Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series

BACKGROUND: Opportunistic invasive fungal infections are increasingly frequent in intensive care patients. Their clinical spectrum goes beyond the patients with malignancies, and for example invasive pulmonary aspergillosis has recently been described in critically ill patients without such condition. Liver failure has been suspected to be a risk factor for aspergillosis. CASE PRESENTATION: We describe three cases of adult respiratory distress syndrome with sepsis, shock and multiple organ failure in patients with severe liver failure among whom two had positive Aspergillus antigenemia and one had a positive Aspergillus serology. In all cases bronchoalveolar lavage fluid was positive for Aspergillus fumigatus. Outcome was fatal in all cases despite treatment with voriconazole and agressive symptomatic treatment. CONCLUSION: Invasive aspergillosis should be among rapidly raised hypothesis in cirrhotic patients developing acute respiratory symptoms and alveolar opacities

Comparative Microsatellite Typing of New World Leishmania infantum Reveals Low Heterogeneity among Populations and Its Recent Old World Origin

Leishmania infantum (syn. L. chagasi) is the causative agent of visceral leishmaniasis (VL) in the New World (NW) with endemic regions extending from southern USA to northern Argentina. The two hypotheses about the origin of VL in the NW suggest (1) recent importation of L. infantum from the Old World (OW), or (2) an indigenous origin and a distinct taxonomic rank for the NW parasite. Multilocus microsatellite typing was applied in a survey of 98 L. infantum isolates from different NW foci. The microsatellite profiles obtained were compared to those of 308 L. infantum and 20 L. donovani strains from OW countries previously assigned to well-defined populations. Two main populations were identified for both NW and OW L. infantum. Most of the NW strains belonged to population 1, which corresponded to the OW MON-1 population. However, the NW population was much more homogeneous. A second, more heterogeneous, population comprised most Caribbean strains and corresponded to the OW non-MON-1 population. All Brazilian L. infantum strains belonged to population 1, although they represented 61% of the sample and originated from 9 states. Population analysis including the OW L. infantum populations indicated that the NW strains were more similar to MON-1 and non-MON-1 sub-populations of L. infantum from southwest Europe, than to any other OW sub-population. Moreover, similarity between NW and Southwest European L. infantum was higher than between OW L. infantum from distinct parts of the Mediterranean region, Middle East and Central Asia. No correlation was found between NW L. infantum genotypes and clinical picture or host background. This study represents the first continent-wide analysis of NW L. infantum population structure. It confirmed that the agent of VL in the NW is L. infantum and that the parasite has been recently imported multiple times to the NW from southwest Europe

Many Labs 2: Investigating Variation in Replicability Across Samples and Settings

We conducted preregistered replications of 28 classic and contemporary published findings, with protocols that were peer reviewed in advance, to examine variation in effect magnitudes across samples and settings. Each protocol was administered to approximately half of 125 samples that comprised 15,305 participants from 36 countries and territories. Using the conventional criterion of statistical significance (p < .05), we found that 15 (54%) of the replications provided evidence of a statistically significant effect in the same direction as the original finding. With a strict significance criterion (p < .0001), 14 (50%) of the replications still provided such evidence, a reflection of the extremely highpowered design. Seven (25%) of the replications yielded effect sizes larger than the original ones, and 21 (75%) yielded effect sizes smaller than the original ones. The median comparable Cohen’s ds were 0.60 for the original findings and 0.15 for the replications. The effect sizes were small (< 0.20) in 16 of the replications (57%), and 9 effects (32%) were in the direction opposite the direction of the original effect. Across settings, the Q statistic indicated significant heterogeneity in 11 (39%) of the replication effects, and most of those were among the findings with the largest overall effect sizes; only 1 effect that was near zero in the aggregate showed significant heterogeneity according to this measure. Only 1 effect had a tau value greater than .20, an indication of moderate heterogeneity. Eight others had tau values near or slightly above .10, an indication of slight heterogeneity. Moderation tests indicated that very little heterogeneity was attributable to the order in which the tasks were performed or whether the tasks were administered in lab versus online. Exploratory comparisons revealed little heterogeneity between Western, educated, industrialized, rich, and democratic (WEIRD) cultures and less WEIRD cultures (i.e., cultures with relatively high and low WEIRDness scores, respectively). Cumulatively, variability in the observed effect sizes was attributable more to the effect being studied than to the sample or setting in which it was studied.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Composition et structure de la vegetation aux bordures entre friches post-culturales et vegetation steppique dans la plaine de Crau (Bouches-du-Rhône)

Melon cultivation (1965-1985) greatly disturbed the composition, structure and species richness of the steppe vegetation, in the plain of La Crau, where a patch of the only Mediterranean steppe in France remains. In order to assess the autogenic restoration of ex-melon fields, three fields, all adjacent to a patch ofsteppe, were studied On each field, vegetation, seed bank, seed rain, seed dispersal by ants and some habitat variables were sampled along three transects perpendicular to field boundaries. Our results show that, 20 years after the abandonment of cultivation, only a few steppe species had colonised the first three meters of field margins. The autogenic restoration of ex-melon fields is thus extremely slow. We discuss possibilities for ecological restoration by sowing or transplanting keystone species in order to identify the factors responsible for this limited autogenic restoration.Dans la plaine de Crau, où persistent encore 11 500 ha d'une formation végétale considérée comme la seule steppe de France, les cultures de melons (1965-1985) ont constitué une forte perturbation ayant gravement altérée la composition floristique, la richesse spécifique et la structure de la végétation (Romermann et al., ce volume). Dans le but d'évaluer les capacités de restauration spontanée des friches post-culturales, 3 friches adjacentes à une parcelle de steppe ont été étudiées. Pour chacune de ces friches, à partir de trois transects perpendiculaires aux bordures entre la steppe et le centre des friches, la végétation exprimée, la banque de graines permanente, la pluie de graines, la dispersion des graines par les fourmis et certaines variables d'habitat ont été échantillonnées. Nos résultats montrent que quelques espèces de la steppe colonisent les friches à partir de la bordure, mais seulement sur de très faibles distances (3 m en moyenne), même après plusieurs dizaines d'années d'abandon des pratiques culturales. La restauration spontanée des friches à partir de la steppe sera donc extrêmement lente. Afin d'accélérer ce processus, nous discutons de la possibilité de mettre en place de véritables opérations de restauration écologique par semis et transplantation d'espèces clés afin de discriminer et hiérarchiser les facteurs responsables de leur non installation dans les friches.Buisson Elise, Dutoit Thierry, Rolando Christiane. Composition et structure de la vegetation aux bordures entre friches post-culturales et vegetation steppique dans la plaine de Crau (Bouches-du-Rhône). In: Ecologia mediterranea, tome 30 n°1, 2004. Biologie de la conservation et gestion des espaces naturels en Crau / Biological conservation and management of the natural areas in the Crau. pp. 71-84

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International audienc

La| gestion du risque de taux d'intérêt

International audienc

Histoire culturale de la Crau : potentialités de ré-établissement des espèces caractéristiques du coussous après abandon

In Europe, the present landscape has been mainly influenced by human activities. Especially for dry semi-natural grasslands, agricultural intensification led to a considerable habitat loss and fagmentation. In the Crau, large parts of the former 60,000 ha semi-natural steppe vegetation (coussous) have been transformed into arable, industrial and military land during the 20th century. However, in the 1980s, most of the cereal and melon fields have been abandoned and sheep grazing has been reintroduced. The current study investigates the effects of historical melon and cereal cultivation on the steppe vegetation and the potential of characteristic coussous species to re-establish after abandonment. At four sites of central Crau, vegetation sampling has been carried out on the different vegetation types (coussous, melon and cereal fllows) using the frequency method. Soil samples were taken and analysed. At one site, seed bank studies were performed. As related to seed bank persistence, dormancy traits were examined for 26 characteristic steppe species. Decades after abandonment, the vegetation of coussous, abandoned cereal and abandoned melon fields are still very different from each other : Due to former fertiliser application, ex-cultivated cereal and melon fields still showed enhanced nutrient levels (N, P, K, Ca, pH). The seed bank of the coussous is dominated by transient species while abandoned field seed banks are dominated by persistent seeds of ruderal species. The germination studies confirmed the absence of dormancy mechanisms for seeds of most coussous species. The successful reestablishment of coussous species in abandoned fields seemed to be hampered by still modified abiotic conditions. More, most coussous species do not build up a persistent soil seed bank and can, therefore, not survive cultivation periods. Species dispersal between coussous and adjacent ex-cultivated fields appeared to be a limiting fctor, too. For following studies complete species lists of ex-cultivated fields and the coussous are providedEn Europe, les paysages actuels ont été en grande partie influencés par les activités humaines. Ainsi, pour les paysages de pelouses sèches, l'intensification des pratiques agricoles a entraîné une perte considérable et une fragmentation importante des habitats. Dans la plaine de Crau, de grandes zones de la steppe semi-naturelle (coussous) ont été transformées en surfaces cultivées, industrielles et militaires durant le XXe siècle. Cependant, dans les années 80, la plupart des cultures de céréales et de melons ont été abandonnées au profit d'un retour au pâturage ovin. Le présent travail a pour objectif de rechercher, d'une part, les effets des cultures de melons et de céréales anciennes sur la végétation steppique et, d'autre part, les potentialités de ré-établissement dans les fiches des espèces steppiques les plus caractéristiques. Dans quatre sites du centre de la Crau, la végétation a été échantillonnée dans différents types de parcelles (coussous, fiches melonnières et céréalières) par la méthode des quadrats. Des échantillons de sol ont également été prélevés et analysés. Pour un site, la banque de graines a été étudiée. En liaison avec la viabilité de la banque de graines dans le sol, les traits biologiques relatifs à la dormance ont été examinés pour 26 espèces caractéristiques de la steppe. Quelques décennies après l'abandon cultural, la végétation des coussous, fiches melonnières et céréalières est très différente. Suite à l'épandage d'engrais et à des labours profonds, les fiches melonnières et céréalières possèdent des teneurs supérieures en éléments minéraux (N, P205, K2 0, CaO). La banque de graines du coussous est dominée par des espèces à viabilité transitoire ( 5 ans) d'espèces rudérales. Les tests de germination confirment l'absence de dormance pour la plupart des espèces du coussous. Le ré-établissement des espèces du coussous dans les champs abandonnés semble ralenti par des changements dans les conditions abiotiques. La plupart des espèces du coussous ne possèdent pas de banque de graines, et donc, ces espèces ne peuvent pas survivre à des périodes de cultures. Les processus de dissémination des espèces entre les coussous et les champs anciennement cultivés apparaissent également comme un facteur limitant. Pour des études futures, des listes complètes d'espèces des fiches et des coussous sont fournies en annexes.Römermann Christine, Bernhardt Markus, Dutoit Thierry, Poschlod Peter, Rolando Christiane. Histoire culturale de la Crau : potentialités de ré-établissement des espèces caractéristiques du coussous après abandon. In: Ecologia mediterranea, tome 30 n°1, 2004. Biologie de la conservation et gestion des espaces naturels en Crau / Biological conservation and management of the natural areas in the Crau. pp. 47-70