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The best crystal identification (CI) algorithms proposed so far for phoswich detectors are based on adaptive filtering and pulse shape discrimination (PSD). However, these techniques require free running analog to digital converters, which is no longer possible with the ever increasing pixelization of new detectors. We propose to explore the dual-threshold time-over-threshold (ToT) technique, used to measure events energy and time of occurence, as a more robust solution for crystal identification with broad energy windows in phoswich detectors. In this study, phoswich assemblies made of various combinations of LGSO and LYSO scintillators with decay times in the range 30 to 65 ns were investigated for the LabPET II detection front-end. The electronic readout is based on a 4 × 8 APD array where pixels are individually coupled to charge sensitive preamplifiers followed by first order CR-RC shapers with 75 ns peaking time. Crystal identification data were sorted out based on the measurements of likeliness between acquired signals and a time domain model of the analog front-end. Results demonstrate that crystal identification can be successfully performed using a dual-threshold ToT scheme with a discrimination accuracy of 99.1% for LGSO (30 ns)/LGSO (45 ns), 98.1% for LGSO (65 ns)/LYSO (40 ns) and 92.1% for LYSO (32 ns)/LYSO (47 ns), for an energy window of [350–650] keV. Moreover, the method shows a discrimination accuracy >97% for the two first pairs and ~90% for the last one when using a wide energy window of [250–650] keV.

In response to the COVID-19 pandemic, many countries have adopted a broad spectrum of containment measures, from recommendations to stay at home to quarantines of large geographic regions. As part of this response, corporations and governments alike have strongly encouraged workers to telecommute where possible. More than 3.4 billion people in 84 countries have been confined to their homes, as estimated in late March 2020, which potentially translates to many millions of workers temporarily exposed to telecommuting. Since 2000, the emergence of digital and broadband internet has facilitated the development of home telework. Despite limited research interest on its impact on occupational health, several health benefits and risks of telework have been identified in academic or grey literature (table 1) (for a review see Ref. 1). …

Background We report the results of INICC surveillance study from 2013 to 2018, in 664 intensive care units (ICUs) in 133 cities, of 45 countries, from Latin-America, Europe, Africa, Eastern-Mediterranean, Southeast-Asia, and Western-Pacific. Methods Prospective data from patients hospitalized in ICUs were collected through INICC Surveillance Online System. CDC-NHSN definitions for device-associated healthcare-associated infection (DA-HAI) were applied. Results We collected data from 428,847 patients, for an aggregate of 2,815,402 bed-days, 1,468,216 central line (CL)-days, 1,053,330 mechanical ventilator (MV)-days, 1,740,776 urinary catheter (UC)-days. We found 7,785 CL-associated bloodstream infections (CLAB), 12,085 ventilator-associated events (VAE), and 5,509 UC-associated urinary tract infections (CAUTI). Pooled DA-HAI rates were 5.91% and 9.01 DA-HAIs/1,000 bed-days. Pooled CLAB rate was 5.30/1,000 CL-days; VAE rate was 11.47/1,000 MV-days, and CAUTI rate was 3.16/1,000 UC-days. P aeruginosa was non-susceptible (NS) to imipenem in 52.72% of cases; to colistin in 10.38%; to ceftazidime in 50%; to ciprofloxacin in 40.28%; and to amikacin in 34.05%. Klebsiella spp was NS to imipenem in 49.16%; to ceftazidime in 78.01%; to ciprofloxacin in 66.26%; and to amikacin in 42.45%. coagulase-negative Staphylococci and S aureus were NS to oxacillin in 91.44% and 56.03%, respectively. Enterococcus spp was NS to vancomycin in 42.31% of the cases. Conclusions DA-HAI rates and bacterial resistance are high and continuous efforts are needed to reduce them.

We consider a vertically differentiated model with two identical countries each having initially one firm. We compare two options: a unique international ecolabel set up by an international authority and two national ecolabels set up non-cooperatively by two national non-governmental authorities. The governments decide then to open or not their economies, then firms choose their environmental qualities and prices. We prove that relative to the case of national ecolabels, the international label lets the global welfare as it is or improves it. However, the improvement is always at the expense of one of the two countries, in which case the international label is not feasible unless the beneficiary country offers a compensation to the aggrieved one.

Whereas the previous research on environmental management practices explores their relationship with innovation performance, this paper investigates whether those practices can help firms to overco...

BackgroundLower limb arterial calcification is a frequent, underestimated but serious complication of diabetes. The DIACART study is a prospective cohort study designed to evaluate the determinants of the progression of lower limb arterial calcification in 198 patients with type 2 diabetes.MethodsLower limb arterial calcification scores were determined by computed tomography at baseline and after a mean follow up of 31.20 ± 3.86 months. Serum RANKL (Receptor Activator of Nuclear factor kB Ligand) and bone remodeling, inflammatory and metabolic parameters were measured at baseline. The predictive effect of these markers on calcification progression was analyzed by a multivariate linear regression model.ResultsAt baseline, mean ± SD and median lower limb arterial calcification scores were, 2364 ± 5613 and 527 respectively and at the end of the study, 3739 ± 6886 and 1355 respectively. Using multivariate analysis, the progression of lower limb arterial log calcification score was found to be associated with (β coefficient [slope], 95% CI, p-value) baseline log(calcification score) (1.02, 1.00–1.04, p ConclusionIn patients with type 2 diabetes, lower limb arterial calcification is frequent and can progress rapidly. Circulating RANKL and triglycerides are independently associated with this progression. These results open new therapeutic perspectives in peripheral diabetic calcifying arteriopathy.Trial registrationNCT02431234

Background Musculoskeletal disorders (MSDs) accounted for nearly 1.71 billion people worldwide in 2019 with an estimate of over 126.6 million Americans (or one in two adults) affected and 40 million European workers in 2017. Since age constitutes an important risk factor for MSDs, the overall aging of the working population is expected to influence the burden of disease. However, factors other than aging may play a role in the global trends in MSDs We conducted a systematic review to summarize the evidence on the role of demographic and temporal changes in the occurrence of MSDs. Methods The study protocol was registered in PROSPERO with the number CRD42020221499. Following the PRISMA guidelines, we searched PubMed, ScienceDirect and Web of Science over the 1990-2020 period for articles reporting temporal trends in MSDs incidence or prevalence in the general working-age population. We only included articles controlling for age in the analysis. To ensure the quality of the articles, the bias risk was assessed using the RoB-SPEO tool. The main indicators we extracted were age-controlled time trends in MSDs incidence or prevalence. Results Among 966 articles, 16 fulfilled the inclusion criteria, representing 23 results according to the indicators extracted. No study was found with a high risk of bias. Nine used a definition of MSDs based on pain and 14 based on repercussions on work or social life. Twelve results presented time trends in prevalence and 11 in incidence. After controlling for age, temporal trends in MSDs presented some heterogeneity. Indeed, 10 results documented increases and 12 reported non-monotonic changes. Only 1 result reported a decreasing trend in the incidence of MSDs. Several factors other than aging were suggested to explain temporal trends in MSDs, mainly trends in obesity, changing occupational exposures, and cultural factors regarding pain tolerance. Conclusion This review shows that factors in addition to aging of the working population may contribute to varying or increasing trends in MSDs. Results also highlight the scarcity of available evidence on time trends in the burden of MSDs and their underlying causes.

Introduction:non-invasive ventilation is widely used in the respiratory management of severe bronchiolitis. Methods:a randomized controlled trial was carried out in a tertiary pediatric university hospital´s PICU over 3 years to compare between continuous positive airway pressure/nasal positive pressure ventilation (CPAP/NPPV) and high flow nasal cannula (HFNC) devices for severe bronchiolitis. The trial was recorded in the national library of medicine registry (NCT04650230). Patients aged from 7 days to 6 months, admitted for severe bronchiolitis were enrolled. Eligible patients were randomly chosen to receive either HFNC or CPAP/NPPV. If HFNC failed, the switch to CPAP/NPPV was allowed. Mechanical ventilation was the last resort in case of CPAP/NPPV device failure. The primary outcome was the success of the treatment defined by no need of care escalation. The secondary outcomes were failure predictors, intubation rate, stay length, serious adverse events, and mortality. Results:a total of 268 patients were enrolled. The data of 255 participants were analyzed. The mean age was 51.13 ± 34.43 days. Participants were randomized into two groups; HFNC group (n=130) and CPAP/NPPV group (n=125). The success of the treatment was significantly higher in the CPAP/NPPV group (70.4% [61.6%- 78.2%) comparing to HFNC group (50.7% [41.9%- 59.6%])- (p=0.001). For secondary outcomes, lower baseline pH was the only significant failure predictor in the CPAP/NPPV group (p=0.035). There were no differences in intubation rate or serious adverse events between the groups. Conclusion:high flow nasal cannula was safe and efficient, but CPAP/ NPPV was better in preventing treatment failure. The switch to CPAP/NPPV if HFNC failed, avoided intubation in 54% of the cases.

Hemolytic uremic syndrome (HUS), characterized by the triad of micro-angiopathic hemolytic anemia, thrombocytopenia, and acute renal insufficiency, is a common cause of acute renal failure in children. It usually follows an episode of gastroenteritis with enterotoxigenic Escherichia coli and is termed typical HUS. However, HUS is also a complication of invasive pneumococcal infection. Reasons for not diagnosing this condition include the absence of a specific laboratory test, the lack of consistent case definitions, unfamiliarity, a misdiagnosis of disseminated intravascular coagulation (DIC) and cases with micro-angiopathic hemolytic anemia and only mild renal injury. The aim of our study is to describe the epidemiology, the treatment and the evolution of HUS after invasive pneumococcal infections in Tunisia. Cases were identified between 2008 and 2016. Infection with S. pneumoniae was confirmed with culture of cerebrospinal fluid, pleural fluid, or blood. Eight children fulfilled our criteria for inclusion in the study. Primary patterns were fever, respiratory signs, neurological signs and uncommon patterns. Pneumonia was a presenting feature in 6 of 8 cases (75%), two patients had confirmed pneumococcal meningitis. Pneumococcal invasive infection was confirmed by positive yield for S. pneumoniae by culture in pleural levy or drainage in two cases, cerebrospinal fluid in two cases and blood in four cases. The mean duration of hospitalization was 23.5 days. Antibiotic therapy was initiated in all patients. Six patients from eight required dialysis for a median 27.8 days. No patients received plasma exchange therapy. Two patients died and. One patient with pneumococcal pneumatocele and presented a sepsis complicated with a nosocomial infection following a prolonged stay in the intensive care unit. One patient had bronchiectasis leading to recurrent broncho-pulmonary infections. One patient who was dialysis dependent at discharge died 4 months later.

The emergence of new promising technologies used in electric transportation offers opportunities to achieve sustainable urban freight deliveries. In particular fleets of electric vehicles are seen as an efficient ecologic and economic transportation alternative for operating last-mile goods distribution in cities. This paper deals with the use of electric modules which can be added or removed from a freight vehicle to help gain capacity or respect delays when delivering customers. Since the electric vehicles have a limited battery capacity, they have to stop and recharge them at dedicated stations during the delivery tours. However, with the modular feature, this problem of disturbing the whole distribution process for recharging the batteries can be reduced and sometimes overlooked. This paper objective is to design and find the optimal routing strategy for a fleet of electric modular vehicles operating the last-mile delivery, with the minimal cost including the acquisition, the travel and the recharging ones. The research problem arising from the structure of the fleet can be associated with both a truck and trailer problem and a fleet size and mix vehicle routing problem with time windows using electric vehicles. This problem is presented in the first part of the article with the proposed solving procedure. More precisely, for big instances of the problem which is NP-Hard, a Variable Neighborhood Search (VNS) is designed and adapted. Experimental studies carried out on some benchmark instances show that the VNS performs impressively well in comparison with the best solving approaches of the literature.

The issue of personnel planning is still a topic that continues to attract the interest of researchers in various fields of application. This issue is at the core of health decision- makers’ concerns regarding the deficit in human resources. The shortfall in health personnel being one of the obstacles to achieving a Universal Health Coverage, it is a priority to be addressed by health managers and policy makers as part of the plans of the more global Human Resources for Health strategy. To help better manage such a strategy, our analysis focuses on exploring the flow of people in hospital logistics and reviewing the contribution of operational research on patient transport and mobile health workers, particularly approaches using Dial A Ride system. In this study, we provide a comprehensive description of the problem of patient transport and mobile health care personnel in relation to any health care service, focusing on the main contributions of operational research to current optimization problems in this area.

Background Percutaneous left atrial (LA) appendage closure is increasingly used to prevent strokes in patients with atrial fibrillation (AF). While LA appendage plays a key role in LA physiology, data regarding the impact of LA appendage occlusion on LA hemodynamics are lacking. The alteration of LA compliance by LA appendage occlusion may represent a clinical issue in AF patients which are at high risk of heart failure. Purpose To describe the impact of LA appendage occlusion on LA hemodynamics. Material and methods From july 2015 to january 2020, all patients undergoing LA occlusion procedure at Pitié-Salpêtrière Hospital (Paris, France) in whom LA pressure curves were recorded, before and immediately after device implantation, were included. The LA mean pressure was measured at baseline and after LA appendage occlusion during the same procedure. Abnormal LA mean pressure was defined as >15mmHg. We also recorded cardiovascular death and hospitalization for congestive heart failure at longest follow-up. Results We enrolled 85 patients (78±8 years, 46 men), the CHA2DS2-VASc score was 5±1 and the HAS-BLED score was 4±1. The mean LA volume index was 51±15mL/m2, the left ventricular ejection fraction was 60±7%. The LA mean pressure increased significatively after LA appendage closure from 12.6±3.9mmHg to 15.5±5.2mmHg (p During a median follow-up of 364 [124–726] days, 3 (3.5%) patients died from a cardiovascular cause. Hospitalization for heart failure occurred in 6 (16%) of the 38 patients with abnormal postprocedural LA pressure, whereas no congestive episode was observed in the rest of the study population (p=0.006). Conclusion Catheter-based LA appendage occlusion induces an acute alteration of LA hemodynamics. Post procedural abnormal LA pressure may be linked to heart failure episodes in some patients. Further studies are warranted to investigate heart failure as a potential late complication of LA appendage closure. Variations of mean LA pressure Funding Acknowledgement Type of funding source: None

The Time-over-Threshold (ToT) analog-to-digital signal processing approach provides a power-efficient and cost-effective technique to extract all relevant information from detectors in high-energy physics and Positron Emission Tomography (PET) imaging. In this work, three calibration methods were investigated to correct the inherent nonlinear response of the ToT data using 1) γ-ray sources of various energies, 2) internal electronic gain variation in the LabPET II ASIC in combination with a single energy γ-ray source, and 3) internal gain variation along with an embedded pulse charge generator in replacement of a γ-ray source. The electronic gain calibration technique was shown to achieve equivalent correction accuracy as the γ-ray sources calibration. Furthermore, this method has the advantage of allowing a faster calibration requiring only one single γ-ray source (e.g., 511 keV) and a quick automated routine to sweep the internal gain. The last technique would be the most convenient method, provided that the signal pulse shape would be similar to the detector signal responding to a typical γ-ray event. Whereas the concept was demonstrated with a step pulse, extensive processing would be required to recover the nonlinearity correction factors for the detector pulse shape. After calibration, the 511-keV energy resolution of typical LabPET II detectors was only slightly degraded, by less than 12% and 8% for methods 1) and 2), respectively, relative to a conventional ADC-based data acquisition system. The feasibility of fast and accurate calibration for the nonlinearity correction of ToT data in PET imaging was demonstrated, making a daily quality control within reach.

International audience; Background: Contemporary data are lacking regarding the prognosis and management of left ventricular thrombus (LVT).Objectives: The purpose of this study was to quantify the effect of anticoagulation therapy on LVT evolution using sequential imaging and to determine the impact of LVT regression on the incidence of thromboembolism, bleeding, and mortality.Methods: From January 2011 to January 2018, a comprehensive computerized search of LVT was conducted using 90,065 consecutive echocardiogram reports. Only patients with a confirmed LVT were included after imaging review by 2 independent experts. Major adverse cardiovascular events (MACE), which included death, stroke, myocardial infarction, or acute peripheral artery emboli, were determined as well as major bleeding events (BARC ≥3) and all-cause mortality rates.Results: There were 159 patients with a confirmed LVT. Patients were treated with vitamin K antagonists (48.4%), parenteral heparins (27.7%), and direct oral anticoagulants (22.6%). Antiplatelet therapy was used in 67.9% of the population. A reduction of the LVT area from baseline was observed in 121 patients (76.1%), and total LVT regression occurred in 99 patients (62.3%) within a median time of 103 days (interquartile range: 32 to 392 days). The independent correlates of LVT regression were a nonischemic cardiomyopathy (hazard ratio [HR]: 2.74; 95% confidence interval [CI]: 1.43 to 5.26; p = 0.002) and a smaller baseline thrombus area (HR: 0.66; 95% CI: 0.45 to 0.96; p = 0.031). The frequency of MACE was 37.1%; mortality 18.9%; stroke 13.3%; and major bleeding 13.2% during a median follow-up of 632 days (interquartile range: 187 to 1,126 days). MACE occurred in 35.4% and 40.0% of patients with total LVT regression and those with persistent LVT (p = 0.203). A reduced risk of mortality was observed among patients with total LVT regression (HR: 0.48; 95% CI: 0.23 to 0.98; p = 0.039), whereas an increased major bleeding risk was observed among patients with persistent LVT (9.1% vs. 12%; HR 0.34; 95% CI: 0.14 to 0.82; p = 0.011). A left ventricular ejection fraction ≥35% (HR: 0.46; 95% CI: 0.23 to 0.93; p = 0.029) and anticoagulation therapy >3 months (HR: 0.42; 95% CI: 0.20 to 0.88; p = 0.021) were independently associated with less MACE.Conclusions: The presence of LVT was associated with a very high risk of MACE and mortality. Total LVT regression, obtained with different anticoagulant regimens, was associated with reduced mortality.

Background Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM), associated with poor prognosis and requiring specific management in symptomatic patients. Furthermore, new drugs targeting LVOTO are under investigation. Exercise echocardiography is the more relevant test to unmask latent obstruction in patients with HCM and to link obstruction to symptoms during physical activity. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery. Objective We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM. Methods We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position. Results 121 patients with HCM were included (age 49±16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66±7%, max LV wall thickness 19±5 mm, 69% receiving betablockers). Exercise was performed until exhaustion at a mean workload of 118±58 Watts. Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17±18, 39±43 and 55±60 mmHg, p Conclusion The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.

Background Left Ventricular Thrombus (LVT) is associated with a high risk of thromboembolic complications such as stroke. Contemporary data are lacking on the management, prognosis and treatment of LVT, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs). Purpose To study the time and predictive factors associated with thrombus regression on treatment and its association with survival, embolic and bleeding complications. Methods From January 2011 to January 2018, a computerized case sensitive search of LVT was performed on 90 065 consecutive echocardiogram reports. All patients with a confirmed LVT were included in this analysis after imaging review by two independent experts. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. Major adverse cardiac events (MACE), defined as the composite of death, ischemic stroke or transient ischemic attack (TIA), myocardial infarction (MI) or embolic peripheral artery occlusion were analyzed as well as major bleeding events (BARC ≥3) and the predictive factors and impact of LVT regression. Results We identified 174 patients with a suspected LVT of whom 159 had confirmed LVT on two different cardiac imaging exams. Ischemic cardiomyopathy was the main cause of LVT (n=125, 78.6%) including 56 (35.2%) patients with an acute ST segment elevation MI. The mean left ventricular ejection fraction was 31.9±12.5% with predominant (98.1%) apical location of the LVT. Anticoagulation therapy was achieved with vitamin K antagonists, NOACs and parenteral heparins in 48.7%, 22.8% and 27.8% of patients, respectively. Concomitant antiplatelet therapy was prescribed in 67.9% of patients. Total LVT regression was reached in two third of patients (62.3%, n=99) within a median time of 103 [32–392] days. Independent predictors of total LVT regression were an ischemic cardiomyopathy (HR: 0.36 [0.19–0.70], p=0.002), a larger baseline thrombus area (HR=0.66 [0.45–0.96], p During a median follow-up of 632 [187–1126] days, MACE occurred in 59 (37.1%) patients with a 18.9% rate of mortality and 13.2% of major bleeding. Patients with a total LVT regression had a non-significant lower rate of MACE as compared with patients without total LVT regression (35.4% vs. 40.0%; HR=0.71 [0.42–1.21]; p=0.20), and a significant lower rate of mortality (15.2% vs. 25.0%; HR=0.48 [0.23–0.98]; p=0.039). Occurence of mortality (A) and MACE (B) Conclusions The prognosis of LVT remains severe with a high risk of major cardiovascular event and mortality. Total LVT regression, mostly reached in 3 months, can be obtained with both vitamin K antagonists and NOACs and is associated with a better prognosis.

Introduction Sickle cell disease is the most frequent genetic hemoglobinopathy worldwide and early childhood mortality has dramatically decreased in high-income countries. However, in the aging sickle cell disease population, the morbidity related to chronic organ damage, especially kidney and heart, has become a major concern. The disease is well characterized in homozygous SS patients, but the complications associated with Haemoglobin SC disease (HbSC) are mostly unknown. Dyspnea is frequent in SS patients and associated with poor quality of life, this symptom was not investigated in HbSC patients. Our objective is to investigate the prevalence and the factors associated with dyspnea in HbSC patients. Method A total of 221 HbSC patients (mean age 35 years, 47% men) were prospectively investigated. Clinical and biological data were collected, and 109 (49%) patients underwent an echocardiography. Results A dyspnea was observed in 28 (13%) patients. Compared to the rest of the cohort, these patients were older and had a lower hemoglobin level (P Fig. 1 ). Conclusion Dyspnea is relatively uncommon in adult HbSC patients and related to age and hemoglobin level. Cardiac involvement seems not to be a major factor associated to dyspnea in HbSC patients.

Biclustering is an unsupervised classification technique that plays an increasingly important role in the study of modern biology. This data mining technique has provided answers to several challenges raised by the analysis of biological data and more particularly the analysis of gene expression data. It aims to cluster simultaneously genes and conditions. These unsupervised techniques are based essentially on the assumption that the extraction of the co-expressed genes allows to have co-regulated genes. In addition, the integration of biological information in the search process may induce to the extraction of relevant and non-trivial biclusters. Therefore, this work proposes an evolutionary algorithm based on local search method that relies on biological knowledge. An experimental study is achieved on real microarray datasets to evaluate the performance of the proposed algorithm. The assessment and the comparison are based on statistical and biological criteria. A cross-validation experiment is also used to estimate its accuracy. Promising results are obtained. They demonstrate the importance of the integration of the biological knowledge in the biclustering process to foster the efficiency and to promote the discovery of non-trivial and biologically relevant biclusters.

Introduction Surgical treatment is required in approximately half of the patients with infective endocarditis (IE) because of severe complications. To date there is no recommendation favoring a specific valve substitute for IE treatment and accordingly there is a wide variation in routine surgical management of these patients. The purpose of this study is to describe surgical practices in our center and to investigate the impact on clinical outcomes. Method All patients with native valve left-sided IE, who underwent valve replacement surgery with a mechanical or biological prosthesis in our institution between 1 January 2006 and 31 December 2018 were enrolled in this retrospective study. Results A total of 303 patients were included (mean age = 58 years, 80% men). Patients in whom a biological valve was chosen (64%, n = 194) were older and had more comorbid conditions compared to patients who received a mechanical valve (36%, n = 109). In hospital mortality was respectively 19% (n = 36) in the bioprosthesis group avec 3% (n = 3) in the mechanical valve group (P Conclusion For surgical management of IE, a biological valve is the most used valve substitute in our institution. Mechanical valves seem to be implanted in a very selected and low-risk patient subgroup. The valve substitute does not appear to be related to in hospital nor to midterm mortality rates.

The dangerous goods are important to businesses and the life of a city. Thousands of tons of oil, toxic, chemical, corrosive, flammable and radioactive materials are transported each day. However, an accident involving hazardous materials could entail serious consequences for road users, infrastructure, and the environment. In order to build a planning aid system to reduce the risks of transporting hazardous, we adopt a microservices-based architecture on a cloud environment. This type of architecture consists of a set of loosely coupled and independently deployable services for more scalable applications. Due to distributed nature of microservices, the system will be developed as a suite of small services aligned with risk management process; each service will be running in its own logical machine or container technology such as Docker.

The transportation of dangerous goods represents one of the most critical risks particularly in urban areas. For example, every day large quantities of hazardous substances are transported by roads or railways inside areas with high density of population. Thus, to ensure urban and public safety the first challenge that we tackle is to find an environmental information system, which is able to provide risk management and monitoring. Moreover, it can capture urban transportation dynamics and offer specific services, visualization, analyses and evaluation of the hazmat risk in various high-risk zones. In addition, due to wireless technologies and real time intelligent sensors, the risk of dangerous goods can be carried out in real time. In this work, we adopt a microservices based architecture to have a real-time environmental sensors system that have highly scalable applications on cloud environment. By definition, this architecture consists of a set of loosely coupled and independently deployable services. In addition, the proposed system is conducted with a smart data collector, visualization abilities and a variety of distributed sensors in order to enhance the hazmat transportation network monitoring. Finally, we show how to integrate efficiently into the system prototype the hazmat routing container embedded microservice, and illustrate the orchestration with other microservices to improve this system with hazmat routing capabilities using various routing algorithms particularly bi-directional A* algorithm. This work constitutes the first step to build the Hazmat planning aid system that provides valuable data and knowledge to urban planner and decision makers

Hasan, M. Shahnaz/0000-0002-7493-7416; Abouqal, Redouane/0000-0002-6117-4341; Altindis, Mustafa/0000-0003-0411-9669; Masjedi, Mansoor/0000-0001-6175-9289; Popescu, Roxana/0000-0002-9387-1141; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; Meco, Basak Ceyda/0000-0003-2951-9634; Kumar, Perikala Vijayananda/0000-0001-8315-7000; Zand, Farid/0000-0003-3489-3372; Maghsoudi, Behzad/0000-0002-1279-8799; KAMARUL ZAMAN, MAZUIN/0000-0002-7920-6399; Gan, Chin Seng/0000-0002-6758-4798; Horoz, Ozden Ozgur/0000-0001-7590-650X; Medeiros, Eduardo A/0000-0002-6205-259X; Sabetian, Golnar/0000-0001-8764-2150; UNAL, SERHAT/0000-0003-1184-4711; Gan, Chin Seng/0000-0002-6758-4798; Delia, Muntean/0000-0001-9100-4530; Yalcin, Ata Nevzat/0000-0002-7243-7354; Leblebicioglu, Hakan/0000-0002-6033-8543; Horhat, Florin George/0000-0001-6133-0204; Yousef, Reham H. A./0000-0003-4004-3008; Delgado Aguirre, Hector Alberto/0000-0001-5448-7975; El Kholy, Amani/0000-0002-0645-7664; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Sanaei Dashti, Anahita/0000-0002-2827-3575; KARABAY, OGUZ/0000-0003-1514-1685; Barahona G., Nayide/0000-0003-3559-6900; Stagnaro, Juan Pablo/0000-0003-3836-9957; Alexandru Florin, Rogobete/0000-0003-1286-4431; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Jayatilleke, Kushlani/0000-0002-3931-6630; Unal, Necmettin/0000-0002-9440-7893; Duszynska, Wieslawa/0000-0002-5880-4904; Ngo, Quy Chau/0000-0002-6787-2757; Elmanakhly, Arwa/0000-0001-8557-0536; yildizdas, dincer/0000-0003-0739-5108; Kanj, Souha/0000-0001-6413-3396; Gupta, Umesh/0000-0001-7717-1404 WOS: 000392626300014 PubMed: 27742143 Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DAHAI), we collected prospective data from861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central lineassociated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheterassociated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. VDR; Foundation to Fight against Nosocomial Infections The funding for design, development, maintenance, technical support, data validation, and report generation of the Surveillance Online System, and the activities carried out at International Nosocomial Infection Control Consortium headquarters, were provided by VDR and the Foundation to Fight against Nosocomial Infections.

The adoption of electric vehicles are an environmental friendly initiative and a cost-effective opportunity because the number of these vehicles in the globe would be over 35 million by 2022. However, planning the routes of electric vehicles for timely delivery of goods, involves to take into account the limited energy which may lead the drivers to detour from the initial plan for recharging the batteries. In this work, the studied vehicles are modular. It means that they consist of an innovative system with one cabin for the driver and one or more modules for the goods. The research problem arising when planning the routes of such vehicles is recent. It is a particular routing problem (VRP) where the objective is the minimization of all the costs with some adding constraints linked with the recharges and the nature of the vehicles which are composed of modules. Therefore, the best current methods capable of addressing efficiently the VRP have been investigated. In this work, we propose to hybridize the population based evolutionary schema with two possible local search procedures. An intensive phase of experiments is operated to compare the approaches and show the usefulness of using the electric modules for freight delivery.

Variable neighborhood searches and evolutionary techniques have shown their effectiveness when dealing with many combinatorial optimisation problems. This study proposes to combine these two techniques for addressing the routing problem using electric and modular vehicles. This is a recent problem that aims to overcome recharging battery constraints while maintaining a certain performance regarding to the fleet cost and the traveled distance. An experimental study on benchmark instances is provided to show the relevance of the proposed algorithm.

This paper proposes a hybrid evolutionary algorithm for smart urban freight distribution using electric modular vehicles. The hybridization of evolutionary algorithms has recently shown promising results in vehicle routing problems with time windows. We propose here to test this technique on a new problem of routing electric vehicles with limited ranges which have the particularity of being modular. This means that the studied vehicles are composed of several modules which can be released at dedicated locations to go on performing the tours in an optimized way. For big instances of the problem which is NP-Hard, metaheuristics and in particular those involving evolutionary computation are suitable. Therefore, in this study, we propose to address the problem with the hybridization of the genetic algorithm. We use the Best Route crossover operator in combination of a Variable Neighborhood Descent algorithm for the mutation phase. An experimental study on benchmark instances from the literature shows the performance and effectiveness of the resulting evolutionary based algorithm.

Background: Multisystem inflammatory syndrome in children (MIS-C) is a new serious emerging disease that is temporally related to previous exposure to coronavirus infection disease (COVID-19). Aim: To describe the clinical features, laboratory findings, therapies and outcomes for the first Tunisian cluster admissions of critically ill children with severe MIS-C. Methods: Retrospective study conducted between 01 November and 30 November 2020 We included 8 children aged less than 15 years who were admitted to our pediatric intensive care and met the criteria for MIS-C according to the WHO definition case. We reviewed the medical records of all patients to collect demographic and clinical data, severity scores, laboratory test results, echocardiographic findings, treatment, and outcomes. Results: All children were previously fit and well. Seven patients were boys. Known exposure to COVID-19 was reported in 4 cases. Fever and gastrointestinal symptoms were reported in all cases. Five patients had marked abdominal pain and were examined by the surgeon for a possible appendicitis. Seven patients had diarrhea. On examination, we found a rash (n=7), a conjunctivitis (n=7), a cheilitis (n=5) and a meningism (n=3). We reported cardiac dysfunction in 7 cases and a shock with hypotension in 3 cases. All patients received immunoglobulins, methyl prednisolone and a low dose of aspirine. No deaths occurred. Conclusion: We reported here the first Tunisian cluster admissions of 8 critically ill children with MIS-C to highlight the increase of a new severe emerging disease with an evidence of prior COVID-19 infection in older children.

Background Percutaneous left atrial appendage (LAA) closure is increasingly used to prevent strokes in patients with atrial fibrillation (AF). The alteration of left atrial (LA) compliance by LAA occlusion may represent a clinical issue in AF patients, which are also at high risk of heart failure (HF). Aims To describe the impact of LAA occlusion on LA hemodynamics. Materiel and methods This study included patients who underwent LAA occlusion procedure in whom LA pressure curves were recorded, before and immediately after device implantation. Mean LA pressure was defined as abnormal when > 15 mmHg. We recorded all cause death and hospitalizations for congestive HF at longest follow-up. Results We enrolled 86 patients (78 ± 8 years, 46 men). The mean LA pressure increased significatively after LAA closure from 12.6 ± 3.9 mmHg to 15.6 ± 5.2 mmHg (P Fig. 1 ). The prevalence of abnormal mean LA pressure was 20% at baseline and 45% after LAA closure (P = 0.006). Post procedural LA pressure elevation was not related to procedure duration nor to fluid expansion volume. After an average follow-up of 363 [120–731] days, 9 (10%) patients died and 6 (7%) were hospitalized for HF. There were more events (N = 11 of 39, 28%) in patients with abnormal post procedural LA pressure as compared to the rest of the population (N = 4 of 47, 9%; P = 0.02). All HF hospitalizations occurred in patients with abnormal post procedural LA pressure (P = 0.0007). Conclusion Catheter-based LAA occlusion induces an acute alteration of LA hemodynamics that seems to be linked to HF episodes. Further studies are warranted to investigate HF as a potential late complication of LAA closure.

This study identifies and proposes simple methods to assess solar radiation, daylighting availability and Sky-View Factor (SVF) modification, in complex urban environment. Numerical methods and 3D simulation software are combined with photo processing methods using digital cameras with special mirrors to project the hemispherical environment onto a circular image. This methodology has been applied to a real case study in Switzerland that is undergoing a very fast urban densification process, where urban planning strategies will determine significantly the possibility to relish solar irradiation in buildings. This paper analyzed the particularities of different urban scenarios considering the effects of urban densification planning strategies on existing buildings, in particular historical protected buildings.

BIPV technologies applied to façades are strongly affected by complex and dynamic shadings especially when located in dense urban environments. In this case, the shading effects need to be evaluated in detail in order to properly estimate the energy yield and optimise the energy harvest of such PV systems.The S.M.O (String Matching Optimisation) solution represents a new approach, entirely based on open-source software, which allows a very accurate study of the shading effects on façades and the investigation of electrical behaviour of BIPV strings under complex irradiation patterns. This solution has been validated with a real pilot BIPV façade located in southern Switzerland and the model was simulated on other theoretical PV façades with different levels of complexity. The presented method allows an accurate evaluation and optimisation of the energy yield of BIPV facades in complex urban environments.

Purpose– The purpose of this paper is to analyze whether knowledge management (KM) practices trigger environmental innovation. Additionally, distinguishing between two types of KM practices, the authors want to examine whether different types of KM practices have the same role for environmental innovation.Design/methodology/approach– Employing two French surveys, namely, the Community Innovation Survey (2002-2004 and 2006-2008) and Annual Firm Survey (EAE, 2000), the authors analyze empirically the relationship between KM practices and environmental innovation. The theoretical relationship the authors propose is tested using bivariate probit model on 1,117 French manufacturing firms.Findings– The econometric estimations show that the investment in KM practices trigger environmental innovation. Furthermore, the authors distinguish between two types of KM practices: a written policy of KM and a culture intended to promote KM sharing. The main results are also confirmed for both types of KM practices. Moreover, based on coefficients and significance levels, the empirical results indicate that a culture intended to promote KM sharing has a more substantial impact on green innovation than a written policy of KM.Practical implications– KM can boost environmental innovation, which also enhances firm business performance. Therefore, managers should foster investment in KM capabilities. They need to create working atmosphere that generates, stores, transfers and applies knowledge in order to improve a firm’s green innovativeness. Additionally, the study results show that managers can choose among different KM practices in order to enhance environmental innovation. However, managers should be aware that not all KM practices provide the full advantage in terms of performance improvement. They should know that different KM practices have differential impacts on different performance outcomes. In this sense, managers should implement KM practices that fit their performance strategy.Originality/value– The relationship between KM and innovation performance has received increasing attention from researchers during the past years. However, even though scholars underline the importance of environmental innovation, the relationship between KM and environmental innovation remains significantly under-researched. The findings suggest that KM should be considered as an important source for environmental innovation improvement.

Background The optimal management of left ventricular thrombus (LVT) is unknown, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs). Purpose To identify the independent correlates of LVT regression and clinical outcomes. Methods A computerized case sensitive search on 90 065 consecutive echocardiograms performed between January 2011 and December 2017 identified patients with a LVT. Repeated echocardiographic data, treatment and major adverse cardiac events (MACE), including death, stroke, myocardial infarction or acute peripheral artery emboli were analyzed as well as major bleeding events (BARC ≥ 3) and all-cause mortality. Results We included 159 patients with an LVT confirmed by two independent experts. Patients were treated by vitamin K antagonists (48.4%), parenteral heparins (27.7%) and NOACs (22.6%) with additional antiplatelet therapy in 67.9% of the population. Total LVT regression was reached in 62.3% of the patients in a median time of 103 [32–392] days. The independent correlates associated with LVT regression were a non-ischemic cardiomyopathy (HR 0.36; 95%CI [0.19–0.69], P = 0.002) and a smaller baseline thrombus area (HR 0.66; 95%CI [0.45–0.96], P = 0.031). Cardiovascular events were frequent with 37.1% of MACE, 18.9% of major bleeding and 13.2% of all-cause mortality during a median follow-up of 632 [187–1126] days. A left ventricular ejection fraction >35% (HR 0.46; 95%CI [0.23–0.93], P = 0.029) and an anticoagulation therapy > 3 months (HR 0.42; 95%CI [0.20–0.88], P = 0.021) were independently associated with less MACE. A reduced risk of mortality was observed among patients that obtained a total LVT regression (HR 0.48; 95%CI [0.23–0.98]; P = 0.039) ( Fig. 1 ). Conclusions The presence of LVT was associated with a very high risk of MACE and mortality. Total thrombus regression, obtained with either vitamin K antagonists or NOACs, led to a better prognosis.

International audience; The most dangerous emergency situations are those threatening a high population in complex and large scale buildings. Traditional evacuation plans seem to be inefficient and lack of flexibility owing to the difficulty in predicting both the behavior of evacuees and building status in such disasters. The emergence of smart building and technologies can help to design real-time evacuation guidance systems. They will provide shortest routes for evacuees regarding their position in the building by avoiding crowd and fire propagation. We propose a guidance system based on an ant colony optimizer. Experiments are performed to illustrate the ability of this intelligent guidance system in providing realistic plans according to the building parameters. Also, the decision maker can assess the safety of a given building by simulating evacuation process.

Electric vehicles have emerged as a new promising technology guaranteeing sustainable transport activities. To save the environment and avoid our dependence on foreign oil, new laws and regulations concerning the emission of greenhouse gases are made in order to reduce harmful emissions and promote electric vehicles for urban goods distribution. This paper proposes to address the electric Modular Fleet Size and Mix Vehicle Routing Problem with Time Windows, which incorporates electric modules that can be recharged at customer locations. For that purpose, we apply a memetic algorithm that combines a Genetic Algorithm with a Local Search method. Experimental results demonstrate that with the modularity feature, using electric vehicles for freight delivery in cities is interesting economically.

A new, highly pixelated, PET scanner dedicated to mouse imaging is being developed based on the LabPET II detector module. Each module includes four monolithic array of 4×8 avalanche photodiodes (APD) individually coupled to four 4×8 array of 1.12×1.12 mm2 scintillator pixels aimed at achieving submillimetric spatial resolution. A PCB routes the signals from four detector arrays to two 64-channel, mixed-signal, Application Specific Integrated Circuit (ASIC), forming a 128-channel readout unit. A new DAQ system was designed to interface this novel detector module. Its firmware architecture consists of 2 types of custom FPGA-based electronic boards processing data from the detector module. An embedded signal processing unit is in charge of data readout, corrections and sorting. It also features live energy histogramming and count rates computation. An FPGA-based coincidence, data communication and gating unit collects data from all embedded signal processing units and deals with coincidence detection together with random estimation and sends processed data to a host computer. In parallel to the detected events stream, a command and control flow was added for ASIC automatic calibration, electronic boards parameters setting and readout from the host computer. This firmware allows a real-time PET data processing without degrading the detector module performance.

Introduction Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM). Exercise echocardiography is necessary to unmask latent obstruction in patients with HCM. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery. We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM. Method We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position. Results In total, 121 patients with HCM were included (age 49 ± 16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66 ± 7%, max LV wall thickness 19 ± 5 mm, 69% receiving betablockers). Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17 ± 18, 39 ± 43 and 55 ± 60 mmHg, P Conclusion The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.

This work deals with an extension of the well-known vehicle routing problem with time windows (VRPTW), where the fleet consists of electric modular vehicles (EMVs). The main drawback of managing electric vehicles is that they have a limited range. Here the vehicles are modular which means that payload modules are carried by a cabin module and can be detached at certain customer locations allowing the rest of the vehicle to continue the tour. This can also permit to recharge the battery of some modules to further capitalise on the gained energy. To tackle the resulting research problem, a comprehensive mathematical formulation is proposed to take into account the multiple constraints linked with the modularity, the electric charging, time windows to serve the customers and capacity issues. Due to the NP-hardness of the problem, a memetic algorithm is implemented and tested for designing good quality solutions in reasonable computational times. Extensive computational experiments carried out on some benchmark instances show the effectiveness of both the problem formulation and the memetic algorithm.

To achieve submillimetric spatial resolution, a new detection block has been designed for the LabPET II, a small animal PET scanner being developed at Universite de Sherbrooke. Each detection block consists of 2 arrays of 4×8 avalanche photodiodes (APD) individually coupled to an 8×8 scintillator array, to form 64 independent and parallel DAQ channels. This new detection block entails an 8-fold increase in pixel density compared to the LabPET™ I. A 64-channel mixed-signal Application Specified Integrated Circuit (ASIC) was designed to extract relevant PET data in real time from the LabPET II detection blocks. The ASIC is expected to support up to 3000 PET events/sec per channel. In order to interface the ASICs forming the PET camera with the storage units, a real-time FPGA-based digital DAQ system was designed. The DAQ system allows event harvesting, processing and transmission to a distant computer for image reconstruction as well as system programming and calibration. Real-time event processing embedded in the DAQ includes energy computation using a time-over-threshold (TOT) conversion scheme, timing corrections and event sorting trees. A real-time coincidence engine analyzes events and only keeps relevant information to minimize data throughput and post-acquisition data processing. The architecture consists of 3 layers of FPGA-based electronics wired through gigabit links: a Front-End board extracts timing and energy along with a pixel address, a Hub board sorts incoming events chronologically and a Coincidence board matches coincident events and copes with randoms estimation. Every FPGA in the different layers is accessible through an Ethernet link. The real-time digital architecture sustains the required throughput of ~111 Mevents/s for a ∼37000 channels scanner configuration.

Hemolytic uremic syndrome (HUS), characterized by the triad of micro-angiopathic hemolytic anemia, thrombocytopenia, and acute renal insufficiency, is a common cause of acute renal failure in children. It usually follows an episode ofgastroenteritis with enterotoxigenic Escherichia coli and is termed typical HUS. However, HUS is also a complication of invasive pneumococcal infection. Reasons for not diagnosing this condition include the absence of a specific laboratory test, the lack of consistent case definitions, unfamiliarity, a misdiagnosis of disseminated intravascular coagulation (DIC), and cases with micro-angiopathic hemolytic anemia and only mild renal injury. The aim of our study is to describe the epidemiology, the treatment and the evolution of HUS after invasive pneumococcal infections in Tunisia. Cases were identified between 2008 and 2016. Infection with S. pneumoniae was confirmed with culture of cerebrospinal fluid, pleural fluid, or blood. Eight children fulfilled our criteria for inclusion in the study. Primary patterns were fever, respiratory signs, neurological signs and uncommon patterns. Pneumonia was a presenting feature in 6 of 8 cases (75%), two patients had confirmed pneumococcal meningitis. Pneumococcal invasive infection was confirmed by positive yield for S. pneumoniae by culture in pleural levy or drainage in two cases, cerebrospinal fluid in two cases and blood in four cases. The mean duration of hospitalization was 23.5 days. Antibiotic therapy was initiated in all patients. Six patients from eight required dialysis for a median 27.8 days. No patients received plasma exchange therapy. Two patients died and. One patient with pneumococcal pneumatocele and presented a sepsis complicated with a nosocomial infection following a prolonged stay in the intensive care unit. One patient had bronchiectasis leading to recurrent broncho-pulmonary infections. One patient who was dialysis dependent at discharge died 4 months later.

The present study describes an innovative methodology to rank suitable sites for irrigation with TWW using fuzzy-AHP based on GIS where the Nabeul-Hammamet aquifer catchment (Tunisia) is selected as the target area. The model is relatively simple and is extendable worldwide. Several influential parameters are identified considering simultaneously technical, social, economical and environmental aspects. They are grouped in five main criteria, namely land suitability for irrigation, resources conflicts, cost effectiveness, social acceptance and environmental impact. Each criterion is subdivided into several sub-criteria. A pair-wise matrix is used to compare these criteria and sub-criteria and to rank them according to their relative importance for site evaluation. Using GIS, geographical layers are obtained for the sub-criteria, leading to mapping and ranking the suitable sites for TWW irrigation. The results show that the total suitable area covers 11,426 ha which represents 31% of the total Nabeul-Hammamet aquifer watershed. This constitutes quite a large zone that can absorb the entire volume of available treated wastewater, thereby increasing the region's agricultural production. The best sites to receive the surplus amount of TWW, produced by the treatment plants of the region, are located near these plants and inside agricultural lands. In addition, all these sites are located around the districts already irrigated by TWW, which underlines the role these districts may play in encouraging neighbouring farmers to change their attitude towards TWW and to accept it as an alternative resource for irrigation.

This paper introduces the electric Modular Fleet Size and Mix Vehicle Routing Problem with Time Windows (eM-FSMVRPTW), which deals with introducing new types of electric vehicles for urban freight delivery taking into account the possibility of recharging at a customer location. These electric vehicles differ from battery electric vehicles because their modules are autonomous in terms of consumption and electric charging. Therefore, the eM-FSMVRPTW is a completely new problem. Its objective is to minimize the acquisition cost, the total distance travelled and the recharging costs taking into consideration several constraints such as modularity, electric charging, time windows, capacity limit and others. As a solution method, we propose an approach based on a genetic algorithm. The experimental results demonstrate that with the modularity feature, using electric vehicles for freight delivery in urban environment is interesting economically.

We report a case of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) preseptal cellulitis complicated by zygomatic osteomyelitis, cavernous sinus thrombosis, meningitis, and necroziting pneumonia in a previously healthy two and half month old girl. This case exemplifies an aggressive and disseminated CA-MRSA infection with deep venous thrombosis in an infant without predisposing risk factors. The literature is reviewed and recommendations for management are provided.

Nous avons collecte les cas de meningites iatrogenes (MI) survenus a l’hopital d’enfants de Tunis durant la periode allant de janvier 1998 a decembre 2006. Une fiche de renseignements cliniques a ete remplie pour chaque patient retenu. Tous les prelevements bacteriologiques ont ete analyses au laboratoire de microbiologie de l’hopital d’enfants de Tunis. L’identification des bacteries a ete effectuee selon les methodes conventionnelles. Pendant la periode d’etude, nous avons collige trois cas de MI survenus apres ponction lombaire (PL). Deux cas sont survenus chez des nouveau-nes admis pour suspicion d’infection neonatale et un cas est survenu chez un nourrisson de deux mois admis pour exploration de convulsions hyperpyretiques. Dans tous les cas, la PL initiale a ramene un liquide cephalorachidien (LCR) sans anomalies et ils ont tous developpe, 72 heures apres, des symptomes de meningite aigue. La deuxieme PL etait franchement purulente dans tous les cas. Les bacteries isolees etaient Klebsiella pneumoniae, Enterobacter cloacae et Serratia marcescens, toutes productrices de betalactamase a spectre etendu (BLSE). Le recours a un traitement par des quinolones a ete necessaire dans les trois cas. Differentes complications ont marque l’evolution de ces meningites: hydrocephalie et abces cerebral dans un cas, defaillance respiratoire et hemodynamique ayant necessite le transfert dans une unite de soins intensifs dans le deuxieme cas et pour le troisieme cas hygroma cerebral. Cette etude montre la morbidite elevee causee par la MI. De simples precautions d’asepsie prises avant chaque PL peuvent prevenir des cas pareils.

Resume Objectif Determiner le taux de mortalite et les facteurs qui l’influencent chez 70 enfants avec choc septique secondaire a une infection communautaire. Patients et methodes Analyse retrospective de toutes les observations des enfants admis, (janvier 1998 a aout 2005), dans un service de reanimation pediatrique, avec le diagnostic de choc septique, secondaire a une infection communautaire. Ont ete exclus de l’etude les nouveau-nes âges de moins de sept jours et les chocs secondaires a une infection nosocomiale. Resultats Soixante-dix observations ont ete colligees, dont 32 (45,7 %) sont decedes. L’âge moyen etait 3,8 ± 4,2 ans et le Prism durant les 24 premieres heures etait de 19,2 ± 8,4. Une defaillance multiviscerale etait presente au moment du diagnostic de choc chez 69 patients (98,6 %), dont 60 (85,7 %) avaient plus de deux organes defaillants. Le delai moyen de transfert en reanimation par rapport a la constatation des premiers troubles hemodynamiques etait de 9,4 ± 11,3 heures. Trois facteurs de risque independants de mortalite ont ete identifies : une defaillance de plus de deux organes a l’admission (OR = 4,4 ; IC a 95 % [2,1–9,4]), le recours a un volume de remplissage superieur a 20 ml/kg a j2 de reanimation (OR = 3,4 ; IC a 95 % [1,1–10,3]) et le recours a plus de deux substances vasoactives (OR = 3,3 ; IC a 95 % [1,2–9]).

Convergence of development in the wireless communication field, evolution of positioning systems and geographic information systems (GIS) have given rise to a new type of applications and services related to mobility and localization. However, the current information systems do not deal with the management of information concerning the mobile objects. This article initially proposes a mobile object data model, which constitutes a framework for the development of location based applications and services. We define, in this extended object model, a powerful set of data types and operations able to handle mobile objects; and which will be necessary to define a new query language of mobile data based on SQL 3. Furthermore, architecture and object oriented modeling with UML 2 are developed for real time location based mobile information systems. MOTS-CLES : Objets mobiles, Location Based Services, requetes spatio-temporelles, modelisation basee sur les composants.

Resume Objectif Determiner l'epidemiologie des infections bacteriennes nosocomiales dans l'unite de reanimation neonatale et pediatrique de l'hopital d'enfants de Tunis. Materiel et methodes Etude prospective d'incidence portant sur la cohorte des patients admis en 2004 et sejournant plus de 48 heures en reanimation. Les criteres d'infection utilises ont ete ceux du Centers for Disease Control. Resultats Sur un total de 340 patients, dont 249 (73 %) nouveau-nes, 22 episodes infectieux bacteriens ont ete enregistres chez 22 patients. L'incidence des infections bacteriennes nosocomiales etait de 6,5 % et la densite d'incidence de 7,8 pour 1000 jours d'hospitalisation. Deux sites infectieux ont ete identifies : les bacteriemies (68,2 %) et les pneumopathies (31,8 %). Les bacteriemies avaient une incidence de 4,4 % et une densite d'incidence de 15,3 pour 1000 jours de catheterisme veineux central. Les pneumopathies avaient une incidence de 2 % et une densite d'incidence de 4,4 pour 1000 jours de ventilation mecanique. Les bacilles a Gram negatif etaient les bacteries les plus frequemment isolees (68 %) et etaient domines par Klebsiella pneumoniae (22,7 %). Le germe predominant des bacteriemies etait K. pneumoniae (26,7 %), multiresistante dans 85 % des cas, suivi par Staphylococcus aureus (20 %). Pseudomonas aeruginosa etait le germe predominant des pneumopathies (28,6 %). Les procedures invasives et la colonisation par un bacille a Gram negatif multiresistant etaient les principaux facteurs associes a l'infection nosocomiale. Conclusions Les infections bacteriennes nosocomiales, dans notre unite, sont dominees par les bacteriemies et sont principalement dues aux bacilles a Gram negatif. Les facteurs associes a ces infections ont ete identifies.

In order to determine the response to high-frequency oscillatory ventilation (HFOV), used as an “early rescue” therapy, in a cohort of paediatric patients with acute respiratory distress syndrome (ARDS), a prospective clinical study was performed in a tertiary care paediatric intensive care unit. Ten consecutive patients, aged 12 days to 5 years with ARDS and hypoxaemic respiratory failure on conventional ventilation (CV), using a lung protective strategy, were managed with HFOV early in the course of the disease process (median length of CV 4 h). Arterial blood gases, oxygenation index (OI), alveolar-arterial oxygen difference (P(A-a)O2) and PaO2/FIO2 ratio were prospectively recorded prior to HFOV (0 h) and at predetermined intervals throughout the course of the HFOV protocol. There was a significant improvement in PaCO2 4 h after institution of HFOV ( P =0.012). A significant and sustained increase ( P

Group milleri streptococci that colonize the mouth and the upper airways are generally considered to be commensal. In combination with anaerobics, they are rarely responsible for brain abscesses in patients with certain predisposing factors. Mortality in such cases is high and complications are frequent. We present a case of fatal subdural empyema caused by Streptococcus constellatus and Actinomyces viscosus in a previously healthy 7-year-old girl.