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Objective In many countries, before COVID-19 vaccines became available, reluctance to get vaccinated was particularly prevalent among women, the most disadvantaged social groups and ethnoracial minorities, known to be at higher risk for the virus. Using a longitudinal perspective, we analyse the social determinants that are associated with the transition from attitudes towards vaccination to actual vaccination practices.Design Representative population-based prospective cohort.Settings From November 2020 to July 2021.Participants Adults included in the Epidemiology and Living Conditions (EpiCoV) cohort (n=86 701).Main outcome measures Attitudes towards vaccination in November 2020 before COVID-19 vaccines were available in France (in January 2021) and vaccination practices in July 2021.Results Among those who were initially reluctant in November 2020, the youngest, the poorest 10% (OR=0.68, 0.59–0.77), non-European immigrants (OR=0.72, 0.59–0.88) and descendants of non-European immigrants (OR=0.72, 0.61–0.86) were less likely to be vaccinated in July 2021, irrespective of trust in government and scientists. The same social factors were associated with non-vaccination among those who initially were undecided or who favoured vaccination.Conclusion Despite the fact that COVID-19 vaccines were relatively available and free of charge in France in July 2021, social inequalities in vaccination against the virus remained the same than those observed in vaccination reluctance in November 2020, before vaccines were available. While adjusting for trust, migration background, younger age and lower income were associated with lower vaccination uptake irrespective of initial intention. By neglecting to genuinely target specific groups that were initially reluctant to be vaccinated, vaccination policies contributed to strengthening pre-existing social inequalities around COVID-19 burden.

Abstract Background Significant differences in COVID-19 incidence by gender, class and race/ethnicity are recorded in many countries in the world. Lockdown measures, shown to be effective in reducing the number of new cases, may not have been effective in the same way for all, failing to protect the most vulnerable populations. This survey aims to assess social inequalities in the trends in COVID-19 infections following lockdown. Methods A cross-sectional survey conducted among the general population in France in April 2020, during COVID-19 lockdown. Ten thousand one hundred one participants aged 18–64, from a national cohort who lived in the three metropolitan French regions most affected by the first wave of COVID-19. The main outcome was occurrence of possible COVID-19 symptoms, defined as the occurrence of sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days in the 15 days before the survey. We used multinomial regression models to identify social and health factors related to possible COVID-19 before and during the lockdown. Results In all, 1304 (13.0%; 95% CI: 12.0–14.0%) reported cases of possible COVID-19. The effect of lockdown on the occurrence of possible COVID-19 was different across social hierarchies. The most privileged class individuals saw a significant decline in possible COVID-19 infections between the period prior to lockdown and during the lockdown (from 8.8 to 4.3%, P = 0.0001) while the decline was less pronounced among working class individuals (6.9% before lockdown and 5.5% during lockdown, P = 0.03). This differential effect of lockdown remained significant after adjusting for other factors including history of chronic disease. The odds of being infected during lockdown as opposed to the prior period increased by 57% among working class individuals (OR = 1.57; 95% CI: 1.00–2.48). The same was true for those engaged in in-person professional activities during lockdown (OR = 1.53; 95% CI: 1.03–2.29). Conclusions Lockdown was associated with social inequalities in the decline in COVID-19 infections, calling for the adoption of preventive policies to account for living and working conditions. Such adoptions are critical to reduce social inequalities related to COVID-19, as working-class individuals also have the highest COVID-19 related mortality, due to higher prevalence of comorbidities.

ObjectiveTo assess whether lack of trust in the government and scientists reinforces social and racial inequalities in vaccination practices.DesignA follow-up of the EpiCov random population-based cohort survey.SettingIn July 2021, in France.ParticipantsEighty-thousand nine hundred and seventy-one participants aged 18 years and more.Main Outcome MeasuresAdjusted odds ratios of COVID-19 vaccination status (received at least one dose/ intends to get vaccinated/ does not know whether to get vaccinated/refuses vaccination) were assessed using multinomial regressions to test associations with social and trust factors and to study how these two factors interacted with each other.ResultsIn all, 72.2% were vaccinated at the time of the survey. The population of unvaccinated people was younger, less educated, had lower incomes, and more often belonged to racially minoritized groups, as compared to vaccinated people. Lack of trust in the government and scientists to curb the spread of the epidemic were the factors most associated with refusing to be vaccinated: OR = 8.86 (7.13 to 11.00) for the government and OR = 9.07 (7.71 to 10.07) for scientists, compared to vaccinated people. Lack of trust was more prevalent among the poorest which consequently reinforced social inequalities in vaccination. The poorest 10% who did not trust the government reached an OR of 16.2 (11.9 to 22.0) for refusing to be vaccinated compared to the richest 10% who did.ConclusionThere is a need to develop depoliticised outreach programmes targeted at the most socially disadvantaged groups, and to design vaccination strategies conceived with people from different social and racial backgrounds to enable them to make fully informed choices.

We aimed to analyze inequalities in social isolation among older adults in a time of COVID-19 social restrictions, using a gender perspective. A random population-based survey, including 21,543 older adults (65+) was conducted during and post COVID-19 lockdown in France. Our main outcome was a three-dimension indicator of social isolation based on living conditions, i.e., living alone (i) and not having gone out in the past week (ii), completed by an indicator measuring Internet use i.e., never using the Internet (iii). Logistic regressions were used to identify factors associated with isolation for women and men. Women were more likely to live alone (aOR = 2.72 [2.53; 2.92]), not to have gone out in the past week (aOR = 1.53 [1.39; 1.68]), and not to use the Internet (aOR = 1.30 [1.20; 1.44]). In addition to gender effects, being older, at the bottom of the social hierarchy, and from an ethno-racial minority was also associated with social isolation. Preventive policies should take into account these inequalities when addressing the issue of social isolation among older women and men, so as to enable all social groups to maintain social contacts, and access health information.

Abstract Background Treatment decisions on critically ill patients with circulatory shock lack consensus. In an international survey, we aimed to evaluate the indications, current practice, and therapeutic goals of inotrope therapy in the treatment of patients with circulatory shock. Methods From November 2016 to April 2017, an anonymous web-based survey on the use of cardiovascular drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 14 questions focused on the profile of respondents, the triggering factors, first-line choice, dosing, timing, targets, additional treatment strategy, and suggested effect of inotropes. In addition, a group of 42 international ESICM experts was asked to formulate recommendations for the use of inotropes based on 11 questions. Results A total of 839 physicians from 82 countries responded. Dobutamine was the first-line inotrope in critically ill patients with acute heart failure for 84% of respondents. Two-thirds of respondents (66%) stated to use inotropes when there were persistent clinical signs of hypoperfusion or persistent hyperlactatemia despite a supposed adequate use of fluids and vasopressors, with (44%) or without (22%) the context of low left ventricular ejection fraction. Nearly half (44%) of respondents stated an adequate cardiac output as target for inotropic treatment. The experts agreed on 11 strong recommendations, all of which were based on excellent (> 90%) or good (81–90%) agreement. Recommendations include the indications for inotropes (septic and cardiogenic shock), the choice of drugs (dobutamine, not dopamine), the triggers (low cardiac output and clinical signs of hypoperfusion) and targets (adequate cardiac output) and stopping criteria (adverse effects and clinical improvement). Conclusion Inotrope use in critically ill patients is quite heterogeneous as self-reported by individual caregivers. Eleven strong recommendations on the indications, choice, triggers and targets for the use of inotropes are given by international experts. Future studies should focus on consistent indications for inotrope use and implementation into a guideline for circulatory shock that encompasses individualized targets and outcomes.

Background:. In low and middle-income countries (LMICs), individuals suffer from a disproportionately higher number of musculoskeletal (MSK) injuries compared with those living in a high-income setting. However, despite the higher burden of death and disability from MSK injuries in LMICs, there has been little policy, research, and funding invested in addressing this distinctly overlooked problem. Using a consensus-based approach, the aim of this study was to identify research priorities for clinical trials and research in MSK trauma care across sub-Saharan Africa. Methods:. A modified Delphi technique was utilized; it involved an initial scoping survey, a 2-round Delphi process, and, finally, review by an expert panel with members of the Orthopaedic Research Collaboration in Africa. This study was conducted among MSK health-care practitioners treating trauma in sub-Saharan Africa. Results:. Participants from 34 countries across sub-Saharan Africa contributed to the 2 rounds of the Delphi process, and priorities were scored from 1 (low priority) to 5 (high priority). Public health topics related to trauma care ranked higher than those focused on clinical effectiveness, with the top 10 public health research questions scoring higher than the top 10 questions for clinical effectiveness. Ten public health and 10 clinical effectiveness questions related to MSK trauma care were identified; the highest-ranked questions in the respective categories were related to education and training and to the management of femoral fractures. Conclusions:. This consensus-driven research priority study will guide health-care professionals, academics, researchers, and funders to improve the evidence on MSK trauma care across sub-Saharan Africa and inform funders about priority areas of future research.

Objective Although social inequalities in COVID-19 mortality by race, gender and socioeconomic status are well documented, less is known about social disparities in infection rates and their shift over time. We aim to study the evolution of social disparities in infection at the early stage of the epidemic in France with regard to the policies implemented.Design Random population-based prospective cohort.Setting From May to June 2020 in France.Participants Adults included in the Epidémiologie et Conditions de Vie cohort (n=77 588).Main outcome measures Self-reported anosmia and/or ageusia in three categories: no symptom, during the first epidemic peak (in March 2020) or thereafter (during lockdown).Results In all, 2052 participants (1.53%) reported anosmia/ageusia. The social distribution of exposure factors (density of place of residence, overcrowded housing and working outside the home) was described. Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia. Women were more likely to report symptoms during the peak and after. Racialised minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak.Conclusion The shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of a stringent stay-at-home order. Our study shows the importance to consider in a dynamic way the gender, socioeconomic and race direct and indirect effects of the COVID-19 pandemic, notably to implement policies that do not widen health inequalities.

Importance Injuries cause 30% more deaths than HIV, TB and malaria combined, and a prospective fracture care registry was established to investigate the fracture burden and treatment in Malawi to inform evidence-based improvements. Objective To use the analysis of prospectively-collected fracture data to develop evidence-based strategies to improve fracture care in Malawi and other similar settings. Design Multicentre prospective registry study. Setting Two large referral centres and two district hospitals in Malawi. Participants All patients with a fracture (confirmed by radiographs)—including patients with multiple fractures—were eligible to be included in the registry. Exposure All fractures that presented to two urban central and two rural district hospitals in Malawi over a 3.5-year period (September 2016 to March 2020). Main outcome(s) and measure(s) Demographics, characteristics of injuries, and treatment outcomes were collected on all eligible participants. Results Between September 2016 and March 2020, 23,734 patients were enrolled with a median age of 15 years (interquartile range: 10–35 years); 68.7% were male. The most common injuries were radius/ulna fractures (n = 8,682, 36.8%), tibia/fibula fractures (n = 4,036, 17.0%), humerus fractures (n = 3,527, 14.9%) and femoral fractures (n = 2,355, 9.9%). The majority of fractures (n = 21,729, 91.6%) were treated by orthopaedic clinical officers; 88% (20,885/2,849) of fractures were treated non-operatively, and 62.7% were treated and sent home on the same day. Open fractures (OR:53.19, CI:39.68–72.09), distal femoral fractures (OR:2.59, CI:1.78–3.78), patella (OR:10.31, CI:7.04–15.07), supracondylar humeral fractures (OR:3.10, CI:2.38–4.05), ankle fractures (OR:2.97, CI:2.26–3.92) and tibial plateau fractures (OR:2.08, CI:1.47–2.95) were more likely to be treated operatively compared to distal radius fractures. Conclusions and relevance The current model of fracture care in Malawi is such that trained orthopaedic surgeons manage fractures operatively in urban referral centres whereas orthopaedic clinical officers mainly manage fractures non-operatively in both district and referral centres. We recommend that orthopaedic surgeons should supervise orthopaedic clinical officers to manage non operative injuries in central and district hospitals. There is need for further studies to assess the clinical and patient reported outcomes of these fracture cases, managed both operatively and non-operatively.

Abstract. Background:. While the global burden of musculoskeletal injury is increasingly recognized, few epidemiologic studies have specifically recorded its incidence or prevalence, particularly in low- and middle-income countries. Understanding the burden of musculoskeletal injury relative to other health conditions is critical to effective allocation of resources to mitigate the disability that results from trauma. The current study aims to systematically review the existing primary literature on the incidence and prevalence of pelvic and appendicular fractures, a major component of musculoskeletal injury, in low- and lower-middle income countries (LMICs). Methods:. This study conforms to the systematic review and traditional meta-analysis guidelines outlined in the PRISMA-P statement. Incidence rates were calculated as the occurrence of new fracture cases per 100,000 person-years, and prevalence as total fracture cases per population sample, reported as percentages. Results:. The literature search yielded 3497 total citations. There were 21 full-text articles, representing 14 different countries, selected for data extraction. Included studies reported a wide range of incidence and prevalence rates, with an overall mean fracture incidence ranging from 779 (95% CI: 483.0–1188.7) to 1574 (95% CI: 1285.1–1915.1) per 100,000 person-years. Conclusion:. Better understanding the unmet burden of musculoskeletal injury in LMICs is critical to effectively allocating resources and advocating for underserved populations. To address existing gaps and heterogeneity within the literature, future research should incorporate population-based sampling with broader geographic representation in LMICs to more accurately capture the burden of disease.

Abstract Background Vasopressors are commonly applied to restore and maintain blood pressure in patients with sepsis. We aimed to evaluate the current practice and therapeutic goals regarding vasopressor use in septic shock as a basis for future studies and to provide some recommendations on their use. Methods From November 2016 to April 2017, an anonymous web-based survey on the use of vasoactive drugs was accessible to members of the European Society of Intensive Care Medicine (ESICM). A total of 17 questions focused on the profile of respondents, triggering factors, first choice agent, dosing, timing, targets, additional treatments, and effects of vasopressors. We investigated whether the answers complied with current guidelines. In addition, a group of 34 international ESICM experts was asked to formulate recommendations for the use of vasopressors based on 6 questions with sub-questions (total 14). Results A total of 839 physicians from 82 countries (65% main specialty/activity intensive care) responded. The main trigger for vasopressor use was an insufficient mean arterial pressure (MAP) response to initial fluid resuscitation (83%). The first-line vasopressor was norepinephrine (97%), targeting predominantly a MAP > 60–65 mmHg (70%), with higher targets in patients with chronic arterial hypertension (79%). The experts agreed on 10 recommendations, 9 of which were based on unanimous or strong (≥ 80%) agreement. They recommended not to delay vasopressor treatment until fluid resuscitation is completed but rather to start with norepinephrine early to achieve a target MAP of ≥ 65 mmHg. Conclusion Reported vasopressor use in septic shock is compliant with contemporary guidelines. Future studies should focus on individualized treatment targets including earlier use of vasopressors.

Abstract Background Fluids are by far the most commonly administered intravenous treatment in patient care. During critical illness, fluids are widely administered to maintain or increase cardiac output, thereby relieving overt tissue hypoperfusion and hypoxia. Main text Until recently, because of their excellent safety profile, fluids were not considered “medications”. However, it is now understood that intravenous fluid should be viewed as drugs. They affect the cardiovascular, renal, gastrointestinal and immune systems. Fluid administration should therefore always be accompanied by careful consideration of the risk/benefit ratio, not only of the additional volume being administered but also of the effect of its composition on the physiology of the patient. Apart from the need to constantly assess fluid responsiveness, it is also important to periodically reconsider the type of fluid being administered and the evidence regarding the relationship between specific disease states and different fluid solutions. Conclusions The current review presents the state of the art regarding fluid solutions and presents the existing evidence on routine fluid management of critically ill patients in specific clinical settings (sepsis, Adult Respiratory Distress Syndrome, major abdominal surgery, acute kidney injury and trauma).

Research Framework: This article is reviewing the international literature on determinants and measures of child well-being and secondary analysis of some of the main international database in order to identify some unexplained mechanisms. Objectives: It formulates hypotheses to explain the gaps between the level of public and social investment in policies addressed to children and the level of their subjective well-being. Methodology: This research is based on a literature review and secondary analysis of international databases. Results: The article insists on the quality of communication between parents and adolescents in the level of subjective well-being Conclusions: More qualitative research is needed to understand the mechanisms in cause. Contribution: This paper is based on the activities of the chair CNAF-EHESP “Childhood, well-being and parenting” which question the current focus on well-being and happiness in order to better appreciate and understand its conditions by social scientists.

Background: Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases. Methods: A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes. Results: Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%. Conclusions: R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.

In the plain of Meskiana (North-East of Algeria), under a semi-arid climate, the use of irrigation is inevitable for most crops. Groundwater is therefore being increasingly used.A hydrochemical study was carried out; she has focused on the major elements in the water of the aquifer. Four sampling campaigns were realized over two years (2007-2008). The 39 wells that were analyzed are distributed throughout the plain.The analyses reveal a large diversity of chemical compositions, the samples being divided between four facies: calcium bicarbonate, calcium chloride, sodium chloride and calcium sulfate. The data allowed the mapping of suitable water for irrigation. Water mineralization, which is generally high, carries a risk of soil salinization.

Objective: To assess the appropriateness of empirical antimicrobial therapy in trauma patients treated with selective digestive decontamination (SDD) who developed ventilator-associated pneumonia (VAP). Methods: Retrospective study comparing 199 trauma patients receiving SDD and 99 non-trauma patients not receiving SDD hospitalized in a polyvalent intensive care unit (ICU) of a university hospital. Results: Early-onset VAP were recorded in 76 (35%) patients. Late-onset VAP occurred in 86 (72%) trauma patients receiving SDD and 56 (56%) non-trauma patients not receiving SDD (P = 0.02). The empirical antimicrobial therapy was appropriate in 108 (91%) trauma patients receiving SDD and 82 (83%) non-trauma patients not receiving SDD (P = 0.1). In the patients who developed late-onset VAP, the empirical antimicrobial therapy was appropriate in 77 (90%) trauma patients receiving SDD and 49 (88%) non-trauma patients not receiving SDD (P = 0.9). De-escalation was performed in 52 (44%) trauma patients receiving SDD and 37 (37%) non-trauma patients not receiving SDD (P = 0.4). Recurrences were observed in 26 (22%) trauma patients receiving SDD and 18 (18%) non-trauma patients not receiving SDD (P = 0.6). These episodes were due to easy-to-treat pathogens in 75 (63%) trauma patients and 33 (33%) non-trauma patients (P = 0.01). Conclusions: SDD is not associated with a rise in the rate of inappropriateness of the empirical antimicrobial therapy in trauma patients developing late-onset VAP.

Lake Sidi Ali is a natural lake at high altitude (2070-2080 m), without surface outlet, determined by the dam of a basalt flow. With an apparent catchment of 15.6 km2, it is fed by runoff and karst springs. Its level shows strong annual and interannual variations, depending on weather conditions, particularly rainfall and evapotranspiration. Droughts that have marked the last three decades have resulted in a lowering of about 7 m of the water level. But heavy rainfall that occurred in 2008-09 and 2009-10 caused a marked rise. A multiple regression of sufficient quality (r = 0.87) binds the annual change (from august to august) at differents parameters (weather conditions and initial level of the lake).

The hydrological event which affected the Var Department on 15th June 2010 must be considered as very exceptional. The return periods of daily rainfalls are more than millennial and those of peak discharges are at least multi-centennial. After 200 mm of rainfall, rivers presented a flash rising of flood, extremely fast (15 minutes) and violent. This response is in relation with the behaviour of karstic areas, which were largely saturated. Some practises of management (streams covered by a street or a place, too easily flooded bridges, residential and commercial areas located along streams or in dangerous flood areas) took part in exacerbating the consequences of this event. If certain measures can reduce the devastating effects of a so important event, it is also necessary to accept to deal with a risk which can be out of control.The attached file provides the full paper in a single-column version. The few changes to the original paper are indicated by dark blue.

Tropheryma whipplei is the etiologic pathogenic agent of Whipple disease (WD), characterized by various clinical signs, such as diarrhea, weight loss, lymphadenopathy, and polyarthritis. PCR-based methods for diagnosis of WD have been developed. T. whipplei has been identified in saliva and stool samples from patients with WD and from healthy persons. T. whipplei DNA has also been found in bronchoalveolar lavage (BAL) samples of a child with pneumonia. We detected DNA of T. whipplei in 6 (3%) of 210 BAL samples collected in intensive care units by using 16S rDNA and specific quantitative PCR. We identified 4 novel genotypes of T. whipplei. In 1 case, T. whipplei was the only bacterium; in 4 others, it was associated with buccal flora. We suggest that T. whipplei should be investigated as an etiologic agent of pneumonia.

In Algeria, the weather of the last three decades has a negative impact on water resources. The aim of this paper is to determine their impact on the rivers of the Macta basin (North-West of Algeria). The study of annual rainfall (September to August) over the period 1930-2002 shows a sharp decrease of rainfall from the first half of 1970. The flow of Trois Rivières station (wadi El Hammam), Sidi Ali Ben Youb station and Sidi Bel Abbes station (wadi Mekerra) were affected. Over the period 1976-2002, the annual average depth of runoff of runoff is 28 to 36% lower than for the period 1949-1976. On average, rainfall may be lower for all seasons, but the flows are not reduced in the autumn.

The limestone Méjannes-le-Clap plateau is incised by the Cèze canyon. A study of the plateau has shed new light on the paleogeographic evolution of the south-western edge of the French Massif Central between the development of the Miocenian erosion surface and the Pleistocene. The incision of the Cèze in the late Miocene cannot be attributed to the dessication of the Mediterranean Sea during the Messinian (5.9/5.3 Ma), which did result in the incision of the Rhône canyon (236 m bsl). It is clear that Messinian retrogressive erosion stopped at the edge of the Rhône valley. Therefore, the incision of the Cèze canyon predates the Messinian. It goes back certainly to the superior Burdigalian, in agreement with the model of evolution proposed by D. BESSON (2005) for the "Rhodano-Provençal" basin. This incision was followed in the Miocene by two phases of removing sediment (infra-Tortonian and Messinian), each occurring after a phase of filling.Traces left by lithophagous molluscs after flooding of the canyon during the Pliocene transgression can be found at various elevations between 135 and 160 m, due to later tectonic movements. During the Pliocene, the canyon filled up with land deposits that subsist today in the form of mostly quartzose pebbles embedded in reddish matrix rock, up to elevations of 245 m. Outliers of Pliocene alluvial formations subsist on shoulders and benches that are remnants from the Cèze canyon's different hollowing phases. Some of these topographical elements include subhorizontal karst systems at elevations of 180-220 m asl. The cavities with ascending passages that emerge by shafts at an altitude near 280 m are linked, for their part, to the Miocene transgression and/or filling phases.The most useful information about the sector's Messinian and Pliocene evolution is provided by other karst systems composed of subhorizontal and inclined passages with connecting-shafts. As with the Saint-Marcel Cave in Ardèche (L. MOCOCHAIN et al., 2006-a, 2006-b), these systems are the result of ascending karst genesis. The subhorizontal passages located at about 100 m asl under the Méjannes-le-Clap plateau must be interpreted in relation to the level reached by the Cèze canyon after it was hollowed out. These passages are currently functional, the base level being only a few metres below the level of superior Miocene hollowing. The Pliocene transgression caused karst formation to shift upwards to 140­150-m asl. Some of the systems formed as a result of the accumulation of Pliocene terrestrial deposits. At elevations between 130 and 230 m asl, parts of some of the networks are filled in with allochthonous deposits. Deep galleries roughly follow the canyon layout. Downstream of the gorges, divers have reached depths of -35 m bsl in the Marnade system. This deep network developed in connection with the incision of the Rhône canyon. As along the southern edge of the Cévennes (M. SÉRANNE et al., 2002), the sinking of the karst reduced or even eliminated surface runoff, which explains why retrogressive erosion cannot have penetrated far back into the Cèze valley.

To evaluate the role of amoeba-associated bacteria as agents of ventilator-associated pneumonia (VAP), we tested the water from an intensive care unit (ICU) every week for 6 months for such bacteria isolates; serum samples and bronchoalveolar lavage samples (BAL) were also obtained from 30 ICU patients. BAL samples were examined for amoeba-associated bacteria DNA by suicide-polymerase chain reaction, and serum samples were tested against ICU amoeba-associated bacteria. A total of 310 amoeba-associated bacteria from10 species were isolated. Twelve of 30 serum samples seroconverted to one amoeba-associated bacterium isolated in the ICU, mainly Legionella anisa and Bosea massiliensis, the most common isolates from water (p=0.021). Amoeba-associated bacteria DNA was detected in BAL samples from two patients whose samples later seroconverted. Seroconversion was significantly associated with VAP and systemic inflammatory response syndrome, especially in patients for whom no etiologic agent was found by usual microbiologic investigations. Amoeba-associated bacteria might be a cause of VAP in ICUs, especially when microbiologic investigations are negative.

BACKGROUND: Patients admitted to intensive care units are frequently exposed to pathogenic microorganisms present in their environment. Exposure to these microbes may lead to the development of hospital-acquired infections that complicate the illness and may be fatal. Amoeba-associated microorganisms (AAMs) are frequently isolated from hospital water networks and are reported to be associated to cases of community and hospital-acquired pneumonia. METHODOLOGY/PRINCIPAL FINDINGS: We used a multiplexed immunofluorescence assay to test for the presence of antibodies against AAMs in sera of intensive care unit (ICU) pneumonia patients and compared to patients at the admission to the ICU (controls). Our results show that some AAMs may be more frequently detected in patients who had hospital-acquired pneumonia than in controls, whereas other AAMs are ubiquitously detected. However, ICU patients seem to exhibit increasing immune response to AAMs when the ICU stay is prolonged. Moreover, concomitant antibodies responses against seven different microorganisms (5 Rhizobiales, Balneatrix alpica, and Mimivirus) were observed in the serum of patients that had a prolonged ICU stay. CONCLUSIONS/SIGNIFICANCE: Our work partially confirms the results of previous studies, which show that ICU patients would be exposed to water amoeba-associated microorganisms, and provides information about the magnitude of AAM infection in ICU patients, especially patients that have a prolonged ICU stay. However, the incidence of this exposure on the development of pneumonia remains to assess.

Despite the considerable number of studies reported to date, the causative agents of pneumonia are not completely identified. We comprehensively applied modern and traditional laboratory diagnostic techniques to identify microbiota in patients who were admitted to or developed pneumonia in intensive care units (ICUs). During a three-year period, we tested the bronchoalveolar lavage (BAL) of patients with ventilator-associated pneumonia, community-acquired pneumonia, non-ventilator ICU pneumonia and aspiration pneumonia, and compared the results with those from patients without pneumonia (controls). Samples were tested by amplification of 16S rDNA, 18S rDNA genes followed by cloning and sequencing and by PCR to target specific pathogens. We also included culture, amoeba co-culture, detection of antibodies to selected agents and urinary antigen tests. Based on molecular testing, we identified a wide repertoire of 160 bacterial species of which 73 have not been previously reported in pneumonia. Moreover, we found 37 putative new bacterial phylotypes with a 16S rDNA gene divergence ≥ 98% from known phylotypes. We also identified 24 fungal species of which 6 have not been previously reported in pneumonia and 7 viruses. Patients can present up to 16 different microorganisms in a single BAL (mean ± SD; 3.77 ± 2.93). Some pathogens considered to be typical for ICU pneumonia such as Pseudomonas aeruginosa and Streptococcus species can be detected as commonly in controls as in pneumonia patients which strikingly highlights the existence of a core pulmonary microbiota. Differences in the microbiota of different forms of pneumonia were documented.

Avec l’instauration du Revenu de solidarité active (RSA) en juin 2009, la France connaît une réforme d’envergure de sa politique de lutte contre la pauvreté. D’abord expérimenté dans 34 départements, ce nouveau dispositif semble s’inscrire dans le prolongement des aménagements déjà instaurés dans le passé et visant à permettre le cumul d’un salaire et d’une partie d’un revenu minimum, ce que l’on a qualifié de mécanismes d’intéressement. Mais cette première analyse se révèle insuffisante pour rendre compte de cette réforme et de ses conséquences. Ce dispositif suscite d’importantes controverses entre ceux qui défendent la priorité à l’action contre le développement du phénomène des travailleurs pauvres, et ceux qui dénoncent un risque de fragilisation de la protection du droit du travail, mais aussi d’une partie des actifs occupés par le développement d’un sous-emploi. Dans cet article, nous interprétons cette évolution des politiques sociales en France, en référence à la définition de la pauvreté proposée par Simmel, en insistant sur le sens que pourrait avoir le brouillage des frontières entre travail et assistance.

Integrated early childhood development (ECD) programs boost child health and developmental outcomes. However, the factors contributing to the successful implementation of such programs in informal urban settlements are not well researched. We conducted 14 focus group discussions and 13 key informant interviews with 125 caregivers of children under the age of 5 years and stakeholders, exploring their views on enablers and barriers to implementing an integrated ECD program in an informal settlement in Kenya. Strategic engagement, capacity building, transparency, fair compensation of ECD workforce, communication skills, and the need to tailor ECD programs to local realities were discussed. An equity-focused implementation approach for integrated ECD programs is timely.

Si l’on entend, par « société des savoirs », la mobilisation des connaissances pour une meilleure gouvernance des sociétés contemporaines, celle-ci reste largement hypothétique. En effet, nombre d’obstacles s’érigent sur le chemin de la diffusion des savoirs dans la société, dont le premier est le poids des idées reçues et l’importance du contexte idéologique. Selon l’état du débat public, certains résultats de travaux académiques trouveront un écho, quand d’autres seront littéralement négligés, oubliés, voire niés. Ce phénomène de tri, de filtrage de la contribution des chercheurs au débat public est particulièrement puissant dans le domaine des sciences sociales, où la controverse scientifique représente une des modalités de production des savoirs eux-mêmes, et où l’établissement d’une causalité est toujours sujette à caution, tant le nombre de variables en cause est considérable et incontrôlable. Pour rendre compte de cette faiblesse des sciences sociales face au discours de l’opinion, nous prendrons ici l’exemple d’une controverse inscrite depuis plus d’un siècle dans l’histoire des sciences de l’Homme et de la Société : celle qui concerne le lien entre instabilité familiale et délinquance. En retraçant quelques moments de l’histoire de cette hypothétique causalité, il est possible de prendre la mesure, à la fois du rôle que joue indiscutablement le contexte idéologique et politique, et de l’impact du néoconservatisme ambiant sur les relations entre sciences sociales et action publique.