271 research outputs found
Evaluation of a scapula spinal marker cluster to track the scapula kinematics during manual wheelchair propulsion
No abstract availabl
BMJ Open
INTRODUCTION: Antineoplastic drugs (AD) are potentially carcinogenic and/or reprotoxic molecules. Healthcare professionals are increasingly exposed to these drugs and can be potentially contaminated by them. Internal contamination of professionals is a key concern for occupational physicians in the assessment and management of occupational risks in healthcare settings. Objectives of this study are to report AD internal contamination rate in nursing staff and to identify factors associated with internal contamination. METHODS AND ANALYSIS: This trial will be conducted in two French hospital centres: University Hospital of Bordeaux and IUCT-Oncopole of Toulouse. The target population is nurses practicing in one of the fifteen selected care departments where at least one of the five studied AD is handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The trial will be conducted with the following steps: (1) development of analytical methods to quantify AD urine biomarkers, (2) study of the workplace and organization around AD in each care department (transport and handling, professional practices, personal and collective protection equipments available) (3) development of a self-questionnaire detailing professional activities during the day of inclusion, (4) nurses inclusion (urine samples and self-questionnaire collection), (5) urine assays, (6) data analysis. ETHICS AND DISSEMINATION: The study protocol has been approved by the French Advisory Committee on the Treatment of Information in Health Research (CCTIRS) and by the French Data Protection Authority (CNIL). Following the opinion of the Regional Committee for the Protection of Persons, this study is outside the scope of the provisions governing biomedical research and routine care (n degrees 2014/87). The results will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER: NCT03137641
A Community-Driven Framework to Prioritize the Use of Donated Human Biological Materials in the Context of HIV Cure-Related Research at the End of Life
Initiated in 2017 after extensive community engagement, the Last Gift program enrolls altruistic volunteers willing to donate their cells and tissues at the end of life to allow studies on HIV reservoir dynamics across anatomical sites. As the Last Gift team received tissue requests outside the scope of HIV cure research, we noticed the absence of guiding frameworks to help prioritize the use of altruistically donated human biological materials. In this commentary, we present a proposed framework for prioritizing the use of donated human biological materials within and outside the end-of-life (EOL) HIV cure research context, using the Last Gift study as an example. First, we discuss regulatory and policy considerations, and highlight key ethical values to guide prioritization decisions. Second, we present our prioritization framework and share some of our experiences prioritizing requests for donated human biological materials within and outside EOL HIV cure research.
The diagnosis and management of idiosyncratic drugâinduced liver injury
Drugâinduced liver injury (DILI) is an uncommon but important cause of liver disease that can arise after exposure to a multitude of drugs and herbal and dietary supplements. The severity of idiosyncratic DILI varies from mild serum aminotransferase elevations to the development of severe liver injury that can progress to acute liver failure resulting in death or liver transplantation within days of DILI onset. Chronic liver injury that persists for more than 6Â months after DILI onset is also becoming increasingly recognized in up to 20% of DILI patients. Host demographic (age, gender, race), clinical and laboratory features at DILI onset have been associated with the severity and outcome of liver injury in DILI patients. In addition to cessation of the suspect drug, other medical interventions including the use of Nâacetylcysteine and corticosteroids in selected patients have shown some clinical benefit, but additional prospective studies are needed. A number of promising diagnostic, prognostic and mechanistic serum and genetic biomarkers may help improve our understanding of the pathogenesis and treatment of idiosyncratic DILI.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147192/1/liv13931.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147192/2/liv13931_am.pd
L'ergotoxicologie en actions â Mobiliser l'analyse de l'activitĂ© pour rĂ©duire les risques chimiques
Contexte et objectifs Lâergotoxicologie est conçue comme une pratique particuliĂšre de lâergonomie (Garrigou, 2011) visant Ă analyser les activitĂ©s de travail dans des milieux professionnels oĂč des expositions Ă des produits chimiques peuvent se produire. Dans ce cadre, lâergotoxicologie dĂ©veloppe « des modĂšles opĂ©rants (au sens de Wisner, 1972), des outils et des moyens de prĂ©vention efficaces pour gĂ©rer et prĂ©venir les risques pour la santĂ© des travailleurs exposĂ©s Ă des produits chimiques » (Garrigou, 2011). En ce sens, il sâagit bien dâune forme de recherche et de pratique Ă visĂ©e opĂ©rationnelle, et non dâune nouvelle discipline ou sous-discipline de lâergonomie. On peut alors considĂ©rer que lâergotoxicologie est un des domaines de spĂ©cialisation de lâergonomie (Falzon, 2004, p.18). Dans cette perspective lâergotoxicologie est ancrĂ©e profondĂ©ment dans lâergonomie, mais de par ses objectifs, elle mobilise des connaissances et des modĂšles issus de la toxicologie, de la mĂ©decine du travail et de la prĂ©vention. Sa pratique nĂ©cessite donc un engagement transdisciplinaire, en ne perdant pas de vue que ses racines se nourrissent de lâanalyse de lâactivitĂ© (Garrigou, 2011). Lâergotoxicologie se dĂ©veloppe dans un contexte de remise en question des pratiques classiques de prĂ©vention des risques liĂ©s Ă lâutilisation de produits chimiques dĂ©taillĂ© par Mohammed-Brahim & Garrigou (2009). La notion dâergotoxicologie est apparue Ă partir de la nĂ©cessitĂ© de prendre en compte les caractĂ©ristiques rĂ©elles des opĂ©rateurs exposĂ©s en situations de travail pouvant influencer les effets sur la santĂ© ou en raison dâune non certitude dâabsence dâeffets sur la santĂ© malgrĂ© le respect des normes Ă©tablies (Villate, 1985). Ces « bonnes pratiques » actuelles de prĂ©vention sont essentiellement basĂ©es sur la mise en place de barriĂšres entre une source de danger (NPs par exemple) et les opĂ©rateurs, comme dĂ©crit par Mortureux (2016). La principale limite de ce modĂšle et de son opĂ©rationnalisation (Mohammed-Brahim & Garrigou, 2009) est lâefficacitĂ© partielle de ces barriĂšres pouvant ĂȘtre « permĂ©ables ». La mise en place des barriĂšres ne rĂ©sulte pas toujours dâune analyse systĂ©mique des situations Ă risque, les causes rĂ©elles dĂ©terminantes des expositions peuvent ĂȘtre ainsi occultĂ©es. Une telle reprĂ©sentation des actions possibles sâinterdit alors dâagir sur les dĂ©terminants rĂ©els de lâexposition, en raison dâun manque de prise en compte de lâactivitĂ© de travail, au profit dâune prise en compte de la tĂąche prescrite. Les normes Ă©tablies dans ces modĂšles classiques de prĂ©vention sont ainsi souvent dĂ©contextualisĂ©es des situations de travail et de lâactivitĂ© rĂ©elle (Galey & Garrigou., 2020). Ces derniĂšres annĂ©es, lâergotoxicologie a fait lâobjet de nombreux dĂ©veloppements conceptuels et mĂ©thodologiques par la construction de projets de recherche-intervention financĂ©s dans le cadre de rĂ©ponses Ă des appels Ă projets de recherche de publics. On peut citer les travaux de Judon (2017) portant sur les expositions au fumĂ©es de bitume des travailleurs de la route. Ceux de Galey (2019) sur la caractĂ©risation des expositions aux particules nanomĂ©triques dans les nouveaux procĂ©dĂ©s industriels comme la fabrication additive. Ainsi que les travaux de Jolly (Jolly et al., 2021) sur lâexposition des pomiculteurs quĂ©bĂ©cois aux pesticides, de Goutille (Goutille et al., 2016 ; Goutille & Garrigou, 2021 ; Goutille, 2022) sur la co-construction de la prĂ©vention des risques en milieux industriels et agricoles, ou bien les travaux dâAlbert (Albert et al., 2021) sur lâarticulation des sources du droit et de lâergonomie pour concevoir autrement les pulvĂ©risateurs, Lâobjectif de ce symposium est de contribuer Ă la transmission/traduction de ces concepts et mĂ©thodologies pour engager des actions de transformations. En effet, aujourdâhui, lâergotoxicologie nâest pas rĂ©servĂ©e aux seuls ergonomes. Elle est Ă©galement mobilisĂ©e par des prĂ©venteurs internes ou en service de santĂ© au travail et par des toxicologues (Mohammed-Brahim et al., 2018), nourrissant une pratique transprofessionnelle. Axes de rĂ©flexion Le premier axe de rĂ©flexion concerne la transmission des concepts et des mĂ©thodes dĂ©veloppĂ©s en ergotoxicologie et leur traduction et ou leur transformation dans des contextes dâintervention divers (entreprises, services de santĂ© au travail, etc.) et dans des logiques mĂ©tiers diffĂ©rentes (ergonomes, prĂ©venteurs, toxicologues, mĂ©decin du travailâŠ). Le deuxiĂšme axe va porter sur la possibilitĂ© des acteurs mettant en oeuvre des concepts et mĂ©thodes issus de lâergotoxicologie de pouvoir ou pas dĂ©velopper des approches pluridisciplinaires et/ou transprofessionnelles dans leurs actions de construction des problĂšmes, de diagnostics mais aussi de co-construction des transformations de la situation de travail. Cette problĂ©matique va porter sur les interactions entre les « experts » de la prĂ©vention mais aussi sur lâimplication du chef dâentreprise, des salariĂ©s et de leurs reprĂ©sentants. Le troisiĂšme axe portera sur les dĂ©terminants des expositions qui font lâobjet de la construction du problĂšme, des analyses, et des transformations. Nous nous intĂ©resserons aux diffĂ©rents dĂ©terminants de lâexposition prĂ©sents dans la situation de travail, quâils soient dâordre technique, humain ou organisationnels. Lâobjectif de la discussion est aussi dâaller discuter de familles de dĂ©terminants qualifiĂ©s dâĂ©loignĂ©s de la situation de travail mais qui concourent aux expositions. Ce symposium s'appuiera sur 5 prĂ©sentations et un dĂ©bat avec les participants autour des questions que pose la prĂ©vention durable du risque chimique en milieu de travail. Les communicants dâorigine disciplinaire et professionnelle diverse (doctorants, prĂ©venteurs, consultant, service SST, anthropologue, ergonome, toxicologue, âŠ) prĂ©senteront leurs travaux de recherche et dâintervention en milieu hospitalier, agricole, dans le BTP, ainsi que dans des plus petites entreprises (TPE et cabinet de podologie). La premiĂšre contribution sera prĂ©sentĂ©e par CĂ©dric Gouvenelle (ergonome) et Julie Vornax (toxicologue) de lâASPT 18. Elle portera sur lâapport de lâergotoxicologie en service de santĂ© au travail. Dans le cadre de cette Ă©tude prĂ©sentĂ©e, la fabrication dâĂ©lĂ©ments en bĂ©ton est identifiĂ©e par le mĂ©decin du travail comme un secteur exposant les travailleurs Ă de la silice cristalline cancĂ©rogĂšne (ANSES, 2019. Le mĂ©decin du travail identifie ces formes dâexposition lors de lâĂ©tablissement du diagnostic santĂ© travail en sâappuyant sur les donnĂ©es des visites des travailleurs, la dĂ©claration des risques de l!employeurs et la littĂ©rature. Dans un contexte oĂč les perceptions entre les travailleurs et l'employeur apparaissent diffĂ©rentes (perception du contexte et des normes) et Ă des rĂ©gulations concernant le port de certains Ă©quipements de protection individuel, il s'est agi de comprendre l!activitĂ© et ses diffĂ©rents dĂ©terminants. Recueillir les Ă©lĂ©ments nĂ©cessaires Ă l'adaptation du suivi individuel et Ă la traçabilitĂ© des expositions a permis de co-construire des pistes de solutions avec l'employeur, les salariĂ©s et leurs reprĂ©sentants. Lors de cette intervention les outils ergotoxicologiques et la construction d!objets intermĂ©diaires (Vinck, 2009; Vinck & Laureillard, 1996) Ă©volutifs, ont Ă©tĂ© des leviers pour la construction de pistes de solution. La deuxiĂšme contribution sera prĂ©sentĂ©e par Valentin Lamarque (doctorant en ergonomie) et Guillaume Swierczynski (doctorant en santĂ© publique). Elle portera sur lâhybridation de la SantĂ© publique et de lâergotoxicologie dans un contexte dâexposition des soignants aux cytotoxiques, contenus dans les mĂ©dicaments anti-cancĂ©reux administrĂ©s en service dâoncologie. Lâenjeu de la recherche interventionnelle prĂ©sentĂ©e est la co-construction dâun dispositif de formation en e-learning avec les professionnels concernĂ©s. La troisiĂšme contribution sera prĂ©sentĂ©e par Caroline Esterre (ergonome) et Emilie Bussy (mĂ©trologue) au sein dâun service de santĂ© au travail, lâAHI33. La prĂ©sentation va porter sur lâĂ©tude de l'exposition des soignants aux cytotoxiques (contenus dans les mĂ©dicaments anticancĂ©reux) dans un institut d'oncologie. La question qui va ĂȘtre discutĂ©e est de savoir comment l'activitĂ© de travail des professionnels de santĂ© peut induire des situations d'expositions aux agents cytotoxiques ? Cette question va ĂȘtre traitĂ©e Ă partir : - De lâanalyse de l'activitĂ© de travail des soignants (recherche des situations exposantes) en suivant le produit de sa rĂ©ception Ă son Ă©limination dans l'institut - De prĂ©lĂšvements de surface (identification des sources potentielles dâexposition) - De la restitution des analyses aux salariĂ©s grĂące Ă des objets intermĂ©diaires pour dĂ©velopper les pratiques de prĂ©vention La quatriĂšme contribution sera prĂ©sentĂ©e par Jessie Aldana (toxicologue Ă lâASTI en formation en ergonomie) et MaĂ«l Montigny (en formation en ergonomie). La prĂ©sentation va porter sur lâanalyse de lâactivitĂ© et de lâexposition Ă des produits chimiques dans le cadre de la fabrication d'orthĂšses chez des pĂ©dicures podologues. Cette intervention a permis de mettre en Ă©vidence une exposition au risque chimique potentialisĂ©e par des dĂ©terminants organisationnels et techniques de l'activitĂ©. Des variables ont Ă©tĂ© observĂ©es et ont permis de rĂ©vĂ©ler d'autres facteurs d'expositions aux agents chimiques dangereux. Des observations ouvertes et systĂ©matiques de l'activitĂ© ont Ă©tĂ© couplĂ©s Ă une analyse de danger des produits manipulĂ©s. LâĂ©tude a permis de mettre en corrĂ©lation des signes d'intoxication dĂ©clarĂ©s par les opĂ©rateurs avec les rĂ©sultats de mesures. La cinquiĂšme contribution sera prĂ©sentĂ©e par Caroline Jolly (doctorante en ergonomie, IRSST) et Fabienne Goutille (anthropologue doctorante en ergonomie, Inserm). Elle va porter sur les croisements possible entre analyse de lâactivitĂ©, analyse du contexte de lâactivitĂ© et analyse des expositions aux pesticides du point de vue des agriculteurs. Les deux recherches interventions menĂ©es au Canada et en France viendront illustrer la maniĂšre dont lâergonomie peut contribuer Ă la prĂ©vention du risque pesticides dans deux contextes dâintervention diffĂ©rents (acteurs, rĂ©glementations, technologies, âŠ)
Biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2 trial): study protocol for an international, prospective, randomised controlled multicentre trial
IntroductionPrevious studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation.Methods and analysisThe BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2*insulin like growth factor binding protein 7 (TIMP-2)*IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)*(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage.Ethics and disseminationThe BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of MĂŒnster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research.Trial registration numberNCT04647396
To meat or not to meat? New perspectives on Neanderthal ecology.
Neanderthals have been commonly depicted as top predators who met their nutritional needs by focusing entirely on meat. This information mostly derives from faunal assemblage analyses and stable isotope studies: methods that tend to underestimate plant consumption and overestimate the intake of animal proteins. Several studies in fact demonstrate that there is a physiological limit to the amount of animal proteins that can be consumed: exceeding these values causes protein toxicity that can be particularly dangerous to pregnant women and newborns. Consequently, to avoid food poisoning from meat-based diets, Neanderthals must have incorporated alternative food sources in their daily diets, including plant materials as well
A Search for Technosignatures Around 11,680 Stars with the Green Bank Telescope at 1.15-1.73 GHz
We conducted a search for narrowband radio signals over four observing
sessions in 2020-2023 with the L-band receiver (1.15-1.73 GHz) of the 100 m
diameter Green Bank Telescope. We pointed the telescope in the directions of 62
TESS Objects of Interest, capturing radio emissions from a total of ~11,680
stars and planetary systems in the ~9 arcminute beam of the telescope. All
detections were either automatically rejected or visually inspected and
confirmed to be of anthropogenic nature. In this work, we also quantified the
end-to-end efficiency of radio SETI pipelines with a signal injection and
recovery analysis. The UCLA SETI pipeline recovers 94.0% of the injected
signals over the usable frequency range of the receiver and 98.7% of the
injections when regions of dense RFI are excluded. In another pipeline that
uses incoherent sums of 51 consecutive spectra, the recovery rate is ~15 times
smaller at ~6%. The pipeline efficiency affects calculations of transmitter
prevalence and SETI search volume. Accordingly, we developed an improved Drake
Figure of Merit and a formalism to place upper limits on transmitter prevalence
that take the pipeline efficiency and transmitter duty cycle into account.
Based on our observations, we can state at the 95% confidence level that fewer
than 6.6% of stars within 100 pc host a transmitter that is detectable in our
search (EIRP > 1e13 W). For stars within 20,000 ly, the fraction of stars with
detectable transmitters (EIRP > 5e16 W) is at most 3e-4. Finally, we showed
that the UCLA SETI pipeline natively detects the signals detected with AI
techniques by Ma et al. (2023).Comment: 22 pages, 9 figures, submitted to AJ, revise
Long-term outcomes of the global tuberculosis and COVID-19 co-infection cohort
Background: Longitudinal cohort data of patients with tuberculosis (TB) and coronavirus disease 2019 (COVID-19) are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods: We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients were followed-up until cure, death or end of cohort time. All patients had TB and COVID-19; for analysis purposes, deaths were attributed to TB, COVID-19 or both. Survival analysis was performed using Cox proportional risk-regression models, and the log-rank test was used to compare survival and mortality attributed to TB, COVID-19 or both. Results: Overall, 788 patients with COVID-19 and TB (active or sequelae) were recruited from 31 countries, and 10.8% (n=85) died during the observation period. Survival was significantly lower among patients whose death was attributed to TB and COVID-19 versus those dying because of either TB or COVID-19 alone (p<0.001). Significant adjusted risk factors for TB mortality were higher age (hazard ratio (HR) 1.05, 95% CI 1.03-1.07), HIV infection (HR 2.29, 95% CI 1.02-5.16) and invasive ventilation (HR 4.28, 95% CI 2.34-7.83). For COVID-19 mortality, the adjusted risks were higher age (HR 1.03, 95% CI 1.02-1.04), male sex (HR 2.21, 95% CI 1.24-3.91), oxygen requirement (HR 7.93, 95% CI 3.44-18.26) and invasive ventilation (HR 2.19, 95% CI 1.36-3.53). Conclusions: In our global cohort, death was the outcome in >10% of patients with TB and COVID-19. A range of demographic and clinical predictors are associated with adverse outcomes
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