Purpose
Previous clinical trials suggested that inhaled nitric oxide (iNO) could have beneficial effects in sickle cell disease (SCD) patients with acute chest syndrome (ACS).
Methods
To determine ...whether iNO reduces treatment failure rate in adult patients with ACS, we conducted a prospective, double-blind, randomized, placebo-controlled clinical trial. iNO (80 ppm,
N
= 50) gas or inhaled nitrogen placebo (
N
= 50) was delivered for 3 days. The primary end point was the number of patients with treatment failure at day 3, defined as any one of the following: (1) death from any cause, (2) need for endotracheal intubation, (3) decrease of PaO
2
/FiO
2
≥ 15 mmHg between days 1 and 3, (4) augmented therapy defined as new transfusion or phlebotomy.
Results
The two groups did not differ in age, gender, genotype, or baseline characteristics and biological parameters. iNO was well tolerated, although a transient decrease in nitric oxide concentration was mandated in one patient. There was no significant difference in the primary end point between the iNO and placebo groups 23 (46 %) and 29 (58 %); odds ratio (OR), 0.8; 95 % CI, 0.54–1.16;
p
= 0.23. A post hoc analysis of the 45 patients with hypoxemia showed that those in the iNO group were less likely to experience treatment failure at day 3 7 (33.3 %) vs 18 (72 %); OR = 0.19; 95 % CI, 0.06–0.68;
p
= 0.009.
Conclusions
iNO did not reduce the rate of treatment failure in adult SCD patients with mild to moderate ACS. Future trials should target more severely ill ACS patients with hypoxemia.
Clinical trial registration
NCT00748423.
In France, nurse profession has been in constant evolution for the past few years, but the concept of nurse practitioner is still unknown. No data have yet been published about nurse practitioners in ...French ICUs. The aim of this research is to report the practice, skills, and opinions of 391 ICU staff members: doctors, nurses and head nurses. The results show a profound requirement from all staff members (intensivists, nurses and head nurses) to have a possible career evolution in the ICU, and the recognition of specific nursing skills.
Résumé: La ventilation mécanique invasive a pour but de maintenir ou de restaurer l’hématose en cas d’incapacité ventilatoire totale ou partielle. Il s’agit d’une technique spécifique et complexe ...dont les mécanismes doivent être compris. La surveillance du patient ventilé a pour objectifs d’évaluer l’efficacité du support ventilatoire, de prévenir et de détecter précocement la survenue de complications, de diminuer la durée de la ventilation et d’optimiser le confort du patient. Étant au plus proche du patient, l’infirmier(ière) est en première ligne dans la surveillance de l’efficacité et de la tolérance de cette technique. Cet article propose une mise au point sur les éléments de surveillance d’un patient sous ventilation mécanique invasive basée sur des critères spécifiques relevant de l’examen clinique pulmonaire et extrapulmonaire, du mode ventilatoire, de la gestion des alarmes mais également du confort du patient et de son adaptation au ventilateur.
Abstract: Invasive mechanical ventilation allows total or partial respiratory support and restores adequate blood gas exchanges. This complex technique needs specific knowledge to improve management. The objectives of monitoring mechanical ventilation include prevention and early detection of complications, decrease in mechanical ventilation duration, and improvement of patient’s comfort. Nurses are particularly involved in the evaluation of the efficiency of mechanical ventilation and the detection of its complications. In this article, we propose an update on the monitoring of the patient under invasive mechanical ventilation based on clinical examination, information from the ventilator, alarms management, and patient-ventilator interaction.
We analyze how insurance law can mitigate moral hazard by allowing insurers to reduce or cancel coverage in some circumstances. We consider an incomplete contract setting in which the insurer may ...obtain information related to the policyholder's behavior through a costly audit of the circumstances of the loss. Court decisions are based on a standard of proof such as the balance of probabilities. We show that an optimal insurance law brings efficiency gains compared to the no-audit case. We also highlight the conditions under which the burden of proof should be on the insured, provided that insurers are threatened with sanctions for bad faith.
•Fracture patterns and striae on mammoth bones suggest human activity.•Mammoth bone core and flake consistent with human-induced percussion.•Bone technology in the Yukon Territory during MIS 2 (ca. ...30,000–14,000 BP)
The long-debated mammoth bone “core” and “flake” recovered from the Pleistocene loess deposit of Bluefish Cave 2 (Yukon Territory, Canada) and previously described by Cinq-Mars and Morlan (1999) are re-analyzed from a full zooarchaeological and taphonomic perspective. The core and flake are characterized by an absence of carnivore tooth marks and the presence of fresh fracture patterns and two striae potentially attributed to cultural activities. After rejection of several hypotheses involving natural causes, we state that humans were more likely responsible for the bone modifications and we support the hypothesis that a proboscidean bone technology may have been present in eastern Beringia (Alaska/Yukon Territory) sometime between ca. 28,000 and 16,000 years BP.
The timing of the first entry of humans into North America is still hotly debated within the scientific community. Excavations conducted at Bluefish Caves (Yukon Territory) from 1977 to 1987 yielded ...a series of radiocarbon dates that led archaeologists to propose that the initial dispersal of human groups into Eastern Beringia (Alaska and the Yukon Territory) occurred during the Last Glacial Maximum (LGM). This hypothesis proved highly controversial in the absence of other sites of similar age and concerns about the stratigraphy and anthropogenic signature of the bone assemblages that yielded the dates. The weight of the available archaeological evidence suggests that the first peopling of North America occurred ca. 14,000 cal BP (calibrated years Before Present), i.e., well after the LGM. Here, we report new AMS radiocarbon dates obtained on cut-marked bone samples identified during a comprehensive taphonomic analysis of the Bluefish Caves fauna. Our results demonstrate that humans occupied the site as early as 24,000 cal BP (19,650 ± 130 14C BP). In addition to proving that Bluefish Caves is the oldest known archaeological site in North America, the results offer archaeological support for the "Beringian standstill hypothesis", which proposes that a genetically isolated human population persisted in Beringia during the LGM and dispersed from there to North and South America during the post-LGM period.
Genetic data suggest that the Native American founder population diverged from its Asian parent population about 25,000 years ago and was geographically isolated during the Last Glacial Maximum (LGM, ...ca. 21,000 years BP) before dispersing into North and South America as the ice sheets retreated. Archaeological evidence in eastern Siberia and Beringia is scarce, however. Although stone tools and cutmarks on bones dated to the LGM are reported at Bluefish Caves (Yukon Territory, Canada), the stratigraphic integrity of the site and the interpretation of the bone modifications have long been questioned by the scientific community. Here, we describe the results of a zooarchaeological study of the faunal assemblages from Pleistocene loess deposits of Bluefish Caves 1 and 2. Taphonomic analyses indicate that humans hunted a variety of prey at the site, including the Beringian horse (E. lambei), as early as 23,500 years BP. We discuss the significance of the site in debates about the timing of the initial peopling of North America and the role of human-hunters in megafaunal extinctions.
•Human presence in the Yukon between 23,500 and 18,000 years BP.•Bluefish Caves served as a hunting camp to intercept horse and other prey.•Human hunters possibly linked to the extinction of North American Pleistocene horse.
FOOD TRADE AND BIODIVERSITY EFFECTS Bellora, Cecilia; Bourgeon, Jean-Marc
International economic review (Philadelphia),
November 2019, Volume:
60, Issue:
4
Journal Article
Peer reviewed
Pests create biodiversity effects that increase food production risks and decrease productivity when agricultural production is specialized. Pesticides contain these effects, but damage the ...environment and human health. When opening to trade, governments are tempted to restrict pesticide use because, with more food being imported, less pesticide is needed for domestic consumption. However, pesticide restrictions hinder the competitiveness of their agricultural sector on international markets. We show that restrictions on pesticides are more stringent under free trade than under autarky, which reduces the gains from trade, and that trade increases food price volatility.
PDF
