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In November 2021, the United Nations has declared that Madagascar current humanitarian crisis was the world first famine due to drought induced by climate change. Understand the factors triggering these crises is fundamental to anticipate and reduce the effects of future crises. In the ongoing climate change context, rainfall deficit is a key variable in setting up these crises. However, the Malagasy weather station network is far too sparse to describe the spatial variability of rainfall. Thus, this study compares 21 gridded precipitation products (see Fig. 1) to 19 gauges data to assess their reliability to monitor Madagascar precipitation pattern. Based on four statistical indices (Kling-Gupta Efficiency, Root Mean Square Error, Correlation coefficient and Biais), WFDEI-GPCC, CMORPH-BLD and, MSWEP appeared the most reliable product at national scale (Fig. 1). However, the products performances varied throughout Madagascar because the island counts four contrasted bioclimatic zones due to topographic and meteorological influence. To circumvent this variability issue, we developed a new product based on ensemble approach (“EM” in the Fig. 1). EM is calculated from a weighted average of the products according to their KGE score. The weights are specifically defined by bioclimatic zone. EM shows better performances at both regional and national scale. Finally, we evaluated the quality of our results by comparing them with five independent gauge dataset and on a different period. These satisfactory results allow us to continue studying the impact of rainfall related droughts on humanitarian crisis. Figure 1: Scores for 21 gridded products + the new product created based on ensemble approach (« EM »). The monthly precipitation estimated by these products is compared to the monthly precipitation measured by 19 gauges data between 2011 and 2016. Four statistical indices (Kling-Gupta Efficiency, Root Mean Square Error, Correlation coefficient and Biais) are shown. Their optimum is indicated by the dashed green line. The red point is the median value obtained when considering only dry season, and the blue dot is the median value when considering only wet season. The products are sorted by the KGE median value.

Background: We recently reported a worrying 30% rate of early neurological deterioration (END) occurring within 24 hours following intravenous thrombolysis (IVT) in minor stroke with isolated internal carotid artery occlusion (ie, without additional intracranial occlusion), mainly due to artery-to-artery embolism. Here, we hypothesize that in this setting IVT—as compared to no-IVT—may foster END, in particular by favoring artery-to-artery embolism from thrombus fragmentation. Methods: From a large multicenter retrospective database, we compared minor stroke (National Institutes of Health Stroke Scale score 7d ) and 3-month modified Rankin Scale score 0 to 1. Results: Overall, 189 patients were included (IVT=95; antithrombotics=94 [antiplatelets, n=58, anticoagulants, n=36]) from 34 centers. END within 24 hours and END 7d occurred in 46 (24%) and 60 (32%) patients, respectively. Baseline clinical and radiological variables were similar between the 2 groups, except significantly higher National Institutes of Health Stroke Scale (median 3 versus 2) and shorter onset-to-imaging (124 versus 149min) in the IVT group. END within 24 hours was more frequent following IVT (33% versus 16%, adjusted hazard ratio, 2.01 [95% CI, 1.07–3.92]; P =0.03), driven by higher odds of artery-to-artery embolism (20% versus 9%, P =0.09). However, END 7d and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END 7d : adjusted hazard ratio, 1.29 [95% CI, 0.75–2.23]; P =0.37; modified Rankin Scale score of 0–1: adjusted odds ratio, 1.1 [95% CI, 0.6–2.2]; P =0.71). END 7d occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, 1.9–10.1) versus 20.4 hours (interquartile range, 7.8–34.4), respectively, P Conclusions: In our population of minor strokes with iICAO, although END rate at 7 days and 3-month outcome were similar between the 2 groups, END—particularly END due to artery-to-artery embolism—occurred earlier following IVT. Prospective studies are warranted to further clarify the benefit/risk profile of IVT in this population.

Des initiatives d’approches territorialisees de tout ou partie de la sequence Eviter-Reduire-Compenser (ERC) emergent un peu partout en France. A partir de l’analyse de quatorze de ces initiatives, les auteurs de cet article font le point de leur apport pour la prise en compte des impacts cumules et l’amelioration de l’efficacite de la sequence ERC. Enfin, les enjeux actuels pour la recherche en ecologie sont soulignes.

La cotherapie constitue un cadre therapeutique particulier associant deux cotherapeutes pour un ou plusieurs patients. Largement employee dans les prises en charges qui s’adressent a un groupe familial ou a un couple d’adultes, son application reste encore tres peu theorisee dans le contexte de la perinatalite et de la petite enfance. Dans ce contexte, les patients peuvent etre un parent et son enfant, un couple de parents avec leurs enfants ou meme un futur parent et l’enfant a naitre. Deux professionnels mettent leurs competences et leur ecoute respectives au service d’une dyade/triade parent(s)-enfant/fœtus. Il s’agit generalement d’un psychologue-psychotherapeute et d’un professionnel de la petite enfance (puericultrice, auxiliaire de puericulture, educatrice de jeune enfants). Dans cet article, nous proposons de decrire et de discuter les particularites de ce dispositif therapeutique, largement employe dans l’unite petite enfance et parentalite dans laquelle nous exercons. Nos propos seront illustres par quelques vignettes cliniques.