98 research outputs found
Le burn-out des médecins généralistes : influence de l’iniquité perçue et de l’orientation communautaire
Safety of the Combination of PERC and YEARS Rules in Patients With Low Clinical Probability of Pulmonary Embolism: A Retrospective Analysis of Two Large European Cohorts
BACKGROUND: This study aimed to determine the failure rate of a combination of the PERC and the YEARS rules for the diagnosis of pulmonary embolism (PE) in the emergency department (ED).
METHODS: We performed a retrospective analysis of two European cohorts of emergency patients with low gestalt clinical probability of PE (PROPER and PERCEPIC). All patients we included were managed using a conventional strategy (D-dimer test, followed, if positive, by computed tomographic pulmonary angiogram (CTPA). We tested a diagnostic strategy that combined PERC and YEARS to rule out PE. The primary endpoint was a thromboembolic event diagnosed in the ED or at 3-months follow-up. Secondary endpoints included a thromboembolic event at baseline in the ED and a CTPA in the ED. Ninety-five percent confidence intervals (CIs) of proportions were calculated with the use of Wilson\u27s continuity correction.
RESULTS: We analyzed 1,951 patients (mean ± SD age = 47 ± 18 years, 56% women) with an overall proportion of patients with PE of 3.5%. Both PERC and YEARS strategies were associated with 11 missed PE in the ED: failure rate 0.57 (95% CI = 0.32-1.02). At 3-month follow-up, the overall failure rate was 0.83% (95% CI = 0.51-1.35). Among the 503 patients who underwent a CTPA (26%), the use of the PERC-YEARS combination would have ruled out PE without CTPA in 249 patients (50% [95%CI = 45%-54%], absolute reduction 13% (95% CI = 11%-14%]).
CONCLUSION: The combination of PERC then YEARS was associated with a low risk of PE diagnostic failure and would have resulted in a relative reduction of almost half of CTPA
Effects of elevated seawater pCO2 on gene expression patterns in the gills of the green crab, Carcinus maenas
Background: The green crab Carcinus maenas is known for its high acclimation potential to varying environmental
abiotic conditions. A high ability for ion and acid-base regulation is mainly based on an efficient regulation
apparatus located in gill epithelia. However, at present it is neither known which ion transport proteins play a key
role in the acid-base compensation response nor how gill epithelia respond to elevated seawater pCO2 as
predicted for the future. In order to promote our understanding of the responses of green crab acid-base
regulatory epithelia to high pCO2, Baltic Sea green crabs were exposed to a pCO2 of 400 Pa. Gills were screened
for differentially expressed gene transcripts using a 4,462-feature microarray and quantitative real-time PCR.
Results: Crabs responded mainly through fine scale adjustment of gene expression to elevated pCO2. However, 2%
of all investigated transcripts were significantly regulated 1.3 to 2.2-fold upon one-week exposure to CO2 stress.
Most of the genes known to code for proteins involved in osmo- and acid-base regulation, as well as cellular stress
response, were were not impacted by elevated pCO2. However, after one week of exposure, significant changes
were detected in a calcium-activated chloride channel, a hyperpolarization activated nucleotide-gated potassium
channel, a tetraspanin, and an integrin. Furthermore, a putative syntaxin-binding protein, a protein of the
transmembrane 9 superfamily, and a Cl-/HCO3
- exchanger of the SLC 4 family were differentially regulated. These
genes were also affected in a previously published hypoosmotic acclimation response study.
Conclusions: The moderate, but specific response of C. maenas gill gene expression indicates that (1) seawater
acidification does not act as a strong stressor on the cellular level in gill epithelia; (2) the response to hypercapnia
is to some degree comparable to a hypoosmotic acclimation response; (3) the specialization of each of the
posterior gill arches might go beyond what has been demonstrated up to date; and (4) a re-configuration of gill
epithelia might occur in response to hypercapnia
Stable Photosymbiotic Relationship under CO2-Induced Acidification in the Acoel Worm Symsagittifera Roscoffensis
As a consequence of anthropogenic CO2 emissions, oceans are becoming more acidic, a phenomenon known as ocean acidification. Many marine species predicted to be sensitive to this stressor are photosymbiotic, including corals and foraminifera. However, the direct impact of ocean acidification on the relationship between the photosynthetic and nonphotosynthetic organism remains unclear and is complicated by other physiological processes known to be sensitive to ocean acidification (e.g. calcification and feeding). We have studied the impact of extreme pH decrease/pCO2 increase on the complete life cycle of the photosymbiotic, non-calcifying and pure autotrophic acoel worm, Symsagittifera roscoffensis. Our results show that this species is resistant to high pCO2 with no negative or even positive effects on fitness (survival, growth, fertility) and/or photosymbiotic relationship till pCO2 up to 54 K µatm. Some sub-lethal bleaching is only observed at pCO2 up to 270 K µatm when seawater is saturated by CO2. This indicates that photosymbiosis can be resistant to high pCO2. If such a finding would be confirmed in other photosymbiotic species, we could then hypothesize that negative impact of high pCO2 observed on other photosymbiotic species such as corals and foraminifera could occur through indirect impacts at other levels (calcification, feeding)
Burnout in Organizational Life
Burnout is a psychological response to work stress that is characterized by emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment. In this paper, we review the burnout literature from 1993 to present, identifying important trends that have characterized the literature. We focus our attention on theoretical models that explain the process of burnout, the measurement of burnout, means of reducing burnout, and directions for the future of burnout research.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline
Sub-lethal effects of waterborne exposure to copper nanoparticles compared to copper sulphate on the shore crab ( Carcinus maenas )
publisher: Elsevier articletitle: Sub-lethal effects of waterborne exposure to copper nanoparticles compared to copper sulphate on the shore crab (Carcinus maenas) journaltitle: Aquatic Toxicology articlelink: http://dx.doi.org/10.1016/j.aquatox.2017.08.006 content_type: article copyright: © 2017 Elsevier B.V. All rights reserved
Time domains of the hypoxic ventilatory response in ectothermic vertebrates
Over a decade has passed since Powell et al. (Respir Physiol 112:123–134, 1998) described and defined the time domains of the hypoxic ventilatory response (HVR) in adult mammals. These time domains, however, have yet to receive much attention in other vertebrate groups. The initial, acute HVR of fish, amphibians and reptiles serves to minimize the imbalance between oxygen supply and demand. If the hypoxia is sustained, a suite of secondary adjustments occur giving rise to a more long-term balance (acclimatization) that allows the behaviors of normal life. These secondary responses can change over time as a function of the nature of the stimulus (the pattern and intensity of the hypoxic exposure). To add to the complexity of this process, hypoxia can also lead to metabolic suppression (the hypoxic metabolic response) and the magnitude of this is also time dependent. Unlike the original review of Powell et al. (Respir Physiol 112:123–134, 1998) that only considered the HVR in adult animals, we also consider relevant developmental time points where information is available. Finally, in amphibians and reptiles with incompletely divided hearts the magnitude of the ventilatory response will be modulated by hypoxia-induced changes in intra-cardiac shunting that also improve the match between O2 supply and demand, and these too change in a time-dependent fashion. While the current literature on this topic is reviewed here, it is noted that this area has received little attention. We attempt to redefine time domains in a more ‘holistic’ fashion that better accommodates research on ectotherms. If we are to distinguish between the genetic, developmental and environmental influences underlying the various ventilatory responses to hypoxia, however, we must design future experiments with time domains in mind
Allosteric Models for Multimeric Proteins: Oxygen-Linked Effector Binding in Hemocyanin
Review of the projected impacts of climate change on coastal fishes in southern Africa
The coastal zone represents one of the most economically and ecologically important ecosystems on the planet, none more so than in southern Africa. This manuscript examines the potential impacts of climate change on the coastal fishes in southern Africa and provides some of the first information for the Southern Hemisphere, outside of Australasia. It begins by describing the coastal zone in terms of its physical characteristics, climate, fish biodiversity and fisheries. The region is divided into seven biogeographical zones based on previous descriptions and interpretations by the authors. A global review of the impacts of climate change on coastal zones is then applied to make qualitative predictions on the likely impacts of climate change on migratory, resident, estuarine-dependent and catadromous fishes in each of these biogeographical zones. In many respects the southern African region represents a microcosm of climate change variability and of coastal habitats. Based on the broad range of climate change impacts and life history styles of coastal fishes, the predicted impacts on fishes will be diverse. If anything, this review reveals our lack of fundamental knowledge in this field, in particular in southern Africa. Several research priorities, including the need for process-based fundamental research programs are highlighted
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