Florence (Netherlands)

ObjectiveIn this review we sought to determine the clinical benefits and safety of a multiple micronutrient supplement/supplementation (MMS) throughout preconception, pregnancy, and lactation in the mother and their child.BackgroundNo guidelines for pregnancy specifically recommend supplementation with micronutrients other than folic acid and iron or continuing the use of MMS beyond the first trimester. Yet micronutrients are essential during all stages of pregnancy for healthy fetal growth and development and maternal health, with an increased intake of many micronutrients recommended during pregnancy and lactation. The MMS reviewed (Elevit, Bayer) is the most studied prenatal form of MMS, supported by 30 publications reporting studies conducted worldwide over 30 years and used by millions of women over a period of 40 years. Until now, the data have not yet been consolidated.MethodsWe performed a literature search to identify published studies for trials that used MMS at any stage of the pregnancy journey.ResultsOutcomes reported in 30 trials suggested that MMS improves micronutrient status, leads to a healthier reproductive environment during preconception, and can significantly reduce neural tube defects and congenital abnormalities in early pregnancy above and beyond supplementation with folic acid alone. We also found that MMS can reduce adverse pregnancy outcomes during the second and third trimesters, including miscarriage, pre-eclampsia, anemia, preterm birth, and placental insufficiency, and improve docosahexaenoic acid status. In addition, MMS improves the quality of breastmilk and reduces postpartum depression. Using MMS containing 800 μg folic acid is more effective than supplementing with 400 μg folic acid alone. Very few adverse events were reported in infants, almost all of which were considered unrelated to MMS intake. In one cohort, periconceptual MMS in children was linked to higher rates of otitis media and atopic dermatitis than placebo, but these results may be partly attributed to multiple hypothesis testing and differences in family history, respectively.ConclusionImproving micronutrient status with MMS in women who are trying to conceive, pregnant, or breastfeeding may have beneficial effects on fertility, the integrity of the embryonic environment, development of the embryonic brain and nervous system, and the growth, development, and long-term health of the child.

The Tracker of the Compact Muon Solenoid (CMS) experiment is the largest silicon tracker ever built, with 1856 pixel and 15148 strip detector modules that provide accurate track reconstruction. Special challenges must be addressed in the Run 3 data-taking period such as the high instantaneous luminosity and the rapid changes due to module irradiation, particularly in the newly installed Layer 1 of the barrel pixel detector. To achieve high precision in measurements of the momenta of charged particles, corrections for the position, rotation and curvature of the detector modules must be found; a procedure known as tracker alignment. Magnet cycles, temperature variations and aging of modules cause significant time variations that affect the track reconstruction and therefore necessitate continuous alignment throughout the operation of the Large Hadron Collider (LHC) machine. In this paper, the performance of the CMS Tracker pixel and strip detectors on early Run 3 data will be presented. Focus will also be placed on the CMS Tracker alignment, highlighting new features developed for the Run 3 data taking period. The impact of the Tracker alignment on physics performance will also be reviewed.

International audience

Global climate change influences the natural ecosystem and is a threat to human livelihood. Kenya is vulnerable to changing climate with Kibwezi watershed experiencing intense land degradation that has resulted to limited water resource. The Soil and

Astrophysical observations provide compelling evidence for gravitationally interacting dark matter in the universe that cannot be explained by the standard model of particle physics. The extraordinary amount of data from the CERN LHC presents a unique opportunity to shed light on the nature of dark matter at unprecedented collision energies. This Report comprehensively reviews the most recent searches with the CMS experiment for particles and interactions belonging to a dark sector and for dark-sector mediators. Models with invisible massive particles are probed by searches for signatures of missing transverse momentum recoiling against visible standard model particles. Searches for mediators are also conducted via fully visible final states. The results of these searches are compared with those obtained from direct-detection experiments. Searches for alternative scenarios predicting more complex dark sectors with multiple new particles and new forces are also presented. Many of these models include long-lived particles, which could manifest themselves with striking unconventional signatures with relatively small amounts of background. Searches for such particles are discussed and their impact on dark-sector scenarios is evaluated. Many results and interpretations have been newly obtained for this Report.

Abstract Background Cardiac magnetic resonance (CMR) with extracellular volume (ECV) mapping can track treatment response in patients with cardiac amyloidosis by assessing changes in cardiac amyloid burden along with associated changes in structure and function. The CARDIO-TTRansform trial is a phase 3, multicentre, double-blind, randomised, placebo-controlled trial designed to assess the efficacy and safety of eplontersen in transthyretin amyloid cardiomyopathy (ATTR-CM). Eplontersen is a ligand-conjugated antisense oligonucleotide designed to reduce hepatic production of transthyretin protein, the amyloid fibril precursor protein in ATTR-CM. Patients with hereditary or wild-type ATTR-CM on available standard of care were randomized 1:1 to receive 45 mg of eplontersen or placebo via subcutaneous injection every 4 weeks. Patients in the main study with no contraindication to CMR were invited to participate in this sub-study. Purpose The primary objective is to measure the change in amyloid burden (defined as % change in ECV from baseline) over time in patients receiving eplontersen versus placebo. Methods Participants will undergo CMR with ECV mapping at baseline, 25, 49, 97 and 140 weeks (Figure 1). Images will be acquired under a standardized protocol comprising cine imaging with steady state free precession sequence, late gadolinium enhancement imaging (LGE) and T1 mapping. T1 mapping will be performed before the administration of contrast and will be repeated 15 minutes post-contrast using the same slice locations, to produce ECV maps. Results In the main study, 1432 patients were randomized from 120 sites across 20 countries. Of these patients, 157 patients were enrolled in the CMR sub-study, from 6 centers across 4 countries. Images will be read centrally at the end of the study. All participants in the study will also receive serial transthoracic echocardiography with strain analysis to correlate findings with conventional imaging techniques, and a subset of patients from the CMR substudy will be co-enrolled in a scintigraphy substudy for further characterization of amyloid deposition in their heart. Conclusion The CARDIO-TTRansform CMR substudy represents the largest CMR study of ATTR-CM. The CMR sub-study has enrolled a broad global population of patients with hereditary and wild-type ATTR-CM and will provide key information on the impact of eplontersen on the cardiac amyloid load and the associated change in structure and function.

BackgroundConsidering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging.ObjectiveThis 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults’ and their ecosystem’s perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups.MethodsParticipants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6.ResultsAt both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults’ attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (ρ=−.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (ρ=−.23) but not at T6.ConclusionsAt the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology.

Abstract In the professional training field, virtual reality (VR) has received growing interest due to the advantages it provides over traditional means such as simulators: it is immersive but portable. However, the unpleasant side-effects of virtual reality, grouped under the term of cybersickness have hindered or slowed its widespread adoption. In the present study, we investigated the impact of a VR procedure trainer, dedicated to airline pilots, on their vision and well-being. The airline pilots’ license is subject to medical criteria, particularly regarding eyesight. It is thus mandatory to check that VR use will not impact their vision. Moreover, most laboratory studies exploring cybersickness and/or impacts on vision are based on young subjects (< 40 years old). Since the training tool targeted a broader age ranged population (20–60 y.o.), only pilots in the underrepresented age-range were included (i.e. 40-60y.o). 26 professional pilots took part to the experiment, included in 2 successive waves (14 pilots in the 1st group, 12 in the second). They performed three VR sessions on three consecutive days of increasing duration from 20 to 60 minutes. Their cybersickness symptoms were tracked, and accommodation and convergence parameters were measured before and after exposure. We did not find any deleterious impact on vision, and observed mild cybersickness symptoms in the first group, that led the team to suppress a short part of a lesson that was designated as problematic by all pilots. We did not observe any cybersickness symptoms in the second group following this modification. By systematically assessing the well-being of pilots during and after VR exposure, we managed the cybersickness risk.

Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients’ safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts’ opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery.

Present-day home care needs to be more efficiently organized in view of the aging of the population and the current nursing shortages. Ensuring safe medication use is part of the challenge. The number of required visits could be reduced if automated home medication dispensers (AHMD) are adequately implemented. However, the barriers and facilitators for implementation are unknown. This project explored determinants (barriers, facilitators, or both) for implementing AHMD in home care, from Dutch home care nurses' perspective. Semi-structured interviews were conducted with 15 home care nurses. Determinants were identified through thematic content analysis. The first four transcripts were coded inductively. Then, a code tree was developed based on the Tailored Implementation for Chronic Diseases checklist, consisting of seven domains. Each code/determinant was then labelled as a barrier, facilitator, or both. The most relevant domains were innovation factors, individual health professional factors, and patient factors. The most frequently mentioned barrier was the required unplanned visits when patients did not withdraw medication within the scheduled time limit (alarm). According to our respondents, carefully assessing patients' eligibility (e.g., learnability) and properly instructing and guiding them will help prevent these alarms from occurring. Next to these determinants, motivating patients to start using an AHMD and professionals having sufficient knowledge and confidence were the most frequently mentioned facilitators. This project provided an overview of 78 determinants from nurses' perspective for implementation of AHMD in home care. This can form the basis for developing strategies for implementing AHMD in home care. Further research is recommended to investigate the perceived determinants from the patients', relatives', and informal caregivers' perspectives, and to prioritize the determinants from all perspectives.