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Medical students are potential marketing targets for pharmaceutical companies because established prescribing habits are not easily altered. In 2014, Bruno Etain and several other researchers published a paper which investigated the knowledge of and opinions on potential conflict of interest (COI) with regard to preclinical and clinical students enrolled in medical schools in France and residents working in hospitals. An empirical survey study with Korean medical students concerning their educational experiences and views on conflicts of interest and comparing and contrasting the results with Etain's study of French medical students. Receipt of direct or indirect financial offerings from pharmaceutical industries was not properly recognised as COI by the medical students. Therefore, strengthening education on COI and implementing institutional improvements for COI disclosure are essential to prevent bias caused by COI and enhance awareness levels regarding COI. [ABSTRACT FROM AUTHOR]

Veterinarians are a pivotal force in addressing animal health and welfare surveillance, with a critical role in improving public health security and increasing the profits of livestock farmers. Yet, the veterinary profession is adversely affected by personnel shortages, particularly in rural areas. Since the health of people, animals and their shared environment are interconnected in a One Health perspective, a set of policies are required to ensure public health by attraction and retention of veterinarians in rural areas. In France, a tutored internship programme, financially subsiding students and mentors to execute a training period in remote rural areas, was promoted to better integrate and retain veterinary students ending their veterinary training. This paper aims to evaluate how veterinarians' tutored internships influences students' choices for rural practice, using three different statistical methods derived from causal inference theory. Using survey data for the period 2016–2020, we show that: (i) the average effect of the tutored internship on veterinarians' work in food animal sector is not significant; and that (ii) the tutored internship leads veterinarians with a low share of work in the food animal sector to have a rural practise after they graduated between 13 and 20% greater than those who did not participate in the tutored internship. [ABSTRACT FROM AUTHOR]

This paper offers a comparative evaluation of the scientific impact of a citizen science program in ecology, "Vigie-Nature", managed by the French National Museum of Natural History. Vigie-Nature consists of a national network of amateur observatories dedicated to a participative study of biodiversity in France that has been running for the last twenty years. We collected 123 articles published by Vigie-Nature in international peer-reviewed journals between 2007 and 2019, and computed the yearly amount of citations of these articles between 0–12 years post-publication. We then compared this body of citations with the number of yearly citations relative to the ensemble of the articles published in ecology and indexed in the "Web of Science" data-base. Using a longitudinal data analysis, we could observe that the yearly number of citations of the Vigie-Nature articles is significantly higher than that of the other publications in the same domain. Furthermore, this excess of citations tends to steadily grow over time: Vigie-Nature publications are about 1.5 times more cited 3 years after publication, and 3 times more cited 11 years post-publication. These results suggest that large-scale biodiversity citizen science projects are susceptible to reach a high epistemic impact, when managed in specific ways which need to be clarified through further investigations. [ABSTRACT FROM AUTHOR]

Large-scale sports events have become a good opportunity for major enterprises to promote due to their high social attention; however, they also force enterprises to confront the risks of uncertainty and extreme loss. During the 2018 Russia World Cup, Vatti Co., Ltd.'s promotion activity "If France Wins, Get a Full Refund" suffered double losses economically and reputationally due to France's victory and the company's failure to fulfill its promise. This paper uses option hedging theory, and the risk management tools to construct a risk management model. Case analysis and program improvement were carried out. The research results show that using the winning odds can effectively control the risks. Companies should determine their promotion plan based on sale returns and the maximum implicit income generated by promotional activities. The research paper opens a new field using derivative financial instruments to control corporate promotion risks. [ABSTRACT FROM AUTHOR]

Social Scientists and policy makers need precise data on market rents. Yet, while housing prices are systematically recorded, few accurate data sets on rents are available. In this paper, we present a new data set describing local rental markets in France based on online ads collected through to webscraping. Comparison with alternate sources reveals that online ads provide a non biased picture of rental markets and allow coverage of the whole territory. We then estimate hedonic models for prices and rents and document the spatial variations in rent-price ratios. We show that rents do not increase as much as prices in the tightest housing markets. We use our dataset to estimate the market rent of each transaction and of social dwellings. In the latter case,this allows us to estimate the in-kind benefit received by social tenants which is mainly driven by the level of private rent in their municipality. [ABSTRACT FROM AUTHOR]

Using the InCites tool of Thomson Reuters, this study compares normalized citation impact values calculated for China, Japan, France, Germany, United States, and the UK throughout the time period from 1981 to 2010. InCites offers a unique opportunity to study the normalized citation impacts of countries using (i) a long publication window (1981 to 2010), (ii) a differentiation in (broad or more narrow) subject areas, and (iii) allowing for the use of statistical procedures in order to obtain an insightful investigation of national citation trends across the years. Using four broad categories, our results show significantly increasing trends in citation impact values for France, the UK, and especially Germany across the last thirty years in all areas. The citation impact of papers from China is still at a relatively low level (mostly below the world average), but the country follows an increasing trend line. The USA exhibits a stable pattern of high citation impact values across the years. With small impact differences between the publication years, the US trend is increasing in engineering and technology but decreasing in medical and health sciences as well as in agricultural sciences. Similar to the USA, Japan follows increasing as well as decreasing trends in different subject areas, but the variability across the years is small. In most of the years, papers from Japan perform below or approximately at the world average in each subject area. [ABSTRACT FROM AUTHOR]

Science asserts that resilience at work can be developed, with evidence pinpointing to multiple resources that can be built through deliberate coaching, training and interventions. This paper presents a mixed-methods study exploring the effectiveness of group coaching using SPARK Resilience training, a model and a structured coaching protocol that have been administered in educational and workplace settings in face-to-face format and remotely. The study used a non-randomised controlled design with a pre-test and a post-test in a sample of French adults (N = 101 in the intervention group and N = 86 in the waitlist control group). The SPARK Resilience programme was administered online with 8 sessions spanning 4 weeks in April 2020, during the very early stage of the pandemic and lockdown in France. The results indicate beneficial effects of the intervention on meaning, resilience, positive affect, and perceived stress outcomes (d in the.40-.56 range), as well as weaker effects on negative affect (d =.35) and work engagement (d =.21). Moderator analyses suggest that the effects of the intervention on perceived stress and negative affect tended to be stronger for older adults. Participants reported high levels of satisfaction with the intervention and provided 151 responses to three open-ended questions that were coded using thematic analysis, revealing specific benefits of the intervention. The findings are interpreted within the pandemic context, showing the way resilience interventions can help people overcome unprecedented challenges. [ABSTRACT FROM AUTHOR]

In Europe, there is a dearth of studies on abortion-related mobilities within countries where abortion is legal. In France, 18% of women seek abortion care outside their department of residence care. Most of these flows take place within Île-de-France region. This paper aims at providing novel insights into the motives and experiences of women traveling within France and particularly within the Île-de-France region for abortion care. It draws upon official abortion statistics as well as quantitative and qualitative data collected in three Parisian hospitals during a five-year European research project on barriers to legal abortion and abortion travel. Despite governmental efforts to facilitate access to abortions over the past decades, our findings show that various barriers exist for why women do not find services in their department of residence (lack of services or access to preferred methods, quality of care, long waiting times). However, most of our study participants report coming to Paris as a convenience and use commuting as a strategy to overcome obstacles in receiving abortion care. [ABSTRACT FROM AUTHOR]

Long bone breakage for bone marrow recovery is a commonly observed practice in Middle Palaeolithic contexts, regardless of the climatic conditions. While lithic technology is largely used to define cultural patterns in human groups, despite dedicating research by zooarchaeologists, for now butchering techniques rarely allowed the identification of clear traditions, notably for ancient Palaeolithic periods. In this paper, we test the hypothesis of butchery traditions among Neandertal groupsusing the bone assemblages from three sites in southwestern Europe. These sites are located in southeastern France and northern Italy and are dated to the Late Middle Palaeolithic: Abri du Maras (Marine Isotopic Stages (MIS) 4–3, Ardèche), Saint-Marcel (MIS 3, Ardèche), and Riparo Tagliente (MIS 4–3, Verona). The detection of culturally-induced patterns of bone breakage involves differentiating them from intuitively generated patterns. To tackle this issue, we used a zooarchaeological approach focusing on the percussion marks produced during the bone breakage process. Statistical analyses as the chi-square test of independence were employed to verify if percussion mark locations were randomly distributed, and if these distributions were different from the intuitive ones. For femurs and humeri, our results demonstrate that Neandertal groups occupying the Abri du Maras (levels 4.1 and 4.2) and the Saint-Marcel Cave (levels g and h) sites in France applied butchery traditions to recover yellow marrow. However, the traditions developed at each site were different. On the contrary, in Riparo Tagliente, in Italy, several groups or individuals of a same group did not share the same butchery traditions over time. Regarding the Abri du Maras and Saint Marcel Cave assemblages, our research demonstrates that Neandertal groups applied intense standardized bone breakage, far from the intuitive practice observed experimentally and related to bone density and/or skeletal morphology. These standardized patterns, which are systematic and counter-intuitive, can be interpreted as culturally induced for the Abri du Maras and Saint Marcel Cave. The diversity of Neandertal traditions should be considered by taking into account the butchery, in particular the practice of bone marrow extraction, and not only technological behaviours and types of tool kits. [ABSTRACT FROM AUTHOR]

Seemingly empty spaces in various archaeological settings have left many unanswered questions. This paper focuses on the appearance, maintenance and possible function of a large empty area situated at the summit plateau of the Iron Age oppidum Bibracte in France. Multidisciplinary research of the infill of the ditch that delimited this area in the 1st century BC has provided evidence on the primary function and the formation processes of the structure itself, and for the reconstruction of the appearance, maintenance and function of the area it enclosed. The results allow us to gain insight into a variety of topics, including the role of trees, hygiene measures and waste management strategies at this urbanised hilltop centre. This paper demonstrates that multi-proxy analyses provide detailed insight into the function of archaeological features in a local environmental context and the potential of such approaches in archaeology. [ABSTRACT FROM AUTHOR]

Background: The effective reproduction number (Rt) quantifies the average number of secondary cases caused by one person with an infectious disease. Near-real-time monitoring of Rt during an outbreak is a major indicator used to monitor changes in disease transmission and assess the effectiveness of interventions. The estimation of Rt usually requires the identification of infected cases in the population, which can prove challenging with the available data, especially when asymptomatic people or with mild symptoms are not usually screened. The purpose of this study was to perform sensitivity analysis of Rt estimates for COVID-19 surveillance in France based on three data sources with different sensitivities and specificities for identifying infected cases. Methods: We applied a statistical method developed by Cori et al. to estimate Rt using (1) confirmed cases identified from positive virological tests in the population, (2) suspected cases recorded by a national network of emergency departments, and (3) COVID-19 hospital admissions recorded by a national administrative system to manage hospital organization. Results: Rt estimates in France from May 27, 2020, to August 12, 2022, showed similar temporal trends regardless of the dataset. Estimates based on the daily number of confirmed cases provided an earlier signal than the two other sources, with an average lag of 3 and 6 days for estimates based on emergency department visits and hospital admissions, respectively. Conclusion: The COVID-19 experience confirmed that monitoring temporal changes in Rt was a key indicator to help the public health authorities control the outbreak in real time. However, gaining access to data on all infected people in the population in order to estimate Rt is not straightforward in practice. As this analysis has shown, the opportunity to use more readily available data to estimate Rt trends, provided that it is highly correlated with the spread of infection, provides a practical solution for monitoring the COVID-19 pandemic and indeed any other epidemic. [ABSTRACT FROM AUTHOR]

Palaeolithic stone plaquettes are a type of mobiliary art featuring engravings and recovered primarily from Magdalenian sites, where they can number from single finds to several thousand examples. Where context is available, they demonstrate complex traces of use, including surface refreshing, heating, and fragmentation. However, for plaquettes with limited or no archaeological context, research tends to gravitate toward their engraved surfaces. This paper focuses on 50 limestone plaquettes excavated by Peccadeau de l'Isle from Montastruc, a Magdalenian rockshelter site in southern France with limited archaeological context; a feature common to many art bearing sites excavated across the 19th and early 20th Centuries. Plaquette use at Montastruc was explored via a programme of microscopy, 3D modelling, colour enhancement using DStretch©, virtual reality (VR) modelling, and experimental archaeology, the latter focusing on limestone heating related to different functional and non-functional uses. While the limited archaeological context available ensures the results remain only indicative, the data generated suggests plaquettes from Montastruc were likely positioned in proximity to hearths during low ambient light conditions. The interaction of engraved stone and roving fire light made engraved forms appear dynamic and alive, suggesting this may have been important in their use. Human neurology is particularly attuned to interpreting shifting light and shadow as movement and identifying visually familiar forms in such varying light conditions through mechanisms such as pareidolic experience. This interpretation encourages a consideration of the possible conceptual connections between art made and experienced in similar circumstances, such as parietal art in dark cave environments. The toolset used to investigate the Montastruc assemblage may have application to other collections of plaquettes, particularly those with limited associated context. [ABSTRACT FROM AUTHOR]

This paper shows how the Rao-Stirling diversity index may be extensively used for positioning and comparing institutions interdisciplinary practices. Two decompositions of this index make it possible to explore different components of the diversity of the cited references in a corpus of publications. The paper aims at demonstrating how these bibliometric tools can be used for comparing institutions in a research field by highlighting collaboration orientations and institutions strategies. To make the method available and easy to use for indicator users, this paper first recalls a previous result on the decomposition of the Rao-Stirling index into multidisciplinarity and interdisciplinarity components, then proposes a new decomposition to further explore the profile of research collaborations and finally presents an application to Neuroscience research in French universities. [ABSTRACT FROM AUTHOR]

Real-time ride-sharing has become popular in recent years. However, the underlying optimization problem for this service is highly complex. One of the most critical challenges when solving the problem is solution quality and computation time, especially in large-scale problems where the number of received requests is huge. In this paper, we rely on an exact solving method to ensure the quality of the solution, while using AI-based techniques to limit the number of requests that we feed to the solver. More precisely, we propose a clustering method based on a new shareability function to put the most shareable trips inside separate clusters. Previous studies only consider Spatio-temporal dependencies to do clustering on the mobility service requests, which is not efficient in finding the shareable trips. Here, we define the shareability function to consider all the different sharing states for each pair of trips. Each cluster is then managed with a proposed heuristic framework in order to solve the matching problem inside each cluster. As the method favors sharing, we present the number of sharing constraints to allow the service to choose the number of shared trips. To validate our proposal, we employ the proposed method on the network of Lyon city in France, with half-million requests in the morning peak from 6 to 10 AM. The results demonstrate that the algorithm can provide high-quality solutions in a short time for large-scale problems. The proposed clustering method can also be used for different mobility service problems such as car-sharing, bike-sharing, etc. [ABSTRACT FROM AUTHOR]

Background: Digital spaces, and in particular social networking sites, are becoming increasingly present and influential in the functioning of our democracies. In this paper, we propose an integrated methodology for the data collection, the reconstruction, the analysis and the visualization of the development of a country’s political landscape from Twitter data. Method: The proposed method relies solely on the interactions between Twitter accounts and is independent of the characteristics of the shared contents such as the language of the tweets. We validate our methodology on a case study on the 2017 French presidential election (60 million Twitter exchanges between more than 2.4 million users) via two independent methods: the comparison between our automated political categorization and a human categorization based on the evaluation of a sample of 5000 profiles descriptions; the correspondence between the reconfigurations detected in the reconstructed political landscape and key political events reported in the media. This latter validation demonstrated the ability of our approach to accurately reflect the reconfigurations at play in the off-line political scene. Results: We built on this reconstruction to give insights into the opinion dynamics and the reconfigurations of political communities at play during a presidential election. First, we propose a quantitative description and analysis of the political engagement of members of political communities. Second, we analyze the impact of political communities on information diffusion and in particular on their role in the fake news phenomena. We measure a differential echo chamber effect on the different types of political news (fake news, debunks, standard news) caused by the community structure and emphasize the importance of addressing the meso-structures of political networks in understanding the fake news phenomena. Conclusions: Giving access to an intermediate level, between sociological surveys in the field and large statistical studies (such as those conducted by national or international organizations) we demonstrate that social networks data make it possible to qualify and quantify the activity of political communities in a multi-polar political environment; as well as their temporal evolution and reconfiguration, their structure, their alliance strategies and their semantic particularities during a presidential campaign through the analysis of their digital traces. We conclude this paper with a comment on the political and ethical implications of the use of social networks data in politics. We stress the importance of developing social macroscopes that will enable citizens to better understand how they collectively make society and propose as example the “Politoscope”, a macroscope that delivers some of our results in an interactive way. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) induces chronic haemolytic anaemia and intermittent vaso-occlusion that results in tissue ischaemia causing acute, severe pain episodes that can lead to frequent hospitalizations. These consequences can have repercussions on family, social, school and/or professional life. Here, we present some of the results of the PHEDRE study (Pharmacodépendance Et DREpanocytose—drug dependence and sickle-cell disease), which is the largest study of patients with SCD in France. This paper intends to describe characteristics of the French SCD population. We also aimed to assess the impact of the disease on the lives of patients using objective and subjective variables. Methods: The PHEDRE study was a national multicentric observational study. Adults, adolescents and children with a confirmed SCD diagnosis were included in the study by their referring doctor. Then, they were interviewed by phone about their socioeconomic status, about the impact of the disease on their lives and about their analgesic and psychoactive drug use. Results: The study population consisted of 872 patients (28% were minors). Seventy-two percent of adults were active, and all minors were in school. Many patients presented criteria of severe SCD. Seventy-five percent were homozygous SS, 15% were double heterozygotes SC and 8% were heterozygotes Sβthal, 87% received specific treatment, 58% were hospitalized at least once for vaso-occlusive crisis in the past 12 months, and the number of analgesic drugs taken averaged 3.8. Seventy-five percent of patients reported academic or professional consequences related to their SCD, and 52% reported social consequences. Conclusions: The impact of SCD on patients' lives can be significant, nevertheless their social integration seems to be maintained. We highlighted respect of recommendations regarding analgesic treatments and only a few patients used tobacco, alcohol or cannabis. Trial registration: Clinical Trials, NCT02580565; https://clinicaltrials.gov/ Registered 16 October 2015. [ABSTRACT FROM AUTHOR]

The population genetic structure of crop pest populations gives information about their spatial ecology, which helps in designing management strategies. In this paper, we investigated the genetic structure of the Mediterranean Corn Borer (MCB), Sesamia nonagrioides Lefèbvre (Lepidoptera: Noctuidae), one of the most important maize pests in the Mediterranean countries, using microsatellite markers for the first time in this species. Insects were collected in twenty-five locations in southwest and southeast France from cultivated and wild host plants (Zea mays, Sorghum halepense and Typha domingensis). Contrary to what has been reported so far in France, we found that MCB populations could be locally abundant on wild poales plants. Analysis was carried out at 11 polymorphic microsatellite markers. Molecular variance was significantly determined by geography, then by host plant, with 17% and 4%, respectively, when considered as a major effect, and with 14% and 1%, respectively, when considered as a marginal effect in permutational analysis. Multidimensional scaling (MDS) and GENELAND Bayesian clustering suggested that populations infecting wild plants (T. domingensis and S. halepense) were more structured locally than those affecting cultivated maize. In S. halepense, significant Isolation By Distance (IBD) indicated that this factor could explain genetic differentiation of the moth populations. In T. domingensis, local population differentiation was strong but did not depend on distance. The implication of this absence of population structure in maize and the heterogeneity of population genetics patterns in wild plants are discussed in the context of the population dynamics hypothesis and population management strategies. [ABSTRACT FROM AUTHOR]

There appears to be little doubt as to the existence of an intentional technological resolve to produce convergent tools during the Middle Palaeolithic. However, the use of these pieces as pointed tools is still subject to debate: i.e., handheld tool vs. hafted tool. Present-day technological analysis has begun to apply new methodologies in order to quantify shape variability and to decipher the role of the morphology of these pieces in relation to function; for instance, geometric morphometric analyses have recently been applied with successful results. This paper presents a study of this type of analysis on 37 convergent tools from level Ga of Payre site (France), dated to MIS 8–7. These pieces are non-standardized knapping products produced by discoidal and orthogonal core technologies. Moreover, macro-wear studies attest to various activities on diverse materials with no evidence of hafting or projectile use. The aim of this paper is to test the geometric morphometric approach on non-standardized artefacts applying the Elliptical Fourier analysis (EFA) to 3D contours and to assess the potential relationship between size and shape, technology and function. This study is innovative in that it is the first time that this method, considered to be a valuable complement for describing technological and functional attributes, is applied to 3D contours of lithic products. Our results show that this methodology ensures a very good degree of accuracy in describing shape variations of the sharp edges of technologically non-standardized convergent tools. EFA on 3D contours indicates variations in deviations of the outline along the third dimension (i.e., dorso-ventrally) and yields quantitative and insightful information on the actual shape variations of tools. Several statistically significant relationships are found between shape variation and use-wear attributes, though the results emphasize the large variability of the shape of the convergent tools, which, in general, does not show a strong direct association with technological features and function. This is in good agreement with the technological context of this chronological period, characterized by a wide diversity of non-standardized tools adapted to multipurpose functions for varied subsistence activities. [ABSTRACT FROM AUTHOR]

The mechanisms underlying bat and bird activity peaks (attraction) or losses (avoidance) near wind turbines remain unknown. Yet, understanding them would be a major lever to limit the resulting habitat loss and fatalities. Given that bat activity is strongly related to airflows, we hypothesized that airflow disturbances generated leeward (downwind) of operating wind turbines–via the so-called wake effect–make this area less favorable for bats, due to increased flight costs, decreased maneuverability and possibly lower prey abundance. To test this hypothesis, we quantified Pipistrellus pipistrellus activity acoustically at 361 site-nights in western France in June on a longitudinal distance gradient from the wind turbine and on a circular azimuth gradient of wind incidence angle, calculated from the prevailing wind direction of the night. We show that P. pipistrellus avoid the wake area, as less activity was detected leeward of turbines than windward (upwind) at relatively moderate and high wind speeds. Furthermore, we found that P. pipistrellus response to wind turbine (attraction and avoidance) depended on the angle from the wake area. These findings are consistent with the hypothesis that changes in airflows around operating wind turbines can strongly impact the way bats use habitats up to at least 1500 m from the turbines, and thus should prompt the consideration of prevailing winds in wind energy planning. Based on the evidence we present here, we strongly recommend avoiding configurations involving the installation of a turbine between the origin of prevailing winds and important habitats for bats, such as hedgerows, water or woodlands. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the cost-effectiveness of avelumab first-line (1L) maintenance therapy plus best supportive care (BSC) versus BSC alone for adults with locally advanced or metastatic urothelial carcinoma (la/mUC) that had not progressed following platinum-based chemotherapy in France. Methods: A three-state partitioned survival model was developed to assess the lifetime costs and effects of avelumab plus BSC versus BSC alone. Data from the phase 3 JAVELIN Bladder 100 trial (NCT02603432) were used to inform estimates of clinical and utility values considering a 10-year time horizon and a weekly cycle length. Cost data were estimated from a collective perspective and included treatment acquisition, administration, follow-up, adverse event–related hospitalization, transport, post-progression, and end-of-life costs. Health outcomes were measured in quality-adjusted life-years (QALYs) and life-years gained. Costs and clinical outcomes were discounted at 2.5% per annum. Incremental cost-effectiveness ratios (ICERs) were used to compare cost-effectiveness and willingness to pay in France. Uncertainty was assessed using a range of sensitivity analyses. Results: Avelumab plus BSC was associated with a gain of 2.49 QALYs and total discounted costs of €136,917; BSC alone was associated with 1.82 QALYs and €39,751. Although avelumab plus BSC was associated with increased acquisition costs compared with BSC alone, offsets of −€20,424 and −€351 were observed for post-progression and end-of-life costs, respectively. The base case analysis ICER was €145,626/QALY. Sensitivity analyses were consistent with the reference case and showed that efficacy parameters (overall survival, time to treatment discontinuation), post-progression time on immunotherapy, and post-progression costs had the largest impact on the ICER. Conclusions: This analysis demonstrated that avelumab plus BSC is associated with a favorable cost-effectiveness profile for patients with la/mUC who are eligible for 1L maintenance therapy in France. [ABSTRACT FROM AUTHOR]

Background: NEETs (young people not in employment, education or training) are at higher risk for poorer mental and physical health. In France, the Missions locales (MLs) are the only social structures dedicated to this population. We sought to determine whether the systematic offer of a social and preventive medicine consultation at a ML might increase NEET participants’ access to training in the 12 months following the intervention. Methods: This intervention research was a parallel randomised controlled interventional study conducted at five MLs in mainland France in 2011–2012. It included 976 NEETs aged 18 to 25 years who attended one of the five MLs. At inclusion, participants were randomly assigned (1:1:1) to three groups: those in the first group were invited to see a social worker (not studied in this paper), those in the second group were invited to see a doctor and a social worker (intervention group), and the third was a control group. The primary outcome was participation in at least one training session during the year following study inclusion. Results: Among the 976 participants, 504 were randomly assigned to the intervention group and 472 to the control group; 704 (72.1%) were included in the analyses. A significantly higher proportion of the participants in the intervention group participated in a training session in the 12 months following the intervention than of those in the control group (63.3% vs 55.6%; p = 0.04). This difference was significantly greater for women, those less than 21 years of age, those unstably housed and those with a lower level of education. Conclusions: Social and preventive medicine consultations that are fully integrated into the social services for NEETs have an impact on their access to training and contribute to changing some of their health-related behaviours. This may improve their access to the labour market. [ABSTRACT FROM AUTHOR]

Background: Work on long COVID-19 has mainly focused on clinical care in hospitals. Thermal spa therapies represent a therapeutic offer outside of health care institutions that are nationally or even internationally attractive. Unlike local care (hospital care, general medicine, para-medical care), their integration in the care pathways of long COVID-19 patients seems little studied. The aim of this article is to determine what place french thermal spa therapies can take in the care pathway of long COVID-19 patients. Methods: Based on the case of France, we carry out a geographic mapping analysis of the potential care pathways for long COVID-19 patients by cross-referencing, over the period 2020–2022, the available official data on COVID-19 contamination, hospitalisations in intensive care units and the national offer of spa treatments. This first analysis allows us, by using the method for evaluating the attractiveness of an area defined by David Huff, to evaluate the accessibility of each French department to thermal spas. Results: Using dynamic geographical mapping, this study describes two essential criteria for the integration of the thermal spa therapies offer in the care pathways of long COVID-19 patients (attractiveness of spa areas and accessibility to thermal spas) and three fundamental elements for the success of these pathways (continuity of the care pathways; clinical collaborations; adaptation of the financing modalities to each patient). Using a spatial attractiveness method, we make this type of geographical analysis more dynamic by showing the extent to which a thermal spa is accessible to long COVID-19 patients. Conclusion: Based on the example of the French spa offer, this study makes it possible to place the care pathways of long COVID-19 patients in a wider area (at least national), rather than limiting them to clinical and local management in a hospital setting. The identification and operationalization of two geographical criteria for integrating a type of treatment such as a spa cure into a care pathway contributes to a finer conceptualization of the construction of healthcare pathways. [ABSTRACT FROM AUTHOR]

Background: Congenital heart defects are common and occur in approximately 0.9% of births. In France, the registries cover approximately 20% of the population but not the entirety of France; therefore, we aimed to update the incidence data for congenital heart defects in France from 2013 to 2022 using the medico-administrative database PMSI-MCO (French Medical Information System Program in Medicine, Surgery, and Obstetrics). We aimed to compare the frequency of risk factors in a population with congenital heart defects and a reference population. Methods: From 2013 to 2022, we included children aged < 3 years diagnosed with congenital heart defects according to the International Classification of Diseases, 10th Revision, in the PMSI-MCO database. We compared them with a population without congenital defects on several medical data items (e.g., parity, gemellarity, and mortality rate). Bivariate and multivariate analyses compared children with congenital heart defects and children without congenital malformation. Results: We identified 83,879 children with congenital heart defects in France from 2013 to 2022 in the PMSI-MCO database and 7,739,840 children without such defects, including 7,218,952 without any congenital defects. We observed more deaths (7.49% vs. 0.68%, d = 0.59) and more twinning (8.67% vs. 1.23%, d = 0.35) among children with congenital heart defects. Multivariate analysis revealed an increased risk of congenital heart defects in male individuals (OR [odds ratio] 1.056, 95% CI [confidence interval] [1.039–1.076]) and cases of medically assisted reproduction (OR 1.115, 95% CI [1.045–1.189]) and a reduced risk in the case of multiparity (OR 0.921, 95% CI [0.905–0.938]). Conclusions: According to the PMSI-MCO database, the incidence of congenital heart defects in France from 2013 to 2022 is 1% of births. Congenital heart defects are more frequent in cases of prematurity, twinning, primiparity, male sex, and maternal age > 40 years. [ABSTRACT FROM AUTHOR]

Background: Activities embedded in academic culture (international conferences, field missions) are an important source of greenhouse gas emissions. For this reason, collective efforts are still needed to lower the carbon footprint of Academia. Serious games are often used to promote ecological transition. Nevertheless, most evaluations of their effects focus on changes in knowledge and not on behaviour. The main objectives of this study are to 1) Evaluate the feasibility of a control and an experimental behaviour change intervention and, 2) Evaluate the fidelity (the extent to which the implementation of the study corresponds to the original design) of both interventions. Methods: People employed by a French research organisation (N = 30) will be randomised to one of the two arms. The experimental arm consists in a 1-hour group discussion for raising awareness about climate change, carrying out a carbon footprint assessment and participating to a serious game called "Ma terre en 180 minutes." The control arm consists of the same intervention (1h discussion + carbon footprint assessment) but without participating to the serious game. On two occasions over one month, participants will be asked to fill in online surveys about their behaviours, psychological constructs related to behaviour change, sociodemographic and institutional information. For every session of intervention, the facilitators will assess task completion, perceived complexity of the tasks and the perceived responsiveness of participants. Descriptive statistics will be done to analyse percentages and averages of the different outcomes. Discussion: Ma-terre EVAL pilot study is a 1-month and a half pilot randomised controlled trial aiming to evaluate the feasibility and the fidelity of a 24-month randomised controlled trial. This study will provide more information on the levers and obstacles to reducing the carbon footprint among Academia members, so that they can be targeted through behaviour change interventions or institutional policies. [ABSTRACT FROM AUTHOR]

Background: In the last two decades, sex and gender differences have been documented in chronic kidney disease (CKD) management, including access to renal replacement therapy and its outcomes. The objectives of this study were to 1) compare the pre-dialysis healthcare utilization in men and women, and 2) examine the sex-specific factors associated with emergency dialysis start. Methods: Adult patients with CKD who started dialysis in France in 2015 were extracted from the Renal Epidemiology and Information Network registry. Patients were matched to the French National Health Data System database to extract healthcare utilization data for the 2 years before dialysis start. Frequencies and monthly rates of consultations and hospitalizations were compared between men and women. Logistic regression analyses were performed separately in the two groups. Results: Among the 8856 patients included, 3161 (35.7%) were women. Median age (71 years) and estimated glomerular filtration rate (8.1 and 7.7 ml/min for men and women) were similar between groups at dialysis start. Monthly consultations rates with a general practitioner and nephrology-related care were similar between women and men. Some sex-specific differences were found: higher frequencies of consultations with a psychiatrist in women and more frequent hospitalizations for circulatory system diseases in men. Emergency dialysis start rate was 30% in both groups. Emergency dialysis start was associated with acute nephropathy, compared with slowly progressive nephropathy, in women but not in men (OR = 1.48, p<0.01 vs 1.15, p = 0.18). Conclusions: This study found similar quantitative pre-dialysis healthcare utilization in men and women. To better understand sex/gender differences in CKD care trajectories, future research should focus on patients with CKD who are unknown to nephrology services, on patients receiving conservative care and on the sex/gender-specific mechanisms underlying care decision-making. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate secondary intention wound healing in the horse's limbs when treated with the synthetic epidermis spray (Novacika®, Cohesive S.A.S, France) or with a standard bandaging technique. Methods: Six Standardbred mares were included in the study. Four 2.5 x 2.5 cm full-thickness skin wounds were created on each thoracic limb. Two wounds were located on the dorsoproximal aspect of the cannon bone and the other two at the dorsoproximal aspect of the fetlock. Six hours after creation, wounds were randomly treated with synthetic epidermis spray or standard bandaging. The wounds were assessed every 4 days by gross visual assessment and using a 3D imaging camera. Analysis was performed with a 3D imaging application. Results: Out of 46 wounds, 22 showed exuberant granulation tissue and were part of the standard bandaging group. Whether the wounds were treated with synthetic epidermis spray or standard bandaging, the time for healing was the same. Conclusion: The synthetic epidermis spray studied in this model has allowed healing without the production of exuberant granulation tissue but did not reduce the median wound healing time compared to a standard bandaging technique. The synthetic epidermis spray is potentially an interesting alternative for the management of secondary intention wound healing of superficial and non-infected distal limb wounds in adult horses on economical and practical aspects. However, all statistical inference (p-values especially) must be interpreted with caution, given the size of the sample. [ABSTRACT FROM AUTHOR]

Objectives: During the COVID-19 pandemic in France, abortion was recognized as an essential service that cannot be delayed, and such care was therefore presumed to be maintained. The aim is to analyze the changes in the practice of abortion in 2020 to identify the consequences of the two lockdowns and the effects of the extension of the legal time limit. Methods: We analyzed the data collected by the French national health insurance system, which covers 99% of the population. All women who had an elective abortion, either surgical or with medication, in France in 2019 and 2020 were included in the study. Trend changes in abortions were analyzed by comparing the ratio of the weekly number of abortions in 2020 with the weekly number in 2019. Results: Both 2020 lockdowns were followed by a drop in abortions, particularly after the first and stricter lockdown. This may be explained not by an abrupt shutdown of access to abortion services, but rather by a decrease in conceptions during the lockdown weeks. The decrease was more marked for surgical abortions than for medication abortions in a hospital setting, and less so for medication abortions in non-hospital settings. Moreover, the proportion of the latter type of abortions continued to increase, showing the reinforcement of a previous trend. Conclusions: Our findings indicate that expanding the legal time limit for abortion, diversifying the settings where abortions can be performed and the range of abortion providers help to facilitate access to this fundamental reproductive care. [ABSTRACT FROM AUTHOR]

Background: Covid-19 epidemics raged around the world in years 2020–2022. The dynamics of the epidemics and their mortality varied by country depending on prevention, treatments, vaccination and health status of the population. Objective: The study compares Covid-19 morbidity and mortality in South-Africa and in France, two countries with similar population size and with reliable reporting systems, in order to better understand the dynamics and impacts of the epidemics and the effects of health policies and programs. Data and methods: Data on cases, deaths, hospitalizations, vaccinations were drawn from national statistics. Published data on cases and deaths were corrected for undercount. Results: Results show a different epidemiology in the two countries in the first three years of the epidemic (2020–2022). Incidence was higher in South Africa, and some 44% more people were infected by December 2022 than in France. Mortality and case-fatality were also higher in South Africa despite a favourable age structure. The age pattern of mortality showed higher values in South Africa among the young adults. Young women appeared somewhat disadvantaged in South Africa. Lastly, vaccination appeared to have had no effect on incidence, but a large effect on case-fatality in France. Conclusions: Despite about the same population size and the same crude death rate at baseline, South Africa exhibited more cases and more deaths from Covid-19 over the 2020–2022 period. Prevention strategies (lockdown and vaccination) appear to have had large impacts on morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Zoonotic visceral leishmaniasis is endemic in the Mediterranean Basin, where the dog is the main reservoir host. The disease's causative agent, Leishmania infantum, is transmitted by blood-feeding female sandflies. This paper reports an integrative study of canine leishmaniasis in a region of France spanning the southwest Massif Central and the northeast Pyrenees, where the vectors are the sandflies Phlebotomus ariasi and P. perniciosus Methods: Sandflies were sampled in 2005 using sticky traps placed uniformly over an area of approximately 100 by 150 km. High- and low-resolution satellite data for the area were combined to construct a model of the sandfly data, which was then used to predict sandfly abundance throughout the area on a pixel by pixel basis (resolution of c. 1 km). Using literature- and expert-derived estimates of other variables and parameters, a spatially explicit R0 map for leishmaniasis was constructed within a Geographical Information System. R0 is a measure of the risk of establishment of a disease in an area, and it also correlates with the amount of control needed to stop transmission. Conclusions: To our knowledge, this is the first analysis that combines a vector abundance prediction model, based on remotely-sensed variables measured at different levels of spatial resolution, with a fully mechanistic process-based temperature-dependent R0 model. The resulting maps should be considered as proofs-of-principle rather than as ready-touse risk maps, since validation is currently not possible. The described approach, based on integrating several modeling methods, provides a useful new set of tools for the study of the risk of outbreaks of vector-borne diseases [ABSTRACT FROM AUTHOR]

Background: Many different simulation frameworks, in different topics, need to treat realistic datasets to initialize and calibrate the system. A precise reproduction of initial states is extremely important to obtain reliable forecast from the model. Methodology/Principal Findings: This paper proposes an algorithm to create an artificial population where individuals are described by their age, and are gathered in households respecting a variety of statistical constraints (distribution of household types, sizes, age of household head, difference of age between partners and among parents and children). Such a population is often the initial state of microsimulation or (agent) individual-based models. To get a realistic distribution of households is often very important, because this distribution has an impact on the demographic evolution. Usual techniques from microsimulation approach cross different sources of aggregated data for generating individuals. In our case the number of combinations of different households (types, sizes, age of participants) makes it computationally difficult to use directly such methods. Hence we developed a specific algorithm to make the problem more easily tractable. Conclusions/Significance: We generate the populations of two pilot municipalities in Auvergne region (France) to illustrate the approach. The generated populations show a good agreement with the available statistical datasets (not used for the generation) and are obtained in a reasonable computational time. [ABSTRACT FROM AUTHOR]

Background: Migrants account for 35% of HIV diagnoses in the European Union (ECDC/WHO 2014). Little is known about the impact of such a lifelong infection diagnosis on lives that are already disrupted by migration. In this paper, we assess the impact of HIV diagnosis on activity, union, well-being among African migrants living in France, the second group most affected by HIV after MSM. We compare it with the impact of the diagnosis of Hepatitis B, another lifelong infection affecting African migrants. Methods: We use the ANRS PARCOURS survey, a retrospective life-event survey led in 2012–2013 in 74 health structures in Paris greater area which collected 926 life histories of Sub-Saharan migrants living with HIV and 779 with Hepatitis B. We modelled the probability year by year since 18 years of age until data collection to lose one’s activity, to experience a conjugal break up and degradation of well-being and we estimated the impact of migration and of HIV and Hepatitis B diagnoses on these probabilities, after adjustment on other factors, thanks to discrete-time logistic regressions. Results: Migration entailed loss of activity and conjugal break up, though HIV diagnosis after migration did not statistically impact on these outcomes. Yet HIV diagnosis had a massive negative impact on well-being (aOR = 11.31 [4.64–27.56] for men and 5.75 [2.79–11.86] for women). This negative impact on well-being tended to diminish for persons diagnosed after 2004. The negative impact of HIV diagnosis on African migrants’ well-being seems to be attenuated in the last decade, which hints at a normalization of the subjective experience of HIV diagnosis. [ABSTRACT FROM AUTHOR]

An acceleration index is proposed as a novel indicator to track the dynamics of COVID-19 in real-time. Using data on cases and tests in France for the period between the first and second lock-downs—May 13 to October 25, 2020—our acceleration index shows that the pandemic resurgence can be dated to begin around July 7. It uncovers that the pandemic acceleration was stronger than national average for the [59–68] and especially the 69 and older age groups since early September, the latter being associated with the strongest acceleration index, as of October 25. In contrast, acceleration among the [19–28] age group was the lowest and is about half that of the [69–78]. In addition, we propose an algorithm to allocate tests among French "départements" (roughly counties), based on both the acceleration index and the feedback effect of testing. Our acceleration-based allocation differs from the actual distribution over French territories, which is population-based. We argue that both our acceleration index and our allocation algorithm are useful tools to guide public health policies as France might possibly enter a third lock-down period with indeterminate duration. [ABSTRACT FROM AUTHOR]

Introduction: Contradictions remain on the impact of interhospital competition on the quality of care, mainly the mortality. The aim of the study is to evaluate the impact of interhospital competition on postoperative mortality after surgery for colorectal cancer in France. Methods: We conducted a retrospective cross-sectional study from 2015 to 2019. Data were collected from a National Health Database. Patients operated on for colorectal cancer in a hospital in mainland France were included. Competition was measured using number of competitors by distance-based approach. A mixed-effect model was carried out to test the link between competition and mortality. Results: Ninety-five percent (n = 152,235) of the 160,909 people operated on for colorectal cancer were included in our study. The mean age of patients was 70.4 ±12.2 years old, and female were more represented (55%). A total of 726 hospitals met the criteria for inclusion in our study. Mortality at 30 days was 3.6% and we found that the mortality decreases with increasing of the hospital activity. Using the number of competitors per distance method, our study showed that a "highly competitive" and "moderately competitive" markets decreased mortality by 31% [OR: 0.69 (0.59, 0.80); p<0.001] and by 12% respectively [OR: 0.88 (0.79, 0.99); p<0.03], compared to the "non-competitive" market. High hospital volume (100> per year) was also associated to lower mortality rate [OR: 0.74 (0.63, 0.86); p<0.001]. Conclusions: The results of our studies show that increasing hospital competition independently decreases the 30-day mortality rate after colorectal cancer surgery. Hospital caseload, patients' characteristics and age also impact the post-operative mortality. [ABSTRACT FROM AUTHOR]

Objective: Describe the trends of exposure to harmful drugs during pregnancy over recent years in France. Design: Nationwide cohort study. Setting: The French National administrative health Data System (SNDS). Population: Pregnancies starting between 2013 and 2019 and outcomes corresponding to live births, medical terminations of pregnancy, and stillbirths. Methods: Each pregnancy was divided into a preconceptional period of 90 days before conception and three trimesters from conception to birth. Harmful drugs were defined according to their risks to the fetus: teratogenicity or fetotoxicity. Exposure was defined using the critical period during pregnancy for each type of harmful drug: preconceptional period or first trimester for teratogenic drugs and second or third trimesters for fetotoxic drugs. Main outcome measures: Prevalence of pregnancies exposed to at least one harmful drug. Results: Among 5,253,284 pregnancies, 204,402 (389 per 10,000) pregnancies were exposed to at least one harmful drug during the critical periods: 48,326 (92 per 10,000) pregnancies were exposed to teratogenic drugs during the preconceptional period or the first trimester, and 155,514 (299 per 10,000) pregnancies were exposed to fetotoxic drugs during the second or third trimesters. Teratogenic drugs were mainly retinoids for topical use (44 per 10,000 pregnancies), antiepileptics (13 per 10,000 pregnancies) and statins (13 per 10,000 pregnancies). Fetotoxic drugs were mainly non-steroidal anti-inflammatory drugs (NSAIDs), for systemic (128 per 10,000 pregnancies) and topical use (122 per 10,000 pregnancies). Exposure to teratogenic drugs decreased from the preconceptional period to the first trimester. Exposure to fetotoxic drugs decreased from the second to the third trimester. Between 2013 and 2019, we found a decrease in harmful drug exposure overall, mainly for topical and systemic NSAIDs and for topical retinoids. Conclusions: In this nationwide study, about one in 25 pregnancies was exposed to at least one harmful drug, mainly NSAIDs and topical retinoids. Although the prevalence of harmful drug exposure decreased over the study period, NSAID exposure in the second and third trimester remains of concern. [ABSTRACT FROM AUTHOR]

Severe clinical mastitis is not so frequent in dairy cows, but it can have a significant economic impact due to its high mortality rate and adverse effects on milk production. Surveys about the cause of mastitis typically provide overall findings without connecting them to a specific medical condition. There are few studies on the specific etiology of severe mastitis. Only etiological results obtained during field studies are available in France, and the number of mastitic milk samples analyzed is always low. In recent years, veterinary clinics have improved their ability to identify bacteria causing bovine mastitis using a widely used method. This in-clinic milk culture made it possible to better understand the etiology of mastitis according to the symptoms observed. Regarding clinical mastitis, veterinarians treat severe cases differently than less severe ones. Based on data from nineteen veterinary clinics in France and over 2000 severe mastitis cases, the current study revealed that Enterobacteriaceae, particularly Escherichia coli, is the most common cause, isolated on average from 53.9% of milk samples. This information is highly reliable for practitioners to quickly and effectively treat the condition, because early and targeted treatment is crucial to avoid the complication of endotoxic shock. [ABSTRACT FROM AUTHOR]

Background: The value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE. Methods: We conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program. Results: Twenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (p<0.0001 for both skills). Students from the intervention group performed better in a summative OSCE that assessed the structuring of a medical history (median mark 16/20, IQR [15; 17] versus 14/20, [13; 16], respectively, p = 0.012). Adjusted analyses gave similar results. The students from the intervention group reported a feeling of improved competence and a reduced level of stress at the time of the evaluation, supported by the qualitative data showing the benefits of the formative sessions. Conclusion: Our findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program. [ABSTRACT FROM AUTHOR]

Upper Palaeolithic sites in southwestern France attributed to the Upper Gravettian and the Solutrean yielded sub spherical gravels with a highly shiny appearance that have intrigued researchers since the 1930s. In this work, we analyze specimens from five sites, including the recently excavated Solutrean site of Landry, to establish whether their presence in archaeological layers and peculiar aspect are due to natural processes or human agency. We study the spatial distribution of gravels at Landry and submit archaeological gravels from the five sites, natural formations, Landry sediment sieving, and polishing experiments with a rotary tumbling machine to morphometric, colorimetric, microscopic, and textural analyses. Our results indicate the lustrous gravels found at the five sites result from deliberate selection and suggest their shiny appearance is the consequence of human agency, possibly resulting from prolonged contact with a soft material such as animal skin. Ethnographic accounts indicate that these gravels may have been used for magico-religious ritual purposes (charms, sorcery, divination etc.), in games, as elements of musical instruments, and as items serving other social and personal purposes. We argue that these objects reflect a cultural innovation emerged during the Gravettian and continued into the Solutrean. [ABSTRACT FROM AUTHOR]

Fisheries statistics are known to be underestimated, since they are mainly based on information about commercial fisheries. However, various types of fishing activities exist and evaluating them is necessary for implementing effective management plans. This paper assesses the characteristics and catches of the French European sea bass recreational fishery along the Atlantic coasts, through the combination of large-scale telephone surveys and fishing diaries study. Our results demonstrated that half of the total catches (mainly small fish) were released at sea and that the mean length of a kept sea bass was 46.6 cm. We highlighted different patterns of fishing methods and type of gear used. Catches from boats were greater than from the shore, both in abundance and biomass, considering mean values per fishing trip as well as CPUE. Spearfishers caught the highest biomass of sea bass per fishing trip, but the fishing rod with lure was the most effective type of gear in terms of CPUE. Longlines had the highest CPUE value in abundance but not in biomass: they caught numerous but small sea bass. Handlines were less effective, catching few sea bass in both abundance and biomass. We estimated that the annual total recreational sea bass catches was 3,173 tonnes of which 2,345 tonnes were kept. Since the annual commercial catches landings were evaluated at 5,160 tonnes, recreational landings represent 30% of the total fishing catches on the Atlantic coasts of France. Using fishers' self-reports was a valuable way to obtain new information on data-poor fisheries. Our results underline the importance of evaluating recreational fishing as a part of the total amount of fisheries catches. More studies are critically needed to assess overall fish resources caught in order to develop effective fishery management tools. [ABSTRACT FROM AUTHOR]

This paper presents data from the English Channel area of Britain and Northern France on the spatial distribution of Lower to early Middle Palaeolithic pre-MIS5 interglacial sites which are used to test the contention that the pattern of the richest sites is a real archaeological distribution and not of taphonomic origin. These sites show a marked concentration in the middle-lower reaches of river valleys with most being upstream of, but close to, estimated interglacial tidal limits. A plant and animal database derived from Middle-Late Pleistocene sites in the region is used to estimate the potentially edible foods and their distribution in the typically undulating landscape of the region. This is then converted into the potential availability of macronutrients (proteins, carbohydrates, fats) and selected micronutrients. The floodplain is shown to be the optimum location in the nutritional landscape (nutriscape). In addition to both absolute and seasonal macronutrient advantages the floodplains could have provided foods rich in key micronutrients, which are linked to better health, the maintenance of fertility and minimization of infant mortality. Such places may have been seen as ‘good (or healthy) places’ explaining the high number of artefacts accumulated by repeated visitation over long periods of time and possible occupation. The distribution of these sites reflects the richest aquatic and wetland successional habitats along valley floors. Such locations would have provided foods rich in a wide range of nutrients, importantly including those in short supply at these latitudes. When combined with other benefits, the high nutrient diversity made these locations the optimal niche in northwest European mixed temperate woodland environments. It is argued here that the use of these nutritionally advantageous locations as nodal or central points facilitated a healthy variant of the Palaeolithic diet which permitted habitation at the edge of these hominins’ range. [ABSTRACT FROM AUTHOR]

Forest ecosystems where periodical tree bark harvesting is a major economic activity may be particularly vulnerable to disturbances such as fire, since debarking usually reduces tree vigour and protection against external agents. In this paper we asked how cork oak Quercus suber trees respond after wildfires and, in particular, how bark harvesting affects post-fire tree survival and resprouting. We gathered data from 22 wildfires (4585 trees) that occurred in three southern European countries (Portugal, Spain and France), covering a wide range of conditions characteristic of Q. suber ecosystems. Post-fire tree responses (tree mortality, stem mortality and crown resprouting) were examined in relation to management and ecological factors using generalized linear mixed-effects models. Results showed that bark thickness and bark harvesting are major factors affecting resistance of Q. suber to fire. Fire vulnerability was higher for trees with thin bark (young or recently debarked individuals) and decreased with increasing bark thickness until cork was 3-4 cm thick. This bark thickness corresponds to the moment when exploited trees are debarked again, meaning that exploited trees are vulnerable to fire during a longer period. Exploited trees were also more likely to be top-killed than unexploited trees, even for the same bark thickness. Additionally, vulnerability to fire increased with burn severity and with tree diameter, and was higher in trees burned in early summer or located in drier south-facing aspects. We provided tree response models useful to help estimating the impact of fire and to support management decisions. The results suggested that an appropriate management of surface fuels and changes in the bark harvesting regime (e.g. debarking coexisting trees in different years or increasing the harvesting cycle) would decrease vulnerability to fire and contribute to the conservation of cork oak ecosystems. [ABSTRACT FROM AUTHOR]

Progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are progressive disabling neurological conditions usually fatal within 10 years of onset. Little is known about the economic costs of these conditions. This paper reports service use and costs from France, Germany and the UK and identifies patient characteristics that are associated with cost. 767 patients were recruited, and 760 included in the study, from 44 centres as part of the NNIPPS trial. Service use during the previous six months was measured at entry to the study and costs calculated. Mean six-month costs were calculated for 742 patients. Data on patient sociodemographic and clinical characteristics were recorded and used in regression models to identify predictors of service costs and unpaid care costs (i.e., care from family and friends). The mean six-month service costs of PSP were €24,491 in France, €30,643 in Germany and €25,655 in the UK. The costs for MSA were €28,924, €25,645 and €19,103 respectively. Unpaid care accounted for 68-76%. Formal and unpaid costs were significantly higher the more severe the illness, as indicated by the Parkinson's Plus Symptom scale. There was a significant inverse relationship between service and unpaid care costs. [ABSTRACT FROM AUTHOR]

The study explores the direct and mediated impacts of customers' perception of purchase budget (BGT) on purchase intention (PIT) through perceived quality (PPQ), perceived price (PPR), and perceived benefit (PB) in a cross-country setting to understand BGT's role in predicting customer purchase intention in smartphone selling through international online shopping platforms. An online survey was conducted in Kenya, France, and the United States to gather data from 429 consumers who had recently purchased one or more smartphones through international online shopping platforms. SmartPLS-4 was used to test the hypotheses. Results for the entire sample showed a significantly positive mediating role of PPR and PPQ between BGT and PIT. However, the mediating roles of PPQ and PB were not significant in the samples from Kenya, France, and the United States. The results also showed that PPR plays a significant and positive mediating role between BGT and PIT in samples from Kenya, France, the United States, and overall. However, the direct relationships between BGT and PPQ, PPR, and PB are shown to be negatively significant. [ABSTRACT FROM AUTHOR]

Although diabetes is common among people living with HIV/AIDS (PLWHA), few data exists on how migrants from Sub-Saharan Africa (SSA) experience living with these two coexisting conditions in France. The objective of this study was to analyze perception of polypathology among PLWHA from SSA with type 2 diabetes and identify barriers and facilitators to their self-management. A qualitative study was conducted using semi-structured interviews from November 2019 to April 2020 with participants selected from a cohort of PLWHA and diabetes at Avicenne University Hospital. A total of 12 semi-structured interviews were conducted and analyzed using thematic analysis with inductive approach. Stigma remained a major issue in self-managing HIV, and some participants did not consider themselves as having a polypathology, as HIV has always been considered as a distinct condition. In general, emotion-based resources (e.g spirituality, trust in the medical discourse) and social support were mobilized more than problem-solving resources (e.g perception of medication as life-saving). Participants used the same main resource in self-management of HIV and diabetes, and resources used differed from participant to participant. This study highlighted challenges in self-management of diabetes and HIV in this population and complexity related to the socioeconomic and cultural specificities. Self-management could be more successful if patients and carers move in the same direction, having identified the individual coping resources to reach objectives. [ABSTRACT FROM AUTHOR]

Rain-fed pastoral systems are tightly connected to meteorological conditions. It is, therefore, likely that climate change, including changing atmospheric CO2 concentration, temperature, precipitation and patterns of climate extremes, will greatly affect pastoral systems. However, exact impacts on the productivity and carbon dynamics of these systems are still poorly understood, particularly over longtime scales. The present study assesses the potential effects of future climatic conditions on productivity and soil organic carbon (SOC) stocks of mowed and rotationally grazed grasslands in France. We used the CenW ecosystem model to simulate carbon, water, and nitrogen cycles in response to changes in environmental drivers and management practices. We first evaluated model responses to individual changes in each key meteorological variable to get better insights into the role and importance of each individual variable. Then, we used 3 sets of meteorological variables corresponding to 3 Representative Concentration Pathways (RCP 2.6, RCP 4.5 and RCP 8.5) for long-term model runs from 1975 to 2100. Finally, we used the same three RCPs to analyze the responses of modelled grasslands to extreme climate events. We found that increasing temperature slightly increased grasslands productivities but strongly reduced SOC stocks. A reduction in precipitation led to reductions of biomass and milk production but increased SOC. Conversely, doubling CO2 concentration strongly increased biomass and milk production and marginally reduced SOC. These SOC trends were unexpected. They arose because both increasing precipitation and CO2 increased photosynthetic carbon gain, but they had an even greater effect on the proportion of biomass that could be grazed. The amount of carbon remaining on site and able to contribute to SOC formation was actually reduced under both higher precipitation and CO2. The simulations under the three RCPs indicated that grassland productivity was increased, but that required higher N fertilizer application rates and also led to substantial SOC losses. We thus conclude that, while milk productivity may continue at current rates under climate change, or even increase slightly, there could be some soil C losses over the 21st century. In addition, under the highest-emission scenario, the increasing importance of extreme climate conditions (heat waves and droughts) might render conditions at our site in some years as unsuitable for milk production. It highlights the importance of tailoring farming practices to achieve the dual goals of maintaining agricultural production while safeguarding soil C stocks. [ABSTRACT FROM AUTHOR]

Background: A smoking cessation program for adolescents, TABADO, demonstrated its effectiveness following a controlled trial conducted in 2007/2009. The program is now being scaled up nationally. In order to retain its efficacy across the diversity of contexts in the generalization process, we needed to assess the processes and mechanisms that inform its effects. Theory-driven evaluation is one approach used to address these issues. The aim of the present research is to develop the TABADO program theory. More specifically, we attempt to identify the factors and mechanisms that promote or hinder the enrollment and retention of student smokers in the program. Methods: We conducted a realist evaluation of the TABADO program through 1) a documentary analysis to construct the initial program theory, and 2) a multiple case study (n = 10) conducted in three regions in France to test and enrich the initial theory with contextual, organizational and mechanistic components. We used the Intervention-Context-Actors-Mechanisms-Outcomes configurations to guide our analysis and to present our results. Results: Our analysis highlighted 13 mechanisms that foster the enrollment and retention of student smokers in the TABADO program (e.g., being prepared to quit smoking, feeling encouraged in the attempt to quit smoking). To activate these mechanisms, the involvement of various actors is required (e.g., the school nurse, teachers), together with a combination of interventional and contextual factors (e.g., confidentiality, informal speaking time). Conclusions: These findings allowed us to transform the TABADO program into a new optimized strategy, TABADO2, which is theory-based. Our research helps to explain why adolescent smokers enroll and stay in a school-based smoking cessation program. TABADO2 needs to be considered in a more comprehensive way than the original research-based TABADO, and should be tailored to its implementation context. [ABSTRACT FROM AUTHOR]

Background: International research has recently shown an association between exposure to bisphenol A (BPA) and the risk of diabetes, although limited results are available for exposure to bisphenol S (BPS) and bisphenol F (BPF). The aim of this study was to examine the relationships between impregnation with BPA, BPS, and BPF and the prevalence of diabetes or prediabetes in the French adult population. Methods: Based on the Esteban cross-sectional study, 852 adults aged 18 to 74 years living in France were included. To assess the link between urinary concentration of BPA, BPS and BPF and a state of dysglycemia (diabetes or prediabetes), logistic regression multivariable models were performed and adjusted for known risk factors for diabetes and urine creatinine concentration. Results: The percentage of included individuals with diabetes or prediabetes was 17.8% (95% CI = [15.3–20.4]). Urinary BPA concentration was significantly higher in people with diabetes or prediabetes, independent of the known risk factors for diabetes (OR for an increase of 0.1 units in log-transformed concentration of BPA (μg/L) = 1.12; 95%CI = [1.05–1.19], p < 0.001). However, we did not find any significant independent association between urinary BPS and BPF levels and the prevalence of diabetes or prediabetes. Conclusions: In this sample, considering the diabetes risk factors, diabetes or prediabetes was positively associated with higher urinary BPA concentration but not with urinary BPS and BPF concentrations. However, analysis of prospective longitudinal studies are still necessary to demonstrate a causal link between bisphenol exposure and the risk of diabetes or prediabetes. [ABSTRACT FROM AUTHOR]

Background: In France, hospital units responsible for providing inpatient care have few opportunities to address the issue of task interruptions. In Australia, the Dual Perspectives Method (DMP) has been developed to assess interruptions. The method makes it possible to link teamwork and interruptions, by considering the work functions that constitute the system. Objective: To develop a tool that can characterize interruptions from the point of view of work functions that is tailored to French hospital units providing inpatient care. The aim was to adapt the items recorded using the DPM and their response categories, and to study the acceptability of observing interruptions for participating teams. Method: The items recorded in the DPM were translated and adapted taking into account the French definition of interruptions. This step identified 19 items that targeted the interrupted professional, and 16 that targeted the interrupting professional. The characteristics of interruptions were recorded in September 2019 among 23 volunteer teams in a region in western France. Two observers simultaneously observed the same professional. Observations lasted seven consecutive hours, and targeted all professional categories within the same team. Results: The characteristics of 1,929 interruptions were noted. The observation period was well-received by teams. The following terminology regarding the work functions of the interrupting professional was clarified: "coordination of institutional resources", in relation to "the establishment's support processes", "patient services", and "the patient's social life". We believe that our categorization of response modes is exhaustive. Conclusions: We have developed an observational tool, Team'IT, which is tailored to inpatient hospital care in France. Its implementation is the first step in a system to support teams in managing interruptions, and will enable them to reflect on their working methods, and whether interruptions can be avoided. Our work is part of an approach that seeks to improve and enhance the safety of professional practices, by contributing to the longstanding, complex debate about the flow and effectiveness of patient care. Trial registration: ClinicalTrials.gov NCT03786874 (December 26, 2018). [ABSTRACT FROM AUTHOR]

We provide a novel way to correct the effective reproduction number for the time-varying amount of tests, using the acceleration index (Baunez et al., 2021) as a simple measure of viral spread dynamics. Not correcting results in the reproduction number being a biased estimate of viral acceleration and we provide a formal decomposition of the resulting bias, involving the useful notions of test and infectivity intensities. When applied to French data for the COVID-19 pandemic (May 13, 2020—October 26, 2022), our decomposition shows that the reproduction number, when considered alone, characteristically underestimates the resurgence of the pandemic, compared to the acceleration index which accounts for the time-varying volume of tests. Because the acceleration index aggregates all relevant information and captures in real time the sizable time variation featured by viral circulation, it is a more parsimonious indicator to track the dynamics of an infectious disease outbreak in real time, compared to the equivalent alternative which would combine the reproduction number with the test and infectivity intensities. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization declared a pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), on March 11, 2020. The standardized approach of disability-adjusted life years (DALYs) allows for quantifying the combined impact of morbidity and mortality of diseases and injuries. The main objective of this study was to estimate the direct impact of COVID-19 in France in 2020, using DALYs to combine the population health impact of infection fatalities, acute symptomatic infections and their post-acute consequences, in 28 days (baseline) up to 140 days, following the initial infection. Methods: National mortality, COVID-19 screening, and hospital admission data were used to calculate DALYs based on the European Burden of Disease Network consensus disease model. Scenario analyses were performed by varying the number of symptomatic cases and duration of symptoms up to a maximum of 140 days, defining COVID-19 deaths using the underlying, and associated, cause of death. Results: In 2020, the estimated DALYs due to COVID-19 in France were 990 710 (1472 per 100 000), with 99% of burden due to mortality (982 531 years of life lost, YLL) and 1% due to morbidity (8179 years lived with disability, YLD), following the initial infection. The contribution of YLD reached 375%, assuming the duration of 140 days of post-acute consequences of COVID-19. Post-acute consequences contributed to 49% of the total morbidity burden. The contribution of YLD due to acute symptomatic infections among people younger than 70 years was higher (67%) than among people aged 70 years and above (33%). YLL among people aged 70 years and above, contributed to 74% of the total YLL. Conclusions: COVID-19 had a substantial impact on population health in France in 2020. The majority of population health loss was due to mortality. Men had higher population health loss due to COVID-19 than women. Post-acute consequences of COVID-19 had a large contribution to the YLD component of the disease burden, even when we assume the shortest duration of 28 days, long COVID burden is large. Further research is recommended to assess the impact of health inequalities associated with these estimates. [ABSTRACT FROM AUTHOR]

Background and aims: The IMbrave150 clinical trial assessed the efficacy and safety of atezolizumab in combination with bevacizumab (ATZ+BVA) versus sorafenib in adults with advanced/unresectable hepatocellular carcinoma, who have not received prior systemic treatment. Our aim was to assess the cost-effectiveness of ATZ+BVA versus sorafenib in France based on an updated prices and considering French National real-world data, to confirm the initial recommendations from the Heath Technology Assessment submission published in 2021, and provide additional visibility to decision-makers reflecting current clinical practice. Methods: A partition survival model was developed to project clinical outcomes, quality of life, and costs of patients with HCC treated with ATZ+BVA versus sorafenib over a lifetime horizon. Survival outcomes were extrapolated via parametric functions for both treatment strategies. Quality of life (EQ-5D-5L, French tariffs) were sourced from IMbrave150. The Guyot method was considered as a scenario analysis by integrating retrospective real-world data extracted from the French Health Insurance Database to refine long term survival extrapolations. Results: In the reference case, ATZ+BVA was associated with 0.61 additional Quality Adjusted Life Years (QALYs) compared to sorafenib (1.95 vs 1.35), and an incremental cost of €92,704. The incremental cost-utility ratio (ICUR) was 152,974 €/QALY gained. Adjusting the survival curves with French external evidence led to a 14% ICUR reduction (131,163 €/QALY). Conclusions: ATZ+BVA is a cost-effective strategy based on the range recently published for the value of a QALY in France and offers better chances of survival to patients. [ABSTRACT FROM AUTHOR]