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We aim to evaluate the costs associated with healthcare resource consumption for chronic heart failure (HF) management in patients allocated to telemonitoring versus standard of care (SC).OSICAT-ECO involved 745 patients from the OSICAT trial (NCT02068118) who were successfully linked to the French national healthcare database through an indirect deterministic data linkage approach. OSICAT compared a telemonitoring programme with SC follow-up in adults hospitalized for acute HF ≤ 12 months. Healthcare resource costs included those related to hospital and ambulatory expenditure for HF and were restricted to direct costs determined from the French health data system over 18 months of follow-up. Most of the total costs (69.4%) were due to hospitalization for HF decompensation, followed by ambulatory nursing fees (11.8%). During 18-month follow-up, total costs were 2% lower in the telemonitoring versus the SC group, due primarily to a 21% reduction in nurse fees. Among patients with NYHA class III/IV, a 15% reduction in total costs (€3131 decrease) was observed over 18-month follow-up in the telemonitoring versus the SC group, with the highest difference in hospital expenditure during the first 6 months, followed by a shift in costs from hospital to ambulatory at 12 months.HF hospitalization and ambulatory nursing fees represented most of the costs related to HF. No benefit was observed for telemonitoring versus SC with regard to cost reductions over 18 months. Patients with severe HF showed a non-significant 15% reduction in costs, largely related to hospitalization for HF decompensation, nurse fees, and medical transport.

At a critical soil water content (θcrit), terrestrial ecosystem fluxes at the soil-vegetation-atmosphere interface transition from energy into water limitation. Understanding and predicting soil, plant and atmospheric mechanisms that control θcrit are central to interpreting and predicting impacts of drought on ecosystems, including the associated feedbacks to carbon and hydrological cycle. Thanks to the existing monitoring networks, θcrit can now be estimated globally across soils, biomes and climates. However, the mechanisms and key parameters that explain θcrit as a result of soil-, plant-, and climate-interaction remain elusive. Here, we show that the soil hydraulic conductivity function determines mean and variability of θcrit. The underlying concept to calculate θcrit assumes that soil moisture limitation of transpiration is triggered by a loss in soil hydraulic conductivity around the roots. Taking soil-specific hydraulic properties into account, our soil-plant hydraulic model predicts the observed mean and variance of θcrit as a function of soil textural classes. In coarse textured soils, θcrit is small due to the lower absolute soil hydraulic conductivity and its steeper decline with soil drying compared to fine textured soils. The increasing variability of θcrit in fine-textured soils is explained by (i) the wide range of hydraulic conductivity values for similar soil textures as a result of soil structure formation and (ii) by the higher sensitivity to plant traits and climate for soils with less steep hydraulic conductivity curves (i.e., loamy soils). The corresponding critical soil matric potential (hcrit) is also soil texture specific, and it covers a broad range of values, from values close to field capacity in sandy soils (hcrit ca. -100 hPa) to values close to the wilting point in clay soils (hcrit ca. – 1 MPa). The model implies that climate change has a smaller effect on θcrit in sandy soils, suggesting that soil texture modulates climate effects on water use and photosynthesis globally. Overall, our results prove the prominent role of soil hydraulic conductivity for water limitation of ecosystem fluxes and for plants’ potential to adjust to water limitations subject to alterations due to climate change.

Climate change will exacerbate drought events in many regions, increasing the demand on freshwater resources and creating major challenges for viticulture. In viticulture, the terroir governs the hydraulic behavior of the vine. The terroir is defined as the interactions between climate, soil, plant material (vine and rootstock varieties) and human management practices. The knowledge on grapevine drought stress physiology has increased significantly in recent years, but a holistic comprehension on how soil-plant hydraulic resistances develop and are regulated remains poorly understood. In particular, how different soil-rootstock combinations and their plasticity affect the vine hydraulic condition is still an open question. The objective of this study is to understand the hydraulics of the soil-plant system in grapevines (Vitis vinifera cv. Chardonnay) in situ, for different soil-rootstock combinations in a temperate oceanic climate, and to investigate its influence on vine water status. The concomitant and automatic monitoring of soil and collar water potentials, as well as sap flow, made it possible to characterize the evolution of the soil-vine hydraulics in situ in real-time, with hourly measurements for two months. In order to investigate the impact of the soil-rootstock combination, two Belgian vineyards with the same variety (cv. Chardonnay) were selected due to their intra-field heterogeneity of soil physico-chemical properties (two study areas per vineyard). The vines of the first vineyard are grafted on the rootstock 3309C and planted on sandy or loamy soils. Those of the second vineyard are associated to the rootstock 101-14Mgt and grow on loamy or silty-clay soils. In each vineyard the soil is therefore the only variable factor, for which hydraulic properties were measured to a depth of 2 m. The measurements were collected between mid-July and mid-September, during a period of exceptional drought in Belgium leading to soil water-limited conditions (rainfall anomaly of -153,8 mm and -148,4 mm in the first and second vineyard respectively over this period). The mean soil-plant conductances observed over the season were respectively 0,54.10-5 cm.s-1.MPa-1 and 2,18.10-5 cm.s-1.MPa-1 in the sandy and loamy areas of the first vineyard, and 1,79.10-5 cm.s-1.MPa-1 and 2,97.10-5 cm.s-1.MPa-1 in the silty-clay and loamy areas of the second vineyard. Despite this extreme drought, the minimum observed stem water potential (Ψstem) was -1,47 MPa (sandy study area of the first vineyard). This is in line with other studies that have shown in situ vines typically work within a safe range of water potentials (Ψstem > -1,5 MPa) that do not lead to cavitation or turgor loss. These first observations validate the hypothesis that the increase of belowground hydraulic resistance triggers stomatal closure of vine.

Background. There is widespread acknowledgment amongst the rare disease community that effective communication strategies are lacking to explain diagnostic issues and therapeutic challenges to the public. The goal of this study was to objectively assess the communication needs of rare disease associations using validated techniques. - Methods. Sixty-minute structured interviews and objective analysis of transcribed responses were conducted and analyzed for 20 rare disease organizations. - Results. Associations uniformly agreed that effective communication was important to educate the public, advance advocacy and raise funds. However, there was no consensus as to how this should be achieved. Only seven of the 20 organizations had formal communication plans. Only few organizations had staff dedicated to external communication. - Conclusions. Strategic improvement in rare disease communication may increase the awareness of rare diseases and advance science. Communication challenges included staffing, funding, technological resources, training and expertise.

On 16 February 2021, the Grand Chamber of the European Court of Human Rights ruled, in Hanan v. Germany, that Germany exercised its extraterritorial jurisdiction for the purpose of its procedural obligation under Article 2 of the European Convention on human rights to investigate the airstrike it carried out in Afghanistan within the framework of a United Nations Security Council resolution. To establish an extraterritorial jurisdictional link, the Court relied on the ‘special features’ threshold that it has recently introduced in its jurisprudence, along with the threshold of the ‘institution of a criminal investigation’. This potentially extends the standards of protection under the ECHR to situations where Contracting States are carrying out massive military operations in armed conflict, such as airstrikes, even within the framework of a UN mandate. Nonetheless, the Court remains cautious not to formulate general theories of jurisdiction and retains a very strict (and casuistic) control over the new jurisdictional thresholds. Le 16 février 2021, la Grande Chambre de la Cour européenne des droits de l’homme a conclu, dans l’affaire Hanan c. Allemagne, que l’Allemagne a exercé sa juridiction extraterritoriale en invoquant son obligation procédurale, découlant de l’article 2 de la Convention européenne des droits de l’homme, d’enquêter sur la frappe aérienne menée en Afghanistan dans le cadre d’une résolution du Conseil de sécurité des Nations Unies. Pour établir un lien juridictionnel extraterritorial, la Cour s’est appuyée sur la notion de « circonstances propres » qu’elle a récemment introduite dans sa jurisprudence, ainsi que celle d’« institution d’une procédure pénale ». Cela étend potentiellement les normes de protection en vertu de la CEDH à des situations où les États signataires mènent des opérations militaires de grande envergure dans un conflit armé, telles que des frappes aériennes, même dans le cadre d’un mandat des Nations Unies. Néanmoins, la Cour ne se risque pas à formuler des théories de juridiction générales et maintient un contrôle très strict (et au cas par cas) sur les nouveaux seuils juridictionnels. Op 16 februari 2021 oordeelde de Grote Kamer van het Europees Hof voor de Rechten van de Mens in de zaak Hanan tegen Duitsland dat Duitsland zijn extraterritoriale rechtsmacht uitoefende in toepassing van zijn procedurele verplichting krachtens artikel 2 van het Europees Verdrag voor de Rechten van de Mens om een onderzoek in te stellen naar de luchtaanval die het uitvoerde in Afghanistan in het kader van een resolutie van de Veiligheidsraad van de Verenigde Naties. Om een extraterritoriale rechtsbevoegdheidsband vast te stellen, baseerde het Hof zich op de drempel van de ‘specifieke omstandigheden’ die het onlangs in zijn rechtspraak heeft ingevoerd, net zoals de drempel van de ‘instelling van een strafrechtelijk onderzoek’. Hierdoor kunnen de beschermingsnormen krachtens het EVRM mogelijk worden uitgebreid tot situaties waarin verdragsluitende staten grootschalige militaire operaties uitvoeren in een gewapend conflict, zoals luchtaanvallen, zelfs in het kader van een VN-mandaat. Niettemin blijft het Hof voorzichtig met het formuleren van algemene theorieën over rechtsbevoegdheid en behoudt het een zeer strikte (en casuïstische) controle over de nieuwe drempels inzake rechtsbevoegdheid. Il 16 Febbraio 2021 la Grande Camera della Corte europea dei Diritti dell’Uomo ha stabilito che, nella causa Hanan v. Germany, la Germania ha esercitato, ai fini del suo obbligo procedurale ai sensi dell’articolo 2 della Convenzione europea dei diritti dell’uomo, la sua giurisdizione extraterritoriale per indagare sul bombardamento aereo che, nel quadro di una risoluzione del Consiglio di sicurezza delle Nazioni Unite, ha effettuato in Afghanistan. Per stabilire un legame giurisdizionale extraterritoriale, la Corte si è basata sui principi delle “caratteristiche speciali” che ha recentemente introdotto nella sua giurisprudenza, insieme a quelli della “istituzione di un’indagine penale”. Questo estende potenzialmente gli standard di protezione della CEDU a situazioni in cui gli Stati contraenti stanno conducendo operazioni militari di massa in un conflitto armato, come gli attacchi aerei, anche entro il quadro di un mandato delle Nazioni Unite. Tuttavia, la Corte rimane cauta nel non formulare teorie generali di giurisdizione e mantiene un controllo molto rigoroso (e sul caso) sulle nuove soglie giurisdizionali. El 16 de febrero de 2021, la Gran Sala del Tribunal Europeo de Derechos Humanos dictaminó, en Hanan vs. Alemania, que Alemania ejerció su jurisdicción extraterritorial, a efectos de cumplir la obligación procesal en virtud del artículo 2 del Convenio Europeo de Derechos Humanos, al investigar el ataque aéreo que se llevó a cabo en Afganistán en el marco de la ejecución de una resolución del Consejo de Seguridad de las Naciones Unidas. Para establecer un vínculo jurisdiccional extraterritorial, el Tribunal se basa en el umbral de las “características especiales” que ha introducido recientemente en su jurisprudencia, junto con el umbral de la “instrucción de una investigación penal”. Esto amplía potencialmente los estándares de protección bajo el CEDH a situaciones donde los Estados Contratantes llevan a cabo operaciones militares masivas en conflictos armados, tales como ataques aéreos, incluso dentro del marco de un mandato de la ONU. No obstante, el Tribunal se mantiene cauteloso para no formular teorías generales sobre jurisdicción y mantiene un control muy estricto (y casuístico) sobre los nuevos umbrales jurisdiccionales. Am 16. Februar 2021 hat die Große Kammer des Europäischen Gerichtshofs für Menschenrechte in der Sache Hanan vs. Deutschland entschieden, dass Deutschland seine extraterritoriale Gerichtsbarkeit zum Zwecke seiner Verfahrenspflicht nach Artikel 2 der Europäischen Menschenrechtskonvention ausgeübt hat, um den von ihm im Rahmen einer Resolution des UN-Sicherheitsrates durchgeführten Luftangriff zu untersuchen. Zur Feststellung eines extraterritorialen Gerichtsbarkeitsbands basierte sich der Gerichtshof auf die Schwelle der ‘besonderen Merkmale’, die er vor Kurzem in seiner Rechtsprechung eingeführt hat, ebenso wie die Schwelle der ‘Einleitung eines Ermittlungsverfahrens’. Dies weitet die Standards des Schutzes gemäß der EMRK potenziell auf Situationen aus, in denen Vertragsstaaten in einem bewaffneten Konflikt groß angelegte Militäreinsätze, wie Luftangriffe, selbst im Rahmen eines UN-Mandats, durchführen. Trotzdem ist der Gerichtshof weiterhin behutsam, indem er vermeidet, allgemeine Theorien über die Gerichtsbarkeit zu formulieren, und erhält er eine sehr strikte (und kasuistische) Kontrolle über die neuen Gerichtsbarkeitsschwellen aufrecht.

Our objective was to evaluate the potential additional value of electroencephalogram (EEG) and evoked potentials in neonates with hypoxic-ischemic encephalopathy to predict their disability at 1 and 2 years old.30 full-term infants after perinatal asphyxia who underwent therapeutic hypothermia were evaluated at 1 year and 2 years for disability using International Classification of Functioning, Disability and Health classification. Scores for EEG, sensory evoked potentials and brainstem auditory evoked potentials were evaluated after withdrawal of therapeutic hypothermia that lasted 72 h. A regression approach was investigated to build models allowing to distinguish neonates according to their disability at 1 and 2 years. Two models were built, the first by considering the clinical data and EEG before and after therapeutic hypothermia and the second by incorporating evoked potentials recording.Adding EEG and evoked potentials data after rewarming improved dramatically the accuracy of the model considering outcome at 1 and 2 years.We propose to record systematically EEG and evoked potentials following rewarming to predict the outcome of neonates with hypoxic ischemic encephalopathy. Combination of altered evoked potentials with no improvement of EEG after rewarming appeared to be a robust criterion for a poor outcome.

International audience; In sheep, the bond between the dam and her lambs is established during the first hours of a lamb's life. Genetic variability for behavioural reactivity of ewes assessed in an arena test performed 24 hr after lambing has already been reported. However, there is no evidence that this reactivity represents the ewe's maternal reactivity at lambing in outdoor conditions. The objective of this study was to investigate whether or not the behavioural reactivity of ewes in the arena test is genetically related to their maternal reactivity measured at lambing. A total of 935 Romane ewes were studied. The maternal reactivity of ewes at the outdoor lambing site was recorded in response to a human approach and to the handling of the lambs. Their behavioural reactivity was also recorded 24 hr post-lambing in the arena test that involved a separation from the litter and a human presence. Flight distance, aggressive reaction, time to restore contact with the litter, maternal behaviour scores and vocalizations recorded at the lambing site were heritable (0.12-0.34). All of these behaviours were genetically correlated with the behavioural reactivity in the arena test. The highest genetic correlations (from 0.60 to 0.90) were found amongst maternal behavioural scores, flight distance and high-pitched bleats. In conclusion, behavioural reactivity in the arena test can be used to assess early maternal reactivity in standardized conditions. Phenotyping of ewes' behavioural reactivity with a simplified arena test can be performed for genetic improvement in maternal behaviour in sheep.

Objective To evaluate the relevance of transcranial magnetic stimulation (TMS) using triple stimulation technique (TST) to assess corticospinal function in amyotrophic lateral sclerosis (ALS) in a large-scale multicenter study. Methods Six ALS centers performed TST and conventional TMS in upper limbs in 98 ALS patients during their first visit to the center. Clinical evaluation of patients included the revised ALS Functional Rating Scale (ALSFRS-R) and upper motor neuron (UMN) score. Results TST amplitude ratio was decreased in 62% of patients whereas conventional TMS amplitude ratio was decreased in 25% of patients and central motor conduction time was increased in 16% of patients. TST amplitude ratio was correlated with ALSFRS-R and UMN score. TST amplitude ratio results were not different between the centers. Conclusions TST is a TMS technique applicable in daily clinical practice in ALS centers for the detection of UMN dysfunction, more sensitive than conventional TMS and related to the clinical condition of the patients. Significance This multicenter study shows that TST can be a routine clinical tool to evaluate UMN dysfunction at the diagnostic assessment of ALS patients.

Background Gait initiation is an automatized motor program that is preceded by anticipatory postural adjustments (APAs). During attentional tasks, these APAs can be modulated, producing multiple APAs. However, the role of the peripheral nervous system in the regulation of these APAs is unknown. Research question The objective of our study was to investigate whether APAs are also regulated by peripheral nervous afferents. Methods We assessed 21 patients suffering from chronic inflammatory demyelinating neuropathy and 20 healthy controls. Participants initiated gait with the right or left leg either freely (in the standard condition) or according to a visual trigger (i.e., the select condition). Kinetic and kinematic parameters of APAs and step initiation were recorded. Results The select condition was related to a higher rate of multiple APAs compared to the standard condition, and was more attention-consuming in both groups. The group with a neuropathy showed longer APAs than the control group, associated with a longer time to recover from multiple APAs. Consequently, the step execution time was delayed in patients with a peripheral neuropathy. Significance The impairment of the peripheral nervous system is therefore responsible for an alteration of the mechanisms underlying the recovery from multiple APAs during gait initiation. Our results are in favor of a role of proprioceptive afferents in the early peripheral regulation of motor errors. Further study on gait initiation in peripheral nervous disease could be helpful to better explore sensory-motor coupling in tasks requiring balance control.

Resume Contexte Cette etude visait a evaluer l’impact de l’accompagnement des prestataires de sante a domicile (PSAD) sur la diminution de l’hemoglobine glyquee (HbA1c) chez les patients atteints de diabete de type 1 (DT1) traites par perfusion sous-cutanee continue d’insuline (PSCI) en France en comparaison de patients traites par injections quotidiennes multiples (IQM) d’insuline, 6 mois apres l’initiation du traitement, et a identifier les facteurs associes a l’atteinte des objectifs glycemiques chez ces patients. Methodes Il s’agit d’une etude observationnelle multicentrique retrospective appariee par score de propension. L’impact des PSAD a ete evalue par une comparaison indirecte en utilisant les resultats d’un essai controle randomise (ECR) europeen « comparatif » comparant des groupes de patients atteints de DT1, ayant des traitements similaires sans PSAD. Resultats Au total, 323 patients traites par PSCI et 472 patients traites par IQM ont ete inclus dans cette etude. Parmi les patients traites par PSCI, 87,9 % (n = 284) ont ete apparies, fournissant un echantillon apparie de 568 patients. Le taux moyen initial d’HbA1c etait similaire dans les deux groupes. Six mois apres l’initiation du traitement, le taux moyen d’HbA1c etait de 8,06 % (ecart-type [ET] = 1,13) dans le groupe PSCI et de 8,53 % (ET = 1,20) dans le groupe IQM. La difference des moyennes d’HbA1c entre les deux groupes de patients apparies etait de −0,47 % [intervalle de confiance a 90 %, IC90 % : −0,63 a −0,30] en faveur des patients traites par PSCI associee aux PSAD (p Conclusion Cette etude a montre un impact positif de la prise en charge des patients sous PSCI et suivis par des PSAD sur la diminution du taux d’HbA1c a 6 mois, effet qui pourrait etre du a une amelioration de l’observance globale des patients traites par PSCI.

The poster was presented at the Psi-k 2022 conference, August 22-25. The poster presetns the software development strategy and the current achievements of the European Centre of Excellence “Targeting Real chemical accuracy at the EXascale” (TREX). The main objective of TREX is the development of a user-friendly and open-source software suite in the domain of stochastic electronic structure simulations, which integrates a set of flagship quantum Monte Carlo codes within an interoperable, high-performance platform. Core of our software efforts is the creation of two libraries, the TREXIO and the quantum Monte Carlo kernel library (QMCkl).

Background\ud Huntington's disease is a rare, severe, inherited neurodegenerative disease in which we assessed the safety and efficacy of grafting human fetal ganglionic eminence intrastriatally.\ud \ud Methods\ud Patients at the early stage of the disease were enrolled in the Multicentric Intracerebral Grafting in Huntington's Disease trial, a delayed‐start phase II randomized study. After a run‐in period of 12 months, patients were randomized at month 12 to either the treatment group (transplanted at month 13–month 14) or the control group and secondarily treated 20 months later (month 33–month 34). The primary outcome was total motor score compared between both groups 20 months postrandomization (month 32). Secondary outcomes included clinical, imaging, and electrophysiological findings and a comparison of pregraft and postgraft total motor score slopes during the entire study period (month 0–month 52) regardless of the time of transplant.\ud \ud Results\ud Of 54 randomized patients, 45 were transplanted; 26 immediately (treatment) and 19 delayed (control). Mean total motor score at month 32 did not differ between groups (treated controls difference in means adjusted for M12: +2.9 [95% confidence interval, −2.8 to 8.6]; P = 0.31). Its rate of decline after transplantation was similar to that before transplantation. A total of 27 severe adverse events were recorded in the randomized patients, 10 of which were related to the transplant procedure. Improvement of procedures during the trial significantly decreased the frequency of surgical events.We found antihuman leucocytes antigen antibodies in 40% of the patients.\ud \ud Conclusion\ud No clinical benefit was found in this trial. This may have been related to graft rejection. Ectopia and high track number negatively influence the graft outcome. Procedural adjustments substantially improved surgical safety. (ClinicalTrials.gov NCT00190450.) © 2020 International Parkinson and Movement Disorder Society

Objective To describe EEG patterns of critical Coronavirus Disease 2019 (COVID-19) patients with suspicion of encephalopathy and test their association with clinical outcome. Methods EEG after discontinuation of sedation in all patients, and somesthesic evoked potentials and brainstem auditive evoked potentials when EEG did not show reactivity, were performed. Clinical outcome was assessed at day 7 and 14 after neurophysiological explorations. Results 33 patients were included for analysis. We found slowed background activity in 85% of cases, unreactive activity in 42% of cases, low-voltage activity in 21% of cases and rhythmic or periodic delta waves in 61% of cases. EEG epileptic events were never recorded. Clinical outcome at day 14 was associated with unreactive background activity and tended to be associated with rhythmic or periodic delta waves and with low-voltage activity. Results of multimodal evoked potentials were in favor of a preservation of central nervous system somatosensory and auditory functions. Conclusions Among critical COVID-19 patients with abnormal arousal at discontinuation of sedation, EEG patterns consistent with encephalopathy are found and are predictive for short term clinical outcome. Significance The abnormal EEG with presence of periodic discharges and lack of reactivity could be related to encephalopathy linked to COVID-19.

To identify relevant quantitative parameters for early classification of neonatal hypoxic-ischemic encephalopathy (HIE) severity from conventional EEGs.Ninety EEGs, recorded in full-term infants within 6 h of life after perinatal hypoxia, were visually classified according to the French EEG classification into three groups of increasing HIE severity. Physiologically significant EEG features (signal amplitude, continuity and frequency content) were automatically quantified using different parameters. The EEG parameters selection was based on their ability to reproduce the visual EEG classification. Post hoc analysis based on clinical outcome was performed.Six EEG parameters were selected, with overall EEG classification performances between 61% and 70%. All parameters differed significantly between group 3 (severe) and groups 1 (normal-mildly abnormal) and 2 (moderate) EEGs (p 0.001). Amplitude and discontinuity parameters were different between the 3 groups (p 0.01) and were also the best predictors of clinical outcome. Conversely, pH and lactate did not differ between groups.This study provides quantitative EEG parameters that are complementary to visual analysis as early markers of neonatal HIE severity. These parameters could be combined in a multiparametric algorithm to improve their classification performance. The absence of relationship between pH lactate and HIE severity reinforces the central role of early neonatal EEG.

Objective Although a number of clinical factors have been linked to falls in Parkinson’s disease (PD), the diagnostic value of gait parameters remains subject to debate. The objective of this retrospective study was to determine to what extent the combination of gait parameters with clinical characteristics can distinguish between fallers and non-fallers. Methods Using a video motion system, we recorded gait in 174 patients with PD. The patients’ clinical characteristics (including motor status, cognitive status, disease duration, dopaminergic treatment and any history of falls or freezing of gait) were noted. The considered kinematic gait parameters included indices of gait bradykinesia and hypokinesia, asymmetry, variability, and foot clearance. After a parameters selection using an ANCOVA analysis, support vector machine algorithm was used to build classification models for distinguishing between fallers and non-fallers. Two models were built, the first included clinical data only while the second incorporated the selected gait parameters. Results The “clinical-only” model had an accuracy of 94% for distinguishing between fallers and non-fallers. The model incorporating additional gait parameters including stride time and foot clearance performed even better, with an accuracy of up to 97%. Conclusion Although fallers differed significantly from non-fallers with regard to disease duration, motor impairment or dopaminergic treatment, the addition of gait parameters such as foot clearance or stride time to clinical variables increased the model’s discriminant power. Significance: This predictive model now needs to be validated in prospective cohorts.

Anthropogenic environmental change is leading to changes in distribution for many organisms. While this is frequently discussed for prominent organisms of high conservation value, the same is true for the many cryptic species that rarely figure in debates on the human impact. One such cryptic taxon is the European Ptomaphagus sericatus (Chaudoir, 1845) and related forms. During a citizen science expedition in the Vondelpark, Amsterdam, the Netherlands, we obtained two forms of this species complex. We placed the examination of these specimens in the context of a re-analysis of the species group, and, using DNA barcoding and genital study on material collected thoughout Europe, found that the P. sericatus species complex consists of three distinct, partly sympatric species, one of which was previously undescribed. On the basis of collection data, at least two species, P. medius and P. thebeatles sp. n., show signs of having recently undergone (possibly anthropogenic) range changes, with P. medius even reaching North America. We describe P. thebeatles sp. n.; we raise two subspecies, viz. P. sericatus sericatus (Chaudoir, 1854) and P. sericatus medius (Rey, 1889) to the level of species, and designate a neotype for the former; we identify P. dacicus Jeannel, 1934 and P. pyrenaeus Jeannel, 1934 as junior synonyms of P. sericatus, and P. compressitarsus (Rey, 1889) as a junior synonym of P. subvillosus Goeze, 1777; we identify P. septentrionalis Jeannel, 1934 and P. miser (Rey, 1889) as junior synonyms of P. medius; we designate lectotypes for P. medius and P. miser.

Passant de 150 ha (pour 36 exploitations) en 2018 à 300 ha (pour 64 exploitations) à la fin de 2021, la surface viticole wallonne (Belgique – figure 1.a) n’a cessé de croître ces dernières années. Cependant, en 2021, les vignobles wallons ont été fortement touchés par le mildiou (Plasmopara viticola) dû à des conditions météorologiques exceptionnellement humides et fraîches. Cette étude montre que les pertes quantitatives ont été hétérogènes entre les vignobles. Cette variabilité est expliquée principalement par le type de cépage, le mode de production et la gestion liée aux maladies.

For decades, vines have been grown in dry regions, as the plant has to grow under water deficit to produce quality wines. Due in part to climate change, vine cultivation is developing in historically cooler and more humid regions. In addition to climate, soil and plant material are the terroir factors that most influence the water status of the vine, and conditions can be different within the same vineyard plot, implying heterogeneous vineyard management to achieve optimal wine quality.The objective of this study is to explore the potential of Sentinel-2 to characterize the intra-plot variability of vine water status and its evolution through time.Two Belgian vineyards, with high soil water availability intra-plot variation and different grape varieties, were selected. Both vineyards have grass in the inter-row and the spatial distributions of soil depth and soil water holding capacity (WHC) were measured. A cumulative drought index (DIcum) was also estimated for each plot.Four years (2018, 2019, 2020 and 2021) of Sentinel-2 images of these two Belgian vineyards were analyzed. Several spectral indices, based on the blue, red, NIR and SWIR bands on a 10 x 10 m² grid, were calculated and compared to quantify the evolution of the water status of the vine, as a function of the weather conditions (DIcum), the grape variety and the WHC. Predawn leaf water potential (Ψpd) measurements were collected in situ at different dates during dry periods in order to compare them with the remote sensing indices.We observed that spectral indices and the WHC were better correlated when the water conditions were the most constraining for the vine (e.g. R² = 0.72 on 16/08/18 for NDWI/EVI), i.e. when DIcum is lowest. Edaphic heterogeneity is therefore better captured by spectral indices when conditions are dry for the vine. The spectral indices have a low value when the WHC is low, and vice versa. The spectral index NDWI/EVI quantifies the water status of the vine better than the NDWI, when comparing linear regressions between the two spectral indices and the Ψpd measured in the field (R² = 0.67 for NDWI/EVI; R² = 0.64 for NDWI).In conclusion, the NDWI/EVI spectral index, measured from the Sentinel-2 bands, is promising for quantifying the spatial distribution of vine water status on a regular basis at the plot scale.

Pompe disease is a progressive myopathy that combines motor, respiratory, and cardiac impairments. The 6-min walk test is the gold standard for assessing disease severity at the motor level. The objective of this study was to better determine the parameters that influence the total distance covered in patients with Pompe disease.We performed a retrospective review of 15 patients with late-onset Pompe disease who were followed regularly at a single referral center. Logistic regression was used to investigate the links between motor, respiratory and cardiac variables and 6-min walk test performance.When considering baseline clinical and demographic variables, a seven-step backward elimination regression analysis yielded a model with two predictors (age and the use of an assistive device) that explained 85.5% of the variance. When considering the cardiorespiratory variables monitored during gait, a three-step backward elimination regression analysis showed that two predictors (heart rate recovery and the baseline partial pressure of carbon dioxide) explained 42.2% of the variance.Our results highlighted the importance of respiratory and cardiac adaptation during exercise (along with motor ability) during the 6-min walk test in patients with Pompe disease. Further studies of larger cohorts are necessary to validate the model, which might enable investigators to determine whether intra-individual fluctuations in 6-min walk test performance are related to physiological parameters and/or to other variables such as the patient's level of motivation during the test.

International audience; The aims of this narrative review are to provide scientific support to characterize the postural instability commonly observed in Parkinson's disease (PD), and to emphasize how bottom-up rehabilitation programs stimulating the sole of the foot can improve postural stability in PD. Postural instability is a typical characteristic of individuals with PD, which increases the frequency of falls and may worsen their consequences. It thus seems relevant to diagnose these alterations as early as possible, in order to develop specific rehabilitative treatment. The association between sensitivity of the sole of the foot and postural instability in individuals with PD is linked to the key role of peripheral alterations of the sensorimotor system in balance and motor symptoms. By enhancing sensory feedback coming from the feet, bottom-up stimulation allows patients to improve their sensorimotor control. In clinical practice, health practitioners can use sensory stimulation to improve postural control. By improving postural stability, a decrease in fall risk can be achieved and the secondary impairments associated with falls prevented.

With about one third of adults aged 65 years and older being reported worldwide to fall each year, and an even higher prevalence with advancing age, aged-related falls and the associated disabilities and mortality are a major public health concern. In this context, identification of fall risk in healthy older adults is a key component of fall prevention. Since dual-task outcomes rely on the interaction between cognition and motor control, some studies have demonstrated the role of dual-task walking performance or costs in predicting future fallers. However, based on previous reviews on the topic, (1) discriminative and (2) predictive powers of dual tasks involving gait and a concurrent task are still a matter of debate, as is (3) their superiority over single tasks in terms of fall-risk prediction. Moreover, less attention has been paid to dual tasks involving postural control and transfers (such as gait initiation and turns) as motor tasks. In the present paper, we therefore systematically reviewed recent literature over the last 7 years in order to answer the three above mentioned questions regarding the future of lab-based dual tasks (involving posture, gait initiation, gait and turning) as easily applicable tests for identifying healthy older adult fallers. Despite great heterogeneity among included studies, we emphasized, among other things, the promising added value of dual tasks including turns and other transfers, such as in the Timed Up and Go test, for prediction of falls. Further investigation of these is thus warranted. 50;6

International audience; Aims: The aim was to assess the effect of a telemonitoring programme vs. standard care (SC) in preventing all‐cause deaths or unplanned hospitalisations in heart failure (HF) at 18 months.Methods and results: OSICAT was a randomised, multicentre, open‐label French study in 937 patients hospitalised for acute HF ≤12 months before inclusion. Patients were randomised to telemonitoring (daily body weight measurement, daily recording of HF symptoms, and personalised education) (n = 482) or to SC (n = 455). Mean ± standard deviation number of events for the primary outcome was 1.30 ± 1.85 for telemonitoring and 1.46 ± 1.98 for SC [rate ratio 0.97, 95% confidence interval (CI) 0.77–1.23; P = 0.80]. In New York Heart Association (NYHA) class III or IV HF, median time to all‐cause death or first unplanned hospitalisation was 82 days in the telemonitoring group and 67 days in the SC group (P = 0.03). After adjustment for known predictive factors, telemonitoring was associated with a 21% relative risk reduction in first unplanned hospitalisation for HF [hazard ratio (HR) 0.79, 95% CI 0.62–0.99; P = 0.044); the relative risk reduction was 29% in patients with NYHA class III or IV HF (HR 0.71, 95% CI 0.53–0.95; P = 0.02), 38% in socially isolated patients (HR 0.62, 95% CI 0.39–0.98; P = 0.043), and 37% in patients who were ≥70% adherent to body weight measurement (HR 0.63, 95% CI 0.45–0.88; P = 0.006).Conclusion: Telemonitoring did not result in a significantly lower rate of all‐cause deaths or unplanned hospitalisations in HF patients. The pre‐specified subgroup results suggest the telemonitoring approach improves clinical outcomes in selected populations but need further confirmation.

International audience; Gentle handling seems to elicit positive states in sheep. The study investigated whether spatial distance alters sheep responses to brushing and whether spatial distance is influenced by reactivity. Twenty Romane ewes were assessed in three sessions: in Sessions 1 and 3, one grid separated the test animal from pen mates, with no distance between them, and in Session 2 two grids separated the test animal from pen mates by a distance of about 1.7 m. Ewes had been genetically selected for low (R−) or high (R+) behavioural reactivity to social isolation. Body postures, head orientation, ear postures, closed and half-closed eyes, tail wagging and feeding behaviour, in addition to heart rate (HR) and HR variability, as the root mean square of successive differences (RMSSD), standard deviation of all normal-to-normal (NN) intervals (SDNN), RMSSD/SDNN ratio and ratio between low-frequency (LF) and high-frequency (HF) powers (LF/HF) were assessed. Data were analysed using generalized linear models and linear mixed models. Session, genetic line and phase (pre-, brushing and post-brushing) were considered fixed effects. Increased distance in Session 2 might not have influenced ewes’ responses. Fewer changes in ear postures were noted in Session 3 than 1 (P

Resume La telesurveillance medicale pourrait etre un important levier d’amelioration de l’acces au soin et de l’efficience des prises en charge de patients, notamment chroniques, en reduisant les hospitalisations. Elle apparait egalement etre une opportunite a saisir pour redessiner un parcours de soin et une organisation adaptes aux enjeux demographiques, economiques, et techniques que doit relever notre systeme de sante. Afin de preparer le futur du financement socialise de la telesurveillance a l’issue du programme « experimentations de telemedecine pour l’amelioration des parcours en sante » (ETAPES), les participants a la table ronde ont travaille sur 9 recommandations, basees sur l’analyse de la litterature internationale et du systeme de soin francais. La principale orientation retenue est la mise en place d’une remuneration au forfait associe a la creation de lignes generiques pour les pathologies actuellement concernees par les experimentations ETAPES. De meme la mise en place d’une evaluation adaptee aux dispositifs de telesurveillance et d’incitatifs a la qualite des prises en charge semblent necessaires a un deploiement perenne de la telesurveillance en France. D’autres travaux seront necessaires au-dela des points abordes par la table ronde afin d’approfondir certaines thematiques comme l’accompagnement therapeutique des patients.

Au début du xxe siècle déjà, certaines écoles en gestion hôtelière suisses attiraient des étudiant·e·s venu·e·s de l’étranger, bénéficiant en leur sein d’une offre éducative alors unique au monde. Ce phénomène a amené la Suisse à devenir un acteur majeur dans la formation des cadres de l’industrie hôtelière mondiale. Aujourd’hui, le pays compte une vingtaine d’établissements privés, parmi lesquels domine la prestigieuse École hôtelière de Lausanne. Un univers assez peu connu où paradoxalement, ces formations professionnalisantes – a priori peu valorisées par rapport aux filières universitaires – sont très prisées par une population fortunée, prête à venir en Suisse et à payer le prix fort. Dans cet ouvrage, l’auteure revient sur la genèse et la transformation des écoles hôtelières helvétiques ; elle propose une description fine et instructive de leur fonctionnement, de leur positionnement à l’international, de leurs publics ; elle expose leurs discours et stratégies qui visent la construction d’une réputation à diffuser à travers le monde, afin de susciter l’inscription de milliers d’étudiant·e·s chaque année. Au-delà d’analyser les spécificités de ces cursus, l’auteure questionne les acteurs présents et les échelons territoriaux existants dans ce qui est appelé « l’internationalisation de l’enseignement ». Sont investigués : les relations entre le local et le mondial, les mobilités transnationales et les rapports de pouvoir entre institutions. Éclairant les effets de la mondialisation sur la sphère académique et professionnelle, ce livre révèle en outre les inégalités d’accès aux formations internationales les plus valorisées selon les origines sociales des étudiant·e·s.

BACKGROUND In South Africa, diabetes prevalence is expected to reach 5.4 million by 2030. Moreover, a large proportion of adults remain undiagnosed. In South Africa, diabetes-related complications not only severely impact patient health and quality of life, but also the economy. OBJECTIVE The Diabetes Nurse Educator (DNE) study assessed the benefit of adding the MyDiaCare program to standard of care for managing type 1 and 2 diabetes patients in South Africa. An economic study was also performed to assess the benefit of adding MyDiaCare to standard of care in type 2 diabetes patients, older than 19 years, treated in the South African private healthcare sector. METHODS The real-world DNE study was designed as an observational, retrospective, multicenter, single group study. Eligible patients were older than 18 years and with at least 6 months of participation in the MyDiaCare program. The MyDiaCare program combines patient mobile application and a healthcare professional platform with face-to face visits with a DNE. The benefit of MyDiaCare was assessed by the changes in HbA1c levels, the proportion of patient achieving clinical and biological targets, adherence to care plans, and satisfaction after 6 months of participating in the MyDiaCare program. A budget impact model was performed using data from the DNE study and another South African cohort to estimate the economic benefit of MyDiaCare. RESULTS Between 25 November 2019 and 30 June 2020, 117 patients (8 with type 1 diabetes and 109 with type 2) were enrolled in two centers. After 6 months of MyDiaCare, a clinically relevant decrease in mean glycated hemoglobin (HbA1c) levels by 0.6% from 7.8% to 7.2% was observed. Furthermore, 54% of patients reached or maintained their HbA1c targets at 6 months. Most patients achieved their targets for blood pressure (67% for systolic and 89% for diastolic blood pressure) and lipid parameters (69% for low-density lipoprotein (LDL) cholesterol, 58% for high-density lipoprotein (HDL) cholesterol, and 83% for total cholesterol, but fewer patients for triglycerides (46%), waist circumference (18%), and body weight (17%). The mean overall adherence to the MyDiaCare care plan was 93%. Most patients (74%) were satisfied with the MyDiaCare program. The economic study estimated that after 1 year of using the MyDiaCare program, the cost of type 2 diabetes management in the South African private healthcare sector would be reduced by 26 billion rands: from 117 billion rands with standard of care to 91 billion rands by adding MyDiaCare. CONCLUSIONS The MyDiaCare program, that combines digital tools for patients and healthcare professionals with DNE support, is a practical, clinically effective (lowering HbA1c levels and other cardiovascular risk factors), and cost-saving solution for diabetes management in the South African private healthcare sector. CLINICALTRIAL Not applicable.

The pathophysiology of freezing of gait in people with Parkinson's disease (PD) remains unclear, despite its association with motor, cognitive, limbic and sensory-perceptual impairments. Resting-state electroencephalography (EEG) may provide functional information for a better understanding of freezing of gait by studying spectral power and connectivity between brain regions in different frequency bands.High-resolution EEG was recorded in 36 patients with PD (18 freezers, 18 non-freezers), and 18 healthy controls during a 5-min resting-state protocol with eyes open, followed by a basic spectral analysis in the sensor space and a more advanced analysis of functional connectivity at the source level.Freezers showed a diffusely higher theta-band relative spectral power than controls. This increased power was correlated with a deficit in executive control. Concerning resting-state functional connectivity, connectivity strength within a left fronto-parietal network appeared to be higher in freezers than in controls in the theta band, and to be correlated with freezing severity and a history of falls.We have shown that spectral power and connectivity analyses of resting-state EEG provide useful and complementary information to better understand freezing of gait in PD. The higher connectivity strength seen within the left ventral attention network in freezers is in keeping with an excessive guidance of behavior by external cues, due to executive dysfunction, and spectral analysis also found changes in freezers that was closely correlated with executive control deficits. This exaggerated influence of the external environment might result in behavioral consequences that contribute to freezing of gait episodes. These findings should be further investigated with a longitudinal study.

OBJECTIVE: To identify markers of Parkinson's disease (PD) related anxiety, using high density electroencephalography (hd-EEG).METHODS: 108 patients participated in the study. They were divided into two groups: with and without clinically relevant anxiety, according to their score on the Parkinson Anxiety Scale. Resting-state hd-EEG was recorded. Spectral and functional connectivity characteristics were compared between the two groups.RESULTS: Thirty-three patients (31%) had significant anxiety symptoms. In the spectral analysis, relative power in the alpha1 frequency band in the right prefrontal cortex was lower in patients with anxiety than without. Functional connectivity analysis showed a stronger connectivity between the left insula and several regions of the right prefrontal cortex in patients with anxiety than in those without.CONCLUSION: This study shows the pivotal role of the insula and frontal cortex in the pathophysiology of anxiety in PD and extends the results of previous studies using magnetic resonance imaging or positron emission tomography imaging.

L'anàlisi de l'accés a les oportunitats de la ciutat és l'objectiu de l'evolució del paradigma de mobilitat a un d'accessibilitat urbana. En aquest article, aquesta anàlisi està emmarcada per les teories de la ciutat monocèntrica i la centralitat de la xarxa, aquesta última com a aproximació a l'accessibilitat sobre la base de la infraestructura viària que suporta els viatges. Aquest estudi s'enfoca a la concentració de les activitats laborals i la connectivitat com a qualitat dels vincles rellevants entre l'ocupació i la població ocupada. Per a l'abordatge de la connectivitat es van utilitzar quatre mesures diferents de centralitat per mitjà d'eines de processament a SIG: per proximitat, grau de centralitat, per intermediació i “eigenvector”, procurant una anàlisi múltiple de la xarxa. Pel que fa a la concentració del treball a la ciutat, es van aplicar els mètodes didentificació de subcentres urbans: pics de densitat docupació en zones contigües i llindars de concentració. Per a aquests mètodes es va utilitzar informació de l'INEGI, disponible a nivell nacional a Mèxic. Els resultats revelen quantitativament els trets de connectivitat de la xarxa de la ciutat i la força del centre urbà a causa de la concentració de llocs de treball i la seva connectivitat. De la mateixa manera per a cada centre de treball, segons el nombre de llocs ocupats, població ocupada amb potencial accessibilitat i la connectivitat de la seva àrea de servei, expressada per les diferents formes de centralitat. The analysis of access to opportunities in the city is the objective of the evolution of the mobility paradigm into an accessibility paradigm. This analysis is framed in the theories of the monocentric city and the network centrality as an approach to accessibility based on road infrastructure supporting travel. This study focuses on the concentration of work activities and connectivity as a quality of the relevant links between employment and the employed population. For the connectivity approach, four different centrality measures were used by means of GIS processing tools: closeness, degree of centrality, betweenness and “eigenvector”, searching for a multiple analysis of the network. With regard to the concentration of work in the city, the applied methods to identify urban sub-centers were: employment density peaks in contiguous areas and concentration thresholds. Information from INEGI, available at the national level in Mexico, was used for all these methods. The results quantitatively reveal the connectivity features of the city network and the strength of the urban center due to the concentration of jobs and connectivity. In the same way for each employment center, according to the number of job positions occupied, employed population with potential accessibility and the connectivity of its service area, expressed by the different forms of centrality. El análisis del acceso a las oportunidades de la ciudad es el objetivo de la evolución del paradigma de movilidad a uno de accesibilidad urbana. En este artículo, dicho análisis está enmarcado por las teorías de la ciudad monocéntrica y la centralidad de la red, esta última como aproximación a la accesibilidad con base en la infraestructura vial que soporta los viajes. El presente estudio se enfoca en la concentración de las actividades laborales y la conectividad como cualidad de los vínculos relevantes entre el empleo y la población ocupada. Para el abordaje de la conectividad se utilizaron cuatro medidas diferentes de centralidad por medio de herramientas de procesamiento en SIG: por cercanía, grado de centralidad, por intermediación y “eigenvector”, procurando un análisis múltiple de la red. Con respecto a la concentración del trabajo en la ciudad, se aplicaron los métodos de identificación de subcentros urbanos: picos de densidad de empleo en zonas contiguas y umbrales de concentración. Para estos métodos se utilizó información del INEGI, disponible a nivel nacional en México. Los resultados revelan cuantitativamente los rasgos de conectividad de la red de la ciudad y la fuerza del centro urbano debido a la concentración de empleos y su conectividad. De igual forma para cada centro de empleo, según el número de puestos ocupados, población ocupada con accesibilidad potencial y la conectividad de su área de servicio, expresada por las diferentes formas de centralidad.

BACKGROUND: There is little information regarding diaphragmatic dysfunction (DD) following thoracic surgery. Ultrasound allows for non-invasive repeated assessments of diaphragmatic excursion (DE) and thickening fraction (DTF) at the bedside, reflecting DD. We aimed at determining the prevalence of DD and the time-course of DE and DTF following elective thoracic surgery. Secondary endpoints included the association between DD and postoperative complications. METHODS: We led a prospective, single center, observational study in consecutive patients undergoing thoracic surgery. DE and DTF were measured by two observers blinded to each other at 3 different time-points: prior to surgery (D-1), immediately after extubation (D0) and on postoperative day 3 (D3). The changes in excursion and thickening fraction of both hemi-diaphragms over time were compared according to the side (operated or non-operated) using a two-way ANOVA. The association with postoperative complications was assessed using logistic regression.RESULTS: Fifty patients, 60% males, aged 60±15 years were included. Surgical procedures included lobectomy (n=30), wedge-resection (n=17) or pneumonectomy (n=3). DD was highly prevalent after thoracic surgery and was observed on the operated side (or both sides) in, at least, 68% of patients immediately after surgery (D0). Among those patients, 46% still had this DD on the operated side on D3. On the operated side, we observed a decrease in DE and DTF at D0 (-0.71±0.12mm, PPPPP=0.001), ICU-admission (P=0.04) according to univariate analysis and a prolonged length in hospital (OR:1.3, 95% CI [1.1-1.7], P=0.016) according to multivariate analysis.CONCLUSIONS: Diaphragmatic Dysfunction (DD) was very common after thoracic surgery, mainly concerned the operated side and was associated with an increase in the diaphragmatic excursion on the non-operated side. When this dysfunction failed to regress within 72 hours, it was associated with a significant increase in the length of hospital stay.

Experimental studies have suggested that nitrous oxide-induced analgesia depends on interactions with opioids. On the basis of these results, we hypothesized that the effects of inhaled nitrous oxide/oxygen (N 2 O/O 2 ) 50%-50% equimolar mixture (EMONO) on patients with neuropathic pain would be higher in those receiving concomitant opioids. To test this hypothesis, we did exploratory post hoc analyses of our recently published ProtoTOP study to compare the effects of EMONO and placebo in patients with or without concomitant opioid treatment. A total of 92 patients of the 221 (ie, 41.6%) included in the ProtoTOP study were concomitantly treated with opioids. In contrast with our previous analyses, average pain intensity was significantly decreased in comparison with placebo one week after the last treatment administration in patients treated with opioids, but not in those treated without opioid, and this effect was maintained over the 4-week follow-up period. Neuropathic pain symptom inventory (NPSI total and subscores) was also significantly more decreased after inhalation of EMONO in comparison with placebo only in patients receiving opioids. The proportion of patients with at least 30% pain reduction and of those reporting an overall improvement with the Patient Global Impression of Change were significantly higher only in this population of patients. In conclusion, these results complement our previous analyses with the identification of a specific population of responders to EMONO inhalation in patients with neuropathic pain. As suggested by experimental studies, we hypothesized that these long-lasting analgesic effects could depend on the anti-N-methyl-D-aspartate properties of N 2 O.

The relationship between the dose (volume of fluid) and the effect (increase of stroke volume [SV]) has been poorly described. We hypothesised that the analysis of the dynamic response of SV during fluid challenge (FC) helps to determine the optimal volume of FC, along with its diagnostic accuracy parameters for fluid responsiveness.A prospective observational study was conducted in critically ill patients with circulatory failure. Patients monitored with oesophageal Doppler and assigned to an FC of 500 ml of crystalloid were included. The areas under the curve (AUC) and 95% confidence intervals (CIForty-five patients were included. The AUC increased with cumulative volumes of FC up to 250 ml (AUCA volume of FC of 250 ml with a threshold of 9.6% increase in SV showed the highest accuracy in detecting fluid responsiveness in critically ill patients with shock..