Scale In France Research Articles

Digital literacy of patients with chronic heart failure using telemedicine in france: a national observational cohort study

Abstract Introduction Remote patient monitoring (RPM) is increasingly considered for chronic care management. However, several challenges exist for its implementation such as funding resources, lack of standardizations and gaps in digital literacy. Objective The aim of this study was to describe patients using RPM to manage chronic heart failure (CHF) according to their digital literacy at a national scale in France. Methods A national retrospective study was conducted using a remote monitoring system for the management and therapeutic guidance of patients with CHF. Patients were categorized according to their digital literacy (digitally literate vs poor digital literacy). The latter were identified as requiring nurse assistance in medical data entry. Data collection included baseline characteristics, comorbidities, RPM status, heart failure-related hospitalizations and mortality. Results Of the 12,072 patients with CHF enrolled for RPM follow-ups (male: 65.4%, mean age: 74.2±13.1 years), 43.3% had poor digital literacy. These patients were older (79.4±10.2 vs 70.2±13.6 years) and were less among males (39.7% vs 60.3%). Overall, digitally literate patients had more comorbidities, including diabetes (61.8%) and obesity (69.4%). Over a third of all patients withdrew from RPM (37.0%). Continued use of RPM was higher in digitally literate patients (60.1% vs 39.9%, p<0.001). Mortality was higher in patients with poor digital literacy (OR: 0.71, 95%CI: 0.66 to 0.78, p<0.0001). Poor digital literacy was linked to increased occurrences of HF episodes in contrast to digitally literate patients (34.1% vs 25.8%) who had an uHR of 0.66 (95%CI: 0.62 to 0.71, p<0.0001), and an aHR of 0.68 (95%CI: 0.64 to 0.73, p<0.0001). Conclusion Patients with poor digital literacy form a sizable subgroup in heart failure management and may require specialized tools tailored to their needs. Prevalence of poor digital literacy may increase the risk of HF hospitalization and mortality and reduce RPM adherence.

Small independent retailers: digitalize or disappear? An empirical study based on dynamic capabilities

PurposeThis study analyzes how small French retailers are adapting their front-office to the digitalization of their business environment.Design/methodology/approachThe qualitative study focuses on dynamic capabilities of 27 independent French retailers, in a wide variety of sectors.FindingsThe digitalization of small retailers does not date from the pandemic health crisis. Small retailers are willing, agile and organized to make controlled progress, ranging from the visibility on social networks to online sales with its specific logistical constraints. Even if their presence on marketplaces is trickier to implement, it represents the culmination of the digitalization process, once their online store has been launched. The digital transformation of independent retailers should be less radical than for large retailers.Research limitations/implicationsBy distinguishing between the concepts of adaptive, absorptive and innovative capabilities, this research highlights strong differences between small retailers, that is SMEs, and larger companies. In terms of adaptive capabilities, it confirms that small retailers are not embracing digitalization as a fad, but because of real changes in the market, and particularly in demand. In contrast to large companies, small retailers drive it more around external objectives linked to their intimate knowledge of changing customer behavior (customer centricity). In terms of absorptive capabilities, the success or failure of digital transformation weighs directly on the entrepreneur's shoulders, but is less hampered by technological legacy. Despite interviews only conducted in the Paris region, it converges with professional studies carried out on a larger scale in France. Its widespread use is certainly easier in countries at the same stage of commercial development.Practical implicationsIn terms of innovative capabilities, independent retailers need to focus on four key areas: reinventing the in-store experience; increasing visibility on social networks; creating an online store; being present in one or two marketplaces or creating a common platform with other local merchants.Originality/valueThis research is one of the first to analyze the digital transformation experienced by small structures. It draws on the concept of dynamic capabilities, well-suited to technologically and commercially dynamic markets. It puts into perspective studies carried out in other countries on less diversified types of shops. Unlike other studies examining the front office, it does not exclude stores and SEO in marketplaces.

Validation of the Medical Research Council prion disease rating scale in France.

The development of assessment tools other than survival time is necessary to conduct therapeutic trials in prion diseases (also known as subacute transmissible encephalopathies). The Medical Research Council Prion Disease Rating Scale published by Thompson et al. (The Medical Research Council prion disease rating scale: A new outcome measure for prion disease therapeutic trials developed and validated using systematic observational studies. Brain. 2013; 136: 1116-27.) is the first attempt at a specific evaluation of prion diseases to avoid the floor effect seen in other scales. Validation of this scale in other countries is essential because, given the rarity of these diseases, therapeutic trials are likely to be multi-centre and international. After translation into French, we assessed by phone 173 cases classified as sporadic Creutzfeldt-Jakob disease out of 852 patients notified to the French national surveillance network between November 2014 and May 2021. Data showed that the natural history of the disease is similar in the UK and France. Patients who have a heterozygous genotype at codon 129 of the prion protein gene have a slower decline than homozygous patients. In rapidly progressing patients, death occurs shortly after reaching a low score or after a 'pre-terminal plateau' at a very low score. The similarities of disease progression profile observed in France and the UK with somewhat different surveillance systems and by distinct procedures highlight the robustness of the Medical Research Council Prion Disease Rating Scale that can be thus used to define primary endpoints of future trials at the international level.

COVID-19 lockdown related to decrease in premature birth rate and increase in birth weight in metropolitan France.

The worldwide rate of preterm birth (PTB) has been increasing over the last two decades. COVID-19 lockdowns provide a unique opportunity to assess the effects of socioenvironmental and lifestyle factors on premature birth and birth weight. We explored the effects of COVID-19 lockdowns on the PTB rate and birth weight at a nationwide scale in France until one year after their occurrence. This national retrospective observational study evaluated the rate of PTB and birth weight in France from January 2016 to December 2020. Data were obtained from the national Programme Médicalisé des Systèmes d'Information database. The rates of global and sub-categories of PTB were tested. The birth weight was studied before and after lockdown for all live births, for term and premature neonates, and for each category of low birth weight (LBW) by a stratified analysis. Data from 2,949,372 births from January 2016 to December 2019, including 228,857 PTB, were compared to those of 699,344 births and 51,886 PTB from January to December 2020. The national rate of PTB decreased significantly from 7.7% to 7.3%, when compared with the 2016-2019 period. This decrease was persistent up to 9 months later. It was observed only for moderate PTB, whereas very PTB and extremely PTB remained stable. The national mean birth weight for full-term babies increased after the lockdown and was still observable up to 8 months later (+0.16%, p < 0.0001). The proportion of children with LBW also decreased 2 months after lockdown (-0.15%; p = 0.02). For VLBW, the difference only appeared over the 6-month post-lockdown period (-0.06%; p = 0.006). This nationwide study shows a significant reduction in prematurity and a significant increase in birth weight in France after the lockdown for a period of time not limited to the lockdown itself. A more in-depth study of the factors determining these variations may help to drive PTB prevention policies.

Consideration of unmeasured micropollutants released from WWTP for potential impact estimations

During wastewater treatment, micropollutants are only partly eliminated and may present a risk for human health and aquatic ecosystems. The potential impacts these substances may have are currently underestimated due to the lack in available concentrations that lie below the limit of quantification (LOQ) for an important set of micropollutants. Here, the potential impacts due to 261 organic micropollutants on human health and aquatic environments were investigated at the scale of France. Even with concentrations below the LOQ, certain micropollutants were found to have a significant potential impact. For unmeasured concentrations, a global concentration distribution built from several datasets with different LOQ was used. By disregarding the unmeasured micropollutants, the potential impacts have been underestimated by >300 % on both human health and aquatic environments. Certain substances, such as hydrazine, endrin, or 2,3,7,8-TetraCDD, could lead to very strong potential impacts, even with unmeasured concentration levels. Moreover, the usual convention of LOQ/2 to replace unmeasured concentrations also appeared to overestimate the potential impact. The present work can be adapted to any other compartment or geographical context.

The Z-2018 emissions inventory of COS in Europe: A semiquantitative multi-data-streams evaluation

The anthropogenic emissions of carbonyl sulfide (COS) and the uptake of this gas by terrestrial vegetation are major drivers of COS concentration variations in the atmosphere since the beginning of the industrial era. The fine spatial resolution (i.e., 0.1° × 0.1°) of the gridded anthropogenic emissions inventory of COS developed by Zumkehr et al. (2018), Z-2018 hereafter, is designed for a use by regional chemistry-transport models. In order to anticipate future applications at the regional scale, we carried out a first semiquantitative assessment of direct and indirect (i.e., from CS2 conversion) COS anthropogenic emissions at the sub-country scale in France using historical governmental data. Better agreement between the two inventories was found for direct emissions of COS by coal power plants, than for indirect sources. The use in this latter case of a sub-country spatial scaling, based on industrial N2O emissions, (1) strongly underestimates fluxes from food casings and cellulosic sponge industrial activities responsible for atmospheric CS2 emissions in France, and (2) considerably overestimates emissions from Paris and surrounding areas, which are free of a rayon industry. A list of food casings and cellulosic sponge industrial sites is provided to produce a more realistic inventory of CS2 sources in Europe. Nevertheless, a cluster analysis of wintertime air masses trajectories, with the atmospheric COS monitoring site of Gif-sur-Yvette (GIF) as end point, suggests that Z-2018 correctly identifies northern Germany and Belgium as sources of anthropogenic COS. In winter, when the wind blows from the NE sector, advection of anthropogenic COS from coal power plants is illustrated by synchronous variations in GIF and at the Trainou tall tower (distant of about 80 km) of a series of atmospheric pollution tracers, especially between COS and sulfates. These observations support the use of SO2 emissions as temporal and sub-country spatial scaling factors of COS emissions by the coal industry.

Gastroenteritis Forecasting Assessing the Use of Web and Electronic Health Record Data With a Linear and a Nonlinear Approach: Comparison Study.

Disease surveillance systems capable of producing accurate real-time and short-term forecasts can help public health officials design timely public health interventions to mitigate the effects of disease outbreaks in affected populations. In France, existing clinic-based disease surveillance systems produce gastroenteritis activity information that lags real time by 1 to 3 weeks. This temporal data gap prevents public health officials from having a timely epidemiological characterization of this disease at any point in time and thus leads to the design of interventions that do not take into consideration the most recent changes in dynamics. The goal of this study was to evaluate the feasibility of using internet search query trends and electronic health records to predict acute gastroenteritis (AG) incidence rates in near real time, at the national and regional scales, and for long-term forecasts (up to 10 weeks). We present 2 different approaches (linear and nonlinear) that produce real-time estimates, short-term forecasts, and long-term forecasts of AG activity at 2 different spatial scales in France (national and regional). Both approaches leverage disparate data sources that include disease-related internet search activity, electronic health record data, and historical disease activity. Our results suggest that all data sources contribute to improving gastroenteritis surveillance for long-term forecasts with the prominent predictive power of historical data owing to the strong seasonal dynamics of this disease. The methods we developed could help reduce the impact of the AG peak by making it possible to anticipate increased activity by up to 10 weeks.

Converting carbon vulnerable lands to wood plantations for use as building materials: Overall environmental performance and time-dependent assessment of carbon dioxide removals

Bioeconomy addresses the triple balancing challenge posed by the Paris Agreement: inducing additional GHG mitigation alongside biophysical carbon dioxide removals, while keeping fossil carbon in the ground. The use of woody plants as construction materials could simultaneously address this challenge: CO2 is absorbed through photosynthesis, while wood-based products provide mitigation by replacing either petrochemical materials such as plastic boards or energy-intensive materials like bricks. This study combines, at the scale of France, static and dynamic life cycle assessment with soil carbon simulations to investigate the long-term environmental performance of using, as input for the building sector, black locust (Robinia pseudoacacia L.) planted on “carbon vulnerable lands”. These are areas specifically selected for their low soil organic carbon (SOC) levels and low potential to interfere with food security. After the consecutive cultivation of three rotations, black locust was shown to stock an additional 92000 kg ha−1 of carbon in soils as SOC. The mitigation effect from the plastic board replacement is the major contributor to the assessed environmental impacts, including climate change, leading the black locust system to generally perform better than the reference system where the carbon vulnerable areas are left as they are with their initial vegetation. Considering that cultivation starts in 2022, the dynamic evaluation of the global mean temperature change (GMTC) shows that the black locust system results in net negative emissions in the near- and mid-term, but with a GMTC overshot in the second half of the century. Even if a considerable carbon stock is created through time (e.g., 81% and 39% of the carbon captured by photosynthesis, in 2050 and 2100 respectively), the GHG emissions stemming from manufacturing and end-of-life processes were shown to offset the benefit of carbon capture.

How much agricultural land is there close to residential areas? An assessment at the national scale in France

In 2019, aiming at reducing resident's exposure to pesticides, the French government announced mandatory pesticide-free buffer zones of 3–20 m around inhabited areas. As pesticide reduction is often associated with lower productivity, this raised questions about the amount of agricultural area located around residential buildings, which has not yet been quantified in France. The best available data describing spatial organization of crops at the field parcel scale and location of residential buildings over the whole French territory were combined to calculate the amount of agricultural area within 10 m, 50 m, 100 m, and 150 m (a distance advocated by some environmental NGOs) to residential buildings for 23 crop types. Results show that 0.2%, 5%, 16%, and 29% of the total national agricultural area is located within 10 m, 50 m, 100 m, and 150 m to residential buildings, respectively. The proportion of crop-specific national area that is close to housings is low at 10 m (0–1%) and increases up to 10–58% depending on crop type at 150 m. About 32%–45% of vineyards and 37%–53% of orchards national area, two crop types with high pesticide use intensity, are located within 150 m to residential buildings. We conclude that (i) the implementation of pesticide-free buffer zones around housings may have a strong impact on agricultural production at the national scale because of likely associated yield and quality losses on large areas, and (ii) the large presence of treated crops close to residential buildings requires attention for its potential effect on residents' exposure to pesticides.

What complete mitochondrial genomes tell us about the evolutionary history of the black soldier fly, Hermetia illucens

BackgroundThe Black Soldier Fly (BSF) Hermetia illucens is a cosmopolitan fly massively used by industrial companies to reduce biowaste and produce protein and fat for poultry and aquaculture feed. However, the natural history and the genetic diversity of the BSF are poorly known. Here, we present a comprehensive phylogeny and time tree based on a large dataset of complete mitochondrial genomes better to understand the evolution and timing of the BSF.ResultsIn this study, we analyzed 677 CO1 sequences derived from samples found all over the five continents, leading us to discover 52 haplotypes, including ten major haplotypes. This worldwide cryptic genetic and genomic diversity is mirrored at a local scale in France, in which we found five major haplotypes sometimes in sympatry. Phylogenetic analyses of 60 complete mitochondrial genomes robustly resolved the phylogeny of the major BSF haplotypes. We estimate the separation events of the different haplotypes at more than 2 million years for the oldest branches characterizing the ancestral split between present North American lineages and the other highly diverse south-central American clades, possibly the following radiation beyond the isthmus of Panama northwards. Our data confirm that this North American lineage ultimately gave birth to almost all commercial BSF stocks that participated in the worldwide BSF dissemination through farm escapements.ConclusionsOur data resolve the phylogenetic relationships between the major lineages and give insights into the BSF’s short and long-term evolution. Our results indicate that commercial BSF stock’s genetic and genomic diversity is very low. These results call for a better understanding of the genomic diversity of the BSF to unravel possible specific adaptations of the different lineages for industrial needs and to initiate the selection process.

Spatialized epidemiological forecasting applied to Covid-19 pandemic at departmental scale in France.

In this paper, we present a spatialized extension of a SIR model that accounts for undetected infections and recoveries as well as the load on hospital services. The spatialized compartmental model we introduce is governed by a set of partial differential equations (PDEs) defined on a spatial domain with complex boundary. We propose to solve the set of PDEs defining our model by using a meshless numerical method based on a finite difference scheme in which the spatial operators are approximated by using radial basis functions. Such an approach is reputed as flexible for solving problems on complex domains. Then we calibrate our model on the French department of Isère during the first period of lockdown, using daily reports of hospital occupancy in France. Our methodology allows to simulate the spread of Covid-19 pandemic at a departmental level, and for each compartment. However, the simulation cost prevents from online short-term forecast. Therefore, we propose to rely on reduced order modeling to compute short-term forecasts of infection number. The strategy consists in learning a time-dependent reduced order model with few compartments from a collection of evaluations of our spatialized detailed model, varying initial conditions and parameter values. A set of reduced bases is learnt in an offline phase while the projection on each reduced basis and the selection of the best projection is performed online, allowing short-term forecast of the global number of infected individuals in the department. The original approach proposed in this paper is generic and could be adapted to model and simulate other dynamics described by a model with spatially distributed parameters of the type diffusion–reaction on complex domains. Also, the time-dependent model reduction techniques we introduced could be leveraged to compute control strategies related to such dynamics.

Circulating serogroups of Leptospira in swine from a 7-year study in France (2011\u20132017)

BackgroundLeptospirosis is a widespread zoonotic disease caused by pathogenic Leptospira and is responsible for significant economic porcine livestock losses. Knowledge of Leptospira serogroups and their distributions is important for evaluation of the relevance of leptospirosis management measures, including use of the prophylactic vaccine that was recently made available in France. A retrospective study was conducted to determine the relationships between different circulating Leptospira serogroups. Pigs from across France presenting clinical signs suggestive of leptospirosis were tested with the microagglutination test (MAT) between 2011 and 2017. We used weighted averages to determine serogroup distributions according to MAT results and considering cross-reactions.ResultsA total of 19,395 pig sera, mostly from Brittany, were tested, and 22.7% were found to be positive for at least one Leptospira serogroup. Analysis of the 4,346 seropositive results for which the putative infective serogroup could be defined, revealed that two out of ten serogroups were much more frequent than the others: Australis (48.5%) and Icterohaemorrhagiae (38.2%). Other serogroups, including Autumnalis, Panama, Ballum, Tarassovi, Sejroe, Grippotyphosa, Bataviae, and Pomona, were less common.ConclusionsAlthough diagnostic laboratory data cannot be extrapolated to infer the distribution of Leptospira serogroups at the nationwide scale in France, the analysis of such data can provide an overview of the relationship between circulating Leptospira serogroups in space and time. During the last decade, protection against the serogroups Australis and Icterohaemorrhagiae would have prevented most of the clinical porcine leptospirosis cases in the large number of farms that we studied. In the future, epidemiological information related to circulating Leptospira serogroups should be extracted from data with a standardized approach for use in nationwide or international surveillance and prophylactic strategy support.

Use of electroconvulsive therapy for individuals receiving inpatient psychiatric care on a nationwide scale in France: Variations linked to health care supply

BackgroundA comprehensive understanding of variations in the use of electroconvulsive therapy (ECT) among health care providers in charge of ECT referrals is lacking. ObjectiveOur objectives were to document ECT use and its variations on a nationwide scale in France and to identify the factors that were significantly associated with these variations. MethodsAdministrative health claims data on hospitalization were used to perform a descriptive analysis of ECT use for adult patients receiving inpatient psychiatric care in mainland France in 2019 and its variations across hospitals in charge of ECT referrals. Based on a conceptual framework drawn from the literature on medical practice variations, a multilevel logistic regression was then conducted to identify patients, hospitals and contextual characteristics that were significantly associated with ECT treatment using non-ECT-treated patients receiving inpatient psychiatric care as the reference population. ResultsPatients receiving ECT (n = 3288) were older, more frequently female and had more severe diagnoses than other patients seen in inpatient care (n = 295,678). Significant variations were observed in the rate of ECT use across hospitals (n = 468), with a coefficient of variation largely above one. In the multivariable analysis, ECT treatment was associated with patient characteristics (which accounted for 6% of the variations) but also with characteristics of the hospitals and their environments (44% of the variations), including the type of hospital and its distance to the closest facility providing ECT. ConclusionsVariations in ECT use were strongly linked to health care supply characteristics, which raises questions about access to quality mental health care.

Ventral Hernia Repair and Obesity: Results from a Nationwide Register Study in France According to the Timeframes of Hernia Repair and Bariatric Surgery.

Several strategies are suggested for ventral hernia repair (VHR) in bariatric candidates, in terms of timing and technique. The aim was to describe practices in VHR in bariatric patients on a nationwide scale in France. We used the prospective national hospital discharge summaries database system to conduct a retrospective cohort study. We included patients operated once for sleeve or bypass, between 2007 and 2018, and who had VHR concomitant with bariatric surgery (BS) or within 2years before or after. Among 11,680 eligible patients, 2039 underwent VHR in the 2years before BS, 3388 had concomitant BS and VHR, and 6260 patients had VHR within 2years after BS. Patients who underwent a concomitant surgery presented a higher suture repair rate (86.1% versus 37.1% and 44.0%, P < 0.001). Overall recurrence of VH at 10years was 23.3% and was higher for patients who underwent VHR first (36.2%) than patients who underwent BS first (24.5%) and the concomitant group (18.6%), P < 0.001. Major complication rate was 11.1%, 7.8%, and 16.9% (P < 0.001) for VHR-first, concomitant, and BS-first groups, respectively. Mesh infection was found in 0.6% (13/2039) of patients in the VHR-first group, in 0.6% (20/3388) in the concomitant group, and in 1.1% (68/6260) in the BS-first group (P < 0.001). About one-quarter of bariatric patients undergoing VHR will be reoperated for an anterior hernia. VHR before BS entailed a higher risk of reoperation for recurrence and should be avoided. A concomitant repair entailed the lowest rate of recurrence.

Designing an effective small farmers scheme in France

The 2014 CAP introduced the Small Farmers Scheme (SFS), offering small farms the option of an unconditional annual lump-sum payment per farm replacing the standard first pillar direct payments. This paper assesses the acceptability in France of an extended version of the 2014 SFS for the post-2020 CAP: it includes conditions on farmers' environmental efforts and on salaried employment. The results of a discrete choice experiment conducted at the scale of France with 608 farmers receiving less than 15,000€ in first pillar payments show that an SFS with an environmental certification prerequisite is attractive to French small farmers, notably in the market gardening sector. We provide simulated results of the uptake rate and budgetary impacts of different SFS scenarii on the population of non-retired French farmers based on the last agricultural census.

Bleeding and thromboembolism risk of standard antithrombotic prophylaxis after hip or knee replacement within an enhanced recovery program

IntroductionPrevention of venous thromboembolism (VTE) generally consists of low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Enhanced recovery after surgery (ERAS) protocols may reduce the VTE risk after these procedures. The aim of this study was to compare the risk of VTE and the risk of bleeding complications in a non-selected population of primary THA and TKA cases done within an ERAS protocol. HypothesisThe risk of postoperative VTE after primary THA and TKA is lower than the risk of bleeding complications within an ERAS protocol. MethodsThis was a prospective observational study conducted on a national scale in France. All patients who underwent primary unilateral THA or TKA at one of 11 participating hospitals between October 2016 and October 2017 were enrolled and followed for 3 months. The occurrence of a VTE or major bleeding event was recorded. No patients were lost to follow-up at 3 months. ResultsOf the 1110 THA cases, there were 5 VTE (0.4%) and 19 bleeding events (1.7%). Of the 893 TKA cases, there were 9 VTE (1.0%) and 14 bleeding events (1.7%). There was no significant difference in the VTE incidence and bleeding event incidence after THA and TKA. The overall incidence of bleeding complications (1.7%) was significantly greater than the overall incidence of VTE complications (0.7%) (p=0.005). This was the case after THA (p=0.004) but not after TKA. DiscussionThe primary finding of this study is that bleeding complications are significantly more common than VTE complications after THA or TKA within an ERAS protocol. Based on these findings, the cost-benefit ratio of antithrombotic prophylaxis by LMWH or DOACs in this context should be reassessed.Level of evidence: IV; Prospective cohort study without control group.

Fast track protocol for primary total hip arthroplasty in non-trauma cases reduces the length of hospital stay: Prospective French multicenter study

BackgroundFast-track (FT) procedures continue to evolve; however, their benefits are still controversial. This led us to conduct a prospective study of FT procedures for total hip arthroplasty (THA) on a national scale in France with historical control data. The aims were to (1) evaluate the effectiveness of FT procedures after THA on the length of hospital stay (LOS) in a multicenter analysis, (2) measure the immediate return to home, rehospitalization and reoperation rates. HypothesisFT procedures reduce the LOS after primary THA for non-traumatic indications relative to national historical data. MethodsA prospective observational study was done at 11 hospital facilities throughout France. Patients who underwent primary THA for a non-traumatic condition and FT procedures were followed for 3 months. The average LOS, discharge to home, unexpected readmissions, and reoperation rate were compared to 2016 figures from the French national database of 104,745 procedures on the same population. ResultsThe study included 1,110 patients, 499 men (45%) and 611 women (55%), with a mean age of 67.5±11.9 years. The average LOS was 3.3±2.9 days versus 7.5±5.3 days in the national database (p<0.001). Eight hundred eighty patients (79%) were discharged directly to home versus 72,577 (69%) in the national database (p<0.001). Forty-two patients (4%) were readmitted to the hospital within 90 days of the THA versus 11,092 (11%) in the national database (p<0.001). Eighteen patients (1.6%) were reoperated within 90 days of the THA procedure versus 2100 (2.0%) in the national database (p=0.72). DiscussionFT procedures help to significantly reduce the average LOS and rehospitalization rate after primary THA for non-traumatic conditions and significantly increased the percentage of patients being discharged directly to home relative to national historical data, without altering the risk of reoperation. FT procedures should become the standard of care after THA. Level of evidenceIII; prospective case-control study.

Impact assessment of a large panel of organic and inorganic micropollutants released by wastewater treatment plants at the scale of France

Micropollutants emitted by Human activities represent a potential threat to our health and aquatic environment. Thousands of active substances are used and go to WWTP through wastewaters. During water treatment, incomplete elimination occurs. Effluents released to the environment still contain part of the micropollutants present in the influents. Here, we studied the potential impacts on Human health and aquatic environment of the release of 261 organic micropollutants and 25 inorganic micropollutants at the scale of France. Data were gathered from national surveys, reports, papers and PhD works. The USEtox ® model was used to assess potential impacts. The impacts on Human health were estimated for 94 organic and 15 inorganic micropollutants and on aquatic environment for 88 organic and 19 inorganic micropollutants highlighting lack of concentration and toxicological data in literature. Some Polycyclic Aromatic Hydrocarbons and pesticides as well as As and Zn showed highest potential impacts on Human health. Some pesticides, PCB 101, βE2, Al, Fe and Cu showed highest potential impacts on aquatic environment.

Orthogeriatric assessment of patients over 75 years of age with a proximal femur fracture: Predictors of 6-month mortality

IntroductionProximal femur fractures are common and dangerous in older adults, given the high short-term mortality rate. While surgical treatment is vital, medical orthogeriatric care may reduce the 6-month mortality rate; however, this has not been determined on a broad scale in France. This led us to conduct a retrospective study to answer the following questions: (1) Does delayed surgical treatment impact the 6-month mortality rate? (2) Are there correctable medical factors that impact the 6-month mortality? HypothesisDelayed surgical treatment is not an isolated risk factor for higher 6-month mortality after proximal femur fracture. MethodsWe included all patients 75 years or older who had suffered a proximal femur fracture requiring surgical treatment. This allowed us to analyze the medical records of 476 patients retrospectively. We documented their comorbidities and pre-, intra- and postoperative characteristics. A univariate then multivariate analysis was done to identify risk factors for mortality at 6 months. ResultsIn the univariate analysis, time to surgery of more than 48hours increased the risk of dying at 6 months by 1.5 fold (Odds ratio (OR)=1.57/95% CI: 1–2.48/p=0.04). However, this risk factor was not significant in the multivariate analysis since it is not an independent risk factor. In the multivariate analysis, anticoagulants (OR=2/95% CI: 1.13–3.50/p=0.02), dementia (OR=2.2/95% CI: 1.32–3.59/p=0.002), peripheral artery disease (OR=2.9/95% CI: 1.10–7.70/p=0.03), 2-point drop in hemoglobin count from preoperative to postoperative (OR=1.9/95% CI: 1.05–3.12/p=0.04), male sex (OR=1.82/95% CI: 1.05–3.12/p=0.04), age above 85 years (OR=5.26/95% CI: 1.49–5.26/p=0.002) and Charlson comorbidity index≥7 (OR=2.13/95% CI: 1.29–3.52/p=0.003) were statistically associated with mortality at 6 months. Discussion/ConclusionOur study found that the patients most at risk for dying within 6 months of a hip fracture were males, older than 85 and have associated medical conditions (Charlson index≥7). Prior anticoagulant treatment increases the time to surgery in our study and therefore increases the risk of these patients dying within 6 months. Treatment of these at-risk patients should ensure that their underlying medical conditions are not made worse, while providing treatment within 48hours. Patients taking anticoagulants must be monitored carefully to ensure surgical treatment is not delayed. Level of evidenceIV, retrospective study without control group.

Measuring the Risk of Supply and Demand Imbalance at the Monthly to Seasonal Scale in France

Transmission system operator (TSOs) need to project the system state at the seasonal scale to evaluate the risk of supply-demand imbalance for the season to come. Seasonal planning of the electricity system is currently mainly adressed using climatological approach to handle variability of consumption and production. Our study addresses the need for quantitative measures of the risk of supply-demand imbalance, exploring the use of sub-seasonal to seasonal forecasts which have hitherto not been exploited for this purpose. In this study, the risk of supply-demand imbalance is defined using exclusively the wind energy production and the consumption peak at 7 pm. To forecast the risks of supply-demand imbalance at monthly to seasonal time horizons, a statistical model is developed to reconstruct the joint probability of consumption and production. It is based on a the conditional probability of production and consumption with respect to indexes obtained from a linear regression of principal components of large-scale atmospheric predictors. By integrating the joint probability of consumption and production over different areas, we define two kind of risk measures: one quantifies the probablity of deviating from the climatological means, while the other, which is the value at risk at 95% confidence level (VaR95) of the difference between consumption and production, quantifies extreme risks of imbalance. In the first case, the reconstructed risk accurately reproduces the actual risk with over 0.80 correlation in time, and a hit rate around 70–80%. In the second case, we find a mean absolute error (MAE) between the reconstructed and real extreme risk of 2.5 to 2.8 GW, a coefficient of variation of the root mean square error (CV-RMSE) of 3.8% to 4.2% of the mean actual VaR95 and a correlation of 0.69 and 0.66 for winter and fall, respectively. By applying our model to ensemble forecasts performed with a numerical weather prediction model, we show that forecasted risk measures up to 1 month horizon can outperform the climatology often used as the reference forecast (time correlation with actual risk ranging between 0.54 and 0.82). At seasonal time horizon (3 months), our forecasts seem to tend to the climatology.