Real-life epidemiology and current outcomes of hospitalized adults with invasive fungal infections

We aimed to describe the current epidemiology of both hosts with invasive fungal infections (IFI) and causative fungi. And detail outcomes of these infections at 12 weeks in a real-life cohort of hospitalized patients. The study was retrospective and observational to describe IFI diagnosed in a tertiary hospital (February 2017 - December 2021). We included all consecutive patients meeting criteria for proven or probable IFI according to EORTC-MSG and other criteria. A total of 367 IFI were diagnosed. 11.7% were breakthrough infections, and 56.4% were diagnosed in the intensive care unit (ICU). Corticosteroid use (41.4%) and prior viral infection (31.3%) were the most common risk factors for IFI. Lymphoma and pneumocystis pneumonia were the most common baseline and fungal diseases. Only 12% of IFI occurred in patients with neutropenia. Fungal cultures were the most important diagnostic tests (85.8%). The most frequent IFI were candidemia (42.2%) and invasive aspergillosis (26.7%). Azole-resistant candida strains and non-fumigatus aspergillus infection represented 36.1% and 44.5% of the cases, respectively. Pneumocystosis (16.9%), cryptococcosis (4.6%) and mucormycosis (2.7%) were also frequent, as well as mixed infections (3.4%). Rare fungi accounted for 9.5% of infections. Overall IFI mortality at 12 weeks was 32.2%; higher rates were observed for Mucorales (55.6%), Fusarium (50%) and mixed infections (60%). We documented emerging changes in both hosts and real-life IFI epidemiology. Physicians should be aware of these changes to suspect infections and be aggressive in diagnoses and treatments. Currently, outcomes for such clinical scenarios remain extremely poor.© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology

Severe atypical pneumonia in critically ill patients: a retrospective multicenter study

International audienceBackground: Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure.Methods: Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs.Results: A total of 104 patients were included, 71 men and 33 women, with a median age of 56[44-67] years. MP was the causative agent for 76(73%) patients and CP for 28(27%) patients. Co-infection was documented for 18 patients (viruses for 8[47%] patients). Median number of involved quadrants on chest X-ray was 2[1-4], with alveolar opacities (n = 61,75%), interstitial opacities (n = 32,40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75(72%) patients and vasopressors for 41(39%) patients. ICU length of stay was 16.5[9.5-30.5] days, and 11(11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6(8%) vs. 17(22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP.MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation.Conclusion: In this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia

Temporal Trends in the Use of Computed Tomographic Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department : A Retrospective Analysis.

Recently, validated clinical decision rules have been developed that avoid unnecessary use of computed tomographic pulmonary angiography (CTPA) in patients with suspected pulmonary embolism (PE) in the emergency department (ED). To measure any resulting change in CTPA use for suspected PE. Retrospective analysis. 26 European EDs in 6 countries. Patients with CTPA performed for suspected PE in the ED during the first 7 days of each odd month between January 2015 and December 2019. The primary end points were the CTPAs done for suspected PE in the ED and the number of PEs diagnosed in the ED each year adjusted to an annual census of 100 000 ED visits. Temporal trends were estimated using generalized linear mixed regression models. 8970 CTPAs were included (median age, 63 years; 56% female). Statistically significant temporal trends for more frequent use of CTPA (836 per 100 000 ED visits in 2015 vs. 1112 in 2019; P < 0.001), more diagnosed PEs (138 per 100 000 in 2015 vs. 164 in 2019; P = 0.028), a higher proportion of low-risk PEs (annual percent change [APC], 13.8% [95% CI, 2.6% to 30.1%]) with more ambulatory management (APC, 19.3% [CI, 4.1% to 45.1%]), and a lower proportion of intensive care unit admissions (APC, -8.9% [CI, -17.1% to -0.3%]) were observed. Data were limited to 7 days every 2 months. Despite the recent validation of clinical decision rules to limit the use of CTPA, an increase in the CTPA rate along with more diagnosed PEs and especially low-risk PEs were instead observed. None specific for this study

Can multiple streams predict the territorial cohesion debate in the EU?

This article contributes to the debate over the fashionable but contested concept of ‘territorial cohesion’ in the European Union. Scholars have long recognised and traced discursive shifts in EU territorial development policies, but theoretical accounts of the drivers and parameters of such shifts are rare. This article applies the multiple streams model of agenda-setting to the territorial cohesion debate in order to explore how useful this model is in analysing and predicting the outcome of a debate. The article is structured according to the three ‘streams’ that are relevant to agenda-setting: problems, policies and politics. The analysis relies on the responses to the 2008 Green Paper on Territorial Cohesion in order to determine how politically feasible different policy solutions are. More recent developments such as the Territorial Agenda 2020 and the European Commission’s proposals for Cohesion Policy for 2014–2020 are then used to assess the predictive power of multiple streams. It is shown that the model successfully predicts the endurance of solidarity-based cohesion goals, the emergence of territorial capital as a key policy solution, and the rejection of geographical criteria for the allocation of EU Structural Funds. At the same time, the multiple streams model fails to predict the introduction of spatial planning tools into EU cohesion policy. This shows that explaining a substantial redefinition of existing policy terms requires some reference to key actors’ broader discursive strategies. The article concludes that the multiple streams model has some predictive and explanatory power; criticisms of the model as overly descriptive are exaggerated

On the Entity and Antiquity of the Aurignacian at Willendorf (Austria): Implications for Modern Human Emergence in Europe

International audienc

The Emergence of Ornaments and Art: An Archaeological Perspective on the Origins of “Behavioral Modernity”

The earliest known personal ornaments come from the Middle Stone Age of southern Africa, c. 75,000 years ago, and are associated with anatomically modern humans. In Europe, such items are not recorded until after 45,000 radiocarbon years ago, in Neandertal-associated contexts that significantly predate the earliest evidence, archaeological or paleontological, for the immigration of modern humans; thus, they represent either independent invention or acquisition of the concept by long-distance diffusion, implying in both cases comparable levels of cognitive capability and performance. The emergence of figurative art postdates c. 32,000 radiocarbon years ago, several millennia after the time of Neandertal/modern human contact. These temporal patterns suggest that the emergence of “behavioral modernity” was triggered by demographic and social processes and is not a species-specific phenomenon; a corollary of these conclusions is that the corresponding genetic and cognitive basis must have been present in the genus Homo before the evolutionary split between the Neandertal and modern human lineages