Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND: The potential interest of antifungal treatment of non-immunocompromized patients with sepsis, extra-digestive Candida colonization and multiple organ failure is unknown. It represents three-quarters of antifungals prescribed in Intensive Care Units. It may allow early treatment of invasive fungal infection in the incubation phase but expose patients to unnecessary antifungal treatments with subsequent cost and fungal selection pressure. As early diagnostic tests for invasive candidiasis are still considered to be insufficient, the potential interest in this strategy needs to be demonstrated. METHODS: This prospective multicenter, double blind, randomized-controlled trial is conducted in 23 French Intensive Care Units. All adult patients, mechanically ventilated for more than four days with sepsis of unknown origin and with at least one extradigestive fungal colonization site and multiple organ failure are eligible for randomization. Patients with proven invasive candidiasis are not included. After a complete mycological screening, patients are allocated to receive micafungin 100 mg intravenously once a day or placebo for 14 days. We plan to enroll 260 patients. The main objective is to demonstrate that micafungin increases survival of patients without invasive candidiasis at day 28 as compared to placebo. Other outcomes include day 28 and 90 survival and organ failure evolution. Additionally, pharmacokinetics of micafungin in enrolled patients will be measured and evolution of fungal biomarkers and susceptibility profiles of infecting fungi will also be followed. DISCUSSION: This study will help to provide guidelines for treating non-immunocompromized patients with fungal colonization multiple organ failure and sepsis of unknown origin.Trial registration: Clinicaltrials.gov number NCT01773876.
ISSN: 1745-6215

inserm-00913515
http://www.hal.inserm.fr/inserm-00913515
http://www.hal.inserm.fr/inserm-00913515/document
http://www.hal.inserm.fr/inserm-00913515/file/1745-6215-14-399.pdf
PUBMED : 24261608

Éditeur(s) : HAL CCSD
Résumé : National audience
Since the 1950s, Friedman's curves served as reference to guide obstetrical practice around the world. However, recent studies have suggested guidelines based on Freidman's results were too stringent and induce inappropriate and excessive interventionism. The committee aimed to redefine the structure and the normal duration of the labor, as well as the criterion to be fulfilled to consider a labor as abnormal. Several recommendations have been produced based on a systematic literature review. Labor dystocia should not be diagnosed during the latency phase. The beginning of the active phase of the 1st stage of labor has been established between 5 and 6 cm of cervical dilatation, which is later than previously suggested. Rate of cervical dilatation is considered as abnormal below 1 cm per 4 hour during the first part of the active phase, and blow 1 cm per 2 hour above 7 cm of dilatation. A maximum duration for the 2nd stage of labor cannot be defined in the French context, based on the literature. However, exceeding 3 hours, the risk-benefit balance becomes less beneficial. These new guidelines would help to reduce the use of oxytocin and caesarian delivery for labor dystocia. © 2016 Elsevier Masson SAS
Revue Sage - Femme

hal-01467546
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01467546
PUBMED : 28483643
DOI : 10.1016/j.sagf.2016.10.006

Éditeur(s) : HAL CCSD
Résumé : Climate change is one of the biggest public health threats in the 21th century. An increase in temperatures will lead to an increase in mortality attributable to temperature. In addition, some populations and territories are particularly vulnerable to the impact of increases in heat. It is thus necessary to identify these populations and territories as well as examine future heat-Related health impacts in order to recommend equity-Oriented policies today and in the future. The general objective of this thesis is to document current and future heat-Related vulnerability factors in the context of climate change. In order to address this general objective, the thesis involved four components: a) to conduct a systematic review and a meta-Analysis to assess the heterogeneity in the heat-Mortality associations with respect to individual and contextual population characteristics; b) to identify whether and how the magnitude of mean temperature effects on all-Cause mortality were modified by chronic air pollution exposure, social deprivation, and a combination of these two dimensions; c) to develop a method to quantify the climate change impacts on heat-Related mortality using climate modeling; d) to assess historical and future social disparities in years of life lost caused by ambient temperature in Montreal and Paris, and compare these estimates as well as the impact of climate change on social disparities between the two cities. This thesis highlights which populations are more vulnerable to heat and shows that several differences exist with regard to guidelines from international public health institutions for the identification of vulnerable populations. This thesis also identified chronic air pollution exposure as a new vulnerability factor in heat-Related mortality and that it has a double interaction with social deprivation. Furthermore, in this thesis a novel method to quantify future heat-Related mortality was developed which emphasized the strong evidence of an increase in heat-Related mortality under climate change. This method was then applied to estimate the increase in daily years of life lost social disparities in both Montreal and Paris under climate change which showed that this increase would be greater in Montreal compared to Paris in the future. Thus, this thesis which used a variety of epidemiologic methods has clarified which populations are particularly vulnerable to heat impacts and challenges guidelines for the identification of vulnerable populations from international public health institutions. It has also highlighted the climate change impacts on health inequalities and aims to reorient equity-Focused policies.
Les changements climatiques constituent l’un des enjeux les plus importants en santé publique du XXIème siècle. En effet, une hausse des températures provoquera une hausse de la mortalité attribuable à la chaleur. En outre, certaines populations et territoires sont particulièrement vulnérables aux effets de la chaleur. Il est donc nécessaire de les identifier clairement ainsi que les impacts futurs pour orienter avec équité les politiques publiques aujourd’hui et à l’avenir. L’objectif de cette thèse est de documenter les facteurs de vulnérabilité à la chaleur dans le présent et les éléments permettant leur prise en compte pour l’avenir dans le contexte des changements climatiques. Quatre étapes ont été menées pour répondre à cet objectif : a) Mener une revue systématique et une méta-Analyse des facteurs de vulnérabilité face aux risques de mortalité en lien avec la chaleur ; b) Analyser si l’exposition chronique à la pollution atmosphérique modifie la relation entre la chaleur et la mortalité dans un contexte urbain (Paris) et explorer la double interaction avec la défaveur sociale ; c) Développer une méthode de quantification des impacts liés à la chaleur en lien avec les changements climatiques en intégrant une grande diversité de simulations climatiques ; d) Estimer les inégalités d’années de vies perdues attribuables à la chaleur et leurs projections futures dans deux contextes distincts (Montréal et Paris) et comparer ces inégalités. Cette thèse a permis de mettre en évidence sur la base de la littérature épidémiologique les groupes de population qui sont les plus vulnérables face aux effets de la chaleur et de montrer qu’il y a plusieurs divergences par rapport aux recommandations émises par les institutions de santé publique vis-À-Vis de l’identification de populations vulnérables. Cette thèse a permis également d’identifier l’exposition chronique à la pollution atmosphérique comme nouveau facteur de vulnérabilité à la chaleur et que cette vulnérabilité était encore plus prononcée lorsqu’il s’agissait de populations défavorisées socialement. Puis, une méthode permettant de quantifier l’impact des changements climatiques sur les décès attribuables à la chaleur et ses sources d’incertitudes a été développée, et a permis de mettre en évidence que la probabilité que les changements climatiques conduisent à une augmentation de la mortalité en lien avec la chaleur est très forte. Cette méthode a ensuite été utilisée pour estimer que l’augmentation de la température conduira à une augmentation des inégalités sociales d’années de vie perdues à la fois à Montréal et à Paris, l’effet des changements climatiques sur l’accroissement de ces inégalités étant plus fort à Montréal qu’à Paris. Cette thèse, en se basant sur diverses méthodes épidémiologiques, a permis dans l’ensemble de clarifier quelles populations étaient particulièrement à risque face aux effets de la chaleur et de questionner les recommandations émises par les organismes tels que l’OMS. Elle a également permis de montrer l’effet des changements climatiques sur l’évolution de vulnérabilités face à la chaleur pour inciter dès aujourd’hui la mise en place de politiques publiques équitables et limiter l’impact des changements climatiques sur l’accroissement des inégalités de santé.
https://tel.archives-ouvertes.fr/tel-01456772

Droits : info:eu-repo/semantics/OpenAccess
NNT : 2015PA11T003
tel-01456772
https://tel.archives-ouvertes.fr/tel-01456772
https://tel.archives-ouvertes.fr/tel-01456772/document
https://tel.archives-ouvertes.fr/tel-01456772/file/VA_BENMARHNIA_TARIK_05022015.pdf

Éditeur(s) : HAL CCSD
Résumé : International audience
INTRODUCTION: There are no French guidelines for the management of complicated parapneumonic effusions. A national observational study was carried out to assess the main features of current clinical practice for this condition. MATERIAL AND METHODS: A questionnaire was sent by email to the 1500 members of the Société de Pneumologie de Langue Française (SPLF) between 15th November and 15th December 2012. RESULTS: There were 92 responders, i.e. a response rate of 6%. Of these, 87 physicians mentioned that they were involved in the management of patients with complicated parapneumonic effusions with a median number of cases of 10 per year (IQR: 5-20). Chest tube drainage was the main approach used for pleural fluid aspiration (n=51/87), followed by repeated thoracentesis (n=29/87) and early surgery (1/87). Five physicians answered both chest tube drainage or repeated thoracentesis and one physician either chest tube drainage or early surgery. Pleural fibrinolytics were never used by 20% of physicians, only in case of loculations by 70% and by 10% of respondents in all cases. Only 3 physicians combined fibrinolytics with DNAse. A double antibiotic dose was used by one third of physicians. All the physicians used respiratory physiotherapy during hospitalization and to aid recovery. Follow-up practices were heterogeneous. CONCLUSIONS: The management of complicated parapneumonic effusions varies significantly in France. National guidelines may be helpful to define best practice and aid in its implementation.
Revue Des Maladies Respiratoires

hal-01146851
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01146851
DOI : 10.1016/j.rmr.2015.01.001
PUBMED : 25725981

Éditeur(s) : HAL CCSD European Centre for Disease Prevention and Control
Résumé : International audience
Leishmaniasis is endemic in southern Europe, and in other European countries cases are diagnosed in travellers who have visited affected areas both within the continent and beyond. Prompt and accurate diagnosis poses a challenge in clinical practice in Europe. Different methods exist for identification of the infecting Leishmania species. Sixteen clinical laboratories in 10 European countries, plus Israel and Turkey, conducted a study to assess their genotyping performance. DNA from 21 promastigote cultures of 13 species was analysed blindly by the routinely used typing method. Five different molecular targets were used, which were analysed with PCR-based methods. Different levels of identification were achieved, and either the Leishmania subgenus, species complex, or actual species were reported. The overall error rate of strains placed in the wrong complex or species was 8.5%. Various reasons for incorrect typing were identified. The study shows there is considerable room for improvement and standardisation of Leishmania typing. The use of well validated standard operating procedures is recommended, covering testing, interpretation, and reporting guidelines. Application of the internal transcribed spacer 1 of the rDNA array should be restricted to Old World samples, while the heat-shock protein 70 gene and the mini-exon can be applied globally.
ISSN: 1560-7917

hal-01460743
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01460743
DOI : 10.2807/1560-7917.ES.2016.21.49.30418
PUBMED : 27983510

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
During the treatment process of drinking water, disinfectants (chlorine, ozone, chlorine dioxide) react on water containing organic matter and bromide to produce disinfection by-products at trace levels. Among them, five of the nine existing halo-acetic acids (HAAs) are commonly found in drinking water (monochloroacetic acid (MCAA), dichloroacetic acid (DCAA), monobromoacetic acid (MBAA), dibromoacetic acid (DBAA), and Trichloroacetic acid (TCAA)), including four classified in the 2B IARC group of potential carcinogens (BCAA, DBAA, DCAA, TCAA). With respect to drinking water quality, guidelines are proposed by WHO (2006) and water quality standards are imposed in many countries such as less than 100 μg/L for the sum of the five HAAs by US EPA (1998) and Canadian Health Department (2008). For this purpose, two analytical methods are commonly used, GC/MS with derivatization and LC/MS, UV or conductivity. A new method, based on two-dimensional ion chromatography (IC 2D) with suppressed conductivity is proposed. This method presents the main advantage of offering a quick implementation compared to GC or LC methods: direct injection, slight maintenance, lower cost of investment, by leading to good performances (specificity and sensitivity). The use of two different selectivity columns, and the fractionation on the first dimension canceling interferences, improves the specificity. The sensitivity is enabled by interfacing a preconcentration column between the two different internal diameter columns. The analytical conditions are optimized for the analysis of nine HAAs. The performances of the method are evaluated. The optimized method applied to natural water samples demonstrates its ability to quantify HAAs at trace levels in drinking water.
Microchemical Journal

hal-00877151
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00877151
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00877151/document
DOI : 10.1016/j.microc.2013.07.012

Éditeur(s) : Université des Antilles Études caribéennes
Résumé : Brazil and Canada have two of the biggest protected area systems in the world, both of them based in the protected areas model established by the USA in the XIX century. However, they have distinct policies when it comes to public use and ecotourism inside those areas. Canadian guidelines have a greater focus on leisure and recreation activities, in a more permissive use of its resources with activities geared to large scale tourism. On the other hand, Brazil has a focus more limited on low-impact activities with a strong component of environmental education and restrictions of activities within its protected areas. From that approach, this article analyzes the Brazilian and the Canadian public policies for public use development inside protected areas and how they address the three main aspects of ecotourism: environmental conservation, environmental awareness of visitors and involvement of local community.
Brésil et le Canada ont deux des plus grands réseaux d´aires protégées du monde, tous les deux basés dans le modèle d’aires protégées établi par les États-Unis au XIXe siècle. Cependant, ils ont des politiques distinctes quand il s´agit de l'usage du public et de l'écotourisme à l'intérieur de ces zones. Les lignes directrices canadiennes ont une plus grande focalisation sur les activités de loisirs et de détente, dans une utilisation plus permissive de ses ressources à des activités visant à grande échelle le tourisme. D'autre part le Brésil a un objectif plus limité sur les activités à faible impact avec une forte composante de l'éducation et les restrictions d'activités au sein de ses aires protégées de l'environnement. A partir de cette approche, cet article analyse les politiques publiques brésiliennes et canadiennes pour le développement du ecotourisme à l'intérieur d’aires protégées et de la façon dont ils abordent les trois principaux aspects de l'écotourisme: conservation de l'environnement, education environmental et la participation de la communauté locale.
Brésil
Canada
Colombie-Britannique
São Paulo

Droits : info:eu-repo/semantics/openAccess
urn:doi:10.4000/etudescaribeennes.9344
http://journals.openedition.org/etudescaribeennes/9344

Éditeur(s) : HAL CCSD
Résumé : International audience
Systemic Antifungal therapy (SAT) of invasive candidiasis (IC) needs to be started immediately upon clinical suspicion. Controversies exist then about potential harms from antifungal de-escalation (DE).(1) in cases of documented IC, early DE to fluconazole is recommended by US guidelines but discouraged in EU guidelines. in non-documented IC, no data are available to guide SAT DE. These questions are key issues however as the relationship between antifungal use and Candida antifungal resistance has been repeatedly demonstrated.
Intensive Care Medicine Experimental

hal-01334073
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01334073
DOI : 10.1186/2197-425X-3-S1-A5
PUBMED : 27290057

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
In intrauterine pregnancies of uncertain viability with a gestational sac without a yolk sac (with a mean of three orthogonal transvaginal ultrasound measurements <25 mm), the suspected pregnancy loss should only be confirmed after a follow-up scan at least 14 days later shows no embryo with cardiac activity (Grade C). In intrauterine pregnancies of uncertain viability with an embryo <7 mm on transvaginal ultrasound, the suspected pregnancy loss should only be confirmed after a follow-up scan at least 7 days later (Grade C). In pregnancies of unknown location after transvaginal ultrasound (i.e. not visible in the uterus), a threshold of at least 3510 IU/l for the serum human chorionic gonadotrophin assay is recommended; above that level, a viable intrauterine pregnancy can be ruled out (Grade C). Postponing conception after an early miscarriage in women who want a new pregnancy is not recommended (Grade A). A work-up for women with recurrent pregnancy loss should include the following: diabetes (Grade A), antiphospholipid syndrome (Grade A), hypothyroidism with anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies (Grade A), vitamin deficiencies (B9, B12) (Grade C), hyperhomocysteinaemia (Grade C), hyperprolactinaemia (Grade B), diminished ovarian reserve (Grade C), and a uterine malformation or an acquired uterine abnormality amenable to surgical treatment (Grade C). The treatment options recommended for women with a missed early miscarriage are vacuum aspiration (Grade A) or misoprostol (Grade B); and the treatment options recommended for women with an incomplete early miscarriage are vacuum aspiration (Grade A) or expectant management (Grade A). In the absence of both chorioamnionitis and rupture of the membranes, women with a threatened late miscarriage and an open cervix, with or without protrusion of the amniotic sac into the vagina, should receive McDonald cerclage, tocolysis with indomethacin, and antibiotics (Grade C). Among women with a threatened late miscarriage and an isolated undilated shortened cervix (<25 mm on ultrasound), cerclage is only indicated for those with a history of either late miscarriage or preterm delivery (Grade A). Among women with a threatened late miscarriage, an isolated undilated shortened cervix (<25 mm on ultrasound) and no uterine contractions, daily treatment with vaginal progesterone up to 34 weeks of gestation is recommended (Grade A). Hysteroscopic section of the septum is recommended for women with a uterine septum and a history of late miscarriage (Grade C). Correction of acquired abnormalities of the uterine cavity (e.g. polyps, myomas, synechiae) is recommended after three early or late miscarriages (Grade C). Prophylactic cerclage is recommended for women with a history of three late miscarriages or preterm deliveries (Grade B). Low-dose aspirin and low-molecular-weight heparin at a preventive dose are recommended for women with obstetric antiphospholipid syndrome (Grade A). Glycaemic levels should be controlled before conception in women with diabetes (Grade A)
ISSN: 0301-2115

hal-01295639
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01295639
DOI : 10.1016/j.ejogrb.2016.02.015
PUBMED : 27039249

Éditeur(s) : HAL CCSD EDP Sciences
Résumé : International audience
We show first results of 3D simulation of sea currents in a realistic context. We use the full Navier-Stokes equations for incompressible viscous fluid. The problem is solved using a second order incremental projection method associated with the finite volume of the staggered (MAC) scheme for the spatial discretization. After validation on classical cases, it is used in a numerical simulation of the Pointe à Pitre harbour area. The use of the fictious domain method permits us to take into account the complexity of bathymetric data and allows us to work with regular meshes and thus preserves the efficiency essential for a 3D code.
ISSN: 1270-900X
Guidel, France

hal-00728894
https://hal.archives-ouvertes.fr/hal-00728894
DOI : 10.1051/proc/201235025

Éditeur(s) : HAL CCSD ACM
Résumé : International audience
Environmental resources (e.g., air quality, water quantity) are needed to understand fundamental questions such as global change. Such resources are often collected from sensors, including humans acting as sensors. Tools have emerged to manage such data in the form of time series and, in particular, the Sensor Observation Service (SOS) which offers a framework based on predefined relational database schema. Environmental observatories can be built using such frameworks, allowing to address specific key scientific questions by collecting and sharing large-scale environmental data. However, the strict schema of SOS database makes it difficult to integrate some data that cannot be directly mapped to the schema. Guidelines and best practices are offered in the literature in order to reuse standards from the Semantic Web but they do not cover all needs. In particular, they do not help to reflect the fact that a single environmental database can lead to several SOS models. Since being aware of these multiple possibilities is crucial for a better use of the observatories, we argue that some extensions of the existing works are required. In this paper, we thus propose an extension of existing vocabularies to achieve this goal. Our contribution is illustrated on the real case of the Lebanese-French O-LiFE environmental observatory.
6th ACM International Conference on Web Intelligence, Mining and Semantics
Nimes, France

lirmm-01381082
https://hal-lirmm.ccsd.cnrs.fr/lirmm-01381082
https://hal-lirmm.ccsd.cnrs.fr/lirmm-01381082/document
https://hal-lirmm.ccsd.cnrs.fr/lirmm-01381082/file/presentationwims_s1_2.pdf
DOI : 10.1145/2912845.2912856

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Marine Protected Areas (MPAs) are increasingly used for biodiversity conservation and the management of sustainable fisheries. The use of taxonomic surrogates in routine monitoring of the reserve effects on fish assemblages may represent a promising method due to its substantial technical and economic benefits. However, higher taxonomic ranks should be used as surrogates with caution, especially for fish, where the approach is still virtually undocumented. This study aims to shed light on relationships between taxonomic relatedness and ecological similarity, which is crucial to assess the relevance of species surrogacy to reflect species-level information and detect changes in fish related to protection regimes. By analyzing data from a Mediterranean MPA, we show that rather being related to taxonomic relationships, the ability of higher taxa to reflect species-level patterns was explained in terms of aggregation level and distribution of species within taxa. Null models using random aggregations of species were created to identify the best surrogates able to depict changes in responses of assemblages to protection observed at the species-level. Comparison of null model predictions with the more classical higher-taxon approach revealed that the latter was not reliable because, unlike null model outcomes, surrogates determined empirically were not relevant for other subsequent independent monitoring. The effectiveness of species surrogates to depict changes in responses of assemblages to protection observed at the species-level depended (1) on the numerical resolution of the aggregation and (2) the magnitude of differences between protected and unprotected locations. Such findings suggest that surrogacy approaches may be applied for routine monitoring of Mediterranean reef fish communities, although mere empirical determinations of sufficient taxonomy seems to be not reliable, legitimizing the use of alternative methods based on null models. Guidelines for the careful use of species surrogacy in the ecological evaluation of MPAs on fish assemblages are provided.
ISSN: 0006-3207

hal-01174428
https://hal-univ-perp.archives-ouvertes.fr/hal-01174428
DOI : 10.1016/j.biocon.2015.06.002

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
STUDY OBJECTIVE: There is no consensus about the management of large spontaneous pneumothoraces. Guidelines recommend either needle aspiration or chest tube drainage and most patients are hospitalized. We assess the efficiency of ambulatory management of large spontaneous pneumothoraces with pigtail catheters. METHODS: From February 2007 to January 2011, all primary and secondary large spontaneous pneumothoraces from Lorient's hospital (France) were managed with pigtail catheters with a 1-way valve. The patients were discharged immediately and then evaluated every 2 days according to a specific algorithm. RESULTS: Of the 132 consecutive patients (110 primary, 22 secondary), 103 were exclusively managed as outpatients, with full resolution of the pneumothorax by day 2 or 4, which represents an ambulatory success rate of 78%. Mean time (SD) of drainage was 3.4 days (1.8). Seven patients were initially hospitalized but quickly discharged and had full resolution by day 2 or 4, leading to a total success rate of 83%. The use of analgesics was low. The 1-year recurrence rate was 26%. If successful, this outpatient management is potentially cost saving, with a mean cost of 926, assuming up to 2 outpatient visits and 1 chest radiograph, compared with 4,276 if a chest tube was placed and the patient was admitted to the hospital for 4 days. CONCLUSION: Ambulatory management with pigtail catheters with 1-way valves could be a reasonable first-line of treatment for large spontaneous pneumothoraces. Compared with that of other studies, our protocol does not require hospitalization and is cost saving.
ISSN: 0196-0644

hal-01063942
https://hal.archives-ouvertes.fr/hal-01063942
DOI : 10.1016/j.annemergmed.2013.12.017
PUBMED : 24439715

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Clostridium difficile infection (CDI) is the primary cause of nosocomial diarrhoea in industrialised countries, usually occurring as a complication of antibiotic therapy in elderly patients. Landmark events contributed to boosting interest in CDI over the last 10 years, including the emergence of unusually severe and recurrent CDI due to the NAP1/BI/027 strain, as well as reports suggesting that CDI is also significantly encountered in patients previously considered at no risk, such as community-acquired CDI in patients with no recent antibiotic use, or CDI during pregnancy. Despite this growing interest from the medical community, we do not know the real dimensions of the disease for the following reasons: (i) despite comprehensive guidelines published in Europe and in the USA, most laboratories still use diagnostic tests with suboptimal sensitivity as a 'rule-out' test, hence a significant proportion of CDIs remain undiagnosed; (ii) use of PCR as a stand-alone test by others will probably overestimate the real incidence of CDI and jeopardise any comparison between institutions with different diagnostic procedures; and (iii) transversal studies, with optimum design and diagnostic tests, are rapidly outdated due to the dramatic changes in CDI epidemiology that may occur from one year to another. To get an accurate picture of the real dimensions of the CDI issue, we need more systematic use of an adequate and homogeneous diagnostic strategy in the field as well as the implementation of continuous monitoring of CDI incidence through surveillance programmes.
ISSN: 0924-8579

inserm-00863350
http://www.hal.inserm.fr/inserm-00863350
http://www.hal.inserm.fr/inserm-00863350/document
http://www.hal.inserm.fr/inserm-00863350/file/Clostridium_difficile_infections._Do_we_know_the_real_dimensionssur the_problem-accepted.pdf
DOI : 10.1016/j.ijantimicag.2013.04.009

Éditeur(s) : HAL CCSD Wiley
Résumé : The extent of gene dispersal is a fundamental factor of the population and evolutionary dynamics of tropical tree species, but directly monitoring seed and pollen movement is a difficult task. However, indirect estimates of historical gene dispersal can be obtained from the fine-scale spatial genetic structure of populations at drift-dispersal equilibrium. Using an approach that is based on the slope of the regression of pairwise kinship coefficients on spatial distance and estimates of the effective population density, we compare indirect gene dispersal estimates of sympatric populations of 10 tropical tree species. We re-analysed 26 data sets consisting of mapped allozyme, SSR (simple sequence repeat), RAPD (random amplified polymorphic DNA) or AFLP (amplified fragment length polymorphism) genotypes from two rainforest sites in French Guiana. Gene dispersal estimates were obtained for at least one marker in each species, although the estimation procedure failed under insufficient marker polymorphism, limited sample size, or inappropriate sampling area. Estimates generally suffered low precision and were affected by assumptions regarding the effective population density. Averaging estimates over data sets, the extent of gene dispersal ranged from 150 m to 1200 m according to species. Smaller gene dispersal estimates were obtained in species with heavy diaspores, which are presumably not well dispersed, and in populations with high local adult density. We suggest that limited seed dispersal could indirectly limit effective pollen dispersal by creating higher local tree densities, thereby increasing the positive correlation between pollen and seed dispersal distances. We discuss the potential and limitations of our indirect estimation procedure and suggest guidelines for future studies
ISSN: 0962-1083

hal-01031603
https://hal.archives-ouvertes.fr/hal-01031603
DOI : 10.1111/j.1365-294X.2005.02785.x

Éditeur(s) : HAL CCSD
Résumé : International audience
Recent studies have shown that accounting for intraspecific trait variation (ITV) may better address major questions in community ecology. However, a general picture of the relative extent of ITV compared to interspecific trait variation in plant communities is still missing. Here, weconducted a meta-analysis of the relative extent of ITV within and among plant communities worldwide, using a data set encompassing 629 communities (plots) and 36 functional traits. Overall, ITV accounted for 25% of the total trait variation within communities and 32% of the totaltrait variation among communities on average. The relative extent of ITV tended to be greater for whole-plant (e.g. plant height) vs. organ-level traits and for leaf chemical (e.g. leaf N and P concentration) vs. leaf morphological (e.g. leaf area and thickness) traits. The relative amount of ITV decreased with increasing species richness and spatial extent, but did not vary with plant growth form or climate. These results highlight global patterns in the relative importance of ITV in plant communities, providing practical guidelines for when researchers should include ITV in trait-based community and ecosystem studies.
Ecology Letters

hal-01237101
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01237101
DOI : 10.1111/ele.12508
PUBMED : 26415616

Éditeur(s) : HAL CCSD American College of Physicians
Résumé : International audience
BACKGROUND: Most clinical guidelines recommend that AIDS-free, HIV-infected persons with CD4 cell counts below 0.350 × 10(9) cells/L initiate combined antiretroviral therapy (cART), but the optimal CD4 cell count at which cART should be initiated remains a matter of debate. OBJECTIVE: To identify the optimal CD4 cell count at which cART should be initiated. DESIGN: Prospective observational data from the HIV-CAUSAL Collaboration and dynamic marginal structural models were used to compare cART initiation strategies for CD4 thresholds between 0.200 and 0.500 × 10(9) cells/L. SETTING: HIV clinics in Europe and the Veterans Health Administration system in the United States. PATIENTS: 20, 971 HIV-infected, therapy-naive persons with baseline CD4 cell counts at or above 0.500 × 10(9) cells/L and no previous AIDS-defining illnesses, of whom 8392 had a CD4 cell count that decreased into the range of 0.200 to 0.499 × 10(9) cells/L and were included in the analysis. MEASUREMENTS: Hazard ratios and survival proportions for all-cause mortality and a combined end point of AIDS-defining illness or death. RESULTS: Compared with initiating cART at the CD4 cell count threshold of 0.500 × 10(9) cells/L, the mortality hazard ratio was 1.01 (95% CI, 0.84 to 1.22) for the 0.350 threshold and 1.20 (CI, 0.97 to 1.48) for the 0.200 threshold. The corresponding hazard ratios were 1.38 (CI, 1.23 to 1.56) and 1.90 (CI, 1.67 to 2.15), respectively, for the combined end point of AIDS-defining illness or death. Limitations: CD4 cell count at cART initiation was not randomized. Residual confounding may exist. CONCLUSION: Initiation of cART at a threshold CD4 count of 0.500 × 10(9) cells/L increases AIDS-free survival. However, mortality did not vary substantially with the use of CD4 thresholds between 0.300 and 0.500 × 10(9) cells/L.
ISSN: 0003-4819

hal-00875307
https://hal.archives-ouvertes.fr/hal-00875307
PUBMED : 21502648
DOI : 10.7326/0003-4819-154-8-201104190-00001

Éditeur(s) : HAL CCSD
Résumé : International audience
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Revue Des Maladies Respiratoires

hal-01560287
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01560287
DOI : 10.1016/j.rmr.2017.03.034
PUBMED : 28552256

Éditeur(s) : HAL CCSD
Résumé : International audience
We show first results of 3D simulation of sea currents in a realistic context. We use the full Navier-Stokes equations for incompressible viscous fluid. The problem is solved using a second order incremental projection method associated with the finite volume of the staggered (MAC) scheme for the spatial discretization. After validation on classical cases, it is used in a numerical simulation of the Pointe à Pitre harbour area. The use of the fictious domain method permits us to take into account the complexity of bathymetric data and allows us to work with regular meshes and thus preserves the efficiency essential for a 3D code.
ESAIM : Proceedings
Guidel, France

hal-00770270
https://hal.univ-antilles.fr/hal-00770270
DOI : 10.1051/proc/201235025

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Liposomal amphotericin B (LAmb) may fail to heal Leishmania infantum visceral leishmaniasis (VL) in the immunodeficient host. There are currently no guidelines on how to treat such patients and efficacy of miltefosine monotherapy seems limited in this indication. We present 2 cases of patients with VL and AIDS for which LAmb had to be interrupted (one because of toxicity, one because of treatment failure) and who were treated effectively with pentamidine followed by miltefosine.
ISSN: 1383-5769

hal-01509592
https://hal.archives-ouvertes.fr/hal-01509592
PUBMED : 27353022