The Study of Geographical Distribution in the Analysis of Domestication as an Evolutionary Process: Tensions in Alphonse de Candolle's Approach.

Interest in the study of domesticated plants increased near the end of the 18th century, mainly because of their economic potential. In the 19th century, there was a new focus on the historical understanding of species, their origin, changes in their distribution, and their evolutionary history. Charles Darwin developed an extended interpretation of species domestication, considering variations, reproduction, inheritance, and modification as standard processes between wild and domesticated organisms. In this context, one relatively neglected aspect was the geographical distribution of domesticated species. Alphonse de Candolle addressed and developed in detail the question of the geographical origin of cultivated plants. Since 1836 Alphonse de Candolle had been studying the topic and obtained evidence that contributed to understanding aspects such as the center of origin, dispersion, competition, selection, and time of domestication. Although Darwin himself admitted that Géographie botanique raisonnée (de Candolle, Alphonse,de. Géographie botanique raisonnée; ou, exposition des faits principaux et des lois concernant la distribution géographique des plantes de l'epoque actuelle, 2ème tome. Paris: Masson.) was of great help to him in the development of his evolutionary theory, the importance of de Candolle's contribution is seldom recognized. Our purpose is to detail the dialogue between Alphonse de Candolle and Darwin on the geography of domesticated plants, to understand some of the most critical discussions that contributed to the reinterpretation of domestication under the Darwinian proposal of modified descent.

River flow intermittence influence biodiversity-stability relationships across spatial scales: Implications for an uncertain future.

Climate change is increasing the proportion of river networks experiencing flow intermittence, which in turn reduces local diversity (i.e., α-diversity) but enhances variation in species composition among sites (i.e., ß-diversity), with potential consequences on ecosystem stability. Indeed, the multiscale theory of stability proposes that regional stability can be attained not only by local processes but also by spatial asynchrony among sites. However, it is still unknown whether and how scale-dependent changes in biodiversity associated with river flow intermittence influence stability across spatial scales. To elucidate this, we here focus on multiple metacommunities of French rivers experiencing contrasting levels of flow intermittence. We clearly show that the relative contribution of spatial asynchrony to regional stability was higher for metacommunities of intermittent than perennial rivers. Surprisingly, spatial asynchrony was mainly linked to asynchronous population dynamics among sites, but not to ß-diversity. This finding was robust for both truly aquatic macroinvertebrates and for taxa that disperse aerially during their adult stages, implying the need to conserve multiple sites across the landscape to attain regional stability in intermittent rivers. By contrast, metacommunities of truly aquatic macroinvertebrates inhabiting perennial rivers were mainly stabilized by local processes. Our study provides novel evidence that metacommunities of perennial and intermittent rivers are stabilized by contrasting processes operating at different spatial scales. We demonstrate that flow intermittence enhances spatial asynchrony among sites, thus resulting in a regional stabilizing effect on intermittent river networks. Considering that climate change is increasing the proportion of intermittent rivers worldwide, our results suggest that managers need to focus on the spatial dynamics of metacommunities more than on local-scale processes to monitor, restore, and conserve freshwater biodiversity.

Fulgence Raymond: from rural life and veterinary medicine to Charcot's successor at La Salpêtrière Hospital.

This paper provides a historical overview of Professor Fulgence Raymond, Charcot's eldest pupil, who was chosen as his successor. It explores Raymond's origins as a veterinary surgeon, his evolution as a neurologist under Charcot's mentorship, and his tenure as the professor's successor at the La Salpêtrière Hospital in Paris, France, from 1894 to 1910.

O presente artigo oferece um perfil histórico do professor Fulgence Raymond, que foi o pupilo mais velho do Professor Jean-Martin Charcot, é apresentado, destacando-se a origem de Raymond como cirurgião veterinário, sua carreira como médico neurologista sob supervisão de Charcot e, finalmente, a sua atuação como sucessor do professor , na cadeira de doenças do sistema nervoso do Hospital de La Salpêtrière, em Paris, França, entre os anos de 1894 e 1910.

Pierre Fauchard's Contribution to Oral Medicine and Oral and Maxillofacial Pathology: An historical essay.

Pierre Fauchard, considered the father of dentistry, contributed to the development of different fields of dentistry that we know today. However, the contribution of this important individual to the fields of oral medicine and oral and maxillofacial pathology is unknown. This study aimed to identify Pierre Fauchard's contribution to these areas of dentistry. We focused on "Le Chirurgien Dentiste, or Traité des Dents" in both French and English, looking for information about the oral diseases diagnosed and treated by Fauchard. Information on patient history, disease description, treatment applied, and clinical follow-up was collected. A contemporary analysis of the diseases was performed, and the collected data were systematized, reported, and analyzed descriptively, according to the current literature on the addressed topics. Information on conditions such as scurvy, parulides, epulides, oral ulcers, dentoalveolar abscesses, dental alterations, and post-exodontia incidents were elucidated. Findings indicated that Pierre Fauchard described, diagnosed, and treated different soft and hard tissue diseases of great interest to the fields of oral medicine and oral and maxillofacial pathology.

Identifying suicidal risk factors in the French Overseas Territories with multimethod psychological autopsy (AUTOPSOM): a mixed-methods study protocol.

INTRODUCTION: Understanding suicide in more isolated territories is a challenge because of the entanglement of cultural identity with historical, geographical and sociocultural specificities. This knowledge is a necessary precondition for the implementation of targeted prevention strategies in regions such as the French overseas territories (FOT), where data concerning suicidal risk factors is still incomplete. We aim to untangle sociocultural and clinical suicide risk factors by integrating a novel anthropological and psycholinguistic approach into the psychological autopsy method. This article describes the protocol of the clinical study 'Contribution of Psychological Autopsy to the Understanding of Suicidal Behaviours in Overseas France' (AUTOPSOM study), designed to identify common or new specific suicide risk factors in four FOT. METHODS AND ANALYSIS: A multicentre epidemiological study will be carried out in four FOTs (French Polynesia, Martinique, La Reunion and French Guiana) and at a comparison site in mainland France (La Somme). The methodology will be based on a mixed-methods (quantitative and qualitative) approach using a psychological autopsy to collect clinical data and life events in the deceased's life. We implemented an exploratory multimethod strategy that combines a succession of epidemiological, anthropological, psycholinguistic and psychological methods with a semiautomated analysis of the discourse of relatives bereaved by suicide. ETHICS AND DISSEMINATION: The study protocol (first version) was approved by the French Ethics Committee (CPP OUEST II, approval #22.04267.000122) and the Ethics Committee of French Polynesia (JOPF of 5 April 2022; CEPF opinion n°91 of 29 March 2022). The overall results and the perspectives established at the end of the study will be communicated to the bereaved relatives according to their will and serve for local suicide prevention purposes. TRIAL REGISTRATION NUMBER: NCT05773898.

A hiatus in the rivalry between Pierre Marie and Jules Dejerine: a collaborative study on sensory disorders by Andre Pierre Marie and Gustave Roussy.

Personal and professional rivalries involving prominent neurologists mark the history of nineteenth-century French neurology. One of the great examples is the feud between Pierre Marie and Jules Dejerine. The dispute between the two, nevertheless, did not prevent Pierre Marie's son, André Marie, and Gustave Roussy - one of Dejerine's favorite pupils, from collaborating on significant research that led to the doctoral dissertation by Andre Marie regarding sensory disturbances associated with painful hemiagnosia found in thalamic lesions.

As rivalidades pessoais e profissionais entre neurologistas proeminentes marcaram a história da neurologia francesa do século XIX. Um dos grandes exemplos é a rivalidade entre Pierre Marie e Jules Dejerine. A disputa entre os dois, no entanto, não impediu que o filho de Pierre Marie, André Marie, e Gustave Roussy, um dos pupilos preferidos de Dejerine, colaborassem numa investigação significativa que resultou na tese de doutorado de André Marie sobre os distúrbios sensoriais associados à hemiagnosia dolorosa encontrada nas lesões talâmicas.

Exploring food and beverage pairing from a cross-cultural projective mapping.

Culture is a well-known driver of food choices, and therefore, it could also impact food pairing preferences. Food pairing has been studied from different approaches; however, little cross-cultural research has been done. This work explored food and beverage pairing using projective mapping (PM) to create maps of food-beverage combinations. Four countries (Mexico, Argentina, France, and Norway), thirty foods, and six beverages were selected. PM was carried out through an online study in each country. Participants were asked to map foods together with beverages following the instruction that foods and beverages closer together represented a good combination. The coordinates of each product were analyzed through Multiple Factorial Analyses (MFA) by countries. The first four factors of each MFA were used to perform RV coefficients to test similarities in food-beverage pairings between the countries. Finally, a k-means clustering was performed on the beverage coordinates of each MFA. PM provided maps representing food and beverage pairings for each country in which the proximity between food-beverages represented a good combination according to consumers. RV coefficients between countries were low, showing that food-beverage pairings were not similar across countries, evidencing the cultural effect in food-drink combinations. Results from the k-means clustering showed some similarities and differences between countries. In general, the food-beverage pairing was effectively explored with PM, from which several differences and similarities were found within cultures.

Identifying selection strategies based on the practices and preferences of small ruminant farmers to improve the sustainability of their breeding systems.

Small ruminant farming is of socio-economic and environmental importance to many rural communities around the world. The SMARTER H2020 project aims to redefine genetic selection criteria to increase the sustainability of the sector. The objective of this study was to analyse the selection and breeding management practices of small ruminant producers and breeders, linked with socio-technical elements that shape them. The study is based on farm surveys using semi-structured interviews conducted in five countries (France, Spain, Italy, Greece, and Uruguay) across 272 producers and breeders of 13 sheep and goat breeds, and 15 breed × system combinations. The information was collected in four sections. The first and second sections dealt with general elements of structure and management of the system and the flock/herd. The third section focused on selection and breeding management practices: criteria for culling and replacement of females, selection criteria for males, use of estimated breeding values and global indexes, and preferences for indexing new traits to increase the sustainability of their system. The fourth section aimed to collect socio-technical information. We used a data abstraction method to standardise the representation of these data. A mixed data factor analysis followed by a hierarchical ascending classification allowed the characterisation of three profiles of selection and breeding management: (1) a profile of producers (n = 93) of small flocks/herds, with little knowledge or use of genetic selection and improvement tools (selection index, artificial insemination, performance recording); these farmers do not feel that new traits are needed to improve the sustainability of their system. (2) a profile of producers (n = 34) of multibreed flocks/herds that rely significantly on grazing; they are familiar with genetic tools, they currently use AI; they would like the indexes to include more health and robustness characteristics, to make their animals more resistant and to increase the sustainability of their system. And (3) a profile of producers or breeders (n = 145) of large flocks/herds, with specific culling criteria; these farmers are satisfied with the current indexes to maintain the sustainability of their system. These results are elements that can be used by private breeding companies and associations to support the evolution of selection objectives to increase the resilience of animals and to improve the sustainability of the small ruminant breeding systems.

Paraspecificity of Mexican antivipmyn TRI antivenom in envenomation by Chinese Protobothrops mangshanensis (Mangshan pit viper) in France: A case report and experimental neutralization of venom procoagulant effect.

This case report presents an exotic envenomation by a Chinese snake, Protobothrops mangshanensis. Its venom exhibited potent activity against plasma and fibrinogen, among other enzymatic activities. The patient initially presented with edema of the right upper limb, without tissue necrosis. There were no signs of bleeding; however, severe hypofibrinogenemia was observed (nadir value at 0.4 g/L), with a marked increase in fibrinogen degradation products and D-dimers, without any other coagulation disturbances. In the absence of a specific antivenom available against Asian Crotalinae venoms, the patient was treated at the 29th hour after bite with six vials of Antivipmyn™ TRI (Instituto Bioclon, Mexico, Mexico), a Mexican antivenom initially intended for American Crotalinae venoms, i.e., Bothrops asper, Lachesis muta and Crotalus durissus. Fibrinogen began to rise 6 hours after the antivenom infusion and was within the normal range 38 hours later. The report also underscores the utility of ClotPro® (Haemonetics ®USA), a viscoelastic test, for real-time monitoring of the snakebite-related coagulopathy. The clotting time was extended to 188 seconds on the EX-test while the MCF was decreased to 31 mm on the EX-test and the AP-test and was not measurable on the FIB-test, confirming severe hypofibrinogenemia. In order to confirm the paraspecificity of antivenom on the venom of P. mangshanensis, we studied the experimental neutralization of the venom procoagulant effect by Antivipmyn TRI and Green Pit Viper antivenom, which has been used in previous published clinical cases of P. mangshanensis envenomation. Both Antivipmyn™ TRI and Green Pit Viper antivenom corrected the procoagulant effect induced by P. mangshanensis venom. These findings suggest that Antivipmyn™ TRI cross-reacts with Protobothrops mangshanensis venom. In the absence of antivenom covering Asian Crotalinae, Antivipmyn TRI should be considered to treat an envenomation by Protobothrops spp.

[Oncology in French Guiana: A challenge to win]. / La cancérologie en Guyane : un défi à gagner.

French Guiana is an equatorial, multicultural, overseas territory in South America. The region is unique: a wealthy country with a universal healthcare system, but significant poverty, which bears little resemblance to its neighbors Brazil and Suriname. Cancer is the second leading cause of death. The incidence of cancer is lower than in France, stages are generally more advanced and the prognosis worse. To date, oncology has been organized through a joint venture between local institutions and healthcare professionals and a cancer center in mainland France, in line with the recommendations of the Institut National du Cancer. The implementation of a medical project and a complete medical studies curriculum in French Guiana is a tremendous opportunity for the development of oncology. The main challenges are consolidating medical care for patients, quality control, genetic oncology, molecular biology, implementation of radiotherapy and nuclear medicine, clinical and translational research, and teaching programs. Working in oncology in French Guiana is exciting because of the scientific interest (particular characteristics of cancers, notably the role of viral or micro-organism-induced carcinogenesis, genetic factors in these populations with African and Asian roots, and the importance of a public health policy) and human interest (patients from different cultures; all of them bring original approaches to health and illness that need to be deciphered in order to offer quality care). This requires the support of healthcare professionals who are enthusiastic about this unique adventure.

François Rabelais and his dystonic giants.

Spasmodic torticollis was an early designation used for cervical dystonia. The origin of this name is attributed to French physician and writer François Rabelais in the mid-sixteenth century. This early description of torticollis in the book Pantagruel was an inspiration for the understanding of cervical dystonia. The art expressed in Rabelais' literature ‒ which was immortalized by the drawings of Gustave Doré ‒ influenced poetry, art, and photography, and led to the adoption of the term torticollis in the neurological sciences.

Uma designação inicial usada para distonia cervical era torcicolo espasmódico. A origem desse termo é atribuída ao médico e escritor francês François Rabelais em meados do século XVI. Essa descrição inicial do torcicolo no livro Pantagruel foi uma inspiração para a compreensão da distonia cervical. A arte exibida na literatura de Rabelais ‒ imortalizada pelos desenhos de Gustave Doré ‒ influenciou a poesia, a arte e a fotografia, e levou à adoção do termo torcicolo nas ciências neurológicas.

Asthma patients' and physicians' perspectives on the burden and management of asthma: Post-hoc analysis of APPaRENT 1 and 2 to assess predictors of treatment adherence.

INTRODUCTION: Patient adherence to maintenance medication is critical for improving clinical outcomes in asthma and is a recommended guiding factor for treatment strategy. Previously, the APPaRENT studies assessed patient and physician perspectives on asthma care; here, a post-hoc analysis aimed to identify patient factors associated with good adherence and treatment prescription patterns. METHODS: APPaRENT 1 and 2 were cross-sectional online surveys of 2866 adults with asthma and 1883 physicians across Argentina, Australia, Brazil, Canada, China, France, Italy, Mexico, and the Philippines in 2020-2021. Combined data assessed adherence to maintenance medication, treatment goals, use of asthma action plans, and physician treatment patterns and preferences. Multivariable logistic regression models assessed associations between patient characteristics and both treatment prescription (by physicians) and patient treatment adherence. RESULTS: Patient and physician assessments of treatment goals and adherence differed, as did reporting of short-acting ß2-agonist (SABA) prescriptions alongside maintenance and reliever therapy (MART). Older age and greater patient-reported severity and reliever use were associated with better adherence. Patient-reported prescription of SABA with MART was associated with household smoking, severe or poorly controlled asthma, and living in China or the Philippines. CONCLUSIONS: Results revealed an important disconnect between patient and physician treatment goals and treatment adherence, suggesting that strategies for improving patient adherence to maintenance medication are needed, focusing on younger patients with milder disease. High reliever use despite good adherence may indicate poor disease control. Personalised care considering patient characteristics alongside physician training in motivational communication and shared decision-making could improve patient management and outcomes.

Un padre olvidado de la Microbiología: Louis Joblot / A forgotten father of Microbiology

El microscopista francés Louis Joblot (1645-1723), contemporáneo de Antoine van Leeuwenhoek y Robert Hooke, puede ser considerado uno de los padres de la protistología/microbiología. Su obra titulada "Descripciones y usos de varios microscopios nuevos" de 1718 contiene varias extraordinarias imágenes de protozoos en movimiento y en división binaria. Lamentablemente, algunas imágenes de dicha obra contenían figuras fantásticas, por lo que su legado fue rápidamente obscurecido. Sus experimentos sobre el fenómeno de generación espontánea marcaron un hito en el desarrollo de este debate y se adelantaron en casi siglo y medio a los experimentos de Louis Pasteur.

The French microscopist Louis Joblot (1645-1723), a contemporary of Antoine van Leeuwenhoek and Robert Hooke, he can be considered one of the fathers of protistology/microbiology. His work entitled "Descriptions and uses of various new microscopes" of 1718 contains several extraordinary images of protozoa in motion and in binary division. Unfortunately, some images of this work contained fantastic figures, so his legacy was quickly obscured. His experiments on the phenomenon of spontaneous generation marked a milestone in the development of this debate and anticipated Louis Pasteur's experiments by almost a century and a half.

Molecular epidemiology identifies the expansion of the DENV2 epidemic lineage from the French Caribbean Islands to French Guiana and mainland France, 2023 to 2024.

In 2023, dengue virus serotype 2 (DENV2) affected most French overseas territories. In the French Caribbean Islands, viral circulation continues with > 30,000 suspected infections by March 2024. Genome sequence analysis reveals that the epidemic lineage in the French Caribbean islands has also become established in French Guiana but not Réunion. It has moreover seeded autochthonous circulation events in mainland France. To guide prevention of further inter-territorial spread and DENV introduction in non-endemic settings, continued molecular surveillance and mosquito control are essential.

Identifying Newborns with Hypoxic-Ischemic Encephalopathy in Hospital Discharge Data: A Validation Study.

Hospital discharge databases (HDDs) are increasingly used for research on health of newborns. Linkage between a French population-based cohort of newborns with hypoxic-ischemic encephalopathy (HIE) and national HDD showed that the HIE ICD-10 code was not accurately reported. Our results suggest that HDD should not be used for research on neonatal HIE without prior validation of HIE ICD-10 codes.

Relationship between spinal structural damage and sagittal balance in axial spondyloarthritis: Is the thoracic spine the starting point?

OBJECTIVES: To assess the relationship between spinal structural damage, sagittal balance parameters and spine curvatures in patients with axial spondyloarthritis (axSpA). MATERIAL AND METHODS: In this cross-sectional study, the pelvic and sagittal balance parameters were obtained through EOS® (Biospace, Paris, France). Patients were divided into three groups according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) tertiles (G1 ≤6, n = 36; G2: 6.1-31, n = 36; G3 >31, n = 35) and pelvic and sagittal parameters were compared across them. Multivariable regression analysis was performed to analyze the impact of spinal structural damage and of other factors on sagittal vertical axis (SVA), an important sagittal balance parameter. RESULTS: A total of 107 patients was included. G2 and 3 exhibited higher mean values of thoracic kyphosis T1-T12 when compared to G1 (10.5°(12.3) vs. 22.3°(17.3) vs. 35.2°(14.6), p < 0.001), and G3 demonstrated lumbar L1-S1 straightening compared to the other groups (55.7°(9) and 50.7°(19.8), G1 and G2, respectively, vs. 35.7°(13.2), p < 0.001). Mean SVA values showed an increasing gradient from G1 to G3 (21.6(25.1) vs. 41(44.3) vs. 84.3(47.2)mm, p < 0.001). In the multivariable regression, a one-unit increase in total mSASSS was associated with an average 0.8 mm higher SVA. CONCLUSIONS: Our data showed that more spinal structural damage is associated with a higher SVA, reflecting poorer sagittal balance. Patients with increasing spinal damage have an important increase in thoracic kyphosis suggesting that postural modifications in patients with axSpA might have their origin in the thoracic spine.

Novel COVID-19 biomarkers identified through multi-omics data analysis: N-acetyl-4-O-acetylneuraminic acid, N-acetyl-L-alanine, N-acetyltriptophan, palmitoylcarnitine, and glycerol 1-myristate.

This study aims to apply machine learning models to identify new biomarkers associated with the early diagnosis and prognosis of SARS-CoV-2 infection.Plasma and serum samples from COVID-19 patients (mild, moderate, and severe), patients with other pneumonia (but with negative COVID-19 RT-PCR), and healthy volunteers (control) from hospitals in four different countries (China, Spain, France, and Italy) were analyzed by GC-MS, LC-MS, and NMR. Machine learning models (PCA and PLS-DA) were developed to predict the diagnosis and prognosis of COVID-19 and identify biomarkers associated with these outcomes.A total of 1410 patient samples were analyzed. The PLS-DA model presented a diagnostic and prognostic accuracy of around 95% of all analyzed data. A total of 23 biomarkers (e.g., spermidine, taurine, L-aspartic, L-glutamic, L-phenylalanine and xanthine, ornithine, and ribothimidine) have been identified as being associated with the diagnosis and prognosis of COVID-19. Additionally, we also identified for the first time five new biomarkers (N-Acetyl-4-O-acetylneuraminic acid, N-Acetyl-L-Alanine, N-Acetyltriptophan, palmitoylcarnitine, and glycerol 1-myristate) that are also associated with the severity and diagnosis of COVID-19. These five new biomarkers were elevated in severe COVID-19 patients compared to patients with mild disease or healthy volunteers.The PLS-DA model was able to predict the diagnosis and prognosis of COVID-19 around 95%. Additionally, our investigation pinpointed five novel potential biomarkers linked to the diagnosis and prognosis of COVID-19: N-Acetyl-4-O-acetylneuraminic acid, N-Acetyl-L-Alanine, N-Acetyltriptophan, palmitoylcarnitine, and glycerol 1-myristate. These biomarkers exhibited heightened levels in severe COVID-19 patients compared to those with mild COVID-19 or healthy volunteers.

Global prediction for mpox epidemic.

The mpox epidemic had spread worldwide and become an epidemic of international concern. Before the emergence of targeted vaccines and specific drugs, it is necessary to numerically simulate and predict the epidemic. In order to better understand and grasp its transmission situation, and take some countermeasures accordingly when necessary, we predicted and simulated mpox transmission, vaccination and control scenarios using model developed for COVID-19 predictions. The results show that the prediction model can also achieve good results in predicting the mpox epidemic based on modified SEIR model. The total number of people infected with mpox on Dec 31, 2022 reached 83878, while the prediction of the model was 96456 with a relative error of 15%. The United States, Brazil, Spain, France, the United Kingdom and Germany are six countries with serve mpox epidemic. The predictions of their epidemic are 30543, 11191, 7447, 5945, 5606 and 4291 cases respectively, with an average relative error of 20%. If 30% of the population is vaccinated using a vaccine that is 78% effective, the number of infected people will drop by 29%. This shows that the system can be practically applied to the prediction of mpox epidemic and provide corresponding decision-making reference.

Analyzing the territorial dimensions of work through a comparative study of waste recovery facilities in France and Brazil.

BACKGROUND: Waste production and management from residents and collection for sorting are systems heavily dependent on territorial dimensions. Ergonomic research needs to better integrate such territorial determinants to improve work conditions and design sustainable work systems. OBJECTIVE: Through studies in France and Brazil, this paper analyzes the territorial relations that raise work systems' sustainability challenges for materials recovery facilities (MRFs) and waste management in both countries and examines the links between work activity and territory in MRFs. METHODS: Both studies were based on the principles of activity-oriented ergonomics and used analyses of work activity and sociotechnical systems. The French study focused on interventions conducted over a 42-month period in five MRFs. The Brazilian study was based on a 20-month longitudinal qualitative and quantitative study. RESULTS: In this paper, we argue that territory is a key determining factor in waste production and work. Notably, the consumption patterns of residents and the economic flows within a geographic space determine the waste composition; and the territorially specified public policies, which define technical and social dimensions of waste collection and sorting. However, the territorial dimensions of waste are poorly considered in facility design. Workers' health and sorting system performance are thus affected and negatively compromising plant performance. CONCLUSION: The territory appears as a blind spot in the design of work systems. One of the challenges is to create interfaces and devices that could help to integrate better human activity and waste territorialized anchorage, in a multilevel organization, from local communities to the global recycling chains.

The Impact of Teduglutide on Real-Life Health Care Costs in Children with Short Bowel Syndrome.

OBJECTIVES: To analyze the real-life health care costs of home parenteral nutrition (HPN) in children with short bowel syndrome with intestinal failure (SBS-IF) before and after treatment with teduglutide, and to compare those with costs of children with SBS-IF not treated with teduglutide. STUDY DESIGN: All consecutive children with SBS-IF on HPN treated with subcutaneous teduglutide starting from 2018 through 2020 in a tertiary French referral center were retrospectively included. These patients were matched to children with SBS-IF on HPN followed during the same 3-year period who were eligible for the teduglutide but were not treated. HPN direct medical costs included home-care charges, HPN bags, hospital admissions, and teduglutide. A comparison of costs before/after treatment and between patients treated/not treated was performed. RESULTS: Sixty children were included: 30 (50%) were treated with teduglutide and 30 (50%) were untreated. In the treated group, the median total costs of HPN significantly decreased after 1 (P < .001) and 2 years of treatment (P < .001) from 59 454 euros/year/patient to 43 885 euros/year/patient and 34 973 euros/year/patient, respectively. When we compared patients treated and not treated, the total HPN costs/year/patient were similar at baseline (P = .6) but were significantly lower in the teduglutide-treated group after 1 (P = .006) and 2 years of treatment (P < .001). When we added the cost of teduglutide into the analysis, the total cost increased significantly in the treated group and remained much greater even after modeling a reduction in the cost of the drug to one-third the present cost and PN weaning (P < .001). CONCLUSIONS: Treatment with teduglutide is associated with a significant reduction in the annual costs of HPN but still remains expensive because of the drug itself. Finding cost-saving strategies is essential.