A Brief History of Human Challenge Studies (1900-2021) Emphasising the Virology, Regulatory and Ethical Requirements, Raison D'etre, Ethnography, Selection of Volunteers and Unit Design.

Venetian quarantine 400 years ago was an important public health measure. Since 1900 this has been refined to include "challenge" or deliberate infection with pathogens be they viruses, bacteria, or parasites. Our focus is virology and ranges from the early experiments in Cuba with Yellow Fever Virus to the most widespread pathogen of our current times, COVID-19. The latter has so far caused over four million deaths worldwide and 190 million cases of the disease. Quarantine and challenge were also used to investigate the Spanish Influenza of 1918 which caused over 100 million deaths. We consider here the merits of the approach, that is the speeding up of knowledge in a practical sense leading to the more rapid licensing of vaccines and antimicrobials. At the core of quarantine and challenge initiatives is the design of the unit to allow safe confinement of the pathogen and protection of the staff. Most important though is the safety of volunteers. We can see now, as in 1900, that members of our society are prepared and willing to engage in these experiments for the public good. Our ethnology study, where the investigator observed the experiment from within the quarantine, gave us the first indication of changing attitudes amongst volunteers whilst in quarantine. These quarantine experiments, referred to as challenge studies, human infection studies, or "controlled human infection models" involve thousands of clinical samples taken over two to three weeks and can provide a wealth of immunological and molecular data on the infection itself and could allow the discovery of new targets for vaccines and therapeutics. The Yellow Fever studies from 121 years ago gave the impetus for development of a successful vaccine still used today whilst also uncovering the nature of the Yellow Fever agent, namely that it was a virus. We outline how carefully these experiments are approached and the necessity to have high quality units with self-contained air-flow along with extensive personal protective equipment for nursing and medical staff. Most important is the employment of highly trained scientific, medical and nursing staff. We face a future of emerging pathogens driven by the increasing global population, deforestation, climate change, antibiotic resistance and increased global travel. These emerging pathogens may be pathogens we currently are not aware of or have not caused outbreaks historically but could also be mutated forms of known pathogens including viruses such as influenza (H7N9, H5N1 etc.) and coronaviruses. This calls for challenge studies to be part of future pandemic preparedness as an additional tool to assist with the rapid development of broad-spectrum antimicrobials, immunomodulators and new vaccines.

A temperate rocky super-Earth transiting a nearby cool star.

M dwarf stars, which have masses less than 60 per cent that of the Sun, make up 75 per cent of the population of the stars in the Galaxy. The atmospheres of orbiting Earth-sized planets are observationally accessible via transmission spectroscopy when the planets pass in front of these stars. Statistical results suggest that the nearest transiting Earth-sized planet in the liquid-water, habitable zone of an M dwarf star is probably around 10.5 parsecs away. A temperate planet has been discovered orbiting Proxima Centauri, the closest M dwarf, but it probably does not transit and its true mass is unknown. Seven Earth-sized planets transit the very low-mass star TRAPPIST-1, which is 12 parsecs away, but their masses and, particularly, their densities are poorly constrained. Here we report observations of LHS 1140b, a planet with a radius of 1.4 Earth radii transiting a small, cool star (LHS 1140) 12 parsecs away. We measure the mass of the planet to be 6.6 times that of Earth, consistent with a rocky bulk composition. LHS 1140b receives an insolation of 0.46 times that of Earth, placing it within the liquid-water, habitable zone. With 90 per cent confidence, we place an upper limit on the orbital eccentricity of 0.29. The circular orbit is unlikely to be the result of tides and therefore was probably present at formation. Given its large surface gravity and cool insolation, the planet may have retained its atmosphere despite the greater luminosity (compared to the present-day) of its host star in its youth. Because LHS 1140 is nearby, telescopes currently under construction might be able to search for specific atmospheric gases in the future.

A giant planet undergoing extreme-ultraviolet irradiation by its hot massive-star host.

The amount of ultraviolet irradiation and ablation experienced by a planet depends strongly on the temperature of its host star. Of the thousands of extrasolar planets now known, only six have been found that transit hot, A-type stars (with temperatures of 7,300-10,000 kelvin), and no planets are known to transit the even hotter B-type stars. For example, WASP-33 is an A-type star with a temperature of about 7,430 kelvin, which hosts the hottest known transiting planet, WASP-33b (ref. 1); the planet is itself as hot as a red dwarf star of type M (ref. 2). WASP-33b displays a large heat differential between its dayside and nightside, and is highly inflated-traits that have been linked to high insolation. However, even at the temperature of its dayside, its atmosphere probably resembles the molecule-dominated atmospheres of other planets and, given the level of ultraviolet irradiation it experiences, its atmosphere is unlikely to be substantially ablated over the lifetime of its star. Here we report observations of the bright star HD 195689 (also known as KELT-9), which reveal a close-in (orbital period of about 1.48 days) transiting giant planet, KELT-9b. At approximately 10,170 kelvin, the host star is at the dividing line between stars of type A and B, and we measure the dayside temperature of KELT-9b to be about 4,600 kelvin. This is as hot as stars of stellar type K4 (ref. 5). The molecules in K stars are entirely dissociated, and so the primary sources of opacity in the dayside atmosphere of KELT-9b are probably atomic metals. Furthermore, KELT-9b receives 700 times more extreme-ultraviolet radiation (that is, with wavelengths shorter than 91.2 nanometres) than WASP-33b, leading to a predicted range of mass-loss rates that could leave the planet largely stripped of its envelope during the main-sequence lifetime of the host star.

Metal-ferroelectric supercrystals with periodically curved metallic layers.

Simultaneous manipulation of multiple boundary conditions in nanoscale heterostructures offers a versatile route to stabilizing unusual structures and emergent phases. Here, we show that a stable supercrystal phase comprising a three-dimensional ordering of nanoscale domains with tailored periodicities can be engineered in PbTiO3-SrRuO3 ferroelectric-metal superlattices. A combination of laboratory and synchrotron X-ray diffraction, piezoresponse force microscopy, scanning transmission electron microscopy and phase-field simulations reveals a complex hierarchical domain structure that forms to minimize the elastic and electrostatic energy. Large local deformations of the ferroelectric lattice are accommodated by periodic lattice modulations of the metallic SrRuO3 layers with curvatures up to 107 m-1. Our results show that multidomain ferroelectric systems can be exploited as versatile templates to induce large curvatures in correlated materials, and present a route for engineering correlated materials with modulated structural and electronic properties that can be controlled using electric fields.

Quantum cascade lasers monolithically integrated on germanium.

Silicon (Si) photonics can have a major impact on the development of mid-IR photonics by leveraging on the reliable and high-volume fabrication technologies already developed for microelectronic integrated circuits. Germanium (Ge), already used in Si photonics, is a prime candidate to extend the operating wavelength of Group IV-based photonic integrated circuits beyond 8 µm, and potentially up to 15 µm. High performance quantum cascade lasers (QCLs) and interband cascade lasers grown on Si have been demonstrated, whereas no QCLs monolithically integrated on Ge have been reported yet. In this work, we present InAs-based QCLs directly grown on Ge by molecular beam epitaxy. The lasers emitting near 14 µm exhibited threshold current densities as low as 0.8-0.85 kA/cm2 at room temperature.

Damage Classification Using Supervised Self-Organizing Maps in Structural Health Monitoring.

Improvements in computing capacity have allowed computers today to execute increasingly complex tasks. One of the main benefits of these improvements is the possibility of developing machine learning algorithms, of which the fields of application are extensive and varied. However, an area in which this type of algorithms acquires an increasing relevance is structural health monitoring (SHM), where inspection strategies and guided wave-based approaches make the evaluation of the structural conditions of an aircraft, vessel or building among others possible, by detecting and classifying existing damages. The use of sensors, data acquisition systems (DAQ) and computation has also allowed these damage detection and classification tasks to be carried out automatically. Despite today's advances, it is still necessary to continue with the development of more robust, reliable, and low-cost structural health monitoring systems. For this reason, this work contemplates three key points: (i) the configuration of a data acquisition system for signal gathering from an an active piezoelectric (PZT) sensor network; (ii) the development of a damage classification methodology based on signal processing techniques (normalization and PCA), from which the models that describe the structural conditions of the plate are built; and (iii) the use of machine learning algorithms, more specifically, three variants of the self-organizing maps called CPANN (counterpropagation artificial neural network), SKN (supervised Kohonen) and XYF (X-Y fused Kohonen). The data obtained allowed one to carry out an experimental validation of the damage classification methodology, to determine the presence of damages in two aluminum plates of different sizes, where masses were added to change the vibrational responses captured by the sensor network and a composite (CFRP) plate with real damages, such as delamination and cracks. This classification methodology allowed one to obtain excellent results by validating the usefulness of the SKN and XYF networks in damage classification tasks, showing overall accuracies of 73.75% and 72.5%, respectively, according to the cross-validation process. These percentages are higher than those obtained in comparison with other neural networks such as: kNN, discriminant analysis, classification trees, partial least square discriminant analysis, and backpropagation neural networks, when the cross-validation process was applied.

[An intracranial haemorrhage in a febrile newborn]. / L'image du mois. Une hémorragie intracrânienne chez un nouveau-né fébrile.

A 15 days old newborn was admitted to the emergency room for a recent fever onset. In newborns, the priority is to rule out any bacterial infection and initiate broad spectrum antibiotics. The hemorrhagic appearance of the cerebrospinal fluid after lumbar puncture can sometimes be the only sign to suspect, other than obvious infectious aetiology, an intracranial haemorrhage.

: Un nouveau-né de 15 jours est admis en salle d'urgence pour de la fièvre. Au vu de l'immaturité immunitaire des nouveau-nés et selon les recommandations internationales, la priorité est d'exclure une infection d'origine bactérienne et d'administrer une antibiothérapie intraveineuse empirique. Lors de la réalisation du bilan étiologique, l'aspect hémorragique du liquide céphalo-rachidien peut être le témoin d'un syndrome méningé d'étiologie autre qu'infectieuse, et notamment d'une hémorragie intracérébrale.

[Rare complication of a dog bite: Capnocytophaga species bacteremia followed by an hemolytic uremic syndrome]. / Cas clinique. Complication méconnue des morsures canines : syndrome hémolytique et urémique suite à une bactériémie à Capnocytophaga Canimorsus.

Dog bites are a frequent reason for medical consultation. These can be responsible for severe infectious complications. Bacteria of the genus Capnocytophaga species are Gram-negative bacilli commonly found in the oral cavity of certain animals such as dogs and cats. Following a dog bite or wound contamination with animal spit, these bacteria can cause local (cellulitis), systemic and invasive manifestations (bacteremia, endocarditis, meningitis) or lead to rare and dreadful complications such as thrombotic microangiopathies. The identification of Capnocytophaga is slow due to their specific characteristics and their culture conditions. The treatment of Capnocytophaga species infections is based on antibiotic therapy with amoxicillin - clavulanic acid as the first choice. Although different types of Capnocytophaga have been described, C. Canimorsus appears to be associated with a higher rate of atypical complications. Here is the description of an immunocompetent patient who presented with C. Canimorsus bacteremia complicated by hemolytic uremic syndrome following a dog bite.

Les morsures de chien représentent un motif fréquent de consultation. Celles-ci peuvent entraîner des complications infectieuses graves. Les bactéries du genre Capnocytophaga species sont des bacilles Gram négatif fréquemment retrouvés dans la cavité buccale de certains animaux comme les chiens et les chats. à la suite d'une morsure canine ou d'une contamination de plaie par de la salive animale, ces bactéries peuvent provoquer des manifestations locales (cellulite), systémiques et invasives (bactériémie, endocardite, méningite) ou entraîner des complications rares et redoutables comme les microangiopathies thrombotiques. L'identification des Capnocytophaga est lente de par leurs caractéristiques propres et leurs conditions de mise en culture. Le traitement des infections à Capnocytophaga species repose sur une antibiothérapie par amoxicilline-acide clavulanique en première intention. Bien que différents types de Capnocytophaga aient été décrits, C. Canimorsus semble associé à un taux plus élevé de complications atypiques. Nous décrivons ici le cas d'une patiente immunocompétente ayant présenté une bactériémie à C. Canimorsus compliquée d'un syndrome hémolytique et urémique dans les suites d'une morsure de chien.

Smoothing temperature and ratio of casein to whey protein: Two tools to improve nonfat stirred yogurt properties.

Consumers are not always ready to compromise on the loss of texture and increased syneresis that nonfat stirred yogurts display compared with yogurts that contain fat. In this study, we investigated milk protein composition and smoothing temperature as a means to control nonfat yogurt microstructure, textural properties, and syneresis. Yogurts were prepared with different ratios of casein to whey protein (R1.5, R2.8, and R3.9). Yogurts were pumped through a smoothing pilot system comprising a plate heat exchanger set at 15, 20, or 25°C and then stored at 4°C until analysis (d 1, 9, and 23). Yogurt particle size and firmness were measured. Yogurt syneresis and water mobility were determined, respectively, by centrifugation and time domain low-frequency proton nuclear magnetic resonance (1H-LF-NMR). Increasing the smoothing temperature increased gel firmness and microgel (dense protein aggregates) sizes independently of the whey protein content. Also, yogurt microgel sizes changed with storage time, but the evolution pattern depended on protein ratio. Yogurt R1.5 showed the largest particles, and their sizes increased with storage, whereas R2.8 and R3.9 had smaller microgels, and R3.9 did not show any increase in microgel size during storage. Micrographs showed a heterogeneous gel with the empty area occupied by serum for R1.5, whereas R2.8 and R3.9 showed fewer serum zones and a more disrupted gel embedding microgels. Induced syneresis reduced with greater whey protein content and time of storage. This is in agreement with 1H-LF-NMR showing less bulk water mobility with increasing whey protein content during storage. However, 1H-LF-RMN revealed higher values of spontaneous serum separation during storage for R1.5 and R3.9 yogurts, whereas these were lower and stable for R2.8 yogurt. Microgels play an important structural role in yogurt textural attributes, and their characteristics are modulated by whey protein content and smoothing temperature. Optimization of these parameters may help improve nonfat stirred dairy gel.

Studying stirred yogurt microstructure using optical microscopy: How smoothing temperature and storage time affect microgel size related to syneresis.

A grainy texture and high syneresis are 2 defects in low-fat stirred yogurt that are often disliked by consumers. In this study, a rheometer controlling the shear rate and temperature was used to simulate the smoothing step of yogurt manufacture. Identical formulations containing whey protein isolate or whey protein concentrate were compared. After the yogurt milk underwent heat treatment, inoculation, and fermentation at 42°C, the yogurt was smoothed at 42°C (Y42) or 20°C (Y20) or during a cooling ramp from 42°C to 20°C (YR). Induced syneresis (serum expelled by centrifugation) was measured on d 3. Sizes of microgels (dense protein aggregates) were investigated on d 0, 4, and 7 by laser diffraction and by image analysis using optical microscopy. Optical microscopy was also used to characterize the reorganized protein network embedding microgels. The type of whey protein ingredient had only a slight effect on the induced syneresis of YR and Y20 treated yogurts, and the major effect came from the smoothing temperature. The Y42 treatment presented the highest induced syneresis; YR and Y20 had similar low induced syneresis values. Images showed a heterogeneous microstructure (large microgels, reorganized gel) and serum separation for Y42; the YR and Y20 networks were homogeneous. Both the image analyses and laser diffraction showed that the microgel size depended on the smoothing temperature. However, only the image analyses made it possible to identify a time dependency effect on microgel size during storage. The number of microgels >104 µm2 continued to increase over time, whereas the number of microgels <103 µm2 decreased. Microscopic observations were less destructive than laser diffraction and highlighted the presence of microgel aggregation during storage.

Oiling of American white pelicans, common loons, and northern gannets in the winter following the Deepwater Horizon (MC252) oil spill.

The Natural Resource Damage Assessment and Restoration Trustees for the Deepwater Horizon oil spill assessed the external oiling of migratory bird species dependent on open water in the Gulf of Mexico following the aforementioned spill. The assessment was designed to evaluate birds that use open water during the winter within 40 km of the Gulf shoreline. We focused on the American white pelican (Pelecanus erythrorhynchos), common loon (Gavia immer), and northern gannet (Morus bassanus). Point counts (pelican, loon) or strip transects (gannet) were used and each target species was assessed for oiling (unoiled, trace, light, moderate, or heavy amounts) and photographed. Due to distance at sighting and/or poor visibility, not all visible birds were assessed. The percentage of birds oiled varied by species, with the common loon being the highest (23.6%), followed by American white pelican (16.9%), and northern gannet (6.9%). Most of the American white pelicans and common loons had trace (83% and 72%, respectively) or light levels (11% and 24%, respectively) of oiling. The northern gannet had just trace levels of oiling. Some pelicans (6%) and loons (4%) had moderate amounts of oiling. Based on expert derived-mortality estimates and our estimates of oil exposure, we used Monte Carlo simulations to predict expected decreases of 2.5%, 4%, and 11% in the observed population for the northern gannet, American white pelican, and common loon, respectively. While these values are underestimates of the true values given the long time lag (10-12 months) between the oil spill and the assessment, these data represent some of the few estimates of exposure for these species and describe minimum risk estimates to these species.

[New method to regulate unscheduled urgent care : the ODISSEE interactive self-triage platform]. / Nouvelle approche de régulation de la demande de soins non planifiés : l'application interactive d'auto-triage ODISSEE.

The regulation of the unscheduled care takes part of the different methods engaged to better organize the global demand for unscheduled urgent care among the different levels of care. Indeed, the first level of care equally with the emergency departments are facing major patient inflows often exceeding their available resources. Technological advances in healthcare and spreading of medical information reveal themselves as precursors of new adaptive strategies and daily challenges. The creation of an interactive app for patients self-triage through the different levels of care involves those different concepts. We created a new interactive platform, the ODISSEE mobile application (Outil Décisionnel et Informatif des Structures de Soins Efficientes Existantes), to allow patient's self-triage to the best level of care. The protocols used were directly based on a previously validated tool with a 5-year experience in our institution, the SALOMON algorithm (Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne). Establishment of interactive self-triage platform to guide patients to the best level of care could potentially be a promising tool to improve the regulation of unscheduled urgent care.

La régulation de la demande de soins non planifiés fait partie des approches envisagées pour obtenir une meilleure répartition de la demande de soins parmi les différents intervenants de la santé. En effet, tant la première ligne de soins que les services d'urgence font face à des flux de patients conséquents, saturant fréquemment les ressources qu'ils possèdent pour y répondre. L'apparition de nouvelles technologies et l'entrée dans la pratique courante de la diffusion de l'information médicale se sont révélées être des précurseurs de nouvelles stratégies adaptatives, mais également de nouveaux défis quotidiens. La création d'une application interactive permettant l'auto-triage du patient vers la ligne de soins la plus appropriée fait intervenir ces différents concepts. Nous avons donc développé une plateforme interactive, l'application ODISSEE (Outil Décisionnel et Informatif des Structures de Soins Efficientes Existantes), permettant au patient d'autoévaluer la gravité de son problème et de bénéficier d'un conseil avisé sur le niveau de soins à envisager. Les protocoles utilisés sont directement issus d'un outil créé précédemment dans notre institution et ayant fait ses preuves durant 5 années d'utilisation, l'outil SALOMON (Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne). La création d'un système interactif d'auto-triage du patient le guidant vers le niveau de soins le plus approprié pourrait être une méthode prometteuse pour la régulation de la demande de soins non planifiés.

[SALOMON, a collaboration model between primary and secondary care for nocturnal emergency calls]. / SALOMON, un modèle coopératif entre la première et la seconde ligne de soins pour les appels d'urgence nocturnes.

Facing the aging of primary care practitioners and their still increasing duties, we implemented a new and original solution to maintain the continuity of primary care in the area surrounding of our university hospital. Thereby, we created a new model of nurse telephone triage for the regulation of out-of-hours primary care calls, the SALOMON algorithm ("Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne"). Following the nurse telephone triage and the assessment of the illness severity, the patient is referred to four potential orientations : Emergency Medical Services (EMS), Emergency Department Referred Consultation (EDRC), Primary Care Physician Home visit (PCPH) and Primary Care Physician Delayed visit (PCPD). In this article, we aim to describe the SALOMON model and present a 12-month feasibility study in order to determine the safety of the tool. We can also notice nurse and general practitioner satisfaction about this approach with a positive impact on the global primary care out-of-hour organization. Currently, SALOMON seems to be full of promise. Further investigations on a larger cohort are needed to determine more precisely the reliability of the algorithm.

L'objectif de notre étude est d'apporter une réponse originale à la problématique de la permanence médicale de première ligne liée au vieillissement médical et à la charge de travail croissante. Nous proposons, à cet effet, la mise en place d'une interface de régulation des appels en période critique (nuit profonde) au moyen d'un outil algorithmique original dénommé SALOMON («Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne¼). En fonction du degré de gravité supputé, la plateforme propose l'orientation optimale du patient parmi quatre options possibles : renvoi de la demande vers le centre d'appel unifié 112 et prise en charge par les moyens de l'Aide Médicale Urgente (AMU), orientation du malade vers un service d'urgence spécialisé (SUS) de son choix pour une Mise Au Point Hospitalière (MAPH), mise en Contact avec le Médecin Généraliste de garde (CMG) ou enfin prise en charge par une Visite Différée (VD) via le médecin de famille. Après une description de l'outil, nous présentons l'étude de faisabilité qui a porté sur une période de 12 mois. Cette étude préliminaire était destinée à vérifier la robustesse de SALOMON avant de prévoir, le cas échéant, sa diffusion au sein d'une zone plus vaste. Les résultats préliminaires suggèrent une grande fiabilité de SALOMON. Nous avons également observé que son utilisation était associée à un réel état de satisfaction de l'ensemble des acteurs impliqués, qu'ils aient été infirmiers dispatcheurs ou médecins généralistes. Sous réserve d'une étude à plus grande échelle, les bénéfices actuellement notés en matière d'épargne de ressources humaines durant la garde de première ligne ont rapidement entraîné la fusion de deux zones de garde.

[Hemorrhagic moyamoya disease]. / Le cas clinique du mois. Complication hémorragique d'une forme sévère de maladie de moyamoya.

Moyamoya disease is a rare cerebral vasculopathy. Disease onset is mainly sudden presenting as an ischemic stroke but also sometimes as a brain hemorraghe. Cerebral angiography is the gold standard to confirm the diagnosis. Different therapeutic approaches have been described such as conservative management or endoscopic and surgical approaches. We report the case of a young patient who was diagnosed with a brain hemorraghe following a sudden loss of consciousness.

La maladie de moyamoya est une vasculopathie cérébrale souvent méconnue. Sa découverte est majoritairement brutale dans les suites de la survenue d'un accident vasculaire ischémique ou, dans certains cas, hémorragique. L'artériographie est l'examen de choix pour confirmer le diagnostic. Différentes approches thérapeutiques ont été proposées, qu'elles soient médicamenteuses, endoscopiques ou chirurgicales. Nous présentons le cas d'une jeune patiente chez qui un diagnostic de maladie de moyamoya a été posé dans le décours d'une hémorragie cérébrale avec altération rapide de l'état de conscience.

[Management of emergency department inflows during the COVID-19 outbreak in the CHU of Liege : efficiency of an advanced triage center]. / Gestion des admissions aux Urgences durant la pandémie de COVID-19 au sein du CHU de Liège : Apport d'un centre de tri avancé.

In March 2020, the COVID-19 pandemic started to spread among the Belgian territory. Our university hospital was confronted to the very need of specific reorganizations guided by the implementation of the Hospital Emergency Plan.This article aims to describe the experience of the University Hospital of Liège (CHU Liège) during the COVID-19 outbreak and demonstrates the efficiency of advanced triage centers to regulate hospital admissions from the emergency department (ED). METHODS: since the beginning of March 2020, the CHU of Liège has implemented specific advanced triage centers to manage patients with SARS-CoV-2 suspected symptoms. The first center was organized inside the hospital but the need of outside structures led to the creation of two centers by the end of March. From March 2 to May 3, data from the different visits at the COVID-19 centers were collected (numbers of admissions, rationale for coming, work up and outcome). RESULTS: during the study period, 3,094 patients were admitted to the specific COVID-19 centers of the CHU Liège. This represents 3,431 visits among which 337 were classified as readmission visits. The sensitivity and specificity of the triage centers to determine the need for hospitalization were, respectively, estimated at 87,9 % and 93,4 %. CONCLUSION: our experience tends to demonstrate the role of specific COVID-19 triage centers located very close to the EDs aimed at managing COVID-19 suspected patients in order to actually determine their need for subsequent hospitalization.

La pandémie de COVID-19 a débuté au mois de mars 2020 sur le territoire belge. Elle a contraint nos institutions hospitalières à une série de réorganisations singulières soutenues par l'activation du Plan d'Urgence Hospitalier. Cet article a pour objet de décrire l'expérience du Centre Hospitalier Universitaire de Liège (CHU de Liège) durant la pandémie de COVID-19 et de relater l'efficience de la mise en place d'un centre de tri avancé en amont des services d'urgences pour la gestion des admissions hospitalières. Méthodes : dès le 2 Mars 2020, le CHU de Liège a mis en place une infrastructure d'accueil des patients suspects d'infection par le SARS-CoV-2. D'abord initiée au sein de l'institution hospitalière, la nécessité d'une infrastructure indépendante s'est rapidement révélée indispensable et a, dès lors, vu le jour dès la fin du mois de mars, sur les deux sites hospitaliers universitaires. Du 2 mars au 3 mai 2020, l'ensemble des données relatives aux visites au sein des centres de tri avancé ont été collectées (nombre d'admissions, motif des visites, examens complémentaires et évolutions cliniques). Résultats : sur la période de l'étude, 3.094 patients ont transité par les centres de tri du CHU de Liège. Cette fréquentation était constituée d'un volume global de 3.431 contacts dont 337 représentaient des réadmissions. La sensibilité et la spécificité des centres de tri en regard de la nécessité d'une hospitalisation étaient, respectivement, de 87,9 % et 93,4 %. Conclusion : notre expérience suggère une efficience optimale des centres de tri avancé, en amont des structures hospitalières traditionnelles, pour orienter de manière appropriée le flux des patients suspects d'infection par le SARS-CoV-2.

The Nanodiffraction beamline ID01/ESRF: a microscope for imaging strain and structure.

The ID01 beamline has been built to combine Bragg diffraction with imaging techniques to produce a strain and mosaicity microscope for materials in their native or operando state. A scanning probe with nano-focused beams, objective-lens-based full-field microscopy and coherent diffraction imaging provide a suite of tools which deliver micrometre to few nanometre spatial resolution combined with 10-5 strain and 10-3 tilt sensitivity. A detailed description of the beamline from source to sample is provided and serves as a reference for the user community. The anticipated impact of the impending upgrade to the ESRF - Extremely Brilliant Source is also discussed.

Detection of CMB-Cluster Lensing using Polarization Data from SPTpol.

We report the first detection of gravitational lensing due to galaxy clusters using only the polarization of the cosmic microwave background (CMB). The lensing signal is obtained using a new estimator that extracts the lensing dipole signature from stacked images formed by rotating the cluster-centered Stokes QU map cutouts along the direction of the locally measured background CMB polarization gradient. Using data from the SPTpol 500 deg^{2} survey at the locations of roughly 18 000 clusters with richness λ≥10 from the Dark Energy Survey (DES) Year-3 full galaxy cluster catalog, we detect lensing at 4.8σ. The mean stacked mass of the selected sample is found to be (1.43±0.40)×10^{14}M_{⊙} which is in good agreement with optical weak lensing based estimates using DES data and CMB-lensing based estimates using SPTpol temperature data. This measurement is a key first step for cluster cosmology with future low-noise CMB surveys, like CMB-S4, for which CMB polarization will be the primary channel for cluster lensing measurements.

Prediction of outcome in anal squamous cell carcinoma using radiomic feature analysis of pre-treatment FDG PET-CT.

PURPOSE: Incidence of anal squamous cell carcinoma (ASCC) is increasing, with curative chemoradiotherapy (CRT) as the primary treatment of non-metastatic disease. A significant proportion of patients have locoregional treatment failure (LRF), but distant relapse is uncommon. Accurate prognostication of progression-free survival (PFS) would help personalisation of CRT regimens. The study aim was to evaluate novel imaging pre-treatment features, to prognosticate for PFS in ASCC. METHODS: Consecutive patients with ASCC treated with curative intent at a large tertiary referral centre who underwent pre-treatment FDG-PET/CT were included. Radiomic feature extraction was performed using LIFEx software on baseline FDG-PET/CT. Outcome data (PFS) was collated from electronic patient records. Elastic net regularisation and feature selection were used for logistic regression model generation on a randomly selected training cohort and applied to a validation cohort using TRIPOD guidelines. ROC-AUC analysis was used to compare performance of a regression model encompassing standard clinical prognostic factors (age, sex, tumour and nodal stage-model A), a radiomic feature model (model B) and a combined radiomic/clinical model (model C). RESULTS: A total of 189 patients were included in the study, with 145 in the training cohort and 44 in the validation cohort. Median follow-up was 35.1 and 37. 9 months, respectively for each cohort, with 70.3% and 68.2% reaching this time-point with PFS. GLCM entropy (a measure of randomness of distribution of co-occurring pixel grey-levels), NGLDM busyness (a measure of spatial frequency of changes in intensity between nearby voxels of different grey-level), minimum CT value (lowest HU within the lesion) and SMTV (a standardized version of MTV) were selected for inclusion in the prognostic model, alongside tumour and nodal stage. AUCs for performance of model A (clinical), B (radiomic) and C (radiomic/clinical) were 0.6355, 0.7403, 0.7412 in the training cohort and 0.6024, 0.6595, 0.7381 in the validation cohort. CONCLUSION: Radiomic features extracted from pre-treatment FDG-PET/CT in patients with ASCC may provide better PFS prognosis than conventional staging parameters. With external validation, this might be useful to help personalise CRT regimens in the future.

Black Pastors' Views on preaching about sex: barriers, facilitators, and opportunities for HIV prevention messaging.

OBJECTIVES: Despite the disproportionately high rates of heterosexually transmitted HIV infection among US Blacks and ongoing need for effective inexpensive behavioral interventions, the use of sermons as an HIV prevention tool in Black churches has received little research attention. The Black church plays an important role in Black communities and is a potential ally in development and delivery of sexual risk prevention messages. The objective of this study was to examine Black pastors' thoughts about whether sermons should address issues related to heterosexual relationships - and the barriers and facilitators to discussing these topics in a sermon setting. DESIGN: We conducted in-depth semi-structured, individual interviews among 39 pastors of Black churches in North Carolina and analyzed the interview data using thematic analysis strategies based on grounded theory. RESULTS: Pastors expressed widely ranging opinions, especially about discussion of condom use, but generally agreed that sermons should discuss marriage, abstinence, monogamy, dating, and infidelity - behaviors that impact sexual networks and HIV transmission. The major barriers to incorporation of these subjects into sermons include the extent to which a concept undermines their religious beliefs and uncertainty about how to incorporate it. However, scriptural support for a prevention message and the pastor's perception that the message is relevant to the congregation facilitate incorporation of related topics into sermons. CONCLUSIONS: These findings have implications for the potential utility of sermons as an HIV prevention tool and suggest that it is possible for public health professionals and pastors of Black churches to form partnerships to develop messages that are consonant with pastors' religious convictions as well as public health recommendations.

"What is the efficacy of specialised early intervention in mental health targeting simultaneously adolescents and young adults?'' An HTA.

OBJECTIVES: Current service organization is not adapted for youth with or at risk of mental illness. Access, engagement and continuity of care are notorious challenges, particularly during transition from adolescence to adulthood, when youths are transferred to adult services. An HTA was initiated to evaluate the efficacy of programs for which admission is not a function of the legal age of majority. METHODS: A systematic review of systematic reviews identified literature published between 2000 and 2017 in 4 databases. To be selected, studies had to focus on specialised mental healthcare early intervention (EI) programs targeting both adolescents and young adults. Contextual and experiential data were collected through interviews with local leading experts. Article selection and quality assessment using ROBIS were conducted with inter rater agreement. The analytical framework developed includes 4 domains: access, engagement and continuity, recovery as well as meaningfulness and acceptability. RESULTS: 1841 references were identified. Following inclusion/exclusion criteria, 5 studies were selected, 3 of which focused on EI for psyschosis. EI programs alone do not seem to decrease duration of untreated psychosis. EI including a multi focus campaign were more successful. EI does, however, seem to decrease hospitalisation for psychosis. The experience of service users and professionals with inter agency collaboration and person-centred care models were analysed to identify facilitating and inhibiting implementation factors. CONCLUSIONS: Healthcare policies need to support further research and development of EI where admission is not a function of the legal age of majority and diagnostic, particularly for youths at risk.