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Monitoring Ethical Tensions Encountered When Using Digital Health Solutions: Implementation of an Ethicovigilance Platform
No full textInternational audienceDigital health is transforming healthcare by enhancing accessibility, efficiency, and personalized care. It facilitates telemedicine, provides clinicians with data-driven insights, and streamlines administrative processes to reduce costs and improve patient care. However, challenges persist, including privacy concerns, data security issues, and the risk of exacerbating inequalities. To address these challenges, France’s Digital Health Delegation (DNS) developed a Framework for Ethics in Digital Health (CENS), emphasizing principles such as accessibility, transparency, trustworthy AI, and sustainability. Despite this initiative, achieving consistent ethical compliance remains difficult. In response, the DNS launched the Ethicovigilance platform in late 2023, enabling users to report ethical concerns when using digital health solutions. By 2024, 27 reports were collected, with 11 fully investigated. Key issues included unauthorized access to health data, lack of transparency, and insufficient user autonomy. These cases highlight systemic vulnerabilities, such as data misuse and inequitable access. Promoting trust, transparency, inclusivity, and accountability, alongside clear stakeholder responsibilities, is essential to align digital health with ethical standards and improve patient outcomes
La désinformation par l’image : comment peut-on adhérer à des discours pseudo-médicaux
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High-Dose vs. Standard-Dose Influenza Vaccine in Heart Failure: A Prespecified Analysis of the DANFLU-2 Trial
No full textInternational audienceBackground: Influenza contributes substantially to disease burden in individuals with heart failure (HF) and is an established trigger of cardiovascular (CV) and HF events. Standard-dose inactivated influenza vaccine (SD-IIV) is recommended for HF, though immune responses may be attenuated. High-dose IIV (HD-IIV) was developed to enhance immunogenicity, but its effectiveness compared with SD-IIV against hospitalization for influenza and CV disease by HF status remains uncertain. Methods: This was a prespecified analysis of a pragmatic, prospective, individually randomized, open-label trial with registry-based endpoint-evaluation conducted in Denmark across the 2022/2023 to 2024/2025 influenza seasons. Citizens ≥65 years were randomized 1:1 to HD-IIV or SD-IIV. Outcomes included hospitalization for influenza-related illness, laboratory-confirmed influenza (LCI), any CV disease, cardio-respiratory disease, and HF, assessed by HF status. Effect of HD-IIV vs. SD-IIV in reducing risk of outcomes assessed was expressed as risk ratios (RR). Results: The trial randomized 332,438 participants (48.6% female, mean age 73.7±5.8 years), including 10,410 with HF at baseline (27.4% female, mean age 76.0±6.3 years). Overall, HD-IIV was associated with a statistically significant lower incidence of hospitalization for influenza-related illness, LCI, cardio-respiratory disease, CV disease, and HF compared with SD-IIV. In participants with HF, effect estimates were similar: RR for influenza-related hospitalization was 0.48 (95%CI, 0.20-1.06; p interaction =0.64), for LCI hospitalization 0.55 (95%CI, 0.29-1.02; p interaction =0.59), for cardio-respiratory hospitalization 0.89 (95%CI, 0.77-1.02; p interaction =0.34), for CV hospitalization 0.86 (95%CI, 0.72-1.02; p interaction =0.34), and for HF hospitalization 0.82 (95%CI, 0.61-1.11; p interaction =0.83). Findings were consistent across HF subgroups by disease duration, recency of hospitalization, most recent N-terminal pro-B-type natriuretic peptide, and presence of device therapy. Conclusions: In this prespecified exploratory analysis of the largest individually randomized influenza vaccine trial ever conducted, HD-IIV was associated with lower rates of influenza and CV hospitalizations compared with SD-IIV, with effect estimates similar across HF status at baseline and HF subgroups
Infective endocarditis complicated by shock: a systematic review and meta-analysis
No full textInternational audienceAbstract Infective endocarditis (IE) complicated by septic or cardiogenic shock is linked to a marked increase in morbidity and mortality rates. This systematic review and meta-analysis sought to evaluate clinical outcomes, identify prognostic factors, and assess the effects of valve surgical intervention in patients with infective endocarditis complicated by shock. Systematic searches were performed in PubMed, Cochrane Library, and Google Scholar databases, following PRISMA and MOOSE guidelines. Included were observational studies published from January 2015 to May 2025 that reported on adult patients with infective endocarditis complicated by septic or cardiogenic shock. A random-effects model was utilized for data synthesis (restricted maximum likelihood with Hartung–Knapp adjustment), and meta-regression was conducted to assess sources of heterogeneity. Seven observational studies were included ( n = 183–255,838). In-hospital mortality among patients with shock was 62.3% (95% CI 48.3–74.5%). Compared with IE without shock, the pooled odds ratio for in-hospital mortality (HK–REML) was 5.83 (95% CI 1.35–25.23; 95% prediction interval 0.26–129.69), with substantial heterogeneity ( I 2 = 90.3%). Valve surgical intervention was associated with reduced mortality, particularly in cardiogenic shock. Staphylococcus aureus was the most common pathogen in available microbiological data. Shock was frequently accompanied by acute kidney injury, neurological complications, and multiorgan dysfunction. Infective endocarditis complicated by shock carries an extremely poor prognosis, with pooled mortality exceeding 60%. Prompt recognition of shock, timely initiation of appropriate antimicrobial therapy, hemodynamic stabilization, and early valve surgery are crucial to improve outcomes in this high-risk population. Systematic review registration PROSPERO: CRD420250652570
Association between serum uric acid level and outcome in intensive care unit, an ancillary analysis of the FROG-ICU cohort (URIC-ICU)
No full textInternational audienceBackground: There is increasing evidence that elevated serum uric acid (SUA) levels are associated with increased risk of AKI. However, very little data is available on SUA levels in the ICU setting. We aimed at studying the level of SUA in ICU patients and its association with patient outcomes and incidence of acute kidney injury (AKI).Methods: We conducted an ancillary study using the prospective FROG-ICU cohort. We selected patients with SUA measurement at inclusion. The primary endpoint was 90-day mortality. The secondary endpoints were 1-year mortality, occurrence of AKI, and MAKE at day 30. To better characterize the association between SUA and outcomes, we performed a propensity score matching analysis and a subgroup analysis of patients with unaltered glomerular filtration rate (GFR) at admission.Results: A total of 1741 patients were included with a median SOFA score of 7 [5-10] and a median SUA value of 175 µmol/L [113-273]. Higher SUA at admission (>175 µmol/L) was significantly associated with 90-day mortality after adjustment, OR: 1.43 CI95 % [1.11-1.82], and with every secondary endpoint. This association remained significant after propensity score matching. The association between SUA and AKI and mortality was also significant in the subgroup of patients with unaltered GFR at admission.Conclusions: Patients admitted to the ICU displayed a low level of SUA compared to the general population. Higher SUA level was associated with increased 90-day mortality, increased incidence of AKI, even among patients without altered GFR on admission, suggesting a possible role of uric acid in the worsening of renal function.Study registration: ClinicalTrials.gov under number NCT01367093 (https://clinicaltrials.gov/study/NCT01367093?term = NCT01367093&rank = 1)
QUANTUM REFLECTION EFFECTS IN THE DIFFRACTION OF MATTER WAVES
No full textInternational audienceAmong the fundamental quantum effects, quantum reflection (QR) is one of the most notable phenomena. Approximating arbitrary potentials in the Schrödinger equation as multistep potentials allows us to determine the reflection coefficient by means of a Riccati equation. We introduce a measure for the wavefunction's characteristic reflection distance and derive an analytical expression for this reflection point in an arbitrary power-law potential. We study the associated QR rate in the context of Casimir-Polder atom surface interactions, revealing its strong dependence on critical parameters such as velocity and interaction duration. As an application, we demonstrate how the matter-wave diffraction of a low-velocity metastable Argon beam impinging on a rotated grating facilitates high-precision potential analysis
Prompting-in-a-Series: Psychology-Informed Contents and Embeddings for Personality Recognition With Decoder-Only Models
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Bulle, dôme, cloche. Le climat sous contrôle dans la dystopie française (1850-1950)
No full textInternational audienceLes récits d’anticipation manifestent une prédilection pour le thème de la régulation climatique, entre illusion de maîtrise et fantasme d’autarcie, en particulier dans la veine anxiogène et critique de la dystopie, qui explore les risques et les travers liés à cette question, qu’il s’agisse d’expérimenter de nouvelles infrastructures en prévention d’une pollution menaçant la vie communautaire (Jules Verne, Les Cinq Cents Millions de la Bégum ; Rosny aîné, La Mort de la Terre), de s’appuyer sur des ressources dont l’exploitation non régulée est sujette à catastrophes (le « feu central » de la Terre dans Ignis, la pile thermo-solaire dans La Babylone électrique d’Albert Bleunard) ou de découvrir l’écosystème mis en place par des créatures inconnues dans un biotope alternatif (la gestion des gaz, du rayonnement lumineux et des rythmes vitaux dans La Cité des asphyxiés de Régis Messac ou L’Île sous cloche de Xavier de Langlais). En s’appuyant sur une petite cartographie du contrôle du climat dans les récits d’anticipation de la période 1850-1950, corpus préalable à l’institutionnalisation de la science-fiction comme genre éditorial en France et caractérisé par une grande diversité thématique et générique, cette communication a examiné les enjeux d’une situation narrative récurrente relative à la mise en place d’un micro-climat ou d’un écosystème surveillé, généralement confiné dans de strictes limites géographiques et atmosphériques, et fonctionnant par ses propres ressources ou par la prédation du milieu. Il s’agit, d’une part, d’analyser la place du topos de la bulle climatique dans l’économie narrative des récits, où il joue souvent un rôle de premier plan, en révélant, condensant et illustrant les dimension polémique des scénarios dystopiques. Il s’agit, d’autre part, de remettre en perspective les enjeux environnementaux ainsi soulevés en les situant dans les discours sociaux et médiatiques de leur époque (évolution de l’hygiénisme, désillusions du projet extractiviste, tentatives de terraformation, déclinaisons uchroniques du monde perdu, exploration tâtonnante de l’autarcie énergétique, etc.). On a veillé à proposer des éléments de réflexion relevant de l’écopoétique en articulant l’analyse d’un sujet sociétal de type environnemental et ses mises en forme narratives et discursives dans les littératures de l’imaginaire relevant de la dystopie. Cette dernière sera envisagée sous l’angle d’une fiction proactive qui propose des modélisations plausibles du futur en élaborant, par extrapolation de son premier contexte, certains scénarios du pire qu’il s’agirait d’empêcher d’advenir en révélant leurs lignes de faille et en affichant les principales ressources vitales en tension
