Please enable JS and disable any ad blocker please click the box below to let us know you're not a robot Get the most important global markets news at your fingertips with a Bloomberg.com subscription. Understanding COVID-19 outcomes remains a challenge. While numerous biomarkers have been proposed for severity at admission, limited exploration exists for markers during the infection course, especially for the requirement of oxygen therapy. This study investigates the potential of eosinophil count normalization as a predictor for oxygen weaning during the initial wave of the pandemic. A retrospective study was conducted between March and April 2020 (first wave) among adults admitted directly to a medicine ward. Biological abnormalities, including lymphocyte count, eosinophil count, and C-reactive protein (CRP), were gathered daily during the first week of admission according to oxygen level. In case of worsening, oxygen level was censored at 15 L/min. The primary aim was to assess whether eosinophil count normalization predicts a subsequent decrease in oxygen requirements. The study highlights the relationship between eosinophil count and CRP, with implications for predicting oxygen weaning during COVID-19. Further research is warranted to explore the relevance of these biomarkers in other respiratory infections. Volume 15 - 2024 | https://doi.org/10.3389/fimmu.2024.1381059 Background: Understanding COVID-19 outcomes remains a challenge While numerous biomarkers have been proposed for severity at admission limited exploration exists for markers during the infection course especially for the requirement of oxygen therapy This study investigates the potential of eosinophil count normalization as a predictor for oxygen weaning during the initial wave of the pandemic Methods: A retrospective study was conducted between March and April 2020 (first wave) among adults admitted directly to a medicine ward were gathered daily during the first week of admission according to oxygen level The primary aim was to assess whether eosinophil count normalization predicts a subsequent decrease in oxygen requirements and 20.5% were admitted to the intensive care unit after a median delay of 48 hours The median CRP at admission was 79 (26–130) mg/L whereas the eosinophil count was 10 (0–60)/mm3 Eosinophil count normalization (≥100/mm3) by day 2 correlated significantly with decreased oxygen needs (<2 L) with hazard ratio (HR) = 3.7 [1.1–12.9] (p = 0.04) CRP < 80 mg/L was associated with reduced oxygen requirements (p < 0.001) including underlying chronic respiratory disease exhibited a trend toward a negative association (p = 0.06) Conclusion: The study highlights the relationship between eosinophil count and CRP with implications for predicting oxygen weaning during COVID-19 Further research is warranted to explore the relevance of these biomarkers in other respiratory infections Even if the management of hospitalized patients with COVID-19 largely relies on CT imaging, comorbidities, and vaccination status (6), predicting patient outcome remains challenging. Better anticipating a patient's respiratory worsening allows for more tailored medical treatment. Indeed, possible therapeutics are currently dependent on oxygen supply and the promptness of consultation to consider antiviral drugs (7) or there is no biomarker to predict oxygen dependence during ongoing COVID-19 infection Our work intends to assess the kinetics of eosinophil count over time based on oxygen levels during the acute phase of this viral infection during this first wave of the epidemic when no specific drugs were approved COVID-19 served as an excellent model for investigation particularly considering that patients underwent routine daily biological follow-ups This was a single-center and retrospective study during the first wave of COVID-19 (from early March to late April 2020) of adults admitted to a medicine ward for a COVID-19 infection confirmed by SARS-CoV-2 RT-PCR in a tertiary care hospital Hôpital Raymond Poincaré (AP-HP) The following data were collected from the patients’ medical charts: − Patient characteristics: age, sex, diabetes, cardiovascular risk factors, smoking habits, obesity, chronic pulmonary disease, and Charlson comorbidity index (CCI) (16) − Infection and treatment characteristics: delay between onset of symptoms and admission, percentage of lung injuries on CT scan if applicable and available, requirement of ICU support with invasive ventilation, and associated therapeutic strategies (e.g., oxygen and associated drugs). Of note at the time of the study in our hospital [before the RECOVERY protocol (2)] patients were not eligible for corticosteroids in the medicine ward and were proposed to be treated with steroids in randomized clinical trials only in the ICU including polymorphonuclear neutrophils (PMNs) and CRP were gathered daily during the first week of admission according to oxygen level The aim of the study was to investigate whether normalization of eosinophil count could predict a decrease in oxygen requirements and potentially delay treatment initiation Values were presented as median with 95% CI on figures or interquartile range (IQR) in the main text and statistical analysis utilized the chi-square square test Multivariate analyses used linear logistic regression Statistical significance was set at 0.05 (two-tailed test) All statistical calculations were performed using Prism GraphPad software version 9.1.1 All procedures performed in studies involving human participants were in accordance with the ethical standards and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards This study has passed the CESREES/Health Data Hub regarding ethics committee approval (MR1811190620) and is registered on ClinicalTrials.gov (NCT04453501) As part of an anonymous and retrospective study a non-opposition and information letter was sent to participants afterward Between March 5 and April 25, 2020, 132 patients with COVID-19 were admitted. Baseline characteristics are summarized in Table 1 The mean (± SD) onset of symptoms was 7 ± 4 days with a median (IQR) value of 2.25 (2–4) L/min an additional 10 patients required oxygen during admission Among individuals who underwent a CT scan (n = 103) 53.5% had moderate (25%–50%) to severe (>50%) lung involvement Twenty-seven patients (20.5%) required ICU due to worsening condition 18 patients received corticosteroids after a median delay of 2 (1–8) days from admission Table 1 Baseline characteristics of patients the following median (IQR) values were revealed: CRP = 79 (26–130) mg/L lymphocyte count = 1,005 (730–1,380)/mm3 and eosinophil count = 10 (0–60)/mm3 Eosinophil count increased continuously until normalization (median ≥100/mm3) from day (D) 0 to D3, while the oxygen level started to decrease on day 3 without any rebound observed thereafter (Figure 1) median CRP decreased to 43 mg/L on day 2 but ultimately increased again whose CRP levels eventually increased again were primarily admitted to the ICU (n = 9/13) and were at a higher risk of mortality (38% vs Figure 1 Behavior of eosinophil count over time from the admission (D0) according to C-reactive protein (CRP) value and oxygen level requirements Values represent median with 95% confidence interval (CI) Patients requiring <2 L/min of oxygen were significantly associated with an eosinophil count (≥100/mm3) on day 2 (70.0% vs. 31.5%), with OR = 5.5 [2.19–13.8] (p < 0.001) in univariate analysis (see Table 2) Table 2 Potential factors associated with oxygen need <2 L/min after admission At D2, eosinophil count <100/mm3 was significantly more prevalent in patients who were transferred to the ICU (88%) than hospitalized in the medicine ward (39%), with an OR = 11.4 [3.1–38] (p < 0.0001) (see Figure 2) lymphocyte count and CRP values were potential factors associated with oxygen need <2 L/min after admission (p = 0.008 and <0.001 Figure 2 Distribution of patients between intensive care unit (ICU) and medicine ward according to eosinophil count (<100/mm3 or ≥100/mm3) considering patients who underwent a pulmonary CT scan and had eosinophil count measured until late follow-up (n = 58) lung injury extension (≤25% or >25%) was not predictive of eosinophil count normalization (≥100/mm3) at D3 (42% vs The behavior of eosinophil count over time that tends to normalization was not reproducible using either PMN or lymphocyte count during follow-up, in comparison to oxygen level. Indeed, PMNs continuously increased regardless of normalization, whereas lymphocyte count remained stable (Supplementary Figure 1) In multivariate analyses, factors associated with an oxygen level <2 L/min were eosinophil count ≥100/mm3 (p = 0.04) and CRP < 80 mg/L (p < 0.001). Conversely, there was a trend toward underlying chronic respiratory disease as a negative association (p = 0.06) (see Table 2) Our study highlights that the behavior of two biological markers (eosinophil count and CRP) is associated with oxygen weaning during ongoing COVID-19 infection normalization of eosinophil count appears after day 3 and is related to decreased oxygen need (<2 L) within 48 hours mean CRP values did not achieve normalization after 3 days of admission contrary to eosinophil count (≥100/mm3) which is a more convenient assay for clinical evolution at no extra cost on regular complete blood count but without significant rates in mechanical ventilation conducted during the first and second waves of the pandemic also suggests that the lack of eosinophil recovery events might be indicative of patients at risk for future progression to severe COVID-19 reported no eosinophil infiltration in the lungs of patients with eosinopenia These findings support that peripheral blood eosinophils behave according to the magnitude of immune hyperactivation during moderate-to-severe infection we observed rapid recovery from eosinopenia in cases of favorable outcome which is clinically assessed by oxygen weaning For conditions unrelated to COVID-19, historical predictors of oxygen weaning have been related to patients’ characteristics and dyspnea scales in individuals undergoing pulmonary rehabilitation (27). Similarly, a previous study described the outcomes of respiratory function tests associated with non-invasive ventilation weaning in cases of acute exacerbation of chronic pulmonary disease (28) readily available to predict oxygen weaning in medicine ward is relevant considering that a substantial number of inpatients remain admitted after visiting the emergency room especially during waves of winter seasonal respiratory tract infections typically necessitating supplemental oxygen therapy of at least 2 L/min our surveillance of eosinophil count may remain relevant for patients under oxygen monitoring and not receiving steroids our study involved a limited sample size and did not permit in-depth investigations into confounding factors which today would include considerations such as vaccination status and the impact of different COVID-19 variants suggesting a potentially similar impact on oxygen requirements during the course of treatment Our findings revealed interest in a simple biomarker such as normalization of eosinophil count during the course of COVID-19 infection to predict oxygen weaning the requirement for a specific threshold may be a limitation in its application in daily clinical practice particularly with the emergence of Omicron variants which demonstrate a lower systemic inflammatory response than during previous waves The raw data supporting the conclusions of this article will be made available by the authors The studies were conducted in accordance with the local legislation and institutional requirements Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article PharmD (1) Research Staff Isabelle Bossard (8) Tiphaine Barbarin Nicolier (1) Stanislas Grassin Delyle MCUPH (2,3,5) Elodie Lamy (2,5) Camille Roquencourt MD (5) Gabriel Saffroy (2) Etienne Thevenot (5) Baptiste Abbar (1) Steven Bennington (1) Juliah Dray (1) Pierre Gay (1) Elias Kochbati (1) Majistor Luxman (1) Myriam Moucachen (1) Alice Pascault (1) Juan Tamayo (1) Justine Zini (1) PhD (1,2,7) Jean Bergounioux MD (1,2,5) Maud Guillon MD (1) Laboratory of Physiology Frédéric Lofaso Department of Rehabilitation and Physical Medicine Florence Angioni (1) Elsa Chkron (1) Céline Karabulut (1) Jérôme Lemoine (1) Noémie Trystram (1) Julien Vibert (1) Marc Hobeika (1) Louis Jacob (1) Nicolas Kiavue (1) Aymeric Lanore (1) Aurélie Le Gal (1) Julia Nguyen Van Thang (1) Department of Microbiology and Innovative Biomarkers Platform PhD (1,2,5) Sophie Tocqueville (1) Marie-Anne Welti PhD (1,2,5) And the nonmedical staff of the Department Department of Laboratory Medicine and Pharmacology PharmD (1) Pierre-Alexandre Emmanuelli (1) Firas Jabbour MD (1) And the nonmedical staff of the Department Margot Armani (1) Olivier de Barry (1) Antoine Kirchner (1) Jeffery Zhou (1) Université Versailles Saint Quentin en Yvelines Centre Hospitalier Universitaire de Nantes Université de Versailles Saint-Quentin-en-Yvelines/INSERM Laboratory of Infection & Inflammation–U-1173 Centre d’Evaluation et de Traitement de la Douleur–U-987 Commissariat à l’Energie Atomique Centre Hospitalier Intercommunal Poissy/Saint-Germain The author(s) declare that no financial support was received for the research The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fimmu.2024.1381059/full#supplementary-material Supplementary Figure 1 | Behavior of lymphocyte count and neutrophils over time from the admission (D0) according to oxygen level requirements Cytokine elevation in severe and critical COVID-19: A rapid systematic review and comparison with other inflammatory syndromes doi: 10.1016/S2213–2600(20)30404–5 Dexamethasone in hospitalized patients with covid-19 PubMed Abstract | CrossRef Full Text | Google Scholar Value of quantitative analysis in lung computed tomography in patients severely ill with COVID-19 SARS-coV-2 variants infection in relationship to imaging-based and clinical outcomes CrossRef Full Text | Google Scholar Reduction in chest CT severity and improved hospital outcomes in-coV-2 omicron compared with delta variant infection Pulmonary computed tomographic manifestations of COVID-19 in vaccinated and non-vaccinated patients doi: 10.1038/S41598–023-33942–1 Real-World Effectiveness of Early Molnupiravir or Nirmatrelvir–Ritonavir in Hospitalised Patients with COVID-19 without Supplemental Oxygen Requirement on Admission during Hong Kong’s Omicron BA.2 Wave: A Retrospective Cohort Study doi: 10.1016/S1473–3099(22)00507–2 and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis doi: 10.1136/BMJEBM-2020–111536 Meta-Analysis investigating the relationship between clinical features and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia Biomarkers and outcomes in hospitalised patients with COVID-19: A prospective registry doi: 10.1136/BMJOPEN-2022–067430 Eosinopenia <100/ML as a marker of active COVID-19: an observational prospective study Eosinopenia is a reliable marker of sepsis on admission to medical intensive care units Eosinophil count (EC) as a diagnostic and prognostic marker for infection in the internal medicine department setting Persistent eosinopenia is associated with in-hospital mortality among older patients: unexpected prognostic value of a revisited biomarker doi: 10.1186/S12877–021-02515–0 New method of classifying prognostic comorbidity in longitudinal studies: development and validation Serum C-reactive protein greater than 75 Mg/DL as an early available laboratory predictor of severe COVID-19: A systematic review Comparison of C-reactive protein with distinct hyperinflammatory biomarkers in association with COVID-19 severity Coronavirus disease 2019 and peripheral blood eosinophil counts: A retrospective study Eosinopenia as predictor of poor outcome in hospitalized COVID-19 adult patients from waves 1 and 2 of 2020 pandemic Eosinophil recovery in hospitalized COVID-19 patients is associated with lower rates of ICU admission and in-hospital mortality: an observational cohort analysis Ueber das vorkommen der eosinophilen zellen in menschlichen blute Google Scholar Eosinopenia and increased markers of endothelial damage are characteristic of COVID-19 infection at time of hospital admission Prognostic role of simple inflammatory biomarkers in patients with severe COVID-19: an observational study ELR and CLR in differentiating COVID-19 patients with and without pneumonia Evaluation of emerging inflammatory markers for predicting oxygen support requirement in COVID-19 patients Predictors of successful oxygen weaning in older patients undergoing pulmonary rehabilitation Predictors of successful weaning from noninvasive ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: A single-center retrospective cohort study A living WHO guideline on drugs for covid-19 Eosinopenia in COVID-19: what we missed so far CrossRef Full Text | Google Scholar Changes in eosinophil count during bacterial infection: revisiting an old marker to assess the efficacy of antimicrobial therapy De Truchis P and Annane D (2024) Normalization of eosinophil count is predictive of oxygen weaning over the course of COVID-19 infection among hospitalized adults during the first wave of 2020 pandemic Received: 02 February 2024; Accepted: 07 May 2024;Published: 24 May 2024 Copyright © 2024 Davido, Jaffal, Saleh-Mghir, Vaugier, Bourlet, De Truchis and Annane. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution or reproduction in other forums is permitted provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited in accordance with accepted academic practice distribution or reproduction is permitted which does not comply with these terms *Correspondence: Benjamin Davido, YmVuamFtaW4uZGF2aWRvQGFwaHAuZnI= Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish French Green party leader Marine Tondelier has challenged far-right National Rally leader Jordan Bardella to a televised debate before Sunday's parliamentary election after accusing him of preferring to debate only with men Tondelier has become a prominent figure for the New Popular Front left alliance which is emerging as an alternative to the National Rally in numerous constituencies during the final runoff Following RN's strong performance in the initial round of the snap parliamentary elections on Sunday the 28-year-old who seeks to be prime minister should his party secure a parliamentary majority said he wanted a televised debate this week with seasoned leftist Jean-Luc Melenchon Bardella penned a letter to the French people on Monday branding the left as "agents of chaos" deeming them a grave "existential threat" to the nation and urging Melenchon to participate in a debate who founded the left's La France Insoumise party Left-wing allies have disputed Melenchon's relevance in the race for prime minister Tondelier has criticized Bardella on social media highlighting his insistence on debating Melenchon and prompting the Greens to question Bardella's motives have emphasized the absence of female representation in prior debates and called for Tondelier's inclusion in an upcoming televised debate Since RN's first-round results in parliamentary elections where the right-wing party and its allies captured one-third of the votes including French President Emmanuel Macron's centrists and the left-wing coalition have quickly mobilized to counter the right's momentum seeking to prevent it from achieving an absolute majority and assuming control of the government RN would dominate Parliament if it were to reach the 289-seat threshold for an absolute majority emphasized the urgency by stating the far-right is at the "gates of power" and insisting that the RN should not receive a "single vote "in the election Macron's camp is collaborating with the left-wing alliance advocating for tactical voting and urging third-place candidates from Sunday's vote to withdraw aiming to form a united front against the far right Macron announced plans for a "broad" democratic coalition against the far-right and called a Cabinet meeting to plan further strategies This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page Metrics details A Correction to this article was published on 04 March 2025 This article has been updated Emergency Medical Communication Centres (EMCCs) play a crucial role in emergency care by ensuring timely responses through telephone triage extended communication times can impede accessibility Identifying the factors influencing communication duration is essential for improving EMCC efficiency and contextual factors associated with prolonged communication times in an EMCC where decision-making is conducted by physicians We conducted a retrospective observational study of all calls received at a French EMCC between March 1 and December 31 A total of 108,548 patient medical files were analyzed excluding calls from medical personnel or hospitals We examined the total communication time (from call initiation to decision) and the medical communication time (physician involvement) Bivariate and multivariate logistic regressions were used to identify factors associated with prolonged communication times The median total communication time was 7 min [IQR 5–11] and the median medical communication time was 3 min [IQR 2–4] Psychiatric reasons for calling (OR = 1.75) and elderly patients (OR = 1.58) were associated with longer communication times Calls leading to medical advice (OR = 1.48) and calls during weekends or nighttime were also significant factors Several factors influence communication times in EMCCs Reducing decision-making delays can positively impact patient outcomes and is also a significant organizational goal In France, the EMCC operates on a two-tiered system [6] Calls are initially handled by call takers who have completed a one-year degree course They are responsible for answering the call filling out the patient’s medical file (PMF) calls are directed either to an emergency physician or a general practitioner This study aims to identify the factors associated with longer communication times in a system where regulation and decision-making are conducted by a physician concerning all calls received over this period The year 2019 was chosen to reflect the situation without the impact of the SARS-CoV-2 pandemic The analysis began in March due to an update of the regulation software France is divided into 13 regions and 100 departments The EMCC of the “Hauts de Seine” department (EMCC 92) is located in Garches at the University Hospital Raymond-Poincaré It covers an area of 176 km2 with a population of 1.6 million We included all calls originating from non-medical personnel and outside a hospital structure Criteria for non-inclusion were calls for inter-hospital transfer and calls from community-based physicians the variables collected were those standardized in the medical regulation software Centaure® A daytime hour was defined between 8:00 am and 7:59 pm and a nighttime hour between 8:00 pm and 7:59 am A working hour was defined as a daytime hour on a weekday were collected: cardiological (including cardiac arrest) nose and throat)/stomatology/ophthalmology) The caller’s initial request was notified as a request for a doctor at home a request for an ambulance and other requests (other health professionals The caller category was collected: the subject himself a third party (including family or from another call center) The time of medical regulation and the type of doctor (emergency doctor or general practitioner) were recorded The time and type of medical decision were recorded: dispatch of rescue team (ambulance contact details of a pharmacy on call) or permanent care physician (consultation at the medical center dispatch of a doctor from the home emergency medical service) as well as the profile of the person who triggered it: physician or non-medical staff human and contextual factors influencing total communication time during an EMCC call was defined as the delay between picking up the phone at the EMCC and making a decision was defined as the time between the start of the physician’s notetaking and the decision being made The results are presented in accordance with the RECORD recommendations for observational studies Quantitative data are expressed as mean and standard deviation or median and interquartile range Categorical variables are presented as numbers and percentages Logistic regressions were performed to identify factors associated with total communication time The judgment criterion was dichotomized at its median and given an inter-class correlation coefficient of 12% we used mixed models with the EMCC physician at level 2 The multivariate analysis was carried out using a mixed logistic regression model The variables included in the model were those associated with a p < 0.2 in bivariate analysis In cases where several variables reflected the same data (e.g temporality with the “working hour” variable) The variables selected for the multivariate model were those with the lowest Akaike information criterion variables were compared by Student’s or Mann-Whitney’s T-test for quantitative variables according to their distribution and by Fisher’s test or Chi2 for qualitative variables Analyses were performed using R software (version 4.2.0) After applying the inclusion and non-inclusion criteria The results of the bivariate analyses are presented in Table 1 All variables were retained for multivariate analysis High patient satisfaction (90%) and substantial savings (€91 vs €150; p < 0.01) further support the efficacy of this approach The flow of calls related to non-urgent issues (79%) often resulting in extended telephone medical advice contributes to increased waiting times between the call taker and the regulating physician likely without impacting patient morbidity in this population and respiratory distress are critically time-sensitive the implementation of specialized channels such as the inclusion of nurses specializing in psychiatry or geriatrics we defined our outcomes as the time when the medical decision was recorded in the software as the physician might provide an explanation before entering the decision into the system we were unable to collect data on the availability of call takers at specific times or on the workload during EMCC operations we had no information on the availability of rescue resources during calls nor on any modification of decisions by call takers in the event of resource unavailability These regulatory factors could be confounding and may influence our results Numerous factors influence communication times in emergency medical communication centers (EMCCs) Identifying these factors will guide the organization of responses within EMCCs The statistical code and technical processes are available from the time of publication Appropriate institutional agreements will be required for anonymized participant data transfer Requests should be made via email to the corresponding author along with an analysis proposal A Correction to this paper has been published: https://doi.org/10.1186/s13049-025-01356-9 Variation in accessibility of the population to an Emergency Medical Communication Centre: a multicentre observational study Association between mortality and phone-line waiting time for non-urgent medical care: a Danish registry-based cohort study The effect of language barriers on dispatching EMS response Prehospital Emerg Care off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir Communication difficulties during 999 ambulance calls: observational study The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres: a qualitative descriptive study Organisation of prehospital care: the French experience Impact of two-level filtering on emergency medical communication center triage during the COVID-19 pandemic: an uncontrolled before-after study Penverne Y, Martinez C, Cellier N, Pehlivan C, Jenvrin J, Savary D et al. A simulation based digital twin approach to assessing the organization of response to emergency calls. NPJ Digit Med. 2024;7(1):385. https://doi.org/10.1038/s41746-024-01392-2 [Involuntary Psychiatric hospitalizations: from request to a call center to hospitalization] Effect of a coaching intervention to improve cardiologist communication: a Randomized Clinical Trial [Psychological effects of emergency calls management on medical dispatcher assistants in a SAMU-Center 15] How and when do expert emergency physicians generate and evaluate diagnostic hypotheses A qualitative study using head-mounted video cued-recall interviews Efficacy of emergency medical center use of a protocol during telephone calls to give medical advice related to fever or gastroenteritis: a cluster randomized controlled trial Machine learning as a supportive tool to recognize cardiac arrest in emergency calls Effect of machine learning on dispatcher recognition of out-of-hospital cardiac arrest during calls to Emergency Medical services: a Randomized Clinical Trial The difficult medical emergency call: a register-based study of predictors and outcomes Download references Melisande Bensoussan and Mathilde Vannier are co first authors SAMU 93 - UF Recherche-Enseignement-Qualité JB; analysis: PGR; interpretation of data: MB FL and PGR; drafting the article: FL and PGR; critical revision for important intellectual content: FL; final approval of the version to be published: all authors The lead authors (the manuscript guarantors) affirm that the manuscript is an honest and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and The authors declare no competing interests Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations The original version of this article has been revised: the misspelling in the name of the second author has been corrected unless otherwise stated in a credit line to the data Download citation DOI: https://doi.org/10.1186/s13049-024-01315-w Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article the radical left-wing forces came out on top of the second round of France’s snap legislative elections despite the patriotic camp winning the largest share of votes which does not create a level playing field puts sovereigntist forces at a disadvantage Because of a biased and partisan media environment and an exotic team-up of centrist/liberal forces with the Communists Marine Le Pen’s National Rally was prevented from taking power National Rally’s young leader Jordan Bardella (a regular speaker at CPAC Hungary) has been elected president of the newly established Patriots for Europe group in the European Parliament the long-awaited shift to the right in Paris (and Brussels) is only a question of time The second round of the elections’ most important takeaway is that France won’t be able to form a governmental majority in the coming weeks the country looks ungovernable given the complexity of the current political scene with three main blocks who all won and all lost at the same time Mélenchon’s New Popular Front or NFP and Le Pen’s National Rally or RN) all scored well RN remains by far the largest party in the National Assembly because it is not a coalition of tiny parties RN has gained over 50 seats compared to the previous elections it has doubled in size in the French parliament since 2022 amidst a record high turnout of 66.5 per cent Macron’s centrist force is in a paradoxical situation: it was voted out but remains necessary to form a majority in parliament This illustrates well that the French voting system has proved absolutely crucial in the dismal outcome of the elections RN won by far the largest number of total votes 8,744,437 (32.05 per cent of all ballots cast) To this we need to add the votes for their ally Eric Ciotti’s Les Républicains (The Republicans) in spite of scoring over 3 million fewer votes than the patriotic forces combined This resulted in RN coming in not even second received just over 6.3 million votes (6,314,424 to be exact) Macron rejected the resignation of PM Gabriel Attal It is also interesting to note that the Ministry of the Interior recorded over 2.1 million proxy votes for the two rounds of the legislative elections—an all-time record explained by the timing of holidays but which raises some controversies the two round-election system led to the joining of forces between NFP and Together socialists and radically pro Palestine (anti-Israel) activists This alliance of Together (centrists/liberals) and NFP (radical leftists) referred to as the ‘Republican Front’ managed to prevent RN from winning an absolute majority by withdrawing from the race their candidates and endorsing each other’s the representatives in the second round in over 200 constituencies this looks like a Pyrrhic victory for the anti-national forces One thing that is certain by now is that NFP is supported by radicals not only in terms of views but also of deeds The antifas and Islamists endorsing the Left would have put the country on fire had the RN clinched a landslide victory an apparently unavoidable civil war has just been postponed by a few months or years Macron still has over two and a half years in office as President Given the weakening of Olaf Scholz in Germany and the fact that the latter may not be Chancellor by 2025 Macron can now pose as a leader of the EU and lead it towards further centralization what happened on 7 July suggests that a systemic blocking of Marine Le Pen in the second round of the presidential election could happen again France is organized in a way that prevents a patriotic and so on: virtually all layers of society have been taken over by left-leaning representatives since the 1970s to such an extent that a change of direction would inevitably lead to violent clashes especially given the openly anti-French rhetoric of large parts of NFP supporters Palestinian flags were more numerous than French ones at many anti-RN protests the country has over 7 thousand billion in debt and close to 16 million of its citizens live on the verge of poverty Even if Bardella had obtained an absolute majority and had become PM it is likely that he would have been sabotaged internally and externally so that he would not be able to tackle these burning issues and many others The number of potential scenarios is numerous so forming a new government will take time there are two main options: either maintaining the Attal government to handle current affairs or opting for a temporary technocratic government while forming the ruling coalition but it is not clear whether the outcome would change much compared with what we have observed in the last elections Macron’s centrist Together bloc is more likely to find an agreement with NFP rather than RN as the second round has shown but neither of the blocs will go easy on the negotiations chaos and a freezing of the situation seems unavoidable in the short term When it comes to the bigger picture including Hungary the fact that RN is joining the Patriots for Europe (PfE) in the European Parliament is of key importance The lack of democratic legitimacy on the EU stage but also in its member states (France being a perfect example of this) is blatant once more It can be expected that the liberal mainstream will try to undemocratically curtail the political and legal leeway for PfE on the EU level as it has been doing with RN for decades on the French political stage this undertaking is likely to only delay the breakthrough for right-wing forces both in Brussels and Paris as sovereigntists aiming for peace have a much more down to earth and realistic agenda to meet the demands of the ordinary people From the perspective of Hungarian conservatives Jordan Bardella having been announced president of Patriots for Europe is great news The young and charismatic leader of the French Right was a speaker at the 2022 and 2023 editions of CPAC Hungary and has always been supportive of Hungary’s policies especially when it comes to migration and national sovereignty If he stays as brilliant as he has been so far he would be among the favourites to win the French presidential elections in 2027 Hungarian Conservative is a quarterly magazine on contemporary political philosophical and cultural issues from a conservative perspective A theme exhibition about the ancient Silk Road is being held in Garches in the suburbs of Paris More than 50 images taken by French students from the China Cultural Center in Paris are on display offering a glimpse of the landscapes and people's lives in countries along the ancient Silk Road Co-hosted by the China Cultural Center in Paris and the city government of Garches the exhibition is a prelude to a series of cultural activities under the theme of "Happy Chinese New Year" to welcome the upcoming Year of the Dog deputy head of the Chinese culture center in Paris "The ancient Silk Road not only promoted exchanges between people from the East and West but also witnessed the integration of the two civilizations The infusion of different cultures is shown through these images on display." He also said he hopes the center could further enhance cooperation and art communication with the Garches government Our editors will review what you’ve submitted and determine whether to revise the article while the elder Le Pen remained as controversial as ever an extraordinary party congress was held in August 2015 and Le Pen was formally expelled from the National Front He continued to serve in the European Parliament until 2019 The 150 students from the elementary school in Charly-sur-Marne have just left, and the Aisne-Marne American Cemetery falls silent once again This military cemetery covers 42 acres of green space halfway between Paris and Reims and welcomes almost 2,000 visitors per month between May and November most of whom are school groups and the occasional passing tourist “Military cemeteries and family vacations don’t exactly go together,” says Shane Williams There are nine beautiful American cemeteries between Paris and Strasbourg alone!” a government agency founded in 1923 that now manages 26 cemeteries and 35 monuments created after a variety of wars across four continents The sites are home to a total of 139,855 graves “We are a Franco-centric agency,” says John Wessels who manages the European operations of ABMC The Commission’s headquarters are in Arlington A major part of its annual budget is allocated to maintaining the 12 cemeteries and 16 monuments commemorating the two World Wars in France and 255 people are employed by ABMC in France – and paid in dollars – including 30 Americans Today he supervises the Aisne-Marne American Cemetery and two nearby monuments – the Château-Thierry Monument and another commemorating the valor of the U.S The American veteran honors the promise made to families by the French government almost a century ago Shane Williams manages a team of 13 French employees – the majority of whom are “green-collar” workers horticulturalists and gardeners – and helps maintain the white marble headstones presides commemorative ceremonies alongside French officials and preserves the memory of the 3,349 soldiers in his charge soldiers buried at the Aisne-Marne American Cemetery were killed in action during July and August 1918 fighting in the Champagne and Marne regions most of them had never left the United States before joining the military When accompanying groups of French high-school students or American veterans, the superintendent and history enthusiast likes to take them to the graves of brigadier general James McIndoe and private Willie Wise The first was a white officer from Maryland who graduated from West Point and received the French Légion d’Honneur The second was an African-American private from South Carolina only to die of Spanish flu in the first months of 1919 and are now buried just a few feet away from each other “Our military cemeteries do not have sections reserved for officers “These soldiers came to fight in France for a variety of different reasons Discover the best of  France-Amérique every week in our newsletter You don't have permission to access the page you requested What is this page?The website you are visiting is protected.For security reasons this page cannot be displayed The TimesHundreds of people joined demonstrations to celebrate the death of Jean-Marie Le Pen in France on Tuesday drawing condemnation from a government minister and at least one police intervention About 1,000 people joined a radical left gathering in the Place de la République in Paris cheering and setting off fireworks in a party atmosphere on the square used for many protests against the hard right populist during his lifetime There were similar gatherings in provincial cities across the country as the police charged 200 or so demonstrators in Strasbourg in the east About 1,000 people joined a radical left gathering in the Place de la République in ParisDIMITAR DILKOFF/AFP/GETTY IMAGESDIMITAR DILKOFF/AFP/GETTY IMAGESBruno Retailleau accusing the demonstrators of “dancing on a corpse” “These scenes of joy are quite simply disgraceful,” he said His reaction showed how Le Pen continued to Registered in England No. 894646. Registered office: 1 London Bridge Street, SE1 9GF. View upcoming auction estimates and receive personalized email alerts for the artists you follow. This show retraces the roots of the expressionist artists who made up the Blue Rider group, looking at the influences and connections that shaped them The recent discovery of an art forger's workshop reminds us of the long history of fraudulent artworks – here are the simple rules to work them out. Contributed by John Goodrich / Hindsight, of course, is 20/20. Looking back at the early decades of modernism, we may sense something inevitable about the ascent of Picasso and Matisse. Joan Was Sniffed Out4 minute readBryan Coll / ParisApril 8 2007 12:00 AM EDTIt might not be the Turin Shroud a French research team declared that the alleged remains of St The relics of the iconic saint — burned alive for heresy and witchcraft in 1431 but rehabilitated as a French hero in the 19th century — have been identified as the remnants of an Egyptian mummy Discovered by a student in the attic of a Paris pharmacy in 1867 the saint’s purported remains were declared authentic by the Church before being sent to Chinon in 1876 The town played an important role in the saint’s life as it was at the royal court of Charles VII in Chinon where she convinced the king to send an army to defend the city of Orléans from the invading English Joan later emerged victorious from the siege The tests on the relics took around a year to complete and were led by Philippe Charlier a forensic scientist at the Raymond Poincaré Hospital in Garches A leading figure in matters medieval and macabre Charlier has used forensics to investigate the deaths of other historical figures Following a series of tests in 2006 on the remains of Agnès Sorel whose premature death has long been a source of historical debate Charlier announced she had been killed by mercury poisoning “History and forensic science are crossing paths more and more frequently,” said Charlier “Forensics now gives us the scientific means to perform autopsies on the past our tests give conclusive proof that these aren’t her remains.” As well as using carbon dating and infrared analysis Charlier employed the unusual technique of olfacation two smell experts from French perfumeries Guerlain and Jean Patou whiffed samples of burnt wood “The smells weren’t all horrible,” says Sylvain Delacourte of Guerlain “Some were pleasant and fragrant.” The predominant scent indicated that the relics came from a body that had decomposed naturally; the organic compound vanillin is produced during this process Set alight while tied to a stake (three times over Joan of Arc’s body clearly didn’t meet such a natural end Sniffing is rarely used in the field of paleopathology yet such was the positive correlation between Charlier’s own results and those of his team of smellers that he plans to use the technique in future investigations Carbon 14 analysis dated the human rib contained in the relics to between the 7th and 3rd centuries B.C Pollen testing also found traces of pine — a tree that didn’t exist in medieval Normandy but whose resin was widely used to embalm bodies in ancient Egypt The presence of the cat bones might have added weight to the relics’ authenticity as black cats were traditionally thrown on the fires that burned those accused of witchcraft in medieval times DNA tests revealed however that the animal was of non-European origin Joan of Arc languished in margins of French history before she was revived as a nationalist symbol in the late 19th Century Having been called by God to expel the invading English from France during the Hundred Years War the teenage saint was later appropriated as a symbol of the disputed province of Lorraine during the Franco-Prussian war of 1870-1 The discovery of the false relics would also have added weight to the public campaign to canonize St launched in 1869 by the Bishop of Orléans As for the unlikely materials used by the hoaxers Egypt became a travel destination for wealthy French following Napoleon’s expedition there in 1798 The bogus bones look unlikely to affect the lucrative tourist industry based around one of France’s most famous daughters where the alleged relics were previously exhibited The new museum will house an expanded exhibition featuring previously-unseen written documents that chart the saint’s tumultuous life Despite having exhibited the remains for decades the museum denied it was red-faced after receiving the results of the forensic tests “Some people did think they were genuine,” said former museum director Anne-Marie Salichon “but I knew all along they were fake.” Contact us at letters@time.com