Cost of care pathways before and after appropriate and inappropriate transfers to the emergency department among nursing home residents: results from the FINE study

BACKGROUND

Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate).

METHODS

This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant.

RESULTS

Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€.

CONCLUSIONS

Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents.

TRIAL REGISTRATION

clinicaltrials.gov, NCT02677272.

Applying Landscape Ecology in Local Planning, Some Experiences

Landscape ecology is repeatedly described as an applied science that can help reduce the negative effects of land-use and land-use changes on biodiversity. However, the extent to which landscape ecology is in fact contributing to planning and design processes is questioned. The aim of this paper is to investigate if and how landscape ecology can be integrated in a planning and design process, and to uncover possible problems that, e.g., landscape architects and planners, may face in such processes. Our conclusion, based on a case study from Asker municipality, Norway, is that such a landscape ecological approach has a lot to offer. However, it is difficult to exploit the potential fully for different reasons, e.g., biodiversity information tends to be specialized, and not easily used by planners and designers, and landscape ecological principles need an adaptation process to be applicable in a real-world situation. We conclude that for the situation to improve, landscape ecologists need to ease this process. In addition, we recommend collaboration across disciplinary boundaries, preferably with a common design concept as a foundation.

Probing the role of magnetic fields in star-forming filaments: NIKA2-Pol commissioning results toward OMC-1

Dust polarization observations are a powerful, practical tool to probe the geometry (and to some extent, the strength) of magnetic fields in starforming regions. In particular, Planck polarization data have revealed the importance of magnetic fields on large scales in molecular clouds. However, due to insufficient resolution, Planck observations are unable to constrain the B-field geometry on prestellar and protostellar scales. The high angular resolution of 11.7 arcsec provided by NIKA2-Pol 1.15 mm polarimetric imaging, corresponding to 0.02 pc at the distance of the Orion molecular cloud (OMC), makes it possible to advance our understanding of the B-field morphology in star-forming filaments and dense cores (IRAM 30m large program B-FUN). The commissioning of the NIKA2-Pol instrument has led to several challenging issues, in particular, the instrumental polarization or intensity-to-polarization “leakage” effect. In the present paper, we illustrate how this effect can be corrected for, leading to reliable exploitable data in a structured, extended source such as OMC-1. We present a statistical comparison between NIKA2-Pol and SCUBA2-Pol2 results in the OMC-1 region. We also present tentative evidence of local pinching of the B-field lines near Orion-KL, in the form of a new small-scale hourglass pattern, in addition to the larger-scale hourglass already seen by other instruments such as Pol2.

Multi-probe analysis of the galaxy cluster CL J1226.9+3332: Hydrostatic mass and hydrostatic-to-lensing bias

We present a multi-probe analysis of the well-known galaxy cluster CL J1226.9+3332 as a proof of concept for multi-wavelength studies within the framework of the NIKA2 Sunyaev-Zel’dovich Large Program (LPSZ). CL J1226.9+3332 is a massive and high redshift (z = 0.888) cluster that has already been observed at several wavelengths. A joint analysis of the thermal SZ (tSZ) effect at millimeter wavelength with the NIKA2 camera and in X-ray with the XMM-Newton satellite permits the reconstruction of the cluster’s thermodynamical properties and mass assuming hydrostatic equilibrium. We test the robustness of our mass estimates against different definitions of the data analysis transfer function. Using convergence maps reconstructed from the data of the CLASH program we obtain estimates of the lensing mass, which we compare to the estimated hydrostatic mass. This allows us to measure the hydrostatic-to-lensing mass bias and the associated systematic effects related to the NIKA2 measurement. We obtain M500HSE = (7:65 ± 1:03) × 1014M⊙ and M500lens = (7:35 ± 0:65) × 1014M⊙, which implies a HSE-to-lensing bias consistent with 0 within 20%.

Exploring the millimetre emission in nearby galaxies: Analysis of the edge-on galaxy NGC 891

New observations of the edge-on galaxy NGC 891, at 1.15 and 2mm obtained with the IRAM 30-m telescope and the NIKA2 camera, within the framework of the IMEGIN (Interpreting the Millimetre Emission of Galaxies with IRAM and NIKA2) Large Program, are presented in this work. By using multiwavelength maps (from the mid-IR to the cm wavelengths) we perform SED fitting in order to extract the physical properties of the galaxy on both global and local (~kpc) scales. For the interpretation of the observations we make use of a state-of-the-art SED fitting code, HerBIE (HiERarchical Bayesian Inference for dust Emission). The observations indicate a galaxy morphology, at mm wavelengths, similar to that of the cold dust emission traced by submm observations and to that of the molecular gas. The contribution of the radio emission at the NIKA2 bands is very small (negligible at 1.15 mm and ~ 10% at 2 mm) while it dominates the total energy budget at longer wavelengths (beyond 5 mm). On local scales, the distribution of the free-free emission resembles that of the dust thermal emission while the distribution of the synchrotron emission shows a deficiency along the major axis of the disc of the galaxy.

The NIKA2 Sunyaev-Zeldovich Large Program: Precise galaxy cluster physics for an accurate cluster-based cosmology

The NIKA2 Guaranteed-Time SZ Large Program (LPSZ) is dedicated to the high-angular resolution SZ mapping of a representative sample of 45 SZ-selected galaxy clusters drawn from the catalogues of the Planck satellite, or of the Atacama Cosmology Telescope. The LPSZ sample spans a mass range from 3 to 11 × 1014M⊙ and a redshift range from 0:5 to 0:9, extending to higher redshift and lower mass the previous samples dedicated to the cluster mass calibration and universal properties estimation. The main goals of the LPSZ are the measurement of the average radial profile of the ICM pressure up to R500 by combining NIKA2 with Planck or ACT data, and the estimation of the scaling law between the SZ observable and the mass using NIKA2, XMM-Newton and Planck/ACT data. Furthermore, combining LPSZ data with existing or forthcoming public data in lensing, optical/NIR or radio domains, we will build a consistent picture of the cluster physics and further gain knowledge on the mass estimate as a function of the cluster morphology and dynamical state.

We give an overview of the LPSZ, present recent results and discuss the future implication for cosmology with galaxy clusters.

Searching for high-z DSFGs with NIKA2 and NOEMA

As the possible progenitors of passive galaxies at z=2-3, dusty starforming galaxies (DSFGs) at z>4 provide a unique perspective to study the formation, assembly, and early quenching of massive galaxies in the early Universe. The extreme obscuration in optical-IR makes (sub)mm spectral scans the most universal and unbiased way to confirm/exclude the high-z nature of candidate dusty star-forming galaxies. We present here the status of the NIKA2 Cosmological Legacy Survey (N2CLS), which is the deepest wide-area singledish survey in the millimeter searching for high-z DSFGs. We also introduce a joint-analysis method to effciently search for the spectroscopic redshift of high-z DSFGs with noisy spectra and photometric data and present its success in identifying the redshift of DSFGs found in NIKA2 science verification data.

Galactic star formation with NIKA2 (GASTON): Filament convergence and its link to star formation

In the past decade filaments have been recognised as a major structural element of the interstellar medium, the densest of these filaments hosting the formation of most stars. In some star-forming molecular clouds converging networks of filaments, also known as hub filament systems, can be found. These hubs are believed to be preferentially associated to massive star formation. As of today, there are no metrics that allow the systematic quantification of a filament network convergence. Here, we used the IRAM 30m NIKA2 observations of the Galactic plane from the GASTON large programme to systematically identify filaments and produce a filament convergence parameter map. We use such a map to show that: i. hub filaments represent a small fraction of the global filament population; ii. hubs host, in proportion, more massive and more luminous compact sources that non-hubs; iii. hub-hosting clumps are more evolved that non-hubs; iv. no discontinuities are observed in the properties of compact sources as a function of convergence parameter. We propose that the rapid global collapse of clumps is responsible for (re)organising filament networks into hubs and, in parallel, enhancing the mass growth of compact sources.

PSZ2 G091: A massive double cluster at z ~ 0.822 observed by the NIKA2 camera

PSZ2 G091.83+26.11 is a massive galaxy cluster with M500 = 7:43 × 1014M⊙ at z = 0:822. This object exhibits a complex morphology with a clear bimodality observed in X-rays. However, it was detected and analysed in the Planck sample as a single, spherical cluster following a universal profile [1]. This model can lead to miscalculations of thermodynamical quantities, like the pressure profile. As future multiwavelength cluster experiments will detect more and more objects at higher redshifts (where we expect the fraction of merging objects to be higher), it is crucial to quantify this systematic effect. In this work, we use high-resolution observations of PSZ2 G091.83+26.11 by the NIKA2 camera to integrate the morphological characteristics of the cluster in our modelling. This is achieved by fitting a two-halo model to the SZ image and then by reconstruction of the resulting projected pressure profile. We then compare these results with the spherical assumption.

Galactic Star Formation with NIKA2 (GASTON): Evidence of mass accretion onto dense clumps

High-mass stars (m* ≳ 8 M⊙) play a crucial role in the evolution of galaxies, and so it is imperative that we understand how they are formed. We have used the New IRAM KIDs Array 2 (NIKA2) camera on the Institut de Radio Astronomie Millimétrique (IRAM) 30-m telescope to conduct high-sensitivity continuum mapping of ~ 2 deg2 of the Galactic plane (GP) as part of the Galactic Star Formation with NIKA2 (GASTON) large program. We have identified a total of 1467 clumps within our deep 1.15 mm continuum maps and, by using overlapping continuum, molecular line, and maser parallax data, we have determined their distances and physical properties. By placing them upon an approximate evolutionary sequence based upon 8 μm Spitzer imaging, we find evidence that the most massive dense clumps accrete material from their surrounding environment during their early evolution, before dispersing as star formation advances, supporting clump-fed models of high-mass star formation.

Overdensity of SubMillimiter Galaxies in the GJ526 Field mapped with the NIKA2 Camera

Using the NIKA2 dual band millimeter camera installed on the IRAM30m telescope, we have mapped a relatively large field (~ 70 arcmin2) in the direction of the star GJ526 to investigate the nature of the sources found with the MAMBO camera at 1.2 mm ten years earlier. We have found that they must be dust-obscured galaxies (SMGs) in the background beyond the star. The new NIKA2 map at 1.15 mm reveals additional sources and, in fact, an overdensity of SMGs predominantly distributed along a filament-like structure in projection on the sky across the whole observed field. We speculate this might be a cosmic filament at high redshift as revealed in cosmological hydrodynamical simulations. Measurement of spectroscopic redshifts of the SMGs in the candidate filament is required now for a definitive confirmation of the nature of the structure.

Crab nebula at 260 GHz with the NIKA2 polarimeter: Implications for the polarization angle calibration of future CMB experiments

The quest for primordial gravitational waves enclosed in the Cosmic Microwave Background (CMB) polarization B-modes signal motivates the development of a new generation of high sensitive experiments (e.g. CMBS4, LiteBIRD), thus allowing to probe the inflationary epoch in the early Universe. However, this will be only possible by ensuring a high control of the instrumental systematic effects and an accurate absolute calibration of the polarization angle.

The Crab nebula is known to be a polarization calibrator on the sky for CMB experiments. Already used for the Planck satellite it exhibits a high polarized signal at microwave wavelengths. In this work we present Crab polarization observations obtained, in the 260 GHz frequency band, with the NIKA2 instrument. Furthermore, we discuss the accuracy needed on such a measurement to improve the constraints on the absolute angle calibration for CMB experiments.

The LPSZ-CLASH galaxy cluster sample: Combining lensing and hydrostatic mass estimates

Starting from the clusters included in the NIKA sample and in the NIKA2 Sunyaev-Zel’dovich Large Program (LPSZ) we have selected a sample of six common objects with the Cluster Lensing And Supernova survey with Hubble (CLASH) lensing data. For the LPSZ clusters we have at our disposal both high-angular resolution observations of the thermal SZ with NIKA and NIKA2 and X-ray observations with XMM-Newton from which hydrostatic mass estimates can be derived. In addition, the CLASH dataset includes lensing convergence maps that can be converted into lensing estimates of the total mass of the cluster. One-dimensional mass profiles are used to derive integrated mass estimates accounting for systematic effects (data processing, modeling, etc.). Two-dimensional analysis of the maps can reveal substructures in the cluster and, therefore, inform us about the dynamical state of each system. Moreover, we are able to study the hydrostatic mass to lensing mass bias, across different morphology and a range of redshift clusters to give more insight on the hydrostatic mass bias. The analysis presented in this proceeding follows the study discussed in [20].

Mapping the intracluster medium temperature in the era of NIKA2 and MUSTANG-2

We present preliminary results from an on-going program that aims at mapping the intracluster medium (ICM) temperature of high redshift galaxy clusters from the MaDCoWS sample using a joint analysis of shallow X-ray data obtained by Chandra and high angular resolution Sunyaev-Zel’dovich (SZ) observations realized with the NIKA2 and MUSTANG-2 cameras. We also present preliminary results from an on-going Open Time program within the NIKA2 collaboration that aims at mapping the ICM temperature of a galaxy cluster at z = 0.45 from the resolved detection of the relativistic corrections to the SZ spectrum. These studies demonstrate how high angular resolution SZ observations will play a major role in the coming decade to push the investigation of ICM dynamics and non-gravitational processes to high redshift before the next generation X-ray observatories come into play.

Dust Emission in Galaxies at Millimeter Wavelengths: Cooling of star forming regions in NGC6946

Interstellar dust plays an important role in the formation of molecular gas and the heating and cooling of the interstellar medium. The spatial distribution of the mm-wavelength dust emission from galaxies is largely unexplored. The NIKA2 Guaranteed Time Project IMEGIN (Interpreting the Millimeter Emission of Galaxies with IRAM and NIKA2) has recently mapped the mm emission in the grand design spiral galaxy NGC6946. By subtracting the contributions from the free-free, synchrotron, and CO line emission, we map the distribution of the pure dust emission at 1:15mm and 2mm. Separating the arm/interarm regions, we find a dominant 2mm emission from interarms indicating the significant role of the general interstellar radiation field in heating the cold dust. Finally, we present maps of the dust mass, temperature, and emissivity index using the Bayesian MCMC modeling of the spectral energy distribution in NGC6946.

GASTON: Galactic Star Formation with NIKA2 A new population of cold massive sources discovered

Understanding where and when the mass of stars is determined is one of the fundamental, mostly unsolved, questions in astronomy. Here, we present the first results of GASTON, the Galactic Star Formation with NIKA2 large programme on the IRAM 30m telescope, that aims to identify new populations of low-brightness sources to tackle the question of stellar mass determination across all masses. In this paper, we focus on the high-mass star formation part of the project, for which we map a ~ 2 deg2 region of the Galactic plane around l = 24° in both 1.2 mm and 2.0 mm continuum. Half-way through the project, we reach a sensitivity of 3.7 mJy/beam at 1.2mm. Even though larger than our target sensitivity of 2 mJy, the current sensitivity already allows the identification of a new population of cold, compact sources that remained undetected in any (sub-)mm Galactic plane survey so far. In fact, about 25% of the ~ 1600 compact sources identified in the 1.2mm GASTON image are new detections. We present a preliminary analysis of the physical properties of the GASTON sources as a function of their evolutionary stage, arguing for a potential evolution of the mass distribution of these sources with time.

Cluster cosmology with the NIKA2 SZ Large Program

The main limiting factor of cosmological analyses based on thermal Sunyaev-Zel’dovich (SZ) cluster statistics comes from the bias and systematic uncertainties that affect the estimates of the mass of galaxy clusters. High-angular resolution SZ observations at high redshift are needed to study a potential redshift or morphology dependence of both the mean pressure profile and of the mass-observable scaling relation used in SZ cosmological analyses. The NIKA2 camera is a new generation continuum instrument installed at the IRAM 30-m telescope. With a large field of view, a high angular resolution and a high-sensitivity, the NIKA2 camera has unique SZ mapping capabilities. In this paper, we present the NIKA2 SZ large program, aiming at observing a large sample of clusters at redshifts between 0.5 and 0.9, and the characterization of the first cluster oberved with NIKA2.

Mapping the gas thermodynamic properties of the massive cluster merger MOO J1142+1527 at z = 1.2

We present the results of the analysis of the very massive cluster MOO J1142+1527 at a redshift z = 1.2 based on high angular resolution NIKA2 Sunyaev-Zel’dovich (SZ) andChandraX-ray data. This multi-wavelength analysis enables us to estimate the shape of the temperature profile with unprecedented precision at this redshift and to obtain a map of the gas entropy distribution averaged along the line of sight. The comparison between the cluster morphological properties observed in the NIKA2 andChandramaps together with the analysis of the entropy map allows us to conclude that MOOJ1142+1527 is an on-going merger hosting a cool-core at the position of the X-ray peak. This work demonstrates how the addition of spatially-resolved SZ observations to low signal-to-noise X-ray data can bring valuable insights on the intracluster medium thermodynamic properties atz>1.

Observing with NIKA2Pol from the IRAM 30m telescope : Early results on the commissioning phase

The NIKA2 polarization channel at 260 GHz (1.15 mm) has been proposed primarily to observe galactic star-forming regions and probe the critical scales between 0.01-0.05 pc at which magnetic field lines may channel the matter of interstellar filaments into growing dense cores. The NIKA2 polarime-ter consists of a room temperature continuously rotating multi-mesh HWP and a cold polarizer that separates the two orthogonal polarizations onto two 260 GHz KIDs arrays. We describe in this paper the preliminary results obtained during the most recent commissioning campaign performed in December 2018. We concentrate here on the analysis of the extended sources, while the observation of compact sources is presented in a companion paper [12]. We present preliminary NIKA2 polarization maps of the Crab nebula. We find that the integrated polarization intensity flux measured by NIKA2 is consistent with expectations. In terms of polarization angle, we are still limited by systematic uncertainties that will be further investigated in the forthcoming commissioning campaigns.

Preliminary results on the instrumental polarization of NIKA2-Pol at the IRAM 30m telescope

Clarifying the role of magnetic fields in the star formation process is crucial. Observations have already shown that magnetic fields play an important role in the early stages of star formation. The high spatial resolution (∼0.01 to 0.05 pc) provided by NIKA2-Pol 1.2 mm imaging polarimetry of nearby clouds will help us clarify the geometry of the B-field within dense cores and molecular filaments as part of the IRAM 30m large program B-FUN. There are numerous challenging issues in the validation of NIKA2-Pol such as the calibration of instrumental polarization. The commissioning phase of NIKA2-Pol is underway and is helping us characterize the intensity-to-polarization “leakage” pattern of the instrument. We present a preliminary analysis of the leakage pattern and its dependence with elevation. We also present the current leakage correction made possible by the NIKA2 pipeline in polarization mode based on the NIKA2-Pol commissioning data taken in December 2018. Based on reduced Stokes I, Q, U data we find that the leakage pattern of NIKA2-Pol depends on elevation and is sensitive to the focus of the telescope.

Debris disks around stars in the NIKA2 era

The new NIKA2 camera at the IRAM 30m radiotelescope was used to observe three known debris disks in order to constrain the SED of their dust emission in the millimeter wavelength domain. We have found that the spectral index between the two NIKA2 bands (1mm and 2mm) is consistent with the Rayleigh-Jeans regime (λ-2), unlike the steeper spectra (λ-3) measured in the submillimeter-wavelength domain for two of the three disks - around the stars Vega and HD107146. We provide a succesful proof of concept to model this spectral inversion in using two populations of dust grains, those smaller and those larger than a grain radius a0 of 0.5mm. This is obtained in breaking the slope of the size distribution and the functional form of the absorption coefficient of the standard model. The third disk - around the star HR8799 - does not exhibit this spectral inversion but is also the youngest.

NIKA2 mapping and cross-instrument SED extraction of extended sources with Scanamorphos

The steps taken to tailor to NIKA2 observations the Scanamorphos algorithm (initially developed to subtract low-frequency noise from Herschel on-the-fly observations) are described, focussing on the consequences of the different instrument architecture and observation strategy. The method, making the most extensive use of the redundancy built in the multi-scan coverage with large arrays of a given region of the sky, is applicable to extended sources, while the pipeline is so far optimized for compact sources. An example of application is given. A related tool to build consistent broadband SEDs from 60 microns to 2 mm, combining Herschel and NIKA2 data, has also been developed. Its main task is to process the data least affected by low-frequency noise and coverage limitations (i.e. the Herschel data) through the same transfer function as the NIKA2 data, simulating the same scan geometry and applying the same noise and atmospheric signal as extracted from the 1mm and 2mm data.

The NIKA polarimeter on science targets: Crab nebula observations at 150 GHz and dual-band polarization images of Orion Molecular Cloud OMC-1

We present here the polarization system of the NIKA camera and give a summary of the main results obtained and performed studies on Orion and the Crab nebula. The polarization system was equipped with a room temperature continuously rotating multi-mesh half wave plate and a grid polarizer facing the NIKA cryostat window. NIKA even though less sensitive than NIKA2 had polarization capability in both 1 and 2 millimiter bands. NIKA polarization observations demonstrated the ability of such a technology in detecting the polarization of different targets, compact and extended sources like the Crab nebula and Orion Molecular Cloud region OMC-1. These measurements together with the developed techniques to deal with systematics, opened the way to the current observations of NIKA2 in polarization that will provide important advances in the studies of galactic and extra-galactic emission and magnetic fields.

NIKA: a mm camera for Sunyaev-Zel’dovich science in clusters of galaxies

Clusters of galaxies, the largest bound objects in the Universe, constitute a cosmological probe of choice, which is sensitive to both dark matter and dark energy. Within this framework, the Sunyaev-Zel’dovich (SZ) effect has opened a new window for the detection of clusters of galaxies and for the characterization of their physical properties such as mass, pressure and temperature. NIKA, a KID-based dual band camera installed at the IRAM 30-m telescope, was particularly well adapted in terms of frequency, angular resolution, field-of-view and sensitivity, for the mapping of the thermal and kinetic SZ effect in high-redshift clusters. In this paper, we present the NIKA cluster sample and a review of the main results obtained via the measurement of the SZ effect on those clusters: reconstruction of the cluster radial pressure profile, mass, temperature and velocity.

A low-mass galaxy cluster as a test-case study for the NIKA2 SZ Large Program

High-resolution mapping of the hot gas in galaxy clusters is a key tool for cluster-based cosmological analyses. Taking advantage of the NIKA2 millimeter camera operated at the IRAM 30-m telescope, the NIKA2 SZ Large Program seeks to get a high-resolution follow-up of 45 galaxy clusters covering a wide mass range at high redshift in order to re-calibrate some of the tools needed for the cosmological exploitation of SZ surveys. We present the second cluster analysis of this program, targeting one of the faintest sources of the sample in order to tackle the difficulties in data reduction for such faint, low-SNR clusters. In this study, the main challenge is the precise estimation of the contamination by sub-millimetric point sources, which greatly affects the tSZ map of the cluster. We account for this contamination by performing a joint fit of the SZ signal and of the flux density of the compact sources. A prior knowledge of these fluxes is given by the adjustment of the SED of each source using data from both NIKA2 and the Herschel satellite. The first results are very promising and demonstrate the possibility to estimate thermodynamic properties with NIKA2, even in a compact cluster heavily contaminated by point sources.

Tissue-resident memory T cells play a key role in the efficacy of cancer vaccines

Resident memory CD8⁺T cells (T_RM) usually defined by the CD103 marker represent a new subset of long-lived memory T cells that remain in the tissues. We directly demonstrate their specific role in cancer vaccine-induced tumor regression. In human, they also seem to play a major role in tumor immunosurveillance.

Mechanisms of action and rationale for the use of checkpoint inhibitors in cancer

The large family of costimulatory molecules plays a crucial role in regulation of the immune response. These molecules modulate TCR signalling via phosphorylation cascades. Some of the coinhibitory members of this family, such as PD-1 and CTLA-4, already constitute approved targets in cancer therapy and, since 2011, have opened a new area of antitumour immunotherapy. Many antibodies targeting other inhibitory receptors (Tim-3, VISTA, Lag-3 and so on) or activating costimulatory molecules (OX40, GITR and so on) are under evaluation. These antibodies have multiple mechanisms of action. At the cellular level, these antibodies restore the activation signalling pathway and reprogram T cell metabolism. Tumour cells become resistant to apoptosis when an intracellular PD-L1 signalling is blocked. CD8⁺ T cells are considered to be the main effectors of the blockade of inhibitory receptors. Certain CD8⁺ T cell subsets, such as non-hyperexhausted (CD28⁺, T-bet^high, PD-1^int), follicular-like (CXCR-5⁺) or resident memory CD8⁺ T cells, are more prone to be reactivated by anti-PD-1/PD-L1 monoclonal antibody (mAb). In the future, the challenge will be to rationally combine drugs able to make the tumour microenvironment more permissive to immunotherapy in order to potentiate its clinical activity.

Mucosal vaccines: novel strategies and applications for the control of pathogens and tumors at mucosal sites

The mucosal immune system displays several adaptations reflecting the exposure to the external environment. The efficient induction of mucosal immune responses also requires specific approaches, such as the use of appropriate administration routes and specific adjuvants and/or delivery systems. In contrast to vaccines delivered via parenteral routes, experimental, and clinical evidences demonstrated that mucosal vaccines can efficiently induce local immune responses to pathogens or tumors located at mucosal sites as well as systemic response. At least in part, such features can be explained by the compartmentalization of mucosal B and T cell populations that play important roles in the modulation of local immune responses. In the present review, we discuss molecular and cellular features of the mucosal immune system as well as novel immunization approaches that may lead to the development of innovative and efficient vaccines targeting pathogens and tumors at different mucosal sites.

The contribution of intra- and interspecific tolerance variability to biodiversity changes along toxicity gradients

The worldwide distribution of toxicants is an important yet understudied driver of biodiversity, and the mechanisms relating toxicity to diversity have not been adequately explored. Here, we present a community model integrating demography, dispersal and toxicant-induced effects on reproduction driven by intraspecific and interspecific variability in toxicity tolerance. We compare model predictions to 458 species abundance distributions (SADs) observed along concentration gradients of toxicants to show that the best predictions occur when intraspecific variability is five and ten times higher than interspecific variability. At high concentrations, lower settings of intraspecific variability resulted in predictions of community extinction that were not supported by the observed SADs. Subtle but significant species losses at low concentrations were predicted only when intraspecific variability dominated over interspecific variability. Our results propose intraspecific variability as a key driver for biodiversity sustenance in ecosystems challenged by environmental change.

Microsatellite instability analysis for the screening of synchronous endometrial and ovarian cancer in Lynch syndrome

We report on a case of synchronous endometrial and ovarian cancer in a patient with Lynch syndrome. An endometrial biopsy performed during routine screening revealed microsatellite instability (MSI) and loss of expression of human mutL homolog-1 (MLH1) and postmeiotic segregation increased-2 (PMS2) in a setting of complex hyperplasia. Whereas gynaecological screening including clinical examination, pelvic ultrasound, and endometrial biopsy, has not proven its benefit, our case report points out the place of MSI analysis and immunohistochemical investigation of mismatch repair protein expression in endometrial samples during gynaecological screening.

Expression and mutational status of treatment-relevant targets and key oncogenes in 123 malignant salivary gland tumours

BACKGROUND

Malignant tumours of the salivary glands (MSGT) are rare and pleomorphic entities. Patients with advanced disease may benefit from targeted therapy; however, specific targets for optimising and personalising treatments are yet to be identified.

DESIGN

Immunohistochemistry for C-KIT, EGFR, HER2, MUC1, phospho-mTOR, androgen/estrogens/progesterone receptors and Ki67 was carried out and evaluated in terms of progression-free and overall survival. High throughput molecular screening of key oncogenes was done in 107 patients using routine diagnostic methods and Sequenom technology.

RESULTS

Several therapy leads were identified, including high levels of HER2 and androgen receptors in salivary duct carcinomas, C-KIT in myoepithelial carcinomas and EGFR in mucoepidermoid carcinomas. Recurrent mutations involving downstream elements of the EGFR pathway were found in HRAS, notably in tumours with a myoepithelial component, and in other key oncogenes (KRAS/NRAS/PI3KCA/BRAF/MAP2K). On the other hand, <1% of samples had EGFR or HER2 mutations.

CONCLUSION

Several tumour subtypes overexpressed targets of directed therapies suggesting potential therapy leads. Genotyping results suggest activation downstream of EGFR in 18 of the 107 samples that could be associated with low efficacy of EGFR inhibitors. Other molecules, such as PI3K/MEK or mTOR inhibitors, may have anti-tumour activity in this subgroup. The high mutation rate in HRAS highlights a novel key oncogenic event in MSGT.

ERCC1, p16, and Ki-67 immunohistochemichal expression as predictive and prognostic markers in head and neck squamous cell carcinoma treated with platin-based induction chemotherapy: Staining with the two anti-ERCC1 antibodies (8F1 and FL-297) was compared

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Background: Head and neck squamous cell carcinoma (HNSCC) treatment had undergone important changes, in particular due to the organ preservation and the advent of chemotherapy, particularly using platinum. The excision repair cross-complementation group 1 (ERCC1) enzyme plays a rate-limiting role in the nucleotide excision repair pathway and has been associated with resistance to platinum-based chemotherapy. The purpose of this study was to evaluate the role of ERCC1expression with p16 and Ki-67 as predictive markers in the response to platin-based induction chemotherapy and as prognostic markers in patients with HNSCC. Methods: 208 patients treated from 2000 to 2006 by an induction chemotherapy regimen for HNSCC were included retrospectively. ERCC1 (8F1 and FL297 clone), p16 and Ki-67 staining were performed on paraffin-embedded tumor tissue collected before chemotherapy. We assessed response to treatment, progression-free survival (PFS) and overall survival (OS). Results: Respectively, 68% (142/208 patients) and 81.5% (163/200 patients) of HNSCC showed low expression of 8F1 and FL297 ERCC1. No correlation was found between the two clones (p=0.1). There was no correlation between the expression of 8F1 ERCC1, FL297 ERCC1 and Ki-67 and the response to induction chemotherapy, OS or PFS. However, in the subgroup of 129 patients treated with induction cisplatin-5FU chemotherapy, a low expression of 8F1 ERCC1 was significantly associated with a better response (p=0.027). Over expression of p16, found in 34.5% of cancers of the oropharynx was significantly correlated with a better OS (p=0.0007) and a better PFS (p = 0.01). Conclusions: These results suggest that ERCC1 expression might be a useful predictive marker of HNSCC in patients treated by cisplatin-based chemotherapy. The 8F1 ERCC1 clone appears to be the best for immunohistochemical analysis; clone FL297 did not show any association with treatment response and survival. Independently, our study confirms the prognostic value of the over expression of p16 in carcinoma of the oropharynx.

Cd, Pb and Zn oral bioaccessibility of urban soils contaminated in the past by atmospheric emissions from two lead and zinc smelters

Ingestion of dust or soil particles could pose a potential health risk due to long-term metal trace element (MTE) exposure. Twenty-seven urban topsoil samples (kitchen garden and lawn) were collected and analyzed for Cd, Pb and Zn using the unified Bioaccessibility Research Group of Europe (BARGE) method (UBM) test to estimate the human bioaccessibility of these elements. The quantities of Cd, Pb and Zn extracted from soils indicated, on average, 68, 62 and 47% bioaccessibility, respectively, in the gastric phase and 31, 32 and 23% bioaccessibility, respectively, in the gastro-intestinal phase. Significant positive correlations were observed between concentrations extracted with UBM and total MTE contents. Stepwise multiple regression analysis showed that human bioaccessibility was also affected by some physico-chemical soil parameters (i.e. total nitrogen, carbonates, clay contents and pH). The unified test presents some valuable data for risk assessment. Indeed, the incorporation of oral bioaccessible concentrations into risk estimations could give more realistic information for health risk assessment.

Growth, structure and magnetic properties of FePt nanostructures on NaCl(001) and MgO(001)

A comparison of the structural and magnetic properties of FePt nanostructures grown at different temperatures on NaCl(001) and MgO(001) substrates is presented. A strong influence of the deposition temperature on the epitaxial growth as well as on the size distribution of FePt nanostructures grown on NaCl substrates is observed. In spite of a large lattice mismatch between FePt and NaCl, a 'cube-over-cube' growth of nanostructures with a narrow size distribution was achieved at 520 K. Moreover, the growth of FePt nanostructures on NaCl(001) is not preceded by the formation of a wetting layer as observed on MgO(001). The higher degree of L1(0) chemical ordering in FePt nanostructures grown on MgO(001) accompanied by the absence of L1(0) variants with an in-plane tetragonal c-axis indicates that the tensile epitaxial stress induced by the MgO substrate is a key factor in the formation of the L1(0) phase with an out-of-plane c-axis. Superparamagnetic behavior is revealed for the FePt nanostructures grown on NaCl(001) due to their small size and relatively poor chemical order.

Assessment of a remediation technique using the replacement of contaminated soils in kitchen gardens nearby a former lead smelter in Northern France

Vegetables cultivated in kitchen gardens that are strongly contaminated by heavy metals (Pb, Cd) may represent to consumers a means of exposure to these metals. This exposure is more problematic for those families that include a large quantity of home-grown vegetables in their diet. Researchers have shown that the majority of vegetables produced in kitchen gardens in the vicinity of the Metaleurop Nord smelter (Northern France) do not conform to European regulations. This study was carried out in three of these kitchen gardens. The concentrations of Cd and Pb in the topsoils were up to 24 and 3300 mg kg(-1) respectively. The method consisted of delineating a surface area of about 50 to 100 m(2) for each garden, then removing the contaminated soil and replacing it with a clean one. Seven species of vegetables were cultivated from 2003 to 2005 in the original contaminated soils and the remediated ones. The data showed a clear improvement of the quality of the vegetables cultivated in remediated soils, although 17% of them were still over the European legislative limits for foodstuffs. This suggested that there was a foliar contamination due to contaminated dust fallout coming from the closed smelter site and the adjacent polluted soils. In addition, the measurement of the Cd and Pb concentrations in the dust fallout showed that the substantial rise in metal concentrations in the remediated soil was not only due to atmospheric fallout. These results raise questions about possible technical, economic and sociological problems associated with this kind of remediation.

Alteration of leaf decomposition in copper-contaminated freshwater mesocosms

The influence of copper on leaf litter decomposition was examined in experimental streams. Controls and three levels of contamination (5, 25, and 75 microg/L) were tested in triplicate in 20-m-long mesocosms. Equal quantities of alder, maple, and oak leaves were enclosed in mesh bags and placed in the upper and lower mesocosm sections that exhibited different habitat characteristics (shallow with pebble substrate or deep with fine substrate and macrophytes, respectively). Decomposition rate in the upper section of the 75 micro.g/L mesocosms was significantly reduced to 28% of control values. No significant reductions in the decomposition rate were seen in the lower section. No differences in the leaf-associated mycelial biomass and sporulation rates were observed between treatments, but they were consistently higher in the upper sections. The aquatic hyphomycete community was not affected by the contamination. The abundances of total leaf-associated macroinvertebrates and the dominant shredder (Gammarus pulex) were considerably reduced in the upper sections at 75 microg/L. Therefore, the reduced leaf decomposition probably resulted from a reduction in the abundance of macroinvertebrate detritivores. In addition, local variations in physical and biological characteristics of the habitat along the mesocosms significantly influenced the effects of copper on leaf-associated decomposers.

Increased exposure to statins in patients developing chronic muscle diseases: a 2-year retrospective study

OBJECTIVE

Case reports have suggested that lipid-lowering drugs (LLDs), especially statins, could induce or reveal chronic muscle diseases. We conducted a study to evaluate the association between chronic muscle diseases and prior exposure to LLDs.

METHOD

This was a retrospective study of chronic primary muscle disease cases newly diagnosed at the Toulouse University Hospitals between January 2003 and December 2004 among patients living in the Midi-Pyrénées area, France. All patients remained symptomatic for more than 1 year after drug withdrawal, or required drugs for inflammatory myopathy. Data on the patient's exposure to LLDs and to other drugs were compared with that of matched controls (5/1) selected through the Midi-Pyrénées Health Insurance System database.

RESULTS

A total of 37 patients were included in the study. Of those, 21 (56.8%) suffered from dermatomyositis (DM) or polymyositis (PM), 12 (32.4%) from genetic myopathy, and 4 (10.8%) from an unclassified disease. The prevalence of exposure to statins was 40.5% in patients and 20% in controls (odds ratio (OR) 2.73, 95% confidence interval (CI) 1.21-6.14; p<0.01). There was a significant positive interaction between statins and proton pump inhibitors exposure (weighted OR 3.3, 95% CI 1.37-7.54; p = 0.02). Statin exposure rate was 47.6% among patients with DM/PM (OR 3.86, 95% CI 1.30-11.57; p<0.01). There was no difference between patients and controls for exposure to fibrates.

CONCLUSION

Patients who developed chronic muscle diseases after the age of 50, including DM/PM, had a higher than expected frequency of prior exposure to statins. Further studies are needed to confirm this association and the role of proton pump inhibitors.