APPRENDRE DU PASSE POUR OPTIMISER LA PREVENTION ET LA GESTION DES INONDATIONS SUR LE FERROVIAIRE

International audienceArchives records dealing with historical floods constitute a remarkable heritage for railway system analysis, but they are under-exploited. This article deals with their interest. Then a methodology to build a chronological synthesis from historical records is presented. Finally, the advantages of geovisualisation, as a tool to ease the exploitation of historical information, are presented.Les archives sur les inondations historiques constituent un patrimoine riche pour l'analyse du système ferroviaire, mais actuellement sous-exploité. Nous expliquons ce qu'elles peuvent apporter, puis nous présentons une méthode de synthèse des données issues d'archives. Enfin, nous présentons les apports de la géovisualisation, comme outil pour faciliter l'utilisation de l'information historique

Unusual Transmission of Plasmodium falciparum, Bordeaux, France, 2009

Plasmodium falciparum malaria is usually transmitted by mosquitoes. We report 2 cases in France transmitted by other modes: occupational blood exposure and blood transfusion. Even where malaria is not endemic, it should be considered as a cause of unexplained acute fever

Prospective, observational, multicenter study on minimally invasive gastrectomy for gastric cancer: robotic, laparoscopic and open surgery compared on operative and follow-up outcomes - IMIGASTRIC II study protocol: IMIGASTRIC II

Background:Several meta-analyses have tried to defi ne the role of minimally invasive approaches. However, further evidence to get a wider spread of these methods is necessary. Current studies describe minimally invasive surgery as a possible alternative to open surgery but deserving further clarifi cation. However, despite the increasing interest, the difficulty of planning prospective studies of adequate size accounts for the low level of evidence, which is mostly based on retrospective experiences.A multi-institutional prospective study allows the collection of an impressive amount of data to investigate various aspects of minimally invasive procedures with the opportunity of developing several subgroup analyses.A prospective data collection with high methodological quality on minimally invasive and open gastrectomies can clarify the role of diff erent procedures with the aim to develop specifi c guidelines.Methods and analysis:a multi-institutional prospective database will be established including information on surgical, clinical and oncological features of patients treated for gastric cancer with robotic, laparoscopic or open approaches and subsequent follow-up.The study has been shared by the members of the International study group on Minimally Invasive surgery for GASTRIc Cancer (IMIGASTRIC)The database is designed to be an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centers.Ethics:This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevantlaws/regulations.Trial registration number:NCT0275108

a planned ancillary analysis of the coVAPid cohort

Funding: This study was supported in part by a grant from the French government through the «Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). The funders of the study had no role in the study design, data collection, analysis, or interpreta tion, writing of the report, or decision to submit for publication.BACKGROUND: Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. FINDINGS: Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16-2.47), p = 0.006), and influenza groups (1.75 (1.03-3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64-1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. INTERPRETATION: VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov, number NCT04359693.publishersversionpublishe

Novel Blood Pressure Locus and Gene Discovery Using Genome-Wide Association Study and Expression Data Sets From Blood and the Kidney.

Elevated blood pressure is a major risk factor for cardiovascular disease and has a substantial genetic contribution. Genetic variation influencing blood pressure has the potential to identify new pharmacological targets for the treatment of hypertension. To discover additional novel blood pressure loci, we used 1000 Genomes Project-based imputation in 150 134 European ancestry individuals and sought significant evidence for independent replication in a further 228 245 individuals. We report 6 new signals of association in or near HSPB7, TNXB, LRP12, LOC283335, SEPT9, and AKT2, and provide new replication evidence for a further 2 signals in EBF2 and NFKBIA Combining large whole-blood gene expression resources totaling 12 607 individuals, we investigated all novel and previously reported signals and identified 48 genes with evidence for involvement in blood pressure regulation that are significant in multiple resources. Three novel kidney-specific signals were also detected. These robustly implicated genes may provide new leads for therapeutic innovation

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

Monitoreo de servicios ecosistémicos en un observatorio de cafetales agroforestales. Recomendaciones para el sector cafetalero

Ocho años de estudio de la ecofisiología del café, a través de experimentación y de modelación y el monitoreo de los servicios del ecosistema (SE) en una gran finca cafetalera en Costa Rica, revelaron varias recomendaciones prácticas para los agricultores y los formuladores de políticas. El sistema de cultivo estudiado dentro de nuestro observatorio colaborativo (Coffee-Flux), corresponde a un sistema agroforestal (SAF) a base de café bajo la sombra de grandes árboles de Erythrina poeppigiana (16% de la cubierta del dosel). Una gran cantidad de SE y limitantes dependen de las propiedades locales del suelo (en este caso Andisoles), especialmente de la erosión/infiltración, el agua/carbono y la capacidad de almacenamiento de nutrientes. Por lo tanto, para la evaluación de SE, el tipo de suelo es crucial. Una densidad adecuada de árboles de sombra (bastante baja aquí por la condición de libre crecimiento), redujo la severidad de las enfermedades de las hojas con la posibilidad de reducir el uso de plaguicidas y fungicidas. Un inventario simple del área basal en el collar de las plantas de café permitió estimar la biomasa subterránea y la edad promedio de la plantación, para juzgar su valor de mercado y decidir cuándo reemplazarla. Las fincas de café probablemente estén mucho más cerca de la neutralidad de C que lo indicado en el protocolo actual de C-neutralidad, que solo considera árboles de sombra, no los cafetos ni el suelo. Se proponen evaluaciones más completas, que ncluyen árboles, café, hojarasca, suelo y raíces en el balance C del SAF. Los árboles de sombra ofrecen muchos SE si se gestionan adecuadamente en el contexto local. En comparación con las condiciones a pleno sol, los árboles de sombra pueden (i) reducir la erosión laminar en un factor de 2; (ii) aumentar la fijación de N y el % de N reciclado en el sistema, reduciendo así los requisitos de fertilizantes; (iii) reducir la severidad de enfermedades de las hojas; (iv) aumentar el secuestro de C; (v) mejorar el microclima y (vi) reducir sustancialmente los efectos del cambio climático. En nuestro estudio de caso, no se encontró ningún efecto negativo sobre el rendimiento del café

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)