Time-dependent sensitivity and uncertainty analyses of an agro-climatic model for the water status management of vineyard

International audienceThis work describes the global sensitivity analysis (SA) of an agro-climatic model embedded in a decision support system (DSS) for the water status management of vineyard in the Languedoc-Roussillon region, France

Breast cancer: a randomized controlled trial assessing the effect of a decision aid on mammography screening uptake: study protocol

IntroductionBreast cancer (BC) is the primary cancer among women. The World Health Organization recommends a bilateral screening mammogram every 2 years for women aged 50 to 74 years. However, it has been shown that there is an absence of information about the benefits and risks of screening. Shared medical decision-making is important to ensure patients are involved in the decision process. Decision aids can facilitative this decision-making process. This article presents a protocol to evaluate the effect of a decision aid on participation rates in the French organized BC screening program.Methods and analysisDesign and setting. The design is a 2 arm randomized controlled study, performed in the Pays de la Loire region (French West Coast). Randomization will be based on general medicine practices (Primary Care).ParticipantsWomen aged between 50 and 74 years, eligible for BC screening. In this region, there are 75000 women, and 2800 general practitioners eligible for recruitment.InterventionIn the « Decision aid for organized cancer screening » arm, the intervention will distribute invitation letters to eligible women combined with the provision of decision aid to these women and their general practitioners and an incentive to implement shared medical decision-making. In the « Standard organized cancer screening » arm, only the screening invitation will be sent to eligible women.Primary endpointBC screening participation rates will be assessed after an 18-month follow-up period.Statistical analysisIn this non-inferiority trial, the percentage of women who are up-to-date with their screening at 18 months after the intervention will be compared across arms using a generalized mixed linear model.DiscussionThe research team expect to demonstrate that providing a better explanation of the benefits and risks of BC screening is not at odds with screening participation. The study results should help policy makers thinking about implementing shared medical decision-making within the framework of organized BC screening programs in the future.Ethics and disseminationOn 6 December 2021, the protocol received a favorable opinion from the French Committee for the Protection of Persons (2021-A01583-38). This study is registered with ClinicalTrials.gov, number NCT05607849. (Version 1, November 7, 2022; https://www.clinicaltrials.gov/ct2/show/NCT05607849). The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Critical analysis of two approaches for modelling water transfers in the soil-vegetation-atmosphere continuum: application to vineyard

International audienceAims and Background: As part of a project on optimization of vineyard irrigation, we discuss the validity of two modeling approaches for soil-water transfers in terms of accuracy and parameterization cost. We compared an empirical ‘bucket-like’ model to an innovative 1D model (M2), based on a dual porosity nonrigid aggregated representation of the soil-water medium. Methods: The two models are coupled to the same canopy growth and radiation absorption models. Root water uptake is described as a bilinear change in relative transpiration rate as a function of the fraction of extractible soil water. The accuracy of the two models was evaluated in vineyards varying in soil type, rooting depth and irrigation procedure in the Languedoc region (France), by comparing soil moisture and predawn leaf potential, a reference indicator of soil water deficit. Results: A sensitivity analysis shows that, provided an accurate estimate of rooting depth, both approaches give relevant and similar results. M2 is robust to most of the hard-to-obtain parameters as root repartition versus depth. However, the two models calculated very different water losses by deep drainage out of the root zone. Conclusion: Considering the robustness of M2 to parameters uncertainty, we privilege it as a decision-support tool for irrigation, and as a ground for further modeling developments

Comparison of two modeling approaches for water transfer in the soil-vegetation-atmosphere continuum

As part of a R&D project aiming at providing vineyard managers with a computer-based decision support system for optimizing irrigation, we discuss the validity of two modeling approaches for water transfers in the soil-plant-atmosphere continuum. The two models are an empirical ‘bucketlike’ model and a mechanistic model based on the 1D Richards’ equation. The practical context implying that soil-water parameters are poorly estimated, both models are compared in terms of accuracy and parameterization cost. The models are coupled to the same canopy growth, radiation absorption, evaporation and transpiration models, and the predawn leaf water potential (PLWP) is used as the indicator of soil-water deficit. The parameters of both models are estimated with pedotransfer functions from the single texture and the only additional input for the 1D model is root repartition versus depth. A multi-factor sensitivity analysis relative to the input parameters of the soil-vegetation-atmosphere coupling shows that the hard-to-obtain rooting depth is the key factor of the PLWP sensitivity. It also shows that the computation of PLWP with the 1D model is robust against root distribution uncertainty, so that root distribution can be fixed to a mean value. The accuracy of the two models is evaluated in vineyards varying in soil type, rooting depth and irrigation procedure in the Languedoc region (France), by comparing simulated to measured values of vine transpiration and PLWP. Provided the calibration of rooting depth, both models give results coherent with field measurements, with no significant improvement when the more physical mechanistic model is used

A model-driven decision support system for vineyard water status management: a time-dependent sensitivity analysis

International audienceThe global sensitivity analysis of a dynamic soil water balance model embedded in a Decision Support System for vineyard water management is achieved via the Sobol variance-based method. The sensitivity analysis is applied sequentially at each simulation step so that the variation of parameter influence over time can be followed. Results allow identification of four soil-related parameters having the highest influence at the vine plot scale, and for various climate scenarios. This provides fundamental information for the operational use of the model, i.e. when few input data are available to the end-user

A decision-support system for vineyard water status management based on a modeling approach

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