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In older adults, prognostic performances of admission biomarkers have been poorly investigated. This study aims to compare the prognostic abilities of usual admission biomarkers, especially PCT and CRP, for major clinical outcomes, comparing older to younger adults diagnosed with an infection in the ED, and to investigate the prognostic abilities of PCT and CRP depending on the glomerular filtration rate (GFR).It was an observational, single-center, retrospective study, conducted in the Reims University Hospital, France. Endpoints were bacteremia, septic shock, and in-hospital mortality, related to the same ED visit.Over 1 year, 852 patients were included with 291 (34.2%) ≥75 years, and 127 (15.3%) patients had a GFR30 mL.minCaution must be taken when interpreting admission biomarkers, as their prognostic abilities are lower in older adults or in patients with renal insufficiency diagnosed with an infection.

International audience; In modern cropping systems, the near-universal use of plant protection products selects for resistance in pest populations. The emergence and evolution of this adaptive trait threaten treatment efficacy. We identified determinants of fungicide resistance evolution and quantified their effects at a large spatiotemporal scale. We focused on Zymoseptoria tritici, which causes leaf blotch in wheat. Phenotypes of qualitative or quantitative resistance to various fungicides were monitored annually, from 2004 to 2017, at about 70 sites throughout 22 regions of France (territorial units of 25000km2 on average). We modelled changes in resistance frequency with regional anti-Septoria fungicide use, yield losses due to the disease and the regional area under organic wheat. The major driver of resistance dynamics was fungicide use at the regional scale. We estimated its effect on the increase in resistance and relative apparent fitness of each resistance phenotype. The predictions of the model replicated the spatiotemporal patterns of resistance observed in field populations (R2 from 0.56 to 0.82). The evolution of fungicide resistance is mainly determined at the regional scale. This study therefore showed that collective management at the regional scale could effectively complete local actions.This article is protected by copyright. All rights reserved.

Background In adults, the most common cause of out-of-hospital cardiac arrests (OHCA) is acute coronary artery occlusion. If an immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST segment elevation. Hypothesis Performing an immediate CAG after an OHCA without ST segment elevation on the post-resuscitation ECG and no obvious non-cardiac cause of arrest could lead to a better 180-day survival rate with no or minimal neurological sequel as compared with a delayed CAG performed 48 to 96 hours after the arrest. Design The EMERGE trial is a prospective national, randomized, open and parallel group trial, in which 970 survivors of OHCA will be randomized (1:1) to either immediate (as soon as possible after return of spontaneous circulation) or delayed (48 to 96 h) CAG. Participants will be OHCA patients with no ST segment elevation on the post resuscitation ECG and no obvious non-cardiac cause of arrest. The primary endpoint of the study is the 180-day survival rate with no or minimal neurological sequel corresponding to Cerebral Performance Category (CPC) 1 or 2. The secondary endpoints are: occurrence of shock during the first 48 hours, ventricular tachycardia and/or fibrillation during the first 48 hours, change in left ventricular ejection fraction between baseline and 180 days assessed by echocardiogram, neurological status evaluated by the CPC score at intensive care unit (ICU) discharge and day 90 neurological status assessed by the Glasgow Outcome Scale Extended score (GOSE) at 90 and 180 days, overall survival rate, and hospital length of stay. Summary The EMERGE trial is a prospective, multicenter, randomized, controlled trial that will assess the 180-day survival rate with no or minimal neurologic sequel in patients resuscitated from an OHCA without ST segment elevation and who will be managed with either immediate or delayed CAG.

La présente étude vise à dresser un survol des principaux constats tirés des revues systématiques et des méta-analyses portant sur l’effet du leadership sur la santé mentale et le mieux-être au travail, et de proposer une analyse critique de leur application au contexte des travailleurs expatriés. Les bases de données Medline, EMBASE, EBM et Web of Knowledge ont été consultées avec des mots-clés spécifiques au leadership, à la santé mentale et au mieux-être. Les résultats montrent que malgré l’augmentation des études examinant les effets du leadership sur la santé mentale en contexte organisationnel, la problématique demeure sous-étudiée en gestion internationale des ressources humaines. À cet effet, des recommandations sont formulées afin que les superviseurs soient mieux outillés pour répondre aux situations dans un contexte où leurs subordonnés sont déployés à l’étranger.

Introduction: In adults, the most common cause of out-of-hospital cardiac arrests (OHCA) is coronary artery disease. If an immediate coronary angiogram (CAG) is recommended for survivors presenting a ST segment elevation (ST +) on the electrocardiogram (ECG) performed after resuscitation, there is still a debate regarding the best strategy in patients without ST +. Hypothesis: Performing an immediate CAG after an OHCA without ST + on the post-resuscitation ECG and no obvious non-cardiac cause of arrest leads to a better outcome. Methods: The EMERGE trial is a multicenter, randomized, controlled trial that assessed the 180-day survival rate with no or minimal neurologic sequel in patients resuscitated from an OHCA without ST + randomized (1:1) to either immediate or delayed (48 to 96h) CAG. The primary endpoint of the study is the 180-day survival rate with no or minimal neurological sequel (Cerebral Performance Category (CPC) 1 or 2). The secondary endpoints are: occurrence of shock during the first 48 hours, ventricular tachycardia and/or fibrillation during the first 48 hours, change in left ventricular ejection fraction between baseline and 180 days assessed by echocardiogram, neurological status evaluated by the CPC scale at intensive care unit (ICU) discharge and day 90 neurological status assessed by the Glasgow Outcome Scale Extended score (GOSE) at 90 and 180 days, overall survival rate, and hospital length of stay. Results: 279 patients were enrolled, 141 in the immediate and 138 in the delayed CAG group. Mean age was 65 and 195 were males. The mean delays between randomization and CAG were 0.6 ± 3.7 hours and 55.1 ± 37.2 hours in the immediate and delayed CAG group respectively. The 180-day survival rates among patients with CPC 1 or 2 were 34.1% and 30.7% in the immediate and delayed CAG group, respectively (hazard ratio: 0.87 [95% CI, 0.65; 1.15], P=0.324). The 180-day survival rates in the whole population were 36.2% and 33.3% in the immediate and delayed CAG group, respectively (HR: 0.86 [95% CI, 0.64-1.15], P=0.308). Conclusions: In patients successfully resuscitated after an OHCA without ST +, a strategy of immediate CAG was not found to be better than a strategy of delayed CAG with respect to 180-day survival rate with no or minimal neurological sequel.

Introduction Initial procalcitonin (PCT) levels may fail in mortality and septic shock prediction and raise cost-effectiveness issues. Since measurement of lactate, C-reactive protein (CRP), white blood cells and neutrophils is common in the emergency department (ED), we compared prediction abilities of these biomarkers to PCT. Methods From January 1st to December 31st, 2018, an observational, single center, retrospective study was conducted in the adult ED of the Reims University Hospital (France). Endpoints were bacteremia, septic shock, and in-hospital mortality, related to the same ED visit. Results Over one year, 459 patients suspected with infection were included, of mean age 60.4 years (SD: 22.0), with 50.8% male, and 364 (79.3%) were hospitalized following ED visit. Overall, 45 (9.8%) patients had a bacteremia, 39 (8.5%) a septic shock and 54 (11.8%) died during their hospitalization. PCT and CRP showed the best discrimination for bacteremia, with an area under curve (AUC) of 0.68 for PCT and 0.65 for CRP. PCT and lactate showed similar good discriminative power for septic shock, with an AUC of 0.78 for both, and poor discrimination for in-hospital mortality, with an AUC of 0.62 for PCT and 0.69 for lactate. Systolic blood pressure and pulse oximetry showed similar discrimination for septic shock as PCT or lactate, while they showed higher discrimination for in-hospital mortality than PCT. Conclusion Usual admission biomarkers lack clinical utility in predicting septic shock or in-hospital mortality. CRP and PCT are poorly efficient in predicting bacteremia.

International audience; Procalcitonin (PCT) may be useful for early risk stratification in the emergency department (ED), but the transposition of published data to routine emergency practice is sometimes limited. An observational retrospective study was conducted in the adult ED of the Reims University Hospital (France). Over one year, 852 patients suspected of infection were included, of mean age 61.7 years (SD: 22.6), and 624 (73.2%) were hospitalized following ED visit. Overall, 82 (9.6%) patients died during their hospitalization with an odds ratio (OR) of 5.10 (95% CI: 2.19–11.87) for PCT ≥ 0.5, in multivariate logistic regression analyses. Moreover, 78 (9.2%) patients were admitted to an ICU, 74 (8.7%) had attributable bacteremia, and 56 (6.6%) evolved toward septic shock with an OR of 4.37 (2.08–9.16), 6.38 (2.67–15.24), and 6.38 (2.41–16.86), respectively, for PCT ≥ 0.5. The highest discriminatory values were found for patients with age

BACKGROUND Management of pesticide resistance is a major issue in modern agricultural systems, particularly in the context of the broader challenge of reducing pesticide use. However, such management must be adapted to resistance dynamics, which remains challenging to predict due to its dependence on many biological traits of pests, interactions with the environment and pesticide use. We retrospectively studied the evolution of reported resistances to four modes of action (benzimidazoles, quinone outside inhibitors, sterol demethylation inhibitors and succinate dehydrogenase inhibitors), in French populations of the wheat pathogen Zymoseptoria tritici. RESULTS We used statistical models to analyse the Performance trial network data set (2004-2017; ∼ 70 locations in France yearly). They highlighted contrasting behaviours between phenotypes, for example: (i) stable spatial distributions and colonization front structures over time, and (ii) different frequency growth rates at the national scale and between regions. CONCLUSION We provide a quantitative description of the spatiotemporal patterns of resistance evolution for fungicides with several modes of action. Moreover, we highlight some unexpected resistance dynamics in France, with major differences between the north and south. This complex pattern of resistance evolution in French populations is consistent with previous descriptions of dynamics at the European scale. These results should make it easier to anticipate evolution locally and to improve the management of resistance. © 2019 Society of Chemical Industry.

International audience

Background and importance Early identification of the cause of shock is associated with better prognosis. Objective The aim of this study was to explore the performances of an ultrasound protocol (echoSHOCK) to diagnose the cause of shock in the emergency department (ED). Design, settings and participants This was a prospective study performed in two EDs. Included patients were older than 18 years admitted with shock. After routine workup strategy, the suspected cause of shock and the planned treatment were reported. The echoSHOCK protocol, using only B mode, was then performed. After performing echoSHOCK, the investigator reported the same two items. Intervention echoSHOCK protocol that assessed: compressive pericardial effusion (tamponade), right ventricle dilatation and flattening of the septum, left ventricle dimension and systolic function, indices of hypovolemia. Outcomes measure and analysis We defined four different causes for shock (tamponade, acute cor pulmonale, cardiogenic and hypovolemia). The primary endpoint was the degree of agreement of the routine workup and echoSHOCK with an expert panel. Main results 85 patients [mean age of 73 (14) years] were included. Kappa coefficients between routine strategy and echoSHOCK for the cause of shock, with the expert panel were 0.33 (95% CI, 0.26-0.4) and 0.88 (95% CI, 0.83-0.93), respectively. Likewise, for the planned treatment, kappa were 0.21 (95% CI, 0.14-0.28) and 0.9 (95% CI, 0.85-0.94), respectively. The physician's confidence increased from 3.9 (2.1) before echoSHOCK to 9.3 (1.1) after, (P Conclusion This study suggested that echoSHOCK significantly increased the ability to determine the cause of undifferentiated shock in the ED.

International audience; L’objectif de ce dossier est de mettre en évidence la frontière poreuse entre univers en ligne et univers hors ligne que révèle le discours de haine dans les réseaux socio-numériques. Cette porosité se comprend à travers cinq problématiques que ce dossier cherche à étayer : (1) la question des représentations préalables qui nourrissent le discours de haine ; (2) son orientation actionnelle et les actes de langage opérés ; (3) les rapports de force qu’il cristallise ; (4) la question des cibles concernées ; (5) la tension sous-jacente entre discours de haine et liberté d’expression. Dans cette perspective, « en ligne » et « hors ligne » ne sont pas des zones distinctes ou des environnements discursifs différents, mais plutôt des espaces qui s'interpénètrent, compte-tenu des spécificités propres aux différents supports. Les luttes définitionnelles de ce qui est socialement et juridiquement acceptable se jouent hors ligne et, de manière plus brutale peut-être, en ligne, parce qu’exacerbées et polarisées, incitées en cela par les formats courts, l’anonymat et la spontanéité. De ce fait, le discours de haine met à l’épreuve les principes démocratiques de liberté d’expression et d’opinion, en ce qu’il place au centre du jeu la lutte pour le dicible légitime. Quand des groupes s’opposent, c’est autour du pouvoir des mots et de ses formes énonciatives que l’affrontement se déroule ; c’est aussi parce que ce pouvoir de nommer touche à l’identité de soi et d’autrui qu’il est empreint de tant d’affect.

L’objectif de ce dossier est de mettre en evidence la frontiere poreuse entre univers en ligne et univers hors ligne que revele le discours de haine dans les reseaux socio-numeriques. Cette porosite se comprend a travers cinq problematiques que ce dossier cherche a etayer : (1) la question des representations prealables qui nourrissent le discours de haine ; (2) son orientation actionnelle et les actes de langage operes ; (3) les rapports de force qu’il cristallise ; (4) la question des cibles concernees ; (5) la tension sous-jacente entre discours de haine et liberte d’expression. Dans cette perspective, « en ligne » et « hors ligne » ne sont pas des zones distinctes ou des environnements discursifs differents, mais plutot des espaces qui s'interpenetrent, compte-tenu des specificites propres aux differents supports. Les luttes definitionnelles de ce qui est socialement et juridiquement acceptable se jouent hors ligne et, de maniere plus brutale peut-etre, en ligne, parce qu’exacerbees et polarisees, incitees en cela par les formats courts, l’anonymat et la spontaneite. De ce fait, le discours de haine met a l’epreuve les principes democratiques de liberte d’expression et d’opinion, en ce qu’il place au centre du jeu la lutte pour le dicible legitime. Quand des groupes s’opposent, c’est autour du pouvoir des mots et de ses formes enonciatives que l’affrontement se deroule ; c’est aussi parce que ce pouvoir de nommer touche a l’identite de soi et d’autrui qu’il est empreint de tant d’affect.

SummaryResearch rationale: In modern cropping systems, the near-universal use of plant protection products selects for resistance in pest populations. The emergence and evolution of this adaptive trait threaten treatment efficacy. We identified determinants of fungicide resistance evolution and quantified their effects at a large spatiotemporal scale.Methods: We focused onZymoseptoria tritici, which causes leaf blotch in wheat. Phenotypes of qualitative or quantitative resistance to various fungicides were monitored annually, from 2004 to 2017, at about 70 sites throughout 22 regions of France (territorial units of 25 000km2on average). We modelled changes in resistance frequency with regional anti-Septoriafungicide use, yield losses due to the disease and the regional area under organic wheat.Key results: The major driver of resistance dynamics was fungicide use at the regional scale. We estimated its effect on the increase in resistance and relative apparent fitness of each resistance phenotype. The predictions of the model replicated the spatiotemporal patterns of resistance observed in field populations (R2from 0.56 to 0.82).Main conclusion: The evolution of fungicide resistance is mainly determined at the regional scale. This study therefore showed that collective management at the regional scale could effectively complete local actions.

Technology has enabled banks to introduce new products that integrate markets, simplify operations and enable expansion of business at low cost, expand to new markets, take new risks and deepen their markets. Zimbabwe registered significant growth in adoption and diffusion of financial innovations over the past two decades, which coincided with a shift in the structure of credit portfolios of banks, and growth in credit as well as risk appetite. This study empirically evaluates the impact of financial innovations in influencing bank behaviour, specifically, portfolio structure risk appetite and delivery channels of banks in Zimbabwe. The study applied co-relational analysis, Fully Modified OLS and the Dynamic OLS estimation models as well as Autoregressive Granger causality approaches. Empirical results show that technology has the capacity to influence activities of banks in risk management, credit and delivery of banking service in lowincome countries. Precisely, financial innovation influences increase in credit towards previously high-risk areas, compositions of credit portfolios in banks and support growth in number of bank accounts. Causality was found to run from financial innovation to bank behaviour, and only in the long run.

The mainly limitations and problems in test carried out with conventional dead load tribometers are the limits on the loading to a constant load applied by a mass weight and intense uncontrolled vibrations at high loads or high speeds. Nanovea has developed a groundbreaking high load tribometer with an active applied load up to 2000 N and a dual-load control system. In this paper we describe our system and we present the results of the first test carried out and a comparison with the dead load systems giving a clear idea of the improvements granted by the use of a controlled pneumatic load also over the traditional load-controlled techniques.

Philippe J. Maarek livre ici, et cette fois avec Arnaud Mercier, son quatrieme ouvrage post-election presidentielle (apres ceux de 2002, 2007, 2012, Paris, Ed L’Harmattan), se proposant de regrouper un ensemble d’analyses relatives a la communication politique de la campagne presidentielle en explorant, d’un cote, la mediatisation et, de l’autre, les strategies de communication des candidats. Le principe de ces differents ouvrages n’etant pas d’examiner systematiquement des elements specifiqu...