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Objectif : Déterminer si la réalisation d’une échographie clinique en médecine d’urgence (ECMU) modifie la prise en charge des patients présentant une douleur abdominale aiguë d’origine non traumatique. Matériel et méthodes : Étude rétrospective, monocentrique, incluant les patients qui ont consulté aux urgences pour douleur abdominale aiguë d’origine non traumatique entre le 1 er juin 2019 et le 31 octobre 2019. Les données recueillies étaient le nombre d’examens complémentaires d’imagerie réalisés, le temps de prise en charge, le taux d’hospitalisation, le diagnostic et le taux de reconsultation à 30 jours. Le critère de jugement principal était le recours aux examens complémentaires d’imagerie spécialisée (parmi lesquels : échographie spécialisée, tomodensitométrie abdominopelvienne et abdomen sans préparation) chez les patients ayant bénéficié d’une échographie clinique (groupe « ECMU ») comparativement aux patients n’ayant pas bénéficié d’échographie (groupe « sans ECMU »). Résultats : Mille cinquante-trois patients ont été inclus. Parmi ces patients, 16 % ont bénéficié d’une échographie clinique par le médecin urgentiste. Il existait une réduction significative du recours à l’échographie spécialisée dans le groupe ECMU (4 % dans le groupe « avec ECMU » versus 9 % dans le groupe « sans ECMU », OR = 0,45, IC 95 % : [0,17–1,00], p = 0,04), sans différence significative entre les deux groupes concernant le temps de prise en charge, l’orientation, le taux de reconsultation à 30 jours et la concordance diagnostique. Conclusion : La réalisation d’une ECMU dans l’exploration des douleurs abdominales aiguës d’origine non traumatique entraînait une réduction significative du nombre d’échographies spécialisées, sans pour autant diminuer le temps de prise en charge ni la concordance entre le diagnostic posé aux urgences et celui en fin d’hospitalisation. Objective : To determine if point of care ultrasonography (POCUS) has an impact on the management of nontraumatic acute abdominal pain. Methods : This was a single-center retrospective study, including patients who were admitted in the emergency room of the hospital of Saint-Lô, France, for non-traumatic acute abdominal pain, between 01 June 2019 and 31 October 2019. The data collected were the number of subsequent imaging tests performed, the length of stay, the hospitalization rate, the diagnosis, and the reconsultation rate within 30 days. The primary outcome was the realization of an imaging test (among radiologist ultrasonography, abdominopelvic scanner, and plain abdominal X ray) in patients who underwent a point of care ultrasonography (POCUS group) as compared to those who did not (non-POCUS group). Results : One thousand fifty-three patients were included. Sixteen percent of those patients underwent POCUS. There were significantly fewer prescriptions for radiologist ultrasonography in the POCUS group (4% in the POCUS group versus 9% in the non-POCUS group, OR = 0.45, IC 95%: [0.17-1.00], P = 0.04). There was no significant difference between the two groups concerning the length of stay, hospitalization, reconsultation rates and diagnosis agreement. Conclusion : POCUS in the exploration of non-traumatic acute abdominal pain reduced the prescription of radiologist ultrasonography, without reducing the length of stay and the agreement between the emergency and the hospitalization diagnosis.

Le management consiste à organiser, à coordonner et/ou à planifier une tâche. Les structures de médecine d’urgences (SMU) sont soumises à des défis organisationnels du fait de l’activité qui leur est propre, de l’interprofessionnalité au sein de l’équipe et avec les partenaires intra- et extrahospitaliers. Pour aider à relever ces défis, la Société française de médecine d’urgence (SFMU) a souhaité réunir des experts exerçant en SMU et des experts enseignantschercheurs pour proposer un référentiel de management en SMU à partir des données de la littérature. Si le manager doit être reconnu pour ses compétences médicales, il doit également développer ses compétences de leader grâce à des formations spécifiques. Ces compétences lui permettront d’adapter son style de leadership aux situations et aux équipes pour favoriser la motivation et l’engagement des équipes. Son rôle, à l’interface entre les équipes de terrain, la direction et les partenaires institutionnels, doit permettre de favoriser le dialogue et de sécuriser les équipes. Le rôle et les moyens du manager doivent être formalisés avec la direction, en particulier l’accès à l’information pour que le manager puisse porter une vision stratégique auprès des équipes et des partenaires. La mise en place d’un projet et la tenue de réunions doivent être organisées avec une stratégie efficace. Pour cela, l’énonciation et le partage d’objectifs clairs, les règles de fonctionnement, l’implication des agents dans les décisions sont des outils efficaces pour limiter la résistance au changement et favoriser la coconstruction des transformations. Le développement des compétences par le biais de formations individuelles et collectives permet les temps d’échanges nécessaires à l’épanouissement des professionnels, au renforcement de la motivation et à la construction de valeurs communes. Certains facteurs sont directement associés à l’attractivité d’une SMU comme l’ambiance de travail, la diversification de l’activité et la gestion individualisée des carrières. Les organisations mises en place doivent permettre d’assurer une sécurité psychologique et une collaboration interprofessionnelle effective pour améliorer la qualité de vie au travail et la qualité des soins. La communication et la gestion de crise doivent être réfléchies et organisées avec méthode pour construire une SMU où chaque collaborateur pourra s’investir et se reconnaître. Les experts s’accordent à penser que manager une SMU doit être une activité organisée avec des outils et des compétences qui lui sont propres. Ce rôle doit être reconnu par les équipes, la direction et les partenaires. Management involves organizing, planning, coordinating, and/or scheduling a task. Emergency medical services (EMS) are subject to organizational challenges due to their specific activity, interprofessional relations within the team and with partners inside and outside the hospital. To help meet these challenges, the French Society of Emergency Medicine (SFMU) wanted to bring together experts practicing in EMS and teaching, and research experts to propose a set of guidelines for EMS management based on data from the literature. While managers must be recognized for their medical skills, they must also develop their leadership skills through specific training. These skills will enable them to adapt their leadership style to situations and teams in order to encourage team motivation and commitment. As the interface between teams in the field, management, and institutional partners, their role should be to encourage dialogue and reassure teams. The manager’s role and resources need to be formalized with management, in particular access to information so that the manager can convey a strategic vision to teams and partners. The implementation of a project and the holding of meetings must be organized with an effective strategy. To achieve this, setting out and sharing clear objectives, operating rules, and involving staff in decision making are effective tools for limiting resistance to change and encouraging the co-construction of transformations. The development of skills through individual and group training provides the time for exchanges necessary for professionals to flourish, for motivation to be strengthened, and for shared values to be built. Certain factors are directly associated with the attractiveness of an EMS, such as the working environment, diversification of activities, and individualized career management. The organizations that put in place must ensure psychological safety and effective interprofessional collaboration to improve the quality of working life and the quality of care. Communication and crisis management must be carefully thought out and methodically organized to build an EMS in which every employee can invest and feel at home. The experts agree that managing an EMS must be an organized activity with its own tools and skills. This role must be recognized by the teams, management, and partners.

Management involves organizing, planning, coordinating, and scheduling tasks. Emergency departments (EDs) face organizational challenges due to their specific activities, interprofessional collaboration within the team, and coordination with both intra- and extra-hospital partners. To address these challenges, the French Society of Emergency Medicine (FSEM) sought to bring together experts working in EDs, along with academic researchers and educators, to develop evidence-based guidelines for ED management. While managers must be recognized for their medical skills, they must also develop their leadership skills through dedicated training. These skills will enable them to adapt their leadership style to different situations and teams to encourage team motivation and commitment. Serving as the interface between frontline teams, management, and institutional partners, their role should be to promote dialogue and ensure team security. The manager’s role and resources need to be formalized in collaboration with senior leadership, in particular regarding access to information, so that the manager can convey a strategic vision to teams and partners. Projects should be implemented and meetings should be organized within the framework of an effective strategy. To achieve this, setting out and sharing clearly defined objectives and operating rules, as well as involving staff in decision-making, are effective tools for reducing resistance to change and encouraging the co-construction of organizational transformation. Skills development through individual and group training creates opportunities for the meaningful exchanges needed to support professionals to flourish, strengthen motivation, and build shared values. Certain factors are directly associated with the attractiveness of an ED, such as the working environment, the variety of activities, and individualized career management. The organizational structures put in place must ensure psychological safety and effective interprofessional collaboration to improve both the quality of work life and the quality of care. Communication and crisis management must be carefully thought out and methodically organized to build an ED in which every team member can fully engage and feel valued. Experts agree that managing an ED should be a structured activity, requiring specific tools and skills. This role must be recognized by the teams, leadership, and partners.

Background Microhaplotypes have the potential to be more cost-effective than SNPs for applications that require genetic panels of highly variable loci. However, development of microhaplotype panels is hindered by a lack of methods for estimating microhaplotype allele frequency from low-coverage whole genome sequencing or pooled sequencing (pool-seq) data. Results We developed new methods for estimating microhaplotype allele frequency from low-coverage whole genome sequence and pool-seq data. We validated these methods using datasets from three non-model organisms. These methods allowed estimation of allele frequency and expected heterozygosity at depths routinely achieved from pooled sequencing. Conclusions These new methods will allow microhaplotype panels to be designed using low-coverage WGS and pool-seq data to discover and evaluate candidate loci. The python script implementing the two methods and documentation are available at https://www.github.com/delomast/mhFromLowDepSeq .

Genetic stock identification (GSI) is an important fisheries management tool to identify the origin of fish harvested in mixed stock fisheries. Periodic updates of genetic baselines can improve performance via the addition of unsampled or under‐sampled populations and the inclusion of more informative markers. We used a combination of baselines to evaluate how population representation, marker number, and marker type affected the performance and accuracy of genetic stock assignments (self‐assignment, bias, and holdout group tests) for steelhead (Oncorhynchus mykiss) in the Snake River basin. First, we compared the performance of an existing genetic baseline with a newly developed one which had a reduced number of individuals from more populations using the same set of markers. Self‐assignment rates were significantly higher (p < 0.001; +5.4%) for the older, larger baseline, bias did not differ significantly between the two, but there was a significant improvement in performance for the new baseline in holdout results (p < 0.001; mean increase of 25.0%). Second, we compared the performance of the new baseline with increased numbers of genetic markers (~2x increase of single‐nucleotide polymorphisms; SNPs) for the same set of baseline individuals. In this comparison, results produced significantly higher rates of self‐assignment (p < 0.001; +9.7%) but neither bias nor leave‐one‐out were significantly affected. Third, we compared 334 SNPs versus opportunistically discovered microhaplotypes from the same amplicons for the new baseline, and showed the latter produced significantly higher rates of self‐assignment (p < 0.01; +2.6%), similar bias, but slightly lower holdout performance (−0.1%). Combined, we show the performance of genetic baselines can be improved via representative and efficient sampling, that increased marker number consistently improved performance over the original baseline, and that opportunistic discovery of microhaplotypes can lead to small improvements in GSI performance.

Fish migrations are energetically costly, especially when moving between freshwater and saltwater, but are a viable strategy for Pacific salmon and trout (Oncorhynchus spp.) due to the advantageous resources available at various life stages. Anadromous steelhead (O. mykiss) migrate vast distances and exhibit variation for adult migration phenotypes that have a genetic basis at candidate genes known as greb1L and rock1. We examined the distribution of genetic variation at 13 candidate markers spanning greb1L, intergenic, and rock1 regions versus 226 neutral markers for 113 populations (n = 9,471) of steelhead from inland and coastal lineages in the Columbia River. Patterns of population structure with neutral markers reflected genetic similarity by geographic region as demonstrated in previous studies, but candidate markers clustered populations by genetic variation associated with adult migration timing. Mature alleles for late migration had the highest frequency overall in steelhead populations throughout the Columbia River, with only 9 of 113 populations that had a higher frequency of premature alleles for early migration. While a single haplotype block was evident for the coastal lineage, we identified multiple haplotype blocks for the inland lineage. The inland lineage had one haplotype block that corresponded to candidate markers within the greb1L gene and immediately upstream in the intergenic region, and the second block only contained candidate markers from the intergenic region. Haplotype frequencies had similar patterns of geographic distribution as single markers, but there were distinct differences in frequency between the two haplotype blocks for the inland lineage. This may represent multiple recombination events that differed between lineages where phenotypic differences exist between freshwater entry versus arrival timing as indicated by Micheletti et al. (2018a). Redundancy analyses were used to model environmental effects on allelic frequencies of candidate markers, and significant variables were migration distance, temperature, isothermality, and annual precipitation. This study improves our understanding of the spatial distribution of genetic variation underlying adult migration timing in steelhead as well as associated environmental factors and has direct conservation and management implications. Anadromous steelhead (O. mykiss) migrate vast distances and exhibit variation for migration phenotypes that have a genetic basis at candidate genes known as greb1L and rock1. We examined the distribution of genetic variation at 13 candidate markers spanning greb1L, intergenic, and rock1 regions versus 246 neutral markers for 113 populations (n = 9,471) of steelhead from inland and coastal lineages in the Columbia River. This study improves our understanding of the spatial distribution of genetic variation underlying migration timing in steelhead as well as associated environmental factors and has direct conservation and management implications.

Managing and conserving populations of large carnivores, including gray wolves Canis lupus , often involves making decisions that balance conflicting stakeholder desires. To help inform these decisions, we developed a microhaplotype amplicon sequencing panel consisting of 341 loci. Of these, 321 were selected from candidates identified through restriction-site associated DNA sequencing (RADseq) with 62 samples collected across Idaho, United States. These loci were selected for high expected heterozygosity in order to inform individual identification and relationship inference. The mean ± SD expected heterozygosity of these loci in a sample of 733 individuals collected in Idaho during 2018–2020 was 0.57 ± 0.09. The 20 additional loci were composed of ten selected for differentiation of western coyotes and wolves, nine selected for differentiation of wolves and domestic dogs, and one locus designed to amplify sry to identify genetic sex. This panel will facilitate monitoring, conservation, and management of gray wolves in the western United States.

Understanding reproductive patterns in endangered species is critical for supporting their recovery efforts. In this study we use a combination of paired‐parent and single‐parent assignments to examine the reproductive patterns in an endangered population of sockeye salmon (Oncorhynchus nerka) that uses Redfish Lake in central Idaho as a spawning and nursery lake. Recovery efforts include the release of maturing adults into the lake for volitional spawning. The lake is also inhabited by a population of resident O. nerka that is genetically indistinguishable, but phenotypically smaller, to the maturing adults released into the lake. The resident population is difficult to sample and the reproductive patterns between the two groups are unknown. We used results of paired‐ and single‐parentage assignments to specifically examine the reproductive patterns of male fish released into the lake under an equal sex ratio and a male‐biased sex ratio. Assignment results of offspring leaving the lake indicated a reproductive shift by males under the two scenarios. Males displayed an assortative mating pattern under an equal sex ratio and spawned almost exclusively with the released females. Under a male‐biased sex ratio most males shifted to a negative‐assortative mating pattern and spawned with smaller females from the resident population. These males were younger and smaller than males that spawned with released females suggesting they were unable to compete with larger males for spawning opportunities with the larger, released females. The results provided insights into the reproductive behavior of this endangered population and has implications for recovery efforts. Parentage assignments indicated a reproductive shift by male sockeye salmon under two different sex ratios. Males displayed an assortative mating pattern under an equal sex ratio and spawned almost exclusively with similarly sized females but shifted to a negative‐assortative mating pattern under a male‐biased sex ratio and spawned with smaller females in the resident population.