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Chronic spontaneous urticaria (CSU) can significantly impact health-related quality of life (HRQoL). This study investigated the burden of CSU on HRQoL and patients' personal treatment goals. Urticaria Voices is a global cross-sectional online survey with CSU patients (self-reported clinician-provided diagnosis of CSU, recruited through nationally representative online panels of the general population and patient advocacy groups) in the US, Canada, UK, Germany, France, Italy, Japan. The perceived negative impact of CSU on 6 HRQoL domains (mental & emotional wellbeing, social life & intimate relationships, activities of daily living, family life, professional & academic life, finances) and the personal importance of 16 treatment goals were assessed with a 10-point Likert scale. Symptoms control was assessed with the UCT. Statistical differences in HRQoL between adequately and inadequately controlled patients were assessed with independent sample t -tests assuming unequal variances. In all, 582 CSU patients responded to the survey. Most patients (80%) were inadequately controlled (UCT < 12) and reported a significantly (P < 0.001) higher negative impact than controlled patients on the 6 HRQoL domains assessed, with the most impacted domains being mental & emotional wellbeing, social life & intimate relationships, and activities of daily living. Among inadequately controlled patients, 82% reported currently taking antihistamine (AH) for their CSU after their doctor had already on average switched the types of AH 2.4 times and increased dosage 2 times. Regarding treatment goals, patients rated as extremely important being free of itch and hives, having complete control over symptoms, improved quality of life and staying in remission over the long-term. In all, 4/5 of the CSU patients in this study were inadequately controlled on their current treatment, with 82% of them being on AH. These patients reported a significantly higher negative impact across all HRQoL domains compared to adequately controlled patients. Treatments that target symptom relief, complete control and improved HRQoL are important for CSU patients and therapies, which address these goals effectively, are needed. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) is characterized by unpredictable itchy wheals/hives and/or angioedema for more than 6 weeks. This study investigated the perceptions and potential gaps between CSU patients and physicians on the quality of their relationship and the treatment decision-making process. Urticaria Voices is a global cross-sectional online survey with CSU patients (self-reported clinician-provided diagnosis of CSU, recruited through nationally representative online panels of the general population and patient advocacy groups) and CSU-treating physicians (Dermatologists, allergists, or immunologists treating CSU patients, invited from specialized online panels) in the US, Canada, UK, Germany, France, Italy, and Japan. With a ten-point scales, patients rated perceived level of trust, empathy and care, attentiveness, and medical care they receive from their physicians, while physicians rated their perceived ability to establish trust, empathy and care, and a high-quality relationship with their patients. Both were asked to identify the final treatment decision-maker: patient, physician or jointly. Pooled results are reported as top 3 box scoring, i.e., % of respondents selecting the 3 highest ratings on the scale. In all, 582 CSU patients and 862 CSU-treating physicians were included in the study. Physicians and patients were aligned on high levels of trust (65% and 68%) and empathy and care (64% and 66%). Patients reported further high levels of attentiveness (67%) and medical care (60%) that they receive from their physician. Physicians reported an overall high quality of relationship (66%) with their patients. 35% of patients and 51% of physicians believed the final treatment decision is made together. Only 17% of patients and 7% of physicians believed the physician made the final treatment decision. Respondents largely aligned on perceived quality of the patient-physician relationship, with two thirds reporting very high levels of trust, empathy & care, and medical care. Despite these encouraging findings, there is potential for improved dialogue between patients and physicians regarding treatment preferences and objectives. [ABSTRACT FROM AUTHOR]

The unpredictability of chronic spontaneous urticaria (CSU) symptoms makes assessment and monitoring of symptoms challenging. Patient-Reported Outcome Measures (PROMs) could help to assess symptoms, health-related quality of life (HRQoL), however the extent of PROMs' use in clinical practice to manage CSU is not well understood. This study investigated the frequency of PROM usage from both patients' and physicians' perspectives. Urticaria Voices is a global cross-sectional online survey with CSU patients and CSU-treating physicians in the US, Canada, UK, Germany, France, Italy, and Japan. Patients with a self-reported clinician-provided diagnosis of CSU and prescription treatment were recruited through nationally representative online panels of the general population and patient advocacy groups. Dermatologists, allergists, or immunologists treating CSU patients were invited from specialized online panels. Investigated PROMs were the UCT, ISS, UAS7, CU-Q2oL, AAS, AECT, AE-QoL and the DLQI. Physicians additionally evaluated the use of the Patient Global Impression of Severity (PGI-S). In all, 582 CSU patients and 862 CSU-treating physicians were included in this study. 80% of CSU patients recognized at least 1 of the prompted PROMs. Among these, 69% reported completing at least 1 PROM during every doctor's visit, 27% completed at least 1 PROM for some doctor visits and a minority (4%) did not recall completing any of the PROMs. Among physicians, 45% reported using at least 1 PROM for every patient consultation, 44% use at least 1 PROM at some consultations and 11% do not use any of the PROMs. In addition, most physicians also ask patients general questions about symptoms (84%), HRQoL (77%) and visually inspect the skin (71%) to assess and monitor symptoms and treatment outcomes. PROMs are not extensively used in clinical practice. Only half of patients reported completing UCT at every visit and only 1 in 8 physicians reported using it for every patient consultation. Majority of the physicians relied on more subjective methods to assess symptoms and monitor treatment outcomes. Increased use of PROMs in may facilitate monitoring of symptoms and inform treatment decisions. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria (CSU) is characterised by recurrent wheals (hives) and/or angioedema for > 6-weeks. Some patients may have extracutaneous systemic symptoms during episodes of wheals and/or angioedema. Here, we describe the prevalence and characteristics of systemic symptoms among CSU patients during worsening episodes as reported in the Urticaria Voices study. Urticaria Voices, a multinational cross-sectional study, assessed the overall burden and management of CSU in adult patients undergoing physician-prescribed treatments. Patients completed an online survey comprising of questions on cutaneous and extracutaneous systemic symptoms, disease-severity (as reported by their physician) and treatments. Data were analyzed using descriptive statistics. Overall, 582 CSU patients (women, 62%; age, mean [SD], 42.2 [11.9] years; 79% currently on H1-antihistamines; 43% with angioedema in past 12-months) participated in the study. In the previous 4 weeks, 47% of patients reported a physician assessment during which disease activity was reported as mild (16%), moderate (49%), severe (18%), very severe (11%) and not known/no symptoms (6%). In addition to the core CSU symptoms (itch, hives, angioedema), difficulty in sleeping (62%), pain (55%) and fatigue (49%) were the most frequent patient-reported physical symptoms during CSU-worsening. Most patients reported pain at the location of hives (58%), angioedema (33%), and joints (36%) during episodes of disease worsening. Less frequent symptoms included flushing, headache, and gastrointestinal symptoms. This study shows that patients experience extracutaneous symptoms beyond itch, hives and/or angioedema during CSU worsening, which suggests a high physical impact. New therapies that offer sustained relief from CSU exacerbations are needed. [ABSTRACT FROM AUTHOR]

Abstract: The Biological Diatom Index (BDI) is a standardized method routinely used in France for the surveillance of watercourse quality. This index is based on a list of 209 key species showing different pollution sensitivities. The pollution sensitivity, or “ecological profile”, is determined through the species presence probability values along a seven quality classes gradient. In a sample, the presence and abundance of species from this list are used to calculate the BDI score. Recently, water managers pointed out several weaknesses of this index: (a) the BDI fails to correctly assess water quality in acidobiontic and brackish conditions, and (b) pollution sensitivity and tolerance of several key species used to calculate the index need to be improved. This paper presents and discusses the new version of the BDI, called BDI-2006. 2802 samples were used to create this new index (samples collected on all French river types during the last thirty years), where 1063 diatom species were identified. For each sample, the community was described with species relative abundance, and relevant physico-chemical parameters were collected: pH, conductivity, dissolved oxygen, biological oxygen demand, ammonium, orthophosphates and nitrates. Eight hundreds and thirty eight key species were finally kept, including species typical of acidic and brackish waters, tropical taxa and abnormal forms of many widespread taxa (as evidence of toxicological impacts). The physico-chemical and the biological datasets were explored with classical analysis (Principal Component Analysis) and neural networks (Self-Organizing Maps), combined to draw the new key species ecological profiles. Comparing to the initial version of the BDI, several species profiles (Nitzschia paleacea for example) were clearly enhanced. This new version was adopted by the French standardisation authority (AFNOR) in October 2007. [Copyright &y& Elsevier]

Abstract: The chemical treatment of industrial effluent, containing sulphuric acid, is typically completed by neutralising it with lime through solid/liquid separation. The mineral precipitation processes developed by Veolia Environnement use sludge recirculation. The production of a high sludge density characterises these processes, at a minimum of at least 25% weight in solids. The first laboratory tests studied the precipitation reaction, confirming the production of gypsum (CaSO4·2H2O). Then the precipitation mechanisms, nucleation and crystal growth kinetics, are determined in order to establish a model which predicts population density in reactor in accordance with fluid dynamics. The determined nucleation and growth kinetics are then used to feed a reaction model, coupling computational fluid dynamics (CFD) and population balance modelling to simulate the precipitation process. [Copyright &y& Elsevier]

Abstract: In a metal-polluted stream in the Riou Mort watershed in SW France, periphytic biofilm was analyzed for diatom cell densities and taxonomic composition, dry weight and metal bio-accumulation (cadmium and zinc). Periphytic diatom communities were affected by the metal but displayed induced tolerance, seen through structural impact (dominance of small, adnate species) as well as morphological abnormalities particularly in the genera Ulnaria and Fragilaria. Species assemblages were characterized by taxa known to occur in metal-polluted environments, and shifts in the community structure expressed seasonal patterns: high numbers of Eolimna minima, Nitzschia palea and Pinnularia parvulissima were recorded in Summer and Autumn, whereas the species Surirella brebissonii, Achnanthidium minutissimum, Navicula lanceolata and Surirella angusta were dominant in Winter and Spring. Commonly used indices such as the Shannon diversity index and Specific Pollution Sensitivity Index reflected the level of pollution and suggest seasonal periodicity, the lowest diversities being observed in Summer. [Copyright &y& Elsevier]

Abstract: The biomonitoring of pesticide pollution in streams and rivers using algae such as diatoms remains difficult. The responses of diatom communities to toxic stress in stream water are disturbed by the variations of environmental parameters. In this study, periphytic algae collected in situ were exposed under controlled conditions to two major herbicides used in French agriculture (isoproturon and s-metolachlor). Three exposure regimes were tested: 5 and 30μgL−1 for 6 days and 30μgL−1 for 3 days followed by a recovery period of 3 days. The algal biomasses were assessed from pigment concentrations (chlorophyll a and c) and from live cell density. The highest concentration (30μgL−1) of isoproturon inhibited the biomass increase statistically significantly. In periphyton exposed to 5 and 30μgL−1 of s-metolachlor, chlorophyll c concentration and live cell density were also statistically significantly lower than in the control. Periphyton left to recover after reduced exposure duration (3 days) showed higher growth rates after treatment with s-metolachlor than with isoproturon. Taxonomic identifications showed that species like Melosira varians, Nitzschia dissipata and Cocconeis placentula were not affected by the herbicide exposure. Other species like Eolimna minima and Navicula reichardtiana were more sensitive. Studying diatoms according to their trophic mode showed that facultative heterotroph species were statistically significantly favoured by isoproturon exposure at the highest concentration. Results obtained with s-metolachlor exposure showed a disturbance of cell multiplication rather than that of photosynthesis. These results suggest that photosynthesis inhibitors like isoproturon favour species able to survive when the autotroph mode is inhibited. [Copyright &y& Elsevier]

Abstract: Benthic diatoms are well known bio-indicators of river pollution by nutrients (nitrogen and phosphorus). Biological indexes, based on diatom sensitivity for non-toxic pollution, have been developed to assess the water quality. Nevertheless, they are not reliable tools to detect pollution by pesticides. Many authors have suggested that toxic agents, like pesticides, induce abnormalities of the diatom cell wall (frustule). High abnormal frustule abundances have been reported in natural diatom communities sampled in streams contaminated by pesticides. However, no direct link was found between the abundances of abnormal frustules in these communities and the pesticide concentrations in stream water. In the present study, a freshwater benthic diatom community, isolated from natural biofilm and cultured under controlled conditions, was treated with a known genotoxic herbicide, maleic hydrazide (MH). Cells were exposed to three concentrations of MH (5×10−6, 10−6, 10−7 M) for 6h followed by a 24h-recovery time. After MH treatments, nucleus alterations were observed: abnormal nucleus location, micronucleus, multinuclear cell or disruption of the nuclear membrane. A dose-dependent increase of nuclear alterations was observed. The difference between the control (9.65 nuclear alterations per 1000 cells observed (9.65‰), S.D.=4.23) and the highest concentrations (29.40‰, S.D.=8.49 for 10−6 M and 35.96‰, S.D.=3.71 for 5×10−6 M) was statistically significant (Tukey test, P <0.05). Diatoms also exhibited frustules with deformed morphology and abnormal ornamentation. Significantly increased abundances of abnormal frustules were observed for the highest concentrations (10−6 and 5×10−6 M; Tukey test, P <0.05). These two parameters tended to increase together (Pearson correlation=0.702, P <0.05). The results suggest that the induction of abnormal frustules could be associated with the genotoxic effects of MH. The alterations observed could be related to the effects of MH on the synthesis of the proteins involved in frustule formation or in the regulation of the cytoskeleton of the diatom cells. [Copyright &y& Elsevier]

Abstract: Community structure changes with pollution or stress. In the Water Framework Directive, high ecological status through biological parameters is defined as a slight or minor deviation from the reference community, while the good status is defined as a small deviation. To assess the importance of this deviation, and then to measure the degradation of ecological status along a river, an index based on the concept of “ecological distance” between species was created and called ecological distance index (EDI). It was tested on diatom data from a pilot watershed (the Garonne river basin, South-West France). The results show a good correlation between the EDI and the IPS (Indice de Pollusensibilité Spécifique – specific pollusensitivity index – a diatom-based biotic index) ecological ratios, which means first that the EDI is a valuable indicator of ecological status, and that it can account for ecoregional specificities. This index can be applied to any communities (macro-invertebrates, fish, etc.), since: (i) typical reference communities are found for each river type; (ii) species are characterised then ranked by pollution sensitivity values. [Copyright &y& Elsevier]

Distinguishing natural variations from human related changes becomes crucial in assessment, maintenance and restoration of aquatic ecosystems. The present work aims to focus on variation in the biogeographical frame of diatom assemblages in natural or near-natural conditions. First, 233 diatom samples collected from clean to less disturbed sites of the French hydrographic network were classified based on similarities of community assemblages using a self-organizing map. The results showed five different community types, corresponding to specific environmental conditions and made sense with the existing French hydro-ecoregions. Second, the community types were predicted with a set of environmental variables through a multilayer perceptron (MLP) with a backpropagation learning algorithm. The predictability was further compared with a discriminant function analysis and a regression tree. The best results were obtained with MLP. The relative importance of environmental variables to predict diatom community types was additionally evaluated through a sensitivity analysis of MLP. In each French hydro-ecoregion it was possible to predict how the community should be like out of anthropogenic pressure. According to the Water Framework Directive requirements in Europe, this work gives idea of the diatom assemblage representative of the good ecological status, taking into account ecoregional particularities of natural environment. [Copyright &y& Elsevier]

Le Centre fédératif prévention dépistage (CFPD), composé d'un centre de vaccinations polyvalentes (CVP), d'un centre de lutte antituberculeuse (CLAT) et d'un centre de dépistage des IST (CeGIDD), travaille en partenariat avec une PASS depuis 2007. En 2012, un travail d'optimisation de ce partenariat a été initié avec élaboration d'un parcours global de prévention/dépistage coordonné et d'outils d'aide au dépistage des IST/VIH/hépatites virales chroniques et tuberculose, en particulier pour les migrants primo-arrivants (MPA) vus à la PASS. L'objectif de cette étude est de réaliser une évaluation de ce partenariat de 2012 à 2019. Les données utilisées sont extraites du logiciel institutionnel et des bilans des dépistages réalisés sur l'unité de la PASS chez les primo-consultants, de janvier 2012 à décembre 2019. Entre 2012 et 2019, 5600 bilans sérologiques ont été réalisés à la PASS chez 12 053 primo-consultants (PMC), permettant le dépistage de 112 infections VIH (2 % des PMC dépistés), 335 hépatites B chroniques AgHBs+ (5,98 % des PMC dépistés) dont 28 co-infections delta (8,3 % des personnes AgHBs +) et 74 infections VHC actives avec PCR VHC + (1,32 % des PMC dépistés). Près de 55 % des PMC ont été dépistés à la PASS (n = 6453), les autres PMC ayant le plus souvent été dépistés sur une des unités du CFPD avant ou après leur passage à la PASS ou bien non dépistés en raison de problèmes médicosociaux plus urgents à traiter. De plus, 40 tuberculoses-maladies (TM) ont pu être diagnostiquées : 9 TM entre 2012 et 2015 et 31 TM (1,82 % des PMC dépistés) depuis la mise en place du dépistage systématique par RxP, initié en 2016 en partenariat avec le CLAT, avec 1705 RxP réalisées en 4 ans et interprétées par les médecins du CLAT. Les TM dépistées à la PASS représentaient 2,77 % de l'ensemble des TM déclarées au CLAT entre 2012 et 2015 (n = 325 dont 40 TM chez des SDF) et 7,54 % de l'ensemble des TM déclarées entre 2016 et 2019 (n = 411 dont 95 chez des SDF), (p < 0,05). La population de MPA a bien repéré le bâtiment du CHU abritant le CFPD et la PASS et y sont orientés par les associations d'aide et soutien à cette population. Ce partenariat actif et de qualité permet de proposer à tous les MPA vus à la PASS ou sur une des unités du CFPD, une offre de prévention globale systématique et de dépister la tuberculose, le VIH et les hépatites virales chroniques B et C. Les résultats de ce travail soulignent la fréquence du diagnostic de ces pathologies infectieuses contagieuses dans cette population de MPA souvent SDF, nécessitant une prise en charge rapide. L'optimisation du partenariat PASS/CLAT a permis par ailleurs une augmentation significative du dépistage de la TM à la PASS. Actuellement, l'objectif de ces 2 unités est d'appuyer le projet départemental et régional de mise en place d'une consultation systématique pour tous les MPA, idéalement dans les 4 mois suivant leur arrivée sur le territoire, comme recommandé dans l'instruction DGS de 2018. [ABSTRACT FROM AUTHOR]

Abstract: By comparing diatom communities in natural and disturbed sites, indicators for different types and levels of anthropogenic disturbance can be found. As a first step, this study aims to describe the different natural and disturbed community types found throughout the French hydrosystem. 836 diatom samples were analysed with an unsupervised neural network, the self-organising-map, a well accepted method for community ordination. 11 different communities were identified, 5 corresponding to non-impacted or slightly impacted conditions and representing the diatom natural variability of our dataset. These 5 communities corresponded to 5 different hydro-ecoregions, i.e. 5 river types with similar geological context and range in altitude. The 6 other communities were typical of rivers under anthropogenic pressure. The influence of natural conditions within the hydro-ecoregions was overwhelmed by the nature and the intensity of the pollution at the sampling stations. This work was done in the context of the application and enforcement of the Water Framework Directive. [Copyright &y& Elsevier]

Résumé Nous rapportons le cas d’un nourrisson de 21 mois, atteint de fibrose pulmonaire, qui a présenté une détresse respiratoire aiguë sévère et une atteinte hépatique par surdosage accidentel en émulsion lipidique intraveineuse. Cette intoxication rare a une gravité potentielle et un caractère quasi-exclusivement iatrogène qui méritent d’être rappelés. Summary We report the case of a 21-month-old child suffering from pulmonary fibrosis, who presented with acute respiratory distress and liver damage, due to an accidental overdose of intravenous lipid emulsion. This poisoning is a rare entity, whose potential severity and almost exclusive iatrogenic effect deserve to be remembered. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: L’infection de la voie veineuse centrale (VVC) est la principale complication de la nutrition parentérale. L’objectif de notre travail était de connaître l’écologie de ces infections dans notre centre de nutrition parentérale à domicile et d’évaluer notre protocole de prise en charge. Patients et méthodes: Il s’est agi d’une étude monocentrique, rétrospective réalisée au centre hospitalier universitaire (CHU) de Marseille entre le 1er janvier 2011 et le 31 mai 2012. Les enfants en nutrition parentérale, exclusive ou non, admis pour fièvre en urgence et ayant des hémocultures positives ont été inclus. Les caractéristiques de ces infections ont été analysées. Résultats: En 17 mois, 29 enfants ont été suivis, 17 ont présenté une infection de leur VVC, 47 bactériémies ont été recensées, soit 5,4 infections pour 1000jours de VVC. Le nombre moyen d’hémocultures réalisées à l’arrivée était de 2,8. Le germe le plus fréquemment identifié était le Staphylococcus hominis. Les traitements avaient initialement associé une bi-antibiothérapie en hospitalisation et des verrous antibiotiques. Discussion: Le taux d’infection durant la période étudiée était très élevé. Ce taux a été surévalué du fait des conditions de prélèvement des hémocultures et d’analyse. Enfin, on note que certains enfants ont fait des infections récidivantes sans qu’un facteur prédisposant ait pu être mis en évidence. Le traitement par bi-antibiothérapie était en accord avec les bonnes pratiques et l’écologie bactérienne. Conclusion: Le nombre important d’infections constatées pendant la période étudiée nous a amenés à une évaluation prospective de nos pratiques. [Copyright &y& Elsevier]

Abstract: Vineyard areas are important causes of water contamination, especially by pesticides and residues. These compounds can markedly disturb aquatic communities particularly photosynthetic organisms that are targeted by herbicides. Biofilms and diatoms were used as bioindicators for quality assessment in the Morcille watershed, an area impacted by Beaujolais vineyards (SE France), during the pesticide spreading period (April–May 2008). Biofilms were allowed to settle on glass slides for 4 or 8 weeks at three sites along a 7-km long gradient of trophic (mainly orthophosphate) and pesticide pollution. After a 4-week colonization, samples from the two contaminated downstream sites were transferred upstream to the clean site for 4 weeks while others were left in the same place. In vivo fluorescence measurements indicated that the periphytic communities were dominated by diatoms. Going downstream, biofilm biomass and diatom species richness decreased; normalized diatom indices (including the French standard BDI) expressed the increase in trophic status quite well. The species composition of the assemblages was used to discriminate between the effects of nutrients and toxicants, which increased simultaneously as the river continued downstream. The way in which the biofilm samples transferred upstream recovered was quite different depending on the location of the original site in the contamination gradient. Most of the quantitative descriptors reached a level comparable to that of the reference communities, but the diatom assemblages (cell density per surface unit, taxonomic composition) varied between dates and along the gradient. These communities did not entirely recover a reference structure but the increase in diversity, associated with the settlement of sensitive species, suggested an elevated recovery potential. [Copyright &y& Elsevier]

Abstract: This study addresses the interaction of Cd with natural biofilms of periphytic diatoms grown during different seasons in metal-contaminated and metal-non-contaminated streams, along a tributary of the Lot River, France. Specifically, it aims to test whether the biofilms from contaminated sites have developed a protective mechanism due to high Cd exposure. Towards this goal, reversible adsorption experiments on untreated biofilms were performed in 0.01M NaNO3 with a pH ranging from 2 to 8, Cd concentration from 0.5 to 10,000μg/L and exposure time from 1 to 24h. Two types of experiments, pH-dependent adsorption edge and constant-pH “Langmuirian”-type isotherms were conducted. Results were adequately modeled using a Linear Programming Model. It was found that the adsorption capacities of natural biofilm consortia with respect to Cd do not depend on season and are not directly linked to the growth environment. The biofilms grown in non-contaminated (4.6ppb Cd in solid) and contaminated (570ppb Cd in solid) settings exhibit similar adsorption capacities in the Cd concentration range in solution of 100–10,000μg/L but quite different capacities at low Cd concentration (0.5–100μg/L); unexpectedly, the non-contaminated biofilm adsorbs approximately 10 times more Cd than the contaminated one. It is therefore possible that the strong low-abundant ligands (for example, phosphoryl or sulfhydryls) are already metal-saturated on surfaces of biofilm grown in the contaminated site whereas these sites are still available for metal adsorption in samples grown in non-contaminated sites. [Copyright &y& Elsevier]

Abstract: A large-scale field survey was undertaken in the Neste system (South-West France) to investigate the impact of pesticide inputs on the structure of riverine benthic diatom communities. A total of 18 sites in the “Coteaux de Gascogne” study area were sampled during periods of pesticide use over two consecutive years (2005–2006). The typology of the diatoms collected was determined using artificial neural networks generating patterns in diatom community composition that indicated the species influenced by pesticide inputs, combined with organic pollution. Small, pioneer species of the Achnanthales group were more frequent in the pesticide-contaminated assemblages, whereas slower colonizers were more often found in the sites where disturbance was lower. The Phytopixal approach, a means to assess the spatial contamination potential, provided valuable information about pesticide exposure and was a successful means of discriminating diatom assemblages, suggesting that a global estimate of pesticide pollution risk, although rough, would be more appropriate and more representative than sporadic pesticide analyses. [Copyright &y& Elsevier]

Abstract: The pediatric nursing staff of the emergency unit has established a list of items for the triage of patients which can be used by the registered nurses. This scale defined 3 stages of severity. Objectives: 1) to estimate the relevance of this list through the appraisal of the total time necessary to take care of the patients according to their severity stage, and the confrontation of the severity stage determined by the registered nurse and the severity stage determined by the paediatrician; 2) to determine a possible correlation between the severity stage and the rate of hospitalization. Method: This prospective study was carried out over a period of 1 month in winter for every child admitted in the pediatric emergency unit for medical reasons (traumatisms excluded). Results: One thousand six hundred and fifty-six children have been included in the study. Among them, 136 have been classified stage I, 1020 stage II and 500 stage III. The children have been taken care of in an average period of 20 min for stage I, 32 min for stage II, 43 min for stage III. The coherence rate between the severity stage determined by the nurse and the severity rate determined by the paediatrician was good. The rate of sub-estimation was low (4,2%). Nevertheless the reception nurses tend to overestimate the stage of severity in 17,6% of the cases. The prediction rate for hospital admittance was good: 68,7% of children classified in stage 1 were admitted, 23,5% of children in stage 2 and only 1,6% of children in stage 3. Conclusion: Patients suffering from severe illnesses were taken care without injurious delay which was the main purpose of this list. [Copyright &y& Elsevier]

Objectif Le but était d’évaluer l’apport du TDR grippe dans l’estimation de la probabilité clinique de grippe aux urgences pédiatriques de Nantes en période épidémique. Méthodes Cette étude prospective s’est déroulée au pic de l’épidémie 2013 et a inclus des enfants de 1 mois et 5 ans, présentant une fièvre mal tolérée sans point d’appel. Tous les TDRs Quickvue® ont bénéficié d’un contrôle virologique par PCR ou immunofluorescence. La probabilité clinique de grippe et d’IBS était estimée avant et après la réalisation du TDR. Résultats 170 enfants ont été inclus en 9 semaines. La prévalence de la grippe était de 57%. Après l’examen clinique, la probabilité clinique de grippe était de 66,0% [IC 95% : 63,4–68,4]. Cette probabilité augmentait significativement à 92,4% [IC 95% 89,5–95,3] en cas de test positif et diminuait significativement à 30,8% [IC 95% : 29,0–32,5] s’il était négatif. La probabilité clinique d’IBS a toujours été surestimée (30% vs. 8,8%). Le TDRG a permis une réduction significative des prescriptions d’examens complémentaires. Enfin l’analyse médico-économique a montré une épargne potentielle de 102 euros par patients. Conclusion Le TDRG semble une aide diagnostique intéressante en période épidémique, et limiterait les prescriptions, ainsi que le coût de passages. [ABSTRACT FROM AUTHOR]