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Permacrisis and the Policy Continuum in the UK: Deepening inequalities before, during and after Covid-19
No full textInternational audienc
Evaluation of 6‐Month Knowledge Retention and Satisfaction After Pedagogical Escape Games in Dentistry
No full textInternational audiencePurpose To evaluate 6‐month knowledge retention and long‐term satisfaction after two pedagogical escape games (PEGs) addressing foundational (3D printing) and clinical (pediatric dentistry) content in a dental curriculum. Methods In this monocentric serial cross‐sectional study, immediate post‑PEG knowledge was assessed in fifth‑year dental students using two 16‑item true/false tests on 3D printing and pediatric dentistry ( n = 176 and n = 190, respectively). Delayed knowledge was assessed 6 months later using the same tests in independent cohorts of sixth‑year students who had previously completed the same PEGs ( n = 106 and n = 116). A five‑item Likert‑scale questionnaire completed by sixth‑year students ( n = 127) captured long‑term satisfaction and perceived educational value. Between‐cohort comparisons used Wilcoxon rank‐sum tests. Results Knowledge scores declined for 3D printing (13.83 ± 2.19 vs. 12.13 ± 1.89/16, p < 0.05) and remained stable for pediatric dentistry (13.23 ± 1.61 vs. 12.92 ± 1.54/16, p > 0.05). Losses in 3D‑printing knowledge were concentrated on conceptual and procedural items. Delayed satisfaction remained high, with strong lasting impressions of the PEGs, perceived learning benefits, improved perception of the disciplines, and a clear desire for more PEGs in the curriculum. Conclusion Six‑month knowledge retention differed by domain, likely reflecting routine clinical reinforcement for pediatric dentistry and lack of downstream rehearsal for 3D printing. Embedding brief spaced refreshers for foundational topics and relying on clinical exposure for consolidation of clinical content may help sustain learning over time. Findings support integration of PEGs with follow‐up
Transcultural validation in Soninke of a language assessment tool: The Avicenne ELAL <sup>©</sup>
No full textInternational audienceChildren of migrants are often exposed to more than one language from an early age. The Avicenne ELAL © test has been created to better assess language skills, avoid misdiagnosing learning disabilities, and inform early interventions. Plurilingual children aged 3.5 to 6.5 take the test in their mother tongues, with an interpreter's assistance. The test comprises three scales: Comprehension, Expression, and Storytelling. The objectives of this study were to describe steps of the transcultural validation of the Avicenne ELAL © for the Soninke culture and language, both for children living in a monolingual environment in Mauritania and for migrant children living in a multilingual environment in France; to compare the performance of these two groups; and to explore its qualitative use in studying language pathways among bilingual and plurilingual children. A total of 71 children participated in this study in Mauritania ( n = 25) and France ( n = 46). The Avicenne ELAL ©, a 30-minute plurilingual language assessment using objects, picture boards, and storytelling tasks, was administered in Soninke (and in French for children in France) to migrant children in France and to children in Mauritania, with standardized procedures to minimize distractions and ensure comfort. All sessions were recorded, de-identified, and supplemented with field notes and a logbook to capture contextual and qualitative elements of children's language use. The results of the two groups of children were analyzed and compared with quantitative and qualitative methods. Given the excellent results of the monolingual children, the ELAL in the Soninke language can be considered valid. Statistical analysis confirmed significant differences between the children's scores in Mauritania and France, for both the total score and each separate scale (Comprehension, Expression, and Storytelling). The results also showed that the quality of the narrative skills (storytelling) was strongly correlated with the child's age. Comparing the language assessments collected in these two settings highlights the variations and cultural specificities that should be considered when studying the language skills of Soninke-speaking migrant children
A Systematic Review and Meta‐Analysis of Postoperative Opioid Consumption, Pain and Complications Following Intraoperative Autonomic Nervous System‐Based Nociception Monitoring
No full textInternational audienceABSTRACT Background Autonomic nervous system–based nociception monitors have been proposed to optimise intraoperative opioid administration. While they reduce intraoperative opioid use, evidence on postoperative outcomes remains limited. We conducted a systematic review and meta‐analysis to evaluate their effects on postoperative pain, opioid consumption and complications. Methods MEDLINE, EMBASE, LILACS, Google Scholar, Cochrane and ClinicalTrials.gov were searched for randomised controlled trials comparing intraoperative nociception monitoring with standard care and reporting postoperative outcomes. Risk of bias was assessed per Cochrane guidance. Data were pooled with random‐effects models (RevMan 5.4.1). Continuous outcomes were summarised as mean or standardised mean differences (95% CI) and dichotomous outcomes as risk ratios (95% CI). Results Thirty‐eight RCTs comprising 3243 patients were included. Post‐anaesthesia care unit (PACU) opioid consumption was lower in monitor‐guided groups (mean difference −0.6 mg, 95% CI –1.00 to −0.19). Likewise, 24‐h morphine consumption decreased (mean difference −2.56 mg, 95% CI –4.01 to −1.11); however, these reductions did not reach the minimal clinically important difference. PACU and 24‐h pain scores, as well as the incidence of postoperative nausea and vomiting, respiratory events, urinary retention, delirium and chronic postsurgical pain (CPSP), were not significantly different between groups. Conclusions Intraoperative nociception monitors modestly reduce early postoperative opioid requirements, but without clinically meaningful benefit. No improvements were observed in postoperative pain or complications. These findings suggest that, despite their impact on intraoperative opioid titration, nociception monitors do not improve patient‐centered postoperative outcomes. Significance This systematic review and meta‐analysis shows that intraoperative autonomic nervous system‐based nociception monitors significantly reduce postoperative opioid consumption at PACU discharge and 24 hours, but the effect size does not reach the minimal clinically important difference. Pain scores and postoperative complications are not significantly impacted. These findings suggest that, while nociception monitors influence intraoperative opioid titration, their clinical benefit on postoperative outcomes remains limited. Trial Registration PROSPERO number: CRD42023490440; ClinicalTrials.gov identifier: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202349044
Avis du CNGOF concernant les accouchements instrumentaux par ventouse obstétricale
No full textNational audienceLa commission d’obstétrique du CNGOF, saisie par le CNP GOGM à la demande de l’ANSM, a examiné la sécurité d’utilisation des ventouses obstétricales. L’accouchement instrumental peut être réalisé pour écourter l’expulsion, notamment en cas de ralentissement du rythme cardiaque fœtal. Les instruments disponibles sont la ventouse, le forceps et les spatules, le choix dépendant de la situation et de l’opérateur. En France, environ 12 % des naissances sont instrumentales, un taux stable depuis 2016. La ventouse est utilisée dans environ deux tiers des cas, proportion similaire à celle observée dans la plupart des pays européens et au Canada, mais supérieure à celle des États-Unis. La ventouse agit par dépression sur le scalp fœtal, permettant une traction contrôlée et sécurisée. Les complications maternelles (lésions périnéales, hémorragies) et néonatales (notamment hémorragies intracrâniennes) sont rares et comparables à celles observées lors des césariennes en cours de travail. Les études épidémiologiques ne mettent pas en évidence de surrisque neurologique ou de séquelles à long terme chez les enfants nés par ventouse. Comparée au forceps, la ventouse réduit la morbidité maternelle, notamment le risque de lésion du sphincter anal, sans différence notable sur la santé néonatale globale, hormis un léger sur-risque de céphalhématome ou d’ictère. Aucune différence n’est observée selon l’expérience de l’opérateur. En conclusion, l’accouchement instrumental par ventouse qui fait partie des techniques recommandées par le CNGOF, constitue une alternative pertinente à la césarienne à dilatation complète
Experiences of discrimination and their impact on healthcare utilization: non-uptake of covid-19 vaccination
No full textInternational audienceObjective This article examines the relationship between experiences of discrimination and COVID-19 vaccine non-uptake, with particular attention to the domains in which discrimination occurs (healthcare, employment, housing, and public services) and to the frequency of such experiences. Methods The analysis draws on the most recent wave of the Epidemiology and Living Conditions (EpiCov) cohort survey, conducted in October 2022, which included 65,403 adults living in metropolitan France. Results Although the vast majority of the population in France ultimately received the COVID-19 vaccine, a significant minority remained reluctant to take advantage of this free and widely accessible intervention. Our findings indicate that past experiences of discrimination exerted both specific and cumulative effects on vaccination behavior: discrimination encountered in interactions with healthcare professionals and public services had a stronger influence on non-vaccination than discrimination related to employment or housing. Moreover, the frequency of discriminatory experiences was positively associated with vaccine non-uptake. Importantly, these associations were not limited to racialized minorities. Conclusions By adopting a broad perspective on discrimination, the study demonstrates that feelings of social exclusion contribute to vaccine non-uptake across all social groups
Novel Drug‐Disease Modeling Framework for Oncology Benefit–Risk Evaluation: Application to Tusamitamab Ravtansine
No full textInternational audienceThis study introduces a novel drug-disease modeling framework designed to assess the benefit–risk balance of antibody-drug conjugates (ADC) in oncology. The framework integrates dose levels, pharmacokinetics, tumor growth dynamics, progression-free survival (PFS), and dose-adjusted adverse events. We demonstrated this through its application to tusamitamab ravtansine (Tusa), an ADC targeting Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5 in non-squamous non-small cell lung cancer (nsq NSCLC). We developed our model using phase I trial safety data from 254 patients (doses: 5–190 mg/m2) and efficacy data from 88 nsq NSCLC patients (dose 100 mg/m2). This model accurately predicted phase III outcomes for the Tusa arm via an iterative simulation. Using phase III baseline characteristics, simulations of Tusa doses comparing three dose levels (80, 100, and 120 mg/m2 every 2 weeks) revealed a critical trade-off: while higher doses increased response rates, they also substantially increased corneal toxicity without improving survival. These findings demonstrate how early-phase data can inform optimal dose selection by quantifying benefit–risk. This robust framework and methodology is generalizable beyond Tusa, offering value to support dose selection and trial decision-making in oncology drug development
Prêts ou réticents à se lancer dans l’entrepreneuriat ? Une étude de cas française sur les aspirants entrepreneurs »
No full textInternational audienceEntrepreneurship education is widely recognised as a key influence on the decision to start a business. However, many nascent entrepreneurs find it challenging to transform entrepreneurial intention into concrete action. This paper sheds light on the ambiguity of the entrepreneurial environment, the role of entrepreneurship skills and the personal experiences of aspiring entrepreneurs, particularly those characterised by disappointment and disengagement. A qualitative multiple case study was conducted through face-to-face interviews with eight individuals from a French business school. The aim of this exploratory study is to gain a better understanding of the combined barriers that hinder entrepreneurial engagement. While the empirical data is drawn from student cases, the findings may be relevant more broadly to early-stage entrepreneurship.L'éducation à l'entrepreneuriat est largement reconnue comme un facteur clé dans la décision de créer une entreprise. Cependant, de nombreux entrepreneurs en herbe ont du mal à transformer leur intention entrepreneuriale en action concrète. Cet article met en lumière l'ambiguïté de l'environnement entrepreneurial, le rôle des compétences entrepreneuriales et les expériences personnelles des entrepreneurs en herbe, en particulier celles caractérisées par la déception et le désengagement. Une étude de cas qualitative multiple a été menée à travers des entretiens en face à face avec huit personnes issues d'une école de commerce française. L'objectif de cette étude exploratoire est de mieux comprendre les obstacles combinés qui entravent l'engagement entrepreneurial. Bien que les données empiriques proviennent de cas d'étudiants, les résultats peuvent s'appliquer plus largement à l'entrepreneuriat en phase de démarrage
Psychosocial burden in type 1 diabetes: a cross-sectional network analysis in the SFDT1 study
No full textInternational audienceObjectives Using network analysis, which takes a holistic approach to health systems, we aimed to identify which psychosocial burden dimensions are the most central and, thus, critical to prioritising to improve the overall health of people with type 1 diabetes (PwT1D). Design A cross-sectional network analysis. Setting We used data from participants attending 44 diabetes centres in France, who were enrolled in the SFDT1 cohort study between June 2020 and February 2024. Participants We included 1430 PwT1D (52% women, median age (IQR) 41 (31-52.8) years) who had completed questionnaires on diabetes burden. Outcome measures The items from questionnaires on diabetes distress, fear of hypoglycaemia, quality of life, treatment burden and the impact of diabetes on education and work. Results The network was highly stable (correlation stability coefficient=0.75). We observed nine domains within the network; 'Loneliness, Worrying & Burnout' was the most influential. We further grouped the domains into three distinct syndromes labelled 'Diabetes Distress', 'Treatment Burden' and 'Impact of Diabetes on Life'. These syndromes reflect the most relevant pillars of the psychosocial burden in PwT1D. Conclusions We observed that 'Loneliness, Worrying & Burnout' is the most influential psychosocial burden network domain to prioritise for type 1 diabetes care. This new network-based approach opens the path to defining personalised interventions targeting the most critical burden parameters to expect the most significant overall beneficial impact on PwT1D's health. Trial registration number NCT04657783.⇒ This analysis provides a more detailed and global view of the psychosocial burden of type 1 diabetes (T1D), considers the multiple interactions of the involved variables and identifies central variables and domains that are not visible in a traditional regression analysis. ⇒ We analysed a large sample size of patients with T1D in a deeply phenotyped cohort. ⇒ Some limitations of this analysis are that the information is self-reported by patients and is therefore likely to be subject to recall bias. ⇒ Not all participants completed the data collection, so there may be a selection bias. ⇒ Networks depend on the variables included, and we could not include other relevant variables, such as depression and anxiety symptoms, because they were unavailable at the time of the assessment.Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies.</p
Morfetik : Une ressource lexicale morphologique extensible et modulaire pour le français
No full textInternational audienceMorphological lexical resources, describing the internal structure of words and their inflected forms, are crucial for natural language processing (NLP) and computational linguistics.We present MORFETIK, a comprehensive open-source lexical resource for French, capable of automatically generating and identifying all inflected forms of words (nouns, verbs, adjectives, phrases, etc.). It offers broad coverage of the contemporary and specialised lexicon, an extensible and modular architecture, and easy integration with external resources.We also illustrate its use through two case studies and detail its architecture, showing how its modularity and interoperability facilitate corpus analysis and the development of NLP tools.Les ressources lexicales morphologiques, décrivant la structure interne des mots et leurs formes fléchies, sont essentielles pour le traitement automatique des langues (TAL) et la linguistique computationnelle. Nous présentons MORFETIK, une ressource lexicale open-source complète pour le français, capable de générer et d'identifier automatiquement toutes les formes fléchies des mots (noms, verbes, adjectifs, locutions, etc.). Il offre une couverture large du lexique contemporain et spécialisé, une architecture extensible et modulaire, et une intégration aisée avec des ressources externes. De même, nous illustrons son utilisation à travers deux études de cas et détaillons son architecture, montrant comment sa modularité et son interopérabilité facilitent l'analyse de corpus, et le développement d'applications TAL