Impact of free on-site vaccine and/or healthcare workers training on hepatitis B vaccination acceptability in high-risk subjects: a pre-post cluster randomized study

AbstractDespite recommendations for adults at high-risk of hepatitis B virus (HBV) infection, HBV vaccine uptake remains low in this population. A pre-post randomized cluster study was conducted to evaluate the impact of on-site free HBV vaccine availability and/or healthcare worker training on HBV vaccination acceptability in high-risk adults consulting in 12 free and anonymous HIV and hepatitis B/C testing centres (FATC). The FATC were randomly allocated into three groups receiving a different intervention: training on HBV epidemiology, risk factors and vaccination (Group A), free vaccination in the FATC (Group B), both interventions (Group C). The main outcomes were the increase in HBV vaccination acceptability (receipt of at least one dose of vaccine) and vaccine coverage (receipt of at least two doses of vaccine) after intervention. Respectively, 872 and 809 HBV-seronegative adults at high-risk for HBV infection were included in the pre- and post-intervention assessments. HBV vaccination acceptability increased from 14.0% to 75.6% (p <0.001) in Group B and from 17.1% to 85.8% (p <0.001) in Group C and HBV vaccine coverage increased from 9.4% to 48.8% (p <0.001) in Group B and from 11.2% to 41.0% (p <0.001) in Group C. The association of training and free on-site vaccine availability was more effective than free on-site vaccine availability alone to increase vaccination acceptability (ratio 1.14; from 1.02 to 1.26; p 0.017). No effect of training alone was observed. These results support the policy of making HBV vaccine available in health structures attended by high-risk individuals. Updating healthcare workers’ knowledge on HBV virus and its prevention brings an additional benefit to vaccination acceptability

Tuber donnagotto, a new winter truffle species from Istria, Croatia

Tuber donnagotto is a new winter black truffle belonging to the order Pezizales and the family Tuberaceae. It grows in winter in the calcareous gravel soil (pH 7.6–7.8) near the Adriatic Sea (Rovinj, Istria, Croatia) in predominantly pine forests (Pinus halepensis). Although similar to other black truffles, it has very irregular and hard fruit bodies, lobate and knotted in form, with deep irregular cavities reaching the middle of the fruit bodies. These cavities are clearly evident in the cross-section of the fruit bodies. A distinctive characteristic of this truffle is the fact that when it is hermetically closed it can be kept in a refrigerator (2–4 °C) for more than 60 days. Tuber donnagotto has a slight but pleasant odor, reminiscent of boletus (Boletus reticulates, B. edulis). Furthermore, T. donnagotto has yellow-brownish and reticulate-alveolate spores, measuring 20–30 × 20–25 mm

Comment améliorer la prise en charge des patients atteints de BPCO en France : état des lieux en 2019 et perspectives de demain

Cette thèse a pour objectif de réaliser un état des lieux des différents moyens, thérapeutiques et non thérapeutiques, à la disposition des patients atteints de BPCO en France, actuels et futurs. Cette pathologie insidieuse est encore trop méconnue en France. Elle se révèle en général lors d’exacerbations rendant le diagnostic trop tardif. Des optimisations sont nécessaires sur plusieurs plans pour préserver la qualité de vie de ses patients. Les mesures hygiéno-diététiques sont encore sous-utilisées, alors qu’elles constituent le premier niveau de prise en charge. L’arsenal thérapeutique est abondant, mais les patients ne maîtrisent pas correctement les techniques d’administration de leur inhalateur, rendant inefficace leur prise en charge. Enfin, le parcours de soin est complexe et le patient manque de repères. En 2017, plusieurs experts pneumologues associés à des sociétés savantes poussent une sonnette d’alarme, afin de faire reconnaître la BPCO comme une priorité de santé publique. Ils rédigent le livre blanc de la BPCO et posent les fondements d’une nouvelle ère de prise en charge. Des solutions émergent, à la fois sur le diagnostic, l’observance et la gestion du traitement. La révolution digitale et les avancées technologiques offrent de nouvelles perspectives pour améliorer la prise en charge des patients atteints de BPCO en France, et cela ne fait que commencer. Le digital n’est qu’un moyen pour atteindre cet objectif, car l’amélioration de la prise en charge du patient BPCO est avant tout l’affaire de tous les professionnels de santé et institutions, leurs champs d’action commençant à s’élargir vers de nouvelles expertises au bénéfice du patient

Observed radar and environmental properties of United States warm season bowing convective systems, 2003-2004

Fall 2006.Includes bibliographical references (pages [135]-142).This study examines radar-indicated structures and environments of bowing convective systems in the United States during the warm seasons of 2003 and 2004 (April-December). The bowing process is defined as local acceleration of a convective cell or cells on the convex leading edge of a convective system to form an "arch" or "bow"-shaped line. This study perused data for each day of the two-year time period and investigated the bowing process using 2-km national radar reflectivity composite data. This procedure yielded 381 bowing convective systems, the majority of which occurred from May to July. The locations of these systems show a distribution similar to past studies of warm season derechos with two primary corridors: one in the Upper Great Plains, and secondarily, a maximum toward the Central/Southern Great Plains. The entire population of bowing convective systems is classified into five modes, based on their differences in initial convective cell structures, convection evolution processes, locations, diurnal beginning and ending times, severe weather reports, and kinematic/thermodynamic environments. These modes are termed bow echo/extensive stratiform, bow echo/minimal stratiform, bowing squall line, multiple bowing squall lines, and bowing single cell. Bow echoes/extensive stratiform exhibited trailing stratiform precipitation and most commonly evolved from groups of cells. Bow echoes/weak stratiform showed very limited trailing precipitation usually evolving from the merging of supercells with ordinary or multicells. Single and multiple bowing squall lines most often evolved from trailing stratiform mesoscale convective systems. An assessment of bowing convective line lengths and movement speeds was performed. Bowing convective line lengths of bow echoes/extensive stratiform and bow echoes/weak stratiform ranged from 40-110 km. Bowing squall lines and multiple bowing squall lines had convective lines segments between 110-225 km while bowing single cells were observed between 20-40 km. The bowing convective systems observed in this study exhibit a preferred range of speeds between 10 and 24 m s-1. This study also examines the characteristics of trailing stratiform precipitation in bowing convective systems. Pre-existing or convectively generated trailing precipitation tends to enhance the longevity of a bowing convective system. In some cases an enhanced trailing stratiform precipitation region was arranged in a perpendicular fashion behind the bowing convective systems while in other cases the trailing precipitation sustained a wide stratiform precipitation transition zone with minimal precipitation separating a bowing convective line from moderate-to-heavy stratiform precipitation. The latter precipitation pattern showed a strong tendency to increase system longevity. Examination of convection properties related to bowing convective systems demonstrates the importance of identifying supercells and multiple supercells evolving or interacting with exterior convection to initiate bowing convection. Convective cell mergers, which also usually aid in the initiation of bowing convection, are strongly preferred near the resultant apex. Observations of ensuing bowing convective lines display a preference toward strong convection that is nearly homogeneous (slabular as opposed to cellular) in the along-line direction. It was further observed that warm season bowing convection is favored in hybrid synoptic boundary forcing environments (moving parallel to or initiating on a synoptic boundary), while bowing convective systems forced by no synoptic boundary is of secondary importance. Also, bowing convective systems that moved parallel to synoptic boundaries exhibited enhanced longevities. No bowing convective system that traversed a synoptic boundary continued for longer than three hours. Finally, this study classifies severe weather production from bowing convective systems into four spatial patterns based on their shape and the nature of their effects. These are termed narrow apex swath, widespread high winds, widening swath, and destructive rotation. These patterns were compared to past studies of detailed severe weather surveys. It was observed that severe hail production was favored early in the evolution of bowing convection while severe wind production could occur throughout a storm evolution. Although tornadoes were uncommon in bowing convective systems, they tended to appear in the early-to-mature stages of evolution.Research supported by the National Science Foundation under grants ATM-0071371, ATM-0500061 and by a one-year AMS Graduate Fellowship