Centre hospitalier Robert-Ballanger

It is undeniable that digital technology enables, e.g., building information modelling, digital twins, extended reality (i.e., virtual reality, augmented reality, mixed reality), and automation, have recently played a significant role in the construction and engineering industry. The traditional applications of digital technologies include design and construction management, waste management, and, to a limited extent, asset management. Despite some applications of digital technologies, the technology users are often isolated and siloed. In reality, the cross-functional applications, roles, and co-benefits have not been thoroughly understood or well demonstrated. This is evident by a very limited usage of such technology across either the whole lifecycle or the value chain of built environment sectors. On this ground, this study is the first to tackle the challenges by conducting expert and stakeholder interviews using open-ended questionnaires both online and offline (n = 42) to identify synergic roles and influences, as well as co-benefits of digital technology enablers. Industry participants are dominant in our study and, unsurprisingly, siloed practice can undermine cross-collaboration among value chain stakeholders. Clearly, co-benefits may hypothetically occur, but they can be only unlocked by genuine, participative stakeholder engagement. This study is unprecedented, and our new findings also reveal technical and societal capabilities of digital technologies, which can inclusively enable participative decision-making, engagement, and integration of stakeholders for implementing buildings’ circularity through viable business and management models. New insights clearly exhibit that digital technology enablers must be co-created by main stakeholders in order to yield co-benefits and harvest synergic value for circular management models in the built environment.

First described in the 19th century, Marfan syndrome is a rare hereditable genetic disease, mainly caused by mutations in FBN1 leading to connective tissue defects. While the patient phenotype is highly variable, many affected present with tall stature, long and flexible limbs and joints, eye disorders, and life-threatening aortic enlargements. Modern medical treatments can alleviate these symptoms, but it is important for people living with connective tissue disorders to learn about their situation and connect with others facing the same challenges. The Marfan Europe Network (M.E.N.) is an umbrella organization of 14 national Marfan patient organizations, integrating efforts to inform the public and improve the lives of those affected. Here, we interview Tuija Ekegren, Françoise Steinbach, and Margit Aschenbrenner from the Board of Directors of the M.E.N.

This study reexamines historical "dengue" epidemics of the 18th and 19th centuries, suggesting that chikungunya virus (CHIKV), rather than dengue virus (DENV), may have been responsible for many of these outbreaks. While "dengue" was identified as a tropical disease in the 19th century, its exact characteristics remain unclear, and some descriptions align more closely with CHIKV, known for its distinctive symptom of joint pain. Three approaches were used to investigate these historical epidemics: (A) Expert opinion provided a contextualized and comprehensive analysis but faced criticism for its subjective nature (B) Clinical Score Application allowed for greater objectivity and a more stringent diagnosis, although it was limited by the need for a complete description (C) Double Proofreading: Two expert groups independently reviewed the articles, which enhanced objectivity but also led to greater variability in the results. The study suggests that CHIKV was mainly responsible for the epidemics historically attributed to "dengue". It highlights the challenges of diagnosing diseases from historical records. It also raises the possibility that other alphaviruses, like mayaro virus, could be involved, but CHIKV remains the primary candidate. This study offers intriguing insights into pathogen identification in historical epidemics, emphasizing the importance of a combined approach for a more precise understanding of past diseases and their evolution.

BackgroundStudies suggest that up to 70% of chronic obstructive pulmonary disease (COPD) cases globally are undiagnosed worldwide. Some of these undiagnosed patients may present with severe exacerbation and factors associated with underdiagnosis in this population are unknown. We investigated the key factors associated with underdiagnosis in two cohorts of patients hospitalised for severe COPD exacerbation at different time points.MethodsThis retrospective, multicentre study analysed data from patients hospitalised for COPD exacerbation at two independent centres during two distinct time periods: between 1 January 2017 and 31 December 2018 in the Aquitaine region and between 1 January and 31 December 2022 in Paris. Undiagnosed COPD was defined as the absence of pulmonary function testing before the index exacerbation. Multivariate logistic regression was used to evaluate associations between underdiagnosis and patient characteristics.ResultsAmong the 424 patients, 93 (21.9%) were undiagnosed before hospitalisation, with a stable rate over time (22% in 2017–2018 and 21% in 2022). Multivariate analysis revealed that underdiagnosis was related to higher forced expiratory volume in one second (FEV1; adjusted OR (aOR)=1.02, p=0.043) and female sex (aOR=1.91, p=0.015). Patients with undiagnosed COPD had significantly lower rehospitalisation and mortality rates. After the initial severe exacerbation, higher mortality was associated with a higher Charlson Comorbidity Index (HR=1.24, p=0.007) and older age (HR=1.05, p=0.008).ConclusionThis retrospective, multicentre study demonstrated that about 20% of patients admitted with severe exacerbation were undiagnosed for COPD. Higher FEV1 and female sex were associated with underdiagnosis, emphasising the need for special attention to this population. These findings highlight the need to improve training and access to spirometry and develop new diagnostic tools that facilitate earlier detection and management of COPD.

BackgroundPaediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).ObjectiveTo assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.MethodsThis was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0–24%; moderate 25–74%; high 75–100%) according to: bolus volume of 10–20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.Results63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10–20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).ConclusionsThis study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.Trial registration numberNCT05066464.