Epidemiology and Outcomes of Critically Ill Children at Risk for Pediatric Acute Respiratory Distress Syndrome:A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study

OBJECTIVES: Interventional trials aimed at pediatric acute respiratory distress syndrome prevention require accurate identification of high-risk patients. In this study, we aimed to characterize the frequency and outcomes of children meeting "at risk for pediatric acute respiratory distress syndrome" criteria as defined by the Pediatric Acute Lung Injury Consensus Conference. DESIGN: Planned substudy of the prospective multicenter, international Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study conducted during 10 nonconsecutive weeks (May 2016-June 2017). SETTING: Thirty-seven international PICUs. PATIENTS: Three-hundred ten critically ill children meeting Pediatric Acute Lung Injury Consensus Conference "at-risk for pediatric acute respiratory distress syndrome" criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated the frequency of children at risk for pediatric acute respiratory distress syndrome and rate of subsequent pediatric acute respiratory distress syndrome diagnosis and used multivariable logistic regression to identify factors associated with subsequent pediatric acute respiratory distress syndrome. Frequency of at risk for pediatric acute respiratory distress syndrome was 3.8% (95% CI, 3.4-5.2%) among the 8,122 critically ill children who were screened and 5.8% (95% CI, 5.2-6.4%) among the 5,334 screened children on positive pressure ventilation or high-flow oxygen. Among the 310 at-risk children, median age was 2.1 years (interquartile range, 0.5-7.3 yr). Sixty-six children (21.3%) were subsequently diagnosed with pediatric acute respiratory distress syndrome, a median of 22.6 hours (interquartile range, 9.8-41.0 hr) later. Subsequent pediatric acute respiratory distress syndrome was associated with increased mortality (21.2% vs 3.3%; p < 0.001) and longer durations of invasive ventilation and PICU care. Subsequent pediatric acute respiratory distress syndrome rate did not differ by respiratory support modality at the time of meeting at risk criteria but was independently associated with lower initial saturation:FIO2 ratio, progressive tachycardia, and early diuretic administration. CONCLUSIONS: The Pediatric Acute Lung Injury Consensus Conference "at-risk for pediatric acute respiratory distress syndrome" criteria identify critically ill children at high risk of pediatric acute respiratory distress syndrome and poor outcomes. Interventional trials aimed at pediatric acute respiratory distress syndrome prevention should target patients early in their illness course and include patients on high-flow oxygen and positive pressure ventilation

Protocol for creating a single, holistic and digitally implementable consensus clinical guideline for multiple multi-morbid conditions

Delivery of future healthcare information systems requires systems to support patients with multi-morbidity. Current approaches to computer interoperable guidelines typically consider only a single clinical guideline for a single condition. There is a need to establish a robust protocolized approach to the development of holistic consensus computer interoperable guidelines in the context of multi-morbidity. The presence of mild cognitive impairment (MCI) and dementia adds an additional challenge to the delivery of effective digital health solutions. CAREPATH proposes an ICT-based solution for the optimization of clinical practice in the treatment and management of multi-morbid older adults with mild cognitive impairment or mild dementia. In this manuscript, we present an evidence-based protocol for the development of a single computer interoperable holistic guideline for a collection of multi-morbid conditions. To the best of our knowledge, this is the first published protocol for the production of a consensus interoperable clinical guideline for people with multi-morbidity, with special focus on older adults with MCI or mild dementia. This addresses a still unmet need for such processes which are expected to play a central role for future integrated healthcare information systems

Modulation de l’absorption intestinale de la chlordécone (CLD) par l’utilisation de substances séquestrantes : application à l’élevage en zones contaminées

The contamination of agricultural soils by chlordecone threatens the sustainability of outdoor farming in the West Indies. In order to maintain the latter while protecting consumers of terrestrial animal products, several strategies are being studied. This thesis is focused on one of them which consists of sequestering chlordecone in order to significantly reduce its bioavailability for the animal. The experimental approach was carried out in stages, based on three pillars: biochar or activated carbon as sequestering materials, the use of artificial soils and the concept of relative bioavailability to assess sequestration performance. Tests conducted with activated charcoal (based on dates kernels, coconut or lignite) have shown that chlordecone is sequestered in an aqueous medium or in animals, but for the latter it only works if chlordecone and sequestering matrix had a prolonged contact time (or maturation) with ingestion by the animal. These results show the interest of in situ sequestration, ie directly in the contaminated soil likely to be ingested by the animals. As activated charcoal has a high cost, a priori less expensive carbonaceous materials have been tested: biochars based on various wood species. These biochars produced at two pyrolysis temperatures (500 and 700 ° C) were characterized from a physical point of view (porosity) and selected via an in vitro environmental availability test. In vivo tests (on piglets) did not show that these selected biochars were able to effectively sequester chlordecone, since the relative bioavailability was not different from one (reference = standard soil without organic matter). The presence of peat in the artificial soil does not prevent trapping by exogenous carbonaceous matrices. The in vitro test used and the in vivo test give equivalent tendencies to reduce the relative bioavailability, which is interesting in a logic of validation of the in vitro test. These positive results show that the strategy of sequestration by highly carbonaceous materials is possible, requires properties of microporosity and access to pores close to those of an activated carbon, but contingent on the experimental conditions implemented, they must be continued and validated on natural soilsLa contamination des sols agricoles par la chlordécone menace la durabilité de l’élevage de plein air aux Antilles. Afin de maintenir ce dernier tout en protégeant les consommateurs de denrées animales d’origine terrestre, plusieurs stratégies sont étudiées. Ces travaux de thèse sont focalisés sur l’une d’entre elles qui consiste à séquestrer la chlordécone afin de réduire significativement sa biodisponibilité pour l’animal. La démarche expérimentale a été réalisée par étape, elle s’appuie sur trois piliers : des matières séquestrantes carbonées de type biochar ou charbon activé, l’utilisation de sols artificiels et sur le concept de biodisponibilité relative pour évaluer les performances de séquestration. Les essais conduits avec du charbon activé (à base de noyaux de dattes, de coco ou de lignite) ont montré une séquestration de la chlordécone en milieu aqueux ou chez l’animal, mais pour ce dernier cela ne fonctionne que si la chlordécone et la matrice séquestrante ont eu un temps de contact prolongé (ou maturation) avec l’ingestion par l’animal. Ces résultats montrent l’intérêt d’une séquestration in situ, à savoir directement dans le sol contaminé susceptible d’être ingéré par les animaux. Comme le charbon activé a un coût élevé, des matières carbonées a priori moins coûteuses ont été testées : des biochars à base de diverses essences de bois. Ces biochars produits à deux températures de pyrolyse (500 et 700°C) ont été caractérisés d’un point de vue physique (porosité) et sélectionnés via un test in vitro de disponibilité environnementale. Les tests in vivo (sur porcelets) n’ont pas montré que ces biochars sélectionnés étaient aptes à séquestrer efficacement la chlordécone, puisque la biodisponibilité relative n’était pas différente de un (référence = sol standard sans matière organique). La présence de tourbe dans le sol artificiel ne s’oppose pas au piégeage par les matrices carbonées exogènes. Le test in vitro utilisé et le test in vivo donnent des tendances équivalentes de réduction de la biodisponibilité relative, ce qui est intéressant dans une logique de validation du test in vitro. Ces résultats positifs montrent que la stratégie de séquestration par des matériaux hautement carbonés est possible, requiert des propriétés de microporosité et d’accès aux pores proches de celles d’un charbon activé, mais contingents des conditions expérimentales mises en œuvre ils doivent être poursuivis et validés sur des sols dits naturel

Modulation of intestinal absorption of chlordecone (CLD) using sequestering substances : Application on contaminated zones breed

La contamination des sols agricoles par la chlordécone menace la durabilité de l’élevage de plein air aux Antilles. Afin de maintenir ce dernier tout en protégeant les consommateurs de denrées animales d’origine terrestre, plusieurs stratégies sont étudiées. Ces travaux de thèse sont focalisés sur l’une d’entre elles qui consiste à séquestrer la chlordécone afin de réduire significativement sa biodisponibilité pour l’animal. La démarche expérimentale a été réalisée par étape, elle s’appuie sur trois piliers : des matières séquestrantes carbonées de type biochar ou charbon activé, l’utilisation de sols artificiels et sur le concept de biodisponibilité relative pour évaluer les performances de séquestration. Les essais conduits avec du charbon activé (à base de noyaux de dattes, de coco ou de lignite) ont montré une séquestration de la chlordécone en milieu aqueux ou chez l’animal, mais pour ce dernier cela ne fonctionne que si la chlordécone et la matrice séquestrante ont eu un temps de contact prolongé (ou maturation) avec l’ingestion par l’animal. Ces résultats montrent l’intérêt d’une séquestration in situ, à savoir directement dans le sol contaminé susceptible d’être ingéré par les animaux. Comme le charbon activé a un coût élevé, des matières carbonées a priori moins coûteuses ont été testées : des biochars à base de diverses essences de bois. Ces biochars produits à deux températures de pyrolyse (500 et 700°C) ont été caractérisés d’un point de vue physique (porosité) et sélectionnés via un test in vitro de disponibilité environnementale. Les tests in vivo (sur porcelets) n’ont pas montré que ces biochars sélectionnés étaient aptes à séquestrer efficacement la chlordécone, puisque la biodisponibilité relative n’était pas différente de un (référence = sol standard sans matière organique). La présence de tourbe dans le sol artificiel ne s’oppose pas au piégeage par les matrices carbonées exogènes. Le test in vitro utilisé et le test in vivo donnent des tendances équivalentes de réduction de la biodisponibilité relative, ce qui est intéressant dans une logique de validation du test in vitro. Ces résultats positifs montrent que la stratégie de séquestration par des matériaux hautement carbonés est possible, requiert des propriétés de microporosité et d’accès aux pores proches de celles d’un charbon activé, mais contingents des conditions expérimentales mises en œuvre ils doivent être poursuivis et validés sur des sols dits naturelsThe contamination of agricultural soils by chlordecone threatens the sustainability of outdoor farming in the West Indies. In order to maintain the latter while protecting consumers of terrestrial animal products, several strategies are being studied. This thesis is focused on one of them which consists of sequestering chlordecone in order to significantly reduce its bioavailability for the animal. The experimental approach was carried out in stages, based on three pillars: biochar or activated carbon as sequestering materials, the use of artificial soils and the concept of relative bioavailability to assess sequestration performance. Tests conducted with activated charcoal (based on dates kernels, coconut or lignite) have shown that chlordecone is sequestered in an aqueous medium or in animals, but for the latter it only works if chlordecone and sequestering matrix had a prolonged contact time (or maturation) with ingestion by the animal. These results show the interest of in situ sequestration, ie directly in the contaminated soil likely to be ingested by the animals. As activated charcoal has a high cost, a priori less expensive carbonaceous materials have been tested: biochars based on various wood species. These biochars produced at two pyrolysis temperatures (500 and 700 ° C) were characterized from a physical point of view (porosity) and selected via an in vitro environmental availability test. In vivo tests (on piglets) did not show that these selected biochars were able to effectively sequester chlordecone, since the relative bioavailability was not different from one (reference = standard soil without organic matter). The presence of peat in the artificial soil does not prevent trapping by exogenous carbonaceous matrices. The in vitro test used and the in vivo test give equivalent tendencies to reduce the relative bioavailability, which is interesting in a logic of validation of the in vitro test. These positive results show that the strategy of sequestration by highly carbonaceous materials is possible, requires properties of microporosity and access to pores close to those of an activated carbon, but contingent on the experimental conditions implemented, they must be continued and validated on natural soil

Adsorption Isotherm and Kinetic Modeling of Chlordecone on Activated Carbon Derived from Date Stones

International audienceEnvironment contamination by pesticides is a major issue threatening human health. Adsorption is one of the most effective processes for removing pesticides, such as the organochlorine compounds chlordecone. The objective of this study was to determine the rate of chlordecone adsorption from drinking water by date stones-based activated carbon (C.A.). This laboratory scaleexperimental study was performed during March 2016 to September 2016 in the Laboratory of Water and Environmental Sciences, Lebanese University-Faculty of Public Health. The used activated carbon was derived from date stones and activated chemically by phosphoric acid.In order to determine the adsorption efficacity of chlordecone on activated carbon derived from date stones, a mixture of 0.5g of activated carbon and 100 ml of chlordecone concentration 100 µg/l was studied under differentpH values ranging from 2 to 10 andcontact time (15, 30, 45, 60, 90, 120, 150, 180). In addition, 0.5 g of activated carbon were exposed to different initial chlordecone concentration (50, 75, 100, 250, 750) in order to determine the chlordecone concentration effect on the adsorption mechanism. The rate of residual pesticides was determined using liquid chromatography coupled to a UV/visible detector. The kinetic data were analyzed by applying pseudo-first-order and pseudo-second-order models. The applicability of Langmuir and Freundlich adsorption isotherms was evaluated to better understand the adsorption process. The results revealed that the equilibrium data were perfectly represented using Langmuir II and Freundlich isotherms. The maximum multilayer adsorption capacity was found to be at pHZPC and a contact time 90 min. The kinetic data followed closely the pseudo-second-order model. Results from this study suggest that the activated carbon produced from date stones residue is an effective, low cost and locally available adsorbent for removing chlordecone from aqueous systems. This study imposed a conclusion of great concern since activated carbon from natural resources is considered as a renewable and cheaper precursor compared to the commercially available activated carbons

A literature review addressing midwakh and e-cigarette use in the Gulf region

Abstract A notable decrease in conventional cigarette smoking has been witnessed on a global scale. However, this decrease has been accompanied by an equally striking global increase in the consumption of alternative tobacco products (ATPs), namely e-cigarettes and midwakh in the Arabian Gulf region. A literature review was used to outline the chemical composition of these two ATPs and review their impacts on health. The study was conducted using databases like PubMed, Google Scholar, MDPI, and WorldCat. The literature search included terms such as “e-cigarettes,” “midwakh,” “dokha,” “heath impacts,” “psychological effects,” “social influences,” and “cigarette smoking” with emphasis on literature from the Arabian Gulf region. Data shows that midwakh contains markedly high levels of tar, nicotine, and various compounds of notable effects on the human body. Similarly, it was found that e-cigarettes contain non-negligible amounts of nicotine and other chemical compounds that may not have been extensively investigated. Alarming reports of system-specific effects brought about by midwakh, and e-cigarette consumption, have been reported, although further research is needed to deduce the mechanism. We also discussed some of the social and psychological factors leading to their consumption within this population. Hence, this review raises questions around the safety of these two types of ATPs and encourages comprehensive studies globally and regionally

Chemical composition and potential health risks of raw Arabian incense (Bakhour)

Burning Arabian incense (Bakhour) is a common indoor practice in the Middle East and the Arabian Gulf region. However, the chemical composition of this substance has never been studied. Three different Bakhour brands were selected for this study. A complete chemical profile for the raw samples was determined using carbon, hydrogen, and nitrogen elemental analysis, inductively coupled plasma optical emission spectroscopy, scanning electron microscopy coupled with energy dispersive X-ray spectroscopy and gas chromatography mass spectrometry techniques. A wide range of elements and compounds were identified, many of which are hazardous to health. Nitrogen was found in all samples which should raise concerns due to the known health implications of amines, nitrogen oxides and nitrites. In addition toxic metals such as cobalt, copper, iron, nickel, lead, and zinc were also determined in all samples. The amounts of these metals are equivalent to those in raw tobacco, where they are known to pose health risks. Three types of solvents (acetone, dichloromethane and toluene) were used for the extraction of organic compounds. Carcinogens, toxins and irritants were found along others of different health implications. Isolation of these compounds provides preliminary evidence on the harmful consequences of being exposed to Bakhour

Activated carbon, a useful medium to bind chlordecone in soil and limit its transfer to growing goat kids

Chlordecone (Kepone) (CLD) is a highly persistent pesticide which was extensively used in the French West Indies; high levels of CLD can still currently be found in large agricultural areas. As CLD transfers from soil to animals mainly via involuntary ingestion, the consumption of foodstuffs derived from animals raised in contaminated areas may significantly contribute to exposure of humans to CLD. The present study was designed to test the efficacy of two different activated carbons (ACs) sources in limiting CLD transfer from soil to animal. Three soils (ASs) were prepared according to the OECD guideline 207. One standard soil (SS) lacking AC, and two modified preparations of SS supplemented with 2% coconut-based activated carbon (ORBO), SSO or with 2% lignite-based one (DARCO), SSD. All three soils were spiked with 10 μg of kepone per g of dry matter and aged for three weeks. This study involved 15 goat kids randomly assigned to the 3 experimental groups (n = 5/group), which were fed the experimental matrices at an exposure dose of 10 μg CLD per kg of body weight per day. After 21 d of oral exposure, CLD in adipose tissue and liver were analysed by LC-MS-MS. A significant decrease of 63.7% and 74.7% of CLD concentrations in adipose tissue and liver, respectively, were obtained from animals exposed using SS containing DARCO as compared to those receiving only SS. Decreases in CLD levels of 98.2% (adipose tissue) and 98.7% (liver) were obtained for animals exposed using SS containing ORBO. This study leads us to conclude that (i) the presence of AC in CLD-contaminated soil strongly reduces CLD bioavailability, and (ii) the efficacy depends on the nature and characteristics of the AC used

In‐situ force measurement during nano‐indentation combined with Laue microdiffraction

International audienc