GeoHealth and QuickOSM, two QGIS plugins for health applications

International audienceMaps and spatial analyses are increasingly used in the field of health to illustrate the spatial and temporal organization of data and to provide a geographical perspective on health data. Geographic Information Systems (GIS), and geomatics tools in general, are thus used by health organizations (local or international) to inform on the distribution of diseases, by managers to monitor and control epidemics, and by doctors and researchers to understand disease distributions. Scientific publications in the field of health also show the widespread use of spatial maps and analyses. Major organizations such as the World Health Organization, ministries of health in many countries, and research organizations have set up GIS laboratories with geomaticians or health geographers to conduct these tasks. However, many organizations do not have in-house expertise and still wish to conduct such analyses. More and more people in the field of health are thus being trained in geomatics, but implementation remains difficult due to the complexity of the tools and the often sporadic use

Deux extensions de QGIS pour des applications en santé : GeoHealth et QuickOSM

International audienceDeux extensions de QGIS pour des applications en santé : GeoHealth et QuickOSM 7.1. Contexte de l'utilisation des SIG en santé et du développement d'extensions dédiées à la santé dans QGIS Les cartes et les analyses spatiales sont de plus en plus utilisées dans le domaine de la santé pour illustrer l'organisation spatio-temporelle des données et permettre un regard géographique sur les données sanitaires. Les systèmes d'information géographique (SIG), et plus généralement les outils de la géomatique, sont ainsi utilisés par les organisations de santé (locales ou internationales) pour informer sur la distribution des maladies, par les gestionnaires pour suivre et contrôler les épidémies, et par les médecins et les chercheurs pour comprendre les distributions des maladies. Les cartes et les analyses spatiales sont aujourd'hui régulièrement utilisées dans les publications scientifiques du domaine de la santé. Les grandes organisations comme l'Organisation mondiale de la santé, les ministères de la Santé de nombreux pays, des organismes de recherche, comme les Instituts Pasteur, se sont dotés de « cellules SIG » avec des géomaticiens ou des géographes de la santé pour réaliser ces tâches. Toutefois, beaucoup d'organismes n'ont pas les compétences en interne et souhaitent tout de même réaliser de telles analyses. De plus en plus de personnes du domaine de la santé se forment ainsi à la géomatique, mais n'en faisant usage que ponctuellement et avec des outils complexes, la mise en pratique reste concrètement difficile. Chapitre rédigé par Vincent HERBRETEAU, Christophe RÉVILLION et Étienne TRIMAILLE

Surface tension of cavitation bubbles

International audienceWe have studied homogeneous cavitation in liquid nitrogen and normal liquid helium. We monitor the fluid content in a large number of independent mesopores with an ink-bottle shape, either when the fluid in the pores is quenched to a constant pressure or submitted to a pressure decreasing at a controlled rate. For both fluids, we show that, close enough to their critical point, the cavitation pressure threshold is in good agreement with the Classical Nucleation Theory (CNT). In contrast, at lower temperatures, deviations are observed, consistent with a reduction of the surface tension for bubbles smaller than two nanometers in radius. For nitrogen, we could accurately measure the nucleation rate as a function of the liquid pressure down to the triple point, where the critical bubble radius is about one nanometer. We find that CNT still holds, provided that the curvature dependence of the surface tension is taken into account. Furthermore, we evaluate the first- and second-order corrections in curvature, which are in reasonable agreement with recent calculations for a Lennard-Jones fluid

Evaporation process in porous silicon: cavitation vs pore-blocking

International audienceWe have measured sorption isotherms for helium and nitrogen in wide temperature ranges and for a series of porous silicon samples, both native samples and samples with reduced pore mouth so that the pores have an ink-bottle shape. Combining volumetric measurements and sensitive optical techniques, we show that, at high temperature, homogeneous cavitation is the relevant evaporation mechanism for all samples. At low temperature, the evaporation is controlled by meniscus recession, the detailed mechanism being dependent on the pore length and on the mouth reduction. Native samples and samples with ink-bottle pores shorter than one micrometer behave as an array of independent pores. In contrast, samples with long ink-bottle pores exhibit long-range correlations between pores. In this latter case, evaporation takes place by a collective percolation process and not by heterogeneous cavitation as previously proposed. The variety of evaporation mechanisms points to porous silicon being an anisotropic three dimensional pore network rather than an array of straight independent pores

Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort study

International audienceBackground: Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events.Methods: From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097).Findings: Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p < 0.001). Similar results were found after adjustment for comorbidities (hazard ratio [HR] [95% confidence interval (CI)]): 5.92 [2.43-14.38]) or parameters of in-hospital severity (HR 6.09, 95% CI [2.51-14.80]) and propensity score matching (HR 7.46, 95% CI [1.70-32.8]). CO > 11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56-44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06-28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33-6.98] and 1.66 [0.96-2.85] respectively).Interpretation: Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events

Prevalence and impact of recreational drug use in patients with acute cardiovascular events

International audienceObjective While recreational drug use is a risk factor for cardiovascular events, its exact prevalence and prognostic impact in patients admitted for these events are not established. We aimed to assess the prevalence of recreational drug use and its association with in-hospital major adverse events (MAEs) in patients admitted to intensive cardiac care units (ICCU).Methods In the Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study, systematic screening for recreational drugs was performed by prospective urinary testing all patients admitted to ICCU in 39 French centres from 7 to 22 April 2021. The primary outcome was prevalence of recreational drug detection. In-hospital MAEs were defined by death, resuscitated cardiac arrest, or haemodynamic shock.Results Of 1499 consecutive patients (63±15 years, 70% male), 161 (11%) had a positive test for recreational drugs (cannabis 9.1%, opioids 2.1%, cocaine 1.7%, amphetamines 0.7%, 3,4-methylenedioxymethamphetamine (MDMA) 0.6%). Only 57% of these patients declared recreational drug use. Patients who used recreational drugs exhibited a higher MAE rate than others (13% vs 3%, respectively, p<0.001). Recreational drugs were associated with a higher rate of in-hospital MAEs after adjustment for comorbidities (OR 8.84, 95% CI 4.68 to 16.7, p<0.001). After adjustment, cannabis, cocaine, and MDMA, assessed separately, were independently associated with in-hospital MAEs. Multiple drug detection was frequent (28% of positive patients) and associated with an even higher incidence of MAEs (OR 12.7, 95% CI 4.80 to 35.6, p<0.001).Conclusion The prevalence of recreational drug use in patients hospitalised in ICCU was 11%. Recreational drug detection was independently associated with worse in-hospital outcomes. Clinical trial registration NCT05063097 .Clinical trial registration NCT05063097

Prevalence of psychoactive drug use in patients hospitalized for acute cardiac events: Rationale and design of the ADDICT-ICCU trial, from the Emergency and Acute Cardiovascular Care Working Group and the National College of Cardiologists in Training of the French Society of Cardiology

International audienceBackground: Psychoactive drugs, including illicit drugs, are associated with an increased rate of cardiovascular events. The prevalence and outcome of patients using these drugs at the time of admission to an intensive cardiac care unit is unknown.Aim: To assess the prevalence of psychoactive drugs detected in consecutive patients hospitalized in an intensive cardiac care unit for an acute cardiovascular event.Methods: This is a nationwide prospective multicentre study, involving 39 centres throughout France, including all consecutive patients hospitalized in an intensive cardiac care unit within 2weeks. Psychoactive drug use will be assessed systematically by urine drug assay within 2hours of intensive cardiac care unit admission, to detect illicit (cannabinoids, cocaine, amphetamines, ecstasy, heroin and other opioids) and non-illicit (barbiturates, benzodiazepines, tricyclic antidepressants, methadone and buprenorphine) psychoactive drugs. Smoking will be investigated systematically by exhaled carbon monoxide measurement, and alcohol consumption using a standardized questionnaire. In-hospital major adverse events, including death, resuscitated cardiac arrest and cardiogenic shock, will be recorded. After discharge, all-cause death and major adverse cardiovascular events will be recorded systematically and adjudicated at 12months of follow-up.Results: The primary outcome will be the prevalence of psychoactive drugs detected by systematic screening among all patients hospitalized in an intensive cardiac care unit. The in-hospital major adverse events will be analysed according to the presence or absence of detected psychoactive drugs. Subgroup analysis stratified by initial clinical presentation and type of psychoactive drug will be performed.Conclusions: This is the first prospective multicentre study to assess the prevalence of psychoactive drugs detected by systematic screening in consecutive patients hospitalized for acute cardiovascular events

Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry

Background The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline‐directed heart failure (HF) medical therapy (GDMT) and one‐year survival rate in patients who are post‐CS. Methods and Results FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in‐hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta‐blockers, renin‐angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P<0.001 and 29% versus 37%, P<0.001, respectively). In the overall cohort, the one‐year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one‐year all‐cause mortality compared with non‐triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19–0.80]; P=0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one‐year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P<0.001). Conclusions In survivors of CS, the one‐year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS

Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry

International audienceBackground The effects of pharmacological therapy on cardiogenic shock (CS) survivors have not been extensively studied. Thus, this study investigated the association between guideline‐directed heart failure (HF) medical therapy (GDMT) and one‐year survival rate in patients who are post‐CS. Methods and Results FRENSHOCK (French Observatory on the Management of Cardiogenic Shock in 2016) registry was a prospective multicenter observational survey, conducted in metropolitan French intensive care units and intensive cardiac care units. Of 772 patients, 535 patients were enrolled in the present analysis following the exclusion of 217 in‐hospital deaths and 20 patients with missing medical records. Patients with triple GDMT (beta‐blockers, renin‐angiotensin system inhibitors, and mineralocorticoid receptor antagonists) at discharge (n=112) were likely to have lower left ventricular ejection fraction on admission and at discharge compared with those without triple GDMT (n=423) (22% versus 28%, P <0.001 and 29% versus 37%, P <0.001, respectively). In the overall cohort, the one‐year mortality rate was 23%. Triple GDMT prescription was significantly associated with a lower one‐year all‐cause mortality compared with non‐triple GDMT (adjusted hazard ratio 0.44 [95% CI, 0.19–0.80]; P =0.007). Similarly, 2:1 propensity score matching and inverse probability treatment weighting based on the propensity score demonstrated a lower incidence of one‐year mortality in the triple GDMT group. As the number of HF drugs increased, a stepwise decrease in mortality was observed (log rank; P <0.001). Conclusions In survivors of CS, the one‐year mortality rate was significantly lower in those with triple GDMT. Therefore, this study suggests that intensive HF therapy should be considered in patients following CS

Carbon monoxide and prognosis in smokers hospitalised with acute cardiac events: a multicentre, prospective cohort studyResearch in context

Summary: Background: Smoking cigarettes produces carbon monoxide (CO), which can reduce the oxygen-carrying capacity of the blood. We aimed to determine whether elevated expiratory CO levels would be associated with a worse prognosis in smokers presenting with acute cardiac events. Methods: From 7 to 22 April 2021, expiratory CO levels were measured in a prospective registry including all consecutive patients admitted for acute cardiac event in 39 centres throughout France. The primary outcome was 1-year all-cause death. Initial in-hospital major adverse cardiac events (MAE; death, resuscitated cardiac arrest and cardiogenic shock) were also analysed. The study was registered at ClinicalTrials.gov (NCT05063097). Findings: Among 1379 patients (63 ± 15 years, 70% men), 368 (27%) were active smokers. Expiratory CO levels were significantly raised in active smokers compared to non-smokers. A CO level >11 parts per million (ppm) found in 94 (25.5%) smokers was associated with a significant increase in death (14.9% for CO > 11 ppm vs. 2.9% for CO ≤ 11 ppm; p  11 ppm was associated with a significant increase in MAE in smokers during initial hospitalisation after adjustment for comorbidities (odds ratio [OR] 15.75, 95% CI [5.56–44.60]) or parameters of in-hospital severity (OR 10.67, 95% CI [4.06–28.04]). In the overall population, CO > 11 ppm but not smoking was associated with an increased rate of all-cause death (HR 4.03, 95% CI [2.33–6.98] and 1.66 [0.96–2.85] respectively). Interpretation: Elevated CO level is independently associated with a 6-fold increase in 1-year death and 10-fold in-hospital MAE in smokers hospitalized for acute cardiac events. Funding: Grant from Fondation Coeur &amp; Recherche