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Infective endocarditis: it takes a team
No full textInternational audienceInfective endocarditis (IE) is a relatively rare but life-threatening systemic infection, which remains associated with high morbidity and mortality. The epidemiology of IE has shifted to involve an increasing numbers of older patients with both cardiovascular and other types of prosthetic devices, multiple comorbid conditions often requiring invasive procedures, increasingly virulent pathogens, in particular Staphylococcus aureus, or that can harbour anti-microbial resistance, and an escalation of injection drug use in many areas of the world. In parallel, advancements in diagnostic and therapeutic options have led to complex strategies in patients’ management. Despite these epidemiologic shifts, clinical trials have been rare and most of the evidence guiding IE management derives from expert consensus or analysis of large registries. Because of this, a multi-disciplinary IE team-based approach has been recommended as the standard of care. The aim of this review is to explore the rationale for a multi-disciplinary team-based approach to the management of IE. This approach has proved to be potentially beneficial based on multiple investigations that have evaluated patient outcomes. In addition, implementation strategies, feasibility and options of the team approach have also been highlighted
RSero: A user-friendly R package to reconstruct pathogen circulation history from seroprevalence studies
No full textInternational audiencePopulation-based serological surveys are a key tool in epidemiology to characterize the level of population immunity and reconstruct the past circulation of pathogens. A variety of serocatalytic models have been developed to estimate the force of infection (FOI) (i.e., the rate at which susceptible individuals become infected) from age-stratified seroprevalence data. However, few tool currently exists to easily implement, combine, and compare these models. Here, we introduce an R package, Rsero, that implements a series of serocatalytic models and estimates the FOI from age-stratified seroprevalence data using Bayesian methods. The package also contains a series of features to perform model comparison and visualise model fit. We introduce new serocatalytic models of successive outbreaks and extend existing models of seroreversion to any transmission model. The different features of the package are illustrated with simulated and real-life data. We show we can identify the correct epidemiological scenario and recover model parameters in different epidemiological settings. We also show how the package can support serosurvey study design in a variety of epidemic situations. This package provides a standard framework to epidemiologists and modellers to study the dynamics of past pathogen circulation from cross-sectional serological survey data
Local characterization of block-decomposability for multiparameter persistence modules
No full textversion accepted in Homology, Homotopy and ApplicationsLocal conditions for the direct summands of a persistence module to belong to a certain class of indecomposables have been proposed in the 2-parameter setting, notably for the class of indecomposables called block modules, which plays a prominent role in levelset persistence. Here we generalize the local condition for decomposability into block modules to the n-parameter setting, and prove a corresponding structure theorem. Our result holds in the generality of pointwise finite-dimensional modules over finite products of arbitrary totally ordered sets. Our proof extends the one by Botnan and Crawley-Boevey from 2 to n parameters, which requires some crucial adaptations at places where their proof is fundamentally tied to the 2-parameter setting
Modéliser l'impact d'un retrait du PEPFAR en Afrique de l'Ouest (ANRS 0792) · Résultats préliminaires
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Management of obstructive sleep apnea-hypopnea syndrome in children: what is the role of orthodontics? A scoping review
No full textInternational audienceAbstract Purpose Obstructive sleep apnoea syndrome (OSAHS) is a respiratory disorder that greatly affects the health and quality of life of patients. OSAHS affects up to 5.7% of children aged up to 18 years old, and its prevalence is doubled in children with risk factors such as obesity, craniofacial syndromes, Prader-Willi syndrome or trisomy 21. The most common aetiology of OSAHS in children is tonsil hypertrophy, and the first line treatment proposed for the majority of patients is the surgical removal of these tonsils. However, the risk of residual OSAHS after surgery is approximately 10–20%, and, thus, other therapeutic options are being developed to improve patient care. The objective of this scoping review is to assess the extent of the evidence regarding the effectiveness of the different types of treatments offered for OSAHS in children. Methods Relevant studies over a 13 year period were identified using three search engines: PubMed, Scopus and Web of Science. The selection of studies was made using previously defined inclusion and exclusion criteria based on a review of the title and abstracts initially, followed by a full reading of the texts. The studies were classified based on their design and following the grades and level of scientific proof defined by the Health High Authority. Results Twenty-nine manuscripts were included for synthesis. The first-line treatment proposed for the majority of patients with OSAHS is surgical removal of the tonsils, but the risk of residual OSAHS after surgery remains significant, and other less invasive options, such as orthodontics, are also useful for improving the management of these patients. Conclusion OSAHS treatment recommendations should consider orthodontic treatment as a minimally invasive approach with beneficial effects
High prevalence of chronic endometritis in women with nonstructural abnormal uterine bleeding and benefits of antimicrobial treatment on blood loss pattern: A prospective, observational study
No full textInternational audienceObjective: The causal link between chronic endometritis (CE) and nonstructuralabnormal uterine bleeding (AUB) has been poorly investigated and requires furtherclarification. This study aimed to evaluate the prevalence of CE in women withnonstructural AUB and to assess the effect of CE cure on the menstrual blood losspattern.Methods: This prospective study was conducted between 2022 and 2024 at theDepartment of Obstetrics and Gynecology, University of Bari, Italy. Women aged20–45 undergoing hysteroscopy for AUB with confirmation of nonstructural causeswere evaluated for CE and considered affected when both hysteroscopic andhistologic/immunohistochemical (HIS/IHC) criteria were met. Women with CE weretreated with specific culture-guided therapy. Cure ascertainment was confirmed bytriple negativity at hysteroscopy-HIS/IHC-culture (Group A). In cases of a positivetest, a second course of therapy, up to three courses, was repeated before declaring apersistent condition (Group B). At enrollment and at end-of-treatment evaluation, allparticipants completed a questionnaire to describe the bleeding characteristics andthe Pictorial Blood Assessment Chart (PBAC). Serum hemoglobin and ferritin werealso assessed.Results: Chronic endometritis was diagnosed in 102 of 145 (70.3%) women withnonstructural AUB enrolled in the study. Out of 102 CE patients, 81 (79.4%) patientsshowed CE resolution after therapy (group A), while in 21 patients (20.6%) CE waspersistent (group B). The duration of heavy bleeding before treatment (baseline)was similar in both groups (P = ns). In contrast, at the end of treatment, days ofheavy bleeding, days of spotting, and PBAC scores decreased significantly ingroup A compared with both same-group baseline assessment and group B. Serumhemoglobin and ferritin levels in cured women (A) were significantly higher than inthose with persistent CE (B). PBAC scores in group A at 3 and 6 months after the endof treatment showed persistence of cure benefits on AUB. Finally, among patients with CE diagnosis, both univariate and multivariate regressions showed a significantassociation between cure of CE and reduced bleeding.Conclusion: Chronic endometritis was highly prevalent in women with nonstructuralAUB in our cohort. Cure of CE by targeted antimicrobial therapy led to significantimprovements in bleeding patterns
H.D.’s War Ghosts
No full textInternational audienceAgainst the typical postwar understanding of occultism as apolitical and escapist, this article showcases a striking instance of “engaged occultism” in the modernist poet H.D. [Hilda Doolittle]. By focusing on the poet’s spiritualist experiments during World War Two, notably her communications with what she believed to be the spirits of dead R.A.F. airmen, it demonstrates the fusion of political thought and occultist thought in her war writings. It brings together studies of the modernist occult and studies of war modernism to analyze the complex, sometimes self-contradictory belief system of H.D., its relationship to empire and race, and its formal implications in both poetry (Trilogy) and prose (Majic Ring and Within the Walls).Dans les décennies d’après-guerre, l’occultisme et le spiritisme sont typiquement pensés comme une fuite hors de la réalité politique. Cet article, au contraire, présente un cas d’“occultisme engagé” chez la poète moderniste H.D. [Hilda Doolittle]. Il se penche sur les expériences spirites que celle-ci raconte avoir vécues pendant la Seconde Guerre Mondiale — notamment ses tentatives de communication avec les esprits de pilotes de la Royal Air Force morts au combat — pour montrer la fusion entre pensée politique et pensée occulte dans ses écrits, qu’ils soient en vers (Trilogy) ou en prose (Majic Ring et Within the Walls). L’enjeu est de rapprocher études de la tradition occulte moderniste et études du modernisme de guerre pour mettre en avant les complexités et contradictions du système de croyances de H.D., en particulier dans sa réinterprétation des dynamiques impérialistes et raciales de l’époque. Enfin, l’article interroge les paradoxes formels de textes qui se veulent à la fois engagés et secrets
Theoretical design and practical implementation of the food sampling for the 3 rd French total diet study
No full textInternational audienceBased on composite food samples representative of the whole diet, prepared as consumed, total diet studies (TDSs) are amongst the most cost-effective approaches to assess population dietary exposure to chemicals residues and contaminants, and to provide representative data for health risk assessment. The third French TDS was launched in 2018. From the most recent French dietary survey, 276 foods were selected based on consumption and contamination levels, thus covering over 90% of the French diet. Stratification by season (3, 6 or 12-monthperiods) and agricultural type (organic vs. conventional) led to collecting 719 composite samples. Each sample was made up of 12 pooled subsamples of the same food, representative of the food supply and habits of the French population and prepared as consumed according to the typical household practices. Food collection took place in 2021-2022 in three French departments. Substitution rules were applied when necessary to increase the likelihood of finding a product or to replace unavailable items (e.g. from supermarket, retailed shop…), that allowed collection of 98% of the expected subsamples. It is intended that the foodcomposite samples will be analyzed for approximately 300 chemicals to update concentration levels, estimate dietary exposure, and support health risk assessment in France
La cosaisine, une notion unitaire en procédure pénale
No full textInternational audienceLa cosaisine intervient à plusieurs niveaux lors de la phase préparatoire de la procédure pénale : des juges d’instruction peuvent être cosaisis pour mener l’information judiciaire, de même que des service de police judiciaire peuvent l’être, entre eux ou avec des agents de certaines administrations spécialisées, pour mener à bien leurs investigations dans des affaires complexes. Ces cosaisines sont fondées sur des dispositions différentes et soulèvent des enjeux qui leur sont propres. Elles n’en répondent pas moins à une logique commune et à des critères de définition identifiables, ce qui permet de considérer que la cosaisine est une notion unitaire en procédure pénale
NONPARAMETRIC ESTIMATION FOR CENSORED CIRCULAR DATA
No full textInternational audienceWe study the problem of estimating the probability density function of a circular random variable subject to censoring. To this end, we propose a fully computable quotient estimator that combines a projection estimator on linear sieves with a method-of-moments approach. We derive an upper bound for its mean integrated squared error and establish convergence rates when the underlying density lies in a Sobolev class. The practical performance of the estimator is illustrated through simulated examples