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Purpose: Clinical guidelines have been developed to standardize the management of mild traumatic brain injury (mTBI) in the emergency room, in particular the indication of brain CT scan and the use of blood biomarkers. The objective of this study was to determine the degree of adherence to guidelines in the management of these patients across four countries of Southern Europe. Methods: An electronic survey including structural and general management of mTBI patients and six clinical vignettes was conducted. In-charge physicians from France, Spain, Greece and Portugal were contacted by telephone and email. Differences among countries were searched using an unconditional approach test on contingency tables. Results: One hundred and eighty eight physicians from 131 Hospitals (78 Spain, 36 France, 12 Greece and 5 Portugal) completed the questionnaire. There were differences regarding the in-charge specialist across these countries. There was variability in the use of guidelines and their adherence. Spain was the country with the least guideline adherence. There was a global agreement in ordering a brain CT for patients receiving anticoagulation or platelet inhibitors, and for patients with seizures, altered consciousness, neurological deficit, clinical signs of skull fracture or signs of facial fracture. Aging was not an indication for CT in French centres. Loss of consciousness and posttraumatic amnesia were considered as indications for CT more frequently in Spain than in France. These findings were in line with the data from the 6 clinical vignettes. The estimated use of CT reached around 50% of mTBI cases. The use of S100B is restricted to five French centres. Conclusions: There were large variations in the guideline adherence, especially in the situations considered to order brain CT after mTBI. [ABSTRACT FROM AUTHOR]

Insufficient analgesia affects around 50% of emergency department patients. The use of a protocol helps to reduce the risk of oligoanalgesia in this context. Our objective was to describe the feasibility and efficacy of a multimodal analgesia protocol (combining paracetamol, oxycodone, and inhaled methoxyflurane) initiated by triage nurse. We performed a prospective, observational study in an emergency department (Grenoble Alpes University Hospital, France) between December 2017 and April 2018. Adult non-severe trauma patients with a numerical pain rating scale (NRS) score ≥ 4 were included. The primary efficacy criterion was the proportion of patients with an NRS score ≤ 3 at 15 min. Pain intensity was measured for 60 min and during radiography. Data on adverse events and satisfaction were recorded. A total of 200 adult patients were included (median [interquartile range (IQR)] age: 32 [23-49] years; 126 men (63%)). Sixty-six patients (33%) reported an NRS score ≤ 3 at 15 min. The time required to achieve a decrease of at least 2 points in the NRS score was 10 (5-20) min. The median [IQR] pain intensity was 4 [2-5] before radiography and 4 [2-6] during radiography. Adverse events were frequent (n = 128, 64%). No serious adverse events were reported. The patients and caregivers reported good levels of satisfaction. The administration of a nurse-driven multimodal analgesia protocol (combining paracetamol, oxycodone, and methoxyflurane) was feasible on admission to the emergency department. It rapidly produced long-lasting analgesia in adult trauma patients.Trial registration: NCT03380247. [ABSTRACT FROM AUTHOR]

Background and objective: Pain, a symptom often present in patients with Chronic Obstructive Pulmonary Disease (COPD), alters quality of life. COPD exacerbation augments several mechanisms that may cause pain (dyspnea, hyperinflation and inflammation) and therefore we hypothesized that pain might be increased during exacerbation. Methods: A prospective cohort study was conducted in patients admitted for acute exacerbations of COPD (AECOPD) in two emergency departments in France and Canada. Patients with cancer-related pain or recent trauma were not included. The Short Form McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory (BPI) scale were used to evaluate pain intensity and location. Patients also completed the Borg Dyspnea Scale and Hospital Anxiety and Depression Scale. The questionnaires were completed again during an outpatient assessment in the stable phase. The primary outcome was difference in pain intensity (SF-MPQ) between the exacerbation and stable phases. Results: Fifty patients were included. During exacerbation, 46 patients (92%) reported pain compared to 29 (58%) in the stable phase (p<0.001). Pain intensity was higher during exacerbation (SF-MPQ 29.7 [13.6–38.2] vs. 1.4 [0.0–11.2]; p<0.001). Pain was predominantly located in the chest during exacerbation and in the limbs during the stable phase. Pain intensity during exacerbation correlated with anxiety score. Conclusion: The frequency and intensity of pain were higher during AECOPD, with a specific distribution. Pain should therefore be routinely assessed and treated in patients with AECOPD. [ABSTRACT FROM AUTHOR]

Study objective: To investigate the performance of a rapid RT-PCR assay to detect influenza A/B at emergency department admission. Methods: This single-center prospective study recruited adult patients attending the emergency department for influenza-like illness. Triage nurses performed nasopharyngeal swab samples and ran rapid RT-PCR assays using a dedicated device (cobas Liat, Roche Diagnostics, Meylan, France) located at triage. The same swab sample was also analyzed in the department of virology using conventional RT-PCR techniques. Patients were included 24 hours-a-day, 7 days-a-week. The primary outcome was the diagnostic accuracy of the rapid RT-PCR assay performed at triage. Results: A total of 187 patients were included over 11 days in January 2018. Median age was 70 years (interquartile range 44 to 84) and 95 (51%) were male. Nine (5%) assays had to be repeated due to failure of the first assay. The sensitivity of the rapid RT-PCR assay performed at triage was 0.98 (95% confidence interval (CI): 0.91–1.00) and the specificity was 0.99 (95% CI: 0.94–1.00). A total of 92 (49%) assays were performed at night-time or during the weekend. The median time from patient entry to rapid RT-PCR assay results was 46 [interquartile range 36–55] minutes. Conclusion: Rapid RT-PCR assay performed by nurses at triage to detect influenza A/B is feasible and highly accurate. [ABSTRACT FROM AUTHOR]

Importance: The high mortality rate in critically ill elderly patients has led to questioning of the beneficial effect of intensive care unit (ICU) admission and to a variable ICU use among this population.Objective: To determine whether a recommendation for systematic ICU admission in critically ill elderly patients reduces 6-month mortality compared with usual practice.Design, Setting, and Participants: Multicenter, cluster-randomized clinical trial of 3037 critically ill patients aged 75 years or older, free of cancer, with preserved functional status (Index of Independence in Activities of Daily Living ≥4) and nutritional status (absence of cachexia) who arrived at the emergency department of one of 24 hospitals in France between January 2012 and April 2015 and were followed up until November 2015.Interventions: Centers were randomly assigned either to use a program to promote systematic ICU admission of patients (n=1519 participants) or to follow standard practice (n=1518 participants).Main Outcomes and Measures: The primary outcome was death at 6 months. Secondary outcomes included ICU admission rate, in-hospital death, functional status, and quality of life (12-Item Short Form Health Survey, ranging from 0 to 100, with higher score representing better self-reported health) at 6 months.Results: One patient withdrew consent, leaving 3036 patients included in the trial (median age, 85 [interquartile range, 81-89] years; 1361 [45%] men). Patients in the systematic strategy group had an increased risk of death at 6 months (45% vs 39%; relative risk [RR], 1.16; 95% CI, 1.07-1.26) despite an increased ICU admission rate (61% vs 34%; RR, 1.80; 95% CI, 1.66-1.95). After adjustments for baseline characteristics, patients in the systematic strategy group were more likely to be admitted to an ICU (RR, 1.68; 95% CI, 1.54-1.82) and had a higher risk of in-hospital death (RR, 1.18; 95% CI, 1.03-1.33) but had no significant increase in risk of death at 6 months (RR, 1.05; 95% CI, 0.96-1.14). Functional status and physical quality of life at 6 months were not significantly different between groups.Conclusions and Relevance: Among critically ill elderly patients in France, a program to promote systematic ICU admission increased ICU use but did not reduce 6-month mortality. Additional research is needed to understand the decision to admit elderly patients to the ICU.Trial Registration: clinicaltrials.gov Identifier: NCT01508819. [ABSTRACT FROM AUTHOR]

Aim: Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population.Methods: Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014.Results: 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40-65] vs. 66 [52-79] years, p<0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p<0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p<0.001) and the time to the first electric shock was shorter (7.5min vs 14min, p<0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p<0.001, RR=3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42-4.81, p=0.002).Conclusion: Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests. [ABSTRACT FROM AUTHOR]

We analyze how biases of meteorological drivers impact the calculation of ecosystem CO2, water and energy fluxes by models. To do so, we drive the same ecosystem model by meteorology from gridded products and by meteorology from local observation at eddy-covariance flux sites. The study is focused on six flux tower sites in France spanning across a climate gradient of 7-14°C annual mean surface air temperature and 600-1040 mm mean annual rainfall, with forest, grassland and cropland ecosystems. We evaluate the results of the ORCHIDEE process-based model driven by meteorology from four different analysis data sets against the same model driven by site-observed meteorology. The evaluation is decomposed into characteristic time scales. The main result is that there are significant differences in meteorology between analysis data sets and local observation. The phase of seasonal cycle of air temperature, humidity and shortwave downward radiation is reproduced correctly by all meteorological models (average R² = 0.90). At sites located in altitude, the misfit of meteorological drivers from analysis data sets and tower meteorology is the largest. We show that dayto-day variations in weather are not completely well reproduced by meteorological models, with R² between analysis data sets and measured local meteorology going from 0.35 to 0.70. The bias of meteorological driver impacts the flux simulation by ORCHIDEE, and thus would have an effect on regional and global budgets. The forcing error, defined by the simulated flux difference resulting from prescribing modeled instead of observed local meteorology drivers to ORCHIDEE, is quantified for the six studied sites at different time scales. The magnitude of this forcing error is compared to that of the model error defined as the modeled-minus-observed flux, thus containing uncertain parameterizations, parameter values, and initialization. The forcing error is on average smaller than but still comparable to model error, with the ratio of forcing error to model error being the largest on daily time scale (86%) and annual time scales (80%). The forcing error incurred from using a gridded meteorological data set to drive vegetation models is therefore an important component of the uncertainty budget of regional CO2, water and energy fluxes simulations, and should be taken into consideration in up-scaling studies. [ABSTRACT FROM AUTHOR]

The Leaf Area Index (LAI) is a measure of the amount of photosynthetic leaves and governs the canopy conductance to water vapor and carbon dioxide. Four different estimates of LAI were compared over France: two LAI products derived from satellite remote sensing, and two LAI simulations derived from land surface modelling. The simulated LAI was produced by the ISBA-A-gs model and by the ORCHIDEE model (developed by CNRM-GAME and by IPSL, respectively), for the 1994-2007 period. The two models were driven by the same atmospheric variables and used the same land cover map (SAFRAN and ECOCLIMAPII, respectively). The MODIS and CYCLOPES satellite LAI products were used. Both products were available from 2000 to 2007 and this relatively long period allowed to investigate the interannual and the seasonal variability of monthly LAI values. In particular the impact of the 2003 and 2005 droughts were analyzed. The two models presented contrasting results, with a difference of one month between the average leaf onset dates simulated by the two models, and a maximum interannual variability of LAI simulated at springtime by ORCHIDEE and at summertime by ISBA-Ags. The comparison with the satellite LAI products showed that, in general, the seasonality was better represented by ORCHIDEE, while ISBA-A-gs tended to better represent the interannual variability, especially for grasslands. While the two models presented comparable values of net carbon fluxes, ORCHIDEE simulated much higher photosynthesis rates than ISBA-A-gs (+70 %), while providing lower transpiration estimates (-8 %). [ABSTRACT FROM AUTHOR]

The Leaf Area Index (LAI) is a measure of the amount of photosynthetic leaves and governs the canopy conductance to water vapor and carbon dioxide. Four different estimates of LAI were compared over France: two LAI products derived from satellite remote sensing, and two LAI simulations derived from land surface modelling. The simulated LAI was produced by the ISBA-A-gs model and by the ORCHIDEE model (developed by CNRM-GAME and by IPSL, respectively), for the 1994-2007 period. The two models were driven by the same atmospheric variables and used the same land cover map (SAFRAN and ECOCLIMAP-II, respectively). The MODIS and CYCLOPES satellite LAI products were used. Both products were available from 2000 to 2007 and this relatively long period allowed to investigate the interannual and the seasonal variability of monthly LAI values. In particular the impact of the 2003 and 2005 droughts were analyzed. The two models presented contrasting results, with a difference of one month between the average leaf onset dates simulated by the two models, and a maximum interannual variability of LAI simulated at springtime by ORCHIDEE and at summertime by ISBA-A-gs. The comparison with the satellite LAI products showed that, in general, the seasonality was better represented by ORCHIDEE, while ISBAA-gs tended to better represent the interannual variability, especially for grasslands. While the two models presented comparable values of net carbon fluxes, ORCHIDEE simulated much higher photosynthesis rates than ISBA-A-gs (+70 %), while providing lower transpiration estimates (-8 %). [ABSTRACT FROM AUTHOR]

We analyze how biases of meteorological drivers impact the calculation of ecosystem CO2, water and energy fluxes by models. To do so, we drive the same ecosystem model by meteorology from gridded products and by "true" meteorology from local observation at eddy-covariance flux sites. The study is focused on six flux tower sites in France spanning across a 7-14 °C and 600-1040mmyr-1 climate gradient, with forest, grassland and cropland ecosystems. We evaluate the results of the ORCHIDEE process-based model driven by four different meteorological models against the same model driven by site-observed meteorology. The evaluation is decomposed into characteristic time scales. The main result is that there are significant differences between meteorological models and local tower meteorology. The seasonal cycle of air temperature, humidity and shortwave downward radiation is reproduced correctly by all meteorological models (average R² = 0.90). At sites located near the coast and influenced by sea-breeze, or located in altitude, the misfit of meteorological drivers from gridded dataproducts and tower meteorology is the largest. We show that day-to-day variations in weather are not completely well reproduced by meteorological models, with R² between modeled grid point and measured local meteorology going from 0.35 (REMO model) to 0.70 (SAFRAN model). The bias of meteorological models impacts the flux simulation by ORCHIDEE, and thus would have an effect on regional and global budgets. The forcing error defined by the simulated flux difference resulting from prescribing modeled instead than observed local meteorology drivers to ORCHIDEE is quantified for the six studied sites and different time scales. The magnitude of this forcing error is compared to that of the model error defined as the modeled-minus-observed flux, thus containing uncertain parameterizations, parameter values, and initialization. The forcing error is the largest on a daily time scale, for which it is as large as the 25 model error. The forcing error incurring from using gridded meteorological model to drive vegetation models is therefore an important component of the uncertainty budget of regional CO2, water and energy fluxes simulations, and should be taken into consideration in up-scaling studies. [ABSTRACT FROM AUTHOR]

Based on a consumer survey conducted in France, Germany, and the U.S., the study investigates consumers' readiness to support socially responsible organizations and examines their evaluations of the economic, legal, ethical, and philanthropic responsibilities of the firm. French and German consumers appear more willing to actively support responsible businesses than their U.S. counterparts. While U.S. consumers value highly corporate economic responsibilities, French and German consumers are most concerned about businesses conforming with legal and ethical standards. These findings provide useful guidance for the efficient management of social responsibility initiatives across borders and for further academic inquiries. [ABSTRACT FROM AUTHOR]

Based on an extensive review of the literature and field surveys, the paper proposes a conceptualization and operationalization of corporate citizenship meaningful in two countries: the United States and France. A survey of 210 American and 120 French managers provides support for the proposed definition of corporate citizenship as a construct including the four correlated factors of economic, legal, ethical, and discretionary citizenship. The managerial implications of the research and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Every winter, respiratory viruses put most Emergency Departments (ED) around the world under intense pressure. To reduce the consequent stress for hospitals, anticipation of the massive increase of intakes for illness-based symptoms is essential. As the Covid-19 2020 pandemic clearly illustrates, patients are not systematically tested. The ED staff therefore has no real-time knowledge of the presence of the virus in the patients flow. To address this issue, we propose here to use the hospital's laboratory-confirmed database as an attractor for the manifold-based approach for clustering the clinical codes associated with respiratory viruses. We propose a new framework based on the embedding of time series onto the Stiefel manifold, coupled with a density-based clustering algorithm (HDBSCAN) enhanced by a reduction of dimension (UMAP) for the clustering on that manifold. In particular, we show, based on real data sets of two academic hospitals in France, the significant benefits of using geometrical approaches for time series clustering as compared to traditional methods. • We use clustering of time series to detect the presence of winter viruses in ED. • Time series are seen as elements of the Stiefel using delay coordinate embedding. • We point out the gain obtained compared to classic time series clustering approaches. • ICD codes close to winter viruses are detected. • A real-time representation of the presence of the winter viruses is then possible. [ABSTRACT FROM AUTHOR]

Aim The French Sarcoma Group performed this retrospective analysis of the ‘RetrospectYon’ database with data of patients with recurrent advanced soft tissue sarcoma (STS) treated with trabectedin 1.5 mg/m 2 as a 24-h infusion every three weeks. Methods Patients who achieved non-progressive disease after six initial cycles could receive long-term trabectedin treatment until disease progression. Results Overall, 885 patients from 25 French centres were included. Patients received a median of four trabectedin cycles (range: 1–28). The objective response rate was 17% (six complete/127 partial responses) and 50% ( n = 403) of patients had stable disease for a disease control rate of 67%. After a median follow-up of 22.0 months, median progression-free survival (PFS) and overall survival (OS) were 4.4 and 12.2 months, respectively. After six cycles, 227/304 patients with non-progressive disease received trabectedin until disease progression and obtained a significantly superior median PFS (11.7 versus 7.6 months, P < 0.003) and OS (24.9 versus 16.9 months, P < 0.001) compared with those who stopped trabectedin treatment. Deaths and unscheduled hospitalisation attributed to drug-related events occurred in 0.5% and 9.4% of patients, respectively. Conclusion The results of this real-life study demonstrate that treatment with trabectedin of patients with STS yielded comparable or improved efficacy outcomes versus those observed in clinical trials. A long-term treatment with trabectedin given until disease progression is associated with significantly improved PFS and OS. [ABSTRACT FROM AUTHOR]

Aims Recent data suggest that patients with pulmonary metastases from sarcomas might benefit from ablation of their metastases. Some data are available regarding osteosarcomas/angiosarcomas and lung metastases. The purpose of this study was to assess the efficacy of local ablative treatment on the survival of patients with oligometastases (one to five lesions, any metastatic site, any grade/histology) from sarcomas. Materials and Methods A multicentric retrospective study of the French Sarcoma Group was conducted in sarcoma patients with oligometastases who were treated between 2000 and 2012. Survival was analysed using multivariate sensitivity analyses with propensity scores to limit bias. Results Of the 281 patients evaluated, 164 patients received local treatment for oligometastases between 2000 and 2012. The groups' characteristics were similar in terms of tumour size and remission of the primary tumours. The median follow-up was 25.7 months; 129 (45.9%) patients had died at this point. The median overall survivals were 45.3 (95% confidence interval = 34–73) months for the local treatment group and 12.6 for the other group (95% confidence interval = 9.33–22.9). Survival was better among patients who received local treatment (hazard ratio = 0.47; 95% confidence interval = 0.29–0.78; P < 0.001). Subgroup analyses revealed similar findings in the patients with single oligometastases (hazard ratio = 0.48; 95% confidence interval = 0.28–0.82; P = 0.007); a significant benefit was observed for grade 3, and a trend was observed for grade 2. Conclusion Local ablative treatment seemed to improve the overall survival of the patients who presented with oligometastatic sarcomas, including soft tissue and bone sarcomas. The survival benefit remained after repeated local treatments for several oligometastatic events. Surgery yielded the most relevant results, but alternative approaches (i.e. radiofrequency ablation and radiotherapy) seemed to be promising. The relevance of these results is strengthened by our analysis, which avoided biases by restricting the population to patients with oligometastatic disease and used propensity scores. [ABSTRACT FROM AUTHOR]

Remotely-sensed vegetation phenology is used here to identify key stages of annual cropdevelopment and, in this basis, as an indicator of annual crop type. Crop monitoring requires both high spatial resolution data (HSR) for observing withinsub-parcel scale, and high temporal resolution (HTR) to monitor vegetation changes duringalong the crop cycle. However, these simultaneous requirements are difficult to fulfill by thesame satellite. In temperate areas such as the Versailles Plain, near Paris, France, HRS datahave at best a dozen images exploitable per year, even with Sentinel-2 because of cloud cover,while those with medium spatial resolution (MRS) provide daily images, but at the generallymixed pixel scale. In France, the Land Parcel Identification System (LPIS) is an information system of thecrop types declared by farmers, providing reference information about the annual cropscultivated within each agricultural parcel. In this work, the objective was to monitor thephenology of annual crops recorded in the LPIS of 2016, using satellite image time seriesfrom HRS Sentinel-2 (10m) and MRS Proba-V (100m) acquired from early to end of 2016over the Versailles Plain, a small agricultural region (221 km2) cultivated with annualcrops. From the two types of time series, the temporal variations of vegetation indices (NDVI/ EVI2) of crops were extracted in order to analyze the crop seasonal variationsof winter wheat, winter oilseed rape and maize over 2857 parcels with averagesize of 6.88 ha. The linear method of spatial disaggregation was applied on theMRS data, using fractions of each crop type in the mixed pixels calculated from the2016-LPIS. The temporal responses from HRS data were compared with those of the MRS sub-pixels.Comparisons between both time series revealed significant correlations for thethree studied crops (winter wheat = 0.94, winter oilseed rape = 0.74 and maize =0.79). By improving the temporal frequency of the monitoring, from13 imagesfor HRS to 25 images for MRS, the disaggregated MRS time series enabled todistinguish the phenological stages of the three studied crops better than the HRS timeseries. In conclusion, our method of spatial disaggregation can be used to improve theexploitation of satellite data at MRS in seasonal crop monitoring, especially during thetransition periods when the spectral indices of crops are likely to change quickly. [ABSTRACT FROM AUTHOR]