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Les rencontres faites avec les personnes transidentitaires ont provoque un veritable renversement pratique et theorique. Ces renversements ont depasse la question transidentitaire pour penser autrement l’abord psychanalytique des problematiques humaines et aboutir a la construction d’une psychanalyse nouvelle, la psychanalyse sociale. Cette derniere se distingue de la psychanalyse classique en partant d’une autre base : la base de la vie sociale qui est transferentielle. Dans ce contexte de vie sociale transferentielle, la reference a l’œuvre de Marx est utilisee et permet une analyse des experiences de vies transidentitaires a partir des concepts de transfert social et de transfert de valeurs. La logique de la dynamique transidentitaire est centree sur la valeur de genre qui fait vivre et la reconnaissance par les autres de cette valeur. Le nouage entre les elements fondamentaux de l’identite, « mot-image-corps », et la privation, pris dans la vie sociale transferentielle donne les reperes logiques permettant une intelligibilite des problematiques. Un exemple concret est analyse a travers le commentaire d’un film vietnamien portant sur la transidentite Finding Phong.

Background: According to guidelines and bystander skill, two different methods of cardiopulmonary resuscitation (CPR) are feasible: standard CPR (S-CPR) with mouth-to-mouth ventilations and chest compression-only CPR (CO-CPR) without rescue breathing. CO-CPR appears to be most effective for cardiac causes, but there is a lack of evidence for asphyxial causes of out-of-hospital cardiac arrest (OHCA). Thus, the aim of our study was to compare CO-CPR versus S-CPR in adult OHCA from medical etiologies and assess neurologic outcome in asphyxial and non-asphyxial causes.Methods: Using the French National OHCA Registry (RéAC), we performed a multicenter retrospective study over a five-year period (2013 to 2017). All adult-witnessed OHCA who had benefited from either S-CPR or CO-CPR by bystanders were included. Non-medical causes as well as professional rescuers as witnesses were excluded. The primary end point was 30-day neurological outcome in a weighted population for all medical causes, and then for asphyxial, non-asphyxial and cardiac causes. Results: Of the 8 619 subjects included for all medical causes, 6 742 had a non-asphyxial etiology, including 5 904 of cardiac causes, and 1 710 had an asphyxial OHCA. 8.6%; 95% CI [8.1-9.3] of subjects had a good neurological outcome (i.e. cerebral performance category of 1 or 2). Bystanders who performed S-CPR began more often immediately (89.0%; 95% CI [87.3-90.5] versus 78.2%; 95% CI [77.2-79.2]) and in younger subjects (64.1 years versus 65.7; p < 0.001). In the weighted population, subjects receiving bystander-initiated CO-CPR had an adjusted relative risk (aRR) of 1.04; 95% CI [0.79-1.38] of having a good neurological outcome at 30 days for all medical causes, 1.28; 95% CI [0.92-1.77] for asphyxial etiologies, 1.08; 95% CI [0.80-1.46] for non-asphyxial etiologies and 1.09; 95% CI [0.93-1.28] for cardiac-related OHCA.Conclusions: We observed no significant difference in neurological outcome when lay bystanders of OHCA initiated CO-CPR or S-CPR, whether the cause was asphyxial or not. CO-CPR should probably be promoted in adults because it has many advantages (easier to learn and lower infection risk).

Introduction : Notre objectif était d’analyser la survie des patients victimes d’un arrêt cardiaque extrahospitalier (ACEH) durant la pandémie Covid-19 et de comparer les données en fonction du centre de traitement de l’appel choisi, le 15 ou le 18. Méthode : Nous avons extrait les données exhaustives du Registre des arrêts cardiaques (RéAC), entre le 1er mars et le 30 avril 2020. Nous avons effectué trois comparaisons de la survie à 30 jours (J30) de cohortes de patients : 1) Covid vs non-Covid ; 2) appels arrivés au service d’aide médicale urgente (Samu) (15) vs aux sapeurs-pompiers (SP) (18) et 3) appels arrivés au 15 vs 18 pour les patients Covid. Résultats : Sur un total de 870 ACEH, 184 étaient atteints de la Covid. Nous avons observé 487 (56 %) appels arrivés au 15 et 383 (44 %) au 18. La survie à J30 était de 3 %. Les ACEH Covid avaient une survie à J30 plus faible que les non-Covid (0 vs 4 %, p < 0,001). Le délai d’arrivée de SP était plus long lors d’un appel au 15. En revanche, aucune différence de survie n’est observée entre les appels arrivés au 15 ou au 18. Conclusion : La survie consécutive à un ACEH durant la pandémie est extrêmement faible. Cependant, quel que soit le numéro composé (15 ou 18), la survie n’est pas différente, même si le délai d’arrivée des prompts secours est plus court lors d’un appel au 18.

International audience; Aims: There are large differences between emergency medical systems, which may account for variability in outcomes. We seek to compare prehospital organizations, response modes, patient characteristics and outcomes after out-of-hospital cardiac arrest, between France and Canada, and discuss the need for the first European-North American prehospital research network on out-of-hospital cardiac arrest.Methods: Preliminary comparative description of data drawn from two nation-wide, population-based, Utstein-style prospectively implemented registries for out-of-hospital cardiac arrest in France and Canada (France: RéAC, Canada: CanROC), covering approximately 80 million people, and soon to be participating in an international research network in 2020.Results: Since creation, 103,722 cases were included in France and approximately 99,317 in Canada. Data used in this work were drawn from 2011 to 2016, and comprised around 33,688 adult, non-traumatic, treated cases in Canada, and 55,358 in France, leading to estimated incidence rates of 75.3/100,000 inhabitants in France and 83/100,000 in Canada. In both countries, out-of-hospital cardiac arrest predominantly occurred in male patients, in their late sixties, at home, of presumed cardiac aetiology. Bystander cardiopulmonary resuscitation was provided in half of the cases. First assessed cardiac rhythm was shockable in 16% (France) vs. 22% (Canada). Professional resuscitation was attempted in 82% (France) and 60% (Canada). Prehospital organizations and response modes differed in the constitution of responding teams (France: physician-led advanced life support, Canada: trained paramedics), in response time intervals (call to first professional responders' arrival at scene 6.5 min (interquartile range IQR [5.2-8.3]) (Canada) vs. 10 min [7-15] (France)), in on-scene interventions, type of referral at hospital (France: systematic bypass of emergency department, tertiary hospital first, Canada: occasional bypass, mainly closest hospital first), and in outcomes (overall survival at hospital discharge in France: 5% vs. Canada: 11%).Conclusion: Despite similarities in some out-of-hospital cardiac arrest Utstein variables, several differences exist between French and Canadian prehospital systems, and ultimately, between outcomes. The creation of the ReACanROC research network will facilitate the conduction of further analyses to better understand predictors of this variability.

This study examines the risk of multisystem inflammatory syndrome in children among those aged 12 years or older by COVID-19 vaccination status during September 2021 and October 2021 in France.

Background Pulmonary embolism (PE) represents 2% to 5% of all causes of out-of-hospital cardiac arrest (OHCA) and is associated with extremely unfavorable prognosis. In PE-related OHCA, inconsistent data showed that thrombolysis during cardiopulmonary resuscitation may favor survival. Methods This was a retrospective, observational, multicenter study from July 2011 to March 2018. All adults with OHCA, treated by a mobile ICU and with a diagnosis of PE confirmed on hospital admission, were included. The primary end point was 30-day survival in a weighted population. Results Of the 14,253 patients admitted to hospitals, 328 had a final diagnosis of PE and 246 were included in the analysis. In the group that received thrombolysis during resuscitation (n = 58), 14 (24%) received alteplase, 43 (74%) received tenecteplase, and one (2%) received streptokinase. Thirty-day survival was higher in the thrombolysis group than in the control group (16% vs 6%; P = .005; adjusted log-rank test) but the good neurologic outcome was not significantly different (10% vs 5%; adjusted relative risk, 1.97; 95% CI, 0.70-5.56). Median duration of stay in the ICU was 1 (0-5) day for the thrombolysis group and 1 (0-3) day for the control group (P = .23). Conclusions In patients with OHCA with confirmed PE and admitted with recuperation of spontaneous circulation in the hospital, there was significantly higher 30-day survival in those who received thrombolysis during cardiopulmonary resuscitation compared with patients who did not receive thrombolysis.

Background: Air pollution is increasingly associated with cardiovascular events. As for ozone (O3 ) pollution, results are inconsistent though O3 levels are associated with hospital admissions, global mortality, and respiratory, and cardiovascular mortality. Methods: In this time-stratified case-crossover study, the associations between short-term exposure to O3 (on an hourly and daily scale) and out-of-hospital cardiac arrests (OHCA) were investigated. Specific subgroups were explored by sex, age, diabetes status, for OHCA during non-holiday periods. Data were collected in the Nord-Pas-de-Calais region, France, in 2015. Data were statistically analyzed using conditional logistic regression (CLR). Results: The study included 1039 cases of OHCA. Significant negative associations were found between OHCA and O3 levels measured in 3 or 4 days before the arrest for all the people, and 1, 2 or 3 days before the arrest for men. As for OHCA during non-holiday periods, there was no significant negative associations but a positive association was revealed for women between OHCA and O3 levels measured in 5 days before the arrest (OR=1.53, P=0.008). Conclusion: According to the results, OHCA should be investigated during non-holiday periods to control potential confounders that would lead to negative associations. Women might be a susceptible subgroup to O3 pollution.

Background In out-of-hospital cardiac arrest (OHCA), bystander initiated cardiopulmonary resuscitation (CPR) increases the chance of return of spontaneous circulation and survival with a favourable neurological status. Socioeconomic disparities have been highlighted in OHCA field. In areas with the lowest average socioeconomic status, OHCA incidence increased, and bystander CPR decreased. Evaluations were performed on restricted geographical area, and European evaluation is lacking. We aimed to analyse, at a national level, the impact of area-level social deprivation on the initiation of CPR in case of a witnessed OHCA. Methods We included all witnessed OHCA cases with age over 18 years from July 2011 to July 2018 form the OHCA French national registry. We excluded OHCA occurred in front of rescue teams or in nursing home, and patients with incomplete address or partial geocoding. We collected data from context, bystander and patient. The area-level social deprivation was estimated by the French version of the European Deprivation Index (in quintile) associated with the place where OHCA occurred. We assessed the associations between Utstein variables and social deprivation level using a mixed-effect logit model with bystander-initiated CPR. Results We included 23,979 witnessed OHCA of which 12,299 (51%) had a bystander-initiated CPR. More than one third of the OHCA (8,326 (35%)) occurred in an area from the highest quintile of social deprivation. The higher the area-level deprivation, the less the proportion of bystander-initiated CPR (56% in Quintile 1 versus 48% in Quintile 5). The In the multivariable analysis, bystander less often began CPR in areas with the highest deprivation level, compared to those with the lowest deprivation level (OR=0.69, IC95%: 0.63-0.75). Conclusions The level of social deprivation of the area where OHCA occurred was associated with bystander-initiated CPR. It decreased in the more deprived areas although these areas also concentrate more younger patients.

Background: Although some studies have questioned whether cardiopulmonary resuscitation (CPR) in older people could be futile, age is not considered an essential out-of-hospital cardiac arrest (OHCA) prognostic factor. However, in the daily clinical practice of mobile medical teams (MMTs), age seems to be an important factor affecting OHCA care. Aims: The purpose of this study was to compare OHCA care and outcomes between young patients (Methods: We performed a case-control study based on data extracted from the French National Cardiac Arrest (CA) registry. All adult patients with CA recorded between July 2011 and May 2014 were included. Each older patient was matched on three criteria: sex, initial cardiac rhythm and no-flow duration. Results: We studied 4347 pairs. We found significantly less basic life support initiation, shorter advanced cardiac life support duration, less MMT automated chest compression, less MMT ventilation and less MMT epinephrine injection in the older patients. Significant differences were also observed for return of spontaneous circulation (odds ratio (OR)=0.84, 95% confidence interval (CI) 0.77–0.92, pConclusion: All OHCA guidelines, ethical statements and clinical procedures do not propose age as a discrimination criterion in OHCA care. However, in our case-control study, we notice a shorter duration and less intensive care among older patients. This finding may partly explain the lower survival rate compared with younger people.

There is increasing evidence of association between particulate matter air pollution and cardiovascular mortality and morbidity. However, the association with the out-of-hospital cardiac arrest (OHCA) event is less clear. We investigated the effects of short-term particulate matter exposure on OHCA especially among specific subgroups. The study included OHCA that occurred in the Nord-Pas-de-Calais region, France, in 2015. A time-stratified case-crossover study design coupled with a conditional logistic regression was used to evaluate the association between OHCA and particle levels of 10 or 2.5 micrometers or less (PM10 or PM2.5 respectively) measured within the hour of the arrest up to 5 days before. Susceptible subgroups by sex, age, diabetes status among OHCA that occurred during non-holiday periods were investigated. In all, 1039 cases were included. Significant associations were found between OHCA during non-holiday periods and PM2.5 and PM10 exposure four days before the arrest and on the day of the arrest. The largest OR were found for the cumulative average twelve hours before the arrest of PM2.5 (OR = 1.17, p = 0.016) and PM10 (OR = 1.33, p < 0.001). With PM2.5, larger OR with smaller p-values were generally obtained within the subgroups of men, age 50 to 75 years old and cases with diabetes. The findings show a significant link between short-term exposure to particulate matter and OHCA during non-holiday periods, with susceptible subgroups to PM2.5 (men, age 50 to 75 years old and diabetics).

Background Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France. Purpose Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA. Methods 24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time). Results CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p The effect of bystander CPR on survival Conclusion Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.

International audience; OBJECTIVE: Malnutrition affects 5-10% of elderly people living in the community. A few studies suggest that nutritional intervention may reduce health care costs. The present study included malnourished elderly patients living at home. It aimed to compare health care costs between patients that were prescribed ONS by their general practitioner and those who were not, and to assess the effect of ONS prescription on the risk of hospitalisation.METHODS: This prospective multicentre observational study included malnourished patients ≥70 years old who lived at home. Patients were defined as malnourished if they presented with one or more of the following criteria: weight loss ≥5% in 1 month, weight loss ≥10% in 6 months, BMI

International audience

The incidence of cardiac arrest (CA) in nursing homes is rising. Our objective was to compare nursing home CAs with at-home CAs in patients aged 65 and over with regard to the CAs' characteristics, the use and characteristics of cardiopulmonary resuscitation (CPR), and the outcome.We performed an ancillary analysis of a French nationwide cohort of over-65 patients having experienced an out-of-hospital CA (at home or in a nursing home) treated by a physician-manned mobile intensive care unit (MICU) between July 2011 and September 2015.Out of 21,720 CAs, 1907 (9%) occurred in a nursing home. The presence of a witness was more frequent in the nursing home than at home (77% vs. 62%, respectively; p 0.001) and bystander-initiated CPR was more frequent (62% vs. 34%, respectively; p 0.001). CPR by a MICU was less likely in the nursing home than at home - even after adjustment for the patients' and CAs' characteristics (adjusted odds ratio (aOR) [95% confidence interval] = 0.49 [0.42-0.57]). A return of spontaneous circulation was less frequent in the nursing home than at home (14% vs. 16%, respectively; OR = 0.86 [0.75-0.99]; p = 0.03) except when CPR was performed by the MICU (31% vs. 26%, respectively; OR = 1.25 [1.07-1.47]; p = 0.005). There was no intergroup difference in the CA outcome at day 30.Nursing home residents who experience a CA are less likely to receive CPR from a MICU. If CPR is performed, however, the residents' prognosis is no worse than that of patients treated at home.

INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.METHODS: This was an international, pr ...

Correction: vol 105, pg 188, 2016 Introduction: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe. Methods: This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries. Results: Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge. Conclusion: The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe. EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events. (C) 2016 The Author(s). Published by Elsevier Ireland Ltd.

Metabolic syndrome (MetS) is increasingly reported in children, mainly in the presence of overweight/obesity. From the most recent report, up to 60% of overweight and obese children can be affected by this syndrome. MetS acquired during childhood has been shown to track into adulthood, including its clinical complications, such as type 2 diabetes and cardiovascular diseases. Among the practical preventive and therapeutic measures to be taken in children, physical activity (PA) appears to be at least as efficient as the most adequate pharmacology. The current literature suggests that exercise programs based either on aerobic-or resistance-type exercises, or a combination of these 2 types of structured activity, may promote insulin sensitivity and weaken or suppress MetS in children. Furthermore, daily-living activities such as brisk walking were found to substantially reduce the risk of MetS among children. Regardless of their weight status, PA needs to be promoted among children as early as possible.

This study was designed to examine the hourly variation in and the interplay between physical activity and sedentary behavior (SB) in order to highlight key time periods for physical activity interventions for children. Data for physical activity and SB obtained with ActiGraph in 56 boys and 47 girls aged from 8 to 11 years. These data were divided into sixty minute-time samples for moderate-to-vigorous physical activity (MVPA) and SB, and analyzed using a principal component analysis (PCA) and correlation statistics. The PCA provides 10 factors which account for 80.4% of the inertia. Only two of these factors did not display competition between MVPA and SB. Contrary to some reports, a coefficient of correlation of —.68 (p

Introduction: Few studies report results on cardiac arrests (CA) care in the elderly. Even if age is not considered as an essential prognostic factor some studies questioned if cardiopulmonary resuscitation (CPR) in the elderly could be futile. Nevertheless in daily clinical practice, age seems to be an important factor conditioning CA care. Hypothesis: The aim of this case-control study was to compare out of hospital cardiac arrest care and outcome between young ( Methods: We performed a prospective case-control study based on data extracted from the French National CA registry. All adult patients (>18 years old) with CA recorded between July 2011 and May 2014 were included. Each elderly (>=65 years old) patient (case) was matched on 3 criteria: sex, initial cardiac rhythm, and the no-flow duration. Results: We studied 4,347 pairs. We significantly found less BLS starting, ACLS duration, mobile medical team (MMT) automated chest compression, MMT ventilation and MMT epinephrine injection in the elderly. Statistical differences were also observed for return of spontaneous circulation (ROSC) (OR=0.84[0.77-0.92]), transport to hospital (OR=0.58[0.51-0.61]), vital status at hospital admission (OR=0.55[0.50-0.60]), vital status at Day 30 (OR=0.42[0.35-0.50]), and Cerebral Performance Category (CPC) at Day 30 (OR=0.44[0.37-0.53]). Conclusions: All CA guidelines, ethical statement, clinical procedures do not propose age as a discrimination criterion in OHCA care. However, our study shows that with similar CA conditions, elderly patients are victims of medical discrimination by a shorter duration and less intensive care leading to a lower survival rate compared to young people.

The stoichiometry of boron suboxide (B6O1−δ) synthesized from mixtures of boron and boron oxide (B2O3) at high pressure lies closer to the nominal composition (δ=0) than materials obtained at atmospheric pressure. The materials obtained in the high pressure syntheses in the presence of molten B2O3 also have a higher degree of crystallinity than for sintered powders. For syntheses at temperatures of 1700–1800°C at pressures between 4 and approximately 5.5 GPa, the well-crystallized particles are dominated by icosahedral multiply-twinned particles up to approximately 40 μm in diameter. This unusual morphology is obtained by Mackay packing, i.e., by assembly of successive shells of icosahedral B12 units around a central icosahedral nucleus to give a multiply twinned particle in which each of the 20 elements has the R 3 m space group of the rhombohedral α-B structure. We examine the thermodynamic and kinetic factors associated with the development of this morphology during high pressure growth and use ab initio calculations to investigate the energetic driving forces for initiation of the Mackay packing around the central icosahedral nucleus.

Hexagonal boron nitride (hex BN) containing significant amounts of C and O substituting for N (hex BCNO) was synthesized at 75 kbar and 1700°C from mixtures of C, B2O3, and amorphous B contained in a hex BN crucible. Hex BCNO is a minor constituent of the product and occurs as small

We synthesized severalα-rhombohedral B-rich materials belonging to the B–C–N–O system using a multianvil press. B–C–O materials were prepared by reacting mixtures of B, C, and B2O3in the 5 to 7.5 GPa pressure range and at a temperature of 1700°C. Powder X-ray diffraction and parallel electron energy-loss spectroscopy with a transmission electron microscope showed that the BxCyOzphases obtained are based on theα-rhombohedral B structure. Crystals of composition B6C1.1O0.33to B6C1.28O0.31ranging in size from 1 to 20 μm were grown. Small transparent lustrous red cleavage flakes were obtained for stoichiometries close to B6O. The growth of boron carbide nanorods was also observed in some of the run products. We report the first conclusive bulk synthesis of a new boron nitride, B6N1−x, obtained by reacting B and hexagonal BN at 7.5 GPa and 1700°C. The structure of this compound is derived from that ofα-rhombohedral B (space groupeR 3 m) and the refined hexagonal cell parameters areah=5.457 A andch=12.241 A.

Objective: Validation of body adiposity index (BAI) in a paediatrics sample; and to develop, if necessary, a valid BAI for paediatrics (i.e. BAIp). Methods: A total of 1615 children (52% boys) aged 5-12 years underwent anthropometry. Their body composition was assessed using a foot-to-foot bioimpedance. The validity of BAI=(Hip circumference/Height1.5)-18 was tested by combining correlation and agreement statistics. Then, the sample was split into two sub-samples for the construction of BAIp. A regression was used to compute the prediction equation for BAIp-based percentage of body fat (%BF). Results: The initial BAI over-estimated the %BF of children by 49% (29.6±4.2% versus 19.8±6.8%; p

AimThis study aims to compare three body mass index (BMI)-based classification systems of childhood obesity: the French, the International Obesity Task Force (IOTF) and the World Health Organization (WHO) references.MethodsThe study involved 1382 schoolchildren, recruited from the Lille Academic District in France in May 2009 aged 8.4±1.7 years (4.0–12.0 years). Their mean height and body mass were 131.5±10.9cm and 30.7±9.2kg, respectively, resulting in a BMI of 17.4±3.2kg/m2. The weight status was defined according to the three systems considered in this study. The agreement between these references was tested using the Cohen's kappa coefficient.ResultsThe prevalence of overweight was higher with the WHO references (20.0%) in comparison with the French references (13.8%; P

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care.

Objectives. Simplification of Basic Life Support was proposed with the introduction of Chest-Compression only Cardio-Pulmonary Resuscitation (CC-CPR) as an alternative to Standard CPR (S-CPR). This study aimed to compare retention of knowledge, in the general public, of both CPR techniques (CC-CPR vs. S-CPR). Design, setting and participants. Multicentric prospective comparative cohort study. A training program was conducted among 906 individuals who were assigned to CC-CPR or to S-CPR group. They were evaluated before training (T0), after training (T1) and six months later (T2) on 17 CPR assessment criteria, they were evaluated twice at each time period and one global CPR performance score. Results. Initial knowledge was low. At T1, all CPR performance criteria improved significantly. Results were similar in both groups except for the rate of trainees calling for help and the time to turn on the automated external defibrillator and to deliver the first shock. At T2, the knowledge level was lower than at T1. Finally, CPR performance score was lower in both groups at T2 compared to T1 but statistically higher than at T0. CPR performance score was higher in the CC-CPR group than in the S-CPR group at T2 (p=0.041). Conclusions. Performance score was significantly higher in the CC-CPR group. CC-CPR training seems to result in better retention and a faster reaction in the setting of an out of hospital cardiac arrest. Moreover, the retention of knowledge among a trained population fades partially with time. Regular CPR training should therefore be proposed to avoid the loss of benefit with time.

AIM: To examine: (i) if maturity-related gender differences in moderate-to-vigorous physical activity (MVPA) depend on how maturity status is defined and measured; and (ii) the influence of maturity level on compliance with PA recommendations. METHODS: The study involved 253 children (139 boys) aged 9.9 ± 0.9 years, with mean stature and weight of 1.39 ± 0.08 m and 35.8 ± 8.8 kg respectively. Their PA was evaluated using an Actigraph accelerometer (Model 7164). Maturity was assessed using the estimated age at peak height velocity (APHV) and a standardized APHV by gender (i.e. centred APHV). RESULTS: Boys engaged in significantly more MVPA than girls (P < 0.0001). There was a significant correlation between the centred APHV and MVPA in boys (r = 0.20; P = 0.016), but not in girls (r = 0.13; P = 0.155). An ancova controlling for the estimated APHV showed no significant interactions between gender and APHV, and the main effect of gender on MVPA was negated. Conversely, there was a significant main effect of APHV on MVPA (F 1,249 = 6.12; P = 0.014; η p (2) = 0.024). Only 9.1% of children met the PA recommendations, including 14.4% of boys and 2.6% of girls (P < 0.01). This observation also applies in both pre-APHV (12.7% of boys vs. 2.4% of girls, P < 0.001) and post-APHV children (23.8% of boys vs. 3.4% of girls, P < 0.0001). No differences in PA guidelines were observed between pre-APHV and post-APHV children. CONCLUSIONS: Among prepubescent children, the influence of biological maturity on gender differences in PA may be a function of how maturity status is determined. The most physically active prepubescent children were those who were on time according to APHV.

Objects with icosahedral symmetry (Ih) bear a special fascination; natural examples are rare, but include radiolaria1 and virus particles (virions)2. The discovery3 of C60, a molecule in the shape of a truncated icosahedron with Ih symmetry, has aroused widespread interest. In 1962, Mackay4 described a radiating packing of spheres in Ih symmetry, in which the centres of successive shells of spheres lie on the surfaces of icosahedra. There has been extensive investigation of the conditions under which such packing might be realized in assemblies of atoms or of molecules such as C60 (ref. 5). Here we report the preparation, at high temperatures and pressures, of boron suboxide (B6O) in which the preferred form of the material is as macroscopic, near-perfect, regular icosahedra, similar to the multiply-twinned particles observed in some cubic materials. A major difference is that B6O has a rhombohedral structure that nearly exactly fits the geometrical requirements needed to obtain icosahedral twins. These icosahedral particles have a structure that can be described as a Mackay packing of icosahedral B12 units, and thus has long-ranged order without translational symmetry.

Objective: To highlight the discrepancies in accelerometry cut-off points of moderate-to-vigorous physical activity (MVPA) according to the definitions of Puyau et al. (MVPAP) and Trost et al. (MVPAT). Research Methods and Procedures: Forty-five children from 8 to 11 years old were monitored with the ActiGraph (ActiGraph, LLC, Fort Walton Beach, FL) for 3 consecutive days. Daily time spent at MVPA obtained with MVPAP was compared with that obtained with MVPAT using variability, regression, and agreement statistics. Data were then discussed with regard to physical activity recommendations. Results: The mean daily time spent at MVPAP (28 ± 18 minutes) was significantly lower (p < 10−4) than that spent at MVPAT (141 ± 39 minutes). The coefficient of determination between the two definitions was low (R2 = 0.49 ± 0.71). There was a lack of agreement between the two definitions, with a mean error or bias of 113 min/d. Thirty-four point eight percent and 100% of children underwent 30-minute MVPA/d with MVPAP and MVPAT definitions, respectively. Discussion: Comparability between studies devoted to describing children's physical activity or to assessing interventions may lack consistency according to the definition, with a real risk of misclassification.

We investigated whether the respiratory changes in arterial pulse pressure (ΔPP), an accurate indicator during mechanical ventilation (MV), and in arterial systolic pressure (ΔPS), easy to calculate, could predict fluid responsiveness in spontaneously breathing patients. The respiratory changes in intrathoracic pressure during spontaneous breathing, reversed compared with MV, could be insufficient to modify loading conditions of ventricles. We thus also tested those indicators during a forced respiratory cycle.

Entre le Kimméridgien et le Valanginien, le bassin delphino-helvétique savoyard et sa marge jurassienne enregistrent les effets d'une crise tectonique. L'épaisseur, la nature et l'organisation séquentielle des sédiments prouvent qu'une déformation des domaines internes de la marge continentale européenne se poursuivait durant la période d'expansion océanique de la Téthys occidentale; avec, localement, une reprise de l'activité des failles synsédimentaires. Sur les cinq cycles sédimentaires, de troisième ordre, définis sur ce laps de temps, trois sont affectés par des mouvements tectoniques qui avancent ou retardent et parfois annulent les effets des variations eustatiques. Ils modifient également la géométrie du passage entre la plate-forme jurassienne et le bassin subalpin et conduisent à la différentiation d'un domaine paléogéographique mixte; le domaine présubalpin. Son individualisation intervient dès la base du Berriasien inférieur. Elle est précédée par le développement d'importantes coulées boueuses, sur la bordure occidentale du domaine subalpin, au Kimméridgien-Tithonique inférieur et suivie par le basculement de la plate-forme jurassienne au Valanginien inférieur. A tectonic crisis affected the sedimentological evolution of the delphino-helvetic basin and its western border, the Jura platforrn (Savoie, occidental Alps), between Kimmeridgian and Valanginian times. The nature, thickness and sedimentary accumulation indicate that the internal zone of the European continental margin was still in a distension phase while an oceanic expansion period was taking place in the western Tethysian sea. The regional coast line variation curve shows five third order sedimentary cycles from the Upper Tithonian to the Upper Valanginian. When compared with global sea-level changes diagrams, three of them are affected by tectonic movements which advance, delay or even cancel the effects of eustatic variations. Similarly, they change the geometrical relationship between the Jura platform and the Subalpine basin. At first (late Kimmeridgian-early Tithonian), the western edge of the subalpine zone is marked by the development of large mudflow and debrisflow resedimentations followed from the early Berriasian onwards by the individualisation of a new palaeogeographic unit: the presubalpine zone. It is characterized by the deposition of a very thick sedimentary sequence, typical of a mainly regressive tendency leading to the progradation of the platform edge. Finally, the probable basinward tilting of the Jura platform occurred from earily Valanginian times onward.