Dynamic Modeling of Carbon Dioxide Transport through the Skin Using a Capnometry Wristband.

The development of a capnometry wristband is of great interest for monitoring patients at home. We consider a new architecture in which a non-dispersive infrared (NDIR) optical measurement is located close to the skin surface and is combined with an open chamber principle with a continuous circulation of air flow in the collection cell. We propose a model for the temporal dynamics of the carbon dioxide exchange between the blood and the gas channel inside the device. The transport of carbon dioxide is modeled by convection-diffusion equations. We consider four compartments: blood, skin, the measurement cell and the collection cell. We introduce the state-space equations and the associated transition matrix associated with a Markovian model. We define an augmented system by combining a first-order autoregressive model describing the supply of carbon dioxide concentration in the blood compartment and its inertial resistance to change. We propose to use a Kalman filter to estimate the carbon dioxide concentration in the blood vessels recursively over time and thus monitor arterial carbon dioxide blood pressure in real time. Four performance factors with respect to the dynamic quantification of the CO2 blood concentration are considered, and a simulation is carried out based on data from a previous clinical study. These demonstrate the feasibility of such a technological concept.

Safety of use of the ENDOSWIR near-infrared optical imaging device on human tissues: prospective blind study.

Cancer surgery requires removing the tumor tissue in necessary and sufficient quantities. Spectral optical imaging in the short-wave infrared (900-1700 nm) could provide an intraoperative guidance to the surgeon based on the absorption of the tissues without contrast agent. Our objective was to ensure the safety of our ENDOSWIR device on human tissues. Histological analysis of fresh human tonsils exposed to the SWIR light or not was compared and showed no histological differences. This demonstrates the safety of using the SWIR device on human tissues and allows us to initiate a clinical study for the resection of tumors intraoperatively.

Delayed return of gastrointestinal function after hepatectomy in an ERAS program: incidence and risk factors.

BACKGROUND: Delayed return of gastrointestinal function (DGIF) after hepatectomy can involve increased morbidity and prolonged hospital stay. Yet, data on incidence and risks factors are lacking. METHODS: All consecutive patients who underwent hepatectomy between June 2018 and December 2020 were included. All patients were included in an enhanced recovery after surgery (ERAS) program. DGIF was defined by the need for nasogastric tube (NGT) insertion after surgery. DGIF risk factors were identified. RESULTS: Overall, 206 patients underwent hepatectomy. DGIF occurred in 41 patients (19.9%) after a median time of 2 days (range, 1-14). Among them, 6 patients (14.6%) developed aspiration pneumonia, of which one required ICU for mechanical ventilation. DGIF developed along with an intraabdominal complication in 7 patients (biliary fistula, n = 5; anastomotic fistula, n = 1; adhesive small bowel obstruction, n = 1). DGIF was associated with significantly increased severe morbidity rate (p = 0.001), prolonged time to normal food intake (p < 0.001) and hospital stay (p < 0.001) and significantly decreased overall compliance rate (p = 0.001). Independent risk factors of DGIF were age (p < 0.001), vascular reconstruction (p = 0.007), anaesthetic induction using volatiles (p = 0.003) and epidural analgesia (p = 0.004). Using these 4 variables, a simple DGIF risk score has been developed allowing patient stratification in low-, intermediate- and high-risk groups. CONCLUSION: DGIF after hepatectomy was frequently observed and significantly impacted postoperative outcomes. Identifying risk factors remains critical for preventing its occurrence.

Reflexões sobre a morte e o morrer / Reflections on death and dying

Resumo Este ensaio teórico tem por objetivo propor reflexões acerca da morte e do morrer sob o prisma de possíveis antagonismos, do adoecimento e das ocupações humanas envolvidas nesse processo. Os antagonismos são colocados em pauta obedecendo ao sentido de oposição mútua entre vida e morte, nascimento e morte, bem como entre sua previsão e sua negação. O adoecimento é discutido sob o prisma dos modelos dinâmico e ontológico de Laplantine, abrindo-se reflexões sobre o significado do adoecimento para o doente, muitas vezes expropriado de seu processo de morrer. Também aborda como a morte é impelida, atualmente, para os bastidores da vida social. Por último, são abordadas as ocupações da morte pautadas nos "princípios da boa morte", sob o olhar da terapia ocupacional, sendo discorridos os preparativos e os ritos fúnebres desenvolvidos pelo morrente, seu círculo social e pelos profissionais da saúde, religiosos, agentes fúnebres e funcionários de cemitérios. Depreendemos que a morte é um processo social.

Abstract This theoretical essay aims to propose reflections on death and dying through the prism of possible antagonisms, illness and human occupations involved in this process. The antagonisms are put up for discussion obeying the sense of mutual opposition between life and death, birth and death, as well as between their prediction and their negation. Illness is discussed from the perspective of Laplantine's dynamic and ontological models, opening up reflections on the meaning of illness for the patient, who is often expropriated from their dying process. It also addresses how death is currently pushed behind the scenes of social life. Finally, the occupations of death based on the "principles of good death" are approached from the perspective of occupational therapy, discussing funeral preparations and rites developed by the deceased, their social circle and by health professionals, religious people, funeral agents and cemetery workers. We understand that death is a social process.

Contact, high-resolution spatial diffuse reflectance imaging system for skin condition diagnosis: a first-in-human clinical trial.

SIGNIFICANCE: Oxygenation is one of the skin tissue physiological properties to follow for patient care management. Furthermore, long-term monitoring of such parameters is needed at the patient bed as well as outside the hospital. Diffuse reflectance spectroscopy has been widely used for this purpose. AIM: The aim of the study is to propose a low-cost system for the long-term measurement of skin physiological parameters in contact. APPROACH: We have developed a low-cost, wearable, CMOS-based device. We propose an original method for processing diffuse reflectance data to calculate the tissue oxygen saturation (StO2). RESULTS: We tested the device for the assessment of tissue oxygenation during a first-in-human clinical trial that took place at the Grenoble University Hospital France. CONCLUSIONS: The results of this clinical trial show a good accordance between our sensor and commercial devices used a reference.

Evaluation in Healthy Subjects of a Transcutaneous Carbon Dioxide Monitoring Wristband during Hypo and Hypercapnia Conditions.

The development of wearable devices for healthcare monitoring is of primary interest, in particular for homecare applications. But it is challenging to develop an evaluation framework to test and optimize such a device by following a non-invasive protocol. As well established reference devices do exist for capnometry, we propose a protocol to evaluate and compare the performance of the transcutaneous carbon dioxide monitoring wristband that we develop. We present here this protocol, the signal processing pipeline and the data analysis based on signal alignment and intercorrelation study, and the first results on a cohort of 13 healthy subjects. This test allows demonstrating the influence of the device response time and of the carbon dioxide content in the ambient air.Clinical Relevance-The protocol described here allows to test and optimize the new device in clinical conditions simulating hypo and hypercapnia variations on a subject at rest, as it would be the case at home to monitor the health status of chronic respiratory patients, and to compare the performances with reference devices. A strong intercorrelation greater than 0.8 has been observed in 5 healthy subjects out of 13 and factors influencing the intercorrelation are suggested.

Evaluation of the French National Program on Home Return of Patients with Chronic Heart Failure (PRADO-IC): Pilot Study of 91 Patients During Its Deployment in the Bas Rhin Area.

OBJECTIVE: The main objective of this study was to evaluate the impact of the French national program on home return of chronic heart failure patients (PRADO-IC) in terms of re-hospitalizations for heart failure (HF) during its deployment in the Bas-Rhin (France). PATIENTS AND METHODS: This was a pilot, descriptive, quantitative, retrospective, and bi-centric study (University Hospitals of Strasbourg and Haguenau Hospital Center, France). It included all patients included in the PRADO-IC program from these centers between January 1, 2015 and December 31, 2015. The primary endpoint of our study was the evaluation of the number of 1-year, 6-month, and 30-day re-admissions to the hospital in relation to an acute HF episode, before and after the inclusion of patients in the PRADO-IC program. The secondary endpoints were the number of overall re-hospitalizations (all-cause); the number of days of hospitalization for HF; the time to first re-hospitalization and the average length of hospital stay, before and after inclusion in PRADO-IC; and the overall and cardiovascular mortality rates. RESULTS: 91 patients out of 271 (33,6%) with a mean age of 79.2 years (67-94) were included. They all had chronic HF, essentially class II-III NYHA (90.1%), mostly of ischemic origin (41.9%), with altered left ventricular ejection fraction in 71.4% of cases. A reduction in the mean number of hospitalizations for HF per patient at 30 days, 6 months and 1 year was observed, respectively, from 0.18 ± 0.42 per patient before inclusion to 0.15 ± 0.36 after inclusion (p = 0.56); 0.98 ± 1.04 hospitalizations to 0.53 ± 0.81 at 6 months (p < 0.01); and 1.64 ± 1.14 hospitalizations 1.04 ± 1.05 at 1 year (p < 0.001). Patients were hospitalized less overall after inclusion in the PRADO-IC program. The number of days of hospitalization for HF was reduced after inclusion of patients from 18.02 ± 7.78 days before inclusion to 14.28 ± 11.57 days for the 6 month follow-up (p = 0.006), and from 22.07 ± 10.33 days before inclusion to 16.39 ± 15.94 days for the 1 year follow-up (p < 0.001). In contrast, inclusion in PRADO-IC statistically increased the mean time to first re-hospitalization for HF from mean 99.36 ± 72.39 days before inclusion to 148.11 ± 112.77 days after inclusion (p < 0.001). CONCLUSION: This study seems to demonstrate that the PRADO-IC program could improve the management of chronic HF patients in ambulatory care, particularly regarding HF re-hospitalization. However, due to the limitations of the methodology used and the small number of patients, it is advisable to consolidate its initial results with a randomized controlled study on a larger number of patients. In our opinion, its results need to be communicated because, to our knowledge, no equivalent study exists.

Contact, high-resolution spatial diffuse reflectance imaging system for skin condition diagnosis.

Spatially resolved diffuse reflectance spectroscopy (srDRS) is a well-established technique for noninvasive, in vivo characterization of tissue optical properties toward diagnostic applications. srDRS has a potential for depth-resolved analysis of tissue, which is desired in various clinical situations. However, current fiber-based and photodiode-based systems have difficulties achieving this goal due to challenges in sampling the reflectance with a high enough resolution. We introduce a compact, low-cost architecture for srDRS based on the use of a multipixel imaging sensor and light-emitting diodes to achieve lensless diffuse reflectance imaging in contact with the tissue with high spatial resolution. For proof-of-concept, a prototype device, involving a commercially available complementary metal-oxide semiconductor coupled with a fiber-optic plate, was fabricated. Diffuse reflectance profiles were acquired at 645 nm at source-to-detector separations ranging from 480 µm to 4 mm with a resolution of 16.7 µm. Absorption coefficients (µa) and reduced scattering coefficients (µs') of homogeneous tissue-mimicking phantoms were measured with 4.2 ± 3.5 % and 7.0 ± 4.6 % error, respectively. The results obtained confirm the potential of our approach for quantitative characterization of tissue optical properties in contact imaging modality. This study is a first step toward the development of low-cost, wearable devices for skin condition diagnosis in vivo.

Comparing Prescriptive and Descriptive Gender Stereotypes About Children, Adults, and the Elderly.

Gender stereotypes have descriptive components, or beliefs about how males and females typically act, as well as prescriptive components, or beliefs about how males and females should act. For example, women are supposed to be nurturing and avoid dominance, and men are supposed to be agentic and avoid weakness. However, it is not clear whether people hold prescriptive gender stereotypes about children of different age groups. In addition, research has not addressed prescriptive gender stereotypes for the elderly. The current research measured prescriptive gender stereotypes for children, adults, and elderly men and women in 3 studies to (a) compare how prescriptive gender stereotypes change across age groups and (b) address whether stereotypes of males are more restrictive than stereotypes of females. Students (Studies 1 and 2) and community members (Study 3), which were all U.S. and majority White samples, rated how desirable it was for different target groups to possess a list of characteristics from 1 (very undesirable) to 9 (very desirable). The target age groups included toddlers, elementary-aged, adolescent, young adult, adult, and elderly males and females. The list of 21 characteristics was created to encompass traits and behaviors relevant across a wide age range. In a meta-analysis across studies, prescriptive stereotypes were defined as characteristics displaying a sex difference of d > 0.40 and an average rating as desirable for positive prescriptive stereotypes (PPS) or undesirable for negative proscriptive stereotypes (NPS) for male or females of each age group. Results replicated previous research on prescriptive stereotypes for adults: Women should be communal and avoid being dominant. Men should be agentic, independent, masculine in appearance, and interested in science and technology, but avoid being weak, emotional, shy, and feminine in appearance. Stereotypes of boys and girls from elementary-aged to young adults still included these components, but stereotypes of toddlers involved mainly physical appearance and play behaviors. Prescriptive stereotypes of elderly men and women were weaker. Overall, boys and men had more restrictive prescriptive stereotypes than girls and women in terms of strength and number. These findings demonstrate the applicability of prescriptive stereotypes to different age groups.

Highlighting the impact of aging on type I collagen: label-free investigation using confocal reflectance microscopy and diffuse reflectance spectroscopy in 3D matrix model.

During aging, alterations of extracellular matrix proteins contribute to various pathological phenotypes. Among these alterations, type I collagen cross-linking and associated glycation products accumulation over time detrimentally affects its physico-chemical properties, leading to alterations of tissue biomechanical stability. Here, different-age collagen 3D matrices using non-destructive and label-free biophotonic techniques were analysed to highlight the impact of collagen I aging on 3D constructs, at macroscopic and microscopic levels. Matrices were prepared with collagens extracted from tail tendons of rats (newborns, young and old adults) to be within the physiological aging process. The data of diffuse reflectance spectroscopy reveal that aging leads to an inhibition of fibril assembly and a resulting decrease of gel density. Investigations by confocal reflectance microscopy highlight poor-fibrillar structures in oldest collagen networks most likely related to the glycation products accumulation. Complementarily, an infrared analysis brings out marked spectral variations in the Amide I profile, specific of the peptidic bond conformation and for carbohydrates vibrations as function of collagen-age. Interestingly, we also highlight an unexpected behavior for newborn collagen, exhibiting poorly-organized networks and microscopic features close to the oldest collagen. These results demonstrate that changes in collagen optical properties are relevant for investigating the incidence of aging in 3D matrix models.

Spatial resolution in depth for time-resolved diffuse optical tomography using short source-detector separations.

Diffuse optical tomography for medical applications can require probes with small dimensions involving short source-detector separations. Even though this configuration is seen at first as a constraint due to the challenge of depth sensitivity, we show here that it can potentially be an asset for spatial resolution in depth. By comparing two fiber optic probes on a test object, we first show with simulations that short source-detector separations improve the spatial resolution down to a limit depth. We then confirm these results in an experimental study with a state-of-the-art setup involving a fast-gated single-photon avalanche diode allowing maximum depth sensitivity. We conclude that short source-detector separations are an option to consider for the design of probes so as to improve image quality for diffuse optical tomography in reflectance.

Evidence for the social role theory of stereotype content: observations of groups' roles shape stereotypes.

In applying social role theory to account for the content of a wide range of stereotypes, this research tests the proposition that observations of groups' roles determine stereotype content (Eagly & Wood, 2012). In a novel test of how stereotypes can develop from observations, preliminary research collected participants' beliefs about the occupational roles (e.g., lawyer, teacher, fast food worker, chief executive officer, store clerk, manager) in which members of social groups (e.g., Black women, Hispanics, White men, the rich, senior citizens, high school dropouts) are overrepresented relative to their numbers in the general population. These beliefs about groups' typical occupational roles proved to be generally accurate when evaluated in relation to data from the Bureau of Labor Statistics. Then, correlational studies predicted participants' stereotypes of social groups from the attributes ascribed to group members' typical occupational roles (Studies 1a, 1b, and 1c), the behaviors associated with those roles (Study 2), and the occupational interest profile of the roles (Study 3). As predicted by social role theory, beliefs about the attributes of groups' typical roles were strongly related to group stereotypes on both communion and agency/competence. In addition, an experimental study (Study 4) demonstrated that when social groups were described with changes to their typical social roles in the future, their projected stereotypes were more influenced by these future roles than by their current group stereotypes, thus supporting social role theory's predictions about stereotype change. Discussion considers the implications of these findings for stereotype change and the relation of social role theory to other theories of stereotype content.

Time-resolved diffuse optical tomography using fast-gated single-photon avalanche diodes.

We present the first experimental results of reflectance Diffuse Optical Tomography (DOT) performed with a fast-gated single-photon avalanche diode (SPAD) coupled to a time-correlated single-photon counting system. The Mellin-Laplace transform was employed to process time-resolved data. We compare the performances of the SPAD operated in the gated mode vs. the non-gated mode for the detection and localization of an absorbing inclusion deeply embedded in a turbid medium for 5 and 15 mm interfiber distances. We demonstrate that, for a given acquisition time, the gated mode enables the detection and better localization of deeper absorbing inclusions than the non-gated mode. These results obtained on phantoms demonstrate the efficacy of time-resolved DOT at small interfiber distances. By achieving depth sensitivity with limited acquisition times, the gated mode increases the relevance of reflectance DOT at small interfiber distance for clinical applications.

Student reactions to public safety reports of hate crimes.

This study investigated participant's reactions to hate crime versus nonbiased crime incident reports that included more or less detail about the crime using a 2 (victim race: African American, unstated)×2 (amount of information: vague, detailed) between-subjects factorial design. We hypothesized that participants would be more sympathetic, more distressed, and blame the victim less if the victim was African American (designating a hate crime) and if more detail was included in the incident report. The results generally showed greater psychological impact for a hate crime versus nonbiased crime and when more information was presented than with vague information, and these two manipulations did not interact in influencing participants' reactions. These results indicate that amount of detail provided about a crime should be considered when publishing incident reports.

Time-domain reflectance diffuse optical tomography with Mellin-Laplace transform for experimental detection and depth localization of a single absorbing inclusion.

We show how to apply the Mellin-Laplace transform to process time-resolved reflectance measurements for diffuse optical tomography. We illustrate this method on simulated signals incorporating the main sources of experimental noise and suggest how to fine-tune the method in order to detect the deepest absorbing inclusions and optimize their localization in depth, depending on the dynamic range of the measurement. To finish, we apply this method to measurements acquired with a setup including a femtosecond laser, photomultipliers and a time-correlated single photon counting board. Simulations and experiments are illustrated for a probe featuring the interfiber distance of 1.5 cm and show the potential of time-resolved techniques for imaging absorption contrast in depth with this geometry.

Detection of brain tumors using fluorescence diffuse optical tomography and nanoparticles as contrast agents.

Near-infrared fluorescence-enhanced diffuse optical tomography (fDOT) is used to localize tumors in mice using fluorescent nanoparticles as a blood pool contrast agent. The infrared dye DiR is loaded in the lipid core of nontargeted nanoparticles (DiR-lipidots) and injected systemically via the tail vein in mice bearing U87 tumors. Distribution and time-course of DiR-lipidots are followed using in vivo fluorescence reflectance imaging and reveal enhanced fluorescent signal within the subcutaneous tumors up to seven days due to the enhanced permeability and retention effect. Tumor growth into the brain is followed using bioluminescent imaging, and tumor localization is further determined by magnetic resonance imaging. The fDOT provides three-dimensional fluorescent maps that allow for consistent localization for both subcutaneous and brain tumors.

Positive effects of a cognitive-behavioral intervention program for family caregivers of demented elderly.

OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT) program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.

Positive effects of a cognitive-behavioral intervention program for family caregivers of demented elderly / Efeitos positivos de um programa de intervenção cognitivo-comportamental para cuidadores familiares de idosos com demência

OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT) program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.

OBJETIVO: Foi analisar os efeitos de um programa de intervenção de Terapia Cognitivo-Comportamental (TCC) administrado a cuidadores familiares de pacientes com demência. MÉTODOS: Foram incluídos 40 cuidadores familiares que participaram do programa durante oito sessões semanais. Foi avaliado o perfil cognitivo, funcional e comportamental dos pacientes, bem como sua qualidade de vida e de seus cuidadores familiares. Foram utilizados instrumentos específicos para a avaliação do nível de estresse do cuidador, estilos de enfrentamento (coping), ansiedade e depressão. RESULTADOS: Ao final do programa, os cuidadores familiares relataram diminuição dos sintomas neuropsiquiátricos nos pacientes e aumento da qualidade de vida deles. Observou-se ainda mudança no estilo de coping dos cuidadores e diminuição significativa do nível de ansiedade. CONCLUSÃO: O Programa de TCC mostrou-se instrumento útil e promissor para a prática clínica, revelando efeitos positivos na qualidade de vida e nos sintomas neuropsiquiátricos da demência, bem como promovendo alívio da ansiedade e do estresse dos cuidadores familiares.

Are leader stereotypes masculine? A meta-analysis of three research paradigms.

This meta-analysis examined the extent to which stereotypes of leaders are culturally masculine. The primary studies fit into 1 of 3 paradigms: (a) In Schein's (1973) think manager-think male paradigm, 40 studies with 51 effect sizes compared the similarity of male and leader stereotypes and the similarity of female and leader stereotypes; (b) in Powell and Butterfield's (1979) agency-communion paradigm, 22 studies with 47 effect sizes compared stereotypes of leaders' agency and communion; and (c) in Shinar's (1975) masculinity-femininity paradigm, 7 studies with 101 effect sizes represented stereotypes of leadership-related occupations on a single masculinity-femininity dimension. Analyses implemented appropriate random and mixed effects models. All 3 paradigms demonstrated overall masculinity of leader stereotypes: (a) In the think manager-think male paradigm, intraclass correlation = .25 for the women-leaders similarity and intraclass correlation = .62 for the men-leaders similarity; (b) in the agency-communion paradigm, g = 1.55, indicating greater agency than communion; and (c) in the masculinity-femininity paradigm, g = 0.92, indicating greater masculinity than the androgynous scale midpoint. Subgroup and meta-regression analyses indicated that this masculine construal of leadership has decreased over time and was greater for male than female research participants. In addition, stereotypes portrayed leaders as less masculine in educational organizations than in other domains and in moderate- than in high-status leader roles. This article considers the relation of these findings to Eagly and Karau's (2002) role congruity theory, which proposed contextual influences on the incongruity between stereotypes of women and leaders. The implications for prejudice against women leaders are also considered.

Fluorescence diffuse optical tomography for free-space and multifluorophore studies.

We present two major advances in preclinical fluorescence-enhanced diffuse optical tomography (fDOT) system and assess its performance. It is now possible to perform experiments without adaptation liquid or a glass plate over the animal, and our system is equipped with a filter wheel in order to discriminate two injected fluorophores. Evaluation carried out on characterization phantoms and in vivo on mice demonstrates enriched use of the system for biological studies on small animals.