L'archéologie française à l'étranger: Nouveaux enjeux de politique scientifique et de coopération internationale pour le Ministère des affaires étrangères et européennes

L'organisation et le financement de la recherche archéologique française hors du territoire national reposent pour une très large part sur le dispositif géré depuis plus d'un demi-siècle par le Ministère des Affaires Etrangères et Européennes : la Commission consultative de la recherche archéologique à l'étranger évalue et propose le financement des projets de recherche grâce à un appel d'offre annuel, les Instituts français de recherche à l'étranger, codirigés avec le CNRS, organisent dans bon nombre de pays hôtes la coordination des actions de recherche et l'accueil de chercheurs grâce à des structures pérennes. Cette double organisation, seule en France à être explicitement et uniquement dévolue à l'archéologie, prend en charge chaque année de 150 à 200 projets dans une organisation fortement internationalisée puisqu'elle permet à près de 1800 personnes, dont près de 800 non français, de travailler à l'étranger (chiffres année 2010). Elle répond avec une grande efficacité aux besoins des projets et des équipes qui s'en félicitent : une organisation administrative et gestionnaire légère permet une adaptation très rapide et souple aux conditions de travail à l'étranger ; un appel d'offre annuel totalement ouvert géographiquement et thématiquement laisse la capacité d'initiative aux acteurs de la discipline ; le soutien sur place des instituts et des services diplomatiques est un outil précieux pour la réalisation des projets en concertation avec les institutions et les collègues des pays hôtes. après avoir décrit le dispositif, le rapport traite quatre aspects : les relations entre les institutions françaises et étrangères intervenant dans la recherche archéologique à l'étranger les thématiques de recherche et l'évaluation des projets l'organisation et la réalisation des projets l'exploitation des projets à travers la production scientifique, la diffusion et la valorisation des résultats. Ces aspects nous permettent de concentrer l'attention sur les enjeux déterminants et les évolutions souhaitables du dispositif général

Direct admission to the intensive care unit from the emergency department and mortality in critically ill hematology patients

Background: The aim of this study was to assess the benefit of direct ICU admission from the emergency department (ED) compared to admission from wards, in patients with hematological malignancies requiring critical care. Methods: Post hoc analysis derived from a prospective, multicenter cohort study of 1011 critically ill adult patients with hematologic malignancies admitted to 17 ICU in Belgium and France from January 2010 to May 2011. The variable of interest was a direct ICU admission from the ED and the outcome was in-hospital mortality. The association between the variable of interest and the outcome was assessed by multivariable logistic regression after multiple imputation of missing data. Several sensitivity analyses were performed: complete case analysis, propensity score matching and multivariable Cox proportional-hazards analysis of 90-day survival. Results: Direct ICU admission from the ED occurred in 266 (26.4%) cases, 84 of whom (31.6%) died in the hospital versus 311/742 (41.9%) in those who did not. After adjustment, direct ICU admission from the ED was associated with a decreased in-hospital mortality (adjusted OR: 0.63; 95% CI 0.45-0.88). This was confirmed in the complete cases analysis (adjusted OR: 0.64; 95% CI 0.45-0.92) as well as in terms of hazard of death within the 90 days after admission (adjusted HR: 0.77; 95% CI 0.60-0.99). By contrast, in the propensity score-matched sample of 402 patients, direct admission was not associated with in-hospital mortality (adjusted OR: 0.92; 95% CI 0.84-1.01). Conclusions: In this study, patients with hematological malignancies admitted to the ICU were more likely to be alive at hospital discharge if they were directly admitted from the ED rather than from the wards. Assessment of early predictors of poor outcome in cancer patients admitted to the ED is crucial so as to allow early referral to the ICU and avoid delays in treatment initiation and mis-orientation

Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician’s decision-making process

International audienceIntroduction: ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. Methods: COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation. Results: Self-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation. Conclusions: The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed

Dates, Diet, and Dismemberment: Evidence from the Coldrum Megalithic Monument, Kent

We present radiocarbon dates, stable isotope data, and osteological analysis of the remains of a minimum of 17 individuals deposited in the western part of the burial chamber at Coldrum, Kent. This is one of the Medway group of megalithic monuments – sites with shared architectural motifs and no very close parallels elsewhere in Britain – whose location has been seen as important in terms of the origins of Neolithic material culture and practices in Britain. The osteological analysis identified the largest assemblage of cut-marked human bone yet reported from a British early Neolithic chambered tomb; these modifications were probably undertaken as part of burial practices. The stable isotope dataset shows very enriched & 15N values, the causes of which are not entirely clear, but could include consumption of freshwater fish resources. Bayesian statistical modelling of the radiocarbon dates demonstrates that Coldrum is an early example of a British Neolithic burial monument, though the tomb was perhaps not part of the earliest Neolithic evidence in the Greater Thames Estuary. The site was probably initiated after the first appearance of other early Neolithic regional phenomena including an inhumation burial, early Neolithic pottery and a characteristic early Neolithic post-and-slot structure, and perhaps of Neolithic flint extraction in the Sussex mines. Coldrum is the only site in the Medway monument group to have samples which have been radiocarbon dated, and is important both for regional studies of the early Neolithic and wider narratives of the processes, timing, and tempo of Neolithisation across Britai

Linguistique et archéologie (et paléogénétique)

Les relations entre archéologie et linguistique sont consubstantielles, dans la mesure où l’archéologie a d’abord été définie comme une « science auxiliaire de l’histoire », l’essentiel des sources étant les textes, que l’archéologie ne venait que compléter. Au cours du XXe siècle l’archéologie, en développant de nouvelles méthodes, a pris son indépendance pour devenir l’étude des sociétés à travers leurs vestiges matérielles. Parmi ces méthodes, l’informatique a joué très tôt un rôle essentiel afin de traiter des masses de données, ce qui impliqua leur formalisation. Par ailleurs, préhistoire et linguistique ont convergé dans la recherche problématique d’une « langue-mère », recherche très en vogue dans les années 1990, avant de l’être moins ensuite. En revanche, cette même association, maintenant complétée par la génétique, s’est efforcé depuis deux siècles d’expliquer historiquement l’existence de grandes familles linguistiques, celle des langues indo-européennes avant tout, mais aussi austronésiennes et langues bantoues. À ce stade de nos connaissances, il semble que les modèles purement migrationnistes et arborescents méritent d’être complétés par des modèles en réseaux.The relationship between archaeology and linguistics is consubstantial, insofar as archaeology was initially defined as an “auxiliary science of history”, the main sources being texts, which archaeology merely supplemented. In the course of the 20th century, archaeology developed new methods and became independent, as the study of societies through their material remains. Among these methods, computer science played an essential role very early on in order to process masses of data, which meant formalising them. Moreover, prehistory and linguistics converged in the problematic search for a “mother language”, a search that was very much in vogue in the 1990s, before becoming less so thereafter. On the other hand, this same association, now supplemented by genetics, has for the last two centuries been trying to explain historically the existence of major language families, first and foremost Indo-European, but also Austronesian and Bantu languages. At this stage of our knowledge, it seems that purely migrationist and tree-based models need to be supplemented by network-based models

Archéologie, art contemporain et recyclage des déchets

Les œuvres d’art sont par nature des objets éminemment irremplaçables. Toutefois ce terme recouvre des réalisations dont la fonction a été très diverse : centrée sur la sexualité au paléolithique ; célébrant le pouvoir et son allié le divin à partir du chalcolithique ; illustrant le prestige des élites dans les sociétés urbaines ; et aussi, conférant une dimension esthétique à des objets utilitaires (ce que nous appelons aujourd’hui le design). Avec l’invention de la photographie, l’art de nos sociétés industrielles contemporaines n’a plus eu à reproduire et n’a donc cessé de s’interroger sur ses nouvelles fonctions. Ainsi se sont développés l’art abstrait et, en liaison avec leur abondance croissante, le recyclage des déchets sous forme d’œuvres d’art, transformant en objets irremplaçables des objets remplaçables et remplacés. Le cas du Déjeuner sous l’Herbe de Daniel Spoerri, « premières fouilles archéologiques de l’art moderne », est ici développé. L’archéologie, indissociable de l’histoire de l’art en ses débuts, retrouve aujourd’hui, en tant qu’étude des sociétés humaines à travers leurs déchets, les préoccupations de certains courants artistiques (Nouveaux Réalistes, etc.), qui réfléchissent sur la durabilité des sociétés humaines et sur ce qu’il en restera.Works of art are by nature eminently irreplaceable objects. Yet the term covers works whose functions have been very diverse and have become superimposed through time: focussed on sexuality in the Palaeolithic; celebrating power and its ally the divine from the Chalcolithic onwards; illustrating the prestige of elites in urban societies; and also, conferring an aesthetic dimension to utilitarian objects (what we now call design). With the invention of photography, the art of our present-day industrial societies no longer has to reproduce reality and is thus continuously wondering about its new functions. So abstract art developed and, linked to their increasing quantity, the recycling of refuse as works of art, transforming replaceable and replaced objects into irreplaceable objects. The case of the Déjeuner sous l’Herbe by Daniel Spoerri, the "first archaeological excavation of modern art", is discussed here. Archaeology, in its early days inseparable from art history, now rediscovers, as the study of human societies through their refuse, the preoccupations of certain artistic movements (Nouveaux Réalistes, etc) which are thinking about the durability of human societies and what will remain of them

High-flow nasal cannulae for respiratory support in adult intensive care patients

Background High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adult patients experiencing acute respiratory failure in the intensive care unit (ICU). Objectives We evaluated studies that included participants 16 years of age and older who were admitted to the ICU and required treatment with HFNC. We assessed the safety and efficacy of HFNC compared with comparator interventions in terms of treatment failure, mortality, adverse events, duration of respiratory support, hospital and ICU length of stay, respiratory effects, patient-reported outcomes, and costs of treatment. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3), MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Web of Science, proceedings from four conferences, and clinical trials registries; and we handsearched reference lists of relevant studies. We conducted searches from January 2000 to March 2016 and reran the searches in December 2016. We added four new studies of potential interest to a list of ‘Studies awaiting classification' and will incorporate them into formal review findings during the review update. Selection criteria We included randomized controlled studies with a parallel or cross-over design comparing HFNC use in adult ICU patients versus other forms of non-invasive respiratory support (low-flow oxygen via nasal cannulae or mask, continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP)). Data collection and analysis Two review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. Main results We included 11 studies with 1972 participants. Participants in six studies had respiratory failure, and in five studies required oxygen therapy after extubation. Ten studies compared HFNC versus low-flow oxygen devices; one of these also compared HFNC versus CPAP, and another compared HFNC versus BiPAP alone. Most studies reported randomization and allocation concealment inadequately and provided inconsistent details of outcome assessor blinding. We did not combine data for CPAP and BiPAP comparisons with data for low-flow oxygen devices; study data were insufficient for separate analysis of CPAP and BiPAP for most outcomes. For the primary outcomes of treatment failure (1066 participants; six studies) and mortality (755 participants; three studies), investigators found no differences between HFNC and low-flow oxygen therapies (risk ratio (RR), Mantel-Haenszel (MH), random-effects 0.79, 95% confidence interval (CI) 0.49 to 1.27; and RR, MH, random-effects 0.63, 95% CI 0.38 to 1.06, respectively). We used the GRADE approach to downgrade the certainty of this evidence to low because of study risks of bias and different participant indications. Reported adverse events included nosocomial pneumonia, oxygen desaturation, visits to general practitioner for respiratory complications, pneumothorax, acute pseudo-obstruction, cardiac dysrhythmia, septic shock, and cardiorespiratory arrest. However, single studies reported adverse events, and we could not combine these findings; one study reported fewer episodes of oxygen desaturation with HFNC but no differences in all other reported adverse events. We downgraded the certainty of evidence for adverse events to low because of limited data. Researchers noted no differences in ICU length of stay (mean difference (MD), inverse variance (IV), random-effects 0.15, 95% CI -0.03 to 0.34; four studies; 770 participants), and we downgraded quality to low because of study risks of bias and different participant indications. We found no differences in oxygenation variables: partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) (MD, IV, random-effects 7.31, 95% CI -23.69 to 41.31; four studies; 510 participants); PaO2 (MD, IV, random-effects 2.79, 95% CI -5.47 to 11.05; three studies; 355 participants); and oxygen saturation (SpO2) up to 24 hours (MD, IV, random-effects 0.72, 95% CI -0.73 to 2.17; four studies; 512 participants). Data from two studies showed that oxygen saturation measured after 24 hours was improved among those treated with HFNC (MD, IV, random-effects 1.28, 95% CI 0.02 to 2.55; 445 participants), but this difference was small and was not clinically significant. Along with concern about risks of bias and differences in participant indications, review authors noted a high level of unexplained statistical heterogeneity in oxygenation effect estimates, and we downgraded the quality of evidence to very low. Meta-analysis of three comparable studies showed no differences in carbon dioxide clearance among those treated with HFNC (MD, IV, random-effects -0.75, 95% CI -2.04 to 0.55; three studies; 590 participants). Two studies reported no differences in atelectasis; we did not combine these findings. Data from six studies (867 participants) comparing HFNC versus low-flow oxygen showed no differences in respiratory rates up to 24 hours according to type of oxygen delivery device (MD, IV, random-effects -1.51, 95% CI -3.36 to 0.35), and no difference after 24 hours (MD, IV, random-effects -2.71, 95% CI -7.12 to 1.70; two studies; 445 participants). Improvement in respiratory rates when HFNC was compared with CPAP or BiPAP was not clinically important (MD, IV, random-effects -0.89, 95% CI -1.74 to -0.05; two studies; 834 participants). Results showed no differences in patient-reported measures of comfort according to oxygen delivery devices in the short term (MD, IV, random-effects 0.14, 95% CI -0.65 to 0.93; three studies; 462 participants) and in the long term (MD, IV, random-effects -0.36, 95% CI -3.70 to 2.98; two studies; 445 participants); we downgraded the certainty of this evidence to low. Six studies measured dyspnoea on incomparable scales, yielding inconsistent study data. No study in this review provided data on positive end-expiratory pressure measured at the pharyngeal level, work of breathing, or cost comparisons of treatment. Authors' conclusions We were unable to demonstrate whether HFNC was a more effective or safe oxygen delivery device compared with other oxygenation devices in adult ICU patients. Meta-analysis could be performed for few studies for each outcome, and data for comparisons with CPAP or BiPAP were very limited. In addition, we identified some risks of bias among included studies, differences in patient groups, and high levels of statistical heterogeneity for some outcomes, leading to uncertainty regarding the results of our analysis. Consequently, evidence is insufficient to show whether HFNC provides safe and efficacious respiratory support for adult ICU patients