Eco-friendly MA3Bi2I9perovskite thin films based ammonia sensor.

Organic-inorganic perovskite halides (OIPH) have emerged as a wonder material with growing interest in sensors detecting various toxic gases. However, lead toxicity represents a potential obstacle, and therefore finding lead-free cost-effective compatible materials for gas sensing applications is essential. In this work, methylammonium bismuth iodide i.e. (CH3NH3)3Bi2I9(MABI) perovskite thin films-based ammonia (NH3) sensor was synthesized using an antisolvent-assisted one-step spin coating method. The MABI sensor shows a linear relationship between the responsivity and concentration of NH3with excellent reversibility, high gas responsivity, and humidity stability. The MABI thin-film sensor exhibits a maximum gas response of 24%, a short response/recovery time i.e. 0.14 s /8.15 s and good reversibility at 6 ppm of NH3. It was observed that MABI thin films based sensors have excellent ambient stability over a couple of months. This work reveals that it is feasible to design high-performance gas sensors based on environmentally-friendly Bi-based OIPH materials.

Misrecognition, social stigma, and COVID-19.

As social and interdependent beings, we have responsibilities to each other. One of them is to recognize each other appropriately. When we fail to meet this responsibility, we often stigmatize. In this paper, I argue that the COVID-19-related stigmatization is a variation of the lack of recognition understood as an orientation to our evaluative features. Various stereotypical behaviors regarding COVID-19 become stigmatized practices because of labeling, stereotyping, separation, status loss and discrimination, and power. When people stigmatize COVID-19 victims, they orient themselves to their evaluative quality of being vulnerable to the SARS-CoV-2 virus by internalizing the victims as dangerous, understanding them as separable, and being motivated to act with them differently. All this causes the COVID-19 victims to lose status and suffer discrimination for which they do not experience participatory parity in different facets of their lives, rendering the COVID-19-related stigmatization an appalling example of misrecognition.

Inhibitor binding to mutants of protein kinase A with GGGxxG and GxGxxA glycine-rich loop motifs.

The conserved GxGxxG motif of protein kinases forms a beta turn at the tip of the flexible glycine-rich loop and creates much of the ATP pocket binding surface. Notable exceptions to this sequence include GGGxxG in ABL kinase and GxGxxA in protein kinase C isoforms. We constructed the corresponding mutants of PKA, T51G, and G55A, and tested quinazoline inhibitors that were designed to bind via glycine-rich loop interactions, testing also staurosporine for comparison. The quinazoline inhibitors have significantly reduced binding strengths in both mutants. In striking contrast to these results, the binding of the "pan-kinome" inhibitor staurosporine is strengthened in the mutants. Surface plasmon resonance (SPR) shows that the tightened binding of staurosporine arises from increased kon rates, changes not offset by more moderately increased koff rates. The SPR results fit best to a two step binding process for staurosporine in wild type PKA, but not the mutants.

Performance across WorldView-2 and RapidEye for reproducible seagrass mapping.

Satellite remote sensing offers an effective remedy to challenges in ground-based and aerial mapping that have previously impeded quantitative assessments of global seagrass extent. Commercial satellite platforms offer fine spatial resolution, an important consideration in patchy seagrass ecosystems. Currently, no consistent protocol exists for image processing of commercial data, limiting reproducibility and comparison across space and time. Additionally, the radiometric performance of commercial satellite sensors has not been assessed against the dark and variable targets characteristic of coastal waters. This study compared data products derived from two commercial satellites: DigitalGlobe's WorldView-2 and Planet's RapidEye. A single scene from each platform was obtained at St. Joseph Bay in Florida, USA, corresponding to a November 2010 field campaign. A reproducible processing regime was developed to transform imagery from basic products, as delivered from each company, into analysis-ready data usable for various scientific applications. Satellite-derived surface reflectances were compared against field measurements. WorldView-2 imagery exhibited high disagreement in the coastal blue and blue spectral bands, chronically overpredicting. RapidEye exhibited better agreement than WorldView-2, but overpredicted slightly across all spectral bands. A deep convolutional neural network was used to classify imagery into deep water, land, submerged sand, seagrass, and intertidal classes. Classification results were compared to seagrass maps derived from photointerpreted aerial imagery. This study offers the first radiometric assessment of WorldView-2 and RapidEye over a coastal system, revealing inherent calibration issues in shorter wavelengths of WorldView-2. Both platforms demonstrated as much as 97% agreement with aerial estimates, despite differing resolutions. Thus, calibration issues in WorldView-2 did not appear to interfere with classification accuracy, but could be problematic if estimating biomass. The image processing routine developed here offers a reproducible workflow for WorldView-2 and RapidEye imagery, which was tested in two additional coastal systems. This approach may become platform independent as more sensors become available.

Assessing protein kinase target similarity: Comparing sequence, structure, and cheminformatics approaches.

In just over two decades, structure based protein kinase inhibitor discovery has grown from trial and error approaches, using individual target structures, to structure and data driven approaches that may aim to optimize inhibition properties across several targets. This is increasingly enabled by the growing availability of potent compounds and kinome-wide binding data. Assessing the prospects for adapting known compounds to new therapeutic uses is thus a key priority for current drug discovery efforts. Tools that can successfully link the diverse information regarding target sequence, structure, and ligand binding properties now accompany a transformation of protein kinase inhibitor research, away from single, block-buster drug models, and toward "personalized medicine" with niche applications and highly specialized research groups. Major hurdles for the transformation to data driven drug discovery include mismatches in data types, and disparities of methods and molecules used; at the core remains the problem that ligand binding energies cannot be predicted precisely from individual structures. However, there is a growing body of experimental data for increasingly successful focussing of efforts: focussed chemical libraries, drug repurposing, polypharmacological design, to name a few. Protein kinase target similarity is easily quantified by sequence, and its relevance to ligand design includes broad classification by key binding sites, evaluation of resistance mutations, and the use of surrogate proteins. Although structural evaluation offers more information, the flexibility of protein kinases, and differences between the crystal and physiological environments may make the use of crystal structures misleading when structures are considered individually. Cheminformatics may enable the "calibration" of sequence and crystal structure information, with statistical methods able to identify key correlates to activity but also here, "the devil is in the details." Examples from specific repurposing and polypharmacology applications illustrate these points. This article is part of a Special Issue entitled: Inhibitors of Protein Kinases.

Epidemiology of Pertussis Among Young Pakistani Infants: A Community-Based Prospective Surveillance Study.

BACKGROUND: Pertussis remains a cause of morbidity and mortality among young infants. There are limited data on the pertussis disease burden in this age group from low- and lower-middle-income countries, including in South Asia. METHODS: We conducted an active community-based surveillance study from February 2015 to April 2016 among 2 cohorts of young infants in 4 low-income settlements in Karachi, Pakistan. Infants were enrolled either at birth (closed cohort) or at ages up to 10 weeks (open cohort) and followed until 18 weeks of age. Nasopharyngeal swab specimens were obtained from infants who met a standardized syndromic case definition and tested for Bordetella pertussis using real-time polymerase chain reaction. We determined the incidence of pertussis using a protocol-defined case definition, as well as the US Centers for Disease Control and Prevention (CDC) definitions for confirmed and probable pertussis. RESULTS: Of 2021 infants enrolled into the study, 8 infants met the protocol-defined pertussis case definition, for an incidence of 3.96 (95% confidence interval [CI], 1.84-7.50) cases per 1000 infants. Seven of the pertussis cases met the CDC pertussis case definition (5 confirmed, 2 probable), for incidences of CDC-defined confirmed pertussis of 2.47 (95% CI, .90-5.48) cases per 1000 infants, and probable pertussis of 0.99 (95% CI, .17-3.27) cases per 1000 infants. Three of the pertussis cases were severe according to the Modified Preziosi Scale score. CONCLUSIONS: In one of the first prospective surveillance studies of infant pertussis in a developing country, we identified a moderate burden of pertussis disease in early infancy in Pakistan.

Addressing the Glycine-Rich Loop of Protein Kinases by a Multi-Facetted Interaction Network: Inhibition of PKA and a PKB Mimic.

Protein kinases continue to be hot targets in drug discovery research, as they are involved in many essential cellular processes and their deregulation can lead to a variety of diseases. A series of 32 enantiomerically pure inhibitors was synthesized and tested towards protein kinase A (PKA) and protein kinase B mimic PKAB3 (PKA triple mutant). The ligands bind to the hinge region, ribose pocket, and glycine-rich loop at the ATP site. Biological assays showed high potency against PKA, with Ki values in the low nanomolar range. The investigation demonstrates the significance of targeting the often neglected glycine-rich loop for gaining high binding potency. X-ray co-crystal structures revealed a multi-facetted network of ligand-loop interactions for the tightest binders, involving orthogonal dipolar contacts, sulfur and other dispersive contacts, amide-π stacking, and H-bonding to organofluorine, besides efficient water replacement. The network was analyzed in a computational approach.

A Mixed-Culture Biofilm Model with Cross-Diffusion.

We propose a deterministic continuum model for mixed-culture biofilms. A crucial aspect is that movement of one species is affected by the presence of the other. This leads to a degenerate cross-diffusion system that generalizes an earlier single-species biofilm model. Two derivations of this new model are given. One, like cellular automata biofilm models, starts from a discrete in space lattice differential equation where the spatial interaction is described by microscopic rules. The other one starts from the same continuous mass balances that are the basis of other deterministic biofilm models, but it gives up a simplifying assumption of these models that has recently been criticized as being too restrictive in terms of ecological structure. We show that both model derivations lead to the same PDE model, if corresponding closure assumptions are introduced. To investigate the role of cross-diffusion, we conduct numerical simulations of three biofilm systems: competition, allelopathy and a mixed system formed by an aerobic and an anaerobic species. In all cases, we find that accounting for cross-diffusion affects local distribution of biomass, but it does not affect overall lumped quantities such as the total amount of biomass in the system.

Utility and feasibility of integrating pulse oximetry into the routine assessment of young infants at primary care clinics in Karachi, Pakistan: a cross-sectional study.

BACKGROUND: Hypoxemia may occur in young infants with severe acute illnesses or congenital cardiac anomalies, but is not reliably detected on physical exam. Pulse oximetry (PO) can be used to detect hypoxemia, but its application in low-income countries has been limited, and its feasibility in the routine assessment of young infants (aged 0-59 days) has not been previously studied. The aim of this study was to characterize the operational feasibility and parent/guardian acceptability of incorporating PO into the routine clinical assessment of young infants in a primary care setting in a low-income country. METHODS: This was a cross-sectional study of 862 visits by 529 infants at two primary care clinics in Karachi, Pakistan (March to June, 2013). After clinical assessment, oxygen saturation (Sp02) was measured by a handheld PO device (Rad-5v, Masimo Corporation) according to a standardized protocol. Performance time (PT) was the time between sensor placement and attainment of an acceptable PO reading (i.e., stable SpO2 + 1% for at least 10 s, heart rate displayed, and adequate signal indicators). PT included the time for one repeat attempt at a different anatomical site if the first attempt did not yield an acceptable reading within 1 min. Parent/guardian acceptability of PO was based on a questionnaire and unprompted comments about the procedure. All infants underwent physician assessment. RESULTS: Acceptable PO readings were obtained in ≤ 1 and ≤ 5 min at 94.4% and 99.8% of visits, respectively (n = 862). Median PT was 42 s (interquartile range 37; 50). Parents/guardians overwhelmingly accepted PO (99.6% overall satisfaction, n = 528 first visits). Of 10 infants with at least one visit with Sp02 <92% on a first PO attempt, 3 did not have a significant acute illness on physician assessment. There were no PO-related adverse events. DISCUSSION: Using a commercially available handheld pulse oximeter, acceptable Sp02 measurements were obtained in nearly all infants in under 1 minute. The procedure was readily integrated into existing assessment pathways and parents/guardians had positive views of the technology. CONCLUSIONS: When incorporated into routine clinical assessment of young infants at primary care clinics in a low-income country, PO was feasible and acceptable to parents/guardians. Future research is needed to determine if the introduction of routine PO screening of young infants will improve outcomes in low-resource settings.

Monitoring polio supplementary immunization activities using an automated short text messaging system in Karachi, Pakistan.

PROBLEM: Polio remains endemic in many areas of Pakistan, including large urban centres such as Karachi. APPROACH: During each of seven supplementary immunization activities against polio in Karachi, mobile phone numbers of the caregivers of a random sample of eligible children were obtained. A computer-based system was developed to send two questions--as short message service (SMS) texts--automatically to each number after the immunization activity: "Did the vaccinator visit your house?" and "Did the enrolled child in your household receive oral polio vaccine?" Persistent non-responders were phoned directly by an investigator. LOCAL SETTING: A cluster sampling technique was used to select representative samples of the caregivers of young children in Karachi in general and of such caregivers in three of the six "high-risk" districts of the city where polio cases were detected in 2011. RELEVANT CHANGES: In most of the supplementary immunization activities investigated, vaccine coverages estimated using the SMS system were very similar to those estimated by interviewing by phone those caregivers who never responded to the SMS messages. In the high-risk districts investigated, coverages estimated using the SMS system were also similar to those recorded--using lot quality assurance sampling--by the World Health Organization. LESSONS LEARNT: For the monitoring of coverage in supplementary immunization activities, automated SMS-based systems appear to be an attractive and relatively inexpensive option. Further research is needed to determine if coverage data collected by SMS-based systems provide estimates that are sufficiently accurate. Such systems may be useful in other large-scale immunization campaigns.

A survey of sitting time among UK employees.

BACKGROUND: Sedentary behaviour is a known risk factor for a wide range of chronic diseases. This major health risk is likely to increase given the increasingly sedentary nature of work. AIMS: To investigate the prevalence of sedentary behaviour in a sample of UK working-aged adults, across a range of employment sectors. METHODS: A cross-sectional survey conducted with organizations throughout the UK in the education, government administration, retail, telecommunications and service industry sectors. The questionnaire examined employee and organizational information, self-reported domain-specific sitting time, sleep and physical activity. RESULTS: A total of 1141 employees completed the questionnaire, of which 504 completed all aspects of the Domain-Specific Sitting Time Questionnaire for work day sitting. Work time sitting accounted for more than half of the total daily sitting time on a work day (54%). Significantly more time was reported sitting on a work day than time reported sleeping (P < 0.001). Males spent more time sitting at work and using a personal computer at home compared with females. Workers in the telecommunications industry had the highest sitting times. There were significant positive associations between sitting time and body mass index. CONCLUSIONS: There is a pressing need for future workplace health interventions to reduce employee sitting times.

Solid fuel use is a major risk factor for acute coronary syndromes among rural women: a matched case control study.

OBJECTIVES: Almost half of the world's population uses solid fuel for cooking, exposing women to high levels of particulate pollution in indoor air. The risk of acute coronary syndrome (ACS) was assessed among rural women, according to their use of solid fuel. STUDY DESIGN: Matched case control study. METHODS: Data were collected at a public tertiary care hospital in a rural district of Pakistan. Seventy-three women with ACS were compared with controls, individually matched for sex and age (± 5 years), who were admitted to hospital for other reasons. Fuels used for cooking and exposures to potentially confounding variables were ascertained through a questionnaire administered at interview and measurement of height and weight. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: After adjustment for potential confounding factors, current use of solid fuel was strongly associated with ACS (OR 4.8, 95% CI: 1.5-14.8), and risk was lowest in women who had last used solid fuel more than 15 years earlier. The population attributable fraction for ACS in relation to current use of solid fuel was 49.0% (95% CI: 41.3%-57.4%). CONCLUSIONS: These findings support the hypothesis that indoor air pollution from use of solid fuel is an important cause of ACS. Our study demonstrates the feasibility of case-control studies in rural populations of women to address this question, and is an encouragement to larger and statistically more powerful investigations.

The Relationship Between Procedural Volume, Hospital Quality, and Postoperative Mortality in Pediatric Neurosurgery: Review of the Literature.

BACKGROUND: Studies of neurosurgical pediatric patients associate treatment at low-volume hospitals and by low-volume surgeons with increased odds of adverse outcomes. Although these associations suggest that increased centralization of care could be considered, we evaluate whether confounding endogenous factors mitigate against the proposed outcome benefits. METHODS: Literature review of English language articles from 1999 to 2021. We included articles that assessed volume-outcome effects in pediatric neurosurgical patients. RESULTS: Twelve papers were included from 1999 to 2021. Primary outcomes included mortality (9), length of stay (LOS) (6), complications (4), and shunt revision/failure rates (3). Volume was measured at the hospital level (8) and at the surgeon level (6). Four papers found that higher volume hospitals had lower odds of mortality. Two papers found that hospitals with higher volume had fewer complications. Two papers found that higher volume surgeons had decreased mortality (odds ratio [OR] 0.09-0.3). One paper found that high-volume surgeons had fewer complications (-2.4%; P = 0.006). After controlling for hospital factors (HF), two out of 7 analyses remained significant. Five analyses did not control for HF. CONCLUSIONS: The literature consistently demonstrates a relationship between higher hospital and surgeon volume and better outcomes for pediatric neurosurgical patients. Of the 7 articles that assessed HF, only 2 analyses found that surgical volume remained associated with better outcomes. No reports assessed the degree of centralization already present. The call for centralization of pediatric care should be tempered until variables such as hospital factors, distribution of cases, and clinical thresholds can be defined and studied.

Mechanical, Fire, and Electrical Insulation Properties of Polyurethane Fly Ash Composites.

This paper demonstrates that ash composites, comprising fly ash and polyurethane, can be used to develop value-added products that exhibit an effective decrease in the leaching of coal ash inorganics to less than one-third of the Environmental Protection Agency (EPA)'s maximum contaminant level (MCL) when soaked in a water circulation system for 14 months. Furthermore, the composite blocks remain safe even with ruptured surfaces. The concept of encapsulating fly ash within ash composites by using a polar polymer to bind the fine inorganic particles, mimicking how nature does it in the original unburned coal, ensures the safety of the composite. The ash composites can be formulated to have designed mechanical, fire, and electrical properties by controlling the formulation and the density. The properties of typical density composites were produced, measured, and compared with commercial materials. This paper also demonstrates that ash composite technology can be extended to coal ash stored in ponds. Finally, a typical electric utility box cover was designed, fabricated, and test validated. The box cover has less than one-half the weight of the original box cover for the same design limits. Finally, the benefits of this ash-composite technology for product manufacturers, society, and ash producers are summarized.

Post-operative complications of cholecystectomy: what the radiologist needs to know.

Cholecystectomy is one of the most performed surgical procedures. The safety of this surgery notwithstanding, the sheer volume of operations results in a notable incidence of post-cholecystectomy complications. Early and accurate diagnosis of such complications is essential for timely and effective management. Imaging techniques are critical for this purpose, aiding in distinguishing between expected postsurgical changes and true complications. This review highlights current knowledge on the indications for cholecystectomy, pertinent surgical anatomy and surgical technique, and the recognition of anatomical variants that may complicate surgery. The article also outlines the roles of various imaging modalities in identifying complications, the spectrum of possible postsurgical anatomical changes, and the implications of such findings. Furthermore, we explore the array of complications that can arise post-cholecystectomy, such as biliary system injuries, gallstone-related issues, vascular complications, and the formation of postsurgical collections. Radiologists should be adept at identifying normal and abnormal postoperative findings to guide patient management effectively.

The Ultrasound Hepato-Jugular Reflux: Measuring the Hepato-Jugular Reflux with Ultrasound with Comparison to Invasive Right Heart Catheterization.

BACKGROUND: Ultrasound can overcome barriers to visualizing the internal jugular vein, allowing hepato-jugular reflux and jugular venous pressure measurement. We aimed to determine operating characteristics of the ultrasound hepato-jugular reflux and ultrasound jugular venous pressure predicting right atrial and pulmonary capillary occlusion pressures. METHODS: In a prospective observational cohort at three US academic hospitals the hepato-jugular reflux and jugular venous pressure were measured with ultrasound before right heart catheterization. Receiver operating curves, likelihood ratios, and regression models were utilized to compare the ultrasound hepato-jugular reflux and ultrasound jugular venous pressure to the right atrial and pulmonary capillary occlusion pressures. RESULTS: In 99 adults undergoing right heart catheterization, an ultrasound hepato-jugular reflux had a negative likelihood ratio of 0.4 if 0 cm and a positive likelihood ratio of 4.3 if ≥ 1.5 cm for predicting a pulmonary capillary occlusion pressure ≥ 15 mmHg. Regression modeling predicting pulmonary capillary occlusion pressure was not only improved by including the ultrasound hepato-jugular reflux (P < .001), it was the more impactful predictor compared with the ultrasound jugular venous pressure (adjusted odds ratio 2.6 vs 1.2). The ultrasound hepato-jugular reflux showed substantial agreement (kappa 0.76; 95% confidence interval, 0.30-1.21), with poor agreement for the ultrasound jugular venous pressure (kappa 0.11; 95% confidence interval, -0.37-0.58). CONCLUSION: In patients undergoing right heart catheterization, the ultrasound hepato-jugular reflux is reproducible, has modest impact on the probability of a normal pulmonary capillary occlusion pressure when 0 cm, and more substantial impact on the probability of an elevated pulmonary capillary occlusion pressure when ≥ 1.5 cm.

Immune checkpoint inhibitors and pericardial disease: a systematic review.

INTRODUCTION: Despite the growing use of immune checkpoint inhibitors (ICI) in cancer treatment, data regarding ICI-associated pericardial disease are primarily derived from case reports and case series. ICI related pericardial disease can be difficult to diagnose and is associated with significant morbidity. We conducted a systematic review to further characterize the epidemiology, clinical presentation, and outcomes of this patient population. METHODS: A search of four databases resulted in 31 studies meeting inclusion criteria. Patients > 18 years old who presented with ICI mediated pericardial disease were included. Intervention was medical + surgical therapy and outcomes were development of cardiac tamponade, morbidity, and mortality. RESULTS: Thirty- eight patients across 31 cases were included. Patients were majority male (72%) with a median age of 63. Common symptoms included dyspnea (59%) and chest pain (32%), with 41% presenting with cardiac tamponade. Lung cancer (81%) was the most prevalent, and nivolumab (61%) and pembrolizumab (34%) were the most used ICIs. Pericardiocentesis was performed in 68% of patients, and 92% experienced symptom improvement upon ICI cessation. Overall mortality was 16%. DISCUSSION: This study provides the most comprehensive analysis of ICI-mediated pericardial disease to date. Patients affected were most commonly male with lung cancer treated with either Nivolumab or Pembrolizumab. Diagnosis may be challenging in the setting of occult presentation with normal EKG and physical exam as well as delayed onset from therapy initiation. ICI-associated pericardial disease demonstrates high morbidity and mortality, as evidenced by a majority of patients requiring pericardiocentesis.

Malignant Pericardial Effusion: A Systematic Review.

Background: Malignant pericardial effusion (Eff) is often asymptomatic and has an unknown prevalence, due to its occult presentation. The condition often is identified postmortem on autopsy, and it is associated with a poor prognosis. Given the late presentation of malignant pericardial Effs, a minimal volume of literature has examined the epidemiology, clinical characteristics, and outcomes of these complex patients. We conducted a systematic review to advance present understanding of this condition. Methods: A search of 4 databases resulted in 41 case reports meeting criteria. Inclusion criteria were being a patient aged > 18 years who presented with pericardial Eff in the setting of malignancy. Intervention was medical and/or surgical therapy, and the outcome was mortality. Results: For the 41 patients included, the median age was 54 years, and the majority were male patients (58%). Dyspnea was the leading symptom (90%), and cardiac tamponade was present in 78% of cases. Common cancers included lung, gastrointestinal, and renal neoplasms (59%). Pericardiocentesis occurred in 98% of cases, with a median fluid extraction volume of 1000 mL. Death occurred in 44%, primarily due to disease progression and/or metastasis. Conclusions: This study presents the largest systematic review on malignancy-induced pericardial Effs to date. Notably, solid tumours, and specifically lung adenocarcinomas, are common culprits. Malignant pericardial Effs are often severe, with a majority of patients presenting with cardiac tamponade. Overall, treatment options are limited, and the associated mortality rate is high.

Contexte: L'épanchement péricardique malin (EPM) est un état généralement asymptomatique, de prévalence inconnue en raison de son tableau clinique occulte. Il est souvent reconnu post-mortem, à l'autopsie, et est associé à un pronostic médiocre. En raison de la consultation tardive pour un EPM, les données publiées relatives à l'épidémiologie, aux caractéristiques cliniques et à l'issue de ces cas complexes sont limitées. Nous avons réalisé une analyse systématique dans le but d'élargir les connaissances sur cette affection. Méthodologie: Une recherche réalisée dans quatre bases de données a permis de repérer 41 rapports de cas qui répondaient aux critères de recherche. Les critères d'inclusion étaient les suivants : être âgé de plus de 18 ans; présenter un épanchement péricardique en présence d'un cancer; intervention pharmacologique et/ou chirurgicale; issue mortelle. Résultats: L'âge médian des 41 patients inclus était de 54 ans; la majorité d'entre eux étaient des hommes (58 %). Le symptôme principal était la dyspnée (90 %), et une tamponnade cardiaque était présente dans 78 % des cas. Les cancers les plus fréquents étaient le cancer du poumon, le cancer gastro-intestinal et les néoplasmes rénaux (59 %). Une péricardiocentèse a été réalisée dans 98 % des cas. Le volume de drainage médian était de 1 000 mL. Quarante-quatre pour cent des sujets sont décédés, principalement en raison de la progression de la maladie et/ou de métastases. Conclusions: Cette étude est la plus vaste analyse systématique réalisée à ce jour sur l'EPM. Les tumeurs solides, et plus particulièrement les adénocarcinomes pulmonaires, sont des causes fréquentes. L'EPM est souvent grave, la majorité des patients présentant une tamponnade cardiaque. Les traitements disponibles sont généralement limités, et le taux de mortalité associé est élevé.

Stress management standards: a warning indicator for employee health.

BACKGROUND: Psychological stress is a major cause of lost working days in the UK. The Health & Safety Executive (HSE) has developed management standards (MS) to help organizations to assess work-related stress. AIMS: To investigate the relationships between the MS indicator tool and employee health, job attitudes, work performance and environmental outcomes. METHODS: The first phase involved a survey employing the MS indicator tool, General Health Questionnaire-12 (GHQ-12), job attitudes, work performance and environmental measures in a call centre from a large utility company. The second phase comprised six focus groups to investigate what employees believed contributed to their perceived stress. RESULTS: Three hundred and four call centre employees responded with a response rate of 85%. Significant negative correlations were found between GHQ-12 and two MS dimensions; demands (Rho = -0.211, P < 0.001) and relationships (Rho= -0.134, P < 0.05). Other dimensions showed no significant relationship with GHQ-12. Higher levels of stress were associated with reduced job performance, job motivation and increased intention to quit but low stress levels were associated with reduced job satisfaction. Lack of management support, recognition and development opportunities were identified as sources of stress. CONCLUSIONS: The findings support the utility of the MS as a measure of employee attitudes and performance.