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Objectives: Patient Blood Management (PBM) is defined as a patient‐centered, systematic, evidence‐based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost‐effectiveness depends on the health insurance system considered. This analysis aims to estimate the one‐year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives. Methods: A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico‐administrative database. Results: A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested. Conclusion: Implementing PBM programs could result in important savings for the health care system in France. [ABSTRACT FROM AUTHOR]

Land use and landscape structure play an important role in the functioning of flash floods on the arable plateaus of northern France. Landscape structures have changed considerably over the last decades with an increase in runoff-producing surfaces and an enlargement of the plots. This evolution results in an increase in runoff volumes accompanied by an increasingly easy diffusion of runoff on the slopes. There is therefore potentially an increasingly frequent and important spatial connectivity from the plots to the thalwegs, which can lead to the formation of flash floods. This study proposes to model this diachronic evolution of connectivity in a small agricultural basin of Seine Maritime using a multiagent system (MAS) and to develop synthetic indicators characterising these spatial links in the flow processes. The model outputs show that spatial connectivity has been steadily increasing over the past 70 years due to the enlargement of the parcel grid and the growth of runoff surfaces. For example, for the same 20 mm/h rainfall, the connectivity indicator increases from 40.99% (in 1947) to 78.33% (in 2015). This observation is observed for all levels of rainfall intensity, including the lowest. This modelling, carried out for a 116 ha basin in arable farming, can be transposed to all small agricultural basins. [ABSTRACT FROM AUTHOR]

Background Infective endocarditis (IE) is a severe disease requiring microbial identification to successfully adapt its treatment. Currently, identification of its etiological microorganism remains unresolved in 5.2% of cases. We aimed to improve IE diagnosis using an ultra-sensitive molecular technique on cardiac samples in microbiologically nondocumented (culture and conventional polymerase chain reaction [PCR]) IE (NDIE) cases. Methods Cardiac samples explanted in a tertiary hospital in Lyon, France, from patients with definite IE over a 5-year period were retrospectively analyzed. NDIE was defined as Duke definite-IE associated with negative explorations including cardiac samples culture, bacterial amplification, and serologies. Ultrasensitive molecular diagnosis was achieved using the Universal Microbe Detection kit (Molzym®). Fungal identification was confirmed using 26S-rDNA and internal transcribed spacer amplifications. Fungal infection was confirmed using Grocott-Gromori staining, auto-immunohistochemistry on cardiac samples, and mannan serologies. Results Among 88 included patients, microbial DNA was detected in all 16 NDIE cases. Bacterial taxa typical of IE etiologies were detected in 13/16 cases and Malassezia restricta in the 3 other cases. In these 3 cases, histological examination confirmed the presence of fungi pathognomonic of Malassezia that reacted with patient sera in an auto-immunohistochemistry assay and cross-reacted with Candida albicans in an indirect immunofluorescent assay. Conclusions M. restricta appears to be an underestimated causative agent of NDIE. Importantly, serological cross-reaction of M. restricta with C. albicans may lead to its misdiagnosis. This is of major concern since M. restricta is intrinsically resistant to echinocandins; the reference treatment for Candida -fungal IE. [ABSTRACT FROM AUTHOR]

Résumé: Le TDA/H a une prévalence de 3,5 % à 5,6 % environ actuellement en France. Il est un trouble neuropsychique dimensionnel d'évolution chronique mal connu. Le médecin généraliste est le plus souvent le premier interlocuteur face à ce trouble, il est donc nécessaire qu'il sache le repérer et le prendre en charge précocement pour éviter les complications ultérieures, fréquentes notamment en l'absence de diagnostic. Dans ce premier article, nous verrons quels sont les moyens diagnostiques disponibles avant d'envisager dans une deuxième partie la prise en charge thérapeutique. ADHD has a prevalence of around 3.5% to 5.6% currently in France. It is a poorly understood, chronic dimensional neuropsychic disorder. The general practitioner is most often the first point of contact with this disorder, so it is necessary for him to know how to spot it and deal with it early to avoid later complications, which are frequent especially in the absence of a diagnosis. In this first article we will see what diagnostic means are available before considering therapeutic management in a second part. [ABSTRACT FROM AUTHOR]

Background: Because of insufficient data about their benefit–risk ratio in real life, drugs used for Alzheimer's disease (AD; cholinesterase inhibitors and memantine) were withdrawn from the list of reimbursable drugs in France on 1 August 2018. Objectives: In this context, this study aimed to investigate the effects of the removal of AD drugs from the list of reimbursed drugs among patients followed in memory centres in France, in terms of prevalence and factors associated with drug discontinuation and evolution of disease management and cognition after drug discontinuation. Methods: This is an observational study based on data from the National Alzheimer Data Bank ('Banque Nationale Alzheimer' [BNA]), which centralizes information about patients consulting in memory centres. The drug discontinuation rate was estimated among patients receiving AD drugs at the last visit before the end of reimbursement. Factors associated with drug discontinuation were investigated among sociodemographic and disease characteristics, as well as among the use of healthcare resources before the end of reimbursement. We compared the evolution of disease management (psychotropic drugs and non-pharmacological interventions) and Mini-Mental State Examination (MMSE) score during the year following the end of reimbursement among patients with a diagnosis of AD. Results: Among the 19,380 patients of the study sample (62.5% females, mean age 81 years, 86.8% with a diagnosis of AD), 19.5% discontinued their treatment after the end of reimbursement. The main factors associated with drug discontinuation were the type of dementia and lower MMSE level. Compared with patients with a diagnosis of AD, those with vascular dementia were more likely to stop their treatment, whereas those with dementia with Lewy bodies were less likely to discontinue. Among patients with a diagnosis of AD, drug discontinuation was associated with increased use of psychotropic medications, especially antidepressants, and non-pharmacological interventions afterwards, but there was no difference regarding the evolution of MMSE score. Conclusion: This study provides real-life information about the use of AD drugs after they were withdrawn from reimbursement in France and shows that drug discontinuation was limited among patients followed in memory centres and accompanied by increased use of other healthcare resources. [ABSTRACT FROM AUTHOR]

Background. Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment. Methods. We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome. Results. Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)--based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects. Conclusion. L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients. [ABSTRACT FROM AUTHOR]

The article offers information on the raised concerns by the widespread use of proton pump inhibitors. Topics discussed include information on the proton pump inhibitors have potential adverse effects and impact on healthcare costs; discussions on the rotential adverse effects of proton pump inhibitors include community-acquired pneumonia, Clostridium difficile infections and the osteoporosis; and examining the real-life use of proton pump inhibitors in elderly hospitalized patients.

Background: Looking for and treating the portal of entry (POE) of infective endocarditis (IE) is important, but published research on this topic is nonexistent.Objectives: The goal of this study was to systematically search for the POEs of present and potentially new episodes of IEs.Methods: Patients were systematically seen by a stomatologist, an ear, nose, and throat specialist, and a urologist; women were systematically seen by a gynecologist; patients were seen by a dermatologist when there were cutaneous and/or mucous lesions. Colonoscopy and gastroscopy were performed if the microorganism came from the gastrointestinal tract in patients ≥50 years of age and in those with familial histories of colonic polyposis. Treatment of the POE was systematically considered.Results: The POEs of the present IE episodes were identified in 74% of the 318 included patients. The most frequent POE was cutaneous (40% of identified POEs). It was mainly (62% of cutaneous POEs) associated with health care and with intravenous drug use. The second most frequent POE was oral or dental (29%). A dental infectious focus was more often involved (59% of oral or dental POEs) than a dental procedure (12%). POEs were gastrointestinal in 23% of patients. Colonic polyps were found in one-half of the patients and colorectal adenocarcinomas in 14%. Performance was good regarding the search for an oral or dental or a colonic potential POE, which were found in 53% and 40% of patients, respectively.Conclusions: Our search for the POEs of present IEs was often successful, as was searching for an oral or dental or a gastrointestinal POE of a new IE episode. We advise the systematic performance of stomatologic examinations in patients with IE and performance of colonoscopy in patients ≥50 years of age or at high risk for colorectal cancer. [ABSTRACT FROM AUTHOR]

Worsening of heart failure in patients with myocardial infarction is seldom studied, elderly patients often are not included, and multivariate analysis is uncommon. The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute myocardial infarction) sought to determine the incidence of worsening heart failure, its risk factors, and its prognostic importance in patients with myocardial infarction, regardless of age and hospital facilities, in the ‘real world’ in a region in France, using multivariate analysis. Data were prospectively collected in all patients with myocardial infarction admitted in all hospitals in three departments in the Rhône–Alpes region in France between 1 September 1993 and 31 January 1995. Among the 2507 patients included, 33% were in Killip classes II–IV at admission. After exclusion of patients with admission Killip class IV, 416 patients (17% of the cohort, 24% of women and 14% of men) had worsening of Killip class during the first 5 days. In-hospital mortality (overall, 14%) increased dramatically with Killip class at admission (9% in class I, 62% in class IV) and with worsening of Killip class during the first 5 days (36.5 vs. 8.5% if no worsening). In multivariate analysis, older age, diabetes mellitus and anterior Q-wave myocardial infarction were significant predictors of Killip class at admission and of its worsening; Killip class > I at admission was a significant predictor of Killip-class worsening. The significant predictors of in-hospital mortality were older age, Killip class III at admission and worsening of Killip class during the first 5 days. This large, unselected cohort revealed that, among patients with myocardial infarction, heart failure and its worsening are frequent, especially in the elderly, and dramatically worsen the in-hospital mortality. [ABSTRACT FROM PUBLISHER]

This paper presents an application of a cellular automaton-based run-off model (RUICELLS) to a series of small dry valleys in the Seine-Maritime department, northern France, to better assess their susceptibility to flash flood. These muddy floods shortly follow high rainfall (50-100 mm in less than 6 h) and occur in very small areas (<20 km). A surge generally rushes down through the main valley just a few minutes after rains have peaked. Previous events ( n = 69, in the period 1983-2005) have occasionally threatened human lives and have caused significant damage to property and infrastructure. Nonetheless, given the variation among the valleys and the infrequency of events, these floods have not been numerous enough to permit a statistical analysis. Instead, we numerically simulate the possible future flash floods using RUICELLS, a cellular automaton model driven by a set of three deterministic hydrological rules. Simulations have been conducted for 148 basins, each subject to 16 different rainfall scenarios (2.368 simulations in total) to (1) estimate the peak flow discharges ( Q), the specific peak flows ( Q), and the lag times ( T) of the flash floods and (2) detect the critical rainfall intensities that would trigger warnings and increased vigilance. Our simulations indicate that the number of basins susceptible to flash flooding greatly increases with the higher rainfall intensity, the distribution of sensitive crops (sugar beet, corn, maize, and flax) and the basin morphology. Several small basins could also induce by convergence a bigger flood in the downstream humid valleys. The location of the highest simulated discharges is aligned with observed events, and this comparison provides an evaluation of the modelling performance and of the credibility of the results. [ABSTRACT FROM AUTHOR]

Aims To improve knowledge of epidemiological data, management, and clinical outcome of acute heart failure (AHF) in a real-life setting in France. Methods and results We conducted an observational survey constituting a single-day snapshot of all unplanned hospitalizations because of AHF in 170 hospitals throughout France (the OFICA survey). A total of 1658 patients (median age 79 years, 55% male) were included. Family doctors were the first medical contact in 43% of cases, and patients were admitted through emergency departments in 64% of cases. Clinical scenarios were mainly acutely decompensated HF (48%) and acute pulmonary oedema (38%) with similar clinical and biological characteristics as well as outcome. Characteristics were different and severity higher in both shock and right HF. Infection and arrhythmia were the most frequent precipitating factors (27% and 24% of cases); diabetes and chronic pulmonary disease were the most frequent co-morbidities (31% and 21%). Over 80% of patients underwent both natriuretic peptide testing and echocardiography. LVEF was preserved (>50%) in 36% of patients and associated with specific characteristics and lower severity. Median hospital stay was 13 days; in-hospital mortality was 8.2%, and independent predictors were age, blood pressure, and creatinine. Treatment at discharge in patients with reduced LVEF included ACE inhibitors/ARBs, beta-blockers, and aldosterone inhibitors in 78, 67, and 27% cases. Non-surgical devices were reported in <20% of potential candidates. Conclusion This comprehensive survey analysing AHF in real life emphasizes the heterogeneous nature and overall high severity of AHF. It could be a useful tool to identify unsolved medical issues and improve outcome. [ABSTRACT FROM PUBLISHER]

This article reviews the status of the CLIC (Compact Linear Collider) study toward feasibility demonstration of a novel and challenging technology that has been specially developed to extend the energy reach of linear colliders into the multi-TeV range so that they will be complementary to the LHC (Large Hadron Collider). A conceptual design report is being prepared; it summarizes the performance of a high-energy facility based on this technology, as well as the results of the research and development carried out to address its feasibility. [ABSTRACT FROM AUTHOR]

The article discusses how French eighteenth-century playwrights Louis-Benoît Picard and Jean-Antoine Lebrun Tossa responded to the political upheaval in France caused by the French Revolution through Picard's comedies "Le passé, le présent et l'avenir," and "Les suspects," and Lebrun Tossa's drama "Arabelle et Vascos ou les Jacobins de Goa." It addresses the effects of Jacobin France on theater, political opposition, and popular works as a representation of public sentiment.

Background. Observational studies showed that the profile of infective endocarditis (IE) significantly changed over the past decades. However, most studies involved referral centers. We conducted a population-based study to control for this referral bias. The objective was to update the description of characteristics of IE in France and to compare the profile of community-acquired versus healthcare-associated IE. Methods. A prospective population-based observational study conducted in all medical facilities from 7 French regions (32% of French individuals aged ≥18 years) identified 497 adults with Duke-Li-definite IE who were first admitted to the hospital in 2008. Main measures included age-standardized and sex-standardized incidence of IE and multivariate Cox regression analysis for risk factors of in-hospital death. Results. The age-standardized and sex-standardized annual incidence of IE was 33.8 (95% confidence interval [CI], 30.8-36.9) cases per million inhabitants. The incidence was highest in men aged 75-79 years. A majority of patients had no previously known heart disease. Staphylococci were the most common causal agents, accounting for 36.2% of cases (Staphylococcus aureus, 26.6%; coagulase-negative staphylococci, 9.7%). Healthcare-associated IE represented 26.7% of all cases and exhibited a clinical pattern significantly different from that of communityacquired IE. S. aureus as the causal agent of IE was the most important factor associated with in-hospital death in community-acquired IE (hazard ratio [HR], 2.82 [95% CI, 1.72-4.61]) and the single factor in healthcare-associated IE (HR, 2.54 [95% CI, 1.33-4.85]). Conclusions. S. aureus became both the leading cause and the most important prognostic factor of IE, and healthcare-associated IE appeared as a major subgroup of the disease. [ABSTRACT FROM AUTHOR]

The article reviews the status of the Compact Linear Collider (CLIC) study towards feasibility demonstration of a novel and challenging technology which has been specially developed to extend Linear Colliders energy reach into the multi-TeV range in order to be complementary to LHC (Large Hadron Collider). A Conceptual Design Report is being published summarizing the performance of a High Energy facility based on such a technology as well as the results of the R&D performed to address its feasibility. [ABSTRACT FROM AUTHOR]

The article presents a study which tests the Spatialisation d'éChelle fine de l' ALéa (SCALES) model in Basse-Normandie in France. It reveals that the model exhibits strong predisposition of the area to soil erosion. It compares its results with those from models such as Pan-European Soil Erosion Risk Assessment (PESERA). It notes that these models miscalculate levels of medium soil erosion and vary in the areas' spatial localization with the highest risk of erosion.

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: A European Union Directive provides for the designation of a surrogate who can consent to or refuse inclusion of an incapacitated patient in research studies. The accuracy with which surrogates consent to research on behalf of patients has not been evaluated in the intensive care unit (ICU).Methods: A prospective multicenter study was conducted in ten ICUs of the French Famirea study group between July and October 2004. Two hypothetical studies were simultaneously submitted to the patient, surrogate, and physician at the time that the patient was discharged to a ward. One study involved minimal risk and the other greater-than-minimal risk to the patients.Results: With the minimal risk study there was patient-surrogate discrepancy in 32% of cases and patient-physician discrepancy in 25%. Corresponding figures with the greater-than-minimal risk study were 42% and 46%. None of the collected variables differed significantly between cases with and without patient-surrogate discrepancy.Conclusions: Family members designated to serve as surrogate decision makers may fail to accurately consent to research for critically ill patients in one-third to nearly one-half of cases. [ABSTRACT FROM AUTHOR]

Copyright of Societes Contemporaines is the property of Fondation Nationale des Sciences Politiques and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Context: Since the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies including a French survey performed in 1991. Objective: To update information gained from the 1991 study on the epidemiology of IE in France. Design and Setting: Population-based survey conducted from January through December 1999 in all hospitals in 6 French regions representing 26% of the population (16 million inhabitants). Patients: Three hundred ninety adult inpatients diagnosed with IE according to Duke criteria. Main Outcome Measures: Incidence of IE; proportion of patients with underlying heart disease; clinical characteristics; causative microorganisms; surgical and mortality outcomes. Results: The annual age- and sex-standardized incidence was 31 (95% confidence interval [CI], 28-35) cases per million, not including the region of New Caledonia, which had 161 (95% CI, 117-216) cases per million. There was no previously known heart disease in 47% of the cases. The proportion of prosthetic-valve IE was 16%. Causative microorganisms were: streptococci, 48% (group D streptococci, 25%; oral streptococci, 17%, pyogenic streptococci, 6%); enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8%. Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases. Early valve surgery was performed in 49% of the patients. In-hospital mortality was 16%. Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P = .67) and staphylococci (4.9 cases per... [ABSTRACT FROM AUTHOR]

This study was an epidemiological questionnaire survey of a representative sample of the French population that included 12 778 individuals and in which adapted DSM-IV criteria for the definition of insomnia were used. Our goals were not only to assess the prevalence of ‘insomnia’ using these criteria, but also to compare the results obtained with those of prior studies using different definitions of ‘insomnia’. The aim of this study was also to identify where areas of agreement and disaggreement existed, as we believe that it is important to emphasize these points because DSM-IV recommendations are supposedly reflected in clinical practice. Seventy-three per cent of the individuals surveyed complained of a nocturnal sleep problem, but only 29% reported at least one sleep problem three times per week for a month, and 19% (2428 subjects) had at least one sleep problem three times per week for a month and complained of daytime consequences (DSM-IV criteria). Only 9% had two or more nocturnal sleep problems with daytime consequences and were classified as ‘severe insomniacs’. Our study indicates that if DSM-IV criteria are used, the diagnosis of ‘insomnia’ is lower than in other epidemiological studies. The DSM criteria have an advantage in that they emphasize the daytime consequences of nocturnal sleep disturbances, which seem to be responsible for the most important socio-economic costs of the problem. [ABSTRACT FROM AUTHOR]

The upgrade of the 'Système de Production d'Ions Radioactifs en Ligne' phase I (SPIRAL I) installed at the 'Grand Accélérateur National d'Ions Lourds' (GANIL) situated at Caen, France, is in progress and should be ready by 2014. In parallel, the first part of SPIRAL II facility is currently under construction. The global status of the upgrade is presented: goal, radioactive ion production systems, modification of the production cave and impact of the current safety re-evaluation of GANIL. [ABSTRACT FROM AUTHOR]

Background: In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population.Methods: An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products' uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users' behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively.Results: Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as "positively accepted," the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as "negatively accepted," the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified "negatively accepted," the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified "positively accepted" in men.Conclusion: This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women. [ABSTRACT FROM AUTHOR]

More and more patients are operated on during the active phase of infective endocarditis. Between 1991 and 1999, in France, the rate of cardiac surgery has increased from 31% to 50%. This may, at least in part, explain the concomitant decrease of in hospital mortality, from 22% to 17%. Nonetheless, the indications for cardiac surgery and its optimal timing remain difficult decisions. The principal indications for cardiac surgery are heart failure, no control of infection, embolisms, large size of vegetations, severe valvar and perivalvar lesions, and infection caused by some microorganisms. If heart failure is present, the mortality rate of native valve infective endocarditis is 55-85% in the case of medical treatment only and 10-35% in operated patients.

The structural map describing the northwestern Paris Basin prioritise several directions governing regional faults depending of N150–160, N120–130 (Armorican) and secondarily N30–50 (Variscan) orientations. The fractal analysis of talweg networks of the ‘Pays de Caux’ plateau, compared with the stratigraphic, structural and cartographic studies of the clay with flints and chalk, underscores a new major direction oriented N90–100. The purpose of this study is to suggest a new structural map in this part of the northwestern Paris Basin. To cite this article: E. Hauchard et al., C. R. Geoscience 334 (2002) 295–302. [Copyright &y& Elsevier]

The proportion of infective endocarditis (IE) caused by group D streptococci (GDS; formerly Streptococcus bovis) increased markedly in France, to account for 25% of all cases of IE by 1999. In an attempt to explain this phenomenon, a comparative analysis of GDS and oral streptococci (OS) causing IE was performed. This study was based on data collected from a large cross-sectional population-based survey that was conducted in 1999. In total, 559 cases of definite IE were recorded, of which 142 involved GDS and 79 involved OS. Patients with GDS IE were older (62.7 vs. 56.6 years, p 0.01) and had a history of valve disease less frequently than did patients with OS IE (33.8% vs. 67.1%, p <0.0001). At-risk procedures for IE were performed less frequently in patients with GDS than in patients with OS (14.8% vs. 24.1%, p 0.08), but co-morbidities were more frequent in the GDS group (59.9% vs. 32.9%, p 0.0001). Diabetes, colon diseases and cirrhosis were also more frequent in the GDS group (p 0.006, p <0.0001 and p 0.08, respectively). Rural residents accounted for 31.0% of the GDS group, but for only 15.2% of the OS group (p 0.001). Likewise, the proportion of GDS IE was higher in regions with mixed (urban and rural) populations (Franche-Comté 81.8%, Marne 68.7%, Lorraine 70.3% and Rhône-Alpes 65.3%) than in exclusively urban regions (Paris and Ile de France 58.0%). Further investigations are required to elucidate the link in France between the incidence of GDS IE, rural residency and nutritional factors. [ABSTRACT FROM AUTHOR]

Background – Worsening of heart failure in patients with myocardial infarction is seldom studied, elderly patients often are not included, and multivariate analysis is uncommon.Aims – The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute myocardial infarction) sought to determine the incidence of heart failure worsening, its risk factors, and its prognostic importance in patients with myocardial infarction, regardless of age and hospital facilities, in the « real world» in a region in France, using multivariate analysis.Methods – Data were prospectively collected in all patients with myocardial infarction admitted in all hospitals in three departments in the Rhoˆne-Alpes region in France between September 1, 1993 and January 31, 1995.Results – Among 2,507 patients, 33% were in Killip classes II–IV at admission. Four hundred and sixteen patients (17%) had worsening of Killip class during the first five days. In-hospital mortality (overall: 14%) increased dramatically with Killip class at admission (9% in class I; 62% in class IV) and with worsening of Killip class during the first five days (36% vs 8% if no worsening). In multivariate analysis, older age, diabetes mellitus and anterior Q-wave myocardial infarction were significant predictors of Killip class at admission and of its worsening. The significant predictors of in-hospital mortality were older age, Killip class III at admission and worsening of Killip class during the first five days.Conclusion – This large, unselected cohort revealed that among patients with myocardial infarction, heart failure and its worsening are frequent, especially in the elderly, and dramatically worsen the in-hospital mortality. [ABSTRACT FROM AUTHOR]

This paper presents an innovative approach that combines optimization and simulation techniques for solving scheduling problems under uncertainty. We introduce an Opt–Sim closed-loop feedback framework (Opt–Sim) based on a sliding-window method, where a simulation model is used for evaluating the optimized solution with inherent uncertainties for scheduling activities. The specific problem tackled in this paper, refers to the airport capacity management under uncertainty, and the Opt–Sim framework is applied to a real case study (Paris Charles de Gaulle Airport, France). Different implementations of the Opt–Sim framework were tested based on: parameters for driving the Opt–Sim algorithmic framework and parameters for driving the optimization search algorithm. Results show that, by applying the Opt–Sim framework, potential aircraft conflicts could be reduced up to 57% over the non-optimized scenario. The proposed optimization framework is general enough so that different optimization resolution methods and simulation paradigms can be implemented for solving scheduling problems in several other fields. • The Opt-Sim Framework includes the inherent stochasticity of dynamic operations. • The Opt-Sim Framework improves the robustness of the airport capacity management. • Conflicts are reduced by about 57% compared to a non-optimized solution. • The conflict severity for airspace and runway is introduced as a new metric. • The framework developed is generic and can be extended to other fields. [ABSTRACT FROM AUTHOR]

The militaryintensive care field hospital is a new tool set up by the military medical service as part of Operation Resilience to provide medical support in the regions of France most affected by the SARS-Cov-2 pandemic. Deployed in Mulhouse and Mayotte, this hospital facility is a functional intensive care unit set up to support an existing hospital structure. The caregivers and logistics specialists are all from the military medical service, active personnel or reservists, predominantly nurses. The implementation of this intensive care field hospital in a constrained environment requires an efficient provision of care in accordance with medical guidelines, while protecting the healthcare staff and, notably, the frontline nursing staff., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

ABSTRACTBackground:The increasing use of antidepressants (ADs) has raised concerns about their inappropriate use in old people., Objective: To examine the prevalence of potentially inappropriate prescribing (PIP) of ADs, their associated factors, and their impact on mortality in a sample of old people in France., Methods: The analysis used data from the SIPAF study, a cross-sectional study consisting of 2,350 people aged ≥ 70 years. Trained nurses interviewed participants at home between 2008 and 2010. Information was collected concerning socio-demographic and health characteristics, including medication use. The study population consisted of the 318 AD users from the SIPAF study (13.5%). PIP of ADs was defined according to national and international criteria. Factors associated with PIP of ADs were assessed using a multivariate logistic regression model. The influence of PIP of ADs on mortality was assessed using a Cox model (median follow-up 2.8 years)., Results: Among the SIPAF study, 71% of AD users were female and the mean age was 84 ± 7 years. Selective serotonin reuptake inhibitors (SSRIs) were the most prescribed ADs (19.8%). We found PIP of ADs in 36.8% of the study population, mainly the co-prescription of diuretics with SSRIs (17.6%) and the prescription of tricyclics (12.9%). PIP of ADs was associated with polypharmacy (aOR5-9 drugs 2. 61, 95% CI 1.11-6.16 and aOR≥10 drugs 2.69, 95% CI 1.06-6.87) and comorbidity (aOR3-4 chronic diseases 2.59, 95%CI 1.04-6.44 and aOR≥5 chronic diseases 2.33, 95%CI 0.94-5.79), and increased the risk of mortality during follow-up (aHR 2.30, 95%CI 1.28-4.12)., Conclusions: This study shows that more than one third of AD prescriptions may be inappropriate in old people. PIP of ADs was related to polypharmacy and comorbidity and increased mortality among AD users.

Background: Meta-analyses of nonrandomized studies have provided conflicting data on therapeutic hypothermia, or targeted temperature management (TTM), at 33°C in patients successfully resuscitated after nonshockable cardiac arrest. Nevertheless, the latest recommendations issued by the International Liaison Committee on Resuscitation and by the European Resuscitation Council recommend therapeutic hypothermia. New data are available on the adverse effects of therapeutic hypothermia, notably infectious complications. The risk/benefit ratio of therapeutic hypothermia after nonshockable cardiac arrest is unclear., Methods: HYPERION is a multicenter (22 French ICUs) trial with blinded outcome assessment in which 584 patients with successfully resuscitated nonshockable cardiac arrest are allocated at random to either TTM between 32.5 and 33.5°C (therapeutic hypothermia) or TTM between 36.5 and 37.5°C (therapeutic normothermia) for 24 hours. Both groups are managed with therapeutic normothermia for the next 24 hours. TTM is achieved using locally available equipment. The primary outcome is day-90 neurological status assessed by the Cerebral Performance Categories (CPC) Scale with dichotomization of the results (1 + 2 versus 3 + 4 + 5). The primary outcome is assessed by a blinded psychologist during a semi-structured telephone interview of the patient or next of kin. Secondary outcomes are day-90 mortality, hospital mortality, severe adverse events, infections, and neurocognitive performance. The planned sample size of 584 patients will enable us to detect a 9% absolute difference in day-90 neurological status with 80% power, assuming a 14% event rate in the control group and a two-sided Type 1 error rate of 4.9%. Two interim analyses will be performed, after inclusion of 200 and 400 patients, respectively., Discussion: The HYPERION trial is a multicenter, randomized, controlled, assessor-blinded, superiority trial that may provide an answer to an issue of everyday relevance, namely, whether TTM is beneficial in comatose patients resuscitated after nonshockable cardiac arrest. Furthermore, it will provide new data on the tolerance and adverse events (especially infectious complications) of TTM at 32.5-33.5°C., Trial Registration: ClinicalTrials.gov: NCT01994772 .

Faced with a mental health crisis, the intervention of nurses, psychologists and psychiatrists is rarely limited to an individual approach. Our team has chosen to structure and systematise the involvement of the families of hospitalised soldiers.A family psychotherapy consultation has also been reinforced in orderto favourthe inclusion of the families of soldiers in crisis. These two tools are complementary and have enabled us to enrich the multidisciplinary work within the unit, as well as the relationship with the patients and families confronted with a crisis.

Array-CGH has revealed a large number of copy number variations (CNVs) in patients with multiple congenital anomalies and/or mental retardation (MCA/MR). According to criteria recently listed, pathogenicity was clearly suspected for some CNVs but benign CNVs, considered as polymorphisms, have complicated the interpretation of the results. In this study, genomic DNAs from 132 French patients with unexplained mental retardation were analysed by genome wide high-resolution Agilent 44K oligonucleotide arrays. The results were in accordance with those observed in previous studies: the detection rate of pathogenic CNVs was 14.4%. A non-random involvement of several chromosomal regions was observed. Some of the microimbalances recurrently involved regions (1q21.1, 2q23.1, 2q32q33, 7p13, 17p13.3, 17p11.2, 17q21.31) corresponding to known or novel syndromes. For all the pathogenic CNVs, further cases are needed to allow more accurate genotype-phenotype correlations underscoring the importance of databases to group patients with similar molecular data., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Background: The 22q13.3 deletion syndrome (or Phelan-McDermid syndrome, MIM 606232) is characterized by developmental delay, absent or severely delayed speech, neonatal hypotonia, autistic behavior, normal to accelerated growth, and minor dysmorphic facial features. Among the three genes in the minimal critical region (from the centromere to the telomere: SHANK3, ACR and RABL2B), the defect in the SHANK3 gene is considered to be the cause of the neurobehavioral symptoms., Objective: We describe the molecular characterization of a de novo interstitial del(22)(q13.3q13.3) disrupting the SHANK3 gene in a child with a phenotype compatible with the 22q13.3 deletion syndrome., Methods: Clinical work-up included clinical histories, physical, neurological, and ophthalmological examinations, and imaging of the brain. Commercially available MLPA for subtelomeric analysis, FISH specific probes and quantitative real-time PCR were used to characterize the rearrangement., Results: Subtelomere analysis by MLPA showed a discrepancy between P036B and P070 kits (MCR Holland): the P070 MLPA 22q probe (targeting the ARSA gene) showed a deletion but the P036B one (targeting the RABL2B gene) showed a normal result. FISH analysis using LSI TUPLE1/LSI ARSA (Vysis) probes confirmed deletion of ARSA, whereas FISH with N25/N85A3 (Cytocell) probes, targeting the SHANK3 locus was normal. Supplemented FISH analysis using BAC clones allowed us to specify the centromeric breakpoint region of the interstitial deletion between clones RP11-354I12 and RP11-232E17, at less than 2 Mb from the telomere. Quantitative real-time PCR of exon 5, 22 and 24 and intron 9 of SHANK3 showed that the telomeric breakpoint occurred between intron 9 and exon 22., Conclusions: These data highlight the difficulty of performing an appropriate test aimed at looking for cryptic 22q13.3 deletion. Furthermore, the molecular characterization of this interstitial 22q13.3 deletion contributes to the clinical and genetic delineation of the 22q13.3 deletion syndrome.

Introduction: Several thousands of deaths were attributed to heat stroke during August 2003 in France. To date, only a very few studies have analyzed the prognosis in the intensive care unit (ICU) of the most severely hyperthermic patients., Method: Descriptive observational study of the patients admitted to the intensive care unit at the Lariboisière hospital in Paris, for heat stroke defined by an elevated core body temperature above 40 degrees C with central nervous system dysfunction, in the absence of other etiologies explaining the hyperthermia., Results: In the Lariboisière hospital, an elevation in the ICU (+143%) and hospital mortality rate (+191%) were registered during August 2003, in comparison with August 2002. Fifteen patients (10 men, 5 women, median age: 57 years) were admitted to the ICU for heat stroke between the 4th and 14th of August 2003. Seven of them (47%) died. On admission, the occurrence of a pre-hospital cardiac arrest, the presence of coagulation abnormalities (reduction in prothrombin time and in platelet count) or of an elevation in plasma lactate concentration were significantly associated with the risk of death in the ICU. Conversely, age, body temperature, coma depth on admission and convulsions were not predictive of death. Neurological after effects (cerebellar syndrome, polyneuropathy and residual brain damage) were noted in 50% of the survivors., Discussion: Although it is possible that heat alone precipitated the death of very sick people, our study clearly showed that young and valid patients died of heat stroke and suggests the possible increase in the 2003 death rate secondary to the heat wave. Moreover, it is still difficult at the moment to really appreciate the long-term consequences for survivors who presented serious neurological after effects., Conclusion: The August 2003 heat wave resulted in an elevation of the hospital and ICU death rates in the Lariboisière hospital in Paris. Despite adequate cooling and supportive therapies, the mortality of patients admitted to the ICU for heat stroke remained elevated and the neurological after effects severe. These preliminary results should be confirmed by larger cohort studies.