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Integrative medicine, need to be inoffensive, effective, and of quality (World Health Organization). In 2010, the American Society of Teachers of Family Medicine approved 19 competencies for teaching integrative medicine to residents. In 2018, the University of Rennes created a course: "Integrative Medicine and Complementary Therapies". Up until then, the only feedback from the courses was the students' opinions. We investigated the impact on medical students' social representation.We performed a sociological analysis of students' social representations before and after the course. The social representation is based on the way an individual creates his or her universe of beliefs and ideas. After hearing, "What word or group of words comes to mind when you hear people speak of integrative medicine and complementary therapies?", students were asked to provide 5 words/phrases, rank their importance, and show their attitude towards these words/phrases. The frequency and importance of these words/phrases were used to construct social representations (with central cores, and primary and secondary peripheries) before and after the course.Among the 101 students registered, 59 provided complete responses before and 63 after the course. Before, the central core comprised "hypnosis" and "alternative medicine", while after: "complementary care" and "global care". We only identified first periphery before the course: "acupuncture" and "homeopathy". 4 new contrasting elements: "integration with conventional treatment", "patient's choice", "personalisation of care", and "caring relationship of trust".This teaching course positively affected students' social representation of integrative medicine, and might promote their use during future practices.

In school settings, students' mindset about intelligence (i.e., fixed versus growth mindset) and their sense of belonging to school (SBS) have both been shown to predict academic attainment. However, these constructs have rarely been examined together although both were found to be impacted by students' socioeconomic status (SES). Across the literature, findings are inconsistent concerning this moderating effect of SES. In the present preregistered study, we used data from the French sample of the Programme for International Student Assessment 2018 (PISA; N = 6308) to examine whether growth mindset positively predicted SBS and whether this association was moderated by students' SES. Results showed that growth mindset was positively associated with SBS. On the confirmatory linear regression analyses, we found no moderation effect of any of the SES indicators on the association between growth mindset and SBS. However, pre-registered supplementary multigroup analyses showed descriptively that this association was stronger for high than for low SES students and notably when SES indicators concerned family financial resources. Limitations of this research and perspectives for future studies are discussed, with a focus on why the literature should care about the different meanings and consequences of SES indicators.

In the absence of a contemporaneous measure, the present study aimed to validate a French language translation of the Multidimensional Test Anxiety Scale (MTAS). In addition, measurement invariance was tested for gender and age. The participants were 520 secondary school students aged 11-16 years. A four-factor model of the MTAS showed a good fit to the data, good internal consistency, and the expected relations with trait anxiety and fear of assessment (positive), and examination performance (negative). Scalar invariance was shown for gender and age. Female students reported higher test anxiety scores. Older students reported higher scores on just one MTAS factor (cognitive interference); remaining factors were stable with age. The translated measure will greatly assist researchers and practitioners in the assessment of test anxiety in French language populations.

We investigate the labor market effects of a loan guarantee program targeting French SMEs during the financial crisis. Exploiting differences in regional treatment intensity in a border discontinuity design, we uncover a central trade-off for such interventions. While the program has a positive impact on workers' employment and earnings trajectories that translates into positive aggregate employment effects, it dampens the worker reallocation toward more productive firms that happens following recessions, and particularly so for high-skill workers. This labor allocation effect is economically significant and translates into a reduction in aggregate productivity. [ABSTRACT FROM AUTHOR]

Background: Teacher social support (TSS) has been identified as one of the most important factors of success and well-being for students. Yet, there is a gap in the literature regarding the impact of students' socioeconomic status (SES) on their perceptions of TSS, and whether SES may impact the strength of the relationship between teacher social support and students' sense of belonging to school (SBS). Aims: In this preregistered study, we aimed at filling this gap by testing the moderating role of SES on the TSS-SBS link, along with the direct associations between these variables. Sample: We used data from the French sample of the Programme for International Student Assessment 2018 (PISA; N = 6308). Methods: TSS was primarily assessed as a latent construct based on three indicators provided by PISA--teacher support, teacher emotional support and teacher feedback. Regarding SES, we primarily focused on family wealth possessions and parents' highest level of education. Results: Using structural equation modelling, findings confirmed that the TSS-SBS link was stronger for high-SES than low-SES students. We also found a negative association between teacher support and SES. Importantly, preregistered additional analyses highlight that findings depend on the SES and TSS indicators considered. Conclusions: Findings support the importance of SES effect on students' perceptions of their interactions with teachers and the extent to which they perceive they belong to the school. The implications and limitations of this research are discussed.

The purpose of this study was to better understand how middle school students consider the source of information when processing videos with conflicting information. To this end, we exposed a sample of seventh-graders to a series of videos in which two interviewees expressed divergent positions on a socioscientific issue ('Will organic farming be able to feed the entire world population by 2050?'). After viewing the videos, students were asked to recall the sources they had seen and indicate how far they had perceived the sources to be credible and convincing. Results showed that students paid close attention to the information given about the sources during viewing and rated their credibility accordingly. However, only a minority of students rated the expert sources as the most convincing after viewing the videos, while students' beliefs on the topic contributed to source evaluation. These results suggest that although middle school students may pay attention to the identity of sources when viewing a video, they are unlikely to use this information to assess the reliability of the message. [Spanish translation by Mercè Rius.]

In the teaching of natural science, field trips are a means of bringing students directly into contact with the biological and geological aspects of the environment. The present study explored French students' views of fieldwork and the relationships they establish with the natural environment as a result. We analyzed the responses of 293 primary and secondary school students to a questionnaire administered immediately before and after a fieldwork. Students' interest in fieldwork was based on their affinity for nature and desire to learn, as well as their sensory experience of the natural world and the sense of wellbeing they derived from it. The relationship between affinity, self-interest and situational interest is discussed in terms of how a fieldwork can help to reinforce students' relationship with nature.

This paper reports the results of a study aimed at understanding the processes governing the construction of educational inequalities in French classrooms, the French school system being particularly unequal. Traditional explanations have focused on the factors governing the production of inequalities but have not always shown how these factors translate into learning inequalities in class. Consistent with relational approaches, the study draws on ethnographic research conducted over an 18-month period in 6 socially contrasting Parisian schools. Both students from wealthy families considered to be 'high-achieving' and students from poor families viewed as being 'low-achieving' were observed over the course of full school days to understand the factors that lead them to develop different activities. The evidence suggests that children interpret teacher expectations very differently, although the same expectations were observed in all the classes observed during the study. These expectations point to an invisible curriculum operating alongside the formal curriculum and generally perceived only by high-achieving students, who are able to grasp and understand it through their prior socialization. A further characteristic of the invisible curriculum is that it is rarely made explicit by teachers. This finding highlights the need to further examine explicitation strategies in schools.

This study has two main goals: (a) to compare whether objective and self-reported PA levels, and motivational regulations were similar among European adolescents with different cultural norms, and (b), to analyse whether the associations between those motivational regulations towards objective and self-reported PA levels vary across Spanish and French cultures. Data were collected from 637 adolescents (50.9% Spanish, 40.8% girls). Participants completed questionnaires on motivational variables and subjective PA. Objective PA was assessed by accelerometer. Data were analysed by structural equation modelling and invariance tests. Cross-country differences were found in objective PA levels and motivational factors, with Spanish obtaining higher values than French adolescents. Association of motivational factors with PA was similar regardless of the cultural origin of subjects. This study reinforces the premises of SDT according to cross-country validity. Intervention strategies should focus on encouraging the most self-determined motivational forms regardless of the culture of origin.

This paper deals with the question of French PhDs' career trajectories and especially those that lead to private sector employment. Using quantitative longitudinal survey "Génération" from Céreq, which allows observing professional pathways over the first five years of working life, it shows that for PhDs graduated in 2010, public-sector research remains the main opening. There are few career paths leading to private sector, and PhDs employed in firm found their job at a very early stage in their working life. Data analysis and econometrics methods find that thesis conditions, professional expectations, and early pathways are a key determinant to employment in firms.

We explored the use of field trips for educational and teaching purposes by French kindergarten, primary-school teachers and natural science teachers in secondary schools. More specifically, we studied field trips in a "natural" environment by undertaking a French curriculum analysis and surveying teachers. We examined the responses of 511 teachers about their practices and motivations, as well as the levers and barriers to implementing these field trips. Results showed that this practice is widespread at all years of education, and differences between years seem to be related to the curriculum. We found few differences in learning motivations (reasons/objectives and interests/specific feature) and perceived barriers between different school teachers. Indeed, the teachers' motivations are essentially scientific and rooted in a scientific inquiry approach. Studying 'on real' was the interest most often cited by teachers, essentially for the purpose of scientific learning. The only notable difference we found concerns the levers for implementing the field trips: a larger proportion of kindergarten and primary-school teachers see field trips as an ideal support for environmental and sustainable development educations. These results are dependant of the French official curriculum which plays a key role in influencing the current implementation of school-organised field trips by the teachers.

Purpose: The aim was to identify the competencies professionals need to promote co-creation engagement within communities. Design/methodology/approach: Co-creation could contribute to building community capacity to promote health. Professional development is key to support co-creative practices. Participants were professionals in a position to promote co-creation processes in health-promoting welfare settings across Denmark, Portugal, France and United Kingdom. An overarching unstructured topic guide was used within interviews, focus groups, questionnaires and creative activities. Findings: The need to develop competencies to promote co-creation was high across all countries. Creating a common understanding of co-creation and the processes involved to increase inclusivity, engagement and shared understanding was also necessary. Competencies included: How to run co-creation from the beginning of the process right through to evaluation, using feedback and communication throughout using an open action-oriented approach; initiating a perspective change and committing to the transformation of co-creation into a real-life process. Practical implications: Overall, learning about underlying principles, process initiation, implementation and facilitation of co-creation were areas identified to be included within a co-creation training programme. This can be applied through the framework of enabling change, advocating for co-creative processes, mediating through partnership, communication, leadership, assessment, planning, implementation, evaluation and research, ethical values and knowledge of co-creative processes. Originality/value: This study provides novel findings on the competencies needed for health promoting professionals to embed co-creative processes within their practice, and the key concerns that professionals with a position to mediate co-creation have in transferring the abstract term of co-creation into a real-world practice.

Background: Capacity building and community-level participation are important to enhance the efficiency and sustainability of health promotion programmes, as well as to promote empowerment and decision-making power. However, stakeholders' participation in the design and implementation of health promotion projects often involves the provision of information and consultation rather than partnership or citizen control, especially in school settings. Co-creation could be a means to support higher levels of participation, yet its definition remains unclear. A further challenge relates to the methods needed to promote participation. Examining what co-creation represents for health promoters could help in both of these respects. Objectives and goals: This study explored how school health promotion professionals perceived and defined co-creation to gain insight into how to encourage co-creation processes in school-based health promotion. Methods: Qualitative data including documents and illustrations were collected during creative thinking activities undertaken with school health promotion professionals. All data collected were transcribed and analysed using a three-stage screening process. Results: Co-creation is a multi-dimensional construct. Based on our findings, it is a voluntary-based process of bottom-up collaboration informed by values of diversity, mutual trust, openness, autonomy, freedom, respect and shared expertise, responsibility and decision-making. Co-creation can result in out-of-the-box, new or improved tailored health-promoting practices and projects, which address a co-defined need, for the benefit of all members of the group. Conclusion: Co-creation is timely and key in school health promotion practices. Further research is needed into the specific competences needed to promote co-creation, as well as the methods used to evaluate achievements and added value of co-creation at different levels of implementation.

In his teaching, Charcot often used artistic representations from previous centuries to illustrate the historical developments of various conditions, particularly hysteria, mainly with the help of his pupil Paul Richer. Charcot liked to draw portraits and sketches of colleagues during boring faculty meetings and students’ examinations, including caricatures of himself and others, church sculptures, landscapes, soldiers, and so on. He also used this skill in his clinical and scientific work. He drew histological or anatomic specimens, as well as patients’ features and demeanor. His most daring artistic experiments were drawing under the influence of hashish. Charcot’s tastes in art were conservative; he displayed little interest for the avant-gardes of his time, including impressionism, or for contemporary musicians, such as César Franck or Hector Berlioz. The pamphleteer Léon Daudet described Charcot’s home as a pseudo-gothic kitsch accumulation of heteroclite pieces of furniture and materials. However, he taught medicine not only as a science but also as an art, a style that has now been almost universally forgotten. [ABSTRACT FROM AUTHOR]

Background: The aging population in France and Western Europe is on the rise, particularly among individuals aged 65 years and older. Although older adults are susceptible to traumatic injuries, they constitute a minority of trauma center admissions especially those aged 85 and above. The aim of our study was to investigate the prognostic factors for mortality among the older old population (aged 85 years and above) managed in ICU of Traumabase group trauma centers. Methods: This retrospective observational cohort study, conducted from 2013 to 2022, analyzed all severely injured older patients (aged ≥ 85 years) managed in 14 ICU trauma centers enrolled in the Traumabase registry. The study examined sociodemographic, clinical, and outcome variables. Frailty was assessed using the Clinical Frailty Scale. Results: Among the 365 older trauma patients, 190 (52.1%) were classified as non-frail (CFS 1–3), 80 (21.9%) as pre-frail (CFS 4,5), and 95 (26%) as frail (CFS 6–9). Falls were the most common mechanism of injury. High mortality rates were observed, with 43.5% ICU mortality and 45.5% mortality at day 30. Factors most associated with ICU mortality included traumatic brain injury (CGS < 13), pre-hospital micromethod hemoglobin < 13 and severity of injury (ISS > 16). Conclusion: Factors such as traumatic brain injury and severe hemorrhage (micromethod hemoglobin < 13) and ISS > 16 are associated with ICU mortality in in patients older than 85 years trauma patient. Early geriatric intervention is crucial for optimizing outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

The article discusses the ongoing struggles within French pediatric nephrology, highlighting a survey revealing that many pediatric nephrologists work excessively long hours and face mental health challenges, reflecting a broader crisis in the field. It mentions the "Assises de la Pédiatrie et de la Santé de l'Enfant," launched on December 7, 2022, by the French Health Ministry, aimed at addressing pediatric healthcare issues.

Background: Rubinstein-Taybi syndrome (RSTS) is a multiple congenital anomaly syndrome characterised by several typical somatic characteristics and by developmental disabilities with various degrees of severity. Focusing on children with RSTS, the aim of this study was to describe their psychomotor, cognitive, and socio-emotional developmental profiles. Method: Twenty-three children with RSTS (12 boys; 11 girls; mean chronological age: 4 years and 10 months) with severe intellectual disability (mean developmental quotient = 32.39) were recruited from an Expert Department of Medical Genetics. Developmental assessments were carried out with the Brunet-Lézine-Revised scale and the Social Cognitive Evaluation Battery. Results: The participants' developmental profiles were characterised by heterogeneous psychomotor development, homogeneous cognitive and socio-emotional development, by more severe delays in expressive language, vocal imitation, and symbolic play skills, and by better developmental levels in socio-emotional abilities. Conclusions: Based on these atypical developmental profiles, early interventions should target the three most delayed abilities.

This article provides an assessment of French media coverage of intelligence research. The analysis is based on articles published between 1992 and 2020 in French nationwide newspapers, local newspapers and science magazines. Two themes regularly appear in nationwide newspapers and science magazines: environmental effects on IQ and animal intelligence. High-IQ children are often covered in local newspapers. A substantial proportion of articles on the genetics of intelligence, IQ in general and behavioural genetics in general contain statements contradicting the conclusions of mainstream intelligence research; the tendency is even more pronounced in science magazines than in nationwide newspapers. Implications for relationships between scientists and journalists are discussed.

Children and adolescents with ASD are increasingly included in regular school settings, however little is known about how placement decisions are made. In the present study, we examined the types and duration of school attendance among children and adolescents in the ELENA Cohort, a multi-center study of children and adolescents with ASD, ages 2-16 years, in France. Results showed that 88% of subjects were attending school and that children and adolescents with more severe adaptive and cognitive deficits were less likely to attend school. The results provide a topography on school inclusion and ASD in France. Challenging behaviors and sensory processing difficulties were associated with partial-inclusion; and co-occurring anxiety symptoms were associated with inclusion on a full-time basis.

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Background: Intravenous steroid pulses (SP) are successfully used for the treatment of patients with idiopathic nephrotic syndrome (INS) resistant to oral prednisone. Methods: We performed a retrospective analysis of all patients in the three pediatric nephrology centers of the Paris region from 2002 to 2022 who were resistant to a 30-day course of oral prednisone and who received SP for their first INS flare and analyzed their disease course over 4 years. Results: Forty-seven patients (17 girls), median age 3.4 years, were analyzed. Of them, 68% reached remission within 7 days of SP. No significant short-term side effects were noted. Half of the patients started immunosuppressive treatment immediately after their first remission and 62% of them relapsed at least once, whereas all the patients who did not receive immunosuppressive treatment since their first remission relapsed. Among the SP-sensitive patients, 75% needed calcineurin inhibitor (CNI) or B-cell depletion during their disease course to achieve stable remission. Forty-two percent of the whole cohort received B-cell-depleting agents. Among the 15 SP-resistant patients, all received CNI. Twelve/fifteen patients reached remission. After 4 years, 68% among the SP-sensitive patients and 87% of SP-resistant patients still had an active disease. Conclusions: SP are helpful to obtain rapid remission in pediatric INS patients resistant to oral steroids. However, as most SP-sensitive patients need immunosuppressive drugs, mainly CNI and B-cell-depleting agents it could be interesting to discuss the possibility to start CNI directly after the 30-day course of prednisone instead of SP. [ABSTRACT FROM AUTHOR]

Background: Neurological complications pose a significant threat in pediatric hemolytic and uremic syndrome (HUS) resulting from infections with Shiga toxin-producing Escherichia coli (STEC), with no established treatment. The involvement of complement activation in the pathogenesis of STEC-HUS is acknowledged, and eculizumab (ECZ), a terminal complement blocker, has been documented in several pediatric series with inconsistent results. Antibody-mediated mechanisms have also been suggested, with IgG-immunoadsorption (IgIA) showing promise in adults with neurological complications. We aimed to assess the benefit of combining IgIA with ECZ in pediatric patients with neurological STEC-HUS compared to patients treated with ECZ alone or supportive care. Methods: Multicenter retrospective study conducted on pediatric patients (< 18 years) with neurological STEC-HUS treated with IgIA + ECZ or ECZ alone from 2010 to 2020 in France. A historical cohort treated with supportive care served as controls. Primary outcome included survival and neurological evaluation at 1-year follow-up (dichotomized as normal vs. abnormal). Results: A total of 42 children were included: 18 treated with IgIA + ECZ, 24 with ECZ alone, and 27 with supportive care. Although there was no significant difference in survival between groups, three deaths occurred in the control group in the acute phase, while none was reported in both the IgIA + ECZ and ECZ alone groups, despite presenting with more severe neurological symptoms for IgIA + ECZ patients. No significant association was found between treatment group and 1-year neurological evaluation after adjustment for age, sex, and initial neurological presentation. Conclusions: Systematic association of IgIA + ECZ is not supported for all neurological STEC-HUS pediatric patients; potential rescue therapy for severe cases warrants consideration. [ABSTRACT FROM AUTHOR]

Based on the complex dynamic system approach, this research aimed to study the variability of the typical configurations of interactions between the adults' participation and the engagement of a child with autism spectrum disorder (ASD) in two activities proposed in a French preschool. The classroom sessions were filmed once a month for 8 months and focused on two activities (free play and adult-led activities). The results of this preliminary exploration revealed that the typical interactions developed differently over time. Indeed, during activities that are adult led, observation behaviors with a passive participation of the adult intensified. Moreover, active engagement behaviors, without and with adult participation, increased meaningfully during free play.

Assess the changes in post‐traumatic stress disorder (PTSD), burnout, anxiety, depression, jobstrain, and isostrain levels over time among healthcare workers in emergency departments (EDs) after successive outbreaks of COVID‐19. A prospective, multicenter study was conducted in 3 EDs and an emergency medical service. Healthcare workers who participated in our previous study were invited to participate in a follow‐up 16 and 18 months and completed the questionnaires to assess symptoms of PTSD, burnout, anxiety, depression, jobstrain, and isostrain. Among the 485 healthcare workers asked to participate, 211 (43.5%) completed the survey at inclusion (122 were followed up at 3 months) and 59 participate to the follow‐up study. At 16 months, 10.9% of healthcare workers had symptoms of PTSD and 17.4% at 18 months. At inclusion, 33.5% and 11.7% of healthcare workers had symptoms of anxiety and depression, respectively. A decrease in anxiety between inclusion and 16 months (p = 0.02) and an increase between 16 and 18 months (p = 0.009) was observed. At inclusion, 40.8% of all healthcare workers had symptoms of burnout. There was an increase in symptoms of burnout between inclusion and 18 months (p = 0.006). At inclusion, 43.2% and 29.5% of healthcare workers were exposed to jobstrain and isostrain, respectively. Jobstrain were higher among paramedics and administrative staff compared to physicians (p = 0.001 and p = 0.026, respectively). Successive outbreaks of COVID‐19 led to long‐term mental health consequences among ED healthcare workers that differed according to occupation. This must be taken into account to rethink the management of teams. [ABSTRACT FROM AUTHOR]

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) down-regulates angiotensin-converting enzyme 2, potentially increasing angiotensin II. We hypothesized that losartan compared to usual care decreases mortality and is safe in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the effect of losartan versus usual care on 28-day mortality in patients hospitalized for acute COVID-19. Methods Eligibility criteria included adults admitted for acute COVID-19. Exclusion criteria were hypotension, hyperkalemia, acute kidney injury, and use of angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors within 7 days. Participants were randomized to losartan 25–100 mg/day orally for the hospital duration or 3 months or the control arm (usual care) in 29 hospitals in Canada and France. The primary outcome was 28-day mortality. Secondary outcomes were hospital mortality, organ support, and serious adverse events (SAEs). Results The trial was stopped early because of a serious safety concern with losartan. In 341 patients, any SAE and hypotension were significantly higher in the losartan versus usual care groups (any SAE: 39.8% vs 27.2%, respectively, P =.01; hypotension: 30.4% vs 15.3%, respectively, P <.001) in both ward and intensive care patients. The 28-day mortality did not differ between losartan (6.5%) versus usual care (5.9%) (odds ratio, 1.11 [95% confidence interval,.47–2.64]; P =.81), nor did organ dysfunction or secondary outcomes. Conclusions Caution is needed in deciding which patients to start or continue using ARBs in patients hospitalized with pneumonia to mitigate risk of hypotension, acute kidney injury, and other side effects. ARBs should not be added to care of patients hospitalized for acute COVID-19. Clinical Trials Registration NCT04606563. [ABSTRACT FROM AUTHOR]

Background: Previous retrospective research has shown that maintaining prone positioning (PP) for an average of 40 h is associated with an increase of survival rates in intubated patients with COVID-19-related acute respiratory distress syndrome (ARDS). This study aims to determine whether a cumulative PP duration of more than 32 h during the first 2 days of intensive care unit (ICU) admission is associated with increased survival compared to a cumulative PP duration of 32 h or less. Methods: This study is an ancillary analysis from a previous large international observational study involving intubated patients placed in PP in the first 48 h of ICU admission in 149 ICUs across France, Belgium and Switzerland. Given that PP is recommended for a 16-h daily duration, intensive PP was defined as a cumulated duration of more than 32 h during the first 48 h, whereas standard PP was defined as a duration equal to or less than 32 h. Patients were followed-up for 90 days. The primary outcome was mortality at day 60. An Inverse Probability Censoring Weighting (IPCW) Cox model including a target emulation trial method was used to analyze the data. Results: Out of 2137 intubated patients, 753 were placed in PP during the first 48 h of ICU admission. The intensive PP group (n = 79) had a median PP duration of 36 h, while standard PP group (n = 674) had a median of 16 h during the first 48 h. Sixty-day mortality rate in the intensive PP group was 39.2% compared to 38.7% in the standard PP group (p = 0.93). Twenty-eight-day and 90-day mortality as well as the ventilator-free days until day 28 were similar in both groups. After IPCW, there was no significant difference in mortality at day 60 between the two-study groups (HR 0.95 [0.52–1.74], p = 0.87 and HR 1.1 [0.77–1.57], p = 0.61 in complete case analysis or in multiple imputation analysis, respectively). Conclusions: This secondary analysis of a large multicenter European cohort of intubated patients with ARDS due to COVID-19 found that intensive PP during the first 48 h did not provide a survival benefit compared to standard PP. [ABSTRACT FROM AUTHOR]

Study Objective: The present study is aimed at providing an assessment of the changes in burnout, job strain, isostrain, sleepiness, and fatigue levels over time and identifying factors associated with these symptoms among healthcare workers in French emergency departments (EDs). Method: We conducted a prospective, multicenter study in four EDs and an emergency medical service. Participants completed questionnaires at inclusion and at 90 days to assess burnout, job strain, isostrain, sleepiness, and fatigue. Results: A total of 211 respondents (43.5%) completed the questionnaires at inclusion. At the beginning of the study, 84 (40.8%) participants presented symptoms of burnout, 86 (43.2%) had symptoms of job strain, and 58 (29.4%) of isostrain. Forty‐two (20.1%) healthcare workers presented symptoms of sleepiness, and 8 (3.8%) had symptoms of fatigue. We found that symptoms of burnout were more frequent for healthcare workers with a previous psychiatric history (55.3% vs. 39.1%, p = 0.02) and were lower among participants who had at least one dependent child (33.1% vs. 48.3%, p = 0.013). Symptoms of job strain were higher among administrative staff compared to physicians (55.6% vs. 28.7%, p = 0.01) and among healthcare workers with managerial responsibilities compared to those without (45.6% vs. 28.8%, p = 0.015). Symptoms of isostrain were higher among administrative staff (42.3%) compared to paramedics (34.1%) and physicians (19.8%, p = 0.026). Conclusion: We identified that potential factors associated with the emergence of symptoms of burnout and job strain are suggested, underlining several areas of improvement for the prevention against mental health disorders in the specific population of ED healthcare workers. Trial Registration: ClinicalTrials.gov identifier: NCT04383886. [ABSTRACT FROM AUTHOR]

Background: Medial meniscal ramp lesions have recently been an area of interest because of their recognized prevalence in association with anterior cruciate ligament (ACL) ruptures. Anatomically, the medial meniscal ramp is composed of the meniscocapsular ligament in continuity with the semimembranosus muscle and the meniscotibial ligament. Diagnosis of ramp semimembranosus complex (RSC) injuries remains challenging, and their prevalence is likely to be underestimated in comparison with ramp lesions. Purpose: To determine the prevalence of RSC lesions after a complete ACL rupture. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database analysis was performed. The cohort consisted of the first 100 patients with complete ACL rupture confirmed by magnetic resonance imaging (MRI) who underwent knee arthroscopy for ACL reconstruction in 2019. The semimembranosus lesions were identified using MRI by 2 independent radiologists specializing in musculoskeletal imaging. The ramp lesions were initially diagnosed using MRI and then confirmed during arthroscopy by an experienced knee surgeon. The magnitude of rotatory instability was recorded using the pivot-shift test. A multivariate analysis was used to determine the lesions associated with the semimembranosus complex. Results: Of 100 patients, 53 showed lesions of the RSC; among them, 30 ramp lesions were confirmed after arthroscopic evaluation, and 40 semimembranosus lesions (23 without ramp lesion and 17 with ramp lesion) were found using MRI. A positive pivot shift was present in 57% of patients with combined RSC injury (P =.04) compared with 36% in patients without an RSC lesion. Conclusion: Lesions of the RSC were found in more than half of ACL ruptures in this retrospective cohort. Rotational instability could be associated with combined ACL and RSC injury. [ABSTRACT FROM AUTHOR]

Background: Post-intensive care syndrome could be responsible for inability to receive proper cancer treatment after ICU stay in patients with solid tumors (ST). Our purpose was to determine the factors associated with cancer treatment resumption and the impact of cancer treatment on the outcome of patients with ST after ICU stay. Methods: We conducted a retrospective study including all patients with ST admitted to the ICU between 2014 and 2019 in a French University-affiliated Hospital. Results: A total of 219 patients were included. Median SAPS II at ICU admission was 44.0 [IQR 32.8, 66.3]. Among the 136 patients who survived the ICU stay, 81 (59.6%) received cancer treatment after ICU discharge. There was an important increase in patients with poor performance status (PS) of 3 or 4 after ICU stay (16.2% at admission vs. 44.5% of patients who survived), with significant PS decline following the ICU stay (median difference − 1.5, 95% confidence interval [-1.5-1.0], p < 0.001). The difference between the PS after and before ICU stay (delta PS) was independently associated with inability to receive cancer treatment (Odds ratio OR 0.34, 95%CI 0.18–0.56, p value < 0.001) and with 1-year mortality in patients who survived at ICU discharge (Hazard ratio HR 1.76, 95%CI 1.34–2.31, p value < 0.001). PS before ICU stay (OR 3.73, 95%IC 2.01–7.82, p value < 0.001) and length of stay (OR 1.23, 95%CI 1.06–1.49, p value 0.018) were independently associated with poor PS after ICU stay. Survival rates at ICU discharge, at 1 and 3 years were 62.3% (n = 136), 27.3% (n = 59) and 17.1% (n = 37), respectively. The median survival for patients who resumed cancer treatment after ICU stay was 771 days (95%CI 376–1058), compared to 29 days (95%CI 15–49) for those who did not resume treatment (p < 0.001). Conclusion: Delta PS, before and after ICU stay, stands out as a critical determinant of cancer treatment resumption and survival after ICU stay. Multidisciplinary intervention to improve the general condition of these patients, in ICU and after ICU stay, may improve access to cancer treatment and long-term survival. [ABSTRACT FROM AUTHOR]

Purpose: Comparison of access times to CT and surgical/radiological bleeding control between two European military trauma centers. Methods: Retrospective and observational study conducted in two military level 1 trauma centers in Toulon (France) and Koblenz (Germany) between 2013 and 2018. Inclusion of severe trauma patients with ISS > 15 with clinical and biological criteria of bleeding. Results: Inclusion of 607 patients (318 in Toulon and 289 in Koblenz). Mean ISS 30. Median access time to CT significantly lower for Koblenz, 14 vs. 30 min; p < 0.001. Median access time to the emergency bleeding control lower in Toulon 84 min vs. 92 (p = 0.114). No impact on mortality at 24 h 9% in Koblenz and 11% in Toulon. Mortality at 28 days identical 17%. Conclusion: The organizational innovation at the military hospital in Koblenz saves time in the injury assessment. However, it has no impact on the access time to the scanner and on the mortality at 24 and 28 days. This fight against hemorrhage is a management bundle including delays, transfusion, and team training. Clinical trial registration: 2,002,878 v 0. [ABSTRACT FROM AUTHOR]

Objectives The efficacy of anti-IL-6 receptors such as tocilizumab (TCZ) was demonstrated in patients with PMR in two recent randomized controlled trials. The objective of this multicentre retrospective study was to assess the efficacy of TCZ in PMR patients requiring glucocorticoid (GC)-sparing treatment, as well as different strategies for TCZ withdrawal. Methods We conducted a multicentre study in French tertiary healthcare departments for patients with PMR. PMR patients receiving off-label TCZ between 2015 and 2022 were included. The primary endpoint was the proportion of patients tapering to GCs ≤5 mg/day 6 months after the first TCZ infusion. The secondary endpoints were the proportion in whom GC was discontinued during follow-up, and the proportion of patients in whom TCZ was discontinued. Results Fifty-three PMR patients were included. Thirty-one patients suffered from active PMR despite conventional synthetic DMARDs. GCs were ≤5 mg/day in 77% of the patients (95% CI 36–89) at 6 months, and in 97% of the patients at 12 months. Six and 12 months after the first TCZ infusion, the proportions of GC-free patients were 22.5% (95% CI 12.7–37.8) and 58.3% (95% CI 43.2–74.1), respectively. Among TCZ withdrawal strategies, TCZ infusion spacing and TCZ dose reduction were more successful (success in 87% and 79% of attempts, respectively) than TCZ discontinuation (success in 52% of attempts; P  = 0.012 and P  = 0.039, respectively). Conclusion In GC-dependent PMR patients, treatment with TCZ led to a drastic decrease in GC dose and remission of PMR. TCZ dose reduction or TCZ infusion spacing are good options to consider in TCZ withdrawal. [ABSTRACT FROM AUTHOR]

We studied 50 patients with invasive nocardiosis treated during 2004-2023 in intensive care centers in France and Belgium. Most (65%) died in the intensive care unit or in the year after admission. Nocardia infections should be included in the differential diagnoses for patients in the intensive care setting. [ABSTRACT FROM AUTHOR]

Many studies have stressed the key role played by competitive sports in the socialization of boys, particularly in middle-class families. This article looks at the minority group of boys from this social class who dislike competition and participate in few, if any, sports. We present case studies of six boys and their families, interviewed on several occasions. Based on Bourdieu's [1979. "La Distinction. Une critique sociale du jugement" [Distinction. A social critique of the judgement of taste]. Paris: Minuit; 1980. "Le sens pratique" [Practical reason. On the theory of action]. Paris: Minuit] theoretical framework and the concepts of "capital," "habitus," and "lifestyle," we analyze the socialization modes involved in the construction of an atypical gender habitus. All of the boys we interviewed had developed a liking for activities socially attributed to females, in specific family configurations. Beyond these common points, our data allowed us to identify two groups of families: in the middle-class families well endowed with cultural capital, the parents place priority on a 'cultivated' lifestyle and pass on to their sons a taste for mainstream cultural activities, which (from their point of view) do not include sports. In the middle-class families less interested in mainstream cultural forms, the parents wish their sons were more sports-oriented. In these homes, there is evidence of problems related to the transmission of the paternal sports capital.

Starting from the CVTS-2 survey in which responses by Austrian and French employers revealed their very limited use of "non-school" types of training (on-the-job training, self-learning, job rotation, apprenticeship and quality circles, etc.), the author searches for the reasons for these two European exceptions. Although certain national institutional and structural characteristics common to both countries may explain this particular vision of continuing training, they only account for part of the similarities between Austria and France in terms of training practices. The cultural dimension therefore assumes an interest as a possible explanation for this behaviour. The assumption of a common social notion of training can therefore be advanced to explain the responses of employers in these two countries. (Contains 4 tables and 6 footnotes.)

Background: Therapeutic plasma exchanges (TPE), which affect the humoral response, are often performed in combination with immunosuppressive drugs. For this reason, TPE may be associated with an increased susceptibility to infections. We aimed to describe blood stream infection (BSI) incidence in ICU patients treated with TPE and to identify associated risk factors. Methods: We retrospectively included patients that had received at least one session of TPE in the ICU of one of the 4 participating centers (all in Paris, France) between January 1st 2010 and December 31th 2019. Patients presenting with a BSI during ICU stay were compared to patients without such an infection. Risk factors for BSI were identified by a multivariate logistic regression model. Results: Over 10 years in the 4 ICUs, 387 patients were included, with a median of 5 [2–7] TPE sessions per patient. Most frequent indications for TPE were thrombotic microangiopathy (47%), central nervous system inflammatory disorders (11%), hyperviscosity syndrome (11%) and ANCA associated vasculitis (8.5%). Thirty-one patients (8%) presented with a BSI during their ICU stay, a median of 7 [3–11] days after start of TPE. In a multivariate logistic regression model, diabetes (OR 3.32 [1.21–8.32]) and total number of TPE sessions (OR 1.14 [1.08–1.20]) were independent risk factors for BSI. There was no difference between TPE catheter infection related BSI (n = 11 (35%)) and other sources of BSI (n = 20 (65%)) regarding catheter insertion site (p = 0.458) or rate of TPE catheter related deep vein thrombosis (p = 0.601). ICU course was severe in patients presenting with BSI when compared to patients without BSI, with higher need for mechanical ventilation (45% vs 18%, p = 0.001), renal replacement therapy (42% vs 20%, p = 0.011), vasopressors (32% vs 12%, p = 0.004) and a higher mortality (19% vs 5%, p = 0.010). Conclusion: Blood stream infections are frequent in patients receiving TPE in the ICU, and are associated with a severe ICU course. Vigilant monitoring is crucial particularly for patients receiving a high number of TPE sessions. [ABSTRACT FROM AUTHOR]

Rationale: Airway occlusion pressure at 100 ms (P0.1) reflects central respiratory drive. Objectives: We aimed to assess factors associated with P0.1 and whether an abnormally low or high P0.1 value is associated with higher mortality and longer duration of mechanical ventilation (MV). Methods: We performed a secondary analysis of a prospective cohort study conducted in 10 ICUs in France to evaluate dyspnea in communicative MV patients. In patients intubated for more than 24 hours, P0.1 was measured with dyspnea as soon as patients could communicate and the next day. Measurements and Main Results: Among 260 patients assessed after a median time of ventilation of 4 days, P0.1 was 1.9 (1–3.5) cm H2O at enrollment, 24% had P0.1 values >3.5 cm H2O, 37% had P0.1 values between 1.5 and 3.5 cm H2O, and 39% had P0.1 values <1.5 cm H2O. In multivariable linear regression, independent factors associated with P0.1 were the presence of dyspnea (P = 0.037), respiratory rate (P < 0.001), and PaO2 (P = 0.008). Ninety-day mortality was 33% in patients with P0.1 > 3.5 cm H2O versus 19% in those with P0.1 between 1.5 and 3.5 cm H2O and 17% in those with P0.1 < 1.5 cm H2O (P = 0.046). After adjustment for the main risk factors, P0.1 was associated with 90-day mortality (hazard ratio per 1 cm H2O, 1.19 [95% confidence interval, 1.04–1.37]; P = 0.011). P0.1 was also independently associated with a longer duration of MV (hazard ratio per 1 cm H2O, 1.10 [95% confidence interval, 1.02–1.19]; P = 0.016). Conclusions: In patients receiving invasive MV, abnormally high P0.1 values may suggest dyspnea and are associated with higher mortality and prolonged duration of MV. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence supports the use of plasma biomarkers of amyloid, tau, neurodegeneration, and neuroinflammation for diagnosis of dementia. However, their performance for positive and differential diagnosis of dementia with Lewy bodies (DLB) in clinical settings is still uncertain. Methods: We conducted a retrospective biomarker study in two tertiary memory centers, Paris Lariboisière and CM2RR Strasbourg, France, enrolling patients with DLB (n = 104), Alzheimer's disease (AD, n = 76), and neurological controls (NC, n = 27). Measured biomarkers included plasma Aβ40/Aβ42 ratio, p-tau181, NfL, and GFAP using SIMOA and plasma YKL-40 and sTREM2 using ELISA. DLB patients with available CSF analysis (n = 90) were stratified according to their CSF Aβ profile. Results: DLB patients displayed modified plasma Aβ ratio, p-tau181, and GFAP levels compared with NC and modified plasma Aβ ratio, p-tau181, GFAP, NfL, and sTREM2 levels compared with AD patients. Plasma p-tau181 best differentiated DLB from AD patients (ROC analysis, area under the curve [AUC] = 0.80) and NC (AUC = 0.78), and combining biomarkers did not improve diagnosis performance. Plasma p-tau181 was the best standalone biomarker to differentiate amyloid-positive from amyloid-negative DLB cases (AUC = 0.75) and was associated with cognitive status in the DLB group. Combining plasma Aβ ratio, p-tau181 and NfL increased performance to identify amyloid copathology (AUC = 0.79). Principal component analysis identified different segregation patterns of biomarkers in the DLB and AD groups. Conclusions: Amyloid, tau, neurodegeneration and neuroinflammation plasma biomarkers are modified in DLB, albeit with moderate diagnosis performance. Plasma p-tau181 can contribute to identify Aβ copathology in DLB. [ABSTRACT FROM AUTHOR]

Background: Glenzocimab is a novel antithrombotic agent which targets platelet glycoprotein VI (GPVI) and does not induce haemorrhage. SARS-CoV-2 triggers a prothrombotic state and lung injury whose mechanisms include coagulopathy, endothelial dysfunction, and inflammation with dysregulated platelets. Methods and patients: GARDEN was a randomised double-blind, exploratory phase II study of glenzocimab in SARS-CoV-2 respiratory failure (NCT04659109). PCR+ adults in Brazil and France (7 centres) were randomized to standard-of-care (SOC) plus glenzocimab (1000 mg/dayx3 days) or placebo, followed for 40 days. Primary efficacy endpoint was clinical progression at Day 4. All analyses concerned the intention-to-treat population. Results: Between December 2020 and August 2021, 61 patients received at least one dose (30 glenzocimab vs 32 placebo) and 58 completed the study (29 vs 29). Clinical progression of COVID-19 ARDS was not statistically different between glenzocimab and placebo arms (43.3% and 29.0%, respectively; p = 0.245). Decrease in the NEWS-2 category at D4 was statistically significant (p = 0.0290) in the glenzocimab arm vs placebo. No Serious Adverse Event (SAE) was deemed related to study drug; bleeding related events were reported in 6 patients (7 events) and 4 patients (4 events) in glenzocimab and placebo arms, respectively. Conclusions: Therapeutic GPVI inhibition assessment during COVID-19 was conducted in response to a Public Health emergency. Glenzocimab in coagulopathic patients under therapeutic heparin was neither associated with increased bleeding, nor SAE. Clinical impact of glenzocimab on COVID-19 ARDS was not demonstrated. A potential role for GPVI inhibition in other types of ARDS deserves further experimentation. Glenzocimab is currently studied in stroke (ACTISAVE: NCT05070260) and cardiovascular indications. [ABSTRACT FROM AUTHOR]

Simple Summary: Spinal cord tumors represent a significant surgical challenge. Neurophysiological evaluation using motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) is used to assess the function of motor and somatosensory pathways before and during surgery. However, its role with respect to the detection of neurological damage is not fully known. This study assesses the prognostic value of alterations of pre- and per-operative MEPs and SSEPs in a cohort of 67 patients undergoing spinal cord tumor surgery. We show that pre- and intraoperative alterations to MEPs and SSEPs are strongly associated with a risk of neurological deterioration 3 months after surgery that is independent of initial clinical severity, tumor size, or histological subtype. Leveraging a classical machine learning approach, it is possible to predict neurological outcomes with an accuracy of 84%. Thus, this study demonstrates the pivotal role of pre- and intraoperative neurophysiological explorations in detecting and preventing neurological suffering during spinal tumor surgery. Surgery for spinal cord tumors poses a significant challenge due to the inherent risk of neurological deterioration. Despite being performed at numerous centers, there is an ongoing debate regarding the efficacy of pre- and intraoperative neurophysiological investigations in detecting and preventing neurological lesions. This study begins by providing a comprehensive review of the neurophysiological techniques commonly employed in this context. Subsequently, we present findings from a cohort of 67 patients who underwent surgery for intradural tumors. These patients underwent preoperative and intraoperative multimodal somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), with clinical evaluation conducted three months postoperatively. The study aimed to evaluate the neurophysiological, clinical, and radiological factors associated with neurological outcomes. In univariate analysis, preoperative and intraoperative potential alterations, tumor size, and ependymoma-type histology were linked to the risk of worsening neurological condition. In multivariate analysis, only preoperative and intraoperative neurophysiological abnormalities remained significantly associated with such neurological deterioration. Interestingly, transient alterations in intraoperative MEPs and SSEPs did not pose a risk of neurological deterioration. The machine learning model we utilized demonstrated the possibility of predicting clinical outcome, achieving 84% accuracy. [ABSTRACT FROM AUTHOR]

Background: Immunosuppression at intensive care unit (ICU) admission has been associated with a higher incidence of ICU-acquired infections, some of them related to opportunistic pathogens. However, the association of immunosuppression with the incidence, microbiology and outcomes of ICU-acquired bacterial bloodstream infections (BSI) has not been thoroughly investigated. Methods: Retrospective single-centered cohort study in France. All adult patients hospitalized in the ICU of Lille University-affiliated hospital for > 48 h between January 1st and December 31st, 2020, were included, regardless of their immune status. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, hematopoietic stem cell and solid organ transplants, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic immune deficiency. The primary objective was to compare the 28-day cumulative incidence of ICU-acquired bacterial BSI between immunocompromised and non-immunocompromised patients. Secondary objectives were to assess the microbiology and outcomes of ICU-acquired bacterial BSI in the two groups. Results: A total of 1313 patients (66.9% males, median age 62 years) were included. Among them, 271 (20.6%) were immunocompromised at ICU admission. Severity scores at admission, the use of invasive devices and antibiotic exposure during ICU stay were comparable between groups. Both prior to and after adjustment for pre‐specified baseline confounders, the 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between immunocompromised and non-immunocompromised patients. The distribution of bacteria was comparable between groups, with a majority of Gram-negative bacilli (~ 64.1%). The proportion of multidrug-resistant bacteria was also similar between groups. Occurrence of ICU-acquired bacterial BSI was associated with a longer ICU length-of-stay and a longer duration of invasive mechanical ventilation, with no significant association with mortality. Immune status did not modify the association between occurrence of ICU-acquired bacterial BSI and these outcomes. Conclusion: The 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between patients with and without immunosuppression at ICU admission. [ABSTRACT FROM AUTHOR]

Purpose Recommendations to improve therapeutics are proposals made by pharmacists during the prescription review process to address suboptimal use of medicines. Recommendations are generated daily as text documents but are rarely reused beyond their primary use to alert prescribers and caregivers. If recommendation data were easier to summarize, they could be used retrospectively to improve safeguards for better prescribing. The objective of this work was to train a deep learning algorithm for automated recommendation classification to valorize the large amount of recommendation data. Methods The study was conducted in a French university hospital, at which recommendation data were collected throughout 2017. Data from the first 6 months of 2017 were labeled by 2 pharmacists who assigned recommendations to 1 of the 29 possible classes of the French Society of Clinical Pharmacy classification. A deep neural network classifier was trained to predict the class of recommendations. Results In total, 27,699 labeled recommendations from the first half of 2017 were used to train and evaluate a classifier. The prediction accuracy calculated on a validation dataset was 78.0%. We also predicted classes for unlabeled recommendations collected during the second half of 2017. Of the 4,460 predictions reviewed, 67 required correction. When these additional labeled data were concatenated with the original dataset and the neural network was retrained, accuracy reached 81.0%. Conclusion To facilitate analysis of recommendations, we have implemented an automated classification system using deep learning that achieves respectable performance. This tool can help to retrospectively highlight the clinical significance of daily medication reviews performed by hospital clinical pharmacists. [ABSTRACT FROM AUTHOR]

Perioperative anaphylaxis is rare but is associated with significant morbidity. This complication has been well described in France by the GERAP (Groupe d'Etude des Réactions Anaphylactiques Périopératoires), a network focused on its study. The epidemiology of perioperative anaphylaxis is evolving, influenced by environmental factors and clinical practice. The aim of this study was to update the epidemiology of perioperative anaphylaxis in France. This multicentre retrospective study was performed in 26 allergy clinics of the GERAP network in 2017–8. There were 765 patients with perioperative anaphylaxis included. Most cases were severe, with 428 (56%) reactions graded as 3 or 4 according to the Ring and Messmer classification. Skin test results were available for 676 patients, with a culprit agent identified in 471 cases (70%). Neuromuscular blocking agents were the main cause of perioperative anaphylaxis (n =281; 60%), followed by antibiotics (n =118; 25%) and patent blue dye (n =11; 2%). Cefazolin was the main antibiotic responsible for perioperative anaphylaxis (52% of antibiotic-related reactions). Suxamethonium and rocuronium were the main neuromuscular blocking agents responsible for perioperative anaphylaxis with 7.1 (6.1–8.4) and 5.6 (4.2–7.4) reactions per 100,000 vials sold, respectively, whereas cefazolin-related cases were estimated at 0.7 (0.5–0.9) reactions per 100,000 vials sold. Our results confirm that most commonly identified triggering agents remain neuromuscular blocking agents. Reactions to antibiotics, particularly cefazolin, are becoming increasingly frequent. The origin of sensitisation to cefazolin is unknown, as no cross-sensitisation has been described, and it should be the subject of further study. Perioperative anaphylaxis should be followed over the years and understood given the changing triggers. ClinicalTrials.gov (NCT 04654923). [ABSTRACT FROM AUTHOR]

Terrestrial subsidies are important for freshwater ecosystems and, in lakes supporting recreational fisheries, angling baits can represent an important allochthonous input. This resource can directly contribute to fish diet but its consumption may be influenced by fish body size and the type of angling baits used in different fisheries. In this study, we evaluated angling baits consumption by two common cyprinid species, Cyprinus carpio and Rutilus rutilus, in three fishery types (specialised carp, specialised roach, and put‐and‐take fisheries).We used stable isotope analyses (δ13C and δ15N) of cyprinids, their natural prey and different angling baits in 16 gravel pit lakes located in south‐western France, including four lakes without angling.Angling baits were significantly δ13C‐enriched and δ15N‐depleted compared to natural prey. Overall, angling bait consumption was highly variable between individuals. For C. carpio, angling bait consumption averaged 30.5% (±17.0 SD) and was higher in specialised carp fisheries (40.0% ± 16.7 SD) than in put‐and‐take fisheries (15.9% ± 9.0 SD) and was not related to body size. For R. rutilus, angling bait consumption averaged 41.3% (±15.7 SD), did not differ significantly among fishery types, but increased with body size. The niche width of C. carpio was six times larger in specialised carp fisheries than in lakes without angling. For R. rutilus, niche width was two times larger in specialised carp and put‐and‐take fisheries compared to lakes without angling and specialised roach fisheries.These results indicate that angling bait subsidies represent a novel and substantial resource opportunity for fishes in angling lakes, with trophic consequences for the targeted species through increase of their stable isotope niche size. These impacts are partly influenced by the type of angling baits used by anglers and the characteristics of the fisheries, suggesting the need for improved quantification of the temporal dynamics of this type of subsidy to better understand its consequences on freshwater fish and recipient ecosystems. [ABSTRACT FROM AUTHOR]

Background and Objectives: Meningioma is one of the most common neoplasm of the central nervous system. To describe the epidemiology of meningioma operated in France and, to assess grading and histopathological variability among the different neurosurgical centres. Methods: We processed the French Brain Tumour Database (FBTDB) to conduct a nationwide population-based study of all histopathologically confirmed meningiomas between 2006 and 2015. Results: 30,223 meningiomas cases were operated on 28,424 patients, in 61 centres. The average number of meningioma operated per year in France was 3,022 (SD ± 122). Meningioma was 3 times more common in women (74.1% vs. 25.9%). The incidence of meningioma increased with age and, mean age at surgery was 58.5 ± 13.9 years. Grade 1, 2, and 3 meningiomas accounted for 83.9%, 13.91% and, 2.19% respectively. There was a significant variability of meningioma grading by institutions, especially for grade 2 which spanned from 5.1% up to 22.4% (p < 0.001). Moreover, the proportion of grade 2 significantly grew over the study period (p < 0.001). There was also a significant variation in grade 1 subtypes diagnosis among the institutions (p < 0.001). 89.05% of the patients had solely one meningioma surgery, 8.52% two and, 2.43% three or more. The number of surgeries was associated to the grade of malignancy (p < 0.001). Conclusion: The incidence of meningioma surgery increased with age and, peaked at 58.5 years. They were predominantly benign with meningothelial subtype being the most common. However, there was a significant variation of grade 1 subtypes diagnosis among the centres involved. The proportion of grade 2 meningioma significantly grew over the study time, on contrary to malignant meningioma proportion, which remained rare and, stable over time around 2%. Likewise, there was a significant variability of grade 2 meningioma rate among the institutions. [ABSTRACT FROM AUTHOR]

The Pyrenean Platform for Observation of the Atmosphere (P2OA) is a coupled plain-mountain instrumented platform in southwest France. It is composed of two physical sites: The 'Pic du Midi' mountain top observatory (2877 m a.s.l.) and the 'Centre de Recherches Atmosphériques' (600 m a.s.l). Both sites are complementarily instrumented for the monitoring of climate variables and the study of meteorological processes in a mountainous region. The scientific topics covered by the P2OA include surface-atmosphere interactions in heterogeneous landscape and complex terrain, physics and chemistry of atmospheric trace species at large scale, influence of local and regional-scale emissions and transport on the atmospheric composition, and transient luminous events above thunderstorms. With a large number of instruments and a high hosting capacity, the P2OA contributes to atmospheric sciences in (i) building long-term series of atmospheric observations, (ii) hosting experimental field campaigns and instrumental tests, (iii) educational training in atmospheric observation techniques. Here we present the complete instrumentation of the P2OA and the associated datasets, give a meteorological characterization of the platform, and illustrate the potential of the P2OA and its dataset with past or ongoing studies and projects. [ABSTRACT FROM AUTHOR]

The decarbonization and decentralization of district heating networks lead to the shared use of on-site resources by multiple stakeholders. The optimal design of prospective equipment in such contexts should take into account the preferences and objectives of each stakeholder. This article focuses on the adaptation of a 4E multicriteria model (the criteria being energy, exergy, economic, and exergoeconomic) to include and compare the stakeholders' performance criteria around the technical design. In addition, two graphical supports are proposed that represent and cross-analyze the different stakeholders' preferred optima. A preliminary implementation of the methodology is illustrated through a study case in France, which features waste heat recovery for district heating utilization. After presenting the results, a discussion is offered on how to complete the methodology with an iterative negotiation procedure to determine the most suitable design. It was concluded, among other considerations, that the relaxation of the stakeholders' optimality requirements can greatly enable the project's feasibility. Such a relaxation could be implemented in the form of a joint consortium. In addition, the results showed that stakeholder relaxations of requirements can lead to new solutions that may outperform the best solutions pre-relaxation. Lastly, perspectives are suggested toward verifying whether relaxed requirements from upstream stakeholders might be more impactful than those of downstream stakeholders. [ABSTRACT FROM AUTHOR]

Background: Early access program (formerly cohort Temporary Authorization for Use) was granted for trastuzumab deruxtecan (T‐DXd) in France based on DESTINY‐Breast01 trial which demonstrated its efficacy and safety in HER2‐positive metastatic/unresectable breast cancer after ≥2 anti‐HER2‐based regimens received at metastatic stage. Method s : This multicenter real‐world early access program included HER2‐positive metastatic/unresectable breast patients pretreated with at least two lines of anti‐HER2 regimens who received T‐DXd 5.4 mg/kg intravenously in monotherapy every 3 weeks. Results: Four hundred and fifty‐nine patients (median age, 58 years; hormone receptor‐positive, 67%; brain metastases, 28.1%) received T‐DXd. Before inclusion, 81.7% of patients had radiation therapy and 76.5% had undergone surgery. Median number of prior metastatic treatment lines was four (range, 2–22); 99.8% patients had received trastuzumab, 94.8% trastuzumab emtansine and 79.3% pertuzumab. Follow‐up was performed from September 30, 2020 to March 30, 2021; when the early access program stopped, the median duration of T‐DXd treatment was 3.4 (range, 0–7.8) months. In 160 patients with available tumor assessment, objective response rate was 56.7% and 12.1% had progression. In 57 patients with available brain tumor assessment, complete or partial intracranial response was reported for 35.7% patients and 5.4% had progression. A total of 17 (3.7%) patients with interstitial lung disease (ILD) was reported with no cases of ILD‐related death. Conclusions: In this early access program in patients with heavily pretreated HER2‐positive metastatic/unresectable breast cancer, T‐DXd had antitumor activity with a similar response to that reported in previous clinical studies. T‐DXd was well tolerated and no new safety signals were observed. [ABSTRACT FROM AUTHOR]

Aim: Sodium‐glucose cotransporter‐2 inhibitors (SGLT‐2i) have been commercialized in France for type 2 diabetes since April 2020 and later for heart and renal diseases. Given the recent developments in treating diabetes and the widening of SGLT‐2i indications, we aimed to study changes in the use of glucose‐lowering drugs in France and to characterize SGLT‐2i new users. Methods: We performed a nationwide utilization study using the French health insurance database. Trends in incidence and prevalence of glucose‐lowering drug use were assessed by a repeated cross‐sectional study in 2019 and 2021. A cohort study of incident SGLT‐2i users was then conducted to describe patient characteristics and the strategy for treating diabetes. Results: The prevalence of SGLT‐2i use gradually reached 0.1% in the third quarter of 2021 and increased more significantly to 0.2% thereafter. SGLT‐2i became the second most prescribed glucose‐lowering drug class after metformin at the end of 2021 (0.1%). Among the cohort of 125 387 SGLT‐2i new users (mean age 65.0 years; 60.1% of men), 87.6% presented a diabetic comorbidity. The patient profile changed over the study period with an increasing proportion of patients with cardiovascular (28.7% in 2020 vs. 40.2% in 2021) or renal (7.7% in 2020 vs. 11.8% in 2021) comorbidities at initiation. The main combinations used at SGLT‐2i initiation were metformin (12.5%) and metformin plus dipeptidyl peptidase‐4 inhibitors (8.1%). One‐year probability of SGLT‐2i persistence was estimated to be 55%. Conclusion: The expansion of indications for SGLT‐2i and the broadening of the target population make it essential to assess the reasons for discontinuation and review their safety profile. [ABSTRACT FROM AUTHOR]