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Introduction Although Human Papilloma Virus (HPV)-driven oropharyngeal cancer (OPC) prognosis is significantly better than that of other head and neck cancers, up to 25% of cases will recur within 5 years. Data on the pattern of disease recurrence and efficiency of salvage treatment are still sparse. Material and method Observational study of all recurrent OPCs diagnosed, following a curative intent treatment, in seven French centers from 2009 to 2014. p16 Immunohistochemistry was used to determine HPV status. Clinical characteristics, distribution of recurrence site, and treatment modalities were compared by HPV tumor status. Overall survival was examined using Kaplan–Meier and multivariate Cox regression modeling. Results 350 recurrent OPC patients (246 p16-negative and 104 p16-positive patients). The site of recurrence was more frequently locoregional for p16-negative patients (65.4% versus 52.9% in p16-positive patients) and metastatic for p16-positive patients (47.1% versus 34.6% in p16-patients, p = 0.03). Time from diagnosis to recurrence did not differ between p16-positive and p16-negative patients (12 and 9.6 months, respectively, p-value = 0.2), as the main site of distant metastasis (all p-values ≥0.10). Overall and relapse-free survival following the first recurrence did not differ according to p16 status (p-values from log-rank 0.30 and 0.40, respectively). In multivariate analysis, prognosis factors for overall survival in p16-negative patients were distant metastasis (HR 2.11, 95% CI 1.30–3.43) and concurrent local and regional recurrences (HR 2.20, 95% CI 1.24–3.88). Conclusion With the exception of the initial site of recurrence, the pattern of disease relapse and the efficiency of salvage treatment are not different between p16-positive and negative OPCs.

Background Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes. Methods GLOSS was a facility-based, prospective, 1-week inception cohort study implemented in 713 health-care facilities in 52 countries and included 2850 hospitalised pregnant or recently pregnant women with suspected or confirmed infections. All women admitted for or in hospital with suspected or confirmed infections during pregnancy, childbirth, post partum, or post abortion at any of the participating facilities between Nov 28 and Dec 4 were eligible for inclusion. In this study, we included all GLOSS participating facilities that collected facility-level data (446 of 713 facilities). We used data obtained from individual forms completed for each enrolled woman and their newborn babies by trained researchers who checked the medical records and from facility forms completed by hospital administrators for each participating facility. We described facilities according to country income level, compliance with providing core clinical interventions and services according to women's needs and reported availability, and severity of infection-related maternal outcomes. We used a logistic multilevel mixed model for assessing the association between facility characteristics and infection-related maternal outcomes. Findings We included 446 facilities from 46 countries that enrolled 2560 women. We found a high availability of most services and resources needed for obstetric care and infection prevention. We found increased odds for severe maternal outcomes among women enrolled during the post-partum or post-abortion period from facilities located in low-income countries (adjusted odds ratio 1middot84 [95% CI 1middot05-3middot22]) and among women enrolled during pregnancy or childbirth from non-urban facilities (adjusted odds ratio 2middot44 [1middot02-5middot85]). Despite compliance being high overall, it was low with regards to measuring respiratory rate (85 [24%] of 355 facilities) and measuring pulse oximetry (184 [57%] of 325 facilities). Interpretation While health-care facilities caring for pregnant and recently pregnant women with suspected or confirmed infections have access to a wide range of resources and interventions, worse maternal outcomes are seen among recently pregnant women located in low-income countries than among those in higher-income countries; this trend is similar for pregnant women. Compliance with cost-effective clinical practices and timely care of women with particular individual characteristics can potentially improve infection-related maternal outcomes. Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and US Agency for International Development. Copyright (c) 2021 World Health Organization; licensee Elsevier. This is an Open Access article under the CC BY 3.0 IGO license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products, or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Résumé L’association entre les caractéristiques individuelles des mères et la prématurité ou le faible poids à la naissance, tout comme l’effet de l’environnement de vie sur la santé périnatale ont fait l’objet de nombreux travaux. Plus rares sont les études qui se sont penchées sur l’effet que l’environnement de vie pouvait avoir sur l’association entre ces caractéristiques individuelles et la santé périnatale. Dans cet article, nous adoptons une perspective multi-niveaux pour prendre en compte conjointement l’effet de l’environnement de vie et les déterminants individuels des mères sur deux indicateurs de santé périnatale, la prématurité et le faible poids à la naissance en Wallonie. Les analyses portent sur 147 718 naissances vivantes uniques issues de mères qui résidaient en Wallonie de 2010 à 2013. Les variables indépendantes principales sont le niveau d’instruction, le statut professionnel et l’état de cohabitation des mères. Les variables dépendantes sont la prématurité et le faible poids à la naissance. Un indice synthétique des conditions de bien-être (ICBE) est utilisé pour décrire l’environnement de vie et mis en relation avec la prématurité et le faible poids à la naissance grâce à des modèles de régression logistique multivariables à un et plusieurs niveaux. La fréquence de la prématurité et du faible poids s’avère plus élevée dans les communes avec un environnement de vie défavorisé. Les mères ayant un faible niveau d’instruction, n’ayant pas d’activité professionnelle ou déclarant vivre seule courent par ailleurs un risque plus élevé d’accoucher prématurément ou d’avoir un enfant de faible poids à la naissance. Dans les analyses multi-niveaux, les mesures d’association entre les variables socio-économiques de la mère et les deux variables dépendantes restent identiques aux mesures d’association observées dans les régressions classiques. Les conditions de bien-être dans une commune, mesurées par l’ICBE, n’ont pas d’effet additionnel sur les associations entre les caractéristiques socio-économiques de la mère et la prématurité ou le faible poids à la naissance. Abstract The association between the individual characteristics of mothers, preterm birth or low birth weight and the impact of the living environment on perinatal health have been widely studied. Far fewer studies have examined the way the living environment can influence the association between characteristics and perinatal health. In this paper, we adopt a multi-level analysis to simultaneously study the effects of the living environment and the individual characteristics of the mothers on preterm birth and low-birth weight in Wallonia. The study population consists of 147’718 single live births to mothers who resided in Wallonia and delivered between 2010 and 2013. The main independent variables are the mothers’s level of education, their occupational and cohabitation status. The dependent variables are preterm birth and low birth weight. A synthetic index of Well-being condition (ICBE) is used to describe living conditions. The association between these conditions, preterm birth and low birth weight is quantified through multilevel logistic regression models adjusted for mothers’ characteristics. Preterm birth and low birth weight rates are higher in municipalities with a poor living environment. Non-working, single mothers or with low levels of education are at higher risk of delivering a preterm or low birth weight baby. In the multilevel analyses, the association between the socio-economic variables and the two dependent variables is similar to the one observed in the classical regressions (one level-analysis). Well-Being conditions, measured through ICBE, have no additional effect on the association between individual socio-economic characteristics of the mother, preterm birth or low birth weight.

L’objectif est de developper des courbes de croissance ajustees sur des facteurs maternels et fœtaux dans deux regions belges (Wallonie et Bruxelles) afin de creer un indicateur « petit poids pour âge gestationnel » (PAG). Trois indicateurs PAG ont ete crees sur la base de modeles de croissance in utero, developpes par Gardosi: non ajuste (modele 1), tenant compte du sexe (modele 2) et ajuste sur les facteurs maternels (taille et poids de la mere, parite) et fœtaux (modele 3). Parmi les naissances, la proportion d’enfants avec un petit poids pour leur âge gestationnel (AG) est de 8,1 % avec le modele 1, 7,9 % avec le modele 2 et 6,8 % avec le modele 3. Le modele 3 reclasse 2,6 % des naissances. L’indicateur PAG, prenant en consideration les facteurs maternels et fœtaux, est une premiere en Belgique. La proportion d’enfants avec un petit poids pour leur AG diminue lorsque les facteurs maternels et fœtaux sont pris en compte.

To investigate the effect of maternal origin on the association between maternal height and the risk of preterm birth (PTB)., SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction HPV-driven oropharyngeal cancer (OPC) patients have a better prognosis than their HPV-negative counterparts but several studies have suggested that among HPV-positive patients those with a smoking history had worse oncological outcomes. The aim of our study is to characterize the interplay between tobacco consumption, patient and disease characteristics, and disease control. Materials and methods All patients diagnosed with HPV-driven OPC and treated with curative intent between 2007 and 2009 and 2011–2016 at Gustave Roussy cancer center were included (n = 282). Demographic, clinical, morphological and tobacco consumption were correlated with oncologic outcomes. Results 157 (56%) patients had a positive smoking history, including 23.8% who were smoking at the time of diagnosis and 37.6% who had a tobacco consumption exceeding 20 pack-years. In multivariate analysis, the strongest prognostic factor for survival was smoking status at cancer diagnosis, with a hazard ratio (HR) for non-smokers compared to smokers of 0.25 ([0.12, 0.50], p = 0.0001). Smoking history, either more than 20 pack-years or smoking at diagnosis, was associated with local relapse and distant relapse. There was no difference in terms of comorbidity (p = 0.32) and radiotherapy duration (p = 0.93) according to tobacco consumption. Discussion Smoking is frequent among patients with HPV-driven OPC and increases the risk of death and oncologic failure.

Introduction Les inegalites sociales en perinatalite decoulent des caracteristiques individuelles et contextuelles de la mere. L’objectif est d’etudier l’influence combinee des caracteristiques socioeconomiques maternelles individuelles et contextuelle sur les risques de prematurite et de faible poids a la naissance. Methodologie L’indicateur contextuel est la hierarchie urbaine de Van Hecke qui a ete organisee en trois categories : grandes villes, villes regionales et petites villes/communes non urbaines bien equipees, petites villes/communes non urbaines moyennement et faiblement equipees en biens et services. Des modeles de regression logistique ont ete generes afin d’etudier les associations entre les caracteristiques socioeconomiques individuelles et la prematurite, d’une part, et le faible poids a la naissance, d’autre part, apres ajustement sur les facteurs potentiellement confondants. Ces modeles multivariables ont ete appliques pour les categories d’equipements des communes. Resultats Les caracteristiques socioeconomiques maternelles, la prematurite et le faible poids a la naissance varient significativement selon l’equipement des communes. Dans les communes bien equipees, les meres ont un moins bon niveau d’etude et sont plus souvent inactives que dans les communes faiblement ou moyennement equipees. C’est aussi dans ces communes bien equipees que les proportions les plus elevees de prematurite et de faible poids s’observent. Cependant, l’association entre le niveau d’etudes superieures et le faible poids est plus elevee dans les communes faiblement equipees que dans les communes moyennement ou bien equipees. Conclusion L’association entre le niveau d’etudes de la mere et le faible poids a la naissance differe selon le niveau d’equipement des communes : le risque de faible poids a la naissance chez les meres n’ayant pas fait d’etudes superieures etant plus important dans les communes faiblement equipees que dans les communes moyennement ou bien equipees. Un probleme de litterature en sante chez les meres peu instruites serait amplifie dans les communes faiblement equipees comparees aux communes bien equipees.

Introduction L’objectif est de developper des courbes de croissance ajustees sur des parametres individuels maternels et fœtaux ce qui permet de mieux distinguer les petits poids pour âge gestationnel d’origine constitutionnelle ou pathologique. Methodologie La construction des modeles de croissance a ete realisee a partir des naissances en 2013 en Belgique (Wallonie et region bruxelloise) sur la base du modele de croissance developpe par Gardosi. Cette methode a permis de modeliser la croissance in utero et de prendre en compte les parametres maternels (taille et poids de la mere, parite) et fœtaux. Trois modeles ont ete developpes, un modele non ajuste, un modele ajuste sur le sexe de l’enfant et un modele ajuste sur les caracteristiques maternelles et fœtales. Resultats Pour les naissances uniques vivantes, la proportion de petit poids pour âge gestationnel (percentile 10) est de 7,3 % avec le modele non ajuste et 7,0 % avec le modele ajuste sur le sexe ; 2,0 % des naissances ont ete reclassees suite a l’ajustement sur le sexe. Le modele non ajuste sur le sexe identifie de preference le petit poids pour âge gestationnel chez les filles et ignore des faibles poids pour âge gestationnel chez les garcons. Le modele ajuste sur les caracteristiques maternelles et fœtales reclasse 2,5 % des naissances et presente une proportion de 6,0 % de petit poids pour âge gestationnel ; 1,6 % des nouveau-nes sont definis comme ayant un petit poids pour leur âge gestationnel avec le modele ajuste sur le sexe mais eutrophes avec le modele ajuste sur les differentes caracteristiques. Conclusion Le developpement des courbes ajustees sur les caracteristiques maternelles et fœtales permet de creer un indicateur « petit poids pour âge gestationnel » adapte aux naissances en Belgique (Wallonie et region bruxelloise) et de tenir compte des facteurs physiologiques maternels et fœtaux associes au poids.

Extracting coherent wavefronts between passive receivers using cross-correlations of ambient noise (CAN) provides a means for monitoring the seismoacoustic environment without using active sources. However, using cross-correlations between single receivers can require a long recording time in order to extract stable coherent arrivals from CAN. This becomes an issue if the propagation medium fluctuates significantly during the recording period. To address this issue, this article presents a general spatio-temporal filtering procedure to enhance the emergence rate for coherent wavefronts extracted from time-averaged ambient noise correlations between two spatially separated arrays. The robustness of this array-based CAN technique is investigated using ambient shipping noise recorded over 24 h in the frequency band [250–850 Hz] on two vertical line arrays deployed 143 m apart in shallow water (depth 20 m). Experimental results confirm that the array-based CAN technique can significantly reduce the recording duration (e.g., from 22 h to 30 min) required for extracting coherent wavefronts of sufficient amplitude (e.g., 20 dB over residual temporal fluctations) when compared to conventional CAN implementations between single pairs of hydrophones. These improvements of the CAN technique could benefit the development of noise-based ocean monitoring applications such as passive acoustic tomography.

Recent theoretical and experimental studies have demonstrated that an estimate of the Green’s function between two hydrophones can be extracted passively from the cross‐correlation of ambient noise recorded at these two points. Hence monitoring the temporal evolution of these estimated Green’s functions can provide a means for noise‐based acoustic tomography using a distributed sensor network. However, obtaining unbiased Green’s function estimates requires a sufficiently spatially and temporally diffuse ambient noise field. Broadband ambient noise ([200 Hz–20 kHz]) was recorded continuously for 3 days during the SWAMSI09 experiment (next to Panama City, FL) using two moored vertical line arrays (VLAs) spanning the 13‐m water column and separated by 150 m. The feasibility of noise‐based acoustic tomography was assessed in this dynamic coastal environment over the whole recording period. Furthermore, coherent array processing of the computed ocean noise cross‐correlations between all pairwise combinations o...