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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.

Background Although prehospital cardiac arrest (CA) remains associated with poor long-term outcome, recent studies show an improvement in the survival rate after prehospital trauma associated CA (TCA). However, data on the long-term neurological outcome of TCA, particularly from physician-staffed Emergency Medical Service (EMS), are scarce, and results reported have been inconsistent. The objective of this pilot study was to evaluate the long-term outcome of patients admitted to several trauma centres after a TCA. Methods This study is a retrospective database review of all patients from a multicentre prospective registry that experienced a TCA and had undergone successful cardiopulmonary resuscitation (CPR) prior their admission at the trauma centre. The primary end point was neurological outcome at 6 months among patients who survived to hospital discharge. Results 88 victims of TCA underwent successful CPR and were admitted to the hospital, 90% of whom were victims of blunt trauma. Of these 88 patients, 10 patients (11%; CI 95% 6% to 19%) survived to discharge: on discharge, 9 patients displayed a GCS of 15 and Cerebral Performance Categories (CPC) 1-2 and one patient had a GCS 7 and CPC of 3. Hypoxia was the most frequent cause of CA among survivors. 6-month follow-up was achieved for 9 patients of the 10 surviving patients. The 9 patients with a good outcome on hospital discharge had a CPC of 1 or 2 6 months post discharge. All returned to their premorbid family and social settings. Conclusions Among patients admitted to hospital after successful CPR from TCA, hypoxia as the likely aetiology of arrest carried a more favourable prognosis. Most of the patients successfully resuscitated from TCA and surviving to hospital discharge had a good neurological outcome, suggesting that prehospital resuscitation may not be futile.

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.

Introduction L’arthrose trapezo-metacarpienne est la deuxieme localisation d’arthrose. Apres l’echec d’un traitement medical, un traitement chirurgical peut etre propose. La trapeziectomie est le gold standard actuel. Les resultats sont bons mais avec une recuperation longue et une perte de force. Ces problemes peuvent etre resolus avec une arthroplastie, la problematique reside dans la survie de l’implant et sur les resultats des chirurgies de reprises. Le but de notre etude est d’evaluer cliniquement et radiologiquement les trapezectomies secondaires apres les resultats de la revision de l’implant et de le comparer avec les trapezectomies primaires. Nous avons analyse les resultats lors d’une etude appariee retrospective. Materiel et methodes Nous avons effectue une etude retrospective monocentrique apparies. Entre octobre 2003 et fevrier 2015, 35 patients ont eu besoin d’une trapezectomie secondaire apres echec d’arthroplastie. Les criteres d’inclusion etaient les suivants- - trapezectomie totale avec le retrait de l’implant apres arthroplastie, stade 2 ou 3 de la classification Dell lors de l’arthroplastie. - âge superieur a 18 ans. Les criteres d’exclusion etaient les suivants- -stade 4 classification de Dell. -arthrose post-traumatique ou inflammatoire -hauteur du trapeze inferieure a 2 3 du cote controlateral. Nous avons apparie toutes les trapezectomies secondaires avec des trapezectomies primaires selon le type de sexe, date de l’operation et de l’âge. Nous avons evalue la fonction, la mobilite, l’autonomie, la douleur, la force, les complications et le raccourcissement de la colonne du pouce a la radiographie. Resultats Trente et un patients (30 femmes, 1 homme) ont ete analyses dans le groupe trapezectomies secondaires. Ces patients ont ete couples avec 31 trapezectomies primaires. L’âge moyen dans le groupe de trapezectomies secondaires etait 60,7 ± 8,2 ans et de 57,9 ± 15,9 ans dans le groupe de trapezectomies primaires ( p = 0,905). Le suivi moyen a ete de 81 ± 35 mois dans le groupe de trapezectomies primaires et 79 ± 24 mois dans le groupe trapezectomies secondaires ( p = 0,99) Il n’y avait pas de difference statistique entre les 2 groupes en ce qui concerne la fonction, la mobilite, l’autonomie, la douleur, la force, le taux de complications et le raccourcissement du pouce. Conclusion La trapezectomie donne de bons resultats, mais la recuperation est longue, la perte de force de prehension et la difficulte de revision secondaire doivent etre prises en compte. L’arthroplastie semble une bonne alternative et la revision par trapezectomie secondaire donne des resultats fonctionnels identiques a une primaire. Il faut toutefois prendre soin d’effectuer une resection metacarpienne minimale pour preserver sa longueur en prevision de la reprise.