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Real-life data on hepatocellular carcinoma in the French prospective CHIEF cohort in the era of immunotherapy
No full textInternational audienceBackground The burden of hepatocellular carcinoma (HCC) increases worldwide. We report the current landscape of HCC, in France. Methods Carcinome HépatocellulaIrE en France (CHIEF) is a national, prospective, observational cohort initiated in 2019 with the aim of including 5000 patients with HCC, with a 5-year follow-up for each. CHIEF Epidemio 2000, is the first global analysis. Results In September 2021, 2043 patients were included in 32 centers. We analyzed 1640 patients, 86% men, 68-year-old, BMI 26.8. 70.8% of patients had cirrhosis (MELD score 9, Child–Pugh A in 77.8%, and portal hypertension in 39%. Liver disease was related to alcohol 58.5%, metabolic syndrome 39%, and virus 23.3%. HCC was confirmed by histology in 46.3%. The Milan criteria fulfilled 32.9%, median AFP 39 ng/ml, 5.9% portal thrombosis, and 10.7% metastases. BCLC classes 0, A, B, C, and D were 6.1, 29.8, 28.8, 32.1, and 3.2%, respectively. HCC was detected during a surveillance program in 35.2% associated with better survival ( P < 0.001). Median follow-up was 17.76 months (29.1% deaths). The 6, 12, and 18 months overall survival rates were 84.9% (95% CI: 82.8–87), 76.7% (95% CI: 74.2–79.2), 69.3% (95% CI: 66.4–72.3). One-year survival for BCLC 0, A, B, C, and D was at 95.6, 89.7, 81.7, 54.9, and 40%, respectively ( P < 0.0001). First-line treatment was curative, locoregional, or systemic in 40.5, 36.2, and 19.2%, with 1-year survival at 92.9, 82.2, and 57.8%, respectively ( P < 0.0001). Atezolizumab–bevacizumab yielded a median overall survival of 17.05 months versus nine for TKI ( P < 0.0001). Conclusion In real-life data, metabolic syndrome becomes the second cause of HCC in France. The 1-year survival rates are high for all treatments applied, and Immunotherapy yields similar results than in trials
Revealing a Pathway for Low-Temperature Recrystallization in Germanium
No full textInternational audienceThermally activated annealing in semiconductors faces inherent limitations, such as dopant diffusion. Here, a nonthermal pathway is demonstrated for a complete structural restoration in predamaged germanium via ionization-induced recovery. By combining experiments and modeling, this study reveals that the energy transfer of only 2.4 keV nm -1 from incident ions to target electrons can effectively annihilate pre-existing defects and restore the original crystalline structure at room temperature. Moreover, it is revealed that the irradiation-induced crystalline-to-amorphous (c/a) transformation in Ge is reversible, a phenomenon previously considered unattainable without additional thermal energy imposed during irradiation. For partially damaged Ge, the overall damage fraction decreases exponentially with increasing fluence. Surprisingly, the recovery process in preamorphized Ge starts with defect recovery outside the amorphous layer and a shrinkage of the amorphous thickness. After this initial stage, the remaining damage decreases slowly with increasing fluence, but full restoration of the pristine state is not achieved. These differences in recovery are interpreted in the framework of structural differences in the initial defective layers that affect recovery kinetics. This study provides new insights on reversing the c/a transformation in Ge using highly-ionizing irradiation and has broad implications across materials science, radiation damage mitigation, and fabrication of Ge-based devices.</div
Le droit d’accès à la justice environnementale des peuples et communautés autochtones
No full textCette recherche est issue de l’appel à projet lancé en 2020 sur le thème : Justice et écologieCarried out from a comparative (Europe, South and North America) and multidisciplinary (law, anthropology, sociology) perspective, the report examines theright of access of indigenous peoples and communities to environmental justice, how the right of access to the courts has been adapted in environmental matters and what are the specific features of the jurisdictions, remedies and procedures that enable indigenous peoples to defend their environmental rights effectively and efficiently in order to obtain fair and equitable compensation in the event of infringement of their rights. It is clear from the analysis that this right of access implies, on the one hand, guaranteeing these peoples a right of access to information and participation, the only way of enabling them to challenge decisions which, in their view, have not taken their rights and interests into account. On the other hand, indigenous peoples must be guaranteed effective legal protection of their individual and collective rights in the fight against environmental injustice. The research also highlights the challenges and efforts that have been made to improve access to environmental justice and remedies, such as the use of the indigenous language in legal proceedings, interest in bringing an action, the invocability of indigenous custom before the judge, and the intercultural interpretation of collective rights. More generally, the harmonious and complementary relationship between state environmental justice and indigenous environmental justice remains to be developed. Finally, we note that in South America and Northern Europe, in contrast to the Canadian experience, the indigenous peoples have developed a litigation strategy to resolve environmental and territorial conflicts before the courts because of the multiplicity of legal proceedings available. In view of the results obtained, the research considers some twenty recommendations for improving the right of access to environmental justice for indigenous peoples and communities in France.Menée dans une perspective comparée (Europe, Amérique du Sud et du Nord) et pluridisciplinaire (droit, anthropologie, sociologie), le rapport interroge le droit d’accès des peuples et des communautés autochtones à la justice environnementale, comment le droit d’accès au juge a été adapté en matière environnementale et quelles sont les spécificités des juridictions, des recours, des procédures qui permettent aux peuples autochtones de défendre leurs droits environnementaux de manière effective et efficace afin d’obtenir une réparation juste et équitable en cas d’atteinte à leurs droits. Il ressort de l’analyse que ce droit d’accès implique d’une part, de garantir à ces peuples un droit d’accès à l’information et à la participation, seul à même de leur permettre de pouvoir remettre en question des décisions qui, selon eux, n’auraient pas pris en compte leurs droits et intérêts. D’autre part, il s’agit de garantir aux peuples autochtones une protection juridictionnelle effective de leurs droits individuels et collectifs pour lutter contre les injustices environnementales. La recherche met également en évidence les défis et les efforts qui ont été déployés pour améliorer l’accès à la justice environnementale et aux voies de recours tels que l’usage de la langue autochtone dans le cadre d’un procès, l’intérêt à agir, l’invocabilité de la coutume autochtone devant le juge ou encore l’interprétation interculturelle des droits collectifs. Plus globalement, l’articulation harmonieuse et complémentaire entre la justice environnementale étatique et la justice environnementale autochtone reste à construire. Enfin, on remarque qu’en Amérique du Sud et en Europe du Nord, contrairement à l’expérience canadienne, les Autochtones ont développé une véritable stratégie de judiciarisation des conflits environnementaux et territoriaux en raison d’une multiplicité des recours judiciaires disponibles. Au regard des résultats obtenus, la recherche envisage une vingtaine de recommandations afin d’améliorer le droit d’accès à la justice environnementale des peuples et communautés autochtones en France
Evaluating and leveraging large language models in clinical pharmacology and therapeutics assessment: From exam takers to exam shapers
No full textInternational audienceAims In medical education, the ability of large language models (LLMs) to match human performance raises questions about their potential as educational tools. This study evaluates LLMs' performance on Clinical Pharmacology and Therapeutics (CPT) exams, comparing their results to medical students and exploring their ability to identify poorly formulated multiple‐choice questions (MCQs). Methods ChatGPT‐4 Omni, Gemini Advanced, Le Chat and DeepSeek R1 were tested on local CPT exams (third year of bachelor's degree, first/second year of master's degree) and the European Prescribing Exam (EuroPE + ). The exams included MCQs and open‐ended questions assessing knowledge and prescribing skills. LLM results were analysed using the same scoring system as students. A confusion matrix was used to evaluate the ability of ChatGPT and Gemini to identify ambiguous/erroneous MCQs. Results LLMs achieved comparable or superior results to medical students across all levels. For local exams, LLMs outperformed M1 students and matched L3 and M2 students. In EuroPE + , LLMs significantly outperformed students in both the knowledge and prescribing skills sections. All LLM errors in EuroPE + were genuine (100%), whereas local exam errors were frequently due to ambiguities or correction flaws (24.3%). When both ChatGPT and Gemini provided the same incorrect answer to an MCQ, the specificity for detecting ambiguous questions was 92.9%, with a negative predictive value of 85.5%. Conclusion LLMs demonstrate capabilities comparable to or exceeding medical students in CPT exams. Their ability to flag potentially flawed MCQs highlights their value not only as educational tools but also as quality control instruments in exam preparation
Decoupling of Mixed Crack Modes in 3D Orthotropic Viscoelastic Medium with the Influence of a Moisture content Field
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La grande histoire de deux carrés. Les dilemmes de la photo de reportage
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A New Method to Estimate Surface Donor Density (N TD ) in AlGaN/GaN HEMT by Validated DCT Simulations
No full textInternational audienceThis work proposes a new method to estimate surface donor density ( N TD ) in AlGaN/GaN high‐electron‐mobility transistors (HEMTs) using validated drain current transient (DCT) simulations. The DCT signal is actually induced by an acceptor‐type buffer trap at E C −0.65 eV. Although the DCT signal amplitude (Δ I DS ) reflects ionized acceptor density ( N TA − ) in the buffer, N TA concentration is not self‐sufficient to predict the actual Δ I DS variations. The simulation analysis reveals that 2D electron gas (2DEG) density augments with increasing N TD , resulting in more electron trapping under the gate edge region (towards the drain end) of the buffer. The increased buffer trapping raises the Δ I DS signal during the emission transient. After multiple simulation runs, N TD for the donor trap at E C −0.2 eV is estimated to be 1.3 × 10 13 cm −2 , based on the validated DCT properties at different temperatures. The matched output admittance ( Y 22 ) and forward transfer admittance ( Y 21 ) parameters also yield similar N TD =1.4 × 10 13 cm −2 , thus verifying the DCT findings. N TD is often assumed in simulations, so the extracted N TD (1.3–1.4 × 10 13 cm −2 ) benefits the GaN HEMT community for accurately modeling the surface donor properties
Changement climatique, Santé et Facteurs de Risque d'intérêts
No full textInternational audienceLes États et territoires insulaires se trouvent en première ligne du réchauffement climatique. Dans la région de l’Indianocéanie, les effets du changement climatique sont particulièrement marqués : la hausse des températures, l’élévation du niveau de la mer (qui accentue les risques d’inondation) et l’augmentation de la fréquence et de l’intensité des événements climatiques extrêmes, tels que les cyclones, déstabilisent les équilibres écologiques, économiques et sociaux des îles.Ces perturbations aggravent les facteurs de risque des maladies non transmissibles (telles que les maladies cardiovasculaires, le diabète, l’hypertension et les affections respiratoires), tout en favorisant l’apparition de troubles psychiques tels que l’éco-anxiété.Face à ces enjeux croisés de santé et d’environnement, il est essentiel de disposer de données fiables pour guider l’action publique. C’est pourquoi des enquêtes rigoureuses seront menées afin de dresser un état des lieux précis dans l’Indianocéanie. Elles viseront à recueillir des informations sur la perception des risques climatiques, les comportements en matière de santé, l’exposition environnementale, ainsi que le niveau de connaissances et les pratiques adoptées lors d’épisodes climatiques extrêmes. En complément, une enquête spécifique portera sur les connaissances et habitudes de vie liés aux facteurs de risque des maladies non transmissibles, afin d’évaluer le niveau d’information de la population et d’identifier les freins à l’adoption de comportements préventifs.Ces enquêtes seront essentielles pour établir un diagnostic solide et formuler des recommandations concrètes à l’attention des systèmes de santé nationaux, afin de renforcer la résilience des populations locales face aux transformations écologiques en cours
Lightweight Image Quality Prediction Guided by Perceptual Ranking Feedback
No full textInternational audienceAutomatic Image Quality Assessment (IQA) remains a difficult challenge due to the complexity of mimicking the Human Visual System (HVS) and the limitations of traditional objective Image Quality Metrics (IQM). Existing learnable methods often involve high computational costs and fail to adequately capture the nuanced perceptual characteristics of the HVS, including the human ability to rank image quality and human sensitivity to differences in areas with high-frequency. In this study, we propose an effective approach that addresses these challenges by incorporating the characteristics of HVS and the perceptual classification into a lightweight IQM framework based on the transformer architecture. This allows our method to capture long-range dependencies effectively. Our approach leverages Objective Error Maps (OEMs) to enhance sensitivity to visual errors and employs a ranking module as an objective function, providing feedback on the perceptual quality at the feature level. Experimental results demonstrate that our approach not only achieves competitive performance compared to state-of-the-art IQMs but also significantly reduces computational complexity