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In this work, we developed a site-selective functionalization of levoglucosan analogues. This strategy used simple zinc diamine complexes for regioselective functionalization at O2 or O4. Successful transformations of monotosyl analogues allowed the preparation of useful intermediates in carbohydrate chemistry, such as four protected Černý epoxides and three protected amino sugars. This unique method represents a rare use of zinc for the desymmetrization of 1,3-diols.

Purpose/objectives: There are limited data on outcomes in patients with ultracentral pulmonary oligometastases treated with SABR. The purpose of this study was to determine whether ultracentral location was prognostic for toxicity and survival., Material and Methods: Oligometastatic lung lesions treated on the single-arm phase 2 SABR-5 trial were retrospectively stratified into 2 cohorts: ultracentral tumors (UC), defined as planning target volume overlap or direct tumor abutment to the proximal bronchial tree, esophagus, great vessels, or heart, and nonultracentral tumors. Cohorts were compared with respect to grade ≥ 2 toxicity, progression-free survival (PFS), and overall survival (OS)., Results: In total, 41 patients with 45 ultracentral metastases and 93 patients with 172 nonultracentral metastases underwent SABR. The most common primary histologies were colorectal (30%), lung (13%), and renal (13%), and these did not differ between groups. Patients with UC had a lower median PFS of 5.8 months compared with 15.8 months in patients with non ultracentral tumors (P < .001). OS was also worse in the UC cohort: median 29.0 months versus not yet reached (P < .001). On multivariable regression, UC remained prognostic for worse PFS (hazard ratio 2.18, P = .004) and OS (hazard ratio 3.45, P < .001). Groups had similar rates of local tumor control. Patients with UC had higher 2-year cumulative incidence of polymetastatic progression: 69.2% versus 31.4% (P < .001). The 2-year cumulative incidence of grade ≥ 2 toxicity was 14.6% for patients with UC and 9.8% for patients with nonultracentral tumors (P = .74). There were no grade 4 or 5 toxicities., Conclusions: In this prospective patient cohort, SABR for ultracentral tumor had low toxicity rates and good local control. However, ultracentral location was an adverse prognostic feature for survival. This finding should be validated with larger studies and may be a factor when weighing the benefit versus risk of SABR in patients with pulmonary oligometastases., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Background: Despite vaccination, patients receiving anti-CD20 monoclonal antibodies (mAbs) for multiple sclerosis (MS) or neuromyelitis optica spectrum disorders (NMOSD) have an increased risk of developing severe or protracted COVID-19. The aim of this study was to describe the effect of COVID-19 convalescent plasma (CCP) in patients with MS or NMOSD exposed to anti-CD20 and infected by SARS-CoV-2., Methods: This French national, retrospective cohort study was conducted between November 2020 and June 2023. Patients with MS or NMOSD, under anti-CD20 mAbs, with symptomatic COVID-19 and treated by CCP were screened. Protracted COVID-19 was defined by a duration of symptoms >21 days. The primary endpoint was the overall survival 30 days after CCP administration., Results: Ninety-two patients from 34 hospitals were included, 84 (91%) with MS and 8 (9%) with NMOSD. Overall, 30-day survival was 97% (IC95%: 91-99). SARS-CoV-2 viremia was positive in 47/75 (61%) patients before CCP versus 9/59 (15%) seven days post-CCP. In the 52 patients (57%) with protracted COVID-19, the duration of symptoms before CCP was 51 [28-69] days, including fever in 75% of cases, which disappeared in 100% of patients 7 days post-CCP., Conclusions: CCP could be a therapeutic option in patients exposed to anti-CD20 mAbs for inflammatory demyelinating disease, particularly in those with protracted COVID-19., Competing Interests: Declarations of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: KL has received funds from Gilead, MSD, Janssen, ViiV Healthcare and Abbvie for expert boards and travel grants. None of those funds target COVID-19. CL has received compensation for travel fees, consulting services or speaker honoraria from Biogen, Merck Serono, Novartis, Sanofi and Roche and IIT Research grant from Biogen. AF reports honorariat by Fisher & Paykel for a lecture during SFMU Congress 2022, outside the submitted work. AM is president of an association that has received funding from GSK and Blueprint, hospitality from GSK, Novartis, Sanofi, Janssen, Teva, Shire, Ipsen, training funding from Novartis, LFB, Leo Pharma, and has a contract to speak at scientific events from Leo Pharma. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The present study aimed to assess the mediating role of adjustment processes in known risk factors associated with prolonged grief disorder. Data were collected in March-April 2021 through an online survey of 542 Canadian adults bereaved since March 2020. The mediating role of satisfaction with funeral rituals, bereavement support, and coping strategies on grief outcomes was tested using structural equation modeling. Results showed that such adjustment processes played a significant role in the grief process and that they were better predictors than risk factors alone. Since they are more amenable determinants of grief reactions, they should be further studied using a longitudinal design., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Advances in pediatric oncology have significantly increased survival rates, yet have introduced challenges in managing long-term treatment side effects. This study process introduces an interdisciplinary clinical intervention program rooted in the family resilience framework, aimed at improving well-being across the cancer trajectory for children and their families, especially those in Canadian communities far from specialized oncology centers with limited access to resources., Methods: Employing an intervention mapping approach, this program collaboratively involves patients, families, professionals, and researchers. It aims to identify vulnerability factors, establish a logic model of change, and devise comprehensive strategies that include professional interventions alongside self-management tools. These strategies, tailored to address biopsychosocial and spiritual challenges, are adapted to the unique contexts of communities distant from specialized cancer treatment centers. A mixed-methods approach will evaluate program effectiveness., Expected Results: Anticipated outcomes include the empowerment of families with self-management tools and professional support, designed to mitigate biopsychosocial and spiritual complications. By addressing the specific needs and limitations of these communities, the program strives to improve the overall health and well-being of both undergoing treatment and survivorship phases., Discussion: By focusing on comprehensive care that includes both professional interventions and self-management, this initiative marks a significant shift toward a holistic, family-centered approach in pediatric oncology care for remote communities. It underlines the necessity of accessible interventions that confront immediate and long-term challenges, aiming to elevate the standard of care by emphasizing resilience, professional support, and family empowerment in underserved areas., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Simard, Roberge, St-Pierre, Cherblanc, Bergeron-Leclerc, Kadri, Lacharité, Bérubé, Lapointe, Faucher and Dufresne.)

Nutrient enrichment and climate warming threaten freshwater systems. Metabolic theory and the paradox of enrichment predict that both stressors independently can lead to simpler food-webs having fewer nodes, shorter food-chains and lower connectance, but cancel each other's effects when simultaneously present. Yet, these theoretical predictions remain untested in complex natural systems. We inferred the food-web structure of 256 lakes and 373 streams from standardized fish community samplings in France. Contrary to theoretical predictions, we found that warming shortens fish food-chain length and that this effect was magnified in enriched streams and lakes. Additionally, lakes experiencing enrichment exhibit lower connectance in their fish food-webs. Our study suggests that warming and enrichment interact to magnify food-web simplification in nature, raising further concerns about the fate of freshwater systems as climate change effects will dramatically increase in the coming decades., (© 2024 The Author(s). Ecology Letters published by John Wiley & Sons Ltd.)

Objective: Adults sustaining a traumatic brain injury (TBI) are at risk of sleep disturbances during their recovery, including when such an injury requires hospitalization. However, the sleep-wake profile, and internal and external factors that may interfere with sleep initiation/maintenance in hospitalized TBI patients are poorly understood. This review aimed to: (1) identify/summarize the existing evidence regarding sleep and sleep measurements in TBI adults receiving around-the-clock care in a hospital or during inpatient rehabilitation, and (2) identify internal/external factors linked to poor sleep in this context., Methods: A scoping review was conducted in accordance with the PRISMA Scoping Review Extension guidelines. A search was conducted in MEDLINE, PsycINFO, CINAHL, and Web of Science databases., Results: Thirty relevant studies were identified. The most common sleep variables that were put forth in the studies to characterize sleep during hospitalization were nighttime sleep time (mean = 6.5 hours; range: 5.2-8.9 hours), wake after sleep onset (87.1 minutes; range: 30.4-180 minutes), and sleep efficiency (mean = 72.9%; range: 33%-96%) using mainly actigraphy, polysomnography, and questionnaires (eg, the sleep-wake disturbance item of the Delirium Rating Scale or the Pittsburgh Sleep Quality Index). Twenty-four studies (80%) suggested that hospitalized TBI patients do not get sufficient nighttime sleep, based on the general recommendations for adults (7-9 hours per night). Sleep disruptions during hospitalization were found to be associated to several internal factors including TBI severity, cognitive status, and analgesia intake. External and modifiable factors, such as noise, light, and patient care, were consistently associated with sleep disruptions in this context., Conclusion: Although the literature on sleep disturbances in hospitalized TBI patients has been increasing in recent years, many gaps in knowledge remain, including phenotypes and risk factors. Identifying these factors could help clinicians better understand the multiple sources of TBI patients' sleep difficulties and intervene accordingly., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Prior studies on Prolonged Grief Disorder (PGD) primarily employed classical approaches to link bereaved individuals' characteristics with PGD symptom levels. This study utilized machine learning to identify key factors influencing PGD symptoms during the COVID-19 pandemic., Methods: We analyzed data from 479 participants through an online survey, employing classical data exploration, predictive machine learning, and SHapley Additive exPlanations (SHAP) to determine key factors influencing PGD symptoms measured with the Traumatic Grief Inventory - Self Report (TGI-SR) from 19 variables, comparing five predictive models., Results: The classical approach identified eight variables associated with a possible PGD (TGI-SR score ≥ 59): unexpected causes of death, living alone, seeking professional support, taking anxiety and/or depression medications, using more grief services (telephone or online supports) and more confrontation-oriented coping strategies, and higher levels of depression and anxiety. Using machine learning techniques, the CatBoost algorithm provided the best predictive model of the TGI-SR score (r 2  = 0.6479). The three variables influencing the most the level of PGD symptoms were anxiety, and levels of avoidance and confrontation coping strategies used., Conclusions: This pioneering approach within the field of grief research enabled us to leverage the extensive dataset collected during the pandemic, facilitating a deeper comprehension of the predominant factors influencing the grieving process for individuals who experienced loss during this period., Limitations: This study acknowledges self-selection bias, limited sample diversity, and suggests further research is needed to fully understand the predictors of PGD symptoms., Competing Interests: Declaration of competing interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Because of a high rate of HIV diagnosis and restricted medical access in the Centre-Val de Loire region in France , remote consultations (RC) with a community-based approach has been implemented to promote access to healthcare. Our study aimed to determine whether RC could improve access to pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) as part of the healthcare pathway associated with PrEP., Materials and Methods: A qualitative approach involving semi-structured interviews with 17 MSM and 3 physicians from specialized sexual health centres was performed, with a mean duration of interview over one hour. The research focused on the health pathway associated with PrEP, from initial awareness to ongoing prescription and follow-up., Results: Transitioning PrEP consultations to RC is feasible, but concerns about a potential decline in care quality compared to traditional sexual health centres follow-ups were noted. Both MSM and physicians recognized that RC could complement face-to-face approaches, especially in terms of organizational benefits. In rural areas, access to specialists through RC was seen as a partial solution, though it could be hindered by barriers in accessing laboratory testing and pharmacy services, like fear of stigmatization. More generally, distrust of medication and the difficulty of discussing sexuality with a GP were highlighted, which could limit the uptake of PrEP without access to specialists., Conclusions: The initiation and uptake of PrEP among MSM are more effectively influenced by initiatives that provide information, reassurance, and facilitate initial procedures, rather than solely through RC. A strategy combining digital and community-based approaches, along with medical expertise, is recommended to increase PrEP utilization among MSM., Competing Interests: Declaration of competing interest Authors have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience., Methods: This study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival., Discussion: This study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone., Trial Registration: Clinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023., (© 2024. The Author(s).)

Objective The aim of this text is to describe the challenges and issues associated with family caregivers during the experience of caring for a person at the end of life at home, in the context of a pandemic. This support situation, already normally demanding, turned out to be more difficult and complicated than usual due to the many challenges and issues associated, in particular, with the health restrictions imposed at the time. Here, we present an analysis of comments gathered from family caregivers during the pandemic. Method Testimonials from caregivers were drawn from a research study entitled COVIDEUIL. The qualitative component of this study included many rich comments drawn from the voices of PPA and collected by questionnaire. For the present article, the focus was on qualitative data relating to the end-of-life situation at home of a loved one. This theme was documented by analyzing the responses of 71 caregivers. These people described, sometimes in detail, the particular circumstances surrounding their loved one's final days and death. Results PPAs report various issues in end-of-life care at home during the pandemic. Some results are similar to studies already carried out, including fatigue and the benefits of outside help, while others are perhaps more amplified, including the lack of support from caregivers, isolation, and the absence of continuity in services, due to the pandemic context. Testimonies show that home care requires physical and mental availability on the part of PPAs; the burden is imposing. In some cases, financial resources have been invested to pay for home care services. Moreover, formal and informal help remains an important element in maintaining home care until the end, otherwise it is compromised and institutional care becomes necessary. Conclusion For PPAs who were able to provide end-of-life care at home for their loved one at the end of life, various challenges were reported. In short, if end-of-life care at home is to be a safe and satisfying experience, PPAs must receive adequate support, and care must be tailored to the needs of the person being cared for. Support at the end of life at home is part of a long process of assistance and care provided by PPAs. The formal assistance offered should follow the evolution of the dyad's journey-PPA and cared-for person. End-of-life care at home is likely to increase as the population ages. As such, care and services must be orchestrated and adapted from the moment the diagnosis is announced. The Observatoire québécois de la proche aidance will certainly be able to assess the impact of the national policy on PPAs and measure the effects on their health, well-being and quality of life (art. 40) (ministère de la Santé et des Services sociaux, 2021a).

Therapeutic hypothermia (TH) is used to treat patients with cerebral ischemia. Body surface cooling provides a simple noninvasive method to induce TH. We compared three surface cooling systems (Arctic Sun with adhesive ArcticGel pads [AS]); Blanketrol III with two nonadhesive Maxi-Therm Lite blankets [BL]); and Blanketrol III with nonadhesive Kool Kit [KK]). We hypothesized that KK would remove more heat due to its tighter fit and increased surface area. Eight subjects (four females) were cooled with each system set to 4°C outflow temperature for 120 minutes. Heat loss, skin and esophageal temperature, and metabolic heat production were measured. Skin temperature was higher with KK ( p  = 0.002), heat loss was lower with KK in the first hour ( p  = 0.014) but not after 120 minutes. Heat production increased similarly with all systems. Core temperature decrease was greater for AS (0.57°C) than BL (0.14°C; p  = 0.035), but not KK (0.24°C; p  = 0.1). Each system had its own benefits and limitations. Heat transfer capability is dependent on the cooling pump unit and the design of the liquid-perfused covers. Both Arctic Sun and Blanketrol III cooling/pump units had 4°C output temperatures. However, the Blanketrol III unit had a greater flow rate and therefore more cooling power. The nonadhesive BL and KK covers were easier to apply and remove compared with the adhesive AS pads. AS had an early transient advantage in heat removal, but this effect decreased over the course of cooling, thus minimizing or eliminating any advantage during longer periods of cooling that occur during clinical TH. Clinical Trial Registration number: NCT04332224.