French Agency Research Articles

Managing Open Twin Transition in SMEs: a Case Study in Fashion Industry

According to the French Agency for Ecological Transition, ADEME, the textile sector is projected to contribute to 26% of global greenhouse gas emissions by 2050, highlighting the significance of sustainable fashion. The current market, influenced by increasingly conscientious consumers seeking transparency regarding product origins and production conditions, alongside stricter regulations, compels fashion companies to diminish their environmental footprint by embracing progressively sustainable and eco-friendly practices. With the ability to purchase garments online from anywhere in the world, the necessity of providing clear and accurate information to customers and the supply chain about product features through a document in a smart format has become essential. Consequently, digitization has become imperative in the fashion industry, with the digital passport serving as a pivotal milestone in advancing towards an eco-friendly and more digitalized sector. However, small, and medium-sized enterprises (SMEs) face an uncertain landscape where standards and technologies may not always be mature or readily accessible. Furthermore, limited internal expertise and scarce financial resources often pose challenges in independently developing new technological solutions. One proposed solution is to adopt open innovation approaches. This qualitative research study employs a single case study approach, presenting insights from a small enterprise in the fashion industry specializing in label printing. Utilizing primary data sources such as multiple interviews with managers and secondary sources like detailed briefings of company meetings with technological partners and machinery suppliers, the study aims to shed light on the initial phase of an open innovation approach by SMEs amidst the challenges of twin transition. It highlights that the shift from internal RD& to open innovation is not a direct one, but an iterative one. Scholars will gain a deeper understanding of open innovation mechanisms within SMEs, while practitioners will gain insights into building innovation networks to navigate twin transition challenges.

Geolocation of Old Photographs and Rephotography in the Field: Contribution to a New Understanding of the al-ʿŪla Oasis in the Early 20th Century a.d.

ABSTRACT Historical photographs are commonly available in landscape archaeology; however, they are rarely used systematically for the maximum benefit in terms of spatial and temporal information. In the framework of the al-ʿŪla Cultural Oasis Project (funded and steered by the French Agency for AlUla Development on behalf of the Royal Commission for AlUla), photographs taken at ground level by the Dominican Fathers Antonin Jaussen and Raphaël Savignac in the early 20th century a.d. were geolocated by identifying mountain peaks in the background and comparing distance ratios (on the photos) with angle ratios (on GIS). These locations were then visited in the field to re-take the photographs. This work demonstrates the value of recontextualized ground-level photographs to improve our knowledge of archaeological landscapes when cross-referenced with data from a systematic archaeological survey. We also propose a reproducible methodology for geolocating historical photographs in similar or other contexts.

HF/HR VSP acquisition, processing, and interpretation in the deviated section of the high angle geothermal borehole of Grigny GGR5, targeting intra Dogger thin, porous beds.

Defining 5m thin, or even thinner, porous reservoir beds was the feasibility objective assigned to the High Frequency/High Resolution (HF/HR) look ahead VSP survey to be recorded in the deviated section of a geothermal production well drilled down to the top of the carbonate Dogger aquifer in the Paris basin, around 1500m in vertical depth, with a landing angle of 65°. The idea was to predict the depth of the first porous bed(s) to be drilled at high angle, and to determine the minimal DLS (Dog Leg Severity) to be applied by the driller after setting a production casing at the top Dogger level and changing the drilling fluid composition, so as to avoid directional drilling with sharp angles. A 50-100m vertical depth range was targeted for the acoustic impedance to be predicted below the top Dogger carbonate aquifer. Besides, a Pilot Hole (PH) was drilled prior to the high angle leg to assess with full reliability the depth of productive thin beds to be subsequently drilled at high angle. These actions were undertaken within a global R&D project named “SISMOSUB” aiming reservoir characterisation, conducted by the reservoir and drilling engineers of GEOFLUID/GPCIP, in a partnership with IFPEN, and partially financed by ADEME (French Agency for Ecological Transition). High Frequency (HF) VSP still represents a frontier seismic domain to investigate, for which technical difficulties are piling up: First, the surface fix source needs to be extremely repeatable and preferably deliver an increased amount of HF energy to compensate somehow for the higher loss of seismic amplitudes with high frequency. Second, downhole receiver tool or toolstring may not present constant vector fidelity of 3 component reception over the whole recording frequency range, mainly in high frequency, due to mechanical coupling characteristics of the VSP tool hardware and the open borehole ruggedness; in cased hole, the mechanical coupling of the VSP tool to the formation is insured by a good cementing quality between casing and borehole wall. Third, the physics of the seismic attenuation is not fully understood and depends on several factors, mainly viscoelasticity and heterogeneity, potentially variable in depth and laterally to the wellbore. Additionally, the geometrical spreading represents the main factor of amplitude decay, independent from frequency, and can be estimated at processing stage. Surprisingly, the VSP image produced underneath the deviated hole section evidenced a faulted structure. A remarkable abrupt amplitude loss of high frequencies above 120Hz occurs where the direct P-wave ray crosses one of the confirmed minor faults before reaching Total Depth (TD); secondary downgoing arrivals appear locally in depth, mainly in the high frequencies, which are not strictly parallel to the first P-wave arrival...

Scientific opinion on the ANSES analysis of Annex I of the EC proposal COM (2023) 411 (EFSA-Q-2024-00178).

EFSA was asked by the European Parliament to provide a scientific opinion on the analysis by the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) of Annex I of the European Commission proposal for a regulation 'on plants obtained by certain new genomic techniques (NGTs) and their food and feed, and amending regulation (EU) 2017/625'. The Panel on genetically modified organisms (GMO) assessed the opinion published by ANSES, which focuses on (i) the need to clarify the definitions and scope, (ii) the scientific basis for the equivalence criteria and (iii) the need to take potential risks from category 1 NGT plants into account. The EFSA GMO Panel considered the ANSES analysis and comments on various terms used in the criteria in Annex I of the European Commission proposal and discussed definitions based on previous EFSA GMO Panel opinions. The EFSA GMO Panel concluded that the available scientific literature shows that plants containing the types and numbers of genetic modifications used as criteria to identify category 1 NGT plants in the European Commission proposal do exist as the result of spontaneous mutations or random mutagenesis. Therefore, it is scientifically justified to consider category 1 NGT plants as equivalent to conventionally bred plants with respect to the similarity of genetic modifications and the similarity of potential risks. The EFSA GMO Panel did not identify any additional hazards and risks associated with the use of NGTs compared to conventional breeding techniques in its previous Opinions.

Different pathways toward net-zero emissions imply diverging health impacts: a health impact assessment study for France

In the transport sector, efforts to achieve carbon neutrality may generate public health co-benefits by promoting physical activity. This study aims to quantify the health impacts related to active transport based on four different scenarios leading France toward carbon neutrality in 2050. The French Agency for Ecological Transition developed four consistent and contrasting scenarios (S1 to S4) achieving carbon neutrality by 2050 as well as a business-as-usual (BAU) scenario that extends our current lifestyles until 2050, without reaching net-zero. For each of these Transitions2050 scenarios, we distributed the mobility demand for walking, cycling and e-cycling across age groups. Relying on the health impact assessment framework, we quantified the impacts of the corresponding physical activity on all-cause mortality. The impact of each of the carbon neutrality scenarios was determined by comparison with estimates from the BAU scenario. In S1 and S2 scenarios, volumes of active transport are projected to increase to fulfill the World Health Organizations (WHO) recommendations by 2050, while they increase slightly in S3 and decrease in S4. S2 scenario reaches the highest levels of health co-benefits, with 494 000 deaths prevented between 2021 and 2050. This would translate into a life expectancy gain of 3.0 months for the general population in 2050, mainly driven by e-bikes. S1 would provide smaller but important health benefits, while these benefits would be modest for S3. On the contrary, S4 implies 52 000 additional deaths as compared to the BAU scenario and a loss of 0.2 month in life expectancy. Different ways to decarbonize mobility in a net-zero perspective may achieve very contrasting public health co-benefits. This study illustrates how the public health dimension may provide a relevant insight in choices of collective transformation toward net-zero societies.

Human epicardial adipose tissue contains innate and adaptive lymphoid cells and a higher proportion of innate type 2 lymphoid cells compared to other adipose tissues

ImportanceEpicardial adipose tissue (EAT) is a biologically active organ surrounding myocardium and coronary arteries that has been associated with coronary artery disease (CAD) and atrial fibrillation. Previous work has shown that EAT exhibits beige features. ObjectiveOur objective was to determine whether the stromal vascular fraction of the human EAT contains innate or adaptive lymphoid cells compared to thoracic subcutaneous (thSAT), visceral abdominal (VAT) and subcutaneous abdominal (abSAT). ParticipantsNew pangenomic microarray analysis was performed on previous transcriptomic dataset using significance analysis of microarray and ingenuity pathway analysis (n=41) to identify specific immune signature and its link with browning genes. EAT, thSAT, VAT and abSAT samples from explanted patients with severe cardiomyopathies and multi-organ donor patients (n=17) were used for flow cytometry (FC) immunophenotyping assay. Patients were on average 55±16 years-old; 47% had hypertension and 6% CAD. Phenotypic adaptive and innate immune profiles were performed using a TBNK panel and a specific ILC1-2-3 panel including CD127, CD117, CRTH2 (CD294) and activation markers such as CD25 and CD69. ResultsTranscriptomic analysis showed a significant positive correlation between the TH2 immune pathway (IL-4, IL-5, IL-13, IL-25, IL-33) and browning genes (UCP-1, PRDM16, TMEM26, CITED1, TBX1) in EAT versus thSAT (R=0.82, P<0.0001). Regarding adaptive immune cells, a preponderance of CD8T cells, a contingent of CD4T cells, and a few B cells were observed in all ATs (P<0.0001). In innate lymphoid cells (ILCs), an increase was observed in visceral ATs (i.e. EAT; VAT 35±8ILCs/g of tissue) compared to their subcutaneous counterpart (i.e. thSAT+abSAT: 8±3 ILCs/g of AT, P=0.002), with a difference in the proportion of the 3 subtypes of ILCs (ILC1>ILC3>ILC2). In addition, we observed an increase in EAT-ILC2 compared to other ATs and almost all these EAT-ILC2 expressed CD69 and/or CD25 activation markers (99.75±0.16%; P<0.0001). We also observed more NKs in EAT and VAT (1520±71 cells/g of AT) than in SATs (562±17 cells/g of AT); P=0.01. ConclusionThis is the first study to provide a comparison between innate and adaptive lymphoid cells in human epicardial versus abdominal or thoracic adipose tissues. Further studies are ongoing to decipher whether these cells could be involved in EAT beiging. Trial RegistrationCODECOH No. DC-2021-4518 The French agency of biomedicine PFS21-005.

Placental DNA methylation signatures of prenatal air pollution exposure and potential effects on birth outcomes: an analysis of three prospective cohorts.

Pregnancy air pollution exposure (PAPE) has been linked to a wide range of adverse birth and childhood outcomes, but there is a paucity of data on its influence on the placental epigenome, which can regulate the programming of physiological functions and affect child development. This study aimed to investigate the association between prenatal air pollutant exposure concentrations and changes in placental DNA methylation patterns, and to explore the potential windows of susceptibility and sex-specific alterations. This multi-site study used three prospective population-based mother-child cohorts: EDEN, PELAGIE, and SEPAGES, originating from four French geographical regions (Nancy, Poitiers, Brittany, and Grenoble). Pregnant women were included between 2003 and 2006 for EDEN and PELAGIE, and between 2014 and 2017 for SEPAGES. The main eligibility criteria were: being older than 18 years, having a singleton pregnancy, and living and planning to deliver in one of the maternity clinics in one of the study areas. A total of 1539 mother-child pairs were analysed, measuring placental DNA methylation using Illumina BeadChips. We used validated spatiotemporally resolved models to estimate PM2·5, PM10, and NO2 exposure over each trimester of pregnancy at the maternal residential address. We conducted a pooled adjusted epigenome-wide association study to identify differentially methylated 5'-C-phosphate-G-3' (CpG) sites and regions (assessed using the Infinium HumanMethylationEPIC BeadChip array, n=871), including sex-specific and sex-linked alterations, and independently validated our results (assessed using the Infinium HumanMethylation450 BeadChip array, n=668). We identified four CpGs and 28 regions associated with PAPE in the total population, 469 CpGs and 87 regions in male infants, and 150 CpGs and 66 regions in female infants. We validated 35% of the CpGs available. More than 30% of the identified CpGs were related to one (or more) birth outcome and most significant alterations were enriched for neural development, immunity, and metabolism related genes. The 28 regions identified for both sexes overlapped with imprinted genes (four genes), and were associated with neurodevelopment (nine genes), immune system (seven genes), and metabolism (five genes). Most associations were observed for the third trimester for female infants (134 of 150 CpGs), and throughout pregnancy (281 of 469 CpGs) and the first trimester (237 of 469 CpGs) for male infants. These findings highlight the molecular pathways through which PAPE might affect child health in a widespread and sex-specific manner, identifying the genes involved in the major physiological functions of a developing child. Further studies are needed to elucidate whether these epigenetic changes persist and affect health later in life. French Agency for National Research, Fondation pour la Recherche Médicale, Fondation de France, and the Plan Cancer.

Global transmission of extended-spectrum cephalosporin resistance in Escherichia coli driven by epidemic plasmids

Extended-spectrum cephalosporins (ESCs) are third and fourth generation cephalosporin antimicrobials used in humans and animals to treat infections due to multidrug-resistant (MDR) bacteria. Resistance to ESCs (ESC-R) in Enterobacterales is predominantly due to the production of extended-spectrum β-lactamases (ESBLs) and plasmid-mediated AmpC β-lactamases (AmpCs). The dynamics of ESBLs and AmpCs are changing across countries and host species, the result of global transmission of ESC-R genes. Plasmids are known to play a key role in this dissemination, but the relative importance of different types of plasmids is not fully understood. In this study, Escherichia coli with the major ESC-R genes blaCTX-M-1, blaCTX-M-15, blaCTX-M-14 (ESBLs) and blaCMY-2 (AmpC), were selected from diverse host species and other sources across Canada, France and Germany, collected between 2003 and 2017. To examine in detail the vehicles of transmission of the ESC-R genes, long- and short-read sequences were generated to obtain complete contiguous chromosome and plasmid sequences (n=192 ESC-R E.coli). The types, gene composition and genetic relatedness of these plasmids were investigated, along with association with isolate year, source and geographical origin, and put in context with publicly available plasmid sequences. We identified five epidemic resistance plasmid subtypes with distinct genetic properties that are associated with the global dissemination of ESC-R genes across multiple E.coli lineages and host species. The IncI1 pST3 blaCTX-M-1 plasmid subtype was found in more diverse sources than the other main plasmid subtypes, whereas IncI1 pST12 blaCMY-2 was more frequent in Canadian and German human and chicken isolates. Clonal expansion also contributed to the dissemination of the IncI1 pST12 blaCMY-2 plasmid in ST131 and ST117 E.coli harbouring this plasmid. The IncI1 pST2 blaCMY-2 subtype was predominant in isolates from humans in France, while the IncF F31:A4:B1 blaCTX-M-15 and F2:A-:B- blaCTX-M-14 plasmid subtypes were frequent in human and cattle isolates across multiple countries. Beyond their epidemic nature with respect to ESC-R genes, in our collection almost all IncI1 pST3 blaCTX-M-1 and IncF F31:A4:B1 blaCTX-M-15 epidemic plasmids also carried multiple antimicrobial resistance (AMR) genes conferring resistance to other antimicrobial classes. Finally, we found genetic signatures in the regions surrounding specific ESC-R genes, identifying the predominant mechanisms of ESC-R gene movement, and using publicly available databases, we identified these epidemic plasmids from widespread bacterial species, host species, countries and continents. We provide evidence that epidemic resistance plasmid subtypes contribute to the global dissemination of ESC-R genes, and in addition, some of these epidemic plasmids confer resistance to multiple other antimicrobial classes. The success of these plasmids suggests that they may have a fitness advantage over other plasmid types and subtypes. Identification and understanding of the vehicles of AMR transmission are crucial to develop and target strategies and interventions to reduce the spread of AMR. This project was supported by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR), through the Medical Research Council (MRC, MR/R000948/1), the Canadian Institutes of Health Research (CFC-150770), and the Genomics Research and Development Initiative (Government of Canada), the German Federal Ministry of Education and Research (BMBF) grant no. 01KI1709, the French Agency for food environmental and occupational health & safety (Anses), and the French National Reference Center (CNR) for antimicrobial resistance. Support was also provided by the Biotechnology and Biological Sciences Research Council (BBSRC) through the BBSRC Institute Strategic Programme Microbes in the Food ChainBB/R012504/1 and its constituent project BBS/E/F/000PR10348 (Theme 1, Epidemiology and Evolution of Pathogens in the Food Chain).

Order for Profit: On the Architecture of a Nineteenth-Century French Agency

Order for Profit: On the Architecture of a Nineteenth-Century French Agency

The Cretaceous deposits of the Paris Basin

Abstract Since the creation of the Cretaceous system by Jean-Baptiste d'Omalius d'Halloy, numerous analyses have provided details about the Cretaceous sedimentary successions of the Paris Basin, where many boreholes have been drilled. We present a synthesis of the Cretaceous deposits using data from recent drilling carried out in the central and eastern parts of the basin which, during the early Cretaceous, corresponded to a continental environment represented by Wealden facies. However, from the Berriasian to the Barremian, the southeastern part of the basin was occasionally invaded by a shallow sea during transgressions originating from the Tethys Ocean. The sedimentary successions of this age presented in this article have been studied thanks to drilling carried out by Andra (French Agency for Nuclear Waste Disposal). Several new results are presented here: a discussion on the age of the Argiles ostréennes, the identification of an equivalent of oceanic anoxic event (OAE)1a, and the construction of a continuous section of the Albian clays in their type area. Regarding the Upper Cretaceous chalk, the Cenomanian to Maastrichtian stages are represented over the entire basin and correlations are proposed based on biostratigraphic data and various marker beds including marly levels, bentonites, hardgrounds and eco-events.

Cost-effectiveness of the ONCORAL multidisciplinary programme for the management of outpatients taking oral anticancer agents at risk of drug-related event: protocol for a pragmatic randomised controlled study

IntroductionThe development of oral anticancer agents (OAA) has profoundly changed cancer care, leading patients to manage their chemotherapy treatment on an outpatient basis. The prevention of iatrogenic effects of OAA...

Length–weight relationships of the French pikes Esox spp. (Teleostei, Esocidae)

Length–weight relationships for Pike Esox aquitanicus and Esox lucius from France are provided. A total of 9070 specimens were collected, measured and weighted from 1981 to 2022 throughout France by Departmental Angling Federations and the French Agency of Biodiversity during their survey by electrofishing. For all species, the values of b are 2.960 for E. aquitanicus and 2.987 for Esox lucius. We hypothetize this difference by the poor environment where live the Aquitanian pike with no abundant available food and small prey fish species which do not contribute to good conditions for the growth. The study provides the first reference of length–weight relationships for E. aquitanicus.

MRI volumetry and diffusion tensor imaging for diagnosis and follow-up of late post-traumatic injuries

BackgroundTraumatic Brain Injury (TBI) is a major cause of acquired disability and can cause devastating and progressive post-traumatic encephalopathy. TBI is a dynamic condition that continues to evolve over time. A better understanding of the pathophysiology of these late lesions is important for the development of new therapeutic strategies. ObjectivesThe primary objective was to compare the ability of fluid-attenuated reversion recovery (FLAIR) and diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) markers to identify participants with a Glasgow outcome scale extended (GOS-E) score of 7–8, up to 10 years after their original TBI. The secondary objective was to study the brain regionalization of DTI markers. Finally, we analyzed the evolution of late-developing brain lesions using repeated MRI images, also taken up to 10 years after the TBI. MethodsIn this retrospective study, participants were included from a cohort of people hospitalized following a severe TBI. Following their discharge, they were followed-up and clinically assessed, including a DTI-MRI scan, between 2012 and 2016. We performed a cross-sectional analysis on 97 participants at a median (IQR) of 5 years (3–6) post-TBI, and a further post-TBI longitudinal analysis over 10 years on a subpopulation (n = 17) of the cohort. ResultsAlthough the area under the curve (AUC) of FLAIR, fractional anisotropy (FA), and mean diffusivity (MD) were not significantly different, only the AUC of FA was statistically greater than 0.5. In addition, only the FA was correlated with clinical outcomes as assessed by GOS-E score (P<10−4). On the cross-sectional analysis, DTI markers allowed study post-TBI white matter lesions by region. In the longitudinal subpopulation analysis, the observed number of brain lesions increased for the first 5 years post-TBI, before stabilizing over the next 5 years. ConclusionsThis study has shown for the first time that post-TBI lesions can present in a two-phase evolution. These results must be confirmed in larger studies. French Data Protection Agency (Commission nationale de l'informatique et des libertés; CNIL) study registration no: 1934708v0.

Acute Effects of Brevetoxin-3 Administered via Oral Gavage to Mice.

Brevetoxins (BTXs) constitute a family of lipid-soluble toxic cyclic polyethers mainly produced by Karenia brevis, which is the main vector for a foodborne syndrome known as neurotoxic shellfish poisoning (NSP) in humans. To prevent health risks associated with the consumption of contaminated shellfish in France, the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) recommended assessing the effects of BTXs via an acute oral toxicity study in rodents. Here, we investigated the effect of a single oral administration in both male and female mice with several doses of BTX-3 (100 to 1,500 µg kg-1 bw) during a 48 h observation period in order to provide toxicity data to be used as a starting point for establishing an acute oral reference dose (ARfD). We monitored biological parameters and observed symptomatology, revealing different effects of this toxin depending on the sex. Females were more sensitive than males to the impact of BTX-3 at the lowest doses on weight loss. For both males and females, BTX-3 induced a rapid, transient and dose-dependent decrease in body temperature, and a transient dose-dependent reduced muscle activity. Males were more sensitive to BTX-3 than females with more frequent observations of failures in the grip test, convulsive jaw movements, and tremors. BTX-3's impacts on symptomatology were rapid, appearing during the 2 h after administration, and were transient, disappearing 24 h after administration. The highest dose of BTX-3 administered in this study, 1,500 µg kg-1 bw, was more toxic to males, leading to the euthanasia of three out of five males only 4 h after administration. BTX-3 had no effect on water intake, and affected neither the plasma chemistry parameters nor the organs' weight. We identified potential points of departure that could be used to establish an ARfD (decrease in body weight, body temperature, and muscle activity).

Fate of nitrogen in French human excreta: Current waste and agronomic opportunities for the future

Nitrogen (N) is essential for plant growth and protein synthesis but global reactive N losses, mainly from food systems, induce strong environmental impacts. N losses after human excretion are often overlooked because, in Western societies, they partly occur as inert N2, following denitrification in wastewater treatment plants (WWTP), and losses in waters are often small compared to diffuse agricultural emissions. Yet N from human excretions could be used for crop fertilization, potentially with very high recycling rates via source separation. In this study we use unique operational data from the ∼20,000 French WWTPs to produce a N mass-balance of excretions in the French sanitation system. Even though 75 % of WWTPs' sludge is spread on crops, only 10 % of the excreted N is recycled and 50 % of N is lost to the atmosphere, mainly through WWTP nitrification-denitrification. The remaining 40 % ends up in water or in diffuse losses in the ground, of which about half is lost outside of the WWTPs' discharge system, through sewers storm water and individual autonomous systems. While WWTPs removal efficiency increased in the 2000s, it has been followed by a decade of stagnation, reaching 70 % at the national level. This national average hides regional discrepancies, from 60 to 85 % in the 6 French water agencies basins. These differences closely correlate with the classification as “N sensitive areas” and is mainly due to large WWTPs which handle most of the N load. Recycling all N in excretions could supply 10 % of domestic protein consumption in the current French food system, and up to 30 % if it is prioritized towards crop production for human consumption. Redesigning the food system (decrease of nutrient losses, more plant-based diets) could further increase this contribution.

PP97 How Health Technology Agencies Estimate Target Population Size For Medical Devices: The Example Of Spinal Cord Stimulation

IntroductionSpinal cord stimulation (SCS) is an effective and safe option for patients with refractory neuropathic pain, with positive health technology assessment (HTA) recommendations across Western Europe, yet SCS uptake remains low. Estimating target patient populations within HTAs may impact upon medical device uptake, pricing and access. However, there is a dearth of information on how this is typically conducted. This study aimed to compare the approaches of Western Europe HTA agencies for estimating the target population for SCS.MethodsA survey was conducted among members of the Health Economics and Reimbursement function from Western Europe to collect country-specific information on how HTA agencies assess the target population of medical devices (MD). The estimations of the target population for SCS were extracted from HTA publications and compared.ResultsEight Health Economics and Reimbursement (HER) Analysts from France, Germany, the United Kingdom (UK), Belgium, Spain, Italy, Sweden and Norway completed the survey. HTA Agencies in France, UK and Belgium routinely ask for epidemiological data in the manufacturer submission, whereas in Germany, Sweden and Norway the request is dependent on the type of HTA submission. All HTA agencies, except NICE (UK), perform an independent estimation of the target population. HTA agencies in Germany and UK typically use epidemiological data from industry. In all countries, the estimation of the target population may indirectly impact the price of the MD, especially when budget impact analysis indicates a potential high use of healthcare resources. Only France, Belgium and UK have published HTA recommendations about SCS, however the estimated target population, nor the number of patients with refractory neuropathic pain, is not always included. Only the French and UK HTA agencies publish an approximation of the target population for SCS using the number of patients implanted every year.ConclusionsThis study showed there is a lack of harmonization between Western European HTA agencies’ guidelines on the inclusion and estimation of target patient populations. The new EU HTA Regulation should help to address this situation.

Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study

Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference -23%, 95% CI -33 to -13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (-13%, -24 to -3; p=0·01). DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. For the French and Portuguese translations of the abstract see Supplementary Materials section.

Implementation of Biocontrol Macro-Organisms in France

The use of macro-organisms for crop protection is one of the four pillars of biocontrol. These predators or parasitoids of crop pests are used, by introduction or conservation, in fields, greenhouses and orchards in order to reduce the impact of sucking (sap-feeding) or chewing (phytophagous) insects. However, plant protection is not the only usage of these macro-organisms, and the category was recently expanded to include global usefulness for plants in Europe. Since 2012, under the provisions of Articles L. 258-1 and -2, R. 258-1 of the French Rural and Maritime fishing Code (CRPM), and Decree no. 2012-140 of 30 January 2012, the introduction of non-indigenous macro-organisms has been regulated. Using all published national regulations, organism lists and outcomes from the French Agency for Food, Environmental and Occupational Health Safety (ANSES), we have characterized these indigenous and allowed non-indigenous macro-organisms in a systemic and complete way. After first studying these regulations and their impact in 2018, we analyze here the macro-organisms involved and their implementation regarding their origins, targets and applications in crop growth and protection.

#5120 CARBON FOOTPRINT OF IN-CENTER HEMODIALYSIS: RESULTS OF A FRENCH PILOT STUDY

Abstract Background and Aims Since the beginning of the industrial era, human activities have led to a significant increase in the concentration of greenhouse gases (GHGs) in the atmosphere and are the cause of climate change, the negative effects of which on human health are already visible (1). Paradoxically, the health sector also exerts a major pressure on the environment through carbon-based care activities that emit GHGs (2). In this context, a few studies have highlighted the significant carbon footprint associated with hemodialysis (3). However, to date, no similar study has been conducted in France. Method The objective of this work was to evaluate the carbon footprint of a hemodialysis unit in France using the Bilan Carbone ® approach developed by The French Agency for Ecological Transition and the Bilan Carbone Association. Activity data associated with hemodialysis provision at the Charles De Gaulle facility in 2021 was collected and converted to a common measurement unit of tonnes of CO2 equivalents (t CO2-eq) via established emissions factors. This facility, that belongs to the ARTIC 42 association, is located in the town of Saint-Priest en Jarez and provides hemodialysis through a total of 56 hemodialysis generators. Results Over the year 2021, the Charles de Gaulle facility provided a total of 25270 hemodialysis treatments ensuring the care of approximately 162 patients (at a rate of 3 sessions per week). The associated annual carbon footprint for the facility was 1436 t CO2-eq. Annual carbon footprint amounted to 8.9 t CO2-eq/patient/year corresponding to 57 kg CO2-eq /treatment. Emissions were essentially indirect, with more than 90% coming from scope 3. The main sources of emissions were: products and services purchase (30% of total emissions, that is 437 t CO2-eq), patients and staff travels (25% of total emissions, that is 361 t CO2-eq), and fixed assets (21% of total emissions, that is 299 t CO2-eq). Energy consumption (particularly electricity) and waste treatment accounted for a small proportion of GHG emissions (respectively 8% et 6%). Conclusion Our results confirm the high carbon footprint associated with in-center hemodialysis, showing that it is mainly attributable to indirect emissions. These empirical data will serve as a basis for reflection in the development of a strategy to reduce GHG emissions associated with hemodialysis. This work will hopefully be paving the way for the necessary ecological transition of medical practices, focused on the patient and the ecosystems on which he/she depends.

Emerging phycotoxins in the Chilean coast: First localized detection of the neurotoxic cyclic imine Pinnatoxin-G in shellfish banks

Pinnatoxins (PnTXs) produced by the cosmopolitan dinoflagellate Vulcanodinium rugosum are highly potent cyclic imines that represent a risk for seafood consumers, artisanal fisheries, and the local aquaculture industry. Among the eight known PnTXs, pinnatoxin-G (PnTX-G) is the most frequent toxin analog detected in shellfish. Despite PnTX-G is still not internationally regulated, the French Agency for Food, Environmental and Occupational Health and Safety established that a risk for human consumers may exist when the accumulation of PnTX-G in shellfish exceeds 23 μg kg−1. This study reports the first detection of these fast-acting lipophilic toxins in localized shellfish banks (Mytilus chilensis) from the Chilean coast. Among 32 sentinel sampling stations monthly monitored for phytotoxins detection and quantification between 2021 and 2022 along the southern Chilean coast (from 36°25′ S to 54°57′S), PnTx-G was only detected in shellfish from the southernmost region of Magallanes in concentrations that ranged between 15 and 100 μg kg−1, highlighting the binational (Chile/Argentina) Beagle Channel as a ‘hotspot’. As Chile is one of the major mussel producers worldwide, this result raises concern about the potential adverse effect of PnTXs for human health and point to the need of governmental actions for an enhanced monitoring of these emerging toxins. To date, the production of PnTXs has not yet been associated with any microalgae species in Chilean waters.