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BACKGROUND: Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis. METHODS: Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement. RESULTS: Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1-4 days) prior to ICU admission. Most patients (n=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2-6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, P=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, P

Abstract Background Deep Brain Stimulation (DBS) of the anterior cingulum has been recently proposed to treat refractory chronic pain but its safety and its efficacy have not been evaluated in controlled conditions. Our objective was to evaluate the respective feasibility and safety of sensory thalamus (Thal-DBS) combined with anterior cingulate (ACC-DBS) DBS in patients suffering from chronic neuropathic pain. Methods We conducted a bicentric study (clinicaltrials.gov NCT03399942) in patients suffering from medically-refractory chronic unilateral neuropathic pain surgically implanted with both unilateral Thal-DBS and bilateral ACC-DBS, to evaluate successively: Thal-DBS only; combined Thal-DBS and ACC-DBS; ACC-DBS “on” and “off” stimulation periods in randomized cross-over double-blinded conditions; and a 1-year open phase. Safety and efficacy were evaluated by repeated neurological examination, psychiatric assessment, comprehensive assessment of cognitive and affective functioning. Changes on pain intensity (Visual Analogic Scale) and quality of life (EQ-5D scale) were used to evaluate DBS efficacy. Results All the patients (2 women, 6 men, mean age 52,1) completed the study. Adverse events were: epileptic seizure (2), transient motor or attention (2), persistent gait disturbances (1), sleep disturbances (1). No patient displayed significant cognitive or affective change. Compared to baseline, the quality of life (EQ-5D utility score) was significantly improved during the ACC-DBS “On” stimulation period (p = 0,039) and at the end of the study (p = 0,034). Conclusion This pilot study confirmed the safety of anterior cingulate DBS alone or in combination with thalamic stimulation and suggested that it might improve quality of life of patients with chronic refractory neuropathic pain. Trial registration The study has been registered on 20,180,117 (clinicaltrials.gov NCT03399942).

This article empirically explores how women who are members of UK-based women-only networks for women working in the media and communications industries blog about the menopause, specifically Bloom (www.bloomnetwork.uk), Women in Advertising and Communications Leadership (www.wacl.info), and Women in Public Relations (www.womeninpr. org). The overarching research question in this paper is: How do women who are members of women-only networks for women working in communications blog about the menopause? I seek to answer this question by exploring whether the selected blog posts' texts on the websites of women-only networks have a feminist and/or postfeminist sensibility. Specifically, do they engender an individualistic approach and/or promote solidarity? Furthermore, I examine the texts for indications regarding the 'sources and solutions for gender inequality in the workplace' (Gill, Orgad 2015: 340) and ask: What can this tell us about the networks' position vis-à-vis the menopause, feminism, and postfeminism? Discourse analysis reveals an entanglement of feminist and postfeminist sensibilities in the narratives constructed in the blogs, which can be characterised by two main interpretative repertoires, Stigma and Support, the implications of which call for multilevel and multifaceted changes to support mid-life women in the contemporary media and communications workplace and beyond.

Abstract Background To describe the use of life-sustaining therapies and mortality in patients with acute leukemia admitted to the intensive care unit (ICU). Methods The PubMed database was searched from January 1st, 2000 to July 1st, 2023. All studies including adult critically ill patients with acute leukemia were included. Two reviewers independently selected the studies, assessed bias using the Newcastle-Ottawa scale for cohort studies, and performed data extraction from full-text reading. We performed a proportional meta-analysis using a random effects model. The primary outcome was all-cause ICU mortality. Secondary outcomes included reasons for ICU admission, use of organ support therapies (mechanical ventilation, vasopressors and renal replacement therapy), hospital, day-90 and one-year mortality rates. Results Of the 1,331 studies screened, 136 (24,861 patients) met the inclusion criteria and were included in the meta-analysis. Acute myeloid leukemia affected 16,269 (66%) patients, acute lymphoblastic leukemia affected 835 (3%) patients, and the type of leukemia was not specified in 7,757 (31%) patients. Acute respiratory failure (70%) and acute circulatory failure (25%) were the main reasons for ICU admission. Invasive mechanical ventilation, vasopressors and renal replacement therapy, were needed in 65%, 53%, and 23% of the patients, respectively. ICU mortality was available in 51 studies (6,668 patients, of whom 2,956 died throughout their ICU stay), resulting in a metanalytical proportion of 52% (95% CI [47%; 57%]; I 2 93%). In a meta-regression, variables that influenced ICU mortality included year of publication, and intubation rate. Conclusion Acute respiratory failure is the main reason for ICU admission in patients with acute leukemia. Mechanical ventilation is the first life-sustaining therapy to be used, and also a strong predictor of mortality. Trial registration This study’s protocol was preregistered on PROSPERO (CRD42023439630).

Background: Cancer patients who are exposed to sepsis and had previous chemotherapy may have increased severity. Among chemotherapeutic agents, anthracyclines have been associated with cardiac toxicity. Like other chemotherapeutic agents, they may cause endothelial toxicity. The aim of this study was to evaluate the effect of anthracycline treatment on the outcome of cancer patients with sepsis. Methods: Data from cancer patients admitted to intensive care units (ICUs) for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994–2015). Comparison between patients who received anthracycline and those who did not was performed using a propensity score, including confounding variables (age and underlying diseases). A competing risk adjusted for severity of illness (Sequential Organ Failure Assessment [SOFA] score) was used to analyze the duration of vasopressor requirement. Results: Among 2046 patients, 1070 (52.3%) patients who received anthracycline were compared with 976 (47.7%) who did not. The underlying disease was mostly acute hematological malignancy (49.2%). Sepsis, mostly pneumonia (47.7%), had developed 2 days (interquartile range [IQR]:1–4 days) prior to ICU admission. Most patients (n=1156/1980,58.4%) required vasopressors for 3 days (IQR: 2–6 days). Factors associated with the need for vasopressors were aplasia (hazard ratio [HR]=1.72, 95% confidence interval [CI]: 1.21 to 2.47, P=0.002) and day 1 respiratory SOFA score (HR=7.07, 95% CI: 2.75 to 22.1, P

Background: Admission to the intensive care unit (ICU) is frequently required for patients with acute leukemia (AL) because of life-threatening complications such as intracranial hemorrhage (IH). In this study, we evaluated the impact of IH on survival and neurological outcomes in this population. Methods: This was a single-center retrospective cohort study including adult patients with AL requiring ICU admission and experiencing IH between 2002 and 2019 at Saint Louis Hospital. Leukemia type was determined according to the French–American–British classification. Brain imaging (either computed tomography or magnetic resonance imaging) was available for all the patients. The primary endpoint of the study was to describe the clinical and biological characteristics and evaluate the mortality and neurological outcome of patients hospitalized in the ICU with newly diagnosed AL and IH. The secondary endpoint was to identify predictive factors of IH in these patients. Results: Thirty-five patients with AL were included, median age of the patients was 59.00 (interquartile range [IQR]: 36.00–66.00) years. Twenty-nine patients (82.9%) had acute myeloid leukemia, including 12 patients with acute promyelocytic leukemia. Thrombocytopenia was constant, and 48.5% of patients had disseminated intravascular coagulation (DIC). At ICU admission, the median Sequential Organ Failure Assessment score was 5 (IQR: 3–9). The median time between AL onset and IH was 2.0 (IQR: 0.0–9.5) days. The ICU and hospital mortality rates were 60.0% (n =21) and 65.7% (n=23), respectively. In univariate analysis, mechanical ventilation and stupor were associated with mortality, but DIC and acute promyelocytic leukemia were not. Upon multivariate analysis, stupor or coma was the only factor significantly associated with a poor outcome (odds ratio = 8.56, 95 % confidence interval: 2.40 to 30.46). Conclusion: IH is associated with a high mortality rate in AL patients, with stupor or coma at the onset of intracranial bleeding being independently associated with poor outcomes.

Abstract Background Mental health symptoms among healthcare professionals (HCP) in intensive care units (ICUs) are a significant concern affecting both HCP well-being and patient care outcomes. Cross-sectional studies among members of the European Society of Intensive Care Medicine (ESICM) report up to 50% burnout rates. Determinants of burnout include communication, team cohesion, psychological support, and well-being promotion. We designed the 'Hello Bundle' intervention to mitigate burnout among ICU-HCPs by fostering positive social interactions and a supportive work environment. This justification synthesizes evidence from social psychology, positive psychology, and healthcare communication research to support the intervention. The 'Hello Bundle' aims to enhance interpersonal relationships, improve team cohesion, and reduce burnout rates. The six components include: Hello campaign posters, email reminders, integrating greetings in morning huddles, hello jars, lead-by-example initiatives, and a daily updated hello board in each ICU. This protocol describes a cluster randomized controlled trial to evaluate the effectiveness of the intervention. Methods This protocol describes a cluster randomized controlled trial (RCT) conducted among ESICM-affiliated ICUs, consisting of at least 73 clusters with in average of 50 respondents per cluster, totaling approximately 7300 participants. Intervention clusters will implement the 6-component Hello Bundle between October 14 and November 10, 2024, while control clusters will be wait-listed to receive the intervention in January 2025 after the RCT concludes. Clusters will be matched based on ICU size (fewer or more than 20 beds), region, and average 2023 mortality. The primary outcome is the proportion of HCPs with burnout between intervention and control clusters at the end of the intervention. Secondary outcomes include comparing the following between clusters: (1) number of HCPs with high emotional exhaustion; (2) number with high depersonalization; (3) number with loss of accomplishment; (4) perception of ethical climate (5) satisfaction at work (VAS); (6) professional conflicts; (7) intention to leave the ICU (VAS); (8) patient-centered care rating; (9) family-centered care rating. The last secondary outcome is the comparison of burnout rates before and after the intervention in the intervention cluster. Outcomes will be based on HCP reports collected within four weeks before and after the intervention. Discussion This is the first large trial of healthcare communication, social, and positive psychology intervention among ICU-HCPs. It holds the potential to provide valuable insights into effective strategies for addressing burnout in ICU settings, ultimately benefiting both HCPs and patients. Trial registration: This trial was registered on ClinicalTrials.Gov on June 18, 2024. Registration: NCT06453616.

Decreasing the share of protein contributed by animal-based foods is recommended to move towards more sustainable and healthier diets. This study aimed to assess the potential environmental impacts of diets with a lower share of animal protein. The diets were modeled to include the minimum share of animal protein in total protein that met nutrient requirements and did not increase costs. The new diets also minimized the difference in the quantity of food from those of observed (OBS) diets. They were modeled for five adult subpopulations (defined by sex and age) using mathematical optimization. The model was created by combining the INCA2 database (to model OBS diets in the French population) and a database of 207 food items to adjust nutritional and price parameters. All modeled diets satisfied nutritional and cost constraints. A low-animal-protein (LAP) diet was identified for each subpopulation by progressively decreasing the share of animal protein by steps of 5% until the recommended quantity of protein and/or consumption constraints were no longer satisfied. Potential environmental impacts of the LAP diets in eight impact categories were calculated using life cycle assessment and life cycle inventories from Agribalyse® 3.0. A LAP diet for the entire population was calculated as a weighted mean of the subpopulations’ LAP diets. The share of animal protein decreased from 70% in the OBS diet to 50% in the LAP diet. Compared to the OBS diet, the LAP diet decreased five environmental impacts: climate change (greenhouse gas emissions), acidification (emissions of acidifying compounds) and land occupation (all by more than 30%), cumulative energy demand (by 23%) and marine eutrophication (by 13%). Conversely, it increased three environmental impacts: freshwater eutrophication and water use (both by ca. 40%) and biodiversity damage potential (potential loss of species associated with land use) (by 66%). These results suggest that decreasing the share of animal protein to 50% is compatible with nutritional requirements, affordability and consumption constraints, but would have mixed effects on the environment.

BackgroundArtificial intelligence (AI) predictive models in primary health care have the potential to enhance population health by rapidly and accurately identifying individuals who should receive care and health services. However, these models also carry the risk of perpetuating or amplifying existing biases toward diverse groups. We identified a gap in the current understanding of strategies used to assess and mitigate bias in primary health care algorithms related to individuals’ personal or protected attributes. ObjectiveThis study aimed to describe the attempts, strategies, and methods used to mitigate bias in AI models within primary health care, to identify the diverse groups or protected attributes considered, and to evaluate the results of these approaches on both bias reduction and AI model performance. MethodsWe conducted a scoping review following Joanna Briggs Institute (JBI) guidelines, searching Medline (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), and Web of Science databases for studies published between January 1, 2017, and November 15, 2022. Pairs of reviewers independently screened titles and abstracts, applied selection criteria, and performed full-text screening. Discrepancies regarding study inclusion were resolved by consensus. Following reporting standards for AI in health care, we extracted data on study objectives, model features, targeted diverse groups, mitigation strategies used, and results. Using the mixed methods appraisal tool, we appraised the quality of the studies. ResultsAfter removing 585 duplicates, we screened 1018 titles and abstracts. From the remaining 189 full-text articles, we included 17 studies. The most frequently investigated protected attributes were race (or ethnicity), examined in 12 of the 17 studies, and sex (often identified as gender), typically classified as “male versus female” in 10 of the studies. We categorized bias mitigation approaches into four clusters: (1) modifying existing AI models or datasets, (2) sourcing data from electronic health records, (3) developing tools with a “human-in-the-loop” approach, and (4) identifying ethical principles for informed decision-making. Algorithmic preprocessing methods, such as relabeling and reweighing data, along with natural language processing techniques that extract data from unstructured notes, showed the greatest potential for bias mitigation. Other methods aimed at enhancing model fairness included group recalibration and the application of the equalized odds metric. However, these approaches sometimes exacerbated prediction errors across groups or led to overall model miscalibrations. ConclusionsThe results suggest that biases toward diverse groups are more easily mitigated when data are open-sourced, multiple stakeholders are engaged, and during the algorithm’s preprocessing stage. Further empirical studies that include a broader range of groups, such as Indigenous peoples in Canada, are needed to validate and expand upon these findings. Trial RegistrationOSF Registry osf.io/9ngz5/; https://osf.io/9ngz5/ International Registered Report Identifier (IRRID)RR2-10.2196/46684

Attention to inequality is increasingly taking centerstage in the fight against climate change and environmental devastation. More and more scholars and activists emphasize the need to put the reduction of inequality at the core of environmental and climate politics, and more and more propose a (socially just) “sufficiency” approach and politics to do so. Just sufficiency is presented as the new desirable societal pact, tasked with taking over from the current dominant growth pact driving “excess,” and replacing it with a politics of “enough,” through “collectively defined self-limitation.” However, an excess/enough lens misses the dynamics of production of inequality in the first place, with important political implications. This article thus seeks to contribute a tighter critical theoretical understanding of the inequality-unsustainability relation as a nexus historically powered by specific mechanisms of fossil, metabolic, as well as “green” accumulation. Through the theorization of these relations, one can better apprehend how inequality is not only a question of unfair distribution or exclusion from affluence demanding to be addressed through social and environmental justice, but also the condition for the modes of extraction and exploitation that produce and reproduce unsustainability. I argue that the counterhegemonic struggle must be waged on that terrain: putting limitations (not self-limitations) on the accumulation machine and its inequality-unsustainability nexus. This reading, which builds on critical theory and Marxist and feminist political ecology, is related to notions of class as structured not only by exploitation, but also, crucially by dispossession and status hierarchization. Adopting a nexus approach to inequality and unsustainability offers a critical theoretical method that can hopefully shift the assessments and orientations of the sufficiency movement away from the moral terrain of self-limitation (whose self?) toward the class politics of limits on capital needed today for socio-ecological transformation.

Author(s): Guillaume Dumas [sup.1], Yaseen M. Arabi [sup.2] [sup.3] [sup.4], Raquel Bartz [sup.5], Otavio Ranzani [sup.6] [sup.7], Franziska Scheibe [sup.8] [sup.9], Michaël Darmon [sup.10], Julie Helms [sup.11] Author Affiliations: (1) [...], Autoimmune diseases encompass a broad spectrum of disorders characterized by disturbed immunoregulation leading to the development of specific autoantibodies, resulting in inflammation and multiple organ involvement. A distinction should be made between connective tissue diseases (mainly systemic lupus erythematosus, systemic scleroderma, inflammatory muscle diseases, and rheumatoid arthritis) and vasculitides (mainly small-vessel vasculitis such as antineutrophil cytoplasmic antibody-associated vasculitis and immune-complex mediated vasculitis). Admission of patients with autoimmune diseases to the intensive care unit (ICU) is often triggered by disease flare-ups, infections, and organ failure and is associated with high mortality rates. Management of these patients is complex, including prompt disease identification, immunosuppressive treatment initiation, and life-sustaining therapies, and requires multi-disciplinary involvement. Data about autoimmune diseases in the ICU are limited and there is a need for multicenter, international collaboration to improve patients' diagnosis, management, and outcomes. The objective of this narrative review is to summarize the epidemiology, clinical features, and selected management of severe systemic autoimmune diseases.