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Introduction Eliminating acute malnutrition in children under 5 years of age stands as a critical health priority outlined in the United Nations Sustainable Development Goal 2, ‘Zero Hunger’. This requires targeted provision of treatment and preventative services. However, accurately forecasting future prevalence of cases remains challenging, with the application of predictive models being notably scarce. Addressing this gap, this paper aims to identify factors associated with Global Acute Malnutrition (GAM) and explores the potential of machine learning in predicting its prevalence using data from Somalia.Methods Survey data on GAM prevalence systematically collected in Somalia every 6 months at a district level from 2017 to 2021 were collated alongside a range of potential climatic, demographic, disease, environmental, conflict and food security-related factors over a matching time period. We conducted both simple and multiple, parametric and non-parametric statistical analyses to identify factors associated with GAM to be used as input in forecasting future GAM prevalence. We then applied tree-based machine learning algorithms to a dataset comprising the GAM prevalence estimates and associated factors to try to forecast the trajectory and fluctuations in GAM prevalence 6 months into the future.Results We found factors statistically associated with GAM prevalence relating to rainfall, land vegetation quality, food security status, crop production and demographics. The majority of these associations were nonlinear, motivating the use of tree-based machine learning–based forecasts. Among the forecasting methods tested, random forest machine learning proves to be the most effective and was found to accurately forecast the direction of GAM prevalence in test data for many of the districts in Somalia.

Abstract Background We designed this study based on both a physician practice survey and real-world patient data to: (1) evaluate clinical management practices in extensive-stage small cell lung cancer (ES-SCLC) among medical centers located across France; and (2) describe first-line treatment patterns among patients with ES-SCLC following the introduction of immunotherapy into clinical practice. Methods A 50-item questionnaire was completed by physicians from 45 medical centers specialized in SCLC management. Responses were collected from June 2022 to January 2023. The survey questions addressed diagnostic workup of ES-SCLC, chemoimmunotherapy in first-line and second-line settings, and use of prophylactic cranial irradiation (PCI) and radiotherapy. In parallel, using a chart review approach, we retrospectively analyzed aggregated information from 548 adults with confirmed ES-SCLC receiving first-line treatment in the same centers. Results In ES-SCLC, treatment planning is based on chest computed tomography (CT) (as declared by 100% of surveyed centers). Mean time between diagnosis and treatment initiation was 2–7 days, as declared by 82% of centers. For detection of brain metastases, the most common imaging test was brain CT (84%). The main exclusion criteria for first-line immunotherapy in the centers were autoimmune disease (87%), corticosteroid therapy (69%), interstitial lung disease (69%), and performance status ≥ 2 (69%). Overall, 53% and 36% of centers considered that patients are chemotherapy-sensitive if they relapse within ≥ 3 months or ≥ 6 months after first-line chemoimmunotherapy, respectively. Among the 548 analyzed patients, 409 (75%) received chemoimmunotherapy as a first-line treatment, 374 (91%) of whom received carboplatin plus etoposide and 35 (9%) cisplatin plus etoposide. Overall, 340/548 patients (62%) received maintenance immunotherapy. Most patients (68%) did not receive radiotherapy or PCI. Conclusions There is an overall alignment of practices reflecting recent clinical guidelines among medical centers managing ES-SCLC across France, and a high prescription rate of immunotherapy in the first-line setting.

La France est actuellement au premier rang des productions européennes de poulets biologiques. Cette production ne représente toutefois encore que quelques pourcents de la production nationale. L’élevage avicole biologique est souvent considéré comme respectueux du bien-être animal et de l’environnement. Cependant, au-delà de ces images positives que l’élevage avicole biologique et les produits biologiques véhiculent, certaines contraintes déjà identifiées limitent leur développement. Le contact avec la faune sauvage présentant un risque sanitaire, la gestion du parcours, les tensions sur l’environnement dues à une excrétion des déjections sur le parcours difficilement maîtrisables et la sensibilité au contexte économique et aux comportements de consommation sont autant d’obstacles. L’élevage biologique offre néanmoins des opportunités 1) pour l’animal : le parcours facilite l’expression de nombreux comportements et permet la consommation d’insectes et de plantes possédant diverses propriétés (nutritionnelle, médicinales…) ; 2) pour l’éleveur : une amélioration des conditions de travail ainsi qu’une plus grande satisfaction sont mises en avant ; 3) pour l’environnement : le parcours constitue une source de biodiversité. Après une présentation des conditions d’élevage des poulets biologiques en France et en Europe, nous proposons d’identifier les barrières à l’extension de l’élevage biologique et les leviers/opportunités pour les dépasser.

Objective To describe antibiotic prescribing practices using the WHO AWaRe (Access, Watch, Reserve) classification in West African children under 5 years of age attending public primary health centres (PHCs).Design Cross-sectional study.Setting The AIRE project implemented the systematic use of pulse oximetry into integrated management of childhood illness consultations in West African countries (Burkina Faso, Guinea, Mali and Niger). We described antibiotic prescriptions for outpatient children at 16 PHCs and for severe cases referred at district hospitals.Patients Between 14 June 2021 and 19 June 2022, 15 854 outpatients were included: 968 neonates and young infants (0–28 days) and 14 886 children (2–59 months). Among them, 78 (8.1%) neonates and young infants and 385 (2.6%) children were hospitalised. We evaluated 58 hospitalised neonates and young infants and 275 hospitalised children, respectively.Main outcome measures Frequency of antibiotic prescriptions according to the AWaRe classification recommended by WHO.Results At the PHC level, proportions of neonates and young infants with ≥1 antibiotic prescription were 83%, 62%, 71% and 59% in Burkina Faso, Guinea, Mali and Niger, respectively. A total of 805 antibiotics were prescribed (85% Access and 13% Watch). The proportions of children with ≥1 antibiotic prescription reached 71%, 66%, 63% and 36% in Burkina Faso, Guinea, Mali and Niger, respectively. Out of the 9630 antibiotics prescribed, 93% were Access (mainly amoxicillin), and 7% Watch. At the hospital level, Watch antibiotics were mainly prescribed for severe cases referred. No Reserve antibiotics were prescribed.Conclusions High proportions of antibiotics were prescribed to outpatient children included, the appropriateness of which needs further study. Nevertheless, in every country, the proportion prescribed in the Access group reached the minimum threshold of 60% of all antibiotic prescriptions, as recommended by WHO.Trial registration number PACTR202206525204526.

La viande de volaille et les œufs sont des sources principales de protéines animales pour l'alimentation humaine dans le monde. Leur production a augmenté rapidement au cours des dernières décennies. Cependant, les productions avicoles sont vulnérables au changement climatique, en particulier au réchauffement de la planète et à ses conséquences directes et indirectes. Pour y faire face, il est nécessaire de mettre en place des stratégies d'adaptation des animaux, en particulier en améliorant leur résilience. Ces stratégies nécessitent d’une part de mieux comprendre la physiologie des oiseaux (thermorégulation, efficacité pour la production de viande et d'œufs…) et d’autre part de rechercher des innovations en lien avec la nutrition, la santé, la reprogrammation précoce ou encore la génétique (intégration de nouveaux caractères adaptatifs dans les stratégies de sélection). Il faut également trouver des solutions au niveau des systèmes de production, par exemple en prenant en compte les aires de répartition géographique des maladies liées au changement climatique et en introduisant des pratiques d'atténuation pour réduire les consommations d'énergie et les émissions de gaz à effet de serre. Des recherches interdisciplinaires axées sur la génétique, les méthodes techniques (telles que la programmation thermique précoce), les solutions d'ingénierie, des innovations nutritionnelles et de nouvelles stratégies d'élevage agroécologiques sont ainsi développées. Ces stratégies tiennent compte de la demande sociale croissante en faveur de productions animales éthiques dans les perspectives d’une seule santé (« One Health ») et d’un seul bien-être (« One Welfare ») et visent à limiter la concurrence entre l'homme et les animaux pour les ressources alimentaires. Cette revue illustre par quelques exemples les leviers d'amélioration et de stratégies adaptatives envisageables pour rendre les animaux et les systèmes de production avicole plus résilients dans le contexte du changement climatique.

Vortex fiber nulling (VFN) is a technique for detecting and characterizing faint companions at small separations from their host star. A near-infrared (∼2.3 μ m) VFN demonstrator mode was deployed on the Keck Planet Imager and Characterizer (KPIC) instrument at the Keck Observatory and presented earlier. In this Letter, we present the first VFN companion detections. Three targets, HIP 21543 Ab, HIP 94666 Ab, and HIP 50319 B, were detected with host–companion flux ratios between 70 and 430 at and within one diffraction beamwidth ( λ / D ). We complement the spectra from KPIC VFN with flux ratio and position measurements from the CHARA Array to validate the VFN results and provide a more complete characterization of the targets. This Letter reports the first direct detection of these three M dwarf companions, yielding their first spectra and flux ratios. Our observations provide measurements of bulk properties such as effective temperatures, radial velocities, and $v\sin i$ , and verify the accuracy of the published orbits. These detections corroborate earlier predictions of the KPIC VFN performance, demonstrating that the instrument mode is ready for science observations.

Abstract Background The AIRE operational project will evaluate the implementation of the routine Pulse Oximeter (PO) use in the integrated management of childhood illness (IMCI) strategy for children under-5 in primary health care centers (PHC) in West Africa. The introduction of PO should promote the accurate identification of hypoxemia (pulse blood oxygen saturation Sp02

BackgroundIntraepithelial lymphocytes (IELs) are the first immune cells to contact and fight intestinal pathogens such as Cryptosporidium, a widespread parasite which infects the gut epithelium. IFN-γ producing CD4+ T IELs provide an efficient and a long-term protection against cryptosporidiosis while intraepithelial type 1 innate lymphoid cells limits pathogen spreading during early stages of infection in immunodeficient individuals. Yet, the role of T-cell like innate IELs, the most frequent subset of innate lymphocytes in the gut, remains unknown.MethodsTo better define functions of innate IELs in cryptosporidiosis, we developed a co-culture model with innate IELs isolated from Rag2-/- mice and 3D intestinal organoids infected with C. parvum using microinjection.ResultsThanks to this original model, we demonstrated that innate IELs control parasite proliferation. We further showed that although innate IELs secrete IFN-γ in response to C. parvum, the cytokine was not sufficient to inhibit parasite proliferation at early stages of the infection. The rapid protective effect of innate IELs was in fact mediated by a cytotoxic, granzyme-dependent mechanism. Moreover, transcriptomic analysis of the Cryptosporidium-infected organoids revealed that epithelial cells down regulated Serpinb9b, a granzyme inhibitor, which may increase their sensitivity to cytolytic attack by innate IELs.ConclusionBased on these data we conclude that innate IELs, most likely T-cell-like innate IELs, provide a rapid protection against C. parvum infection through a perforin/granzymes-dependent mechanism. C. parvum infection. The infection may also increase the sensitivity of intestinal epithelial cells to the innate IEL-mediated cytotoxic attack by decreasing the expression of Serpin genes.

Abstract Background National projections of life expectancy are made periodically by statistical offices or actuarial societies in Europe and are widely used, amongst others for reforms of pension systems. However, these projections may not provide a good estimate of the future trends in life expectancy of different social-economic groups. The objective of this study is to provide insight in future trends in life expectancies for low, mid and high educated men and women living in the Netherlands. Methods We used a three-layer Li and Lee model with data from neighboring countries to complement Dutch time series. Results Our results point at further increases of life expectancy between age 35 and 85 and of remaining life expectancy at age 35 and age 65, for all education groups in the Netherlands. The projected increase in life expectancy is slightly larger among the high educated than among the low educated. Life expectancy of low educated women, particularly between age 35 and 85, shows the smallest projected increase. Our results also suggest that inequalities in life expectancies between high and low educated will be similar or slightly increasing between 2018 and 2048. We see no indication of a decline in inequality between the life expectancy of the low and high educated. Conclusions The educational inequalities in life expectancy are expected to persist or slightly increase for both men and women. The persistence and possible increase of inequalities in life expectancy between the educational groups may cause equity concerns of increases in pension age that are equal among all socio-economic groups.

Abstract Objective We investigate whether there are changes over time in years in good health people can expect to live above (surplus) or below (deficit) the pension age, by level of attained education, for the past (2006), present (2018) and future (2030) in the Netherlands. Methods We used regression analysis to estimate linear trends in prevalence of four health indicators: self-assessed health (SAH), the Organization for Economic Co-operation and Development (OECD) functional limitation indicator, the OECD indicator without hearing and seeing, and the activities-of-daily-living (ADL) disability indicator, for individuals between 50 and 69 years of age, by age category, gender and education using the Dutch National Health Survey (1989–2018). We combined these prevalence estimates with past and projected mortality data to obtain estimates of years lived in good health. We calculated how many years individuals are expected to live in good health above (surplus) or below (deficit) the pension age for the three points in time. The pension ages used were 65 years for 2006, 66 years for 2018 and 67.25 years for 2030. Results Both for low educated men and women, our analyses show an increasing deficit of years in good health relative to the pension age for most outcomes, particularly for the SAH and OECD indicator. For high educated we find a decreasing surplus of years lived in good health for all indicators with the exception of SAH. For women, absolute inequalities in the deficit or surplus of years in good health between low and high educated appear to be increasing over time. Conclusions Socio-economic inequalities in trends of mortality and the prevalence of ill-health, combined with increasing statutory pension age, impact the low educated more adversely than the high educated. Policies are needed to mitigate the increasing deficit of years in good health relative to the pension age, particularly among the low educated.

# Background Maternal and infant deaths can be prevented through integrated service delivery during pregnancy, postpartum, and early childhood. Our study analyses the gaps and opportunities associated with integrating maternal, newborn, and child health (MNCH) services with postpartum family planning (PPFP) and nutrition services at different points of contact in health facilities in a preintervention context in west Africa. # Methods We conducted a qualitative study from June to July 2018 in Burkina Faso, Côte d'Ivoire and Niger. The points of contact studied at the health facility level were the prenatal care, postpartum care and immunisation/growth monitoring services. Individual in-depth interviews were used to collect data from key informants (providers, community health workers and mother-child health programme managers). To measure the degree of service integration, we used the dimensions and indicators included in the Integra Initiative framework concerning four aspects of integration: physical (the availability of multiple services in the health facility), temporal (the availability of care more than one day per week), provider level, and functional (the receipt of integrated services by the client). # Results The findings of this study show that the integrated delivery of MNCH, PPFP, and nutrition services is configured in similar ways in Burkina Faso, Côte d'Ivoire and Niger and is insufficient at all points of contact. Physical integration is high. However, the study found important gaps in temporal, functional and provider-level integration. The main barriers to integrated service delivery are the shortage of providers, the lack of training in integrated service delivery, and insufficient service organisation. However, the availability of multiple services throughout the week, the multiple points of contact between the mother-child pair and the health system, and the multiple skills of providers represent opportunities for functional integration through the establishment of a formal referral system between the different care units with follow-up and feedback among service providers. # Conclusions The provision of training and the development of a well-organised referral system in different health facilities, taking into account the specific characteristics of each health facility (urban/rural, primary health facility/district hospital), can improve the delivery of integrated MNCH, PPFP, and nutrition care to the mother-child pair.

Background: Pneumococcal disease is a major public health concern globally and particularly in Burkina Faso, where the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced nationwide into the routine immunization schedule in 2013. The aim of this study was to evaluate vaccine impact on all-cause pneumonia hospitalizations among children

One of the primary objectives of the SPHEREx mission is to understand the origin of molecules such as H _2 O, CO _2 , and other volatile compounds at the early stages of planetary system formation. Because the vast majority of these compounds—typically exceeding 95%—exist in the solid phase rather than the gaseous phase in the systems of concern here, the observing strategy planned to characterize them is slightly unusual. Specifically, SPHEREx will target highly obscured sources throughout the Milky Way, and observe the species of concern in absorption against background illumination. SPHEREx spectrophotometry will yield ice column density measurements for millions of obscured Milky Way sources of all ages and types. By correlating those column densities with source ages, the SPHEREx mission will shed light on whether those molecules were formed in situ along with their nascent stellar systems, or whether instead they formed elsewhere and were introduced into those systems after their formation. To that end, this work describes version 7.1 of the SPHEREx target List of ICE Sources (SPLICES) for the community. It contains 8.6 × 10 ^6 objects brighter than W 2 ∼ 12 Vega mag over much of the sky, principally within a broad strip running the length of the Milky Way midplane, but also within high-latitude molecular clouds and even the Magellanic Clouds.

Direct-imaging observations of terrestrial exoplanets will enable their atmospheric characterization and habitability assessment. Considering Earth, the key atmospheric signatures for the biosphere are O _2 and the photochemical product O _3 . However, this O _2 –O _3 biosignature is not detectable in the visible wavelengths for most of the time after the emergence of oxygenic photosynthesis life (i.e., Proterozoic Earth). Here we demonstrate spectroscopic observations in the ultraviolet wavelengths for detecting and characterizing O _2 and O _3 in Proterozoic-Earth-like planets, using ExoReL ${}^{{\mathfrak{R}}}$ . For an O _2 mixing ratio 2–3 orders of magnitude less than the present-day Earth and an O _3 mixing ratio of 10 ^−7 to 10 ^−6 , we find that O _3 can be detected and its mixing ratio can be measured precisely (within 1 order of magnitude) in the ultraviolet (0.25–0.4 μ m), in addition to visible-wavelength spectroscopy. With modest spectral resolution ( R = 7) and signal-to-noise ratio (∼10) in the ultraviolet, the O _3 detection is robust against other potential gases absorbing in the ultraviolet (e.g., H _2 S and SO _2 ), as well as the short-wavelength cutoff between 0.2 and 0.25 μ m. While the O _3 detection does not rely on the near-infrared spectra, extending the wavelength coverage to the near-infrared (1–1.8 μ m) would provide essential information to interpret the O _3 biosignature, including the mixing ratio of H _2 O, the cloud pressure, and the determination of the dominant gas of the atmosphere. The ultraviolet and near-infrared capabilities should thus be evaluated as critical components for future missions aiming at imaging and characterizing terrestrial exoplanets, such as the Habitable Worlds Observatory.

Abstract Background Dengue fever is prevalent in the world; in recent years, several outbreaks occurred in West Africa. It affects pregnant women. We aimed to assess the consequences of dengue fever on pregnant women and their fetuses during dengue epidemic in Burkina Faso. Methods We conducted a cross-sectional study from November 1, 2015 to January 31, 2017 in 15 public and private health facilities in Ouagadougou, using secondary data. Immunochromatographic rapid test Duo detecting specific antibodies, immunoglobin M/G and /or dengue non structural antigen1 virus was used to diagnose dengue cases. Results Out of 399 (48%) women registered during the study period, 25 (6%) were pregnant. The average age of pregnant women was 30 years, with 18 and 45 years as extremes. The main symptoms were fever (92%) and headache (92%). Nine patients (36%) had severe dengue characterized by bleeding (16%), neurological symptoms (16%) and acute respiratory distress (8%). Eight (32%) of the 25 women had early miscarriage and 8 (32%) women gave birth to viable fetuses. Among those with viable babies, 5 (20%) presented post-partum hemorrhage and 3 (12%) presented early delivery. The main fetal complications included 3 cases of acute fetal distress (12%). One case of maternal death (4%) and 4 cases of neonatal mortality (44.5%) were notified. Conclusion Dengue fever occurring during pregnancy increases maternal and neonatal mortality. Its severe complications require specific monitoring of pregnant women until delivery.

Abstract Lymph node metastasis is an important prognosis factor in non‐small cell lung cancer (NSCLC) patients. The aim of this study was to investigate the role of epithelial to mesenchymal transition (EMT) in lymph node progression in the early stages of NSCLC. We studied a retrospective cohort of 160 consecutive surgically treated NSCLC patients with available frozen tumor samples for expression of EMT markers (CDH1, CTNNB1, CDH2, and VIMENTIN), inducers (TGFB1, c‐MET, and CAIX), and transcription factors (EMT‐TF: SNAI1, SNAI2, ZEB1, TWIST1, and TWIST2). Partial EMT was more frequent in N1‐2 (N+) vs N0 patients (P

Context: At 30-day follow-up, patients with moderate- and high-risk acute coronary syndromes (ACS) undergoing early invasive treatment in the ACUITY trial with bivalirudin monotherapy vs heparin plus glycoprotein (GP) IIb/IIIa inhibitors had noninferior rates of adverse ischemic events with reduced rates of major bleeding. Deferred upstream use of GP IIb/IIIa inhibitors for selective administration to patients undergoing percutaneous coronary intervention (PCI) resulted in a significant reduction in major bleeding, although a small increase in composite ischemia could not be excluded.Objective: To determine 1-year ischemic outcomes for patients in the ACUITY trial.Design, Setting, and Patients: A prospective, randomized, open-label trial with 1-year clinical follow-up at 450 academic and community-based institutions in 17 countries. A total of 13,819 patients with moderate- and high-risk ACS undergoing invasive treatment were enrolled between August 23, 2003, and December 5, 2005.Interventions: Patients were assigned to heparin plus GP IIb/IIIa inhibitors (n = 4603), bivalirudin plus GP IIb/IIIa inhibitors (n = 4604), or bivalirudin monotherapy (n = 4612). Of these patients, 4605 were assigned to routine upstream GP IIb/IIIa administration and 4602 were deferred to selective GP IIb/IIIa inhibitor administration.Main Outcome Measure: Composite ischemia (death, myocardial infarction, or unplanned revascularization for ischemia) at 1 year.Results: Composite ischemia at 1 year occurred in 15.4% of patients assigned to heparin plus GP IIb/IIIa inhibitors and 16.0% assigned to bivalirudin plus GP IIb/IIIa inhibitors (compared with heparin plus GP IIb/IIIa inhibitors, HR, 1.05; 95% CI, 0.95-1.16; P = .35), and 16.2% assigned to bivalirudin monotherapy (HR, 1.06; 95% CI, 0.95-1.17; P = .29). Mortality at 1 year occurred in an estimated 3.9% of patients assigned to heparin plus GP IIb/IIIa inhibitors, 3.9% assigned to bivalirudin plus GP IIb/IIIa inhibitors (HR, 0.99; 95% CI, 0.80-1.22; P = .92), and 3.8% assigned to bivalirudin monotherapy (HR, 0.96; 95% CI, 0.77-1.18; P = .67). Composite ischemia occurred in 16.3% of patients assigned to deferred use compared with 15.2% of patients assigned to upstream administration (HR, 1.08; 95% CI, 0.97-1.20; P = .15).Conclusions: At 1 year, no statistically significant difference in rates of composite ischemia or mortality among patients with moderate- and high-risk ACS undergoing invasive treatment with the 3 therapies was found. There was no statistically significant difference in the rates of composite ischemia between patients receiving routine upstream administration of GP IIb/IIIa inhibitors vs deferring their use for patients undergoing PCI.Trial Registration: clinicaltrials.gov Identifier: NCT00093158. [ABSTRACT FROM AUTHOR]

Context: In patients with moderate- and high-risk acute coronary syndromes (ACS) who undergo an early, invasive treatment strategy, current guidelines recommend administration of platelet glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors, either upstream to all patients prior to angiography or deferred for selective use in the catheterization laboratory just prior to angioplasty. The preferred approach is undetermined.Objective: To determine the optimal strategy for the use of Gp IIb/IIIa inhibitors in patients with moderate- and high-risk ACS undergoing an early, invasive treatment strategy.Design: Prospective, randomized, open-label trial with 30-day clinical follow-up.Setting: Four hundred fifty academic and community-based institutions in 17 countries.Patients: A total of 9207 patients with moderate- and high-risk ACS undergoing an invasive treatment strategy.Interventions: Patients were randomly assigned to receive either routine upstream (n=4605) or deferred selective (n=4602) Gp IIb/IIIa inhibitor administration, respectively.Main Outcome Measures: The primary outcome was assessment of noninferiority of deferred Gp IIb/IIIa inhibitor use compared with upstream administration for the prevention of composite ischemic events (death, myocardial infarction, or unplanned revascularization for ischemia) at 30 days, using a 1-sided alpha level of .025. Major secondary end points included noninferiority or superiority of major bleeding and net clinical outcomes (composite ischemia or major bleeding).Results: Glycoprotein IIb/IIIa inhibitors were used more frequently (98.3% vs 55.7%, respectively) and for a significantly longer duration (median, 18.3 vs 13.1 hours; P<.001) in patients in the upstream group compared with the deferred group. Composite ischemia at 30 days occurred in 7.9% of patients assigned to deferred use compared with 7.1% of patients assigned to upstream administration (relative risk, 1.12; 95% confidence interval, 0.97-1.29; P = .044 for noninferiority; P = .13 for superiority); as such, the criterion for noninferiority was not met. Deferred use compared with upstream use resulted in reduced 30-day rates of major bleeding (4.9% vs 6.1%, respectively; P<.001 for noninferiority; P = .009 for superiority) and similar rates of net clinical outcomes (11.7% vs 11.7%; P<.001 for noninferiority; P = .93 for superiority).Conclusions: Among patients with moderate- and high-risk ACS undergoing an invasive treatment strategy, deferring the routine upstream use of Gp IIb/IIIa inhibitors for selective administration in the cardiac catheterization laboratory only to patients undergoing percutaneous coronary intervention resulted in a numerical increase in composite ischemia that, while not statistically significant, did not meet the criterion for noninferiority. This finding was offset by a significant reduction in major bleeding.Trial Registration: ClinicalTrials.gov Identifier: NCT00093158. [ABSTRACT FROM AUTHOR]

Abstract Objectives Assessment of the adaptive immune response against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is crucial for studying long‐term immunity and vaccine strategies. We quantified IFNγ‐secreting T cells reactive against the main viral SARS‐CoV‐2 antigens using a standardised enzyme‐linked immunospot assay (ELISpot). Methods Overlapping peptide pools built from the sequences of M, N and S viral proteins and a mix (MNS) were used as antigens. Using IFNγ T‐CoV‐Spot assay, we assessed T‐cell and antibody responses in mild, moderate and severe SARS‐CoV‐2 patients and in control samples collected before the outbreak. Results Specific T cells were assessed in 60 consecutive patients (mild, n = 26; moderate, n = 10; and severe patients, n = 24) during their follow‐up (median time from symptom onset [interquartile range]: 36 days [28;53]). T cells against M, N and S peptide pools were detected in n = 60 (100%), n = 56 (93.3%), n = 55 patients (91.7%), respectively. Using the MNS mix, IFNγ T‐CoV‐Spot assay showed a specificity of 96.7% (95% CI, 88.5–99.6%) and a specificity of 90.3% (75.2–98.0%). The frequency of reactive T cells observed with M, S and MNS mix pools correlated with severity and with levels of anti‐S1 and anti‐RBD serum antibodies. Conclusion IFNγ T‐CoV‐Spot assay is a reliable method to explore specific T cells in large cohorts of patients. This test may become a useful tool to assess the long‐lived memory T‐cell response after vaccination. Our study demonstrates that SARS‐CoV‐2 patients developing a severe disease achieve a higher adaptive immune response.

Gastrointestinal metastases from lung cancer are rare and usually asymptomatic. We report a case of small bowel metastases from primary lung cancer revealed by abdominal pain and severe recurrent anaemia. The diagnosis was obtained with capsule endoscopy. This non-invasive procedure thus represents a valuable method contributing to a rapid and detailed diagnosis while reducing underdiagnosis, and it should thus be considered for lung cancer patients complaining of abdominal symptoms, which may indeed be related to gastrointestinal metastases.

L'alimentation animale peut représenter de 30 à 95 % des impacts environnementaux des produits animaux en sortie de ferme. Des données d’impacts environnementaux des matières premières ont été publiées mais il n’existait pas de données adaptées aux productions françaises. Le projet ECOALIM propose une base de données d’impacts environnementaux des matières premières utilisées en alimentation animale en France (154 matières premières disponibles). Dans le projet, une méthodologie de formulation multiobjectif a été développée pour produire des éco-aliments à impacts réduits et à prix maitrisé. Les impacts des aliments calculés à la tonne d'aliment sont ainsi modifiés de - 6 à - 14 % en production de porcs charcutiers et de + 4 à - 18 % en poulet de chair selon l'impact considéré, par rapport à une formulation à moindre coût classique et en considérant la disponibilité actuelle des MP. Dans le même temps, le prix de l'aliment est augmenté en moyenne d'1% en porc charcutier et de 3 % en poulet de chair. En biphase, avec restriction en porc charcutier, les impacts du kg de poids vif en sortie de ferme sont alors réduits de - 2 % à - 10 %. En poulet de chair, avec une alimentation classique en 3 phases, les impacts du kg de poids vif en sortie de ferme sont quant à eux réduits de - 2 à – 14 % (sauf pour l’occupation des terres qui augmente de 3%). A l’échelle territoriale, la réduction des impacts des aliments n’excède pas - 10 % en raison des compétitions entre filières pour les matières premières à faibles impacts.

Here we report our experience of ceritinib in crizotinib-pretreated patients with anaplastic lymphoma kinase (ALK) positive (ALK+) non-small cell lung cancer (NSCLC) in a French temporary authorisation for use (TAU) study. The French TAU study included crizotinib-pretreated patients with advanced ALK+ or ROS proto-oncogene 1 positive (ROS1+) tumours. Patients received oral ceritinib (750 mg·day−1 as a starting dose) and best tumour response (as evaluated by the investigator) and safety were reported every 3 months. A total of 242 TAUs were granted from March 12, 2013 to August 05, 2015. Of the 242 patients, 228 had ALK+ NSCLC and 13 had ROS1+ NSCLC. The median age of ALK+ patients (n=214) was 58.5 years, 51.9% were female, 70.8% had an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0–1 and 50.0% had brain metastases. Of the 149 efficacy evaluable ALK+ NSCLC patients, 5.4% had a complete response (CR), 47.0% had a partial response (PR) and 22.8% had stable disease (SD). At September 05, 2015, the median duration of ceritinib treatment (n=182) was 3.9 months but 5.5 months for patients (n=71) with a follow-up of ≥12 months. Higher objective response rate (ORR) was observed for patients with ECOG PS 0 to 1 (55.0% versus 42.4%) and those receiving prior crizotinib for >5 months (51.6% versus 36.1%). Treatment-related adverse events (AEs) were reported in 118 of 208 patients (56.7%), the most common being diarrhoea (22.1%) and hepatic toxicity (19.7%). Ceritinib (750 mg·day−1) demonstrated efficacy similar efficacy to ASCEND-1, ASCEND-2 and phase 3 ASCEND-5 trials with manageable safety in crizotinib-pretreated patients with ALK+ NSCLC.

The pretreatment detection of an activating mutation of EGFR is now routinely performed in metastatic nonsquamous non-small cell lung cancer (NSCLC). The therapeutic impact of such a detection is major, as patients with advanced NSCLC exhibiting a mutation of exon 19 or 21 will benefit from EGFR-tyrosine kinase inhibitors (TKI). The presence of an EGFR resistance mutation, such as T790M in EGFR-TKI-naïve patients, is seldom looked for and is related either to a germinal mutation or to somatically mutated subclones. It has a negative predictive impact. We present the case of a patient with a lung papillary adenocarcinoma and miliary intrapulmonary metastases whose tumor displays a somatic complex heterozygous EGFR mutation, combining L858R (exon 21) and a primary resistance mutation T790M (exon 20), both detected by direct sequencing.

The Apocalypse of John faces us with a puzzle. Firstly from a historical, philological and exegetical point of view, as despite an apparent consensus, there is still no agreement on the identity of its author, the time the text was written, and the meaning of the visions it unfolds. And secondly from a philosophical and psychological perspective as the very nature of prophetic experience is still unknown. In this article both puzzles are dealt with in turn, and conflicting opinions are discussed. In the first part, the author examines Claude Tresmontant’s work, and attempts in the second to look at the prophetic experience in the light of concepts and knowledge from parapsychology.