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- Benoit, D D, et al.
(författare)
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Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA.
- 2018
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Ingår i: Intensive care medicine. - 1432-1238. ; 44:7, s. 1039-1049
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Tidskriftsartikel (refereegranskat)abstract
- Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown.In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis.Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0-1.00) and 85.9% (75.4-92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20-2.92) or receiving a written TLD (HR 2.32, CI 1.11-4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former.Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life.
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- Bourgoin, M., et al.
(författare)
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Investigation of the small-scale statistics of turbulence in the Modane S1MA wind tunnel
- 2018
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Ingår i: CEAS Aeronautical Journal. - : Springer. - 1869-5582 .- 1869-5590. ; 9:2, s. 269-281
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Tidskriftsartikel (refereegranskat)abstract
- This article describes the planning, set-up, turbulence characterization and analysis of measurements of a passive grid turbulence experiment that was carried out in the S1MA wind-tunnel from ONERA in Modane, in the context of the ESWIRP European project. This experiment aims at a detailed investigation of the statistical properties of turbulent flows at large Reynolds numbers. The primary goal is to take advantage of the unequaled large-scale dimensions of the ONERA S1MA wind-tunnel facility, to make available to the broad turbulence community high-quality experimental turbulence data with unprecendented resolution (both spatial and temporal) and accuracy (in terms of statistical convergence). With this goal, we designed the largest grid-generated turbulence experiment planned and performed to date. Grid turbulence is a canonical flow known to produce almost perfectly homogeneous and isotropic turbulence (HIT) which remains a unique framework to investigate fundamental physics of turbulent flows. Here, we present a brief description of the measurements, in particular those based on hot-wire diagnosis. By comparing results from classical hot-wires and from a nano-fabricated wire (developed at Princeton University), we show that our goal of resolving down to the smallest dissipative scales of the flow has been achieved. We also present the full characterization of the turbulence here, in terms of turbulent energy dissipation rate, injection and dissipation scales (both spatial and temporal) and Reynolds number.
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- Gazzina, S, et al.
(författare)
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Education modulates brain maintenance in presymptomatic frontotemporal dementia
- 2019
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Ingår i: Journal of neurology, neurosurgery, and psychiatry. - : BMJ. - 1468-330X .- 0022-3050. ; 90:10, s. 1124-1130
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Tidskriftsartikel (refereegranskat)abstract
- Cognitively engaging lifestyles have been associated with reduced risk of conversion to dementia. Multiple mechanisms have been advocated, including increased brain volumes (ie, brain reserve) and reduced disease progression (ie, brain maintenance). In cross-sectional studies of presymptomatic frontotemporal dementia (FTD), higher education has been related to increased grey matter volume. Here, we examine the effect of education on grey matter loss over time.MethodsTwo-hundred twenty-nine subjects at-risk of carrying a pathogenic mutation leading to FTD underwent longitudinal cognitive assessment and T1-weighted MRI at baseline and at 1 year follow-up. The first principal component score of the graph-Laplacian Principal Component Analysis on 112 grey matter region-of-interest volumes was used to summarise the grey matter volume (GMV). The effects of education on cognitive performances and GMV at baseline and on the change between 1 year follow-up and baseline (slope) were tested by Structural Equation Modelling.ResultsHighly educated at-risk subjects had better cognition and higher grey matter volume at baseline; moreover, higher educational attainment was associated with slower loss of grey matter over time in mutation carriers.ConclusionsThis longitudinal study demonstrates that even in presence of ongoing pathological processes, education may facilitate both brain reserve and brain maintenance in the presymptomatic phase of genetic FTD.
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