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Multi-Susceptibility: A Validated One Health Indicator of Antimicrobial Resistance
No full textInternational audienceA synthetic indicator applicable to both humans and animals, Representing an ecological measure of resistance, andServing as a foundational step toward a joint approach and communication on antimicrobial resistance. Multi-susceptibility represents the proportion of isolates exhibiting no resistance to a common set of antimicrobial classes tested in both animal and human populations
Subjective cognitive complaint inversely associated to ARMS transition
No full textInternational audienc
Esthétique du sujet des marges dans le roman francophone
No full textInternational audienceCet article examine l’esthétique du sujet marginal dans le roman francophone africain contemporain, en s’intéressant à la manière dont la fiction réfracte les réalités politiques et sociales à travers des prismes esthétiques et subjectifs. À partir de la réflexion d’Edgar Morin sur la relation entre affect et connaissance, l’article analyse comment la littérature transforme l’expérience migratoire en un espace de recomposition identitaire et de critique sociale. S’appuyant sur Le silence des esprits (N’Sondé), Alpha. Abidjan Gare du Nord (Bessora) et Un balcon sur l’Algérois (Nimrod), l’étude met en lumière l’ambivalence du sujet migrant, oscillant entre angoisse existentielle et quête d’ancrage. La littérature francophone contemporaine adopte une approche introspective où la migration devient un vecteur d’interrogation de l’intériorité et de l’extériorité du sujet. En mobilisant les concepts d’Alexis Nouss sur le migrant comme acteur politique, ainsi que les théories d’Emmanuel Lévinas sur l’altérité, l’analyse dévoile comment l’expérience esthétique permet de déconstruire les représentations figées de la marginalité. Elle interroge également l’(in)hospitalité européenne à travers le prisme de Jacques Derrida, révélant une tension entre l’accueil et l’exclusion
Safety and efficacy of REP 2139-Mg in patients with HDV-related advanced liver disease in an international compassionate access program
No full textInternational audienceBackground & aims: REP 2139-Mg (REP), a nucleic acid polymer, blocks HBV subviral particle assembly and HDV replication. We hereby report results of REP treatment in HDV patients in a compassionate access program (NCT05683548).Methods: Thirty-three HDV patients with advanced chronic liver disease (ACLD) received REP 250mg weekly subcutaneously (SC) plus nucleotide analog for a scheduled 48-weeks duration. Pegylated interferon-α (pegIFN) 45-180ug weekly was added in 20 patients without contraindications. Safety and efficacy were monitored regularly, and intra-hepatic markers performed in one liver explant.Results: Among the 33 patients (age 21-69 years, 21 males), 85% (28/33) had previous treatment failure and 6 had decompensated cirrhosis (ascites n=5). Suboptimal response to REP was rescued with dose modifications [250mg intravenously (IV), or 500mg SC or IV] and/or therapy extension in 21 patients. At the end of therapy (EoT), HDV-RNA declined by >2log10 in 70% (23/33) and was undetectable in 58% (19/33). HBsAg loss occurred in 27% (9/33). In the 28 patients with available follow-up, HDV-RNA and HBsAg remained undetectable in 46% (13/28) and 18% (5/28) respectively. ALT normalized in 50% (14/28). Response was similar with or without pegIFN. Ascites improved in 2/5 patients. Three patients underwent liver transplantation while receiving REP, with no complications. One liver explant analysis showed undetectable HDV-RNA and HDAg and very low levels of intra-hepatic cccDNA activity and HBsAg. No REP-related serious adverse events were reported.Conclusions: REP treatment was safe and effective in HDV patients with ACLD. REP may even induce HDV sustained virological response and HBV functional cure independent of combination with pegIFN. Clinical benefits may also be observed in patients with decompensated cirrhosis.Impact and implications: No antiviral treatment is approved for chronic hepatitis D (CHD) patients with decompensated cirrhosis or in patients who have failed previous bulevirtide and/or pegIFN therapy. In the Replicor Compassionate Access Program including 33 CHD patients with advanced chronic liver disease treated with REP2139-Mg (REP) and nucleotide analog, with or without pegylated interferon, loss of HBsAg was observed in 27% by end of treatment and remained undetectable in 18% after one year follow up, inferring HDV sustained virological response and HBV functional cure for these patients. Among the 6 patients with decompensated cirrhosis, five patients had virological response and two patients presented significant clinical improvement with ascites reduction, with no REP-related serious adverse events. Overall, the efficacy of REP, in this \"difficult to treat\" population, appears promising with acceptable tolerability and no safety issues and should be evaluated in a protocol driven, response-guided clinical trial
Approche probabiliste des dégradations en surface des chaussées routières
No full textPavement surface distress, if left untreated, often marks the onset of progressive deterioration and the eventual structural failure. Effective maintenance planning, therefore, relies on predictive models that can capture not only the initiation of surface distress but also their subsequent evolution. Surface damage is strongly governed by the non-uniform, three-dimensional stress states at the tyre-pavement interface, whose analysis requires a robust contact model. Within this context, the ANR MACADAM project demonstrated the effectiveness of the semi-analytical model (SAM) developed at LaMCoS (INSA Lyon). This thesis seeks to advance the current methodology towards a rational framework for surface cracking, commonly referred to as top-down cracking. The variability of key input parameters - such as material properties, layer thicknesses, axle loads, and lateral positions - necessitates a probabilistic approach. Accordingly, the research is structured into two main components: (i) a deterministic approach, coupling a linear-elastic fatigue model with the tyre-pavement contact tool to evaluate surface damage; and (ii) a stochastic approach, allowing the propagation of parameter uncertainties through the model. The deterministic analysis enabled a comparison of the impact of different loading conditions, both tractive and non-tractive, on surface distress, explicitly accounting for the actual geometry of a dual-tire set. To address the uncertainty associated with wheel lateral wander, cumulative damage was modelled using a probabilistic chain that estimates the probable wheel positions for each axle load. This approach provided predictions of pavement life under varying traffic conditions, ranging from highly channelised traffic to wider lateral distributions. Numerical simulations indicate that channelised traffic intensifies local surface damage in relation to tyre geometry, whereas wider lateral wander tends to distribute damage more uniformly, thereby extending surface lifespan. Finally, a sensitivity analysis highlighted the critical influence of vertical load, friction coefficient, and surface layer properties on distress development. Incorporating these uncertainties enabled the quantification of lifespan variability and the identification of risk factors, providing a more robust basis for the design of pavement surface courses.Les dégradations en surface des chaussées, en l'absence d'entretien, peuvent marquer le point de départ d'une détérioration progressive de l'ensemble de la structure. Leur suivi représente donc un enjeu majeur pour la planification de la maintenance du réseau routier et nécessite le recours à des modèles capables de prédire l'amorçage et l'évolution de ces pathologies. Ces dernières sont fortement influencées par les contraintes non uniformes et tridimensionnelles générées à l'interface pneu-chaussée, dont l'étude requiert un modèle de contact robuste. Le projet ANR MACADAM a démontré l'efficacité du modèle semi-analytique (SAM) développé au LaMCoS (INSA de Lyon). La présente thèse s'inscrit dans cette continuité, avec pour objectif d'étendre ce cadre méthodologique vers une approche rationnelle de la fissuration descendante (ou Top-down cracking). La variabilité des paramètres en cause - propriétés des matériaux, épaisseurs des couches, intensité et localisation des chargements, entre autres - impose de travailler dans un cadre probabiliste. Les travaux menés s'articulent alors autour de deux volets : (i) une approche déterministe visant à évaluer l'endommagement en surface par couplage d'un modèle de fatigue en élasticité linéaire avec l'outil de modélisation du contact pneu-chaussée et (ii) une approche stochastique permettant de propager les incertitudes sur ce modèle. L'approche déterministe a permis de comparer l'influence des différents chargements, tractifs et non tractifs, sur l'endommagement en surface en tenant compte de la géométrie réelle d'un jumelage routier. Face à l'incertitude liée à la localisation des chargements, due au balayage transversal, le cumul de dommages est modélisé au moyen d'une chaîne probabiliste permettant d'estimer les positions probables des roues à chaque passage d'essieu. Cette démarche a conduit à une estimation des durées de vie en fonction des conditions de balayage, depuis le trafic canalisé jusqu'à une dispersion latérale plus large des trajectoires. Les simulations numériques montrent que le trafic canalisé accentue localement l'endommagement, alors qu'un balayage plus étendu homogénéise les dommages et allonge la durée de vie de la couche de surface. Enfin, une analyse de sensibilité appliquée aux paramètres conventionnels du dimensionnement a révélé l'importance majeure de la charge verticale, du coefficient de frottement et des propriétés mécaniques de la couche de surface. La prise en compte de ces incertitudes a permis d'évaluer la dispersion des durées de vie et de proposer des coefficients de risque, ouvrant ainsi la voie à un dimensionnement plus fiable des couches de surface
Apprentissage automatique de modèles complexes de fibres optiques multimodales pour le façonnage distant de champs lasers
No full textMultimode fibers (MMFs) can carry many modes, offering opportunities in telecommunications and endoscopic imaging. Their use requires a model describing how they transform the propagated optical field. This thesis develops machine learning models, using only intensity measurements (without a reference wave), to predict the complex output field (amplitude and phase) of a MMF. An experimental setup was built around a step-index MMF (140 LP modes at 1064 nm), a 952-actuator deformable mirror structuring the input field, and two cameras recording speckle patterns in Fourier-conjugated planes at the fiber’s distal end. The structured input and intensity data train two models: a transmission matrix (TM) and a convolutional neural network (CNN). Their performances, quantified by Pearson correlations, reach 99% (near field) and 98.3% (far field) for the TM, and 93.8% (near + far field) for the CNN. Both enable full distal field control and 3D beam shaping through the MMF. A multiparameter study shows that the TM, explicit and data-efficient, excels in linear regimes, while the CNN, more data-demanding, remains robust to nonlinearities. Applied to a GRIN MMF (56 LP modes) excited by 6.5 ps, 50 kW pulses, in a Kerr-dominated regime, the CNN achieved 97% correlation in speckle prediction and was used for Kerr-assisted modal synthesis.Les fibres multimodales (MMF) permettent le transport de nombreux modes, ouvrant notamment des perspectives en télécommunications et en imagerie endoscopique. Leur utilisation requiert un modèle décrivant la transformation que ces fibres opèrent sur le champ lumineux propagé. Cette thèse vise à créer des modèles par apprentissage automatique, avec de simples mesures intensimétriques (sans onde de référence), afin de prédire le champ complexe (amplitude et phase) en sortie d’une MMF. Un dispositif expérimental a été conçu autour d’une MMF à saut d’indice (140 modes LP à 1 064 nm), d’un miroir déformable à 952 actuateurs structurant le champ couplé dans la MMF, et de deux caméras enregistrant les images de speckle produites dans des plans conjugués, au sens de Fourier, à l’extrémité distale de la MMF. Le champ excitateur structuré et les mesures intensimétriques constituent les données d’apprentissage des deux modèles de MMF étudiés de type matrice de transmission (TM) et réseau de neurones convolutif (CNN). Les performances de ces modèles sont quantifiées par des corrélations de Pearson, atteignant 99 % et 98,3 % (resp. champs proche et lointain) pour la TM, et 93,8 % (champs proche et lointain) pour le CNN. Les deux approches permettent le contrôle complet du champ distal et ont servi à la génération de faisceaux 3D à travers la MMF. Une étude multi-paramètres montre leur complémentarité : la TM, modèle explicite et efficace en régime linéaire, requiert peu de données, tandis que le CNN, plus gourmand, reste robuste face aux non-linéarités. Appliqué à une MMF GRIN (56 modes LP) excitée par des impulsions de 6,5 ps (50 kW), dans un régime dominé par l’effet Kerr, le CNN fournit des prédictions de speckles avec des corrélations atteignant 97 % et a été utilisé pour la synthèse modale assistée par auto-nettoyage Kerr
Étude de verres et vitrocéramiques comme joint d’étanchéité pour le scellement d’électrolyseurs haute température
No full textIn the frame of renewable energies and the energy mix, the production of dihydrogen is particularly important. The production of dihydrogen by electrolysis of water vapor at temperatures around 800°C offers the advantage of reversible SOEC/SOFC systems, capable of producing both H2 and electricity in reverse mode. High-temperature operation also enables high conversion efficiencies. However, these temperatures require the use of special seals.Indeed, they must be compatible with high temperatures, the materials to be sealed and various atmospheres (H2, O2, H2O...). They must also present specific physical properties (thermal, electrical, mechanical). Therefore, oxide glasses and glass ceramics are the reference materials for such seals.As part of the development of future generations of electrolyzers, the issue of sealing is central to the improvement of performance and reliability. The sealing performance of glass/glass-ceramic seals is of prime importance in this context, making them a key material for this technology.The aim of this thesis is to study glasses and glass-ceramics sealing materials, specifically adapted to High Temperature Electrolyzers (HTE).Dans le cadre du développement des énergies renouvelables et du mix énergétique, la production de dihydrogène revêt un caractère particulièrement important. La production de dihydrogène par électrolyse de la vapeur d’eau au voisinage de 800°C, présente l’avantage de disposer de systèmes réversibles SOEC/SOFC, pouvant assurer à la fois la production de H2 et la production d’électricité en mode inverse. Le fonctionnement à haute température permet également d’obtenir des rendements de conversion élevé. Néanmoins, ces températures nécessitent l’utilisation de joints d’étanchéité spécifiques.Les caractéristiques chimiques, thermiques, mécaniques et électriques à haute température des scellements oxydes vitrocéramiques/vitreux font de ce type de matériau l’un des rares candidats pouvant être utilisé comme joint d’étanchéité.Dans le cadre du développement des futures générations d’électrolyseurs de puissance, la problématique de l’étanchéité apparait comme un sujet central pour l’amélioration des performances et de la fiabilité des systèmes. Les performances d’étanchéité des joints vitrocéramiques/vitreux sont primordiales au regard de ces contraintes et en font un matériau central de cette technologie. L’objectif de cette thèse est de développer de nouvelle(s) formulation(s) innovante(s) de verre et/ou vitrocéramique en tant que joint d’étanchéité, adaptée(s) spécifiquement aux Électrolyseurs à Haute Température (EHT)
Baseline predictors of poor clinical outcome despite recanalization of distal middle cerebral artery occlusions
No full textInternational audienceObjective Mechanical thrombectomy (MT) is well-established for the treatment of acute ischemic stroke (AIS) from large vessel occlusion (LVO), with growing data supporting the expansion to distal and medium vessel occlusions (DMVO). Despite successful recanalization in DMVO, certain patients still experience poor long-term clinical outcomes, prompting our study to comprehensively explore pre-MT factors influencing outcome despite excellent recanalization (final modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2c). Methods We retrospectively examined data from patients who consecutively underwent MT for a primary middle cerebral artery (MCA) DMVO across 37 centers in North America, Asia, and Europe. We identified baseline clinical and imaging factors associated with poor clinical outcome (defined as a modified Rankin Scale [mRS] score of 3–6) at 3 months, despite excellent recanalization using a multivariable model. Results Between September 2017 and July 2021, 623 patients achieved mTICI > 2b and they were included in our study. Among them, 198 (32%) experienced a poor clinical outcome (mRS 3–6). Predictors of poor clinical outcome included higher age (OR 1.05 [1.03–1.07], p < 0.001), higher NIHSS at admission (OR 1.12 [1.08–1.15], p < 0.001), higher baseline mRS (OR 1.77 [0.96–3.26], p = 0.067), and diabetes (OR 1.59 [1.01–2.48], p = 0.044). Higher ASPECTS was associated with a decreased risk of poor clinical outcome (OR 0.82 [0.71–0.94], p = 0.006). Conclusion Older age, diabetes, higher baseline mRS, and NIHSS were associated with poor clinical outcome in MCA DMVO despite excellent recanalization. Conversely, a higher ASPECTS decreased the probability of such an outcome
Gastric peroral endoscopic pyloromyotomy for refractory gastroparesis following esophagectomy: results from a multicenter series
No full textInternational audienceAbstract Gastroparesis is predominantly caused by diabetes mellitus or vagal nerve injury post-surgery. About 30% of patients develop gastroparesis after esophagectomy with gastric pull-through. Standard treatments often fail, and endoscopic pyloromyotomy (G-POEM) has shown promising results. This study aimed to assess the efficacy and safety of G-POEM in patients with refractory gastroparesis after esophagectomy. A multicenter retrospective cohort study was conducted across 18 expert centers. Patients who underwent G-POEM for refractory gastroparesis following esophagectomy from August 2014 to December 2023 were included. Inclusion criteria were confirmed gastroparesis by scintigraphy, a mean Gastroparesis Cardinal Symptom Index (GCSI) of at least 1.0, and a minimum of 6 months of follow-up. The primary outcome was treatment success at 6 months, defined as a ≥50% decrease in the GCSI score. Of 113 G-POEM procedures, 108 patients (median age 65 years; 75% men) met the inclusion criteria. The primary indication for esophagectomy was adenocarcinoma (75.5%). At 6 months, 63.5% (95%CI 54.1%–72.0%) achieved clinical success, with the mean GCSI significantly decreased to 1.2 (95%CI 1.0–1.4) from 2.9 (95%CI 2.7–3.1) preprocedure. Minor adverse events occurred in 2.8% of cases. Long-term follow-up showed sustained efficacy with success rates of 54.9% and 66.1% at 12 and 24 months, respectively. G-POEM appears to be a safe and effective treatment for refractory gastroparesis in post-esophagectomy patients, achieving significant symptom relief in the majority of patients. Future prospective studies are necessary to further validate these findings and explore predictive factors for treatment success
Traditional knowledge and the challenges of the future: from a cultural heritage to a source of innovation
No full textInternational audienceTraditional activities, such as art and heritage crafts, certain agricultural and culinary professions, as well as various ancestral practices, represent major socio–economic challenges today. Ancient knowledge, faced with the rapid transformation of economic and ecological ecosystems, as well as cultural and social systems, is confronted with unprecedented issues, particularly in terms of preservation, transmission and promotion. Against this backdrop, we need to examine emerging approaches to the sustainable management of this knowledge.This book is based on a four-year series of seminars attended by professionals and academics from several disciplines. It looks at the issue of traditional knowledge from a variety of perspectives – economic, historical, pedagogical, financial, institutional, technological and managerial – and is based on concrete experiences in several French countries and regions.Traditional Knowledge and the Challenges of the Future, which is both informed by firsthand accounts and forward-looking reflections, offers an original perspective on the relationship between cultural heritage and innovation. It offers researchers, practitioners and decision-makers a fresh perspective on the potential of traditional knowledge in a changing world