Non-Invasive Measurement of Hemoglobin: Assessment of Two Different Point-of-Care Technologies

Measurement of blood hemoglobin (Hb) concentration is a routine procedure. Using a non-invasive point-of-care device reduces pain and discomfort for the patient and allows time saving in patient care. The aims of the present study were to assess the concordance of Hb levels obtained non-invasively with the Pronto-7 monitor (version 2.1.9, Masimo Corporation, Irvine, USA) or with the NBM-200MP monitor (Orsense, Nes Ziona, Israel) and the values obtained from the usual colorimetric method using blood samples and to determine the source of discordance.We conducted two consecutive prospective open trials enrolling patients presenting in the emergency department of a university hospital. The first was designed to assess Pronto-7™ and the second NBM-200MP™. In each study, the main outcome measure was the agreement between both methods. Independent factors associated with the bias were determined using multiple linear regression. Three hundred patients were prospectively enrolled in each study. For Pronto-7™, the absolute mean difference was 0.56 g.L(-1) (95% confidence interval [CI] 0.41 to 0.69) with an upper agreement limit at 2.94 g.L(-1) (95% CI [2.70;3.19]), a lower agreement limit at -1.84 g.L(-1) (95% CI [-2.08;-1.58]) and an intra-class correlation coefficient at 0.80 (95% CI [0.74;0.84]). The corresponding values for the NBM-200MP™ were 0.21 [0.02;0.39], 3.42 [3.10;3.74], -3.01 [-3.32;-2.69] and 0.69 [0.62;0.75]. Multivariate analysis showed that age and laboratory values of hemoglobin were independently associated with the bias when using Pronto-7™, while perfusion index and laboratory value of hemoglobin were independently associated with the bias when using NBM-200MP™.Despite a relatively limited bias in both cases, the large limits of agreement found in both cases render the clinical usefulness of such devices debatable. For both devices, the bias is independently and inversely associated with the true value of hemoglobin.ClinicalTrials.gov NCT01321580 and NCT01321593

Conflit agriculture-urbanisation : une concurrence pour l'espace en Vaucluse

Vaucluse is at the same time an agricultural department, with many intensive productions in the Rhone and Durance valleys, and a built-up one, with many large cities and several communication installations. Agriculture, which remains in many towns a primary activity, is threatened by the constant erosion of the agricultural land. An analysis of transactions on agricultural lands shows a decrease in the interventions of farmers with respect to the interventions of non-farmers. However, agriculture is still the only activity that can protect the landscape and the environment. In order to maintain an agricultural activity in peri-urban towns, it is necessary to consider measures such as a division into strictly agricultural areas and agricultural areas that can be modified. / Le Vaucluse est un département à la fois agricole, avec des productions intensives dans les vallées du Rhône et de Durance, et très urbanisé de part la présence de villes importantes et de nombreuses infrastructures de communication. L'agriculture qui constitue encore dans de nombreuses communes une activité agricole de premier plan, est menacée par l'érosion constante du territoire agricole. L'analyse des transactions sur les terres agricoles montre en effet un recul des interventions des agriculteurs par rapport aux non-agriculteurs. L'agriculture est pourtant la seule à pouvoir assurer l'entretien du paysage et du cadre de vie. Pour maintenir une agriculture dans les communes péri-urbaines, il faut donc envisager des mesures de protection, en isolant des zones agricoles strictes et des zones agricoles revisables