The night: a dangerous time to be born?

An analysis of perinatal mortality by hour of birth among 10,059 births in Canton Ticino (Switzerland) during the years 1979-1982 showed that fewer births occurred at night than during the day. The variations in number of births by hour of birth were attributed to obstetric practices. The perinatal mortality rate for night-time births was more than twice as high as that for the daytime births (+127%, P less than 0.001) and the rates for night-time births exceeded those for daytime births for 13 of the 19 causes of death examined. A higher proportion of the low and very-low-birthweight babies (less than 2500 g and less than 1500 g) were born at night between 19.00 and 06.59 hours.

L'Océan de Münsingen BE : une mosaïque entre l'air et l'eau

Les deux mosaïques bien connues des thermes de la villa de Münsingen ont été récemment restaurées et sont aujourd'hui exposées dans le parc d'une fabrique de la commune bernoise. C'est l'occasion de faire le point sur les fouilles entreprises autour du secteur de la découverte depuis 1941, confirmant ainsi l'existence d'une façade de villa de plus de 100 m, bordée par une aile saillante ou une annexe renfermant une zone thermale. Le frigidarium en est constitué d'une pièce d'accès à médaillon central avec tête d'Océan et d'une salle de bains à abside décorée de poissons et de dauphins. L'analyse des motifs amène à repérer au moins trois mains à l'oeuvre sur les pavements, reflétant les tendances de la seconde moitié du IIe siècle et du début du IIIe siècle apr. J.-C. Le maître d'atelier, sans doute installé à Avenches, s'est occupé d'Océan, centrant son discours sur son abondante chevelure d'où sortent deux monstres marins et deux dauphins, allégorie de l'Univers et de l'Empire romain.

Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?

BACKGROUND: The cause of acute exacerbation of chronic obstructive pulmonary disease (COPD) is often difficult to determine. Pulmonary embolism may be a trigger of acute dyspnoea in patients with COPD. AIM: To determine the prevalence of pulmonary embolism in patients with acute exacerbation of COPD. METHODS: 123 consecutive patients admitted to the emergency departments of two academic teaching hospitals for acute exacerbation of moderate to very severe COPD were included. Pulmonary embolism was investigated in all patients (whether or not clinically suspected) following a standardised algorithm based on d-dimer testing, lower-limb venous ultrasonography and multidetector helical computed tomography scan. RESULTS: Pulmonary embolism was ruled out by a d-dimer value <500 microg/l in 28 (23%) patients and a by negative chest computed tomography scan in 91 (74%). Computed tomography scan showed pulmonary embolism in four patients (3.3%, 95% confidence interval (CI), 1.2% to 8%), including three lobar and one sub-segmental embolisms. The prevalence of pulmonary embolism was 6.2% (n = 3; 95% CI, 2.3% to 16.9%) in the 48 patients who had a clinical suspicion of pulmonary embolism and 1.3% (n = 1; 95% CI, 0.3% to 7.1%) in those not suspected. In two cases with positive computed tomography scan, the venous ultrasonography also showed a proximal deep-vein thrombosis. No other patient was diagnosed with venous thrombosis. CONCLUSIONS: The prevalence of unsuspected pulmonary embolism is very low in patients admitted in the emergency department for an acute exacerbation of their COPD. These results argue against a systematic examination for pulmonary embolism in this population.

Should Koos grade I vestibular schwannomas be treated early with gamma knife surgery? A subgroup analysis in a series of 190 consecutive patients.

INTRODUCTION: Gamma knife surgery (GKS) for vestibular schwannomas (VS) has a long-term clinical and scientific track record. After a period of de-escalation of dose prescription, results show a high rate of tumor control with improvement of clinical outcome (less than 1% facial palsy, 50-70% hearing preservation). Régis et al. (J Neurosurg 2013;119 Suppl.:105-11) suggested recently that proactive GKS management in intracanalicular tumors is better than a « wait and see » strategy when hearing is still useful at the time of diagnosis. MATERIALS AND METHODS: Based on these previous findings, we prospectively analyzed 190 vestibular schwannomas (VS), treated with GKS as first intention over a period of 4 years (2010-2014). We concentrated on patient, tumor and dosimetric characteristics. Special attention was given on the dose to the cochlea and its impact in maintaining serviceable hearing. RESULTS: The mean follow-up period was 1.3years (range 0.6-3.6). Preoperative serviceable hearing was present in 63.11% patients. The mean maximal diameter was 15.1mm (range 5-29.5). The size and volume of the tumor corresponded to Koos grade I, II, III and IV in 15.9%, 34.8%, 45.4% and 3.8% of the cases, respectively. The mean target volume was 1.24cm(3) (0.017-7.8). The mean prescription isodose volume was 1.6 cc (0.032-8.5). The mean marginal dose was 12Gy (11-12). The mean maximal dose received by the cochlea in patients with GR class 1 and 2 was 4.1Gy (1.5-7.6). Our preliminary neuroradiological follow-up shows 97% tumor control, with 45% shrinkage. Patients presenting with GR class 1 and class 2 at baseline retained serviceable hearing in 85% of cases. Among the patients with a follow-up of at least one year, those with Koos I tumors had the highest probability to maintain identical level of hearing after GKS. CONCLUSION: Our preliminary data suggest that Koos I patients should be treated early with GKS, before tumor growth and/or hearing deterioration, as they have the highest probability of hearing preservation.

Can the impact of bed closure in intensive care units be reliably monitored?

OBJECTIVE: To assess the properties of various indicators aimed at monitoring the impact on the activity and patient outcome of a bed closure in a surgical intensive care unit (ICU). DESIGN: Comparison before and after the intervention. SETTING: A surgical ICU at a university hospital. PATIENTS: All patients admitted to the unit over two periods of 10 months. INTERVENTION: Closure of one bed out of 17. MEASUREMENTS AND RESULTS: Activity and outcome indicators in the ICU and the structures upstream from it (emergency department, operative theater, recovery room) and downstream from it (intermediate care units). After the bed closure, the monthly medians of admitted patients and ICU hospital days increased from 107 (interquartile range 94-112) to 113 (106-121, P=0.07) and from 360 (325-443) to 395 (345-436, P=0.48), respectively, along with the linear trend observed in our institution. All indicators of workload, patient severity, and outcome remained stable except for SAPS II score, emergency admissions, and ICU readmissions, which increased not only transiently but also on a mid-term basis (10 months), indicating that the process of patient care delivery was no longer predictable. CONCLUSIONS: Health care systems, including ICUs, are extraordinary flexible, and can adapt to multiple external constraints without altering commonly used activity and outcome indicators. It is therefore necessary to set up multiple indicators to be able to reliably monitor the impact of external interventions and intervene rapidly when the system is no longer under control.

Minimal requirements for parameters to be used for the development of predictive models for microbial source tracking. The example of the pair somatic coliphages and phages infecting Bacteroides

Several methods and approaches for measuring parameters to determine fecal sources of pollution in water have been developed in recent years. No single microbial or chemical parameter has proved sufficient to determine the source of fecal pollution. Combinations of parameters involving at least one discriminating indicator and one universal fecal indicator offer the most promising solutions for qualitative and quantitative analyses. The universal (nondiscriminating) fecal indicator provides quantitative information regarding the fecal load. The discriminating indicator contributes to the identification of a specific source. The relative values of the parameters derived from both kinds of indicators could provide information regarding the contribution to the total fecal load from each origin. It is also essential that both parameters characteristically persist in the environment for similar periods. Numerical analysis, such as inductive learning methods, could be used to select the most suitable and the lowest number of parameters to develop predictive models. These combinations of parameters provide information on factors affecting the models, such as dilution, specific types of animal source, persistence of microbial tracers, and complex mixtures from different sources. The combined use of the enumeration of somatic coliphages and the enumeration of Bacteroides-phages using different host specific strains (one from humans and another from pigs), both selected using the suggested approach, provides a feasible model for quantitative and qualitative analyses of fecal source identification.

Are there control processes, and (if so) can they be studied?

Generally, so-called control processes are thought to be necessary when we must perform one out of several competing actions. Some examples include performance of a less well-practiced action instead of a well-practiced one (prepotency); learning a new action (novelty); and rapidly switching from one action to another (task-switching). While it certainly is difficult to perform the desired action in these circumstances, it is less clear that a separate set of processes (e.g., control processes) are necessary to explain the observed behavior. Another way to approach the study of control processes is to investigate physiological dependent measures (e.g., electrophysiological or neuroimaging measures). Although these offer another avenue of inquiry into control processes, they have yet to furnish unambiguous evidence that control processes exist. While this might suggest that there are no control processes, it is also possible that our methods are insufficiently sensitive to measure control processes. We have investigated this latter possibility using tasks that are neuroanatomically distinct, though within the same modality (vision). This approach did not yield evidence for a separable set of control processes. However, recent works using a task-switching paradigm in which subjects switch between a visual and an auditory task suggest that switching both task and modality may be importantly different than switching task within a given modality. This may represent a way forward in the study of control processes.

Can a Halo CME from the limb be geoeffective?

The probability for a halo coronal mass ejection (CME) to be geoeffective is assumed to be higher the closer the CME launch site is located to the solar central meridian. However, events far from the central meridian may produce severe geomagnetic storms, like the case in April 2000. In this work, we study the possible geoeffectiveness of full halo CMEs with the source region situated at solar limb. For this task, we select all limb full halo (LFH) CMEs that occurred during solar cycle 23, and we search for signatures of geoeffectiveness between 1 and 5 days after the first appearance of each CME in the LASCO C2 field of view. When signatures of geomagnetic activity are observed in the selected time window, interplanetary data are carefully analyzed in order to look for the cause of the geomagnetic disturbance. Finally, a possible association between geoeffective interplanetary signatures and every LFH CME in solar cycle 23 is checked in order to decide on the CME's geoeffectiveness. After a detailed analysis of solar, interplanetary, and geomagnetic data, we conclude that of the 25 investigated events, there are only four geoeffective LFH CMEs, all coming from the west limb. The geoeffectiveness of these events seems to be moderate, turning to intense in two of them as a result of cumulative effects from previous mass ejections. We conclude that ejections from solar locations close to the west limb should be considered in space weather, at least as sources of moderate disturbances.

The Internet as an enhancer of the consumers' empowerment - A power to be managed by online firms?

Abstract.

Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference.

OBJECTIVE: Critically ill patients are at high risk of malnutrition. Insufficient nutritional support still remains a widespread problem despite guidelines. The aim of this study was to measure the clinical impact of a two-step interdisciplinary quality nutrition program. DESIGN: Prospective interventional study over three periods (A, baseline; B and C, intervention periods). SETTING: Mixed intensive care unit within a university hospital. PATIENTS: Five hundred seventy-two patients (age 59 ± 17 yrs) requiring >72 hrs of intensive care unit treatment. INTERVENTION: Two-step quality program: 1) bottom-up implementation of feeding guideline; and 2) additional presence of an intensive care unit dietitian. The nutrition protocol was based on the European guidelines. MEASUREMENTS AND MAIN RESULTS: Anthropometric data, intensive care unit severity scores, energy delivery, and cumulated energy balance (daily, day 7, and discharge), feeding route (enteral, parenteral, combined, none-oral), length of intensive care unit and hospital stay, and mortality were collected. Altogether 5800 intensive care unit days were analyzed. Patients in period A were healthier with lower Simplified Acute Physiologic Scale and proportion of "rapidly fatal" McCabe scores. Energy delivery and balance increased gradually: impact was particularly marked on cumulated energy deficit on day 7 which improved from -5870 kcal to -3950 kcal (p < .001). Feeding technique changed significantly with progressive increase of days with nutrition therapy (A: 59% days, B: 69%, C: 71%, p < .001), use of enteral nutrition increased from A to B (stable in C), and days on combined and parenteral nutrition increased progressively. Oral energy intakes were low (mean: 385 kcal*day, 6 kcal*kg*day ). Hospital mortality increased with severity of condition in periods B and C. CONCLUSION: A bottom-up protocol improved nutritional support. The presence of the intensive care unit dietitian provided significant additional progression, which were related to early introduction and route of feeding, and which achieved overall better early energy balance.

Combustibility of Paper Mill Rejects

Tämän työn tarkoituksena oli selvittää mekaanisen massan valmistuksen käsittävän paperitehtaan rejektija jätevirtojen poltettavuutta, jos paperitehtaan vesikiertojen sulkemisastetta lisätään. Jotta prosessin tilannetta sulkemisen jälkeen saatiin arvioitua, Anjalan paperitehtaan nykypäivän PK3:n prosessia tutkittiin kuorimolta jätevesilaitokselle. Kirjallisuusosassa käsiteltiin rejekti- ja jätevirtojen alkuperää mekaanista massaa käyttävässä paperitehtaassa. Myös tämän päivän jätevedenkäsittelyprosessit sekä sulkemisessa mahdolliset prosessiveden puhdistustekniikat esiteltiin lyhyesti. Lisäksikäytiin läpi nykypäivänä metsäteollisuudessa käytössä olevat polttotekniikat sekä polttoaineiden karakterisointi kattilan käytettävyyden ja päästöjen kannalta. Anjalan PK3:lla käytetään sekä peroksidi- että ditioniittivalkaistua tai pelkästään ditioniittivalkaistua hioketta riippuen tuotannossa olevasta lajista. PK3-prosessissa syntyneet jätevesi-, liete- ja muut jätevirrat selvitettiin molemmissa valkaisuolosuhteissa. Prosessin eniten liuennutta orgaanista ainesta sisältävät jätevesijakeet, 3-hiomon kuumankierron ja kirkassuodoksen ulosajot sekä kuoripuristimen suodos, valittiin puhdistettaviksi virroiksi prosessin sulkemista arvioitaessa. Kun peroksidivalkaisua käytettiin 3-hiomolla, TOC-kuorma jokeen oli 30 % suurempi kuin pelkällä ditioniittivalkaisulla. Jos prosessin sulkemisastetta lisättäisiin, TOC-kuorma olisi 30 %pienempi kuin tänäpäivänä peroksidivalkaisua käytettäessä (80 % puhdistustehokkuudella). Prosessin sulkemisastetta lisättäessä biolietettä muodostuisi n. 30 % vähemmän verrattuna nykytilanteeseen, sillä mikrobien ravintona käyttämää orgaanista ainesta päätyisi vähemmän jäteveteen. 3-hiomon peroksidivalkaisun vaikutus kattilan käytettävyyteen ja päästöihin oli pieni, sillä biolietteen osuus polttoaineen syötöstä oli vain 4 %. Vain osa biolietteestä muodostui 3-hiomolta peräisin olevaa orgaanista ainesta poistettaessa. Jos nykyisen pääpolttoaineen, PDF:n,osuuden jättää huomioimatta, SO2- ja NOx-päästöt sekä leijupedin sintrautuvuus ovat hiukan suuremmat käytettäessä peroksidivalkaisua 3-hiomolla kuin pelkästään ditioniittivalkaisulla. Jos kuoripuristimen ja hiomon suodosten puhdistuksen konsentraatit johdetaan poltettaviksi BFB-tyyppiseen kattilaan, leijupedin sintrautuminen tulisi olemaan suurin ongelma. Myös raskasmetalli-, SO2- ja NOx-päästöt lisääntyisivät merkittävästi verrattuna nykyiseen tilanteeseen. Sen sijaan kattilan korroosioriski tuskin lisääntyisi. Lisäksi konsentraattien kosteuspitoisuus olisi korkea, mikä tekisi poltosta kannattamatonta veden haihdutuksen vaatiessa paljon energiaa. Yksityiskohtaisempaa tutkimusta tarvitaan vielä prosessin sulkemisen vaikutuksista päästöihin ja kattilan käytettävyyteen. Myös muita konsentraattien hävittämismahdollisuuksia tulisi tutkia lisää.