2015 Update on Acute Adverse Reactions to Gadolinium based Contrast Agents in Cardiovascular MR. Large Multi-National and Multi-Ethnical Population Experience With 37788 Patients From the EuroCMR Registry.

OBJECTIVES: Specifically we aim to demonstrate that the results of our earlier safety data hold true in this much larger multi-national and multi-ethnical population. BACKGROUND: We sought to re-evaluate the frequency, manifestations, and severity of acute adverse reactions associated with administration of several gadolinium- based contrast agents during routine CMR on a European level. METHODS: Multi-centre, multi-national, and multi-ethnical registry with consecutive enrolment of patients in 57 European centres. RESULTS: During the current observation 37,788 doses of Gadolinium based contrast agent were administered to 37,788 patients. The mean dose was 24.7 ml (range 5-80 ml), which is equivalent to 0.123 mmol/kg (range 0.01 - 0.3 mmol/kg). Forty-five acute adverse reactions due to contrast administration occurred (0.12%). Most reactions were classified as mild (43 of 45) according to the American College of Radiology definition. The most frequent complaints following contrast administration were rashes and hives (15 of 45), followed by nausea (10 of 45) and flushes (10 of 45). The event rate ranged from 0.05% (linear non-ionic agent gadodiamide) to 0.42% (linear ionic agent gadobenate dimeglumine). Interestingly, we also found different event rates between the three main indications for CMR ranging from 0.05% (risk stratification in suspected CAD) to 0.22% (viability in known CAD). CONCLUSIONS: The current data indicate that the results of the earlier safety data hold true in this much larger multi-national and multi-ethnical population. Thus, the "off-label" use of Gadolinium based contrast in cardiovascular MR should be regarded as safe concerning the frequency, manifestation and severity of acute events.

Predictive ability of heel quantitative ultrasound for incident fractures: an individual-level meta-analysis.

UNLABELLED: The relationship between bone quantitative ultrasound (QUS) and fracture risk was estimated in an individual level data meta-analysis of 9 prospective studies of 46,124 individuals and 3018 incident fractures. Low QUS is associated with an increase in fracture risk, including hip fracture. The association with osteoporotic fracture decreases with time. INTRODUCTION: The aim of this meta-analysis was to investigate the association between parameters of QUS and risk of fracture. METHODS: In an individual-level analysis, we studied participants in nine prospective cohorts from Asia, Europe and North America. Heel broadband ultrasonic attenuation (BUA dB/MHz) and speed of sound (SOS m/s) were measured at baseline. Fractures during follow-up were collected by self-report and in some cohorts confirmed by radiography. An extension of Poisson regression was used to examine the gradient of risk (GR, hazard ratio per 1 SD decrease) between QUS and fracture risk adjusted for age and time since baseline in each cohort. Interactions between QUS and age and time since baseline were explored. RESULTS: Baseline measurements were available in 46,124 men and women, mean age 70 years (range 20-100). Three thousand and eighteen osteoporotic fractures (787 hip fractures) occurred during follow-up of 214,000 person-years. The summary GR for osteoporotic fracture was similar for both BUA (1.45, 95 % confidence intervals (CI) 1.40-1.51) and SOS (1.42, 95 % CI 1.36-1.47). For hip fracture, the respective GRs were 1.69 (95 % CI, 1.56-1.82) and 1.60 (95 % CI, 1.48-1.72). However, the GR was significantly higher for both fracture outcomes at lower baseline BUA and SOS (p < 0.001). The predictive value of QUS was the same for men and women and for all ages (p > 0.20), but the predictive value of both BUA and SOS for osteoporotic fracture decreased with time (p = 0.018 and p = 0.010, respectively). For example, the GR of BUA for osteoporotic fracture, adjusted for age, was 1.51 (95 % CI 1.42-1.61) at 1 year after baseline, but at 5 years, it was 1.36 (95 % CI 1.27-1.46). CONCLUSIONS: Our results confirm that quantitative ultrasound is an independent predictor of fracture for men and women particularly at low QUS values.

Impact of quality improvement tools on the performance of firms using different quality management systems

This study compares the impact of quality management tools on the performance of organisations utilising the ISO 9001:2000 standard as a basis for a quality-management system band those utilising the EFQM model for this purpose. A survey is conducted among 107 experienced and independent quality-management assessors. The study finds that organisations with qualitymanagement systems based on the ISO 9001:2000 standard tend to use general-purpose qualitative tools, and that these do have a relatively positive impact on their general performance. In contrast, organisations adopting the EFQM model tend to use more specialised quantitative tools, which produce significant improvements in specific aspects of their performance. The findings of the study will enable organisations to choose the most effective quality-improvement tools for their particular quality strategy

Qualitative, quantitative and temporal study of cutting agents for cocaine and heroin over 9 years

Forensic laboratories mainly focus on the qualification and the quantitation of the illicit drug under analysis as both aspects are used for judiciary purposes. Therefore, information related to cutting agents (adulterants and diluents) detected in illicit drugs is limited in the forensic literature. This article discusses the type and frequency of adulterants and diluents detected in more than 6000 cocaine specimens and 3000 heroin specimens, confiscated in western Switzerland from 2006 to 2014. The results show a homogeneous and quite unchanging adulteration for heroin, while for cocaine it could be characterised as heterogeneous and relatively dynamic. Furthermore, the results indicate that dilution affects more cocaine than heroin. Therefore, the results provided by this study tend to reveal differences between the respective structures of production or distribution of cocaine and heroin. This research seeks to promote the systematic analysis of cutting agents by forensic laboratories. Collecting and processing data related to the presence of cutting agents in illicit drug specimens produces relevant information to understand and to compare the structure of illicit drug markets.

RNA enrichment method for quantitative transcriptional analysis of pathogens in vivo applied to the fungus Candida albicans.

UNLABELLED: In vivo transcriptional analyses of microbial pathogens are often hampered by low proportions of pathogen biomass in host organs, hindering the coverage of full pathogen transcriptome. We aimed to address the transcriptome profiles of Candida albicans, the most prevalent fungal pathogen in systemically infected immunocompromised patients, during systemic infection in different hosts. We developed a strategy for high-resolution quantitative analysis of the C. albicans transcriptome directly from early and late stages of systemic infection in two different host models, mouse and the insect Galleria mellonella. Our results show that transcriptome sequencing (RNA-seq) libraries were enriched for fungal transcripts up to 1,600-fold using biotinylated bait probes to capture C. albicans sequences. This enrichment biased the read counts of only ~3% of the genes, which can be identified and removed based on a priori criteria. This allowed an unprecedented resolution of C. albicans transcriptome in vivo, with detection of over 86% of its genes. The transcriptional response of the fungus was surprisingly similar during infection of the two hosts and at the two time points, although some host- and time point-specific genes could be identified. Genes that were highly induced during infection were involved, for instance, in stress response, adhesion, iron acquisition, and biofilm formation. Of the in vivo-regulated genes, 10% are still of unknown function, and their future study will be of great interest. The fungal RNA enrichment procedure used here will help a better characterization of the C. albicans response in infected hosts and may be applied to other microbial pathogens. IMPORTANCE: Understanding the mechanisms utilized by pathogens to infect and cause disease in their hosts is crucial for rational drug development. Transcriptomic studies may help investigations of these mechanisms by determining which genes are expressed specifically during infection. This task has been difficult so far, since the proportion of microbial biomass in infected tissues is often extremely low, thus limiting the depth of sequencing and comprehensive transcriptome analysis. Here, we adapted a technology to capture and enrich C. albicans RNA, which was next used for deep RNA sequencing directly from infected tissues from two different host organisms. The high-resolution transcriptome revealed a large number of genes that were so far unknown to participate in infection, which will likely constitute a focus of study in the future. More importantly, this method may be adapted to perform transcript profiling of any other microbes during host infection or colonization.

Nutritional behaviour and beliefs of ski-mountaineers: a semi-quantitative and qualitative study.

BACKGROUND: Endurance athletes are advised to optimize nutrition prior to races. Little is known about actual athletes' beliefs, knowledge and nutritional behaviour. We monitored nutritional behaviour of amateur ski-mountaineering athletes during 4 days prior to a major competition to compare it with official recommendations and with the athletes' beliefs. METHODS: Participants to the two routes of the 'Patrouille des Glaciers' were recruited (A, 26 km, ascent 1881 m, descent 2341 m, max altitude 3160 m; Z, 53 km, ascent 3994 m, descent 4090 m, max altitude 3650 m). Dietary intake diaries of 40 athletes (21 A, 19 Z) were analysed for energy, carbohydrate, fat, protein and liquid; ten were interviewed about their pre-race nutritional beliefs and behaviour. RESULTS: Despite belief that pre-race carbohydrate, energy and fluid intake should be increased, energy consumption was 2416 ± 696 (mean ± SD) kcal · day(-1), 83 ± 17 % of recommended intake, carbohydrate intake was only 46 ± 13 % of minimal recommended (10 g · kg(-1) · day(-1)) and fluid intake only 2.7 ± 1.0 l · day(-1). CONCLUSIONS: Our sample of endurance athletes did not comply with pre-race nutritional recommendations despite elementary knowledge and belief to be compliant. In these athletes a clear and reflective nutritional strategy was lacking. This suggests a potential for improving knowledge and compliance with recommendations. Alternatively, some recommendations may be unrealistic.

Pouvoir et genre en pentecôtisme : d'un « paradoxe » à l'autre. Analyse à partir d'une enquête quantitative suisse

A partir d'une étude quantitative de grande envergure des communautés religieuses menées en Suisse, ce chapitre analyse les positions d'autorité selon le genre en s'intéressant aux différents facteurs qui favorisent l'implication des femmes aux postes à responsabilité et en comparant les spécificités des communautés pentecôtistes aux autres communautés religieuses. Si les femmes constituent la majorité des fidèles pentecôtistes et 35% des salariés à temp partiel, seules 4% des communautés sont dirigés par une femme. Parmi les facteurs qui permettent aux femmes d'accéder à des postes à responsabilités, le nombre de salariés apparaît déterminant, car il permet d'inclure les femmes dans l'équipe pastorale sans bouleverser le leadership. En revanche, les variables théologiques n'ont pas d'incidence significative, la revendication d'une théologie conservatrice pouvant aller de pair avec la présence de femmes dans la hiérarchie ecclésiale. Au-delà du décalage supposé entre théorie et pratique, ce chapitre invite à s'interroger sur l'utilisation en sociologie des religions d'arguments théologiques qui ne sont pas forcément pertinent du point de vue sociologique.

La recherche. Méthodes : quantitative, qualitative, mixte.

La simulation sous ses différentes formes est devenue un outil incontournable dans la formation des professionnels de la santé. Il n'en demeure pas moins que la simulation intervient dans un environnement complexe où le comportement humain est une variable essentielle. Dans ce contexte, la recherche en simulation est indispensable : elle doit produire des connaissances qui nous permettent de mieux comprendre l'apprentissage par la simulation. Pour atteindre cet objectif, la recherche en simulation doit être aussi rigoureuse que toute recherche clinique, afin qu'elle puisse produire des connaissances de qualité. De par la complexité de l'environnement simulé, la recherche dans ce domaine est riche et recourt à des méthodes variées issues des sciences du comportement, de l'éducation et plus largement des sciences sociales.

Étude descriptive quantitative et corrélationnelle portant sur la perception de la qualité de vie des proches aidants de plus de 65 ans qui prennent soin d'un proche souffrant d'une problématique de démence

La problématique : En Suisse, même si l'on constate une longue tradition du modèle de famille pluri-générationnelle multi-locale (Tourollier, 2009), l'évolution démographique a pour effet le vieillissement des aidants (Anchisi, 2010). La société véhicule l'idée que trop de personnes en perte d'autonomie sont abandonnées par leurs familles et que celles-ci relèguent toutes leurs responsabilités à l'Etat. Selon Pitaud (2009), cette vision est erronée, car son étude démontre que les membres de la famille forment généralement le noyau de ce réseau d'aide qui permet leur maintien à domicile. Il s'agit, pour l'auteur, d'une solution à la fois humaine et économiquement acceptable. Le contexte global du vieillissement et de la possibilité de fragilisation psychique suggère qu'une meilleure prise en compte des besoins de l'entourage des personnes souffrants de problématique de démence peut améliorer leur qualité ainsi que celle des proches aidants (Thomas, 2005). But : Cette étude quantitative vise à décrire la perception qu'ont les proches aidants de leur propre qualité de vie incluant leur vulnérabilité. Méthode: Cette étude quantitative descriptive corrélationnelle a été effectuée auprès de 30 proches aidants, recrutés selon un échantillonnage non probabiliste. Pour les corrélations exploratoires, des tests de Pearson, Student, Wilcoxon ou Mann Whitney ont été effectués. Le questionnaire proposé est tiré des études Pixel et il contient des données sociodémographiques, quatre dimensions portant sur la qualité de vie perçue ainsi que deux dimensions sur la vulnérabilité. Résultats: L'âge moyen des proches aidants participant est de 77,47 ans (ÉT 4,74). Les résultats montrent que 40% d'entre eux sont impliqués dans l'aide auprès du malade depuis plus de cinq ans. La plus grande partie a un niveau de formation de type maîtrise professionnelle (70%). Le score moyen de la perception de la qualité de vie (max. 105 points) est de 63.20 (ÉT 10.25). La vulnérabilité perçue est divisée en deux dimensions (max 50 points par partie). Pour la dimension 1 ; la moyenne pour l'impact de la maladie est de 29.00 (ÉT 5.63). Pour la dimension 2 ; la moyenne de l'aggravation de la vulnérabilité, est de 34.26 (ÉT 10.25). Des corrélations exploratoires montrent que l'âge, la durée des soins, le genre sont associées avec une diminution de la qualité de vie ou l'aggravation de la vulnérabilité perçue. Conclusion : Malgré les limites de la présente étude qui sont liées à la petitesse de l'échantillon, les résultats sont conciliables avec les écrits antérieurs. Il serait judicieux de poursuivre des recherches sur ce sujet afin d'approfondir et d'affiner les représentations utiles au renforcement du rôle infirmier auprès des proches aidants d'une part et des autres professionnels du réseau de soin d'autre part, ceci dans le but de favoriser la promotion de la santé auprès des proches aidants qui sont un maillon indispensable dans la chaîne des soins.

Objective assessment of low contrast detectability in computed tomography with Channelized Hotelling Observer.

PURPOSE: Iterative algorithms introduce new challenges in the field of image quality assessment. The purpose of this study is to use a mathematical model to evaluate objectively the low contrast detectability in CT. MATERIALS AND METHODS: A QRM 401 phantom containing 5 and 8 mm diameter spheres with a contrast level of 10 and 20 HU was used. The images were acquired at 120 kV with CTDIvol equal to 5, 10, 15, 20 mGy and reconstructed using the filtered back-projection (FBP), adaptive statistical iterative reconstruction 50% (ASIR 50%) and model-based iterative reconstruction (MBIR) algorithms. The model observer used is the Channelized Hotelling Observer (CHO). The channels are dense difference of Gaussian channels (D-DOG). The CHO performances were compared to the outcomes of six human observers having performed four alternative forced choice (4-AFC) tests. RESULTS: For the same CTDIvol level and according to CHO model, the MBIR algorithm gives the higher detectability index. The outcomes of human observers and results of CHO are highly correlated whatever the dose levels, the signals considered and the algorithms used when some noise is added to the CHO model. The Pearson coefficient between the human observers and the CHO is 0.93 for FBP and 0.98 for MBIR. CONCLUSION: The human observers' performances can be predicted by the CHO model. This opens the way for proposing, in parallel to the standard dose report, the level of low contrast detectability expected. The introduction of iterative reconstruction requires such an approach to ensure that dose reduction does not impair diagnostics.

Integrating quantitative proteomics and metabolomics in a cellular model of diabetic retinopathy

Diabetic retinopathy is the leading cause of visual loss in individuals under the age of 55. Most investigations into the pathogenesis of diabetic retinopathy have been concentrated on the neural retina since this is where clinical lesions are manifested. Recently, however, various abnormalities in the structural and secretory functions of retinal pigment epithelium that are essential for neuroretina survival, have been found in diabetic retinopathy. In this context, here we study the effect of hyperglycemic and hypoxic conditions on the metabolism of a human retinal pigment epithelial cell line (ARPE-19) by integrating quantitative proteomics using tandem mass tagging (TMT), untargeted metabolomics using MS and NMR, and 13C-glucose isotopic labeling for metabolic tracking. We observed a remarkable metabolic diversification under our simulated in vitro hyperglycemic conditions of diabetes, characterized increased flux through polyol pathways and inhibition of the Krebs cycle and oxidative phosphorylation. Importantly, under low oxygen supply RPE cells seem to consume rapidly glycogen storages and stimulate anaerobic glycolysis. Our results therefore pave the way to future scenarios involving new therapeutic strategies addressed to modulating RPE metabolic impairment, with the aim of regulating structural and secretory alterations of RPE. Finally, this study shows the importance of tackling biomedical problems by integrating metabolomic and proteomics results.