Reaproveitamento de águas residuais, tratadas por fitopurificação, para a irrigação do jardim botânico “o jardim Landon” (Biskra, Argélia). Solução sustentável para preservação de patrimônio material

The green spaces of the city of Biskra (Algeria) resist the arid climate of the summer season and therefore suffer from water scarcity caused mainly by evaporation and transpiration of the plants. To remedy this problem, the study suggests to reuse the sewage for irrigation after being purified, using constructed wetlands with improved capacity by phytoremediation. As an example of a sustainable solution, it is proposed to apply this technique to the botanical garden of the city of Biskra (Algeria), «le jardin Landon». The design of a Constructed Wetland system is proposed. The Landon Garden was created in 1870 by Count Landon of Longueville, decorated with a variety of flora from the tropics and the Equatorial countries. It is currently considered as national material heritage.Los espacios verdes de la ciudad de Biskra resisten el clima árido de la temporada de verano y, por lo tanto, sufren de escasez de agua, causada principalmente por la evaporación y transpiración de las plantas. Para remediar este problema, el estudio sugiere reutilizar las aguas residuales para el riego después de ser purificadas, utilizando humedales construidos con capacidad mejorada por fitorremediación. Como ejemplo de una solución sostenible, se propone aplicar esta técnica al jardín botánico de la ciudad de Biskra (Algeria), «le jardin Landon». Se propone el diseño de un sistema de humedales construidos. El Landon Garden fue creado en 1870 por el conde Landon de Longueville, decorado con una variedad de flora de los trópicos y los países ecuatoriales. Actualmente se considera patrimonio material nacional.Les espaces verts de la ville de Biskra (Algérie) résistent au climat aride de la saison estivale et souffrent donc d’une pénurie d’eau causée principalement par l'évaporation et la transpiration des plantes. Pour remédier à ce problème, l’étude propose de réutiliser les eaux usées pour l’irrigation après avoir été épurées, en utilisant des zones humides construites avec une capacité améliorée par phytoremédiation. A titre d’exemple de solution durable, il est proposé d’appliquer cette technique au jardin botanique de la ville de Biskra (Algérie), «le jardin Landon». La conception d’un système de zones humides construites est proposée. Le jardin Landon a été créé en 1870 par le comte Landon de Longueville, décoré d’une flore variée des tropiques et des pays équatoriaux. Il est actuellement considéré comme patrimoine matériel national.Gli spazi verdi della città di Biskra (Algeria) resistono al clima arido della stagione estiva e soffrono quindi della scarsità d'acqua causata principalmente dall'evaporazione e dalla traspirazione delle piante. Per ovviare a questo problema, lo studio suggerisce di riutilizzare le acque reflue per l'irrigazione dopo essere state purificate, utilizzando zone umide costruite con capacità migliorata mediante fitodepurazione. Come esempio di una soluzione sostenibile, si propone di applicare questa tecnica al giardino botanico della città di Biskra (Algeria) «le jardin Landon». Viene proposto il progetto di un sistema Constructed Wetland. Il giardino Landon è stato creato nel 1870 dal conte Landon de Longueville, decorato con una varietà di flora dei tropici e dei paesi equatoriali. Attualmente è considerato patrimonio materiale nazionale.Os espaços verdes da cidade de Biskra (Argélia) resistem ao clima árido do verão e por isso sofrem com a escassez de água causada principalmente pela evaporação e transpiração das plantas. Para remediar esse problema, o estudo sugere o reaproveitamento do esgoto para irrigação após purificação, utilizando alagados construídos com capacidade melhorada por fitorremediação. Como exemplo de solução sustentável, propõe-se a aplicação desta técnica ao jardim botânico da cidade de Biskra (Argélia) «le jardin Landon». O projeto de um sistema de Wetland Construído é proposto. O Jardim Landon foi criado em 1870 pelo conde Landon de Longueville, decorado com uma variedade de flora dos trópicos e dos países equatoriais. Atualmente é considerado patrimônio material nacional

Hip fractures after 60 years of age in France in 2005–2017: Nationwide sample of statutory-health-insurance beneficiaries

International audienceBackground: Proximal femoral factures (PFFs) constitute a heavy medical, social, and economic burden. Overall, orthopaedic conditions vary widely in France regarding the patients involved and treatments applied. For PFFs specifically, data are limited. Moreover, the ongoing expansion of geriatric orthopaedics holds promise for improving overall postoperative survival. The objectives of this retrospective study of a nationwide French database were: 1) to describe the pathway of patients with PFFs regarding access to care, healthcare institutions involved, and times to management; 2) to look for associations linking these parameters to post-operative mortality.Hypothesis: Across France, variations exist in healthcare service availability and time to management for patients with PFFs.Material and methods: A retrospective analysis of data in a de-identified representative sample of statutory-health-insurance beneficiaries in France (Échantillon généraliste des bénéficiaires, EGB, containing data for 1/97 beneficiaries) was conducted. All patients older than 60 years of age who were managed for PFFs between 2005 and 2017 were included. The following data were collected for each patient: age, management method, Charlson's Comorbidity Index (CCI), home-to-hospital distance by road, and type of hospital (public, non-profit private, or for-profit private), and time to surgery were collected. The study outcomes were the incidence of PFF, mortality during the first postoperative year, changes in mortality between 2005 and 2017, and prognostic factors.Results: In total 8026 fractures were included. The 7561 patients had a median age of 83.8 years and a mean CCI of 4.6; both parameters increased steadily over time, by 0.18 years and 0.06 points per year, respectively (p1 day (HR 1.35 [95%CI: 1.15-1.50] [p<0.0001]). Day-90 mortality decreased significantly from 2005 to 2017 (HR 0.95 [95%CI: 0.92-0.97] [p<10-4]), with no centre effect.Conclusion: The management of PFF in patients older than 60 varied widely across France. Time to surgery longer than 1 day was a major adverse prognostic factor whose effects persisted throughout the first year. This factor was present in over half the patients. Day-90 mortality decreased significantly from 2005 to 2017 despite increases in age and comorbidities

AtoG: a simple score to predict complications and death after hip fractures, in line with the comprehensive geriatric assessment

International audienceIntroduction: Proximal Femur Fractures (PFFs) are a significant public health issue and occur in the context of global frailty and aging. Recent literature identifies new patient-related prognostic factors that focus on socioeconomic environment, patient well-being, or nutrition status. Specific scores have been developed, but in most cases, they fail to be in line with the comprehensive geriatric assessment, or don't assess the newly identified prognostic factors, contain multitude collinearities, or are too complex to be used in the daily practice.Hypothesis: A comprehensive score with equal representation of the patient's dimensions does at least as good as the Charlson score (CCI), to predict complications and mortality.Objective: To develop a new comprehensive prognostic score, predicting inpatient complications and mortality up to 5-year after PFF.Material and methods: The patients treated surgically for PFF on a native hip, between 2005 and 2017 were selected from a French national database. The variables were the gender, age, the type of treatment (osteosynthesis or arthroplasty), and the CCI. The outcomes were the medical and surgical complications as inpatient and the mortality (up to 5-year). Variables were grouped into dimensions with similar clinical significance, using a Principal Component Analysis, for instance, bed sores and malnutrition. The dimensions were tested for 90-day mortality and complications, in regressions models. Two scores were derived from the coefficients: SCOREpond (strict ponderation), and SCORE (with loose ponderation: 1 point/ risk factors, -1 point/protective factors). Calibration, discrimination (ROC curves with Area Under Curves AUC), and cross-validation were assessed for SCOREpond, SCORE, and CCI.Results: Analyses were performed on 7756 fractures. The factorial analysis identified seven dimensions: age; brain-related conditions (including dementia): 1738/7756; severe chronic conditions (for instance, organ failures) 914/7756; undernutrition:764/7756; environment, including social issues or housing difficulties: 659/7756; associated trauma: 814/7756; and gender. The seven dimensions were selected for the prognostic score named AtoG (ABCDEFG, standing for Age, Brain, Comorbidities, unDernutrition, Environment, other Fractures, Gender). The median survival rate was 50.8 months 95%IC[49-53]. Anaemia and urologic complications were the most prevalent medical complications (1674/7756, 21%, and 1109/7756, 14.2%). A total of 149/7756 patients (1.9%) developed a mechanical inpatient complication (fractures or dislocations), with a slightly higher risk for arthroplasties. The AUCs were 0.69, 0.68, and 0.67 for AtoGpond, AtoG, and CCI, respectively, for 90-day mortality, and 0.64, 0.63, and 0.56 for complications. Compared to patients with AtoG=0, Hazard Ratios for 90-day mortality were 2.3 95%CI[1.7-2.9], 4.2 95%CI[3.1-5.4], 6 95%CI[4.5-8.1], 8.3 95%CI[6.5-12.9], and 13.7 95%CI[8-24], from AtoG=1 to AtoG>=5, respectively (p <10-4); the 90-day survival decreased by 5%/point, roughly. The sur-risk of mortality associated with AtoG was up to 5-year: HR= 1.51 (95%CI[1.46-1.55], p<10-4). Compared to AtoG=0, from AtoG=1 to AtoG ≥5, the pooled Odd Ratios were 1.14 95%CI[1.06-1.2], 1.53 95%CI[1.4-1.7], 2.17 95%CI[1.9-2.4], 2.9 95%CI[2.4-3.4], and 4.9 95%CI[3.3-7.4] for any complication (p <10-4).Conclusion: AtoG is a multidimensional score in line with the concept of comprehensive geriatric assessment. It had good discrimination and performance in predicting 90-day mortality and complications. Performances were as good as CCI for 90-day mortality, and better than it for the complications.Level of proof: IV; retrospective cohort study

Fractures de l’extrémité supérieure du fémur après 60 ans en France : un état des lieux 2005–2017 à partir de la base nationale de l’Échantillon généraliste des bénéficiaires (EGB)

International audienceIntroductionLes fractures de l’extrémité supérieure du fémur (FESF) constituent un fardeau sur le plan médical, social et économique. Il existe de fortes hétérogénéités en termes de patients et de prise en charge, à l’échelle nationale, pour l’ensemble des pathologies orthopédiques, mais la situation concernant les FESF reste peu connue à ce stade. En outre, le développement des filières orthogériatriques fait espérer une amélioration globale de la survie postopératoire. Aussi nous avons mené une étude rétrospective, basée sur l’Echantillon Généraliste des Bénéficiaires, avec pour but : (1) de décrire le parcours de soin des FESFs en termes d’accès aux soins, de structures et délais de prise en charge, (2) de décrire l’influence de ces paramètres sur la mortalité postopératoire.HypothèseIl existe une hétérogénéité dans le maillage territorial de l’offre de soin et délais de prise en charge pour les FESF.Matériel et méthodesUn total de 8026 FESFs (âge moyen 84,5 ans, 3299 prothèses, 4262 ostéosynthèses) issus de l’EGB (échantillon représentatif de 1/97e de la population française) a été analysé entre 2005 et 2017. Les informations complémentaires telles que le score de Charlson (CCI), la distance routière domicile-hôpital ainsi que le type d’établissement (public, Établissement prive d’interet collectif [ESPIC], privé) ont été incluses. Le délai opératoire a été relevé. Les critères de jugement étaient l’incidence, la mortalité jusqu’à 1 an postopératoire, son évolution entre 2005–2017 et les facteurs pronostiques.RésultatsL’âge moyen était de 84,5 ans et le CCI moyen de 4,6 points. Ces deux paramètres étaient en constante augmentation : +0,18 année/an et +0,06 point/an, respectivement (p 1 jour étaient des facteurs pronostiques à 90 jours dont les hazard ratio (HR) étaient respectivement de 1,087 (IC95 % : 1,07–1,10) et 1,35 (IC95 % : 1,15–1,5) (p < 0,0001). Il y avait une diminution de la mortalité à 90 jours entre 2005–2017 (HR = 0,95, IC95 % : 0,92–0,97 [p < 10−4]), mais pas d’effet centre.ConclusionIl existait une grande hétérogénéité de prise en charge, à l’échelle territoriale. Le délai opératoire supérieur à 24 h était un facteur pronostique péjoratif puissant persistant jusqu’à un an postopératoire. Cinquante pour cent des patients avaient un délai supérieur à 24 h. La mortalité à 90 jours après FESF a diminué depuis 2005 malgré des patients plus âgés et plus de comorbidités

Predictive Models for Emergency Department Triage using Machine Learning: A Systematic Review

International audienceBackground: Recently, many research groups have tried to develop emergency department triage decision support systems based on big volumes of historical clinical data to differentiate and prioritize patients. Machine learning models might improve the predictive capacity of emergency department triage systems. The aim of this review was to assess the performance of recently described machine learning models for patient triage in emergency departments, and to identify future challenges.Methods: Four databases (ScienceDirect, PubMed, Google Scholar and Springer) were searched using key words identified in the research questions. To focus on the latest studies on the subject, the most cited papers between 2018 and October 2021 were selected. Only works with hospital admission and critical illness as outcomes were included in the analysis.Results: Twenty-one articles concerned the two outcomes (hospital admission and critical illness) and developed 75 predictive models. Random Forest and Logistic Regression were the most commonly used prediction algorithms, and the receiver operating characteristic-area under the curve (ROC-AUC) the most frequently used metric to assess the algorithm prediction performance. Boosting, Random Forest and Logistic Regression were the most discriminant models according to the selected studies.Conclusions: Machine learning-based triage systems could improve decision-making in emergency departments, thus leading to better patients’ outcomes. However, there is still scope for improvement concerning the prediction performance and explicability of ML models

Predictive Models for Emergency Department Triage using Machine Learning: A Review

International audienceBackground: Recently, many research groups have tried to develop emergency department triage decision support systems based on big volumes of historical clinical data to differentiate and prioritize patients. Machine learning models might improve the predictive capacity of emergency department triage systems. The aim of this review was to assess the performance of recently described machine learning models for patient triage in emergency departments, and to identify future challenges.Methods: Four databases (ScienceDirect, PubMed, Google Scholar and Springer) were searched using key words identified in the research questions. To focus on the latest studies on the subject, the most cited papers between 2018 and October 2021 were selected. Only works with hospital admission and critical illness as outcomes were included in the analysis.Results: Eleven articles concerned the two outcomes (hospital admission and critical illness) and developed 55 predictive models. Random Forest and Logistic Regression were the most commonly used prediction algorithms, and the receiver operating characteristic-area under the curve (ROC-AUC) the most frequently used metric to assess the algorithm prediction performance. Random Forest and Logistic Regression were the most discriminant models according to the selected studies.Conclusions: Machine learning-based triage systems could improve decision-making in emergency departments, thus leading to better patients’ outcomes. However, there is still scope for improvement concerning the prediction performance and explicability of ML models

Efficiency of fine scale and spatial regression in modelling associations between healthcare service spatial accessibility and their utilization

International audienceBackground: Healthcare accessibility, a key public health issue, includes potential (spatial accessibility) and realized access (healthcare utilization) dimensions. Moreover, the assessment of healthcare service potential access and utilization should take into account the care provided by primary and secondary services. Previous studies on the relationship between healthcare spatial accessibility and utilization often used conventional statistical methods without addressing the scale effect and spatial processes. This study investigated the impact of spatial accessibility to primary and secondary healthcare services on length of hospital stay (LOS), and the efficiency of using a geospatial approach to model this relationship.Methods: This study focused on the ≥ 75-year-old population of the Nord administrative region of France. Inpatient hospital spatial accessibility was computed with the E2SFCA method, and then the LOS was calculated from the French national hospital activity and patient discharge database. Ordinary least squares (OLS), spatial autoregressive (SAR), and geographically weighted regression (GWR) were used to analyse the relationship between LOS and spatial accessibility to inpatient hospital care and to three primary care service types (general practitioners, physiotherapists, and home-visiting nurses). Each model performance was assessed with measures of goodness of fit. Spatial statistical methods to reduce or eliminate spatial autocorrelation in the residuals were also explored.Results: GWR performed best (highest R2 and lowest Akaike information criterion). Depending on global model (OLS and SAR), LOS was negatively associated with spatial accessibility to general practitioners and physiotherapists. GWR highlighted local patterns of spatial variation in LOS estimates. The distribution of areas in which LOS was positively or negatively associated with spatial accessibility varied when considering accessibility to general practitioners and physiotherapists.Conclusions: Our findings suggest that spatial regressions could be useful for analysing the relationship between healthcare spatial accessibility and utilization. In our case study, hospitalization of elderly people was shorter in areas with better accessibility to general practitioners and physiotherapists. This may be related to the presence of effective community healthcare services. GWR performed better than LOS and SAR. The identification by GWR of how these relationships vary spatially could bring important information for public healthcare policies, hospital decision-making, and healthcare resource allocation

Excess mortality after hip fracture during COVID-19 pandemic: More about disruption, less about virulence-Lesson from a trauma center

International audienceTo date, literature has depicted an increase in mortality among patients with hip fractures, directly related to acute coronavirus disease 2019 (COVID-19) infection and not due to underlying comorbidities. Usual orthogeriatric pathway in our Department was disrupted during the pandemic. This study aimed to evaluate early mortality within 30 days, in 2019 and 2020 in our Level 1 trauma-center. We compared two groups of patients aged &gt;60 years, with osteoporotic upper hip fractures, in February/March/April 2020 and February/March/April 2019, in our level 1 trauma center. A total of 102 and 79 patients met the eligibility criteria in 2019 and 2020, respectively. Mortality was evaluated, merging our database with the French open database for death from the INSEE, which is prospectively updated each month. Causes of death were recorded. Charlson Comorbidity Index was evaluated for comorbidities, Instrumental Activity of Daily Living (IADL), and Activity of Daily Living (ADL) scores were assessed for autonomy. There were no differences in age, sex, fracture type, Charlson Comorbidity Index, IADL, and ADL. 19 patients developed COVID-19 infection. The 30-day survival was 97% (95% CI, 94%-100%) in 2019 and 86% (95% CI, 79%-94%) in 2020 (HR = 5, 95%CI, 1.4-18.2, p = 0.013). In multivariable Cox’PH model, the period (2019/2020) was significantly associated to the 30-day mortality (HR = 6.4, 95%CI, 1.7-23, p = 0.005) and 6-month mortality (HR = 3.4, 95%CI, 1.2-9.2, p = 0.01). COVID infection did not modify significantly the 30-day and 6-month mortality. This series brought new important information, early mortality significantly increased because of underlying disease decompensation. Minimal comprehensive care should be maintained in all circumstances in order to avoid excess of mortality among elderly population with hip fractures