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.

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.

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.

[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.

Clinical, Radiological, and Microbiological Characteristics of Mycobacterium simiae Infection in 97 Patients.

Mycobacterium simiae is a rare species of slow-growing nontuberculous mycobacteria (NTM). From 2002 to 2017, we conducted a retrospective study that included all patients with NTM-positive respiratory samples detected in two university hospitals of the French overseas department of Reunion Island. We recorded the prevalence of M. simiae in this cohort, as well as the clinical, radiological, and microbiological features of patients with at least 1 sample positive for M. simiae In our cohort, 97 patients (15.1%) were positive for M. simiae Twenty-one patients (21.6%) met the American Thoracic Society (ATS) criteria for infection. M. simiae infection was associated with bronchiectasis, micronodular lesions, and weight loss. Antibiotic susceptibility testing was performed for 60 patients, and the isolates were found to have low susceptibility to antibiotics, except for amikacin, fluoroquinolones, and clarithromycin. Treatment failed for 4 of the 8 patients treated for M. simiae infection. Here, we describe a specific cluster corresponding to a large cohort of patients with M. simiae, a rare nontuberculous mycobacterium associated with low pathogenicity and poor susceptibility to antibiotics.

Euro 6 Unregulated Pollutant Characterization and Statistical Analysis of After-Treatment Device and Driving-Condition Impact on Recent Passenger-Car Emissions.

This study aims to measure and analyze unregulated compound emissions for two Euro 6 diesel and gasoline vehicles. The vehicles were tested on a chassis dynamometer under various driving cycles: Artemis driving cycles (urban, road, and motorway), the New European Driving Cycle (NEDC) and the World Harmonized Light-Duty Test Cycle (WLTC) for Europe, and world approval cycles. The emissions of unregulated compounds (such as total particle number (PN) (over 5.6 nm); black carbon (BC); NO2; benzene, toluene, ethylbenzene, and xylene (BTEX); carbonyl compounds; and polycyclic aromatic hydrocarbons (PAHs)) were measured with several online devices, and different samples were collected using cartridges and quartz filters. Furthermore, a preliminary statistical analysis was performed on eight Euro 4-6 diesel and gasoline vehicles to study the impacts of driving conditions and after-treatment and engine technologies on emissions of regulated and unregulated pollutants. The results indicate that urban conditions with cold starts induce high emissions of BTEX and carbonyl compounds. Motorway conditions are characterized by high emissions of particle numbers and CO, which mainly induced by gasoline vehicles. Compared with gasoline vehicles, diesel vehicles equipped with catalyzed or additive DPF emit fewer particles but more NOx and carbonyl compounds.

Parasites in the inner ear of harbour porpoise: cases from the North and Baltic Seas.

Peribullar sinuses of harbour porpoises Phocoena phocoena are parasitized with high prevalence by the nematode Stenurus minor. The effect of S. minor on the hearing ability of this species is still undetermined. Here, we review the occurrence of S. minor in the inner ear of harbour porpoises recovered from strandings in the North and Baltic Seas. In particular, we present the results from ears collected in German and Danish waters from 2002 to 2016 and from Dutch waters from 2010 to 2016. While the prevalence of S. minor in pterygoid and peribullar sinuses and tympanic cavity was high in harbour porpoises (66.67% in our cases), its prevalence in the cochlea was rare. Only 1 case out of 129 analysed by either histology, electron microscopy or immunofluorescence showed the presence of a nematode parasite morphologically consistent with S. minor at the most basal portion of the right cochlea. This individual also had severe haemorrhage along the right cochlear spiral, which was likely caused by ectopic S. minor migration. Although this animal might have had impaired hearing in the right ear, it was otherwise in good body condition with evidence of recent feeding. These findings highlight the need to study the effect of parasites on hearing, and other pathological changes that might impair appropriate processing of acoustic information.

How to improve the prevention of chemotherapy-induced nausea and vomiting? The French NAVI study.

PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) still remain frequent. The procedure for announcing the diagnosis (PAD) was an emblematic measure of the first French Plan Cancer aiming at providing patients with time to listen, information after cancer diagnosis, and discussion on treatments and their side effects. We aimed at assessing the risk factors of CINV, focusing on patients' satisfaction with the PAD. METHODS: This prospective multicentre study assessed the frequency and intensity of CINV among chemonaïve patients during the first cycle of treatment. CINV was defined by ≥1 emetic episode or reported nausea intensity ≥3 on a 0-10 scale. Multivariate analysis was used to identify factors related to global CINV onset including satisfaction with the PAD (satisfaction score ≥the median on a 0-10 scale). RESULTS: Data from 291 patients (women, 85.2%; mean age, 57 years) were analyzed. Most patients (69.4%) received highly emetogenic chemotherapy regimens and 77.7% received antiemetic drugs consistent with international guidelines. Acute, delayed and overall CINV were experienced by 40.4, 34.8 and 52.4% of patients, respectively. Sixty-seven per cent of patients were satisfied with the PAD. No relation was noted between PAD satisfaction and CINV onset. The nausea and vomiting dimension of the QLQ-C30 questionnaire before chemotherapy (OR 3.62), motion sickness history (OR 2.73), highly emetogenic CT (OR 2.73), anxiety (OR 1.99) and younger age (OR 1.96) were independent predictive factors. CONCLUSIONS: Although patients were mostly satisfied with the PAD, half of them experienced CINV. A state of anxiety could be identified during the PAD to be managed.

Contribution to the Understanding of Particle Motion Perception in Marine Invertebrates.

Marine invertebrates potentially represent a group of species whose ecology may be influenced by artificial noise. Exposure to anthropogenic sound sources could have a direct consequence on the functionality and sensitivity of their sensory organs, the statocysts, which are responsible for their equilibrium and movements in the water column. The availability of novel laser Doppler vibrometer techniques has recently opened the possibility of measuring whole body (distance, velocity, and acceleration) vibration as a direct stimulus eliciting statocyst response, offering the scientific community a new level of understanding of the marine invertebrate hearing mechanism.

The Use of Deep Water Berths and the Effect of Noise on Bottlenose Dolphins in the Shannon Estuary cSAC.

The Shannon Estuary on the west coast of Ireland is one of Europe's premier deepwater berths catering for ships up to 200,000 deadweight tonnage. It is also Ireland's only designated candidate special area of conservation for bottlenose dolphins under the EU Habitats Directive. Long-term static acoustic monitoring was carried out at a number of intensive shipping sites. In 2012, noise monitoring took place over a 6-month period (at 1 site) as part of Ireland's requirements under the Marine Strategy Framework Directive (MSFD). This is the first assessment of the potential effect of vessel traffic on the behavior of this discrete dolphin population.

The European Marine Strategy: Noise Monitoring in European Marine Waters from 2014.

The European Marine Strategy Framework Directive requires European member states to develop strategies for their marine waters leading to programs of measures that achieve or maintain good environmental status (GES) in all European seas by 2020. An essential step toward reaching GES is the establishment of monitoring programs, enabling the state of marine waters to be assessed on a regular basis. A register for impulsive noise-generating activities would enable assessment of their cumulative impacts on wide temporal and spatial scales; monitoring of ambient noise would provide essential insight into current levels and any trend in European waters.

Auditory sensitivity in aquatic animals.

A critical concern with respect to marine animal acoustics is the issue of hearing "sensitivity," as it is widely used as a criterion for the onset of noise-induced effects. Important aspects of research on sensitivity to sound by marine animals include: uncertainties regarding how well these species detect and respond to different sounds; the masking effects of man-made sounds on the detection of biologically important sounds; the question how internal state, motivation, context, and previous experience affect their behavioral responses; and the long-term and cumulative effects of sound exposure. If we are to better understand the sensitivity of marine animals to sound we must concentrate research on these questions. In order to assess population level and ecological community impacts new approaches can possibly be adopted from other disciplines and applied to marine fauna.

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.

Extraction of pulse repetition intervals from sperm whale click trains for ocean acoustic data mining.

The analysis of acoustic data from the ocean is a valuable tool to study free ranging cetaceans and anthropogenic noise. Due to the typically large volume of acquired data, there is a demand for automated analysis techniques. Many cetaceans produce acoustic pulses (echolocation clicks) with a pulse repetition interval (PRI) remaining nearly constant over several pulses. Analyzing these pulse trains is challenging because they are often interleaved. This article presents an algorithm that estimates a pulse's PRI with respect to neighboring pulses. It includes a deinterleaving step that operates via a spectral dissimilarity metric. The sperm whale (SW) produces trains with PRIs between 0.5 and 2 s. As a validation, the algorithm was used for the PRI-based identification of SW click trains with data from the NEMO-ONDE observatory that contained other pulsed sounds, mainly from ship propellers. Separation of files containing SW clicks with a medium and high signal to noise ratio from files containing other pulsed sounds gave an area under the receiver operating characteristic curve value of 0.96. This study demonstrates that PRI can be used for the automated identification of SW clicks and that deinterleaving via spectral dissimilarity contributes to algorithm performance.

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.

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.

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.

[Emergency medicine and vulnerable populations]. / La médecine d'urgence face a la précarité.

In emergency medicine, assessing a situation of precarity is sometimes extremely complex. Home visits often provide useful information which can lead to the putting in place of a system of support. Medical marginalisation results from a combination of multiple difficulties, notably financial. This article is the testimony of a doctor working in a structure providing emergency medical care in the home.

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.

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.