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We study a global panel of green and conventional bonds to assess the borrowing cost advantage at issuance for green bond issuers. We find that, on average, green bonds have a yield spread that is 8 basis points lower relative to conventional bonds. This borrowing cost advantage, or greenium, emerges as of 2019 and coincides with the growth of the sustainable asset management industry following EU regulation. Within this context, we find that the greenium is linked to two proxies of demand pressure, bond oversubscription and bond index inclusion. Moreover, while green bond governance appears to matter for the greenium, the credibility of the underlying projects does not have a significant impact. Instead, the greenium is unevenly distributed to large, investment-grade issuers, primarily within the banking sector and developed economies. These findings have implications for the role of green bonds in incentivizing meaningful green investments throughout the global economy.

Two pups with SCC colonies were removed from service. The most dominant cracks in the colonies are short and deep. One of the pups had a bulge in the area of the SCC colony. The two pups were subjected to hydrostatic burst tests and detailed post-test metallurgical examination. A companion paper covers the formation, dormancy, and growth of these SCC colonies using forensic analysis. This paper covers two main elements aimed at understanding the behavior of pipes with SCC colonies and supporting the work covered in the companion paper: (1) Burst pressure prediction, and (2) Analysis of the bulge. Burst pressure predictions were made with available material properties and flaw dimensions measured by MPI, UT, and PAUT prior to the actual burst tests. After the burst tests, the predictions were updated with more relevant material property data and the flaw dimensions obtained from fracture surfaces exposed. The modified Ln-Sec, CorLAS™, MAT-8, and Level 2 of API 579 burst pressure models and the associated Charpy to fracture toughness correlations were used. Two flaw interaction rules, CEPA and PRCI-CRES, were used to determine the single equivalent crack dimensions for input into the burst pressure models. The burst pressure predictions were compared with the experimentally measured burst pressures. Of the multiple factors affecting the burst pressure prediction, the selection of flaw interaction rules has the most prominent impact on the accuracy of the burst pressure prediction. The selection of burst pressure models has a secondary impact with the exception of API 579, which tends to give lower burst pressure predictions than other models. The formation of the bulge was simulated under different longitudinal/axial loading conditions and two levels of internal pressure. It is shown that the level of the residual bulge has a strong dependence on the severity of SCC (length, depth, and spatial distribution), the level of maximum internal pressure before depressurization, and the longitudinal stress state. Compressive longitudinal stress reduces the level of internal pressure needed to produce a bulge of the same magnitude when the severity of SCC remains constant. Multiple possible conditions could have existed to produce the observed bulge.

Background As the USA grapples with an opioid epidemic, medical emergency departments (EDs) have become a critical setting for intervening with opioid-dependent patients. Brief interventions designed to bridge the gap from acute ED care to longer-term treatment have shown limited efficacy for this population. Strength-based case management (SBCM) has shown strong effects on treatment linkage among patients with substance use disorders in other healthcare settings. This study aimed to investigate whether SBCM is an effective model for linking opioid-dependent ED patients with addiction treatment and pharmacotherapy. Here, we describe the implementation and challenges of adapting SBCM for the ED (SBCM-ED). Study rationale, design, and baseline characteristics are also described. Methods This study compared the effects of SBCM-ED to screening, assessment, and referral alone (SAR) on treatment linkage, substance use, and functioning. We recruited participants from a public hospital in NYC. Working alliance between case managers and participants and the feasibility of SBCM implementation were evaluated. Baseline data from the randomized sample were analyzed for group equivalency. Outcomes analyses are forthcoming. Results Three hundred adult participants meeting DSM-IV criteria for opioid dependence were randomly assigned to either SBCM, in which they received a maximum of six case management sessions within 90 days of enrollment, or SAR, in which they received a comprehensive referral list and pamphlet outlining drug use consequences. No significant differences were found between groups at baseline on demographic or substance use characteristics. All SAR participants and 92.6% of SBCM-ED participants initiated their assigned intervention. Over half of SBCM-ED first sessions occurred in the ED on the day of enrollment. Case managers developed a strong working alliance with SBCM-ED participants after just one session. Conclusion Interventions that exceed SBIRT were accepted by an opioid-dependent patient population seen in an urban medical ED. At the time of study funding, this trial was one of the first to focus specifically on this population in this challenging setting. The successful implementation of SBCM demonstrates its adaptability to the ED and may serve as a potential model for EDs seeking to adopt an intervention that overcomes the barrier between the ED encounter and more intensive treatment. Trial registration ClinicalTrials.gov NCT02586896. Registered on 27 October 2015.

1. Although the frequency of occurrence of plastic ingestion in the large-sized dolphinfish and tunas taken by the Hawai’i longline fishery is very low (frequency of occurrence < 5% of sampled individuals), the ingestion of plastic in smaller-sized specimens caught with pole-and-line gear by commercial and recreational fishers has not been investigated. 2. This study examined ingestion of >0.25 mm marine plastic debris (MPD) by four predatory fish species caught by commercial fishers around the Main Hawaiian Islands, and documented ingestion in three species: 85.7% of albacore tuna (n = 7), 40.0% of skipjack tuna (n = 10) and 12.5% of dolphinfish (n = 8). 3. Yellowfin tuna (n = 10) did not contain any MPD, probably owing to the high proportion of empty stomachs (60%). 4. For skipjack tuna, the frequency of occurrence of MPD ingestion was significantly higher for the smaller-sized specimens caught with pole-and-line (40%), compared with the larger-sized specimens caught with longlines (0%). 5. For dolphinfish, the frequency of occurrence of MPD ingestion was similar for the similar-sized specimens caught with pole-and-line and with longlines. 6. The ingested MPD items were micro–meso plastics, between 1 and 25 mm. While most ingested items were fragments, albacore also ingested line and skipjack also ingested sheets. 7. The predatory fishes ingested light MPD items that float in sea water, but there were species-specific differences in their polymer composition: albacore contained more polypropylene and polyethylene, and skipjack contained more elastomers, characterized by a high percentage of ester plasticizers. 8. Altogether, these results suggest that albacore and skipjack tunas ingest plastic of different types and polymers. Yet more research is needed to understand how differences in vertical distribution, foraging ecology and diet influence the MPD sampled by these predatory fish species.

International audience

Background In a context of the evolution of severe morbidities in patients living with HIV (PLWH), the aim of this study was to describe reasons for hospitalization and the mode of care for the patients requiring hospitalization. Methods All admissions (≥ 24 h) of PLWH to 10 hospitals in the south of Paris (COREVIH Ile-de-France Sud) between 1/1/2011 and 12/31/2011 were identified. The hospital database and the file of patients followed in the HIV referral department of each hospital were matched. Detailed clinical and biological data were collected, by returning to the individual medical records, for a random sample (65% of hospitalized patients). Results A total of 3013 hospitalizations (1489 patients) were recorded in 2011. The estimated rate of hospitalized patients was about 8% among the 10105 PLWH routinely managed in COREVIH Ile-de-France Sud in 2011. The majority (58.5%) of these hospitalizations occurred in a unit other than the HIV referral unit. Non-AIDS-defining infections were the main reason for admission (16.4%), followed by HIV-related diseases (15.6%), hepatic/gastrointestinal diseases (12.0%), and cardiovascular diseases (10.3%). The median length of stay was 5 days overall (IQR: 2-11), it was longer among patients admitted to a referral HIV care unit than to another ward. HIV infection had been diagnosed > 10 years previously in 61.4% of these hospitalized patients. They often had associated comorbidities (coinfection HCV/HVB 40.5%, smoking 45.8%; hypertension 33.4%, dyslipidemia 28.8%, diabetes 14.8%). Subjects over 60 years old accounted for 15% of hospitalized patients, most of them were virologically controlled under HIV treatment, and cardiovascular diseases were their leading reason for admission. Conclusion Needs for hospitalization among PLWH remain important, with a wide variety in causes of admission, involving all hospital departments. It is essential to prevent comorbidities to reduce these hospitalizations, and to maintain a link between the management of PLWH, that becomes rightly, increasing ambulatory, and recourse to specialized inpatient services.

Improving continuity of care is an important objective of various interventions and innovative programs for youngsters in vulnerable situations. Yet, the definition and conceptualization of continuity of youth care remains unclear, as well as important benefits and pitfalls regarding its implementation. Therefore, this study provides a systematic review of the literature, focusing on the conceptualization and evaluation of continuity. Database searches revealed 28 studies that focus on youth care interventions aimed at improving continuity of care. Selected studies were analyzed in Nvivo, using a three dimension model of continuity of care developed in general practice. Results show that continuity of care is rarely the central focus in youth services research. Moreover, its conceptualization is often limited to management aspects of continuity rather than highlighting other dimensions of continuity (e.g., relational and informational continuity). Also, experienced continuity of care as perceived by youngsters themselves is underrepresented in the selected studies, resulting in a partial view on continuity in youth care. It is concluded that more research is needed on youngsters' perceptions of continuity of youth services and its relational and information aspects, using qualitative study designs.

Introduction et but de l’etude L’activite physique adaptee (APA) est de plus en plus integree aux programmes de rehabilitation multimodale dans les pathologies chroniques compliquees de denutrition. Le maintien d’une activite physique au cours de la renutrition dans l’anorexie mentale (AN) reste controverse en raison de l’hyperactivite. Des etudes recentes ont suggere un role benefique d’une APA, au cours de la renutrition dans l’AN, sur la composition corporelle, sur le metabolisme energetique et sur les symptomes anxio-depressifs. L’objectif principal etait d’evaluer l’evolution ponderale et la duree de sejour des patients ayant suivi un programme d’APA au cours de leur hospitalisation pour AN. Nous avons aussi evalue le ressenti des patients sur l’APA et leurs symptomes (hyperactivite, anxiete, dysmorphophobie) et l’acceptation de la reprise de poids. Materiel et methodes Nous avons realise un questionnaire par entretien telephonique chez tous les patients majeurs ayant ete hospitalises pour AN en 2018 dans un service de SSR Nutrition. L’APA etait prescrite selon l’appreciation du clinicien. Le poids d’entree et de sortie d’hospitalisation, l’âge et le diagnostic d’AN restrictive ou mixte ont ete collectes a partir des dossiers. Les patients ont ete repartis en trois groupes selon le nombre de seances d’APA par semaine sur l’ensemble de l’hospitalisation : groupe APA 2 (plus de 2 seances par semaine). Les donnees quantitatives ont ete analysees par ANOVA et celle qualitatives par le test du chi-2. Resultats et analyse statistique Le recueil de donnees a pu etre complete en mars 2019 pour 46 des 81 patients hospitalises en 2018, toutes des femmes (30 restrictives et 16 mixtes). L’âge moyen etait de 33,7 ans (± 15,4), la duree d’evolution moyenne declaree de la maladie de 11,0 ans (± 13,2). Huit patientes etaient dans le groupe APA 2. La duree moyenne d’hospitalisation etait de 63 jours (± 36) sans difference significative entre les groupes. Il existait une difference significative concernant l’IMC (kg/m2) d’entree : APA 2 : 15,0 ± 1,5, p = 0,01), l’IMC de sortie (APA 2 : 16,3 ± 1,2, p = 0,02) et l’IMC lors du recueil (APA 2 : 16,7 ± 2,0, p = 0,04). Toutes les patientes ont pris de la corpulence pendant (sortie-entree : 1,2 ± 1,1) et apres l’hospitalisation (recueil–sortie : 0,4 ± 1,8), sans difference significative entre les groupes. Les patientes ayant pratique le plus d’APA declaraient une amelioration de leur hyperactivite physique (p = 0,04), et une meilleure acceptation de la prise de poids (p = 0,03). Il existait une tendance concernant l’amelioration des symptomes anxio-depressifs (p = 0,07) et de la dysmorphophobie (p = 0,09). Conclusion La pratique de l’APA au cours de la renutrition dans l’AN semble associee a une diminution de l’hyperactivite physique et une meilleure acceptation de la prise de poids. Une etude prospective randomisee est necessaire pour confirmer ces resultats et mieux comprendre les mecanismes impliques.

International audience; The diagnosis of malaria should always be considered in travelers returning from an endemic area and presenting with fever or a history of fever, either isolated or combined with other general, digestive, and/or respiratory symptoms, even if appropriate chemoprophylaxis was used.• Outpatient management of uncomplicated Plasmodium falciparum malaria may be implemented if precise clinical and biological criteria are met and if medical follow-up is possible.• Admission to hospital is recommended for individuals at risk of complications (young children and elderly, comorbidity, pregnancy, splenectomy, etc.).• The first-line treatment of uncomplicated P. falciparum malaria in adults is an artemisinin-derivative combination therapy (ACT): artemether-lumefantrine or artenimol-piperaquine. When such treatment is unavailable, not tolerated, or contraindicated, if interactions with concomitant medication are possible, or if ACT fails, then treatment with atovaquone-proguanil is an alternative option. Pregnant women (1st trimester) presenting with uncomplicated P. falciparum malaria should be hospitalized and treated with atovaquone-proguanil, or quinine if vomiting occurs. From the 2nd trimester on, priority should be given to artemether-lumefantrine or artenimol-piperaquine.• Uncomplicated malaria caused by species other than P. falciparum (i.e., P. vivax, P. ovale, P. malariae, or P. knowlesi) is treated with chloroquine or ACT. The latter is preferable in cases of co-infection or P. vivax malaria in travelers returning from a region known for resistance to chloroquine.• To prevent relapses in individuals infected with P. vivax or P. ovale, the dormant liver forms must be eliminated using primaquine, for which temporary use authorization (TUA) may be obtained once possible contraindications have been ruled out (glucose-6-phosphate dehydrogenase [G6PD] deficiency, pregnancy, breastfeeding).

Background: Case management is a client-centered approach to improve the coordination and continuity of service delivery, especially for persons with substance use disorders (SUD) and multiple and complex support needs. This intervention supports individuals by helping them identify needed services, facilitate linkage with services, and promote participation and retention in services. However, it is questionable whether case management is equally effective in promoting recovery and aspects of personal functioning. The objective was to conduct an updated meta-analysis and to assess whether case management was more effective than treatment as usual (TAU) among persons with SUD for improving treatment-related (e.g., successful linkage with and retention in treatment) as well as personal functioning outcomes (e.g., substance use). Methods: This meta-analysis focuses on randomized controlled trials (RCTs) that included persons with alcohol or drug use disorders and compared case management with TAU. To be eligible, interventions had to meet core case management functions as defined in the literature. We conducted searches of the following databases to May 2017: the Cochrane Drugs and Alcohol Specialized Register, CENTRAL, PubMed, Embase, CINAHL, and Web of Science. Also, reference lists of retrieved publications were scanned for relevant (un)published studies. Results: The overall effect size for case management compared to TAU across all outcome categories and moments was small and positive (SMD = 0.18, 95% CI 0.07-0.28), but statistically significant. Effects were considerably larger for treatment tasks (SMD = 0.33, 95% CI 0.18-0.48) than for personal functioning outcomes (SMD = 0.06, 95% CI -0.02 to 0.15). The largest effect sizes were found for retention in substance abuse treatment and linkage with substance abuse services. Moderator effects of case management models and conditions were assessed, but no significant differences were observed. Conclusions: The primary results from earlier meta-analyses were supported: case management is more effective than TAU conditions for improving outcomes, but this effect is significantly larger for treatment-related tasks than for personal functioning outcomes. Case management can be an important supplement to available services for improving linkage and retention, although further research is needed to assess its potential for supporting recovery from a longitudinal perspective. ispartof: FRONTIERS IN PSYCHIATRY vol:10 issue:MAR ispartof: location:Switzerland status: published

The 2020 coronavirus pandemic and the following quarantine measures have led to significant changes in daily life worldwide. Preliminary research indicates that air quality has improved in many urban areas as a result of these measures. This study takes a neighborhood-scale approach to quantifying this change in pollution. Using data from a network of citizen-hosted, low-cost particulate matter (PM) sensors, called Air Quality & yoU (AQ&U), we obtained high-spatial resolution measurements compared to the relatively sparse state monitoring stations. We compared monthly average estimated PM2.5 concentrations from February 11 to May 11, 2019 at 71 unique locations in Salt Lake County, UT, USA with the same (71) sensors’ measurements during the same timeframe in 2020. A paired t-test showed significant reductions (71.1% and 21.3%) in estimated monthly PM2.5 concentrations from 2019 to 2020 for the periods from March 11-April 10 and April 11-May 10, respectively. The March time period corresponded to the most stringent COVID-19 related restrictions in this region. Significant decreases in PM2.5 were also reported by state monitoring sites during March (p

Phosphodiesterase-5- (PDE-5-)Hemmer werden weltweit zur penilen Rehabilitation nach radikaler Prostatektomie eingesetzt. Zuletzt wurde von Michl et al. monozentrisch in einer retrospektiven nicht randomisierten Analyse gezeigt, dass die Einnahme von PDE-5-Hemmern mit einem erhohten Risiko fur ein biochemisches Rezidiv nach radikaler Prostatektomie assoziiert ist. Diese unerwartete und schwere Nebenwirkung wurde anhand eines Patientenkollektivs unserer prospektiv gefuhrten Tumordatenbank im Rahmen einer retrospektiven Analyse hinterfragt und im Kontext der aktuellen Literatur diskutiert. Es wurden 358 Patienten nach radikaler Prostatektomie mit bilateralem Nervenerhalt und ohne neo- oder adjuvante Therapie im Zeitraum von 2004 bis 2015 retrospektiv analysiert. Von diesen nahmen 65,9 % laut eigener Angabe postoperativ regelmasig PDE-5-Hemmer ein, 34,1 % taten dies nicht. Patienten mit sporadischer Einnahme wurden nicht in die Primaranalyse eingeschlossen. Mittels Kaplan-Mayer-Analyse wurde das rezidivfreie Uberleben von Patienten mit vs. ohne PDE-5-Hemmer-Einnahme verglichen (Endpunkt: PSA-Anstieg >0,2 ng/ml oder Salvagetherapie). Bei vergleichbaren klinischen Parametern beider Gruppen zeigte sich kein signifikanter Unterschied im rezidivfreien Uberleben (p = 0,9334). 60 Monate postoperativ waren 90,4 % der Manner mit verglichen zu 90,8 % der Manner ohne Einnahme von PDE-5-Hemmern rezidivfrei. Trotz vergleichbarem Analysenaufbau konnten die Ergebnisse der Arbeit von Michl et al. in unserem Patientenkollektiv nicht bestatigt werden. In Zusammenschau mit einer Kohortenanalyse aus Skandinavien scheint die postoperative PDE-5-Hemmer-Einnahme sicher zu sein und sollte den Patienten nach kritischer Diskussion nicht vorenthalten werden.

Streptococcus pneumoniae can cause invasive infections. Incidence and severity are linked to patients' risk factors. Due to the resistance to leading antibiotics, the anti-pneumococcal vaccination has become a major public health issue. The purpose of this survey was to evaluate the anti-pneumococcal vaccine coverage in a population of adults with risk factors. This was a prospective study that included patients with at least one recommendation for pneumococcal vaccination as indicated by the Weekly Epidemiological Bulletin (BEH), to which three further US recommendations were added (diabetes, obesity and age>65years). One hundred and thirty-four patients with an average age of 70 years were included. The physician could only confirm 68 % of the patients' vaccination status. Vaccination coverage as recommended by the BEH board was 30 % (n=54). All HIV patients were vaccinated (n=2) and the vaccination coverage was 75 % (n=8) for patients treated for autoimmune diseases and only 10 % (n=20) for patients treated with chemotherapy. Patients with no vaccination didn't know the existence of the vaccine or didn't know that vaccination was recommended to them. This study has highlighted a deficit in pneumococcal vaccination coverage and a high level of ignorance of the existence of recommended vaccination. In addition to awareness campaign for patients and caregiver training, the expansion of the vaccine e-book utilization could improve the vaccination status.

Introduction et but de l’etude La vitamine D est essentielle dans la prevention des chutes et dans la prise en charge de pathologies osseuses. La HAS ainsi que l’Assurance Maladie recommandent le dosage de la vitamine D dans les situations suivantes : patient a risque de chutes a repetition (dont patients denutris severes), medicaments inducteurs de carence, osteomalacie, rachitisme, transplante renal, chirurgie bariatrique. La supplementation en vitamine D fait l’objet de recommandations et semble insuffisante en medecine de ville. Le statut vitaminique D des patients (identification des situations avec une indication au dosage et supplementation) est-il re evalue en medecine aigue et quelle est la place des patients denutris severes qui releveraient d’une evaluation du statut vitaminique ? Materiel et methodes Il s’agit d’une etude observationnelle retrospective. Les criteres d’inclusion sont les patients sortis de 2 services de medecine aigue (medecine interne et geriatrie) du 01/12/18 au 31/12/18. Les patients deja supplementes ont ete analyses de facon independante. Les criteres d’exclusion sont les deces et l’hypercalcemie vraie. Parmi les patients a risque de chutes repetees ont ete differencies les chuteurs averes definis par au moins deux chutes au cours des 12 derniers mois des patients denutris severe. Le dosage de vitamine D, la supplementation en vitamine et ses modalites etaient recueillis. Resultats et analyse statistique Nous avons etudies 238 dossiers patients. Vingt deux patients ont ete exclus (21 deces et 1 hypercalcemie). La moyenne d’âge 85 ans (± 0 ans ; Sex ratio 78/138). 187/216 (87 %) patients relevaient d’une supplementation. Dans ce groupe, 43/187 (23 %) etaient deja supplementes a l’entree. Parmi les 144/187 (77 %) non supplementes en ville : 72/144 (50 %) avaient une indication au dosage de vitamine D : risque de chutes a repetition chez 72/72 (100 %) dont 39/72 (54 %) chuteurs averes et 33/72 (46 %) denutris severes. Aucun de ces 72 patients n’a beneficie du dosage recommande. La place des patients denutris severe represente 33/144 (23 %) des patients necessitant une supplementation. 72/144 (50 %) n’avaient pas d’indication au dosage mais etaient soit osteoporotiques, soit âges de plus de 65 ans et en perte d’autonomie avec une exposition solaire insuffisante relevant d’une supplementation trimestrielle. Seuls 33/187 (18 %) ont beneficie de vitamine D a la sortie, de galeniques et posologies diverses. Pour 23/43 (53 %) des patients deja supplementes, la vitamine D n’a pas ete reconduite. Parmi les patients non supplementes en ville, seuls 13/144 (9 %) ont beneficie d’une introduction de vitamine D. Conclusion Nos resultats montrent que la reevaluation du statut vitaminique D et la prescription de vitamine D semblent tres insuffisants en medecine hospitaliere aigue mais egalement en medecine de ville. Une sensibilisation sur cette thematique est necessaire, surtout chez le patient a risque de chute et notamment les denutris severes.

Causes of hypereosinophilia among travelers returning from North Africa are dominated by helminth infections, especially when associated with gastrointestinal signs. Non-infectious causes must nonetheless be investigated after negative microbiological assessment and failure of a broad empiric antiparasite treatment. We report the case of a young man with epigastralgia and major weight loss since a stay in Tunisia. Empiric treatment with albendazole was not successful. Eosinophilic gastroenteritis was diagnosed and resolved under corticosteroid treatment.

Introduction Les meningites sont des pathologies rares du voyageur. Peu de donnees sont disponibles concernant les donnees microbiologiques dans ce contexte. Materiels et methodes Cette etude observationnelle monocentrique a inclus tous les patients adultes pris en charge pour meningite du 1er janvier 2002 au 31 decembre 2015. Les meningites ont ete classees en bacterienne (culture ou PCR positive dans le LCR ou hemoculture positive), virale certaine (PCR positive dans le LCR), virale probable (evolution favorable sans antibiotherapie dans les 7 jours suivant le diagnostic) ou sans etiologie. Un patient etait considere comme voyageur s’il avait quitte le territoire metropolitain dans le mois precedant le debut des symptomes. L’objectif etait de comparer la microbiologie des meningites des voyageurs aux autres meningites diagnostiquees durant la meme periode. La comparaison a ete realisee par le test du chi-2 ou le test exact de Fisher. Resultats Un total de 296 patients ont ete inclus, dont 47 voyageurs (âge median 31 ans [26–37], 23 [48,9 %] femmes). Les destinations principales etaient l’Afrique sub-saharienne (n = 11, 23,4 %), le Maghreb (n = 10, 21,3 %) et l’Europe (n = 6, 12,8 %). Les mois avec le plus de cas etaient aout, septembre et octobre (respectivement 15,2, 13 et 13 %) sans difference significative avec les autres mois. Pour sept patients (14,9 %), les symptomes avaient debute durant le sejour mais aucun n’avait ete rapatrie. Trente-cinq (74,5 %) presentaient une meningite virale (22 certaines et 13 probables), onze (23,4 %) une meningite d’etiologie indeterminee et 1 (2,1 %) une meningite bacterienne. La microbiologie montrait une predominance nette d’Enterovirus (n = 15, 31,9 %) et d’Herpesviridae (HSV 2, 3 cas et VZV, 2 cas). Un (2,1 %) patient presentait une meningite ourlienne. La seule meningite bacterienne etait due a Mycoplasma pneumoniae chez un jeune de retour de Cote d’Ivoire. Seules deux meningites etaient dues a une etiologie non cosmopolite, un cas de dengue au retour de Malaisie et de meningite a Toscana virus apres un sejour en Italie. En comparant avec le groupe controle, les deux populations n’etaient pas differentes sur l’âge et le sexe (p = 0,69 et 0,57 respectivement). La proportion de meningites bacteriennes (p = 0,14, OR 0,21 [0,04–1,18]), virales certaines (p = 0,59, OR = 1,19 [0,64–2,2]), virales probables (p = 0,59, OR = 1,3 [0,65–2,6] et indeterminees (p = 0,97, OR = 0,95 [0,46–1,96]) n’etaient pas differentes. Conclusion La demarche diagnostique d’une meningite au retour de voyage doit s’attacher en premier lieu a la recherche d’etiologies cosmopolites. Les causes exotiques doivent etre evoquees en 2e intention, notamment en cas de contexte epidemiologique evocateur.

Between 2006 and 2013, we salvaged and necropsied 362 seabird specimens from Tern Island, French Frigate Shoals, Northwestern Hawaiian Islands. Plastic ingestion occurred in 11 of the 16 species sampled (68.75%), representing four orders, seven families, and five foraging guilds: four plunge-divers, two albatrosses, two nocturnal-foraging petrels, two tuna-birds, and one frigatebird. Moreover, we documented the first instance of ingestion in a previously unstudied species: the Brown Booby. Plastic prevalence (percent occurrence) ranged from 0% to 100%, with no significant differences across foraging guilds. However, occurrence was significantly higher in chicks versus adult conspecifics in the Black-footed Albatross, one of the three species where multiple age classes were sampled. While seabirds ingested a variety of plastic (foam, line, sheets), fragments were the most common and numerous type. In albatrosses and storm-petrels, the plastic occurrence in the two stomach chambers (the proventriculus and the ventriculus) was not significantly different.

This study provides the first quantification of plastic ingestion in the Tristram's Storm-petrel (Oceanodroma tristrami) in over 20 years. We found 100% plastic incidence in 57 chicks collected opportunistically over four breeding seasons (2007, 2010, 2011, 2012), with the mass of ingested plastic per individual ranging from 0.1 to 2.8 g (≤3.3% adult mass). While plastic occurred in every bird we examined, the proventriculus contained significantly more plastic, more fragments, and larger fragments than the gizzard. Most of the ingested plastic (97.5% by mass) consisted of fragments, ranging in length from 0.4 to 11.6 mm and ranging in surface area from 0.07 to 45.21 mm2. While fragments were ubiquitous, occurring in every proventriculus and gizzard we analyzed, Tristram's Storm-petrels also ingested foam, line and sheets. Digital analysis of 1425 ingested plastic fragments documented a wide range of colors, involving shades of white, yellow, orange, red, blue, green, and black.

The French joint military health corps has long experience in malaria control. Many military physicians played an essential role in the 19th century: Maillot revolutionized malaria treatment by using quinine during the conquest of Algeria, and Laveran discovered the causal parasite (the genus Plasmodium) there. This experience continued under the direction of Laveran and the Sergent brothers on the eastern front in Greek Macedonia during World War I. The vast coordinated control plan established on this front from 1917 delivered the French infantrymen from malaria and led to victory over the Bulgarian forces, which capitulated in September 1918.

Introduction et but de l’etude Les Troubles du comportement alimentaire (TCA) sont souvent diagnostiques tardivement notamment en medecine generale, ce qui altere le pronostic. Les patients souffrant de TCA presentent tres souvent de Troubles fonctionnels digestifs (TFD), qui sont un motif principal de consultation frequent. Le but de cette etude etait donc de proposer un depistage systematique des TCA par le questionnaire valide de SCOFF-F (5 questions, TCA tres probable si au moins 2 reponses OUI) chez les patients consultant en medecine generale pour des TFD ; une approche de la categorie diagnostique du TCA a ete aussi realisee a l’aide d’un algorithme recemment developpe (Expali™). Materiel et methodes Lors d’une enquete epidemiologique observationnelle transversale (juin a juillet 2017), un questionnaire en ligne a ete rempli par des medecins generalistes de la region a l’occasion d’une consultation au cabinet pour TFD. Le questionnaire comprenait des donnees cliniques usuelles, les criteres de ROME IV et un SCOFF-F. Les reponses du SCOFF-F et les valeurs d’IMC ont ete secondairement exploitees avec l’algorithme Expali™. Les analyses comparatives des variables qualitatives ont ete realises par le test du Chi2 ou le test exact de Fisher et les analyses comparatives des variables quantitatives ont etaient realisees par le test t de Student. Resultats et analyse statistique 36 patients (72 % de femmes) ont ete inclus par 13 medecins. Un questionnaire a ete exclu en raison d’un TCA deja connu. Deux questionnaires ont ete exclus car une lesion organique expliquait les troubles digestifs. L’âge moyen etait de 38 ans (± 9), le poids moyen de 76,4 kg (± 18,6) et l’IMC moyen de 27,8 (± 7), sans difference significative entre les hommes et les femmes. Le TFD le plus represente etait le SII avec 29 %, puis la dyspepsie avec 21 %. Le SCOFF-F etait positif chez 13 patients (36,1 %), ce qui etait tres superieur a la prevalence des TCA de 14,3 % retrouvee dans une large population de medecine generale de la meme region etudiee recemment (p Conclusion En medecine generale, les TCA sont 2 a 3 fois plus frequents chez les patients consultant pour TFD. Cette association importante entre les TCA et les TFD justifie une approche globale de ces patients. Le Score de SCOFF-F test de depistage pratique en medecine generale, est encore plus utile sur la population cible presentant un TFD.

Introduction La dengue est l’arbovirose la plus prevalente au monde. En plus du risque pour le voyageur de retour d’une zone d’endemie, le risque de cas secondaires autochtones existe du faite de la reimplantation perenne d’Aedes. Nous decrivons les caracteristiques des dengues d’importation pris en charge dans deux centres. Materiels et methodes Etude descriptive retrospective multicentrique de 2008 a 2015 de tous les cas de dengue prouvees microbiologiquement. Resultats Deux-cents soixante-quatorze patients ont ete inclus (âge median 34 ans [IQR 24–47]–141 hommes) soit 17,3 % de l’ensemble des dengues diagnostiquees pendant la meme periode dans le pays. La majorite etait des Europeens blancs (220, 80,3 %) effectuant un sejour touristique (203, 74,1 %) en Asie du Sud-Est (117, 42,7 %) et Amerique latine-Caraibes (94, 34,3 %). Vingt patients revenaient d’Afrique Sub-Saharienne, proportion superieure aux autres etudes europeennes. Il existait une saisonnalite avec une majorite des cas en aout et en septembre. Nous observions un parallelisme avec l’epidemiologie mondiale de la dengue avec deux pics de prevalence en 2010 (Epidemie des Caraibes) et en 2013, confirmant que le voyageur est une sentinelle epidemiologique. Trente-quatre patients (12,4 %) presentaient une hemorragie spontanee (epistaxis et gingivorragie) et aucun n’avait de forme neurologique severe. Deux patients (0,73 %) presentaient une forme de dengue grave (collapsus tensionnel) sans cas letal. Les sensibilites des techniques diagnostiques etaient de 88,8 % pour la serologie, 87,4 % pour la detection de l’antigene NS1 et 71,7 % pour la PCR. Cent-treize patients (41,2 %) ont ete hospitalises (duree mediane 4 jours [IQR 2–5] avec une diminution significative du nombre d’hospitalisations entre 2008–2011 et 2012–2015 (82/160 vs 31/114, p Conclusion Le voyageur est une sentinelle epidemiologique et l’analyse des cas importes renseignent sur la circulation virale dans les zones endemiques. Les formes graves sont rares chez le voyageur. Les medecins doivent savoir evoquer la dengue et isoler les patients viremiques dans les departements dans lesquels Aedes est reimplante.

Tuberculosis is a common pulmonary disease, which is still endemic in disadvantaged communities. Pericarditis is a rare but very lethal visceral localization. The authors report the case of a 58-year-old man, without neither medical history nor social risk, who presented a cardiac tamponade as the first and atypic manifestation of a visceral tuberculosis.

Within this work the three dimensional development of a scour around a cylindrical bridge pier has been investigated experimentally. The erosion process has been surveyed in short time intervals using a photogrammetric approach. The results of the work give an unprecedented insight in the development of the scour geometry over time and therefore a crucial step to the fundamental understanding of the phenomena.

Resume Introduction La fievre, bien que frequente chez le patient presentant un cancer colique, en est rarement le symptome revelateur. Patients et methodes Nous rapportons une serie d’observations de cancer colique revele par une fievre, dans les trois hopitaux d’instruction des armees parisiens. Resultats Parmi les 11 patients etudies, il y avait sept hommes et quatre femmes, d’âge moyen 70 ans. Le cancer colique etait localise au niveau du sigmoide (n = 6), du colon gauche (n = 3) et du colon droit (n = 2). La tumeur etait au stade pTis (n = 1), I (n = 4), II (n = 3) et III (n = 3) selon la classification TNM 2002 de l’UICC. La fievre etait le principal motif d’hospitalisation et deux patients avaient une fievre prolongee inexpliquee recurrente. Une infection etait retrouvee dans toutes les observations sauf une. Les hemocultures isolaient Escherichia coli (n = 3), Streptococcus gallolyticus (anciennement bovis) (n = 2) et une bacterie anaerobie non identifiee (n = 1). Un patient avait une endocardite infectieuse a S. gallolyticus. L’imagerie medicale montrait un abces du foie (n = 3) ou peritumoral (n = 3). Dans sept cas, un antecedent familial de cancer du colon et des signes evocateurs de pathologie colique (hemorragie digestive minime et negligee, anemie ferriprive, masse abdominale palpable) auraient pu attirer l’attention. Conclusions La fievre revelant un cancer du colon peut survenir a un stade precoce de la maladie tumorale. Elle est principalement d’origine infectieuse, resultant d’une bacteriemie ou d’un abces locoregional. La presentation sous la forme d’une fievre prolongee inexpliquee est beaucoup plus rare. Un interrogatoire oriente, un examen clinique minutieux et une lecture attentive des cliches tomodensitometriques permettent de recourir precocement a la coloscopie.

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

Phosphodiesterase type 5 (PDE-5) inhibitors are widely used for penile rehabilitation and treatment of erectile dysfunction after radical prostatectomy. Recently, Michl et al. showed in a monocentric, retrospective and non-randomized analysis that PDE-5 inhibitors may cause higher biochemical recurrence rates after radical prostatectomy. This unexpected and serious adverse side effect of PDE-5 inhibitors was scrutinized on the basis of patients in our prospective tumor database.We included 358 patients after radical prostatectomy with bilateral nerve-sparing and without neo- or adjuvant therapy during 2004 and 2015. In all, 65.9% of the patients regularly took PDE-5 inhibitors postoperatively, 34.1% did not. Patients with sporadic use were excluded from the primary analysis. We used Kaplan-Mayer analysis to compare biochemical recurrence rates in both groups (endpoint: PSA 0.2 ng/ml or salvage therapy).Both groups showed comparable clinical parameters. There was no significant difference in recurrence-free survival (p = 0.9334): 60 months postoperatively 90.4% of men with PDE-5 intake vs. 90.8% of men without intake of PDE-5 inhibitors were recurrence-free.Although our analysis was constructed similar to the analysis of Michl et al., we could not confirm their results. Taken together with recent cohort study from Scandinavia, postoperative prescription of PDE-5 inhibitors seems to be safe and should be discussed with patients.

Context In 2012, the French Infectious Diseases Society (French acronym SPILF) initiated the “Coordination of epidemic and biological risk” (SPILF-COREB - Emergences [SCE]) group to support the readiness and response of healthcare workers (HCWs) to new alerts. Objective To present the SCE group, its functioning, and the main support it provided for frontline HCWs. Methods A multidisciplinary group of heads of infectious disease departments from reference hospitals was created to build a network of clinical expertise for care, training, and research in the field of epidemic and biological risk (EBR). The network developed a set of standardized operational procedures (SOPs) to guide interventions to manage EBR-suspect patients. Results A working group created the SOP aimed at frontline HCWs taking care of patients. Priority was given to the development of a generic procedure, which was then adapted according to the current alert. Five key steps were identified and hierarchized: detecting, protecting, caring for, alerting, and referring the EBR patient. The interaction between clinicians and those responsible for the protection of the community was crucial. The SOPs validated by the SPILF and its affiliates were disseminated to a wide range of key stakeholders through various media including workshops and the SPILF's website. Conclusion SPILF can easily adapt and timely mobilize the EBR expertise in case of an alert. The present work suggests that sharing and discussing this experience, initiated at the European level, can generate a new collective expertise and needs to be further developed and strengthened.

Purpose: Given the importance of partnership in improving health care outcomes among children, there is a substantial need to understand better what partnership means to parents and physicians. The goal of this study was to develop a partnership survey that was based on parents9 and pediatricians9 opinions about the key concepts of partnership. Methods: Parents of patients visiting an affluent suburban private practice and a federally qualified health center, and 2 groups of pediatricians, were asked to review 61 partnership concepts and identify those they considered as being important to partnership. Results: Parents and pediatricians from both practices agreed that 42 (68.9%) of the concepts were important to partnership. Sixteen of these concepts were dropped because they were redundant. Parents from both the suburban practice and health center identified 5 (8.2%) concepts that they believed contributed to partnership. Seven (11.5%) concepts were viewed as important to parents and pediatricians from the suburban practice but not to parents from the health center. Significant socioeconomic differences between the 2 parent groups suggested factors that explained the differences between parent groups. Conclusion: The 38 concepts endorsed by parents and pediatricians provided a nuanced view of partnership and formed the Parent Pediatrician Partnership Survey.

Objectives To determine the risk factors for severe infectious mononucleosis (IM) occurrence in immunocompetent adults. Methods We performed a multicenter, retrospective case series including immunocompetent adults presenting with confirmed IM between 2001 and 2011. Severe presentations were compared with uncomplicated presentations using Stata ® 9 software. The significance level was set at 5%. Results In univariate analysis, age over 30 years ( n = 13 or 41.9% vs. n = 5 or 12.8%; P = 0.006), prior use of non-steroidal anti-inflammatory drugs (NSAIDs) ( n = 7 or 87.5% vs. n = 1 or 12.5%; P = 0.009), and smoking ( n = 13 or 68.4% vs. n = 6 or 31.6%; P = 0.013) were associated with severe IM onset. In multivariate analysis, only age over 30 years (OR = 3.55; P = 0.05) and prior use of NSAIDs (OR = 15; P = 0.05) remained associated with severe IM onset, without reaching significance level ( P = 0.05). Conclusion Our study confirmed that age over 30 years is a risk factor for severe IM onset. Prior use of NSAIDs also seems to be correlated with severe presentations. This new data needs to be confirmed in a prospective study.

Au cours de l’année 2009, l’émergence, puis la diffusion rapide aux cinq continents d’une nouvelle souche épidémique de grippe A (H1N1) pdm09 a été à l’origine de la première pandémie grippale du XXIe siècle. En france métropolitaine, la prise en compte de cette pandémie a entraîné une réponse rapide des autorités sanitaires se traduisant par des recommandations concernant les circuits de prise en charge, le traitement antiviral et les mesures de prévention de la transmission. Cet article retrace l’expérience d’un infectiologue militaire exerçant dans un centre référent de maladies infectieuses, aborde les particularités cliniques et thérapeutiques de la grippe A (H1N1) pdm09 et analyse les forces et faiblesses de la gestion médicale de cette crise sanitaire.

Resume La fievre est une cause frequente de morbidite au retour de voyage et responsable d’un nombre sans cesse croissant de consultations dans les services d’accueil des urgences (SAU) des hopitaux. En France, le paludisme en reste l’etiologie principale, a toujours evoquer de premiere intention, en particulier chez les migrants de retour d’Afrique subsaharienne. Les infections cosmopolites de loin les plus frequentes ne doivent pas etre oubliees. L’approche diagnostique repose sur la prise en compte de la region visitee, de l’exposition a des risques infectieux, des mesures de prevention mises en œuvre (vaccination) et de la duree d’incubation des maladies. Un examen clinique rigoureux et quelques explorations paracliniques simples et hierarchisees confirmeront rapidement le diagnostic. Apres avoir elimine le paludisme et les arboviroses, l’attention du praticien doit se porter sur les causes potentiellement severes et curables, au premier rang desquelles figurent les infections meningees. En France, le traitement antipaludique de reference du paludisme grave d’importation est desormais l’artesunate intraveineux. La prise en en charge precoce et adaptee d’une fievre au retour de voyage est facilitee par une consultation precoce en milieu specialise.

Background: The French military forces had to modify their epidemiological surveillance systems at the time of the 2009 A(H1N1) influenza pandemic. The aim of this article was to present an evaluation of the different systems used. Methods: Two influenza surveillance systems are usually used in the French forces: one permanent ( Surveillance epidemiologique des armees or SEA) and one seasonal ( Systeme militaire d’observation de la grippe or SMOG). The pandemic required the implementation of a daily surveillance system ( Surveillance quotidienne —SQ), which aimed to monitor disrupted activity owing to 2009 A(H1N1) influenza. The qualitative evaluation of these three systems during the period from September 2009 to February 2010 was performed using 11 criteria based on the list defined by Centers for Disease Control and Prevention of Atlanta. Results: Although it included only 30 sentinel units vs. 320 for the other systems, the SMOG system was the best-performing system in terms of relevance, feasibility, efficacy, quality of data, usefulness, acceptability, efficiency and cost/benefits/costs ratio. The SQ proved very expensive in terms of logistics. Conclusion: The SQ did not bring any significant advantage compared with the weekly surveillance schemes. In the eventuality of another similar episode, influenza surveillance could be significantly improved by using the SMOG system extended to more units for better geographical coverage.

Aim To examine the construct validity of generic preference-weighted health-related quality of life measures in a sample of patients with a substance use disorder (SUD). Design Longitudinal (baseline and 6-month follow-up) data from a research study that evaluated interventions to improve linkage and engagement with SUD treatment. Setting A central intake unit that referred patients to seven SUD treatment centers in a Midwestern US metropolitan area. Participants A total of 495 individuals with a SUD. Measurements Participants completed two preference-weighted measures: the self-administered Quality of Well-Being scale (QWB-SA) and the standard gamble weighted Medical Outcomes Study SF-12 (SF-6D). They were also administered two clinical assessments: all seven domains of the Addiction Severity Index (ASI) and a symptom checklist based on the DSM-IV. Construct validity was determined via the relationships between disease-specific SUD and generic measures. Findings In unadjusted analyses, the QWB-SA and SF-6D change scores were correlated significantly with six ASI subscale change scores, but not with employment status. In adjusted repeated-measures analyses, three of seven ASI subscale scores were significant predictors of QWB-SA and 5/7 ASI subscale scores were significant predictors of SF-6D. Abstinence and problematic use at follow-up were significant predictors of QWB-SA and SF-6D. Effect sizes ranged from 0.352 to 0.400 for abstinence and −0.484 to −0.585 for problematic use. Conclusions Generic preference-weighted health-related quality of life measures show moderate to good associations with substance-use specific measures and in certain circumstances can be used in their stead. This study provides further support for the use of the Quality of Well-Being scale and Medical Outcomes Study SF-12 in clinical and economic evaluations of substance use disorder interventions.

Resume Introduction Du fait d’une couverture vaccinale insuffisante, une epidemie de rougeole touche actuellement l’Europe et des cas sont observes chez l’adulte. Patients et methodes Nous avons etudie retrospectivement tous les cas consecutifs de rougeole de l’adulte vus entre le 1 er janvier 2007 et le 30 avril 2009 dans quatre hopitaux parisiens. Resultats Vingt et un patients ont ete inclus. Six (29 %) etaient des professionnels de sante (PS), parmi lesquels cinq (83 %) avaient ete vaccines. Vingt malades (95 %) ont ete hospitalises. En plus d’un exantheme febrile, d’une toux et d’un coryza chez tous les patients, une cytolyse hepatique etait presente chez 71 % d’entre eux. Aucun deces ni sequelles n’ont ete observes. Conclusion La rougeole touche les adultes dont des personnels de sante, ceux-ci etant insuffisamment proteges par la vaccination. Depuis 2010, en France, une dose de vaccin est desormais recommandee pour les PS sans antecedent de rougeole ou n’ayant pas recu deux doses de vaccins. De plus, des mesures de precautions respiratoires doivent etre prises lors de l’examen d’un patient presentant un exantheme febrile avec toux.

There is a considerable disparity between the number of individuals who need substance abuse treatment and the number who actually receive it. This is partly due to the fact that many individuals with substance use disorders do not perceive a need for formal treatment. Another contributing factor, however, is a discrepancy between the real and perceived cost of services. Although many cost evaluations of substance abuse treatment have been conducted from the treatment provider perspective, less is known about the client-specific costs of attending treatment (e.g., lost work and leisure time, transportation, out-of-pocket and in-kind payments). Concerns about financial and other barriers to participating in treatment have encouraged addiction researchers to more carefully consider these previously unmeasured costs. To address this information gap, we administered the Client Drug Abuse Treatment Cost Analysis Program (Client DATCAP) to 302 clients (representing a total of 302 outpatient and 142 inpatient treatment episodes) as part of a larger study examining the cost-effectiveness of interventions designed to improve treatment linkage and engagement in Dayton, Ohio. The value of a client’s time accounted for the largest component of total cost (more than 59%). The cost per visit for outpatient clients ranged from $19 for outpatient methadone to $38 for intensive outpatient/aftercare treatment. The average cost per day of treatment for inpatient clients was $235. Policy makers and treatment providers now have a broader view of the opportunity cost of addiction treatment and can use this information to support initiatives for improved treatment access and delivery.

The Texas Christian University–Treatment Motivation Assessment (TCU-TMA) was originally developed to assess motivation among in-treatment opiod users. Numerous studies of in-treatment substance abusers in a variety of settings have confirmed the three factors present in the scale, including Problem Recognition, Desire For Help, and Treatment Readiness. The goal of the present study was to examine the factor structure of the TCU-TMA in a sample of 367 pretreatment substance abusers assessed at a centralized intake unit who had not yet entered treatment. Exploratory and confirmatory factor analyses led to the development of the Pretreatment Readiness Scale (PRS) that, like the TCU-TMA, contained Problem Recognition and Treatment Readiness factors. Desire for Change replaced Desire for Help in the new scale and Treatment Reluctance indicated mixed feelings about entering treatment. The implications of these findings on developing interventions for the pretreatment group will be discussed.