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Beyond overweight, visceral adiposity is associated with estimation of cardiovascular risk in patients living with type 1 diabetes: findings from the SFDT1 cohort
No full textConflicts of interests: EBP reports receiving lecture honorariums from Astra Zeneca and Sanofi, and has been an employee of Boehringer Ingelheim since February 2024International audienceIntroduction & Objectives As in the general population, people living with type 1 diabetes (PWT1D) are faced with overweight and obesity, which contribute to cardiovascular (CV) risk. However, the role of visceral adiposity, due to its adverse metabolic profile, should also be addressed in PWT1D. We aimed to assess the 10-year CV risk of PWT1D according to body mass index (BMI) and waist-to-height ratio (WHtR), a parameter for estimating visceral adiposity. MethodsIn this cross-sectional study, PWT1D in primary CV prevention from the SFDT1 cohort were categorized by BMI status, either normal (18.5-24.9 kg/m 2 ) or overweight/obesity (≥ 25 kg/m 2 ), and by WHtR according to the validated threshold of 0.5. The 10-year CV risk was estimated using the Steno Type 1 Risk Engine and classified into three categories: low (< 10%), intermediate (10-20%) and high (> 20%). The distribution of CV risk was assessed using density plots. In multivariable analysis, the association between BMI, WHtR, and high estimated 10-year CV risk was studied using spline regression models with sex stratification. Thresholds were determined by the Receiver Operating Characteristic (ROC) curve. ResultsThe study included 1,482 patients; 49.9% had a normal BMI, and 50.1% a BMI ≥ 25 kg/m 2 . The proportion of patients with high CV risk was higher in PWT1D with overweight/obesity (12% vs. 7%) and in those with WHtR ≥ 0.5 (13% vs. 4%). BMI was significantly associated with high CV risk in men (p = 0.001) but a non-significant trend was found in women (p = 0.053). WHtR was significantly associated with high CV risk in both men (p < 0.001) and women (p = 0.046). The BMI threshold associated with high CV risk was 24.9 kg/m 2 for men, and the WHtR threshold was 0.5 for both men and women. ConclusionIn PWT1D in condition of primary CV prevention, visceral adiposity, assessed by WHtR, is a more robust marker of estimated 10-year CV risk than overweight/obesity status in both men and women.</div
Antibiotic combination indications for the treatment of community-acquired acute pneumonia
No full textInternational audienceEmpirical dual combination therapy with beta-lactam and macrolide is often the standard treatment of community-acquired acute pneumonia (CAP) in adults hospitalized in non-intensive care units. However, several recent studies question this standard treatment. The present literature review analyzes available data that compare beta-lactam monotherapy and dual antibiotic therapies in moderate CAP. Macrolides are associated with frequent adverse events (digestive, cardiovascular) as well as with an increase in bacterial resistance, and their clinical benefit in non-severe forms of CAP has yet to be proven. Three randomized trials of good quality did not show any reduction in mortality in patients treated with dual antibiotic therapy, and a large-scale observational real-life study did not show the clinical advantage of dual antibiotic therapy. Only patients with severe CAP could benefit from the addition of a macrolide as it covers atypical bacteria (and potentially because of its immuno-modulatory properties). Considering the current state of knowledge, beta-lactam monotherapy seems to be enough and preferable in moderate CAP, thus allowing to reduce exposure to macrolides and their consequences. The 2025 guidelines confirm the absence of indication for dual antibiotic therapy for mild documented CAP (except for Panton-Valentine leukocidin-producing S.aureus). Empirical dual antibiotic therapy is also recommended for patients hospitalized for severe CAP, with rapid de-escalation to monotherapy depending on the clinical evolution and microbiological results
Effects of high overvoltages on the treatment of PFAS in water
No full textInternational audienceThe chemical structure of per-polyfluoroalkyl substances (PFAS), based on strong C-F bonds makes them extremely stable in the natural environments. Plasma technologies have a strong potential for degrading PFAS in water. Understanding of the plasma removal mechanisms is necessary to improve the efficiency and to better control the by-products. Here three types of discharges with the same deposition energy were investigated for plasma removal of PFAS. An AC and a nanosecond high voltage pulse discharge were used in a wire-to-water surface configuration, whereas an atmospheric pressure fast ionization wave was generated in a 3-pins configuration over the water surface.</div
Impact of educational interventions provided to patients with a central venous catheter and their informal caregivers: a systematic review
No full textInternational audienceBackground: Central venous catheters offer considerable benefits, but their presence can expose patients to serious complications. Preventing such complications is crucial, not only for individual patients, but also for hospitals and the healthcare system. Objective: To assess the impact of educational interventions on clinical and non-clinical outcomes provided to patients with central venous catheters and/or their informal caregivers, regardless of the therapeutic indication, and to define the specific characteristics of effective educational strategies. Methods: Medline and Embase were searched, covering all publications since their inception to 13 August 2024. Articles on clinical and/or non-clinical outcomes related to the education of patients with central venous catheters and their informal caregivers were included. Studies focusing solely on the education of healthcare providers were excluded. The reference lists of included studies were hand searched for additional citations. This systematic review followed PRISMA guidelines and the protocol was registered in PROSPERO (CRD42024577193). The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Results: In total, 20 articles, representing 974 patients and 875 informal caregivers, were included in the review: seven randomized trials, ten quantitative studies without randomization, and three descriptive quantitative studies. The compliance rate of 60% for the randomised trials determined using the Mixed Methods Appraisal Tool indicates a low risk of bias, whereas non-randomised and descriptive quantitative studies show more methodological weaknesses (40% and 45%, respectively). There was a positive trend, significant or not, for the impact of patient education on reducing complications, particularly those related to infection (85% of the studies concerned by this outcome). This was often observed (64%) in studies based on educational interventions repeated over time. Studies that showed a significant improvement in patients’ knowledge and skills in terms of self-management showed beneficial results in terms of the occurrence of complications. Nurses were the most common educators (15/20), and the most frequently used tools were written materials and digital resources, often combined with other methods for greater effectiveness. Conclusions: This systematic review encourages the implementation of educational interventions for patients with central venous catheters and their informal caregivers, notably to decrease infections. Providing them with written documents and digital tools, and delivering them repeatedly over time, should be promoted. However, study heterogeneity limits definitive conclusions. Future research should standardize methodologies, involve patients in intervention design, and assess cost-effectiveness to ensure sustainable implementation
Embodied Performances of Non-Hegemonic Masculinities in Afghan Migration: Control, Dispossession, and Self-Affirmation
No full textInternational audienc
In between lived life and a social policy agenda : the Global South social question from the inside (Brazil)
No full textThis article aims to demonstrate how gender, class, and race are intertwined at the micro level, addressing the interaction of lived life and social policy, through biographical interviews, in Brazil. Less interested in the analysis of inequalities per se, this article focuses on the way black, elderly, poor, female heads of families, living in urban neighbourhoods, manage to subjectively resignify objective domination. The in-depth biographical approach reveals the (re)construction of their subjectivity, defining personal sacrifice as a form of protagonism (agency) and empowerment. This process of resignification occurs by exchanging the unit of experience they relate to, from the individual to the family unit. It engages with social policies (social assistance, public health, and social housing) implemented by the latest Labour Party's term of office (2003-2016). These policies are based on the role of women as responsible for the family unit. The focus on subjectivity, in different Brazilian metropoles, challenges the production of conformed neoliberal selves, in this case of women, within a specific Global South context, marked by historically high levels of inequality and informal work, since the formal end of slavery
Optimizing ICU Care: Advancing Nursing Diagnoses with a Decision Support System
No full textInternational audienceThe Nursing Process (NP) is a multi-step, structured framework, that enables nurses to integrate scientific knowledge and optimize patient care. Establishing a Nursing Diagnosis (ND) is a fundamental step of this process, enabling the selection of appropriate interventions. This study presents the development of VIGIL Care, a clinical decision support system designed to enhance NP in intensive care units (ICUs). Using a Delphi method, 13 experts reviewed the 277 nursing diagnoses (NDs) from the latest NANDA-I taxonomy (2024–2026) and selected 32 as relevant for ICU care, and with high criticality or high prevalence. In a second step, a panel of three nursing experts and one internal medicine physician refined the diagnostic indicators associated to the 32 NDs as described in NANDA-I, selecting those deemed highly or moderately relevant. VIGIL Care integrates patient data and employs logical rules to propose patient-specific NDs, while offering an explainable user interface allowing for nursing decisional autonomy preservation. The assessment of 10 NDs across 20 randomly-selected patient cases demonstrated that VlGIL Care achieved 86% sensitivity and 78% specificity, outperforming traditional nursing assessments, especially under time constraints. However, the limited sample size highlights the need for further validation to confirm the system’s effectiveness
Compliance with antimicrobial stewardship guidelines in surgery: an observational, multidisciplinary, cohort study
No full textInternational audiencePurpose: Antimicrobial stewardship aims to improve clinical outcomes while reducing the unintended effects of antimicrobial use. The use of antibiotics in surgical wards, except for surgical antibiotic prophylaxis, has been poorly documented. Our goal was to assess the rate of compliance with the guidelines of antibiotic prescriptions in surgical wards.Method: In a single academic center, a retrospective analysis was conducted over a two-month period to assess the rate of compliance with four criteria reflecting good practice in terms of antimicrobial stewardship: (1) decision of treatment initiation in line with the guidelines, (2) adequate spectrum of antibiotics in terms of patient characteristics; (3) duration of antibiotic treatment in compliance with the guidelines, and (4) whether re-adaptation of treatment was required. Positive responses to these four criteria indicated a 100% compliance rate. A pair of experts assessed the clinical vignettes to decide the compliance of each criterion. The secondary aims were to assess whether a 100% compliance rate was associated with positive outcomes.Results: Among the 1,339 single stays in surgical wards, 232 patients (17%) received antibiotics during the study period. The rate of compliance with all four criteria was 33%. In addition, 149 (64%) patients complied with indication and spectrum, and 91 (39%) patients complied with indication, spectrum, and duration. Compliance with the antimicrobial treatment was associated with improved outcomes.Conclusion: Of the patients hospitalized in the surgical wards, antimicrobial stewardship guidelines were complied with in 33% patients. Full compliance with the guidelines was associated with improved outcomes
Metabolic profile of biodiverse diets in a healthy European cohort
No full textInternational audienceThere is increasing evidence that diets characterized by food biodiversity could contribute to health outcomes. Greater dietary species diversity has been linked to reduced gastrointestinal cancer risk and all-cause mortality. However, mechanistic pathways supporting the association between food biodiversity and health are just beginning to be explored. Aim To characterize the metabolic profile associated with food biodiversity of diets in a pan-European population. Methods Dietary species richness (DSR), or the absolute number of unique species in an individual's diet, was calculated for 7,983 cancer-free control participants within the European Prospective Investigation into Cancer and Nutrition cohort study. Usual dietary intakes in the preceding year were assessed at recruitment with country-specific dietary questionnaires. Metabolomic profiles from blood which included 128 circulating endogenous metabolites,32 polyphenol compounds, and 39 fatty acid isomers were used as biomarkers of potential mechanisms underlying nutrition and health associations. Lasso regression identified key metabolites in discovery and replication sets, and multivariable stepwise linear regression were used to quantify associations between DSR and metabolomic profiles. Results A total of 52 metabolites were selected using Lasso regression in the replication set, of which 70% were statistically significant in stepwise linear regression. Higher DSR was associated with lower levels of 4 amino acids (e.g., tyrosine, -0.0231, 95% CI: -0.0362, -0.0100, p = 0.0009) and 2 acylcarnitines (e.g., C14:2, -0.0834, 95% CI: -0.1084, -0.0583, p < 0.0001). Conversely, higher levels were observed for 7 amino acids (e.g., tryptophan, -0.0954, 95% CI: -0.1049, -0.0860, p < 0.0001) and 9 polyphenols (e.g., epicatechin, p = 0.0017). Conclusion In this European middle-aged adult population, the circulating metabolic profiles of biodiverse diets are consistent with the metabolome linked with health-promoting diets, indicating metabolite groups that provide metabolic homeostasis, anti-inflammatory, anti-oxidative stress, and anti-obesogenic properties. These findings support the health benefits of consuming more diverse dietary species and may partially explain the inverse associations found in relation with mortality or gastrointestinal cancer
Distributed fault-tolerant control approach for discrete event systems using timed automata with guards: application to an electric power network
No full textInternational audienceAbstract This paper proposes a new distributed Fault-Tolerant Control (FTC) method for discrete event systems based on timed automata with guards (TAGs) and min-plus algebra. The principle is to design FTC for subsystems that are synchronised by a coordinator to achieve the objectives of the global system. The local faults are dealt with at the subsystem level, while the global faults affecting more than one part are managed at a global level. This approach considerably reduces the size of the models compared to the centralized FTC method, and it is then suited to large-scale automated systems. Indeed, using timed TAG models and min-plus algebra, an appropriate reconfiguration path is automatically selected in real time in response to a detected fault. For the verification and validation of the theoretical results, the FTC methodology is applied to an automated electrical power supply grid for rail transport systems. In this study, we consider four types of faults: sensor faults, actuator faults, plant faults and controller faults that may appear on an electrical network