1,422 research outputs found

    L'autoconsommation collective d'électricité en France: Emergence d'une innovation contrariée

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    National audienceIn France, collective self-consumption of electricity (ACCE) was born of the French Energy Transition for Green Growth Act (TECV) of 2015. As part of a general trend towards the reorganization of energy systems systems, this new system links consumers to one or more producers to one or more producers via the public electricity distribution network grid, meets a number of expectations: helping to develop renewable energies, respond to citizens' aspirations to produce and consume locally to produce and consume locally (the "short circuit" concept), and to encourage awareness of the challenges of energy efficiency and sobriety, etc. Supported by these diverse motivations, ACCE has since spread and is now and is now part of the range of tools available to local project promoters. can mobilize.The aim of this book is to analyse the emergence dynamics of this new public action tool, by articulating two scales of analysis, national (changes in the regulatory framework between 2015 and 2022, under the effect of sometimes complex interplay between players), and local (study of five operations). The result of interdisciplinary work, the survey shows that the that ACCE's "promise" (to work towards more decentralized energy energy management) has never really been fulfilled, as the scheme has been progressively deprived of its transformative potential to become an instrument of continuity in line with the continuity of the historical forms of regulation in the electricity sector, marked by strong centralism.L’autoconsommation collective d’électricitĂ© (ACCE) est nĂ©e, en France, de la loi relative Ă  la transition Ă©nergĂ©tique pour la croissance verte (TECV) de 2015. S’inscrivant dans un mouvement gĂ©nĂ©ral de recomposition des systĂšmes Ă©nergĂ©tiques, ce nouveau dispositif, qui consiste Ă  relier des consommateurs Ă  un ou plusieurs producteurs en empruntant le rĂ©seau public de distribution d’électricitĂ©, fait Ă©cho Ă  plusieurs types d’attentes : contribuer Ă  dĂ©velopper les Ă©nergies renouvelables, rĂ©pondre aux aspirations des citoyens Ă  produire et consommer au niveau local (notion de « circuit court »), inciter les individus Ă  mieux prendre conscience des enjeux d’efficacitĂ© et de sobriĂ©tĂ© Ă©nergĂ©tiques, etc. PortĂ©e par ces motivations diverses, l’ACCE s’est depuis diffusĂ©e et fait dĂ©sormais partie de la palette des dispositifs que les porteurs de projets locaux peuvent mobiliser.L’objectif de cet ouvrage est de rendre compte des dynamiques d’émergence de ce nouvel outil d’action publique, en articulant deux Ă©chelles d’analyse, nationale d’une part (Ă©volution du cadre rĂ©glementaire entre 2015 et 2022, sous l’effet de jeux d’acteurs parfois complexes), locale d’autre part (Ă©tude de cinq opĂ©rations). Fruit d’un travail interdisciplinaire, l’enquĂȘte montre que la « promesse » de l’ACCE (Ɠuvrer en faveur d’une gestion plus dĂ©centralisĂ©e de l’énergie) n’a jamais Ă©tĂ© vraiment tenue, ce dispositif ayant Ă©tĂ© progressivement dĂ©possĂ©dĂ© de son potentiel de transformation pour devenir un instrument s’inscrivant dans la continuitĂ© des formes de rĂ©gulation historiques du secteur Ă©lectrique, marquĂ©es par un fort centralisme

    The 2021 Association Research Circulation Osseous Classification for Early-Stage Osteonecrosis of the Femoral Head to Computed Tomography–Based Study

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    © 2022 Elsevier Inc.Background: The Association Research Circulation Osseous developed a novel classification for early-stage (precollapse) osteonecrosis of the femoral head (ONFH). We hypothesized that the novel classification is more reliable and valid when compared to previous 3 classifications: Steinberg, modified Kerboul, and Japanese Investigation Committee classifications. Methods: In the novel classification, necrotic lesions were classified into 3 types: type 1 is a small lesion, where the lateral necrotic margin is medial to the femoral head apex; type 2 is a medium-sized lesion, with the lateral necrotic margin being between the femoral head apex and the lateral acetabular edge; and type 3 is a large lesion, which extends outside the lateral acetabular edge. In a derivation cohort of 40 early-stage osteonecrotic hips based on computed tomography imaging, reliabilities were evaluated using kappa coefficients, and validities to predict future femoral head collapse by chi-squared tests and receiver operating characteristic curve analyses. The predictability for future collapse was also evaluated in a validation cohort of 104 early-stage ONFH. Results: In the derivation cohort, interobserver reliability (k = 0.545) and intraobserver agreement (63%-100%) of the novel method were higher than the other 3 classifications. The novel classification system was best able to predict future collapse (P < .05) and had the best discrimination between non-progressors and progressors in both the derivation cohort (area under the curve = 0.692 [0.522-0.863], P < .05) and the validation cohort (area under the curve = 0.742 [0.644-0.841], P = 2.46 × 10−5). Conclusion: This novel classification is a highly reliable and valid method of those examined. Association Research Circulation Osseous recommends using this method as a unified classification for early-stage ONFH. Level of Evidence: Level III, diagnostic study.N

    Osteonecrosis of the femoral head safely healed with autologous, expanded, bone marrow-derived mesenchymal stromal cells in a multicentric trial with minimum 5 years follow-up

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    Background: Osteonecrosis (ON) of the femoral head represents a potentially severe disease of the hip where the lack of bone regeneration may lead to femoral head collapse and secondary osteoarthritis, with serious pain and disability. The aim of this European, multicentric clinical trial was to prove safety and early efficacy to heal early femoral head ON in patients through minimally invasive surgical implantation of autologous mesenchymal stromal cells (MSC) expanded from bone marrow (BM) under good manufacturing practices (GMP). Methods: Twenty-two patients with femoral head ON (up to ARCO 2C) were recruited and surgically treated in France, Germany, Italy and Spain with BM-derived, expanded autologous MSC (total dose 140 million MSC in 7 mL). The investigational advanced therapy medicinal product (ATMP) was expanded from BM under the same protocol in all four countries and approved by each National Competent Authority. Patients were followed during two years for safety, based on adverse events, and for efficacy, based on clinical assessment (pain and hip score) and imaging (X-rays and MRIs). Patients were also reviewed after 5 to 6 years at latest follow-up for final outcome. Results: No severe adverse event was recalled as related to the ATMP. At 12 months, 16/20 per protocol and 16/22 under intention-to-treat (2 drop-out at 3 and 5 months) maintained head sphericity and showed bone regeneration. Of the 4 hips with ON progression, 3 required total hip replacement (THR). At 5 years, one patient (healed at 2 years visit) was not located, and 16/21 showed no progression or THR, 4/21 had received THR (all in the first year) and 1 had progressed one stage without THR. Conclusions: Expanded MSCs implantation was safe. Early efficacy was confirmed in 80% of cases under protocol at 2 years. At 5 years, the overall results were maintained and 19% converted to THR, all in the first yearThe research leading to these results has received funding from the European Research Council under the European Union’s Seventh Framework Programme (FP7/FP7-HEALTH-2009): REBORNE Project, Grant Agreement 241876. Work in EFS and stromalab was also supported by the Agence Nationale pour la Recherche for support of the national infrastructure: “ECELLFRANCE

    Acetabular Bone Marrow Aspiration During Total Hip Arthroplasty

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    Biologically augmented surgical treatments of orthopaedic conditions are increasingly popular. Bone marrow aspirate concentrate is a key orthobiologic tissue source, and the field is moving from the standard iliac crest marrow aspiration toward local aspirations of marrow depots that are accessible during the standard-of-care procedures in an attempt to reduce morbidity, surgery time, and cost. Here, we present the aspiration of the standard iliac marrow depot, but through a novel acetabular approach during total hip arthroplasty. This procedure markedly simplifies biologic augmentation with bone marrow aspirate concentrate in this large patient cohort

    Role of Matrix-Associated Autologous Chondrocyte Implantation with Spheroids in the Treatment of Large Chondral Defects in the Knee: A Systematic Review

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    Autologous chondrocyte implantation (ACI) is a cell therapy for the treatment of focal cartilage defects. The ACI product that is currently approved for use in the European Union (EU) consists of spheroids of autologous matrix-associated chondrocytes. These spheroids are spherical aggregates of ex vivo expanded human autologous chondrocytes and their self-synthesized extracellular matrix. The aim is to provide an overview of the preclinical and nonclinical studies that have been performed to ensure reproducible quality, safety, and efficacy of the cell therapy, and to evaluate the clinical data on ACI with spheroids. A systematic review was performed to include all English publications on self-aggregated spheroids of chondrocytes cultured in autologous serum without other supplements. A total of 20 publications were included, 7 pre- and nonclinical and 13 clinical research publications. The pre- and nonclinical research publications describe the development from concept to in vivo efficacy and quality- and safety-related aspects such as biodistribution, tumorigenicity, genetic stability, and potency. The evaluation of clinical research shows short- to mid-term safety and efficacy for the ACI with spheroid-based treatment of cartilage defects in both randomized clinical trials with selected patients, as well as in routine treatment providing real-world data in more complex patients

    Visual lung damage CT score at hospital admission of COVID-19 patients and 30-day mortality

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    International audienceObjectives: Chest CT has been widely used to screen and to evaluate the severity of COVID-19 disease in the early stages of infection without severe acute respiratory syndrome, but no prospective data are available to study the relationship between extent of lung damage and short-term mortality. The objective was to evaluate association between standardized simple visual lung damage CT score (vldCTs) at admission, which does not require any software, and 30-day mortality.Methods: In a single-center prospective cohort of COVID-19 patients included during 4 weeks, the presence and extent of ground glass opacities(GGO), consolidation opacities, or both of them were visually assessed in each of the 5 lung lobes (score from 0 to 4 per lobe depending on the percentage and out of 20 per patient = vldCTs) after the first chest CT performed to detect COVID-19 pneumonia.Results: Among 210 confirmed COVID-19 patients, the number of survivors and non-survivors was 162 (77%) and 48 (23%), respectively at 30 days. vldCTs was significantly higher in non-survivors, and the AUC of vldCTs to distinguish survivors and non-survivors was 0.72 (95%CI 0.628-0.807, p < 0.001); the best cut-off vldCTs value was 7. During follow-up, significant differences in discharges and 30-day mortality were observed between patients with vldCTs ≄ 7 versus vldCTs < 7: (98 [85.2%] vs 49 [51.6%]; p < 0.001 and 36 [37.9%] vs 12 [12.4%]; p < 0.001, respectively. The 30-day mortality increased if vldCTs ≄ 7 (HR, 3.16 (1.50-6.43); p = 0.001), independent of age, respiratory rate and oxygen saturation levels, and comorbidities at admission.Conclusions: By using chest CT in COVID-19 patients, extensive lung damage can be visually assessed with a score related to 30-day mortality independent of conventional risk factors of the disease.Key points: ‱ In non-selected COVID-19 patients included prospectively during 4 weeks, the extent of ground glass opacities(GGO) and consolidation opacities evaluated by a simple visual score was related to 30-day mortality independent of age, respiratory rate, oxygen saturation levels, comorbidities, and hs-troponin I level at admission. ‱ This severity score should be incorporated into risk stratification algorithms and in structured chest CT reports requiring a standardized reading by radiologists in case of COVID-19