Lessons Learnt from Monitoring the Etna Volcano Using an IoT Sensor Network through a Period of Intense Eruptive Activity.

This paper describes the successes and failures after 4 years of continuous operation of a network of sensors, communicating nodes, and gateways deployed on the Etna Volcano in Sicily since 2019, including a period of Etna intense volcanic activity that occurred in 2021 and resulted in over 60 paroxysms. It documents how the installation of gateways at medium altitude allowed for data collection from sensors up to the summit craters. Most of the sensors left on the volcanic edifice during winters and during this period of intense volcanic activity were destroyed, but the whole gateway infrastructure remained fully operational, allowing for a very fruitful new field campaign two years later, in August 2023. Our experience has shown that the best strategy for IoT deployment on very active and/or high-altitude volcanoes like Etna is to permanently install gateways in areas where they are protected both from meteorological and volcanic hazards, that is mainly at the foot of the volcanic edifice, and to deploy temporary sensors and communicating nodes in the more exposed areas during field trips or in the summer season.

Impact of sleep and physical activity habits on real-life glycaemic variability in patients with type 2 diabetes.

The aim of this study was to better characterise whether sleep habits, eating schedule and physical activity in real-life are associated with glycaemic control in patients with type 2 diabetes. A total of 28 patients (aged 60 years [58; 66], 54% female) with type 2 diabetes treated with basal-bolus insulin therapy administered by insulin pumps were analysed. Glycaemic data measured by Flash Glucose Monitor System, physical activity and sleep data measured by accelerometer, and meal schedules were simultaneously collated with insulin pump administration data, for 7 days in real-life. Their respective impact on the time spent in target, in hypoglycaemia, in hyperglycaemia and on glycaemic variability was evaluated. Multiple regressions showed that the total daily dose of meal boluses of insulin was inversely associated with the coefficient of variation (CV; coefficient ß = -0.073; 95% confidence interval: -0.130, -0.015; p = 0.016), as well as sleep duration. The higher the sleep duration, the lower the glycaemic variability (coefficient ß = -0.012; 95% confidence interval: -0.023, -0.002; p = 0.027). The mean 7 days physical activity of the subjects was very low and was not associated with glycaemic control on the 7 days mean values. However, days with at least 1 hr spent in physical activity higher than 1.5 METs were associated with less glycaemic variability that same day. This real-life observation highlights the importance of sufficient sleep duration and regular physical activity to lessen the glycaemic variability of patients with type 2 diabetes.

From Sensor to Cloud: An IoT Network of Radon Outdoor Probes to Monitor Active Volcanoes.

While radon in soil gases has been identified for decades as a potential precursor of volcanic eruptions, there has been a recent interest for monitoring radon in air on active volcanoes. We present here the first network of outdoor air radon sensors that was installed successfully on Mt. Etna volcano, Sicily, Italy in September 2019. Small radon sensors designed for workers and home dosimetry were tropicalized in order to be operated continuously in harsh volcanic conditions with an autonomy of several months. Two stations have been installed on the south flank of the volcano at ~3000 m of elevation. A private network has been deployed in order to transfer the measurements from the stations directly to a server located in France, using a low-power wide-area transmission technology from Internet of Things (IoT) called LoRaWAN. Data finally feed a data lake, allowing flexibility in data management and sharing. A first analysis of the radon datasets confirms previous observations, while adding temporal information never accessed before. The observed performances confirm IoT solutions are very adapted to active volcano monitoring in terms of range, autonomy, and data loss.

Preliminary Evaluation of an Electronic Patient Prioritization Tool for Pediatric Emergency Department.

The study presents the evaluation of the reliability of the information displayed on the user interface of a homegrown electronic patient prioritization tool dedicated to pediatric emergency department (namely Optimum). Two ergonomists shadowed physicians and nurses throughout their shift in order to (i) identify consistencies and discrepancies between the actual step of the patients in the care process and their assigned step in Optimum and (ii) to understand the causes of the discrepancies. Even if some discrepancies are noted, results show that Optimum provides a quite good reflection of the actual position of the patients in the care process. The use of ethnographic methods allows to understand the cause of the discrepancies.

Different contributions of chemokine N-terminal features attest to a different ligand binding mode and a bias towards activation of ACKR3/CXCR7 compared with CXCR4 and CXCR3.

BACKGROUND AND PURPOSE: Chemokines and their receptors form an intricate interaction and signalling network that plays critical roles in various physiological and pathological cellular processes. The high promiscuity and apparent redundancy of this network makes probing individual chemokine/receptor interactions and functional effects, as well as targeting individual receptor axes for therapeutic applications, challenging. Despite poor sequence identity, the N-terminal regions of chemokines, which play a key role in their activity and selectivity, contain several conserved features. Thus far little is known regarding the molecular basis of their interactions with typical and atypical chemokine receptors or the conservation of their contributions across chemokine-receptor pairs. EXPERIMENTAL APPROACH: We used a broad panel of chemokine variants and modified peptides derived from the N-terminal region of chemokines CXCL12, CXCL11 and vCCL2, to compare the contributions of various features to binding and activation of their shared receptors, the two typical, canonical G protein-signalling receptors, CXCR4 and CXCR3, as well as the atypical scavenger receptor CXCR7/ACKR3, which shows exclusively arrestin-dependent activity. KEY RESULTS: We provide molecular insights into the plasticity of the ligand-binding pockets of these receptors, their chemokine binding modes and their activation mechanisms. Although the chemokine N-terminal region is a critical determinant, neither the most proximal residues nor the N-loop are essential for binding and activation of ACKR3, as distinct from binding and activation of CXCR4 and CXCR3. CONCLUSION AND IMPLICATIONS: These results suggest a different interaction mechanism between this atypical receptor and its ligands and illustrate its strong propensity to activation.

Retrospective cohort study on radial head replacements comparing results between smooth and porous stem designs.

BACKGROUND: When necessary, radial head integrity after a fracture can be re-created by the use of a radial head arthroplasty if the radial head is judged irreparable. The purpose of this study was to compare the clinical and radiographic outcomes of metal modular radial head replacements with a smooth vs. a porous stem. METHODS: A retrospective cohort study of radial head replacements performed in the first 4 weeks after a trauma in an adult patient at our institution between 2000 and 2014 was completed. Patients were divided into 2 groups: a porous stem group (ExploR; Biomet Orthopedics, Warsaw, IN, USA) and a smooth stem group (EVOLVE; Wright Medical Group, Memphis, TN, USA). Primary outcomes were the Disabilities of the Arm, Shoulder, and Hand and Mayo Elbow Performance Index scores. Secondary outcomes were the visual analog scale score for pain, range of motion, grip strength, and radiographic evaluations. RESULTS: Of the 80 eligible patients, 57 agreed to participate (porous stem group, 36; smooth stem group, 21). Demographic data were similar between the 2 groups. Average follow-up was 6.3 years. Average Disabilities of the Arm, Shoulder, and Hand and Mayo Elbow Performance Index scores were similar between the 2 groups. Porous implants were more prone to osteolysis (64.3% vs. 23.5%; P = .01) and were associated with a greater loss of elbow flexion (6° vs. 1°; P = .02). The porous stem group showed a tendency toward more overstuffing (24.0% vs. 5.9%; P = .21). CONCLUSION: Our results reveal that outcomes between smooth and porous stem metal modular radial head implants are equivalent. However, the smooth stem implant may represent the preferred option as it is associated with a lower rate of complications.

Decreasing loco-regional recurrence for oral cavity cancer with total Mohs margins technique.

BACKGROUND: The conventional technique for cancer resection margin analysis studies only 0.1% of the surgical margins. Complete frozen section margins - also known as Mohs margins - allows for analysis of 100% of the surgical margins. METHODS: The objective of our study is to compare oral cavity cancer loco-regional recurrence rates when treated by total frozen sections technique (Total Mohs margins) versus conventional margins. We conducted a multicenter retrospective cohort chart review. Loco-regional oral cancer recurrence rates were compared between patients treated with total Mohs margins (2007-2013) and patients treated with conventional margins techniques (2002-2007). RESULTS: After applying inclusion criteria, a total of 60 patients treated by total Mohs margins and 57 patients with conventional margins were identified. Patients had similar baseline cancer stages, pathological types, past head and neck cancers and comorbidities (all p > 0.05). One-year recurrence rate was lower (10.0% vs 21.1%, p = 0.019) in favor of Mohs total margins and stayed significantly lower at 5 years of follow-up. When adjusted for T grade with N0 disease, Mohs technique was still beneficial in loco-regional recurrence for Tis-T4N0 up to 2 years (10.5% vs 25.7%, z-score 1.849, p = 0.032). The Number Needed to Treat at 2 years of follow-up for this subgroup of patients (Tis-T4N0) is 6.6. Margins had to be retaken more often intra-operatively in Mohs technique (68.3% vs 12.3%, p < 0.0001), mainly for positive deep margins (48.6% of all margins, p = 0.028). Duration of surgery was not increased with Mohs vs conventional technique (380 min vs 475 min respectively, p = 0.025). CONCLUSIONS: Mohs total margins may result in a significant reduction in cancer recurrence rate at 5 years compare to conventional surgery. Moreover, duration of surgery was not increased when using Mohs technique when judiciously performed.

New paradigms in chemokine receptor signal transduction: Moving beyond the two-site model.

Chemokine receptor (CKR) signaling forms the basis of essential immune cellular functions, and dysregulated CKR signaling underpins numerous disease processes of the immune system and beyond. CKRs, which belong to the seven transmembrane domain receptor (7TMR) superfamily, initiate signaling upon binding of endogenous, secreted chemokine ligands. Chemokine-CKR interactions are traditionally described by a two-step/two-site mechanism, in which the CKR N-terminus recognizes the chemokine globular core (i.e. site 1 interaction), followed by activation when the unstructured chemokine N-terminus is inserted into the receptor TM bundle (i.e. site 2 interaction). Several recent studies challenge the structural independence of sites 1 and 2 by demonstrating physical and allosteric links between these supposedly separate sites. Others contest the functional independence of these sites, identifying nuanced roles for site 1 and other interactions in CKR activation. These developments emerge within a rapidly changing landscape in which CKR signaling is influenced by receptor PTMs, chemokine and CKR dimerization, and endogenous non-chemokine ligands. Simultaneous advances in the structural and functional characterization of 7TMR biased signaling have altered how we understand promiscuous chemokine-CKR interactions. In this review, we explore new paradigms in CKR signal transduction by considering studies that depict a more intricate architecture governing the consequences of chemokine-CKR interactions.

Production, structure and in vitro degradation of electrospun honeybee silk nanofibers.

Honeybees produce silken cocoons containing four related fibrous proteins. High levels of each of the honeybee silk proteins can be produced recombinantly by fermentation in Escherichia coli. In this study we have used electrospinning to fabricate a single recombinant honeybee silk protein, AmelF3, into nanofibers of around 200 nm diameter. Infrared spectroscopy found that the molecular structure of the nanofibers was predominantly coiled coil, essentially the same as native honeybee silk. Mats of the honeybee nanofibers were treated with methanol or by water annealing, which increased their ß-sheet content and rendered them water insensitive. The insoluble mats were degraded by protease on a time scale of hours to days. The protease gradually released proteins from the solid state and these were subsequently rapidly degraded into small peptides without the accumulation of partial degradation products. Cell culture assays demonstrated that the mats allowed survival, attachment and proliferation of fibroblasts. These results indicate that honeybee silk proteins meet many prerequisites for use as a biomaterial.

Improving adverse drug reaction reporting in hospitals: results of the French Pharmacovigilance in Midi-Pyrénées region (PharmacoMIP) network 2-year pilot study.

BACKGROUND: Spontaneous reporting of adverse drug reactions (ADRs) is fundamental to drug safety surveillance (pharmacovigilance); however, substantial under-reporting exists and is the main limitation of the system. Several factors could favour under-reporting. OBJECTIVE: The aim of this pilot study was to assess the effect of regular visits of a Clinical Research Assistant (CRA) on the improvement of ADR reporting in non-university hospitals. METHODS: We set up an ADR report collecting system that involved regular visits by a CRA to non-university hospitals, which was similar to a system that already existed in university hospitals in Toulouse, France. Two areas in our region were chosen: Haute Garonne and Gers. We compared firstly the reporting rate (number of reports/number of beds) of total ADRs (i.e. spontaneously reported ADRs plus solicited ADRs collected by the CRA) and secondly, the percentage of serious ADRs reported by non-university hospitals in these two areas, in 2005 (the year prior to CRA visits) and after the start of CRA visits (2006 until the end of December 2008). We also compared the reporting rate of total ADRs in Haute Garonne and Gers non-university hospitals with those reported during the same period with a control group (the Ariège area, which has a similar number of beds to Gers and that was not visited by the CRA). The characteristics of ADRs collected by the CRA were also described. RESULTS: A total of 687 reports were collected by the CRA: 40% were classified as serious, including two deaths. The number of ADRs and the reporting rate increased significantly between 2005 and 2008 in non-university hospitals of Haute-Garonne and Gers, but not in Ariège. In Gers, the reporting rate was 3% in 2005 and 25% in 2008. In Haute-Garonne, the reporting rate was 11% in 2005 and 40% in 2008. The difference between the number of spontaneous and solicited reports also increased. CONCLUSIONS: This study shows that regular visits by a CRA increases the number of ADRs collected by a Regional Pharmacovigilance Centre. Another interesting consequence was the rise in spontaneous reporting by healthcare professionals following the set-up of this system. Further assessment of this procedure is necessary for the long-term evaluation of its effectiveness.

Complete frozen section margins for cancer of the tongue: part 1: animal experience.

OBJECTIVE: Positive margins for squamous cell carcinoma of the oral tongue on final pathology are a poor prognostic factor associated with a higher likelihood of local recurrence. Obtaining margin status in a relatively short time by using complete frozen sections, such as Mohs margins for skin cancer, would lower the recurrence rate. The goal of this study was to compare, on pig tongue, the efficacy of different techniques used to obtain complete frozen sections on histologic glass slides of optimal quality. STUDY DESIGN: We compared the quality of frozen section glass slides on fresh pig tongues. The partial glossectomy was executed with either a sharp instrument (scalpel and scissors), electrocautery in the cutting mode, or electrocautery at the coagulation mode. For each of the three methods, we also compared the frozen section, obtained on the line of resection and for a thickness of 1 to 1.3 mm, using either the cryostat or isopentane for the freezing phase. The percentage and quality of epithelium and muscle present on histologic glass slides were assessed by a pathologist independently. RESULTS: Complete frozen margins of high quality were obtained in a relatively short time for all techniques (28-38 minutes). Sharp dissection showed better results: a shorter processing time for the specimens and better quality for the histologic glass slides. Using cryostat or isopentane for the freezing phase did not show any significant difference. CONCLUSION AND SIGNIFICANCE: Complete frozen margins (Mohs margins) of high quality are feasible. Histologic glass slides of very good quality are obtained when using a sharp dissection technique. For the freezing period, both isopentane and cryostat offer very good results. This approach is appropriate on animals and needs further study in clinical situations. The human experience will be presented in the next article which is: Complete frozen section margins (with measurable 1 or 5 mm thick free margin) for cancer of the oral tongue (Clinical experience Part 2 [CSO2008]).

Complete frozen section margins (with measurable 1 or 5 mm thick free margin) for cancer of the tongue: part 2: clinical experience.

OBJECTIVE: To obtain completely negative margins of 1 to 5 mm at the time of surgery for oral tongue squamous cell carcinoma by using a Mohs-like technique. STUDY DESIGN: Case series of 12 patients (4 T1, 5 T2, 2 T3, 1 T4) and a review of the literature. RESULTS: For the first six cases, complete, colored for precise orientation, frozen margins of high quality were obtained in a relatively short time (20-75 minutes). Four levels were evaluated within 1 to 2 mm of the line of resection. Obtaining complete free margins for a thickness of 5 mm was done for the last six cases. The time was longer (70-120 minutes) but did not exceed the time necessary to perform the neck dissection, except for one patient. The technique using the scalpel and scissors implied slightly more bleeding, which was never a problem. We have observed no recurrence for these 12 patients (follow-up 12-34 months). CONCLUSION: The review of the literature demonstrates that invaded and close margins confer a higher recurrence rate. We have obtained 1 to 2 mm (first six patients) and 5 mm (last six patients) thick, complete, oriented, and free frozen margins with success and no recurrence, but the follow-up was short. We prefer to obtain a 5 mm thick margin when possible. The delay to obtain the pathologic result is reasonable. This approach should reduce dramatically the problem of positive and close margins at the final pathology and, consequently, the rate of local control.

Mohs surgery - a new approach with a mould and glass discs: review of the literature and comparative study.

OBJECTIVE: Mohs surgery is a frozen section-guided surgical excision that is the treatment of choice for aggressive cutaneous malignancy. But it is labour intensive, particularly because numerous levels are needed on each specimen to obtain a complete histologic section. Three different techniques to Mohs surgery are compared. Our new approach with moulds and glass discs is explained and discussed. DESIGN: Review of the literature and comparative study using skin specimens of fresh cadavers. SETTING: Regional care centre. METHOD: First, we evaluate, for each of the three different techniques, the number of 10 micron-thick frozen sections required to obtain a macroscopically complete cross section of the specimen. Second, we examine microscopically the quality of these first complete sections. Finally, once we have obtained a macroscopically complete cross section, we evaluate the number of deeper levels required to obtain an adequate microscopic section. RESULTS: In the first experiment, with the modern method, 90.1 sections were needed to obtain a full macroscopic section, 36.8 sections with the heat extractor method, and 10.6 sections with the new mould. The quality of the histologic glass slides was superior with the new mould. The number of deeper levels required to obtain an adequate microscopic section was 5.9 for the modern method, 4.4 for the heat extractor method, and 2.3 for the new approach (new mould). CONCLUSION: Our new approach with moulds and glass discs is simple and allows us to flatten the specimen (to obtain a complete tissue section) more reliably and efficiently compared with both the modern and the heat extractor methods. The new approach allows us to obtain these results in less time and with fewer histologic glass slides. Some other aspects are discussed.