[The Mission Migrants of the Samu social de Paris, a mobile healthcare service for exiles]. / La Mission Migrants du Samusocial de Paris, dispositif mobile d'accès aux soins pour les exilés.

Since its creation in 1993, Samusocial de Paris has been working with homeless people as part of its "outreach" approach. Mission Migrants, a mobile healthcare access service, works throughout the inner suburbs of Paris, helping precarious exiles wherever they are, and wherever they are at (in their pathways and access to healthcare). Its teams of nurses and mediator-interpreters visit camps, squats, shelters, day shelters and temporary accommodation centers to mediate, assess and guide them towards the care they need.

Identification of distinct subgroups of Sjögren's disease by cluster analysis based on clinical and biological manifestations: data from the cross-sectional Paris-Saclay and the prospective ASSESS cohorts.

BACKGROUND: Sjögren's disease is a heterogenous autoimmune disease with a wide range of symptoms-including dryness, fatigue, and pain-in addition to systemic manifestations and an increased risk of lymphoma. We aimed to identify distinct subgroups of the disease, using cluster analysis based on subjective symptoms and clinical and biological manifestations, and to compare the prognoses of patients in these subgroups. METHODS: This study included patients with Sjögren's disease from two independent cohorts in France: the cross-sectional Paris-Saclay cohort and the prospective Assessment of Systemic Signs and Evolution of Sjögren's Syndrome (ASSESS) cohort. We first used an unsupervised multiple correspondence analysis to identify clusters within the Paris-Saclay cohort using 26 variables comprising patient-reported symptoms and clinical and biological manifestations. Next, we validated these clusters using patients from the ASSESS cohort. Changes in disease activity (measured by the European Alliance of Associations for Rheumatology [EULAR] Sjögren's Syndrome Disease Activity Index [ESSDAI]), patient-acceptable symptom state (measured by the EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI]), and lymphoma incidence during follow-up were compared between clusters. Finally, we compared our clusters with the symptom-based subgroups previously described by Tarn and colleagues. FINDINGS: 534 patients from the Paris-Saclay cohort (502 [94%] women, 32 [6%] men, median age 54 years [IQR 43-64]), recruited between 1999 and 2022, and 395 patients from the ASSESS cohort (370 [94%] women, 25 [6%] men, median age 53 years [43-63]), recruited between 2006 and 2009, were included in this study. In both cohorts, hierarchical cluster analysis revealed three distinct subgroups of patients: those with B-cell active disease and low symptom burden (BALS), those with high systemic disease activity (HSA), and those with low systemic disease activity and high symptom burden (LSAHS). During follow-up in the ASSESS cohort, disease activity and symptom states worsened for patients in the BALS cluster (67 [36%] of 186 patients with ESSPRI score <5 at month 60 vs 92 [49%] of 186 at inclusion; p<0·0001). Lymphomas occurred in patients in the BALS cluster (five [3%] of 186 patients; diagnosed a median of 70 months [IQR 42-104] after inclusion) and the HSA cluster (six [4%] of 158 patients; diagnosed 23 months [13-83] after inclusion). All patients from the Paris-Saclay cohort with a history of lymphoma were in the BALS and HSA clusters. This unsupervised clustering classification based on symptoms and clinical and biological manifestations did not correlate with a previous classification based on symptoms only. INTERPRETATION: On the basis of symptoms and clinical and biological manifestations, we identified three distinct subgroups of patients with Sjögren's disease with different prognoses. Our results suggest that these subgroups represent different heterogeneous pathophysiological disease mechanisms, stages of disease, or both. These findings could be of interest when stratifying patients in future therapeutic trials. FUNDING: Fondation pour la Recherche Médicale, French Ministry of Health, French Society of Rheumatology, Innovative Medicines Initiative 2 Joint Undertaking, Medical Research Council UK, and Foundation for Research in Rheumatology.

Spatial Accessibility to Primary Care in Metropolitan France: Results Using the SCALE Spatial Accessibility Index for All Regions.

Accessibility to care is a major public health issue. Various tools to assess it are available, but they do not solve the problem of scale. Moreover, accessibility is a multidimensional concept that is not taken into account with current tools. The SCALE index aims to overcome these two limitations by proposing a synthetic measure on a more precise scale than the administrative unit or the sub-municipal scale. Under the assumption of access to care facilities for all and access to the nearest facilities, the potential accessibility distance was calculated for each couple (residential area, accessible facilities). This was defined as the average distance by road that the population has to travel to access care. To take the availability of resources into account, these distances were weighted by the theoretical pressure on the facilities. The SCALE index was then calculated using a linear combination of the distances of potential accessibility to care facilities It highlights differences in accessibility at the national and regional scale. Using this index, it was possible to provide maps for all French regions and the major cities in a story-map. The major conurbation around Paris and the main urban centers has high accessibility. Low accessibility forms a "Y" shape. In conclusion, the SCALE index measures accessibility at the scale of a small geographic unit taking the proximity and the availability of health professionals into account. It is also possible to take into account the diversity of accessibility in a given territory.

Genomic characterization of equine influenza A subtype H3N8 viruses by long read sequencing and functional analyses of the PB1-F2 virulence factor of A/equine/Paris/1/2018.

Equine influenza virus (EIV) remains a threat to horses, despite the availability of vaccines. Strategies to monitor the virus and prevent potential vaccine failure revolve around serological assays, RT-qPCR amplification, and sequencing the viral hemagglutinin (HA) and neuraminidase (NA) genes. These approaches overlook the contribution of other viral proteins in driving virulence. This study assesses the potential of long-read nanopore sequencing for fast and precise sequencing of circulating equine influenza viruses. Therefore, two French Florida Clade 1 strains, including the one circulating in winter 2018-2019 exhibiting more pronounced pathogenicity than usual, as well as the two currently OIE-recommended vaccine strains, were sequenced. Our results demonstrated the reliability of this sequencing method in generating accurate sequences. Sequence analysis of HA revealed a subtle antigenic drift in the French EIV strains, with specific substitutions, such as T163I in A/equine/Paris/1/2018 and the N188T mutation in post-2015 strains; both substitutions were in antigenic site B. Antigenic site E exhibited modifications in post-2018 strains, with the N63D substitution. Segment 2 sequencing also revealed that the A/equine/Paris/1/2018 strain encodes a longer variant of the PB1-F2 protein when compared to other Florida clade 1 strains (90 amino acids long versus 81 amino acids long). Further biological and biochemistry assays demonstrated that this PB1-F2 variant has enhanced abilities to abolish the mitochondrial membrane potential ΔΨm and permeabilize synthetic membranes. Altogether, our results highlight the interest in rapidly characterizing the complete genome of circulating strains with next-generation sequencing technologies to adapt vaccines and identify specific virulence markers of EIV.

Understanding the factors that affect households' investment decisions required by the energy transition.

In energy systems' economic models, people's behaviour is often underestimated, and they are generally unaware of how habits impact energy efficiency. Improving efficiency is challenging, and recommendations alone may not be sufficient. Changing behaviour requires understanding the direct impact of needs and habits on energy efficiency. This research introduces a methodology that retrieves human expert knowledge from four key aspects of the current energy transition: everyday appliances, buildings, mobility, flexibility, and energy efficiency. The aim is to examine the causal relationship between energy consumption and human behaviour, gaining a deeper understanding of the links among the factors that drive final energy consumers to change habits through the adoption of energy-saving measures. Working in collaboration with expert panels, this study provides a methodology for extracting expert human knowledge based on a set of future energy transition scenarios aligned with the achievement of the Paris Agreement, a taxonomy of 32 factors that have a strong influence on households' investment decisions, and the results of a survey that characterises the European population through the 32-factor taxonomy and some socioeconomic conditions. In addition, the survey included a sample of the Latin American population to analyse how socioeconomic conditions (region, education, gender, etc.) influence the prioritisation of these factors. We discuss the high priority given to competence and autonomy over financial factors by inhabitants of the European Union residential sector. We provide an analysis of the factors through which other similar projects are focused and on which we converge. In addition, we contribute by presenting the hierarchy of priorities assigned by people. This highlights the importance for policymakers to take these aspects seriously when implementing energy policy interventions that go beyond purely financial measures and fiscal incentives.

High proportion of post-migration HIV acquisition in migrant men who have sex with men receiving HIV care in the Paris region, and associations with social disadvantage and sexual behaviours: results of the ANRS-MIE GANYMEDE study, France, 2021 to 2022.

BackgroundSome migrant men who have sex with men (MSM) acquire HIV in France.AimsWe investigated, in migrant MSM receiving HIV care in France, the (i) rate of post-migration-HIV acquisition in France, (ii) delay between arrival and HIV acquisition and (iii) factors affecting HIV acquisition within 1 year after migration.MethodsThis cross-sectional study focused on ≥ 18-year-old MSM born outside France, receiving HIV care in the Paris region. Information on migration history, socioeconomic condition, sexual activity, and health was collected in May 2021-June 2022 through self-administered questionnaires and medical records. Post-migration-HIV-acquisition rate and delay between arrival in France and HIV acquisition were estimated from biographical data and CD4+ T-cell counts. Predictors of HIV acquisition within 1 year after migration were determined using logistic regression.ResultsOverall post-migration HIV-acquisition rate was 61.7% (715/1,159; 95%CI: 61.2-62.2), ranging from 40.5% (95%CI: 39.6-41.6) to 85.4% (95%CI: 83.9-86.0) in participants from Latin America and North Africa. Among post-migration-HIV acquisitions, those within 1 year after migration represented 13.1% overall (95%CI: 11.6-14.6), being highest in participants from sub-Saharan Africa (25%; 95%CI: 21.5-28.3). Participants ≥ 15-years old at migration, with post-migration-acquired HIV, had a 7.5-year median interval from arrival in France to HIV acquisition (interquartile range (IQR): 3.50-14.75). Older age at arrival, region of origin (sub-Saharan Africa and Asia), degree of social disadvantage and numbers of sexual partners were independently associated with acquiring HIV within 1 year in France.ConclusionOur findings may guide HIV prevention policies for most vulnerable migrants to Europe.

Prospecting for rare earth element (hyper)accumulators in the Paris Herbarium using X-ray fluorescence spectroscopy reveals new distributional and taxon discoveries.

BACKGROUND: Rare earth elements (REEs) are increasingly crucial for modern technologies. Plants could be used as a biogeochemical pathfinder and a tool to extract REEs from deposits. However, a paucity of information on suitable plants for these tasks exists. METHODS: We aimed to discover new REE-(hyper)accumulating plant species by performing an X-ray fluorescence (XRF) survey at the Herbarium of the Muséum national d'Histoire naturelle (MNHN, Paris, France). We selected specific families based on the likelihood of containing REE-hyperaccumulating species, using known taxa that accumulate REEs. A total of 4425 specimens, taken in the two main evolutionary lineages of extant vascular plants, were analysed, including the two fern families Blechnaceae (n = 561) and Gleicheniaceae (n = 1310), and the two flowering plant families Phytolaccaceae (n = 1137) and Juglandaceae (n = 1417). KEY RESULTS: Yttrium (Y) was used as a proxy for REEs for methodological reasons, and a total of 268 specimens belonging to the genera Blechnopsis (n = 149), Dicranopteris (n = 75), Gleichenella (n = 32), Phytolacca (n = 6), Carya (n = 4), Juglans (n = 1) and Sticherus (n = 1) were identified with Y concentrations ranging from the limit of detection (LOD) >49 µg g-1 up to 1424 µg g-1. Subsequently, analysis of fragments of selected specimens by inductively coupled plasma atomic emission spectroscopy (ICP-AES) revealed that this translated to up to 6423 µg total REEs g-1 in Dicranopteris linearis and up to 4278 µg total REEs g-1 in Blechnopsis orientalis which are among the highest values ever recorded for REE hyperaccumulation in plants. It also proved the validity of Y as an indicator for REEs in XRF analysis of herbarium specimens. The presence of manganese (Mn) and zinc (Zn) was also studied by XRF in the selected specimens. Mn was detected in 1440 specimens ranging from the detection limit at 116 µg g-1 up to 3807 µg g-1 whilst Zn was detected in 345 specimens ranging from the detection limit at 77 µg g-1 up to 938 µg g-1. CONCLUSIONS AND IMPLICATIONS: This study led to the discovery of REE accumulation in a range of plant species, substantially higher concentrations in species known to be REE hyperaccumulators, and records of REE hyperaccumulators outside of the well-studied populations in China.

Machine learning solutions for renewable energy systems: Applications, challenges, limitations, and future directions.

The Paris Agreement, a landmark international treaty signed in 2016 to limit global warming to 2°C, has urged researchers to explore various strategies for achieving its ambitious goals. While Renewable Energy (RE) innovation holds promise, it alone may not be sufficient as critical deadlines approach. This field of research presents numerous challenges, foremost among them being the costliness of materials involved. However, emerging advancements in Machine Learning (ML) technologies provide a glimmer of hope; these sophisticated algorithms can accurately predict the output of energy systems without relying on physical resources and instead leverage available data from diverse energy platforms that have emerged over recent decades. The primary objective of this paper is to comprehensively explore various ML techniques and algorithms in the context of Renewable Energy Systems (RES). The investigation will address several vital inquiries, including identifying and evaluating existing RE technologies, assessing their potential for further advancement, and thoroughly analyzing the challenges and limitations associated with their deployment and testing. Furthermore, this research examines how ML can effectively overcome these obstacles by enhancing RES performance. By identifying future research opportunities and outlining potential directions for improvement, this work seeks to contribute to developing environmentally sustainable energy systems.

[Messages from the estates general on French internal medicine]. / Que retenir des états généraux de la médecine interne française ?

Internal medicine is a medical specialty that is often poorly understood by the general public and sometimes misidentified. In an era of increasing subspecialization and high technicality, it is characterized by a comprehensive approach centered on clinical evaluation. Unlike what is observed in most developed countries, where systemic autoimmune diseases are managed by organ specialists based on their mode of presentation, French internists are at the forefront for diagnosing and managing these diseases. Their multidisciplinary training gives them legitimacy to justify this role. Internists also play a crucial role in the management of patients requiring unplanned hospitalizations downstream from emergency departments and in connection with primary care. Internists primarily practice in a hospital setting, with a specific position in the French healthcare system aligned with the training frameworks of all medical specialties. To better define internal medicine, its role in care activities, as well as in education and research, internists organized a General Assembly of internal medicine that took place on September 28, 2023, in Paris. Structured around think tanks focusing on care, education, and research activities, the general assembly aimed to improve visibility on internal medicine and internists. This article recounts the discussions that animated this meeting and highlights the main ideas that emerged. These general assemblies constitute a foundational step and will be followed by a Consultation Conference in order to better identify and promote internal medicine and internists, regardless of their types and places of practice.

Microplastic accumulation in sewer sediments and its potential entering the environment via combined sewer overflows: a study case in Paris.

During wet weather events, combined sewer overflows (CSOs) transfer large amount of particulate matter and associated pollutants into surrounding water bodies, thereby deteriorating the recipients' ecological health. Resuspension of sewer sediments during these events contributes significantly to pollution level of these discharges. However, how much this in-sewer process contributes to CSOs' quality regarding microplastic (MP) pollution is little known. Therefore, an investigation on sewer deposits inside the Parisian combined sewer network was carried out. The study found high MP concentrations stored in this matrix, ranging from 5 × 103 to 178 × 103 particle/kg dry weight. Polymer composition is similar to what found in raw wastewater, containing a high proportion of polyethylene and polypropylene. Thus, the results indicated the persistence of MPs in sewer network during transport during dry weather periods to treatment facilities. Once resuspension of sewer deposits happens, MPs can be released into water flow and get discharged along with CSOs. This highlights another potential pathway of MPs into freshwater environment.

Spatio-temporal variation of noise pollution in South Paris during and outside the COVID-19 lockdowns.

Noise pollution is one of the major environmental problems of contemporary societies. In urban areas, road transport is the main source impacting the spatio-temporal variation of air quality. This work aims to analyse the spatio-temporal variability of the noise level in the 13th arrondissement during peak hours, focusing on the comparison of noise levels between the COVID-19 lockdown and non-lockdown days. This paper provides data that could be used to evaluate noise mitigation options. Mobile surveys, using EXTECH 4017764 sensors, were used to cover 272 points. In this work, the mobile measurements use the median of instant noise levels measured every 5 s over a 5-min period during the peak period. This study confirms that road traffic appears to be the determining factor in noise pollution. The noise levels calculated in 2020 show a strong spatio-temporal variability explained by the proximity of the emission sources, but also that the noise level decreases by 6-10 dB (A) during the lockdowns. Indeed, near the main roads, 57-63 dB (A) are recorded during the lockdowns, compared to 67-72 dB (A) outside the lockdowns. Mainly the number of vehicles contribute to a large part of the noise level, to which the noise of construction sites can occasionally be added as in the south-eastern part of the study area.

Net-zero energy transition in ASEAN countries: The evolutionary model brings novel perspectives to the cooperative mechanism of climate governance.

In an era marked by escalating climate change, the fragile ecological balance faces increasing strain. Whilst significant knowledge exists regarding the accumulation of carbon emission within the Association of Southeast Asian Nations, little is known about when and how countries could reach net-zero emission goal as agreed in Paris Agreement. For this purpose, our study examines the primary driving factors of carbon emission from 1990 to 2020 across the ten countries using the Logarithmic Mean Divisia Index model. We leverage the random forest model to explore the net-zero scenarios and the Autoregressive Integrated Moving Average approach to identify the evolutionary trajectories of carbon emission trends. Our findings underscore the imperative need for expediting decarbonization efforts, emphasizing the urgency for widespread adoption of clean technologies and substantial investment in green initiatives. Countries at similar stages of progress might establish a cooperation mechanism of clean energy base construction, energy storage allocation and policy formulation. These insights can help us better estimate future demand of clean energy, explore strategies for decarbonization, and inform historical commonalities of carbon emission growth.

BA.2.86 variant emergence and spread dynamics through wastewater monitoring in Paris, France.

Numerous SARS-CoV-2 variants are emerging as the epidemic continues, inducing new waves of contamination. In July 2023, a new variant named BA.2.86 was identified, raising concerns about its potential for viral escape, even in an immune population. The reduction in patient-centered testing and the identification of variants by sequencing means that we are now blind to the spread of this new variant. The aim of this study was to track the signature of this variant in wastewater in Paris, France. This variant showed a very rapid spread, highly correlated with national flash studies involving sequencing of clinical samples, but with a moderate impact on virus circulation. This easy-to-implement approach enabled us to monitor the emergence and spread of this new variant in real time at low cost.