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Different types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation is to determine, through a comparative cradle-to-gate life cycle assessment, the environmental impacts of three direct-placement dental restorative materials (DRMs) and their associated packaging.Three direct-placement dental materials; dental amalgam, resin-based composite (RBC) and glass polyalkenoate cements (GIC) are assessed using primary data from a manufacturer (SDI Limited, Australia). The functional unit consisted of 'one dental restoration' of each restorative system under investigation: 1.14 g of dental amalgam; 0.25 g of RBC (plus the adhesive = 0.10 g); and 0.54 g of GIC. The system boundary per restoration included the raw materials and their associated packaging materials for each DRM together with the processing steps for both the materials and packaging. The environmental impacts were assessed using an Egalitarian approach under the ReCiPe method using Umberto software and the Ecoinvent database. Nine different impact categories were used to compare the environmental performance of these materials.Dental amalgam had the highest impact across most of the categories, but RBC had the highest Global Warming Potential. The highest sources of the environmental impacts for each restorative material were: Amalgam, derived from material use; RBC, derived from energy use in processing material and packaging material; GIC, derived from material and energy use for packaging.Less intensive energy sources or more sustainable packaging materials can potentially reduce the impacts associated with RBC and GIC thus making them suitable alternatives to dental amalgam.

Background An increase in fire weather is expected in a warming climate, but its translation to fire activity (fire numbers and sizes) remains largely unknown. Additionally, disentangling the extent to which geographic and seasonal extensions as well as intensification contribute to future fire activity remain largely unknown. Aims We aimed to assess the impact of future climate change on fire activity in southeastern France and estimate changes in spatial and seasonal distributions. Methods We projected future fire activities using a Bayesian modelling framework combined with ensemble climate simulations. Changes in numbers of escaped fires (>1 ha), large fires (>100 ha) and burned area were studied for different emission scenarios or degrees of global warming. Key results Fire activity could increase by up to +180% for +4°C of global warming, with large expansions of fire-prone regions and long seasonal lengthenings. Overall, changes will be dominated by intensification within the historical fire niche, representing two-thirds of additional future fire activity, half of this occurring during the high fire season. Conclusions This study confirms that major changes in fire niches would be expected in Euro-Mediterranean regions. Implications Long-term strategic policies for adapting prevention and suppression resources and ecosystems are needed to account for such changes.

Introduction Despite evidence that public pressure can promote sustainability in various domains (for example, retail and travel), no research has considered the public's attitudes towards sustainability in dentistry.Methods A questionnaire was developed to measure attitudes towards sustainable dentistry among adults living in the UK and their willingness to make compromises to reduce the impact of their dental treatment on the environment. In total, 344 adults completed the questionnaire that also measured pro-environmental identity and concern, general willingness to make compromises for the environment, and the tendency to engage in ecological behaviours.Results Participants reported positive attitudes towards sustainable dentistry, and were willing to compromise their time, convenience and durability of their dental treatment, as well as pay more, to reduce the impact of their dental work on the environment. Participants were not willing to compromise their health or the aesthetics of their teeth. There was also evidence that participants' current oral health shaped their attitudes towards sustainable dentistry, such that better oral health was associated with more positive attitudes towards more sustainable dentistry.Conclusions Given that public pressure can be a significant driver of change, these findings provide valuable insight into the kind of compromises that may be accepted by the public in order to improve the sustainability of dental services.

The recently discovered C-19 stellar stream is a collection of kinematically associated metal-poor stars in the halo of the Milky Way lacking an obvious progenitor. The stream spans an arc of ~15 degrees in the sky, and orbit-fitting suggests an apocentric distance of ~20 kpc and a pericentre of ~10 kpc. The narrow metallicity dispersion of stars with available spectra, together with light element abundance variations, suggests a globular cluster (GC) origin. The observed metallicity ([Fe/H] ~ -3.4), however, is much lower than that of any known GC. In addition, the width and velocity dispersion of the stream are similar to those expected from disrupting dwarf galaxies, and substantially larger than the tidal debris of GCs able to disrupt on C-19's orbit. We propose here an unconventional model where the C-19 progenitor is a dark matter-dominated stellar system with GC-like abundance patterns. We use N-body simulations to show that the tidal disruption of a ~100 pc King-model stellar component embedded in a ~20 km/s cuspy cold dark matter halo yields debris consistent with C-19's observed width and velocity dispersion. The stellar component of the progenitor is fully disrupted, and is spread over two distinct streams; one corresponding to C-19 and another possibly hiding behind the Galactic plane. If such companion stream were found, it would suggest that dark matter-dominated dwarfs may also develop GC-like enrichment patterns, a finding that would inform our theoretical understanding of the formation of multiple populations in GCs and dwarf galaxies alike., Comment: 9 pages, 9 figures. minor edits to match accepted version

Anti-U1-RNP antibodies are necessary for the diagnosis of mixed connective tissue disease (MCTD), but they are also prevalent in other connective tissue diseases, especially systemic lupus erythematosus (SLE), from which distinction remains challenging. We aimed to describe the presentation and outcome of patients with anti-U1-RNP antibodies and to identify factors to distinguish MCTD from SLE. We retrospectively applied the criteria sets for MCTD, SLE, systemic sclerosis (SSc) and rheumatoid arthritis (RA) to all patients displaying anti-U1-RNP antibodies in the hospital of Caen from 2000 to 2020. Thirty-six patients were included in the analysis. Eighteen patients (50%) satisfied at least one of the MCTD classifications, 11 of whom (61%) also met 2019 ACR/EULAR criteria for SLE. Twelve other patients only met SLE without MCTD criteria, and a total of 23 patients (64%) met SLE criteria. The most frequent manifestations included Raynaud's phenomenon (RP, 91%) and arthralgia (67%). We compared the characteristics of patients meeting only the MCTD (n = 7), SLE (n = 12), or both (n = 11) criteria. Patients meeting the MCTD criteria were more likely to display SSc features, including sclerodactyly (p 0.01), swollen hands (p 0.01), RP (p = 0.04) and esophageal reflux (p 0.01). The presence of scleroderma features (swollen hands, sclerodactyly, gastro-oesophageal reflux), was significantly associated with the diagnosis of MCTD. Conversely, the absence of those manifestations suggested the diagnosis of another definite connective tissue disease, especially SLE.

Vapor Pressure Deficit (VPD, atmospheric drought) and soil water potential (Ψsoil, soil drought) have both been reported to affect terrestrial plant water stress, plant functions (growth, stomatal conductance, transpiration) and vulnerability to ecosystem disturbances (mortality or vulnerability to wildfires). Which of atmospheric drought or soil drought has the greatest influence on these responses is yet an unresolved question. Using a state-of-the-art soil-plant-atmosphere hydraulic model, we conducted an in-silico experiment where VPD and Ψsoil were manipulated one at a time to quantify the relative importance of atmospheric vs soil drought on most critical plant functions. The model simulates the combined effects of soil drought and atmospheric drought on plant water potential (ΨPlant), a physiologically meaningful metric of plant water status driving plant turgor, stomatal conductance, hydraulic conductance or water content, and thus mortality and fire risks. Contrary to expectations, we showed that VPD had a weaker effect than Ψsoil on tree water stress and forest disturbances risk (i.e leaf moisture content). While physiological responses associated with low water stress such as stomatal closure or turgor loss could be driven by both VPD or soil drought, consequences of extreme water stress such as hydraulic failure, leaf desiccation and vulnerability to wildfires were almost exclusively driven by low Ψsoil. Our results therefore suggest that most plant functions are affected by VPD through its cumulative effect on Ψsoil via increased plant transpiration, rather than through a direct instantaneous effect on plant water potential. We argue that plant hydraulics provide a strong foundation for predicting tree and terrestrial ecosystem responses to climate changes and propose a list of explanations and testable hypotheses to reconcile plant hydraulic theory and observations of soil and atmospheric drought effects on plant functions.

Purpose Hyper activation of the JAK-STAT signaling underlies the pathophysiology of many human immune–mediated diseases. Herein, the study of 2 adult patients with SOCS1 haploinsufficiency illustrates the severe and pleomorphic consequences of its impaired regulation in the intestinal tract. Methods Two unrelated adult patients presented with gastrointestinal manifestations, one with Crohn’s disease-like ileo-colic inflammation refractory to anti-TNF and the other with lymphocytic leiomyositis causing severe chronic intestinal pseudo-occlusion. Next-generation sequencing was used to identify the underlying monogenic defect. One patient received anti-IL-12/IL-23 treatment while the other received the JAK1 inhibitor, ruxolitinib. Peripheral blood, intestinal tissues, and serum samples were analyzed before-and-after JAK1 inhibitor therapy using mass cytometry, histology, transcriptomic, and Olink assay. Results Novel germline loss-of-function variants in SOCS1 were identified in both patients. The patient with Crohn-like disease achieved clinical remission with anti-IL-12/IL-23 treatment. In the second patient with lymphocytic leiomyositis, ruxolitinib induced rapid resolution of the obstructive symptoms, significant decrease of the CD8+ T lymphocyte muscular infiltrate, and normalization of serum and intestinal cytokines. Decreased frequencies of circulating Treg cells, MAIT cells, and NK cells, with altered CD56bright:CD16lo:CD16hi NK subtype ratios were not modified by ruxolitinib. Conclusion SOCS1 haploinsufficiency can result in a broad spectrum of intestinal manifestations and need to be considered as differential diagnosis in cases of severe treatment-refractory enteropathies, including the rare condition of lymphocytic leiomyositis. This provides the rationale for genetic screening and considering JAK inhibitors in such cases.

Modern cells are complex chemical compartments tightly regulated by an underlying DNA-encoded program. Achieving a form of coupling between molecular content, chemical reactions, and chassis in synthetic compartments represents a key step to the assembly of evolvable protocells but remains challenging. Here, we design coacervate droplets that promote non-enzymatic oligonucleotide polymerization and that restructure as a result of the reaction dynamics. More specifically, we rationally exploit complexation between end-reactive oligonucleotides able to stack into long physical polymers and a cationic azobenzene photoswitch to produce three different phases—soft solids, liquid crystalline or isotropic coacervates droplets—each of them having a different impact on the reaction efficiency. Dynamical modulation of coacervate assembly and dissolution via trans-cis azobenzene photo-isomerization is used to demonstrate cycles of light-actuated oligonucleotide ligation. Remarkably, changes in the population of polynucleotides during polymerization induce phase transitions due to length-based DNA self-sorting to produce multiphase coacervates. Overall, by combining a tight reaction-structure coupling and environmental responsiveness, our reactive coacervates provide a general route to the non-enzymatic synthesis of polynucleotides and pave the way to the emergence of a primitive compartment-content coupling in membrane-free protocells.

Las fracturas de acetábulo asociadas a traumatismos de baja energía, son una identidad frecuente hoy en día en los adultos mayores. La indicación del tratamiento quirúrgico o conservador, depende de múltiples factores como la edad y las comorbilidades del paciente, el tipo y localización de la fractura, y el medio socio-económico. Independientemente del tratamiento elegido, ninguno está exento de complicaciones. Se describe a continuación un paciente con una fractura de acetábulo cerrada, de tratamiento conservador, que derivó en artritis séptica de la articulación coxofemoral.

International audience; Increasing temperature and drought can result in leaf dehydration and defoliation even in drought-adapted tree species such as the Mediterranean evergreen Quercus ilex L. The stomatal regulation of leaf water potential plays a central role in avoiding this phenomenon and is constrained by a suite of leaf traits including hydraulic conductance and vulnerability, hydraulic capacitance, minimum conductance to water vapour, osmotic potential and cell wall elasticity. We investigated whether the plasticity in these traits may improve leaf tolerance to drought in two long-term rainfall exclusion experiments in Mediterranean forests. Osmotic adjustment was observed to lower the water potential at turgor loss in the rainfall-exclusion treatments, thus suggesting a stomatal closure at more negative water potentials and a more anisohydric behaviour in drier conditions. Conversely, leaf hydraulic conductance and vulnerability did not exhibit any plasticity between treatments so the hydraulic safety margins were narrower in the rainfall-exclusion treatments. The sequence of leaf responses to seasonal drought and dehydration was conserved among treatments and sites but trees were more likely to suffer losses of turgor and hydraulic functioning in the rainfall-exclusion treatments. We conclude that leaf plasticity might help the trees to tolerate moderate drought but not to resist severe water stress.

The use of templates in materials chemistry is a well-established approach for producing membrane-bounded hollow spheres used for microencapsulation applications, but also in synthetic biology to assemble artificial cell-like compartments. Sacrificial solid or gel micro-particles, but also liquid-like oil-in-water or water-in-oil emulsion droplets are routinely used as templates to produce capsules. Yet, disruption of the core sacrificial material often requires harsh experimental conditions, such as organic solvents, which limits the use of such approach to encapsulate fragile solutes, including biomolecules. Recently, water-in-water emulsion droplets have emerged as promising alternative templates to produce capsules in solvent-free conditions. These water-in-water droplets result from liquid-liquid phase separation in dilute aqueous polymer or surfactants solutions. Their ease of preparation, the large palette of components they can be assembled from and the lack of harsh solvent or oil used for their production make water-in-water emulsions of practical importance in materials chemistry. Water-in-water droplets can also spontaneously sequester solutes by equilibrium partitioning, which provides a simple strategy to locally accumulate molecules of interest and encapsulate them in capsules after interfacial shell formation. Here, we review recent works that employ water-in-water emulsion droplets to prepare capsules and suggest possible additional applications in materials chemistry.

More than three quarters of the dose from ionizing radiation is caused by natural radiation sources. In most European countries, groundwater is used as a source of drinking water, what can be an additional source of radiation since naturally occurring radionuclides in the bedrock can dissolve into groundwater. Although the Directive 2013/51/EURATOM establishes several parametric and screening values for different radioactivity parameters, there is a lack of harmonized information and publications available that evaluate the overall condition of drinking water in EU. Thereby, it is challenging to uniformly assess the current situation in European countries in regards of effective doses caused by the consumption of drinking water. This paper aims to collect the available information on the main radionuclides of interest in drinking waters of different European countries and create an overview of the existing situation.

Objectives The REPAIR (Right vEntricular remodeling in Pulmonary ArterIal hypeRtension) study evaluated the effect of macitentan on right ventricular (RV) and hemodynamic outcomes in patie...

Geographically weighted regression (GWR) analysis and on-farm precision experiments (OFPE) allow the quantification of the within-field spatial variability of crop response to controllable inputs. Few studies have quantified the magnitude and consistency of these responses across years, and their relationship with site-specific characteristics. In this study we: (1) assessed the within-field spatial variability of corn response to nitrogen (NR) and seed (SR) rates using OFPE data and GWR models; (2) determined the spatial agreement between NR and SR response classes, and their temporal stability; and (3) modeled the effect of weather and site-specific features on the spatial distribution of the responses. Response maps were estimated by fitting GWR models to yields and as-applied NR and SR from 14 OFPE. Response maps classified into positive and non-positive response classes were spatially joined to weather, soil, and landscape covariates to train a random forest model. Zones with positive responses to NR and SR were detected in all fields. In most cases, these zones were inconsistent across years due to weather. The higher spatial agreement between NR and SR response classes for the same year suggests that factors controlling the crop response to these inputs are similar. In both cases, weather variables were the most important predictors followed by landscape and soil attributes. Whereas weather variables acted at a field level, i.e. field-year, the latter reflected the effect of within-field variability on crop response. To reduce this seasonal uncertainty, future research should consider conducting larger numbers of OFPE across multiple seasons.

Theoretical methods that are accurate for both short-distance observables and long-wavelength collective modes are still being developed for the Hubbard model. Here, we benchmark an approach that combines dynamical mean-field theory (DMFT) observables with the two-particle self-consistent theory (TPSC). This offers a way to include non-local correlations in DMFT while also improving TPSC. The benchmarks are published diagrammatic quantum Monte Carlo results for the two-dimensional square lattice Hubbard model with nearest-neighbor hopping. This method (TPSC+DMFT) is relevant for weak to intermediate interaction, satisfies the local Pauli principle and allows us to compute a spin susceptibility that satisfies the Mermin-Wagner theorem. The DMFT double occupancy determines the spin and charge vertices through local spin and charge sum rules. The TPSC self-energy is also improved by replacing its local part with the local DMFT self-energy. With this method, we find improvements for both spin and charge fluctuations and for the self-energy. We also find that the accuracy check developed for TPSC is a good predictor of deviations from benchmarks for this model. TPSC+DMFT can be used in regimes where quantum Monte Carlo is inaccessible. In addition, this method paves the way to multi-band generalizations of TPSC that could be used in advanced electronic structure codes that include DMFT., Comment: 15 pages, 19 figures. Changes from v2: added panels on some figures showing relative deviation from benchmarks, updated references. The self-energy results subsection has been slightly reworded

Fuel moisture content (FMC) is a crucial driver of forest fires in many regions world-wide. Yet, the dynamics of FMC in forest canopies as well as their physiological and environmental determinants remain poorly understood, especially under extreme drought.We embedded a FMC module in the trait-based, plant-hydraulic SurEau-Ecos model to provide innovative process-based predictions of leaf live fuel moisture content (LFMC) and canopy fuel moisture content (CFMC) based on leaf water potential (psi Leaf$$ {\psi}_{\mathrm{Leaf}} $$). SurEau-Ecos-FMC relies on pressure-volume (p-v) curves to simulate LFMC and vulnerability curves to cavitation to simulate foliage mortality.SurEau-Ecos-FMC accurately reproduced psi Leaf$$ {\psi}_{\mathrm{Leaf}} $$ and LFMC dynamics as well as the occurrence of foliage mortality in a Mediterranean Quercus ilex forest. Several traits related to water use (leaf area index, available soil water, and transpiration regulation), vulnerability to cavitation, and p-v curves (full turgor osmotic potential) had the greatest influence on LFMC and CFMC dynamics. As the climate gets drier, our results showed that drought-induced foliage mortality is expected to increase, thereby significantly decreasing CFMC.Our results represent an important advance in our capacity to understand and predict the sensitivity of forests to wildfires.

Randomised clinical studies in psoriatic arthritis (PsA) do not always reflect patients in routine clinical practice. Large-scale data from routine practice are needed to better understand drug persistence, effectiveness and long-term safety of therapeutic agents.PsABIOnd is an international, prospective, observational study designed to collect long-term routine care data in patients with PsA who receive guselkumab (an interleukin-23 [IL-23] inhibitor) or an interleukin-17 (IL-17) inhibitor. Adult patients (≥ 18 years) with a confirmed diagnosis of PsA who are starting guselkumab or any approved IL-17 inhibitor as a first, second, third or fourth line of PsA treatment and who provide written informed consent will be eligible to participate. Participants will be followed for a maximum of 36 months (+3 months) from the start of treatment. Study visits will occur in line with the standard of care, approximately every 6 months, plus an additional visit at 3 months after the start of treatment. eDaily by PsABIOnd - aneHealth substudy, will document the impact of these treatments on wellbeing and symptoms in a subgroup of participants over a 24-week (+4 weeks) observation period on treatment.The primary objective of PsABIOnd is to evaluate treatment persistence with guselkumab and IL-17 inhibitors. Data sources will include validated electronic patient-reported outcomes (ePROs) and physician-completed assessments. Safety data will be collected through reporting adverse events. The eDaily by PsABIOnd substudy will use wearable and digital technologies for continuous activity and sleep monitoring, and frequent patient eDiary and ePRO collection to provide a more detailed and comprehensive picture of PsA.ClinicalTrials.gov identifier: NCT05049798.Psoriatic arthritis (PsA) is a type of arthritis associated with inflammation that occurs in almost one-third of patients with the inflammatory skin condition psoriasis. PsA can vary between individuals, and typically causes joint pain, swelling and stiffness, affecting both physical and social well-being. Over the past decade, several new PsA treatments have become available. However, there is currently a lack of agreement about the best treatment options. As PsA is a chronic (long-term) disease, the duration of time a patient continues taking a prescribed treatment (termed “treatment persistence”) is important. The randomised clinical trials used to determine if a treatment works use strict rules to select patients. Therefore, large studies from everyday practice are needed to better understand the effectiveness and safety of these PsA treatments for a wider range of patients. PsABIOnd is a real-life study that will compare guselkumab (an interleukin-23 inhibitor) and interleukin-17 inhibitors, which are two relatively new types of PsA treatments. The study will provide information about how long patients remain on these treatments and how effectively and safely they work over a 3-year period. PsABIOnd will also explore the impact of PsA on participants’ lives by collecting information about their quality of life, disease activity and treatment satisfaction. In addition, participants also taking part in the eDaily by PsABIOnd substudy will wear a watch-like device and use a smartphone-based app to record measurements including activity, sleep, pain and well-being to give a detailed picture of PsA and its impact on patients’ daily lives.

Background Plants have adapted to survive seasonal life-threatening frost and drought. However, the timing and frequency of such events are impacted by climate change, jeopardizing plant survival. Understanding better the strategies of survival to dehydration stress is therefore timely and can be enhanced by the cross-fertilization of research between disciplines (ecology, physiology), models (woody, herbaceous species) and types of stress (drought, frost). Scope We build upon the ‘growth–stress survival’ trade-off, which underpins the identification of global plant strategies across environments along a ‘fast–slow’ economics spectrum. Although phenological adaptations such as dormancy are crucial to survive stress, plant global strategies along the fast–slow economic spectrum rarely integrate growth variations across seasons. We argue that the growth–stress survival trade-off can be a useful framework to identify convergent plant ecophysiological strategies to survive both frost and drought. We review evidence that reduced physiological activity, embolism resistance and dehydration tolerance of meristematic tissues are interdependent strategies that determine thresholds of mortality among plants under severe frost and drought. We show that complete dormancy, i.e. programmed growth cessation, before stress occurrence, minimizes water flows and maximizes dehydration tolerance during seasonal life-threatening stresses. We propose that incomplete dormancy, i.e. the programmed reduction of growth potential during the harshest seasons, could be an overlooked but major adaptation across plants. Quantifying stress survival in a range of non-dormant versus winter- or summer-dormant plants, should reveal to what extent incomplete to complete dormancy could represent a proxy for dehydration tolerance and stress survival. Conclusions Our review of the strategies involved in dehydration stress survival suggests that winter and summer dormancy are insufficiently acknowledged as plant ecological strategies. Incorporating a seasonal fast–slow economics spectrum into global plant strategies improves our understanding of plant resilience to seasonal stress and refines our prevision of plant adaptation to extreme climatic events.

Background Recent meta-analysis showed that immune checkpoint inhibitors (ICIs) have comparable activity between younger and older patients. However, little is known about efficacy and safety of ICI in elderly patients with relapsed/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). The aim of this study is to compare the efficacy of ICI for patients aged ≥70 y to that for younger patients, while taking into account potential confounding factors. Methods A retrospective study was conducted at four hospitals in France. Patients treated with ICI for R/M SCCHN between September 2014 and December 2018 were eligible. Patients’ charts were reviewed for clinical and radiological data as well as oncologic outcomes. Results We included 226 patients, of whom 67 were aged ≥70 years. Objective response rate (ORR), median overall survival (OS) and median progression-free survival (PFS) were 23%, 9.7 months and 2.7 months, respectively, for elderly patients, compared to 13%, 8.7 months and 1.9 months for younger patients (respective p-values: 0.071, 0.87 and 0.21). After adjustment for performance status, site of progression, number of ICI drugs, time between initial diagnosis and ICI start and number of previous lines, age ≥70 years was significantly associated with a better PFS (hazard ratio [HR], 0.66; p = 0.021) but not OS (HR, 0.91; p = 0.59). Grade 3-5 adverse events (AEs) occurred in 15% of patients aged ≥70 years and in 8% of younger patients (p = 0.13). Conclusion Patients aged ≥70 years with R/M SCCHN may respond to ICI similarly as younger patients in terms of ORR, OS and PFS, while maintaining comparable rate of AEs.

Les videos pedagogiques presentent des benefices (e.g., animations, multi-modalite) mais egalement des contraintes a prendre en compte. Par exemple, en presence de sous-titres, un effet d’attention divisee peut apparaitre entre l’audio, le texte ecrit et les illustrations. Une solution serait de presenter des mots-cles a la place des sous-titres afin d’eviter une redondance inutile et de guider l’apprenant a selectionner l’information pertinente. Dans cette etude, 96 participants ont appris une video de 12 minutes avec ou sans sous-titres, et avec ou sans information mise en saillance (i.e., mots-cles). Les resultats n’ont montre aucun effet des sous-titres, mais les mots-cles ont un effet negatif sur la memorisation, la comprehension et le temps d’apprentissage. Ces resultats sont discutes en termes de strategies mises en place. Les apprenants n’auraient pas utilise les mots-cles pour les guider dans la selection de l’information, mais les auraient consideres comme remplacant ce processus, surestimant ainsi leur apprentissage.

BACKGROUND: In pulmonary arterial hypertension (PAH), there are no data comparing initial triple oral therapy with initial double oral therapy. OBJECTIVES: TRITON (The Efficacy and Safety of Initial Triple Versus Initial Dual Oral Combination Therapy in Patients With Newly Diagnosed Pulmonary Arterial Hypertension; NCT02558231), a multicenter, double-blind, randomized phase 3b study, evaluated initial triple (macitentan, tadalafil, and selexipag) versus initial double (macitentan, tadalafil, and placebo) oral therapy in newly diagnosed, treatment-naive patients with PAH. METHODS: Efficacy was assessed until the last patient randomized completed week 26 (end of main observation period). The primary endpoint was change in pulmonary vascular resistance (PVR) at week26. RESULTS: Patients were assigned to initial triple (n=123) or initial double therapy (n=124). At week 26, both treatment strategies reduced PVR compared with baseline (by 54% and 52%), with no significant difference between groups (ratio of geometric means: 0.96; 95% confidence interval: 0.86-1.07; P=0.42). Six-minute walk distance and N-terminal pro-brain natriuretic peptide improved by week 26, with no difference between groups. Risk for disease progression (to end of main observation period) was reduced with initial triple versus initial double therapy (hazard ratio: 0.59; 95% confidence interval: 0.32-1.09). Most common adverse events with initial triple therapy included headache, diarrhea, and nausea. By the end of the main observation period, 2 patients in the initial triple and 9 in the initial double therapy groups had died. CONCLUSIONS: In patients with newly diagnosed PAH, both treatment strategies markedly reduced PVR by week 26, with no significant difference between groups (primary endpoint not met). Exploratory analyses suggested a possible signal for improved long-term outcomes with initial triple versus initial double oral therapy.

The Oral Healthcare community, including clinical professionals and industry, acknowledges the shared responsibility to deliver products and interventions that improve oral health in a more sustainable manner. To deliver this, the community is working in alignment with the UN Sustainable Development Goals. Key to establishing this collaborative stakeholder consensus is a deep contextual understanding of the challenge. This is achieved through a comprehensive account of the levels of awareness of the environmental impacts, the challenges to resolve these impacts together with the drivers and opportunities to promote sustainable practices. This report concludes with a strategic action framework that makes specific recommendations and identifies best practice to achieve these goals. The promotion of excellent oral healthcare and the development of a circular economy are core to this strategy. Additionally, it is also important to recognise the opportunities to collaborate across the sector, and throughout supply chains, to develop and promote sustainable practices to achieve meaningful and measurable environmental outcomes in the sector. In this context, the FDI World Dental Federation convened the development of this volume, Consensus on Environmentally Sustainable Oral Healthcare: A Joint Stakeholder Statement. This consensus statement brings together a global coalition of stakeholders, representing all aspects of industry, health professionals, experts, legislative authorities and governments. The statement uses a truly collaborative, multi-stakeholder approach to identify the major challenges facing oral healthcare, the complex drivers that underpin current behaviours and practices, and the best opportunities to improve and deliver sustainable oral healthcare for people and the planet. Concluding with an impactful and robust strategic action plan that crosses all boundaries, the statement identifies a series of actions and recommendations for best practice that address the sustainability issues facing the whole sector. Written by The University of Sheffield colleagues Prof Nicolas Martin, Dr Steven Mulligan, Hon. Prof Ian J Shellard and Prof Paul V Hatton, Consensus on Environmentally Sustainable Oral Healthcare: A Joint Stakeholder Statement is the result of a collaborative working partnership between the FDI-Sustainability in Dentistry Task Team and the project founding partners (Colgate-Palmolive, Dentsply Sirona, Haleon, Procter & Gamble and TePe) with the wide participation of stakeholders throughout the oral healthcare supply chain.

Titanium-boron-nitrogen (Ti-B-N) thin films were deposited by RF reactive magnetron sputtering using a titanium diboride (TiB2) target in an argon + nitrogen mixture. The argon mass flow rate was kept constant, whereas that of nitrogen was pulsed during the deposition. A constant pulsing period of P = 10 s was used, and the introduction time of the nitrogen gas (duty cycle (dc)) was systematically varied from dc = 0 to 100% of the pulsing period. This reactive gas pulsing process allowed the deposition of Ti-B-N thin films with various boron and nitrogen concentrations. Such adjustable concentrations in the films also led to changes in their electronic transport properties. Boron and nitrogen contents exhibited a reverse evolution as a function of the nitrogen duty cycle, which was correlated with the transition from a metallic to semiconducting-like behavior. A percolation model was applied to the electrical conductivity as a function of the nitrogen pulsing parameters, assuming some correlations with the evolution of the Ti-B-N thin film nanostructure.

Regional-level applications of dynamic vegetation models are challenging because they need to accommodate the variation in plant functional diversity, which requires moving away from broadly-defined functional types. Different approaches have been adopted in the last years to incorporate a trait-based perspective into modeling exercises. A common parametrization strategy involves using trait data to represent functional variation between individuals while discard taxonomic identity, but this strategy ignores the phylogenetic signal of trait variation and cannot be employed when predictions for specific taxa are needed, as in applications to inform forest management planning. An alternative strategy involves adapting the taxonomic resolution of model entities to that of the data source employed for large-scale initialization and estimating functional parameters from available plant trait databases while adopting alternative solutions for missing data and non-observable parameters. Here we report the advantages and limitations of this second strategy according to our experience in the development of MEDFATE (v. 2.8.1), a novel cohort-based and trait-enabled model of forest dynamics, for its application over a region in the Western Mediterranean Basin. First, 217 taxonomic entities were defined according to woody species codes of the Spanish National Forest Inventory. While forest inventory data were used to obtain some empirical parameter estimates, a large proportion of physiological, morphological, and anatomical parameters were mapped to measured plant traits, with estimates extracted from multiple databases and averaged at the required taxonomic level. Estimates for non-observable key parameters were obtained using meta-modeling and calibration exercises. Missing values were filled using imputation procedures based on trait coordination, taxonomic averages or both. The model properly simulated observed historical basal area changes, with a performance similar to an empirical model trained for the same region. While strong efforts are still required to parameterize trait-enabled models for multiple taxa, estimation procedures can be progressively refined, transferred to other regions or models and iterated following data source changes by employing automated workflows. We advocate for the adoption of trait-enabled population-structured models for regional-level projections of forest function and dynamics.

Carbon emissions and single-use plastics (SUPs) are the main forms of environmental pollution relating to waste arising from oral healthcare. Ownership of this problem is shared with the whole supply chain, from manufacturing to distribution, procurement, clinical use and finally, waste management. Mitigation strategies focus on the individual stakeholders in the supply chain, including the provision of clinical care. Key to this is establishing a baseline analysis of the nature and the size of the problem through life cycle assessments (LCAs). Reduction of CO2 emissions, other associated environmental impacts and plastic waste is considered through remote clinical consultations, recycling, patient education and the provision of high-quality care to achieve high impact environmentally sustainable outcomes. CPD/Clinical Relevance: Environmentally sustainable oral healthcare requires the combined efforts of all stakeholders across the supply chain. The provision of good oral healthcare can deliver environmentally sustainable outcomes from a reduced need for interventions.

Introduction: Tumor Necrosis Factor Type 1 Receptor Associated Periodic Syndrome (TRAPS) is a rare autosomal dominant autosomal autoinflammatory disease associated with mutations in the TNF type 1 receptor gene (TNFRSF1A). It is characterized by relatively long recurrent febrile seizures with an average duration of 7 days accompanied by arthralgia, myalgia, and usually a rash. In a patient of Mediterranean origin with recurrent fever, familial Mediterranean fever is the first diagnosis to be suspected by argument of frequency.Methods: A retrospective observational study was conducted on patients from Mediterranean origin followed for TRAPS and included in the "Juvenile Inflammatory Rheumatism" (JIR) observational cohort in the national French autoinflammatory center. The age of onset of symptoms, age of diagnosis, number of years of wandering and treatments received were collected for each index case.Results: Nine patients from 6 families of Mediterranean origin were included. A molecular diagnosis confirmed TRAPS in all patients. The median age at diagnosis was 26 years, the mean number of years of wandering was 17 years. The diagnosis of FMF was made first in all patients. AA amyloidosis revealed TRAPS in 2 patients. Colchicine was started without any efficacy in all cases. Five patients were treated with interleukin-1 inhibitory biotherapy with 100% efficacy.Conclusion: In a patient of Mediterranean origin presenting with recurrent febrile abdominal pain of AA amyloidosis, the first diagnosis to be suspected is FMF. Long relapses, dominant transmission, a non-Mediterranean relative, and the ineffectiveness of colchicine should evoke TRAPS., IntroductionLe syndrome périodique associé aux mutations du récepteur du facteur de nécrose tumorale de type 1 (TRAPS) est une maladie auto-inflammatoire autosomique dominante rare associée à des mutations du gène du récepteur de type 1 du TNF (TNFRSF1A). Elle se caractérise par des douleurs abdominales fébriles récurrentes relativement longues accompagnées d’arthromyalgies. Le principal diagnostic différentiel est la fièvre méditerranéenne familiale (FMF).MéthodesÉtude observationnelle rétrospective sur les patients d’origine Méditerranéenne suivis pour TRAPS et inclus dans la cohorte observationnelle « Juvenile Inflammatory Rheumatism » (JIR) L’âge du début des symptômes, l’âge du diagnostic, le nombre d’années d’errance et les traitements reçus ont été recueillis pour chaque cas index.RésultatsNeuf patients issus de 6 familles ont été inclus ; un diagnostic moléculaire avait confirmé le TRAPS chez tous. L’âge médian au diagnostic était de 26 ans, le nombre moyen d’année d’errance était de 17 ans. Le diagnostic de FMF avait été porté en premier lieu chez tous les patients. L’amylose AA a révélé le TRAPS chez 2 patients. La colchicine a été débutée sans aucune efficacité dans tous les cas. Cinq patients ont été traités par une biothérapie inhibant l’interleukine-1 avec une efficacité de 100 %.ConclusionChez un patient d’origine méditerranéenne présentant des douleurs abdominales fébriles récurrentes plus ou moins compliquées d’amylose AA, le premier diagnostic à évoquer est la FMF. Des poussées longues, une transmission d’allure dominante, un parent non méditerranéen, et l’inefficacité de la colchicine doivent faire évoquer le TRAPS.

Estimating evapotranspiration (ET) is a primary challenge in modern hydrology. Hydrogravimetry is an integrative approach that provides highly precise continuous measurement of gravity acceleration. However, large-scale effects (e.g. tides, polar motion, atmospheric loading) limit the fine time-scale interpretation of this data and processing leads to residual signal noise. To circumvent this limitation, we exploited the difference between two superconducting gravimeters located 512 m apart on the same vertical. The difference calculation makes it possible to remove shared large-scale effects. Daily variation of this gravity difference is significantly correlated with daily evapotranspiration as estimated using the water balance model SimpKcET (p-value = 4.10-10). However, this approach is effective only during rain-free periods. In the future, comparison with direct ET measurements (e.g. eddy-covariance, scintillometer) may confirm and strengthen our interpretation. Improved hydrogravimetric data processing will allow to extend this approach to other experimental sites equipped with a single superconducting gravimeter.

The FDI World Dental Federation suggests that "dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life." This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan-European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment.

The application is discussed of neutron methods to the study of reentrant spin glasses (RSGs), close to the transition towards a `canonical' spin glass (SG). The focus is on two emblematic systems, namely Au1−x Fe x and amorphous a-Fe1−x Mn x . A set of experimental results is presented to highlight their peculiar static and dynamic properties. The role of small-angle neutron scattering (SANS) is stressed as an important tool to unravel the structure of these complex systems over mesoscopic length scales. Finally, recent SANS results performed under an applied magnetic field in the region of the RSG → SG transition are presented. They show that vortex-like defects are present in the RSG region up to the critical line and vanish in the SG region. These defects, which develop only in a ferromagnetic medium, could be a key feature to probe the emergence of long-range magnetic order.

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