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Prognosis of Hepatocellular carcinoma in the French Overseas Territories and Comparison with a Tertiary Center in Mainland France.
No full textInternational audienceIntroduction and objectives: Limited data are available on the prognosis of hepatocellular carcinoma (HCC) in the French overseas territories (FOT). This study aimed to describe the characteristics and outcomes of patients diagnosed with HCC in FOT, comparing them to those from a tertiary center located in Île-de-France (IDF).Materials and methods: We retrospectively included all patients with HCC diagnosis between 2013 and 2023 in the FOT and IDF. Socio-demographic and medical data were collected, with the first treatment performed and survival data. Overall survival was analyzed using Kaplan- Meier methods and Cox proportional hazards models.Results: A total of 1114 patients were included (FOT 11%, IDF 89%). FOT patients had higher rates of hepatitis B (36% vs. 16%, p<0.001) and worse liver function (defined by higher MELD scores and fewer Child A cases) at HCC diagnosis. In contrast, IDF patients had a higher prevalence of MASLD (29% vs. 16%, p=0.004). HCC was diagnosed at more advanced stages in FOT compared to IDF, with 71% vs. 49% (p<0.001) of cases outside Milan criteria and 29% vs. 5% (p<0.001) in BCLC-D, leading to a significantly lower survival in FOT (median 9 vs. 23 months, p=0.02).Conclusions: HCC patients in FOT have a poorer prognosis compared to IDF, with diagnoses at more advanced stages, limiting curative treatment options. These findings highlight the need for improved access to care and screening strategies for earlier diagnosis of HCC in FOT
Integrating Heterogeneous Perioperative Data Sources: Platform Design and Implementation
No full textBackgroundModern intensive care units and operating rooms generate vast quantities of valuable physiological data that remain largely underutilized for clinical decision support and research. Existing perioperative databases exhibit geographic and specialty biases, limiting the generalizability of derived models. Additionally, healthcare lacks standardized approaches for integrating heterogeneous data sources while supporting both real-time analytics and long-term machine learning applications.ObjectivesWe designed and implemented a comprehensive perioperative data platform to support three clinical workloads: immediate clinical support through digital twin modeling, predictive risk mitigation for adverse events, and population health advancement through discovery of previously undetected disease patterns.MethodsWe developed an integrated data infrastructure at the Greater Paris University Hospitals combining real-time stream processing with robust long-term storage. The platform ingests data from patient monitors, syringe pumps, ventilators, EEG systems, laboratory analyzers, and patient data management systems using standardized protocols. Real-time processing utilizes Apache Kafka with ksqlDB/Flink for streamanalytics, while long-term storage employs TimescaleDB for low-frequency data (1-2 Hz) and Apache Iceberg data lakehouse architecture for high-frequency waveforms.All infrastructure adheres to open-source standards and GDPR compliance.ResultsSince March 2019, we have collected over 42 TB of data encompassing 122,815 cases across multiple specialties including ICU (7,459 cases), emergency surgery (14,059 cases), and post-anesthesia care (63,965 cases). The platform successfully integrates diverse data streams with synchronized timestamps and supports both retrospective analysis and real-time clinical applications.ConclusionsThis work provides a reproducible blueprint for building interoperable perioperative data platforms that enable multinational collaboration while supporting both immediate clinical decision-making and advanced research applications. The vendorneutral, standards-based architecture ensures adaptability as technologies evolve and facilitates wider deployment across healthcare institutions
A Signage Challenge: Visibility and Representation of the Territory
No full textInternational audienceSignage can be considered as a paradoxical mode of visual communication: although intended for our eyes, it seems currently designed not to be seen or at least not to overly solicit our powers of perception, so as to fulfill its primary mission of information. In this perspective, it is part of an approach to graphic design developed, for example, by typographer Beatrice Warde through her theory of the “invisible page”. To question this position, this article will focus on the “signage for cultural and tourist animation” deployed on French highways. Giving prominence to images, the design of these “brown signs” is entrusted to renowned graphic artists who are invited to demonstrate their creativity. Taking a completely different approach than other national road signage, they constitute a way of promoting the areas served by the highway which doesn’t fall under the “territorial brand” (Almeida & Almeida) or “signage as marketing communication” (Kellaris & Machleit) models. As a result of the ban on all forms of advertising on highways, the “brown signs” represent a way of enhancing public space that seems to invite us to rethink the “sense of place” dear to John Brinckerhoff Jackson through extensive use of “connotation” (Barthes). In doing so, their designs constitute a graphic compromise between considerations relating to all signage systems and the will to promote a given space. It is therefore fruitful to study their evolution (in terms of “hardware”, “graphic” or “content information” systems) in relation to the “signage pyramid” model developed by Calori and Vanden-Eynden
Le Labyrinthe, laboratoire des masculinités : cadrage genré des problèmes publics dans une dystopie young adult
No full textInternational audienceThis study explores the ability of 2010s young adult dystopias, part of a political tradition, toembody a counter-hegemonic critic as they display a masculine main character. Consideringdystopia as the critical extrapolation of public problems, it examines more precisely thegendered framing of the movie serie The Maze Runner through a socio-semioticalrepresentation study also calling to focus on its social production context. If the saga invites itsaudience to political reflection through the dramaturgy of public problems, their framingappears to be particularly conservative, ranging from masculinism and populism, valuing awhite virile masculinity.Cette étude interroge la capacité des dystopies Young Adult des années 2010, de tradition politique, à incarner une critique contre-hégémonique dès lors qu'elles mettent en scène un personnage principal masculin. Envisageant la dystopie comme l'extrapolation critique de problèmes publics, elle examine plus précisément le cadrage genré des controverses de la série de films jeunesse Le Labyrinthe à travers une étude de représentation socio-sémiotique appelant également à tenir compte de leur contexte social de production. Si la saga invite ses publics à la réflexion politique à travers la dramaturgie de problèmes publics, leur cadrage s'avère particulièrement conservateur, oscillant entre masculinisme et populisme, en valorisant une masculinité blanche virile
Local Multiple Traces Formulation for Transmission Problems in Linear Elasticity
No full textWe investigate the use of the local Multiple Trace Formulation (MTF) in solving time-harmonic elastic wave transmission problems. Originally devised for heterogeneous acoustic media, MTF recasts the boundary value problem as a well-posed system of first-kind boundary integral equations, naturally amenable to parallelization and preconditioning. The formulation takes independent displacement and traction unknowns per subdomain, enforces Calderón identities locally, and imposes transmission conditions weakly across interfaces. We restrict our analysis to single homogeneous scatterers, representing a foundational step toward the application of MTF techniques in heterogeneous elasticity transmission problems. For the sake of clarity, all derivations in the one-dimensional setting are carried out explicitly, with illustrative examples provided in two dimensions. We analyze the effects of frequency and material contrast on the convergence of the GMRES iterative solver. Finally, we present preliminary results for an elastic Calderón preconditioner and discuss its potential to further accelerate iterative solvers
Management of life-threatening bleeding: Application of Learned Experiences from the Critical Care Clinical Trialists (3CT) Workshop
No full textInternational audienceResume: Mortality from major bleeding in trauma patients is highest within the first six hours post-injury. Advances in patient management, driven by national guidelines and clinical trials, have significantly improved outcomes. However, variability in patient profiles, clinical presentations, and standard care practices complicates the assessment of treatment efficacy in clinical trials. In June 2024, international experts convened at the Critical Care Clinical Trialists (3CT) Workshop to examine the evolution of massive bleeding management and the impact of patient and treatment heterogeneity on trial design. This opinion article builds on the workshop discussions and underscores key considerations for the interpretation of large-scale studies. Three main conclusions emerged: First, the need for standardized definitions of “massive bleeding,” “life-threatening bleeding,” and “massive transfusion” to ensure consistent patient classification and treatment strategies. Second, the importance of tailored approaches that account for patient heterogeneity, including the careful selection of target populations and the use of appropriate primary endpoints. Third, the necessity of methodological adaptations in emergency research settings, such as implementing deferred consent procedures, conducting interim analyses, and using automated adjudication systems to improve objectivity and trial efficiency. In summary, harmonizing terminology, embracing clinical diversity, and refining trial design are essential to enhance the quality, comparability, and clinical relevance of research in massive bleeding. These measures ultimately aim to improve outcomes for critically bleeding patients
IMRED, ICMJE/COPE, EQUATOR : cadres et normes de publication des recherches originales en santé publique
No full textNational audienceThis article presents a structured reflection on the standards and frameworks governing the publication of original research, focusing on the biomedical field, and more specifically, on public health. It draws on Le Moigne’s general systems theory and its systemic triangulation, which analyzes complex objects (in this case, the publication system) through three complementary poles: ontological (what it is), functional (what it does), and genetic (how it evolves). These three dimensions help illuminate the main normative frameworks of publication: (i) the IMRAD structure (Introduction, Methods, Results, and Discussion), which illustrates the ontological pole by ensuring the clarity and replicability of scientific results; (ii) the recommendations of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE), which provide functional and ethical guidance for the writing and submission of articles, including the roles and responsibilities of authors and contributors; and (iii) the guidelines of the EQUATOR network (Enhancing the QUAlity and Transparency Of health Research), which influence both the writing of articles and the design of studies themselves (genetic pole).The analysis offers perspectives to incorporate Le Moigne’s teleological pole, which questions the very purpose of the scientific publication system and its alignment with major societal challenges. Together, these evolving frameworks interact and continuously develop to promote scientific publications that are not only clear and well-structured but also rigorous in both methodological and ethical terms, while opening space for reflection on the place and role of science in our societies.Cet article propose une réflexion structurée sur les normes et cadres qui régissent la publication de recherches originales, en se concentrant sur le domaine biomédical et plus particulièrement sur la santé publique. Il s’appuie sur la théorie du système général de Le Moigne et sa triangulation systémique, qui analyse les objets complexes (ici, le système de publication) à travers trois pôles complémentaires : ontologique (ce que c’est), fonctionnel (ce que cela fait) et génétique (comment cela évolue). Ces trois dimensions permettent d’éclairer les grands cadres normatifs de la publication : (i) la structure IMRED (Introduction, Méthodes, Résultats et Discussion), qui illustre le pôle ontologique en assurant la lisibilité et la réplicabilité des résultats scientifiques ; (ii) les recommandations du Comité international des éditeurs de revues médicales (ICMJE) et du Comité d’éthique de la publication (COPE), qui fournissent des repères fonctionnels et éthiques pour la rédaction et la soumission des articles, intégrant notamment les rôles et responsabilités des auteurs et contributeurs ; (iii) les lignes directrices du réseau EQUATOR (Enhancing the QUAlity and Transparency Of health Research), qui influencent à la fois la rédaction des articles et la conception même des recherches (pôle génétique).L’analyse énonce des perspectives afin d’intégrer le pôle téléologique de Le Moigne, qui interroge la finalité même du système de publication scientifique et sa cohérence avec les grands enjeux sociétaux. Ensemble, ces cadres évolutifs interagissent et évoluent constamment pour tendre vers des publications scientifiques non seulement claires et bien structurées, mais aussi rigoureuses sur les plans méthodologiques et éthiques, tout en ouvrant un espace de réflexion sur la place et le rôle de la science dans nos sociétés
Tracking positive emotions in the course of adult depression: A systematic scoping review of longitudinal studies
No full textInternational audienceResearch on depression has mostly focused on negative emotion with limited attention to the longitudinal evolution of positive emotions. There is a lack of clarity on the methods commonly used for tracking positive emotions in depression research and clinical practice. This methodological scoping review aimed to describe measurement procedures and instruments and appraise the quality of patient-reported outcome measures (PROMs)
