Regression trees to identify combinations of farming practices that achieve the best overall intrinsic quality of milk.

Many studies over the last 30 years have shown the effects of farming practices on milk compounds. Combinations of practices may have antagonistic or synergistic effects on milk compounds, but these combination effects remain underinvestigated. Research needs to focus on overall intrinsic milk quality (including sensory, technological, health, and nutritional dimensions) and identify the combinations that can optimize it. The aim of this study was to identify which combinations of farming practices achieved the best scores for sensory, technological, health, and nutritional dimensions and for overall intrinsic milk quality. Ninety-nine private farms were visited once each to sample their bulk tank milk and survey their farming practices. The surveyed practices concerned herd characteristics, feeding management, housing conditions, and milking and milk storage conditions on the day of test. Analyses of bulk tank milk were designed to evaluate the overall intrinsic quality of the milk for 2 target products: raw milk cheese and semi-skimmed UHT milk. Regression trees were then used to identify the combinations of farming practices that achieved the best scores on each dimension and on overall intrinsic quality of the milk. Breed and diet (type of forage) were the most influential factors for sensory and health dimensions and for technological and nutritional dimension scores, respectively, in the cheese assessment. Overall cheese quality was highly positively correlated with these 4 dimension scores. Therefore, breed and diet emerged as the most influential practices in the regression tree for overall cheese quality. However, the combinations of practices that resulted in the best quality scores differed according to dimension studied and product targeted. This suggests that advice on farming practices to improve intrinsic milk quality needs to be adapted according to the end-purpose of the collected milk. This innovative approach combining on-farm data and regression trees provides farm managers with a valuable and practical tool to prioritize practices in terms of their role in shaping milk quality, and to identify the combinations of practices that promote good milk quality and practice thresholds or modalities needed to achieve it.

Validation of the 'EPICES' social deprivation score in a population of women who have just given birth: a French cross-sectional study.

OBJECTIVES: To assess the diagnostic performance of the EPICES score for identifying social deprivation during pregnancy in a population of women in the immediate postpartum period. STUDY DESIGN: This cross-sectional survey took place between 5th June and 5th August 2017, among women who had just given birth in either of the maternity units in Clermont-Ferrand, France. METHODS: A self-administered questionnaire was completed by women. The questionnaire came in two parts: the EPICES index and the criteria for social deprivation defined by French law. These criteria were chosen to define the reference standard. The women were classified into two groups, living in precarious circumstances or not, according to the criteria defined by the French law (reference standard). To determine the most relevant threshold of the EPICES score, the precision associated with the threshold (the fraction of those predicted positive who are true positives: positive predictive value) was balanced with its sensitivity. EPICES scores above the threshold were classified as deprived, those below as non-deprived. RESULTS: Of the 947 women who gave birth during the study period, 700 (73.9%) completed the self-administered questionnaire. The best trade-off between precision and sensitivity was obtained with a threshold of 22. For this threshold value, the positive predictive value was 42.3% and the sensitivity 70.3%. CONCLUSIONS: The EPICES score with a threshold validated in the population of pregnant women is a useful, rapid, and easy-to-use tool that makes it possible to identify maternal deprivation at an individual level.

COgnitive enhancement and consumption of psychoactive Substances among Youth Students (COSYS): a cross-sectional study in France.

OBJECTIVES: This descriptive and analytical study investigated the consumption rates of psychoactive substances among individuals aged 18-25 years in France. More specifically, it enabled assessment of the extent of the neuroenhancement (NE) phenomenon among students in France (including study of the misuse of psychostimulant medicines). STUDY DESIGN: COgnitive enhancement and consumption of psychoactive Substances among Youth Students (COSYS) is a cross-sectional survey of students in France. METHODS: Between January and June 2017, a questionnaire was mailed to students. All questionnaires were completed anonymously and included questions regarding the use of all kind of psychoactive substances, motivations for use and socio-economic situations. Statistics for all variables and the results of a multiple correspondence analysis (MCA) are presented. RESULTS: This study recorded 46,203 respondents, mostly in universities (>60%), mostly women (63.4%), with an average age of 21.4 years. In terms of substance use, medications were cited in the third position after alcohol and tobacco by women (22.48%) and in the fourth position after alcohol, tobacco and cannabis by men (15.14%). Among medications, opiates were the most frequently used, followed by benzodiazepines. Students who declared a non-medical use (NMU) of drugs obtained these through various ways (e.g. family medicine cabinet, a friend, a dealer or via the Internet), or by increasing their recommended doses (e.g. codeine). In total, 18.6% of students consumed psychoactive substances for 'stress management' and 14.1% for 'sleep management'. Results indicated that NE in students is a problem, with 18.6% of students in the COSYS survey confirming the use of psychoactive substances for this reason. There was a very low prevalence for psychostimulant medications (0.57% of men), mostly NMU (67%). MCA yielded three different profiles (doping candidate, experimenter and psychiatric profile) of psychostimulant users, which complicates the implementation of prevention programmes. CONCLUSIONS: It is evident that NMU and 'conventional' use of medications are highly prevalent in French students, especially females. NMU is associated with substance use disorders, psychopathology and suicidality. Social norms and social media increase NMU of psychoactive substances, but also provide a potential platform for anti-NMU campaigns. CLINICAL TRIAL REGISTRATION NUMBER: NCT02954679.

Risk factors for treatment failure in scabies: a cohort study.

BACKGROUND: Treatment failure, which occurs in about one-third of cases, is considered as a major factor in the increasing incidence of scabies in developed countries. OBJECTIVES: To identify predictors of treatment failure of scabies in ambulatory populations. METHODS: This multicentre study compared the clinical characteristics and treatment modalities between a group of patients with scabies treated successfully and another group who were not cured 3 months after antiscabies treatment. RESULTS: In total 210 patients with a diagnosis of scabies were included, comprising 98 patients in the treatment success group and 112 in the treatment failure group. The main risk factors for treatment failure were (i) the use of only one type of treatment, topical benzyl benzoate (BB) or oral ivermectin, vs. the combination of both treatments [odds ratio (OR) 2·15, 95% confidence interval (CI) 1·22-3·77]; (ii) the use of a single intake (vs. two) of oral ivermectin (OR 10·2. 95% CI 4·49-23·2); (iii) intake of ivermectin during a meal vs. on an empty stomach (OR 4·31, 95% CI 1·89-9·84); (iv) absence of decontamination of furnishings (OR 8·72, 95% CI 3·50-21·8), in particular sofa and cushions (OR 5·90, 95% CI 2·34-14·9), mattresses (OR 4·16, 95% CI 1·35-12·8) or car seats (OR 6·57, 95% CI 3·27-13·2) and (v) absence of written documents explaining treatment modalities (OR 5·18, 95% CI 2·57-10·4). In multivariate analysis, treatment failure was mainly associated with (i) use of a single intake (vs. two) of ivermectin (OR 6·62, 95% CI 2·71-16·2); (ii) use of BB alone vs. two intakes of ivermectin (OR 3·51, 95% CI 1·55-7·95) and (iii) absence of decontamination of furniture with acaricides (OR 5·81, 95% CI 1·96-16·7). CONCLUSIONS: Use of topical BB alone and a single intake (vs. two) of ivermectin are predictors of treatment failure.

A screening focusing on aftereffects of alcohol consumption in a student population. A National cross-sectional survey.

INTRODUCTION: Students overestimate alcohol consumption of those around them and underestimate their own, so that quantitative approach may not be the most relevant to assess students' drinking. The main objective was to provide an appropriate tool for screening for students with potential drinking problems. METHODS: A multicentre cross-sectional survey was conducted by internet between February and June, 2013 in France. Thirteen questions explored alcohol consumption, including 8 concerning after-effects of drinking episodes (4 items of the AUDIT) and alcohol behaviour (CAGE test). A multiple correspondence analysis (MCA) was conducted to identify profiles of student's alcohol consumption. Partitioning methods were used to group students by mode of alcohol use. The most relevant items included in the MCA were identified. Three questions were identified as most pertinent among the students with potential drinking problems and ranked by a decision tree with the Chi-square Automatic Interaction Detector method. Finally, we assessed the generalisation of the model. RESULTS: A total of 36,427 students participated in the survey: 25,679 were women (70.5% of respondents), sex ratio 0.42 and mean aged 21.2 (sd 3.7 years). Among those who had experimented with alcohol (N = 33,113), three consumption profiles were identified: "simple/non-use" (66.9%), "intermediate consumption" (25.9%) and "problem drinking" (7.2%). For the latter group, the three most relevant items were (Q20) "not able to stop drinking after starting", (Q21) "failed to do what was normally expected", and (Q23) "unable to remember what happened the night before". CONCLUSIONS: These results provide healthcare professionals with a 3-item screening tool for students "problem drinking".

Prediction of beef carcass and meat quality traits from factors characterising the rearing management system applied during the whole life of heifers.

In this study, four prediction models were developed by logistic regression using individual data from 96 heifers. Carcass and sensory rectus abdominis quality clusters were identified then predicted using the rearing factors data. The obtained models from rearing factors applied during the fattening period were compared to those characterising the heifers' whole life. The highest prediction power of carcass and meat quality clusters were obtained from the models considering the whole life, with success rates of 62.8% and 54.9%, respectively. Rearing factors applied during both pre-weaning and fattening periods influenced carcass and meat quality. According to models, carcass traits were improved when heifer's mother was older for first calving, calves ingested concentrates during pasture preceding weaning and heifers were slaughtered older. Meat traits were improved by the genetic of heifers' parents (i.e., calving ease and early muscularity) and when heifers were slaughtered older. A management of carcass and meat quality traits is possible at different periods of the heifers' life.

Smoking during pregnancy: a difficult problem to face. Results of a French multi-center study.

INTRODUCTION: Smoking tobacco during pregnancy is a preventable risk factor for adverse pregnancy outcomes. The aim of the study was to assess the impact of an information and training program implemented by the perinatal network of Auvergne, France, on smoking during pregnancy. METHODS: A multi-center before-and-after population-based study, based on two cross-sectional surveys, was carried out between July 2003 and June 2004, and between December 2008 and January 2010. Pregnant women aged over 18 years, with a fluent command of written and spoken French, were eligible. The main outcome was the prevalence of pregnant women who smoked daily. The preventive program consisted of informing women and healthcare providers and training healthcare providers. Multivariate analysis was performed by means of manual logistic regression and crude and adjusted Odds Ratios were calculated. FINDINGS: "Before" and "after" surveys involved 1027 and 720 women, respectively. In the "after" survey, a higher percentage of women smoked daily at the time of diagnosis (43.49% vs 51.94%, adjusted Odds Ratio 1.45 [1.10; 1.90]) and during the third term (40.53% vs 51.94%, adjusted Odds Ratio 1.62 [1.24; 2.12]). Environmental tobacco smoke exposure among non-smokers was higher in the "after" survey: 52.83% vs 69.57% adjusted Odds Ratio 1.95 [1.54; 2.47]. CONCLUSIONS: The program did not reduce smoking during pregnancy. Exposure to environmental tobacco smoke increased. French public health authorities should introduce a new policy aimed specifically at tackling tobacco use during pregnancy and exposure to second-hand smoke, and which takes into account the entire environment of pregnant women.

Prediction of beef carcass and meat traits from rearing factors in young bulls and cull cows.

The aim of this study was to predict the beef carcass and LM (thoracis part) characteristics and the sensory properties of the LM from rearing factors applied during the fattening period. Individual data from 995 animals (688 young bulls and 307 cull cows) in 15 experiments were used to establish prediction models. The data concerned rearing factors (13 variables), carcass characteristics (5 variables), LM characteristics (2 variables), and LM sensory properties (3 variables). In this study, 8 prediction models were established: dressing percentage and the proportions of fat tissue and muscle in the carcass to characterize the beef carcass; cross-sectional area of fibers (mean fiber area) and isocitrate dehydrogenase activity to characterize the LM; and, finally, overall tenderness, juiciness, and flavor intensity scores to characterize the LM sensory properties. A random effect was considered in each model: the breed for the prediction models for the carcass and LM characteristics and the trained taste panel for the prediction of the meat sensory properties. To evaluate the quality of prediction models, 3 criteria were measured: robustness, accuracy, and precision. The model was robust when the root mean square errors of prediction of calibration and validation sub-data sets were near to one another. Except for the mean fiber area model, the obtained predicted models were robust. The prediction models were considered to have a high accuracy when the mean prediction error (MPE) was ≤0.10 and to have a high precision when the was the closest to 1. The prediction of the characteristics of the carcass from the rearing factors had a high precision ( > 0.70) and a high prediction accuracy (MPE < 0.10), except for the fat percentage model ( = 0.67, MPE = 0.16). However, the predictions of the LM characteristics and LM sensory properties from the rearing factors were not sufficiently precise ( < 0.50) and accurate (MPE > 0.10). Only the flavor intensity of the beef score could be satisfactorily predicted from the rearing factors with high precision ( = 0.72) and accuracy (MPE = 0.10). All the prediction models displayed different effects of the rearing factors according to animal categories (young bulls or cull cows). In consequence, these prediction models display the necessary adaption of rearing factors during the fattening period according to animal categories to optimize the carcass traits according to animal categories.

[Interstitial pneumonia after infliximab therapy for psoriasis]. / Pneumopathie interstitielle subaiguë après traitement d'un psoriasis par infliximab.

BACKGROUND: Tumour necrosis factor (TNF)-alpha inhibitors are increasingly used for treatment of severe psoriasis. Hypersensitivity pneumonia is a rare but frequently fatal side-effect of such therapy that is unknown to most dermatologists. PATIENTS AND METHODS: A 68-year-old woman was hospitalized for subacute dyspnoea, fever, dry cough and basal chest pain 3 months after beginning infliximab therapy for severe psoriasis. Blood tests revealed an inflammatory syndrome and hypoxaemia. Thoracic computed tomography showed bilateral basal interstitial infiltrates with pleural effusion. The results of bronchoalveolar lavage and of the other microbiology testing were negative. Probabilistic treatment with amoxicillin/clavulanic acid and spiramycin was ineffective. We suspected drug-induced alveolitis and began corticosteroid therapy which improved dyspnoea, gas exchange and X-ray images. DISCUSSION: Hypersensitivity pneumonia is a potential pulmonary complication of anti-TNF alpha therapy and is frequently fatal. We report the first case of interstitial pneumonia secondary to infliximab given for severe psoriasis without any other pneumotoxic agents. Clinical features include dry cough, dyspnoea, and fever of acute or subacute onset. A diagnosis of allergic alveolitis was retained after elimination of other possible causes of the patient's interstitial pneumonia. CONCLUSION: The indications for anti-TNF agents are increasing in dermatology, and it is thus vital to consider their very rare but serious complications such as hypersensitivity pneumonia.

Caries management decision: influence of dentist and patient factors in the provision of dental services.

OBJECTIVES: Little is known about how dentists implement caries management and provide restorative dental services in everyday practice. This study explored whether or not recent concepts in caries management were implemented in practice by private practitioners. The influence of patient and practitioner characteristics on the provision of restorative dental services was also investigated through multidimensional analyses. METHODS: A sample of French general private dental practitioners was asked to record the characteristics of 35 preventive or restorative treatments made on vital permanent teeth. The data collection form was designed to explore dentists' attitudes towards caries management and their use of minimally invasive therapies. RESULTS: Twenty-six practitioners recorded the characteristics of 921 treatments performed on 457 patients. Results indicate that participants rarely performed non-invasive treatments. They used an inappropriate detection tool, as most of decisions to treat were based on visual inspection frequently associated with probing. Multidimensional analysis showed that dentists provided different restorative treatments depending on patient characteristics, with minimally invasive, esthetic restorations preferentially performed for healthy, young and well-insured patients. Restorative treatments and detection tools also varied markedly among practitioners. These variations in service patterns were not related to a specific patient profile in each dental practice. CONCLUSIONS: Results indicate that recent concepts in caries management have not yet been adopted in everyday practice. Patient and dentist characteristics influence the provision of restorative dental services. Decision-making in caries management not only depends on pathophysiology but also seems to be influenced by many other factors.

Responses of hepatic blood flows to changes in intake in sheep: a meta-analysis.

This work set out to establish the response equations for hepatic blood flows in sheep and the contribution of hepatic arterial flow to hepatic venous blood flow due to changes in intake levels at constant diet composition. The FLORA (FLuxes across Organs and tissues in Ruminant Animals) database was used, and meta-analysis performed. The meta-analysis involved selection of published papers, identification of studies, description and coding of the selected dataset and statistical analysis using a covariance model. Meta-analyses were carried out using a within-study approach. To ensure absence of bias, the analysis incorporated interfering variables and factors studied in between-study comparisons. Variables concerned diet composition; qualitative factors concerned the physiological state of the animals and the methods used to measure blood flow. The results obtained showed that hepatic blood flows were positively related to intake in sheep. The magnitude of the response (as indicated by the slope) varied with the level of intake and the blood vessel (portal, hepatic venous or arterial). Nine linear relationships were established for the portal, hepatic venous and arterial blood flows as a function of dry matter intake (DMI) with below- and above-maintenance levels considered separately. Data obtained at below- and above-maintenance levels were considered together and four quadratic relationships were established for hepatic blood flows as a function of DMI. These relationships expressed a strong effect of intake on hepatic blood flows. The contribution of hepatic arterial to hepatic venous blood flow averaged 18.2%, with a wide variability. It did not vary significantly with level of intake. Although in between-study comparisons the arterial/venous blood flow was positively influenced by the organic matter digestibility of the diet, the relationships we obtained were robust. They can be used in models of net hepatic nutrient fluxes to predict variations and absolute values of hepatic blood flows from variations and absolute values of DMI.

Early changes in biomarkers of skeletal metabolism and their association to the occurrence of osteochondrosis (OC) in the horse.

REASON FOR PERFORMING STUDY: Diagnosis of osteochondrosis (OC) is based on clinical signs and radiography, but alternative methods for detection at an early stage would be useful. OBJECTIVES: To determine in the juvenile horse the relationship between serum concentrations of a number of biomarkers that reflect changes in cartilage and bone turnover and age, feeding level, growth, and the occurrence of OC. METHODS: Foals were assigned to a high (n = 20) or moderate (n = 19) feeding level group from birth to age 1 year. Bodyweight, withers height and cannon width were measured. Osteoarticular status was assessed radiographically at 5.5 and 11 months in all foals, and by necropsy at 12 months for 8 foals/group. Serum biomarkers of bone (osteocalcin, CTX-1) and cartilage (CPII, C2C) metabolism were assayed at 8 time points between ages 2 and 52 weeks. Ratios between biomarkers of tissue formation and degradation were calculated at each time point. RESULTS: Consistent age-related patterns in biomarker serum concentrates were found, indicating a markedly higher metabolism before age 20 weeks but concentrations were not affected by feeding level. Bodyweight was correlated negatively to C2C and CTX-1, and withers height was positively correlated to osteocalcin and the osteocalcin/CTX-1 and CPII/ C2C ratios. Osteocalcin concentration at 2 weeks and CPII/ C2C ratio at 20 weeks had strong positive correlations to OC, as diagnosed radiographically at 5.5 months. Osteocalcin had a strong correlation with radiographically detected OC at 11 months but at that time there was no significant relationship between CPII/C2C ratio and OC. CONCLUSIONS: Occurrence of OC lesions is significantly associated with anabolic changes in bone metabolism during the first weeks post partum, given the strong relation with osteocalcin. POTENTIAL RELEVANCE: Measuring osteocalcin concentrations during the first few weeks post partum may have potential value for the prediction of risk for OC development.

[Intraperitoneal hemorrhage from rupture of uterine varicose vein during pregnancy: case report and review of the literature]. / Hémopéritoine par rupture de varices utérines en cours de grossesse.

We report a case of spontaneous rupture of uterine varicose vein revealed by a massive peritoneal hemorrhage in a 34-year-old patient at 27th weeks of gestation. Laparotomy enabled diagnosis and treatment of this complication. The pregnancy was continued without any problem with a normal delivery at term of a healthy child.

[Bowel obstruction revealing post-traumatic diaphragmatic hernia in a pregnant woman]. / Syndrome occlusif chez une femme enceinte révélant une hernie diaphragmatique post-traumatique méconnue.

We describe a case of late post-traumatic diaphragmatic hernia revealed during pregnancy by bowel obstruction. The diagnosis was made during exploratory laparotomy at 29 weeks. After surgical repair of the hernia the pregnancy went to term uneventfully. A healthy baby was delivered at 39 weeks by elective cesarean section.

[Therapeutic education of patients receiving anticoagulants for thromboembolic venous disease: description of the Educ'AVK program]. / Education thérapeutique des patients sous anticoagulants oraux pour maladie thromboembolique veineuse: description du programme Educ'AVK.

Educ'AVK is an education program designed for patients starting an oral anticoagulant treatment following a thromboembolic event (deep venous thrombosis or pulmonary embolism). Patients enrolled are judged capable of self-management of their drug treatment. The intervention, adapted to a short-term treatment, consists in an 3-step one-on-one teaching session conducted by a trained pharmacist. 1) Identification of the patient's needs--or educational diagnosis. 2) Definition of educational objectives adapted, first, to the patient's cognition: to be able to describe indications for therapy and potential risks factors for anticoagulant bleeding, to interpret INR lab tests and to solve a problematic treatment situation related second, to the patient's behaviour: to be able to anticipate the risk (how to enhance compliance, how to deal with a missed dose.), to take relevant decisions when dealing a therapeutic incident (bleeding, INR outside of the targeted range). 3) Choice of appropriate teaching contents and methods to reach the objectives. We used the "individual guidance" technique associated with original tools: a picture book to describe the pathology and the treatment; a booklet synthesizing all the information given by the educator during the consultation. This booklet presents 3 key-points: the information is specifically targeted to thromboembolic venous disease; the information integrates the risk-level of the patient (3 different booklets according to the patient's level of risk, of bleeding, of thromboemboly, no specific risk); there is a section where the patient writes down his/her INR results in a table specifically adapted to his/her risk level--bleeding, thromboemboly, no specific risk--and giving recommendations for the management of INR out of the targeted range.

[Impact of an education program on patient behaviour favoring prevention of drug-related adverse events: a pilot study in patients receiving oral anticoagulants for thromboembolic venous disease]. / Impact d'un programme d'éducation thérapeutique sur les attitudes de prévention vis-à-vis du risque iatrogène: étude pilote contrôlée visant les patients sous anticoagulants oraux pour maladie thromboembolique veineuse.

OBJECTIVE: Adverse events related to oral anticoagulants represent a major public health problem. Including patient education as part of the prevention strategy could contribute to improved effectiveness and safer use of drugs. The present study aimed at evaluating the outcomes of a patient education program inspired by recommendations from French Health Authorities (AFSSAPS) and based on an "individual guidance" approach. METHOD: The study was conducted in two groups of hospitalized patients treated with oral anticoagulants for thromboembolic disease. Each patient in the first (intervention) group attended an individual teaching session conducted at discharge by a trained pharmacist. Patients in the second (control) group were given usual care. These two groups were compared at inclusion (before intervention) and three months later. The outcomes considered were the acquisition of: 1) knowledge, 2) risk anticipation and compliance behaviours characterized by the stability of INR and the incidence of hemorrhagic episodes during the period of observation. RESULTS: Fifty-nine patients (average age 65 years) were included (29 in the intervention group and 30 in the control group). Three months after the intervention, the intervention group exhibited 1) better knowledge (higher rate of restitution of treatment-related information--name of the drug, administration plan, targeted range for INR (...), interpretation of INR results (p<0.05), management of a specific scenario where INR declines concomitant to elevation of anticoagulant dose (p<0.05)); 2) higher rates of relevant behaviours (p<0.05)--in the event of a missed dose, anticipating an event with a high risk of bleeding, dealing with signs of overdose--and higher compliance profile (ns) (stability of INR, and number of hemorragic episodes). A multivariate model integrating the potential explanatory variables for frequency of hemorrhagic episodes at 3 months (demographic data, history of thrombotic disease, INR stability, reference group (intervention/control)), showed that the only variable significantly associated with frequency of bleeding events was the reference group of the patient (p=0.05; odds-ratio=4.5, interval of confidence: [1-21]). CONCLUSION: Multivariate analysis demonstrated that the probability of developing a hemorrhagic event when taking an oral anticoagulant is on average 4-fold greater in patients given usual care than in patients given individual guidance a pharmacist. A larger randomized trial is currently under way in the Rhône-Alpes region, France, to validate these exploratory results.

Collapse and rapid resumption of Atlantic meridional circulation linked to deglacial climate changes.

The Atlantic meridional overturning circulation is widely believed to affect climate. Changes in ocean circulation have been inferred from records of the deep water chemical composition derived from sedimentary nutrient proxies, but their impact on climate is difficult to assess because such reconstructions provide insufficient constraints on the rate of overturning. Here we report measurements of 231Pa/230Th, a kinematic proxy for the meridional overturning circulation, in a sediment core from the subtropical North Atlantic Ocean. We find that the meridional overturning was nearly, or completely, eliminated during the coldest deglacial interval in the North Atlantic region, beginning with the catastrophic iceberg discharge Heinrich event H1, 17,500 yr ago, and declined sharply but briefly into the Younger Dryas cold event, about 12,700 yr ago. Following these cold events, the 231Pa/230Th record indicates that rapid accelerations of the meridional overturning circulation were concurrent with the two strongest regional warming events during deglaciation. These results confirm the significance of variations in the rate of the Atlantic meridional overturning circulation for abrupt climate changes.

[Paraplegia and pregnancy: anaesthesic management]. / Paraplégie et grossesse: prise en charge anesthésique.

Pregnancy is a rare occurrence in patient suffering from spinal cord lesion. The authors report the case of labour and delivery in a paraplegic patient who was suffering from lesion located T6 level. In early labour epidural analgesia was maintained and the vaginal delivery was successful without associated fluctuation of blood pressure or other signs of autonomic hyperreflexia. The epidural catheter was maintained for 48 h post-partum. The main risks and anaesthesic management of pregnancy in paraplegic patients are discussed.