Bouches Du Research Articles

Prospective screening of liver fibrosis in a primary care cohort using systematic calculation of fib-4 in routine results.

Background & aimLiver fibrosis screening in primary care population is a major public health issue. The FIB-4 index is a simple non-invasive fibrosis test combining age, transaminases, platelets count, developed for the diagnosis of advanced fibrosis. The aim of our study was to evaluate the interest of liver fibrosis screening using systematic calculation of FIB-4 in routine blood analysis.MethodsBetween December 2018 and May 2019, we conducted a prospective screening of liver fibrosis in 134 158 patients during a medical check-up including routine blood analysis. Among these patients, 29 707 had transaminases and platelets counts available and benefited from an automatic calculation of FIB-4. Results were obtained from 21 French clinical laboratories in the Bouches du Rhône region.ResultsAmong the 29 707 patients, 2161 (7.3%) had a high risk of advanced fibrosis (FIB-4>2.67). Individual investigation of patients with FIB-4>2.67 allowed to screen 1268 (1268/2161: 58.7%) patients who were not managed for any liver disease.ConclusionsThis work demonstrates the interest of FIB-4 for the screening of liver fibrosis in primary care population. Although additional clinical validation study is required to determine the utility and applicability of Fib-4 to daily practice, our study strongly supports this easy-to-implement strategy using a simple Fib-4 measure resulting from the use of available routine test results.

A new titanosaur (Dinosauria: Sauropoda) from the Upper Cretaceous of Velaux-La-Bastide Neuve (southern France)

ABSTRACT Remains of Garrigatitan meridionalis nov. gen. et sp. were found in two bonebeds of sequence 2 from the upper Campanian site of Velaux-La Bastide Neuve (Aix-en-Provence Basin, Bouches du Rhône department). The vertebrate assemblage is dominated by dinosaurs, including the titanosaur Atsinganosaurus velauciensis. Garrigatitan meridionalis presents three diagnostic characters: hourglass-shaped humeri (proximal and distal thirds of almost the same transversal width) in anterior and posterior views, ilium with a broad rounded hollow slightly posterior to the base of the pubic peduncle, proximolateral margin of the femur only slightly medially deflected. Garrigatitan was a small to medium-sized sauropod (sub/adult individuals between 4–6 metres and 2–2.5 tonnes), showing anatomical differences with Atsinganosaurus, and with the other Late Cretaceous Ibero-Armorican titanosaurs. Large titanosaurian specimens found at Velaux-La Bastide Neuve could belong to adult Garrigatitan individuals reaching a body length of at least 12 metres. Histological analysis of long bones shows features similar to other Late Cretaceous European titanosaurs, indicating that all individuals had reached skeletal maturity (presence of an EFS, heavy remodelling HOS 12 to 14). The new taxon is recovered within the clade Lirainosaurinae. Garrigatitan meridionalis increases the diversity of Late Cretaceous titanosaurs within the Ibero-Armorican Island.

Everyday marginalization in higher education: the experiences of university students who wear a hidjab in Bouches du Rhone

Régulièrement, l’interdiction du hijab dans l’enseignement supérieur fait l’objet de débats publics. Pourtant, les étudiantes, en tant qu’usagères adultes, ont le droit de le porter. Si l’enseignement supérieur constitue donc un espace « ouvert » pour les femmes portant un hijab, il n’en est pas pour autant protégé des stigmatisations et discriminations. Cet article propose de saisir les logiques de minorisation et d’altérisation à l’œuvre dans l’enseignement supérieur et certains des effets sociaux qu’elles ont sur les femmes ciblées. Le parcours de ces femmes est structuré non seulement par les micro-agressions et la violence symbolique exercées par les majoritaires, mais aussi par l’anticipation des éventuelles formes de stigmatisation et de discrimination. Ainsi, ces femmes ajustent leur comportement et leur trajectoire universitaire pour subir cette stigmatisation le moins possible. Cet article se fonde sur une trentaine d’entretiens menés avec des étudiantes ayant entre 20 et 30 ans, vivant à Marseille et inscrites dans des formations du supérieur, universitaire ou de travail social. Il s’agit de comprendre : 1) le rapport spécifique que ces femmes entretiennent avec l’enseignement supérieur ; 2) les formes de violences symboliques et de micro-agressions auxquelles elles font face au cours de leur formation ; et 3) en quoi les femmes portant un hijab courent toujours le risque d’être exclues de leurs espaces de formation.

Local actions in health: from healthy city workshops to local health contracts

After 10 years of partnership with the main towns within the department of Bouches du Rhône, France, in order to develop ‘ateliers santé ville’ [healthy city workshops], the department’s territorial delegation for the regional health agency of Provence Alpes Côte d’Azur set up a ‘contrats locaux de santé’ (CLS) [local health contracts] scheme, with the goal of shifting from a local health programming and planning process to a cross-cutting process involving all of the related fields in health. The healthy city workshops, through 10 years of working together with towns, enabled the establishment of habits of partnership for joint processes, as well as a solid level of knowledge of the field of prevention. The transition to a more cross-cutting approach involving all health-related fields will be facilitated by this rich shared experience. The CLS is both a challenge for regional health agencies and a tangible manifestation of the new concept of ‘animation territoriale’ [grass-roots programming].

P4-10-09: Hormone Replacement Therapy: A Benign Breast Disease's Risk?

Abstract Background Use of hormone replacement therapy (HRT) has been associated with increased risk of breast cancer. However relations between use of HRT and benign breast lesions remain contradictory (1-3). Our goal was to investigate whether HRT and its duration use are associated with benign breast lesions. Materials & Methods From 2001 to 2007, 2708 patients with a non palpable breast lesion were referred to our breast care center. Radiological abnormalities were screened either by breast ultrasound mammography, or MRI. Of those, 1 329 patients had a biopsy in our Radiology Unit. We focus on the postmenopausal women (n=739). Clinical data including HRT use extent were reported. Patients with previous history of benign breast disease or malignancy were excluded. Results The analysis was performed on 739 patients. Biopsies yielded a benign result in 414 (56%) of them (fibroadenoma n=71, blunt duct adenosis n=94, fibrocystic disease n=92, epithelial hyperplasia n=56, others n=101), high risk lesions in 57 (8%) (atypical ductal hyperplasia n=28, atypical lobular hyperplasia n=19, lobular carcinoma in situ n=10) and malignancy in 268 (36%) (not studied here). For the 471 patients with benign or high risk breast lesion, the median age was 59 years, 80% had at least one pregnancy and 27% had a family history of breast cancer. Among these 471 patients, 47% of them had used an oral contraceptive and 53% of them a HRT, with a mean duration of use of 2 years. The HRT use was not significantly associated with the type of benign or high risk breast disease. No association was observed either between breast disease and duration of HRT (less or more than 7 years respectively).Older age was significantly correlated to atypia or carcinoma (median age at diagnosis 59 y.o in benign lesions, 60 y.o in high risk lesions and 62 y.o in malign lesions, with significant difference) (p<0,0001). Conclusion In this study of postmenopausal women, HRT and its duration use were not associated with the type of benign or high risk breast lesion. Although a lack of statistical power may be invoked to explain the results, we are called to believe that the magnitude of an effect of HRT use is small, if ever it exists. 1. Finkelde DT, Kitchen PR, Hayes PR, McKinlay MR, Henderson MA 2001 Symptomatic benign breast disease and hormone replacement therapy. Breast 10:127–130 2. Gayet A, Esteve J, Seradour B, Piana L, Jacquemier J 2003 Does hormone replacement therapy increase the frequency of breast atypical hyperplasia in postmenopausal women? Results from the Bouches du Rhone district screening campaign. Eur J Cancer 39:1738–1745 3. Rohan TE, Miller AB 1999 Hormone replacement therapy and risk of benign proliferative epithelial disorders of the breast. Eur J Cancer Prev 8:123–130 Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-10-09.

Evaluation of the genotoxicity of river sediments from industrialized and unaffected areas using a battery of short‐term bioassays

The present investigation evaluated the capacity of the Salmonella mutagenicity test, the comet assay, and the micronucleus assay to detect and characterize the genotoxic profile of river sediments. Three stations were selected on an urban river (Bouches du Rhône, France) exposed to various sources of industrial and urban pollution (StA, StB, and StC) and one station on its tributary (StD). One station in a nonurban river was included (REF). The concentrations of 16 polycyclic aromatic hydrocarbons (PAHs) were determined by HPLC, and the genotoxicity of the sediments was monitored by the Salmonella mutagenicity test (TA98 + S9, YG1041 +/- S9), the comet assay, and the micronucleus assay on CHO cells. Chemical analysis showed that the total PAH concentrations ranged from 23 microg kg(-1) dw (REF) to 1285 microg kg(-1) dw (StD). All the sediments were mutagenic in the Salmonella mutagenicity test. The mutagenicity was probably induced by the presence of nitroarenes (StA, StB, StC, and StD) and aromatic amines (REF) as deduced from the mutagenicity profiles of strains YG1041 +/- S9 and TA98 + S9. The comet assay revealed direct DNA lesions in REF, StA, and StB sediments and metabolization-dependent DNA damage in StC and StD. The micronucleus assay showed an absence of clastogenicity for StA +/- S9 and StC-S9, and a significant clastogenicity +/- S9 for the three other stations. The genotoxicity ranking determined by the comet assay + S9 matched the ranking of total and carcinogenic PAH concentrations, and this assay was found to be the most sensitive.

Associations et biostratigraphie des Foraminifères benthiques et planctoniques du Bédoulien sommital et du Gargasien inférieur de La Tuilière - St-Saturnin-lès-Apt

Research on the Bedoulian and Gargasian of the Cassis-La Bedoule (Bouches du Rhone, SE France) area is extended, by a study of four overlapping sections in the stratotypic area of the Aptian stage in the hamlet of La Tuiliere (commune of Saint-Saturnin-les-Apt, Vaucluse, SE France). This new information permitted a detailed analysis of upper Bedoulian and lower Gargasian benthic (30 taxa) and planktonic (15 taxa) foraminiferal assemblages. Here we describe, illustrate and give the ranges and distribution of the most significant forms, and call attention to several benthic and planktonic species that may serve as extra-regional markers. The study of the planktonics in these expanded and continuous sections made it possible to strengthen the zonation which had been established in the Lower Aptian stratotype of Cassis-La Bedoule, i.e. a succession of five zones (cabri, luterbacheri, ferreolensis, barri, algerianus); this zonal scheme is improved by the addition of a horizon with Globigerinelloides ferreolensis heptacameratus nov. subsp., which straddles the boundary between the luterbacheri and ferreolensis zones. We also show the temporal quasi-coincidence of: 1) the top of the Furcata ammonite Zone, 2) the lithological named change of color and 3) a triple micropaleontological datum (FAD of Praehedbergella luterbacheri, LAD of Protocythere bedoulensis and Lenticulina cf. nodosa) of which the importance in the stratotype of Cassis-La Bedoule had already been pointed out. All these data may be valuable in the definition of the Bedoulian-Gargasian boundary. Within the luterbacheri Zone of the early Gargasian, an episode probably of volcanic origin that we interpret as the equivalent of the Van Gogh Level (initially detected in the Vocontian domain), is marked by a strong crisis in the diversity of epibenthic and planktonic foraminifers, as well as in that of the ostracodes. From a paleoecological and paleobiogeographical point of view, a comparison of the benthic and planktonic foraminiferal assemblages of La Tuiliere with those of neighbouring areas reveals specific features related to paleodepth and shows affinities which appear to be closer with the microfaunas of certain boreal areas (e.g. northern Germany) than with the Tethysian realm.

Finding Fear in the Iron Age Of Southern France

Changes in settlement organisation in Mediterranean France throughout the Iron Age have long been viewed as a social and cultural by-product of contact with Greece and Rome. While relationships with the state societies of the Mediterranean would doubtless have left their mark on settlement structures, it is possible that changing habitat-forms during this period could also be used to extrapolate patterns of conflict in the region.Recent anthropological research has revealed a correlation between 'warlike', non-state societies and 'socialization for fear'. In ethnographic accounts this manifests itself as an increased delineation of personal space and reductions in social access on an individual level. It is possible that the fairly commonplace sets of evidence which reveal this 'fear' are apparent in the settlement record of the later Iron Age throughout the Bouches du Rhone.

Southern French thyme oils: chromatographic study of chemotypes

AbstractOils obtained from seven chemotypes (thymol, linalool, geraniol, borneol, (E)‐sabinene hydrate/terpinene‐4‐ol, p‐cymene and carvacrol) of Thymus vulgaris (thyme) that exist in the South of France were analysed by gas chromatography/mass spectrometry (GC/MS) and characterised. Wild thyme growing in three departments (Bouches du Rhone, Var and Vaucluse) of Provence and in a fourth neighbouring department (Gard) was also studied. This is often the result of a mixture of three chemotypes: thymol, carvacrol and p‐cymene. Linalool and (E)‐sabinene hydrate/terpinene‐4‐ol were observed as minor chemotypes. GC/MS was also used to monitor seasonal variations in the composition of the oil obtained from thyme harvested at the same location (Gemenos, near Marseille, Bouches du Rhone) during the plant vegetative and life cycles (19 samples). Four components were determined: the phenols thymol and carvacrol and the monoterpene hydrocarbon precursors p‐cymene and γ‐terpinene. Results showed maximum oil (34.1 mL kg−1 dry matter) and phenolic terpenoid (95.4 mmol kg−1 dry matter) contents occurring in May, the period of flowering and harvesting. In contrast, in December the oil displayed a higher level of phenolic precursors (p‐cymene and γ‐terpinene, 72.8 mmol kg−1 dry matter) than phenolic terpenoids. Depending on the harvesting date, the oils isolated from southern French thyme (T. vulgaris) could have different potential biological activities. Copyright © 2005 Society of Chemical Industry

Évaluation de la qualité de la prise en charge des frottis du col utérin comportant des anomalies cytologiques

The aim of this paper is to report on how AFAQAP guidelines regarding the technical and diagnostic levels of cervical smears as well as the ANAES guidelines relating to the clinical follow-up of abnormal smears are applied. The material upon which the study is based was collected from a series of cervical smears representing 10% of those paid for by the French Social Security over a one year period in the Bouches du Rhône district. It appears that the identification of the quality of the sampling done by the pathology lab was poor (21.5%). With respect to the clinical follow-up of abnormal smears, the number of patients with whom there was no follow-up was rather high (12%), the treatment methods were heterogeneous and the clinical care for high grade lesions was insufficient in some cases. We have highlighted the need for follow-up within a group of subnormal smears not usually classified as pathological, but whose neglect would lead to a detrimental rate of false negatives for the patients concerned.

Does hormone replacement therapy increase the frequency of breast atypical hyperplasia in postmenopausal women? Results from the Bouches du Rhone district screening campaign

It is thought that the risk of atypical hyperplasia (AH) increases with age, particularly among postmenopausal women. Three hypotheses were investigated to try to explain this phenomena: use of hormone replacement therapy (HRT), increased breast cancer screening and improvements in radiological quality. Data were collected from the Bouches du Rhône breast cancer screening programme database and from the pathological registry of all women operated on for breast diseases in the district. The AH incidence rate was studied using a Poisson regression analysis. The change in the profile of breast diseases was explored through studying changes in the proportion of AH among benign lesions and malignant diseases. The AH incidence rate significantly increased over time (13.6% per year). The proportion of AH among the benign diseases increased with time and was significantly higher for HRT users (Odds Ratio (OR)=2.05; 95% Confidence Interval (CI): 1.43–2.93). While AH decreased with age among HRT non-users, it increased among users as a proportion of both benign and malignant lesions. The AH incidence rate significantly increased among pre- and postmenopausal women. Our study suggests that this increase is partly explained by the incidental discovery of these lesions by mammography and partly by a real increase of the disease among HRT users.

First Report of an Isolate of Pelargonium zonate spot virus in Commercial Glasshouse Tomato Crops in Southeastern France.

In summer 2000, symptoms similar to Pelargonium zonate spot virus (PZSV) were observed for the first time on tomato plants in southeastern France. The plants were from commercial glasshouse fresh-market crops. Symptoms observed were chlorotic mottling with bright yellow distinct rings on leaves and curved line patterns on stems. Fruit symptoms included chlorotic and necrotic spotting, marked concentric ring patterns, and distortions. Diagnosis was made from symptomatic leaves and fruits by mechanical inoculation on a set of host plants. Local chlorotic and necrotic lesions were observed on Chenopodium amaranticolor, C. quinoa, Cucumis sativus cv. Marketer, Cucumis melo cv. Vedrantais, Phaseolus vulgaris cv. Pinto, Vicia faba cv. D'Aguadulce, Vigna unguiculata cv. Black Eye, and systemic symptoms were observed on Capsicum annuum cvs. Yolo Wonder, Yolo Y, Florida VR2, and Criollo de Morelos 334, Datura stramonium, Lycopersicon esculentum cvs. Momor and Stevens, L. hirsutum (PI 134417 and PI 247087), Nicotiana benthamiana, N. clevelandii, N. tabacum cv. Xanthi nc, Ocimum basilicum cv. Latino, Petunia hybrida cv. Rose du ciel, and Physalis floridana. No reaction was observed on Pisum sativum cv. Douce Provence, Salvia splendens cv. Etna, or Zinnia elegans cv. Liliput. Symptoms on tomato of PZSV, Parietaria mottle virus (PMoV), and Tomato spotted wilt virus (TSWV) are similar, particularly those elicited in fruits. Therefore, the field samples were checked using double-antibody sandwich enzyme-linked immunosorbent assay against antisera of the type-strain of PZSV and tomato strain of PMoV and their homologous antigenes, which were supplied by D. Gallitelli and P. Roggero respectively, and our antiserum of TSWV. Electron microscopy of negatively stained preparations from leaves of tomato and D. stramonium showed that the sap contained very few paraspheric shaped particles, 26 to 29 nm in diameter. Three isolates collected from two different regions (Vaucluse and Bouches du Rhône) showed a very close serological relationship with the Italian type-strain of PZSV and tested negative against antisera of PMoV and TSWV. The French isolates were biologically different from the type-strain, but were similar to the Spanish strain of PZSV because they infected D. stramonium, N. benthamiana, O. basilicum, and V. unguiculata (2). Moreover, in transverse tissue sections, virions were not observed in the nucleus and tubular structures, unlike the Italian isolates, (1) but were present in the cytoplasm and particularly in the mesophyll cells. There are only a few records of the occurrence and distribution of PZSV in Mediterranean countries.

GH deficiency in adults: an epidemiological approach.

The prevalence of adult onset GH deficiency (GH-D) is poorly documented. Epidemiological data are now required to estimate the financial cost of GH treatment in adults. The aim of the present study was to estimate the prevalence of GH-D, from a cohort of 1652 adult patients with hypothalamo-pituitary diseases. The hormonal status of all patients presenting with pituitary diseaseand observed during the year 1994 in 15 endocrine units was retrospectively analyzed, irrespective of the date of disease onset, of the nature and date of pituitary investigations, and whether or not they included specific testing of the GH axis. Of the whole population of 1652 patients, a selected group (RG2) was chosen after exclusion of patients with active acromegaly (n=1414). GH stimulation tests had been performed in 549 patients of the RG2 group and a documented GH-D was found in 301. A relationship between the value of the GH peak and the number of pituitary deficits was evaluated. For instance, it was shown that 93% of patients with three deficits had GH-D. These results constituted the basis for estimating the number of GH-D in the group of untested patients. The number of GH-D deduced from the number of established GH-D (n=301) and from the number of GH-D hypothesized from other pituitary deficits (n=406) was 707 cases. Prevalence and annual incidence were calculated from data recorded in a referral center with a well-defined catchment area, Marseilles (Bouches du Rhône department). We projected a prevalence of 2638 for France and an annual incidence of 12 GH-D per million of the adult population.

Hormone replacement therapy and screening mammography: analysis of the results in the Bouches du Rhône programme.

To evaluate the effectiveness of a mass screening programme for breast cancer in a French population where hormone replacement therapy (HRT) is common and where mammography is prescribed outside the programme for asymptomatic women. From 1993 to 1996 inclusive, 41,062 women underwent a first test and 48,275 a second or third test in the Bouches du Rhône programme. Their HRT status was ascertained at the time of the test. False positive and false negative tests were identified at one year follow up. The incidence of interval cancers was estimated up to three years after the screening test. The odds of being detected at screening rather than as an interval cancer within one year of the test was five times greater among non-users of HRT than among users (odds ratio (OR) 5.14 (confidence interval 2.5 to 11.8)). This high reduction in sensitivity among users (71% v 92%) was associated with a very small reduction in specificity at the incident screen only. The incidence of interval cancers among HRT users was 3.5 times that of non-users within the first year after the test and 1.7 times during the following two years. When the early results of a programme have been used to measure its effectiveness they should be reassessed in populations where HRT is in widespread use. As interval cancers had better prognostic factors in HRT users than in non-users, the efficacy of a screening programme in such populations should be the subject of further studies.

A comparison of the performance and impact of Breast Cancer Screening Programmes in East Anglia, U.K. and Bouches Du Rhône, France

The purpose of this study was to compare results from the first screening round of two breast cancer screening programmes of similar design implemented in different health care settings. The East Anglian programme is part of the U.K. National Health Service Breast Screening Programme, which is a centralised programme with a limited number of dedicated screening units. The Bouches du Rhône programme is one of 13 French programmes based on a decentralised model using existing radiology clinics. Compliance and cancer detection rates were lower in the Bouches du Rhône programme. Detection rates for small invasive cancers (⩽ 10 mm) were similar in the two programmes, although larger cancers (⩾20 mm) were detected in the Bouches du Rhône programme. Significantly, the shift towards more favourable distribution of prognostic characteristics associated with screen-detected breast cancers compared with those arising outside the programme is less marked in the Bouches du Rhône programme. This is probably due to the more favourable underlying disease status in the district resulting from a long history of breast awareness and spontaneous mammography.

A Comparison of the Performance and Impact of Breast Cancer Screening Programmes in East Anglia, U.K. and Bouches Du Rhône, France

<h2>Abstract</h2> The purpose of this study was to compare results from the first screening round of two breast cancer screening programmes of similar design implemented in different health care settings. The East Anglian programme is part of the U.K. National Health Service Breast Screening Programme, which is a centralised programme with a limited number of dedicated screening units. The Bouches du Rhône programme is one of 13 French programmes based on a decentralised model using existing radiology clinics. Compliance and cancer detection rates were lower in the Bouches du Rhône programme. Detection rates for small invasive cancers (⩽ 10 mm) were similar in the two programmes, although larger cancers (⩾20 mm) were detected in the Bouches du Rhône programme. Significantly, the shift towards more favourable distribution of prognostic characteristics associated with screen-detected breast cancers compared with those arising outside the programme is less marked in the Bouches du Rhône programme. This is probably due to the more favourable underlying disease status in the district resulting from a long history of breast awareness and spontaneous mammography.

Biological evidence of sea-level rise during the last 4500 years on the rocky coasts of continental southwestern France and Corsica

On the rocky coasts of the northwestern Mediterranean basin, biogenic littoral rims built by the coralline rhodophyte Lithophyllum lichenoides develop, whose remains may be preserved for millennia when submerged in a rising sea environment. These remains can be used as biological indicators of recent sea-level variations. Our survey of the continental coasts of Var and Bouches du Rhône, west of Marseilles (southern France) and of northern Corsica shows that relative sea level rose about 1.6 m in the study area during the last 4500 years without exceeding the present datum. The rate of sea-level rise was 0.4 mm per year between 4500 and 1500 yr B.P. and slowed down to 0.2 mm per year from 1500 yr B.P. to present time. There are also morphological indications of an acceleration of the rate of sea-level rise during the last century, supporting the evidence of tide gauges. Regions at the periphery of the above zone (Alpes Maritimes, Italian border zone, and the French and Spanish Catalonia regions) were also surveyed, but a weaker development of Lithophyllum rims and bad preservation of algal remains led to unconvincing dates which could also be linked to regional tectonic trends.

Epidemiological study of congenital diaphragmatic defects with special reference to aetiology

Congenital diaphragmatic defects (CDD) are easily accessible to ultrasonographic diagnosis. In spite of progress in the management of prenatally detected cases, the mortality rate for CDD remains high. The prognosis depends mainly on the severity of fetal lung hypoplasia but is also linked to the associated malformations. We report on 77 cases of CDD ascertained between 1982 and 1988 from 136,161 consecutive births in the Bouches du Rhône area. The spontaneous perinatal mortality rate was 61% with 28 early post-natal deaths and 14 stillbirths. Eight pregnancies were terminated after prenatal diagnosis. The diaphragmatic defect was associated with other congenital anomalies in 33 cases, more often among stillborn (92.8%) than liveborn infants (23.6%). A chromosomal abnormality was present in 9 cases representing 11.6% of all CDD and in 27.2% of cases with other anomalies. A Mendelian disorder was present in 9 cases (eight Fryns syndrome and one Fraser syndrome). This study underlines the necessity of a systematic work up of prenatally diagnosed cases, including fetal karyotyping and analysis of associated malformations in order to adapt the management of the pregnancy and delivery to the prognosis.

What Professional Responsibility Means to Teachers: national contexts and classroom constants

Summary This article discusses some of the findings pertaining to how teachers see their work which were produced by a comparative study of 360 French and 360 English primary school teachers. The sample was drawn from schools in four different types of matched catchment areas—rural, inner‐city, average suburban and affluent suburban— in Avon, UK and Bouches du Rhone, France. Four major dimensions of difference between the two national contexts are identified in terms of the range of professional activities undertaken; the ambiguity of the teacher's task; the style of pedagogy and the relative importance to teachers of the process as against the products of learning. Against a background of contemporary policy changes which seem likely to render the teaching context increasingly similar in the two countries, the article argues that attempts to change teachers’ practice without due regard to those conceptions of professional responsibility which are deeply rooted in particular national traditions as well as...

Crack-seal mechanism in a limestone: A factor of deformation in strike-slip faulting

A repeated crack-seal mechanism may play a major part in the deformation process in a shear zone. This paper develops a microscopic approach to the association of shear planes and tension cracks between two en échelon faults. The simultaneous development of these fractures yields a very specific pattern. The structure, discovered in a Cretaceous limestone of the Arc basin (Bouches du Rhône, France), is located between two left-stepping sinistral strike-slip faults. The horizontal displacement does not exceed a few centimeters: therefore the structure may be representative of the early stage of deformation within a brittle shear zone. Each strain increment includes both shearing and tensile fracturing. Inhomogeneous conditions of friction seem to be prevailing.