[Chemotherapy-induced nausea and vomiting in pediatric oncology patients: 2023 recommendations from the Supportive Care Committee of the French Society of Cancer in Children and Adolescents]. / Nausées et vomissements chimio-induits en oncohématologie pédiatrique : actualisation 2023 des recommandations du comité soins de support de la SFCE.

Chemotherapy-induced nausea and vomiting (CINV) are frequent and dreaded side effects in cancer treatments. CINV has a major impact on patient's condition and quality of life. Prophylaxis is tailored to patient's profile and the emetogenic level of their chemotherapy. The aim of this study is to update the recommendations for CINV prevention and management in pediatric onco-hematology for use in France, by adapting the guidelines of the Pediatric Oncology Group of Ontario (POGO). Clinical practice guideline adaptation is a recognized method for tailoring existing clinical practice guidelines to local context. A multidisciplinary French-speaking panel was formed to discuss about POGO guideline recommendations for the acute and delayed phases, breakthrough, refractory and anticipatory CINV and the evidence supporting them. Panel members were asked whether they wanted to adopt, modify or reject each of the POGO guideline recommendations. Panel members translated each recommendation and adapted recommendations for an implementation in France. Their acceptance required agreement at least 80 % of panel members. Algorithms and tables were created, listing all the recommendations and providing a better overview for decision-making process adapted to the patient's profile. These recommendations should be reviewed for implementation at French institutions caring for pediatric cancer patients and once implemented, the rates of adherence to recommendations and CINV control should be reported.

On-Farm Experimentation to transform global agriculture.

Restructuring farmer-researcher relationships and addressing complexity and uncertainty through joint exploration are at the heart of On-Farm Experimentation (OFE). OFE describes new approaches to agricultural research and innovation that are embedded in real-world farm management, and reflects new demands for decentralized and inclusive research that bridges sources of knowledge and fosters open innovation. Here we propose that OFE research could help to transform agriculture globally. We highlight the role of digitalization, which motivates and enables OFE by dramatically increasing scales and complexity when investigating agricultural challenges.

Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study.

BACKGROUND: Characteristics and outcome of invasive fungal infection (IFI) in critically ill burn patients have been poorly explored. OBJECTIVES: We report the factors associated with 90-day mortality in a multicentre retrospective European study. PATIENTS/METHODS: All burn patients with confirmed IFI admitted between 1 January 2010 to 31 December 2015 in 10 centres in France and Belgium were included. RESULTS: Ninety-four patients were enrolled with 110 cases of IFIs: 79 (71.8%) were yeasts IFI and 31 (28.2%) filamentous IFI. Incidence was 1% among admitted patients. The 90-day mortality was 37.2% for all IFIs combined, 52% for filamentous infection and 31.9% for yeast infection. Patients with more than one IFI had a higher 90-day mortality than patients with only one episode (61.5% vs 33.5% (P = .006)). In multivariate analysis, higher Simplified Acute Physiology Score II (OR = 1.05 (95% CI: 1.02-1.09) P = .003), bacterial co-infection (OR = 3.85 (95% CI: 1.23-12.01), P = .014) and use of skin allografts at the time of IFI diagnosis (OR = 3.87 (95% CI: 1.31-11.42), P = .021) were associated with 90-day mortality. CONCLUSIONS: Although rare, invasive fungal infections remain associated with poor outcome in burn patients. Bacterial co-infection and presence of allograft were potentially modifiable factors independently associated with outcome.

Low cardiac index and stroke volume on admission are associated with poor outcome in critically ill burn patients: a retrospective cohort study.

BACKGROUND: Impact of early systemic hemodynamic alterations and fluid resuscitation on outcome in the modern burn care remains controversial. We investigate the association between acute-phase systemic hemodynamics, timing of fluid resuscitation and outcome in critically ill burn patients. METHODS: Retrospective, single-center cohort study was conducted in a university hospital. Forty critically ill burn patients with total body surface area (TBSA) burn-injured >20 % with invasive blood pressure and cardiac output monitoring (transpulmonary thermodilution technique) within 8 h from trauma were included. We retrospectively examined hemodynamic variables during the first 24 h following admission, and their association with 90-day mortality. RESULTS: The median (interquartile range 25th-75th percentile) TBSA, Simplified Acute Physiology Score II (SAPS II) and Abbreviated Burn Severity Index of the study population were 41 (29-56), 31 (23-50) and 9 (7-11) %, respectively. 90-Day mortality was 42 %. There was no statistical difference between the median pre-hospital and 24-h administered fluid volume in survivors and non-survivors. On admission, stroke volume (SV), cardiac index (CI), oxygen delivery index and mean arterial pressure (MAP) were significantly lower in patients who died despite similar fluid resuscitation volume. ROC curves comparing the ability of initial SV, CI, MAP and lactate to discriminate 90-day mortality gave areas under curves of, respectively, 0.89 (CI 0.77-1), 0.77 (CI 0.58-0.95), 0.73 (CI 0.53-0.93) and 0.78 (CI 0.63-0.92); (p value <0.05 for all). In multivariate analysis, SAPS II and initial SV were independently associated with 90-day mortality (best cutoff value for SV was 27 mL, sensitivity 92 %, specificity 69 %). During 24 h, no interaction was found between time and outcome regarding macrocirculatory parameters changes. Hemodynamic parameters improved during the first 24-h resuscitation in all patients but patients who died had lower SV and CI on admission, which remained through the first 24 h. CONCLUSION: Low initial SV and CI were associated with poor outcome in critically ill burn patients. Very early hemodynamic monitoring may in help detecting under-resuscitated patients. Future prospective interventional studies should explore the impact of early goal-directed therapy in these specific patients.

Detection of Circulating Mucorales DNA in Critically Ill Burn Patients: Preliminary Report of a Screening Strategy for Early Diagnosis and Treatment.

BACKGROUND: Invasive wound mucormycosis (IWM) is associated with an extremely poor outcome among critically ill burn patients. We describe the detection of circulating Mucorales DNA (cmDNA) for the early diagnosis of IWM in those patients and report the potential value of detecting cmDNA for treatment guidance. METHODS: Severely ill burn patients admitted to our tertiary referral center between October 2013 and February 2016 were included. Retrospective plasma samples were tested for the presence of cmDNA by quantitative real-time polymerase chain reaction (qPCR). Patients were then prospectively screened twice a week, and liposomal amphotericin-B therapy initiated based on a positive qPCR. The primary endpoint was the time between cmDNA detection and standard diagnosis. Secondary endpoints were the time from cmDNA detection and treatment initiation and mortality. RESULTS: Seventy-seven patients (418 samples) were included. The average age was 46 (28-60) years, abbreviated burn severity index was 8 (7-10), and simplified acute physiology score was 33 (23-46). The total body surface area was 33% (22%-52%). cmDNA was detected 11 (4.5-15) days before standard diagnosis. The in-hospital mortality was 62% for patients with IWM and 24% for those without (P = .03). The mortality due to IWM was 80% during period A and 33% during period B (P = .46). CONCLUSIONS: This study suggests that the detection of cmDNA allows earlier diagnosis of IWM in severely ill burn patients and earlier initiation of treatment. Further studies are needed to confirm the impact of earlier treatment initiation on patient outcome.

Heart rate variability and cardiac baroreflex inhibition-derived index predicts pain perception in burn patients.

BACKGROUND: Dressing changes induce acute pain in burn patients. This pain is difficult to predict and may be therefore undertreated. Two different non-invasive electrophysiological indices from heart rate variability and baroreflex inhibition-derived indices, analgesia/nociception index (ANI) and cardiovascular depth of analgesia (CARDEAN), have been proposed to predict and better assess adequacy of anti-nociception. The aim of this study was to evaluate these techniques as early pain alert tools in conscious burnt patients during dressing changes' procedures. METHODS: Twenty adult burnt patients undergoing scheduled wound treatment procedures were included in this prospective observational study. Pain intensity was assessed using a 0-10 numerical rating scale (NRS) and was compared with both ANI and CARDEAN, during the procedures. Non parametric rank sum test and linear discriminant analysis were used for evaluating potential differences of measured variables between periods with different pain intensities. Receiver-operating characteristic (ROC) curves were built to assess their performance to detect pain within following 15s. RESULTS: The sensitivity and specificity of ANI to detect pain were 67% and 70% and those of CARDEAN were 77% and 80%, with area under the curve (AUC) values of 0.75 and 0.83, respectively. Their combination increased AUC to 0.87. CONCLUSIONS: Both ANI and CARDEAN indices during wound treatment procedures seem to discriminate periods with and without pain within 15s, serving as a potential complementary tool for early optimized pain control.

Urine sodium concentration to predict fluid responsiveness in oliguric ICU patients: a prospective multicenter observational study.

BACKGROUND: Oliguria is one of the leading triggers of fluid loading in patients in the intensive care unit (ICU). The purpose of this study was to assess the predictive value of urine Na(+) (uNa(+)) and other routine urine biomarkers for cardiac fluid responsiveness in oliguric ICU patients. METHODS: We conducted a prospective multicenter observational study in five university ICUs. Patients with urine output (UO) <0.5 ml/kg/h for 3 consecutive hours with a mean arterial pressure >65 mmHg received a fluid challenge. Cardiac fluid responsiveness was defined by an increase in stroke volume >15 % after fluid challenge. Urine and plasma biochemistry samples were examined before fluid challenge. We examined renal fluid responsiveness (defined as UO > 0.5 ml/kg/h for 3 consecutive hours) after fluid challenge as a secondary endpoint. RESULTS: Fifty-four patients (age 51 ± 37 years, Simplified Acute Physiology Score II score 40 ± 20) were included. Most patients (72 %) were not cardiac responders (CRs), and 50 % were renal responders (RRs) to fluid challenge. Patient characteristics were similar between CRs and cardiac nonresponders. uNa(+) (37 ± 38 mmol/L vs 25 ± 75 mmol/L, p = 0.44) and fractional excretion of sodium (FENa(+)) (2.27 ± 2.5 % vs 2.15 ± 5.0 %, p = 0.94) were not statistically different between those who did and those who did not respond to the fluid challenge. Areas under the receiver operating characteristic (AUROC) curves were 0.51 (95 % CI 0.35-0.68) and 0.56 (95 % CI 0.39-0.73) for uNa(+) and FENa(+), respectively. Fractional excretion of urea had an AUROC curve of 0.70 (95 % CI 0.54-0.86, p = 0.03) for CRs. Baseline UO was higher in RRs than in renal nonresponders (1.07 ± 0.78 ml/kg/3 h vs 0.65 ± 0.53 ml/kg/3 h, p = 0.01). The AUROC curve for RRs was 0.65 (95 % CI 0.53-0.78) for uNa(+). CONCLUSIONS: In the present study, most oliguric patients were not CRs and half were not renal responders to fluid challenge. Routine urinary biomarkers were not predictive of fluid responsiveness in oliguric normotensive ICU patients.

Life cycle assessment of forecasting scenarios for urban water management: A first implementation of the WaLA model on Paris suburban area.

A framework and an associated modeling tool to perform life cycle assessment (LCA) of urban water system, namely the WaLA model, has been recently developed. In this paper, the WaLA model is applied to a real case study: the urban water system of the Paris suburban area, in France. It aims to verify the capacity of the model to provide environmental insights to stakeholder's issues related to future trends influencing the system (e.g., evolution of water demand, increasing water scarcity) or policy responses (e.g., choices of water resources and technologies). This is achieved by evaluating a baseline scenario for 2012 and several forecasting scenarios for 2022 and 2050. The scenarios are designed through the modeling tool WaLA, which is implemented in Simulink/Matlab: it combines components representing the different technologies, users and resources of the UWS. The life cycle inventories of the technologies and users components include water quantity and quality changes, specific operation (electricity, chemicals) and infrastructures data (construction materials). The methods selected for the LCIA are midpoint ILCD, midpoint water deprivation impacts at the sub-river basin scale, and endpoint Impact 2002+. The results of the baseline scenario show that wastewater treatment plants have the highest impacts compared to drinking water production and distribution, as traditionally encountered in LCA of UWS. The results of the forecasting scenarios show important changes in water deprivation impacts due to water management choices or effects of climate change. They also enable to identify tradeoffs with other impact categories and to compare several scenarios. It suggests the capacity of the model to deliver information for decision making about future policies.

WaLA, a versatile model for the life cycle assessment of urban water systems: Formalism and framework for a modular approach.

The emphasis on the sustainable urban water management has increased over the last decades. In this context decision makers need tools to measure and improve the environmental performance of urban water systems (UWS) and their related scenarios. In this paper, we propose a versatile model, named WaLA (Water system Life cycle Assessment), which reduces the complexity of the UWS while ensuring a good representation of water issues and fulfilling life cycle assessment (LCA) requirements. Indeed, LCAs require building UWS models, which can be tedious if several scenarios are to be compared. The WaLA model is based on a framework that uses a "generic component" representing alternately water technology units and water users, with their associated water flows, and the associated impacts due to water deprivation, emissions, operation and infrastructure. UWS scenarios can be built by inter-operating and connecting the technologies and users components in a modular and integrated way. The model calculates life cycle impacts at a monthly temporal resolution for a set of services provided to users, as defined by the scenario. It also provides the ratio of impacts to amount of services provided and useful information for UWS diagnosis or comparison of different scenarios. The model is implemented in a Matlab/Simulink interface thanks to object-oriented programming. The applicability of the model is demonstrated using a virtual case study based on available life cycle inventory data.

Improvement of the chemical content prediction of a model powder system by reducing multiple scattering using polarized light spectroscopy.

Near-infrared spectroscopy (NIRS) is a powerful non-destructive analytical method used to analyze major compounds in bulk materials and products and requiring no sample preparation. It is widely used in routine analysis and also in line in industries, in vivo with biomedical applications, or in field for agricultural and environmental applications. However, highly scattering samples subvert Beer-Lambert law's linear relationship between spectral absorbance and the concentration. Instead of spectral pre-processing, which is commonly used by NIR spectroscopists to mitigate the scattering effect, we put forward an optical method, i.e., coupling polarized light with NIR spectrometry, to free spectra from scattering effect. This should allow us to retrieve linear and steady conditions for spectral analysis. When tested in visible-NIR (Vis-NIR) range (400-800 nm) on model media, mixtures of scattering and absorbing particles, the setup provided significant improvements in absorber concentration estimation precision as well as in the quality and robustness of the calibration model.

Combining linear polarization spectroscopy and the Representative Layer Theory to measure the Beer-Lambert law absorbance of highly scattering materials.

Visible and Near Infrared (Vis-NIR) Spectroscopy is a powerful non destructive analytical method used to analyze major compounds in bulk materials and products and requiring no sample preparation. It is widely used in routine analysis and also in-line in industries, in-vivo with biomedical applications or in-field for agricultural and environmental applications. However, highly scattering samples subvert Beer-Lambert law's linear relationship between spectral absorbance and the concentrations. Instead of spectral pre-processing, which is commonly used by Vis-NIR spectroscopists to mitigate the scattering effect, we put forward an optical method, based on Polarized Light Spectroscopy to improve the absorbance signal measurement on highly scattering samples. This method selects part of the signal which is less impacted by scattering. The resulted signal is combined in the Absorption/Remission function defined in Dahm's Representative Layer Theory to compute an absorbance signal fulfilling Beer-Lambert's law, i.e. being linearly related to concentration of the chemicals composing the sample. The underpinning theories have been experimentally evaluated on scattering samples in liquid form and in powdered form. The method produced more accurate spectra and the Pearson's coefficient assessing the linearity between the absorbance spectra and the concentration of the added dye improved from 0.94 to 0.99 for liquid samples and 0.84-0.97 for powdered samples.

Influence of the central venous site on the transpulmonary thermodilution parameters in critically ill burn patients.

The aim of this study was to verify the measurement concordance of cardiac index (CI), extra-vascular lung water index (EVLWI) and global end diastolic volume index (GEDVI) with transpulmonary thermodilution (TPTD) between the jugular and femoral access with catheters inserted ipsilaterally in critically ill burn patients. Correlations were excellent and the concordance was good for the CI, EVLW and GEDVI (mean bias -0.11 L/min/m², -0.3 mL/kg and -20 mL/m² for CI, EVLW and GEDVI, respectively). We conclude that ipsilateral arterial and venous femoral and jugular measurement of TPTD parameters can be used interchangeably if catheters with different lengths on the femoral site are used.

Life cycle assessments of urban water systems: a comparative analysis of selected peer-reviewed literature.

Water is a growing concern in cities, and its sustainable management is very complex. Life cycle assessment (LCA) has been increasingly used to assess the environmental impacts of water technologies during the last 20 years. This review aims at compiling all LCA papers related to water technologies, out of which 18 LCA studies deals with whole urban water systems (UWS). A focus is carried out on these 18 case studies which are analyzed according to criteria derived from the four phases of LCA international standards. The results show that whereas the case studies share a common goal, i.e., providing quantitative information to policy makers on the environmental impacts of urban water systems and their forecasting scenarios, they are based on different scopes, resulting in the selection of different functional units and system boundaries. A quantitative comparison of life cycle inventory and life cycle impact assessment data is provided, and the results are discussed. It shows the superiority of information offered by multi-criteria approaches for decision making compared to that derived from mono-criterion. From this review, recommendations on the way to conduct the environmental assessment of urban water systems are given, e.g., the need to provide consistent mass balances in terms of emissions and water flows. Remaining challenges for urban water system LCAs are identified, such as a better consideration of water users and resources and the inclusion of recent LCA developments (territorial approaches and water-related impacts).

Assessing water deprivation at the sub-river basin scale in LCA integrating downstream cascade effects.

Physical water deprivation at the midpoint level is assessed in water-related LCIA methods using water scarcity indicators (e.g., withdrawal-to-availability and consumption-to-availability) at the river basin scale. Although these indicators represent a great step forward in the assessment of water-use-related impacts in LCA, significant challenges still remain in improving their accuracy and relevance. This paper presents a methodology that can be used to derive midpoint characterization factors for water deprivation taking into account downstream cascade effects within a single river basin. This effect is considered at a finer scale because a river basin must be split into different subunits. The proposed framework is based on a two-step approach. First, water scarcity is defined at the sub-river basin scale with the consumption-to-availability (CTA) ratio, and second, characterization factors for water deprivation (CFWD) are calculated, integrating the effects on downstream sub-river basins. The sub-river basin CTA and CFWD were computed based on runoff data, water consumption data and a water balance for two different river basins. The results show significant differences between the CFWD in a given river basin, depending on the upstream or downstream position. Finally, an illustrative example is presented, in which different land planning scenarios, taking into account additional water consumption in a city, are assessed. Our work demonstrates how crucial it is to localize the withdrawal and release positions within a river basin.

Environmental assessment of a territory: an overview of existing tools and methods.

In order to reduce our environmental impact, methods for environmental assessment of human activities are urgently needed. In particular in the case of assessment of land planning scenarios, there is presently no consensual and widely adopted method although it is strongly required by the European Directive (2001/42/EC) on Strategic Environmental Assessment. However, different kinds of tools and methods are available such as human and environmental risk assessment, the ecological footprint, material flow analysis, substance flow analysis, physical input-output table, ecological network analysis, exergy, emergy or life cycle assessment. This review proposes a discussion on these tools and methods specifically applied to territories. After the meaning of territory is clarified, these approaches are presented and analyzed based on "key features" such as formalization, system modeling, inventoried flows, indicators provided and usability. This comparison highlights the strengths and weaknesses of each tool. It also emphasizes that the approach of life cycle assessment could provide a relevant framework for the environmental assessment of territories as it is the only method which can avoid burden shifting between life cycle stages, environmental impacts and territories.

Least-squares support vector machines modelization for time-resolved spectroscopy.

By use of time-resolved spectroscopy it is possible to separate light scattering effects from chemical absorption effects in samples. In the study of propagation of short light pulses in turbid samples the reduced scattering coefficient and the absorption coefficient are usually obtained by fitting diffusion or Monte Carlo models to the measured data by use of numerical optimization techniques. In this study we propose a prediction model obtained with a semiparametric modeling technique: the least-squares support vector machines. The main advantage of this technique is that it uses theoretical time dispersion curves during the calibration step. Predictions can then be performed by use of data measured on different kinds of sample, such as apples.