An integrated approach for prescribing fewer chest x-rays in the ICU

Chest x-rays (CXRs) are the main imaging tool in intensive care units (ICUs). CXRs also are associated with concerns inherent to their use, considering both healthcare organization and patient perspectives. In recent years, several studies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a decrease may result from two independent and complementary processes: a raw reduction of CXRs due to the elimination of unnecessary investigations, and replacement of the CXR by an alternative technique. The goal of this review is to outline emblematic examples corresponding to these two processes. The first part of the review concerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated patients and adopting an on-demand prescription strategy. The second part of the review addresses the use of alternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography combined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography is then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces, as well as a valuable post-procedural technique after central venous catheter insertion. The combination of the emblematic examples presented in this review supports an integrated global approach for decreasing the number of CXRs ordered in the ICU

Small-scale properties of Class 0 protostars from the CALYPSO IRAM-PdBI survey

Because the formation of protostars is believed to be closely tied to the angular momentum problem of star formation, characterizing the properties of the youngest disks around Class 0 objects is crucial. However, not much is known on the structure of the youngest protostellar envelopes, on the small scales at which disks and multiple systems are observed around more evolved YSOs, due to a lack of comprehensive high angular resolution observations (probing 50 au, disk structures are not observed in most Class 0 protostars from our sample, which can be described by various envelope models reproducing satisfactorily the intensity distribution of the dust emission at all scales from 50 au to 5000 au

Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF).

AIMS Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. METHODS AND RESULTS This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). CONCLUSION In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement

Multi-probe analysis of the galaxy cluster CL J1226.9+3332: Hydrostatic mass and hydrostatic-To-lensing bias

The precise estimation of the mass of galaxy clusters is a major issue for cosmology. Large galaxy cluster surveys rely on scaling laws that relate cluster observables to their masses. From the high-resolution observations of ∼45 galaxy clusters with the NIKA2 and XMM-Newton instruments, the NIKA2 Sunyaev-Zela'dovich Large Program should provide an accurate scaling relation between the thermal Sunyaev-Zela'dovich effect and the hydrostatic mass. In this paper we present an exhaustive analysis of the hydrostatic mass of the well-known galaxy cluster CL J1226.9+3332, the highest-redshift cluster in the NIKA2 Sunyaev-Zela'dovich Large Program at z=0.89. We combined the NIKA2 observations with thermal Sunyaev-Zela'dovich data from the NIKA, Bolocam, and MUSTANG instruments and XMM-Newton X-ray observations, and tested the impact of the systematic effects on the mass reconstruction. We conclude that slight differences in the shape of the mass profile can be crucial when defining the integrated mass at R500, which demonstrates the importance of the modelling in the mass determination. We prove the robustness of our hydrostatic mass estimates by showing the agreement with all the results found in the literature. Another key factor for cosmology is the bias of the masses estimated assuming the hydrostatic equilibrium hypothesis. Based on the lensing convergence maps from the Cluster Lensing And Supernova survey with Hubble (CLASH) data, we obtain the lensing mass estimate for CL J1226.9+3332. From this we are able to measure the hydrostatic-To-lensing mass bias for this cluster, which spans from 1-bHSE/lens∼0.7 to 1, presenting the impact of data sets and mass reconstruction models on the bias

Relative Impacts of Adult Movement, Larval Dispersal and Harvester Movement on the Effectiveness of Reserve Networks

Movement of individuals is a critical factor determining the effectiveness of reserve networks. Marine reserves have historically been used for the management of species that are sedentary as adults, and, therefore, larval dispersal has been a major focus of marine-reserve research. The push to use marine reserves for managing pelagic and demersal species poses significant questions regarding their utility for highly-mobile species. Here, a simple conceptual metapopulation model is developed to provide a rigorous comparison of the functioning of reserve networks for populations with different admixtures of larval dispersal and adult movement in a home range. We find that adult movement produces significantly lower persistence than larval dispersal, all other factors being equal. Furthermore, redistribution of harvest effort previously in reserves to remaining fished areas (‘fishery squeeze’) and fishing along reserve borders (‘fishing-the-line’) considerably reduce persistence and harvests for populations mobile as adults, while they only marginally changes results for populations with dispersing larvae. Our results also indicate that adult home-range movement and larval dispersal are not simply additive processes, but rather that populations possessing both modes of movement have lower persistence than equivalent populations having the same amount of ‘total movement’ (sum of larval and adult movement spatial scales) in either larval dispersal or adult movement alone

Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility.

Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel Na1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on Na1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings

Esthétique et orthodontie (étude rétrospective évaluant l'impact des traitements avec extractions de prémolaires sur le profil cutané)

L esthétique constitue le principal motif de consultation en orthodontie. Le praticien doit être capable d analyser le visage du patient dans sa globalité et de proposer au- delà des objectifs purement occlusaux, un plan de traitement qui réponde à sa demande. Dans une première partie, nous rappelons les critères d évaluation de l esthétique à travers les différentes étapes de l élaboration du dossier orthodontique et à différentes échelles (macro-, mini- et micro-esthétique). Puis, nous analysons les répercussions sur les tissus mous des traitements orthodontiques avec extractions de prémolaires. Dans une seconde partie, nous présentons une étude rétrospective dont l objectif principal est d évaluer l impact direct du recul des dents sur le recul des lèvres en se basant sur un échantillon de 30 patients adolescents traités par extractions de prémolaires en cabinet privé. Pour cela, nous avons analysé les téléradiographies de profil prises avant le traitement (T0) et un an après débaguage (T,). Nos résultats tendent à prouver que les traitements orthodontiques avec extractions de prémolaires n entrainent que de faibles modifications du profil cutané. Une corrélation a été mise en évidence entre le recul des incisives maxillaires et celui de la lèvre supérieure avec un ratio de un tiers. L épaisseur et la tonicité labiales joueraient un rôle crucial dans la réponse des tissus mous.PARIS7-Odontologie (751062104) / SudocSudocFranceF

Les avis en ligne concernant les MG

International audienceIntroduction. Les évaluations en ligne sont une nouvelle source d’information pour les patients. Elles ont un impact sur la « e-réputation » des médecins généralistes selon le Conseil national de l’ordre des médecins (CNOM). Leur contenu et leur validité sont peu étudiés. L’objectif était de décrire les évaluations sur Internet concernant les médecins généralistes dans un département français, et notamment leurs thèmes, leur tonalité positive ou négative et la description d’éléments factuels.Méthodes. Il s’agit d’une étude descriptive transversale par analyse de contenu qualitative et quantitative. Le recueil des données était rétrospectif, sur toutes les notes et tous les avis textuels concernant les médecins généralistes libéraux exerçant en Ille-et-Vilaine, réalisé de décembre 2018 à mars 2019. Sept sites Internet publics ont été identifiés à partir d’une recherche par mots-clés.Résultats. Parmi l’ensemble des médecins, 58,5 % (n = 853) avaient au moins une évaluation sous forme d’une note et/ou d’un avis (n = 1 687). L’analyse de contenu a porté sur 1 569 notes et 1 030 avis. Les notes étaient polarisées et exprimaient globalement une satisfaction des patients. Une évaluation sur cinq était anonyme. 58 % des avis ne comportaient pas d’élément factuel. Quatre thèmes étaient retrouvés à partir des 3 846 unités de sens contenues dans les 1 030 avis : les compétences relationnelles (n = 1 452, 38 %), les recommandations à l’usage des autres patients (n = 1 047, 27 %), les compétences professionnelles (n = 796, 21 %) et l’organisation du cabinet (n = 551, 14 %). Seuls les avis relatifs à l’organisation du cabinet étaient majoritairement négatifs. Les compétences relationnelles, en particulier l’écoute, étaientprioritaires.Discussion. La méthode et l’exhaustivité sont des points forts de cette première étude qualitative et quantitative française en médecine générale. Une limite en est le caractère monocentrique. Les résultats sont concordants avec la littérature. Il serait utile de détailler l’impact des avis auprès des médecins

Changement climatique et santé : opinions des médecins généralisteset des patients en Polynésie française

National audienceBackground Climate change (CC) is a threat to global health. The opinions of general practitioners (GP) and patients on the link between CC and health are not known in French Polynesia. Objectives The main objective was to describe the perceptions of GPs and patients of CC and its impacts on health. The secondary objective was to study the possible role of the GP addressing CC. Method The study area includes the islands of Tahiti and Moorea in French Polynesia. Sixty-four randomly selected GP practising in offices or dispensaries were sent a paper survey. In seven randomly selected general practices and dispensaries, one hundred and fourteen patients were interviewed with a paper survey. The GPs and patient surveys were taken from an English-language study and translated into French. Results Forty-eight GP surveys (75 %) and 90 patient surveys (79 %) were analysed. Most patients (53 %) said they had never thought about the link between CC and health. They said that they have high trust in their GP (83 %) but only 13 % of them had ever talk about environmental health with their doctor. Among GPs, 56 % felt that current and future CC is relevant to primary care. They anticipated a significant increase in the impact of CC on seven out of nine climate-sensitive diseases over the next 10-20 years. While 46% of GPs thought that they should play an active role in addressing CC with their patients, 44% had no opinion. Conclusion GPs in Tahiti and Moorea and their patients are concerned about the health impacts of CC but they don’t talk about this topic in the medical setting. A qualitative method would enable us to explore the representations of GPs and patients on the links between CC and health.Contexte Le changement climatique (CC) représente une menace pour la santé dans le monde. L’opinion des médecins généralistes et des patients sur le lien entre CC et santé n’est pas connue en Polynésie française (PF). Objectifs L’objectif principal était de décrire les perceptions des médecins généralistes et des patients sur le CC et ses impacts sur la santé. L’objectif secondaire était d’étudier le rôle possible du médecin généraliste face au CC. Méthode Le terrain d’étude comprend les îles de Tahiti et de Moorea en PF. Soixante-quatre médecins généralistes tirés au sort exerçant en cabinet ou dispensaire ont reçu un questionnaire papier. Dans sept cabinets de médecine générale et dispensaires tirés au sort, 114 patients ont été interrogés avec un questionnaire papier. Les questionnaires médecins et patients sont issus d’une étude en langue anglaise et traduits en français. Résultats Quarante-huit questionnaires médecins (75 %) et 90 questionnaires patients (79 %) ont été analysés. Une majorité de patients (53 %) disaient n’avoir jamais réfléchi au lien entre CC et santé. Ils déclaraient avoir une grande confiance en leur médecin généraliste (83 %) mais seuls 13 % d’entre eux avaient déjà discuté de santé environnementale avec leur médecin. Parmi les médecins 56 % estimaient qu’il faut prendre en compte le CC actuel et à venir dans la prise en charge des patients. Ils anticipaient d’ici 10-20 ans une augmentation significative de l’impact du CC sur sept parmi neuf pathologies sensibles au climat. Si 46 % des médecins généralistes pensaient qu’ils ont un rôle actif à jouer dans la lutte contre le CC auprès de leur patientèle, 44% d’entre eux étaient sans avis. Conclusion Les médecins généralistes de Tahiti et Moorea et leurs patients sont préoccupés par les impacts du CC sur la santé mais n’abordent pas ce sujet en consultation. Une méthode qualitative permettrait d’explorer les représentations des médecins et des patients sur le lien entre CC et la santé