Global review of COVID-19 mitigation strategies and their impact on cancer service disruptions.

During the COVID-19 pandemic, countries adopted mitigation strategies to reduce disruptions to cancer services. We reviewed their implementation across health system functions and their impact on cancer diagnosis and care during the pandemic. A systematic search was performed using terms related to cancer and COVID-19. Included studies reported on individuals with cancer or cancer care services, focusing on strategies/programs aimed to reduce delays and disruptions. Extracted data were grouped into four functions (governance, financing, service delivery, and resource generation) and sub-functions of the health system performance assessment framework. We included 30 studies from 16 countries involving 192,233 patients with cancer. Multiple mitigation approaches were implemented, predominantly affecting sub-functions of service delivery to control COVID-19 infection via the suspension of non-urgent cancer care, modified treatment guidelines, and increased telemedicine use in routine cancer care delivery. Resource generation was mainly ensured through adequate workforce supply. However, less emphasis on monitoring or assessing the effectiveness and financing of these strategies was observed. Seventeen studies suggested improved service uptake after mitigation implementation, yet the resulting impact on cancer diagnosis and care has not been established. This review emphasizes the importance of developing effective mitigation strategies across all health system (sub)functions to minimize cancer care service disruptions during crises. Deficiencies were observed in health service delivery (to ensure equity), governance (to monitor and evaluate the implementation of mitigation strategies), and financing. In the wake of future emergencies, implementation research studies that include pre-prepared protocols will be essential to assess mitigation impact across cancer care services.

Towards automated long-term acoustic monitoring of endangered river dolphins: a case study in the Brazilian Amazon floodplains.

Using passive acoustic monitoring (PAM) and convolutional neural networks (CNN), we monitored the movements of the two endangered Amazon River dolphin species, the boto (Inia geoffrensis) and the tucuxi (Sotalia fluviatilis) from main rivers to floodplain habitats (várzea) in the Mamirauá Reserve (Amazonas, Brazil). We detected dolphin presence in four main areas based on the classification of their echolocation clicks. Using the same method, we automatically detected boat passages to estimate a possible interaction between boat and dolphin presence. Performance of the CNN classifier was high with an average precision of 0.95 and 0.92 for echolocation clicks and boats, respectively. Peaks of acoustic activity were detected synchronously at the river entrance and channel, corresponding to dolphins seasonally entering the várzea. Additionally, the river dolphins were regularly detected inside the flooded forest, suggesting a wide dispersion of their populations inside this large area, traditionally understudied and particularly important for boto females and calves. Boats overlapped with dolphin presence 9% of the time. PAM and recent advances in classification methods bring a new insight of the river dolphins' use of várzea habitats, which will contribute to conservation strategies of these species.

Taxanes Versus Androgen Receptor Therapy as Second-Line Treatment for Castrate-Resistant Metastatic Prostate Cancer After First-Line Androgen Receptor Therapy.

BACKGROUND: The optimal therapeutic sequence for metastatic castrate-resistance prostate cancer (mCRPC) is still debated. This study aimed to compare activity of taxanes (TAX) versus that of androgen-receptor therapy (ART) in men with mCRPC treated with first-line ART. PATIENTS AND METHODS: This retrospective study included all consecutive chemo-naive mCRPC patients who have received first-line ART treatment. Progression-free survival (PFS) and overall survival (OS) were compared between patients treated with second-line ART or TAX. RESULTS: Overall, 175 patients treated with first-line enzalutamide (ENZA, n = 75) or abiraterone (ABI, n = 100) were evaluated. Among them, 69 (39%) and 30 (17%) patients received second-line TAX and ART, respectively, while 76 (43%) patients did not receive further treatment. From the start of first-line therapy, the median PFS and OS were 13 months (95% CI: 11-15) and 34 months (95% CI: 29-39), respectively, without any significant difference between ENZA and ABI. From the start of second-line therapy, the median PFS and OS were 6 months (95% CI: 5-7) and 18 months (95% CI: 14-21), respectively. Compared with ART, docetaxel was associated with significantly higher prostate-specific antigen (PSA, ≥ 50%) (29% vs. 0%, P < .001) and radiological responses (21% vs. 0%, P < .001). PFS was longer in TAX than in ART (6.7 months vs. 4 months, HR: 0.63, 95% CI: 0.41-0.96, P = .034), but there was no significant difference in OS (19 months vs. 12 months, P = .1). After propensity score adjustment, PFS (P = .2) and OS (P = .1) were similar between second-line TAX and ART. CONCLUSION: In the second-line setting, TAX provides higher PSA and radiological responses than does ART for mCRPC patients who received first-line ART, but the PFS and OS are similar. This study provides new elements to help deciding the best treatment sequence.

Cross-sensory interference assessment after exposure to noise shows different effects in the blue crab olfactory and sound sensing capabilities.

Underwater noise pollution is an increasing threat to marine ecosystems. Marine animals use sound in communication and orientation processes. The introduction of anthropogenic noise in their habitat can interfere with sound production and reception as well as with the acquisition of vital information through other sensory systems. In the blue crab (Callinectes sapidus), the statocyst is responsible for acoustic perception, and it is housed at the base of its first pair of antennae (antennule). The sensilla of the distal part of these antennule hosts the olfactory system, which is key for foraging. Given the anatomical proximity of the two sensory regions, we evaluated the possible interference of sound exposure with the crab ability to find food, by using an aquatic maze, and looked at the potential impairment of the righting reflex as well as at ultrastructural damages in statocysts. Although a significant effect was observed when looking at the time used by the animal to recover its habitual position ("righting reflex"), which was associated to lesions in the statocyst sensory epithelia, the time required to find food did not increase after the exposure to sound. When the crabs were exposed to natural sounds (marine background noise and sounds of their predators: Micropogonias undulates and Sciaenops ocellatus) they did not show significant differences in foraging behaviour. Although we found no unequivocal evidence of a negative impact of sound on olfactory capabilities, the study showed a clear righting reflex impairment correlated with ultrastructural damages of the statocysts. We argue that crab populations that cannot easily avoid noise sources due to their specific coastal distributions may incur in significant direct fitness costs (e.g. impairment of complex reflexes). This integrated approach to sound effect assessment could be used as a model for other invertebrate species to effectively monitor noise impact in marine environments.

Analysis of residual feed intake in Nellore bulls of different ages, rib eye area, and backfat thickness.

The aim of the present study was to use different models that include body composition phenotypes for the evaluation of residual feed intake (RFI) in Nellore bulls of different ages. Phenotypic and genotypic data of bulls that had participated in feed efficiency tests of a commercial (COM) and an experimental (EXP) herd between 2007 and 2019 were used. The mean entry age in the two herds was 645 and 279 days, respectively. The phenotypes were evaluated: rib eye area (REA), backfat thickness (BFT), residual feed intake (RFIKOCH), RFI adjusted for REA (RFIREA), RFI adjusted for BFT (RFIBFT), and RFI adjusted for REA and BFT (RFIREA BFT). The (co)variance components and prediction of genomic estimated breeding values (GEBV) were obtained by REML using ssGBLUP in single and two-trait analyses. Spearman's correlations were calculated based on the GEBV for RFIKOCH. The RFI phenotypes exhibited moderate heritability estimates in both herds (0.17 ± 0.03 to 0.27 ± 0.04). The genetic correlation between phenotypes was positive and high (0.99) in the two herds, a fact that permitted the creation of a single database (SDB). The heritability estimates of the SDB were also of moderate magnitude for the different definitions of RFI (0.19 ± 0.04 to 0.21 ± 0.04). The genetic correlations were positive and high between RFI traits 0.97 ± 0.01 to 0.99 ± 0.01), and positive and low/moderate between REA and BFT (0.01 ± 0.10 to 0.31 ± 0.12). The selection of animals based on the GEBV for RFIKOCH did not alter the ranking of individuals selected for RFIREA, RFIBFT, and RFIREA BFT. The results of the present study suggest that records of Nellore bulls of different ages and with different body compositions can be combined in a SDB for RFI calculation. Therefore, young animals can be evaluated in feed efficiency tests in order to reduce costs and the generation interval and possibly to obtain a higher response to selection.

A decade of underwater noise research in support of the European Marine Strategy Framework Directive.

Underwater noise from human activities is now widely recognised as a threat to marine life. Nevertheless, legislation which directly addresses this source of pollution is lacking. The first (and currently only) example globally is Descriptor 11 of the Marine Strategy Framework Directive (MSFD), adopted by the European Union in 2008, which requires that levels of underwater noise pollution do not adversely affect marine ecosystems. The MSFD has stimulated a concerted research effort across Europe to develop noise monitoring programmes and to conduct research towards specifying threshold values which would define 'Good Environmental Status' (GES) for underwater noise. Here, we chart the progress made during the first decade of Descriptor 11's implementation: 2010-2020. Several international joint monitoring programmes have been established for impulsive and continuous noise, enabling ecosystem-scale assessment for the first time. Research into the impact of noise on individual animals has grown exponentially, demonstrating a range of adverse effects at various trophic levels. However, threshold values for GES must be defined for 'populations of marine animals.' Population-level consequences of noise exposure can be modelled, but data to parameterise such models are currently unavailable for most species, suggesting that alternative approaches to defining GES thresholds will be necessary. To date, the application of measures to reduce noise levels (quieting/noise abatement) has been limited. To address this, the EU in 2021 identified an explicit need to reduce underwater noise pollution in its waters. Delivering on this ambition will require further research focused on the development and implementation of quieting measures.

The Odontocete Ear Canal-Associated Lymphoid Tissue (ECALT) and Lymph Nodes: Morphological and Pathological Description with Immuno-Phenotypic Characterisation.

A changing marine environment with emerging natural and anthropogenic stressors challenges the marine mammal immune system. The skin and adnexa form a first protective barrier in the immune response, although this is still relatively understudied in cetaceans. The cellular and tissue morphology of the nodular and diffuse lymphoid tissue are not fully charted and the physiological responses are not yet completely understood. The odontocete's external ear canal has a complex relationship with the external environment, with an artificial lumen rendering the inside of the canal a relatively secluded environment. In this work, we studied the odontocete ear canal-associated lymphoid tissue (ECALT) by histo- and immunohistochemistry (HC, IHC) with anti-CD3, anti-CD20, anti-Iba-1, anti-HLA-DR, and anti-vimentin antibodies. The ECALT cellular composition consists mainly of B-lymphocytes with the occasional presence of T-lymphocytes and the dispersed distribution of the macrophages. In cases of activation, the cellular reaction showed a similar pattern with the occasional presence of T-cells, plasma cells, and neutrophils. Nodular lymphoid tissue was generally in line with the description in other odontocetes, although with abundant erythrocytes throughout the entire organ. This study contributes to the understanding of the cellular composition of diffuse and nodular lymphoid tissue in several species of odontocetes, and in association with inflammation of the external ear canal.

Commercial cuttlefish exposed to noise from offshore windmill construction show short-range acoustic trauma.

The installation of marine renewable energy devices (MREDs, wind turbines and converters of wave, tidal and ocean thermal energy) has increased quickly in the last decade. There is a lack of knowledge concerning the effects of MREDs on benthic invertebrates that live in contact with the seabed. The European common cuttlefish (Sepia officinalis) is the most abundant cephalopod in the Northeast Atlantic and one of the three most valuable resources for English Channel fisheries. A project to build an offshore wind farm in the French bay of Saint-Brieuc, near the English Channel, raised concern about the possible acoustic impact on local cuttlefish communities. In this study, consisting of six exposure experiments, three types of noise were considered: 3 levels of pile-driving and 3 levels of drilling. The objectives were to assess possible associated changes in hatching and larva survival, and behavioural and ultrastructural effects on sensory organs of all life stages of S. officinalis populations. After exposure, damage was observed in the statocyst sensory epithelia (hair cell extrusion) in adults compared to controls, and no anti-predator reaction was observed. The exposed larvae showed a decreased survival rate with an increasing received sound level when they were exposed to maximum pile-driving and drilling sound levels (170 dB re 1 µPa2 and 167 dB re 1 µPa2, respectively). However, sound pressure levels's lower than 163 dB re 1 µPa2 were not found to elicit severe damage. Simulating a scenario of immobile organisms, eggs were exposed to a combination of both pile driving and drilling as they would be exposed to all operations without a chance to escape. In this scenario a decrease of hatching success was observed with increasing received sound levels.

Molecular profile of non-small cell lung cancer in reunion Island.

BACKGROUND: In recent years, the discovery of predictive biomarkers has enabled the development of targeted therapies that have improved the prognosis of patients with non-small cell lung cancer (NSCLC). No data are available at present on the molecular profile of NSCLC in Reunion Island, a French overseas department located in the Indian Ocean and characterized by an ethnically-mixed population. METHOD: This observational, retrospective, and multicenter study included all patients who were diagnosed with NSCLC in Reunion Island during 2 years and whose tumor specimens were sent for molecular analysis at Bordeaux University Hospital. The aim of the study was to determine the molecular profile of NSCLC in the Reunionese population, including the frequency of epidermal growth factor receptor (EGFR) mutation. RESULTS: A total of 310 patients with NSCLC were screened for genetic mutations. Of these, 281 (91%) had adenocarcinoma, 207 (66%) were born in Reunion Island, 79 (25%) were never-smokers, and 109 (35%) were women. One hundred and seventy-eight (57%) patients had a genetic mutation. An EGFR mutation was detected in 69 patients (22%) of the 310 included patients. This mutation was detected in 23% of patients with adenocarcinoma, 40% of women, 55% of never-smokers, and 23% of patients born in Reunion Island. CONCLUSION: The frequency of EGFR mutation is high in the Reunionese population. This frequency is similar to that reported in Asia and may be explained by the history of migrations and ethnic mixing in Reunion Island. These findings suggest complex interactions between genetic and environmental factors in the carcinogenesis of NSCLC.

Supervised Physical Activity Quickly Improves Social Dimension of Quality of Life in Breast Cancer Patients.

PURPOSE: The objectives of the present study was to evaluate the implementation of the program in real life and the evolution of the quality of life (QoL) in breast cancer patients after 3 months of supervised PA in real life and to determine the factors associated with changes in various QoL dimensions. METHODS: This prospective cohort study was carried out in female patients with breast cancer diagnosed within a maximum of 3 yr. QoL and physical exertion intensity during the supervised physical activity (PA) sessions were assessed by the Quality of Life Questionnaire for Cancer and Borg scale, respectively. Statistical analyses comparing QoL scores between the start and the end of supervised PA program were assessed using paired Student's t -tests. Multivariate analysis was performed by linear regression with only variables with a P value <0.15 in univariate model. RESULTS: A total of 93 patients were included in the analyses. There was a significant improvement of social functioning at T3 (∆ = 11.5; P < 0.001). The improvement of social functioning was significantly and independently associated with the Borg improvement ( ß = 2.66 ± 1.31, P = 0.046), chemotherapy ( ß = 11.03 ± 5.45, P = 0.046), hormone therapy ( ß = -13.91 ± 5.51, P = 0.013), social isolation ( ß = -14.81 ± 6.55, P = 0.026), and comorbidities ( ß = -15.32 ± 5.59, P = 0.007). CONCLUSIONS: We observed a real enthusiasm and need among patients for practicing PA supervised by a sport trainer near their home. The increase in the intensity of exercise over time contributes to the improvement of the QoL, especially on the social functioning. These results, consistent with previous literature, reinforce the importance of exercise intensity on many dimensions of QoL. In addition, patients expressed great satisfaction with the supervised program, resulting in a strong desire to maintain long-term PA.

Lack of Prognostic Value of CTNNB1 Mutation Profile in Desmoid-Type Fibromatosis.

PURPOSE: This prospective nationwide cohort study aimed to investigate desmoid-type fibromatosis (DF) outcomes, focusing on the prognostic value of CTNNB1 mutations. EXPERIMENTAL DESIGN: ALTITUDES (NCT02867033) was a nationwide prospective cohort study of DF diagnosed between January 2016 and December 2020. At diagnosis, CTNNB1 molecular alterations were identified using next-generation sequencing or Sanger sequencing. The primary endpoint was event-free survival (EFS; progression, relapse, or death). We enrolled 628 patients managed by active surveillance, surgical resection, or systemic treatment as first-line therapy. RESULTS: Overall, 516 (82.2%) patients [368 females (71.3%), median age 40.3 years (range, 1-89)] were eligible for analysis. In 435 (84.3%) cases, there was one CTNNB1 molecular alteration: p.T41A, p.S45F, or p.S45P. The first-line management was active surveillance in 352 (68.2%), surgical resection in 120 (23.3%), and systemic treatments in 44 (8.5%) patients. CTNNB1 mutation distribution was similar across the three therapeutic groups. The median follow-up period was 24.7 (range, 0.4-59.7) months. The estimated 3-year EFS rate was 66.2% [95% confidence interval (CI), 60.5%-71.2%]. DF harboring p.S45F was significantly associated with male sex (P = 0.03), non-abdominal wall sites (P = 0.05), pain (P = 0.007), and large tumor size (P = 0.025). CTNNB1 p.S45F mutation was not significantly associated with EFS, either in univariate (HR, 1.06; 95% CI, 0.65-1.73; P = 0.81) or in multivariate analysis (HR, 0.91; 95% CI, 0.55-1.49; P = 0.71). CONCLUSIONS: We found that CTNNB1 mutation profile was associated with unfavorable prognostic factors but was not a prognostic factor for EFS. See related commentary by Greene and Van Tine, p. 3911.

Studies of Intra-Fraction Prostate Motion During Stereotactic Irradiation in First Irradiation and Re-Irradiation.

BACKGROUND: Understanding intra-fractional prostate motions is crucial for stereotactic body radiation therapy (SBRT). No studies have focused on the intra-fractional prostate motions during re-irradiation with SBRT. The objective was to evaluate these translational and rotational motions in primary treated patients and in the context of re-irradiation. METHODS: From January 2011 to March 2020, 162 patients with histologically proven prostate cancer underwent prostate SBRT, including 58 as part of a re-irradiation treatment. We used the continuous coordinates of the fiducial markers collected by an orthogonal X-ray dual-image monitoring system. The translations and rotations of the prostate were calculated. Prostate deviations representing overall movement was defined as the length of the 3D-vectors. RESULTS: A total of 858 data files were analyzed. The deviations over time in the group of primary treated patients were significantly larger than that of the group of re-irradiation, leading to a mean deviation of 2.73 mm (SD =1.00) versus 1.90 mm (SD =0.79), P<0.001. In the re-irradiation group, we identified displacements of -0.05 mm (SD =1.53), 0.20 mm (SD =1.46); and 0.42 mm (SD =1.24) in the left-right, superior-inferior and anterior-posterior planes. Overall, we observed increasing deviations over the first 30 min followed by a stabilization related to movements in the three translational axes. CONCLUSION: This is the first study to focus on intrafraction prostate motions in the context of re-irradiation. We observed that intra-fraction prostate motions persisted in the setting of re-irradiation, although they showed a significant reduction when compared with the first irradiation. These results will help to better estimate random errors during SBRT treatment of intra-prostatic recurrence after irradiation.

FOLFIRINOX relative dose intensity and disease control in advanced pancreatic adenocarcinoma.

BACKGROUND: Most patients with advanced pancreatic adenocarcinoma (PA) treated with FOLFIRINOX experience adverse events requiring dose reduction. We aimed to assess the association between relative dose intensity (RDI) and disease control in a European setting. METHODS: We retrospectively included patients with advanced PA treated with three or more cycles of FOLFIRINOX between 2011 and 2018 in six French centers. We computed the cumulative single-agent RDI (csRDI) before the first reassessment for each FOLFIRINOX agent (oxaliplatin, irinotecan, 5FU bolus, and 5FU intravenous infusion) and the cumulative multi-drug RDI (cmRDI) of their combination. The association between RDI and disease control or objective response at first reassessment was evaluated using multivariable logistic regression models controlling for performance status, liver metastases, and center. RESULTS: We included 243 patients. Median csRDIs were 81%, 79%, 75%, and 85% for oxaliplatin, irinotecan, 5FU bolus, and 5FU intravenous infusion, respectively. Median cmRDI was 80%. None of the RDIs was significantly associated with disease control or objective response. Including RDI in a clinical model did not improve its ability to predict disease control; the area under the curve was 0.79 (95% CI: 0.73-0.85) with RDI versus 0.78 (95% CI: 0.72-0.85) without. Similar results were observed for the objective response. CONCLUSION: Pragmatic dose adjustments of FOLFIRINOX should be made by oncologists without considering a loss of effect.

Seagrass Posidonia is impaired by human-generated noise.

The last hundred years have seen the introduction of many sources of artificial noise in the sea environment which have shown to negatively affect marine organisms. Little attention has been devoted to how much this noise could affect sessile organisms. Here, we report morphological and ultrastructural changes in seagrass, after exposure to sounds in a controlled environment. These results are new to aquatic plants pathology. Low-frequency sounds produced alterations in Posidonia oceanica root and rhizome statocysts, which sense gravity and process sound vibration. Nutritional processes of the plant were affected as well: we observed a decrease in the number of rhizome starch grains, which have a vital role in energy storage, as well as a degradation in the specific fungal symbionts of P. oceanica roots. This sensitivity to artificial sounds revealed how sound can potentially affect the health status of P. oceanica. Moreover, these findings address the question of how much the increase of ocean noise pollution may contribute in the future to the depletion of seagrass populations and to biodiversity loss.

Performance of lambs under four levels of dietary supplementation and artificially mix-infected with Haemonchus contortus and Trichostrongylus colubriformis.

The effect of four diets on the performance of Dorper lambs that were artificially mix-infected with 1000 infective larvae (L3) of Haemonchus contortus and 1000 L3 of Trichostrongylus colubriformis every three days for 12 weeks was evaluated. For each diet, one infected group (n = 7) and one control group (n = 4) were set up. The four diets contained the following proportions of hay (H) and concentrate (C): Diet 1 - 100%H; Diet 2 - 75%H:25%C; Diet 3 - 50%H:50%C; Diet 4 - 25%H:75. All the infected groups showed decreases in mean packed cell volume (PCV) and total plasma protein, especially the Diet 1-infected, which was also the group with the highest fecal egg count. The diets and infection had significant effects (P < 0.05) on daily body weight gain (DBWG), cold carcass weight and daily food consumption. The control and infected groups had mean DBWG (in kg), respectively, of 0.048 and 0.025 with Diet 1; 0.082 and 0.067 with Diet 2; 0.188 and 0.189 with Diet 3; and 0.303 and 0.221 with Diet 4. In conclusion, the infection affected the productive performance regardless of the diet; however, with increased metabolizable protein and energy, the risk of occurrence of anemia and hypoproteinemia diminished.

Co-infection in patients with hypoxemic pneumonia due to COVID-19 in Reunion Island.

ABSTRACT: This study aimed to evaluate the incidence of co-infection with different types of pathogens in patients with hypoxemic pneumonia due to coronavirus disease 2019 (COVID-19) in Reunion Island.This observational study using a prospectively collected database of hypoxemic pneumonia due to COVID-19 cases was conducted at Félix Guyon University Hospital in Reunion Island, France.Between 18 March 2020 and 15 April 2020, 156 patients were admitted to our hospital for COVID-19. A total of 36 patients had hypoxemic pneumonia (23.1%) due to COVID-19. Thirty of these cases (83.3%) were imported by travelers returning mainly from metropolitan France and Spain. Patients were screened for co-infection with other pathogens at admission: 31 (86.1%) by multiplex polymerase chain reaction (PCR) and 16 (44.4%) by cytobacteriological examination of sputum culture. Five patients (13.9%) were found to have co-infection: 1 with influenza virus A H1N1 (pdm09) associated with Branhamella catarrhalis, 1 with Streptococcus pneumoniae associated with Haemophilus influenzae, 1 with Human Coronavirus 229E, 1 with Rhinovirus, and 1 with methicillin-susceptible Staphylococcus aureus. Patients with co-infection had higher D-dimer levels than those without co-infection (1.36 [1.34-2.36] µg/mL vs 0.63 [0.51-1.12] µg/mL, P = .05).The incidence of co-infection in our cohort was higher than expected (13.9%). Three co-infections (with influenza virus A(H1N1) pdm09, Streptococcus pneumoniae, and Staphylococcus aureus) required specific treatment. Patients with hypoxemic pneumonia due to COVID-19 should be screened for co-infection using respiratory cultures or multiplex PCR. Whilst our study has a number of limitations, the results from our study suggest that in the absence of screening, patients should be commenced on treatment for co-infection in the presence of an elevated D-dimer.

High Prevalence of Nontuberculous Mycobacteria in Cystic Fibrosis Patients in Tropical French Reunion Island.

BACKGROUND: Reunion Island is a French overseas department located in a tropical area, where cystic fibrosis incidence is high. Cystic fibrosis (CF) patients are at risk of developing nontuberculous mycobacteria (NTM) infection. Epidemiologic studies are lacking in Reunion Island. METHODS: From 2002 to 2015, a retrospective review was performed in university hospitals on Reunion Island. All CF patients having at least 1 positive NTM isolate were included. Clinical, radiologic, and microbiologic data were collected from patient records. RESULTS: Fifty-one CF patients were included. The overall estimated prevalence of NTM was 26.4% in total CF population and 36.9% in patients over 12 years of age. Mycobacterium abscessus and Mycobacterium avium were the most frequently identified species found in 31 patients (60.8%) and 14 patients (27.4%), respectively. A rare NTM species: Mycobacterium simiae was found in 4 patients (7.8%). Twenty-nine patients (56.9%) met the American Thoracic Society (ATS) criteria for infection. They were more likely younger with a low body mass index and more frequently infected by Mycobacterium abscessus (22/29). CONCLUSION: The overall prevalence of NTM in tropical Reunion Island is 3 times higher than in metropolitan France. A different environmental exposure in a tropical climate or risk factors related to cystic fibrosis or its treatment in Reunion patients could explain it.

Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital.

BACKGROUND: Home hospitalization at the end of life can sometimes be perturbed by unplanned hospital admissions (UHAs, defined as any admission that is not part of a preplanned care procedure), which increase the likelihood of death in hospital. The objectives were to describe the occurrence and causes of UHAs in cancer patients receiving end-of-life care at home, and to identify factors associated with UHAs and death in hospital. METHODS: A retrospective, single-center study (performed at a regional cancer center in the city of Lille, northern France) of advanced cancer patients discharged to home hospitalization between January 2014 and December 2017. We estimated the incidence of UHA over time using Kaplan-Meier method and Kalbfleish and Prentice method. We investigated factors associated with the risk UHA in cause-specific Cox models. We evaluated factors associated with death in hospital in logistic regressions. RESULTS: One hundred and forty-two patients were included in the study. Eighty-two patients (57.7 %) experienced one or more UHAs, a high proportion of which occurred within 1 month after discharge to home. Most UHAs were related to physical symptoms and were initiated by the patient's family physician. A post-discharge palliative care consultation was associated with a significantly lower incidence of UHAs. Sixty-five patients (47.8 % of the deaths) died in hospital. In a multivariate analysis, living alone and the presence of one or more children at home were associated with death in hospital. CONCLUSIONS: More than 40 % of cancer patients receiving end of life home hospitalization were not readmitted to hospital, reflecting the effectiveness of this type of palliative care setting. However, over half of the UHAs were due to an acute intercurrent event. Our results suggest that more efforts should be focused on anticipating these events at home - primarily via better upstream coordination between hospital physicians and family physicians.

Performance of lambs under four levels of dietary supplementation and artificially mix-infected with Haemonchus contortus and Trichostrongylus colubriformis / Efeito de quatro dietas na performance de cordeiros artificialmente infectados com Haemonchus contortus e Trichostrongylus colubriformis

Abstract The effect of four diets on the performance of Dorper lambs that were artificially mix-infected with 1000 infective larvae (L3) of Haemonchus contortus and 1000 L3 of Trichostrongylus colubriformis every three days for 12 weeks was evaluated. For each diet, one infected group (n = 7) and one control group (n = 4) were set up. The four diets contained the following proportions of hay (H) and concentrate (C): Diet 1 - 100%H; Diet 2 - 75%H:25%C; Diet 3 - 50%H:50%C; Diet 4 - 25%H:75. All the infected groups showed decreases in mean packed cell volume (PCV) and total plasma protein, especially the Diet 1-infected, which was also the group with the highest fecal egg count. The diets and infection had significant effects (P < 0.05) on daily body weight gain (DBWG), cold carcass weight and daily food consumption. The control and infected groups had mean DBWG (in kg), respectively, of 0.048 and 0.025 with Diet 1; 0.082 and 0.067 with Diet 2; 0.188 and 0.189 with Diet 3; and 0.303 and 0.221 with Diet 4. In conclusion, the infection affected the productive performance regardless of the diet; however, with increased metabolizable protein and energy, the risk of occurrence of anemia and hypoproteinemia diminished.

Resumo Avaliou-se o efeito de quatro dietas sobre o desempenho de cordeiros Dorper infectados artificialmente, a cada três dias, durante 12 semanas, com 1.000 larvas infectantes (L3) de Haemonchus contortus e 1.000 L3 de Trichostrongylus colubriformis. Um grupo infectado (n=7) e um controle (n=4) foram constituídos para cada uma das dietas, que continham a seguinte proporção de feno (F) e concentrado (C): Dieta 1 - 100%F; Dieta 2 - 75%F:25%C; Dieta 3 - 50%F:50%C; Dieta 4 - 25%F:75%C. Todos os grupos infectados apresentaram redução nas médias de hematócrito (VG) e proteína plasmática total (PPT), principalmente o grupo Dieta 1 infectado, que também apresentou maior contagem de ovos nas fezes. Houve efeito significativo da dieta e da infecção (P <0,05) no ganho em peso médio diário, peso da carcaça e consumo diário de alimento. Os grupos controle e infectado tiveram ganho em peso médio diário (em kg), respectivamente, de 0,048 e 0,025 na Dieta 1; 0,082 e 0,067 na Dieta 2; 0,188 e 0,189 na Dieta 3; e 0,303 e 0,221 na Dieta 4. Concluiu-se que a infecção afetou o desempenho produtivo independentemente da dieta, porém, com o aumento da proteína e da energia metabolizável, o risco de ocorrência de anemia e hipoproteinemia diminuiu.

[History of a pandemic in child protection]. / Histoire d'une pandémie en protection de l'enfance.

The child welfare sector was not spared by the first containment related to COVID-19. Everywhere, a unique organisation had to be set up to combat the spread of the epidemic. In Isère, a doctor explains how one stage followed another, in an unprecedented and uncertain context.