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Bridging the digital divide for outpatients treated with anticancer chemotherapy: a retrospective quantitative and qualitative analysis of an adapted electronic Patient Reported Outcome program
No full textInternational audienceAbstract Purpose Using electronic patient-reported outcomes (ePRO) in clinical trial has shown benefits for patients. However, the digital divide can lead to unequal access to telehealth. We investigated whether a dedicated support program could bridge that divide. Methods Between February 2021 and June 2022, outpatients undergoing chemotherapy for cancer at our teaching hospital in France were given the Onco’nect® ePRO application if they were affected by the digital divide. They were also offered a dedicated support program that included the lending of a tablet, access to healthcare professionals, training, technical support, and peer-to-peer guidance. We conducted semi-structured interviews to assess the challenges they faced. Results We enrolled 22 patients, of whom 10 (45%) made good use of the application and completed > 50% of the questionnaires in the application, while 5 (23%) completed > 75%. However, 12 (55%) of the 22 patients remained poor users of the application over a median participation of 4 months (IQR, 3–7). We also measured social deprivation but found no association with questionnaire completion rate. The under-use of Onco’nect® was due not only to the patients’ understanding of its clinical benefit or to their computer skills, but also to poor health literacy and strong emotional responses to using the application. Conclusion Dedicated support programs help many patients make the most of telehealth. However, most of our patients in the digital divide under-used the ePRO application, primarily due to their poor health literacy
Control strategies for meeting time and capacity constraints in manufacturing plants based on discrete event systems.
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Erratum: The Filippov characteristic flow for the aggregation equation with mildly singular potentials
No full textIn this short erratum, we provide a corrected version and a corrected proof of the existence and uniqueness result of a weak measure-valued solutions to the so-called aggregation equation
Pratiques discrètes d’écologie populaire dans le Grand Paris. Migrantes chinoises et cueillette de plantes
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Les limites de la décolonisation d'une organisation humanitaire internationale - La "décolonialité" comme principe?
No full textInternational audienceIn 2025, the proportion of international staff from the Global South (and Africa in particular) within the humanitarian organization Médecins Sans Frontières (MSF) reached almost 50%. By changing the relationship to time, authority, abuse, management and gender, this “southernization” of staff has led to internal tensions and criticism. Based on participant observation and semi-structured interviews, we examine the possibility of decolonizing aid by assessing the extent to which these new members can break away from relations of domination and/or propose their own ways of thinking and acting.En 2025, la part du personnel international issue du Sud Global (et en particulier d'Afrique) au sein de l'organisation humanitaire Médecins Sans Frontières (MSF) a atteint près de 50%. En changeant le rapport au temps, à l'autorité, aux abus, au management ou au genre, cette « sudisation » du personnel génère tensions et critiques internes. À partir d'une observation participante et d'entretiens semi-directifs, nous interrogeons la possibilité d'une décolonisation de l'aide en évaluant dans quelle mesure ces nouveaux membres peuvent se départir des rapports de domination et/ou proposer leurs propres façons de penser et d'agir
What is personalized lung poromechanical modeling and how can it improve the understanding and management of fibrotic interstitial lung diseases?
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Ils sont déjà passés. Subjectivité protofasciste et politique de la fin
No full textInternational audienceThe article analyses how, on the threshold of the second round of the French legislative elections of 2024, the classic anti-fascist moto “No pasarán!” ("they shall not pass") comes at the wrong time, given that the Far right “has already passed” (in that country and around the world). Thus, it is argued that the emergence of the Far right is the culmination of decades of production of a neoliberal-digital subjectivity. Hence, just as neoliberalism was imposed by way of military dictatorship and violence, this neo-fascist acceleration is imposed through votes and mobile screens.From this perspective, it is argued that the Right has been able to capitalise on fear, anger and the feeling of imminent collapse, mobilising basic emotions and depoliticising citizens. In contrast, the Left continues to cling to the search for a political subject that articulates a future project, without recognising that the current triumph of the far right is, in essence, the product of a transformation of subjectivities. Thus, the text invites us to rethink political strategies, suggesting the urgency of a “politics of the end (of the world)” that, recognizing the accumulated defeats, reorients itself towards the mobilization of the sectors vulnerable to apocalyptic and hopeless discourses. (Here, the text is available in English and French).El artículo analiza cómo, en el umbral de la segunda vuelta de las elecciones legislativas francesas de 2024, el clásico grito antifascista «¡No pasarán!» llega a destiempo, dado que la extrema derecha "ya pasó" (en ese país y en todo el mundo). Así, se argumenta que la emergencia de la extrema derecha es la culminación de décadas de producción de una subjetividad neoliberal-digital. De allí que, así como el neoliberalismo fue impuesto por la vía de la dictadura militar y la violencia, esta aceleración neofascista se impona a través de votos y pantallas móviles. A partir de esta perspectiva, se sostiene que la derecha ha sabido capitalizar el miedo, la ira y la sensación de inminente colapso, movilizando emociones básicas y despolitizando a la ciudadanía. En contraste, la izquierda continúa aferrándose a la búsqueda de un sujeto político que articule un proyecto futuro, sin reconocer que el triunfo actual de la extrema derecha es, en esencia, el producto de una transformación de las subjetividades. Así, el texto invita a repensar las estrategias políticas, sugiriendo la urgencia de una “política del final” que, reconociendo las derrotas acumuladas, se reoriente hacia la movilización de aquellos sectores vulnerables a discursos apocalípticos y de desesperanza. (Artículo disponible aquí en Inglés y en Francés: la versión original en español forma parte de un libro).L'article analyse comment, à l'aube du deuxième tour des élections législatives françaises de 2024, le classique moto antifasciste « ¡No pasarán ! » (« Ils ne passeront pas ! ») arrive au mauvais moment, car l'extrême droite « est déjà passée » (dans ce pays et dans le monde entier). Ainsi, le texte argumente que l’émergence de l’extrême droite est le point culminant de décennies de production d’une subjectivité néolibérale-numérique. De même que le néolibéralisme a été imposé par la dictature militaire et la violence, cela a permis que l'accélération néofasciste s’impose par le biais des urnes et des écrans mobiles.De ce point de vue, il est proposé que la droite a su capitaliser la peur, la colère et la sensation d'effondrement imminent, en mobilisant des émotions fondamentales et en dépolitisant la population. En revanche, la gauche continue à s'accrocher à sa quête d’un sujet politique qui articule un projet futur, sans reconnaître que la réussite actuelle de l’extrême droite est, en essence, le produit d’une transformation des subjectivités. De-là le texte invite à repenser les stratégies politiques, suggérant l’urgence d’une « politique de la fin » qui, reconnaissant les défaites accumulées, se réoriente vers la mobilisation des secteurs vulnérables aux discours apocalyptiques et de désespoir. (Article disponible ici en français et anglais)
Same data, different analysts: variation in effect sizes due to analytical decisions in ecology and evolutionary biology
No full textInternational audienceAlthough variation in effect sizes and predicted values among studies of similar phenomena is inevitable, such variation far exceeds what might be produced by sampling error alone. One possible explanation for variation among results is differences among researchers in the decisions they make regarding statistical analyses. A growing array of studies has explored this analytical variability in different fields and has found substantial variability among results despite analysts having the same data and research question. Many of these studies have been in the social sciences, but one small "many analyst" study found similar variability in ecology. We expanded the scope of this prior work by implementing a large-scale empirical exploration of the variation in effect sizes and model predictions generated by the analytical decisions of different researchers in ecology and evolutionary biology. We used two unpublished datasets, one from evolutionary ecology (blue tit, Cyanistes caeruleus, to compare sibling number and nestling growth) and one from conservation ecology (Eucalyptus, to compare grass cover and tree seedling recruitment). The project leaders recruited 174 analyst teams, comprising 246 analysts, to investigate the answers to prespecified research questions. Analyses conducted by these teams yielded 141 usable effects (compatible with our meta-analyses and with all necessary information provided) for the blue tit dataset, and 85 usable effects for the Eucalyptus dataset. We found substantial heterogeneity among results for both datasets, although the patterns of variation differed between them. For the blue tit analyses, the average effect was convincingly negative, with less growth for nestlings living with more siblings, but there was near continuous variation in effect size from large negative effects to effects near zero, and even effects crossing the traditional threshold of statistical significance in the opposite direction. In contrast, the average relationship between grass cover and Eucalyptus seedling number was only slightly negative and not convincingly different from zero, and most effects ranged from weakly negative to weakly positive, with about a third of effects crossing the traditional threshold of significance in one direction or the other. However, there were also several striking outliers in the Eucalyptus dataset, with effects far from zero. For both datasets, we found substantial variation in the variable selection and random effects structures among analyses, as well as in the ratings of the analytical methods by peer reviewers, but we found no strong relationship between any of these and deviation from the meta-analytic mean. In other words, analyses with results that were far from the mean were no more or less likely to have dissimilar variable sets, use random effects in their models, or receive poor peer reviews than those analyses that found results that were close to the mean. The existence of substantial variability among analysis outcomes raises important questions about how ecologists and evolutionary biologists should interpret published results, and how they should conduct analyses in the future
Conduite à tenir devant une femme ayant une cytologie cervico-utérine anormale : actualisation des recommandations INCa après la mise en place du dépistage par le test HPV
No full textInternational audienceObjectiveTo update the recommendations issued by the National Cancer Institute (INCa) on the management of women with abnormal cervical cytology.MethodsINCa recommendations on the management of women with abnormal cervical cytology were published in 2016. In 2019, the High Authority of Health (HAS) recommends HPV test for cervical cancer screening in women over 30. It was therefore necessary to update the initial management and follow-up of women with a reflex cytology abnormality after a positive HPV test. We used the modified Delphi method. Each decision tree was modified by the 3 members of the organizing committee and then presented to 35 experts over 2 rounds, in order to obtain their agreement in terms of validity and clarity.ResultsThis formalized consensus of experts allowed the creation of 17 decision trees instead of 15 previously: 13 on the diagnostic management of abnormal cytology, stratified according to age, and 4 on therapeutic indications in abnormal histology. The median agreement scores were 89% (81–97).ConclusionThese 17 decision trees respond to the different situations that health professionals may encounter in order to enable them to act, to follow-up or delegate according to their specialties.ObjectifActualiser les recommandations émises par l’Institut national du cancer (INCa) sur la conduite à tenir devant une femme ayant une cytologie cervico-utérine anormale.MéthodesLes recommandations de l’INCa sur la conduite à tenir devant une femme ayant une cytologie cervico-utérine anormale ont été publiées en 2016. En 2019, la Haute Autorité de santé (HAS) recommande le test HPV pour dépister le cancer du col chez les femmes de plus de 30 ans. Il était donc nécessaire de revoir la prise en charge initiale et le suivi des femmes ayant une anomalie de la cytologie réflexe après un test HPV positif. Nous avons utilisé la méthode de Delphi modifiée. Chaque arbre décisionnel était modifié par les 3 membres du comité d’organisation, puis présenté à 35 experts à deux reprises, afin d’obtenir leur agrément en termes de validité et de clarté.RésultatsCe consensus formalisé d’experts a permis la création de 17 arbres décisionnels au lieu de 15 précédemment : 13 sur la conduite diagnostique face aux différentes anomalies cytologiques, stratifiée selon l’âge, et 4 sur les indications thérapeutiques face aux anomalies histologiques. Les scores médians d’agrément étaient de 89 % (81–97).ConclusionCes 17 arbres décisionnels répondent aux différentes situations que peuvent rencontrer les professionnels de santé de façon à leur permettre d’agir, de surveiller ou de déléguer selon leurs spécialités
Evaluation of Efficacy and safety of Rituximab in patients with progressive Interstitial Lung Disease (ILD) with inflammatory component (EvER-ILD2): A multicentre double-blind placebo-controlled randomized trial
No full textInternational audienceIntroduction: Progressive interstitial lung diseases (ILDs) are rare but severe diseases, with high mortality and morbidity, with no effective pharmacological treatment allowing for long-term remission, and therefore no clear therapeutic recommendations. Several ILDs present inflammatory components (ILDic), which may justify the use of anti-inflammatory and immunosuppressive drugs, as first-step therapy. Except for systemic sclerosis (SSc)-ILD and sarcoidosis, the evidence in favor of this approach is very weak. The EvER-ILD2 study is the first one to prospectively evaluate the efficacy and safety of rituximab (RTX) versus placebo in a broad range of progressive ILD outside sarcoidosis and connective tissue diseases. A pharmacokinetic-pharmacodynamic analysis based on RTX serum concentrations will allow identification of potential factors associated with therapeutic response and/or adverse effects.Methods: EvER-ILD2 study is a French multicentre, prospective, randomized, double blind, placebo-controlled, superiority trial. Patients with progressive ILDic will be randomized into 2 groups of treatment: one course of RTX (RTX group) and one course of placebo (Placebo group). The primary outcome is the change in Forced Vital Capacity (FVC, mL) from baseline to 6 months. Several clinical, biological, and quality of life secondary outcomes will be measured at 3 and 6 months. A sample size of 126 patients (63 patients per group) would allow to show a 100 mL difference between groups in the change of FVC from baseline to 6 months, based on a common standard deviation for FVC change of 200 mL with a power of 80% and a two-sided alpha of 5%.Ethics and dissemination: The protocol was approved by the French Research Ethics Committee (CPP Ile de France VI) on September 27, 2022, and by the French competent authority on October 02, 2022. This article refers to protocol V1, dated September 2022. An independent data safety monitoring board will review safety data for the duration of the trial. Results will be disseminated via peer reviewed publication and presentation at international conferences.Trial registration number: NCT05596786 (clinicaltrials.gov), EU-CT number 2022-500,375-31-00 (European Medicines agency)