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Background: French laws governing end-of-life medical practices forbid euthanasia and affirm patients' right to deep and continuous sedation until death. Cultural traditions and disparities in health care provision, as in overseas France, could limit the enforcement of such laws and modify end-of-life medical practices. Aim: This research aims to describe end-of-life medical decisions in overseas France and to compare with those described in mainland France. Methods: A retrospective study of a random sample of adult patients who died between March 2020 and February 2021 was conducted in four overseas French departments. Physicians who certified the deaths were asked to describe end-of-life care and medical decisions in a questionnaire. Results: A total of 1815 deaths were analysed over 8730 questionnaires sent. Withholding treatments was the most frequent decision (41%), treatment for pain or symptoms was intensified for a third of patients, Deep and continuous sedation until death was implemented in 13.3% cases. The use of drugs to deliberately end life was mentioned in 1.3% deaths. At least one decision was made in 61.6% deaths. More decisions that may hasten death were made before predictable deaths. Intensification of pain and symptoms treatment was more frequent in 2022 than in 2010. Deep and continuous sedation was introduced by law in 2016 without prejudice to other decisions. Conclusion: Physicians in overseas France have implemented recent changes in end-of-life laws, including deep and continuous sedation. Comparisons with 2010 mainland France survey show a better implementation of palliative medicine in 2022, with higher proportions of treatment withholding. [ABSTRACT FROM AUTHOR]

Seasonal precipitation estimation in ungauged mountainous areas is essential for understanding and modeling a physical variable of interest in many environmental applications (hydrology, ecology, and cryospheric studies). Precipitation lapse rates (PLRs), defined as the increasing or decreasing rate of precipitation amounts with the elevation, play a decisive role in high-altitude precipitation estimation. However, the documentation of PLR in mountainous regions remains weak even though their utilization in environmental applications is frequent. This article intends to assess the spatial variability and the spatial-scale dependence of seasonal PLRs in a varied and complex topographical region. At the regional scale (10 000 km 2), seven different precipitation products are compared in their ability to reproduce the altitude dependence of the annual/seasonal precipitation of 1836 stations located in France. The convection-permitting regional climate model (CP-RCM) AROME is the best in this regard, despite severe precipitation overestimation in high altitudes. The fine resolution of AROME allows for a precise assessment of the influence of altitude on winter and summer precipitation on 23 massifs at the sub-regional scale (∼ 1000 km 2) and 2748 small catchments (∼ 100 km 2) through linear regressions. With AROME, PLRs are often higher in winter at the catchment scale. The variability in the PLR is higher in high-altitude regions such as the French Alps, with higher PLRs at the border than inside the massifs. This study emphasizes the interest of conducting a PLR investigation at a fine scale to reduce spatial heterogeneity in the seasonal precipitation–altitude relationships. [ABSTRACT FROM AUTHOR]

Seasonal precipitation estimation in ungauged mountainous areas is essential for understanding and modeling a physical variable of interest in many environmental applications (hydrology, ecology, cryospheric studies). Precipitation Lapse Rates (PLRs), defined as the increasing or decreasing rate of precipitation amounts with the elevation, play a decisive role in high-altitude precipitation estimation. However, the documentation of PLR in mountainous regions remains weak even though their utilization in environmental applications is frequent. This article intends to assess the spatial variability and the spatial-scale dependence of seasonal PLRs in a varied and complex topography region. At the regional scale (10,000 km2), seven different precipitation products are compared in their ability to reproduce the altitude dependence of the annual/seasonal precipitations of 1,836 stations located in France. The Convection-Permitting Regional Climate Model (CP-RCM) AROME is the best in this regard, despite severe precipitation overestimation in high altitudes. The fine resolution of AROME allows for a precise assessment of the influence of altitude on winter and summer precipitations on 23 massifs at the sub-regional scale (∼ 1,000 km2) and 2,748 small catchments (∼ 100 km2) through linear regressions. With AROME, PLRs are mostly higher in winter at the catchment scale. The variability of PLR is higher in high-altitude regions such as the French Alps, with higher PLRs at the border than inside the massifs. This study emphasizes the interest of conducting PLR investigation at a fine scale to reduce spatial heterogeneity in the seasonal precipitations–altitude relationships. [ABSTRACT FROM AUTHOR]

Context: In addition to curative care, supportive care is beneficial in managing the anxiety symptoms common in patients in sterile hematology unit. We hypothesize that personal massage can help the patient, particularly in this isolated setting where physical contact is extremely limited. The main objective of this study was to show that anxiety could be reduced after a touch-massage® performed by a nurse trained in this therapy. Methods: A single-center, randomized, unblinded controlled study in the sterile hematology unit of a French university hospital, validated by an ethics committee. The patients, aged between 18 and 65 years old, and suffering from a serious and progressive hematological pathology, were hospitalized in sterile hematology unit for a minimum of three weeks, patients were randomized into either a group receiving 15-minute touch-massage® sessions or a control group receiving an equivalent amount of quiet time once a week for three weeks. In the treated group, anxiety was assessed before and after each touch-massage® session, using the State-Trait Anxiety Inventory questionnaire with subscale state (STAI-State). In the control group, anxiety was assessed before and after a 15-minute quiet period. For each patient, the difference in the STAI-State score before and after each session (or period) was calculated, the primary endpoint was based on the average of these three differences. Each patient completed the Rosenberg Self-Esteem Questionnaire before the first session and after the last session. Results: Sixty-two patients were randomized. Touch-massage® significantly decreased patient anxiety: a mean decrease in STAI-State scale score of 10.6 [7.65–13.54] was obtained for the massage group (p ≤ 0.001) compared with the control group. The improvement in self-esteem score was not significant. Conclusion: This study provides convincing evidence for integrating touch-massage® in the treatment of patients in sterile hematology unit. Trial registration: NCT02343965. [ABSTRACT FROM AUTHOR]

At the end of February 2018 the Mediterranean area of Montpellier in France was struck by a significant snowfall that turned into an intense rain event caused by an exceptional atmospheric situation. This rain-on-snow event produced pronounced damage to many buildings of different types. In this study, we report a detailed back analysis of the roof collapse of a large building, namely Irstea Cévennes. Attention is paid to the dynamics of the climatic event, on the one hand, and the mechanical response of the metal roof structure to different snow and rain loads, on the other hand. The former aspect relies on multiple sources of information that provide reliable estimates of snow heights in the area before the rain came into play and substantially modified the load on the roof. The latter aspect relies on detailed finite-element simulations of the mechanical behavior of the roof structure in order to assess the pressure due to snow and rain loading, which could theoretically lead to failure. By combining the two approaches, it is possible to reconstruct the most probable scenario for the roof failure before its full collapse. As an example of building behavior and vulnerability to an atypical rain-on-snow event in the Mediterranean area of France, this detailed case study provides useful key points to be considered in the future for a better mitigation of such events in non-mountainous areas. [ABSTRACT FROM AUTHOR]

Large datasets of long-term streamflow measurements are widely used to infer and model hydrological processes. However, streamflow measurements may suffer from what users can consider anomalies, i.e. non-natural records that may be erroneous streamflow values or anthropogenic influences that can lead to misinterpretation of actual hydrological processes. Since identifying anomalies is time consuming for humans, no study has investigated their proportion, temporal distribution, and influence on hydrological indicators over large datasets. This study summarizes the results of a large visual inspection campaign of 674 streamflow time series in France made by 43 evaluators, who were asked to identify anomalies falling under five categories, namely, linear interpolation, drops, noise, point anomalies, and other. We examined the evaluators' individual behaviour in terms of severity and agreement with other evaluators, as well as the temporal distributions of the anomalies and their influence on commonly used hydrological indicators. We found that inter-evaluator agreement was surprisingly low, with an average of 12 % of overlapping periods reported as anomalies. These anomalies were mostly identified as linear interpolation and noise, and they were more frequently reported during the low-flow periods in summer. The impact of cleaning data from the identified anomaly values was higher on low-flow indicators than on high-flow indicators, with change rates lower than 5 % most of the time. We conclude that the identification of anomalies in streamflow time series is highly dependent on the aims and skills of each evaluator, which raises questions about the best practices to adopt for data cleaning. [ABSTRACT FROM AUTHOR]

Introduction: One of the aims of physical education (PE) is to develop social skills such as cooperation, teamwork, and mutual helping among students. Cooperation is a broad research topic, implicating several disciplines in the human sciences (e.g. psychology, sociology, linguistics, philosophy). It is also an important topic in various domains of practice like organizational management, ergonomics, sports performance, and PE and sports pedagogy. Studies in sport have shown that cooperation between partners is not automatically produced by the cooperative structure of the learning tasks. In this exploratory study, we focused on the links between cooperation and trust judgments about one's partner. We characterized the processes by which students construct trust judgments in dyadic cooperative interactions during climbing lessons. This study was carried out within the theoretical and methodological frameworks of the 'course of action.' Method: Two middle-school students in 10th-grade participated in this study. They formed a fixed dyad based on personal affinity. During the four climbing lessons under study, the students alternated the roles of climber and belayer. Their behaviors and communications were recorded on video and after each session they participated in self-confrontation interviews. From these data, we then reconstructed their courses of experience and focused particularly on preoccupations, meaningful elements in the situation, and mobilized knowledge. The elements contributing to the construction of the climber's trust judgments about his belayer were identified. Changes in these judgments were characterized in relation to the modes of cooperation between the students. Twenty-seven climbs were analyzed. Results and discussion: The results showed that the climber's trust judgments focused on two dimensions of the belayer's activity: the reliability of both the belay and his advice for success in the task. To build these trust judgments, the climber combined knowledge about his belayer (the partner's climbing skills, his mastery of safety techniques, his familiarity with the climbing equipment, and his typical attitudes in class) and interpretations of the events during belayer--climber cooperation (the attention shown by the partner, his requests for advice from other students, and the teacher's interventions). Moreover, the results showed the relationship between the development of each student's trust judgments about his partner and the positive and negative dynamics of cooperation between the students. Three typical connections were identified between the climber's trust judgments about his partner and the climber's involvement in cooperation. The results are discussed on the basis of two points: (a) the dynamic and composite character of the construction of trust judgments and (b) the construction of trust judgments as a condition for genuine cooperation between students. The students in the situation of climber displayed typical processes to build a trust judgment about their partner, and this trust judgment appears to be an important element in promoting and regulating cooperative interactions between students. Conclusions: We propose pedagogical perspectives for teachers with regard to understanding trust judgments in climbing and student cooperation. We also suggest new research perspectives with the objective of fully elucidating the dimensions of trust involved in cooperation.

Log Size Index (LSI) has been developed and used in archaeozoology to perform biometric studies of often small datasets, a recurrent limitation of archaeological faunal assemblages. This approach consists of aggregating measurements taken on different anatomical parts by standardisation, using a reference to which the studied measurements are scaled. No consensus exists in the choice of the reference to be used for LSI analyses and several datasets are now available, differing in their specimens and variables composition, and geographic and temporal origin. Using a biometric dataset of 5533 measurements of cattle, suids, sheep and goat from southern France and dated from the Roman times we compared the use of several references, provided by the R package zoolog, with a 'mean' reference specifically built for our studied sample and that corresponds to an averaged specimen. We demonstrated that references differ both in their raw measurements and their allometries, and that the choice of the reference influences the number of variables and measurements that can be analysed, but also diachronic LSI analyses and potentially their interpretations. While the main patterns are similar among references, local variation exist and it could not be excluded that the choice of the reference will more strongly influence other studies. We advocate to use the mean of the studied archaeological assemblage as reference, with the double benefit of exploiting to the maximum the number of available measurements, and of minimising, on average, the possible allometric differences between the studied population and the reference. [ABSTRACT FROM AUTHOR]

Background: Since 2016, France is the only country in the World where continuous deep sedation until death (CDSUD) is regulated by law. CDSUD serves as a response to refractory suffering in palliative situations where the patients' death is expected to occur in the following hours or days. Little is known on the psychological adjustment surrounding a CDSUD procedure for healthcare providers (HCPs) and relatives. Our study aims to gather qualitative and quantitative data on the specific processes behind the psychological adjustment of both relatives and HCPs, after the administration of CDSUD for patients with cancer. Methods: The APSY-SED study is a prospective, longitudinal, mixed-methods and multicenter study. Recruitment will involve any French-speaking adult cancer patient for who a CDSUD is discussed, their relatives and HCPs. We plan to include 150 patients, 150 relatives, and 50 HCPs. The evaluation criteria of this research are: 1/ Primary criterion: Psychological adjustment of relatives and HCPs 6 and 13 months after the death of the patient with cancer (psychological adjustment = intensity of anxiety, depression and grief reactions, CDSUD-related distress, job satisfaction, Professional Stress and Professional experience). Secondary criteria: a)occurrence of wish for a CDSUD in patients in palliative phase; b)occurrence of wish for hastened death in patients in palliative phase; c)potential predictors of adjustment assessed after the discussion concerning CDSUD as an option and before the setting of the CDSUD; d) Thematic analysis and narrative account of meaning-making process concerning the grief experience. Discussion: The APSY-SED study will be the first to investigate the psychological adjustment of HCPs and relatives in the context of a CDSUD procedure implemented according to French law. Gathering data on the grief process for relatives can help understand bereavement after CDSUD, and participate in the elaboration of specific tailored interventions to support HCPs and relatives. Empirical findings on CDSUD among patients with cancer in France could be compared with existing data in other countries and with results related to other medical fields where CDSUD is also conducted. Trial registration: This protocol received the National Registration Number: ID-RCB2021-A03042-39 on 14/12/2021. [ABSTRACT FROM AUTHOR]

At the end of February 2018 the Mediterranean area of Montpellier in France was struck by a significant snowfall that turned into an intense rain event caused by an exceptional atmospheric situation. This rain-on-snow event produced pronounced damages to many buildings of different types. In this study, we report a detailed back analysis of the roof collapse of a large building, namely the Irstea Cévennes building. Attention is paid to the dynamics of the climatic event, on the one hand, and to the mechanical response of the metal roof structure to normal loading, on the other hand. The former aspect relies on multiple sources of information that provide reliable estimates of snow heights in the area before the rain came into play and substantially modified the snow quality. The latter aspect relies on detailed finite element simulations of the mechanical behaviour of the roof structure in order to assess the pressure due to snow cover loading which could theoretically lead to failure. By combining the two approaches, it is possible to reconstruct the most probable scenario for the roof collapse. As an example of building behaviour and vulnerability to an exceptional rain-on-snow event in the Mediterranean area of France, this detailed case study provides useful key points to be considered in the future for a better mitigation of such events in non-mountainous areas. [ABSTRACT FROM AUTHOR]

The article presents information about Myotis escalerai, a new species of French bats and was known for being endemic to the Iberian Peninsula. It is noted that Myotis escalerai has different morphological and ecological traits, an example of which is that the species creates big breeding colonies in caves unlike the European Myoris Natterei which lives in small groups in tree holes. It is asserted that Myotis escalerai and Myotis Sp. A are two new cryptic taxa that were discovered through molecular species identification tools.

Background: Grieving relatives can suffer from numerous consequences like anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and prolonged grief. This study aims to assess the psychological consequences of grieving relatives after patients' death in French palliative care units and their needs for support. Methods: This is a prospective observational multicenter mixed study. Relatives of adult patients with a neoplasia expected to be hospitalized more than 72 h in a palliative care unit for end-of-life issues will be included within 48 h after patient admission. End-of-life issues are defined by the physician at patient admission. Relatives who are not able to have a phone call at 6-months are excluded. The primary outcome is the incidence of prolonged grief reaction defined by an ICG (Inventory Complicate Grief) > 25 (0 best-76 worst) at 6 months after patient' death. Prespecified secondary outcomes are the risk factors of prolonged grief, anxiety and depression symptoms between day 3 and day 5 and at 6 months after patients' death based on an Hospital Anxiety and Depression score (range 0–42) > 8 for each subscale (minimal clinically important difference: 2.5), post-traumatic stress disorder symptoms 6 months after patient' death based on the Impact of Events Scale questionnaire (0 best-88 worst) score > 22, experience of relatives during palliative care based on the Fami-Life questionnaire, specifically built for the study. Between 6 and 12 months after the patient's death, a phone interview with relatives with prolonged grief reactions will be planned by a psychologist to understand the complex system of grief. It will be analyzed with the Interpretative Phenomenological Analysis. We planned to enroll 500 patients and their close relatives assuming a 25% prolonged grief rate and a 6-month follow-up available in 60% of relatives. Discussion: This study will be the first to report the psychological consequences of French relatives after a loss of a loved one in palliative care units. Evaluating relatives' experiences can provide instrumental insights for means of improving support for relatives and evaluation of bereavement programs. Trial registration: NCT03748225 registered on 11/19/2018. Recruiting patients. [ABSTRACT FROM AUTHOR]

In bioarchaeology, the biometry of archaeozoological remains is an important component of studies on domestic species and size has been used for multiple purposes from identifying domestication, to track environmental changes or evolution of husbandry practices. The establishment of the Roman Empire has been accompanied by social, political and economic transformations that also reflect in farming practices and animal husbandry. In southern France, biometric variation has already been partially perceived during Roman times, particularly for cattle, but lack chronological accuracy and statistical validation. This paper presents a diachronic analysis of linear measurements of post-cranial bones belonging to the domestic triad (sheep, goat, cattle and suids) in western Gallia Narbonensis (France), between the Roman conquest and Late Antiquity, i.e. from 200 BCE to 400 AD. Biometric data from 64 archaeological sites, excavated and studied over more than 30 years of preventive archaeology, were analysed using a Log Size Index (LSI) approach using time as a continuous variable. The analysis of 5533 measurements first analysed per bone and variable, then separating length, breadth and depth dimensions, revealed different trends, highly influenced by the number of measurements, reflecting allometric differences but also cases of asynchronous evolution. However, these allometries within species are small when compared to interspecies differences. Overall, the size of the four taxa increased from the 2nd century BC to the 2nd century AD. Cattle and pig sizes then decreased from the 2nd century AD and only from the 4th century onwards for goats, while sheep size tends to increase during the 3rd-4th centuries. If the Roman conquest influences the size of the domestic animals, this does not affect the four species in the same way. This potentially reflects differentiated agropastoral strategies for each of the species in the western part of Gallia Narbonensis during the Roman period. This study, which provides a diachronic and cross-species study framework, should be seen as a first step for a more in-depth understanding of micro-regional and socio-economic variation in domestic species morphologies. [ABSTRACT FROM AUTHOR]

Sheep and goat are often herded together and show morphological similarities in their skeleton. Being able to identify archaeological remains of these two taxa to species level is particularly important for understanding and characterising past herding practices. Discrete criteria are now available to identify a large number of their bones and teeth, and quantitative approaches have been developed for post-cranial elements but not for mandible and isolated teeth. In this paper we explore the discriminating potential of geometric morphometrics to identify modern sheep and goat third lower molar and mandible and its application on archaeological specimens. The size and shape of the mandible and the third lower molar of 143 modern specimens (101 sheep and 42 goats) were quantified using 2D-landmark and sliding semi-landmarks geometric morphometric approaches. The results show that sheep and goat differ in terms of the size, shape, and form (i.e. size and shape together) in both studied elements. Classification accuracy of the two species reaches 93.3% (CI: 90.0–95.7%) for third lower molar shape, 62.7% (CI 57.1–68.6%) for third lower molar size, 95.2% (CI: 92.0–97.4%) for mandible shape and 84.0% (CI 81.6–86.8%) for mandible size. Form does not provide better classification than shape alone. Sex and age appear to have little impact on the ability to differentiate between sheep and goat, despite the two species displaying distinct sexual dimorphism and changes through age. The same methodology was then applied on 32 Middle Ages third lower molars from Missignac-Saint Gilles le Vieux, Aimargues, France. The identifications obtained through geometric morphometrics were only partially congruent with the identifications based on visual observations calling for caution in the interpretation and further investigations. Further research should include molecular identification of the archaeological specimens to assess whether the geometric morphometric identification can be made with confidence for all periods and all geographic areas. Nevertheless, the results obtained with the newly developed geometric morphometric protocols represent an important contribution toward a better understanding of past livestock husbandry practices. • Sheep and goat differ in their third lower molar and mandible size and shape. • Based on shape, 93% of the molar and 95% of the mandibles can be correctly identified. • Geometric morphometrics allow the identification of archaeological specimens. • Geometric morphometric and macroscopic identifications are only partially congruent. [ABSTRACT FROM AUTHOR]

The cultivation of grapevines has spanned millennia, leading to thousands of varieties through exchanges, mutations, and crosses between genotypes, as well probably as gene flow from wild populations. These varieties are typically categorized by regional origin and primary use, either for wine production or fruit consumption. France, within the Western European group, hosts many of the world's renowned wine grape varieties. However, the historical development of cultivated grapevines in France and in the world remains poorly understood. This study applies morphometry on 19,377 charred and waterlogged archaeological grape pips to investigate the evolutionary history of grapevine in France over the last 10,000 years. The study compares seed outlines and lengths, corrected for taphonomic distortions, with a reference collection of 80 wild and 466 modern domestic grapevine accessions. Findings reveal a shift from wild grapevine exploitation to the expansion of domestic varieties around 600-500 BCE, coinciding with Mediterranean cultural influences and the introduction of eastern grape types. The identification of the East-Table group, a group of varieties of eastern origin for fruit consumption, indicates that grapes were also grown for food, especially in Mediterranean regions and near urban areas, alongside wine production. Early French viticulture featured a notable presence of Western European wine-type grapevines. The abundance of pips with wild-like morphology suggests early cultivation involved plants at an initial domestication stage and gene flow between introduced and wild grapevines. As viticulture spread northward, wild and Eastern morphotypes declined, leading to the dominance of Western European wine types in inner France during the Middle Ages., (© 2024. The Author(s).)

Aim: This article aims to set some theoretical and practical milestones to better understand the challenges of interdisciplinary research in palliative care., Method: A theoretical perspective of the main challenges of interdisciplinary research is provided through a review of existing literature, supported by practical experiences learnt from the implementation of two research projects on the improvement of the organization of healthcare services in palliative care in France., Results: Palliative care is historically and philosophically grounded in interdisciplinary culture. Implementation of interdisciplinary research in palliative care is particularly challenging as it implies engaging in a “paradigm dialogue” with different disciplines involved. Beyond the relational skills inherent in and required for actual interdisciplinary practice, interdisciplinary research calls for metacognitive skills such as the ability to search, identify, understand, connect and integrate theoretical and methodological perspectives of different disciplines., Conclusion: Addressing the challenges of interdisciplinary research in palliative care requires an educational program that integrates an interdisciplinary approach at the early stage of the medical and healthcare curriculum. Paradigm dialogue should also be encouraged in national research and innovation programs.

Introduction: Co-occurring pain impairs depression's prognosis. Selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) are first-line pharmacotherapies for depression and inhibit many cytochrome 2D6 enzymes. Codeine is a first-line treatment for pain and needs to be metabolized into morphine by cytochrome 2D6 to exert its analgesic effect. Concomitant prescription of both pharmacotherapies leads to inadequate analgesia. Areas covered: We performed a systematic review of the literature to amalgamate the current knowledge regarding the clinical effect of this association and quantified its prevalence in clinical practice in the French Pays de la Loire area using a retrospective observational cohort study design. Expert opinion: The literature review highlighted that antidepressants with moderate-to-strong inhibition of CYP2D6 should be avoided in patients receiving codeine. However, 0.44% of the 12,296 sampled patients received concomitant codeine and CYP2D6 inhibitor between January 2015 and June 2015. Switching drugs in both painful and depressive patients depends on the pain and depression subtypes. Promising drugs that both show an effect on pain and depression are currently being studied but are not usable in clinical practice. Until then, tailored communication reinforcement toward health-care professionals is needed to prevent these problematic occurrences of concomitant prescription administration.