Evolution of the spectral lineshape at the magnetic transition in Sr2IrO4 and Sr3Ir2O7

Sr2IrO4 and Sr3Ir2O7 form two families of spin-orbit Mott insulators with quite different charge gaps and an antiferromagnetic (AF) ground state. This offers a unique opportunity to study the impact of long-range magnetic order in Mott insulators. It appears to play a different role in the two families, as there is almost no change of the resistivity at the magnetic transition TN in Sr2IrO4 and a large one in Sr3Ir2O7. We use angle-resolved photoemission to study the evolution of the spectral lineshape through the magnetic transition. We use Ru and La substitutions to tune TN and discriminate changes due to temperature from those due to magnetic order. We evidence a shift and a transfer of spectral weight in the gap at TN in Sr3Ir2O7, which is absent in Sr2IrO4. We assign this behavior to a significantly larger coherent contribution to the spectral lineshape in Sr3Ir2O7, which evolves strongly at TN. On the contrary, the Sr2IrO4 lineshape is dominated by the incoherent part, which is insensitive to TN. We compare these findings to theoretical expections of the Slater vs Mott antiferromagnetism within Dynamical Mean Field Theory

The Sacred Geography of Dawei: Buddhism in peninsular Myanmar (Burma)

The paper opens by recounting the beginnings of Buddhism in Dawei as preserved in local chronicles and sustained in stupas marking the episodes of the chronicle narrative. The chronicles start with a visit of the Buddha whose arrival triggers a series of events bringing together pre-existing tutelary figures, weiza, a hermit and offspring born of a golden fish, culminating in the establishment of the first Buddhist kingdom circa the eighth to tenth century CE. The enshrinement of sacred hairs gifted by the Buddha also includes patronage by a king of the ‘Suvannbhumi’ lineage. Associated with the monks Sona and Uttara from Sri Lanka sent by King Asoka’s son Mahinda, ‘Suvannbhumi’ literally can refer to the archaeology of Thaton, a walled site in the present day Mon State, or, as is the case here, more widely to the missionary tradition associated with Asoka (Sao Saimong Mengrai 1976). The third story in the establishment of the Buddhist king at Thagara is the longest of the chronicle, the tale of a royal hunter who failed to capture a golden peacock for the queen. The hunter became a hermit living by a pond with a golden fish and as he urinated in the pond, two children were born from the fish. The boy becomes the first Buddhist king of Thagara, 11 km north of Dawei, where artefacts from survey and excavation confirm the chronology of the chronicle, with the closest archaeological parallels found not at the ancient sites of the Mon State but to the first millennium CE Buddhist ‘Pyu’ heritage of Upper Myanmar which is notably absent in the chronicle compilation

Charcot Spine and Parkinson’s Disease

Charcot spine is rare condition whose association with Parkinson’s disease (PD) has not been reported yet. The authors reported the cases of two patients with PD who developed Charcot spine. Both patients presented with a history of back pain and bilateral radicular leg pain. They had complete clinical and radiological assessment. Lumbar spine was involved in both patients. Clinical features and response to treatment were described. In the first case, circumferential fusion and stabilization were performed on the dislocated vertebral levels. A solid and stable fusion of the spine was obtained with satisfactory clinical outcome. Surgical treatment has been recommended to the other patient. In both cases, no other neurological etiology was found to account for Charcot spine. In conclusion, Charcot spine is associated with several neurological affections but has not previously been reported in association with Parkinson’s disease

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Quels sont l'objectif réel et la portée du dépistage des aneuploïdies ?

International audienceIn France, the recommended method for Down syndrome screening is the first trimester combined test, the risk assessment, based on maternal age, ultrasound measurement of fetal nuchal translucency and maternal serum markers (free β-hCG and PAPP-A). The Down syndrome detection rate is 78.7% at a screen positive rate of 5%. However, the best screening test is the integrated test using a combination of first trimester combined test and second trimester quadruple test (serum α-fetoprotein, human chorionic gonadotropin, unconjugated E3, and dimeric inhibin-A) and being able to achieve a detection rate for Down syndrome of approximately 96% at a screen-positive rate of 5%. In recent years, the isolation of small fragments of “fetal” cell-free DNA in the maternal blood dramatically changed the screening strategy paradigm allowing a Down syndrome detection rate and false positive rate of 99.2 and 0.09%, respectively. However, aneuploidy screening based on cell-free DNA presents two major limitations which must be taken into account because they considerably limit its benefit: (i) not every woman will receive an interpretable result and that those who fail to receive a result are at increased risk for fetal aneuploidy: whether an inconclusive result is treated as screen positive or screen negative affects the overall detection rate (sensitivity) and false-positive rate (specificity) of the test; (ii) the limited number of targeted aneuploidies (trisomies 21, 18, 13 and common sex chromosome aneuploidies) in contrast to conventional noninvasive screening which is also able to detect rare aneuploidies, duplications, deletions, and other structural rearrangements. Of course, genetic counseling has to include a discussion about benefits and limitations of aneuploidy screening based on cell-free DNA. However, it should not be considered as a new screening test to substitute for conventional noninvasive screening. Moreover, if the ultimate goal is to deliver the most information about potential risk of various chromosomal abnormalities associated with adverse perinatal outcomes, then current cell-free DNA screening strategies may not be the best approach. These data highlight the limitations of cell-free DNA screening and the importance of a clear and fair information during pretest genetic counseling about benefits and limitations of any prenatal noninvasive screening (whether conventional or by cell-free DNA), but also about risks and benefits of invasive diagnostic procedures (in first- or second-line), especially since the cytogenetic analysis with chromosomal microarray analysis has improved the detection of genome microdeletions and microduplications (variants of the copy number) that can not be detected by standard cytogenetic analysis

L'allaitement maternel aujourd'hui en France (revue de la littérature)

ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans

International audienceThis study aimed to investigate the effect of hospital staffing resources on medical practice in public versus private hospitals. We used exhaustive delivery data from a French district of 11 hospitals over an 11-year period, from 2008 to 2018, including 168,120 observations. We performed multilevel logistic regression models with hospital fixed or random effects, while controlling for factors known to influence obstetric practice. We found that hospital staff ratios of obstetricians and that of midwives affected caesarean rates, but with different effects depending on the hospital sector. In public hospitals, the higher the ratio of obstetricians and that of midwives, the lower the probability of planned caesareans. In private hospitals, the higher the ratio of obstetricians, the greater the probability of planned caesareans. Indeed, in public hospitals, obstetricians and midwives, both salaried employees, do not have financial or organizational incentives to perform more caesareans. In private hospitals, obstetricians, who are independent doctors, may have such incentives. Our results underline the importance of having an adequate supply of health professionals in healthcare facilities to ensure appropriate care, with specific regard to the different characteristics of the public and private sectors

Home-based postnatal coordinated care after hospital discharge: a PRADO French experiment

International audienceObjective: To determine the factors that affect enrollment and full participation (adherence) in the PRADO home-based postnatal coordinated care program in France after hospital discharge. Methods: A population-based retrospective study was performed using the public health insurance database for the Yvelines district in France. The study population included all affiliated women admitted for delivery and classified as low risk in 2013. These women were eligible for home-based midwifery support after their discharge from the hospital. The enrollment and full participation of the women in home-based postnatal coordinated care were modeled using a simple probit model. Full participation in the home-based postnatal coordinated care was also modeled using a probit Heckman selection model in order to assess the self-selection process of enrollment in the program. The control variables were the characteristics of the patients, the municipalities, and the hospitals. Results: 2,859 (68.3%) of the 4,189 eligible women chose to participate in the home-based postnatal coordinated care program, of whom 2,496 (59.6% of the eligible women) subsequently took part in the entire PRADO program. On the one hand, enrollment in the home-based postnatal coordinated care was influenced mostly by family context variables including the woman's age at the time of her pregnancy and the number of children in the household, the woman's level of information including prenatal education and prenatal information regarding postpartum care, as well as hospital variables including characteristics and organization of the maternity units. On the other hand, full participation in the home-based postnatal coordinated care was influenced by the accessibility to health professionals, particularly midwives. 3 Furthermore, both the woman's level of information and accessibility to health professionals correlated with the socioeconomic environment. Conclusion: Women who become pregnant at a very early or late stage of their life as well as women with low levels of prenatal education and prenatal information regarding postpartum care have a relatively low rate of participation in home-based postnatal coordinated care. A public health policy promoting awareness of prenatal as well as postnatal issues could increase the participation in this coordinated community care. In addition, reducing regional inequality is likely to have a positive impact, as the availability of midwives is a key factor for participation in home-based postnatal coordinated care