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Crossing times and building worlds. On steampunk seriality in the 19th century futuristic novel
No full textInternational audienceThe works of Jules Verne, Albert Robida, H. G. Wells and the popular “Edisonades” are seen as the origins of a retro-futuristic imaginary that leads to the stabilization of a fictional world in the so-called steampunk aesthetic. But, although considered a genre based on iterative elements given as signs of a coherent universe (machines, urbanization, industrial progress, Victorian style), steampunk proves to be both heterogeneous —since it is made up of multiple interactions between real and fictional characters with crossover processes— and diversified in numerous variations. These variations are not confined to a single historical period, as there is also dieselpunk based on the inter-war period and atompunk focused on the pre-digital period from 1945-1965. To what extent is steampunk a kind of rearrangement of intertextual and visual repetitions of the very first productions dealing with retrofuturism? Why is the 19th century a pivotal moment for these fictions? How do they use counterfactual dynamics to generate multiple universes based on uchronic divergences from the real historical context? By choosing the perspective of seriality, considered as a generic process that deals with speed, the mixing of generic codes and literary creativity, this paper intends to analyse this dual dynamic of coherence and fluctuation in steampunk fictions inherited from futuristic literature. The aim is to explain both the autonomy of this world which makes steampunk an easily recognizable aesthetic, and at the same time the plasticity of such a fictional world that spreads across many different media and cultural expressions including today’s films, video games, role-playing games and fan communities
A Rocq Formalization of Simplicial Lagrange Finite Elements
No full textThe finite elements method is a popular method to numerically solve partial differential equations. In the long-term goal of proving its correctness, we focus here on the formal definition of what is a finite element: a record in the Rocq proof assistant with both values and proofs of validity, including the main one called unisolvence. We then instantiate this record with the most popular and useful, the simplicial Lagrange finite elements for evenly distributed nodes, for any dimension and any polynomial degree. These proofs require many results (definitions, lemmas, canonical structures) about finite families, affine spaces, multidimensional polynomials, in the context of finite or infinite-dimensional spaces
Oral anticoagulant periprocedural management in patients undergoing an oral, dental implant or periodontal surgery: a prospective national observational survey
No full textInternational audienceBackgroundOral surgery is a frequent invasive procedure in patients on oral anticoagulants. In usual care, the periprocedural management of these patients is questioned, with conflicting guidelines for patients on direct oral anticoagulants (DOACs).ObjectivesTo assess the risk of hemorrhagic and thromboembolic events during the periprocedural period (5 days before and 30 days after the oral invasive procedure).MethodsThe PRatiques Anticoagulants oraux DIrects Chirurgie Orale Study (NCT 03150303) is a prospective noninterventional national study including patients receiving long-term oral anticoagulants (duration of treatment of at least 1 month) and referred to dental surgeons for an invasive procedure. Hemorrhagic and thromboembolic events and death on days 2, 7, and 30 were reported and analyzed according to anticoagulant management (interruption/continuation). Bleedings were classified according to the International Society on Thrombosis and Haemostasis classification after blinded review.ResultsOverall, between July 2017 and December 2019, 523 patients (mean age 74) were recruited (345 on DOACs and 178 on vitamin K antagonists [VKAs]). During the periprocedural period, 62 events (11.8 events per 100 person-month [PM]) occurred, all local bleedings, in 50 patients (90.3% during the 7 days). The incidence of postoperative bleeding was greater in patients who continued on DOACs compared with patients who continued on VKAs (15.9/100 PM vs 5.9/100 PM; P = .003). Conversely, no significant difference was observed between patients with DOAC discontinuation and patients with VKA continuation (6.2/100 PM vs 5.9/100 PM; P = .75).ConclusionIn patients on anticoagulants undergoing an invasive oral procedure, the risk of bleeding occurs mainly within the 7 days following the procedure. Our data suggest the benefit of short perioperative discontinuation of DOACs
Cardiac rhythm devices in heart failure with reduced ejection fraction – role, timing, and optimal use in contemporary practice. European Journal of Heart Failure expert consensus document
No full textInternational audienceGuidelines for management of heart failure with reduced ejection fraction (HFrEF) emphasize personalized care, patient engagement, and shared decision‐making. Medications and cardiac rhythm management (CRM) devices are recommended with a high level of evidence. However, there are significant disparities: patients who could benefit from devices are frequently referred too late or not at all. Misconceptions about device therapy and the notion that the needs of patients (especially the prevention of sudden cardiac death) can now be met by expanding drug therapies may play a role in these disparities. This state‐of‐the‐art review is produced by members of the DIRECT HF initiative, a patient‐centred, expert‐led educational programme that aims to advance guideline‐directed use of CRM devices in patients with HFrEF. This review discusses the latest evidence on the role of CRM devices in reducing HFrEF mortality and morbidity, and provides practical guidance on patient referral, device selection, implant timing and patient‐centred follow‐up
Clinical course of children with postinfectious bronchiolitis obliterans with versus without comorbid bronchopulmonary dysplasia
No full textInternational audienceAbstractBackground: Post-infectious bronchiolitis obliterans (PIBO) is a rare chronic obstructive pulmonary disease that occurs after a respiratory infection. Its diagnosis is generally based on clinical history, respiratory symptoms, and computed tomography (CT) findings.Purpose: Here we evaluated the frequency of exacerbations, clinical progress, and inhaled corticosteroid (ICS) usage in children diagnosed with PIBO with or without comorbid bronchopulmonary dysplasia (BPD).Methods: This retrospective observational study was conducted in Rouen, France. The inclusion criteria were as follows: child diagnosed with PIBO (history of respiratory infection, airway obstruction with no or poor response to bronchodilation treatment, and/or mosaic pattern or trapping on chest high-resolution CT (HRCT) in 2009-2024 treated with intravenous corticosteroid pulses.Results: Fifty-seven patients were included: 13 (23%) with BPD and 44 (77%) without BPD. The mean age at diagnosis was 7 ± 3.6 months, with no significant intergroup difference. We observed a significant reduction in exacerbations following corticosteroid pulse treatment as soon as 6 months (p<0.001), with persistent effects observed up to 24 months (p=0.02). We also noted a reduced daily ICS dose starting at 12 months (p=0.03). Respiratory syncytial virus is the most commonly identified causative virus, followed by rhinoviruses and adenoviruses. The viral co-detection rates were 18% and 61% in the BPD and non-BPD groups, respectively.Conclusion: In our cohort, intravenous corticosteroid pulse treatment effectively treated PIBO, with a rapid and long-lasting reduction in exacerbations and ICS requirements. BPD was a significant comorbidity of PIBO
Cueillir en ville. Rendre visible une écologie des marges
No full textInternational audienceCet article s’intéresse aux pratiques de cueillette des plantes en ville et interroge leur rôle dans l’appropriation des espaces urbains végétalisés. Il s’appuie sur une enquête de terrain portant sur une écologie des marges menée entre 2019 et 2024 dans les agglomérations parisienne et marseillaise, dans le cadre d’une collaboration entre géographie et photographie
Arpenter la ville en quête de plantes. S’approprier le territoire par la cueillette dans le Grand Paris.
No full textInternational audienceThis article looks at plant foraging practices in the city and examines their role in the appropriation of urban green spaces. It is based on a survey carried out between 2019 and 2021 at a dozen sites in the Greater Paris area. It relies on qualitative ethnographic methods, enhanced by photographic work carried out with an artist. We show how gatherers’ practices shape singular territorialities through a survey of urban spaces in order to seek out plants and their nutritional and medicinal uses. This geography reveals original forms of territorial appropriation, characterized by knowledge, uses and representations focused on relationships with plants. These practices redefine the role of vegetated spaces in a metropolitan context, shaping shifting archipelagic territorialities that are both discreet and subversive. They integrate ecological and urban dynamics, partially freeing themselves from the dominant urban planning and development practices, while at the same time co-existing with them. They are spatially and socially distinct, and reflect the unequal appropriation of space as a function of people’s socio-economic situations and migratory trajectories.Cet article s’intéresse aux pratiques de cueillette des plantes en ville et interroge leur rôle dans l’appropriation des espaces urbains végétalisés. Il s’appuie sur une enquête menée entre 2019 et 2021 dans une dizaine de sites localisés dans l’agglomération parisienne. Il repose sur des méthodes qualitatives ethnographiques, valorisées par un travail photographique mené avec un artiste. Nous montrons comment les pratiques des cueilleurs et des cueilleuses façonnent des territorialités singulières au travers d’un arpentage des espaces urbains motivé par la quête de plantes et leur usage alimentaire et médicinal. Cette géographie donne à voir des formes d’appropriation territoriale originales, caractérisées par des savoirs, des usages et des représentations focalisées sur les relations au végétal. Ces pratiques redéfinissent le rôle des espaces végétalisés en contexte métropolitain et façonnent des territorialités archipélagiques mouvantes, à la fois discrètes et subversives. Elles intègrent les dynamiques écologiques et urbaines, s’affranchissent partiellement des modalités d’urbanisme et d’aménagement dominantes tout en composant avec elles. Les acteurs de la cueillette dessinent des territorialités néanmoins multiples, qui rendent compte des inégales appropriations des espaces en fonction des situations socio-économiques et des trajectoires migratoires des personnes
Dosing and route of administration of clindamycin given in combination with rifampicin
No full textInternational audienceObjectivesThe aim of this study was to develop a pharmacokinetic (PK) interaction model of intravenous (i.v.) and oral clindamycin when combined with rifampicin, and to determine whether appropriate clindamycin concentrations could be achieved for different doses and administration routes (oral, intermittent and continuous infusion) of clindamycin.MethodsFive hundred and eighteen plasma samples were prospectively obtained from 124 patients treated for bone and joint infections. Population pharmacokinetic analysis was performed using Monolix software. Monte Carlo simulations were run to determine the probability of achieving a minimal clindamycin plasma concentration equal to at least twice the MIC, or an unbound area under the curve/MIC ≥60.ResultsA linear one-compartment model with first-order absorption and elimination was developed. Concomitant administration of rifampicin increased clindamycin clearance by an average factor of 3, whereas the impact on clindamycin bioavailability was dose dependent, with decreases from 56 to 11 and 4% for rifampicin doses of 600 mg and 900 mg q12 h, respectively. When administered simultaneously with rifampicin, satisfactory clindamycin concentrations could not be obtained when given orally. i.v. administration of a daily 3600 mg dose would be convenient for more than 80% of the patients, but doses of at least 4800 mg/d would be needed for a MIC equal to the 0.25 mg/L European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoint for Staphylococcus aureus. Intermittent i.v. administration every 6 hours is preferable to q8h regimens for the Cmin/MIC criteria, but still performed poorly compared with continuous infusion.DiscussionThis model satisfyingly described the differential effect of rifampicin on the bioavailability and clearance of clindamycin. As previously described, this combination must not be taken orally. However, administration of clindamycin doses of at least 3600 mg/d by intermittent or, preferably, continuous infusion, can balance the impact of rifampicin
Invisible survivors: sexual and reproductive health and rights of migrant women in French Guiana
No full textInternational audienceFrench Guiana faces significant sexual health challenges, notably a high prevalence of HIV. Migrant women are particularly vulnerable, and are impacted by socio-economic factors such as poverty, food insecurity, and precarious living conditions, which affect their sexual and reproductive health and rights. Previous research has primarily utilised quantitative data, neglecting qualitative insights into the factors shaping women's health and rights. The aim of this study was to explore the factors and phenomena liable to have an impact on the sexual and reproductive health and rights (SRHR) of migrant women in French Guiana. Between 2021 and 2022, semi-structured interviews were conducted with health and social professionals. Data triangulation against evidence from two existing surveys on mental health and healthcare access reinforced the findings. The results highlight some of the socio-economic environment factors affecting SRHR, with transactional relationships and gender-based violence exacerbating physical and mental health risks. Addressing these issues requires a systemic approach sensitive to women's lives and the context, prioritising efforts to tackle gender-based violence. The study's findings provide support to local health stakeholders and policymakers in enhancing services and policies to better care for migrant women in French Guiana.</div
Improving an integrative framework of health system resilience and climate change: Lessons from Bangladesh and Haiti
No full textInternational audienceThe analysis of health system resilience has advanced considerably, yet a wide range of conceptual frameworks continues to be employed. The ClimHB conceptual framework, developed in 2019, combines two influential models: the Levesque model of healthcare access and the DFID’s resilience framework. It is designed to examine health system resilience in response to climate-induced events. What sets the ClimHB framework apart is its emphasis on the population as an active participant on the demand side, complementing the supply side represented by healthcare services and providers. The framework is defined by three key dimensions – exposure, sensitivity, adaptive capacity. Its dual focus on demand and supply highlights their dynamic interaction in shaping health system resilience. A workshop and the World Café method refined the ClimHB framework by incorporating empirical data from Haiti and Bangladesh with findings from a literature review. The updated framework offers a dynamic perspective on resilience, focusing on the interconnected nature of its elements to guide decision-making across all levels of health systems. Key enhancements include greater emphasis on contextual factors, highlighting the influence of socio-economic and ecological conditions. It also features strengthened connections between resilience outcomes and contextual variables, improving the understanding of how context affects results. Governance and professional awareness were highlighted as critical elements for improving health system responses, and feedback loops were integrated in the supply side to enhance adaptability and decision-making processes. Empirical studies have demonstrated the ClimHB framework’s adaptability and capacity to create synergy between theoretical concepts and practical implementation. However, challenges remain in operationalising the framework for policymakers. These challenges highlight the need for further validation of the framework, the development of standardised measures, and a deeper understanding of resilience dynamics. Future research should prioritise the framework’s implications for structural management, workforce training, and resource allocation, addressing critical gaps in resilience research