Nosocomial bacteremia in very old patients: predictors of mortality

Background and aims: Nosocomial Bacteremia (NB) is associated with high mortality in elderly patients. To determine specific prognostic factors for 7- and 30-day mortality in elderly patients with NB, we analysed the characteristics of 62 NB patients, retrospectively. Methods: This retrospective study concerns 62 cases of NB diagnosed within a 3-year period in a geriatric department. Bacteremia is described according to CDC definitions. Epidemiological characteristics, co-morbidities, clinical (activities of daily living (ADL) before NB) and biological findings (neutrophil count, lymphocyte count, albuminemia before NB) were collected for each patient. A systemic clinical reaction was defined by the presence of one of the following parameters: chills, hypothermia 38.5°C, or shock. Types of micro-organism and source of NB were also collected. All variables were analysed for mortality at day 7 (7-day mortality) and at day 30 (30-day mortality). Results: The 7-day mortality rate was 21% and the 30-day rate was 45%. In multivariate analysis, 7-day mortality was only associated with the absence of systemic clinical reaction [OR 9.7 (3.7-25.7)]. Again, in multivariate analysis, 30-day mortality was associated with an ADL score <2 [OR 8.3 (4.3-16.4)] and cocci gram positive NB [OR= 3.6 (1.9-6.9)]. Conclusions: The absence of any systemic clinical reaction as a single independent predictor for 7-day mortality suggests either a poorer immune response to nosocomial bacteremia or a delay in diagnosis. Functional status was the strongest predictor for 30-day mortality. In this population, further prospective studies need to include these factors to evaluate predictors of mortality for serious infectious disease

Évaluation du risque hémorragique des personnes âgées de plus de 75 ans sous anti-vitamine K, ayant reçu une éducation thérapeutique

Introduction : L hémorragie est la principale complication du traitement anti-vitamine K et concerne particulièrement les patients âgés, pour lesquels l évaluation de ce risque est complexe. L objectif de l étude était d évaluer et comparer l efficacité des scores HAS-BLED et ATRIA dans la prédiction du risque hémorragique des patients de plus de 75 ans. Secondairement, nous avons recherchés des facteurs intrinsèques et extrinsèques au sujet âgé influençant ce risque. Méthode : 208 patients ont été inclus dans une étude cas-témoins : 52 cas appariés à 156 témoins. Ces patients, issus de l étude SCORE, avaient été inclus lors d une éducation thérapeutique de mai 2009 à mai 2010 dans 4 centres hospitaliers de l Isère, et suivis à 3 mois et à 1 an. Le critère de jugement principal, recueilli de manière prospective, était la survenue d un évènement hémorragique grave ou cliniquement relevant. Résultat : Selon les courbes ROC, le score ATRIA était plus performant que HAS-BLED pour prédire l ensemble des hémorragies (c-index respectifs= 0.59 versus 0.56) comme les hémorragies graves (c-index respectifs= 0.64 contre 0.61). En analyse multi-variée, étaient associés à une augmentation du risque hémorragique : l anémie (OR=2.6; IC à 95% 1.34 à 5.23; p=0.005), la consommation d inhibiteur de la recapture de la sérotonine (IRS) (OR=2.8; IC 95% 1.08 à 7.47; p=0.034) et la gestion du traitement par la famille (OR=2.8; IC 95% 1.28 à 6.15; p=0.01). Conclusion : Le score ATRIA était plus performant dans la prédiction du risque de l ensemble des hémorragies et des plus graves, et il était amélioré par la prise en compte de la consommation d IRS et de la gestion du traitement par la famille.Introduction: Bleeding is the main complication of anti-vitamin K treatments and particularly for elderly patients for whom risk assessment is complex. The aim of this study is to assess and compare the effectiveness of HAS-BLED and ATRIA scores in predicting bleeding risk for patients over 75. Secondarily, we sought intrinsic and extrinsic factors to the elderly patient having an influence on this risk. Methods: we have carried out a case-control study on 208 patients, 52 cases matching to 156 control patients. These patients, who had been identified during the SCORE study, participated in a therapeutic education programme between May 2009 and May 2010 in four Isère hospitals and were followed for 1 year. The major endpoints, which were collected prospectively, were the occurrence of a major or clinically relevant bleeding event. Results: According to ROC curves, the ATRIA score performed best compared to HAS-BLED in predicting all bleeding events (c-index = 0.59 versus 0.56 respectively) and major bleeding events (c-index = 0.64 against 0.61 respectively). In a multivariate analysis, were associated with an increased risk of bleeding: anemia (OR = 2.6, 95% CI 1.34 to 5.23, p = 0.005), the use of selective serotonin reuptake inhibitors (SSRI) (OR = 2.8, 95% CI 1.08 to 7.47, p = 0.034) and therapy management by the patient's family (OR = 2.8, 95% CI 1.28 to 6.15; p = 0.01). Conclusions: The ATRIA score showed superior performance in predicting bleeding risk and in particular major bleeding risk, for patients over 75 years. It was also improved by taking into account the use of SSRI and treatment management by the patient's family.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Virage : Une réflexion pluridisciplinaire autour du temps dans la création numérique

We present in this article the development of the Virage project. This project aims to create a platform software for writting time and interaction in the context of digital stage management for living art. This project tries to answer some questions risen by a work group of AFIM (the french association for computer music). The project intends to produce a state of the art of the digital stage management, and to use this state to develop a prototype sotware. This propotype will be used in real conditions of stage management to get manager's points of view about our choices

A fiber-modified adenoviral vector interacts with immunoevasion molecules of the B7 family at the surface of murine leukemia cells derived from dormant tumors

Tumor cells can escape the immune system by overexpressing molecules of the B7 family, e.g. B7-H1 (PD-L1 or CD86), which suppresses the anti-tumor T-cell responses through binding to the PD-1 receptor, and similarly for B7.1 (CD80), through binding to CTLA-4. Moreover, direct interactions between B7-H1 and B7.1 molecules are also likely to participate in the immunoevasion mechanism. In this study, we used a mouse model of tumor dormancy, DA1-3b leukemia cells. We previously showed that a minor population of DA1-3b cells persists in equilibrium with the immune system for long periods of time, and that the levels of surface expression of B7-H1 and B7.1 molecules correlates with the dormancy time. We found that leukemia cells DA1-3b/d365 cells, which derived from long-term dormant tumors and overexpressed B7-H1 and B7.1 molecules, were highly permissive to Ad5FB4, a human adenovirus serotype 5 (Ad5) vector pseudotyped with chimeric human-bovine fibers. Both B7-H1 and B7.1 were required for Ad5FB4-cell binding and entry, since (i) siRNA silencing of one or the other B7 gene transcript resulted in a net decrease in the cell binding and Ad5FB4-mediated transduction of DA1-3b/d365; and (ii) plasmid-directed expression of B7.1 and B7-H1 proteins conferred to Ad5FB4-refractory human cells a full permissiveness to this vector. Binding data and flow cytometry analysis suggested that B7.1 and B7-H1 molecules played different roles in Ad5FB4-mediated transduction of DA1-3b/d365, with B7.1 involved in cell attachment of Ad5FB4, and B7-H1 in Ad5FB4 internalization. BRET analysis showed that B7.1 and B7-H1 formed heterodimeric complexes at the cell surface, and that Ad5FB4 penton, the viral capsomere carrying the fiber projection, could negatively interfere with the formation of B7.1/B7-H1 heterodimers, or modify their conformation. As interactors of B7-H1/B7.1 molecules, Ad5FB4 particles and/or their penton capsomeres represent potential therapeutic agents targeting cancer cells that had developed immunoevasion mechanisms

OSSIA: Towards a unified interface for scoring time and interaction

International audienceThe theory of interactive scores addresses the writing and execution of temporal constraints between musical objects, with the ability to describe the use of interactivity in the scores. In this paper, a notation for the use of conditional branching in interactive scores will be introduced. It is based on a high level formalism for the authoring of interactive scores developed during the course of the OS-SIA research project. This formalism is meant to be at the same time easily manipulated by composers, and translat-able to multiple formal methods used in interactive scores like Petri nets and timed automaton. An application programming interface that allows the interactive scores to be embedded in other software and the authoring software, I-SCORE, will be presented

Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units

Background: among elderly patients, readmission in the month following hospital discharge is a frequent occurrence which involves a risk of functional decline, particularly among frail subjects. While previous studies have identified risk factors of early readmission, geriatric syndromes, as markers of frailty have not been assessed as potential predictors. Objective: to evaluate the risk of early unplanned readmission, and to identify predictors in inpatients aged 75 and over, admitted to medical wards through emergency departments. Design: prospective multi-centre study. Setting: nine French hospitals. Subjects: one thousand three hundred and six medical inpatients, aged 75 and older admitted through emergency departments (SAFES cohort). Methods: using logistic regressions, factors associated with early unplanned re-hospitalisation (defined as first unplanned readmission in the thirty days after discharge) were identified using data from the first week of hospital index stay obtained by comprehensive geriatric assessment. Results: data from a thousand out of 1,306 inpatients were analysed. Early unplanned readmission occurred in 14.2% of inpatients and was not related with sociodemographic characteristics, comorbidity burden or cognitive impairment. Pressure sores (OR=2.05, 95% CI = 1.0-3.9), poor overall condition (OR = 2.01, 95% CI = 1.3-3.0), recent loss of ability for self-feeding (OR = 1.9, 95% CI = 1.2-2.9), prior hospitalisation during the last 3 months (OR = 1.6, 95% CI = 1.1-2.5) were found to be risk factors, while sight disorders appeared as negatively associated (OR = 0.5, 95% CI = 0.3--0.8). Conclusions: markers of frailty (poor overall condition, pressure sores, prior hospitalisation) or severe disability (for self-feeding) were the most important predictors of early readmission among elderly medical inpatients. Early identification could facilitate preventive strategies in risk grou

Loss of independence in Katz's ADL ability in connection with an acute hospitalization: early clinical markers in French older people

Background: The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization. Objectives: To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals. Methods: Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Évolution et suivi—Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30days using Katz's ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30days were considered. Results: About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n=619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.2-3.6), walking difficulties (OR=2.7, 95% CI=1.3-5.6), fall risk (OR=2.1, 95% CI=1.3-6.8) and malnutrition risk (OR=2.2, 95% CI=1.5-7.6) were found in multifactorial analysis to be clinical markers for loss of independence. Conclusions: Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitatio

Diving into the vertical dimension of elasmobranch movement ecology

Knowledge of the three-dimensional movement patterns of elasmobranchs is vital to understand their ecological roles and exposure to anthropogenic pressures. To date, comparative studies among species at global scales have mostly focused on horizontal movements. Our study addresses the knowledge gap of vertical movements by compiling the first global synthesis of vertical habitat use by elasmobranchs from data obtained by deployment of 989 biotelemetry tags on 38 elasmobranch species. Elasmobranchs displayed high intra- and interspecific variability in vertical movement patterns. Substantial vertical overlap was observed for many epipelagic elasmobranchs, indicating an increased likelihood to display spatial overlap, biologically interact, and share similar risk to anthropogenic threats that vary on a vertical gradient. We highlight the critical next steps toward incorporating vertical movement into global management and monitoring strategies for elasmobranchs, emphasizing the need to address geographic and taxonomic biases in deployments and to concurrently consider both horizontal and vertical movements

Diving into the vertical dimension of elasmobranch movement ecology

Knowledge of the three-dimensional movement patterns of elasmobranchs is vital to understand their ecological roles and exposure to anthropogenic pressures. To date, comparative studies among species at global scales have mostly focused on horizontal movements. Our study addresses the knowledge gap of vertical movements by compiling the first global synthesis of vertical habitat use by elasmobranchs from data obtained by deployment of 989 biotelemetry tags on 38 elasmobranch species. Elasmobranchs displayed high intra- and interspecific variability in vertical movement patterns. Substantial vertical overlap was observed for many epipelagic elasmobranchs, indicating an increased likelihood to display spatial overlap, biologically interact, and share similar risk to anthropogenic threats that vary on a vertical gradient. We highlight the critical next steps toward incorporating vertical movement into global management and monitoring strategies for elasmobranchs, emphasizing the need to address geographic and taxonomic biases in deployments and to concurrently consider both horizontal and vertical movements