Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department.

An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively validated in some settings, and their added value in the emergency department remains unknown. To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones. International prospective cohort study, conducted in France, Spain, Belgium, and Switzerland between May and June 2016. In the 30 participating emergency departments, for a 4-week period, consecutive patients who visited the emergency departments with suspected infection were included. All variables from previous and new definitions of sepsis were collected. Patients were followed up until hospital discharge or death. Measurement of qSOFA, SOFA, and SIRS. In-hospital mortality. Of 1088 patients screened, 879 were included in the analysis. Median age was 67 years (interquartile range, 47-81 years), 414 (47%) were women, and 379 (43%) had respiratory tract infection. Overall in-hospital mortality was 8%: 3% for patients with a qSOFA score lower than 2 vs 24% for those with qSOFA score of 2 or higher (absolute difference, 21%; 95% CI, 15%-26%). The qSOFA performed better than both SIRS and severe sepsis in predicting in-hospital mortality, with an area under the receiver operating curve (AUROC) of 0.80 (95% CI, 0.74-0.85) vs 0.65 (95% CI, 0.59-0.70) for both SIRS and severe sepsis (P < .001; incremental AUROC, 0.15; 95% CI, 0.09-0.22). The hazard ratio of qSOFA score for death was 6.2 (95% CI, 3.8-10.3) vs 3.5 (95% CI, 2.2-5.5) for severe sepsis. Among patients presenting to the emergency department with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than did either SIRS or severe sepsis. These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting. clinicaltrials.gov Identifier: NCT02738164

Making space for shellfish farming along the Adriatic coast

This work focuses on the selection of new areas for shellfish farming along the coast of the Northern Adriatic Sea (Italy). Shellfish site suitability was assessed by means of a methodology based on Spatial Multi-Criteria Evaluation (SMCE), which provided the framework to combine mathematical models and operational oceanography products. Intermediate level criteria considered in the analysis included optimal growth conditions, environmental interactions, and socio-economic evaluation (e.g. organic carbon deposition; distance to harbour). Results showed that the whole coastal area comprised within 0 and 3 nm is highly suitable for farming of mussel, while the area comprised between 3 and 12 nm is divided between a highly suitable northern part, and a less suitable southern one. Seven different scenarios of development of shellfish aquaculture industry were explored. The introduction of a new species, and the assessment of the exposure to storm events are specific aspects taken into account in development scenarios. Results show that the degree of suitability for shellfish aquaculture in this area would not change dramatically with the introduction of oyster farming. Furthermore, results highlight that: (i) the growth potential in this area is high; (ii) the space with suitability index >0.5 increases when prioritizing the optimal growth condition criteria, and (iii) the socio-economic is the most restrictive Intermediate Level Criteria. Results were discussed by deriving general lessons concerning the use of SMCE in aquaculture space allocation, from the specific application in the Northern Adriatic Sea. Challenges and opportunities related to the proposed methodological framework, with particular reference to the use of resources provided by remote sensing and operational oceanography by means of mathematical models, were also discussed. Results can support a science-based identification of allocated zones for aquaculture in order to avoid conflicts, and promote sustainable aquaculture in the Mediterranean Sea, where the space for these activities is becoming increasingly limited

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Traitement à haute température des huîtres infectées par l’ostreid herpesvirus 1 (OsHV-1). TEMPO - Rapport 2016

Le naissain d’huître creuse Crassostrea gigas est touché chaque année depuis 2008 par des mortalités causées par un microvariant de l’ostreid herpesvirus 1 (OsHV-1 μVar). Plusieurs études montrent que ces évènements de mortalité se produisent préférentiellement lorsque la température de l’eau est comprise entre 16°C et 24°C. Par conséquent, une exposition rapide des huîtres infectées par OsHV-1 à des températures supérieures à 24°C pourrait limiter les mortalités causées par le virus. Il est proposé de (1) vérifier l’hypothèse selon laquelle l’exposition à haute température réduit la mortalité des huîtres infectées par OsHV-1, et (2) déterminer si les animaux qui ont survécu suite à l’infection par OsHV-1 et au traitement thermique sont sensibles/résistants à l’infection par OsHV-1et sains/porteurs lorsque la température est à nouveau favorable au développement d’une infection exprimée. La survie des huîtres infectées par OsHV-1 à 29°C est nettement supérieure (81%) à celle des huîtres à 21°C (49%) et à 26°C (41%). Par ailleurs, les huîtres survivantes à une infection par OsHV-1 à 29°C ne semblent pas infectieuses, même lorsque la température devient permissive pour le virus (21°C). Enfin, lors d’une seconde exposition au virus en milieu naturel, les huîtres survivantes à une infection par OsHV-1 à 29°C présentent un risque de mortalité 2 fois supérieur à celui des huîtres infectées aux autres températures. Néanmoins, considérée sur l’ensemble de l’expérience, la survie des huîtres exposées à OsHV-1 à 29°C est 1.5 fois supérieures (57%) à celles des huîtres exposées à OsHV-1 à 21°C et à 26°C (37%). Par conséquent, il y a un bénéfice à exposer les huîtres à OsHV-1 à 29°C plutôt qu’à 21°C ou à 26°C. Il restera à comprendre les fondements de cette interaction hôte-agent pathogène- température. La diminution du risque de mortalité à 29°C reste à élucider.

Implantation distribuée temps réel de programmes conditionnés à l'aide d'ordonnancements mixtes hors-ligne en-ligne de tâches périodiques avec contraintes de latence et acceptation de tâches apériodiques

PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Mathématiques rech (751052111) / SudocSudocFranceF

The future is now: marine aquaculture in the anthropocene

Aquaculture now produces more seafood than wild capture fisheries and this production is expected to at least double by 2050. Representing almost half of global production, marine aquaculture will contribute to sustainably feeding the growing humanity. However, climate change will undoubtedly challenge the future growth of marine aquaculture. Temperature and sea-level rise, shifts in precipitation, freshening from glacier melt, changing ocean productivity, and circulation patterns, increasing occurrence of extreme climatic events, eutrophication, and ocean acidification are all stressors that will influence marine aquaculture. The objective of this themed article set was to bring together contributions on the broad theme of the potential impacts, adaptation, and mitigation strategies of marine aquaculture to climate change. Here we present 14 papers covering a diverse set of approaches including experimentation, modelling, meta-analysis and review, and disciplines like biology, ecology, economics, and engineering. These articles focus on the impacts of climate change-related stressors on the aquaculture potential itself and on the resulting ecological interactions (e.g. parasitism and predation), on phenotypic plasticity and adaptation potential of species, and on measures to mitigate the effects of climate change on aquaculture and vice versa. Considering this, adaptation of the aquaculture sector relies on anticipating the biogeographical changes in the distribution of species, determining their potential for adaptation and selective breeding for resistance or tolerance to climate-induced stressors, and fostering ecosystem resilience by means of conservation, restoration, or remediation. By will or by force, aquaculture will contribute to the low carbon economy of tomorrow. Aquaculture must move towards a new paradigm where the carbon footprint and the analysis of the life cycle of products are at least as important as economic profitability

Influence of low temperatures on the survival of the Pacific oyster (Crassostrea gigas) infected with ostreid herpes virus type 1

Mortalities of oyster seed of Crassostrea gigas associated with ostreid herpes virus OsHV-1 mu Var have been observed in many oyster producing countries since 2008. The objective of this study was to further investigate whether low temperature treatments can offer a viable option to mitigate oyster mortalities. An experiment was set-up to further evaluate the effect of low temperature treatments (10 and 13 degrees C vs. 21 degrees C) and their duration (6 d to 83 d) on the survival of oysters previously infected with OsHV-1 mu Var by means of exposure to field conditions in areas where mortalities were occurring. Average survival of oysters infected with OsHV1-mu Var was 71% after 83 d at low temperatures compared to only 23% in controls maintained at 21 degrees C. During cold-exposure, levels of OsHV-1 DNA in oyster tissues gradually decreased, down to nearly the detection limit after 24 d. However, when cold-acclimated oysters were suddenly exposed at 21 degrees C in the laboratory, they exhibited high levels of mortality along with an enhancement of OsHV-1 DNA concentration in their tissues. Therefore, OsHV-1 persists in oysters even at low temperature and is reactivated during subsequent thermal elevation to 21 degrees C. Low temperature treatments did not improve overall survival of oyster seed infected with OsHV-1. These results suggest that moving infected oysters to a cooler area only delays mortality and may increase the risk of infection in neighbouring stocks when rising temperatures become permissive for viral replication. Statement of relevance: This study is relevant for building disease control measures

Effet de traitements thermiques sur la résistance du naissain d’huître creuse au phénomène de mortalité massive - THERMARES

L’objectif de cette étude vise à déterminer l’effet de basses températures (10°C et 13°C) pendant des durées variables (0 et 80 jours) sur la survie du naissain d’huîtres creuses préalablement infecté suite à une exposition en rade de Brest pendant 5 ou 8 jours. Le naissain d’huître creuse préalablement infecté par OsHV-1 µvar par exposition en milieu naturel pendant 5 d ou 8 d, puis transféré à basse température (10°C ou 13°C) pendant 5 à 80 d, présente des mortalités plus faibles et plus tardives que les animaux témoins en laboratoire. La réduction des mortalités observée dans le naissain exposé à basse température coïncide avec une diminution progressive des concentrations d’ADN appartenant à OsHV-1 dans les tissus, au point de devenir non-détecté ou non quantifiable après 6 à 41 d. En revanche, lorsque ces animaux sont exposés à une augmentation de température à 21°C en laboratoire, le virus est réactivé et d’importantes mortalités sont constatées. Bien que ces mortalités soient souvent inférieures à celles des animaux témoins, le gain de survie est généralement faible et semble indépendant de la température (10°C ou 13°C) et de la durée d’exposition à basse température (5 à 80 d). Enfin, lorsque les naissains sont réexposés en milieu naturel où la maladie sévit, des mortalités similaires à celles des groupes témoins sont constatées. Par conséquent, les huîtres naturellement exposées à OsHV-1, chez lesquelles le développement de la maladie est limité par une exposition plus ou moins longue à basses températures, demeurent sensibles à cet agent infectieux

Seawater carbonate chemistry and growth retardation of Pacific oyster Crassostrea gigas

We evaluated the recovery capacity of a model calcifier, the Pacific oyster Crassostrea gigas. We exposed juveniles to 15 pH conditions between 6.4 and 7.8 for 14 days. Oyster growth was retarded below pH 7.1 while shells were corroded at pH 6.5. We then placed the oysters under ambient pH > 7.8 for 42 days. The oysters from each pH condition were briefly dried with absorbent paper and the total wet body weight was measured with a Mettler precision balance (Mettler-Toledo) during the exposure period on days 6, 10 and 14, and then during the ambient pH period on days 4, 7, 9, 11, 14, 18, 22, 28, 36 and 42