[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.

Gynecological health and uptake of gynecological care after domestic or sexual violence: a qualitative study in an emergency shelter.

BACKGROUND: Domestic and sexual violence have been linked to adverse gynecological and obstetric outcomes. Survivors often find it difficult to verbalize such violence due to feelings of shame and guilt. Vulnerable or socially excluded women are frequently excluded from research, particularly qualitative studies on violence. This study aimed to characterize the perceived impact of domestic or sexual violence on the gynecological health and follow-up among women with complex social situations. METHODS: We analyzed the data following inductive thematic analysis methods. RESULTS: Between April 2022 and January 2023, we conducted 25 semi-structured interviews, lasting on average 90 min (range: 45-180), with women aged between 19 and 52, recruited in an emergency shelter in the Paris area. The women described physical and psychological violence mainly in the domestic sphere, their altered gynecological and mental health and their perception of gynecological care. The levels of uptake of gynecological care were related to the characteristics of the violence and their consequences. The description of gynecological examination was close to the description of coerced marital sexuality which was not considered to be sexual violence. Gynecological examination, likely to trigger embarrassment and discomfort, was always perceived to be necessary and justified, and consent was implied. CONCLUSION: This study can help question the appropriateness of professional practices related to the prevention of violence against women and gynecological examination practices. Any gynecological examination should be carried out within the framework of an equal relationship between caregiver and patient, for the general population and for women with a history of violence. It participates in preventing violence in the context of care, and more widely, in preventing violence against women.

Impacts of Behavioral, Organizational, and Spatial Factors on the Carbon Footprint of Traditional Retail and E-commerce in the Paris Region.

Carbon footprint assessment of retail is necessary to optimize procurement strategies and adopt sustainable shopping habits. However, estimating carbon footprints is a complex task, given the diversity of existing distribution channels. Average values for carbon emissions of "conventional" retail (i.e., purchasing and receiving the product directly at the physical point of sale) found in most studies mask a heterogeneous reality: different retail strategies entail diverse shopping behavior for consumers, as well as varied procurement processes for outlets. In this paper, we propose a methodology to assess greenhouse gas (GHG) impacts of different distribution systems related to the consumption of goods in the Paris Region by coupling traditional transport modeling with a life-cycle assessment (LCA) approach. We model and compare six distribution systems, including five traditional retail formats (hypermarkets, supermarkets, small generalist retail, small food retail, and small nonfood retail) and E-commerce home deliveries. Our model includes warehouse activity, shop and home delivery, shop energy consumption, consumer mobility, and goods packaging. Overall, we conclude that E-commerce emits fewer GHG emissions than retail outlets per kilogram of product purchased. This result is in line with the existing literature on the topic. However, the carbon footprint varies greatly within the case study depending on the characteristics of the logistics procurement processes of outlets, the behavior of shoppers, and spatial characteristics.

Early exposure to sunlight and allergic morbidity: The PARIS birth cohort.

The relationship between sunlight and allergies in children has received limited attention from researchers. We sought to explore how early exposure to solar radiation is associated with allergic morbidity within the PARIS birth cohort study. Our research dealt with children who attended at least one of two health checkups: at 18 months (n = 2012) and at 8-9 years (n = 1080). Early exposure to solar radiation was assessed using meteorological data (e.g., solar radiation, temperature, and relative humidity). Children with similar meteorological exposure trajectories were grouped by a longitudinal and multidimensional cluster analysis. The association between solar radiation exposure and allergic morbidity (i.e., allergic sensitization at 18 months and 8-9 years; current asthma, rhinitis, and eczema at 8-9 years) was quantified by multivariable logistic regression models adjusted for potential confounders. The effect modification of maternal vitamin D supplementation during pregnancy was tested. Four meteorological exposure trajectories were found. The trajectory with the highest exposure to early solar radiation had a reduced risk of sensitization at 8-9 years compared to the trajectory with the lowest exposure (p = 0.06). The association was statistically significant in the vitamin D supplementation group. Solar radiation during prenatal and postnatal periods was significantly associated with a lower risk of sensitization at 8-9 years (for one interquartile range (IQR) increase, adjusted odds ratio (aOR): 0.47; 95 % confidence interval (CI): 0.25-0.87 and 0.84; 0.7-1.00, respectively). Increased prenatal exposure to solar radiation was significantly associated with a lower risk of asthma at 8-9 years (for one IQR increase, aOR: 0.32; 95 % CI: 0.1-0.96). Early sunlight exposure may reduce the risk of sensitization and asthma in school-aged children, especially in those prenatally exposed to vitamin D. These findings highlight the importance of vitamin D in preventing allergic diseases in children, either through supplementation or sunlight exposure.

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.

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.

Maintenance oxytocin in the immediate postpartum period: Frequency, determinants and practices in a tertiary maternity unit.

OBJECTIVE: To prevent post-partum haemorrhage (PPH), national and international guidelines recommend the administration of a prophylactic injection of oxytocin after all vaginal births. Although additional maintenance oxytocin is not recommended in the immediate postpartum, its administration is quite common (30 % of French births in 2021). To assess in a single center, the frequency and determinants associated with the administration of maintenance oxytocin in immediate postpartum. STUDY DESIGN: A retrospective observational single-centre study was conducted in a tertiary-care university centre in Paris (France), with data from April-May 2022. All women who gave birth vaginally at or after 37 weeks, except for those with immediate PPH. Univariate and multivariate analysis were performed to compare determinants between the group receiving maintenance oxytocin and the control group without this intervention. A sensitivity analysis in a population of women at low risk of PPH was performed. Maternal, obstetrical, perinatal and organisational determinants were collected. RESULTS: This study included 584 patients, 278 (47.6 %) of whom received maintenance oxytocin. We observed a significantly higher rate of maintenance oxytocin administration to parous women (OR 1.57, 90 %CI 1.09-2.27) and women with a history of PPH (OR 2.88, 90 %CI 1.08-9.08). Additional maintenance oxytocin was also administered more often when the midwife handling the birth had more than 5 years of practice since completion of training (OR 1.77, 1.24-2.53) or during night-time births (OR 1.47, 90 %CI 1.03-2.10). CONCLUSION: Maintenance oxytocin administration is a frequent practice, performed for almost half the patients in our center. This practice is associated with maternal and obstetric factors, but also with health professionals' individual decisions and practices.

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.

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.

Factors associated with extent of COVID-19 outbreaks: A prospective study in a large hospital network.

BACKGROUND: The COVID-19 pandemic has generated numerous hospital outbreaks. This study aimed to identify factors related to the extent of nosocomial COVID-19 outbreaks in the largest French public health institution. METHODS: An observational study was conducted from July 2020 to September 2021. Outbreaks were defined as at least 2 cases, patients and/or health care workers (HCWs), linked by time and geographic location. Logistic regression was performed to identify risk factors for large outbreaks among nine variables: variant, medical ward, COVID-19 vaccination rate and incidence among HCWs and Paris population, number of weekly COVID-19 tests among HCWs and the positivity rate, epidemic waves. RESULTS: Within 14 months, 799 outbreaks were identified: 450 small ones (≤6 cases) and 349 large ones (≥7 cases), involving 3,260 patients and 3,850 HCWs. In univariate analysis, large outbreaks were positively correlated to geriatrics wards, COVID-19 incidence, and rate of weekly positive tests among HCWs; and negatively correlated to intensive care units, variant Delta, fourth wave, vaccination rates of the Paris region's population and that of the HCWs. In multivariate analysis, factors that remained significant were the type of medical ward and the vaccination rate among HCWs. CONCLUSIONS: Intensive care unit and high vaccination rates among HCWs were associated with a lower risk of large COVID-19 outbreaks, as opposed to geriatric wards, which are associated with a higher risk.

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.