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Anticoagulant drugs targeting Factor XI/XIa and coagulation tests: we urgently need reliable pharmacodynamic data
No full textInternational audienceAntifactor (F)XI/FXIa anticoagulants under development include antisense oligonucleotides, monoclonal antibodies, and small molecules. They do not require routine monitoring, but knowledge of their impact on coagulation tests is essential in view of their expected widespread use. A concentration-dependent prolongation of activated partial thromboplastin time has been shown but varies according to reagents, and the lack of comprehensive data makes interpretation of this test difficult. Measurement of FXI clotting activity is relevant only in case of treatment with antisense oligonucleotides. Measurement of contact pathway factors, if required, should be performed after multiple dilutions of the plasma sample to overcome any inhibitory effect of the anticoagulant. All other tests used in clinical trials (FXIa, FXI antigenic method, and specific thrombin generation assay) are not implemented in clinical laboratories. More comprehensive information on the effect of anti-FXI/FXIa anticoagulants on coagulation tests is urgently needed to anticipate the use of these drugs once they are approved
Association Between Breastfeeding and Neurodevelopment at 6 Years of Age in the French PELAGIE Birth Cohort
No full textInternational audienceIntroduction: Breastfeeding has been shown to be associated with improved child cognitive performance, but the causality of this association is still debated because it tends to disappear when accounting for maternal cognitive performance and socioeconomic status. We aimed to explore the relationship between breastfeeding and the cognitive performance of children in the French general population.Methods: From the PELAGIE woman-child cohort, which included pregnant women between 2002 and 2006 in Brittany (France), 286 children were evaluated using the Wechsler Intelligence Scale for Children (WISC-IV) and the Developmental Neuropsychological Assessment (NEPSY) scales at age 6. Associations between breastfeeding and cognitive performance were assessed using multivariable linear regression models adjusted for maternal verbal cognitive performance and education level, familial stimulation and environment (Home Observation for Measurement of the Environment scale), and Rey's Social Deprivation Index (contextual indicator). In addition, we performed structural equation modeling (SEM) to investigate the complex interrelation between these variables.Results: Children who were breastfed for at least 4 months had significantly higher scores on the WISC Verbal Comprehension Index (WISC-VCI) than those who were never breastfed or who were breastfed less than 15 days (βadjusted, 4.95 points; 95% CI, 0.54-9.37). Among the 193 children who were breastfed, the duration of breastfeeding, in particular during the first 4 months, was increasingly associated with the WISC-VCI score. We also observed statistically significant associations between breastfeeding itself or the duration of breastfeeding and better performance on several NEPSY subtests, including visual attention, design copying, arrows, and narrative memory. SEM analysis confirmed these associations. No statistical association was observed between breastfeeding and the WISC Working Memory Index or other NEPSY subtests.Discussion: These data support current national and World Health Organization global 2025 targets of promoting breastfeeding for at least 4 to 6 months
A framework for risk assessment during natural hazard based on the Choquet integral and MACBETH
No full textInternational audienceThis research is part of a doctoral program in geography, geomatics, and computer science, which began in October 2023.Risk assessment in the face of natural disasters is an increasingly critical issue with climate change. Evaluating risk involves two distinct assessments: first, the probability of the disaster occurring, and second, the potential stakes or impacts of such an event. These impacts are generally categorized along several dimensions, notably human factors and infrastructure concerns. However, even when focusing solely on humanstakes, characterizing risk—particularly in terms of the potential to prevent casualties—is complex. This complexity arises from multiple factors, including the vulnerabilityof individuals present in the affected area (such as the presence of schools or nursing homes), the availability of a safe zone, and the ease with which emergency responders can intervene. Assessing risks presents several challenges. First, it is necessaryto find ways to objectively analyze the situation through measurable indicators (e.g. ease to access the victims for first responders, presence of a safe zone or not, vulnerability of the population). This includes not only defining these indicatorsbut also evaluating their consequences. One possible approach would be to create separate maps for each dimension of risk. However, this would result in a large number of maps, making interpretation difficult. Decision-makers would then need to synthesize these maps to identify the most at-risk areas and prioritize interventions accordingly. To account for the various dimensions inherent to risk assessment,it is first necessary to process these metrics through a function that determines the level of risk for each criterion. Once this step is completed, these criteria are then combined using aggregation functions, allowing for a comprehensive evaluationof the overall risk based on individual indicators. The most common approach to this problem relies on a weighted sum, which assigns specific weights to each criterion.This method effectively establishes the relative importance of one criterion over another and has the advantage of being linear. However, it also presents certain limitations. In particular, its linearity prevents it from capturing interactions between criteria, such as veto effects (where failing to meet a single critical criterion results in a severe situation regardless of other factors, but meeting it alone is not sufficient to ensure a low-risk scenario), as well as complementarities or substitutability betweencriteria (e.g. ease to evacuate a place can be substituted by the presence of a safe zone). In this paper, we propose a risk mapping method that utilizes an alternative aggregation function. Specifically, we rely on the Choquet integral, which allows for the modeling of interactions between criteria, whether in terms of complementarity orsubstitutability, while maintaining desirable properties such as monotonicity.The Choquet integral has been widely used in multi-criteria decision-making problems (Grabisch and Labreuche, 2010), as it enables a more refined representation of interactions compared to the weighted sum, which can be seen as a special caseof this function. Like the weighted sum, the Choquet integral is a parametricfunction based on the definition of an underlying function called a capacity. Determining this capacity requires input from a domain expert or decision-maker. However specifying the model parameters or providing an absolute evaluation can be challenging for these experts.To address this, we rely on MACBETH (Measuring Attractiveness by a Categorical Based Evaluation Technique) (Bana and Costa et al., 2010) and its adaptation to the elicitation of the capacity, a widely used method in multi-criteria decision analysis. MACBETH operates through pairwise comparisons and preference levels, making it more interpretable and accessible for experts.We evaluate our approach by applying it to the challenge addressed in the MOGEC project: coastal flooding projections under IPCC’s RCP 8.5 scenario in the Pays-de-la-Loire region, following a storm of similar magnitude to Xynthia.For this assessment, we rely on the expertise of emergency response teams, particularly the SDIS (Departmental Fire and Rescue Service), for whom risk mapping is a key concern. Specifically, we demonstrate the advantages and limitations of ourapproach in the municipality of Batz-sur-Mer within this projected scenario.Acknowledgement This project has received financial support from the CNRS through the MITI interdisciplinary programs. ReferencesBana and Costa, C. A., de Corte, J.-M., Vansnick, J.-C., 2010. Macbeth (measuring attractiveness by a categorical based evaluation technique). Wiley Encyclopedia of Operations Research and Management Science.Grabisch, M., Labreuche, C., 2010. A decade of application of the Choquet and Sugeno integrals in multi-criteria decision aid. Annals of Operations Research, 175, 247–286
Analysis of the Prevalence of Missed Nursing Care Using Three Workload Assessment Methods: A Nationwide Cross‐Sectional Study Among Intensive Care Nurses
No full textInternational audienceBackground: Increased workload is associated with a higher prevalence of missed nursing care.Aim: Describe the prevalence of missed care in intensive care units (ICUs) and identify the workload scale most strongly associated with this prevalence.Study design: A cross-sectional survey was combined with a longitudinal study conducted in 2024, between 15 January and 15 April, in France to assess the workload. A total of 1271 nurses working in 61 ICUs completed the questionnaire one time per shift.Results: A total of 72.3% of nurses reported at least one missed care. The Nursing Activities Score provided the strongest association with the prevalence of missed care compared to patient-to-nurse ratio and the Practice Environment Scale of the Nursing Work Index.Conclusion: The prevalence of missed care and nursing workload was high. Nurses tended to focus on direct patient care.Relevance to clinical practice: Continuously assessing the prevalence of missed care can be a valuable tool for managing workload in ICUs
Novel VAC14 Variants Identified in a Patient with Striatonigral Degeneration and Prolonged Survival
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Focusing on Nonlinear Targets Embedded in a Complex Environment
No full textInternational audienceIn the microwave regime, electronic devices typically couple nonlinearly with the electromagnetic field. It is then possible to design approaches to detect and/or focus on targets based on their nonlinear interaction with an incoming wave. Here, we build up on a recent technique based on the measurement of a monochromatic scattering matrix at two different incident power. This noninvasive method has been used to focus waves on a single nonlinear target embedded in a chaotic microwave cavity. Here, we extend this work for the case of multiple targets located in a complex environment. We show that we are able to extract wavefronts that focus selectively on each of the targets. Additionally, we tune a disordered system through a reconfigurable metasurface to enhance the intensity received by a nonlinear target over a chosen wide range of frequency
Gastrointestinal Segment Tracking of Ingestible Capsules Using Biodegradable Superstrates
No full textInternational audienceMiniaturized wireless capsule endoscopes offer minimally invasive real-time monitoring of vital parameters of the gastrointestinal tract. Although various ingestible capsules are commercially available for wireless endoscopy, the precise real-time localization of these capsules within the tract remains a challenge. This work proposes the utilization of a pH -sensitive biodegradable superstrate for gastrointestinal segment tracking in the 433 MHz Industrial, Scientific, and Medical (ISM) band. The superstrate consists of three rings engineered to degrade at specific pH levels that correspond to the distinct environments of the GI tissues - stomach, small intestine, and large intestine. This superstrate covers the outer surface of a capsule which features an integrated conformal dipole antenna. Hence, biodegradation of each ring of the superstrate in its respective GI segment leads to the alteration of the near-field of the antenna, changing its center frequency and reflection coefficient at 434 MHz in each segment. In this way, biodegradation process links the location data to the input parameters of the antenna, enabling segment tracking within the tract. Simulation results show that a shift of at least 5 MHz can be created in the center frequency as the capsule advances along each segment while the antenna is kept operational over the 433 MHz ISM band throughout the entire tract. Finally, preliminary tests using liquid gastrointestinal phantoms are conducted to validate the proposed technique
Reconstructing monthly 20th century salinity fields using a data-driven method and Argo data
No full textInternational audienceThe distribution of ocean salinity is influenced by factors such as ocean currents, freshwater exchanges with the atmosphere, continental inputs, and sea ice formation and melting. Salinity is a fundamental variable in the seawater’s equation of state, influencing density, ocean dynamics, and stratification. To understand its distribution and impact, salinity variability must be accurately estimated from in situ observations. In the 20th century, temperature observations were scarce, but salinity data were even more limited, as many instruments measured only temperature. In 2002, the implementation of the Argo observing system improved sampling and reduced the disparity between both variables. Salinity variability can now be better assessed from the 20-year Argo period. In this study, information from the Argo period and estimates of salinity covariability with temperatureare used to reconstruct monthly subsurface salinity fields. The reconstruction uses in situ measurements and employs the data-driven RedAnDA scheme, which combines Data Assimilation, Analog Prediction, and Reduced-space Interpolation, a method previously validated for temperature reconstruction. The coupling of temperature and salinity is achieved using density-weighted three-dimensional empirical orthogonal functions. The method is applied to the tropical Pacific to evaluate its ability to reconstruct variability at monthly, interannual and decadal timescales, with emphasis on ENSO-related variability, which is the primary mode of variability in the region. Compared to Optimal Interpolation results, salinity analysis by RedAnDA shows significant improvements. The results yield a salinity product that provides valuable insights into historical salinity variability, includingfresh pool displacements and salinity-driven stratification changes. Changes in subsurface salinity associated with El Ni˜no and La Ni˜na events are estimated from 1930 to 2001
Des potentialités d'apprentissages scientifiques dans les écoles de la forêt
No full textNational audienceNous réalisons une analyse didactique d'une pédagogie alternative, appelée pédagogie par la nature et pratiquée dans des écoles de la forêt. Notre investigation a été menée à l'international à l'occasion d'une thèse entre 2021 et 2024. Nous mobilisons le modèle praxéologique de Yves Chevallard et le rapport au vivant de Michèle Dell'Angelo-Sauvage. Nous dégageons alors une organisation praxéologique de l'institution de la pédagogie par la nature (PPN) autour de dix types de tâches, qui modélisent ce que les enfants sont les plus susceptibles d'y faire. Nous modélisons aussi, par l'intermédiaire du logos, des savoirs scientifiques que les enfants pourraient potentiellement mobiliser dans ce contexte. L'analyse du rapport au vivant et la nature montre que le rapport qui pourrait être préférentiellement construit est de l'ordre de l'affectif, notamment du contact sensoriel et de l'échange avec les autres êtres vivants (humains et non humains). Nous proposons enfin des pistes pour une convergence possible avec l'institution scolaire française, en contexte notamment de classe dehors
Sodium-Glucose Cotransporter-2 Inhibitor in Diabetic and Nondiabetic Renal Transplant Recipients
No full textInternational audienceIntroduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular prognosis in patients with chronic kidney disease (CKD), diabetes, and heart failure; and slow the decline of kidney dysfunction in patients with albuminuria. Although safety and efficacy of SGLT2i have not been investigated in kidney transplant recipients (KTRs), their marketing authorization leaves the possibility of their use in these patients in France.Methods: This was a prospective multicenter real-life study including all consecutive KTRs treated with SGLT2i.Results: We identified 347 KTRs treated with SGLT2i (97% with dapagliflozin), with an initiation of treatment most often beyond the first year after transplantation (87%). Importantly, 226 (65.1%) were diabetic and 245 (70.6%) were treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). We found a low incidence of urinary tract infections (UTIs) (6.6%) and genital mycosis (0.6%), without any serious adverse event. Overall, SGLT2i were stopped in 54 patients (15.6%). The causes of SGLT2i discontinuations were very diverse. The main causes were graft dysfunction (32%), intercurrent infections (17%), urinary infections (11%), and digestive symptoms (9%). KTRs with a low estimated glomerular filtration rate (eGFR), especially those with eGFR < 30 ml/min per 1.73 m2, presented with the highest incidence of SGLT2i discontinuation (P = 0.003). SGLT2i were associated with a reduction in proteinuria, found in both diabetic and nondiabetic KTRs. In addition, they had an antihypertensive effect restricted to uncontrolled-hypertensive patients.Conclusion: SGLT2i have been used in KTRs since their authorization in France. They were discontinued more frequently in patients with impaired graft function; however, the expected side effects were infrequent and not life-threatening. The short-term antiproteinuric and antihypertensive effects are promising