Separation Practices in Children and Adolescents Admitted for Suicidal Behavior: A National Survey of French Psychiatrists

ObjectivesTo assess practices of French psychiatrists regarding their management of children and adolescents with suicidal behaviors, focusing on the use of a separation protocol in which the youths are separated from their relatives.MethodsIn 2017, we conducted an online cross-sectional survey of French psychiatrists caring for children and adolescents. Participants were asked to describe their practice of a separation protocol in children and adolescents admitted for suicidal behavior. Our main analysis followed a descriptive approach. We also explored whether participant characteristics were associated with the use of a separation protocol.ResultsThe response rate was 218/2403 (9,1%); 57.9 % of respondents worked in a University hospital, and 60% of respondents reported routinely hospitalizing children. A separation protocol was set up by 91.1% of survey participants (systematically 39.6%, on a case-by-case basis 51.5%). The mean age from which a separation protocol was indicated was above 11 years; 64% of participants reported a separation period of ≤ 48 h. The most common (87%) criterion cited for establishing a separation period was family relationship difficulties. The most common (80.9%) reason to justify the use of a separation protocol was to allow a better clinical assessment. Exploratory analyses did not identify any participant characteristics associated with the use of a separation protocol (p > 0.2 for all).ConclusionThe use of a separation protocol in children and adolescents admitted for suicidal behavior is a widespread practice in France, despite the deprivation of liberty it implies. This raises the question of the relevance and usefulness of such a practice

Membrane Bioreactor Energy Consumption: Helping Utilities Understand And Manage Cost Savings

E arly in the life cycle of a wastewater treatment project, there will be facility managers, operators, and designers who select a treatment process alternative among competing feasible technologies. The process selection decision process balances trade-offs, such as capital and operating costs, with multiple required performance factors, such as treatment effectiveness to meet effluent permit limits, ease of operation, etc. Proven technologies, such as conventional activated sludge (CAS) treatment, offer decades of operating data on which to base life cycle cost estimates, providing confidence in them. Newer technologies, such as membrane bioreactors (MBRs), lack the depth of available capital and operation cost data on which to base project lifecycle costs. The technology of MBRs has evolved over the last decade to include improvements intended to reduce energy consumption. Published energy consumption values show considerable variability. Attempts to reconcile energy consumption discrepancies in operating MBR facilities are discussed and should provide decision makers with increased confidence in operating cost estimates for this technology in order to develop accurate life cycle costs. Objective and Method Energy consumption of operating MBR wastewater treatment plants (WWTPs), mostly in North America, were summarized and evaluated. Data were gathered from the literature and directly from WWTP records to compare unit energy consumption in kilowatt hours per million gallons (kWh/MG) of wastewater treated, and was compared on a plant-by-plant basis. The literature reports MBR energy consumption ranges from 1,170 to 20,300 kWh/MG. This represents a factor of twenty and demonstrates the difficulty in developing accurate estimates For comparison, the National Association of Clean Water Agencies (NACWA) reported an average consumption of 1,766 kWh/MG for wastewater treatment facilities in its 2008 financial survey summary. The survey included 101 agencies representing over 67 million people, primarily from secondary treatment CAS facilities, and considered in-plant energy consumption only. Results and Conclusions The nine plants that were investigated used membranes from three vendors: GE/Zenon, Siemens/Memcor and Enviroquip/Kubota. The plants investigated using published literature data included Fowler, Pooler, and Cauley Creek in Georgia; Dundee in Michigan; and Varsseveld in the Netherlands. Data investigated directly from the facility operating data included Healdsburg i

Détermination des vitesses de nitrification-dénitrification dans un bioréacteur à membranes immergées fonctionnant en aération séquencée (contrôle et optimisation du séquençage de l'aération)

MONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF

Pulmonary Tuberculosis and Management of Contact Patients in a Department of Nephrology and Kidney Transplantation

OBJECTIVES: To describe the investigation, follow-up, management and outcomes in a cohort of chronic kidney disease and kidney transplant recipients exposed to a case of pulmonary tuberculosis. METHODS: Contacts were investigated following a concentric circles approach and followed-up according to their level of priority. In those with an evidence of latent tuberculous infection, treatment decision was based on the level of exposure, individual vulnerability, as well as the results of an interferon-gamma release assay. RESULTS: 130 patients with chronic kidney disease and 180 kidney transplant recipients were identified as contacts and followed-up over a two-year period.Only few vulnerable high-priority contacts received an anti-tuberculosis treatment, including the 2 (100%)highly exposed patients in circle 1, 11/78(14.1%)chronic kidney disease patients and 4/142 (2.8%) kidney transplant recipients in circle 2, and10/52 (19.2%) chronic kidney disease patients and 2/36 (5.6%) kidney transplant recipients in circle 3;all having a positive interferon-gamma release assay result. No incident case of tuberculosis disease occurred. CONCLUSIONS: These findings suggest that latent tuberculosis treatment, as recommended in European guidelines, might be reasonably avoided in vulnerable high-priority contacts of circle 2 with a negative interferon-gamma release assay in countries with low prevalence of tuberculosis

Exposition / Surexposition

Si l’exposition donne à voir, ou parfois même dénonce ce qu’elle met sous nos yeux, la surexposition entraîne au plan visuel une perte de contraste et de profondeur, et attire l’attention sur le procédé technique autant que sur l’objet représenté. À des fins exploratoires nous avons importé la notion de surexposition de l’histoire de la photographie dans le champ littéraire et avons aussi joué sur la polysémie de l’anglais « exposure ». Cette prise de risque a été récompensée car elle a inspiré une vaste gamme d’approches à un écrivain et à de nombreux chercheurs spécialistes de littérature et/ou des arts visuels américains

Lectrices d'Ancien Régime

La lecture et le lectorat ont fait, depuis une vingtaine d’années, l’objet de nombreuses études, qui ont mis en évidence des disparités importantes entre un lectorat masculin et féminin. La lecture est un lieu socialement construit de la différence des sexes. Se manifeste, dès le XIVe siècle, un processus de sécularisation dans les pratiques de lecture à mettre en relation avec un phénomène de désacralisation du livre. La lecture au féminin est l’enjeu de débats moraux où s’y affirme sa dangerosité. Dans le même temps apparaissent des prises de position en faveur du contrôle des lectures féminines qui s’inscrivent dans une conception du partage des pouvoirs de l’écrit en corrélation avec un partage hiérarchique des savoirs. Parce qu’elle est transgression, séduction, perversion, la lecture et la lectrice se déploient en un imaginaire dont la littérature s’est emparée pour en proposer des représentations multiples et protéiformes. Territoires de l’historien et espaces littéraires ont été dans cet ouvrage confrontés en une approche transséculaire, transdisciplinaire, à partir de l’étude de documents multiples, bibliothèques, correspondances, manuels, iconographie et de textes littéraires. Il constitue une contribution importante à la construction d’une histoire sociale et culturelle de la lecture féminine. Il propose un bilan des savoirs de ces dernières décennies et de nouveaux jalons pour les études à venir

HIV-1 subtype B-infected MSM may have driven the spread of transmitted resistant strains in France in 2007–12: impact on susceptibility to first-line strategies

International audienceBackground: Our study describes the prevalence of transmitted drug resistance (TDR) among 1318 French patients diagnosed at the time of primary HIV-1 infection (PHI) in 2007-12.Methods: HIV-1 resistance-associated mutations (RAMs) were characterized using both the 2009 WHO list of mutations and the French ANRS algorithm. A genotypic susceptibility score was estimated for each first-line recommended ART combination.Results: Patients were mainly MSM (72.6%). Non-B variants were identified in 33.7% of patients. The proportion of TDR was estimated as 11.7% (95% CI 10.0-13.5). The prevalences of PI-, NRTI-, first-generation NNRTI and etravirine/rilpivirine-associated RAMs were 2.5%, 5.2%, 3.9% and 3.2%, respectively. Single, dual and triple class resistance was found in 9.6%, 1.0% and 1.1% of cases, respectively. Additionally, 5/331 strains isolated in 201012 had integrase inhibitor (II)-related RAMs (isolated E157Q mutation in all cases). TDR was more common among MSM than in other groups (12.9% versus 8.6%, P = 0.034), and in case of B versus non-B subtype infections (13.6% versus 7.9%, P = 0.002). The proportions of fully active combinations were >= 99.2%, >= 97.3% and >= 95.3% in cases of PI-, II- and NNRTI-based regimens, respectively. In 2010-12, the proportion of fully active efavirenz-based ART was lower in cases of subtype B versus non-B infection (P = 0.021).Conclusions: Compared with our previous studies, the proportion of NRTI- and first-generation NNRTI-related TDR has continued to decline in French seroconverters. However, subtype B-infected MSM could drive the spread of resistant HIV strains. Finally, we suggest preferring PI- or II- to NNRTI-based combinations to treat PHI patients

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence