Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure

Aim To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre-hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point-of-care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST-elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12-lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point-of-care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non-invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST-elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre-hospital conditions

Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

Introduction: Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. Methods: For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland–Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. Results: The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Conclusion: Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs

Automated entire thrombus density measurements for robust and comprehensive thrombus characterization in patients with acute ischemic stroke

Background and Purpose: In acute ischemic stroke (AIS) management, CT-based thrombus density has been associated with treatment success. However, currently used thrombus measurements are prone to inter-observer variability and oversimplify the heterogeneous thrombus composition. Our aim was first to introduce an automated method to assess the entire thrombus density and then to compare the measured entire thrombus density with respect to current standard manual measurements. Materials and Method: In 135 AIS patients, the density distribution of the entire thrombus was determined. Density distributions were described usingmedians, interquartile ranges (IQR), kurtosis, and skewedness. Differences between themedian of entire thrombusmeasurements and commonly applied manualmeasurements using 3 regions of interest were determined using linear regression. Results: Density distributions varied considerably with medians ranging from 20.0 to 62.8 HU and IQRs ranging from 9.3 to 55.8 HU. The average median of the thrombus density distributions (43.5 ± 10.2 HU) was lower than the manual assessment (49.6 ± 8.0 HU) (p<0.05). The difference between manual measurements and median density of entire thrombus decreased with increasing density (r = 0.64; p<0.05), revealing relatively higher manual measurements for low density thrombi such that manual density measurement tend overestimates the real thrombus density. Conclusions: Automatic measurements of the full thrombus expose a wide variety of thrombi density distribution, which is not grasped with currently used manual measurement. Furthermore, d

Emergence of surfactant-​free micelles from ternary solutions

Curious effects ranging from enzyme activity to anomalies in evapn. rates that have been known for over fifty years suggest the existence and thermodn. stability of surfactant-free micelles. Only recently, joint X-ray, light and neutron scattering expts. have demonstrated that aggregates and bulk pseudo-phases coexist in presumably normal solns., in which a water insol. component is solubilized in a certain domain of concn. of a hydrotrope component like ethanol. Nevertheless, nothing is known about the mol.-level shape and structure of such aggregates. In this work we characterize mixts. of octanol, ethanol, and water by mol. dynamics simulations. For compns. in the "pre-ouzo" region (close to the single phase stability limit) we observe micelle-like aggregates that are clearly distinct from simple crit. d. fluctuations. We define an ethanol partition in the pseudo-phase from an integral of the van der Waals dispersion energy term. From this partition, octanol-rich aggregates swollen with ethanol appear with an emerging interface. Ethanol is present in the water pseudo-phase with an exponential decay similar to the one predicted by Marcelja and Radic forty years ago

ANALYSE DESCRIPTIVE ET PROSPECTIVE DE LA POPULATION ADMISE AU S.A.U. DE RENNES (ANALYSE ET DISCUSSION)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Storage of natural water samples and preservation techniques for pharmaceutical quantification

International audienceIn order to perform a human and ecological risk assessment of pharmaceutical products (PPs) in natural waters, it is necessary to accurately quantify a broad variety of PPs at low concentrations. Although numerous currently implemented analytical methodologies, less is known about the preservation of PPs in natural water samples within the period before analysis (holding time, storage conditions). This paper is the first literature review about the stability of PPs in natural waters (surface and groundwaters) during sample storage. The current work focuses on a comparison of the performances of the available preservation techniques (filtration, container materials, storage temperature, preservative agents, etc.) for PPs in samples. All 58 reviewed PPs may be successfully stabilized during 7 days in surface waters by at least one appropriate methodology regarding temperature, acidic and non-acidic preservatives. When temperature is not a sufficient preservation parameter f! or some PPs (hormones and fluoxetine) its combination with the addition of chemical agents into the samples may prolong the integrity of the PPs during storage in surface water. There is a strong need to use standard protocols to assess and compare the stability of PPs in environmental water matrices during storage as well as during analytical preparation or analysis (European criteria 2002/657/EC). Since the stability of PPs during sample storage is a critical parameter that could call into question the quality of the data provided for the concentrations, the design of stability studies should rigorously take into account all critical parameters that could impact the concentrations of the PPs with time

Veterinary pharmaceutical contamination in mixed land use watersheds: from agricultural headwater to water monitoring watershed

International audienceVeterinary pharmaceuticals, widely used in intensive livestock production, may contaminate surface waters. Identifying their sources and pathways in watersheds is difficult because i) most veterinary pharmaceuticals are used in human medicine as well and ii) septic or sewer wastewater treatment plants (WWTP) can release pharmaceuticals into surface water, even in agricultural headwater watersheds. This study aimed to analyze the spatiotemporal variability of animal-specific, mixed-use, and human-specific pharmaceuticals, from agricultural headwaters with intensive livestock production and a WWTP to a watershed used for Water Framework Directive monitoring. Grab sampling was performed during one hydrological year upstream and downstream from a WWTP and at three dates in seven nested watersheds with areas of 1.9-84.1km. Twenty pharmaceuticals were analyzed. Animal-specific pharmaceuticals were detected at all sampling dates upstream and downstream from the WWTP and at concentrations higher than those of human-specific pharmaceuticals. The predominance of animal-specific and mixed-use pharmaceuticals vs. human-specific pharmaceuticals observed at these sampling points was confirmed at the other sampling points. Animal-specific pharmaceuticals were detected mainly during runoff events and periods of manure spreading. A large percentage of mixed-use pharmaceuticals could come from animal sources, but it was difficult to determine. Mixed-use and human-specific pharmaceuticals predominated in the largest watersheds when runoff decreased. In areas of intensive livestock production, mitigation actions should focus on agricultural headwater watersheds to decrease the number of pathways and the transfer volume of veterinary pharmaceuticals, which can be the main contaminants

Prioritisation of veterinary pharmaceuticals prior to a monitoring campaign into water resources and drinking water: Case of Brittany, an intensive husbandry area

International audiencePharmaceuticals residues are nowadays of growing concern, especially in aquatic environments. Numerous and detailed researches have been conducted on human pharmaceutical residues at national and european scale, while ocurrence of veterinary pharmaceutical residues remains still largely unknown. Brittany is a region subjected to high animal husbandry pressures. Veterinary pharmaceuticals residues can enter the environment directly or indirectly during pastures or spreading of animal manure on soils. Thus, aquatic environments in Brittany are sensitive spots, potentially contaminated by a lot of veterinary residues, such as antibiotics or antiparasitic drugs. The project aims at realizing an overview of the contamination (types molecules and levels of concentrations) of raw water resources subjected to a strong agricultural pressure, and into drinking water obtained from those resources. In order to realize a monitoring study during one year, the first step was to perform a prioritization of veterinary pharmaceuticals, to select the veterinary pharmaceuticals which are the most susceptible to reach and to be detected in the aquatic environment

Résidus médicamenteux vétérinaires : quelles molécules rechercher dans les eaux superficielles en contexte d’élevage intensif ?

National audienceThe occurrence of human and veterinary pharmaceuticals in the rivers flowing through watershed draining agricultural soils is of growing concern. Veterinary drugs are particularly widespread in intensive livestock watershed. Nevertheless, in these contexts, their occurrence has not yet been extensively studied. To develop analytical methods dedicated to the analysis of those veterinary pharmaceuticals, a prioritization of the molecules of interest is necessary. Surveys have been conducted with cattle, pigs and poultry veterinarians working on two watershed. The identification of the prescribed molecules and their hierarchy has been performed thanks to an indicator of the level of global prescription and has led to a list of 60 prioritized molecules to analyze in the mixed-use watershed. Among those molecules, 27 have been effectively analyzed in the superficial water from two watershed in Brittany. The quantification of 5 veterinary drugs (sulfamethazine, flunixin, enrofloxacin, tylosine and eprinomectin) in the rivers evidenced the occurrence of pharmaceuticals from livestock origin in the mixed-use watersheds.La contamination des eaux par les résidus médicamenteux d’origine vétérinaire a été peu étudiée en contexte d’élevage intensif. Des enquêtes ont été réalisées auprès de vétérinaires spécialisés bovins lait, porcins et volaille de chair sur deux bassins versants. L’identification des molécules prescrites et leur hiérarchisation à partir d’enquêtes auprès des vétérinaires ont permis de définir une liste d’environ 60 molécules à rechercher dans les eaux superficielles, appartenant à différentes classes thérapeutiques. Seules 27 d’entre elles ont pu être effectivement recherchées, pour des raisons de coûts et de faisabilité dans les laboratoires. La quantification de cinq molécules à usage exclusivement vétérinaire (la sulfaméthazine, la flunixine, l’enrofloxacine, la tylosine et l’éprinomectine) confirme la présence dans les eaux superficielles de résidus médicamenteux d’origine agricole

Impact of agricultural practices on veterinary pharmaceutical occurrence in superficial waters

International audienceDiffuse contamination of surface water by veterinary pharmaceuticals (VP) has been poorly studied in intensive breeding context. Recycling animal waste on soil is supported to fertilize crops and reduce utilization of mineral fertilizer but may have some environmental impact by recycling pollutants on soils and transferring pollutants from soils to rivers. Most of pharmaceuticals are consumed indifferently by human and animal, especially antibiotics. This study aims to quantify veterinary pharmaceuticals (VP) in superficial water in two agricultural catchments. One is dedicated to the production of drinkable water. Agriculture but also waste water treatment plant may contribute to the contamination of water and it is difficult to distinguish animal versus human source of contamination