Improving the Timing of Insulin Administration in Adult Acute Care Patients

Background: The correct timing of insulin administration in diabetic patients admitted to the hospital is important for the prevention of transient and serious glycemic deviations that could lead to negative patient outcomes. In November 2021, a South Florida Hospital identified an area of opportunity for quality improvement related to the process of subcutaneous insulin administration. In addition to bar code scanning, manual verification of the insulin dose by the primary nurse and another nurse was required prior to administration. Patients were experiencing delays in the timing of their insulin dose and nurses were reporting frustration with the process. Methods: The project followed the Plan-Do-Study-Act (PDSA) cycle for performance improvement. Results: The change in medication administration workflow resulted in achievement of administering insulin within 30 minutes of the scheduled time. Ninety percent of the nurses surveyed reported improvement in their workflow when giving subcutaneous insulin to their patients (n=112). Conclusion: Interdisciplinary collaboration, innovation in education of the nursing staff, monitoring adherence to the process, and sustaining engagement among stakeholders contributed to the success of this initiative, resulting in improved workflow in subcutaneous insulin administration. Keywords: Bar code medication administration, insulin, safety, quality improvemen

The Gaia mission

Gaia is a cornerstone mission in the science programme of the EuropeanSpace Agency (ESA). The spacecraft construction was approved in 2006, following a study in which the original interferometric concept was changed to a direct-imaging approach. Both the spacecraft and the payload were built by European industry. The involvement of the scientific community focusses on data processing for which the international Gaia Data Processing and Analysis Consortium (DPAC) was selected in 2007. Gaia was launched on 19 December 2013 and arrived at its operating point, the second Lagrange point of the Sun-Earth-Moon system, a few weeks later. The commissioning of the spacecraft and payload was completed on 19 July 2014. The nominal five-year mission started with four weeks of special, ecliptic-pole scanning and subsequently transferred into full-sky scanning mode. We recall the scientific goals of Gaia and give a description of the as-built spacecraft that is currently (mid-2016) being operated to achieve these goals. We pay special attention to the payload module, the performance of which is closely related to the scientific performance of the mission. We provide a summary of the commissioning activities and findings, followed by a description of the routine operational mode. We summarise scientific performance estimates on the basis of in-orbit operations. Several intermediate Gaia data releases are planned and the data can be retrieved from the Gaia Archive, which is available through the Gaia home page. http://www.cosmos.esa.int/gai

Validation of precipitable water from ECMWF model analyses with GPS and radiosonde data during the MAP SOP

Precipitable water vapour contents (PWCs) from European Centre for Medium-Range Weather Forecasts (ECMWF) analyses have been compared with observations from 21 ground-based Global Positioning System receiving stations (GPS) and 14 radiosonde stations (RS), covering central Europe, for the period of the Mesoscale Alpine Programme experiment special observing period (MAP SOP). Two model analyses are considered: one using only conventional data, serving as a control assimilation experiment, and one including additionally most of the non-operational MAP data. Overall, a dry bias of about −1 kg m−2 (−5.5% of total PWC), with a standard deviation of ∼2.6 kg m−2 (13% of total PWC), is diagnosed in both model analyses with respect to GPS. The bias at individual sites is quite variable: from −4 to ∼0 kg m−2. The largest differences are observed at stations located in mountainous areas and/or near the sea, which reveal differences in representativeness. Differences between the two model analyses, and between these analyses and GPS, are investigated in terms of usage and quality of RS data. Biases in RS data are found from comparisons with both model and GPS PWCs. They are confirmed from analysis feedback statistics available at ECMWF. An overall dry bias in RS PWC of 4.5% is found, compared to GPS. The detection of RS biases from comparisons both with the model and GPS indicates that data screening during assimilation was generally effective. However, some RS bias went into the model analyses. Inspection of the time evolution of PWC from the model analyses and GPS occasionally showed differences of up to 5–10 kg m−2. These were associated with severe weather events, with variations in the amount of RS data being assimilated, and with time lags in the PWCs from the two model analyses. Such large differences contribute strongly to the overall observed standard deviations. Good confidence in GPS PWC estimates is gained through this work, even during periods of heavy rain. These results support the future assimilation of GPS data, both for operational weather prediction and for mesoscale simulation studies

Morphodynamique fluviale holocène et établissements humains protohistoriques en fond de vallée de la Moselle à Crévéchamps (Lorraine méridionale)

Holocene fluvial morphodynamics and Protohistoric human settlements in the Moselle floodplain at Crévéchamps (Southern Lorraine). — The study of a Protohistoric archeological site and of its morpho-sedimentary environment allowed us to find the unexpected installation of five houses and c. fifty cornlofts in the Moselle river floodplain at Crévéchamps (Southern Lorraine). They were built on the bank of an abandoned channel used as a dumping ground. For eight centuries, this installation was undeniably rendered possible by the fluvial style metamorphosis which occured before the Atlantic period ; if, in regard of this example alone, evidence of a quiet hydrologie period for the Moselle river from the Middle Bronze Age to the first Iron Age cannot be strongly established, the Sub-Boreal period was certainly drier before flooding reappeared in the Subatlantic period, since 2 400 y. B.P.L'étude conjointe d'un site archéologique protohistorique et de son environnement morphosédimentaire a permis d'observer l'installation inattendue de cinq maisons et d'une cinquantaine de greniers dans le lit majeur de la Moselle à Crévéchamps (Lorraine), au bord d'un chenal qui a servi de dépotoir. L'installation qui a duré environ 800 ans, du Bronze moyen au Premier âge du Fer, a été incontestablement rendue possible par la métamorphose du style fluvial survenue dès avant l'Atlantique ; si on ne peut conclure à l'existence d'une période de calme hydrologique généralisée du Bronze moyen au Premier âge du Fer sur la Moselle au vu de cet exemple encore trop isolé, il y a eu néanmoins certainement un relatif assèchement au Subboréal, avant un retour des inondations durant une partie du Subatlantique, à partir de 2 400 ans B.P.Buzzi P., Carcaud Nathalie, Koenig M.-P., Weisrock André. Morphodynamique fluviale holocène et établissements humains protohistoriques en fond de vallée de la Moselle à Crévéchamps (Lorraine méridionale). In: Revue Géographique de l'Est, tome 33, n°4,1993. Vallées fluviales en Europe à l’Holocène. pp. 281-295

Patient Satisfaction and Perspectives on Self-Management Education Programs: A Qualitative Study

Purpose: According to the Centre for Disease Control and Prevention, "Self-management education (SME) refers to programs that help people who have ongoing health conditions learn how to live life to the fullest". Most studies to date have focused on SME outcomes, such as the acquisition of predefined knowledge or skills or quality of life. However, no study has yet investigated patients' satisfaction with SMEs. The aim of the present study was therefore to explore participants' subjective appreciation of SME programs using qualitative methods and formulate propositions based on patients' preferences to improve ultimately clinical outcomes.Patients and Methods: Twenty-five participants from five French SME programs to conduct focus groups were recruited. An inductive approach using grounded theory as an overall methodology orientation for the thematic analysis process has been followed. The study was reported in compliance with the consolidated criteria for reporting qualitative research criteria (COREQ).Results: Patients expressed great satisfaction concerning the effective delivery of SME sessions. They appreciated the considerations for their concerns and needs, the adaptation of sessions' content to their interests and questions, and learning to take care of themselves. Moreover, patients had a positive opinion on the quality of their relationship with health care providers. However, the major point of improvement of SMEs was the opportunity to repeat the program if needed, as this opportunity was not offered. This consideration was particularly salient when patients did not consider themselves autonomous for disease management at the end of the program, ie, when they had low levels of perceived self-efficacy.Conclusion: While patients expressed great satisfaction regarding SME programs, our results suggest that some changes might be needed to make the endpoint of SME interventions coincide with the patient's perception of self-efficacy in disease self-management and ultimately improve clinical outcomes

On the usefulness of cytometric tools to select homokaryons in Agaricus bisporus

International audienceAgaricus bisporus is one of the most commonly cultivated mushrooms worldwide. The current commercial cultivars are derived from a very narrow genetic basis. Despite its economic relevance, breeding efforts in this crop species are clearly hampered by its unfavorable life cycle equivalent to a pseudoclonal reproductive system. Most of the strains are bisporic with basides bearing a majority of heterokaryotic spores and a very small number of homokaryotic ones. A major bottleneck in the development of a breeding program for A. bisporus lies in the difficulty of isolating homokaryons (n) from heterokarons (n+n) among single spore isolates (SSIs). Several methods based on growth rate, fruiting ability or molecular markers are practiced, with, for each, their own drawbacks and limitations. Based on the difference in spore size between bisporic and tetrasporic A. bisporus strains (Callac et al. 2003), the aim of the study was to evaluate the usefulness of cytometric tools as a new method of isolating homokaryotic spores from SSI’s. While the feasibility of such an approach has been already demonstrated to characterize mushroom spores (Allman, 1992, Kullman et al. 2005, Veselska et al, 2014), to our knowledge, our work is one of the first attempt on A. bisporus

Prevalence and Distribution of HPV Genotypes in Immunosuppressed Patients in Lorraine Region

Background: The primary objective of this work was to assess the prevalence and distribution of HPV genotypes in immunosuppressed patients, and to compare them with the French Monsonego cohort. Secondary objectives were to evaluate whether the risk of HPV infection was correlated with HIV viral load, CD4 cell count in HIV-infected patients and the type, number of immunosuppressive therapies or type of pathology (transplant vs. autoimmune diseases) in patients undergoing long-term immunosuppressive therapy. Methods: An observational, monocentric and historical study was conducted including all immunosuppressed patients having received an HPV testing, in the Laboratory of Virology, Nancy Regional Teaching Hospital Center, between 2014 and 2020. Immunosuppressed patients were either HIV-infected or received long-term immunosuppressive therapy. Results: In our cohort, the prevalence of HPV infection (75.6% vs. 16.1% p p p < 0.05) were significantly higher than in the Monsonego cohort. HPV 52 (13%), 53 (13%) and 16 (10%) were the most common in the immunosuppressed population, while it was HPV 16, 42 and 51 in the Monsonego cohort. Conclusions: This study supports that a particular attention must be given to all the immunosuppressed patients for the screening and care of HPV-related diseases because of major modifications of HPV epidemiology compared with the overall population

Nouvelles données sur l’habitat de l’âge du Fer en Lorraine

International audienc

Nouvelles données sur l’habitat de l’Âge du Fer en Lorraine

La politique active menée par le Service régional de l’Archéologie de Lorraine dans le cadre de la sauvegarde du patrimoine a contribué ces dernières années à la fouille de nombreux sites, au sein desquels les habitats de l’Âge du Fer tiennent une place importante. Leur étude a permis d’ébaucher une première typo-chronologie de la céramique, même si les ensembles de La Tène demeurent encore mal documentés. La fréquence des bâtiments fondés sur poteaux autorise une approche typologique, métrique et fonctionnelle plus fiable. Corrélée à l’analyse des structures annexes, elle permet dès lors de proposer un modèle d’habitat et d’entrevoir les changements qui s’opèrent progressivement entre le premier et le second Âge du Fer.Die aktiven Bemühungen des Service régional de l’archeologie de Lorraine zur Bewahrung der historischen Denkmäler hat in den letzten Jahren zur Ausgrabung an vielen Fundstellen geführt, unter denen die Siedlungen der Eisenzeit einen bedeutenden Anteil ausmachen. Diese Forschungen ermöglichen den Entwurf einer ersten Typochronologie der Keramik, auch wenn die Latènezeit weiter schmal bleibt. Die zahlreichen Pfostenbauten erlauben eine verlässlichere Zuordnung in typologischer, metrischer und funktioneller Hinsicht. Kombiniert mit einer Analyse der Nebengebäude ist es möglich, das Modell einer Siedlung zu entwerfen und die Veränderungen zu skizzieren, die sich allmählich beim Übergang von der älteren zur jüngeren Eisenzeit vollziehen