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In France, there is no religious education in state schools. "Convictional education" appeared by drawing its perimeter around three educational subjects: philosophy, teaching about religions, and moral and civic education. Today, the French school is facing new challenges in a highly secularised society on which religion is laying new claims. As an institution, it is not neutral insofar as it proceeds from a political philosophy that evolved from the French Revolution. It is within the operative framework of this philosophy and with specific teaching practices that it intends to combine unity and plurality within itself.

Background: Although the advent of new therapeutics for juvenile idiopathic arthritis (JIA) patients has considerably lessened the impact of the disease and reduced its sequelae, the outcomes of JIA remain important in their lives. Disease repercussions and side effects of treatments may affect sexual health and cause psychological distress. This aim of the study was to determine the expectations of adolescent JIA patients and the perceptions of their parents regarding knowledge and communication with healthcare providers (HCPs) in the field of sexual health (SH). Methods: In France, from September 2021 to April 2022, a survey was conducted, using anonymous self-administered questionnaires, among JIA patients (adults (aged 18–45 years) to provide insights from their recollection of their adolescence) and their parents in nine rheumatology centers and three patient associations. Results: The responses to the 76 patient questionnaires and 43 parent questionnaires that were collected were analyzed. Half of the patients thought JIA impacted their romantic relationships, but the results were less clear-cut for their sexual activity; and 58.7% of the patients said they would be comfortable discussing the subject with HCPs, but only 26.3% had done so, mainly regarding biomedical issues. The patients and their parents thought that ideally, the topic should be addressed in an individual patient education session at the hospital (51.3% and 34.9%, respectively), in a regular consultation (47.4% and 53.5%), or in a dedicated consultation requested by the adolescent without the adolescent's parents being informed (38.2% and 20.9%). Most of the respondents thought HCPs should be proactive in SH (77.6% of the patients and 69.8% of their parents). More patients than parents said the following digital information tools must be used: videos (29.0% vs. 9.3%, p = 0.0127) and smartphone applications (25.0% vs. 9.3%, p = 0.0372). Conclusion: HCPs should consider addressing the unmet need for SH discussions during their patient encounters. To meet this need, we propose concrete actions in line with the wishes of patients and parents. Clinical trial registration number: NCT04791189. [ABSTRACT FROM AUTHOR]

This case study documents the influence of preservice teachers' experiences in a Video-Enhanced Training Program (VETP) on their teaching. The conceptual framework of this VETP comes from a research program in cultural anthropology based on Wittgenstein's analytical philosophy. Influence was identified during self-confrontation interviews with preservice teachers (n = 8) in physical education with a video of their teaching. The findings indicated that this VETP program improved their ability to conduct a lesson. More precisely, these results showed the kinds of experiences PTs mobilized from the VETP (and others) when teaching, their number (n = 6), and the ways in which they drew on a variety of experiences. Two main avenues for modifying VETPs are then proposed: First, teaching should be viewed as both an object and a training situation, and second, VETPs should be integrated into a broad teacher-training path, which should be understood as a pool of experiences from which each teachers forge their own initial teaching practice.

Purpose: To describe the incidence, management, and survival outcomes of patients with muscle-invasive urothelial carcinoma (MIUC) undergoing radical surgery (RS) in France. Methods: We relied on a non-interventional real-world retrospective study based on French National Hospitalization Database. Adults with MIUC with a first RS between 2015 and 2020 were selected. Subpopulations of patients with RS performed in 2015 and 2019 (pre-COVID-19) were extracted, according to cancer site: muscle-invasive bladder cancer (MIBC) or upper tract urothelial carcinoma (UTUC). Disease-free and overall survival (DFS, OS – Kaplan–Meier) were assessed on the 2015 subpopulation. Results: Between 2015 and 2020, 21,295 MIUC patients underwent a first RS. Of them, 68.9% had MIBC, 28.9% UTUC, and 2.2% both cancers. Apart from fewer men among UTUC (70.2%) than MIBC patients (90.1%), patients' demographic (mean age ~ 73 years) and clinical characteristics were similar whatever the cancer site or year of first RS. In 2019, RS alone was the most frequent treatment, occurring in 72.3% and 92.6% in MIBC and UTUC, respectively. Between 2015 and 2019, neoadjuvant use rate increased from 13.8% to 22.2% in MIBC, and adjuvant use rate increased from 3.7% to 6.3% in UTUC. Finally, median [95% confidence interval] DFS times were 16.0 [14.0–18.0] and 27.0 [23.0–32.0] months among MIBC and UTUC, respectively. Conclusion: Among patients with resected MIUC annually, RS alone remained the main treatment. Neoadjuvant and adjuvant use increased between 2015 and 2019. Nonetheless, MIUC remains of poor prognosis, highlighting an unmet medical need, notably among patients at high risk of recurrence. [ABSTRACT FROM AUTHOR]

Presents a case study as a framework within which to discuss the concepts of function and their representations. (KHR)

Objectives To describe new-onset IBD (new IBD) in patients treated with IL-17 inhibitors (IL-17i), to assess their incidence and to identify their risk factors in real life. Methods A French national registry (MISSIL) aimed to report all cases of new IBD in patients treated with IL-17i from January 2016 to December 2019. Using the estimated number of patients treated by IL-17 in France during the study period, the annual incidence rates of new IBD was reported in IL-17i-treated patients. A case–control study was performed with two controls per new IBD case matched by gender, age and underlying inflammatory disease. Results Thirty-one cases of new IBD under IL-17i were collected: 27 patients treated for spondyloarthritis and four patients for psoriasis. All were observed with secukinumab (SEK). The median time to onset of new IBD symptoms was 4.0 (1.5–7.5) months. SEK was discontinued in all patients. The evolution was favourable with complete resolution (17/31), improvement (7/31) or stabilization (5/31). Two patients died: one due to a massive myocardial infarction and one due to post-colectomy complications. The incidence of new IBD decreased from 0.69/100 patient-years [PY] (7/1010) in 2016 to 0.08/100 PY (6/7951) in 2019. No previous treatment with etanercept (odds ratio [OR] = 0.33, 95% CI: 0.14–0.80, P  = 0.014) and low number of previous biologic therapies (OR = 0.67, 95% CI: 0.47, 0.94, P  = 0.021) were significantly associated with new IBD. Conclusion The incidence of new IBD was low and decreased from 2016 to 2019. The outcome was favourable in 24 out of 31 patients, but two patients died. [ABSTRACT FROM AUTHOR]

Background: With more than 160 000 confirmed COVID-19 cases and about 30 000 deceased people at the end of June 2020, France was one of the countries most affected by the coronavirus crisis worldwide. We aim to assess the efficiency of global lockdown policy in limiting spatial contamination through an in-depth reanalysis of spatial statistics in France during the first lockdown and immediate post-lockdown phases.Methods: To reach that goal, we use an integrated approach at the crossroads of geography, spatial epidemiology, and public health science. To eliminate any ambiguity relevant to the scope of the study, attention focused at first on data quality assessment. The data used originate from official databases (Santé Publique France) and the analysis is performed at a departmental level. We then developed spatial autocorrelation analysis, thematic mapping, hot spot analysis, and multivariate clustering.Results: We observe the extreme heterogeneity of local situations and demonstrate that clustering and intensity are decorrelated indicators. Thematic mapping allows us to identify five "ghost" clusters, whereas hot spot analysis detects two positive and two negative clusters. Our re-evaluation also highlights that spatial dissemination follows a twofold logic, zonal contiguity and linear development, thus determining a "metastatic" propagation pattern.Conclusions: One of the most problematic issues about COVID-19 management by the authorities is the limited capacity to identify hot spots. Clustering of epidemic events is often biased because of inappropriate data quality assessment and algorithms eliminating statistical-spatial outliers. Enhanced detection techniques allow for a better identification of hot and cold spots, which may lead to more effective political decisions during epidemic outbreaks. [ABSTRACT FROM AUTHOR]

Objective: To assess the contribution of maternal blood detection of IGFBP‐1 for the diagnosis of amniotic‐fluid embolism in clinical daily practice. Design: A retrospective multicentre cohort study. Setting: Three tertiary care obstetric units in France. Sample: Data of 86 women for whom amniotic‐fluid embolism had been suspected and maternal serum detection of IGFBP‐1 had been performed between 2011 and 2019 were analysed. Methods: The criteria defined by the United Kingdom Obstetric Surveillance System (UKOSS) were used for the retrospective diagnosis of amniotic‐fluid embolism. The more structured definition proposed by the Society for Maternal‐Fetal Medicine and the Amniotic Fluid Embolism Foundation (SMFM) was also used as secondary endpoint. Main outcome measures: Agreements between biological and clinical assessments were tested. The performance of blood detection of IGFBP‐1 for the diagnosis of amniotic‐fluid embolism according to the UKOSS criteria, and to the SMFM definition, was also assessed. Results: There was only slight agreement between clinical and laboratory diagnosis of amniotic‐fluid embolism (Cohen's Kappa coefficient: 0.04). Blood detection of IGFBP‐1 had a sensitivity of 16%, a specificity of 88%, a positive and a negative likelihood ratio of 1.3 and 0.95, respectively, and a positive and a negative predictive value of 58 and 50%, respectively, for the diagnosis of amniotic‐fluid embolism based on the UKOSS criteria. The use of the more structured SMFM definition of amniotic‐fluid embolism did not substantially change the results. Conclusion: These results question the usefulness of blood detection of IGFBP‐1 for the early diagnosis of amniotic‐fluid embolism in daily clinical practice. This retrospective multicentre study questions the contribution of IGFBP‐1 detection for the diagnosis of AFE. This retrospective multicentre study questions the contribution of IGFBP‐1 detection for the diagnosis of AFE. [ABSTRACT FROM AUTHOR]

Background Halyomorpha halys (Stål, 1855), the brown marmorated stinkbug (BMSB) is a highly successful invasive species, native to eastern Asia. It has managed to spread into North America and Europe in recent decades, causing severe damage to various crops. BMSB has been detected in Europe in 2004 and has since expanded in more than 20 countries from Sweden to Greece and Spain to Turkey, the South European Territory of Russia (Krasnodar region) and Abkhazia. In 2012, we set up a citizen science survey to monitor BMSB expansion in France. [ABSTRACT FROM AUTHOR]

Objectives Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation. Methods Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n  = 102; 18–37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit. Results A gradual decrease in patients' serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (DAS28: r = –0.27, P = 0.003; CRP: r = –0.16, P = 0.06). Conclusion This is the first study to determine serum AMH levels of a large cohort of RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled. ClinicalTrials.gov Identifier NCT03666091. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the current study is to estimate the cost-effectiveness of adjuvant treatment with nivolumab relative to clinically relevant comparators in adult patients with melanoma with lymph node involvement or metastatic disease who have undergone complete resection from a French societal perspective. Methods: The comparators were observation, low-dose interferon and pembrolizumab. A subgroup analysis was carried out in patients with BRAF mutation, adding dabrafenib plus trametinib. A three-state partitioned survival model was developed to project costs and health benefits over a 20-year time horizon. Extrapolation for recurrence-free survival (RFS) and overall survival (OS) was carried out using spline-based models. Because of the immaturity of OS data in pivotal trials for nivolumab and pembrolizumab, a predictive model of OS treatment effect based on RFS effect was developed using a correlation equation. Health state utilities and adverse events disutilities were derived from the CheckMate 238 trial and literature. Costs were estimated in 2019 euros. The model's primary outcome was efficiency frontier. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of results. Results: Observation, low-dose interferon and nivolumab were on the efficiency frontier. The incremental cost–utility ratio of nivolumab versus low-dose interferon (closest therapy on the efficiency frontier) was €37,886/quality-adjusted life year (QALY). Probabilistic sensitivity analysis reported an 80% probability of nivolumab being a cost-effective strategy for a willingness-to-pay threshold of €52,000/QALY. In the subgroup with BRAF mutation, the efficiency frontier was not changed by the addition of dabrafenib plus trametinib. Conclusions: Nivolumab is a cost-effective strategy as adjuvant treatment in adult patients with surgically resected melanoma in France. [ABSTRACT FROM AUTHOR]

Sacculina carcini is an endoparasite of the green crab, Carcinus maenas. This parasite induces behavioural changes in its host and affects its metabolism by inhibiting moulting and reproduction. Using a proteomic approach in mass spectrometry, we studied the haemolymph proteomes of healthy and parasitized wild green crabs from Brittany, France to identify proteins that are differentially expressed as a consequence of parasitization. We also investigated specific proteins involved in reproduction, moulting, and immunity. We detected 77 proteins for females and 53 proteins for males that were differentially present between the healthy and parasitized crabs, some of which were sex-specific. Detection of these differentially expressed proteins suggests that the parasite can inhibit and promote different aspects of the immune response of the host. Sacculina appears to inhibit host melanisation for self-protection, while promoting the presence of immune factors, such as antimicrobial peptides to cope with possible bacterial superinfections. Moreover, one protein, juvenile hormone esterase-like carboxylesterase, was 17-times more abundant in parasitized crabs than in healthy crabs and may be responsible for inhibiting moulting and reproduction in parasitized crabs, thus ensuring the success of Sacculina reproduction. [Display omitted] • First proteomic analysis of a parasite-host relationship between a crab and Sacculina. • Sacculina effect on crab proteins involved in immunity, moulting, and reproduction. • Elevated juvenile hormone esterase-like carboxylesterase in a parasitized crab. [ABSTRACT FROM AUTHOR]

Objective: We conducted this study to determine whether alcohol consumption influences radiological progression in early rheumatoid arthritis (RA).Method: Patients fulfilling the European League Against Rheumatism/American College of Rheumatology 2010 criteria in the early arthritis cohort ESPOIR (Étude et Suivi des Polyarthrites Indifférenciées Récentes) were included in this study. Alcohol consumption was collected at baseline and at each visit. We classified alcohol consumption into three groups: abstinent (0 g/day), moderate (≤ 20 g/day for women, ≤ 30 g/day for men), and abuse (> 20 g/day for women, > 30 g/day for men). The primary outcome was the occurrence of radiological progression, defined as an increase ≥ 5 points in the total Sharp/van der Heijde score. We investigated whether alcohol consumption is predictive of radiological progression at 1, 3, and 5 years by univariate and multivariate analysis adjusted for age, baseline erosion, rheumatoid factor, anti-citrullinated peptide antibody, smoking status, body mass index, and treatment with leflunomide or methotrexate and biologics.Results: The study included 596 patients. When considering the influence of gender on the interaction between alcohol consumption and radiological progression, we showed a deleterious effect of moderate consumption in women [odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.01; 2.96, p = 0.045] and a trend towards a protective effect of moderate consumption in men (OR = 0.50, 95% CI 0.21; 1.16, p = 0.106) in multivariate analysis.Conclusion: Our data suggest a deleterious effect of moderate consumption of alcohol on radiological progression in women, but not in men, with early RA. [ABSTRACT FROM AUTHOR]

The French healthcare system is a universal healthcare system with no financial barrier to access to health services and cancer drugs. The objective of the study is to investigate associations between, on the one hand, incidence and survival of patients diagnosed with lung cancer in France and, on the other, the socioeconomic deprivation and population density of their municipality of residence. A national, longitudinal analysis using data from the French National Hospital database crossed with the population density of the municipality and a social deprivation index based on census data aggregated at the municipality level. For lung cancer diagnosed at the metastatic stage, one-year and two-year survival was not associated with the population density of the municipality of residence. In contrast, mortality was higher for people living in very deprived, deprived and privileged areas compared to very privileged areas (hazard ratios at two years: 1.19 [1.13–1.25], 1.14 [1.08–1.20] and 1.10 [1.04–1.16] respectively). Similar associations are also observed in patients diagnosed with non-metastatic disease (hazard ratios at two years: 1.21 [1.13–1.30], 1.15 [1.08–1.23] and 1.10 [1.03–1.18] for people living in very deprived, deprived and privileged areas compared to very privileged areas). Despite a universal healthcare coverage, survival inequalities in patients with lung cancer can be observed in France with respect to certain socioeconomic indicators. [ABSTRACT FROM AUTHOR]

Background: Management of metastatic melanoma is changing rapidly following the introduction of innovative effective therapies, with consequences for the allocation of healthcare resources. The objective of this study was to assess hospitalisation costs of metastatic melanoma in France from 2011 to 2013 from the perspective of the government payer.Methods: The population studied corresponded to all adults with metastatic melanoma hospitalised in France between 1st January 2011 and 31st December 2013 who required chemotherapy, immunotherapy or radiotherapy due to tumour progression and unresectable Stage III or Stage IV melanoma. Metastatic melanoma was identified by ICD-10 codes documented in the hospital patient discharge records. For each patient, hospital stays were stratified into a pre- or post- progression health state using proxy variables for the RECIST criteria. All healthcare expenditure documented in the French national hospital claims system database and incurred between the index hospitalisation (or change of progression state) and the end of follow-up were analysed. For the principal analysis, valuation of healthcare resource consumption was performed using official national hospitalisation tariffs. Any expensive therapy administered during the stay was documented from a linked database of expensive drugs (FICHCOMP).Results: Seventy-eight thousand seven hundred fifty hospital stays by 10,337 patients with metastatic melanoma were identified over the three-year study period. Annual per capita costs of hospitalisation were € 5046 in the pre-progression stage and € 19,006 in the post-progression stage. Hospitalisations attributed to adverse drug reactions to chemotherapy or immunotherapy were observed in 27% of patients. Annual per capita costs of these hospitalisations related to adverse drug reactions were € 3762 in the pre-progression stage and € 5523 in the post-progression stage.Conclusions: Hospitalisation costs related to metastatic melanoma rise substantially as the disease progresses. Treatment strategies which slow down disease progression would be expected to reduce costs of hospitalisation for metastatic melanoma, although they may also entail significant acquisition costs. This will entail organisational changes of resource allocation for the treatment of metastatic melanoma in hospitals. [ABSTRACT FROM AUTHOR]

Objective. To investigate the frequency and risk factors of postoperative complications in RA patients treated with abatacept (ABA). Methods. The Orencia RA registry recruited 1012 patients receiving ABA for RA in routine care. Data from patients treated with ABA who underwent surgery were reviewed to describe the frequency of postoperative complications. Characteristics of patients and surgeries with and without complications were compared to identify factors associated with complications. Results. We identified 205 (20.3%) patients who underwent 263 surgeries, including 176 (66.9%) orthopaedic surgeries. Nineteen (7.2%) surgeries, in 19 patients (9.3%), entailed complications, including 7 delayed wound healing (2.7% of surgeries) and 6 surgical site infections (2.3% of surgeries). The median time between the last infusion of ABA and surgery was 5.9 weeks (range: 0.3-12.0 weeks), with no significant difference between patients with and without complications. The median corticosteroids daily dosage was higher in the group with complications [10.0 (6.25-15.0) vs 6.0 (5.0-10.0) mg/day, P = 0.042]. In multivariate analysis, only the duration of ABA treatment was significantly associated with postoperative complications [adjusted odds ratio (aOR) = 0.94 (95% CI: 0.89, 0.99) for each month of treatment], as were orthopaedic surgeries compared with other kinds of surgery [aOR = 4.45 (95% CI: 1.01, 20.2)]. Conclusion. In RA patients treated with ABA, the rate of surgical complications was low: 7.2% and higher in case of orthopaedic procedure and a more recent initiation of ABA. The median time between surgery and the last infusion of ABA was short and did not influence the rate of postoperative complications. [ABSTRACT FROM AUTHOR]

Objective To validate the measurement properties and the detection performance of the FLARE-RA questionnaire in a longitudinal prospective study. Methods To validate the FLARE-RA self-administered questionnaire, we conducted a prospective trial in rheumatoid arthritis (RA) patients to document: 1) content and construct validity by factor analysis, convergent validity by Pearson's correlation with routine assessment of patient index data (Routine Assessment of Patient Index Data 3 [RAPID-3] questionnaire), RA Impact of Disease (RAID) score, Disease Activity Score in 28 joints (DAS28), and Health Assessment Questionnaire (HAQ), 2) reliability (intraclass correlation coefficient [ICC] and Bland-Altman plot), and 3) feasibility of use. Patients were examined and questionnaires were collected at baseline and 3 months, and every week in between for RAPID-3. Results We recruited 138 patients from 13 centers: 81.9% women, mean age 57.4 years, mean DAS28 2.9, mean C-reactive protein level 6.2 mg/liter, 84.4% rheumatoid factor positive, 78.0% anti-citrullinated protein antibody positive, and 78.8% with erosive disease. At baseline, the mean ± SD FLARE-RA score was 2.3 ± 2.3. The content and construct validity of FLARE-RA was good. A substantial floor effect, but no ceiling effect, was observed. Principal components analysis revealed 1 domain disentangled in 2 subdomains: physical and emotional. The FLARE-RA total score was correlated with the DAS28 (r = 0.63, P < 0.001), RAID (r = 0.80, P < 0.001), RAPID-3 (r = 0.77, P < 0.001), and HAQ (r = 0.53, P < 0.001). The ICC for reliability was 0.94 (95% confidence interval 0.92-0.96). Conclusion The FLARE-RA self-administered questionnaire represents a valid and valuable instrument to detect RA flare between visits to the physician. [ABSTRACT FROM AUTHOR]

Background: Migraine is a prevalent and incapacitating condition that affects individuals in the prime of their productive life, thus generating an economic burden for both society and healthcare systems. The direct annual healthcare costs of migraine in France were assessed over 10 years ago, and the current study updates these figures.Objective: The objective of this study was to determine the economic cost (primarily direct costs) of migraine and other episodic headache in France based on a general population survey of headache, the GRIM2000 (Groupe de Researche Interdisciplinaire sur la Migraine).Design: From a representative general population sample of 10,585 individuals aged > or = 15 years in France in 1999, 1486 individuals experiencing headaches were identified and interviewed regarding healthcare resource consumption in the previous 6 months. By applying unit costs to the resource data, costings (in 1999 values) were determined for physician consultations, hospitalisation, medication use and diagnostic/laboratory tests, and evaluated from a healthcare system perspective. Information on absenteeism and lost productivity was derived from the Migraine Disability Assessment Score (MIDAS) questionnaire.Results: The prevalence of migraine (including migrainous disorder) was determined to be 17%. Total annual direct healthcare costs were estimated to be Euros 128 per individual with migraine in 1999, corresponding to Euros 1044 million when extrapolated to all individuals experiencing migraine and aged > or = 15 years. Around two-thirds of this cost accrued to the social security system (Euros 698 million; Euros 85 per individual). The total annual direct cost of other forms of episodic headache was much lower at Euros 28 per individual (social security cost Euros 18); with a prevalence of 9.2%, the annual national direct cost for other forms of episodic headache totalled Euros 124 million. The principal cost element was physician consultations. However, it was found that many individuals had never consulted a physician for their headaches, and self-medication contributed substantially to the medication costs (the second greatest cost factor for migraine). The cost per individual rose steeply with increasing severity of headache.Conclusions: The direct healthcare costs of migraine do not seem to have risen significantly over the past decade. A small minority of individuals with more severe headaches consume most of the healthcare resources devoted to migraine, while most individuals generate relatively low direct costs. The total annual direct costs in France for migraine are almost 10-fold higher than those of other episodic headache. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to evaluate the impact of introducing tocilizumab (TCZ) as co-therapy with CS in patients with RA. Methods. This study was an open, observational, retrospective multicentre study. RA patients treated with oral CS for >3 months who started treatment with TCZ between December 2009 and June 2011 in five centres were included. Variables included demographic data, disease history, co-treatments, disease activity and dose of CS at inclusion and at weeks 4, 8, 12 and 24. The evolution of disease activity and of the dose of CS (analysis of variance with repeated measures) were analysed, searching for factors correlated with changes in the dose of CS. Results. Inclusion of 130 patients [women 80.8%, mean age 56.7 years (S.D. 14.0), RA duration 16.3 years (S.D. 10.4), mean baseline 28-joint DAS (DAS28) 5.1 (S.D. 1.4), mean baseline dose of CS 10.0 mg/day (S.D. 8.2) prednisone equivalent. Decreases in the mean daily dose of CS and in the DAS28 were observed during follow-up [respectively 6.5mg (S.D. 4.8) at week 24 (P< 0.0001) and 3.0mg (S.D. 1.4) at week 24 (P<0.0001)]. The only variable that correlated with the decrease in the dose of CS was the initial dose of the drug (r = 0.82, P<0.001). Conclusion. The introduction of TCZ led to rapid and long-lasting CS sparing that did not correlate with the reduction in disease activity. It is possible that in patients treated with high-dose CS, the main objective of the clinician is to reduce dosage of CS rather than RA activity. [ABSTRACT FROM AUTHOR]

We conducted an exploratory study of a complex and dynamic medical activity, namely the collective management of an epidemiological alert situation. With a view to improving our knowledge of how this activity is managed, we set up simulated situations of epidemiological alerts. A multidisciplinary medical team was assisted by a decision-support system called ASTER and we recorded a set of systematised observations of human–human and human–machine interactions. Participants were physicians belonging to the Department of Epidemiology at the French Army's Institute of Tropical Medicine. After presenting the epidemiological domain and our theoretical approach, we describe the simulated situation and the communication dataset we collected and analysed, applying the EORCA method. Finally, in our discussion of the results, we suggest how communication could be enhanced between technology-mediated teams in complex and dynamic situations. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to identify predictors of response and remission to tocilizumab (TCZ) in RA patients seen in daily routine clinical practice.Methods. The efficacy of TCZ was evaluated after 12 and 24 weeks of treatment by the European League Against Rheumatism (EULAR) response criteria. Regression analysis was performed to study the association between remission or EULAR response and the following characteristics: gender, age, current smokers, prior cardiovascular disease (CVD), 28-joint disease activity score (DAS28), CRP, RF or ACPA positivity, combination therapy with DMARDs and TCZ as the first biological therapy or after failure of at least one biological therapy.Results. In total, 204 patients were included with a mean DAS28 score of 5.14. EULAR response and remission were obtained in 86.1% and 40% of patients, respectively, at week 24. In multiple regression analysis, a high baseline CRP level [odds ratio (OR) 4.454 (95% CI 1.446, 13.726)] was significantly associated with EULAR response at week 24 and, inversely, age >55 years [OR 0.285 (95% CI 0.086, 0.950)] and prior CVD [OR 0.305 (95% CI 0.113, 0.825)] were significantly associated with lower EULAR response at week 24. Older age was also associated with less remission at week 24 [OR 0.948 (95% CI 0.920, 0.978)]. No additional effectiveness was found when TCZ was used in combination with a DMARD or when patients were naive to biological agents.Conclusion. In daily practice we identified three predictors of a better response for TCZ therapy in RA: a younger age, a high baseline CRP level and no history of CVD. [ABSTRACT FROM PUBLISHER]

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This contribution provides a brief historical review of NATM applications in France by presenting a selection of motorway projects implemented in the last five decades. In the late 1950s, the development of the French motorway network became a national priority. The implementation of major transit projects (e.g. the A8 motorway link between Italy and the Côte d'Azur as well as the Mont Blanc and Frejus Alpine transit routes) involved the construction of a significant number of motorway tunnels. The first generation of these tunnels was still constructed using traditional methods. However, to keep pace with the booming motorway development, a faster and more cost-efficient tunnelling method was needed. The answer was found in the New Austrian Tunnelling Method (NATM). The construction of the Nice Motorway Bypass with ten tunnels in the early 1970s - 40 years ago - was the first French NATM application. The method was implemented with the guidance of Prof. Rabcewicz. Since then, the observational approach to tunnelling has become the standard method in French tunnelling. Dieser Beitrag gibt anhand einer Auswahl von französischen Autobahnprojekten aus den vergangenen fünf Jahrzehnten einen kurzen historischen Überblick über die Anwendung der Neuen Österreichischen Tunnelbauweise (NÖT) in Frankreich. In den späten 1950er-Jahren wurde der Ausbau des französischen Autobahnnetzes zur Staatspriorität erklärt. Die Verwirklichung von wichtigen Verkehrsachsen wie die A8 Autobahnanbindung der Côte d'Azur oder die alpenquerenden Tunnel Mont Blanc und Frejus bedingte die Errichtung zahlreicher neuer Autobahntunnel. Die erste Generation dieser Tunnel wurde noch mit traditionellen Methoden gebaut. Die rasche Erweiterung des französischen Autobahnnetzes erforderte jedoch schon bald eine schnellere und wirtschaftlichere Tunnelbaumethode, die in der NÖT gefunden wurde. Der Bau von zehn Tunneln der Autobahnumfahrung Nizza in den frühen 1970er-Jahren, also vor exakt 40 Jahren, stellt die erste französische Anwendung der NÖT dar. Die damals neuartige Beobachtungsmethode wurde unter Mithilfe von Prof. Ladislaus von Rabcewicz zur Anwendung gebracht und ist seither aus dem französischen Tunnelbau nicht mehr wegzudenken. [ABSTRACT FROM AUTHOR]

Background and study aims: In France, in about 5% of cases colonoscopies are incomplete or temporarily contraindicated. We tested the diagnostic yield of colon capsule endoscopy (CCE) in these patients. Patients and methods: In a prospective study, in 17 French centers, inclusion criteria were colonoscopy failure or general disease that excluded colonoscopy with anesthesia. Patients underwent CCE using the first-generation PillCam Colon capsule. The main end point was CCE diagnostic yield, defined as identification of a colorectal lesion that directly explained symptoms or necessitated a diagnostic or therapeutic examination. A secondary objective was to test a simplified Movi-Prep colon cleansing. Follow-up to identify missed symptomatic cancer was scheduled. Results: CCE showed positive findings in 36 patients (diagnostic yield 33.6 %), among whom 23 subsequently underwent therapeutic intervention. Among 64 patients with negative capsule findings, 9 had a complementary procedure showing adenomas in only 1 case. CCE was incomplete in 7/107 patients. Colonoscopy was done in one patient to retrieve a capsule retained in the left colon, and sigmoidoscopy in 11 because the rectum was not reached. No colorectal cancer was diagnosed during the follow-up period. Colon cleansing with MoviPrep was rated good or excellent in 75.9% of cases. Conclusion: This study shows the feasibility and the usefulness of CCE in the situation of colonoscopy failure or contraindication. The colon capsule modality should be tested against other available approaches, such as virtual colonoscopy or repeat colonoscopy by an expert. [ABSTRACT FROM AUTHOR]

Objective To assess the performance of computed tomography (CT) scanning for ascertaining sacroiliitis in patients with suspected spondylarthritis (SpA). Methods The Echography in Spondylarthritis French cohort consists of 489 patients with suspected SpA. At baseline, all patients underwent clinical examination, HLA-B typing, and pelvic radiography. Pelvic CT scanning was performed if sacroiliitis on radiography was considered uncertain or if patients presented with buttock pain duration of >6 months. A set of 100 paired radiographs and CT scans was read in a blinded manner by 2 radiologists, and the kappa coefficient was used to assess their interreader reliability. One of the radiologists read the 173 available pairs of radiographs and CT scans performed at baseline. Results After training, interreader reliability was moderate for sacroiliitis grading on radiographs (κ = 0.59), excellent on CT scans (κ = 0.91), and excellent for ascertaining sacroiliitis on both radiographs (κ = 1) and CT scans (κ = 0.96). The first and second readers considered the quality of imaging to be excellent in 66% and 67%, respectively, of the radiographs (κ = 0.88) and in 93% and 92%, respectively, of the CT scans (κ = 0.93). Concordance between radiographs and CT scans was low for sacroiliitis grading (κ = 0.08) or ascertainment (κ = 0.16). Definite sacroiliitis was ascertained on radiographs in 6 patients (3.5%) (confirmed by CT scans in 4 patients) and on CT scans in 32 patients (18.5%). A history of uveitis was associated with definite sacroiliitis on radiographs ( P = 0.04) and CT scans ( P < 0.0001). Conclusion Definite sacroiliitis was underestimated by radiography, as compared to CT scanning. CT scanning should facilitate the diagnosis of ankylosing spondylitis in patients with suspected SpA. [ABSTRACT FROM AUTHOR]

Objectives. The efficacy of pharmacological interventions in sciatica is limited and the use of systemic steroids is still controversial. We aimed at evaluating the efficacy and tolerance of systemic steroids in sciatica.Methods. A systematic literature search was performed in the Medline, Embase and Cochrane databases until February 2010. Randomized placebo-controlled trials evaluating the efficacy and the tolerance of systemic steroids in sciatica were included. Efficacy and tolerance were assessed using the relative risk (RR) and 95% CI with the inverse variance method (RR > 1 means that the event is more likely to occur in the steroid group). We explored the heterogeneity between the studies using subgroup analysis.Results. Seven studies (383 patients) were included. The difference in the rate of responders between both groups was not statistically significant (RR = 1.22, 95% CI 0.96, 1.56). The rate of adverse events was 13.3% for the patients in the steroid group and 6.6% for the placebo group (RR = 2.01, 95% CI 1.06, 3.80). The number needed to harm was 20 (95% CI 10, ∞). Twenty (15.3%) patients in the steroid group and seven (5.7%) patients in the placebo group underwent surgery. A trend towards a higher requirement for spinal surgery was observed in the steroid group (RR = 1.14, 95% CI 0.74, 1.75). The methodological quality slightly influenced the results. We did not find any publication bias.Conclusion. Steroid efficacy is not superior to the placebo in sciatica, but it has more side effects. The tolerance : efficacy ratio indicates against the use of systemic steroids in sciatica. [ABSTRACT FROM PUBLISHER]

Grimardias D, Merchermek N, Manicki A, Garnier J, Gaudin P, Jarry M, Beall E. Reproductive success of Atlantic salmon ( Salmo salar) mature male parr in a small river, the Nivelle: influence of shelters. Ecology of Freshwater Fish 2010: 19: 510-519. © 2010 John Wiley & Sons A/S The breeding activity of a small population of Atlantic salmon ( Salmo salar L.) was monitored on the Nivelle River in southwest France to estimate the overall contribution of mature male parr and the numbers involved in egg fertilisation. In the twelve redds sampled, 563 eggs were collected for parental assignment and the physical habitat was characterised to investigate the possible relationship between parr reproductive success and habitat complexity. The overall contribution of mature male parr was particularly high (87%, one of the highest estimates ever reported). Concerning habitat complexity, granulometry and shelter diversity were correlated with the number of parr breeders contributing to egg fertilisation in each redd. A complex habitat increased multiple paternity, which could affect the effective size and genetic variability of small salmon populations. [ABSTRACT FROM AUTHOR]

This article introduces the resolution of a medical complex, uncertain, and time-constraint situation: the outbreak early warning in military deployment, which is assisted by a decision-supported system, ASTER, an application developed for early epidemiological alerting for French army forces. A simulated alarm occurring in the Department of Epidemiology in the Institute of Tropical Medicine of the French Forces, managed by physicians belonging to this department, has been studied. One goal was to have a set of systematized observations on the human-system interactions in a constrained and critical situation implying a team of public health experts. The ASTER system and a first study of its usage by experts in a simulated situation are presented, and the first results obtained in the context of the insertion of a complex human-computerized system interaction in a naturalistic situation of decision making are discussed. [ABSTRACT FROM AUTHOR]

Abstract  New methodologies using Geographical Information Systems (GIS) and statistical tools were developed to provide new elements to the interpretation of fossil pollen records on the large spatial scale of north-western France. The originality of these methods lies in the analysis of the spatial distribution of the archaeobotanical data in order to identify correlations with other spatial parameters such as geological, climatic, pedological, topographical and archaeological characteristics. 218 pollen analyses from north-western France and a series of thematic maps (geological, archaeological, climatic, etc.) were used. The application of numerical analyses makes it possible to describe the spatial distribution of pollen data at a regional scale, and to identify spatial correlations between pollen data and other environmental parameters, and between archaeobotanical groups, archaeological and abiotic parameters simultaneously. Two examples are presented and discussed: (A) The spatial distributions of the predominance of hazel over oak between 6700 and 5700 cal b.p. and of modern precipitation are shown to be positively correlated, i.e. hazel is dominant in the most humid areas of the region. (B) The pollen data from the Bronze Age show associations of (1) pollen groups ascribed to meadows, shrubland, and forests with cooler temperatures, higher altitudes and northern latitudes, and (2) pollen groups ascribed to moor environments and anthropogenic vegetation with warmer temperatures, southern latitudes and lower altitudes. The latter implies that the agricultural landscapes of the Bronze Age were mainly confined to southern latitudes and low altitudes of the region, while the areas characterised by high altitudes and low temperatures were characterised by extensive activities such as grazing by cattle. [ABSTRACT FROM AUTHOR]

The practice of applying large amounts of P to agricultural land over several previous decades, particularly in regions with intensive livestock production, has resulted in P accumulation in soils with an increased risk of P losses into water bodies and thus of eutrophication. This work is aimed at analyzing the spatiotemporal changes in extractable soil P content at the regional level by means of a soil test database and then comparing results with independent data from agricultural censuses. A total of 228 079 soil P-test values [Dyer method: 1:5 soil-citric acid solution (20 g/L) ratio] generated between 1980 and 2003 by certified commercial laboratories in Brittany (northwestern France) were integrated into a database. Changes in P were analysed by considering four 4–6 year periods between 1980 and 2003 using cumulative frequencies and summary statistics performed on raw soil test values. Then data were aggregated into discrete entities (canton: administrative entities) and summary statistics, linear regression and spatial distribution were carried out. P balances were measured for the same entities taken from the agricultural censuses of 1979, 1988 and 2000. Over the entire study period, a marked spatial variability was observed with higher P content in the western part of Brittany, as well as a systematic increase in median P content with lower amplitude over the past decade. The mean cantonal soil P surplus accumulated over 24 years amounted to 763 kg P/ha of usable agricultural land. Similar P balances sometimes gave rise to widely different increases in P. Cumulative balances were positively correlated with an increase in soil P ( r2 = 0.34). [ABSTRACT FROM AUTHOR]

Spatiotemporal changes in microphytobenthos species composition were investigated in relation to structural variables—biomass; life-forms; detritus ratio, pheopigment a (pheo a):chl a; and sediment characteristics—at mesoscale in a shellfish macrotidal ecosystem. To characterize algae assemblages, multivariate analyses were performed (multidimensional scaling [MDS] ordination and clustering), supported by correlations between structural variables. Microphytobenthos, dominated by 97% diatoms belonging to 89 taxa, was constituted by two main assemblages: The first one, composed of common species (occurrence >50%), mainly nanobenthic (size <30 μm) and epipsammic (sand-fixed cells), was associated with mixed sediments. The major species contributing to this assemblage were Navicula perminuta, Achnanthes hauckiana, Fallacia tenera, A. lanceolata var. elleptica, Amphora spp. , Plagiogrammopsis vanheurkii, and Plagiogramma tenuissimum (see Table 2 for taxonomic authors). Species diversity was high ( N1∼ 11), often linked to high biomass values (>70 mg chl a · m−2) and low detritus ratio. Conversely, the second assemblage comprised occasional species (occurrence from 10% to 50%), mainly microbenthic (>30 μm) and epipelic (moving cells), occurring during summer at muddy sites. This assemblage, characterized by low diversity, high biomass variability, and high detritus ratio, was dominated by Scolioneis tumida or Plagiotropis vitrea and Navicula spartinetensis. Whereas hydrodynamics globally explained the gradual assemblage changes throughout the entire mudflat and the year, oyster beds and ridge and runnel features appeared to be local spatial structuring factors allowing the establishment of specific assemblages. This study suggests a significant role for epipsammon biomass, until now underestimated, in the functioning of this turbid coastal ecosystem. [ABSTRACT FROM AUTHOR]

The article reports on the results of a study of a biacore method for screening eight sulfonamides in milk and porcine muscle tissues according to European decision 2002/657/EC. A description of the experimental set-up and measurement method is presented. The study detected eight different sulfonamides, of which sulfamethazine, sulfamerazine and sulfadiazine are authorized in France.

The article discusses the use of scale measurement as a conservation tool on endangered Zingel asper in France. It states that Z. asper inhabits the grayling and the upper barbel zones of rivers and were monitored by a capture-mark-recapture (CMR) protocol. Moreover, the scale reading method, back-calculation, validation of the back-calculation method and the growth rate analysis are also discussed. Furthermore, it has been stated that scale reading and back-calculations are standard methods in freshwater fish biology provided by CMR protocol that allows validation of back-calculation method and growth rate estimates..

Located in the south-eastern part of the Bay of Biscay, the Capbreton Canyon incises the continental shelf up to the 30 m isobath contour, and acts as a natural conduit for continental and shelf-derived sediments. EM1000 multibeam bathymetry shows two main features characterising the canyon — a deeply entrenched meandering channel, bordered by fluvial-like terraces constituting large sediment traps. A dataset of cores and seismic profiles together with a multibeam bathymetry map has enabled the characterisation of recent sedimentary activity in the axial channel and on the terraces. Data analysis evidenced the major role of the canyon head in recent sediment dynamics. This part of the canyon is a temporary reservoir for sediments, accumulated by coastal hydrodynamic processes. Exceptional climatic, tectonic or hydrodynamic events can mobilise the sediments and generate gravity-driven flows. Under the present-day sea-level highstand conditions, these flows are not powerful enough to bring their bedload to the deep sea, and are confined mainly to the upper part of the canyon. Turbidity currents model the axial channel pathway and are at the origin of terrace formation. Terraces in the Capbreton Canyon are not typical but rather are reduced to confined levees. Three factors control the vertical growth of a terrace: (1) the amount of overspilled sediments brought by turbidity currents, (2) hemipelagic sedimentation and (3) terrace height. The amount of sediment spilling over a terrace decreases with increased terrace elevation. Concurrently, the proportion of hemipelagic fallout depositing on a terrace increases. Terraces are considered to be fossil when the height of the terrace prevents further deposition by overspilling. The terraces studied in this paper are interpreted as having formed during the Holocene, implying that the sediment dynamics of the Capbreton Canyon is continuous through time. Highstand periods differ from lowstand periods because they show a decrease in the energy of erosive processes. Temporal variations in erosive and depositional processes in the canyon are controlled by the Adour River, which delivers large amounts of sediment to the system. [ABSTRACT FROM AUTHOR]

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— The health costs of alcohol-related problems in France were estimated using two cost evaluation approaches: (1) estimate based on the proportion of cases attributable to alcohol abuse (the alcohol abuse factor); (2) estimate based on prevalence of alcohol abuse for in- and out-patients. For a 10% prevalence of alcohol abuse in the general population, the minimum cost in 1996 was about US$ 2300 million; for a prevalence of 15% it was US$ 2700 million. This cost concerns the health disorders that are linked directly or indirectly to alcohol abuse. It did not allow for injuries from accidents caused by alcohol intoxication and undervalued the cost of out-patient care. Based on the prevalence of alcohol-related disorders seen at hospitals, a percentage of the total in-patient and out-patient costs due to effects of alcohol could be estimated. However, this did not permit an estimate of the cost of care in which alcohol abuse was a risk factor only. Based on the available data showing that between 3% and 10% of inpatients have a directly alcohol-related condition, estimates of in-patient treatment costs varied from US$ 1300 to 2100 million. Among adult out-patients, 20% present with a disorder in which alcohol is a factor or suffer from an alcohol-related illness, which corresponds to a cost of about US$ 1600 million. Thus, these methods yield minimum year's cost estimated between US$ 2500 and 3300 million. These costs are high, compared to the low level of financing for the specialized facilities offering treatment to people in difficulty due to alcohol excess, which was US$ 23 million in that year. As regards social and total costs, estimates from four Western countries have found that about 75% of the total costs of alcohol abuse was attributable to social harm, and 25% to medical costs. Applying this ratio to the French data gives an estimated total cost to French society of about US$ 13 200 million, i.e. 1.04% of the gross national product. [ABSTRACT FROM PUBLISHER]

This article discusses the origins and research themes of the Programme Interdisciplinaire de Recherche sur la Ville (PIR Villes), a research initiative launched in France, with particular emphasis on urban public policy. In early 1992 a number of bodies took the initiative to create an interdisciplinary research program on cities, entitled the Centre National de Recherche Scientifique (CNRS). It can be seen that the program not only brings together the body responsible for basic research and the main agencies of urban planning, but also creates bridges between the different technical ministries specializing in urban issues which had allegedly developed in an isolated way. The presence of the Caisse des Dépôts et Consignations is due to its role as one of the main sources of loans for the construction of social housing, and, through its subsidiaries, as one of the main banks for local collectives. Apparently, the creation of the PIR Villes initiative is linked to the crisis of the suburbs in France, but its birth also results from a desire to overcome the division which has existed in France between two types of research. On the one hand, from the 1960s, the technical ministries responsible for planning and housing policies gradually developed their own research capacities. On the other hand, over the same period, the CNRS had developed a body of research which directly or indirectly addressed the same questions.

The beginning of legal town planning in France is commonly dated back to the period 1919-1924. The acts which were adopted at the time made official a view of town plans which attempted to encompass a whole series of specific policies — environmental improvement via public art, the regulation of road provision, the sanitation of existing blocks and the setting up of new districts. The principle of making town-planning programmes compulsory was first discussed by the French Chamber of Deputies in 1909, on the basis of ideas put forward by social reformers and experts in architecture and public health. The projects were proposed there by members of parliament, who belonged to the center and center-left. But as the issue of town planning was linked from the start to the issue of the reform of compulsory purchase, increasing the powers of the communes and the government, the adoption of these projects was deferred from year to year until the war. Various measures, which were welcomed by a first generation of French town planners as though they were opening up a new era and bringing about a break with the past, have left but very faint traces today and had almost no impact.

• The Tertre Rouge kaolin deposit replaces ordovician schists of the Armorican Massif. • Al-phosphates are major concentrators of LREE and Sr. • Kaolinization was mainly produced by Paleogene weathering. • A minor, older hydrothermal event is suggested by high-T clay mineral veinlets. Several kaolinite occurrences of economic interest have been reported in Europe and are usually interpreted as resulting from weathering during the Paleogene tropical climate. However, a hydrothermal contribution is also recognized in some kaolinite occurrences. Such occurrences are common throughout the Hercynian Armorican Massif, where they are developed mostly on granitoids. The kaolin deposit of the Tertre Rouge pit, South Brittany (France), has been mined for the past 70 years. It is the only deposit developed from carbon-rich (~1% C) Ordovician schists affected by a low-grade metamorphic event during the late Hercynian orogeny. Herein, we report the results of a detailed field and petrological study combining optical microscopy with SEM investigation, XRD analyses, and ICP-OES and ICPMS geochemical data. A typical weathering profile was identified in the pit. It is marked from the bottom to the top by an increasing kaolinite volume (~45%) at the expense of muscovite/illite, a decreasing volume of chlorite and graphite, and numerous occurrences of Fe oxides/oxyhydroxides that replaced former pyrites or sulfates in veins. Despite this intense weathering, the analyzed Tertre Rouge schists preserved a black shale bulk chemical composition characterized by lithophile trace elements contents at 2× to 5× the Upper Continental Crust composition. This was made possible by accessory minerals inherited from the parent rock, especially Al phosphates, namely florencite (Ce), which were systematically identified as the main concentrators of LREE and Sr. Their occurrence in the Tertre Rouge kaolinized schist confirms the regional Sr and P geochemical anomalies previously reported in the Paleozoic sedimentary formations in this area of the Armorican Massif. High temperature clay minerals, pyrophyllite (>270 °C) and nacrite/dickite (generally considered to be high-T kaolinite polymorphs), were also identified inside the weathered zone, filling millimeter-thick veinlets cutting across or lying parallel to the cleavage plane S of the schist. We ascribe this high-temperature clay mineral assemblage to a hydrothermal event related to the numerous documented evidences of Late Hercynian fluid circulations in Central/South Armorican tectonometamorphic domains. Hence, we strongly favor a two-stage formation for the Tertre Rouge kaolin deposit, including a minor hydrothermal contribution to weathering-related kaolinite. [ABSTRACT FROM AUTHOR]

High-throughput sequencing of two lettuces showing virus-like symptoms in France provided evidence of infection by members of the family Secoviridae. One plant (JG1) had a complex mixed infection that involved, among others, a novel waikavirus (lettuce waikavirus 1) and two isolates of a sequivirus related to lettuce mottle virus (LeMoV). The second lettuce plant (JG2) was singly infected by LeMoV. Complete genomic sequences were obtained for all four isolates and, in addition, near complete genome sequences were obtained for other LeMoV or LeMoV-related isolates (from French cultivated and wild lettuces and from a Brazilian cultivated lettuce) and for two isolates of another family Asteraceae-infecting sequivirus, dandelion yellow mosaic virus (DaYMV). Analysis of these genomic sequences allows the proposal of tentative genome organization for the various viruses and clarification of their phylogenetic relationships. Sequence and host range comparisons point to significant differences between the two sequivirus isolates identified in the JG1 plant and LeMoV isolates from France and Brazil, suggesting they belong to a novel species for which the name lettuce star mosaic virus is proposed. [ABSTRACT FROM AUTHOR]

Objective The HAS-BLED, ATRIA, and HEMORR 2 HAGES risk scores were created to evaluate individual bleeding risk in atrial fibrillation (AF). We sought to estimate and compare the predictive ability of these scores for major hemorrhage in AF, including elderly (≥ 80 years) and non-elderly (< 80 years) patients. Methods This cross-sectional study is based on the French National Hospital Database (PMSI), which covers the entire French population. Data from all patients with an AF diagnosis in 2012 were extracted. Demographic and comorbidity data were used to calculate the three bleeding risk scores for each patient. Patients hospitalized with a principal diagnosis of major bleeding were identified. Results Of the 533,044 AF patients identified, 53.2% were ≥ 80 years; 7013 patients (1.3%) were hospitalized for a bleeding event (1785 for intracranial hemorrhage). Bleeding occurred more frequently in patients with higher HAS-BLED, HEMORR 2 HAGES, and ATRIA scores. In patients ≥ 80 years, the c-statistics did not differ (p = 0.27) between HAS-BLED (0.54; 95% confidence interval [CI]: 0.53–0.54), HEMORR 2 HAGES (0.53; 95% CI: 0.53–0.54), and ATRIA (0.53; 95% CI: 0.52–0.54). In patients < 80 years, HAS-BLED (0.59; 95% CI: 0.58–0.60) had a slightly higher c-statistic than HEMORR 2 HAGES (0.56; 95% CI: 0.55–0.57) and ATRIA (0.55, 95% CI: 0.55–0.56) (p < 0.0001). Conclusions Given its simplicity and similar performance, HAS-BLED may be an attractive alternative to HEMORR 2 HAGES for estimation of bleeding risk in AF patients < 80 years. However, accurate determination of bleeding risk among the elderly is difficult with existing risk-prediction scores, indicating a clear need for improvement in their clinical utility. [ABSTRACT FROM AUTHOR]

Introduction: Esophageal and gastroesophageal junction cancer (EC/GEJC) is a poor prognosis disease with a high risk of recurrence even in patients curatively resected. Adjuvant nivolumab is currently used for patients with completely resected (R0) EC/GEJC who have residual pathologic disease following prior neoadjuvant chemoradiotherapy. This study aimed to determine the cost effectiveness of nivolumab in this indication in France according to the collective perspective excluding indirect costs.A simplified four-health-state semi-Markov model was developed to model EC/GEJC patients who have residual disease after neoadjuvant chemoradiotherapy followed by R0 over a 15-year time horizon, comparing adjuvant nivolumab versus surveillance, which was the recommended French clinical practice before immunotherapy arrival. Time-to-recurrence (TTR) from CheckMate 577 was used to inform transition from disease-free to post-recurrence health state; patients who recurred were split according to the distribution of type of recurrence observed during the trial. Post-recurrence survival (PRS) according to the type of recurrence was derived from a real-world registry.Adjuvant treatment with nivolumab led to an incremental survival gain of 1.19 years (+ 34%), mostly in the disease-free state, an incremental cost of €48,634 and QALY of 0.98 resulting in an incremental cost-utility ratio (ICUR) of €49,572/QALY with limited uncertainty. ‘Cure assumption’ at 5 years had an important impact on the results (€41,115/QALY; − 17%), as that tends to increase life-years and QALYs while costs remain the same. Probabilistic sensitivity analyses confirmed reference ICUR (€52,542/QALY) with 80% probability of nivolumab being cost effective at a willingness-to-pay threshold of €75,000/QALY.Our analysis suggests that adjuvant nivolumab is cost effective in the treatment of EC/GEJC patients who have residual disease after neoadjuvant CRT followed by R0 resection. Compared with previously evaluated cost-effectiveness analyses for other immune-checkpoint inhibitors indicated in metastatic settings, ICUR appears particularly low in this early setting thanks to the important impact on health outcomes and capped treatment duration.Materials and Methods: Esophageal and gastroesophageal junction cancer (EC/GEJC) is a poor prognosis disease with a high risk of recurrence even in patients curatively resected. Adjuvant nivolumab is currently used for patients with completely resected (R0) EC/GEJC who have residual pathologic disease following prior neoadjuvant chemoradiotherapy. This study aimed to determine the cost effectiveness of nivolumab in this indication in France according to the collective perspective excluding indirect costs.A simplified four-health-state semi-Markov model was developed to model EC/GEJC patients who have residual disease after neoadjuvant chemoradiotherapy followed by R0 over a 15-year time horizon, comparing adjuvant nivolumab versus surveillance, which was the recommended French clinical practice before immunotherapy arrival. Time-to-recurrence (TTR) from CheckMate 577 was used to inform transition from disease-free to post-recurrence health state; patients who recurred were split according to the distribution of type of recurrence observed during the trial. Post-recurrence survival (PRS) according to the type of recurrence was derived from a real-world registry.Adjuvant treatment with nivolumab led to an incremental survival gain of 1.19 years (+ 34%), mostly in the disease-free state, an incremental cost of €48,634 and QALY of 0.98 resulting in an incremental cost-utility ratio (ICUR) of €49,572/QALY with limited uncertainty. ‘Cure assumption’ at 5 years had an important impact on the results (€41,115/QALY; − 17%), as that tends to increase life-years and QALYs while costs remain the same. Probabilistic sensitivity analyses confirmed reference ICUR (€52,542/QALY) with 80% probability of nivolumab being cost effective at a willingness-to-pay threshold of €75,000/QALY.Our analysis suggests that adjuvant nivolumab is cost effective in the treatment of EC/GEJC patients who have residual disease after neoadjuvant CRT followed by R0 resection. Compared with previously evaluated cost-effectiveness analyses for other immune-checkpoint inhibitors indicated in metastatic settings, ICUR appears particularly low in this early setting thanks to the important impact on health outcomes and capped treatment duration.Results: Esophageal and gastroesophageal junction cancer (EC/GEJC) is a poor prognosis disease with a high risk of recurrence even in patients curatively resected. Adjuvant nivolumab is currently used for patients with completely resected (R0) EC/GEJC who have residual pathologic disease following prior neoadjuvant chemoradiotherapy. This study aimed to determine the cost effectiveness of nivolumab in this indication in France according to the collective perspective excluding indirect costs.A simplified four-health-state semi-Markov model was developed to model EC/GEJC patients who have residual disease after neoadjuvant chemoradiotherapy followed by R0 over a 15-year time horizon, comparing adjuvant nivolumab versus surveillance, which was the recommended French clinical practice before immunotherapy arrival. Time-to-recurrence (TTR) from CheckMate 577 was used to inform transition from disease-free to post-recurrence health state; patients who recurred were split according to the distribution of type of recurrence observed during the trial. Post-recurrence survival (PRS) according to the type of recurrence was derived from a real-world registry.Adjuvant treatment with nivolumab led to an incremental survival gain of 1.19 years (+ 34%), mostly in the disease-free state, an incremental cost of €48,634 and QALY of 0.98 resulting in an incremental cost-utility ratio (ICUR) of €49,572/QALY with limited uncertainty. ‘Cure assumption’ at 5 years had an important impact on the results (€41,115/QALY; − 17%), as that tends to increase life-years and QALYs while costs remain the same. Probabilistic sensitivity analyses confirmed reference ICUR (€52,542/QALY) with 80% probability of nivolumab being cost effective at a willingness-to-pay threshold of €75,000/QALY.Our analysis suggests that adjuvant nivolumab is cost effective in the treatment of EC/GEJC patients who have residual disease after neoadjuvant CRT followed by R0 resection. Compared with previously evaluated cost-effectiveness analyses for other immune-checkpoint inhibitors indicated in metastatic settings, ICUR appears particularly low in this early setting thanks to the important impact on health outcomes and capped treatment duration.Conclusions: Esophageal and gastroesophageal junction cancer (EC/GEJC) is a poor prognosis disease with a high risk of recurrence even in patients curatively resected. Adjuvant nivolumab is currently used for patients with completely resected (R0) EC/GEJC who have residual pathologic disease following prior neoadjuvant chemoradiotherapy. This study aimed to determine the cost effectiveness of nivolumab in this indication in France according to the collective perspective excluding indirect costs.A simplified four-health-state semi-Markov model was developed to model EC/GEJC patients who have residual disease after neoadjuvant chemoradiotherapy followed by R0 over a 15-year time horizon, comparing adjuvant nivolumab versus surveillance, which was the recommended French clinical practice before immunotherapy arrival. Time-to-recurrence (TTR) from CheckMate 577 was used to inform transition from disease-free to post-recurrence health state; patients who recurred were split according to the distribution of type of recurrence observed during the trial. Post-recurrence survival (PRS) according to the type of recurrence was derived from a real-world registry.Adjuvant treatment with nivolumab led to an incremental survival gain of 1.19 years (+ 34%), mostly in the disease-free state, an incremental cost of €48,634 and QALY of 0.98 resulting in an incremental cost-utility ratio (ICUR) of €49,572/QALY with limited uncertainty. ‘Cure assumption’ at 5 years had an important impact on the results (€41,115/QALY; − 17%), as that tends to increase life-years and QALYs while costs remain the same. Probabilistic sensitivity analyses confirmed reference ICUR (€52,542/QALY) with 80% probability of nivolumab being cost effective at a willingness-to-pay threshold of €75,000/QALY.Our analysis suggests that adjuvant nivolumab is cost effective in the treatment of EC/GEJC patients who have residual disease after neoadjuvant CRT followed by R0 resection. Compared with previously evaluated cost-effectiveness analyses for other immune-checkpoint inhibitors indicated in metastatic settings, ICUR appears particularly low in this early setting thanks to the important impact on health outcomes and capped treatment duration. [ABSTRACT FROM AUTHOR]

The extent and nature of triptan use for headache relief has been evaluated in a large epidemiological survey in the French general population. Over 25 000 individuals were screened for headache and for triptan use. Of this sample, 290 triptan users were identified from whom extensive data on headache characteristics and healthcare resource consumption were obtained. The use of triptans is relatively infrequent, 0.2% in the general population, with only 7.5% of migraine sufferers using these drugs. The majority of triptan users were female (80%) and presented headache characteristics typical of migraine (80%). The remaining 20% of subjects were thus using triptans for headache types in which the utility of these drugs has not been demonstrated. Among migraineurs, triptan consumers reported more frequent and severe headaches than non-consumers, and reported a higher incidence of nausea and vomiting. The principal determinant of triptan prescription was consultation with a general practitioner (GP), which may itself have been triggered by the severity of the headaches. GPs, rather than specialists, are the primary prescribers of triptans in France. [ABSTRACT FROM AUTHOR]

[Display omitted] • Several Francisella spp. isolates were isolated from mussels in Normandy. • Two strain types of Francisella halioticida were found in a same mortality event. • The strain FR21 induced low mortality rates when injected at high dose in adult mussels. Mass mortality events affecting the blue mussels Mytilus edulis have been observed in France since 2014. The DNA of the bacterium Francisella halioticida , reported as pathogen of giant abalone (Haliotis gigantea) and Yesso scallop (Mizuhopecten yessoensis) has been detected recently in mussels from areas suffering mortalities. Isolation of this bacterium was attempted from individuals collected during mortality events. Identification was performed by 16S rRNA gene sequencing, real-time specific PCR and MALDI-ToF using spectra produced from the strain 8472-13A isolated from diseased Yesso scallop in Canada. Five isolates were identified as F. halioticida by real-time specific PCR and 16S rRNA sequencing. MALDI-ToF allowed the direct identification of four isolates (FR22a,b,c,d) which had 100% identity on the 16S rRNA gene with the known strains. On the other hand, one isolate (FR21) was not recognized by MALDI-ToF and had 99.9% identity on the 16S rRNA gene. The FR22 isolates showed difficult growth and required media optimization, which was not the case with the FR21 isolate. For these reasons, it was hypothesized that two type strains are present on French coasts, named FR21 and FR22. The FR21 isolate was selected for phenotypic analysis (growth curve, biochemical characteristics, electron microscopy), phylogenetic analysis and an experimental challenge. This isolate showed distinct differences compared to published F. halioticida strains, both at phenotypic and genotypic levels. Experimental infections of adult mussels led to 36% mortalities in 23 days following intramuscular injection with 3 × 107 CFU while a lower dose (3 × 103 CFU) did not lead to significant mortalities. In the context of this study, the strain FR21 was not virulent towards adult mussels. [ABSTRACT FROM AUTHOR]