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In the area around Angkor, Cambodia, several ceramics kilns dating from the ninth to 15th centuries ce have been discovered since 1995. The technical, typological and compositional characterization of their production has been one of the main goals of the Cerangkor Project. Samples of green‐glazed 'Kulen‐type' stoneware and non‐glazed stoneware produced in five kiln sites in the Angkor region were analysed chemically by wavelength‐dispersive X‐ray fluorescence spectrometry (WDS‐XRF) and also petrographically. The data indicate that some workshops used similar raw materials for the same types of ceramics, suggesting the exploitation of the same geological formations in the whole region. Several references groups were established for each type of stoneware offering an important database for future provenance studies of sherds from consumption sites. [ABSTRACT FROM AUTHOR]

With the development of micro-LIBS imaging, the ever-increasing size of datasets (sometimes >1 million spectra) makes the processing of spectral data difficult and time consuming. Advanced statistical methods have become necessary to process these data, but most of them still require strong expertise and are not adapted to fast data treatment or a high throughput analysis. To address these issues, we evaluate, in the present work, the use of an artificial neural network (ANN) for LIBS imaging spectral data processing for the identification of different mineral phases in archaeological lime mortar. Common in ancient architecture, this building material is a complex mixture of lime with one or more aggregates, some components of which are of the same chemical nature (e.g. calcium carbonates). In this study, we trained an artificial neural network (ANN) for automatic detection of different phases in these complex samples. The training of such a predictive model was made possible by building a LIBS dataset of more than 1300 reference spectra, obtained from various selected materials that may be present in mortars. The ANN parameters (pre-treatment of data, number of neurons and of iterations) were optimized to ensure the best recognition of mortar components, while avoiding overtraining. The results demonstrate a fast and accurate identification of each component. The use of an ANN appears to be a strong means to provide an efficient, fast and automated LIBS characterization of archaeological mortar, a concept that could later be generalized to other samples and other scientific fields and methods. [ABSTRACT FROM AUTHOR]

Abstract: Invasive hospital-acquired aspergillosis (IA) is responsible for lethal outbreaks. In 2002, an interdisciplinary team was created in the teaching hospital of Rouen in order to organize the surveillance of construction sites by the implementation of environmental measures of prevention. The aim of our study was to estimate the efficiency of these measures using an indirect indicator, reflecting the incidence of the cases of invasive nosocomial aspergillosis (AI): the consumption of antifungals. From the nominative prescriptions established, we studied the medical files about 210 patients to track down the number of IA cases in intensive care unit (ICUI) and in pediatric hematology-oncology units between 2002 and 2006. The incidence of the cases was put in parallel with the various periods of level 5-risk works during these five years. The relative risk of appearance of the disease was calculated. In pediatric haematology-oncology unit, 35 cases were diagnosed on 99 medical files which have been studied and in ICU 19 cases were classified on 93 studied files. The follow-up of the incidence in both units stake in parallel with the periods of level 5-risk works does not show increase of the number of cases. The calculated relative risk indicates the same result: the level 5-risk works are not a factor facilitating the appearance of invasive aspergillosis cases. This study shows the importance of the environmental measures of prevention during the periods of works within services for risk. The coordination of the actors within an interdisciplinary cell seems thus essential for the prevention of AIN. [Copyright &y& Elsevier]

Résumé: Le but de ce travail était d''estimer le pronostic vital à court terme chez les patients transfusés et d’identifier les facteurs qui l''influencent. Patients et méthodes. – Les patients admis et transfusés au CHU de Rouen au premier semestre 1996 ont été recherchés de façon rétrospective, ainsi que leur état à six mois (vivant ou décédé). Les caractéristiques des patients transfusés ont été comparées à celles de l''ensemble des patients admis. Les facteurs indépendants associés au décès à six mois ont été recherchés par le modèle de Cox. Résultats. – En six mois, 1887 patients ont été transfusés. Ils étaient plus âgés, avaient été admis plus souvent en chirurgie et en réanimation, et avaient eu des séjours plus longs que l’ensemble des patients admis. La survie actuarielle était de 76,1 % à six mois chez les patients transfusés. La mortalité à six mois était plus forte, de façon indépendante, chez les patients de 75 ans et plus, chez les hommes, en cas de passage en réanimation, en cas de transfusion de plasma frais ou de concentrés de plaquettes homologues. Elle était moins élevée en cas d''intervention chirurgicale, chez les enfants de moins de 16 ans, et chez les patients dont les séjours étaient classés en « Affections de l''appareil circulatoire », « Affections et traumatismes de l''appareil musculosquelettique et du tissu conjonctif » ou « Traumatismes, allergies et empoisonnements ». Conclusion. – Dans cette étude réalisée dans un établissement hospitalo-universitaire, la survie des patients transfusés est principalement associée aux caractéristiques et à la gravité des pathologies ayant justifié les transfusions. [Copyright &y& Elsevier]

• The issue of this article is of interest to prescribing physicians, infectious disease physicians, bacteriologists, and hygienists. Recalling the guidelines on blood culture collection to limit the number of unnecessary blood cultures reduces the number of venipunctures in patients, facilitates the interpretation of results, and has an economic impact. The originality of the intervention was the presence of a striking look on the poster to draw the reader's attention, that has more impact than a poster with only guidelines without image. At the methodological level, randomization makes it possible to ensure the initial comparability of groups. The before-after design, in the presence of a control group, makes it possible to evaluate the effect of the intervention. To reduce the number of blood culture samples collected. We performed a cluster randomized controlled trial in adult acute care, and subacute care and rehabilitation wards in a university hospital in France. A poster associating an image of eyes looking at the reader with a summary of blood culture sampling guidelines was displayed in hospital wards in the intervention group. The incidence rate of blood cultures per 1000 days during pre- and post-intervention periods was calculated. Thirty-one wards participated in the study. The median difference in blood cultures/1000 days between periods was −1.863 [−11.941; 1.007] in the intervention group and −5.824 [−14.763; −2.217] in the control group (P = 0.27). The intervention did not show the expected effect, possibly due to the choice of blood cultures as a target of good practice, but also to confounding factors such as the stringent policy of decreasing unnecessary costly testing. [ABSTRACT FROM AUTHOR]

Aims: Our objective was to construct and then evaluate a monitoring indicator of the initiation time to adjuvant chemotherapy for colon cancer, based on the French diagnosis-related group-based information system (PMSI). Procedure: From PMSI databases at Rouen University Hospital, we have calculated the time between colectomy and the first chemotherapy in patients hospitalized between 2009 and 2015. We have calculated the positive predictive value (PPV) of our method in comparison with the medical records. Results: Of the 102 patients selected, the PPV was 91% (95% CI: [86-97]). Conclusion: The performance of the indicator should be confirmed in other hospital centers. It could be applied to national PMSI databases, and thus be used as a guidance tool within, regional health agencies and the French National Cancer Institute. [ABSTRACT FROM AUTHOR]

Introduction French national guidelines state that antibiotic therapies should be reassessed between 48 and 72 hours after treatment initiation and that reassessment of antibiotic therapy (RA) must be recorded in patients’ files. Objective To determine whether RA is performed and recorded in patients’ files in hospitals in a region of France. Methods Setting: hospitals participating in the National nosocomial infection point- prevalence survey (NPS) in Upper-Normandy, France. Patients included those receiving antibiotic therapy (excluding antibiotic prophylaxis) on NPS day, started in the hospital in which the survey was conducted and ongoing for more than 72 hours. Data collected included characteristics of participating hospitals and, for each included patient, characteristics of ward, infection and antibiotic therapy, and mention in the patients’ files of explicit or implicit RA. The rate of explicit and implicit RA was calculated and factors associated with explicit or implicit RA were evaluated using a univariate analysis. Results Thirty-three hospitals representing 87% of hospital beds region-wide were included in the study. In addition, 933 prescriptions were assessed for 724 infections in 676 patients. The overall rate of RA was 67.6% (49.3% of explicit RA and 18.3% of implicit RA). The rate of RA differed significantly according to infection and antibiotic class but not according to hospital or ward characteristics. Conclusion Our study provides new and reassuring results regarding reassessment of antibiotic therapy. [ABSTRACT FROM AUTHOR]

Background Crohn's disease incidence rates have stabilised in industrialised countries since the 1980s. Conversely, a continuing increase in childhood-onset Crohn's disease incidence has been reported. Aim To confirm trends in inflammatory bowel disease (IBD) incidence in northern France over an extended time period (1988-2007) with a focus on childhood-onset Crohn's disease. Methods The IBD patients recorded in the EPIMAD registry between 1988 and 2007 were included. Standardised incidence rates were calculated for Crohn's disease and ulcerative colitis in the entire population, and separately according to age. Evolution of phenotypes at diagnosis was also studied. Results A total of 12 084 incident IBD cases (7428 Crohn's disease and 4656 ulcerative colitis) were recorded. Crohn's disease incidence rates increased from 5.2 cases /100 000 persons in 1988-1990 to 6.7 in 2006-2007 (+29%), stabilising after a peak at 7.1 in 1997-1999. Crohn's disease incidence rates in the 10-19-year age category increased by 71%, from 6.5 (1988-1990) to 11.1 (2006-2007). The frequency of initial ileo-colonic localisation increased from 52.9% in 1988-1990 to 68.6% in 2006-2007 (P < 0.0001). Ulcerative colitis incidence rates decreased during the same period. Conclusions From 1988 to 2007, Crohn's disease incidence increased by 29% in northern France and by 71% in the 10-19-year-old age group. Consequently, studies on Crohn's disease risk factors should focus on the population under 20 years of age. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated. DESIGN: Prospective, double-blind, controlled, randomized trial. SETTING: ICUs in 16 hospitals in France. PATIENTS: One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11). INTERVENTIONS: Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days. MEASUREMENTS AND MAIN RESULTS: Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group. CONCLUSIONS: TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance. [ABSTRACT FROM AUTHOR]

Background: Environmental exposures in early life have been implicated in the aetiology of inflammatory bowel disease. Objective: To examine environmental risk factors prior to the development of inflammatory bowel disease in a paediatric population based case control study. Methods: A total of 222 incident cases of Crohn's disease and 60 incident cases of ulcerative colitis occurring before 17 years of age between January 1988 and December 1997 were matched with one control subject by sex, age, and geographical location. We recorded 140 study variables in a questionnaire that covered familial history of inflammatory bowel disease, events during the perinatal period, infant and child diet, vaccinations and childhood diseases, household amenities, and the family's socioeconomic status. Results: In a multivariate model, familial history of inflammatory bowel disease (odds ratio (OR) 4.3 (95% confidence interval 2.3-8)), breast feeding (OR 2.1 (1 .3-3.4)), bacille Calmette-Guerin vaccination (OR 3.6 (1.1-11.9)), and history of eczema (OR 2.1 (1-4.5)) were significant risk factors for Crohn's disease whereas regular drinking of tap water was a protective factor (OR 0.56 (0.3-1)). Familial history of inflammatory bowel disease (OR 12.5 (2.2-71.4)), disease during pregnancy (OR 8.9 (1.5-52)), and bedroom sharing (OR 7.1 (1.9-27.4)) were risk factors for ulcerative colitis whereas appendicectomy was a protective factor (OR 0.06 (0.01-0.36)). Conclusions: White family history and appendicectomy are known risk factors, changes in risk based on domestic promiscuity, certain vaccinations, and dietary factors may provide new aetiological clues. [ABSTRACT FROM AUTHOR]

Résumé: Le dépistage péri transfusionnel du virus de l''hépatite C justifie une évaluation médicoéconomique. Méthodes. – Quatre stratégies de dépistage péri transfusionnel appliquées à la population des patients transfusés en 1996 au CHU de Rouen ont été comparées : une stratégie renonçant au dépistage systématique réglementaire, une seconde appliquant le dépistage réglementaire pré et post-transfusionnel à trois mois, une troisième différant le dépistage post-transfusionnel à six mois et une dernière limitée au seul dépistage pré-transfusionnel. L’efficacité (nombre de cas positifs dépistés), l’efficience (coût moyen par cas positif dépisté) et les coûts marginaux de passage d’une stratégie à une autre ont été évalués par une analyse de décision. Résultats. – Le dépistage pré-transfusionnel isolé (361 € par cas positif dépisté), le dépistage post-transfusionnel à 3 mois (523 € par cas positif dépisté) et à six mois (488 € par cas positif dépisté) avaient une efficacité similaire. Le renoncement au dépistage systématique réglementaire (385 € par cas positif dépisté) était moins efficace que les trois autres. L''introduction des dépistages pré et post transfusionnels à trois et six mois engendrait un coût marginal respectivement de 619 € et 559 € par cas dépisté. La systématisation du seul dépistage pré-transfusionnel donnait un coût marginal de 343 € par cas supplémentaire, mais le coût marginal de l''ajout du dépistage post-transfusionnel était de 5824 € par cas supplémentaire. Conclusion. – Le dépistage systématique pré-transfusionnel isolé est la stratégie la plus efficiente. [Copyright &y& Elsevier]

Background: Northern France was characterised by a high incidence of Crohn's disease (CD) and a low incidence of ulcerative colitis (UC) according to the first inquiry undertaken in the late 1980s. Aims: To assess the trends in the incidence of inflammatory bowel disease (IBD) over a 12 year period (1988-1999) in the same area of Northern France. Patients: Patients living in Northern France (Nord, Pas-de-Calais, Somme, and Seine Maritime--total of 5,790,526 inhabitants) between 1988 and 1999 were included in the study. Case ascertainment was established according to methodology previously described. Methods: Trends in incidence were studied using a Poisson regression model in four three year periods (1988-90, 1991-93, 1994-96, and 1997-99) adjusted for age at diagnosis and sex. Incidence rates were standardised for age with the European standard population. Results: During 1988-99, 7066 cases of IBD were recorded (56.8% CD, 37.7% UC, and 5.5% indeterminate colitis). Mean annual incidence rate of CD increased from 5.2/100,000 inhabitants in 1988-90 to 6.4 in 1997-99 (adjusted p for trend <0.001). In contrast, the incidence of UC decreased from 4.2 to 3.5 (adjusted p for trend <0.001). The ileocolonic subtype of CD increased by 25% even though median age at diagnosis and frequency of digestive investigations were not different. CONCLUSIONS: Contrary to what has been reported in other countries in Northern Europe, the incidence of CD increased by 23% in 12 years in Northern France while that of UC decreased by 17% during the same period. This indicates that some factors which influence IBD frequency (in both directions) are still at work in this area of Europe, and that further studies aimed at identifying these should be performed. The rising incidence of CD could enhance the burden of this disease on the public health system in France. [ABSTRACT FROM AUTHOR]

Introduction Les antibiotiques (ATB) actifs sur les staphylocoques méticilline résistant (anti-SARM) sont considérés comme des ATB critiques de réserve et font l’objet d’une surveillance de leur consommation à l’échelle de chaque établissement. L’objectif de ce travail était d’évaluer la pertinence des prescriptions (PC) d’anti-SARM au sein d’un CHU. Matériels et méthodes Durant 5 semaines dans les services de court séjour (dont les services de réanimation), les PC de vancomycine, teicoplanine, linézolide et daptomycine ont été étudiées selon 4 critères : indication, réévaluation, posologie (jugée pour les glycopeptides sur le dosage sérique) et durée de traitement. La méthode utilisée était la revue de pertinence : (a) constitution d’un référentiel (REF) basé sur l’ePOPI et les recommandations de sociétés savantes puis validé en Commission des Anti-Infectieux, (b) évaluation de la pertinence des PC par des professionnels non experts par comparaison au REF, (c) avis d’expert (infectiologue ou réanimateur, audit croisé) en cas de PC jugées non pertinentes selon le REF. Résultats Cent quarante-six PC ont été analysées chez 122 patients : vancomycine (78), teicoplanine (41), daptomycine (12) et linézolide (15). Les indications principales étaient : infections ostéoarticulaires (23 %), pulmonaires (15 %) et endocardites (13 %). Dans 71 % des cas, les infections étaient associées aux soins et survenaient dans 38 % des cas sur matériel. Pour 51 % des PC, l’antibiothérapie était probabiliste. La pertinence de l’indication des PC était de 93 % (IC 95 % [87 ; 96]). Pour les PC non pertinentes, la documentation microbiologique finale ne justifiait pas d’utiliser un anti-SARM. La posologie était conforme dans 54 % (IC 95 % [46 ; 63] des PC étudiées. Les non conformités concernaient les glycopeptides. Dans 93 % (IC 95 % [87 ; 96]) des cas, les réévaluations ont été jugées pertinentes. Le motif de non-conformité principal était une réévaluation trop tardive. La durée de traitement était conforme dans 77 % des PC (durée moyenne = 15 jours). Le motif principal de non-conformité était une durée de traitement trop longue. Les indications des prescriptions probabilistes étaient significativement moins pertinentes que les prescriptions documentées d’emblée (test de Fisher, p = 0,026). Au total, 47 % (IC 95 % [39 ; 55]) des prescriptions étaient conformes à 100 % pour les 4 critères évalués. Conclusion Cette étude montre que les PC d’anti-SARM étudiées étaient, dans leur majorité, conformes aux recommandations. Deux actions d’amélioration ont été mises en œuvre : rédiger et diffuser un référentiel d’antibiothérapie probabiliste et créer une PC « couplée » dans le logiciel pour les glycopeptides, associant la prescription médicamenteuse à un dosage sérique. [ABSTRACT FROM AUTHOR]