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/)

Le suicide de la personne âgée en milieu hospitalier

Médecine. PsychiatrieLe suicide de la personne âgée est une problématique de santé publique. Dans le monde entier, et principalement dans les pays développés comme la France, les taux de mortalité par suicide augmentent avec l’avancée en âge, atteignant des sommets après l’âge de 75 ans. De nombreux facteurs de risque suicidaire s’accumulent au cours du vieillissement : pertes dans l’entourage et réactions de deuil, isolement social, troubles sensoriels, maladies physiques chroniques ayant des répercussions douloureuses et invalidantes. Ces facteurs cumulés favorisent le risque de troubles dépressifs qui sont souvent banalisés, sous-diagnostiqués et donc peu traités chez les sujets âgés. L’émergence d’idées suicidaires peut conduire à une crise suicidaire pouvant aboutir au suicide. Les établissements de santé sont considérés comme soignants et protecteurs, cependant, les sujets âgés hospitalisés présentent un cumul de facteurs de risque suicidaire. De fait, le suicide peut survenir à l’hôpital, ce phénomène reste toutefois rare et peu documenté dans la littérature scientifique. L’épidémiologie du suicide du sujet âgé en population générale et du suicide en milieu hospitalier sont repris à partir de données de la littérature internationale. Sans un deuxième temps, ce travail de thèse expose une revue de la littérature sur le suicide de la personne âgée en milieu hospitalier ainsi qu’une étude rétrospective descriptive portant sur 14 suicides de patients âgés de plus de 60 ans survenus au cours d’hospitalisations dans différents établissements de soin de la région Grand-Est sur une période de 2 ans. Un cas clinique détaillé d’un patient s’étant donné la mort au cours d’une hospitalisation vient illustrer notre propos. Cela nous a permis d’identifier certaines caractéristiques propres aux personnes âgées se suicidant à l’hôpital, qui constitue donc un groupe à risque, ainsi que les méthodes principalement employées qui sont en règle générale violentes. Le suicide à l’hôpital est lourd de conséquences à plusieurs niveaux : sur le plan familial, pour l’entourage, sur le plan institutionnel, pour le personnel soignant et sur le plan médico-légal en termes de responsabilité. Il apparaît donc primordial de dépister les individus âgés particulièrement à risque de suicide à l’hôpital et notamment de diagnostiquer les troubles dépressifs afin de les traiter. Ceci dans le but de prévenir le suicide en milieu hospitalier en proposant une prise en charge adaptée et spécialisée et de prendre des mesures de prévention spécifiques.Suicide in later life is a global public health problem. People aged 75 years and over have the highest suicide rates of all age groups in most developed countries as in France. Later life is a period associated with multiple losses that constitute risk factors for suicide: bearevement, social isolation, sensory disturbances, chronic physical illnesses with painful and disabling impacts. These combined factors increase the risk of depressive disorders which are often trivialized, underdiagnosed and therefore undertreated in elderly people. The emergence of suicidal thoughts can lead to a suicidal crisis that can lead to suicide. Health establishments are considered as caregivers and protectors, however, hospitalized elderly patients are at greatest risk of suicide. An in-hospital suicide is a rare phenomenon and poorly documented in the scientific literature. The epidemiology of suicide in the elderly population and in-hospital suicides is based on data from international literature. This thesis work focuses on a literature review on suicide among the elderly in hospital. A retrospective study on 14 suicides of 60 years inpatients and over occurring during hospitalizations in different care establishments in the Grand-Est region over a period of 2 years is described. A clinical case of a 94 years inpatient who killed himself illustrates our point. The aim of our work was to identify some specific characteristics of elderly individuals who commit suicide in hospital, which is therefore a risk group. Suicide in the hospital has serious consequences: for the family and relatives, for the institution, for the nursing staff and in terms of legal liability. It appears essential to screen elderly people who are particularly at risk of suicide in the hospital and in particular to diagnose depressive disorders in order to treat them and to prevent in-hospital suicide by offering suitable care and by taking specific preventive measures

Does disturbance and restoration of alpine grassland soils affect the genetic structure and diversity of bacterial and N2-fixing populations?

Responses of bacterial communities to disturbance and restoration processes were investigated on alpine grassland soil. Bulk soil, rhizosphere soil and two soil separates, i.e. sand-size (2000-200 mm) and silt-size (50-2 mm) were sampled from undisturbed grassland soil to soil under restoration for 1 month, 1 year, 4 years and 13 years after disturbance. Automated ribosomal intergenic spacer analysis (ARISA) and restriction fragment length polymorphism (RFLP) of nifH gene pools were used to assay genetic structure of the bacterial communities and N2-fixing guild. According to the distribution of ARISA band length in bacterial phyla, the dominance of ARISA bands below 400 bp showed that Gram-positive bacteria would be predominant in the studied grassland soil when not disturbed. Disturbance affected the genetic structure of bacterial community and of N2-fixing guild in relation to their location within the selected habitats. Shifts in IGS and nifH profiles of bulk soil metagenome were larger than those observed from sandsize- and silt-size-fractions, accounting for 40–50% of the variance in the profiles. Restoration of the genetic structure of telluric bacteria community and N2-fixing populations was found to be influenced by the spatial heterogeneity of the soil and niche diversification.Particular bacterial genetic structure within distinct habitats were evidenced and must be defined as subdivisions of the meta-community of bulk soil. Scale of soil microbial diversity/stability relationships is discussed with special attention to disconnected bacterial habitat compared with whole soil with multiple niches

Does disturbance and restoration of alpine grassland soils affect the genetic structure and diversity of bacterial and N2-fixing populations?

Responses of bacterial communities to disturbance and restoration processes were investigated on alpine grassland soil. Bulk soil, rhizosphere soil and two soil separates, i.e. sand-size (2000-200 mm) and silt-size (50-2 mm) were sampled from undisturbed grassland soil to soil under restoration for 1 month, 1 year, 4 years and 13 years after disturbance. Automated ribosomal intergenic spacer analysis (ARISA) and restriction fragment length polymorphism (RFLP) of nifH gene pools were used to assay genetic structure of the bacterial communities and N2-fixing guild. According to the distribution of ARISA band length in bacterial phyla, the dominance of ARISA bands below 400 bp showed that Gram-positive bacteria would be predominant in the studied grassland soil when not disturbed. Disturbance affected the genetic structure of bacterial community and of N2-fixing guild in relation to their location within the selected habitats. Shifts in IGS and nifH profiles of bulk soil metagenome were larger than those observed from sandsize- and silt-size-fractions, accounting for 40–50% of the variance in the profiles. Restoration of the genetic structure of telluric bacteria community and N2-fixing populations was found to be influenced by the spatial heterogeneity of the soil and niche diversification.Particular bacterial genetic structure within distinct habitats were evidenced and must be defined as subdivisions of the meta-community of bulk soil. Scale of soil microbial diversity/stability relationships is discussed with special attention to disconnected bacterial habitat compared with whole soil with multiple niches

Congenital Partial Colonic Agenesis in Dogs and Cats: Clinical, Biological, Diagnostic Imaging, Endoscopic and Histopathologic Characterization, a Retrospective Study

Congenital diseases of the large intestine of dogs and cats have scarcely been reported and mostly include fistula, atresia or colonic duplication. Cases of partial colonic agenesis have rarely been described. The purpose of this study was to report a cohort of dogs and cats diagnosed with partial colonic agenesis. The colon was measured during colonoscopy or contrast-radiography and compared to the average length described in the literature. Six dogs and 17 cats were retrospectively included. Depending on the case, partial colonic agenesis could represent an incidental finding or the likeliest cause of clinical signs. Diarrhea was reported in most cases, and no specific clinical or biological abnormality was observed. Median age of presentation was variable and long asymptomatic periods were common. Abdominal ultrasound was useful and identified a short colon in 14/17 cats but only in one dog. Endoscopy was useful to confirm the diagnosis and to identify associated lesions and complications. Among others, colonic stenosis was reported in 8/9 cases that had lifelong clinical signs and the shortest colon length. This anatomical abnormality could promote chronic inflammation that might generate fibrosis and ultimately stenosis

SOIL PHYSICO-CHEMICAL CHANGES FOLLOWING APPLICATION OF MUNICIPAL SOLID WASTE LEACHATES TO GRASSLANDS

Concerns about the use of residues from municipal solid waste incinerators (MSWI) in construction materials usually focus on the potential for heavy metals and organic chemicals to leach into drainage waters under the influence of rain.We hypothesised that high level of salts in the MSWI leachates may cause more of a problem, particularly on soil physico-chemical properties. Both bottom ash (BA) and Solidified Air Pollution Control residue (SAPCr) leachates were added to experimental grassland plots. The amounts of Na+ increased by up to 13% in soils supplemented with each leachate. A decrease of the soil total porosity (−14%) was evidence of a subsequent adverse physical effect of this strong salinity. The potential for the grass cover type (species composition or density) to limit this adverse effect was discussed. Laboratory tests allowed us to determine that undiluted SAPCr induced slaking of aggregates accompanied by a strong decrease of aggregate stability, to 49% of control values. Undiluted BA induced dispersion of clays and others fine particles, which are then dislodged and transported into pores, causing blockage and decreasing total porosity. Clay dispersion followed by aggregate collapse occurred when soil solution contaminated by SAPCr was diluted by rainwater. This work stressed the importance of accounting for mineral contaminants, such as salts, when conducting an assessment of waste reuse scenarios

SOIL PHYSICO-CHEMICAL CHANGES FOLLOWING APPLICATION OF MUNICIPAL SOLID WASTE LEACHATES TO GRASSLANDS

Concerns about the use of residues from municipal solid waste incinerators (MSWI) in construction materials usually focus on the potential for heavy metals and organic chemicals to leach into drainage waters under the influence of rain.We hypothesised that high level of salts in the MSWI leachates may cause more of a problem, particularly on soil physico-chemical properties. Both bottom ash (BA) and Solidified Air Pollution Control residue (SAPCr) leachates were added to experimental grassland plots. The amounts of Na+ increased by up to 13% in soils supplemented with each leachate. A decrease of the soil total porosity (−14%) was evidence of a subsequent adverse physical effect of this strong salinity. The potential for the grass cover type (species composition or density) to limit this adverse effect was discussed. Laboratory tests allowed us to determine that undiluted SAPCr induced slaking of aggregates accompanied by a strong decrease of aggregate stability, to 49% of control values. Undiluted BA induced dispersion of clays and others fine particles, which are then dislodged and transported into pores, causing blockage and decreasing total porosity. Clay dispersion followed by aggregate collapse occurred when soil solution contaminated by SAPCr was diluted by rainwater. This work stressed the importance of accounting for mineral contaminants, such as salts, when conducting an assessment of waste reuse scenarios

An Integrated Framework for Understanding Multimodal Embodied Experiences in Interactive Virtual Reality

International audienceVirtual Reality (VR) technology enables ``embodied interactions'' in realistic environments where users can freely move and interact, with deep physical and emotional states. However, a comprehensive understanding of the embodied user experience is currently limited by the extent to which one can make relevant observations, and the accuracy at which observations can be interpreted. Paul Dourish proposed a way forward through the characterisation of embodied interactions in three senses: ontology, intersubjectivity, and intentionality. In a joint effort between computer and neuro-scientists, we built a framework to design studies that investigate multimodal embodied experiences in VR, and apply it to study the impact of simulated low-vision on user navigation. Our methodology involves the design of 3D scenarios annotated with an ontology, modelling intersubjective tasks, and correlating multimodal metrics such as gaze and physiology to derive intentions. We show how this framework enables a more fine-grained understanding of embodied interactions in behavioural research

On the link between emotion, attention and content in virtual immersive environments

International audienceWhile immersive media have been shown to generate more intense emotions, saliency information has been shown to be a key component for the assessment of their quality, owing to the various portions of the sphere (viewports) a user can attend. In this article, we investigate the tri-partite connection between user attention, user emotion and visual content in immersive environments. To do so, we present a new dataset enabling the analysis of different types of saliency, both lowlevel and high-level, in connection with the user's state in 360 • videos. Head and gaze movements are recorded along with self-reports and continuous physiological measurements of emotions. We then study how the accuracy of saliency estimators in predicting user attention depends on user-reported and physiologically-sensed emotional perceptions. Our results show that high-level saliency better predicts user attention for higher levels of arousal. We discuss how this work serves as a first step to understand and predict user attention and intents in immersive interactive environments