[Local administration of amphotericin B by VAC instillation: Therapeutic aid in the treatment of mucormycosis]

Mucormycosis is a rare and serious fungal infection, occurring mainly in immunocompromised, diabetic, polytrauma or burn patients. Current standard treatments include iterative carcinological surgical trimming, systemic treatment with liposomal amphotericin B and second-line Posaconazole or Isavuconazole. We report the case of a 37-year-old female patient with no previous medical history who developed a disseminated mucormycosis, with an estimated 25 % loss of skin substance and major decay of the chest wall. In addition to standard treatment, local instillations of amphotericin B using the VAC Veraflow® system were performed. We believe that local instillations of amphotericin B by VAC could improve the functional prognosis of patients with skin involvement.

Dynamics of magnetization at infinite temperature in a Heisenberg spin chain

Understanding universal aspects of quantum dynamics is an unresolved problem in statistical mechanics. In particular, the spin dynamics of the one-dimensional Heisenberg model were conjectured as to belong to the Kardar-Parisi-Zhang (KPZ) universality class based on the scaling of the infinite-temperature spin-spin correlation function. In a chain of 46 superconducting qubits, we studied the probability distribution of the magnetization transferred across the chain's center, [Formula: see text]. The first two moments of [Formula: see text] show superdiffusive behavior, a hallmark of KPZ universality. However, the third and fourth moments ruled out the KPZ conjecture and allow for evaluating other theories. Our results highlight the importance of studying higher moments in determining dynamic universality classes and provide insights into universal behavior in quantum systems.

Stable quantum-correlated many-body states through engineered dissipation

Engineered dissipative reservoirs have the potential to steer many-body quantum systems toward correlated steady states useful for quantum simulation of high-temperature superconductivity or quantum magnetism. Using up to 49 superconducting qubits, we prepared low-energy states of the transverse-field Ising model through coupling to dissipative auxiliary qubits. In one dimension, we observed long-range quantum correlations and a ground-state fidelity of 0.86 for 18 qubits at the critical point. In two dimensions, we found mutual information that extends beyond nearest neighbors. Lastly, by coupling the system to auxiliaries emulating reservoirs with different chemical potentials, we explored transport in the quantum Heisenberg model. Our results establish engineered dissipation as a scalable alternative to unitary evolution for preparing entangled many-body states on noisy quantum processors.

Measurement-induced entanglement and teleportation on a noisy quantum processor

Measurement has a special role in quantum theory1: by collapsing the wavefunction, it can enable phenomena such as teleportation2 and thereby alter the 'arrow of time' that constrains unitary evolution. When integrated in many-body dynamics, measurements can lead to emergent patterns of quantum information in space-time3-10 that go beyond the established paradigms for characterizing phases, either in or out of equilibrium11-13. For present-day noisy intermediate-scale quantum (NISQ) processors14, the experimental realization of such physics can be problematic because of hardware limitations and the stochastic nature of quantum measurement. Here we address these experimental challenges and study measurement-induced quantum information phases on up to 70 superconducting qubits. By leveraging the interchangeability of space and time, we use a duality mapping9,15-17 to avoid mid-circuit measurement and access different manifestations of the underlying phases, from entanglement scaling3,4 to measurement-induced teleportation18. We obtain finite-sized signatures of a phase transition with a decoding protocol that correlates the experimental measurement with classical simulation data. The phases display remarkably different sensitivity to noise, and we use this disparity to turn an inherent hardware limitation into a useful diagnostic. Our work demonstrates an approach to realizing measurement-induced physics at scales that are at the limits of current NISQ processors.

Animal board invited review: Quantification of resilience in farm animals

Resilience, when defined as the capacity of an animal to respond to short-term environmental challenges and to return to the prechallenge status, is a dynamic and complex trait. Resilient animals can reinforce the capacity of the herd to cope with often fluctuating and unpredictable environmental conditions. The ability of modern technologies to simultaneously record multiple performance measures of individual animals over time is a huge step forward to evaluate the resilience of farm animals. However, resilience is not directly measurable and requires mathematical models with biologically meaningful parameters to obtain quantitative resilience indicators. Furthermore, interpretive models may also be needed to determine the periods of perturbation as perceived by the animal. These applications do not require explicit knowledge of the origin of the perturbations and are developed based on real-time information obtained in the data during and outside the perturbation period. The main objective of this paper was to review and illustrate with examples, different modelling approaches applied to this new generation of data (i.e., with high-frequency recording) to detect and quantify animal responses to perturbations. Case studies were developed to illustrate alternative approaches to real-time and post-treatment of data. In addition, perspectives on the use of hybrid models for better understanding and predicting animal resilience are presented. Quantification of resilience at the individual level makes possible the inclusion of this trait into future breeding programmes. This would allow improvement of the capacity of animals to adapt to a changing environment, and therefore potentially reduce the impact of disease and other environmental stressors on animal welfare. Moreover, such quantification allows the farmer to tailor the management strategy to help individual animals to cope with the perturbation, hence reducing the use of pharmaceuticals, and decreasing the level of pain of the animal.

Non-Abelian braiding of graph vertices in a superconducting processor

Indistinguishability of particles is a fundamental principle of quantum mechanics¹. For all elementary and quasiparticles observed to date-including fermions, bosons and Abelian anyons-this principle guarantees that the braiding of identical particles leaves the system unchanged^2,3. However, in two spatial dimensions, an intriguing possibility exists: braiding of non-Abelian anyons causes rotations in a space of topologically degenerate wavefunctions^4-8. Hence, it can change the observables of the system without violating the principle of indistinguishability. Despite the well-developed mathematical description of non-Abelian anyons and numerous theoretical proposals^9-22, the experimental observation of their exchange statistics has remained elusive for decades. Controllable many-body quantum states generated on quantum processors offer another path for exploring these fundamental phenomena. Whereas efforts on conventional solid-state platforms typically involve Hamiltonian dynamics of quasiparticles, superconducting quantum processors allow for directly manipulating the many-body wavefunction by means of unitary gates. Building on predictions that stabilizer codes can host projective non-Abelian Ising anyons^9,10, we implement a generalized stabilizer code and unitary protocol²³ to create and braid them. This allows us to experimentally verify the fusion rules of the anyons and braid them to realize their statistics. We then study the prospect of using the anyons for quantum computation and use braiding to create an entangled state of anyons encoding three logical qubits. Our work provides new insights about non-Abelian braiding and, through the future inclusion of error correction to achieve topological protection, could open a path towards fault-tolerant quantum computing.

Real-time monitoring of honeybee colony daily activity and bee loss rates can highlight the risk posed by a pesticide

Information on honeybee foraging performance and especially bee loss rates at the colony level are crucial for evaluating the magnitude of effects due to pesticide exposure, thereby ensuring that protection goals for honeybee colonies are met (i.e. threshold of acceptable effects). However, current methods for monitoring honeybee foraging activity and mortality are very approximate (visual records) or are time-limited and mostly based on single cohort analysis. We therefore assess the potential of bee counters, that enable a colony-level and continuous monitoring of bee flight activity and mortality, in pesticide risk assessment. After assessing the background activity and bee loss rates, we exposed colonies to two concentrations of sulfoxaflor (a neurotoxic insecticide) in sugar syrup: a concentration that was considered to be field realistic (0.59 μg/ml) and a higher concentration (2.36 μg/ml) representing a worst-case exposure scenario. We did not find any effect of the field-realistic concentration on flight activity and bee loss rates. However, a two-fold decrease in daily flight activity and a 10-fold increase in daily bee losses were detected in colonies exposed to the highest sulfoxaflor concentration as compared to before exposure. When compared to the theoretical trigger values associated with the specific protection goal of 7 % colony-size reduction, the observed fold changes in daily bee losses were often found to be at risk for colonies. In conclusion, the real-time and colony-level monitoring of bee loss rates, combined with threshold values indicating at which levels bee loss rates threaten the colony, have great potential for improving regulatory pesticide risk assessments for honeybees under field conditions.

Clinical features and outcomes of COVID-19 patients hospitalized for psychiatric disorders: a French multi-centered prospective observational study

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Formation of robust bound states of interacting microwave photons

Systems of correlated particles appear in many fields of modern science and represent some of the most intractable computational problems in nature. The computational challenge in these systems arises when interactions become comparable to other energy scales, which makes the state of each particle depend on all other particles1. The lack of general solutions for the three-body problem and acceptable theory for strongly correlated electrons shows that our understanding of correlated systems fades when the particle number or the interaction strength increases. One of the hallmarks of interacting systems is the formation of multiparticle bound states2-9. Here we develop a high-fidelity parameterizable fSim gate and implement the periodic quantum circuit of the spin-½ XXZ model in a ring of 24 superconducting qubits. We study the propagation of these excitations and observe their bound nature for up to five photons. We devise a phase-sensitive method for constructing the few-body spectrum of the bound states and extract their pseudo-charge by introducing a synthetic flux. By introducing interactions between the ring and additional qubits, we observe an unexpected resilience of the bound states to integrability breaking. This finding goes against the idea that bound states in non-integrable systems are unstable when their energies overlap with the continuum spectrum. Our work provides experimental evidence for bound states of interacting photons and discovers their stability beyond the integrability limit.

Noise-resilient edge modes on a chain of superconducting qubits

Inherent symmetry of a quantum system may protect its otherwise fragile states. Leveraging such protection requires testing its robustness against uncontrolled environmental interactions. Using 47 superconducting qubits, we implement the one-dimensional kicked Ising model, which exhibits nonlocal Majorana edge modes (MEMs) with ℤ 2 parity symmetry. We find that any multiqubit Pauli operator overlapping with the MEMs exhibits a uniform late-time decay rate comparable to single-qubit relaxation rates, irrespective of its size or composition. This characteristic allows us to accurately reconstruct the exponentially localized spatial profiles of the MEMs. Furthermore, the MEMs are found to be resilient against certain symmetry-breaking noise owing to a prethermalization mechanism. Our work elucidates the complex interplay between noise and symmetry-protected edge modes in a solid-state environment.

Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis

Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making.

Immune Profiling Demonstrates a Common Immune Signature of Delayed Acquired Immunodeficiency in Patients With Various Etiologies of Severe Injury

OBJECTIVES

The host response plays a central role in the pathophysiology of sepsis and severe injuries. So far, no study has comprehensively described the overtime changes of the injury-induced immune profile in a large cohort of critically ill patients with different etiologies.

DESIGN

Prospective observational cohort study.

SETTING

Adult ICU in a University Hospital in Lyon, France.

PATIENTS

Three hundred fifty-three septic, trauma, and surgical patients and 175 healthy volunteers were included in the REAnimation Low Immune Status Marker study.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Extensive immune profiling was performed by assessing cellular phenotypes and functions, protein, and messenger RNA levels at days 1-2, 3-4, and 5-7 after inclusion using a panel of 30 standardized immune markers. Using this immunomonitoring panel, no specificity in the immune profile was observed among septic, trauma, and surgical patients. This common injury-induced immune response was characterized by an initial adaptive (i.e., physiologic) response engaging all constituents of the immune system (pro- and anti-inflammatory cytokine releases, and innate and adaptive immune responses) but not associated with increased risk of secondary infections. In contrary, the persistence in a subgroup of patients of profound immune alterations at the end of the first week after admission was associated with increased risk of secondary infections independently of exposure to invasive devices. The combined monitoring of markers of pro-/anti-inflammatory, innate, and adaptive immune responses allowed a better enrichment of patients with risk of secondary infections in the selected population.

CONCLUSIONS

Using REAnimation Low Immune Status Marker immunomonitoring panel, we detected delayed injury-acquired immunodeficiency in a subgroup of severely injured patients independently of primary disease. Critically ill patients' immune status could be captured through the combined monitoring of a common panel of complementary markers of pro-/anti-inflammatory, innate, and adaptive immune responses. Such immune monitoring needs to be incorporated in larger study cohorts with more extensive immune surveillance to develop specific hypothesis allowing for identification of biological systems affecting altered immune function related to late infection in the setting of acute systemic injury.

Realizing topologically ordered states on a quantum processor

[Figure: see text].

Factors Associated with Clostridioides (Clostridium) Difficile Infection and Colonization: Ongoing Prospective Cohort Study in a French University Hospital

Introduction: Clostridioides (Clostridium) difficile can be isolated from stool in 3% of healthy adults and in at least 10% of asymptomatic hospitalized patients. C. difficile, the most common cause of hospital-acquired infectious diarrhea in the developed world, has re-emerged in recent years with increasing incidence and severity. In an effort to reduce the spread of the pathogen, published recommendations suggest isolation and contact precautions for patients suffering from C. difficile infection (CDI). However, asymptomatic colonized patients are not targeted by infection control policies, and active surveillance for colonization is not routinely performed. Moreover, given the current changes in the epidemiology of CDI, particularly the emergence of new virulent strains either in the hospital or community settings, there is a need for identification of factors associated with colonization by C. difficile and CDI. Methods and analysis: We are carrying out a prospective, observational, cohort study in Edouard Herriot Hospital, Hospices Civils de Lyon, a 900-bed university hospital in Lyon, France. All consecutive adult patients admitted on selected units are eligible to participate in the study. Stool samples or rectal swabs for C. difficile testing are obtained on admission, every 3–5 days during hospitalization, at the onset of diarrhea (if applicable), and at discharge. Descriptive and logistic regression analyses will be completed to mainly estimate the proportion of asymptomatic colonization at admission, and to evaluate differences between factors associated with colonization and those related to CDI. Ethics: The study is conducted in accordance with the ethical principles of the Declaration of Helsinki, French law, and the Good Clinical Practice guidelines. The study protocol design was approved by the participating units, the ethics committee and the hospital institutional review board (Comité de protection des personnes et Comission Nationale de l’Informatique et des Libertés; N°: 00009118). Dissemination: The results of this study will be disseminated by presenting the findings locally at each participating ward, as well as national and international scientific meetings. Findings will be shared with interested national societies crafting guidelines in CDI.

A machine learning-based clinical decision support system to identify prescriptions with a high risk of medication error

Objective

To improve patient safety and clinical outcomes by reducing the risk of prescribing errors, we tested the accuracy of a hybrid clinical decision support system in prioritizing prescription checks.

Materials and Methods

Data from electronic health records were collated over a period of 18 months. Inferred scores at a patient level (probability of a patient’s set of active orders to require a pharmacist review) were calculated using a hybrid approach (machine learning and a rule-based expert system). A clinical pharmacist analyzed randomly selected prescription orders over a 2-week period to corroborate our findings. Predicted scores were compared with the pharmacist’s review using the area under the receiving-operating characteristic curve and area under the precision-recall curve. These metrics were compared with existing tools: computerized alerts generated by a clinical decision support (CDS) system and a literature-based multicriteria query prioritization technique. Data from 10 716 individual patients (133 179 prescription orders) were used to train the algorithm on the basis of 25 features in a development dataset.

Results

While the pharmacist analyzed 412 individual patients (3364 prescription orders) in an independent validation dataset, the areas under the receiving-operating characteristic and precision-recall curves of our digital system were 0.81 and 0.75, respectively, thus demonstrating greater accuracy than the CDS system (0.65 and 0.56, respectively) and multicriteria query techniques (0.68 and 0.56, respectively).

Discussion

Our innovative digital tool was notably more accurate than existing techniques (CDS system and multicriteria query) at intercepting potential prescription errors.

Conclusions

By primarily targeting high-risk patients, this novel hybrid decision support system improved the accuracy and reliability of prescription checks in a hospital setting.

Siland a R package for estimating the spatial influence of landscape

The spatial distributions of populations are both influenced by local variables and by characteristics of surrounding landscapes. Understanding how landscape features spatially structure the frequency of a trait in a population, the abundance of a species or the species' richness remains difficult specially because the spatial scale effects of the landscape variables are unknown. Various methods have been proposed but their results are not easily comparable. Here, we introduce "siland", a general method for analyzing the effect of landscape features. Based on a sequential procedure of maximum likelihood estimation, it simultaneously estimates the spatial scales and intensities of landscape variable effects. It does not require any information about the scale of effect. It integrates two landscape effects models: one is based on focal sample site (Bsiland, b for buffer) and one is distance weighted using Spatial Influence Function (Fsiland, f for function). We implemented "siland" in the adaptable and user-friendly R eponym package. It performs landscape analysis on georeferenced point observations (described in a Geographic Information System shapefile format) and allows for effects tests, effects maps and models comparison. We illustrated its use on a real dataset by the study of a crop pest (codling moth densities).

Two-year follow-up of 196 interstitial lung disease patients after ICU stay

OBJECTIVE: Interstitial lung diseases (ILDs) are associated with poor prognosis in the intensive care unit (ICU). We aimed to assess factors associated with hospital mortality in ILD patients admitted to the ICU and to investigate long-term outcome.MATERIAL AND METHODS: This was a retrospective study in a teaching hospital specialised in ILD management. Patients with ILD who were hospitalised in the ICU between 2000 and 2014 were included. Independent predictors of hospital mortality were identified using logistic regression.RESULTS: A total of 196 ILD patients were admitted to the ICU during the study period. Overall hospital mortality was 55%. Two years after ICU admission, 70 (36%) patients were still alive. Of the 196 patients, 108 (55%) required invasive mechanical ventilation, of whom 21 (20%) were discharged alive from hospital. Acute exacerbation of ILD and multi-organ failure were highly associated with hospital mortality (OR 5.4, 95% CI 1.9-15.5 and OR 12.6, 95% CI 4.9-32.5, respectively).CONCLUSION: Hospital mortality among ILD patients hospitalised in the ICU was high, but even where invasive mechanical ventilation was required, a substantial number of patients were discharged alive from hospital. Multi-organ failure could lead to major ethical concerns.

High flow nasal oxygen therapy to avoid invasive mechanical ventilation in SARS-CoV-2 pneumonia: a retrospective study

BACKGROUND

The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). The aim of this study was to compare the risk of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patients.

METHODS

This was a bicenter retrospective study which took place in two intensive care units (ICU) of tertiary hospitals in the Paris region from March 11, to May 3, 2020. We enrolled consecutive patients hospitalized for COVID-19 and acute respiratory failure (ARF) who did not receive IMV at ICU admission. The primary outcome was the rate of IMV after ICU admission. Secondary outcomes were death at day 28 and day 60, length of ICU stay and ventilator-free days at day 28. Data from the HFNO group were compared with those from the standard oxygen therapy (SOT) group using weighted propensity score.

RESULTS

Among 138 patients who met the inclusion criteria, 62 (45%) were treated with SOT alone, and 76 (55%) with HFNO. In HFNO group, 39/76 (51%) patients received IMV and 46/62 (74%) in SOT group (OR 0.37 [95% CI, 0.18-0.76] p = 0.007). After weighted propensity score, HFNO was still associated with a lower rate of IMV (OR 0.31 [95% CI, 0.14-0.66] p = 0.002). Length of ICU stay and mortality at day 28 and day 60 did not significantly differ between HFNO and SOT groups after weighted propensity score. Ventilator-free days at days 28 was higher in HNFO group (21 days vs 10 days, p = 0.005). In the HFNO group, predictive factors associated with IMV were SAPS2 score (OR 1.13 [95%CI, 1.06-1.20] p = 0.0002) and ROX index > 4.88 (OR 0.23 [95%CI, 0.008-0.64] p = 0.006).

CONCLUSIONS

High flow nasal canula oxygen for ARF due to COVID-19 is associated with a lower rate of invasive mechanical ventilation.

Volatile anaesthesia and peri-operative outcomes related to cancer: a feasibility and pilot study for a large randomised control trial

Published data suggest that the type of general anaesthesia used during surgical resection for cancer may impact on patient long-term outcome. However, robust prospective clinical evidence is essential to guide a change in clinical practice. We explored the feasibility of conducting a randomised controlled trial to investigate the impact of total intravenous anaesthesia with propofol vs. inhalational volatile anaesthesia on postoperative outcomes of patients undergoing major cancer surgery. We undertook a randomised, double-blind feasibility and pilot study of propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia during cancer resection surgery at three tertiary hospitals in Australia and the USA. Patients were randomly allocated to receive propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia. Primary outcomes for this study were successful recruitment to the study and successful delivery of the assigned anaesthetic treatment as per randomisation arm. Of the 217 eligible patients approached, 146 were recruited, a recruitment rate of 67.3% (95%CI 60.6-73.5%). One hundred and forty-five patients adhered to the randomised treatment arm, 99.3% (95%CI 96.2-100%). Intra-operative patient characteristics and postoperative complications were comparable between the two intervention groups. This feasibility and pilot study supports the viability of the protocol for a large, randomised controlled trial to investigate the effect of anaesthesia technique on postoperative cancer outcomes. The volatile anaesthesia and peri-operative outcomes related to cancer (VAPOR-C) study that is planned to follow this feasibility study is an international, multicentre trial with the aim of providing evidence-based guidelines for the anaesthetic management of patients undergoing major cancer surgery.

Lactation curve model with explicit representation of perturbations as a phenotyping tool for dairy livestock precision farming

In the context of dairy farming, ruminant females often face challenges inducing perturbations that affect their performance and welfare. A key issue is how to assess the effect of perturbations and provide metrics to quantify how animals cope with their environment. Milk production dynamics are good candidates to address this issue: i) they are easily accessible, ii) overall dynamics throughout lactation process are well described and iii) perturbations are visible through milk losses. In this study, a perturbed lactation model (PLM) with explicit representation of perturbations was developed. The model combines two components: i) the unperturbed lactation model that describes a theoretical lactation curve, assumed to reflect female production potential and ii) the perturbation model that describes all the deviations from the unperturbed lactation model with four parameters: starting date, intensity and shape (collapse and recovery). To illustrate the use of the PLM as a phenotyping tool, it was fitted on a data set of 319 complete lactations from 181 individual dairy goats. A total of 2 354 perturbations were detected, with an average of 7.40 perturbations per lactation. Loss of milk production for the whole lactation due to perturbations varied between 2 and 19% of the milk production predicted by the unperturbed lactation model. The number of perturbations was not the major factor explaining the loss of milk production, suggesting that there are different types of animal response to challenges. By incorporating explicit representation of perturbations in a lactation model, it was possible to determine for each female the potential milk production, characteristics of each perturbation and milk losses induced by perturbations. Further, it was possible to compare animals and analyze individual variability. The indicators produced by the PLM are likely to be useful to move from raw data to decision support tools in dairy production.

[Promoting autonomy by redesigning support in psychiatry]

Therapeutic patient education in psychiatry is a unique form of support in which the relational aspect is used as a means of developing the patient's capabilities and awareness of the disorder. This time helps to support users' autonomy and favours health professionals' participative approach.

Genome-wide association study of intracranial aneurysms identifies 17 risk loci and genetic overlap with clinical risk factors

Rupture of an intracranial aneurysm leads to subarachnoid hemorrhage, a severe type of stroke. To discover new risk loci and the genetic architecture of intracranial aneurysms, we performed a cross-ancestry, genome-wide association study in 10,754 cases and 306,882 controls of European and East Asian ancestry. We discovered 17 risk loci, 11 of which are new. We reveal a polygenic architecture and explain over half of the disease heritability. We show a high genetic correlation between ruptured and unruptured intracranial aneurysms. We also find a suggestive role for endothelial cells by using gene mapping and heritability enrichment. Drug-target enrichment shows pleiotropy between intracranial aneurysms and antiepileptic and sex hormone drugs, providing insights into intracranial aneurysm pathophysiology. Finally, genetic risks for smoking and high blood pressure, the two main clinical risk factors, play important roles in intracranial aneurysm risk, and drive most of the genetic correlation between intracranial aneurysms and other cerebrovascular traits.

Exploring simultaneous perturbation profiles in milk yield and body weight reveals a diversity of animal responses and new opportunities to identify resilience proxies

Livestock husbandry aims to manage the environment in which animals are reared to enable them to express their production potential. However, animals are often confronted with perturbations that affect their performance. Evaluating effects of these perturbations on animal performance could provide metrics to quantify and understand how animals cope with their environment, and therefore to better manage them. Body weight (BW) and milk yield (MY) dynamics over lactation may be used for this purpose. The goal of this study was to estimate an unperturbed performance trajectory using a differential smoothing approach on both MY and BW time series, and then to identify the perturbations and extract their phenotypic features. Daily MY and BW records from 490 primiparous Holstein cows from 33 commercial French herds were used. From the fitting procedure, estimated unperturbed performance trajectories of BW and MY were clustered into 3 groups. After the fitting procedure, 1,754 deviations were detected in the MY time series and 964 were detected in the BW time series across all cows. Overall, 425 of these deviations were detected during the same period (±10 d) in both MY and BW time series, 76 of which started at the same time. Results suggest that combining various individual dynamic measures and revealing the relationship that exists between them could be of great value in obtaining reliable estimates of resilience components in large populations.

Validation of a novel milk progesterone-based tool to monitor luteolysis in dairy cows: Timing of the alerts and robustness against missing values

Automated monitoring of fertility in dairy cows using milk progesterone is based on the accurate and timely identification of luteolysis. In this way, well-adapted insemination advice can be provided to the farmer to further optimize fertility management. To properly evaluate and compare the performance of new and existing data-processing algorithms, a test data set of progesterone time-series that fully covers the desired variability in progesterone profiles is needed. Further, the data should be measured with a high frequency to allow rapid onset events, such as luteolysis, to be precisely determined. Collecting this type of data would require a lot of time, effort, and budget. In the absence of such data, an alternative was developed using simulated progesterone profiles for multiple cows and lactations, in which the different fertility statuses were represented. To these, relevant variability in terms of cycle characteristics and measurement error was added, resulting in a large cost-efficient data set of well-controlled but highly variable and farm-representative profiles. Besides the progesterone profiles, information on (the timing of) luteolysis was extracted from the modeling approach and used as a reference for the evaluation and comparison of the algorithms. In this study, 2 progesterone monitoring tools were compared: a multiprocess Kalman filter combined with a fixed threshold on the smoothed progesterone values to detect luteolysis, and a progesterone monitoring algorithm using synergistic control, PMASC, which uses a mathematical model based on the luteal dynamics and a statistical control chart to detect luteolysis. The timing of the alerts and the robustness against missing values of both algorithms were investigated using 2 different sampling schemes: one sample per cow every 8 h versus 1 sample per day. The alerts for luteolysis of the PMASC algorithm were on average 20 h earlier compared with the ones of the multiprocess Kalman filter, and their timing was less sensitive to missing values. This was shown by the fact that, when 1 sample per day was used, the Kalman filter gave its alerts on average 24 h later, and the variability in timing of the alerts compared with simulated luteolysis increased with 22%. Accordingly, we postulate that implementation of the PMASC system could improve the consistency of luteolysis detection on farm and lower the analysis costs compared with the current state of the art.

Contemporary families and digital practices : which adjustments for which norms ?

Research Framework : Sociological knowledge about the link between digital practices and family life still needs developing. It is within this context, this journal issue and introductory article explore how marital negotiations and parent-child relationships are being transformed by these digital practices, forms of surveillance mediated by these technologies or, conversely, new ways in which autonomy is attained, the balance between peer and familial socialisation, as well as the connection between gender roles and the ways in which these technologies are used by couples and families.

Objectives : This introductory article is designed to present the current state of research on these topics and critically examine the corpus of articles included in this issue.

Methodology : Through a review of the literature, we situate this special issue within a broader context of research that, for nearly twenty years, at the intersection of work on the family and work on communication technologies and the internet.

Results : In the first section, we suggest that this field of research is yet to be developed. In the following sections, we will show how the articles in this themed issue largely demonstrate that family digital practices reflect current social norms, as well as the tensions these norms may create. Although this analysis is not new (Pasquier, 2018), it is refined by the multiplicity of actors, discourses, and methodologies.

Conclusions : As a result of the evaluation and selection of the articles, this themed issue is intended to give a voice to sociologists influenced by a relationist approach and a constructivist language. These articles deal with intimacy and fall within the framework of the sociology of everyday life, taking a close look at ordinary practices. Technologicaly deterministic analyses (Jauréguilberry and Proulx, 2011) are therefore less present. Scholars interested in these topics will find that much remains to be done, and the constant evolution of these practices and technologies ensures that there will always be new questions to address.

Contribution : This themed issue contributes to the dialogue between various sociological studies of the individual and his or her relationship to norms, where some believe that the norms govern the individual (structuralism), while others believe that the individual negotiate and co-creates the norms regulating these 'good practices' (pragmatism, interactionism). Moreover, this introductory article will provide a short but necessary survey of French-language sociological knowledge about families in the digital era   –   a way to remind ourselves and our readers of the Foucauldian idea that scientific works about a research topic are not neutral.

Familles contemporaines et pratiques numériques : quels ajustements pour quelles normes ?

Cadre de la recherche : Le savoir sociologique sur l’articulation entre pratiques numériques et vie familiale reste encore peu développé. C’est dans ce contexte que ce dossier et cet article introductif abordent les négociations conjugales et le lien parent/enfant qui sont transformés par ces pratiques numériques, les formes de surveillance médiées par ces technologies ou au contraire les nouvelles formes d’acquisition de l’autonomie, l’équilibre entre socialisation par les pairs et socialisation familiale ainsi que la relation entre usages de ces technologies et rôles sexués au sein des couples et des familles.

Objectifs : Cet article introductif au dossier thématique vise à présenter l’état des recherches actuelles et à problématiser le corpus d’articles sélectionnés.

Méthodologie : Grâce à une revue de la littérature, nous situons ce dossier spécial dans le contexte général des publications consacrées, depuis près de vingt ans, aux thématiques à l’interface des travaux sur la famille et des travaux sur les techniques de communications et l’internet.

Résultats : Dans la première section, nous constatons qu’il s’agit d’un domaine de recherche à développer. Dans les sections suivantes, nous relevons que les contributions de ce numéro thématique ont amplement montré que les pratiques numériques des familles sont le reflet des normes sociales en vigueur, mais aussi des tensions parfois portées par ces normes. Si le constat n’est en soi pas nouveau (Pasquier, 2018), il est affiné par la multiplicité des acteurs, des discours et des méthodes d’enquête.

Conclusions : Au terme du processus d’évaluation et de sélection des articles, ce dossier thématique se pose davantage comme porte-voix de sociologues marqués par un programme relationniste et un langage constructiviste. Ces articles traitent de fait d’intimité et s’inscrivent dans une sociologie du quotidien située au plus près des pratiques ordinaires. Les analyses à connotation déterministes technologiques (Jauréguiberry et Proulx, 2011) y sont de facto moins représentées. Il reste encore beaucoup de chantiers pour les acteurs et actrices de la recherche que toutes ces questions stimulent, et l’évolution des pratiques comme des techniques assurent que ces questions ne seront jamais épuisées.

Contribution : Ce dossier thématique participe à cette conversation entre sociologies de l’individu face aux normes, où, pour les uns, l’individu est gouverné par les normes (structuralisme), et pour les autres, l’individu négocie et co-construit les normes de ces “bons usages” (pragmatisme, interactionnisme). De plus, cet article d’introduction au dossier thématique est une brève mais nécessaire archéologie des savoirs sociologiques et francophones sur les familles à l’ère numérique – manière de rappeler l’idée foucaldienne selon laquelle les corpus scientifiques, construits autour d’un objet de recherche, ne sont pas neutres.

Analysis of PI-RADS 4 cases: Management recommendations for negatively biopsied patients

PURPOSE

To evaluate if subgroups of patients assigned to MRI category PI-RADS 4 regarding clinical and MRI imaging aspects have distinct risks of prostate cancer (PCa) to facilitate adequate clinical management of this population, especially after negative targeted biopsy.

METHODS

This prospective, IRB approved single center cross-sectional study includes 931 consecutive patients after mp-MRI at 3 T for PCa detection. 193 patients with PI-RADS assessment category 4 received subsequent combined targeted MRI/US fusion-guided and systematic 12-core TRUS-guided biopsy as reference standard and were finally analyzed. The primary endpoint was PCa detection of PI-RADS 4 with MRI subgroup analyses. Secondary endpoints were analyses of clinical data, location of PCa, and detection of targeted biopsy cores.

RESULTS

PCa was detected in 119 of 193 patients (62%) including clinically significant PCa (csPCa; Gleason score ≥3 + 4 = 7) in 92 patients (48%). MRI subgroup analysis revealed 95% PCa (73% csPCa) in unambiguous PI-RADS 4 index lesions without additional, interfering signs of prostatitis in the peripheral zone or overlaying signs of severe stromal hyperplasia in the transition zone according to PI-RADS v2. Transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia showed PCa only in 11% (4% csPCa). Targeted biopsy cores missed the csPCa index lesion in 7% of the patients. PSA density (PSAD) was significantly higher in PCa patients.

CONCLUSIONS

Small csPCa can reliably be detected with mp-MRI by experienced readers, but can be missed by targeted MR/US fusion biopsy alone. Targeted re-biopsy of unambiguous (peripheral) PI-RADS-4-lesions is recommended; whereas transition zone confined PI-RADS-4-lesions with overlaying signs of stromal hyperplasia might be followed-up by re-MRI primarily.

Preparation of highly active phosphated TiO2catalystsviacontinuous sol–gel synthesis in a microreactor

Highly efficient TiO₂based catalysts for biomass conversion were obtained through optimised and well-controlled sol–gel synthesis in a multi-mixer microreactor.

Inferring pathogen dynamics from temporal count data: the emergence of Xylella fastidiosa in France is probably not recent

Unravelling the ecological structure of emerging plant pathogens persisting in multi-host systems is challenging. In such systems, observations are often heterogeneous with respect to time, space and host species, and may lead to biases of perception. The biased perception of pathogen ecology may be exacerbated by hidden fractions of the whole host population, which may act as infection reservoirs. We designed a mechanistic-statistical approach to help understand the ecology of emerging pathogens by filtering out some biases of perception. This approach, based on SIR (Susceptible-Infected-Removed) models and a Bayesian framework, disentangles epidemiological and observational processes underlying temporal counting data. We applied our approach to French surveillance data on Xylella fastidiosa, a multi-host pathogenic bacterium recently discovered in Corsica, France. A model selection led to two diverging scenarios: one scenario without a hidden compartment and an introduction around 2001, and the other with a hidden compartment and an introduction around 1985. Thus, Xylella fastidiosa was probably introduced into Corsica much earlier than its discovery, and its control could be arduous under the hidden compartment scenario. From a methodological perspective, our approach provides insights into the dynamics of emerging plant pathogens and, in particular, the potential existence of infection reservoirs.

A dynamic model as a tool to describe the variability of lifetime body weight trajectories in livestock females

Until now, the development of precision livestock farming has been largely based on data acquisition automation. The future challenge is to develop interpretative tools to capitalize on high-throughput raw data and to generate benchmarks for phenotypic traits. We developed a dynamic model of female BW that converts BW time series into a vector of biologically meaningful parameters. The model is based on a first submodel that split a female's weight into elementary mass changes related to biological functions: growth (G component), reserves balance (R component), uterine load (U component), and maternal investment (M component). These elementary weight components are linked to the second submodel, which represents the litter developmental stages (oocyte, fetus, neonate, and juvenile) that drive elementary components of dam weight over each reproductive cycle. The so-called GRUM model is based on ordinary differential equations and laws of mass action. Input data are BW measures, age, and litter weight at birth for each parturition. Outputs of the fitting procedure are a vector of parameters related to each GRUM component and indexed by reproductive cycle. We illustrated the potential application of the model with a case study including growth and successive lactations ( = 202) from 45 dairy goats from the Alpine ( = 27) and Saanen ( = 18) breeds. The fitting procedure converged for all individuals, including goats that went through extended lactations. We analyzed the fitted parameters to quantify breed and parity effects over 4 reproductive cycles. We found significant differences between breeds regarding gestation components (fetal growth and reserves balance). We also found significant differences among reproductive cycles for reserves balance. Although these findings are based on a small sample, they illustrate how use the model can be to adapt herd management and implement grouping strategies to account for individual variability.

Expression of receptor tyrosine kinase targets PDGFR-β, VEGFR2 and KIT in canine transitional cell carcinoma

Transitional cell carcinoma (TCC) is the most common neoplasia of the canine urinary tract. It tends to be locally invasive and has a moderate metastatic rate. Receptor tyrosine kinases (RTKs) play an important role in promoting cell growth, differentiation and regulation of cell function. RTK inhibitor toceranib phosphate has been used anecdotally to treat TCC. The goal of this study was to evaluate archived normal urinary bladder, TCC and cystitis bladder samples for expression of toceranib phosphate targets: VEGFR2, PDGFR-β and stem cell factor receptor (KIT). A significant number of TCC samples expressed PDGFR-β compared with cystitis and normal bladder samples (P<.0001). While all the tumour samples stained positively for VEGFR2, there was no significant difference between tumour, cystitis and normal bladder samples in intensity scores or staining distribution. Minimal positive staining for KIT was noted in the tumour samples. Based on this proof of target study, further investigation is warranted to determine clinical response of TCC to toceranib phosphate.

Evaluating the ability of a lifetime nutrient-partitioning model for simulating the performance of Australian Holstein dairy cows

The present study determined the ability of a lifetime nutrient-partitioning model to simulate individual genetic potentials of Australian Holstein cows. The model was initially developed in France and has been shown to be able to accurately simulate performance of individual cows from various breeds. Generally, it assumes that the curves of cow performance differ only in terms of scaling, but the dynamic shape is universal. In other words, simulations of genetic variability in performance between cow genotypes can be performed using scaling parameters to simply scale the performance curves up or down. Validation of the model used performance data from 63 lactations of Australian Holstein cows offered lucerne cubes plus grain-based supplement. Individual cow records were used to derive genetic scaling parameters for each animal by calibrating the model to minimise root mean-square errors between observed and fitted values, cow by cow. The model was able to accurately fit the curves of bodyweight, milk fat concentration, milk protein concentration and milk lactose concentration with a high degree of accuracy (relative prediction errors <5%). Daily milk yield and weekly body condition score were satisfactorily predicted, although slight under-predictions of milk yield were identified during the last stage of lactation (relative prediction errors ≈11.1–15.6%). The prediction of feed intake was promising, with the value of relative prediction error of 18.1%. The results also suggest that the current recommendation of energy required for maintenance of pasture-based cows might be under-estimated. In conclusion, this model can be used to simulate genetic variability in the production potential of Australian cows. Thus, it can be used for simulation of consequences of future genetic-selection strategies on lifetime performance and efficiency of individual cows.

Routine delayed voiding cystourethography after initial successful endoscopic treatment with Dextranomer/Hialuronic Acid Copolimer (Dx/HA) of vesicoureteral reflux (VUR). Is it necessary?

INTRODUCTION

Some guidelines recommend an early voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR), but there's no consensus if it's necessary a long-term follow-up in these patients. The aim of our study is analyze if it's necessary a delayed VCUG after initial successful treatment with Dx/HA.

MATERIAL AND METHOD

We have reviewed all medical charts of patients that underwent Dx/HA treatment from 2006 to 2010. We have selected patients with initial successful treatment and more than 3 years of radiological and clinical follow-up. We have analyzed late clinical and radiological outcomes.

RESULTS

One hundred and sixty children with 228 refluxing ureters underwent Dx/HA endoscopic treatment with a mean follow-up of 52.13 months. Early VCUG was performed in 215 ureters with an initial successful rate of 84.1%. The group of study was 94/215 ureters with more than 3 years of follow-up with a delayed VCUG. VUR was still resolved in 79,8% of the ureters. Clinical success rate was 91.7%. The incidence of febrile urinary tract infection in those patients with cured VUR and those with a relapsed VUR was 8 and 15%, respectively; but there were no significant differences. We have not found any variable related with relapsed VUR except those ureters that initially received 2 injections (P<.05).

CONCLUSION

If our objective in the treatment of VUR is to reduce the incidence of febrile urinary tract infection it is not necessary to perform a delayed VCUG even though the long-term radiological outcomes is worse than clinical outcome.

Mixture of linear mixed models for clustering gene expression profiles from repeated microarray experiments

Data variability can be important in microarray data analysis. Thus, when clustering gene expression profiles, it could be judicious to make use of repeated data. In this paper, the problem of analysing repeated data in the model-based cluster analysis context is considered. Linear mixed models are chosen to take into account data variability and mixture of these models are considered. This leads to a large range of possible models depending on the assumptions made on both the covariance structure of the observations and the mixture model. The maximum likelihood estimation of this family of models through the EM algorithm is presented. The problem of selecting a particular mixture of linear mixed models is considered using penalized likelihood criteria. Illustrative Monte Carlo experiments are presented and an application to the clustering of gene expression profiles is detailed. All those experiments highlight the interest of linear mixed model mixtures to take into account data variability in a cluster analysis context.

[Effectively communicate active listening : Comparison of two concepts]

Communication between physicians and patients has a great influence on patient adherence, patient satisfaction and the success of treatment. In this context, patient centered care and emotional support have a high positive impact; however, it is unclear how physicians can be motivated to communicate with patients in an appreciative and empathetic way. The implementation of such behavior requires a multitude of communicative skills. One of them is active listening, which is very important in two respects. On the one hand active listening provides the basis for several conversational contexts as a special communication technique and on the other hand active listening is presented in current textbooks in different ways: as an attitude or as a technique. In light of this, the question arises how active listening should be taught in order to be not only applicable in concrete conversations but also to lead to the highest possible level of patient satisfaction. The aim of this pilot study was to examine some variations in simulated doctor-patient conversations, which are the result of the different approaches to active listening. For this purpose three groups of first semester medical students were recruited, two of which were schooled in active listening in different ways (two groups of six students), i.e. attitude versus technique oriented. The third group (seven students) acted as the control group. In a pre-post design interviews with standardized simulation patients were conducted and subsequently evaluated. The analysis of these interviews was considered from the perspectives of participants and observers as well as the quantitative aspects. This study revealed some interesting tendencies despite its status as a pilot study: in general, the two interventional groups performed significantly better than the control group in which no relevant changes occurred. In a direct comparison, the group in which active listening was taught from an attitude approach achieved better results than the group in which the focus was on the technical aspects of active listening. In the group with active listening schooled as an attitude, the response to the feelings of the standardized simulation patients was significantly better from the perspectives of both participants and observers.

Delayed toxicity following acute ingestion of valpromide

As valpromide is a prodrug of valproic acid (valproate), the clinical presentation of overdoses with either valpromide or valproate sodium is generally considered similar. Whereas plasma peak levels and signs of central nervous system depression occur within a few hours after the acute ingestion of regular-release forms of valproate sodium, delayed toxicity and time to peak levels following valpromide ingestion can be seen as shown by the three reported cases. They were initially considered as mild because patients presented with no or only moderate symptoms and serum valproate levels were below or at therapeutic levels on admission more than 3 hours post-ingestion in two of the three patients. Serum valproate levels were not monitored until marked deterioration more than 10 hours after ingestion. At the time of deterioration, serum valproate was at toxic level in the three reported cases. Therefore, large intake of valpromide should be closely monitored because no or moderate symptoms together with low plasma levels in the first few hours after ingestion do not exclude a subsequent severe intoxication. Despite the usual favourable outcome and the poor correlation between plasma levels and toxic symptoms, patients should not be discharged until plasma levels are documented to remain at low levels for at least 10 hours after the ingestion of valpromide and the patient asymptomatic.