L’occupation du territoire en Haute-Auvergne durant l’Antiquité tardive et le haut Moyen Âge (ivᵉ-viiiᵉ siècle) : une approche archéologique

1. Cadre de l’étude La Haute-Auvergne est un territoire situé dans le sud-ouest de l’actuelle région Auvergne-Rhône-Alpes, correspondant au département du Cantal. Elle se situe sur les marges de la cité de Clermont et se présente comme un verrou de l’Aquitaine première durant l’Antiquité tardive. Il s’agit d’une zone de moyenne montagne composée essentiellement des monts du Cantal et du sud du massif du Sancy, dont l’altitude s’élève de 600 à 1 800 m. Cet espace offre une remarquable fenêtre ..

Technology Roadmap for Beyond 5G Wireless Connectivity in D-band

International audienceWireless communication in millimeter wave bands, namely above 20 GHz and up to 300 GHz is foreseen as a key enabler technology for the next generation of wireless systems. The huge available bandwidth is contemplated to achieve high data rate wireless communications, and hence, to fulfill the requirements of future wireless networks. Several Beyond 5G applications are considered for these systems: high capacity back-haul, enhanced hot-spot kiosk as well as short-range Device-to-Device communications. In this paper we propose to discuss the trade-offs between scenario requirements and current silicon technologies limits to draw a technology roadmap for the next generation of wireless connectivity in D-band

Impact of HFE genetic testing on clinical presentation of hereditary hemochromatosis: new epidemiological data

BACKGROUND: Hereditary hemochromatosis (HH) is a common inherited disorder of iron metabolism in Northern European populations. The discovery of a candidate gene in 1996 (HFE), and of its main mutation (C282Y), has radically altered the way to diagnose this disease. The aim of this study was to assess the impact of the HFE gene discovery on the clinical presentation and epidemiology of HH. METHODS: We studied our cohort of 415 patients homozygous for the C282Y allele and included in a phlebotomy program in a blood centre in western Brittany, France. RESULTS: In this cohort, 56.9% of the patients were male and 21.9% began their phlebotomy program before the implementation of the genetic test. A significant decrease in the sex ratio was noticed following implementation of this DNA test, from 3.79 to 1.03 (p < 10(-5)), meaning that the proportion of diagnosed females relatives to males greatly increased. The profile of HH patients at diagnosis changed after the DNA test became available. Serum ferritin and iron values were lower and there was a reduced frequency of clinical signs displayed at diagnosis, particularly skin pigmentation (20.1 vs. 40.4%, OR = 0.37, p < 0.001) and hepatomegaly (11.0 vs. 22.7%, OR = 0.42, p = 0.006). In contrast, fatigue became a more common symptom at diagnosis (68.0 vs. 51.2%, OR = 2.03, p = 0.004). CONCLUSION: This study highlights the importance of the HFE gene discovery, which has simplified the diagnosis of HH and modified its clinical presentation and epidemiology. This study precisely measures these changes. Enhanced diagnosis of HFE-related HH at an early stage and implementation of phlebotomy treatment are anticipated to maintain normal life expectancy for these patients

Future development of apricot blossom blight under climate change in Southern France

International audienceClimate change will have several consequences for agro-systems, one of which will concern changes to the development of pathogens. Because of the losses it causes, particularly in organic farming, Monilinia laxa is an important pathogen affecting apricot crops. This study focuses on the consequences of climate change regarding blossom and twig blight (Monilinia laxa) of apricot. To achieve this, a Climatic Index of cumulated Blight risk (CIB) was built, to obtain the weighted sum of blossom blight incidence throughout the blooming period. An epidemiological model to calculate the incidence of blossom blight during every potentially infectious episode and based on biological parameters, was calibrated using a trap pot experiment where trees were placed in orchards and subject to various meteorological conditions. The CIB derived from this model was evaluated on field data, and was shown to be a robust and useful tool to predict the effects of climate change on the development of apricot blight. Then, using the CIB with a phenological model to predict blooming periods in the future, we estimated the risks of apricot blight until 2100 on four contrasted apricot cultivars and in three geographical zones under climate change scenarios RCP 4.5 and 8.5. This study revealed different effects of climate change depending on the cultivar and altitude. Apricot trees would bloom earlier (up to a difference of 50 days between 1950 and 2100) under climate change. Under the combined effects of these shifts of blooming period and changing climatic conditions, late cultivars such as Bergarouge might see a reduction in the risk of blossom blight (down to 31%) because of warmer but dryer blooming periods. Other varieties (e.g.: Bergeron) could experience an increase in this risk by up to 27% with a shift of the blooming period towards rainier conditions at the highest altitudes. The results of this study could be used to anticipate future changes as well as be used at present as a decision-support tool for farmers

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)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Calcul par réseaux de neurones de la dose déposée en radiothérapie par un faisceau fin dans un volume hétérogène

National audienceUne méthode de calcul de la dose déposée en radiothérapie est présentée. À partir de courbes de dose en milieu homogène, apprises par des réseaux de neurones, nous proposons une heuristique de reconstruction de la dose en milieu hétérogène, dans le cas d'une interface orthogonale au faisceau. Les premiers tests donnent une erreur maximale de 3%, qui rentre bien dans les marges de sécurité imposées par les protocoles de radiothérapie