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Satellite-derived spectral indices such as the relativized burn ratio (RBR) allow fire severity maps to be produced in a relatively straightforward manner across multiple fires and broad spatial extents. These indices often have strong relationships with field-based measurements of fire severity, thereby justifying their widespread use in management and science. However, satellite-derived spectral indices have been criticized because their non-standardized units render them difficult to interpret relative to on-the-ground fire effects. In this study, we built a Random Forest model describing a field-based measure of fire severity, the composite burn index (CBI), as a function of multiple spectral indices, a variable representing spatial variability in climate, and latitude. CBI data primarily representing forested vegetation from 263 fires (8075 plots) across the United States and Canada were used to build the model. Overall, the model performed well, with a cross-validated R2 of 0.72, though there was spatial variability in model performance. The model we produced allows for the direct mapping of CBI, which is more interpretable compared to spectral indices. Moreover, because the model and all spectral explanatory variables were produced in Google Earth Engine, predicting and mapping of CBI can realistically be undertaken on hundreds to thousands of fires. We provide all necessary code to execute the model and produce maps of CBI in Earth Engine. This study and its products will be extremely useful to managers and scientists in North America who wish to map fire effects over large landscapes or regions.

This study investigates the impact of management quality on the operating performance of Canadian IPO's. Several dimensions of management quality are explored, including: the average tenure of management team members, the heterogeneity of tenures of team members, the size of the top management team, the number of outside directors, the educational and professional credentials of managers, the CEO dominance of the team, the past industry-specific experience of team members, and the presence of the founder in the management team. Operating performance is positively associated with the management team's tenure, size, and the team's inclusion of chartered accountants. Heterogeneous tenures of the top management team as well as dominant CEO's, and MBAs are negatively related to performance. Some evidence of earnings management by managers in the sample is also observed. Equity retention of directors and officers following the IPO has a nonlinear relationship with firm value.

Polypharmacy in patients with advanced cancer represents a major public health problem, leading to risk of iatrogenesis, decrease of quality of life and increase of healthcare costs. In the field of geriatrics, health policies have been developed to address polypharmacy through the use of deprescribing tools. Recently, palliative care initiatives have been introduced, yet these have not fully considered the specificities of this population, particularly their perceptions. It is therefore important to better understand patients' perceptions of deprescribing in order to adapt tools and actions to make these approaches more effective. The aim is to investigate patients' perceptions of deprescribing in palliative oncology care, and to explore factors that may influence patients' attitudes and beliefs about deprescribing and to validate a specific questionnaire (rPATD) in this population. An ancillary study will investigate the relationship between patients' health literacy and their perception of deprescribing. A prospective, observational, multicenter study will be conducted using a sequential mixed exploratory design in a population of patients living with advanced cancer and with a physician-estimated life expectancy of less than 1 year. The study will include an initial qualitative phase. Individual semi-structured interviews using a descriptive approach (thematic analysis) will be conducted (upon saturation). Following analysis of the qualitative data, a quantitative study including 300 patients will be realized to meet secondary objectives. Several data will be collected and 2 self-questionnaires will be administered: the BMQ (beliefs about medicine) and rPATD (perception of deprescribing) possibly supplemented by additional items if required by the qualitative analysis. The auxiliary study will be conducted during this second phase, using a validated self-questionnaire to assess patients' level of literacy. The disparate outcomes will facilitate the understanding of the perception of deprescribing in palliative oncology care, enabling the development of tailored approaches adapted to this population. ClinicalTrials Identifier: NCT06193083.

Considering the preferences in Shared Decision Making (SDM) of patients with Digestive Cancer (DC) is crucial to ensure the quality of care. To date, there is limited information on preferences in SDM of patients with DC. The objectives of this study were to describe digestive cancer patients’ preference for involvement in therapeutic decision-making and to identify variables associated with these preferences. An observational prospective study in a French university cancer center has been conducted. Patients completed two questionnaires to qualify and quantify their preference for involvement in therapeutic decision-making: the Control Preference Scale (CPS) and the Autonomy Preference Index (API), which is composed of the Decision Making (DM) score and the Information Seeking (IS) score. Associations between these scores and socio-demographic data, disease-related data, coping strategies (Brief-COPE), physical (QLQ-C30) and psychological (HADS) quality of life were tested. One-hundred fifteen patients returned the questionnaires. The majority of patients reported a passive (49.1%) or a collaborative (43.0%) CPS status. The mean DM score was 39.4 Variables associated with decision-making preferences were occupational status and time since diagnosis. The identification of variables associated with patients' preferences for involvement in decision-making can help make clinicians aware of patients' needs and wishes. However, it can only be determined by interviewing the patient individually.

Background Soft-tissue sarcomas (STS) represent a heterogeneous group of rare tumors including more than 70 different histological subtypes. High throughput molecular analysis (next generation sequencing exome [NGS]) is a unique opportunity to identify driver mutations that can change the usual one-size-fits-all treatment paradigm to a patient-driven therapeutic strategy. The primary objective of the MULTISARC trial is to assess whether NGS can be conducted for a large proportion of metastatic STS participants within a reasonable time, and, secondarily to determine whether a NGS-guided therapeutic strategy improves participant’s outcome. Methods This is a randomized, multicentre, phase II/III trial inspired by the design of umbrella and biomarker-driven trials. The setting plans up to 17 investigational centres across France and the recruitment of 960 participants. Participants aged at least 18 years, with unresectable locally advanced and/or metastatic STS confirmed by the French sarcoma pathological reference network, are randomized according to 1:1 allocation ratio between the experimental arm “NGS” and the standard “No NGS”. NGS will be considered feasible if (i) NGS results are available and interpretable, and (ii) a report of exome sequencing including a clinical recommendation from a multidisciplinary tumor board is provided to investigators within 7 weeks from reception of the samples on the biopathological platform. A feasibility rate of more than 70% is expected (null hypothesis: 70% versus alternative hypothesis: 80%). In terms of care, participants randomized in “No NGS” arm and who fail treatment will be able to switch to the NGS arm at the request of the investigator. Discussion The MULTISARC trial is a prospective study designed to provide high-level evidence to support the implementation of NGS in routine clinical practice for advanced STS participants, on a large scale . Trial registration clinicaltrial.gov NCT03784014 .

Background Given the high prevalence of anxiety in palliative care and its frequent underestimation by healthcare professionals, it is important to use simplified tools to facilitate the evaluation of anxiety. The State-Trait Anxiety Inventory–State scale is a reference 20-item questionnaire that has been validated in this population, but is too long for some patients. The visual analog scale (VAS) and the numeric rating scale (NRS) are two short instruments that have been validated to assess pain, but not anxiety in palliative care. Aim This study sought to investigate the correlation between anxiety VAS and NRS and State-Trait Anxiety Inventory-State scale for assessing anxiety in palliative care patients. Methods A single-center cross-sectional observational study was conducted over 2 years. All palliative care patients followed by the palliative care team of a French university hospital were eligible. Each patient completed the State-Trait Anxiety Inventory-State scale and rated their perceived anxiety using the NRS and VAS. Pearson’s correlation test between the scales and receiver operating characteristic (ROC) curve analysis were performed to determine diagnostic cut-offs. Results A total of 186 patients were included (89.8% with cancer), 20.4% of whom had severe or very severe anxiety. The NRS/ State-Trait Anxiety Inventory–State scale and VAS/ State-Trait Anxiety Inventory–State scale correlations were 0.62 and 0.70, respectively. The NRS and VAS showed good discrimination, with an area under the ROC curve of 0.81 and 0.88, respectively. Cut-offs of 5 (NRS) and 49 millimeters (VAS) yielded sensitivities of 89.5% and 89.2%, respectively, for the detection of severe or very severe anxiety, with specificities of 60.1% and 70.3%, respectively. Conclusion Cut-offs of 5 for the NRS and 49 millimeters for the VAS showed excellent sensitivity for detecting anxiety in palliative care.

As part of the EUREC4A (Elucidating the role of cloud–circulation coupling in climate) field campaign, which took place in January and February 2020 over the western tropical Atlantic near Barbados, the French SAFIRE ATR42 research aircraft (ATR) conducted 19 flights in the lower troposphere. Each flight followed a common flight pattern that sampled the atmosphere around the cloud base level, at different heights of the subcloud layer, near the sea surface and in the lower free troposphere. The aircraft's payload included a backscatter lidar and a Doppler cloud radar that were both horizontally oriented; a Doppler cloud radar looking upward; microphysical probes; a cavity ring-down spectrometer for water isotopes; a multiwavelength radiometer; a visible camera; and multiple meteorological sensors, including fast rate sensors for turbulence measurements. With this instrumentation, the ATR characterized the macrophysical and microphysical properties of trade-wind clouds together with their thermodynamical, turbulent and radiative environment. This paper presents the airborne operations, the flight segmentation, the instrumentation, the data processing and the EUREC4A datasets produced from the ATR measurements. It shows that the ATR measurements of humidity, wind and cloud base cloud fraction measured with different techniques and samplings are internally consistent; that meteorological measurements are consistent with estimates from dropsondes launched from an overflying aircraft (the High Altitude and LOng Range Research Aircraft, HALO); and that water-isotopic measurements are well correlated with data from the Barbados Cloud Observatory. This consistency demonstrates the robustness of the ATR measurements of humidity, wind, cloud base cloud fraction and water-isotopic composition during EUREC4A. It also confirms that through their repeated flight patterns, the ATR and HALO measurements provided a statistically consistent sampling of trade-wind clouds and of their environment. The ATR datasets are freely available at the locations specified in Table .

The Gradient in Longitude of Atmospheric Constituents above the Mediterranean Basin (GLAM) airborne campaign was set up to investigate the summertime variability of gaseous pollutants, greenhouse gases, and aerosols between the western (∼3°E) and eastern (∼35°E) sections of the Mediterranean basin as well as how this connects with the impact of the Asian monsoon anticyclone on the eastern Mediterranean in the mid- to upper troposphere (∼5–10 km). GLAM falls within the framework of the Chemistry–Aerosol Mediterranean Experiment (ChArMEx) program. GLAM used the French Falcon-20 research aircraft to measure aerosols, humidity, and chemical compounds: ozone, carbon monoxide, methane, and carbon dioxide. GLAM took place between 6 and 10 August 2014, following a route from Toulouse (France) to Larnaca (Cyprus) and back again via Minorca (Spain), Lampedusa (Italy), and Heraklion (Crete, Greece). The aircraft flew at an altitude of 5 km on its outbound journey and 10 km on the return leg. GLAM also collected vertical profiles around the landing sites listed above. A combination of model outputs, chemical mapping analyses, and spaceborne and surface station measurements gathered prior to and during the campaign were used to interpret the in situ airborne measurements. The main outcome of this study is the impact of intercontinental transport on the longitudinal variability of pollutants, greenhouse gases, and aerosols at an altitude of 10 km. The eastern Mediterranean is affected by air masses from the Arabian Sea surface, and the western Mediterranean is impacted by air masses from North America (biomass burning) and West Africa (desert dust).

Background Off-label or unlicensed medicine use is very common in paediatric practice, ranging from 11 to 80 %, and is one of the predisposing factors for adverse events (23–60 %). Medicine indications are the third leading reason for doctors to perform off-label prescriptions. Objective The aim of our study was to determine the prevalence and nature of off-label and unlicensed medicine prescriptions in children and propose methods for risk reduction and management. Setting 475 bed maternity-paediatric university hospital. Method Retrospective cross-sectional study lasting 1 day on new prescriptions issued over the previous 24 h by departments using electronic prescribing. Age and indication were compared to those in the French independent formulary Thériaque ® database. Main outcome measure Number of off-label/unlicensed prescriptions, number of patients, proportion of off-label/unlicensed prescriptions by age group, treatment class and International Non proprietary Name (INN), using the established classification. Results A total of 315 prescription medicines were analysed for 120 patients, of average age 5.1 years old. For the classification of medicine utilisation, the majority of the medicines were prescribed as licensed (190/60.3 %), followed by off-label (115/36.5 %) and unlicensed (10/3.2 %) medicines. Alimentary tract, metabolic and nervous system medicines constituted the most widely prescribed ATC classes. At least 54 % of patients received an off-label/unlicensed medicine. The indications for these were mainly for off-label prescriptions (80/25.4 %) followed by medicines not evaluated for safety and regarding safety and efficacy in children (14/4.5 %). Pantoprazole was the most widely prescribed off-label INN for stress ulcer prevention (62 %). For risk reduction, we found esomeprazole being prescribed instead of pantoprazole; esomeprazole is indicated for children under a year old. Conclusion This study reflects one given day: 36.5 % of off-label prescriptions and 3.2 % of unlicensed prescriptions in a paediatric setting. Few risk reductions for off-label number prescriptions have been found. This work confirmed the necessity of carrying out further studies in children.

Background Pediatric intensive care patients represent a population at high risk for drug-related problems. There are few studies that compare the activity of clinical pharmacists between countries. Objective To describe the drug-related problems identified and interventions by four pharmacists in a pediatric cardiac and intensive care unit. Setting Four pediatric centers in France, Quebec, Switzerland and Belgium. Method This was a six-month multicenter, descriptive and prospective study conducted from August 1, 2009 to January 31, 2010. Drug-related problems and clinical interventions were compiled from four pediatric centers in France, Quebec, Switzerland and Belgium. Data on patients, drugs, intervention, documentation, approval and estimated impact were compiled. Main outcome measure Number and type of drug-related problems encountered in a large pediatric inpatient population. Results A total of 996 interventions were recorded: 238 (24 %) in France, 278 (28 %) in Quebec, 351 (35 %) in Switzerland and 129 (13 %) in Belgium. These interventions targeted 270 patients (median 21 months old, 53 % male): 88 (33 %) in France, 56 (21 %) in Quebec, 57 (21 %) in Switzerland and 69 (26 %) in Belgium. The main drug-related problems were inappropriate administration technique (29 %), untreated indication (25 %) and supra-therapeutic dose (11 %). The pharmacists’ interventions were mostly optimizing the mode of administration (22 %), dose adjustment (20 %) and therapeutic monitoring (16 %). The two major drug classes that led to interventions were anti-infectives for systemic use (23 %) and digestive system and metabolism drugs (22 %). Interventions mainly involved residents and all clinical staff (21 %). Among the 878 (88 %) proposed interventions requiring physician approval, 860 (98 %) were accepted. Conclusion This descriptive study illustrates drug-related problems and the ability of clinical pharmacists to identify and resolve them in pediatric intensive care units in four French-speaking countries.