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The long-term prospective multi-centre nationwide (French) observational study FRANCISCO will provide new information on perimembranous ventricular septal defect with left ventricular overload but no pulmonary hypertension in children older than 1 year. Outcomes will be compared according to treatment strategy (watchful waiting, surgical closure, or percutaneous closure) and anatomic features of the defect. The results are expected to provide additional guidance about the optimal treatment of this specific population, which is unclear at present.
The climate in central Europe during the last 60 ka is characterized by rapid temperature and moisture changes and strong cold periods (Heinrich events). All these variations are preserved in sediments of marine and also some terrestrial archives. Here we present a continuous, terrestrial sediment record with almost all Greenland stadials and Heinrich events between 60 and 13 ka visible from carbonate roundness of the Eifel Laminated Sediment Archive Dust Stack-20 and CaCO3 data for central Europe. The carbonate roundness data show almost all stadials between 60 and 13 ka. CaCO3 data show a general transport system change with the beginning of Heinrich event 3. Since there are no carbonates west of the Auel Maar, we conclude that the eolian-transported grains were not transported by westerly but easterly winds. These postulated easterly winds during the last glacial maximum are supported by similar findings of previous works.
Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19.
This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis.
In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9–59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1–11.4), an affective disorder (OR 4.1; CI 1.6–10.9), and severe respiratory symptoms (OR 4.6; CI 2.2–9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1–0.9) predicted a lower risk of a confusional state.
COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders.
The last 85,000 years were characterized by high climate and environmental variability on the Yucatán Peninsula. Heinrich stadials are examples of abrupt climate transitions that involved shifts in regional temperatures and moisture availability. Thus, they serve as natural experiments to evaluate the contrasting responses of aquatic and terrestrial ecosystems. We used ostracodes and pollen preserved in a 75.9-m-long sediment core (PI-6, ~85 ka) recovered from Lake Petén Itzá, Guatemala, to assess the magnitude and velocity of community responses. Ostracodes are sensitive to changes in water temperature and conductivity. Vegetation responds to shifts in temperature and the ratio of evaporation to precipitation. Ostracodes display larger and more rapid community changes than does vegetation. Heinrich Stadial 5-1 (HS5-1) was cold and dry and is associated with lower ostracode and vegetation species richness and diversity. In contrast, the slightly warmer and dry conditions during HS6 and HS5a are reflected in higher ostracode species richness and diversity. Our paleoecological study revealed the greatest ecological turnover for ostracodes occurred from 62.5 to 51.0 ka; for pollen, it was at the Pleistocene/Holocene transition. Future studies should use various climate and environmental indicators from lake and marine sediment records to further explore late glacial paleoclimate causes and effects in the northern neotropics.
During glacial times, the North Atlantic region was affected by serious climate changes corresponding to Dansgaard-Oeschger cycles that were linked to dramatic shifts in sea temperature and moisture transfer to the continents. However, considerable efforts are still needed to understand the effects of these shifts on terrestrial environments. In this context, the Iberian Peninsula is particularly interesting because of its close proximity to the North Atlantic, although the Iberian interior lacks paleoenvironmental information so far because suitable archives are rare. Here we provide an accurate impression of the last glacial environmental developments in central Iberia based on comprehensive investigations using the upper Tagus loess record. A multi-proxy approach revealed that phases of loess formation during Marine Isotope Stage (MIS) 2 (and upper MIS 3) were linked to utmost aridity, coldness, and highest wind strengths in line with the most intense Greenland stadials also including Heinrich Events 3–1. Lack of loess deposition during the global last glacial maximum (LGM) suggests milder conditions, which agrees with less-cold sea surface temperatures (SST) off the Iberian margin. Our results demonstrate that geomorphological system behavior in central Iberia is highly sensitive to North Atlantic SST fluctuations, thus enabling us to reconstruct a detailed hydrological model in relation to marine–atmospheric circulation patterns.
New IRSL ages of eolianites close to Muñique (Lanzarote) demonstrate the influence of millennial scale climatic variability on the sedimentary dynamics on the Canary Islands during the last glacial cycle. The repetitive succession of interstadial and stadial climatic conditions formed multiple sequences of eolian deposits, each in general comprising three depositional types. DepoType 1 and DepoType 2 consist mainly of marine biogenic carbonate detritus with small amounts of dust from the Sahara representing interstadial conditions. DepoType 2 compared to DepoType 1 is characterized by larger amounts of land snails and calcified brood cells. A DepoType 3 rich in dust from African subtropical/tropical Latisols terminates a sequence. IRSL dating on DepoType 3 type deposits clearly shows that these were deposited during Heinrich Events under stadial conditions. The stadial cooling of the North Atlantic Ocean caused a southern shift of climate zones that culminated during Heinrich Events when the arctic climate reaches its most southerly extent. As a consequence, atmospheric changes led to massive dust supply from the then-dry Sahel. The increase in dust and precipitation from the dry DepoTypes 1 to the more humid DepoTypes 3 originates from a modified atmospheric dynamic during a millennial cycle.
This study examines the first precisely dated and temporally highly resolved speleothem record from Iberia that reconstructs the Oldest Dryas (OD). The onset of cold conditions in the study area, contemporary with the beginning of Heinrich Stadial 1, is recorded at 18.13 ± 0.08 ka, with a pronounced drop of 6.1‰ in δ13C in 250 years. Henceforth, stadial conditions depict a period of instability in the Atlantic Meridional Overturning Circulation, peaking in freshwater input from iceberg melting during Heinrich Event 1. Anomalies in the δ18O of the stalagmite attributed to such a freshwater event are found from 16.17 to 15.89 ka. Such absolute dates given to the onset of the OD in Iberia and to the main iceberg discharges are reliable anchor points for non-absolute chronologies. Two periods are identified in the OD: OD-a (18.13–16.17 ka) is characterized by wet conditions and a faster growth rate, and OD-b (15.89–14.81 ka) exhibits relative dryness and a slower growth rate. The sudden release of fresh water is considered to be the reason for the disruption of rainfall patterns in eastern Iberia. The present study also highlights the existence of heterogeneous and complex hydrological conditions during the OD in Iberia when both Atlantic and Mediterranean realms are considered.
During each Heinrich stadial (HS), temperatures in southern Europe typically dropped several degrees during several hundred to few thousand years. We have developed a one-dimensional thermal conduction model that transfers the typical surface temperature anomaly of a HS to a series of hypothetical underlying caves. The results show that with increasing depth, the thermal anomaly is attenuated, the lag time increases, and the signal structure experiences larger modifications. The model suggests that in most cases, it is not acceptable to assume a synchronous thermal variability and similar average temperature values between the surface atmosphere and the cave interior at millennial timescales. We also simulated the thermal impact of the modeled HS on speleothem δ18O records. The outputs of most model scenarios suggest that temperature changes associated with the HS produce δ18O anomalies capable of contributing significantly or even decisively to the speleothem isotope variability. Therefore, despite controls other than temperature often being considered more important when interpreting Pleistocene speleothem δ18O records in temperate climates, this research suggests that temperature is expected to be one of the major controls of δ18O values in most cave sites outside the tropics and should be included as a significant parameter affecting Pleistocene speleothem δ18O records.
Recent European Society of Parenteral and Enteral Nutrition guidelines highlighted the interest of prevention, diagnosis and treatment of malnutrition in the management of coronavirus disease 19 (COVID-19) patients. The aim of our study was to evaluate the prevalence of malnutrition in patients hospitalised for COVID-19. In a prospective observational cohort study malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) two-step approach. Patients were divided into two groups according to the diagnosis of malnutrition. Covariate selection for the multivariate analysis was based on P <0·2 in univariate analysis, with a logistic regression model and a backward elimination procedure. A partitioning of the population was realised. Eighty patients were prospectively enrolled. Thirty patients (37·5 %) had criteria for malnutrition. The need for intensive care unit admission (n 46, 57·5 %) was similar in the two groups. Three patients who died (3·75 %) were malnourished. Multivariate analysis exhibited that low BMI (OR 0·83, 95 % CI 0·73, 0·96, P = 0·0083), dyslipidaemia (OR 29·45, 95 % CI 3·12, 277·73, P = 0·0031), oral intake reduction <50 % (OR 3·169, 95 % CI 1·04, 9·64, P = 0·0422) and glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration; CKD-EPI) at admission (OR 0·979, 95 % CI 0·96, 0·998, P = 0·0297) were associated with the occurrence of malnutrition. We demonstrate the existence of a high prevalence of malnutrition in a general cohort of COVID-19 inpatients according to GLIM criteria. Nutritional support in COVID-19 care seems an essential element.
The ocean floor sedimentological signature of Heinrich event 3 (H3) is markedly different from that of other Heinrich events that are known to have originated in Hudson Strait. It has therefore been suggested that the H3 contribution to iceberg flux may have been delivered by ice streams located in the eastern sector of the North Atlantic, from the Fennoscandian or British Isles ice sheets. To investigate this possibility and whether the instability involved may have been tidally induced, as seems to have been the case for H1, we consider several eastern Atlantic sector possibilities: a hypothetical Barents Sea ice stream, the Norwegian ice stream, and the Irish Sea ice stream. We find that the extremely high amplitude of the M2 tidal constituent in the western North Atlantic that appears to have forced H1 did not exist in the northeastern Atlantic. This suggests that, with one possible exception, if destabilized ice streams in this region did contribute to H3, tidal forcing was most probably not the cause. The single exception to this general conclusion may be the Irish Sea ice stream, and we comment on the probability of a contribution to H3 from this source.
Depression and anxiety are two very common psychiatric disorders in late-life. They are markers of poor quality of life and are strongly associated with death among older people. Yet, few studies on these comorbidities have been conducted in the African population. This study aims to present the epidemiology of depression and anxiety among older people in Central Africa.
A cross-sectional population-based study was carried out in Republic of Congo (ROC) and Central African Republic (CAR) between 2011 - 2012 among older people aged ? 65 years (EPIDEMCA study). Data were collected using a standardized questionnaire and participants underwent a brief physical examination. Depression and anxiety symptoms were ascertained using a community version of the Geriatric Mental State (GMS-B3) and the Automated Geriatric Examination for Computer Assisted Taxonomy diagnostic system (AGECAT), probable cases were defined as having a GMS-AGECAT level of 3 or more. Logistic regression models were used to investigate the association between potential risk factors collected and each symptom.
Overall 2002 participants were included in the EPIDEMCA study (500 in Brazzaville and 529 in Gamboma in ROC, 500 in Bangui and 473 in Nola (473) in CAR). Median age of the participants was 72 years [interquartile range: 68 – 78 years] and females were mostly represented (61.8%). Prevalence was 38.1% (95% Confidence Interval: 35.9% - 40.2%) for depression, 7.7% (95% CI: 6.5% - 8.9%) for anxiety and 5.7% (95% CI: 4.6% - 6.7%) for the co-occurrence of both disorders. For all three outcomes, prevalence was significantly higher among females and in rural areas. Only depression increased with age. Preliminary analyses showed that female sex, living in a rural area, and living without a partner were associated with the three outcomes (Odds Ratios from 1.59 to 3.27; p<0.01). In-depth results regarding correlates of depression, anxiety and the co-occurrence of both will be presented.
The prevalence of depression and anxiety was high among Central African older people. Evidence on the epidemiology of these common psychiatric symptoms are of importance for care management and also emphasize the need to maintain and/or strengthen social support around older people in the region.
High-temperature scanning electron microscopy allows the direct study of the temperature behavior of materials. Using a newly developed heating stage, tilted images series were recorded at high temperature and 3D images of the sample surface were reconstructed. By combining 3D images recorded at different temperatures, the variations of material roughness can be accurately described and associated with local changes in the topography of the sample surface.
Equivalence scales, used to compare incomes across household types, strongly influence which households have low reported income, affecting public policy priorities. Yet they draw on abstract, often dated evidence and arbitrary judgements, and on comparisons across the income distribution rather than focusing on minimum requirements. Budget standards provide more tangible comparisons of the minimum required by different household types. The Minimum Income Standard (MIS) method, now established in several countries, applies a common methodological framework for compiling budgets, based on public deliberations. This article draws for the first time on results across countries. In all of the four countries examined, it identifies an under-estimation by the OECD scale of the relative cost of children compared to adults, and, in three of the four, an under-estimation of the cost of singles compared to couples. This more systematically corroborates previous, dispersed evidence, and helps explain which specific expenditure categories influence these results. These results have high policy relevance, showing greater proportions of low income households to contain children than standard income distribution data. While no single equivalence scale can be universally accurate, making use of evidence based directly on benchmarks such as MIS can help inform public priorities in tackling low income.
One of the ways of human parasitic infection is the accidental ingestion of vegetables contaminated with parasites, which represents a major human health hazard. This non-exhaustive review aims to evaluate studies carried out on five types of vegetables (lettuce, parsley, coriander, carrot and radish) since 2000, particularly the methods used for recovery, concentration, detection and identification of protozoan parasites such as Toxoplasma gondii, Giardia duodenalis and Cryptosporidium spp., and the results of each work. Various studies have determined the presence of pathogenic parasites in fresh vegetables with different rates; this variation in rate depends particularly on the detection method used which is related to each parasite and each vegetable type. The variation in parasitic prevalence in food could be due to different factors such as the geographical location, the size of analysed samples and the methods used for parasite detection.
As they evolve, white dwarfs undergo major changes in their atmospheric composition, a phenomenon known as spectral evolution. In particular, most hot He-rich (DO) stars transform into H-rich (DA) stars as they cool off, most likely as a result of the float-up of residual H. We investigate this DO-to-DA transition by taking advantage of the extensive spectroscopic dataset provided by the Sloan Digital Sky Survey (SDSS). Using our new state-of-the-art non-LTE model atmospheres, we perform a spectroscopic analysis of 1882 hot (Teff >30,000 K) white dwarfs identified in the SDSS. We find that at least 15% of all white dwarfs are born with a He-dominated atmosphere. Among these, ∼2/3 turn into H-rich stars before they reach Teff ∼40,000 K, while the remaining ∼1/3 maintain their He-rich surface throughout their entire evolution. We speculate on the origin of these two groups of objects.
Accurate real-time simulations and forecasting of phase-revolved ocean surface waves require nonlinear effects, both geometrical and kinematic, to be accurately represented. For this purpose, wave models based on a Lagrangian steepness expansion have proved particularly efficient, as compared to those based on Eulerian expansions, as they feature higher-order nonlinearities at a reduced numerical cost. However, while they can accurately model the instantaneous nonlinear wave shape, Lagrangian models developed to date cannot accurately predict the time evolution of even simple periodic waves. Here, we propose a novel and simple method to perform a Lagrangian expansion of surface waves to second order in wave steepness, based on the dynamical system relating particle locations and the Eulerian velocity field. We show that a simple redefinition of reference particles allows us to correct the time evolution of surface waves, through a modified nonlinear dispersion relationship. The resulting expressions of free surface particle locations can then be made numerically efficient by only retaining the most significant contributions to second-order terms, i.e. Stokes drift and mean vertical level. This results in a hybrid model, referred to as the ‘improved choppy wave model’ (ICWM) (with respect to Nouguier et al.’s J. Geophys. Res., vol. 114, 2009, p. C09012), whose performance is numerically assessed for long-crested waves, both periodic and irregular. To do so, ICWM results are compared to those of models based on a high-order spectral method and classical second-order Lagrangian expansions. For irregular waves, two generic types of narrow- and broad-banded wave spectra are considered, for which ICWM is shown to significantly improve wave forecast accuracy as compared to other Lagrangian models; hence, ICWM is well suited to providing accurate and efficient short-term ocean wave forecast (e.g. over a few peak periods). This aspect will be the object of future work.
Banked human milk (BHM) has inherent infectious risks, even when pasteurized. Because of the ubiquity of Bacillus cereus in the environment and its ability to resist the Holder pasteurization process, there is a concern that BHM might lead to severe B. cereus infections.
We reviewed observed and published cases to determine the potential causal role of BHM as the source of these infections.
Two infants in the province of Québec (Canada) developed a B. cereus neonatal infection, and both had received BHM. We conducted bacteriological studies to compare clinical isolates and those found in these cases.
After extended culture of BHM retention lots, B. cereus was found to have been involved in batches related to the first case. However, molecular typing showed that the strain was different from the clinical isolate, therefore excluding BHM as the source of contamination. In the second case, a Brevibacillus spp was isolated, a species distinct from the clinical isolate.
Based on these cases and others reported in the literature, a causal link between B. cereus contaminated BHM and preterm neonatal infection has never been documented. Therefore, the risk that BHM can cause this infection remains theoretical. Given the widespread presence of B. cereus in the hospital environment and its capacity to resist standard cleaning procedures, it seems likely that airborne or direct or indirect contact are the main sources of most, if not all, cases of severe B. cereus neonatal infections, even in babies exposed to BHM.
Three localities in the Çankırı Basin—Kale Tepe 1 (KT1), Kale Tepe 2 (KT2), and Mahmutlar—yielded reliably documented rodent and lagomorph assemblages. These are in the Akkaşdağı Formation, which covers large areas in the central and southern parts of this basin in Central Anatolia. The widening of the Kirikkale-Çorum highway produced fresh outcrops that allowed for the discovery of fossiliferous levels in a well-controlled stratigraphy. The assemblages from all three localities are dominated by muroid rodents (Apodemus gorafensis Ruiz Bustos et al., 1984; A. gudrunae van de Weerd, 1976; A. dominans Kretzoi, 1959; Micromys sp. indet.; Allocricetus sp. indet.; Pseudomeriones sp. indet.; Cricetidae gen. indet. sp. indet.; Mimomys sp. indet.) in addition to a glirid (Dryomimus cf. D. eliomyoides Kretzoi, 1959), an eomyid (Keramidomys aff. K. ermannorum Daxner-Höck and Höck, 2009), two ochotonids (Prolagus sorbinii Masini, 1989; Ochotonoma sp. indet.) and one leporid. KT1 and KT2 yielded two large species of Apodemus (A. gorafensis; A. gudrunae) that are typical for the late Miocene/early Pliocene transition in southern Europe, and they are known in Greece and Turkey in localities dated to the latest Miocene, i.e., MN 13 mammalian zone. The occurrence of A. dominans and a rooted arvicolid similar to Mimomys davakosi van de Weerd, 1979 suggests correlation of Mahmutlar to the early Pliocene, or early MN 15 zone. An abundance of muroid rodents in these assemblages indicates woodlands and areas covered by grasses and shrubs, whereas early Pliocene deposits at Mahmutlar provided pollen of abundant herbaceous and shrub elements. Most rodents and lagomorphs from Kale Tepe and Mahmutlar are known in southern European bioprovinces, whereas some elements (Pseudomeriones Schaub, 1934; Ochotonoma Sen, 1998) indicate Asiatic affinities.