Purpose
To assess the impact of computerized transthoracic echocardiography (TTE) simulation on the learning curve to achieve competency in basic critical care echocardiography (CCE).
Methods
In this ...prospective bicenter study, noncardiologist residents novice in ultrasound followed either a previously validated training program with adjunctive computerized simulation on a mannequin (two 3 h-sessions; Vimedix simulator, CAE Healthcare) (interventional group;
n
= 12) or solely the same training program (control group;
n
= 12). All trainees from the same institution were assigned to the same study group to avoid confusion bias. Each trainee was evaluated after 1 (M1), 3 (M3) and 6 (M6) months of training using our previously validated scoring system. Competency was defined by a score ≥ 90% of the maximal value.
Results
The 24 trainees performed 965 TTE in patients with cardiopulmonary compromise during their 6-month rotation. Skills assessments relied on 156 TTE performed in 106 patients (mean age 53 ± 14 years; mean Simplified Acute Physiologic Score 2: 55 ± 19; 79% ventilated). When compared to the control group, trainees of the interventional group obtained a significantly higher mean skills assessment score at M1 (41.5 ± 4.9 vs. 32.3 ± 3.7:
P
= 0.0004) and M3 (45.8 ± 2.8 vs. 42.3 ± 3.7:
P
= 0.0223), but not at M6 (49.7 ± 1.2 vs. 50.0 ± 2.7:
P
= 0.6410), due to higher practical and technical skills scores. Trainees of the control group required significantly more supervised TTE to obtain competency than their counterparts (36 ± 7 vs. 30 ± 9:
p
= 0.0145).
Conclusions
Adjunctive computerized simulation accelerates the learning curve of basic CCE in improving practical and technical skills and reduces the number of TTE examinations required to reach competency.
Pocket Watches (Ensemble de montres rondes) Jean Baptiste Baillon (French clockmaker, died ca. 1770), Charles-Simon Bocher (active mid 18th century), Jacques-Jérôme Gudin (master 1762, died 1789), Julien Le Roy (French clockmaker, 1686-1759), Pierre Le Roy (1687-1762)
Paris, 2nd-3rd quarter 18th century
Art
Land data assimilation system (LDAS)-Monde, an offline land data assimilation system with global capacity, is applied over the CONtiguous US (CONUS) domain to enhance monitoring accuracy for water ...and energy states and fluxes. LDAS-Monde ingests satellite-derived surface soil moisture (SSM) and leaf area index (LAI) estimates to constrain the interactions between soil, biosphere, and atmosphere (ISBA) land surface model (LSM) coupled with the CNRM (Centre National de Recherches Météorologiques) version of the total runoff integrating pathways (CTRIP) continental hydrological system (ISBA-CTRIP). LDAS-Monde is forced by the ERA-5 atmospheric reanalysis from the European Center for Medium Range Weather Forecast (ECMWF) from 2010 to 2016 leading to a seven-year, quarter degree spatial resolution offline reanalysis of land surface variables (LSVs) over CONUS. The impact of assimilating LAI and SSM into LDAS-Monde is assessed over North America, by comparison to satellite-driven model estimates of land evapotranspiration from the Global Land Evaporation Amsterdam Model (GLEAM) project, and upscaled ground-based observations of gross primary productivity from the FLUXCOM project. Taking advantage of the relatively dense data networks over CONUS, we have also evaluated the impact of the assimilation against in situ measurements of soil moisture from the USCRN (US Climate Reference Network), together with river discharges from the United States Geological Survey (USGS) and the Global Runoff Data Centre (GRDC). Those data sets highlight the added value of assimilating satellite derived observations compared with an open-loop simulation (i.e., no assimilation). It is shown that LDAS-Monde has the ability not only to monitor land surface variables but also to forecast them, by providing improved initial conditions, which impacts persist through time. LDAS-Monde reanalysis also has the potential to be used to monitor extreme events like agricultural drought. Finally, limitations related to LDAS-Monde and current satellite-derived observations are exposed as well as several insights on how to use alternative datasets to analyze soil moisture and vegetation state.
•Diode lasers are used for antimicrobial photodynamic therapy (aPDT) as well as antimicrobial photothermal therapy (aPTT) in dentistry.•Curcumin as photosensitizing agent for 445 nm laser irradiation ...did not result in improvement in antibacterial effect.•Greatest antibacterial efficacy could be observed for aPTT treatment.
The main aim in periodontitis treatment is to remove supragingival and subgingival biofilm. Mechanical treatment to eliminate pathogenic bacteria is limited by morphological conditions on the root surface. This study assessed the antibacterial effectiveness of different laser-based photochemical systems, particularly a novel curcumin-based option.
Ninety-one titanium bars were inoculated with an artificial biofilm of common pathogenic periodontal bacteria and inserted into an artificial periodontal pocket model. The following groups (n = 13) were tested: 1, curcumin solution plus SLB laser irradiation (C + L; 445 nm, 0.6 W, 25% duty cycle, 100 Hz, 10 s); 2, curcumin solution (Cur); 3, dimethyl sulfoxide solution (DMSO); 4, SiroLaser Blue (SLB) — laser irradiation (445 nm, 0.6 W, 25% duty cycle, 100 Hz, 10 s); 5, antimicrobial photodynamic therapy (aPDT); 6, antimicrobial photothermal therapy (aPTT); 7, control. The samples were stored in Eppendorf tubes and analyzed microbiologically using quantitative real-time polymerase chain reaction (PCR). The main parameter for analyzing group differences was the total bacterial load. Statistical analysis was performed with nonparametric methods.
Statistically significant reductions in bacterial count were observed in all experimental groups (p < 0.05). The mean percentage reductions were as follows: SLB, 95.03%; aPDT, 83.91%; DMSO, 95.69%; C + L, 97.15%. No statistically significant differences in bacteria reduction were observed for laser alone (SLB), DMSO, or curcumin with or without additional laser irradiation.
The greatest antibacterial efficacy was observed in samples treated with aPTT. Using curcumin as a photosensitizing agent for 445 nm laser irradiation did not result in improved antibacterial effectiveness in comparison with laser alone.
OFSP is being used as an ingredient of baked products and can be a source of pro-vitamin A. Information about OFSP puree bread consumer profile is limited. The current study investigates the consumer ...socio-demographics, knowledge, practices and attitude towards OFSP puree bread in Kenya.
A total of 1024 consumers were interviewed from Nairobi, Kiambu, Kajiado, Kisumu and Kakamega counties. The OFSP bread is purchased by 60% female respondents above 30 years old, who have a university education (79%), formally employed (93%), therefore, middle to high-income earners. Before consumption, 42% of the consumers stored their bread in the refrigerator while 38% stored in the open, and 20% in cupboards. Consumers agree that the OFSP bread could be a good source of energy, vitamins, especially Vitamin A (94%). The acceptance ratings of OFSP bread ranged from 7.37 to 7.65 on a 9-score hedonic scale, hence “liked moderately.” There was a significant relationship between socio-demographics, knowledge about the root, the bread and the overall acceptance of the OFSP puree bread. Consumers were willing to pay more for the OFSP bread based on potential nutritional benefits. There was a significant relationship between consumer demographics and willingness to pay for OFSP puree bread.
Abstract
Delirium is associated with long-term cognitive dysfunction and with increased brain atrophy. However, it is unclear whether these problems result from or predisposes to delirium. We aimed ...to investigate preoperative to postoperative brain changes, as well as the role of delirium in these changes over time. We investigated the effects of surgery and postoperative delirium with brain MRIs made before and 3 months after major elective surgery in 299 elderly patients, and an MRI with a 3 months follow-up MRI in 48 non-surgical control participants. To study the effects of surgery and delirium, we compared brain volumes, white matter hyperintensities and brain infarcts between baseline and follow-up MRIs, using multiple regression analyses adjusting for possible confounders. Within the patients group, 37 persons (12%) developed postoperative delirium. Surgical patients showed a greater decrease in grey matter volume than non-surgical control participants linear regression: B (95% confidence interval) = −0.65% of intracranial volume (−1.01 to −0.29, P < 0.005). Within the surgery group, delirium was associated with a greater decrease in grey matter volume B (95% confidence interval): −0.44% of intracranial volume (−0.82 to −0.06, P = 0.02). Furthermore, within the patients, delirium was associated with a non-significantly increased risk of a new postoperative brain infarct logistic regression: odds ratio (95% confidence interval): 2.8 (0.7–11.1), P = 0.14. Our study was the first to investigate the association between delirium and preoperative to postoperative brain volume changes, suggesting that delirium is associated with increased progression of grey matter volume loss.
Kant et al. report that patients with postoperative delirium have an increased progression of grey matter loss compared to patients without postoperative delirium. These changes may contribute to impaired long-term cognitive outcomes of postoperative delirium.
Graphical Abstract
Graphical abstract
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