Informatique pour les systèmes d'aide à la gestion du trafic : éléments pour un guide technique

Ce rapport vient compléter la liste de documents constituant le corpus technique relatif à l’application du schéma directeur d’exploitation de la route pour les infrastructures classées en niveau 1A. Ce document est avant tout destiné aux DDE qui vont mettre en place un Système d’Aide à la Gestion du Trafic (SAGT) de niveau 1 (réseau de voies rapides urbaines), mais il devrait aussi intéresser les services qui ont déjà mis en place un SAGT, et plus largement d’autres exploitants qui ont mis ou mettent en place des SAGT pour exploiter le trafic sur d’autres types de réseaux, car une bonne partie des problèmes dépasse le seul besoin du SDER (Schéma Directeur de l’Exploitation Routière) de niveau 1, ainsi que les sociétés d’ingénierie et de service qui interviennent dans la définition, la conception et la fourniture de ces systèmes.Ce document est une première version, encore incomplète, de ce qui pourrait constituer un guide technique pour l’informatique du SDER de niveau 1. Il a été constitué sur la base des comptes-rendus du groupe de travail « informatique SAGT » que le CERTU anime depuis juin 98, et de réflexions engagées par le CERTU parallèlement aux activités du groupe, en vue de capitaliser les connaissances accumulées et en améliorer la réutilisation pour les projets à venir. Pour améliorer la version actuelle et mieux répondre aux attentes du public auquel cette étude est destinée, nous remercions d’avance les lecteurs de nous faire part de toutes leurs remarques, critiques et suggestions.Le document décrit d’abord les phases du cycle de vie d’un SAGT puis ses principales fonctions, et liste un certain nombre de recommandations ou remarques issues du groupe de travail « informatique SAGT » animé par le CERTU. Des documents complémentaires figurent en annexe

The role of water fittings in intensive care rooms as reservoirs for the colonization of patients with Pseudomonas aeruginosa

International audienceOBJECTIVE: To assess the role of the water environment in the Pseudomonas aeruginosa colonization of patients in intensive care units in the absence of a recognized outbreak. DESIGN AND SETTING: Prospective, single-centre study over an 8-week period in two adult ICUs at a university hospital. Environmental samples were taken from the water fittings of rooms once per week, during a 8-week period. Patients were screened weekly for P. aeruginosa carriage. Environmental and humans isolates were genotyped by using pulsed-field gel electrophoresis. RESULTS: P. aeruginosa was detected in 193 (86.2%) of the 224 U-bend samples and 10 of the 224 samples taken from the tap (4.5%). Seventeen of the 123 patients admitted were colonized with P. aeruginosa. Only one of the 14 patients we were able to evaluate was colonized by a clone present in the water environment of his room before the patient's first positive sample was obtained. CONCLUSION: The role of the water environment in the acquisition of P. aeruginosa by intensive care patients remains unclear, but water fittings seem to play a smaller role in non-epidemic situations than expected by many operational hospital hygiene teams

Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine.

OBJECTIVE: Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock. METHODS: The European Society of Intensive Care Medicine invited 12 experts to form a Task Force to update a previous consensus (Antonelli et al.: Intensive Care Med 33:575-590, 2007). The same five questions addressed in the earlier consensus were used as the outline for the literature search and review, with the aim of the Task Force to produce statements based on the available literature and evidence. These questions were: (1) What are the epidemiologic and pathophysiologic features of shock in the intensive care unit ? (2) Should we monitor preload and fluid responsiveness in shock ? (3) How and when should we monitor stroke volume or cardiac output in shock ? (4) What markers of the regional and microcirculation can be monitored, and how can cellular function be assessed in shock ? (5) What is the evidence for using hemodynamic monitoring to direct therapy in shock ? Four types of statements were used: definition, recommendation, best practice and statement of fact. RESULTS: Forty-four statements were made. The main new statements include: (1) statements on individualizing blood pressure targets; (2) statements on the assessment and prediction of fluid responsiveness; (3) statements on the use of echocardiography and hemodynamic monitoring. CONCLUSIONS: This consensus provides 44 statements that can be used at the bedside to diagnose, treat and monitor patients with shock

Echocardiography practice, training and accreditation in the intensive care: document for the World Interactive Network Focused on Critical Ultrasound (WINFOCUS)

Echocardiography is increasingly used in the management of the critically ill patient as a non-invasive diagnostic and monitoring tool. Whilst in few countries specialized national training schemes for intensive care unit (ICU) echocardiography have been developed, specific guidelines for ICU physicians wishing to incorporate echocardiography into their clinical practice are lacking. Further, existing echocardiography accreditation does not reflect the requirements of the ICU practitioner. The WINFOCUS (World Interactive Network Focused On Critical UltraSound) ECHO-ICU Group drew up a document aimed at providing guidance to individual physicians, trainers and the relevant societies of the requirements for the development of skills in echocardiography in the ICU setting. The document is based on recommendations published by the Royal College of Radiologists, British Society of Echocardiography, European Association of Echocardiography and American Society of Echocardiography, together with international input from established practitioners of ICU echocardiography. The recommendations contained in this document are concerned with theoretical basis of ultrasonography, the practical aspects of building an ICU-based echocardiography service as well as the key components of standard adult TTE and TEE studies to be performed on the ICU. Specific issues regarding echocardiography in different ICU clinical scenarios are then described

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 < 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

Analyse génétique des souches multi-résistantes de Pseudomonas aeruginosa dans l'Est de la France (apport prédictif sur le risque infectieux)

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

Épidémiologie des infections à Pseudomonas aeruginosa

International audienceBackground Meticillin-resistant Staphylococcus aureus (MRSA) has spread throughout the world and has become highly endemic worldwide. The need for implementing MRSA control strategies is no longer a matter of debate. Aim To determine the temporal association between various infection control practices, the use of antibiotics and the incidence of MRSA in a 1200-bed French university hospital. Methods A multi-variate time-series analysis, based on monthly data from a nine-year period (January 2000-December 2008), was performed in a 1200-bed French university hospital to determine the temporal association between different variables and the incidence of MRSA. MRSA colonization pressure, infection control practices and use of antibiotics were considered in the analysis. Findings Time-series analysis showed a positive significant relationship between the incidence of hospital-acquired MRSA (HA-MRSA) and MRSA colonization pressure, the use of antibiotics (fluoroquinolones, macrolides and aminoglycosides) and the use of gloves. Conversely, a global negative correlation was observed between the incidence of HA-MRSA and the use of alcohol-based hand rub. Overall, the model explained 40.5% of the variance in the monthly incidence of MRSA. Conclusion This study showed that admission of patients with MRSA, the use of antibiotics and infection control practices contributed to the incidence of HA-MRSA. This suggests that efforts should be focused on high compliance with hand disinfection. These results also raise concerns about the use of gloves when caring for patients with MRSA

To what extent can secondary mineral resources replace primary mineral resources?

International audienceNew regulations in France attempt to take into account a circular economy in order to regulate the material flows from quarries. The southeast region of PACA was chosen to develop a large-scale model of primary resources versus secondary resources. Based on an exhaustive inventory of installations, this study identifies brakes and levers to develop secondary resources uses and simulates various scenarios for the next 14 years in order to assist in the political decision-making process. All secondary mineral resources that can be used as substitutes for quarry materials have been studied (e.g. track ballasts, excavated soils, glasses) but the presentation will focus on aggregates and their substitutes. While this resource represents the main volume of mineral material transported within the region, it is the one for which the recycled materials rate of use is the lowest. In 2015, secondary materials represented only 3.7 million tons, out of the 24.5 million tons of aggregates produced in the region. In order to increase the proportion of recycled materials used in construction sites, an inventory has been carried out. More than 200 installations were surveyed (recycling platforms, industries, quarries, landfills) to identify as precisely as possible the volumes involved, the capacities, the market difficulties. More than 50 project owners were interviewed in order to take into account the trend and nugget effects (major construction sites) in the future to determine the future gravel requirements and their position on the use of recycled materials. The presentation will show the results of this broad survey by highlighting the main locks and levers identified. Following this observation, scenarios will be presented proposing important recycling rates for the coming years. For each recycling rate, the means to be implemented is identified. This may involve the opening of new recycling platforms but also new technology requirements. For example, at present, few recycled gravels are used in construction materials such as concrete and this could be increased. The presentation will develop the levers identified (technological barriers, taxation, social acceptability, political issues) and the results of the projection according to the scenario chosen

Application des méthodes de typage génomique au laboratoire d'hygiène

International audienceL'étude de l'épidémiologie des infections doit permettre d'identifier le mode d'acquisition du micro-organisme responsable, les modes de transmission, la dynamique de la colonisation, et les facteurs de risque d'infection. Ce type d'étude suppose que la comparaison des souches isolées des malades et de leur environnement permette d'établir leur degré de similitude génétique. C'est dans ce cadre que se placent le développement et l'évaluation des marqueurs phénotypiques et génotypiques et la validation des stratégies de typage adaptées aux différents micro-organismes impliqués dans les infections nosocomiales et communautaires

Hemodynamic monitoring using echocardiography in the critically ill

info:eu-repo/semantics/publishe