Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Background. The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. Objective. TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. Setting. Eleven ICUs of a French university hospital. Design. We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. Results. Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. Conclusions. ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assesse

Centrality evolution of the charged-particle pseudorapidity density over a broad pseudorapidity range in Pb-Pb collisions at root s(NN)=2.76TeV

Peer reviewe

Evolution des bactériemies nosocomiales à porte d'entrée urinaire au centre hospitalier Lyon sud (étude épidémiologique descriptive)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Cones as a model of intuitionistic linear logic

International audienceFor encompassing the limitations of probabilistic coherence spaces which do not seem to provide natural interpretations of continuous data types such as the real line, Ehrhard and al. introduced a model of probabilistic higher order computation based on (positive) cones, and a class of totally monotone functions that they called "stable". Then Crubillé proved that this model is a conservative extension of the earlier probabilistic coherence space model. We continue these investigations by showing that the category of cones and linear and Scott-continuous functions is a model of intuitionistic linear logic. To define the tensor product, we use the special adjoint functor theorem, and we prove that this operation is and extension of the standard tensor product of probabilistic coherence spaces. We also show that these latter are dense in cones, thus allowing to lift the main properties of the tensor product of probabilistic coherence spaces to general cones. Last we define in the same way an exponential of cones and extend measurability to these new operations

Mode d'analyse des dossiers techniques pour le choix des savons doux en établissement de santé

Analyzing datasheets for selecting soft soaps for healthcare establishments. For tender for soaps issued by the UNIHA hospital purchasing group, a procedure was drawn up for analyzing datasheets to determine tolerance indicators. Method. This was a two-step procedure. Before the tender was issued, a student pharmacist analyzed and summarized the datasheets. When the call for tender was issued, a specification was drawn up and the tenders received were analyzed by a multidisciplinary group. Results. The 20 datasheets available before the tenders were summarized to provide information on the suppliers, the tests carried out and the composition of the soaps. This summary formed the basis, of tender, for determining the assignment, the specifications and the scoring method (taking account of the tests and down-scoring for particular components). The tests taken into account concerned dermal and ocular tolerance and resistance to microbial contamination. Discussion. This procedure avoided field trials while maintaining a satisfactory standard to ensure the tolerance of the soaps supplied. This study will be followed up by monitoring user cohorts and comparing the datasheet analyses with the field test results for the previous local calls for tender. This approach must be continued to assess the relevance and reproducibility of these criteria and to improve tenders from suppliers.Dans le cadre de l'appel d'offres «savons» passé en groupement de commandes UNIHA (Union des hôpitaux pour les achats), une méthode d'analyse des dossiers techniques a été développée pour identifier des indicateurs prédictifs de bonne tolérance. Méthodes. Les travaux ont été menés en deux temps : en pré campagne, analyse et synthèse des dossiers techniques par un étudiant en pharmacie ; au moment de l'appel d'offres, constitution du cahier des charges et analyse des offres reçues en groupe pluridisciplinaire. Résultats. L'étude de 20 dossiers a abouti à la synthèse d'informations relatives aux fournisseurs, aux tests effectués et aux compositions. Cette synthèse a permis de définir dans le cadre de l'appel d'offres, l'allotissement, le cahier des charges, et les méthodes de notation (prise en compte des tests et notation dégressive des composants). Les tests pris en compte concernaient la tolérance cutanée et oculaire, et la résistance à la contamination microbienne. Discussion. La méthode développée a permis de s'affranchir des essais de terrain tout en gardant un niveau d'exigence satisfaisant pour garantir la fourniture de savons bien tolérés. Ce travail sera complété par un suivi des cohortes d'utilisateurs et par une confrontation de l'analyse des dossiers techniques avec les résultats des essais de terrain des précédents appels d'offres locaux. Le travail doit être poursuivi afin d'évaluer la pertinence et la reproductibilité de ces critères et faire évoluer l'offre des fournisseurs

Mode d'analyse des dossiers techniques pour le choix des savons doux en établissement de santé

Analyzing datasheets for selecting soft soaps for healthcare establishments. For tender for soaps issued by the UNIHA hospital purchasing group, a procedure was drawn up for analyzing datasheets to determine tolerance indicators. Method. This was a two-step procedure. Before the tender was issued, a student pharmacist analyzed and summarized the datasheets. When the call for tender was issued, a specification was drawn up and the tenders received were analyzed by a multidisciplinary group. Results. The 20 datasheets available before the tenders were summarized to provide information on the suppliers, the tests carried out and the composition of the soaps. This summary formed the basis, of tender, for determining the assignment, the specifications and the scoring method (taking account of the tests and down-scoring for particular components). The tests taken into account concerned dermal and ocular tolerance and resistance to microbial contamination. Discussion. This procedure avoided field trials while maintaining a satisfactory standard to ensure the tolerance of the soaps supplied. This study will be followed up by monitoring user cohorts and comparing the datasheet analyses with the field test results for the previous local calls for tender. This approach must be continued to assess the relevance and reproducibility of these criteria and to improve tenders from suppliers.Dans le cadre de l'appel d'offres «savons» passé en groupement de commandes UNIHA (Union des hôpitaux pour les achats), une méthode d'analyse des dossiers techniques a été développée pour identifier des indicateurs prédictifs de bonne tolérance. Méthodes. Les travaux ont été menés en deux temps : en pré campagne, analyse et synthèse des dossiers techniques par un étudiant en pharmacie ; au moment de l'appel d'offres, constitution du cahier des charges et analyse des offres reçues en groupe pluridisciplinaire. Résultats. L'étude de 20 dossiers a abouti à la synthèse d'informations relatives aux fournisseurs, aux tests effectués et aux compositions. Cette synthèse a permis de définir dans le cadre de l'appel d'offres, l'allotissement, le cahier des charges, et les méthodes de notation (prise en compte des tests et notation dégressive des composants). Les tests pris en compte concernaient la tolérance cutanée et oculaire, et la résistance à la contamination microbienne. Discussion. La méthode développée a permis de s'affranchir des essais de terrain tout en gardant un niveau d'exigence satisfaisant pour garantir la fourniture de savons bien tolérés. Ce travail sera complété par un suivi des cohortes d'utilisateurs et par une confrontation de l'analyse des dossiers techniques avec les résultats des essais de terrain des précédents appels d'offres locaux. Le travail doit être poursuivi afin d'évaluer la pertinence et la reproductibilité de ces critères et faire évoluer l'offre des fournisseurs

Estimating attributable mortality due to nosocomial infections acquired in intensive care units.

BACKGROUND: The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. OBJECTIVE: To assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. SETTING: Eleven ICUs of a French university hospital. DESIGN: We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was defined as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. RESULTS: Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%-14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. CONCLUSIONS: ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assessed

A meiotic XPF–ERCC1-like complex recognizes joint molecule recombination intermediates to promote crossover formation

Meiotic crossover formation requires the stabilization of early recombination intermediates by a set of proteins and occurs within the environment of the chromosome axis, a structure important for the regulation of meiotic recombination events. The molecular mechanisms underlying and connecting crossover recombination and axis localization are elusive. Here, we identified the ZZS (Zip2–Zip4–Spo16) complex, required for crossover formation, which carries two distinct activities: one provided by Zip4, which acts as hub through physical interactions with components of the chromosome axis and the crossover machinery, and the other carried by Zip2 and Spo16, which preferentially bind branched DNA molecules in vitro. We found that Zip2 and Spo16 share structural similarities to the structure-specific XPF–ERCC1 nuclease, although it lacks endonuclease activity. The XPF domain of Zip2 is required for crossover formation, suggesting that, together with Spo16, it has a noncatalytic DNA recognition function. Our results suggest that the ZZS complex shepherds recombination intermediates toward crossovers as a dynamic structural module that connects recombination events to the chromosome axis. The identification of the ZZS complex improves our understanding of the various activities required for crossover implementation and is likely applicable to other organisms, including mammals.ISSN:0890-9369ISSN:1549-547

Annotation data about multi criteria assessment methods used in the agri-food research: The French national institute for agricultural research (INRA) experience

International audienceThis data article contains annotation data characterizing MultiCriteria Assessment (MCA) Methods proposed in the agri-food sector by researchers from INRA, Europe's largest agricultural research institute (INRA, http://institut.inra.fr/en). MCA can be used to assess and compare agricultural and food systems, and support multi-actor decision making and design of innovative systems for crop production, animal production and processing of agricultural products. These data are stored in a public repository managed by INRA (https://data.inra.fr/; https://doi.org/10.15454/WB51LL)