[Joint study of seclusion, mechanical restraint and chemical restraint: Pilot study in three French psychiatric hospitals]. / Étudier conjointement l'isolement, la contention mécanique et la contention chimique : étude pilote dans trois établissements psychiatriques français.

Psychiatric wards that only exceptionally use isolation and mechanical restraint may be suspected of using "chemical restraint". However, in the case of these services, the hypothesis of a reduction in the general level of restraint can also be formulated. Prior to a comprehensive study to test these hypotheses, the current research aims to assess indicators which define high levels of the use of these measures and a relevant sample. The study was conducted in three facilities with 254 hospitalized patients over a week. Five per cent experienced isolation, 2% mechanical restraint, and 13% received high doses of medication (including "as needed" treatments). These figures are below literature data and national averages. Variances exist among centers, with one showing higher percentages for all three measures. While confirming the feasibility of studying these measures together, the study suggests the need for longer observations and continuous evaluation of prescription practices to better reflect yearly isolation and restraint trends. Future studies should involve more centers and include case studies for a nuanced understanding of administration practices in relation to prescriptions.

[PLAID-Care: Research into the reduced use of coercion in France]. / PLAID-Care : une recherche sur le moindre recours à la coercition en France.

The use of coercion is a common practice in psychiatry despite its deleterious effects and insufficient evidence of benefits. It is so deeply rooted that the mention of establishments that make little use of it arouses a form of incredulity. However, the history of psychiatry and the international literature provide numerous examples of a psychiatry that is hardly coercive and numerous experiences of a reduction in the use of seclusion and/or restraint in psychiatric facilities. Today, in France, there are also less coercive establishments, which, for example, do not use mechanical restraint, have all their units open, or have reduced their use of seclusion and restraint. With regard to the stated policy objectives of reducing the use of coercion, it is surprising that most of these facilities receive little attention. PLAID-Care research aims to contribute to the visibility and analysis of these institutions and the factors involved in the reduced use of coercion. While these factors have already been identified in the international literature, the research is based on the multiplication of disciplinary perspectives (nursing, sociology, anthropology, geography) and the mobilization of a multi-level analytical framework that allows us to embrace their multiplicity and better understand their articulation. The originality of the research also lies in its historical dimension, which allows us to understand, on the scale of an institution, how a policy and practices aiming at the least recourse emerge and are consolidated. The project timeline is divided in three tasks: firstly, an inventory of "low-coercion" facilities in France; secondly, we will select and research four traditionally "low-coercion" facilities in France; thirdly we will focus on recently emerged "low-coercion" practices. PLAID-Care aims to revitalize French research on this theme which to date has been relatively lagging behind the numerous international studies. It will bring together and articulate the knowledge, tools and forms of organization and collaboration that contribute to making a policy of lesser use of coercion operational.

Excess mortality of people living with a mental disorder: lessons from literature and perspectives / Surmortalité des personnes vivant avec un trouble psychique : enseignements de la littérature et perspectives

AIM: Considering the persistent excess mortality of people living with a mental disorder, this article provides an overview of potential causes to identify relevant research perspectives and to support the development of short-term measures in the French context. METHODS: We rely on a narrative review of the literature, both quantitative and qualitative, to define a conceptual framework of the different factors which could contribute to this excess mortality. Particular attention is given to research carried out in France to identify possible measures to implement in line with the specificities of the national context. RESULTS: The excess mortality of people living with a mental disorder represents a health inequality resulting from a combination of factors, which are not only linked to individual behaviors and living conditions detrimental to health but also to the health system – both in terms of its organization and of the health professionals involved. Questions relating to the extent of the role played by the different factors and to the way they interact (specific social processes, combination of inequalities or a particular convergence at the crossing of all these factors…) remain. CONCLUSION: These findings support the development of complementary research, relying on mixed methodologies, as well as of measures promoting access to somatic care for people living with a mental disorder throughout their care pathways (stronger development of prevention and patient education, better integration of somatic and psychiatric care teams, alternative modes of funding supporting a holistic approach to health…).

Objectif: Face au constat d'une surmortalité persistante des personnes vivant avec un trouble psychique, cet article dresse un état des lieux de ses causes potentielles afin d'identifier des perspectives de recherche et d'étayer la mise en place d'actions à court terme dans le contexte français. Méthodes: Nous nous appuyons sur une revue narrative de la littérature, quantitative et qualitative, mobilisée pour proposer un cadre conceptuel des différents facteurs pouvant jouer un rôle dans cette surmortalité. Une attention particulière est portée aux recherches françaises afin d'identifier des pistes d'actions adaptées aux spécificités de ce contexte national. Résultats: La surmortalité des personnes vivant avec un trouble psychique constitue une inégalité de santé résultant d'une combinaison de facteurs qui ne sont pas uniquement liés à des comportements individuels et des conditions de vie défavorables à la santé, mais également au système de santé ­ tant du point de vue de son organisation que des professionnels y intervenant. Des interrogations, relatives à l'ampleur du rôle joué par les différents facteurs et à la façon dont ils interagissent (traitement social spécifique, cumul d'inégalités ou conjonction singulière au croisement de ces facteurs…), demeurent. Conclusions: Ces résultats appellent la mise en œuvre de recherches complémentaires, mobilisant des schémas d'études mixtes, ainsi que de mesures favorisant l'accès aux soins somatiques des personnes vivant avec un trouble psychique, tout au long des parcours de soins (prévention, éducation thérapeutique, meilleure intégration des services somatiques et psychiatriques, modes de financement des soins encourageant une prise en charge globale de la santé…).

Problems maintaining collaborative approaches with excluded populations in a randomised control trial: lessons learned implementing Housing First in France.

BACKGROUND: In 2006, a local collective combating homelessness set up an 'experimental squat' in an abandoned building in Marseille, France's second largest city. They envisioned the squat as an alternative to conventional health and social services for individuals experiencing long-term homelessness and severe psychiatric disorders. Building on what they learned from the squat, some then joined a larger coalition that succeeded in convincing national government decision-makers to develop a scientific, intervention-based programme based on the Housing First model. This article analyses the political process through which social movement activism gave way to support for a state-funded programme for homeless people with mental disorders. METHODS: A qualitative study of this political process was conducted between 2006 and 2014, using a hybrid theoretical perspective that combines attention to both top-down and bottom-up actions with a modified Advocacy Coalition Framework. In addition to document analysis of published and grey literature linked to the policy process, researchers drew on participant observation and observant participation of the political process. Data analysis consisted primarily of a thematic analysis of field-notes and semi-structured interviews with 65 relevant actors. RESULTS: A coalition of local activists, state officials and national service providers transformed knowledge about a local innovation (an experimental therapeutic squat) into the rationale for a national, scientifically based project consisting of a randomised controlled trial of four state-supported Housing First sites, costing several million euros. The coalition's strategy was two-pronged, namely to defend a social cause (the right to housing) and to promote a scientifically validated means of realising positive outcomes (housing tenure) and cost-effectiveness (reduced hospitalisation costs). CONCLUSION: Activists' self-agency, especially that of making themselves audible to public authorities, was enhanced by the coalition's ability to seize 'windows of opportunities' to their advantage. However, in contrast to the United States and Canadian Housing First contexts, which are driven by implementation science and related approaches, it was grassroots activists who promoted a scientific-technical approach among government officials unfamiliar with evidence-based practices in France. The windows of opportunity nevertheless failed to attract participation of those most in need of housing, raising the question of whether and how marginalised and/or subordinate groups can be integrated into collaborative research when a social movement-driven innovation turns into a scientific approach. TRIAL REGISTRATION: The current clinical trial number is NCT01570712 . Registered July 17, 2011. First patient enrolled August 18, 2011.

Plant traits related to nitrogen uptake influence plant-microbe competition.

Plant species are important drivers of soil microbial communities. However, how plant functional traits are shaping these communities has received less attention though linking plant and microbial traits is crucial for better understanding plant-microbe interactions. Our objective was to determine how plant-microbe interactions were affected by plant traits. Specifically we analyzed how interactions between plant species and microbes involved in nitrogen cycling were affected by plant traits related to 'nitrogen nutrition in interaction with soil nitrogen availability. Eleven plant species, selected along an oligotrophic-nitrophilic gradient, were grown individually in a nitrogen-poor soil with two levels of nitrate availability. Plant traits for both carbon and nitrogen nutrition were measured and the genetic structure and abundance of rhizosphere. microbial communities, in particular the ammonia oxidizer and nitrate reducer guilds, were analyzed. The structure of the bacterial community in the rhizosphere differed significantly between plant species and these differences depended on nitrogen availability. The results suggest that the rate of nitrogen uptake per unit of root biomass and per day is a key plant trait, explaining why the effect of nitrogen availability on the structure of the bacterial community depends on the plant species. We also showed that the abundance of nitrate reducing bacteria always decreased with increasing nitrogen uptake per unit of root biomass per day, indicating that there was competition for nitrate between plants and nitrate reducing bacteria. This study demonstrates that nitrate-reducing microorganisms may be adversely affected by plants with a high nitrogen uptake rate. Our work puts forward the role of traits related to nitrogen in plant-microbe interactions, whereas carbon is commonly considered as the main driver. It also suggests that plant traits related to ecophysiological processes, such as nitrogen uptake rates, are more relevant for understanding plant-microbe interactions than composite traits, such as nitrophily, which are related to a number of ecophysiological processes.

Acclimation of leaf nitrogen to vertical light gradient at anthesis in wheat is a whole-plant process that scales with the size of the canopy.

Vertical leaf nitrogen (N) gradient within a canopy is classically considered as a key adaptation to the local light environment that would tend to maximize canopy photosynthesis. We studied the vertical leaf N gradient with respect to the light gradient for wheat (Triticum aestivum) canopies with the aims of quantifying its modulation by crop N status and genetic variability and analyzing its ecophysiological determinants. The vertical distribution of leaf N and light was analyzed at anthesis for 16 cultivars grown in the field in two consecutive seasons under two levels of N. The N extinction coefficient with respect to light (b) varied with N supply and cultivar. Interestingly, a scaling relationship was observed between b and the size of the canopy for all the cultivars in the different environmental conditions. The scaling coefficient of the b-green area index relationship differed among cultivars, suggesting that cultivars could be more or less adapted to low-productivity environments. We conclude that the acclimation of the leaf N gradient to the light gradient is a whole-plant process that depends on canopy size. This study demonstrates that modeling leaf N distribution and canopy expansion based on the assumption that leaf N distribution parallels that of the light is inappropriate. We provide a robust relationship accounting for vertical leaf N gradient with respect to vertical light gradient as a function of canopy size.

Using a physiological framework for improving the detection of quantitative trait loci related to nitrogen nutrition in Medicago truncatula.

Medicago truncatula is used as a model plant for exploring the genetic and molecular determinants of nitrogen (N) nutrition in legumes. In this study, our aim was to detect quantitative trait loci (QTL) controlling plant N nutrition using a simple framework of carbon/N plant functioning stemming from crop physiology. This framework was based on efficiency variables which delineated the plant's efficiency to take up and process carbon and N resources. A recombinant inbred line population (LR4) was grown in a glasshouse experiment under two contrasting nitrate concentrations. At low nitrate, symbiotic N(2) fixation was the main N source for plant growth and a QTL with a large effect located on linkage group (LG) 8 affected all the traits. Significantly, efficiency variables were necessary both to precisely localize a second QTL on LG5 and to detect a third QTL involved in epistatic interactions on LG2. At high nitrate, nitrate assimilation was the main N source and a larger number of QTL with weaker effects were identified compared to low nitrate. Only two QTL were common to both nitrate treatments: a QTL of belowground biomass located at the bottom of LG3 and another one on LG6 related to three different variables (leaf area, specific N uptake and aboveground:belowground biomass ratio). Possible functions of several candidate genes underlying QTL of efficiency variables could be proposed. Altogether, our results provided new insights into the genetic control of N nutrition in M. truncatula. For instance, a novel result for M. truncatula was identification of two epistatic interactions in controlling plant N(2) fixation. As such this study showed the value of a simple conceptual framework based on efficiency variables for studying genetic determinants of complex traits and particularly epistatic interactions.

Tracking Ideal Varieties and Cropping Techniques for Agroecological Weed Management: A Simulation-Based Study on Pea.

Pea or Pisum sativum L. is a key diversification crop, but current varieties are not very competitive against weeds. The objective was to identify, depending on the type of cropping system and weed flora, (1) the key pea parameters that drive crop production, weed control and weed contribution to biodiversity, (2) optimal combinations of pea-parameter values and crop-management techniques to maximize these goals. For this, virtual experiments were run, using FLORSYS, a mechanistic simulation model. This individual-based 3D model simulates daily crop-weed seed and plant dynamics over the years, from the cropping system and pedoclimate. Here, this model was parameterized for seven pea varieties, from experiments and literature. Moreover, ten virtual varieties were created by randomly combining variety-parameter values according to a Latin Hypercube Sampling (LHS) plan, respecting parameter ranges and correlations observed in the actual varieties. A global sensitivity analysis was run, using another LHS plan to combine pea varieties, crop rotations and management techniques in nine contrasting situations (e.g., conventional vs. organic, no-till, type of weed flora). Simulated data were analyzed with classification and regression trees (CART). We highlighted (1) Parameters that drive potential yield and competitivity against weeds (notably the ability to increase plant height and leaf area in shaded situations), depending on variety type (spring vs. winter) and cropping system. These are pointers for breeding varieties to regulate weeds by biological interactions; (2) Rules to guide farmers to choose the best pea variety, depending on the production goal and the cropping system; (3) The trade-off between increasing yield potential and minimizing yield losses due to weeds when choosing pea variety and management, especially in winter peas. The main pea-variety rules were the same for all performance goals, management strategies, and analyses scales, but further rules were useful for individual goals, strategies, and scales. Some variety features only fitted to particular systems (e.g., delayed pea emergence is only beneficial in case of herbicide-spraying and disastrous in unsprayed systems). Fewer variety rules should be compensated by more management rules. If one of the two main weed-control levers, herbicide or tillage, was eliminated, further pea-variety and/or management rules were needed.

A dataset on above- and below-ground traits of 21 species found in banana cropping systems, cultivated individually.

The data presented in this article describe 21 species that can be found in banana cropping systems: 17 cover crops species, 2 spontaneous species and 2 cultivars of banana. The cover crop species belongs mainly to Fabaceae family, but also to Poaceae, Euphorbiacea and Asteraceae. Four repetition of each species were cultivated individually, in the field, under non-limiting conditions. 40 variables were measured on whole plant, leaves and roots, at flowering or after six months of growth for longer cycle species. This dataset is made available to provide data on these species, enable comparisons between datasets and meta-analysis on cover crop or on species presented in arable fields. The data presented in this article were used in the research articles entitled "Trait-based characterisation of cover plants' light competition strategies for weed control in banana cropping systems in the French West Indies" (Tardy et al. 2015) and "Trait-based characterization of soil exploitation strategies of banana, weeds and cover plant species" (Tardy et al. 2017).

Suicides in Psychiatric Patients: Identifying Health Care-Related Factors through Clinical Practice Reviews.

The objective of this study was to identify health care-related factors associated with death by suicide in psychiatric patients and to gain insight into clinician views on how to deal with suicidality. The study material derived from a clinician committee in a psychiatric department reviewing every outpatient and inpatient suicide in a standardized way. Reports' conclusions and corresponding plenary discussion minutes regarding 94 suicides were analyzed using inductive thematic content analysis. Health care-related factors were categorized into 4 themes: patient evaluation, patient management, clinician training, and involvement of relevant non-clinical partners. Clinician views on the themes were expressed through statements (i) promoting or restricting an aspect of care (here called recommendations), which mainly followed existing guidelines and were consensual and (ii) without precise indication (here called comments), which departed from mainstream opinions or addressed topics not covered by existing policy. Involvement of non-clinical partners emerged as a new key issue for suicide prevention in psychiatric departments and should be openly discussed with patients. Clinicians preferred balanced conclusions when they reviewed suicide cases.

Diagnostic bronchoscopy in hematology and oncology patients with acute respiratory failure: prospective multicenter data.

OBJECTIVE: To describe the diagnostic yields of test strategies with and without fiberoptic bronchoscopy and bronchoalveolar lavage (FO-BAL), as well as outcomes, in cancer patients with acute respiratory failure (ARF). DESIGN: Prospective observational study. SETTING: Fifteen intensive care units in France. PATIENTS: In all, 148 cancer patients, including 45 bone marrow transplant recipients (27 allogeneic, 18 autologous) with hypoxemic ARF. INTERVENTION: None. RESULTS: Overall, 146 causes of ARF were identified in 128 patients (97 [66.4%] pulmonary infections). The cause of ARF was identified in 50.5% of the 101 patients who underwent FO-BAL and in 66.7% of the other patients. FO-BAL was the only conclusive test in 34 (33.7%) of the 101 investigated patients. Respiratory status deterioration after FO-BAL occurred in 22 of 45 (48.9%) nonintubated patients, including 16 (35.5%) patients who required ventilatory support. Hospital mortality was 55.4% (82 deaths) overall and was not significantly different in the groups with and without FO-BAL. By multivariate analysis, mortality was affected by characteristics of the malignancy (remission, allogeneic bone marrow transplantation), cause of ARF (ARF during neutropenia recovery, cause not identified), and need for life-sustaining treatments (mechanical ventilation and vasopressors). CONCLUSION: In critically ill cancer patients with ARF, a diagnostic strategy that does not include FO-BAL may be as effective as FO-BAL without exposing the patients to respiratory status deterioration.

The model symbiotic association between Medicago truncatula cv. Jemalong and Rhizobium meliloti strain 2011 leads to N-stressed plants when symbiotic N2 fixation is the main N source for plant growth.

A better knowledge of the nitrogen nutrition of Medicago truncatula at the whole plant level and its modulation by environmental factors is a crucial step to reach a complete understanding of legume nitrogen nutrition. This study was based on the symbiotic system that is the most commonly used by the research community (M. truncatula cv. Jemalong A17 x Rhizobium meliloti strain 2011). Plant nitrogen nutrition was analysed in relation to carbon nutrition, under a range of nitrate concentrations in the nutrient solution and different light conditions. This study shows that this 'model symbiotic association' does not allow the plant to meet its nitrogen requirements, when dinitrogen fixation is the main nitrogen source for plant growth. A strong interaction between nitrogen and carbon nutrition was shown: when plant nitrogen requirements were not sustained, plant leaf area was much affected whereas photosynthesis per unit leaf area remained relatively stable. Both total nitrogen uptake and leaf area increased with increasing nitrate concentration in the nutrient solution; the magnitude of these responses varied according to the light conditions. Interestingly, the plant nitrogen nutrition level remained nearly unaffected by the light conditions. The observed nitrogen-limitation in this 'model symbiotic association' is an important finding for the research community. Based on practical recommendations regarding both the experimental conditions and the phenotypic traits to consider, a methodological framework was proposed to (i) help genomicists to assess plant nitrogen nutrition better, and (ii) assist in the detection of new genetic variants affected for nitrogen uptake in large-scale phenotyping studies.

Bread and Shoulders: Reversing the Downward Spiral, a Qualitative Analyses of the Effects of a Housing First-Type Program in France.

This paper is a qualitative analysis of the effects of accompagnement, a support framework, on recovery trajectories of people with long-term homelessness and severe psychiatric disorders during 24 months in a Housing First-type program in France. A comprehensive methodology based on grounded theory was used to construct an interview guide, conduct multiple interviews with 35 Housing First participants sampled for heterogeneity, and produce memos on their trajectories before and after entering the program based on interview information. Thematic analysis of a representative subsample (n = 13) of memos identified 12 objective factors and 6 subjective factors key to the recovery process. An in-depth re-analysis of the memos generated four recovery themes: (1) the need for secure space favorable to self-reflexivity; (2) a "honeymoon" effect; (3) the importance of even weak social ties; (4) support from and hope among peers. Three challenges to recovery were identified: (1) finding a balance between protection and risk; (2) breaking downward spirals; (3) bifurcating the trajectory. This study provides new insight into the recovery process, understood as a non-linear transformation of an experience-the relationship between objective life conditions and subjective perception of those conditions-which reinforces protective support over risk elements.

Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays.

BACKGROUND: Thrombocytopenia is common in ICU patients. The objective of this study was to evaluate possible links between declining platelet counts early in the ICU stay and survival. METHODS: All patients who were admitted to the ICU for at least 5 days and had no thrombocytopenia at the time of admission were included in the study. A multivariable logistic regression model, with hospital mortality as the outcome variable, was built. RESULTS: We included 1,077 patients in the study. At ICU admission, the median platelet count was not significantly different in survivors (256 x 10(9) cells/L; interquartile range [IQR], 206 to 330 x 10(9) cells/L) and nonsurvivors (262 x 10(9) cells/L; 211 to 351 x 10(9) cells/L). Median simplified acute physiology scores II (SAPS II) at ICU admission was worse in nonsurvivors than in survivors (50 [IQR, 37 to 63] vs 37 [IQR, 27 to 48], respectively; p < 0.0001), as was the mean (+/- SD) sequential organ failure assessment (SOFA) score on day 3 (6.3 +/- 3.24 vs 4 +/- 2.8, respectively; p < 0.0001). Absolute platelet counts were lowest on day 4, but differed significantly between survivors and nonsurvivors only on day 7. Conversely, any percentage decline in platelet counts from 10 to 60% on day 4 was significantly associated with mortality. By multivariable analysis, a 30% decline in platelet count independently predicted death (odds ratio, 1.54; 95% confidence interval, 1.12 to 2.14; p = 0.008), in addition to increasing or stable SOFA scores from ICU admission to day 4, older age, male gender, ICU admission for coma, worse SAPS II score at ICU admission, transfer from another ward, and comorbidity. CONCLUSION: In patients who spend > 5 days in the ICU and have normal platelet counts at ICU admission, a decline in platelet counts provides prognostic information. This parameter deserves to be included in new scoring systems.

Noninvitation of eligible individuals to participate in pediatric studies: a qualitative study.

OBJECTIVE: To identify subjective factors that lead investigators not to invite eligible individuals to participate in pediatric studies. DESIGN: Qualitative study with semistructured interviews. SETTING: Four pediatric teaching hospitals in Paris. PARTICIPANTS: Pediatric investigators (n=24). MAIN OUTCOME MEASURE: Report by investigator that eligible patients were not invited by him or her to participate in a clinical research study. RESULTS: Sixty-three percent of investigators (15 of 24) reported not inviting eligible patients. The noninvitation patterns were global (ie, investigators did not invite anyone) (37.5% [9/24]) or targeted specific patient subgroups (37.5% [9/24]). Noninvitation was often described as driven by ethical concerns related to the study design or patients or by anticipated patient refusal (58.3% [14/24]). None of the investigators kept records of noninvitation rates or refusal rates. Investigators estimated refusal rates of 1% to 10%, and none remembered a study that had failed because of potential subjects' refusals (including healthy participants). CONCLUSIONS: Noninvitation to participate in studies is not an absence of action but rather is an organized practice that reflects investigators' perceptions. Consequences are practical (eg, recruitment bias and study failure) and ethical (eg, unequal access to trials and failure to respect the autonomy of eligible patients). Our data suggest an urgent need for quantitative studies aimed at documenting and understanding noninvitation of eligible patients to participate in research studies in pediatrics and in other medical specialties.

Trait-based characterisation of soil exploitation strategies of banana, weeds and cover plant species.

Cover plants can be introduced in cropping systems to provide agroecosystem services, including weed control via competition for resources. There is currently no consensus on how to identify the best cover plant species, while trait-based approaches are promising for screening plant species due to their agroecosystem service provision potential. This study was carried out to characterize soil exploitation strategies of cover plant species in banana agroecosystems using a trait-based approach, and in turn identify cover plant species with a high weed control potential via competition for soil resources in banana cropping systems. A field experiment was conducted on 17 cover plant species, two weed species and two banana cultivars grown individually. Four functional traits were measured. Two of them (i.e., the size of the zone explored by roots and the root impact density) were used to characterize root system soil exploration patterns. Two other traits (i.e., specific root length and root diameter) were used to characterize resource acquisition within the soil zone explored by the roots. All studied traits exhibited marked variations among species. The findings suggested a trade-off between the abilities of species to develop a limited number of large diameter roots exploring a large soil zone versus many thin roots exploring a smaller soil zone. Three soil-resource exploitation strategies were identified among species: (i) with large diameter roots that explore a large soil zone; (ii) with small diameter roots and a high specific length that explore a smaller soil zone; and (iii) with a high total root-impact density and an intermediate specific root length that explore the uppermost soil layers. Interestingly, in our panel of species, no correlations with regard to belowground and aboveground strategies were noted: species with an acquisitive belowground strategy could display an acquisitive or a conservative aboveground strategy. The findings of this study illustrated that a trait-based approach could be used to identify plant species with potential for competing with weeds, while minimising competition with banana. Six of the 17 studied cover crop species were identified as having this potential. The next step will be to assess them for their weed control performances in banana cropping systems with low reliance on herbicides.

Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study.

PURPOSE: To evaluate the outcome of cancer patients considered for admission to the intensive care unit (ICU). PATIENTS AND METHODS: Prospective, one-year hospital-wide study of all cancer and hematology patients, including bone marrow transplantation patients, for whom admission to the ICU was requested. RESULTS: Of the 206 patients considered for ICU admission, 105 patients (51%) were admitted. Of the 101 patients who were not admitted, 54 patients (26.2%) were considered too sick to benefit, and 47 patients (22.8%) were considered to be too well to benefit from the ICU. Of these 47 patients, 13 patients were admitted later. Survival rates after 30 and 180 days were significantly associated with admission status (P < .0001). Remission of the malignancy (odds ratio [OR], 3.37; 95% CI, 1.25 to 9.07) was independently associated with ICU admission, whereas poor chronic health status (OR, 0.38; 95% CI, 0.16 to 0.74) and solid tumor (OR, 0.43; 95% CI, 0.24 to 0.78) were associated with ICU refusal. In admitted patients, 30-day and 6-month survival rates were 54.3% and 32.4%, respectively. Of the patients considered too sick to benefit from ICU admission, 26% were alive on day 30 and 16.7% on day 180. Among patients considered too well to benefit, the 30-day survival rate was a worrisome 78.7%. Calibration of the Mortality Probability Model (the only score available at triage) was of limited value for predicting 30-day survival (area under the curve, 0.62). CONCLUSION: Both the excess mortality in too-well patients later admitted to the ICU and the relatively good survival in too-sick patients suggest the need for a broader admission policy.

Trophic Relationships between the Parasitic Plant Species Phelipanche ramosa (L.) and Different Hosts Depending on Host Phenological Stage and Host Growth Rate.

Phelipanche ramosa (L.) Pomel (branched broomrape) is a holoparasitic plant that reproduces on crops and also on weeds, which contributes to increase the parasite seed bank in fields. This parasite extracts all its nutrients at the host's expense so that host-parasite trophic relationships are crucial to determine host and parasite growth. This study quantified the intensity with which P. ramosa draws assimilates from its host and analyzed whether it varied with host species, host phenological stage and host growth rate. A greenhouse experiment was conducted on three host species: the crop species Brassica napus (L.) (oilseed rape) and two weed species, Capsella bursa-pastoris (L.) Medik. and Geranium dissectum (L.). Plants were grown with or without P. ramosa and under three light levels to modulate host growth rate. The proportion of host biomass loss due to parasitism by P. ramosa differed between host species (at host fructification, biomass loss ranged from 34 to 84%). B. napus and C. bursa-pastoris displayed a similar response to P. ramosa, probably because they belong to the same botanical family. The sensitivity to P. ramosa in each host species could be related to the precocity of P. ramosa development on them. Host compartments could be ranked as a function of their sensitivity to parasitism, with the reproductive compartment being the most severely affected, followed by stems and roots. The proportion of biomass allocated to leaves was not reduced by parasitism. The proportion of pathosystem biomass allocated to the parasite depended on host species. It generally increased with host stage progression but was constant across light induced-host growth rate, showing that P. ramosa adapts its growth to host biomass production. The rank order of host species in terms of sink strength differed from that in terms of host sensitivity. Finally, for B. napus, the biomass of individual parasite shoots decreased with increasing their number per host plant, regardless of host growth rate. Results will be incorporated into a mechanistic model in order to analyze the effect of parasitic plant species on weed community assembly and to design new cropping systems for controlling P. ramosa.

RhizoTubes as a new tool for high throughput imaging of plant root development and architecture: test, comparison with pot grown plants and validation.

BACKGROUND: In order to maintain high yields while saving water and preserving non-renewable resources and thus limiting the use of chemical fertilizer, it is crucial to select plants with more efficient root systems. This could be achieved through an optimization of both root architecture and root uptake ability and/or through the improvement of positive plant interactions with microorganisms in the rhizosphere. The development of devices suitable for high-throughput phenotyping of root structures remains a major bottleneck. RESULTS: Rhizotrons suitable for plant growth in controlled conditions and non-invasive image acquisition of plant shoot and root systems (RhizoTubes) are described. These RhizoTubes allow growing one to six plants simultaneously, having a maximum height of 1.1 m, up to 8 weeks, depending on plant species. Both shoot and root compartment can be imaged automatically and non-destructively throughout the experiment thanks to an imaging cabin (RhizoCab). RhizoCab contains robots and imaging equipment for obtaining high-resolution pictures of plant roots. Using this versatile experimental setup, we illustrate how some morphometric root traits can be determined for various species including model (Medicago truncatula), crops (Pisum sativum, Brassica napus, Vitis vinifera, Triticum aestivum) and weed (Vulpia myuros) species grown under non-limiting conditions or submitted to various abiotic and biotic constraints. The measurement of the root phenotypic traits using this system was compared to that obtained using "classic" growth conditions in pots. CONCLUSIONS: This integrated system, to include 1200 Rhizotubes, will allow high-throughput phenotyping of plant shoots and roots under various abiotic and biotic environmental conditions. Our system allows an easy visualization or extraction of roots and measurement of root traits for high-throughput or kinetic analyses. The utility of this system for studying root system architecture will greatly facilitate the identification of genetic and environmental determinants of key root traits involved in crop responses to stresses, including interactions with soil microorganisms.