Alveolar echinococcosis (AE) is a helminth zoonosis which is encountered only in the northern hemisphere. In central France, the Auvergne region represents the most western and southern extension of this helminthiasis. In 1999, a human case of AE was diagnosed in the southern part of the Cantal department, where AE was supposed absent, and an epidemiological survey was subsequently carried out. The transmission of the zoonosis in the sylvatic and peridomestic definitive hosts was studied, as well as that in the rodent and human intermediate hosts. Eleven red foxes (Vulpes vulpes) were shot, and 50 fox faecal deposits were collected. Twelve farm dogs had their faeces taken by rectal touch, and four were checked after arecoline purgation. Optical detection of Echinococcus multilocularis worms was achieved on fox intestines after scraping, and also on dog stools after arecoline therapy. Coproantigen ELISA assay was performed for the 11 scraping products, for the 50 fox faeces, and for the 12 dog faecal samples. No adult AE agent was observed by microscopy, and the ELISA assay yielded positive results in one of 11 fox intestines, one of 50 fox faeces, and 2 of 12 dog faecal samples. Twenty-five small mammals were trapped, of which 19 were Arvicola terrestris water voles. One rodent liver exhibited a hepatic lesion consistent with AE. An epidemiological questionnaire was completed in 85 human volunteers, who were also serologically tested for AE. Only one (the case's husband) exhibited a Western-blotting pattern indicative of a low-grade AE infection. The results of this preliminary study suggested a slow AE extension to the south of Cantal department from the northern focus.

Background: Chest tube thoracostomy is frequently performed in the emergency department (ED) for patients with traumatic thoracic injuries. However, this procedure is associated with a high complication rate. Aim Statement: The aim of this study was to describe and assess predictors of complications following chest tube thoracostomy. Measures & Design: A retrospective chart review was conducted in a level 1 trauma center. Patients aged ≥16 who required a chest tube for a traumatic injury between 2016 and 2019 were identified. Variables including demographic data, Charlson Comorbidity Index, mechanism of injury, Injury Severity Score (ISS), chest tube insertion and technique (i.e. position, dislodgement, obstruction, organ perforation), complications and interventions were collected using a standardized data collection form. A second reviewer assessed all ambiguous files. Descriptive statistics and adjusted odds ratios were calculated. Evaluation/Results: 179 patients were included in the study, of which 141 were male (79%). Mean age was 54 18 and median ISS was 17 (Q1-Q3: 9-27). 207 chest tube thoracostomies were performed for pneumothorax (81%) or a hemothorax (38%) mainly after a blunt injury (92%). 183 standard chest tube (88%) and 24 pigtail catheters (12%) were installed. Overall, emergency medicine physicians/residents performed 70% of these procedures and 54% were performed by residents. Sixty-one patients (34%) suffered a total of 73 complications: 45 were infectious (62%) and 28 were technique-related (38%). Pneumonia was the most frequent complication (19%) followed by reintroduced or replaced chest tube (12%). After adjusting for the ISS, there was no statistically significant association between the type of tube (OR 0.36 95% CI: 0.08-1.68), the medical specialty (OR 1.19 95% CI: 0.55-2.58) or the level of training (OR 1.29 95% CI: 0.63-2.64) of the clinician and the incidence of at least one complication. Discussion/Impact: Our results show that one out of three patients experienced at least one complication following a chest tube thoracostomy in the ED, which confirmed existing literature (5%- 38%). After adjustment, the type of tube used, the specialty and level of training of the health professional who performed the procedure was not associated with the incidence of at least one complication.

Introduction: Older (age >=65 years) trauma patients suffer increased morbidity and mortality. This is due to under-triage of older trauma victims, resulting in lack of transfer to a trauma centre or failure to activate the trauma team. There are currently no Canadian guidelines for the management of older trauma patients. The objective of this study was to identify modifiers to the prehospital and emergency department (ED) phases of major trauma care for older adults based on expert consensus. Methods: We conducted a modified Delphi study to assess senior-friendly major trauma care modifiers based on national expert consensus. The panel consisted of 24 trauma care providers across Canada, including medical directors, paramedics, emergency physicians, emergency nurses, trauma surgeons and trauma administrators. Following a literature review, we developed an online Delphi survey consisting of 16 trauma care modifiers. Three online survey rounds were distributed and panelists were asked to score items on a 9-point Likert scale. The following predetermined thresholds were used: appropriate (median score 7–9, without disagreement); inappropriate (median score 1–3; without disagreement), and uncertain (any median score with disagreement). The disagreement index (DI) is a method for measuring consensus within groups. Agreement was defined a priori as a DI score <1. Results: There was a 100% response rate for all survey rounds. Three new trauma care modifiers were suggested by panelists. Of 19 trauma care modifiers, the expert panel achieved consensus agreement for 17 items. The prehospital modifier with the strongest agreement to transfer to a trauma centre was a respiratory rate <10 or >20 breaths/minute or needing ventilatory support (DI = 0.24). The ED modifier with the strongest level of agreement was obtaining a 12-lead electrocardiogram following the primary and secondary survey for all older adults (DI = 0.01). Two trauma care modifiers failed to reach consensus agreement: transporting older patients with ground level falls to a trauma centre and activating the trauma team based solely on an age >=65 years. Conclusion: Using a modified Delphi process, an expert panel agreed upon 17 trauma care modifiers for older adults in the prehospital and ED phases of care. These modifiers may improve the delivery of senior-friendly trauma care and should be considered when developing local and national trauma guidelines.

Introduction: The Brain Injury Guidelines (BIG) stratifies complicated mild traumatic brain injury (mTBI) patients into 3 groups to guide hospitalization, neurosurgical consultation and repeat head-CT. BIG-1 patients could be managed safely without neurosurgical consultation or transfer. Systematic transfer to neurotrauma centers provide few benefits to this subgroup leading to overtriage. Similarly, unnecessary clinical and radiological follow-ups utilize significant health-care resources. Objective: to validate the safety and efficacy of the BIG for complicated mTBIs. Methods: We performed a multicenter historical cohort study in 3 level-1 trauma centers in Quebec. Patients ≥16 years old assessed in the Emergency Department (ED) with complicated mTBI between 2014 and 2017 were included. Patients with penetrating trauma, cerebral aneurysm or tumor were excluded. Clinical, demographic and radiological data, BIG variables, TBI-related death and neurosurgical intervention were collected using a standardized form. A second reviewer assessed all ambiguous files. Descriptive statistics, over- and under-triage were calculated. Results: A total of 342 patients’ records were assessed. Mean age was 63 ± 20,7 and 236 (69 %) were male. Thirty-five patients were classified under BIG-1 (10.2%), 110 under BIG-2 (32.2%) and 197 under BIG-3 (57.6%). Twenty-six patients (7%) required neurosurgical intervention, all were BIG-3. 90% of TBI-related deaths occurred in BIG-3 and none were classified BIG-1. Among the 192 transfers (51%), 14 were classified under BIG-1 (7.3%) and should not have been transferred according to the guidelines and 50 under BIG-2 (26%). In addition, 40% of BIG-1 received a repeat head computed tomography, although not indicated. Similarly, 7 % of all patients had a neurosurgical consult even if not required. Projected implementation of BIG would lead to 47% of overtriage and 0.3% of undertriage. Conclusion: Our results suggest that the Brain Injury Guidelines could safely identify patients with negative outcomes and could lead to a safe and effective management of complicated mTBI. Applying these guidelines to our cohort could have resulted in significantly fewer repeat head CTs, neurosurgical consults and transfers to level 1 neurotrauma centers.

Places such as Poverty Point, Mound City, and Chaco Canyon remind us that the siting of ritual infrastructure in ancient North America was a matter of cosmological precedent. The cosmic gravity of these places gathered persons periodically in numbers that challenged routine production. Ritual economies intensified, but beyond the material demands of hosting people, the siting of these places and the timing of gatherings were cosmic work that preconfigured these outcomes. A first millennium AD civic-ceremonial center on the northern Gulf Coast of Florida illustrates the rationale for holding feasts on the end of a parabolic dune that it shared with an existing mortuary facility. Archaeofauna from large pits at Shell Mound support the inference that feasts were timed to summer solstices. Gatherings were large, judging from the infrastructure in support of feasts and efforts to intensify production through oyster mariculture and the construction of a large tidal fish trap. The 250-year history of summer solstice feasts at Shell Mound reinforces the premise that ritual economies were not simply the amplification of routine production. It also suggests that the ecological potential for intensification was secondary to the cosmic significance of solstice-oriented dunes and their connection to mortuary and world-renewal ceremonialism.

An asymmetric body with a sharp leading edge and a rounded trailing edge produces a smaller wave disturbance moving forwards than backwards, and this is reflected in the wave drag coefficient. This experimental fact is not captured by Michell’s theory for wave drag (Michell Lond. Edinb. Dubl. Phil. Mag. J. Sci., vol. 45 (272), 1898, pp. 106–123). In this study, we use a tow-tank experiment to investigate the effects of asymmetry on wave drag, and show that these effects can be replicated by modifying Michell’s theory to include the growth of a symmetry-breaking boundary layer. We show that asymmetry can have either a positive or a negative effect on drag, depending on the depth of motion and the Froude number.

Introduction: Incentive spirometry (IS) is commonly used in post-operative patients for respiratory recovery. Literature suggest that it can possibly improve lung function and reduce post-operative pulmonary complication. There is no recommendation about the use of IS in the emergency department (ED). However, rib fractures, a common complaint, increase the risk of pulmonary complications. There is heterogeneous ED practice for the management of rib fractures. The objective of this study is to assess the benefits of IS to reduce potential delayed complications in ED discharged patients with confirmed rib fracture. Methods: This is a prospective observational planned sub-study in 4 canadians ED between November 2006 and May 2012. Non-admitted patients over 16 y.o. with a main complaint of minor thoracic injury and at least one suspected/confirmed rib fracture on radiographs were included. Discharge recommendations of IS use was left to attending physician. IS training was done by ED nurses. Main outcomes were pneumonia, atelectasis and hemothorax within 14 days. Analyses were made with propensity score matching. Results: 450 patients with at least one rib fracture were included. Of these, 182 (40%) received IS with a mean age of 57.0 y.o. Patients with IS seem to have worse condition. 61 (33.5%) had 3 fractures comparatively to 56 (20.9) for patient without IS. Although, the groups were similar for mean age, sex and mechanism of injury. There were in total 76 cases of delayed hemothorax (16.9%), 69 cases of atelectasis (15.3%) and five cases of pneumonia (1.1%). The use of IS was not protector for delayed hemothorax (RR= 0.80, 95% CI [0.45 1.36]) and nor for atelectasis or pneumonia (RR=0.74, 95% CI [0.45 1.36]) Conclusion: Our results suggest that unsupervised and broad incentive spirometry use does not seem to add a protective effect against the development of delayed pulmonary complications after a rib fracture. Further study should be made to assess the usefulness of IS in specific injured population in the ED.

ENTRAP comprises a pan-European cooperation of leading scientific institutions and regulatory bodies in the field of nuclear-waste characterization and its quality assurance for the safe disposal of radioactive waste. Here, the scope of this cooperation is presented and explained and links or interfaces for a potential collaboration with partners fulfilling tasks of IDG-TP are pursued.

Introduction: Delirium is a very prevalent cognitive impairment in elderly inpatients, but it often goes undetected, especially in the emergency department (ED). The tools currently available to screen or diagnose patients at risk of delirium are very time-consuming and are impossible to systematically perform in the ED environment. For this reason, short tests are necessary to screen for delirium in this fast-paced setting. The objective of this study was to evaluate the performance of the French version of the Rapid Assessment Test for Delirium (4AT) for the detection of delirium and cognitive impairment in older patients. The 4AT takes less than 2 minutes to administer, which is a great advantage on the others tests. Methods: The study was conducted in four emergency departments across the province of Québec. Participants were independent or semi-independent patients aged 65 and older, admitted to hospital and who had an 8-hour exposure to the ED. The Telephone Interview for Cognitive Status (TICS) was administered at the initial interview and the Confusion Assessment Method (CAM) as well as the 4AT were administered to patients twice a day during their ED or hospital stay. The 4AT’s sensitivity and specificity were compared to that of the CAM (for delirium), and to that of the TICS (for cognitive impairment). Results: 324 patients were included in the study, with a mean age of 76 years old. Among the recruited participants, 21 (6.5%) had a prevalent delirium according to the CAM, and 30 (10.2%) had an incident delirium. According to the 4AT, 48 patients (14.9%) had cognitive impairment and 81 (25.2%) had a prevalent delirium. According to the TICS, 87 patients (29.2%) have cognitive impairment. The 4AT has a sensitivity of 68,4% (IC 95% : 47,5-89,3) and a specificity of 73.2% (IC 95% : 67,8-78,7) for delirium, and a sensitivity of 50% (IC 95% : 35,9-64,1) and a specificity of 87,0% (IC 95% : 81,2-92) for cognitive impairment. Conclusion: The French Version of the 4AT could be a fast and reliable screening tool for delirium and cognitive impairment in ED. Further research is necessary for its validation in the ED.

Introduction: Cognitive dysfunction is getting more common in geriatric emergency department (ED) patients, as the number of seniors visiting our EDs is increasing. ED guidelines recommend a systematic mental status screening for seniors presenting to the ED. As the existing tools are not suitable for the busy ED environment, we need quicker and easier ways to assess altered mental status, such as the O3DY. The purpose of this study is to assess the effectiveness of the French version of the O3DY to screen for cognitive dysfunction in seniors presenting to the ED. Methods: This is a planned sub-study of the INDEED project, which was conducted between February and May 2016 in 4 hospitals across the province of Québec. Inclusion criteria were: patients aged ≥65, with an 8-hour ED stay, admitted on a care unit, independent or semi-independent in their activities of daily living. Exclusion criteria were: patient living in a long-term nursing facility, with an unstable medical condition, pre-existing psychiatric condition or severe dementia, a delirium within the 8-hour exposure to the ED. A trained research assistant collected the following data upon initial interview: socio-demographic information, cognitive assessment (TICS-m), functional assessment (OARS) and delirium screening (CAM). The O3DY was also administered at initial interview and during patient follow-ups, as well as the CAM. Results: This study population was composed of 305 participants, of which 47.7% were men. Mean age was 76 years old (SD: 10.8). Nine of these participants had a previous history of dementia. 151 of these participants (47,04%) had a negative O3DY and 154 (47,98%) a positive O3DY at the initial encounter. When compared to the CAM, the O3DY presents a sensitivity of 85.0% (95% CI [62.1, 96.8]) and a specificity of 57.7% (95% CI [51.8, 63.6]) for prevalent delirium. When compared to the TICS, the O3DY presents a sensitivity of 76.7% (95% CI [66.4, 85.2]) and a specificity of 68.1% (95% CI [61.3, 74.3]) for cognitive impairment. The combined measure presents a sensitivity of 76.7% (95% CI [66.6, 84.9]) and a specificity of 68.4% (95% CI [61.7, 74.5]). Conclusion: A negative result to the O3DY indicates the absence of prevalent delirium or undetected cognitive impairment. The O3DY could be a useful tool for the triage nurses in the ED.

Introduction: Rib fractures represent a frequent condition associated with Minor Thoracic Injury (MTI). Since the last decade, ultrasound have become an important part of emergency physician’s (EP) daily practice, and its applications have become numerous. The main objective of this study was to evaluate the feasibility of Emergency Department Targeted Ultrasound (EDTU) for rib fracture diagnosis in patients with MTI. Secondary objectives were to 1) evaluate patients’ pain during the EDTU procedure, 2) assess clinicians’ degree of certitude over rib fracture diagnosis made by EDTU, 3) identify the limitations of the use of EDTU technique, and 4) compare the diagnosis obtained with EDTU to radiography results. Methods: Adult patients who presented with clinical suspicion of rib fractures after MTI were included. All patients underwent EDTU performed by emergency physicians (EP) prior to a rib view X-ray. Visual Analogue Scale (VAS) ranging from 0 to 100 was used to ascertain feasibility, patients’ pain and clinicians’ degree of certitude. Feasibility was defined as a score of more than 50 on the VAS. We also documented the radiologists’ interpretation of rib view X-ray. Radiologists were blinded to the EDTU results. Results: Ninety-six patients were included. A majority (65%) of EP concluded that the EDTU technique to diagnose rib fracture was feasible (VAS score > 50). Median score for feasibility was 63. Median score was 31 (Interquartile range (IQR) 5-57) for patients’ pain related to the EDTU examination and 72 (IQR 32-92) for the degree of certitude over the diagnosis made by EDTU. The main limiting factor of the EDTU technique was pain during patient examination (15%). Conclusion: EDTU examination appears to be a feasible technique for rib fractures diagnosis in the ED.

Since the discovery of adipose-derived stem cells (ASCs), there have been high expectations of their putative clinical use. Recent advances support these expectations, and it is expected that the transition from pre-clinical and clinical studies to implementation as a standard treatment modality is imminent. However ASCs must be isolated and expanded according to good manufacturing practice guidelines and a basic assurance of quality, safety, and medical effectiveness is needed for authorisation by regulatory agencies, such as European Medicines Agency and US Food and Drug Administration. In this review, a collection of studies investigating the influence of different steps of the isolation and expansion protocol on the yield and functionality of ASCs has been presented in an attempt to come up with best recommendations that ensure potential beneficial clinical outcome of using ASCs in any therapeutic setting. If the findings confirm the initial observations of beneficial effects of ASCs, the path is paved for implementing these ASC-based therapies as standard treatment options.

Since a few years, a new wind measurement instrument has been competing with standard cupanemometers: the LiDAR. The performances of this instrument over complex terrain are stilla matter of debate and this is mainly due to the flow homogeneity assumption made by theinstrument. In this work, the error caused by this hypothesis was evaluated with the helpof OpenFOAM 1.7, MeteoDyn WT 4.0 and WAsP Engineering for a LiDAR deployed on a complexsite covered with dense forest. The assessment of the CFD model firstly revealed thesignificant impact of both the location and nature of the inlet boundary condition.Despite the presence of terrain complexity within a radius of 340 m around the remotesensor, an averaged error of less than 3% was observed, suggesting that the LiDAR is onlyaffected by topographic variations in the immediate vicinity of the scanned volume.

The infiltration of dissolved dyes into vertically aligned carbon nanotube arrays (va-CNT) is reported. The ultra hydrophobic surface of the CNT forest can be wetted and hence infiltrated for an appropriate choice of solvent. The dye-infiltrated CNT array forms a well ordered bulk-heterojunction structure for organic solar cells in which the CNT can act as a large electrode or, for appropriate energy levels, as an acceptor material. Derivatives of the small molecule copper phthalocyanine or the polymer poly(3-hexylthiophene) were used as dyes. Drop coating was chosen as the infiltration technique resulting in a completely embedded CNT forest. Field emission secondary electron microscopy analysis illustrates the final layer quality. Common electrical characterization under AM1.5 illumination proves photosensitivity and implies photovoltaic behavior of the composite.

The Rank Forum on Vitamin D was held on 2nd and 3rd July 2009 at the University of Surrey, Guildford, UK. The workshop consisted of a series of scene-setting presentations to address the current issues and challenges concerning vitamin D and health, and included an open discussion focusing on the identification of the concentrations of serum 25-hydroxyvitamin D (25(OH)D) (a marker of vitamin D status) that may be regarded as optimal, and the implications this process may have in the setting of future dietary reference values for vitamin D in the UK. The Forum was in agreement with the fact that it is desirable for all of the population to have a serum 25(OH)D concentration above 25 nmol/l, but it discussed some uncertainty about the strength of evidence for the need to aim for substantially higher concentrations (25(OH)D concentrations>75 nmol/l). Any discussion of ‘optimal’ concentration of serum 25(OH)D needs to define ‘optimal’ with care since it is important to consider the normal distribution of requirements and the vitamin D needs for a wide range of outcomes. Current UK reference values concentrate on the requirements of particular subgroups of the population; this differs from the approaches used in other European countries where a wider range of age groups tend to be covered. With the re-emergence of rickets and the public health burden of low vitamin D status being already apparent, there is a need for urgent action from policy makers and risk managers. The Forum highlighted concerns regarding the failure of implementation of existing strategies in the UK for achieving current vitamin D recommendations.

The aim of this study was to observe the effects of treatment with a Trainer T4K® myofunc tional appliance of thirteen late mixed dentition patients. We conducted thorough clinical examinations that included assessment of breathing and swallowing capabilities and took profile cephalograms and study models for each one. We also selected a control group that had been treated only with palatal expansion so that we could distinguish the effects of myofunctional therapy from those of expansion. We observed significant mandibular growth (p<0.05) of 3.24 mm on the average and a significant decrease in overjet, essentially linked to dento-alveolar effects, in the Trainer T4K® group. Swallowing and breathing function also improved in these patients. The two groups had similar maxillary and mandibular expansion.

So we conclude that use of a Trainer T4K® myofunctional appliance results in improved antero-postero dental relationships and an improvement in oral functioning.

This prospective, multicentre study was conducted between September and October 2003 in 38 French departments of internal medicine, infectious disease and hepatogastroenterology and included 406 consecutive HBV-infected patients (positive HBsAg), half of whom were HIV-infected (53%). The aim was to outline the main characteristics of hepatitis B virus (HBV)-human immunodeficiency virus (HIV) co-infected patients in French hospitals. HBV-HIV co-infected patients (85% were receiving HAART; mean CD4 count 447±245/μl, HIV RNA load <400 copies/ml, 67% of patients), compared to HIV-negative patients, were more often male, injecting drug users, HBeAg-positive and HCV-HIV co-infected (P<10−4). They underwent liver biopsy less often (31% vs. 51%, P<10−4), particularly those with severe immunodeficiency. They received anti-HBV treatment more often (75% vs. 45·7%, P<10−4), mainly lamivudine and tenofovir. Significant improvements in the management of such patients are awaited mainly in the appraisal of liver disease by either liver biopsy or non-invasive alternatives to liver biopsy.