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LIMICS at ArchEHR-QA 2025: Prompting LLMs Beats Fine-Tuned Embeddings
No full textInternational audienceIn this paper, we investigated two approaches to clinical question-answering based on patientformulated questions, supported by their narratives and brief medical records. The first approach leverages zero-and few-shot prompt engineering techniques with GPT-based Large Language Models (LLMs), incorporating strategies such as prompt chaining and chain-ofthought reasoning to guide the models in generating answers. The second approach adopts a two-steps structure: first, a textclassification stage uses embedding-based models (e.g., BERT variants) to identify sentences within the medical record that are most relevant to the given question; then, we prompt an LLM to paraphrase them into an answer so that it is generated exclusively from these selected sentences. Our empirical results demonstrate that the first approach outperforms the classification-guided pipeline, achieving the highest score on the development set and the test set using prompt chaining. Code: github.com/armandviolle/BioNLP-2025</div
Invasive group A streptococcus infections in the intensive care unit: an unsupervised cluster analysis of a multicentric retrospective cohort
No full textInternational audienceInvasive group A streptococcus (iGAS) infection incidence is rising. These infections have been studied as a whole but can be associated with critical illness in a population with a wide array of underlying conditions, sites of infection and clinical presentations. Using an unsupervised clustering approach, we aimed to identify specific clinical phenotypes regarding presentation, management and outcome. This was a retrospective multicentric study including all patients admitted to one of 9 ICUs of Paris University Hospitals for an iGAS infection between 01/03/2018 and 01/08/2023. iGAS infection was defined as GAS growth in any microbiological sample from a sterile site. Patients were grouped according to a clustering algorithm (k-prototypes) using a comprehensive set of clinical and biological variables available upon ICU admission. Clusters were described and clinical presentation, management and outcome were compared. 148 patients were included. According to the Silhouette criterion, patients were grouped in 3 clusters, and 7 patients remained unclassified. Cluster 1 (n = 73) comprised a greater proportion of less severely-ill female patients with painful skin and soft tissue infections, a quarter of whom had taken non-steroidal anti-inflammatory drugs. Cluster 2 (n = 42) was characterized by a high rate of respiratory infections with frequent viral co-infections. Cluster 3 (n = 26) included mostly socially deprived patients with high rates of chronic alcohol consumption and psychiatric illness, with severe organ dysfunction related to otherwise pauci-symptomatic skin and soft tissue infections. There was no significant difference in time to source control across clusters (0 [0-0] vs 0 [0-0] vs 0 [0-1] days, p = 0.12). Patients included in cluster 2 less frequently received antitoxin antibiotics than patients from clusters 1 and 3 (79% vs 45% vs 69%, p < 0.001) and tended to more frequently require ECMO support (3% vs 12% vs 0%, p = 0.07), while those from cluster 1 were less likely to receive invasive mechanical ventilation (48% vs 74% vs 77%, p = 0.005). There was no difference in ICU-mortality between clusters (19% vs 29% vs 31%, p = 0.32). Based on simple and readily available clinical admission characteristics of critically ill patients with iGAS, unsupervised clustering analysis identified three specific patient populations that differed regarding ICU management. Whether tailoring management would affect outcome warrants further research
Progression of potentially aggressive PitNETs after radiotherapy: risk factors, management, and outcomes
No full textInternational audienceRadiotherapy plays a relevant role in uncontrolled pituitary neuroendocrine tumors (PitNETs). Radiotherapy controls tumor progression in most cases, but not always. Prognostic factors for tumor progression after radiotherapy remain poorly defined. The aim was to evaluate tumor progression after radiotherapy, to identify risk factors, and to report management and outcomes in a cohort of PitNETs with uncontrolled progression. This was a retrospective, single-center, observational study. In total, 123 consecutive patients who underwent radiotherapy for PitNETs and were followed at Cochin Hospital between 2000 and 2022 were included. Indication for radiotherapy was uncontrolled tumor progression (80%), adjuvant (9%), or uncontrolled secretion (11%). The median follow-up after radiotherapy was 10.0 years. Tumor progression after radiotherapy was observed in 28/123 (23%) patients. Higher risk of progression was associated with lactotroph and corticotroph tumor types (HR [95% CI] 12.0 [1.2-117.1] and 9.3 [1.3-69.6], respectively), male sex (3.7 [1.6-8.4]), and necrotic-hemorrhagic changes before radiotherapy on magnetic resonance imaging (3.1 [1.1-8.4]). Surgery, temozolomide, and re-irradiation were the most frequent treatments for the management of patients with tumor progression after radiotherapy, used in 18/28(64%), 16/28(57%), and 8/28(29%) cases, respectively. The most common complication of radiotherapy was the new onset of pituitary deficits, observed in 41% of cases; other complications, including radiation-induced neuroinflammation, cerebrovascular events, and second brain tumors, were rare. Three patients developed metastases, and 6 patients died because of tumor progression. Lactotroph and corticotroph PitNETs, in male patients, and/or with necrotic-hemorrhagic changes are at higher risk of progression after radiotherapy. Patients with progression after radiotherapy require additional heavy treatments with variable outcome
Enhancing physical activity assessment in a French large cohort: Feasibility and acceptability of using wearable accelerometers
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L’alimentation étudiante, du constat à l’action. Comment les universités peuvent-elles accompagner la transition vers une alimentation satisfaisante et de bonne qualité nutritionnelle ?
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Evaluation of remote learning in knowledge translation through massive open online courses in the DRC
No full textInternational audienceBackground: Building capacity in knowledge translation is necessary to bridge the gap between research and practice, but evaluation of knowledge translation training initiatives is limited. In the Democratic Republic of Congo (DRC), stakeholders of a public health project participated in such training that involved completing two massive open online courses (MOOCs) autonomously, with biweekly coaching by a trainer and feedback through email. Objectives: This qualitative study aims to report on their experience with distance training, including implementation barriers and facilitators and the effect on their practice. Method: Twelve semi-structured interviews were conducted with trainees 8 months post-training. The evaluation used three levels of Kirkpatrick’s model – reactions, learning, behaviour change – and the TIPEC framework to identify barriers to implementation. Results: Participants faced significant technological obstacles. Nevertheless, they described a satisfying and collaborative learning experience. The training topic was deemed relevant. The biweekly coaching they received was appreciated, though most did not consider it essential. Most trainees had put their learning into practice by the time of the evaluation. Conclusion: In a context of limited resources, MOOC-based knowledge translation training met the needs of these professionals spread out across a vast territory and was deemed effective from an individual standpoint. This study confirms the importance of tailoring the training to learners’ professional contexts in the DRC. Contribution: This study assessed the effectiveness of MOOC-based learning in a little-described context of a French-speaking low- and middle-income country. It contributes to identifying the added value of this training method
Stopping antihypertensive Treatment amOng hypertensive patients in Primary care: The STOP-Trial
No full textInternational audienceAbstract Background Antihypertensive therapy (AHT) is usually lifelong. The feasibility of discontinuing AHT in selected individuals is insufficiently studied. Aims To assess the feasibility of discontinuing AHT in patients on monotherapy or low-dose dual therapy, and identify factors associated with maintaining normotension without treatment for one year. Methods This prospective, multicenter, non-randomized, open-label study assessed stopping AHT in individuals without self-reported cardiovascular risk factors (other than hypertension) or target organ damage, on monotherapy or low-dose dual AHT. The primary endpoint was maintaining normotension (<135/85 mmHg) for one year (with measurements at 1, 3, 6, 9, and 12 months) based on home blood pressure measurements (HBPM). Factors associated with success and failure of maintaining normotension were explored. Results Among 401 screened individuals, 218 (54.4%) were included after confirmation of controlled blood pressure (BP) by HBPM at baseline and their AHT was discontinued within 3 days. 203 participants had available BP measurements throughout the follow-up and were analyzed. Their mean age was 58.2 (±10.1) years, and 47.3% were women. Of these 203, 73 (36%) maintained BP <135/85 mmHg for one year without AHT while 130 patients (64%) required resumption of their AHT during the follow-up. Baseline HBPM predicted BP values at one year, while office BP or white coat hypertension did not. Patients with systolic HBPM <120 mmHg prior to AHT discontinuation had a 60% chance of maintaining normal BP, compared to 23% with systolic HBPM ≥120 mmHg. One patient with systolic HBPM >120 mmHg at baseline experienced an ischemic stroke. Conclusions About one-third of individuals on monotherapy or low-dose dual AHT who discontinued treatment maintained controlled BP after one year. Discontinuing AHT may be considered in selected individuals with HBPM below 120 mmHg, provided close BP monitoring is performed, particularly within the first year of AHT withdrawal. Clinicaltrial.gov registration number: NCT0226807
Plant to animal protein ratio in the diet of the elderly: potential for increase and impacts on nutrient adequacy and long-term health—a diet optimization study
No full textInternational audienceThe percentage of plant protein in the diet (%PP) is increasing in high-income countries, but concerns exist regarding the elderly, who may require more protein and indispensable amino acids (IAA) than younger adults, although this remains debated. Objectives: We aimed to assess how much %PP can be safely increased in older adults depending on estimated protein requirement, and identify nutritional issues and dietary levers as %PP increases. Methods: Observed diets were extracted from dietary intakes of !65 y French adults (INCA3, n ¼ 433). Using diet optimization, we modeled diets with graded %PP values ensuring full nutrient adequacy-applying constraints on energy and 34 nutrient intakes (accounting for bioavailability) and considering standard or higher protein requirements (reference intakes of 0.83 or 1 g/kg/d, respectively)-while minimizing chronic disease risk from specific food group over-or underconsumption (based on Global Burden of Disease data), with only as much departure from dietary habits as necessary. Results: All modeled diets differed markedly from the current unhealthy diet. Whatever the protein requirement considered, the same ~25%-70% %PP range was compatible with minimal chronic disease risk and full nutrient adequacy. As %PP increased, iodine, calcium, eicosapentaenoic acidþdocosahexaenoic acid, bioavailable iron, vitamins A, B12, and riboflavin became critical; protein was only a concern at high requirement; IAA were never problematic under protein adequacy. Sensitivity analysis revealed that raising consumption limits for legumes, nuts, vegetables, and fruit could broaden the adequate %PP range by supplying more limiting nutrients. Conclusions: Diets must be sufficiently rich in protein to ensure protein adequacy at higher requirements, with no risk of IAA inadequacy when protein intake is sufficient. For sustainability, %PP can potentially increase from the current ~1/3 to ~2/3 in an aging population while improving health and nutrient adequacy, provided sufficient seafood and dairy products remain. Further increases would require nutrient fortification/supplementation and/or new foods
La signalétique, une problématique touristique. Le cas des panneaux autoroutiers « d’animation culturelle et touristique »
No full textInternational audienceCan tourism afford to do without the services of authors and designers? This is a highly relevant question in the context of French touristic and cultural activity motorway signage more commonly known as “brown signs”, as although these visual images are strictly defined in the French highway code they must also meet modern-day touristic challenges (e.g., enhancing “away from home” experiences, a key part of the definition of tourism) and help users who value fluidity to navigate a transport system. Signage designed in this way forms part of a graphic continuum that is typically used in airports, train stations and alongside roads, but becomes problematic in the context of cultural and tourism signage promoting the regional areas that motorways run through. The present article will address this issue from the viewpoint of the artists and designers who created these types of signage: from Adrian Frutiger (creator of the Alphabet Roissy Paris Airport typeface that was later extended to rail and road systems) to Jean Widmer and Philippe Collier, these creators have all proposed discernible solutions through several generations of touristic signage. Initial depictions involved pictograms and stylized landscapes and were intended to be a graphic alternative to tourism advertising. This signage has drawn on the graphic codes of the mainstream press or the postcard genre to such an extent that it has today become a touristic medium in its own right that embraces authors, storytellers, illustrators, and podcast and content creators. It is a landscape that has also been made possible at the motorway operators’ behest. Its evolution therefore raises the question of whether creativity and authorship can help meet contemporary tourism challenges through the valorization of regional areas and the dissemination of new imageries on social networks.¿Puede el turismo prescindir de autores y diseñadores? Esta es la pregunta que surge ante un cartel de autopista para "actividades culturales y turísticas" representado por los "carteles marrones" desplegados en nuestras autopistas. Estrictamente definidas por el Código de Circulación, estas producciones gráficas deben responder a los desafíos del turismo contemporáneo: servir de ayuda a cualquier "desplazamiento" que se sitúa en la base de la definición de turismo y acompañar al usuario de un sistema de transporte que requiere fluidez de tráfico. La señalización así diseñada forma parte de un "continuo gráfico" común de los aeropuertos, las estaciones y las carreteras, lo que plantea un problema respecta a una autopista cuyo objetivo es mejorar los territorios a los que sirve. Este artículo pretende abordar esta problemática desde el punto de vista de los creadores y diseñadores de estos signos. Desde Adrian Frutiger (creador de un "alfabeto Roissy" aplicado al ferrocarril y la carretera) a Jean Widmer y Philippe Collier, se han propuesto elementos de respuesta que se pueden observar a través de varias generaciones de señalización turística. Concebida inicialmente bajo forma de pictogramas y paisajes esquemáticos, y concebida como una alternativa gráfica a la publicidad turística, esta cartelería integró luego los códigos gráficos de la prensa, de los media o de la postal hasta convertirse en la época contemporánea y por iniciativa de las empresas explotadoras de la autopista en un verdadero “media” turístico, recurriendo a los autores, Ilustradores y narradores para la producción de podcasts. Su evolución plantea la siguiente pregunta: ¿la creatividad y la autoría de la cartelería pueden responder a las necesidades actuales del turismo, a la puesta en valor del territorio y a las imágenes nuevas que nos llegan desde las redes sociales?Le tourisme peut-il faire l’économie d’auteurs et de designers ? C’est la question que pose une signalétique autoroutière « d’animation culturelle et touristique » symbolisées par les « panneaux marrons » déployés sur nos voies rapides. Strictement définis par le Code de la route, ces productions graphiques doivent en effet relever des défis touristiques contemporains : être l’adjuvant d’un « déplacement » que l’on peut placer au fondement de la définition du tourisme et accompagner l’usager d’un système de transport friand de fluidité. La signalétique ainsi pensée s’inscrit dans un « continuum graphique » commun à aéroport, gare et route qui pose alors problème vis-à-vis d’une autoroute ayant vocation à valoriser les territoires qu’elle dessert. Le présent article entend aborder ce problème du point de vue des créateurs et designers de ces signalétiques. Depuis Adrian Frutiger (créateur d’un « alphabet Roissy » étendu au rail et à la route) jusqu’à Jean Widmer et Philippe Collier, ceux-ci ont proposé des éléments de réponse perceptibles à travers plusieurs générations de signalétiques touristiques. D’abord conçue sur le mode du pictogramme et de paysages stylisés, et entendant constituer une alternative graphique à la publicité touristique, cette signalétique va ensuite intégrer les codes graphiques de la grande presse ou de la carte postale jusqu’à se constituer à l’époque contemporaine et à l’initiative des sociétés exploitant l’autoroute comme un véritable média touristique en faisant appel à des auteurs, illustrateurs et conteurs pour la production de podcasts. Son évolution pose ce faisant une question : créativité et auctorialité signalétique ne permettent-ils pas de répondre aux enjeux contemporains du tourisme, valorisation du territoire et nouvelle imagerie passant par les réseaux sociaux