Strategic satisficing : civil-military relations and French intervention in Africa

Few issues are more important yet less understood than outside interventions in intra-state conflicts. Under what circumstances do intervening states further their interests and when, contrarily, do they plunge into quagmires? France is a critical case. It is, statistically, the world’s second intervenor and earned the sobriquet of Africa’s gendarme through frequent interventions in African wars. The ability of such a medium-sized state to intervene with greater regularity and ostensible success than larger powers raises questions about how France manages its interventions. Do French interventions draw on the French Army’s distinctive “school” of population-centric counterinsurgency, which emphasizes the need to militarize governance in pursuit of comprehensive victories? Or do the French Fifth Republic’s civil-military institutions encourage policymakers to carefully regulate force’s employment in pursuit of limited ends? This study draws on declassified archives to test which approach most characterizes French interventions. To preview my conclusions, strategic satisficing—the use of minimal force for short durations to produce satisfactory outcomes—distinguishes the Fifth Republic’s interventions from other powers’ practices and prior French counterinsurgencies. This particular form of interventionism enables France to influence a disproportionately large number of intra-state conflicts and maintain a network of security agreements with African states.PostprintPeer reviewe

Simultaneous multi‐slice cardiac cine with Fourier‐encoded self‐calibration at 7 Tesla

International audiencePurposeTo accelerate cardiac cine at 7 tesla using simultaneous multi‐slice (SMS) acquisition with self‐calibration to resolve misalignment between calibration and imaging data due to breathing motion.MethodsA spoiled‐gradient echo cine sequence was modified with radiofrequency phase‐cycled SMS excitations. A Fourier encoding strategy was applied along the cardiac phase dimension to allow for slice untangling and split‐slice GRAPPA calibration. Split‐slice GRAPPA was coupled with regular GRAPPA (SMS‐GRAPPA) and L1‐SPIRiT (SMS‐L1SPIRiT) for image reconstruction. 3‐slice SMS cine MRI was evaluated in ten subjects against single‐slice cine MRI in terms of SNR and contrast‐to‐noise ratio and slice leakage.ResultsSNR decreased significantly from 10.1 ± 7.1 for single‐slice cine to 7.4 ± 2.8 for SMS‐GRAPPA (P = 0.02) and was recovered to 9.0 ± 4.5 with SMS‐L1SPIRiT (P = 0.02). Contrast to noise ratio decreased significantly from 14.5 ± 8.1 for single‐slice cine to 5.6 ± 3.6 for SMS‐GRAPPA (P < 0.0001) and increased slightly but significantly back to 6.7 ± 4.4 for SMS‐L1SPIRiT (P = 0.03). Specific absorption rate restrictions imposed a reduced nominal flip angle (−37 ± 7%, P = 0.02) for 3‐slice SMS excitations compared to single‐slice acquisitions. SMS slice leakage increased significantly from apex (8.6 ± 6.5 %) to base (13.1 ± 4.1 %, P = 0.03) in the left ventricle.ConclusionThree‐fold acceleration of cine at 7T was achieved using the proposed SMS technique. Fourier encoding self‐calibration and regularized image reconstruction enabled simultaneous acquisition of three slices without significant SNR decrease but significant CNR decrease linked to the reduced nominal excitation flip angle

Etude préliminaire sur l'utilisation de l'Aqui'S® comme anesthésique pour la manipulation et l'échantillonnage de truites arc-en-ciel (Oncorhynchus mykiss) et de truites fario (Salmo trutta)

La cinétique d'anesthésie de truites arc-en-ciel (Oncorhynchus mykiss) avec de l'Aqui'S® a été suivie sur des animaux de différents poids (9, 25 et 200 g). La vitesse d'anesthésie augmente avec la dose d'Aqui'S® utilisée. Aucune mortalité n'a été observée lorsque les concentrations utilisées sont inférieures à 60 ml/m3 d'eau pour une durée d'anesthésie inférieure à 30 min. La cinétique de réveil est également dose dépendante. L'anesthésique a également été testé avec succès sur des truites fario (Salmo trutta) de 190 g. L'anesthésie de truites arc-en-ciel dans le bassin d'élevage (sans pêche des animaux) avec une concentration de 40 ml d'Aqui'S®/m3 d'eau ou dans un bac (après une pêche rapide des animaux) avec une concentration de 100 ml d'Aqui'S®/m3 d'eau ne provoque pas d'augmentation des concentrations plasmatiques de Cortisol par rapport à celles mesurées chez des animaux anesthésiés avec une concentration de 1 l de 2-phénoxyéthanol/m3. Lors d'un transport de truites arc-en-ciel à une densité de 145 kg/m3 pendant 6 heures, l'addition d'Aqui'S® ou de 2-phénoxyéthanol à l'eau des cuves permet d'avoir des animaux en légère sédation. Les concentrations plasmatiques de Cortisol sont significativement plus faibles que celles mesurées chez les animaux transportés sans anesthésique. Cependant, ces concentrations sont significativement supérieures à celles des animaux restés dans le bassin d'élevage. Les animaux transportés sous sédation légère ont repris l'alimentation plus rapidement que les animaux non anesthésiés. Ces travaux, bien que préliminaires, montrent que l'Aqui'S® permet d'obtenir le même type d'anesthésie qu'avec le 2-phénoxyéthanol pour un prix de revient légèrement inférieur

Etude préliminaire sur l'utilisation de l'Aqui'S

La cinétique d'anesthésie de truites arc-en-ciel (Oncorhynchus mykiss) avec de l'Aqui'S® a été suivie sur des animaux de différents poids (9, 25 et 200 g). La vitesse d'anesthésie augmente avec la dose d'Aqui'S® utilisée. Aucune mortalité n'a été observée lorsque les concentrations utilisées sont inférieures à 60 ml/m3 d'eau pour une durée d'anesthésie inférieure à 30 min. La cinétique de réveil est également dose dépendante. L'anesthésique a également été testé avec succès sur des truites fario (Salmo trutta) de 190 g. L'anesthésie de truites arc-en-ciel dans le bassin d'élevage (sans pêche des animaux) avec une concentration de 40 ml d'Aqui'S®/m3 d'eau ou dans un bac (après une pêche rapide des animaux) avec une concentration de 100 ml d'Aqui'S®/m3 d'eau ne provoque pas d'augmentation des concentrations plasmatiques de Cortisol par rapport à celles mesurées chez des animaux anesthésiés avec une concentration de 1 l de 2-phénoxyéthanol/m3. Lors d'un transport de truites arc-en-ciel à une densité de 145 kg/m3 pendant 6 heures, l'addition d'Aqui'S® ou de 2-phénoxyéthanol à l'eau des cuves permet d'avoir des animaux en légère sédation. Les concentrations plasmatiques de Cortisol sont significativement plus faibles que celles mesurées chez les animaux transportés sans anesthésique. Cependant, ces concentrations sont significativement supérieures à celles des animaux restés dans le bassin d'élevage. Les animaux transportés sous sédation légère ont repris l'alimentation plus rapidement que les animaux non anesthésiés. Ces travaux, bien que préliminaires, montrent que l'Aqui'S® permet d'obtenir le même type d'anesthésie qu'avec le 2-phénoxyéthanol pour un prix de revient légèrement inférieur

The predictive performance of the ANCA renal risk score in patients over 65 years of age with renal ANCA-associated vasculitis

International audienceBackground The anti-neutrophil cytoplasmic antibody (ANCA) renal risk score (ARRS) for predicting renal survival in ANCA-associated vasculitis (AAV) had not previously been validated in adults over 65 years of age and presenting impairments associated with an aging kidney, a high cardiovascular comorbidity burden, and prevalent microscopic polyangiitis. Methods We retrospectively studied a cohort of 192 patients over 65 years of age (median [interquartile range] age: 73 [68; 78]), including 17.2% with renal-limited vasculitis, 49.5% with microscopic polyangiitis and 33.3% with granulomatosis with polyangiitis, at six centres of northern France. The primary study endpoint was the cumulative incidence of end-stage kidney disease (ESKD, maintenance of dialysis for at least 3 months) at 12 months, with death considered as a competing event. Results The median serum creatinine concentration at diagnosis was 300 [202; 502] µmol/L, and 48 (25.0%) patients required dialysis at presentation. The ARRS was high in 43 (22.4%) patients, medium in 106 (55.2%), and low in 43 (22.4%). The cumulative incidence of ESKD at 12 months was 0% in the low-risk group, 13.0% [7.6–20.0] in the medium-risk group, and 44.0% [29.0–58.0] in the high-risk group (p &lt; 0.001). In the subgroup of 149 patients presenting a medium or high score, the ARRS had a C-index of 0.66 [0.58–0.74] for the prediction of ESKD at 12 months; this rose to 0.86 [0.80–0.90] when dialysis status at diagnosis was included. Conclusion The ARRS was a poor predictor of kidney survival at 12 months among patients over 65 years of age with renal AAV involvement—especially in the high ARRS group. The addition of dialysis status at diagnosis as an additional clinical parameter might improve the ARRS's predictive performance

Repeat kidney biopsies fail to detect differences between azathioprine and mycophenolate mofetil maintenance therapy for lupus nephritis: data from the MAINTAIN Nephritis Trial

Background. In the MAINTAIN Nephritis Trial, azathioprine (AZA) and mycophenolate mofetil (MMF) were compared as maintenance immunosuppressive treatment of proliferative lupus nephritis (LN) after a short-course of intravenous cyclophosphamide. Here, we compare the pathological findings on repeat kidney biopsies between the two groups. Methods. Per protocol, repeat renal biopsies were obtained in 30 patients (16 AZA and 14 MMF) at 2 years (+/-6 months). Baseline and follow-up biopsies were graded according to the International Society of Nephrology/Renal Pathological Society (ISN/RPS) classification. The activity and chronicity indices (AI, CI) were calculated using two different semiquantitative scoring systems (Morel-Maroger and National Institutes of Health). Statistics were performed by non-parametric tests. Results. The clinical characteristics of the 30 re-biopsied patients only marginally differ from the entire MAINTAIN cohort (105 patients). Clinical baseline and follow-up characteristics of AZA- and MMF-treated re-biopsied patients did not differ. Time (SD) to repeat renal biopsy was 25.0 (2.0) and 26.5 (3.3) months in AZA and MMF patients, respectively. More patients had normal renal biopsies or Classes I/II/V LN at follow-up compared to baseline and conversely, less patients had Class IV LN at follow-up. In both groups, the AI statistically decreased at follow-up compared to baseline, while the CI slightly, but significantly, increased. No differences could be detected between the groups. Conclusion. Centralized pathological analyses, including ISN/RPS classification and comparisons of AI/CI, failed to find differences between MMF and AZA at 2 years, a result well in line with the absence of difference in long-term clinical outcome reported elsewhere

Monocyte Trajectories Endotypes Are Associated With Worsening in Septic Patients

International audienceSepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The immune system plays a key role in sepsis onset and remains dysregulated over time in a heterogeneous manner. Here, we decipher the heterogeneity of the first week evolution of the monocyte HLA-DR (mHLA-DR) surface protein expression in septic patients, a key molecule for adaptive immunity onset. We found and verified four distinctive trajectories endotypes in a discovery (n = 276) and a verification cohort (n = 102). We highlight that 59% of septic patients exhibit low or decreasing mHLA-DR expression while in others mHLA-DR expression increased. This study depicts the first week behavior of mHLA-DR over time after sepsis onset and shows that initial and third day mHLA-DR expression measurements is sufficient for an early risk stratification of sepsis patients. These patients might benefit from immunomodulatory treatment to improve outcomes. Going further, our study introduces a way of deciphering heterogeneity of immune system after sepsis onset which is a first step to reach a more comprehensive landscape of sepsis

Significance of eosinophilia in granulomatosis with polyangiitis: data from the french vasculitis study group registry

To describe disease presentation and long-term outcome of granulomatosis with polyangiitis (GPA) patients according to blood eosinophils count (Eos) at vasculitis diagnosis

A stratification strategy to predict secondary infection in critical illness-induced immune dysfunction: the REALIST score

International audienceBackground Although multiple individual immune parameters have been demonstrated to predict the occurrence of secondary infection after critical illness, significant questions remain with regards to the selection, timing and clinical utility of such immune monitoring tests. Research question As a sub-study of the REALISM study, the REALIST score was developed as a pragmatic approach to help clinicians better identify and stratify patients at high risk for secondary infection, using a simple set of relatively available and technically robust biomarkers. Study design and methods This is a sub-study of a single-centre prospective cohort study of immune profiling in critically ill adults admitted after severe trauma, major surgery or sepsis/septic shock. For the REALIST score, five immune parameters were pre-emptively selected based on their clinical applicability and technical robustness. Predictive power of different parameters and combinations of parameters was assessed. The main outcome of interest was the occurrence of secondary infection within 30 days. Results After excluding statistically redundant and poorly predictive parameters, three parameters remained in the REALIST score: mHLA-DR, percentage of immature (CD10 − CD16 − ) neutrophils and serum IL-10 level. In the cohort of interest ( n = 189), incidence of secondary infection at day 30 increased from 8% for patients with REALIST score of 0 to 46% in patients with a score of 3 abnormal parameters, measured ad D5–7. When adjusted for a priori identified clinical risk factors for secondary infection (SOFA score and invasive mechanical ventilation at D5–7), a higher REALIST score was independently associated with increased risk of secondary infection (42 events (22.2%), adjusted HR 3.22 (1.09–9.50), p = 0.034) and mortality (10 events (5.3%), p = 0.001). Interpretation We derived and presented the REALIST score, a simple and pragmatic stratification strategy which provides clinicians with a clear assessment of the immune status of their patients. This new tool could help optimize care of these individuals and could contribute in designing future trials of immune stimulation strategies