Rifampin use in acute community-acquired meningitis in intensive care units: the French retrospective cohort ACAM-ICU study

Abstract Introduction Bacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of bacterial meningitis, and after the introduction of early corticosteroid therapy (in 2002), there was a trend toward increasing rifampin use for intensive care unit (ICU) patients. The aim of this article is to report on this practice. Methods Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004–2008). The ICU mortality was the main outcome measure; Glasgow Outcome Scale and 3-month mortality were also assessed. Results One hundred fifty-seven patients were included. Streptococcus pneumoniae and Neisseria meningitidis were the most prevalent causative microorganisms. The ICU mortality rate was 15 %. High doses of a cephalosporin were the most prevalent initial antimicrobial treatment. The delay between admission and administration of the first antibiotic dose was correlated with ICU mortality. Rifampin was used with a cephalosporin for 32 patients (ranging from 8 % of the cohort for 2004 to 30 % in 2008). Administration of rifampin within the first 24 h of hospitalization could be associated with a lower ICU survival. Statistical association between such an early rifampin treatment and ICU mortality reached significance only for patients with pneumococcal meningitis (p=0.031) in univariate analysis, but not in the logistic model. Conclusions We report on the role of rifampin use for patients with community-acquired meningitis, and the results of this study suggest that this practice may be associated with lower mortality in the ICU. Nevertheless, the only independent predictors of ICU mortality were organ failure and pneumococcal infection. Further studies are required to confirm these results and to explain how rifampin use would reduce mortality. </jats:sec

Avant-propos

L’approche longitudinale est un mode de prise en compte du temps qui consiste à utiliser des données, entre autres individuelles, susceptibles de fournir des informations à différentes dates pour chaque entité. Différentes méthodes sont développées pour les traiter. Elles consistent à décrire et à analyser les parcours d’individus, de groupes sociaux, qu’ils résultent d’interrogations répétées ou qu’ils soient reconstitués rétrospectivement, à partir de données existantes, par exemple de nat..

Prévenir le décrochage : une comparaison entre lycées professionnels et CFA

International audienc

Création Semi-Automatique d'un Modèle Numérique de Terrain

Un modèle numérique de terrain permet de modéliser une zone géographique et principalement son relief. Les applications pratique de ces modèles sont innombrables. Dans cet article, nous décrivons un processus permettant de créer un modèle numérique de terrain à partir d'une carte topographique couleur numérisée. Nous présentons d'abord des techniques classiques d'extraction des courbes de niveaux. Un algorithme de reconnexion automatique des courbes altérées est ensuite proposé. Enfin, nous présentons différentes techniques d'interpolation de terrain et explorons notamment une interpolation par fonctions de bases radiales et une technique de partitionnement de l'unité

Mécanismes de déformation des phases MAX (une approche expérimentale multi-échelle)

Il est couramment admis que la déformation plastique des phases MAX est dueau glissement de dislocations dans les plans de base s'organisant en empilements et murs. Cesderniers peuvent former des zones de désorientation locale appelées kink bands. Cependant, lesmécanismes élémentaires et le rôle exact des défauts microstructuraux sont encore mal connus. Cemanuscrit présente une étude expérimentale multi-échelle des mécanismes de déformation de laphase MAX Ti2AlN. A l'échelle macroscopique, deux types d'expériences ont été menés. Des essaisde compression in-situ à température et pression ambiantes couplés à la diffraction neutroniqueont permis de mieux comprendre le comportement des différentes familles de grains dans le Ti2AlNpolycristallin. Des essais de compression sous pression de confinement ont également été réalisés dela température ambiante jusqu'à 900 C. À l'échelle mésoscopique, les microstructures des surfacesdéformées ont été observées par MEB et AFM. Ces observations complétées par des essais denanoindentation ont montré que la forme des grains et leur orientation par rapport à la directionde sollicitation gouvernent l'apparition de déformations intra- et inter-granulaires ainsi que lalocalisation de la plasticité. Finalement à l'échelle microscopique, une étude détaillée par METdes échantillons déformés sous pression de confinement a révélé la présence de configurations dedislocations inédites dans les phases MAX, telles que des réactions entre dislocations, des dipôleset des dislocations hors plan de base. À la vue de ces résultats nouveaux, les propriétés mécaniquesdes phases MAX sont rediscutées.It is commonly believed that plastic deformation mechanisms of MAX phases consistin basal dislocation glide, thus forming pile-ups and walls. The latter can form local disorientationareas, known as kink bands. Nevertheless, the elementary mechanisms and the exact role ofmicrostructural defects are not fully understood yet. This thesis report presents a multi-scale experimentalstudy of deformation mechanisms of the Ti2AlN MAX phase. At the macroscopic scale,two kinds of experiments were performed. In-situ compression tests at room temperature coupledwith neutron diffraction brought new insight into the deformation behavior of the different grainfamilies in the polycrystalline Ti2AlN. Compression tests from the room temperature to 900 Cunder confining pressure were also performed. At the mesoscopic scale, deformed surface microstructureswere observed by SEM and AFM. These observations associated with nanoindentationtests showed that grain shape and orientation relative to the stress direction control formationof intra- and inter- granular strains and plasticity localization. Finally, at the microscopic scale,a detailed dislocation study of samples deformed under confining pressure revealed the presenceof dislocation configurations never observed before in MAX phases, such as dislocation reactions,dislocation dipoles and out-of-basal plane dislocations. In the light of these new results, mechanicalproperties of MAX phases are discussed.POITIERS-SCD-Bib. électronique (861949901) / SudocSudocFranceF

Toponym Recognition in Scanned Color Topographic Maps

International audienceTopographic paper maps are a common support for geographical information. In the field of document analysis of this kind of support, this paper proposes an automatic approach to extract and recognize toponyms. We present a technique based on image segmentation and connected component processing. Different filtering stages ensure the consistency of plausible characters and strings. Detected text areas are used to feed an OCR software and the recognized words are analyzed and corrected. The main advantage of our technique is that no assumption is made about the character font, size or orientation. Experimental results obtained are encouraging in term of recognition efficiency

Adaptive Hierarchical RBF Interpolation for Creating Smooth Digital Elevation Models

International audienceThis paper presents a fast algorithm for smooth digital elevation model interpolation and approximation from scattered elevation data. The global surface is reconstructed by subdividing it into overlapping local subdomains using a perfectly balanced binary tree. In each tree leaf a smooth local surface is reconstructed using radial basis functions. Finally a hierarchical blending is done to create the final C^1-continuous surface using a family of functions called Partition of Unity. We present two terrain data sets and show that our method is robust since the number of data points in the Partition of Unity blending areas is explicitly specified

Impact of early enteral versus parenteral nutrition on mortality in patients requiring mechanical ventilation and catecholamines: study protocol for a randomized controlled trial (NUTRIREA-2)

BACKGROUND: Nutritional support is crucial to the management of patients receiving invasive mechanical ventilation (IMV) and the most commonly prescribed treatment in intensive care units (ICUs). International guidelines consistently indicate that enteral nutrition (EN) should be preferred over parenteral nutrition (PN) whenever possible and started as early as possible. However, no adequately designed study has evaluated whether a specific nutritional modality is associated with decreased mortality. The primary goal of this trial is to assess the hypothesis that early first-line EN, as compared to early first-line PN, decreases day 28 all-cause mortality in patients receiving IMV and vasoactive drugs for shock. METHODS/DESIGN: The NUTRIREA-2 study is a multicenter, open-label, parallel-group, randomized controlled trial comparing early PN versus early EN in critically ill patients requiring IMV for an expected duration of at least 48 hours, combined with vasoactive drugs, for shock. Patients will be allocated at random to first-line PN for at least 72 hours or to first-line EN. In both groups, nutritional support will be started within 24 hours after IMV initiation. Calorie targets will be 20 to 25 kcal/kg/day during the first week, then 25 to 30 kcal/kg/day thereafter. Patients receiving PN may be switched to EN after at least 72 hours in the event of shock resolution (no vasoactive drugs for 24 consecutive hours and arterial lactic acid level below 2 mmol/L). On day 7, all patients receiving PN and having no contraindications to EN will be switched to EN. In both groups, supplemental PN may be added to EN after day 7 in patients with persistent intolerance to EN and inadequate calorie intake. We plan to recruit 2,854 patients at 44 participating ICUs. DISCUSSION: The NUTRIREA-2 study is the first large randomized controlled trial designed to assess the hypothesis that early EN improves survival compared to early PN in ICU patients. Enrollment started on 22 March 2013 and is expected to end in November 2015. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01802099 (registered 27 February 2013)

Acute respiratory failure in kidney transplant recipients: a multicenter study

International audienceINTRODUCTION: Data on pulmonary complications in renal transplant recipients are scarce. The aim of this study was to evaluate acute respiratory failure (ARF) in renal transplant recipients. METHODS: We conducted a retrospective observational study in nine transplant centers of consecutive kidney transplant recipients admitted to the intensive care unit (ICU) for ARF from 2000 to 2008. RESULTS: Of 6,819 kidney transplant recipients, 452 (6.6%) required ICU admission, including 200 admitted for ARF. Fifteen (7.5%) of these patients had combined kidney-pancreas transplantations. The most common causes of ARF were bacterial pneumonia (35.5%), cardiogenic pulmonary edema (24.5%) and extrapulmonary acute respiratory distress syndrome (ARDS) (15.5%). Pneumocystis pneumonia occurred in 11.5% of patients. Mechanical ventilation was used in 93 patients (46.5%), vasopressors were used in 82 patients (41%) and dialysis was administered in 104 patients (52%). Both the in-hospital and 90-day mortality rates were 22.5%. Among the 155 day 90 survivors, 115 patients (74.2%) were dialysis-free, including 75 patients (65.2%) who recovered prior renal function. Factors independently associated with in-hospital mortality were shock at admission (odds ratio (OR) 8.70, 95% confidence interval (95% CI) 3.25 to 23.29), opportunistic fungal infection (OR 7.08, 95% CI 2.32 to 21.60) and bacterial infection (OR 2.53, 95% CI 1.07 to 5.96). Five factors were independently associated with day 90 dialysis-free survival: renal Sequential Organ Failure Assessment (SOFA) score on day 1 (OR 0.68/SOFA point, 95% CI 0.52 to 0.88), bacterial infection (OR 0.43, 95% CI 0.21 to 0.90), three or four quadrants involved on chest X-ray (OR 0.44, 95% CI 0.21 to 0.91), time from hospital to ICU admission (OR 0.98/day, 95% CI 0.95 to 0.99) and oxygen flow at admission (OR 0.93/liter, 95% CI 0.86 to 0.99). CONCLUSIONS: In kidney transplant recipients, ARF is associated with high mortality and graft loss rates. Increased Pneumocystis and bacterial prophylaxis might improve these outcomes. Early ICU admission might prevent graft loss

Resourcecode framework:A high-resolution wave parameter dataset for the European shelf and analysis toolbox

Resource mapping is a key element in the planning and consequent deployment of Offshore Renewable Energy (ORE) converters. A proper characterization of the environmental forcing enables the optimization of energy extraction and a more accurate assessment of the structural loading. This contributes to improving reliability and extending the operational life of devices at a given extraction site. Providing an accurate characterisation of the environmental loading is subjected to the availability and quality of relevant datasets, which are either obtained from measurements, in-situ or via remote sensing, or from numerical models. Then, the adequate use of these datasets relies on the analysis’ tools and selected methods which allow an appropriate description of the underlying physics. This paper presents the high-resolution wave hindcast database extending across European waters and developed to be the reference dataset of the ResourceCODE Marine Data Toolbox, designed to provide a full suite of tools to support ocean energy analytics.</p