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Neurological Outcome of Spinal Hemangioblastomas: An International Observational Multicenter Study About 35 Surgical Cases
No full textInternational audienceIntroduction: Hemangioblastomas (HBs) are benign, highly vascular tumors that can be found intracranially or in the spinal region, representing around 2–15% of primary intramedullary tumors. They can occur sporadically or in association with Von Hipple–Lindau (VHL) disease. Despite recent of advancement of nonsurgical treatments, complete surgical resection remains the gold standard of care for the spinal HBs. Materials and Methods: We conducted an international multicenter retrospective analysis of adult patients surgically treated for spinal HBs in four European referral centers between January 2000 and September 2024, with a minimum post-operative follow-up duration of 6 months. Patients’ sex and age at surgical intervention, clinical presentation, and duration symptoms prior to clinical diagnosis were identified. The pre- and post-operative neurological status at 1 and 6 months and at the last visit was assessed using the modified McCormick score (MCS). The extent of surgical resection was divided into gross total resection (GTR) and subtotal resection (STR). Finally, post-operative complications were inspected as well, namely cerebrospinal fluid leaks, infections, hemorrhages and post-operative spinal stability. Results: A total of 35 patients were included in the cohort, with an age median of 52 years (34.5–60) and a slight male predominance (21/35, i.e., 60%). The median follow-up period was 37.5 months (12–75). More than half were located in the cervical region, making it the most common (54.3%). Syrinxes were observed in 23 cases (72%), and HBs were more commonly intramedullary (80%). GTR was achievable in around 88% of cases. Post-operative complications were observed in nine patients (25.7%). Nearly half of patients were discharged into rehabilitations centers (48.5%). Tumor recurrence was seen in 10.3% only. At the last follow-up, an excellent overall post-operative neurological status (positive ∆ McCormick) was observed in most of patients (88%) and was found to be associated with a relatively younger age group. Tumor location and presence of syrinxes did not show any statistical significance regarding clinical outcome. In patients having benefited from intra-operative monitoring, only D-wave changes showed statistical significance regarding post-operative outcome (p < 0.05). Conclusions: A large majority of patients operated for a spinal HB demonstrated favorable outcome after surgery, with unchanged or improved neurological status. Advanced age could have an impact on the post-operative neurological outcome. Other factors such as tumor size, location, and the presence of syrinx did not seem to significantly impact the neurological outcome. Finally, the surgery of these vascular lesions with no possibility of debulking or piece-meal removal and requiring “en bloc” resection is technically demanding and should be performed by experienced teams in spine and spinal cord surgery only
Dentists’ Knowledge, Attitudes, and Practices Regarding Molar Incisor Hypomineralization (MIH): A French Survey
No full textInternational audienceIntroduction: With an estimated 878 million cases worldwide in 2015, molar incisor hypomineralization(MIH) is a growing issue. Early detection and management require knowledge and application of goodclinical practices. The aim of the study was to evaluate the knowledge, attitudes, and practices of Frenchdentists regarding MIH.Method: A self-administered questionnaire was distributed to different groups of practitioners between 30January and 27 March 2023, including members of the French dental practice-based research network,members of the social network “French pediatric dentists,” and members of the professional social networkLinkedIn (LinkedIn, Sunnyvale, California, United States). The data from 311 questionnaires were analyzed.Results: Around 277 (89%) practitioners were familiar with MIH, 180 (58%) were perfectly aware of theclinical features of MIH, and 193 (62%) reported being able to clinically identify MIH. Nearly 100% (310) ofdentists cited “environmental pollutants” as the most frequent etiological factor. Glass ionomer is the mostused restorative material.Conclusion: Education regarding MIH must be improved among dentists to correctly detect, treat, or referpatients. It would seem useful to carry out an MIH prevalence study in France
Association between HIV risk perception, knowledge of biomedical prevention and sexual behaviour among sub-Saharan African immigrants living in a precarious situation in France
No full textInternational audienceObjectives Sub-Saharan African immigrants are particularly affected by HIV in France, with many acquiring the infection after migration due to precarious circumstances that increase their vulnerability. This study aimed to explore the association between HIV risk perception, knowledge of biomedical HIV prevention methods and sexual behaviours among sub-Saharan African immigrants living in precarious conditions in the greater Paris area. Methods This cross-sectional study analysed data from 614 participants in the MAKASI project, conducted in the greater Paris area (2019–2020). Sociodemographic characteristics, living conditions, knowledge of biomedical HIV prevention methods (postexposure prophylaxis, treatment as prevention and pre-exposure prophylaxis (PrEP)) and sexual behaviours were described by sex using Pearson’s χ 2 tests. HIV risk perception, defined as self-reported exposure to HIV comparable to or greater than the general population, was analysed by participant characteristics. A multivariable logistic regression model identified factors associated with HIV risk perception using variables with a significance threshold of 20%. Results Most participants (76.5%) were men, with a median age of 34 years (IQR: 29–41) and living in precarious conditions. Forty-one per cent of respondents reported perceiving their HIV exposure risk as comparable to or greater than the general population. Participants aware of PrEP (adjusted OR (aOR) =2.60 (1.17–5.80); p<0.020) and those who had sex with occasional partners without a condom within in the 3 months preceding the survey (aOR=1.89 (1.12–3.18); p<0.017) were more likely to report the same or greater risk of HIV exposure. Conclusions Our findings reveal that PrEP knowledge and sex with occasional partners, particularly participants who did not use condoms, are associated with increased HIV risk perception among sub-Saharan African immigrants. Further research should explore the relationship between PrEP uptake and HIV risk perception in this population. Trial registration number NCT0446872
Une première traduction française de L’Ami Melquiadès : critères de cette édition
No full textInternational audienceCe travail analyse les conditions de traduction, pour la première fois en France, d'une oeuvre du dramaturge espagnol Carlos Arniches (1866-1943). Il complète l'introduction rédigée par Serge Salaün sur l'auteur et son oeuvre
FinRL-DeepSeek: LLM-Infused Risk-Sensitive Reinforcement Learning for Trading Agents
No full textThis paper presents a novel risk-sensitive trading agent combining reinforcement learning and large language models (LLMs). We extend the Conditional Value-at-Risk Proximal Policy Optimization (CPPO) algorithm, by adding risk assessment and trading recommendation signals generated by a LLM from financial news. Our approach is backtested on the Nasdaq-100 index benchmark, using financial news data from the FNSPID dataset and the DeepSeek V3, Qwen 2.5 and Llama 3.3 language models. The code, data, and trading agents are available at: \url{https://github.com/benstaf/FinRL_DeepSeek
Tate modules as condensed modules
No full textWe prove that the category of countable Tate modules over an arbitrary discrete ring embeds fully faithfully into that of condensed modules. If the base ring is of finite type, we characterize the essential image as generated by the free module of infinite countable rank under direct sums, duals and retracts. In the ∞-categorical context, under the same assumption on the base ring, we establish a fully faithful embedding of the ∞-category of countable Tate objects in perfect complexes, with uniformly bounded tor-amplitude, into the derived ∞-category of condensed modules. The boundedness assumption is necessary to ensure fullness, as we prove via an explicit counterexample in the unbounded case.</div
Entre hier et aujourd’hui. Créativité médiatique et expressivité politique des immigrés marocains
No full textInternational audienc
Vulnérabilités et approche relationnelle de l'autonomie
No full textInternational audienceDer Ansatz der Autonomie ist entscheidend für die rechtliche Wahrnehmung der Schutzbedürftigkeit. Im Hinblick auf ein Konzept der persönlichen Autonomie, verstanden als Fähigkeit, die eigenen Entscheidungen selbst auszudrücken, werden Personen aufgrund einer Beeinträchtigung ihrer geistigen oder körperlichen Fähigkeiten, die die Äußerung ihres Willens verhindern kann, als schutzbedürftig eingestuft. Daher kann der Schutz von schutzbedürftigen Erwachsenen nicht nur durch Unterstützungsmaßnahmen, sondern auch durch Vertretungsmaßnahmen erfolgen. Dieser Paradigmenwechsel wird heute durch einen Autonomieansatz konkurrenziert, der aufgrund der gegenseitigen Abhängigkeit der Träger von Grundrechten den relationalen Charakter der Autonomie betont. Der relationale Ansatz der Autonomie hat verschiedene Facetten, je nachdem, welche Arten von Verletzlichkeit vom Recht erfasst werden, sei es eine Verletzlichkeit aufgrund einer der Person innewohnenden Eigenschaft oder/und einer äußeren Eigenschaft, die mit ihrer Situation zusammenhängt.Dieses Gemeinschaftswerk, das aus einem multidisziplinären Kolloquium hervorgegangen ist, das im Dezember 2023 im Maison des Sciences de l'Homme Paris Nord unter der Schirmherrschaft des IRDA (Institut de Recherche et Documentation en Action Sociale) organisiert wurde, analysiert verschiedene Aspekte: Betreuung von Menschen mit eingeschränkten Fähigkeiten, älteren Menschen in Pflegeheimen, Menschen mit Behinderungen, Stellung der pflegenden Angehörigen, Misshandlung, Betreuung von Minderjährigen, die von der französischen Sozialhilfe für Kinder und Jugendliche (ASE) betreut werden, und schutzbedürftigen jungen Erwachsenen, Unterstützung der Autonomie von Patienten, Menschen, die Sterbehilfe beantragen.The approach to autonomy is decisive in the legal understanding of vulnerability. It is in the light of a conception of personal autonomy, understood as the capacity to express one's own choices by oneself, that persons are identified as vulnerable because of an impairment of their mental or physical faculties such as to prevent the expression of their will. Consequently, the protection of vulnerable adults can be achieved not only through assistance measures but also through representation. This paradigm is now being challenged by an approach to autonomy that emphasises the relational nature of autonomy due to the interdependence of subjects with fundamental rights. The relational approach to autonomy has various facets depending on the types of vulnerabilities apprehended by the law, whether these vulnerabilities are due to a characteristic intrinsic to the person, or/and extrinsic, relating to their situation.This collective work, the result of a multidisciplinary symposium organised in December 2023 at the Maison des Sciences de l'Homme Paris Nord under the aegis of the IRDA, analyses various aspects: support for people with impaired faculties, elderly people in nursing homes, disabled people, the role of family carers, abuse, support for minors in the care of the Child Protection Service and vulnerable young adults, support for patient autonomy, people requesting assistance in dying.El enfoque de la autonomía es determinante en la comprensión jurídica de la vulnerabilidad. En función de una concepción de la autonomía personal, entendida como la capacidad de expresar por sí mismo las propias elecciones, se identifica a las personas como vulnerables debido a una alteración de sus facultades mentales o físicas que impide la expresión de su voluntad. Por lo tanto, la protección de las personas mayores vulnerables puede traducirse no solo en medidas de asistencia, sino también de representación. Este paradigma se ve hoy en día desafiado por un enfoque de la autonomía que hace hincapié en el carácter relacional de la autonomía debido a la interdependencia de los sujetos titulares de derechos fundamentales. El enfoque relacional de la autonomía tiene diversas facetas según los tipos de vulnerabilidades que abarca el derecho, ya sean vulnerabilidades debidas a una característica intrínseca de la persona o extrínseca, relacionada con su situación.Esta obra colectiva, resultado de un coloquio multidisciplinar organizado en diciembre de 2023 en la Maison des Sciences de l'Homme Paris Nord bajo los auspicios del IRDA, analiza diversos aspectos: acompañamiento de personas con facultades alteradas, personas mayores en residencias de ancianos, personas con discapacidad, lugar de los cuidadores familiares, maltrato, acompañamiento de menores a cargo de la ASE y jóvenes vulnerables mayores de edad, apoyo a la autonomía de los pacientes, personas que solicitan ayuda para morir.L’approche de l’autonomie est déterminante dans l’appréhension juridique de la vulnérabilité. C’est au regard d’une conception de l’autonomie personnelle, comprise comme capacité d’exprimer par soi-même ses propres choix, que des personnes sont identifiées comme vulnérables en raison d’une altération de leurs facultés mentales ou physiques de nature à empêcher l’expression de leur volonté. Dès lors la protection des majeurs vulnérables peut se traduire non seulement par des mesures d’assistance mais également de représentation. Ce paradigme est aujourd’hui concurrencé par une approche de l’autonomie qui met l’accent sur le caractère relationnel de l’autonomie en raison de l’interdépendance des sujets titulaires de droits fondamentaux. L’approche relationnelle de l’autonomie possède diverses facettes selon les types de vulnérabilités appréhendés par le droit, qu’il s’agisse de vulnérabilités en raison d’une caractéristique intrinsèque à la personne, ou / et extrinsèque, tenant à sa situation.Cet ouvrage collectif, issu d’un colloque pluridisciplinaire organisé en décembre 2023 à la Maison des Sciences de l’Homme Paris Nord sous l’égide de l’IRDA, en analyse divers aspects : accompagnement des personnes dont les facultés sont altérées, des personnes âgées en EHPAD, des personnes handicapées, place des proches aidants, maltraitance, accompagnement des mineurs pris en charge par l’ASE et des jeunes majeurs vulnérables, soutien à l’autonomie des patients, personnes demandant une aide à mourir.Table des matières • Préface - Didier GUÉVEL• Propos introductifs. Approches juridiques de l’autonomie et de la vulnérabilité - Céline RUETPartie 1 ÉMERGENCE ET DÉVELOPPEMENT DE L’APPROCHE RELATIONNELLE DE L’AUTONOMIE• Accompagner et favoriser l’autonomie des personnes les plus vulnérables tout en les protégeant : un défi - Anne CARON-DÉGLISE• Relation d’aide à l’autonomie et lutte contre la maltraitance des personnes dans une situation de vulnérabilité - Valérie DEPADT• La place des proches dans l’accompagnement des personnes en situation de vulnérabilité - Anaëlle CAPPELLARI• Médiation en situation de vulnérabilité. Relation entre proches aidants, personnes en situation de vulnérabilité et personnels d’EHPAD : conflits et expérimentation de médiation - Richard GRIVELPartie 2 DIVERSITÉ DES VULNÉRABILITÉS ET APPROCHE RELATIONNELLE DE L’AUTONOMIE• L’accompagnement des mineurs confiés à l’ASE et des jeunes majeurs en situation de vulnérabilité. Entre protection et contrôle social - Yann FAVIER• Accueil et accompagnement des mineurs pris en charge par l’ASE et accompagnement des jeunes majeurs.La politique du département de la Seine-Saint-Denis - Nadia AZOUG• L’accompagnement des personnes en situation de handicap : transformations, expérimentations, perspectives -Louis BERTRAND• L’autonomie relationnelle, au-delà des évidences et des bonnes intentions - Olivia GROSS• Soutenir l’autonomie des personnes âgées en établissement pour personnes âgées dépendantes . – François VIALLA• Vivre et laisser mourir ». Vulnérabilité et dignité dans la jurisprudence de la Cour constitutionnelle italienne - Franck LAFFAILLE• Euthanasie pour souffrance psychique, autonomie et place d’autrui. Réflexions à propos de l’affaire Mortier c. Belgique - Céline RUET• L’autonomie en question. Le cas de la loi sur l’euthanasie pour seule souffrance psychique en Belgique - Gertrudis DE VIJVER et Ariane BAZAN• Propos conclusifs - Céline RUETL'approccio all'autonomia è determinante nella comprensione giuridica della vulnerabilità. È in base a una concezione di autonomia personale, intesa come capacità di esprimere da sé le proprie scelte, che le persone sono identificate come vulnerabili a causa di un'alterazione delle loro facoltà mentali o fisiche tale da impedire l'espressione della loro volontà. Pertanto, la protezione delle persone maggiorenni vulnerabili può tradursi non solo in misure di assistenza, ma anche di rappresentanza. Questo paradigma è oggi messo in discussione da un approccio all'autonomia che pone l'accento sul carattere relazionale dell'autonomia a causa dell'interdipendenza dei soggetti titolari di diritti fondamentali. L'approccio relazionale all'autonomia ha diverse sfaccettature a seconda dei tipi di vulnerabilità considerati dal diritto, che si tratti di vulnerabilità dovute a una caratteristica intrinseca alla persona o/e estrinseca, legata alla sua situazione.Questo libro collettivo, frutto di un convegno multidisciplinare organizzato nel dicembre 2023 alla Maison des Sciences de l'Homme Paris Nord sotto l'egida dell'IRDA, ne analizza vari aspetti: assistenza a persone con capacità alterate, anziani in case di riposo, persone con disabilità, ruolo dei caregiver, maltrattamenti, assistenza ai minori affidati all'ASE e ai giovani maggiorenni vulnerabili, sostegno all'autonomia dei pazienti, persone che chiedono aiuto per morire
Anticipatory muscle activations to coordinate balance and movement during motor transitions: A narrative review
No full textInternational audienceBackground: Maintaining balance while moving is vital for day-to-day activities. A key challenge in the comprehension of human movement is to determine how muscles contribute to balance-movement coordination. Motor transitions, defined as movements executed between two steady balance states, are particularly interesting phases to study balance-movement coordination because a large, discrete change in whole-body momentum may disturb balance. During voluntarily-initiated motor transitions, anticipatory muscle patterns provide the biomechanical conditions that are favourable to both maintaining balance and executing the movement.Research question: What are the mechanical consequences of anticipatory muscle activations for balance-movement coordination during voluntarily-initiated motor transitions?Methods: We review the biomechanical contributions of the anticipatory muscle activations identified in the literature during four types of voluntarily-initiated motor transitions, through the prism of three balance mechanisms (‘moving the centre of pressure (CoP)’, ‘counter-rotating segments’, and ‘applying new external force(s)’). In particular, we investigate how anticipatory muscle activations modulate whole-body centre of mass acceleration.Results:We show that the mechanical consequences of anticipatory muscle activations have been extensively described, but mainly using the ‘moving the CoP’ mechanism. Unlike their role during steady balance states, both ‘moving the CoP’ and ‘applying new external force(s)’ mechanisms create a required mechanical instability during the anticipatory phase of motor transitions. The ‘counter-rotating’ mechanism may act as a stabiliser during motor transitions, but additional research is needed to clarify this assumption.Significance: This review establishes that muscle activation processes have different mechanical consequences for balance-movement coordination during the anticipatory phases of motor transitions, compared to steady balance states. Because the mechanical instability that is created can lead to falls, a better understanding of the mechanisms underlying motor transitions is needed to enable the design of more effective fall prevention programs and/or devices for population with balance deficits
Addressing evidence needs during health crises in the province of Quebec (Canada): a proposed action plan for rapid evidence synthesis
No full textInternational audienceAbstract Background The COVID-19 pandemic necessitated the rapid availability of evidence to respond in a timely manner to the needs of practice settings and decision-makers in health and social services. Now that the pandemic is over, it is time to put in place actions to improve the capacity of systems to meet knowledge needs in a situation of crisis. The main objective of this project was thus to develop an action plan for the rapid syntheses of evidence in times of health crisis in Quebec (Canada). Methods We conducted a three-phase collaborative research project. First, we carried out a survey with producers and users of rapid evidence syntheses ( n = 40) and a group interview with three patient partners to prioritize courses of action. In parallel, we performed a systematic mapping of the literature to identify rapid evidence synthesis initiatives developed during the pandemic. The results of these two phases were used in a third phase, in which we organized a deliberative workshop with 26 producers and users of rapid evidence syntheses to identifying strategies to operationalize priorities. The data collected at each phase were compared to identify common courses of action and integrated to develop an action plan. Results A total of 14 specific actions structured into four main axes were identified over the three phases. In axis 1, actions on raising awareness of the importance of evidence-informed decision-making among stakeholders in the health and social services network are presented. Axis 2 includes actions to promote optimal collaboration of key stakeholders in the production of rapid evidence synthesis to support decision-making. Actions advocating the use of a variety of rapid evidence synthesis methodologies known to be effective in supporting decision-making are presented in axis 3. Finally, axis 4 is about actions on the use of effective knowledge translation strategies to promote the use of rapid evidence synthesis products to support decision-making. Conclusions This project led to the development of a collective action plan aimed at preparing the Quebec ecosystem and other similar jurisdictions to meet knowledge needs more effectively in times of health emergency. The implementation of this plan and its evaluation will enable us to continue to fine-tune it