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Awake Prone Positioning in Adults With COVID-19: An Individual Participant Data Meta-Analysis
No full textInternational audienceImportance The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain. Objective To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers. Data Sources PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024. Study Selection Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included. Data Extraction and Synthesis Individual participant data (IPD) were extracted according to PRISMA-IPD guidelines. For binary outcomes, logistic regression was used and odds ratio (OR) and 95% CIs were reported, while for continuous outcomes, linear regression was used and mean difference (MD) and 95% CIs were reported. Main Outcomes and Measures The primary outcome was survival without intubation. Secondary outcomes included intubation, mortality, death without intubation, death after intubation, escalation of respiratory support, intensive care unit (ICU) admission, time from enrollment to intubation and death, duration of invasive mechanical ventilation, and hospital and ICU lengths of stay. Results A total of 14 RCTs involving 3019 patients were included; 1542 patients in the APP group (mean [SD] age, 59.3 [14.1] years; 1048 male [68.0%]) and 1477 in the control group (mean [SD] age, 59.9 [14.1] years; 979 male [66.3%]). APP improved survival without intubation (OR, 1.42; 95% CI, 1.20-1.68), and it reduced the risk of intubation (OR, 0.70; 95% CI, 0.59-0.84) and hospital mortality (OR, 0.77; 95% CI, 0.63-0.95). APP also extended the time from enrollment to intubation (MD, 0.93 days; 95% CI, 0.43 to 1.42 days). In exploratory subgroup analyses, improved survival without intubation was observed in patients younger than age 68 years, as well as in patients with a body mass index of 26 to 30, early implementation of APP (ie, less than 1 day from hospitalization), a pulse saturation to inhaled oxygen fraction ratio of 155 to 232, respiratory rate of 20 to 26 breaths per minute (bpm), and those receiving advanced respiratory support at enrollment. However, none of the subgroups had significant interaction with APP treatment. APP duration 10 or more hours/d within the first 3 days was associated with increased survival without intubation (OR, 1.85; 95% CI, 1.37-2.49). Conclusions and Relevance This IPD meta-analysis found that in adults with COVID-19 and AHRF, APP was associated with increased survival without intubation and with reduced risks of intubation and mortality, including death after intubation. Prolonged APP duration (10 or more hours/d) was associated with better outcomes
Proposition d'analyse des accords d'entreprise relatifs à la QVCT
No full textInternational audienceThe presentation aims to present the first analyses of company agreements relating to quality of life and working conditions, concluded between september 2023 and november 2024
Ibrutinib, venetoclax plus CD20 monoclonal Ab: Initial results of OASIS II, a prospective randomized phase 2 trial in previously untreated mantle cell lymphoma patients.
No full textInternational audienceBackground: Ibrutinib is approved in R/R MCL. Enrich trial (Lewis, ASH 2024, abst 235) showed that Ibrutnib/CD20mAb outperforms chemotherapy front-line. We demonstrated that Ibrutnib/CD20mAb plus Venetoclax has a good safety profile in R/R and untreated MCL (Le Gouill, Blood 2021). Whether or not Ibrutnib/CD20mAb is superior to Ibrutnib/CD20/Venetoclax front-line is a key question. OASIS 2 (NCT04802590) is a phase 2 prospective randomized international trial that investigates Ibrutinib/CD20mAb (Arm A) plus Venetoclax (Arm B) in untreated MCL. Methods: Patients were stratified by country, age (< / >=66 years) and MIPI. All patients (18-80y) with untreated MCL, stage II-IV and nodal disease were eligible. Treatment consisted of Ibrutinib (560 mg/d, C1-24) and anti-CD20mAb (C1-6), then 2 monthly (C7-42). In Arm B, Venetoclax was added for a fixed duration of 2y (400 mg/d). The study uses a two-stage Simon’s design. A preplanned interim futility analysis occurred after 39 pts with informative MRD were randomized in each arm. The primary endpoint of the futility analysis is the measurable residual disease (MRD) negativity rate assessed by digital-droplet PCR technique at the end of C6. Each treatment arm was to be considered effective if the 80% upper CI MRD negativity percentage was ≥ 64%. The interim analysis result was mandatory to re-open the trial (only for effective arms) for the second phase of recruitment. Herein, we present the results of the futility pre-planed interim analysis. Results: 102 pts were randomized (51 in each arm, 78 were MRD informative). Pts’ characteristics were comparable between the two arms. One patient in arm B withdrew consent before any treatment. 46 in arm A and 45 in arm B completed the first 6 cycles. The median dose intensity for CD20mAb was 100%, 96% for Ibrutinib in arm A and 90% in Arm B, 91% for Venetoclax. At least one dose adjustment of Ibrutinib was more frequent in Arm B (28% vs 15.7%). At least one Venetoclax dose reduction was needed in 24% of patients in Arm B. AE, AESI, AE grade ≥ 3 were more frequent in Arm B (92% vs 82.4%; 82% vs 52.9%; 64% vs 47.1%) but not for SAE grade ≥ 3 (32% vs 31.4%). The most frequent grade 3 AE was neutropenia (11.8% vs 34%). MRD negativity was obtained in 53.8% (CI 80% 42.4% - 65%) in Arm A and 82.1% (CI 80% 71.7% - 89.7%) in Arm B. According to Lugano criteria at the end of C6, 21 out of 39 (54%) pts were in a complete metabolic remission in Arm A vs 27 out of 39 (69%) in Arm B. The export in Oct 2024 showed that the 2-y PFS and OS were 87.9% (95%CI, 79.7-92.9) and 91.9% (95%CI, 84.5-95.9). Conclusions: Ibrutinib/CD20mAb /Venetoclax frontline provides very high MRD negativity rate. According to the statistical analysis plan, both arms were thus re-opened for inclusion on 02APR24 and 102 new patients have been included (end of inclusion DEC 2024). Clinical trial information: NCT04802590
Temporal modeling of surface water bacteriological quality in West Africa using remote sensing and machine learning methods
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Following the Fish, Mapping the Way: Cod Routes, Fisher-Pilots and Early Maps of the Grand Banks, 16th–19th Centuries
No full textInternational audienceThis paper posits that relations between cod ecology, traditional piloting practices, and transatlantic fishing methods underline the construction of cartographic knowledge of the Atlantic coast of North America and the Grand Banks in the 16th to 18th centuries. Based on an inventory of more than 200 maps showing the Grand Banks from 1500 to 1825, we show France’s preeminent role in mapping the Banks. We identify the early 16th-century role of fisher-pilots in mapping the coastline and the accore, or outer edge of the Banks, two corridors of abundant marine life. A new cartographic idea, showing the Banks as a chain of plateaux, appears in 1543 and increased from 1584 to 1630. Beginning in 1674, the French Admiralty acquired and reproduced charts made by Basque and Breton cartographers who had direct contact with fisher-pilots. The Admiralty began producing its own charts after 1713, using a system of consulting fishing captains.Cet article postule que les relations entre l’écologie de la morue, les pratiques de pilotage traditionnelles et les méthodes de pêche transatlantiques sous-tendent la construction de la connaissance cartographique de la côte atlantique de l’Amérique du Nord et des Grands Bancs aux XVIe et XVIIIe siècles. À partir d’un inventaire de plus de deux cents cartes représentant les Grands Bancs de 1500 à 1825, nous démontrons le rôle prééminent de la France dans la cartographie des Bancs. Une sélection de cartes du XXe siècle illustre les dernières années de cartographie des Bancs, fondée sur le savoir des pêcheurs-pilotes. Nous identifions le rôle des pêcheurs-pilotes au début du XVIe siècle dans la cartographie du littoral et de l’accore, ou bordure extérieure des Bancs, deux corridors d’une vie marine abondante. Une nouvelle idée cartographique, représentant les Bancs comme une chaîne de plateaux, apparaît en 1543 et se développe de 1584 à 1630. Cette idée est née en Bretagne et en Normandie, mais nous trouvons également des liens avec la région salicole de Brouage. À partir de 1674, l’Amirauté française acquit et reproduisit des cartes réalisées par des cartographes basques et bretons en contact direct avec les pilotes-pêcheurs. L’Amirauté commença à produire ses propres cartes après 1713, en utilisant un système de consultation des capitaines de pêche
A Matlab-based program to develop control laws for wind turbines with OpenFAST: study of the pitch control case
No full textIn the framework of wind turbine energy management, control laws allow optimizing globally the energy extraction. The OpenFAST tool is a complete solution to simulate the whole wind turbine dynamics under different wind speed profiles, for which the user can define and experiment its own controllers. To improve the user experience regarding the design of control algorithms and the management of the simulation cases, we propose a Matlab-based program to facilitate the development of advanced control algorithms and co-simulate the dynamic behavior of specific wind turbine structures. Simulation examples focus on the reduction of the blade fatigue by controlling the aerodynamic lift of the blades using a model-free based control approach
L'Etat, les stratégies de gestion intégrée du trait de côte et les ouvrages de défense contre la mer
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Measuring Waveguide Devices Based on Rotational Corrugations Through OMTs
No full textInternational audienceRotational corrugations, based on discrete rotational symmetries, allow for a frequency-dependent physical rotation of the electromagnetic fields by arbitrary angles. They are especially promising in dual-polarization applications in which, due to geometrical or manufacturing constraints, it is not possible to physically twist the system. In this work, we will briefly discuss their working principle and explore how it is possible to characterize such devices through the use of orthoMode transducers. Moreover, one dual-polarization-plane rotator manufactured through 3D printing has been measured, and its performance validated in terms of rotational symmetries
Design of Dual-Polarized 3-D Slotline Reflective Metasurface to Improve Millimeter-Wave Coverage
No full textInternational audienceThis paper proposes a dual-polarized slotline unit cell for designing reflective metasurface at millimeter waves. The unit cell consists of a three-dimensional (3-D) assembly of PCB layers. The metallic pattern of each PCB layer implements an orthogonal short-circuited slotlines whose length can be varied independently to control the phase in reflection of each incident polarization. The performance has been studied for normal and oblique incidences, showing high levels of co-polar and a linear phase between 37 GHz and 44 GHz. Using the proposed unit cell, a use case is presented where a reflective metasurface is needed to improve the coverage at various positions of an NLOS scenario. Two design options for the phase distribution in the metasurface are discussed. Through their radiation patterns, a comparison is performed. The advantages of using a metasurface with a broad-beam for coverage over a large bandwidth and for different angularly separated positions are demonstrated
