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The French National Reference Center for Invasive Mycoses and Antifungals leads an active and sustained nationwide surveillance program on probable and proven invasive fungal diseases (IFDs) to determine their epidemiology in France. Between 2012 and 2018, a total of 10,886 IFDs were recorded. The incidence increased slightly over time (2.16 to 2.36/10,000 hospitalization days, P = 0.0562) in relation with an increase of fungemia incidence (1.03 to 1.19/10,000, P = 0.0023), while that of other IFDs remained stable. The proportion of >/=65-year-old patients increased from 38.4% to 45.3% (P < 0.0001). Yeast fungemia (n = 5,444) was due mainly to Candida albicans (55.6%) with stable proportions of species over time. Echinocandins became the main drug prescribed (46.7% to 61.8%), but global mortality rate remained unchanged (36.3% at 1 month). Pneumocystis jirovecii pneumonia (n = 2,106) was diagnosed mostly in HIV-negative patients (80.7%) with a significantly higher mortality than in HIV-positive patients (21.9% versus 5.4% at 1 month, P < 0.0001). Invasive aspergillosis (n = 1,661) and mucormycosis (n = 314) were diagnosed mostly in hematology (>60% of the cases) with a global mortality rate of 42.5% and 59.3%, respectively, at 3 months and significant changes in diagnosis procedure over time. More concurrent infections were also diagnosed over time (from 5.4% to 9.4% for mold IFDs, P = 0.0115). In conclusion, we observed an aging of patients with IFD with a significant increase in incidence only for yeast fungemia, a trend toward more concurrent infections, which raises diagnostic and therapeutic issues. Overall, global survival associated with IFDs has not improved despite updated guidelines and new diagnostic tools. IMPORTANCE The epidemiology of invasive fungal diseases (IFDs) is hard to delineate given the difficulties in ascertaining the diagnosis that is often based on the confrontation of clinical and microbiological criteria. The present report underlines the interest of active surveillance involving mycologists and clinicians to describe the global incidence and that of the main IFDs. Globally, although the incidence of Pneumocystis pneumonia, invasive aspergillosis, and mucormycosis remained stable over the study period (2012 to 2018), that of yeast fungemia increased slightly. We also show here that IFDs seem to affect older people more frequently. The most worrisome observation is the lack of improvement in the global survival rate associated with IFDs despite the increasing use of more sensitive diagnostic tools, the availability of new antifungal drugs very active in clinical trials, and a still low/marginal rate of acquired in vitro resistance in France. Therefore, other tracks of improvement should be investigated actively.

In the surgical setting, the most accepted technique for measuring tissue perfusion includes subjective identification, with visual and tactile inspections of the tissue, performed by a surgeon. Recently, fields such as ophthalmology, plastic surgery, and other surgical specialties, such as cardiac, vascular, and transplant surgery, have seen the emergence of laser-assisted fluorescent angiography (LAFA) to visualize real-time tissue perfusion during procedures.The case of an 80-year-old woman, who presented with a wound over the left medial elbow following a subacute recurrent elbow dislocation, illustrates the use of this technology in the field of orthopedics. Initially, the patient was treated at an outside facility where the dislocation was reduced, and she was placed in a long arm splint. With concern of recurrent dislocation and wound development, she presented to the authors with a complex wound measuring about 9 cm x 5 cm with variable thickness ranging from 0 mm to 5 mm in depth. Her initial emergent irrigation and debridement and wound management was assisted by LAFA and the administration of indocyanine green to guide debridement and determine viable wound margins. After staging with external fixation and a negative pressure wound dressing, she later returned for skin grafting and healed uneventfully.In conjunction with plastic surgeons, the orthopaedic team utilized LAFA for debridement that led to both a successful wound repair and skin grafting procedure.

The place of creativity in advertising has long been recognized, however, it remains unclear what creatives actually do and why they do it when it comes to making creative choices between what ideas to show the client. This study focuses upon individual choices made on what ideas to show clients in the absence of copytesting; it examines the decision-making heuristics employed by a global advertising agency. Based on an online survey, the results inter alia suggest that when it comes to deciding which ideas to show to clients, both analytic and pure heuristics are used in various combinations. The results provide insights about the nature of, and factors that influence, decision-making amongst managers with this first field study of managing choices of creative work at an advertising agency.