The impact of online yoga on sleep and quality of life in women with breast cancer: a randomized trial.

INTRODUCTION: There is growing evidence of the benefit of physical activity and mindfulness in breast cancer patients (HC et al. in BMC Complement Altern Med, 2017). Yoga offers a combination of both. The aim of this study was to establish an online yoga program for breast cancer patients and survivors. As the project was launched during the (COVID) pandemic restrictions, we intended to prove effective online yoga as a way to access supportive therapy independently of sanitary issues and geographic locations in rural regions. METHODS: The two main outcomes were quality of life and sleep quality, and both were evaluated by standardized questionnaires (EORTC-QLQ 30 BR 23 and PSQI). Participants (n = 173) had breast cancer or a history of breast cancer and were randomized to either 6 weeks online yoga, twice a week for 45 min or a waiting control group. RESULTS: Our results show improved sleep quality in the PSQI score and improved subitems (dyspnea and physical activity) in the EORTC quality of life score. DISCUSSION: Online yoga seems to be a valid option in supportive therapy for breast cancer patients, as it improves physical fitness, dyspnea and overall sleep quality. It is also safe and cost effective as a remote intervention. TRIAL REGISTRATION: Trial registration number and date of registration for prospectively registered trials: DRKS00029548, 07.07.2022.WHO International clinical trials registry platform number: DRKS00029548. The registration number of the ethical committee CAU in Kiel: D 589/20.

Assessing nitrate groundwater hotspots in Europe reveals an inadequate designation of Nitrate Vulnerable Zones.

Monitoring networks show that the European Union Nitrates Directive (ND) has had mixed success in reducing nitrate concentrations in groundwater. By combining machine learning and monitored nitrate concentrations (1992-2019), we estimate the total area of nitrate hotspots in Europe to be 401,000 km2, with 47% occurring outside of Nitrate Vulnerable Zones (NVZs). We also found contrasting increasing or decreasing trends, varying per country and time periods. We estimate that only 5% of the 122,000 km2 of hotspots in 2019 will meet nitrate quality standards by 2040 and that these may be offset by the appearance of new hotspots. Our results reveal that the effectiveness of the ND is limited by both time-lags between the implementation of good practices and pollution reduction and an inadequate designation of NVZs. Substantial improvements in the designation and regulation of NVZs are necessary, as well as in the quality of monitoring stations in terms of spatial density and information available concerning sampling depth, if the objectives of EU legislation to protect groundwater are to be achieved.

Adaptation of a quantitative trait to a changing environment: New analytical insights on the asexual and infinitesimal sexual models.

Predicting the adaptation of populations to a changing environment is crucial to assess the impact of human activities on biodiversity. Many theoretical studies have tackled this issue by modeling the evolution of quantitative traits subject to stabilizing selection around an optimal phenotype, whose value is shifted continuously through time. In this context, the population fate results from the equilibrium distribution of the trait, relative to the moving optimum. Such a distribution may vary with the shape of selection, the system of reproduction, the number of loci, the mutation kernel or their interactions. Here, we develop a methodology that provides quantitative measures of population maladaptation and potential of survival directly from the entire profile of the phenotypic distribution, without any a priori on its shape. We investigate two different systems of reproduction (asexual and infinitesimal sexual models of inheritance), with various forms of selection. In particular, we recover that fitness functions such that selection weakens away from the optimum lead to evolutionary tipping points, with an abrupt collapse of the population when the speed of environmental change is too high. Our unified framework allows deciphering the mechanisms that lead to this phenomenon. More generally, it allows discussing similarities and discrepancies between the two systems of reproduction, which are ultimately explained by different constraints on the evolution of the phenotypic variance. We demonstrate that the mean fitness in the population crucially depends on the shape of the selection function in the infinitesimal sexual model, in contrast with the asexual model. In the asexual model, we also investigate the effect of the mutation kernel and we show that kernels with higher kurtosis tend to reduce maladaptation and improve fitness, especially in fast changing environments.

Observation of Light Thermalization to Negative-Temperature Rayleigh-Jeans Equilibrium States in Multimode Optical Fibers.

Although the temperature of a thermodynamic system is usually believed to be a positive quantity, under particular conditions, negative-temperature equilibrium states are also possible. Negative-temperature equilibriums have been observed with spin systems, cold atoms in optical lattices, and two-dimensional quantum superfluids. Here we report the observation of Rayleigh-Jeans thermalization of light waves to negative-temperature equilibrium states. The optical wave relaxes to the equilibrium state through its propagation in a multimode optical fiber-i.e., in a conservative Hamiltonian system. The bounded energy spectrum of the optical fiber enables negative-temperature equilibriums with high energy levels (high-order fiber modes) more populated than low energy levels (low-order modes). Our experiments show that negative-temperature speckle beams are featured, in average, by a nonmonotonic radial intensity profile. The experimental results are in quantitative agreement with the Rayleigh-Jeans theory without free parameters. Bringing negative temperatures to the field of optics opens the door to the investigation of fundamental issues of negative-temperature states in a flexible experimental environment.

Agriculture specialization influence on nutrient use efficiency and fluxes in the St. Lawrence Basin over the 20th century.

Increasing the overall use efficiency of nitrogen (N) and phosphorus (P) resources in food production while minimizing losses to the environment are required to meet the dual challenge of food security and sustainability. Yet studies quantifying the overall performance of different agro-system types and how these have changed over time remain rare, although they are essential to propose solution pathways. Here, we reconstructed fluxes of N and P within 78 watersheds of the St. Lawrence Basin (SLB) of eastern Canada between 1901 and 2011, using the Generalized Representation of Agro-Food System model (GRAFS). This analysis allowed us to classify different agro-food system types and to evaluate how agricultural specialization influenced nutrient efficiencies and potential losses to the environment over time. Using a cluster analysis, we identified four agro-food system types with different overall outcomes in efficiencies and losses. We show that agricultural practices in the SLB were similar until the 1950's and deemed unsustainable in several watersheds by depleting agricultural soils of their nutrients (particularly N). With the advent of manufactured fertilizers and the intensification of livestock farming, the SLB then rapidly shifted through the 1970s and 1980s to more intensified and highly unsustainable agro-food system types, where, in 2011, ~77 % of N and ~ 94 % of P inputs were lost to the environment. We also show that nutrient pollution continued to increase despite gains in the nutrient use efficiency of animal farming due to higher nutrient throughput from intensive production. The increased proportion of confined animals, disconnected from croplands, indeed resulted in inefficient nutrient recycling. While nutrient use efficiency may mitigate nutrient pollution, reducing the absolute nutrient flux through agro-food systems should be a priority, likely through a reconnection of crop and animal farming and an overall reduction of meat production, specifically from concentrated, intensive livestock systems.

Biogeochemical functioning of an urbanized tropical estuary: Implementing the generic C-GEM (reactive transport) model.

Estuaries are amongst the most productive ecosystems of the land ocean continuum, but they are also under high anthropic pressures due to coastal urbanization. Too sparse observations have hindered the understanding of complex interactions between water quality and estuarine hydrodynamics and biogeochemical transformations. Until now, estuarine modelling studies have mainly focused on temperate estuarine systems in industrialized countries. This study investigates the responses of a tropical estuary to pollution load from a megacity (Ho Chi Minh City, Southern Vietnam) by applying a one-dimensional, biogeochemical estuarine model (C-GEM). The Saigon River Estuary flows through the megacity of Ho Chi Minh (HCMC) and is subject to episodic hypoxia events due to wastewater inputs from urban discharges. Good agreements are found between simulation outputs and observations for tidal propagation, salinity, total suspended sediment, and water quality variables in dry season in Saigon River Estuary. C-GEM reproduces the increases in ammonium, total organic carbon, phytoplankton and dissolved oxygen depletion in the urban section of the Saigon River as an impact of untreated wastewaters from HCMC. The steady-state version of C-GEM also reveals the formation of a pollutant cloud (30-km stretch) resulting from the combined effects of tidal fluctuation and low flushing capacity during the dry season. Furthermore, the quantification of the reaction fluxes simulated by the model demonstrates that nitrification is the main process removing NH4+ from the Saigon River. For the first time in such a type of environment, our study demonstrates the effectiveness of C-GEM at unraveling the complex interplay between biogeochemical reactions and transport in a tropical estuary with a minimized data requirement. This is significant for tropical estuaries in developing countries, where intensive monitoring programs are rare and have thus been rarely the object of modelling investigations.

Emerging strains of watermelon mosaic virus in Southeastern France: model-based estimation of the dates and places of introduction.

Where and when alien organisms are successfully introduced are central questions to elucidate biotic and abiotic conditions favorable to the introduction, establishment and spread of invasive species. We propose a modelling framework to analyze multiple introductions by several invasive genotypes or genetic variants, in competition with a resident population, when observations provide knowledge on the relative proportions of each variant at some dates and places. This framework is based on a mechanistic-statistical model coupling a reaction-diffusion model with a probabilistic observation model. We apply it to a spatio-temporal dataset reporting the relative proportions of five genetic variants of watermelon mosaic virus (WMV, genus Potyvirus, family Potyviridae) in infections of commercial cucurbit fields. Despite the parsimonious nature of the model, it succeeds in fitting the data well and provides an estimation of the dates and places of successful introduction of each emerging variant as well as a reconstruction of the dynamics of each variant since its introduction.

[Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) -- Text of the Guidelines (short text)]. / Accouchement normal : accompagnement de la physiologie et interventions médicales. Recommandations de la Haute Autorité de Santé (HAS) avec la collaboration du Collège National des Gynécologues Obstétriciens Français (CNGOF) et du Collège National des Sages-Femmes de France (CNSF) ­ Texte des recommandations (texte court).

OBJECTIVE: The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS: These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS: It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION: These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.

Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?

PURPOSE: To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000-March 2011) and period #2 (April 2011-August 2019). RESULTS: All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P < .01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P < .01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (25% vs 24%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, para-aortic lymph nodes invasion rate (0.4% vs 4.6%; P < 0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9 mm vs 6.4 mm (P < .01), respectively) when the resection was not done. In multivariate analysis, CA 19-9 < 500 U/mL (P < .01), and liver DW-MRI prescription (P < .01) favoured the resection. CONCLUSIONS: Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

Classical Rayleigh-Jeans Condensation of Light Waves: Observation and Thermodynamic Characterization.

Theoretical studies on wave turbulence predict that a purely classical system of random waves can exhibit a process of condensation, which originates in the singularity of the Rayleigh-Jeans equilibrium distribution. We report the experimental observation of the transition to condensation of classical optical waves propagating in a multimode fiber, i.e., in a conservative Hamiltonian system without thermal heat bath. In contrast to conventional self-organization processes featured by the nonequilibrium formation of nonlinear coherent structures (solitons, vortices,…), here the self-organization originates in the equilibrium Rayleigh-Jeans statistics of classical waves. The experimental results show that the chemical potential reaches the lowest energy level at the transition to condensation, which leads to the macroscopic population of the fundamental mode of the optical fiber. The near-field and far-field measurements of the condensate fraction across the transition to condensation are in quantitative agreement with the Rayleigh-Jeans theory. The thermodynamics of classical wave condensation reveals that the heat capacity takes a constant value in the condensed state and tends to vanish above the transition in the normal state. Our experiments provide the first demonstration of a coherent phenomenon of self-organization that is exclusively driven by optical thermalization toward the Rayleigh-Jeans equilibrium.

Patient outcome according to the 2017 international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma.

BACKGROUND/OBJECTIVE: We evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0-1) based on anatomical (A) and biological dimensions (B). METHODS: From 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induction chemotherapy and were divided into BR-A (CA 19-9 < 500 U/mL, no regional lymph node metastasis; n = 68) and BR-AB (CA 19-9 > 500 U/mL and/or regional lymph node metastasis; n = 53) groups. RESULTS: The 3 groups were comparable according to patient characteristics (except for back pain (P < .01) and CA 19-9 (P < .01)), intraoperative data, and postoperative courses. BR-AB patients required more venous resections (P < .01). The 3 groups were comparable on pathologic findings, except that BR-B patients had more lymph node invasions (P = .02). Median overall survival (OS) of the 121 patients was 45 months. In multivariate analysis, venous resection (P = .039) and R1 resection (P = .012) were poorly linked with OS, whereas BR-A classification (P < .01) independently favored OS. Median survival times of BR-A, BR-AB, and BR-B groups were undetermined, 27 months, and 20 months (P < .001), respectively. CONCLUSIONS: The 2017 definition was relevant for sub-classifying patients with BR-PDAC. The anatomical dimension (BR-A) was a favorable prognostic factor, whereas the biological dimension (BR-AB and BR-B) poorly impacted survival.

[Impact of sonography simulation in the training of midwifery students]. / Impact de l'intégration de la simulation en échographie obstétricale dans le cursus des étudiants sages-femmes.

OBJECTIVE: During their studies, French midwives need to acquire basic ultrasound skills to measure the amniotic fluid index, fetal biometry and identify fetal lie and placental positions. They have a clinical ultrasound training during their curriculum to acquire these skills. Assess the contribution that a training on an obstetrical ultrasound simulator (OUS) could make to the competence of midwives and to evaluate the best time to integrate it into their curriculum. METHODS: Forty students in their 4th and final year in midwifery were randomized into 2 groups. Group A learned with the traditional academic course, with a clinical ultrasound training which was followed by an evaluation on an OUS (E1A). Group B was evaluated on a simulator before the clinical ultrasound training (E1B). After these initial assessments, both groups were provided with learning and training sessions on OUS, and re-evaluated in the same exercise (E2A and E2B). Group B then completed its clinical ultrasound training and was evaluated one month later on the simulator (E3B). The evaluation consisted of scoring the biometry images according to previously published quality criteria, and of assessing their competence based on a published objective and structured assessment score of ultrasound skills (OSAUS). RESULTS: Evaluation 1 found comparable OSAUS scores (2.375/5 vs. 2.24/5 P=0.52) between the two groups (E1A vs. E1B) but a significantly higher image quality score for Group A (P=0.02). In Evaluation 2, an improvement was noted for both groups with comparable OSAUS averages between the two groups (P=0.76). After the clinical training of Group B, their OSAUS score (E3B) was significantly better than that of Group A (E1A) after their clinical training (3.45/5 vs. 2.375/5 [P=0.00017]). The same was true for the quality of their images (12.67/16 vs. 9.95/16 [P=0.003]). CONCLUSION: Ultrasound simulation-based training, as an adjunct to ultrasound clinical training, significantly improves obstetrical ultrasound skills. The best time to train on simulators seems to be prior to clinical training on real patients.

[Installed Capacity Perception Survey for the Training of Residents Program in Orthopedics and Care Needs in Acute and Chronic Musculoskeletal Pathology in Mexico]. / Encuesta de Percepción en Capacidad Instalada para la Formación de Médicos Residentes en Ortopedia (Traumatología) y Necesidades de la Atención en Patología Musculoesquelética Aguda y Crónica en México. Primera Parte.

INTRODUCTION: It is essential that orthopaedic resident physicians be highly proficient in all aspects, considering the balance between supply, demand, need and context. Fundamental to identify the capacity and quality installed for their training in Mexico. MATERIAL AND METHODS: Observational Study, transverse, non-probabilistic sampling-conglomerates, in two phases. The instrument has 8 domains, 57 variables and 4,867 items. 60 graduate professors of 20 states, 50 hospital sites, 22 university programs. RESULTS: 1,038 years of experience (collective intelligence), 17 years of experience/teacher (01 to 50 years). Identified: acute pathology 30 (2 to 90%), chronic pathology 30 (5 to 96%), patients 15 years, 10 (3 to 30%), patients between 15 and 65 years, 47 (2 to 78%), patients 65 years, 20 (2 to 60%), number of beds/seat 20 (2 to 510), number of clinics 3 (1 to 48), number of surgical procedures/headquarters per year at the national level, was 960 (50 to 24,650). The national average per resident doctor is 362 surgeries/year with 1,450 surgical times/year. CONCLUSIONS: The needs and resources for the training of physicians specializing in orthopedics/traumatology are highly heterogeneous, so it should be adapted to the epidemiological needs of the region of influence, in an area of epidemiological transition. 62.2% expressed not having or have bad academic and scientific infrastructure at its headquarters, more than 50% without rotation overseas and 90% without regular scientific production.

INTRODUCCIÓN: Es fundamental que los médicos residentes de ortopedia (traumatología) sean altamente competentes en todos los aspectos, considerando el equilibrio entre la oferta, demanda, necesidad y contexto. Es primordial identificar la capacidad y calidad instalada para su formación en México. MATERIAL Y MÉTODOS: Estudio observacional, transversal, muestreo no probabilístico-conglomerados, en dos fases. El instrumento tiene ocho dominios, 57 variables y 4,867 ítems. Sesenta profesores de postgrado de 20 estados, 50 sedes hospitalarias, 22 programas universitarios. RESULTADOS: 1,038 años de experiencia (inteligencia colectiva), 17 años de experiencia/profesor (01 a 50 años). Se identificó: patología aguda 30 (2 a 90%), patología crónica 30 (5 a 96%), pacientes 15 años, 10 (3 a 30%), pacientes entre 15 y 65 años, 47 (2 a 78%), pacientes 65 años, 20 (2 a 60%), número de camas/sede 20 (2 a 510), número de consultorios 3 (1 a 48), el número de procedimientos quirúrgicos/sede al año a nivel nacional fue de 960 (50 a 24,650). La media nacional por médico residente es de 362 cirugías/año con 1,450 momentos quirúrgicos/año. CONCLUSIONES: Las necesidades y recursos para la formación de médicos especialistas en ortopedia/traumatología son en alto grado heterogéneos, por lo cual se debería adaptar a las necesidades epidemiológicas de la región de influencia, en un ámbito de transición epidemiológica. Sesenta y dos punto dos por ciento expresó no tener o tener deficiente infraestructura académica y científica en su sede, más de 50% sin rotación al extranjero y 90% sin producción científica regular.

[Human Resources for Unplanned Activities in Obstetrics and Gynecology. Consensus statements by the CNGOF, CARO, CNSF, FFRSP, SFAR, SFMP and SFN]. / Ressources humaines pour les activités non programmées en gynécologie-obstétrique. Propositions élaborées par le CNGOF, le CARO, le CNSF, la FFRSP, la SFAR, la SFMP et la SFN.

OBJECTIVE: To determine a minimum threshold of human resources (midwives, obstetricians and gynecologists, anesthesiology and intensive care units, pediatricians) to ensure the safety and quality of unplanned activities in Obstetrics and Gynecology. MATERIALS AND METHODS: Consultation of the MedLine database, the Cochrane Library and the recommendations of authorities. Meetings of representative members in different modes of practice (university, hospital, liberal) under the aegis of and belonging to the French College of Obstetricians and Gynecologists (CNGOF), the French Society of Anesthesia and Resuscitation (SFAR), the French Society of Neonatalogy (SFN), the French Society of Perinatal Medicine (SFMP), the French College of Midwives (CNSF), the French Federation of Perinatal Care Networks (FFRSP) with elaboration of a re-read text by external experts, in particular by the members of the Boards of Directors of these authorities and of Club of Anesthesiology-Intensive Care Medicine in Obstetrics (CARO). RESULTS: Different minimum thresholds for each category of caregivers were proposed based on the number of births/year. These proposed minimum thresholds can be modulated upwards according to the types (level I, IIA, IIB or III) or the activity (existence of an emergency reception service, maternal-fetal and/or surgical activity of resort or referral). Due to peak activity and the possibility of unpredictable concomitance of urgent medical procedures, it is necessary that organizations plan to use resource persons. The occupancy rate of the target beds of a maternity ward must be 85%. CONCLUSION: These proposed minimum thresholds are intended to help caregivers providing non-scheduled perinatal as well as Obstetrics and Gynecology care to make the most of the human resources allocated to institutional bodies to ensure their safety and quality.

[Expert centre Cancer du sein et Grossesse (CALG): Concordance between the proposed therapeutics and those finally received]. / Centre expert Cancer du sein et Grossesse (CALG) : concordance entre la proposition du CALG et la prise en charge effective.

OBJECTIVE: Breast cancer associated with pregnancy (CSAG) is a rare condition whose management justifies the use of expert center. The Pregnancy-Associated Cancer Network (CALG) was created in France to optimize therapeutic management. The objective of our study was to evaluate its impact on the therapeutic management of CSAGs and the discrepancy rate between the CALG proposal and the treatment performed. METHOD: A retrospective study including 58 CSAGs for which the opinion of the CALG network was solicited between January 2015 and November 2017. A questionnaire was addressed to the practitioner requesting the network. These practitioners were contacted to know the treatments received by the patient to assess the discrepancy rate. RESULTS: In 70% of the cases, the CALG network was solicited before any therapeutic treatment. When the opinion was requested after initiation of therapy, the discrepancy rate between the CALG proposal and the one practiced was 47%. Of the 46 physicians contacted, the response rate was 62.5% (30/46). In 90% of cases, the therapy proposed by the CALG network was the one received by the patient. CONCLUSION: This study emphasizes the need to refer to an expert center before treatment of a CSAG and the need for the contribution of doctors requesting the expert center to inform them of the follow-up of patients and children.

Reducing marine eutrophication may require a paradigmatic change.

Marine eutrophication in the North-East Atlantic (NEA) strongly relies on nutrient enrichment at the river outlets, which is linked to human activities and land use in the watersheds. The question is whether human society can reduce its nutrient emissions by changing land use without compromising food security. A new version of Riverstrahler model (pyNuts-Riverstrahler) was designed to estimate the point and diffuse nutrient emissions (N, P, Si) to the rivers depending on land use in the watersheds across a large domain (Western Europe agro-food systems, waste water treatment). The loads from the river model have been used as inputs to three marine ecological models (PCOMS, ECO-MARS3D, MIRO&CO) covering together a large part of the NEA from the Iberian shelf to the Southern North Sea. The modelling of the land-ocean continuum allowed quantifying the impact of changes in land use on marine eutrophication. Pristine conditions were tested to scale the current eutrophication with respect to a "natural background" (sensu WFD), i.e. forested watersheds without any anthropogenic impact. Three scenarios representing potential management options were also tested to propose future perspectives in mitigating eutrophication. This study shows that a significant decrease in nitrogen fluxes from land to sea is possible by adapting human activities in the watersheds, preventing part of the eutrophication symptoms in the NEA rivers and adjacent coastal zones. It is also shown that any significant achievement in that direction would very likely require paradigmatic changes at social, economic and agricultural levels. This requires reshaping the connections between crop production and livestock farming, and between agriculture and local human food consumption. It also involves cultural changes such as less waste production and a shift towards lower-impact and healthier diets where half of the animal products consumption is replaced by vegetal proteins consumption, known as a demitarian diet (http://www.nine-esf.org/node/281/index.html).

Trajectories of river chemical quality issues over the Longue Durée: the Seine River (1900S-2010).

River quality trajectories are presented for (i) organic pollution, (ii) eutrophication, (iii) nitrate pollution, and (iv) metal contamination over the Longue Durée (130 to 70 years). They are defined by a quantified state indicator (S) specific to each issue, compared to drivers (D) or pressures (P) and to social responses (R) that reflect the complex interactions between society and river quality. The Lower Seine River, naturally sensitive to anthropogenic pressures, greatly impacted by Paris urban growth, industrialization, and intensive agriculture, and well documented by the PIREN-Seine 25-year research program, was chosen to illustrate these trajectories. State indicators, dissolved oxygen, algal pigments, nitrate, and heavy metals (Cd, Cr, Hg, Pb, Zn) in sediments have only been monitored by river basin authorities since 1971. Therefore, their past changes have been reconstructed using three approaches: (i) reassessment of historical sources, (ii) pressure-state models that reconstruct past water quality, and (iii) sedimentary archives of past persistent contamination from dated floodplain cores. The indicators were then transformed into river quality status using contemporary water quality criteria throughout these records. Each environmental issue shows specific trajectories because each has its own relationship between the issue evidence and the social response, but all are characterized by very poor quality in the past, largely ignored: the long-term summer hypoxia (<1880-1995), the summer eutrophication peak (1965-2005), the growing nitrate level since the 1950s, recently stabilized but still high, and the extreme metal contamination (>1935-2000) that peaked in the 1960s. The efficiency of social responses has been highly variable but more efficient in the last 15-25 years.

Polarization domain walls in optical fibres as topological bits for data transmission.

Domain walls are topological defects which occur at symmetry-breaking phase transitions. While domain walls have been intensively studied in ferromagnetic materials, where they nucleate at the boundary of neighbouring regions of oppositely aligned magnetic dipoles, their equivalent in optics have not been fully explored so far. Here, we experimentally demonstrate the existence of a universal class of polarization domain walls in the form of localized polarization knots in conventional optical fibres. We exploit their binding properties for optical data transmission beyond the Kerr limits of normally dispersive fibres. In particular, we demonstrate how trapping energy in well-defined train of polarization domain walls allows undistorted propagation of polarization knots at a rate of 28 GHz along a 10 km length of normally dispersive optical fibre. These results constitute the first experimental observation of kink-antikink solitary wave propagation in nonlinear fibre optics.

Iron isotope fingerprints of redox and biogeochemical cycling in the soil-water-rice plant system of a paddy field.

The iron isotope composition was used to investigate dissimilatory iron reduction (DIR) processes in an iron-rich waterlogged paddy soil, the iron uptake strategies of plants and its translocation in the different parts of the rice plant along its growth. Fe concentration and isotope composition (δ56Fe) in irrigation water, precipitates from irrigation water, soil, pore water solution at different depths under the surface water, iron plaque on rice roots, rice roots, stems, leaves and grains were measured. Over the 8.5-10cm of the vertical profiles investigated, the iron pore water concentration (0.01 to 24.3mg·l-1) and δ56Fe (-0.80 to -3.40‰) varied over a large range. The significant linear co-variation between Ln[Fe] and δ56Fe suggests an apparent Rayleigh-type behavior of the DIR processes. An average net fractionation factor between the pore water and the soil substrate of Δ56Fe≈-1.15‰ was obtained, taking the average of all the δ56Fe values weighted by the amount of Fe for each sample. These results provide a robust field study confirmation of the conceptual model of Crosby et al. (2005, 2007) for interpreting the iron isotope fractionation observed during DIR, established from a series of laboratories experiments. In addition, the strong enrichment of heavy Fe isotope measured in the root relative to the soil solution suggest that the iron uptake by roots is more likely supplied by iron from plaque and not from the plant-available iron in the pore water. Opposite to what was previously observed for plants following strategy II for iron uptake from soils, an iron isotope fractionation factor of -0.9‰ was found from the roots to the rice grains, pointing to isotope fractionation during rice plant growth. All these features highlight the insights iron isotope composition provides into the biogeochemical Fe cycling in the soil-water-rice plant systems studied in nature.