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Massive use of antibiotics has led to increased bacterial resistance to these drugs, making infections more difficult to treat. Few studies have assessed the overall antimicrobial resistance (AMR) burden, and there is a paucity of comprehensive data to inform health policies. This study aims to assess the overall annual incident number of hospitalised patients with AMR infection in France, using the National Hospital Discharge database. All incident hospitalisations with acute infections in 2016 were extracted. Infections which could be linked with an infecting microorganism were first analysed. Then, an extrapolation of bacterial species and resistance status was performed, according to age class, gender and infection site to estimate the total number of AMR cases. Resistant bacteria caused 139 105 (95% CI 127 920–150 289) infections, resulting in a 12.3% (95% CI 11.3–13.2) resistance rate. ESBL-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the most common resistant bacteria (>50%), causing respectively 49 692 (95% CI 47 223–52 142) and 19 493 (95% CI 15 237–23 747) infections. Although assumptions are needed to provide national estimates, information from PMSI is comprehensive, covering all acute bacterial infections and a wide variety of microorganisms.
Between July of 2012 and December of 2014, 39 patients were enrolled prospectively to investigate the prevalence of glucose transporter 1 (GLUT1) deficiency in a ketogenic diet clinic. None of them had GLUT1 deficiency. All patients seen in the same clinic within the same period were reviewed retrospectively. A total of 18 of these 85 patients had a genetic diagnosis, including GLUT1 deficiency, pathogenic copy number variants, congenital disorder of glycosylation, neuronal ceroid lipofuscinosis type II, mitochondrial disorders, tuberous sclerosis, lissencephaly, and SCN1A-, SCN8A-, and STXBP1-associated epileptic encephalopathies. The prevalence of genetic diagnoses was 21% and prevalence of GLUT1 deficiency was 2.4% in our retrospective cohort study.
Gold has been a major economic asset for Suriname for more than a century. The long history of gold mining, concentrated in large parts of a greenstone belt in the northeast of the country, began with small-scale artisanal extraction activities and has recently seen the development of major open-pit operations. Despite the range of mining activities, Suriname's gold deposits and occurrences are under-explored from a scientific point of view. Primary gold mineralisations in the greenstone belt occur in multiple forms, and although their origin is commonly related to the Palaeoproterozoic Trans-Amazonian orogeny, the controls of ore formation in specific cases often remain obscure. This contribution presents an abridged overview of currently available information on the geological setting and characteristics for some of the main deposits where gold is extracted. In view of the consistent link between gold metallogeny and granitoid–greenstone belts in the northern Guiana Shield, the mineralised settings in Suriname are discussed in a regional context.
The new facility Artemis was installed in 2003 in Saclay, France. This 3MV NEC Pelletron is dedicated to high-precision radiocarbon measurements for French 14C laboratories. We will present information on Artemis along with our sample preparation methods. Results from measurements on some intercalibration samples will be given along with the values of measured blanks. Finally, we report on some problems we have encountered when measuring sputter cathodes with high CH− outputs.
The aim of this study was to determine the probability of intervention at birth after prenatal diagnosis of CHD.
A 10-year retrospective study including all foetuses with a prenatally diagnosed CHD and those delivered in a tertiary-care cardiac centre between January, 2002 and December, 2011 was carried out. Patients were classified into eight groups according to the anticipated risk of neonatal intervention.
The need for urgent intervention and/or PGE1 infusion within the first 48 hours of life was 47% (n=507/1080): 72% (n=248) for CHD at risk for a Rashkind procedure, 77% (n=72) for CHD with ductal-dependent pulmonary flow, 13% (n=22) for CHD with potentially ductal-dependent pulmonary flow, 94% (n=62) for CHD with ductal-dependent systemic flow, 29% (n=88) for CHD with potentially ductal-dependant systemic flow, 50% (n=4) for total anomalous pulmonary venous connection, and 17% (n=1) for CHD with atrio-ventricular block. In all, 34% of the patients received PGE1 infusion and 21.4% underwent urgent catheter-based or surgical interventions; 10% of patients without anticipated risk (n=10) underwent an early intervention; 6.7% (n=73) of the patients died; and 55% (n=589) had an intervention before discharge from hospital.
Half of the neonates with foetal CHD benefited from an urgent intervention or PGE1 infusion at birth. We recommend scheduled delivery and in utero transfer for transposition of the great arteries, double-outlet right ventricle with sub-pulmonary ventricular septal defect, total anomalous pulmonary venous connection, CHD with atrio-ventricular block with heart rate <50, all ductal-dependant lesions, and CHD with potentially ductal-dependant systemic flow.
This study examined how nursing home facility ownership and organizational characteristics relate to emergency department (ED) transfer rates. The sample included a retrospective cohort of nursing home residents in the Vancouver Coastal Health region (n = 13,140). Rates of ED transfers were compared between nursing home ownership types. Administrative data were further linked to survey-derived data of facility organizational characteristics for exploratory analysis. Crude ED transfer rates (transfers/100 resident years) were 69, 70, and 51, respectively, in for-profit, non-profit, and publicly owned facilities. Controlling for sex and age, public ownership was associated with lower ED transfer rates compared to for-profit and non-profit ownership. Results showed that higher total direct-care nursing hours per resident day, and presence of allied health staff – disproportionately present in publicly owned facilities – were associated with lower transfer rates. A number of other facility organizational characteristics – unrelated to ownership – were also associated with transfer rates.
This article describes British Columbia’s regulatory model for assisted living and used time series analysis to examine individuals’ use of health care services before and after moving to assisted living. The 4,219 assisted living residents studied were older and predominantly female, with 73 per cent having one or more major chronic conditions. Use of health care services tended to increase before the move to assisted living, drop at the time of the move (most notably for general practitioners, medical specialists, and acute care), and remain low for the 12-month follow-up period. These apparent positive effects are not trivial; the cohort of 1,894 assisted living residents used 18,000 fewer acute care days in the year after, compared to the year before, their move. Future research should address whether and how assisted living affects longer-term pathways of care for older adults and ultimately their function and quality of life.
L’acquisition du mouvement est de plus en plus souvent
effectuée pour améliorer la balistique des traitements en radiothérapie
externe. Cependant, elle est source d’une exposition supplémentaire
pour le patient. Le développement de la plate-forme de simulation
numérique NEMOSIS (NEural NEtwork MOtion SImulation System)
ouvre la voie à l’optimisation de la dose en imagerie. Elle permet
de générer un mouvement pulmonaire localisé et personnalisé à partir
du modèle 3D du patient. Pour 3 patients test, 5 à 6 points anatomiques
ont été simulés puis comparés aux tracés du radiothérapeute. Dans
le cas le plus défavorable, les résultats ont montré une précision
moyennée sur l’ensemble des points d’un patient et sur toutes les
phases d’environ 3 mm avec une incertitude élargie de tracé égale
à 1,5 mm (intervalle de confiance de 95 %) et une incertitude maximale
de phase atteignant 6,53 mm. Une autre étude comparant les GTV (
Gross Tumor Volume) d’un radiothérapeute et ceux
calculés par NEMOSIS a été également menée. Un indice de Dice stipulant une
correspondance minimale de 0,80 a été calculé entre les deux types
de volumes. Ces résultats font de NEMOSIS un outil très prometteur
en tant qu’alternative aux imageries irradiantes.
Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with better care quality. Accordingly, we conducted a cross-sectional survey of nursing home directors of care in Vancouver Coastal Health, a large health region in British Columbia. The survey addressed staffing levels and organization, physician access, end-of-life care, and factors influencing facility-to-hospital transfers. Many of the modifiable organizational characteristics associated in the literature with potentially avoidable hospital transfers and better care quality are present in nursing homes in British Columbia. However, their presence is not universal, and some features, especially the organization of physician care and end-of-life planning and services, are particularly lacking.
Mass casualty triage is the process of prioritizing multiple victims when resources are not sufficient to treat everyone immediately. No national guideline for mass casualty triage exists in the United States. The lack of a national guideline has resulted in variability in triage processes, tags, and nomenclature. This variability has the potential to inject confusion and miscommunication into the disaster incident, particularly when multiple jurisdictions are involved. The Model Uniform Core Criteria for Mass Casualty Triage were developed to be a national guideline for mass casualty triage to ensure interoperability and standardization when responding to a mass casualty incident. The Core Criteria consist of 4 categories: general considerations, global sorting, lifesaving interventions, and individual assessment of triage category. The criteria within each of these categories were developed by a workgroup of experts representing national stakeholder organizations who used the best available science and, when necessary, consensus opinion. This article describes how the Model Uniform Core Criteria for Mass Casualty Triage were developed.
(Disaster Med Public Health Preparedness. 2011;5:129-137)
High quality bulk YBa2CuOx−7 was synthesized by fusing stoichiometric amounts of yttrium and copper nitrates and barium hydroxide, in air, using an ordinary Bunsen burner. The starting materials go through a short-lived liquid phase yielding a solid black product which was subsequently heat treated, (900 C, 18–24 h, in air, followed by 500 C, 5 h., in O2). These materials were greater than 99% phase pure with CuO as the only other phase and they exhibited a transition temperature of 92 K, a 15.5% perfect diamagnetic response (field cooled), 76% (zero field cooled). This synthesis represents an improvement over the much more labor and time intensive conventional methods in that it allows high quality materials of various compositions to be prepared quickly
The temperature and concentration dependence of the electron paramagnetic resonance spectra of YBa2(Cu1−xZnx)3O7 has been measured for 0≤x≤0.16. Zn substituted on the Cu-site cause a rapid nearly linear depression of the superconducting transition temperature Tc with Tc going to zero in the vicinity of x=0.10. Only weak EPR spectra due to ≤1% of the Cu-ions are seen in the superconducting phase of YBa2Cu3O7. These spectra are most likely attributed to Cu-ions in the vicinity of grain boundaries and do not represent a bulk response. However, a strong asymmetric resonance is observed in the Zn-substituted samples with x>0.1. The EPR results obtained for YBa2(Cu1−xZnx)3O7 are discussed in terms of a possible localization of d-electrons.
Solutions of Y, Ba and Cu nitrate were spray-frozen. Very small particles consisting of atomic mixtures of these salts remained after the water was sublimed. These YBCO precursors were characterized and their behavior was studied in detail while they were thermally decomposed by a variety of techniques. Kilogram size batches are routine. The final YBCO products were obtained as powders and sintered bars. Sintered materials exhibited excellent phase purity (>99%) and super-conducting characteristics (Tc = 92 K), while powdered materials had secondary phases present. Some of these samples having high percentages of second phases exhibited sudden drops in resistivity to a few micro-ohms at 200 or 240 K followed by a zero resistance transition at 92 K. Coincident with this drop in resistance was a discontinuity in the magnetization.
We have studied methods of improving glow-discharge-deposited a-Si1−x Gex :H alloys deposited using silane and germane gas mixtures. Material processing methods studied include (1) varying the substrate temperature from 170° to 280°C, (2) varying the process gas composition and pressure, (3) dilution of the feed gas by hydrogen, argon, or helium, (4) enhancing etching during deposition by adding small amounts of XeF2 vapor into the process gas, and (5) postdeposition annealing and/or hydrogenation.
Les codes de calculs Monte Carlo, précis mais lents, sont devenus des outils incontournables dans la grande majorité des spécialités liées à la radiophysique, la radioprotection et la dosimétrie. Une réflexion mérite d’être menée sur l’opportunité d’implémenter d’autres solutions informatiques qui ne seraient pas seulement basées sur l’unique puissance informatique ou sur un « biaisage » permettant une relative accélération de ces calculs dans les cas des rayonnements photoniques, mais sur des méthodes plus judicieuses (RNA-réseaux de neurones artificiels, RàPC — raisonnement à partir de cas ou exploitation d’autres techniques informatiques), déjà utilisées avec succès depuis longtemps dans certaines applications scientifiques ou industrielles dans les domaines souvent éloignés de la radioprotection ou de la dosimétrie médicale.