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Impact of two-level filtering organization on population’s accessibility to an emergency medical communication centre
No full textInternational audienceBackground: Emergency Medical Communication Centres (EMCCs) play a critical role in the timely coordination of out-of-hospital emergency responses. As demand for emergency services continues to rise, these centres face significant challenges in maintaining operational efficiency and service quality in order to provide a priority response to life-threatening emergencies. While the two-level answering system - i.e. a two-tiered response by call takers - has shown promise in simulation studies, its effectiveness in real-world settings has yet to be fully evaluated.Objective: This study aimed to assess the impact of implementing a two-level answering system on service quality (rate of answered calls) at 30 s (QS30) across three EMCCs, marking the first evaluation of this system in everyday operations. We also investigated how variations in organizational structure among the EMCCs may influence QS30.Methods: We conducted a multicentric, observational, retrospective study analyzing call data collected between May and June of 2022 and 2023, in France. Three EMCCs-35, 44, and 86-were included, with EMCCs 35 and 44 having implemented the two-level system, while EMCC 86 served as the control. Each EMCC employed distinct organizational models for the two-level system. Key performance indicators were assessed using non-parametric statistical tests, including the Wilcoxon and Kruskal-Wallis tests. Additionally, structural equation modeling was used to explore relationships between variables affecting service quality.Results: A total of 255,438 calls were analyzed, with 152,108 calls during the two-level period. The QS30 for EMCC 35 ranged from 93% in 2022 to 91% in 2023 (p < 1e-4), while EMCC 44 saw an increase from 91 to 100% (p < 1e-4). In contrast, EMCC 86 maintained a stable QS30 of 100%, with no significant change in activity (p = 0.1). Further analysis revealed significant differences in QS30 across the three EMCCs, suggesting that the distinct organizational structures of the two-level systems influence overall service quality. Structural equation modeling also highlighted strong correlations between call volume, agent workload, and QS30, emphasizing the impact of staffing and organizational structure on service quality.Conclusion: The findings suggest that the two-level answering system may be effective in enhancing EMCC performance, particularly in managing increased call volumes. Additionally, the study highlights the potential importance of organizational differences in shaping QS30 outcomes. Future research should focus on longitudinal effects and explore innovative strategies to sustain high-quality EMCCs amidst evolving demands
Blood flow restriction exacerbates muscle deoxygenation and fatigue during sport climbing specific finger flexors resistance training
No full textInternational audiencePurpose: Low-load blood-flow resistance training (LLBFRT) is increasingly used as an alternative to high-load resistance training (HLRT) to improve muscle strength and endurance while reducing mechanical stress on tissues. However, the acute responses associated with LLBFRT during sport climbing-specific exercises remain unknown. The aims of the study were to describe muscle oxygenation, fatigue and perceptual responses to climbing-specific finger flexors exercise in LLBFRT and compare such responses to HLRT.Methods: Fifteen advanced to elite climbers took part in three visits: a familiarization session and two randomized finger-flexors training sessions in either HLRT (3 sets of 10-12 repetitions, ~70% maximal voluntary contraction, MVC) or LLBFRT (3 sets of 14-20 repetitions, ~40%MVC with cuff set at 60% of limb occlusion pressure). Finger flexors muscle oxygenation was assessed using near-infrared spectroscopy. Force-time integral (FTI) quantified mechanical load under both modalities. Muscle fatigue was quantified as force loss from pre- to 1-min, 5-min and 15-min post-exercise. Perceived discomfort, effort, and finger pain were assessed after each set.Results: LLBFRT led to greater muscle deoxyhemoglobin values (+20 ± 25%, p = 0.005, d = 0.9) during exercise. Despite lower FTI (-7 ± 10%, p = 0.028), muscle fatigue was greater in LLBFRT than HLRT 1-min post-exercise (-24.8 ± 7.9 vs -18.6 ± 7.4%MVC, p = 0.016) but not 5-min and 15-min post-exercise. LLBFRT caused greater discomfort during inter-set recovery but lower finger pain during exercise.Conclusion: Climbing-specific LLBFRT induced a transient increase in finger flexors muscle deoxygenation and fatigue likely due to elevated metabolic stress and venous blood pooling, while reducing mechanical load and thus potentially lowering injury risk
Effect of 5 years of CT-scan and CEA follow-up on survival endpoints in patients with colorectal cancer
No full textInternational audienceBackground: Intensive follow-up of patients after curative surgery for colorectal cancer is recommended by various scientific societies. However, these recommendations are based mainly on expert opinions, while the results of the few clinical trials are controversial. Moreover, no survival benefit has been demonstrated to date.Patients and methods: PRODIGE-13 is a cooperative prospective multicentre controlled phase III trial evaluating by factorial plan the impact of i) intensive radiological monitoring (alternating abdominal ultrasound (US)/CT-scan/3m) versus standard monitoring (US/3m and thoracic radiography/6m) and ii) Carcinoembryonic Antigen (CEA) assessment versus no assessment, in the follow-up of resected stage II or III colorectal cancer with no evidence of residual disease on baseline post-surgical investigation in France and Belgium. The primary endpoint was 5-year overall survival (OS).Results: Altogether, 2009 patients were randomized. Among them, 16% had rectal cancer, and 44% left colon cancer; 75.9% were less than 75 years old. With a median follow-up of 7.8 years, cancer recurred in 22.3% of patients (local 10.5%, metastatic 72.9%, both 16.6%). The 5-year OS rates were 82.1% (95%CI [78.5;85.2]) in group A (intensive imaging + CEA) vs. 84.1% (95%CI [80.5;87.0]) in group B (intensive imaging alone), vs. 83.6%, (95%CI [80.1;86.6]) in group C (standard imaging+ CEA) vs. 79.5% (95%CI [75.7;82.8]) in group D (standard imaging alone) (p(logrank)= 0.170. Median OS was not reached in the four groups, Five-year relapse-free survival (RFS) was 73.8% in the CT-scan surveillance group vs. 69.3% in the no-CT-scan group (HR 0.89 [0.76;1.03]; p=0.108). Five-year RFS was 71.3% in the CEA surveillance group vs. 71.8% in the no-CEA group (HR 1.00 [0.86;1.16]; 0.959).Conclusions: Among patients with stage II or III colorectal cancer, after curative surgery, the implementation of CEA and/or CT-scan surveillance did not provide any benefit in 5-year overall survival for the overall population of the study
Improving Advanced-Line Multiple Myeloma Care: Insights and Real-World Challenges from the EMMY Study
No full textInternational audienceManaging multiple myeloma (MM) patients receiving advanced (four or more) lines of treatment is a complex challenge. Therefore, real-world data are essential to better understand and address the medical need of this challenging population. We used the EMMY cohort, a French longitudinal real-world study, to describe the characteristics and outcomes of 2127 MM patients receiving advanced-line treatments between 2017 and 2020. A wide variety of treatments were used without a predominant combination showing an evolution over time. Patients exhibited median time to next treatment and overall survival ranging from 7.8 months (95% CI: 6.7-7.8) and 19.4 months (95% CI: 17.4-22.5) in Line 4 (L4) to 4.8 months (95% CI: 3.5-6) and 12.6 months (95% CI: 8.7-16.6) in L8, respectively. The EMMY study provides valuable insights into the real-world application of advanced-line treatments, demonstrating rapid disease progression and poor outcomes in these patients before the novel anti-B-cell maturation antigen (BCMA) directed therapies. These findings highlight the critical need for novel therapies in this population
Music and Language in Williams Syndrome: An Integrative and Systematic Mini-Review
No full textInternational audienceIndividuals with Williams syndrome (WS) are known for their interest in language and music. As producing and comprehending music and language usually involve a set of similar or comparable cognitive abilities, the music–language relationship might be of interest to better understand WS. We identified, analyzed, and synthesized research articles on music and language among individuals with WS. Three different databases were searched (SCOPUS, PubMed, PsycInfo). Eight research articles were identified after screening, based on title, abstract and full text. In this integrative–systematic review, we assess methodologies, report findings and examine the current understanding of several subdimensions of the relationship between music and language. The findings suggest that basic musical abilities such as tone, rhythm and pitch discrimination are correlated with several verbal skills, particularly the understanding of prosody. Musical practice seems to benefit individuals with WS, in particular for prosody understanding and verbal memory. A correlation was also observed between emotional responsiveness to music and verbal ability. Further studies are needed to better characterize the relationship between music and language in WS. The clinical use of musical practice could be of interest in improving prosodic skills and verbal memory, which deserves extended experimental investigation
Du jamaïcain au breton. Trajectoire d’une Anglaise en formation pour apprendre le breton
No full textInternational audiencePoltred sokiologelSociological portraitPortrait sociologiqu
Collisional Excitation of HCN by CO to Refine the Modeling of Cometary Comae
No full textInternational audienceWe present the first dataset of collisional (de)-excitation rate coefficients of HCN induced by CO, one of the main perturbing gases in cometary atmospheres. The dataset spans the temperature range of 5-50 K. It includes both state-to-state rate coefficients involving the lowest ten and nine rotational levels of HCN and CO, respectively, and the so-called \"thermalized\" rate coefficients over the rotational population of CO at each kinetic temperature. The derivation of these coefficients exploited the good performance of the statistical adiabatic channel model (SACM) on top of an accurate interaction potential computed at the CCSD(T)-F12b/CBS level of theory. The reliability of the SACM approach was validated by comparison with full quantum calculations restricted at the lowest total angular momentum of the system. These results provide essential input to accurately model the distribution among the rotational energy levels and the abundance of HCN in cometary atmospheres, accounting for deviations from local thermodynamic equilibrium that typically occurs in such environments
Maintaining very low tidal volume ventilation with PEEP during CPB in cardiac surgery patients: are HLA-DR, IL-6, and MDSCs relatively accurately mirror the relationship between atelectasis and immune dysfunction? Author’s reply
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Controllable SnS‐Vapor‐Assisted Selenization to Enhance Carrier Transport for Highly Efficient Kesterite Solar Cells
No full textInternational audienceThe charge loss within polycrystalline Cu2ZnSn(S, Se)4 (CZTSSe) absorbers remains a key bottleneck restricting the performance of this emerging thin‐film solar cell. Herein, a SnS‐vapor‐assisted selenization strategy is proposed to mitigate defects and suppress charge loss in CZTSSe films by tuning the annealing temperature and incorporation of SnS. Notably, SnS does not contribute directly to grain growth, but it plays a crucial role in suppressing Sn volatilization from the film surface. In addition, the thermodynamic equilibrium between SnS and SnS2 regulates the sulfur partial pressure by mediating S transport during annealing. An initial high‐temperature annealing step promotes Se‐for‐S substitution, effectively suppressing S enrichment and its adverse effects on grain nucleation and growth kinetics. Subsequently, a lower‐temperature annealing step sustains sulfur partial pressure through thermodynamic equilibrium of SnS, facilitating defect passivation and interface bandgap tuning. These collective effects have significantly facilitated carrier transport within the device, leading to a notable improvement in the performance of kesterite solar cells. Specifically, a power conversion efficiency exceeding 15% is attained, ranking among the highest values reported for CZTSSe solar cells via vapor‐assisted selenization strategy
Search for key regulators of endogenous viruses replication in ichneumonid wasps through differential gene expression analysis
No full textInternational audienceThe endoparasitoid ichneumonid wasp Hyposoter didymator relies on Endogenous Viral Elements (EVEs) for its development. Its chromosomes contain viral sequences that become active during the pupal stage in a specific tissue of the female reproductive tract called the calyx. This activation leads to the production of thousands of virus particles, which are secreted into the female oviduct and transferred to the parasitoid’s host during egg laying. With the availability of the H. didymator genome, EVEs have been previously annotated, revealing the presence of more than 60 viral loci dispersed in the 12 wasp chromosomes (Lorenzi et al. 2024, doi: 10.1371/journal.ppat.1011980.). We also annotated essential genes for insect development and physiology, including transcription factors from the Hox and Hepatocyte nuclear factor families, as well as genes involved in ecdysone and juvenile hormone-signaling and other hormone-related genes (neuropeptide receptors and their ligands).In this study, we aimed to identify key regulators of the endogenous virus replication by comparing the replicative tissue (calyx) with a non-replicative tissue (oviduct) throughout wasp pupal development. We used microdissection to separate the calyx and the oviduct tissues from more than 500 insects across three pupal stages (five replicates per stage). To analyze the full gene expression profile of the wasp, these samples were sequenced using RNA-Seq, and differentially expressed genes were identified by comparing the two tissues at each time point and by tracking expression changes over time in both tissues.Our analysis revealed 3,405 differentially expressed genes out of 14,975, grouped into 13 clusters based on shared expression patterns each revealing enrichments of peculiar biological processes or molecular functions. Notably, two clusters contained nearly all EVE genes, while eight differentially expressed transcription factors and hormone receptors were distributed across six clusters