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Prabakar Vaittinada Ayar,1,2 Camille Taillé,2,3 Pradeebane Vaittinada Ayar,4 Matthieu Gay,1 Alhassane Diallo,2,5 Aïchata Fofana Dara,6 Olivier Peyrony,2,7 Olivier Chassany,2,6,8 Enrique Casalino2,9 1Emergency Department, Beaujon University Hospital-APHP, Paris, France; 2University of Paris, Paris, France; 3Respiratory Diseases Department, Bichat University Hospital-APHP, Paris, France; 4NORCE Norwegian Research Centre, Bjerknes Centre for Climate Research, Bergen, Norway; 5Epidemiology Department, Biostatistics and Clinical Research, Bichat University Hospital-APHP, Paris, France; 6UMR 1123, Inserm, Paris, France; 7Emergency Department, Saint-Louis University Hospital-APHP, Paris, France; 8Health Economics Clinical Trial Unit (URC-ECO), Hotel-Dieu Hospital-APHP, Paris, France; 9Emergency Department, Bichat University Hospital-APHP, Paris, FranceCorrespondence: Prabakar Vaittinada Ayar, Email pvaittinada@gmail.comPurpose: Identified factors associated with multiple emergency department (ED) visits (≥) for asthma, which is associated with death.Patients and Methods: We first conducted a qualitative study. We invited French-speaking adults (≥ 18 years old) with a diagnosis of asthma for more than 6 months. The identified concepts were transcribed into items. A Delphi method allowed for selecting items for a self-reported questionnaire. In an observational multicentric cross-sectional quantitative study, the resulting 20-item questionnaire and 12-item General Health Questionnaire, exploring psychological distress, were administered to adults visiting an ED for asthma exacerbation. Multivariable logistic regression was used to assess factors associated with ED visits.Results: Data saturation was obtained after 8 patient interviews. Patients who came to the ED seemed unfamiliar with their illness or treatments but were concerned by the disease. The questionnaire was administered to 182 patients. On multivariable logistic regression, multiple and systematic ED visits were associated with asthma exacerbation (adjusted odds ratio (aOR) = 6.89, 95% confidence interval [CI]: 2.25– 21.09), asthma perceived as a handicap (aOR=3.19, 95% CI: 1.55– 6.57) and reported atopy (OR=2.09, 95% CI: 1.03– 4.26). High educational level and lack of maintenance inhaled corticosteroids were protective for multiple ED visits.Conclusion: Inadequate medical care is frequent in patients attending the ED for an asthma exacerbation, associated with strong psychological impact. Questioning the reasons for consulting the ED may help quickly identify patients requiring asthma education and improve their referral.Keywords: asthma, emergency department, multiple attendance, psychological burden

Coronavirus Disease 2019 (COVID-19), a new respiratory disease, is spreading globally. In France, Emergency Medical Service (EMS) teams are mobile medicalized resuscitation teams composed of emergency physician, nurse or anesthesiologist nurse, ambulance driver, and resident. Four types of clinical cases are presented here because they have led these EMS teams to change practices in their management of patients suspected of COVID-19 infection: cardiac arrest, hypoxia on an acute pneumonia, acute chronic obstructive pulmonary disease (COPD) exacerbation with respiratory and hemodynamic disorders, and upper function disorders in a patient in a long-term care facility. The last case raised the question of COVID-19 cases with atypical forms in elderly subjects. Providers were contaminated during the management of these patients. These cases highlighted the need to review the way these EMS teams are responding to the COVID-19 pandemic, in view of heightening potential for early identification of suspicious cases, and of reinforcing the application of staff protection equipment to limit risk of contamination.

Intelligent transport systems (ITS) play a key role in our daily activities. ITS development over the last decades has been based on the rapid evolution of information and communication technologies (ICT), which include processing capabilities, availability of hardware and communication technologies. However, as the development of ITS services increases so does the users' awareness regarding the degree of trust that they demonstrate on adopting this kind of services. This has brought to light several security and privacy concerns that ITS analysts should consider when designing and implementing various IT related services. This paper identifies how risk analysis can interact with security and privacy requirements' engineering world, in order to provide a holistic approach for reasoning about security and privacy in such complex environments like ITS systems.