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Abstract The pollution of surface water and groundwater is a real public health problem that is currently receiving particular attention throughout the world. The use of water for food or hygiene purposes requires excellent physicochemical and microbiological quality. Well water is used for many purposes by the inhabitants of M’pody, a village in the Anyama district of Côte d’Ivoire. In this village, an epidemic of diarrhoea was detected in January 2020. This epidemic claimed sixty-nine (69) victims. This study aims to evaluate well water quality controls using the methods of principal component analysis (PCA), correspondence factorial analysis (CFA), analysis of variance (ANOVA) and self-organizing map (SOM) algorithm. The parameters studied were, turbidity (Tur), conductivity (Cond), hydrogen potential (pH), temperature (T), nitrate ( $$NO_{3^{-}}$$ N O 3 - ), nitrite ( $$NO_{2^{-}}$$ N O 2 - ), ammonium ( $$NH_{4^{+}}$$ N H 4 + ), phosphates ( $$PO_{4}^{3^{-}}$$ P O 4 3 - ), chlorides $$(Cl^{-})$$ ( C l - ) , total hydrotimetric degree (DHT), sulfates ( $$SO_{4}^{2^{-}}$$ S O 4 2 - ), bicarbonate ( $$HCO_{3^{-}}$$ H C O 3 - ), total alkalinity contents (TAC), escherichia coli (E.coli), thermotolerant coliforms (CTH) and enterococcus faecalis (E.faecalis). Data were collected from seventy-two (72) wells in the village during four campaigns in 2020. Physicochemical parameters were determined by electrochemical and spectrophotometric methods. Microbiological analysis was carried out using membrane filtration technique. Descriptive statistics revealed that Tur, Cond, pH and T parameters did not meet world health organization (WHO, 2017) standards. However, the parameters $$NO_{3^{-}}$$ N O 3 - , $$NO_{2^{-}}$$ N O 2 - , $$NH_{4^{+}}$$ N H 4 + , $$PO_{4}^{3^{-}}$$ P O 4 3 - , $$Cl^{-}$$ C l - , DHT, TAC, $$SO_{4}^{2^{-}}$$ S O 4 2 - and $$HCO_{3^{-}}$$ H C O 3 - comply with WHO standards. The results of bacteriological analyzes confirm the presence in very significant numbers of indicators of faecal contamination (CTH, E.coli and E.faecalis) in all wells. The logical explanations for faecal pollution would come from the infiltration of septic tanks located near the wells and the run-off of waste water carrying human and animal faecal matter. The diarrhea epidemic would therefore be caused by the consumption of this polluted water. PCA, FCA and hierarchical cluster analysis (HCA) were jointly employed to identify the structure of wells and deduce the principal factors controlling the parameters of these well waters. ANOVA revealed the effect of human-induced activities as the main factors influencing the physicochemical and microbiological parameters of the studied well waters. Further studies should focus on multivariate statistical techniques for effective forecasting and monitoring of emerging pollution for improved water quality.

Author(s): Thomas Godet [sup.1] [sup.2] [sup.6], Audrey De Jong [sup.2], Côme Garin [sup.1], Renaud Guérin [sup.1], Benjamin Rieu [sup.1], Lucile Borao [sup.1], Bruno Pereira [sup.3], Nicolas Molinari [sup.4], Jean-Etienne Bazin [...], Purpose To investigate the impact of Macintosh blade size used during direct laryngoscopy (DL) on first-attempt intubation success of orotracheal intubation in French intensive care units (ICUs). We hypothesized that success rate would be higher with Macintosh blade size No3 than with No4. Methods Multicenter retrospective observational study based on data from prospective trials conducted in 48 French ICUs of university, and general and private hospitals. After each intubation using Macintosh DL, patients' and operators' characteristics, Macintosh blade size, results of first DL and alternative techniques used, as well as the need of a second operator were collected. Complications rates associated with intubation were investigated. Primary outcome was success rate of first DL using Macintosh blade. Results A total of 2139 intubations were collected, 629 with a Macintosh blade No3 and 1510 with a No4. Incidence of first-pass intubation after first DL was significantly higher with Macintosh blade No3 (79.5 vs 73.3%, p = 0.0025), despite equivalent Cormack-Lehane scores (p = 0.48). Complications rates were equivalent between groups. Multivariate analysis concluded to a significant impact of Macintosh blade size on first DL success in favor of blade No3 (OR 1.44 [95% CI 1.14-1.84]; p = 0.0025) without any significant center effect on the primary outcome (p = 0.18). Propensity scores and adjustment analyses concluded to equivalent results. Conclusion In the present study, Macintosh blade No3 was associated with improved first-passed DL in French ICUs. However, study design requires the conduct of a nationwide prospective multicenter randomized trial in different settings to confirm these results.

When we use secure computer systems, we engage with carefully orchestrated and ordered interactions called 'security ceremonies', all of which exist to assure security. A great deal of attention has been paid to improving the usability of these ceremonies over the last two decades, to make them easier for end-users to engage with. Yet, usability improvements do not seem to have endeared end users to ceremonies. As a consequence, human actors might subvert the ceremony's processes or avoid engaging with it. Here, we consider whether beautification could be one way of making ceremonies more appealing. To explore beautification in this context, we carried out three studies. Study 1 surveyed 250 participants to derive a wide range of potential dimensions of 'beautiful ceremonies'. These statements were sorted into dominant themes and converted into statements, which fed into the second study, with 309 respondents, to reveal the dominant dimensions constituting beauty. Study 3 asked 41 participants to carry out a Q-sort, which revealed the ways that people combine the identified dimensions when characterising security ceremonies as 'beautiful'. These studies have allowed us to pin down the perceived dimensions of beauty in the context of security ceremonies, and also to understand how people combine these dimensions in different ways in judging security ceremonies to be beautiful, confirming the old adage of beauty being 'in the eye of the beholder'. We conclude by highlighting the constraints imposed by the overarching requirement for security to be maintained in the face of any usability improvements and beautification endeavours., Author(s): Giampaolo Bella [sup.1], Jacques Ophoff [sup.2] [sup.3], Karen Renaud [sup.4] [sup.5] [sup.6] [sup.2], Diego Sempreboni [sup.7], Luca Viganò [sup.7] Author Affiliations: (1) grid.8158.4, 0000 0004 1757 1969, Dipartimento di [...]

The Strait of Gibraltar has some of the highest maritime activity in the world. Its populations of cetaceans are threatened by noise, chemical pollution, and collisions by the many boats crossing the strait. One of the greatest threats identified in cetaceans in the Mediterranean are epizootics that severely affect the most sensitive vital rate in long-lived species: adult survival. By a multi-event analysis of a 16-year database of long-finned pilot whale photo identification capture-recapture data, we analysed adult survival in the Strait of Gibraltar's resident population and evaluated the possible effects of epizootics on this vital rate. We identified the large effect of a morbillivirus epizootic that occurred in 2006-2007, but we also revealed a second collapse in survival in 2011, probably due to another morbillivirus epizootic. These episodes seem to affect sexes differently, with females being less affected than males. Interestingly, the morbillivirus epizootic not only sharply decreased survival after the episode, but the effect extended over time, probably showing post-epizootic sequelae. These disease outbreaks have increased during the last decades worldwide and could be linked to anthropogenic threats such as organochlorine contamination. This may explain the high frequency of epizootics in the Gibraltar area. We warn about the conservation status of this long-finned pilot whale population and recommend the application of measures to reduce contamination on this nutrient-rich area to improve conditions for many marine species inhabiting this area., Author(s): Miquel Pons [sup.1] [sup.2] , Renaud De Stephanis [sup.2] [sup.3] , Philippe Verborgh [sup.4] , Meritxell Genovart [sup.1] [sup.5] Author Affiliations: (1) CEAB (CSIC), , Accés Cala Sant Francesc [...]

Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to declare. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the local research ethics committee, with number 24 23 09. Human and animal rights: According to ethic comitte from University Hosdpital of nimes. Consent to participate: Informed consent was obtained from the patient to publish.

Purpose: To compare fertility outcomes of obese patients (body mass index [BMI] ≥ 30 kg/m 2 ) undergoing superovulation and intrauterine insemination (SO-IUI) using gonadotropins versus letrozole., Methods: A single centre retrospective cohort study of obese patients undergoing SO-IUI using gonadotropins or letrozole between January/2019 and June/2022. Primary outcome was clinical pregnancy rate (intrauterine pregnancy with positive fetal heart rate). Secondary outcomes included rates of multifollicular development, multiple pregnancy, spontaneous abortion and cycle cancellation. Subgroup analysis was done stratifying by obesity class. A multivariate logistic regression model was used for primary/secondary outcomes, adjusting for clinically determined covariates., Results: Out of 802 total identified SO-IUI cycles, 715 cycles were completed (518-gonadotropins and 197-letrozole cycles). The clinical pregnancy rates were not significantly different in obese patients undergoing SO-IUI with gonadotropins versus letrozole when adjusted for age, gravidity, parity, cause of infertility, IUI cycle number, endometrial thickness, sperm source and post-wash motile sperm count (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 0.72-2.59). Similarly, no significant associations were found in spontaneous abortion (aOR1.46, 95%CI 0.42-5.08), multiple pregnancy (aOR1.33, 95%CI 0.20-8.88) or cancellation rates (OR0.89, 95%CI 0.55-1.45) between the two groups. The rates of multifollicular development were also comparable between the two groups (aOR0.51, 95% CI 0.19-1.38). For cycles involving gonadotropins, higher BMI classes required higher total gonadotropin dose (p < 0.001)., Conclusion: After adjusting for patient and cycle factors, gonadotropins and letrozole led to comparable odds of achieving pregnancy in obese patients undergoing SO-IUI. Future research in the obese population will help to better understand how to optimize fertility treatments for this growing population., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Management of acute and chronic pain after thoracic surgery for pulmonary resection or thymectomy remains a challenge for both thoracic surgeons and anesthesiologists. Advances in minimally invasive robotic procedures have made subcostal outside-the-cage (OTC) resections possible, but the procedure's pain benefits have not been previously measured. A single-center cohort was consented to undergo robotic-assisted thoracoscopic surgery (RATS) with an OTC or transthoracic (TT) approach. On every post-operative day (POD), patients were asked to complete the visual analog scale (VAS) of pain, assigning a score of 0-10 with higher scores equaling higher pain intensity. Additionally, patients' opioid consumption was recorded and classified using morphine equivalent dose (MED). Descriptive statistics of demographics, Mann-Whitney, and Chi-squared tests were performed in a matched analysis. Altogether, 50 OTC patients and 50 TT patients were included. For each group, 1 pneumonectomy, 19 lobectomies, 10 segmentectomies, and 20 thymectomies were performed. Between groups, most were male (n = 54; p = 0.42) and there were no differences in American Society of Anesthesiologists scores (p = 0.51), or tobacco consumption (p = 0.45). Patients who received an OTC approach experienced significantly lower pain scores on POD-0 (p = 0.001), POD-1 (p < 0.001), and POD-2 (p < 0.001). POD-3 OTC VAS scores were not different from those of the TT group (p = 0.09). Similarly, MED was lower for the OTC group on POD-0 (p < 0.001), POD-1 (p = 0.03), and POD-3 (p = 0.03). The RATS-OTC approach results in a more rapid decrease in self-reported pain by the patient as well as significantly lower levels of MED., (© 2024. The Author(s).)

It is increasingly suggested that the dynamics of antimicrobial-resistant bacteria in the wild are mostly anthropogenically driven, but the spatial and temporal scales at which these phenomena occur in landscapes are only partially understood. Here, we explore this topic by studying antimicrobial resistance in the commensal bacteria from micromammals sampled at 12 sites from a large heterogenous landscape (the Carmargue area, Rhone Delta) along a gradient of anthropization: natural reserves, rural areas, towns, and sewage-water treatment plants. There was a positive relationship between the frequency of antimicrobial-resistant bacteria and the level of habitat anthropization. Although low, antimicrobial resistance was also present in natural reserves, even in the oldest one, founded in 1954. This study is one of the first to support the idea that rodents in human-altered habitats are important components of the environmental pool of resistance to clinically relevant antimicrobials and also that a "One Health" approach is required to assess issues related to antimicrobial resistance dynamics in anthropized landscapes., (© 2023. EcoHealth Alliance.)

Across the many studies of motion picture box office success, unresolved debates and untested assumptions about the contributing factors persist. Using an accessibility-diagnosticity framework and a meta-analysis of 634 effect sizes from 150 studies, the current article seeks to clarify the relationships of star brand equity and product reviews (from consumers and critics) with box office success. The popularity of stars (market and media appeals) exerts a stronger impact on box office success than their artistic recognition (as per award nominations and wins) at the moment of a movie's release but not over its extended theatrical run. Whereas the impact of popular stars on box office success decreases over time, the influence of artistically recognized stars remains steady. The findings also identify a dual role for critics, who influence consumers' movie choice and predict box office performance by merely reflecting moviegoers' tastes. Finally, this study refutes the assumption that the impact of users' reviews strengthens over time, relative to critics' reviews., Author(s): François A. Carrillat [sup.1] , Renaud Legoux [sup.2] , Allègre L. Hadida [sup.3] Author Affiliations: (1) University of Technology Sydney, Business School, 0000 0004 1936 7611, grid.117476.2, , 2007, [...]

The extant literature has studied the effects of a firm's service recovery efforts on the reactions of customers and employees following an individual service failure. However, the impact of recovery efforts on a firm's performance after a public and large service failure-such as a large-scale information breach-has received scant attention. To address this gap, this current research develops a framework and finds support for the impact of service crisis recoveries on a firm's performance, as measured by firm-idiosyncratic risk. Using a unique dataset of service crisis recoveries, the authors find that firms offering compensation (i.e., tangible redresses) or process improvement (i.e., improvements in organizational processes) show more stable performance (less idiosyncratic risk), from two quarters to two calendar years after the announcement of their recovery plan. In line with the documented dual effect of apologies, firms that offer apology-based recoveries display more volatile performance (higher idiosyncratic risk). Of note, this volatility increases with the number of affected individuals, and it remains unaffected even when the apology is expressed with high intensity., Author(s): Shahin Rasoulian [sup.1] , Yany Grégoire [sup.1] , Renaud Legoux [sup.1] , Sylvain Sénécal [sup.2] Author Affiliations: (1) Department of Marketing, HEC Montreal, 0000 0001 0555 9354, grid.256696.8, , [...]

Author(s): Julien Guiot [sup.1] , Catherine Moermans [sup.1] , Monique Henket [sup.1] , Jean-Louis Corhay [sup.1] , Renaud Louis [sup.1] Author Affiliations: (1) 0000 0000 8607 6858grid.411374.4Pneumology Department, CHU Liège, [...], Purpose Idiopathic pulmonary fibrosis (IPF) is a progressive and lethal lung disease of unknown origin whose incidence has been increasing over the latest decade partly as a consequence of population ageing. New anti-fibrotic therapy including pirfenidone and nintedanib have now proven efficacy in slowing down the disease. Nevertheless, diagnosis and follow-up of IPF remain challenging. Methods This review examines the recent literature on potentially useful blood molecular and cellular biomarkers in IPF. Most of the proposed biomarkers belong to chemokines (IL-8, CCL18), proteases (MMP-1 and MMP-7), and growth factors (IGBPs) families. Circulating T cells and fibrocytes have also gained recent interest in that respect. Up to now, though several interesting candidates are profiling there has not been a single biomarker, which proved to be specific of the disease and predictive of the evolution (decline of pulmonary function test values, risk of acute exacerbation or mortality). Conclusion Large scale multicentric studies are eagerly needed to confirm the utility of these biomarkers.

Author(s): Matthieu Jabaudon [sup.1] [sup.2], Nacim Hamroun [sup.1], Laurence Roszyk [sup.2] [sup.3], Renaud Guérin [sup.1], Jean-Etienne Bazin [sup.1], Vincent Sapin [sup.2] [sup.3], Bruno Pereira [sup.4], Jean-Michel Constantin [sup.1] [sup.2] Author [...], Purpose The soluble form of the receptor for advanced glycation end-products (sRAGE) is a promising marker for epithelial dysfunction, but it has not been fully characterized as a biomarker of acute respiratory distress syndrome (ARDS). Whether sRAGE could inform on the response to ventilator settings has been poorly investigated, and whether a recruitment maneuver (RM) may influence plasma sRAGE remains unknown. Methods Twenty-four patients with moderate/severe, nonfocal ARDS were enrolled in this prospective monocentric crossover study and randomized into a 'RM-SHAM' group when a 6-h-long RM sequence preceded a 6-h-long sham evaluation period, or a 'SHAM-RM' group (inverted sequences). Protective ventilation was applied, and RM consisted of the application of 40 cmH.sub.2O airway pressure for 40 s. Arterial blood was sampled for gas analyses and sRAGE measurements, 5 min pre-RM (or 40-s-long sham period), 5, 30 min, 1, 4, and 6 h after the RM (or 40-s-long sham period). Results Mean PaO.sub.2/FiO.sub.2, tidal volume, PEEP, and plateau pressure were 125 mmHg, 6.8 ml/kg (ideal body weight), and 13 and 26 cmH.sub.2O, respectively. Median baseline plasma sRAGE levels were 3,232 pg/ml. RM induced a significant decrease in sRAGE (-1,598 ± 859 pg/ml) in 1 h (p = 0.043). At 4 and 6 h post-RM, sRAGE levels increased back toward baseline values. Pre-RM sRAGE was associated with RM-induced oxygenation improvement (AUC 0.84). Conclusions We report the first kinetics study of plasma sRAGE after RM in ARDS. Our findings reinforce the value of plasma sRAGE as a biomarker of ARDS.

Author(s): Alexandre Lannou [sup.1], Renaud Prevel [sup.1] [sup.2], Gilles Hilbert [sup.1], Hoang-Nam Bui [sup.1] Author Affiliations: (1) grid.414263.6, CHU Bordeaux, Medical Intensive Care Unit, Pellegrin Hospital, , 33000, Bordeaux, France [...]

Background: Long COVID, also known as post-acute sequelae of COVID-19 (PASC), is characterized by persistent clinical symptoms following COVID-19., Objective: To correlate biomarkers of endothelial dysfunction with persistent clinical symptoms and pulmonary function defects at distance from COVID-19., Methods: Consecutive patients with long COVID-19 suspicion were enrolled. A panel of endothelial biomarkers was measured in each patient during clinical evaluation and pulmonary function test (PFT)., Results: The study included 137 PASC patients, mostly male (68%), with a median age of 55 years. A total of 194 PFTs were performed between months 3 and 24 after an episode of SARS-CoV-2 infection. We compared biomarkers evaluated in PASC patients with 20 healthy volunteers (HVs) and acute hospitalized COVID-19 patients (n = 88). The study found that angiogenesis-related biomarkers and von Willebrand factor (VWF) levels were increased in PASC patients compared to HVs without increased inflammatory or platelet activation markers. Moreover, VEGF-A and VWF were associated with persistent lung CT scan lesions and impaired diffusing capacity of the lungs for carbon monoxide (DLCO) measurement. By employing a Cox proportional hazards model adjusted for age, sex, and body mass index, we further confirmed the accuracy of VEGF-A and VWF. Following adjustment, VEGF-A emerged as the most significant predictive factor associated with persistent lung CT scan lesions and impaired DLCO measurement., Conclusion: VEGF-A is a relevant predictive factor for DLCO impairment and radiological sequelae in PASC. Beyond being a biomarker, we hypothesize that the persistence of angiogenic disorders may contribute to long COVID symptoms., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Selective androgen receptor modulators (SARMs) have demonstrated agonist activity on the androgen receptor in various tissues, stimulating muscle mass growth and improving bone reconstruction. Despite being in clinical trials, none has been approved by the Food and Drug Administration (FDA) or European Medicines Agency for pharmacotherapy. Still, SARMs are very popular as performance-enhancing drugs. The FDA has issued warnings about the health risks associated with SARMs, but the long-term exposure and possible adverse events still need to be fully understood. This review aims to evaluate the adverse events associated with using SARMs by humans., Methods: PubMed database was searched from September 16, 2022, to October 2, 2023. In total, 20 records were included in the final review. Data from preclinical and clinical studies supported the review., Results: Since 2020, 20 reports of adverse events, most described as drug-induced liver injury associated with the use of SARM agonists, have been published. The main symptoms mentioned were cholestatic or hepatocellular liver injury and jaundice. Limited data are related to the dosages and purity of SARM supplements., Conclusion: Promoting SARMs as an anabolic agent in combination with other performance-enhancing drugs poses a risk to users not only due to doping controls but also to health safety. The lack of quality control of consumed supplements makes it very difficult to assess the direct impact of SARMs on the liver and their potential hepatotoxic effects. Therefore, more detailed analyses are needed to determine the safety of using SARMs., (© 2023. The Author(s).)

Author(s): José Labarère [sup.1] [sup.2] [sup.7], Renaud Bertrand [sup.3] [sup.4], Michael J. Fine [sup.5] [sup.6] Author Affiliations: (1) grid.410529.b, 0000000107924829, Quality of Care Unit, University Hospital, , 38043, Grenoble, France [...], Background Clinical prediction models are formal combinations of historical, physical examination and laboratory or radiographic test data elements designed to accurately estimate the probability that a specific illness is present (diagnostic model), will respond to a form of treatment (therapeutic model) or will have a well-defined outcome (prognostic model) in an individual patient. They are derived and validated using empirical data and used to assist physicians in their clinical decision-making that requires a quantitative assessment of diagnostic, therapeutic or prognostic probabilities at the bedside. Purpose To provide intensivists with a comprehensive overview of the empirical development and testing phases that a clinical prediction model must satisfy before its implementation into clinical practice. Results The development of a clinical prediction model encompasses three consecutive phases, namely derivation, (external) validation and impact analysis. The derivation phase consists of building a multivariable model, estimating its apparent predictive performance in terms of both calibration and discrimination, and assessing the potential for statistical over-fitting using internal validation techniques (i.e. split-sampling, cross-validation or bootstrapping). External validation consists of testing the predictive performance of a model by assessing its calibration and discrimination in different but plausibly related patients. Impact analysis involves comparative research [i.e. (cluster) randomized trials] to determine whether clinical use of a prediction model affects physician practices, patient outcomes or the cost of healthcare delivery. Conclusions This narrative review introduces a checklist of 19 items designed to help intensivists develop and transparently report valid clinical prediction models.

We tested the possibility of measuring progesterone levels in bubbler samples collected from free-ranging live bottlenose dolphins (n = 11) and long-finned pilot whales (n = 2) as a tool to evaluate the pregnancy status of individuals. Samples were collected during January 2004 and September-October 2005 in the Strait of Gibraltar and Gulf of Cadiz and used for sex-determination by genetic methods (skin samples) and for quantification of progesterone levels by enzyme immunoassay. Photo-identification tracking of females after taking the biopsy was used to observe the presence of newborns and, in this way, to determine if the female was pregnant at the time of sampling. Mean progesterone levels from pregnant bottlenose dolphins (n = 2) were around 9 times higher than those from non-pregnant females (n = 9), with no overlap between concentration ranges demonstrating that this method could constitute an effective tool for determining pregnancy in wild populations of bottlenose dolphins and other cetacean species., Author(s): Sergi Pérez [sup.1] , Ángel García-López [sup.2] , Renaud De Stephanis [sup.3] , Joan Giménez [sup.1] , Susana García-Tiscar [sup.4] , Philippe Verborgh [sup.1] , Juan Miguel Mancera [sup.5] [...]

Author(s): Antoine Roch [sup.1], Renaud Lepaul-Ercole [sup.1], Dominique Grisoli [sup.2], Jacques Bessereau [sup.3], Olivier Brissy [sup.1], Matthias Castanier [sup.1], Stephanie Dizier [sup.1], Jean-Marie Forel [sup.1], Christophe Guervilly [sup.1], Vlad Gariboldi [...], Purpose To compare characteristics, clinical evolution and outcome in adult patients with influenza A (H1N1) acute respiratory distress syndrome (ARDS) treated with or without extracorporeal membrane oxygenation (ECMO). Methods A prospective observational study of patients treated in Marseille South Hospital from October 2009 to January 2010 for confirmed influenza A (H1N1)-related ARDS. Clinical features, pulmonary dysfunction and mortality were compared between patients treated with and without ECMO. Results Of 18 patients admitted, 6 were treated with veno-venous and 3 with veno-arterial ECMO after median (interquartile, IQR) duration of mechanical ventilation of 10 (6-96) h. Six ECMO were initiated in a referral hospital by a mobile team, a median (IQR) of 3 (2-4) h after phone contact. Before ECMO, patients had severe respiratory failure with median (IQR) PaO.sub.2 to FiO.sub.2 ratio of 52 (50-60) mmHg and PaCO.sub.2 of 85 (69-91) mmHg. Patients treated with or without ECMO had the same hospital mortality rate (56%, 5/9). Duration of ECMO therapy was 9 (4-14) days in survivors and 5 (2-25) days in non-survivors. Early improvement of PaO.sub.2 to FiO.sub.2 ratio was greater in ECMO survivors than non-survivors after ECMO initiation [295 (151-439) versus 131 (106-144) mmHg, p < 0.05]. Haemorrhagic complications occurred in four patients under ECMO, but none required surgical treatment. Conclusions ECMO may be an effective salvage treatment for patients with influenza A (H1N1)-related ARDS presenting rapid refractory respiratory failure, particularly when provided by a mobile team allowing early cannulation prior to transfer to a reference centre.

Author(s): Renaud Prevel [sup.1] [sup.2], Marie Kostine [sup.2] [sup.3], Arnaud Desclaux [sup.4], Malek Souayed [sup.5] Author Affiliations: (1) 0000 0004 0593 7118, grid.42399.35, Médecine Intensive Réanimation, Hôpital Pellegrin, CHU de [...]

Byline: Mikaila Fassassi (1), Fabrice Michel (1), Laurent Thomachot (1), Claire Nicaise (1), Renaud Vialet (1), Yves Jammes (2), Pierre Lagier (1), Claude Martin (3) Keywords: Airway humidification; Heated humidifier; Heat and moisture exchanger; Neonates Abstract: Objective We set out to evaluate the efficacy of passive inspiratory gas conditioning in mechanically ventilated neonates and compared it with that of a heated humidifier (HH). Design Prospective, randomized, controlled study. Setting Neonatal and pediatric intensive care unit. Patients Fourteen mechanically ventilated neonates nursed in incubators. Interventions The HH was set to deliver a temperature of 37a-degC and an absolute humidity of 40a-mg[H.sub.2]O/l at the incubator entrance. Inspired temperature (Tdeg) and absolute humidity (AH) were measured by the psychometric method, transpulmonary pressure (Tpres) by means of a differential pressure transducer. Measurements were performed at 5, 10, and 15a-min. Measurements and results The values of Tdeg were significantly higher using the HH (34.6a-+-a-1.6a-degC) than the heat and moisture exchanger (HME) (33.8a-+-a-2.3, pa- Conclusions The use of HMEs in neonates made it possible to achieve an absolute humidity of 28a-mg[H.sub.2]O/l or more and a temperature of 30a-degC or more. Higher values are obtained using a HH. Author Affiliation: (1) Neonatal and Pediatric Intensive Care, Department of Anesthesia and Intensive Care, Hopital Nord, Boulevard Pierre Dramard, 13915, Marseille Cedex 20, France (2) Aix-Marseille 2, EA2201, Faculty of Medicine, Hopital Nord, Boulevard Pierre Dramard, 13915, Marseille Cedex 20, France (3) Department of Anesthesia and Intensive Care, Hopital Nord, Boulevard Pierre Dramard, 13915, Marseille Cedex 20, France Article History: Registration Date: 26/10/2006 Received Date: 11/10/2006 Accepted Date: 25/10/2006 Online Date: 13/12/2006

Byline: Jean-Michel Constantin (1,2), Eric Schneider (1), Sophie Cayot-Constantin (1), Renaud Guerin (1), Francois Bannier (1), Emmanuel Futier (1), Jean-Etienne Bazin (1,3) Keywords: Noninvasive ventilation; Acute respiratory failure; Mechanical ventilation; Remifentanil; Critical care; Sedation Abstract: Objective To assess the feasibility and safety of remifentanil-based sedation during noninvasive ventilation (NIV) in patients with NIV failure. Design and setting Prospective clinical investigation in a 16-bed intensive care unit of a university hospital in France. Patients Thirteen patients in NIV failure due to discomfort and/or refusal to continue this ventilatory support: 10 with acute respiratory failure and 3 with acute hypercapnic respiratory failure. Intervention Patients were administered methylene blue and were sedated (Ramsay scale 2--3) by a continuous perfusion of remifentanil during NIV. Cardiorespiratory and ventilatory parameters, blood gas analysis, and adverse events were prospectively recorded. Measurements and results The 13 patients received a total of 125 NIV sessions, totaling 1200a-h, of NIV under remifentanil-based sedation (mean remifentanil dose 0.1a-+-a-0.03a-ug/kg per minute). Three patients also required propofol. PaO.sub.2/FIO.sub.2 ratio increased from 134a-+-a-69 to 187a-+-a-43a-mmHg after 1a-h. In patients with acute respiratory failure respiratory rate decreased from 34a-+-a-12 per minute before remifentanil to 25a-+-a-4 per minute after 1a-h. In the three patients with acute hypercapnic respiratory failure PaCO.sub.2 decreased from 69a-+-a-7 to 42a-+-a-5a-mmHg. Four patients required endotracheal intubation without aspiration pneumonia. Twelve of the 13 patients left the ICU. Conclusion This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance. Author Affiliation: (1) CHU Clermont-Ferrand, Service de Reanimation Adulte, Hotel-Dieu Hospital, 63058, Clermont-Ferrand, France (2) INSERM, U384, 63001, Clermont-Ferrand, France (3) Univ Clermont 1, Fac Medecine, 63001, Clermont-Ferrand, France Article History: Registration Date: 11/10/2006 Received Date: 16/02/2006 Accepted Date: 10/10/2006 Online Date: 14/11/2006

Byline: Alexandre Mebazaa (1), Peter Karpati (1), Estelle Renaud (1), Lars Algotsson (2) Keywords: Heart failure; Levosimendan; Vasodilator agents; Inotropic agents; Pathophysiology; Pharmacology Abstract: The right ventricle (RV) provides sustained low-pressure perfusion of the pulmonary vasculature, but is sensitive to changes in loading conditions and intrinsic contractility. Factors that affect right ventricular preload, afterload or left ventricular function can adversely influence the functioning of the RV, causing ischaemia and right ventricular failure (RVF). As RVF progresses, a pronounced tricuspid regurgitation further decreases cardiac output and worsens organ congestion. This can degenerate into an irreversible vicious cycle. The effective diagnosis of RVF is optimally performed by a combination of techniques including echocardiography and catheterisation, which can also be used to monitor treatment efficacy. Treatment of RVF focuses on alleviating congestion, improving right ventricular contractility and right coronary artery perfusion and reducing right ventricular afterload. As part of the treatment, inhaled nitric oxide or prostacyclin effectively reduces afterload by vasodilating the pulmonary vasculature. Traditional positive inotropic drugs enhance contractility by increasing the intracellular calcium concentration and oxygen consumption of cardiac myocytes, while vasopressors such as norepinephrine increase arterial blood pressure, which improves cardiac perfusion but increases afterload. A new treatment, the calcium sensitiser, levosimendan, increases cardiac contractility without increasing myocardial oxygen demand, while preserving myocardial relaxation. Furthermore, it increases coronary perfusion and decreases afterload. Conversely, traditional treatments of circulatory failure, such as mechanical ventilation and volume loading, could be harmful in the case of RVF. This review outlines the pathophysiology, diagnosis and treatment of RVF, illustrated with clinical case studies. Author Affiliation: (1) Department of Anaesthesiology and Critical Care Medicine, Hopital Lariboisiere, 2 Rue Ambroise Pare, 75475 , Paris Cedex 10, France (2) Department of Anaesthesiology--Heart-Lung Division, University Hospital of Lund, 22185, Lund, Sweden Article History: Received Date: 03/02/2003 Accepted Date: 08/09/2003 Online Date: 15/11/2003 Article note: Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-003-2025-3

Background: Rollators are preferred to compensate physiological limitations and to maintain mobility in old age; however, environmental obstacles or limited perception of fall hazards can lead to fall events., Objective: The present study evaluates an electronic box that is used to supplement conventional rollators with various technical assistance systems (e.g. call for help to contact persons, fall detection). The rollator equiped with the electronic box (DigiRoll) was tested for its suitability for everyday use during the pilot phase of the study, with the aim of further development., Methods: In a qualitative design, the DigiRoll was tested in a pilot phase with 10 participants. Individuals were interviewed in focus groups and individual interviews. In addition, ethnographic observations were made. The data evaluation was carried out using qualitative content analysis., Results: The test persons showed great interest in the development of the assistance systems to increase the feeling of safety. At the same time, the necessity of adapting the DigiRoll to individual needs became clear, depending on the living situation, the type of impairment and personal habits., Conclusion: The DigiRoll has the potential to provide sustainable support for people with reduced mobility by increasing the users' sense of safety. Other contextual factors such as access to suitable rollators and safe walkways cannot be influenced by the DigiRoll., (© 2022. The Author(s).)

The Barents Sea is among the most productive areas in the world oceans, and its shallow banks exhibit particularly high rates of primary productivity reaching over 300 g C [m.sup.-2][year.sup.-1]. Our study focused on the Svalbard Bank, an important feeding area for fishes and whales. In order to investigate how benthic community structure and benthic secondary production vary across environmental gradients and through time, we sampled across the bank and compared results with a similar study conducted 85 years ago. Considerable variability in community structure and function across bank corresponded with differences in the physical structure of the habitat, including currents, sedimentation regimes and sediment type, and overlying water masses. Despite an intensive scallop fishery and climatic shifts that have taken place since the last survey in the 1920s, benthic community structure was very similar to that from the previous survey, suggesting strong system resilience. Primary and secondary production over shallow banks plays a large role in the Barents Sea and may act as a carbon subsidy to surrounding fish populations, of which many are of commercial importance., Introduction The Arctic Ocean and its marginal seas overlie more than 25 % of the world's continental shelves, and many of these shallow areas are characterized by seasonally high primary [...]

Introduction Infantile myofibromatosis (IM) is rare, but represents the most frequent cause of fibrous tumors in pediatrics [1]. The disease commonly occurs at birth or in infancy. Its clinical presentation [...], Infantile myofibromatosis is a rare disorder characterized by the formation of tumors in the skin, soft tissues, bone, and viscera. We report the case of a 3-weekold girl who presented with severe hypertension due to generalized infantile myofibromatosis including renal involvement. The infant was treated by chemotherapy and showed progressive regression of the tumors. However, her evolution was marked by the development of aneurismal dilations of the renal and iliac arteries as observed in fibromuscular dysplasia. We discuss the possibility of a link between these two mesenchymal disorders. Keywords Infantile myofibromatosis * Fibromuscular dysplasia * Renovascular hypertension * Aneurysm * Mesenchymal disorder

Since the 1990 imposition of an arms embargo, the European Union has kept on furthering its sanction policies towards Burma's military regime in response to its poor record on human rights and authoritarian rule over the country. However, more than a decade after the 1996 EU Common Position on Burma, the European approach to the Burmese conundrum has still failed to achieve its initial objective of facilitating a transition to democracy and of stimulating aid and development in the country. This article seeks to underline the limits of the EU position by highlighting the internal and external obstacles the Europeans have been facing in their policymaking process towards Burma. It is argued that the varied and multiple interests of the 27 EU members; an influential European public opinion favouring an attitude of ostracism; and misunderstandings or miscalculations in appreciating the current state of Burmese affairs have hindered the EU from playing an efficacious role. Moreover these factors also impede its reappraisal. Keywords Burma * Common position * Engagement * EU foreign policy * Myanmar * Ostracism * Sanctions, Introduction In 2007 and 2008, Burma (1) experienced two major political crises that have drawn international focus - and criticism - on the country and its military junta led by [...]

Les medias de masse jouent un role important dans la formation des normes sociales de sante (1-4). Faisant office de relais entre des depositaires d'enjeux et les populations, les medias [...], As social elements of our environment, mass media are regarded as determinants of individual and population beliefs, social norms and habits. Since it is recognized that they influence population health, this study aims to obtain a better portrait of Quebec media content regarding physical activity and nutrition messages on a public health level. First, we analyzed the content of fictional television shows (n=13) and advertisements broadcast during those shows (n=68). Second, we reviewed the content of La Presse newspaper and of French television Societe Radio-Canada from 1986 to 2005 with regard to physical activity and nutrition messages. Our results indicate a difference between how men and women are portrayed on French television, with women more often being shown as underweight and men as at or above healthy body weight. The results also show that during the 20-year period of the reviewed content, there were fewer messages about physical activity than about nutrition. To be successful in their goal of improving population health, mass media should address both subjects together in their messages. Key words: Media content; messages; health communication Elements socioculturels de l'environnement, les medias peuvent agir comme des determinants sur les croyances, les normes et les habitudes de vie des individus et des populations. Leurs messages etant susceptibles d'influencer la sante populationnelle, nous avons cherche a connaEtre l'offre mediatique quebecoise au regard des messages d'alimentation et d'activite physique, sous l'angle de la sante publique. Dans un premier temps, nous avons analyse le contenu de teleromans (n=13) diffuses sur les quatre chaEnes generalistes, ainsi que le contenu des publicites durant ces emissions (n=68). Nous avons par la suite etudie le contenu du quotidien La Presse entre 1986 et 2005, de meme que celui des emissions de la Societe Radio-Canada au cours de la meme periode, relativement aux messages d'alimentation et d'activite physique. Nos donnees revelent un ecart entre la representation des hommes et des femmes en vigueur a la television quebecoise, la corpulence des hommes s'averant plus forte que celle des femmes. De plus, au cours des vingt annees analysees, les messages lies a l'alimentation furent plus nombreux que ceux abordant l'activite physique. Pour atteindre leurs objectifs d'amelioration de la sante des populations, les concepteurs de messages gagneraient a associer ces deux sujets. Mots cles : medias; offre mediatique; communication pour la sante