride-related associations with increased size at birth were not explained by changes in maternal thyroid hormone levels

Rubor, calor, dolor, tumor : infections de la peau et des tissus mous [Rubor, calor, dolor, tumor : skin and soft tissue infections]

Skin infections are a frequent cause of consultation, yet the diagnosis can be challenging for physicians. Microbiological documentation is rare, and empiric antibiotic regimens should cover the most commonly identified bacteria, i.e. streptococci Staphylococcus aureus. Other pathogens should be considered in case of immunosuppression or certain exposures. Necrotizing fasciitis (NF) is a severe but rare infection. Early surgical management in parallel with antibiotics is the cornerstone of treatment. Despite the high incidence of these infections, little progress has been made in their management and some areas of uncertainty exist, especially regarding the optimal duration of treatment, the prevention of recurrences and the use of polyclonal immunoglobulins for NF. This article reviews the main aspects of diagnosis and treatment of these infections

Stigmatisation et VIH : tous concernés [Stigma and HIV: relevant for everyone]

Medical advances in the treatment of HIV over the last 35 years mean that people living with HIV (PLHIV) now have a life expectancy close to that of the general population. Further, when successfully treated, PLHIV cannot transmit the virus. Despite this, HIV-related stigma remains widespread, including within healthcare settings. Stigma is not a vague sociological notion but represents a real threat to public health, with repercussions for both PLHIV and HIV-negative individuals. Stigma has been shown to have a negative impact on HIV prevention, testing, access to health services, and on the healthcare management of PLHIV. Taking stigma into consideration is essential, both in meeting the medical and psycho-social needs of PLHIV and in order to effectively combat HIV/AIDS

The impact of using assimilated Aeolus wind data on regional WRF-Chem dust simulations

Land–atmosphere interactions govern the process of dust emission and transport. An accurate depiction of these physical processes within numerical weather prediction models allows for better estimating the spatial and temporal distribution of the dust burden and the characterisation of source and recipient areas. In the presented study, the ECMWF-IFS (European Centre for Medium-Range Weather Forecast – Integrated Forecasting System) outputs, produced with and without the assimilation of Aeolus quality-assured Rayleigh–clear and Mie–cloudy horizontal line-of-sight wind profiles, are used as initial or boundary conditions in the Weather Research and Forecasting model coupled with Chemistry (WRF-Chem) to simulate 2-month periods in the spring and autumn of 2020, focusing on a case study in October. The experiments have been performed over the broader eastern Mediterranean and Middle East (EMME) region, which is frequently subjected to dust transport, as it encompasses some of the most active erodible dust sources. Aerosol- and dust-related model outputs (extinction coefficient, optical depth and concentrations) are qualitatively and quantitatively evaluated against ground- and satellite-based observations. Ground-based columnar and vertically resolved aerosol optical properties are acquired through AERONET sun photometers and PollyXT lidar, while near-surface concentrations are taken from EMEP. Satellite-derived vertical dust and columnar aerosol optical properties are acquired through LIVAS (LIdar climatology of Vertical Aerosol Structure) and MIDAS (ModIs Dust AeroSol), respectively. Overall, in cases of either high or low aerosol loadings, the model predictive skill is improved when WRF-Chem simulations are initialised with the meteorological fields of Aeolus wind profiles assimilated by the IFS. The improvement varies in space and time, with the most significant impact observed during the autumn months in the study region. Comparison with observation datasets saw a remarkable improvement in columnar aerosol optical depths, vertically resolved dust mass concentrations and near-surface particulate concentrations in the assimilated run against the control run. Reductions in model biases, either positive or negative, and an increase in the correlation between simulated and observed values was achieved for October 2020.</p

Ir-Catalysed Nitrous Oxide (N2O) Decomposition:Effect of Ir Particle Size and Metal–Support Interactions

The effect of the morphology of Ir particles supported on γ-Al2O3, 8 mol%Y2O3-stabilized ZrO2 (YSZ), 10 mol%Gd2O3-doped CeO2 (GDC) and 80 wt%Al2O3–10 wt%CeO2–10 wt%ZrO2 (ACZ) on their stability on oxidative conditions, the associated metal–support interactions and activity for catalytic decomposition of N2O has been studied. Supports with intermediate or high oxygen ion lability (GDC and ACZ) effectively stabilized Ir nanoparticles against sintering, in striking contrast to supports offering negligible or low oxygen ion lability (γ-Al2O3 and YSZ). Turnover frequency studies using size-controlled Ir particles showed strong structure sensitivity, de-N2O catalysis being favoured on large catalyst particles. Although metallic Ir showed some de-N2O activity, IrO2 was more active, possibly present as a superficial overlayer on the iridium particles under reaction conditions. Support-induced turnover rate modifications, resulted from an effective double layer [Oδ−–δ+](Ir) on the surface of iridium nanoparticles, via O2− backspillover from the support, were significant in the case of GDC and ACZ

Land Use Regression Models for Ultrafine Particles in Six European Areas

Long-term ultrafine particle (UFP) exposure estimates at a fine spatial scale are needed for epidemiological studies. Land use regression (LUR) models were developed and evaluated for six European areas based on repeated 30 min monitoring following standardized protocols. In each area; Basel (Switzerland), Heraklion (Greece), Amsterdam, Maastricht, and Utrecht ("The Netherlands"), Norwich (United Kingdom), Sabadell (Spain), and Turin (Italy), 160-240 sites were monitored to develop LUR models by supervised stepwise selection of GIS predictors. For each area and all areas combined, 10 models were developed in stratified random selections of 90% of sites. UFP prediction robustness was evaluated with the intraclass correlation coefficient (ICC) at 31-50 external sites per area. Models from Basel and The Netherlands were validated against repeated 24 h outdoor measurements. Structure and model R2 of local models were similar within, but varied between areas (e.g., 38-43% Turin; 25-31% Sabadell). Robustness of predictions within areas was high (ICC 0.73-0.98). External validation R2 was 53% in Basel and 50% in The Netherlands. Combined area models were robust (ICC 0.93-1.00) and explained UFP variation almost equally well as local models. In conclusion, robust UFP LUR models could be developed on short-term monitoring, explaining around 50% of spatial variance in longer-term measurements