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Objective. For optimal RA management, the current recommendation is to adapt DMARD therapy to the level of inflammation and not only of patient complaints. We designed the DUO (epidemiological study of treatment decison in RA: DROs and PROs) study to assess the relative weight of patient-reported outcomes (PROs) and doctor-reported outcomes (DROs) in DMARD intensification in RA patients.Methods. This French, observational, multicentre, cross-sectional study was conducted in 2009 on RA patients included by rheumatologists. The percentage of patients with DMARD intensification was evaluated with regard to the concomitant DAS28-ESR and Patient Acceptable Symptom State (PASS) questionnaire assessments. Logistic regression was used to find significant criteria of DMARD intensification. The relative weight of subjective/objective criteria was assessed using attributable risk fractions.Results. A total of 1107 patients were analysed (76% women; median disease duration 6 years); DMARD intensification was proposed to 15% of patients (24% of patients with DAS >3.2 and 33% of patients with non-acceptable PASS). DMARD intensification determinants comprised both DROs (high tender and swollen joint counts) and PROs (high patient global assessment of disease activity), but also short disease duration and rheumatologist characteristics (young, hospital based). Respectively, 61% and 42% of DMARD intensification were attributable to PROs and DROs.Conclusion. The DUO study showed DMARD intensification was predominantly based on PROs compared with DROs and influenced by disease duration and type of rheumatology practice. Most RA patients with DAS28 >3.2 had no DMARD intensification. [ABSTRACT FROM AUTHOR]

Water quality monitoring is essential for managing water resources and ensuring human and environmental health. However, obtaining reliable data can be challenging and costly, especially in complex systems such as estuaries. To address this problem, we propose a novel deep learning-based approach that uses limited available data to accurately estimate and reconstruct critical water quality variables, such as electrical conductivity, dissolved oxygen, and turbidity. Our approach included two tasks, numerical modeling and historical reconstruction, and was applied to the Seine River in the Normandy region of France at four quality stations. In the first task, we evaluated four deep learning approaches (GRU, BiLSTM, BiLSTM-Attention, and CNN-BiLSTM-Attention) to numerically simulate each variable for each station under different input data selection scenarios. We found that incorporating the quality data with the water level data collected at the various stations into the input data improved the accuracy of the water quality data simulation. Combining water levels from multiple stations reliably reproduced electrical conductivity, especially at stations near the sea where tidal fluctuations control saltwater intrusion in the area. While each model had its strengths, the CNN-BiLSTM-Attention model performed best in complex tasks with dissimilar input trends, and the GRU model outperformed other models in simple monitoring tasks with similar input-target trends. The second task involved automatically searching the optimal configurations for completing the missing historical data in sequential order using the modeling task results. The electrical conductivity data were filled before the dissolved oxygen data, which were in turn more reliable than the turbidity simulation. The deep learning models accurately reconstructed 15 years of water quality data using only six and a half years of modeling data. Overall, this research demonstrates the potential of deep learning approaches with their limitations and discusses the best configurations to improve water quality monitoring and reconstruction. [ABSTRACT FROM AUTHOR]

England and France have developed distinct treatment systems to address the shock of a substantial increase in over-indebted individuals since the mid-1980s. In France, Over-Indebtedness Commissions, with the Bank of France playing a central role in their management, now dominate the system. A more fragmented system of private and public providers of remedies developed in England, with innovation driven by private actors modifying existing commercial procedures and increased access to bankruptcy relief a side-effect of government promotion of entrepreneurialism. This article explains the differences between these countries in terms of the influence of interest groups, including state actors, and ideologies. Historical contingency also plays a role. The distinct responses were not hard-wired to legal origins and the article argues that analysis of the interaction of interest groups, state actors and ideology in shaping institutions, which in turn structure future change, provides a productive approach for future comparative research in this area. [ABSTRACT FROM AUTHOR]

We present 2 yr (October 2008 to September 2010) of in situ measurements of molecular hydrogen (H) and carbon monoxide (CO) sampled at the tall tower of Trainou, France (47.96°N, 02.11°E, 131 masl, sampling height: 50, 100 and 180 m). Radon-222 (Rn) measurements were added in May 2009. Background seasonal cycles, based on afternoon values, exhibit an amplitude of 45 and 60 ppb for H and CO, respectively, for the three different heights (50, 100 and 180 m above ground). The vertical gradient also shows seasonal variations with a maximum (during the night) of 20 and 45 ppb for H and CO, respectively. We also observe diurnal cycles for H and CO for the three different heights. In the afternoon, the mixing ratios at the three different heights are similar and are comparable with maritime background stations, such as Mace Head (Ireland). The diurnal cycle of Rn follows the boundary layer height variations, with maximum values in the morning. Throughout the year but especially in summer and autumn, the H mixing ratio shows nighttime depletion, with the lowest values at 06:00 UTC, due to soil uptake and the low boundary layer height. Using a simple box approach and the Radon-Tracer-Method, the H deposition velocity is calculated for the catchment area of Trainou. We find a mean value for the H deposition velocity of 2.6 ± 0.9 10 cm s. During wintertime, H and CO are sometimes strongly correlated leading to a H/CO ratio around 0.25. This ratio is lower than the ratio from traffic emissions, thus highlighting the mixing of sources in this area. [ABSTRACT FROM AUTHOR]