Estimating controlled direct effects in the presence of intermediate confounding of the mediator-outcome relationship: Comparison of five different methods.

In mediation analysis between an exposure X and an outcome Y, estimation of the direct effect of X on Y by usual regression after adjustment for the mediator M may be biased if Z is a confounder between M and Y, and is also affected by X Alternative methods have been described to avoid such a bias: inverse probability of treatment weighting with and without weight truncation, the sequential g-estimator and g-computation. Our aim was to compare the usual linear regression adjusted for M to these methods when estimating the controlled direct effect between X and Y in the causal structure and to explore the size of the potential bias. Estimations were computed in several simulated data sets as well as real data. We observed an increased bias of the controlled direct effect estimation using linear regression adjusted for M for larger effects of X on M and larger effects of Z on M The sequential g-estimator and g-computation gave unbiased estimations with adequate coverage values in every situation studied. With continuous exposure X and mediator M, inverse probability of treatment weighting resulted in some bias and less satisfactory coverage for large effects of X on M and Z on M.

Acute flaccid paralysis following enterovirus D68 associated pneumonia, France, 2014.

Human enterovirus D68 (EV-D68) is known to be associated with mild to severe respiratory infections. Recent reports in the United States and Canada of acute flaccid paralysis (AFP) in children with detection of EV-D68 in respiratory samples have raised concerns about the aetiological role of this EV type in severe neurological disease. This case study is the first report of AFP following EV-D68 infection in Europe.

[Lactic acidosis in a child with acute severe asthma]. / Acidose lactique chez un nourrisson au cours d'une crise d'asthme grave.

Lactic acidosis is a recognized event in adult patients with acute severe asthma (ASA). Only a few cases have been reported in children. Hereinafter is reported the case of a 2-year-old girl hospitalized in the pediatric intensive care unit for ASA, which was treated with high-flow oxygen therapy and intravenous methylprednisolone and salbutamol. During hospitalization, she had metabolic acidosis with a 7.29 pH, a 26mmHg hypocapnia, and a decrease in bicarbonates to 12 mmol/L. The anion gap was increased to 20 mmol/L and lactates to 8 mmol/L. The work-up for a congenital metabolic disease was normal. Progression was propitious with spontaneous improvement of lactic acidosis, and the child was discharged from the intensive care unit after 72 h. The origin of lactic acidosis during ASA seems to be multifactorial. Although its recovery can be spontaneous, it is important to know how to identify it because it can worsen respiratory symptoms and can lead to incongruous therapeutic escalation.

General model, based on two mixed weibull distributions of bacterial resistance, for describing various shapes of inactivation curves.

Cells of Listeria monocytogenes or Salmonella enterica serovar Typhimurium taken from six characteristic stages of growth were subjected to an acidic stress (pH 3.3). As expected, the bacterial resistance increased from the end of the exponential phase to the late stationary phase. Moreover, the shapes of the survival curves gradually evolved as the physiological states of the cells changed. A new primary model, based on two mixed Weibull distributions of cell resistance, is proposed to describe the survival curves and the change in the pattern with the modifications of resistance of two assumed subpopulations. This model resulted from simplification of the first model proposed. These models were compared to the Whiting's model. The parameters of the proposed model were stable and showed consistent evolution according to the initial physiological state of the bacterial population. Compared to the Whiting's model, the proposed model allowed a better fit and more accurate estimation of the parameters. Finally, the parameters of the simplified model had biological significance, which facilitated their interpretation.

Quantifying the combined effects of the heating time, the temperature and the recovery medium pH on the regrowth lag time of Bacillus cereus spores after a heat treatment.

The purpose of this study was to quantify the lag time of re-growth of heated spores of Bacillus cereus as a function of the conditions of the heat treatment: temperature, duration and pH of the recovery medium. For a given heating temperature, curves plotting lag times versus time of heating show more or less complex patterns. However, under a heating time corresponding to a decrease of 2 decimal logarithms of the surviving populations of spores, a linear relationship between the lag time of growth and the time of the previous heat treatment can be observed. The slope of this linear relationship followed itself a Bigelow type linear relationship, the slope of which yielded a zeta-value very close to the observed conventional z-value. It was then concluded that the slope of the regrowth lag time versus the heating time followed a linear relationship with the sterilisation value reached in the course of the previous heat treatment. A sharp effect of the pH of the medium which could be described by a simple "secondary" model was observed. As expected, the observed intercept of the linear relationship between lag time and heating time (lag without previous heating) was dependent on only the pH of the medium and not on the heating temperature.