French Program Research Articles

X-Ray Phase Contrast Osteo-Articular Imaging: A Pilot Study on Cadaveric Human Hands

Objectives: X-ray Phase Contrast Imaging (PCI) is an emerging modality whose availability in clinics for mammography and lung imaging is expected to materialize within the coming years. In this study, we evaluate the PCI performances with respect to current conventional imaging modalities in the context of osteo-articular disorders diagnosis. Materials and Methods: X-ray PCI was performed on 3 cadaveric human hands and wrists using a synchrotron beam. Conventional CT, MRI and Ultrasound were also performed on these three samples using routine procedures as well as research protocols. Six radiologists and rheumatologists independently evaluated qualitatively and semi quantitatively the images' quality. Medical interpretations were also made from the images. Results: PCI allows the simultaneous visualization of both the high absorbing and the softer tissues. The 6 reader evaluations characterized PCI as a visualization tool with improved performances for all tissue types (significant p-values) which provides sharper outlines and clearer internal structures than images obtained using conventional modalities. The PCI images contain overall more information, especially at smaller scales with for instance more visible micro-calcifications in our chondrocalcinosis case. Conclusions: Despite a reduced number of samples used, this pilot study highlights the possible medical benefits of PCI for osteo-articular disorders evaluation. Although PCI is not yet available in hospitals, the improved visualization capabilities demonstrated so far and the enhanced tissue measurement quality let suggest strong diagnosis benefits for rheumatology in case of a widespread application of PCI. Funding: Part of this study was financed by Labex PRIMES. Grenoble MRI facility IRMaGe was partly funded by the French program “Investissement d’Avenir” run by the ‘Agence Nationale pour la Recherche’; grant 'Infrastructure d’avenir en Biologie Sante' - ANR-11-INBS-0006. Declaration of Interest: The authors have no conflict of interest related to this study. Ethical Approval: Anatomical pieces were extracted from body to science donors. This donation was granted by our local ethics committee. However, due to local regulations, the anatomic pieces obtained from donors did not grant us access to the details of the patients’ medical history.

Essays in Experiment

Essays in Experiment Mary Ann Caws (bio) What a range of essays and experiments! We hear from many parts of the world and our present surroundings and the brain. How could we not agree with what every essay here advances and how not to experiment with our own readings? And, of course, on another level, our own writings? So, to refer to Paul Benzon's essay, is using electronic literature already itself experimental literature? Loss Pequeño Glazier's argument that materiality is a key to understanding innovative practice seems most persuasive to me. How can it not matter, how what we write looks and is distributed, to say nothing about what kind of things we dare to say in our—drastically embodied!—private and public experiments? To finish with these totally rhetorical questions, we can right now repeat from several of the really intelligent essays, how it is that formal experimentation is always political? How it is that everything comes into all this, even the imperial cast of the history of the South and the Caribbean? It is so often about power relations, of course, and sociological relations are always in place. I much enjoyed the wonderfully described issues of the subjective and lyric as contrasted with the collective, to say nothing of the fantastically interesting concepts of migratory poetics and varieties of identity culture. It seems to me that the metapoetics of any writing, experimental or not, is what we want to concentrate upon—but wait an instant, [End Page 254] is not all writing experimental, since it takes on everything and at once? I love that here in this issue we run the large gamut of writers written about, just take three of them: Alejo Carpentier, Edouard Glissant, and Gertrude Stein: already the mind reacts excitedly. Ada Smailbegović's delicious essay on Gertrude Stein's zoopoetics and all those animals named and cared about, before even getting to the little dog Basket, plays a metapoetic of texts, quite up to the slipping and oozing of the texts written about. These essays together make an important expansion of the very idea of experiment, even if we cannot truly distinguish between the reaching out of human nature and the human mind. I get seized by ideas like the perspective of the seagull: now writing from that point of view, that would really be experimental! And of course, that brings me to the magnificent books that Seagull publications in India is putting forth. They are just right: they look right, they feel right, and they read right. Years ago, and this leads me immediately to the realm of the visual, the French poet Yves Bonnefoy's authoritative and delicious essays on art (in my view, his most ongoing in our minds book) called L'Arrière-Pays could not find a publisher in the United States for its grand translation by Stephen Romer, and Seagull, to its everlasting credit, not that it needs more of that (but on the other hand, who does not?), published it very grandly. That book and his poetry and writing on art from early to late, are essential for writers launching into experimental territory, if the poetic matters to them as much as the visual. In my own work on surrealism—which has not ceased, since I am at present holding a seminar of five weeks on surrealism from 1922 to 1944, called Surrealism 1, to be followed by Surrealism 2 in the spring, if all goes well—there are thirteen students from doctoral programs in French, English, and Comparative Literature, and as well as the class discussions and presentations, all have their own individual projects to write about and talk about in the last week. And, in the penultimate session, a wonderful cellist, Susan Salm, will play and speak about musical interpretations, and I will say a few words about the poetics of translation, about which I care greatly. As for music and text and the avant-garde or not very derrière-garde at least, like surrealism, the visual is crucial, to under-state the issue. I am saving André Breton's superbly large collection, Surrealism and Painting, for the second part of...

The Superior Colliculus in De Novo Parkinson's Disease: A Prodromal Dysfunction?

Background: The dual hit hypothesis about the pathogenesis of Parkinson's disease (PD) suggests that the brainstem can convey pathological entries to the brain. However, information about the involvement of different brainstem structures are difficult to collect in living PD patients. We have filled this gap by studying with functional brain MRI the superior colliculus (SC), a brainstem sensorimotor structure. Starting with the discovery that the SC shows abnormal visual responses in PD rat models, we aimed at studying the SC also in de novo PD patients. Methods: De novo PD patients and controls were studied using a recently developed fMRI protocol to stimulate and visualize the SC, the lateral geniculate nucleus (LGN) and the primary visual cortex (V1). The visual responses modulation of these structures was studied using luminance contrasts from 1% to 9%. We compared SC, LGN, and V1 BOLD responses of de novo PD patients with matching controls. The effects of dopaminergic treatment in PD patients were further evaluated. Findings: In the 22 enrolled PD patients, there was no modulation of the SC responses to the luminance contrasts, and the LGN was only modulated by 3%-9% luminance contrasts compared to the 22 controls. No major differences were found in V1 between both groups. Moreover, SC lack of modulation was more frequent in less affected de novo PD patients (Hoehn & Yahr stage 1). Dopaminergic treatment had no effect on SC and LGN modulation. Interpretation: De novo PD patients showed pathological responses to the luminance contrasts in the SC, suggesting that SC dysfunction could be diagnostic of PD. Since the SC seems to be more affected at stage 1 of PD, its dysfunction might be detected even earlier, supporting its potential role as a prodromal biomarker of PD. Clinical Trial Number: ClinicalTrial.gov (NCT02488395). Funding Statement: The work was funded by the University Grenoble Alpes, “La Fondation de l’Avenir” and “France Parkinson”. The Grenoble MRI facility IRMaGe was partly funded by the French program ‘Investissement d’Avenir” run by the Agence Nationale pour la Recherche (ANR-11-INBS-0006). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: All participants provided written informed consent to the study. The study was approved by the local ethical committee (ID RCB- 2014-A01835-42).

Grand-Pressigny was not alone: Acquiring and sharing data about raw materials in the collective research project “Réseau de lithothèques en région Centre-Val de Loire” (France)

In the wake of the discovery of numerous large blade workshops at Le Grand-Pressigny site (Indre-et-Loire, France), which initially aroused great interest, the mid-Loire Valley region became central to studies of flint diffusion. Despite the quality of the initial work, the widely shared view now is that the capacity for this concept to continue to provide useful archaeological modelling has diminished. Establishing real and actual correlations between archaeological objects and geological samples remains difficult, making it almost impossible to determine the source of certain materials represented in an archaeological series. In response to this problem, the French collective research project "Réseau de lithothèque en région Centre-Val de Loire" assembled about 30 amateur and professional researchers from various European institutions to work on three strategic missions:
 
 Mission 1: establish a list of current lithotheques (“rock-libraries” or comparative collections), verify their contents and complete them if necessary;
 Mission 2: link the major types of depositional environments with the properties acquired by flint through its life;
 Mission 3: spread knowledge and information both within the project and to all interested persons.
 
 The project is closely associated with similar French programs already in place in Auvergne-Rhône-Alpes and Aquitaine regions. The ultimate objective is to build a national and international community around a common project, bringing participants together regularly to share knowledge and technical expertise.

A cost-effectiveness analysis comparing the originator follitropin alfa to its biosimilars in patients undergoing a medically assisted reproduction program from a French perspective

Objective: To assess the cost-effectiveness (CE) of the originator follitropin-α (Gonal-F) in patients undergoing a medically assisted reproduction (MAR) program in comparison to its biosimilars Bemfola and Ovaleap in a French context.Methods: A CE model was developed for France with a National Health Service (NHS) perspective. Clinical, safety, and dosage data were derived from pivotal clinical trials that compared Gonal-F to Ovaleap and Bemfola. Costs pertaining to drugs, hospitalizations, specialist visits, and examinations were retrieved from the French Programme de Médicalisation des Systèmes d'Information (PMSI) hospital database, literature review, and French clinical experts using 2017 Euro tariffs. In order to test the robustness of results, deterministic one-way sensitivity analyses were carried out on the main variables to assess the impact of treatment cost, probability of birth, ovarian hyperstimulation syndrome (OHSS) rates, and dosage.Results: The average incremental cost per live birth with OHSS and without OHSS was €259.56 and €278.39, respectively, for Gonal-F compared to the pooled biosimilars (i.e. Ovaleap and Bemfola). GONAL-F had an incremental efficacy of 0.06 over the pooled biosimilars. The incremental cost-effectiveness ratio for Gonal-F with OHSS ranged from €3,274.80 to €4,877.76 compared to the pooled biosimilars, owing to the additional live births reported with Gonal-F. Sensitivity analyses also supported results from the base case analyses, with Gonal-F being cost-effective or the dominant strategy in most cases.Conclusion: Gonal-F seems to be a cost-effective strategy compared to its biosimilars Ovaleap and Bemfola, irrespective of the incidence of OHSS events, but further data are needed to confirm these results.

52 SFPM working group on DBT internal quality control

Introduction The introduction of Digital Breast Tomosynthesis (DBT) within the French breast cancer screening program is forecast by the authorities in the near future. A regulatory internal and external quality control is an essential prerequisite to this introduction. The French Society for Medical Physics (SFPM) has appointed a working group in order to establish recommendations in the scope of DBT and synthetic_2D internal quality control. These recommendations need to stand for the specific French context, in France, mammography is essentially done in private centers that do not necessarily have competence in medical physics. Internal quality controls are therefore principally intended to be done by technicians under radiologist responsibility. Methods Literature has been reviewed and a feasibility study has been done. Then several metrics have been tested on a weekly basis for several months: acquisition parameters consistency, image score, SDNR, SNR, homogeneity and volume viewer lag test. These tests are consistent with the French regulatory internal quality controls defined for full field digital mammography (2D) and complement DBT quality controls recommended by EUREF [1] . Four phantoms have been evaluated: MTM 100, TOMOMAM, ACR 086 and GAMMEX DBT Phantom. Tests have been done on 3 systems from different brands: GEHC, HOLOGIC and SIEMENS. Results Each week, half an hour is needed for the tests. The results show that MTM 100, ACR 086 and GAMMEX DBT Phantoms are not discriminant. The visual method to evaluate image score shows an important variability of the results for 2D, synthetic_2D as well as DBT with coefficients of variation in the range of 0.1 to 0.4. Some of the metrics (SNR, SDNR, homogeneity) make it possible to detect system performance degradation. The volume viewer lag test has been abandoned due to technical constraints. Conclusions The tests requiring a short time and enabling to detect performance degradation are suitable to routine implementation in medical imaging centers. The study should be extended to all brands of DBT systems in order to refine the scope and methodology of internal quality controls and to establish acceptability criteria. The assessment of the phantoms needs to be deepened in order to stabilize the interpretation grid for visual image score analysis.

Therapeutic education of patients taking oral chemotherapy at home

Oral cancer drugs make the patient more active and autonomous. They reduce the number of hospital appointments and the risk of infection. However, they result in new problems such as the management of side effects. In this context, therapeutic education is essential. The first French therapeutic education programme for patients taking oral cancer drugs at home has been set up.

Deceased organ donation activity and efficiency in Switzerland between 2008 and 2017: achievements and future challenges

BackgroundVarious actions have been taken during the last decade to increase the number of organs from deceased donors available for transplantation in Switzerland. This study provides an overview on key figures of the Swiss deceased organ donation and transplant activity between 2008 and 2017. In addition, it puts the evolution of the Swiss donation program’s efficiency in relation to the situation in the neighboring countries.MethodsThis study is an analysis of prospective registry data, covering the period from 1 January 2008 to 31 December 2017. It includes all actual deceased organ donors (ADD) in Switzerland. Donor data were extracted from the Swiss Organ Allocation System. The “donor conversion index” (DCI) methodology and data was used for the comparison of donation program efficiency in Switzerland, Germany, Austria, Italy and France.ResultsDuring the study period there were 1116 ADD in Switzerland. The number of ADD per year increased from 91 in 2008 to 145 in 2017 (+ 59%). The reintroduction of the donation after cardiocirculatory death (DCD) program in 2011 resulted in the growth of annual percentages of DCD donors, reaching a maximum of 27% in 2017. The total number of organs transplanted from ADD was 3763 (3.4 ± 1.5 transplants per donor on average). Of these, 48% were kidneys (n = 1814), 24% livers (n = 903), 12% lungs (n = 445), 9% hearts (n = 352) and 7% pancreata or pancreatic islets (n = 249). The donation program efficiency assessment showed an increase of the Swiss DCI from 1.6% in 2008 to 2.7% in 2017 (+ 69%). The most prominent efficiency growth was observed between 2012 and 2017. Even though Swiss donation efficiency increased during the study period, it remained below the DCI of the French and Austrian donation programs.ConclusionSwiss donation activity and efficiency grew during the last decade. The increased donation efficiency suggests that measures implemented so far were effective. The lower efficiency of the Swiss donation program, compared to the French and Austrian programs, may likely be explained by the lower consent rate in Switzerland. This issue should be addressed in order to achieve the goal of more organs available for transplantation.

Burden of cytomegalovirus disease in allogeneic hematopoietic cell transplant recipients: a national, matched cohort study in an inpatient setting

Purpose of the studyNo studies have compared the risk of mortality or graft-versus-host disease, in an inpatient setting in France, in allogeneic hematopoietic cell transplant recipients who develop cytomegalovirus disease with those who do not. This study assessed the impact of cytomegalovirus disease on clinical outcomes and healthcare resource utilization in allogeneic hematopoietic cell transplant recipients using the French Programme de Médicalisation des Systèmes d'Information database. Patients and methodsRecipients who had undergone allogeneic hematopoietic cell transplant in French hospitals between 2008 and 2011 were included in this retrospective, matched cohort study. Those with cytomegalovirus disease were each matched with two allogeneic hematopoietic cell transplant recipients without cytomegalovirus disease according to demographic and clinical characteristics. Probabilities of in-hospital mortality, graft rejection and/or graft-versus-host disease, and healthcare resource utilization were compared up to 12 months after cytomegalovirus disease diagnosis. ResultsOverall, 4884 transplant recipients were enrolled, of which 194 had cytomegalovirus disease. Of these, 165 recipients with cytomegalovirus disease were matched to 330 without cytomegalovirus disease (1:2 ratio). The development of cytomegalovirus disease was associated with a significantly higher risk of in-hospital mortality (relative risk = 1.7, p = 0.0005) and higher cumulative number of inpatient days (p < 0.0001), but was not associated with a significantly higher risk of graft rejection and/or graft-versus-host disease or healthcare costs. ConclusionsDue to the increased risk of in-hospital mortality and higher cumulative number of inpatient days in allogeneic hematopoietic cell transplant recipients with cytomegalovirus disease versus those without, new strategies to prevent and manage cytomegalovirus disease are warranted.

Repertoires of three second language learners of mathematics: distal and situational sources of meaning

ABSTRACTThis article presents the results of an analysis of ethnographic data collected in three second language mathematics classrooms in Canada. The elementary school classes consisted of a group of indigenous students, a group of new immigrant students and a class in a French immersion programme. The focus of the analysis was on the sources of meaning students use in mathematics classrooms. The notion of sources of meaning is framed by a Bakhtinian perspective on language, in which they are examined in terms of discourses, voices and languages. For one student in each class, I describe a repertoire of sources of meaning and discuss similarities and differences relating to the sociolinguistic context of each class. Students’ repertoires are shown to include both situational and distal sources of meaning. The relationship between distal and situational sources of meaning reflects the stratified nature of mathematics classroom interaction.

More Harm than Good?

By analyzing a French program that targeted low-achieving and socially disadvantaged junior high schools we provide evidence that school-based compensatory education policies create sorting effects. We use geocoded original data and a regression discontinuity framework to show that the program decreases the individual probability of attending a treated school and symmetrically increases the probability of attending a private school. The effects are driven by pupils from high socioeconomic backgrounds, resulting in an increase in social segregation across schools.

L’influence linguistique de l’espagnol et du français lors de l’apprentissage de l’anglais

El presente artículo tiene como objetivo analizar los resultados de una investigación cuantitativa sobre la influencia lingüística del español-francés en el aprendizaje del inglés, en estudiantes bilingües consecutivos, en un contexto por inmersión precoz parcial en francés. Los resultados revelan que ambas lenguas tienen una influencia en el aprendizaje del inglés. Por un lado, la estructura del francés tiene una influencia positiva en la estructura del inglés puesto que se halló una correlación positiva entre ambas lenguas; por otro lado,en el caso del español, se demostró que hay un traspaso negativo ya que se evidencia el bajo repertorio lingüístico de los aprendientes en la le.

Prospective association between adherence to dietary recommendations and incident depressive symptoms in the French NutriNet-Santé cohort.

A posteriori healthier dietary patterns and several nutrients have been associated with lower risks of depression in various studies; however, evidence is lacking with regard to the prospective association between adherence to nutritional recommendations (food-based and nutrient-based recommendations) and incident depression or depressive symptoms. In this study, we investigate such associations in the NutriNet Santé cohort. The study sample included 26 225 participants (aged 18-86 years) who were initially free of depressive symptoms. Adherence to nutritional recommendations was measured by four scores namely modified French Programme National Nutrition Santé-Guideline Score (mPNNS-GS), Alternative Healthy Eating Index-2010 (AHEI-2010), Probability of Adequate Nutrient Intake Dietary Score (PANDiet) and Diet Quality Index-International (DQI-I), using non-consecutive dietary record data during the first 2 years of follow-up (mean number of recording days=8, sd 2). Depressive symptoms were defined by a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥17 for men and ≥23 for women. We used Cox proportional hazards models to estimate hazard ratios and 95 % CI, modelling the dietary scores as standardised continuous variables and as tertiles. Over a mean follow-up of 6 years, we identified 2166 incident cases of depressive symptoms. All dietary scores with the exception of the AHEI-2010 were significantly inversely associated with incident depressive symptoms. In the fully adjusted model, an increase of 1 sd in the mPNNS-GS, PANDiet and DQI-I was, respectively, associated with an 8 % (95 % CI 4, 13), 5 % (95 % CI 1, 9) and 9 % (95 % CI 5, 13) reduction in the risk of depressive symptoms. Overall, these findings suggest that diet in accordance with national or international guidelines could have beneficial effects with regard to mental health.

Adaptation transculturelle francophone de la Confusion Assessment Method

IntroductionThe Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual. MethodsCross-cultural adaptation to achieve equivalence between the original version and a French adapted version of the CAM manual. ResultsA rigorous process was conducted including control of cultural adequacy of the tool's components, double forward and back translations, reconciliation, expert committee review (including bilingual translators with different nationalities, a linguist, highly qualified clinicians, methodologists) and pretesting. A consensual French version of the CAM was achieved. ConclusionImplementation of the CAM French version in daily clinical practice will enable optimal diagnosis of delirium diagnosis and enhance communication between health professionals in French speaking countries. Validity and psychometric properties are being tested in a French multicenter cohort, opening up new perspectives for improved quality of care and research programs in French speaking countries.

Les programmes de pairs aidants en santé mentale en France : état de situation et difficultés de mise en place

ObjectivesRecovery is a process through which people experiencing mental illness learn to live with their disorder and reach social insertion and citizenship. This positive approach focuses on a person's competencies and strengths rather than on the symptoms. Within this philosophy, peer support has been unevenly developing in mental health services worldwide with roots in the South-American social programs for homeless people and in the American recovery circles in the field of addiction. Therapeutic efficiency of peer support has been proven by several studies including a control group, as being at least as good as traditional services and even better in some specific areas such as reduction of need for emergency services and ability to reach “difficult” patients. The integration of former psychiatric services users in mental health services can take several forms, from the participation to scientific research studies to the direct involvement in a professional team at mental health facilities. In this context, our research aims to sum up the situation in France in comparison with other countries. MethodsWe conducted a worldwide literature review in English and in French on peer support experiences and policies in mental health services, using medical and psychological databases (PsycInfo, PsycArticles, SantéPsy, Cairn, Medline, Wiley Interscience and PubPsych) on a recent period: 2005–2016. In total, 32 relevant scientific papers have been included in our research. In some cases, we have also used official reports, blogs, Internet sites, and mass media articles when they were relevant. ResultsOur results show that this movement has been long to develop in France, with controversies having been raised since the beginning on the role that peers should play and confusion with existing social integration programs in the associative sector. Drawing inspiration from the Canadian model, a recent “peer mentor” initiative has been analyzed after 2 years of existence: many benefits for services users such as the optional aspect of this care process, a more authentic therapeutic relationship, a less normative frame, an active partnership, and a more optimistic philosophy aiming to make “small steps” towards improvement have been reported. Health professionals and peer mentors themselves have found benefits during the process. However, several limits such as difficulties to find a place with regards to the psychiatric team and difficulties to take advantage of the peer specificity, resulting in a significant attrition of the number of peer mentors, could be observed. A few other important initiatives focused on social insertion and using the help of professional peer support have been developed in recent years, but they seem to have encountered the same issues about positioning themselves both in terms of day-to-day integration in the professional environment and in the job title given by institutions which rarely corresponds to their experience and specificity. In addition, it remains difficult to obtain reliable information, as only a few papers have been published on this matter. Also, while some evaluation studies are currently being carried out, independent quantitative studies of the few running programs seem to lack in this field. ConclusionsIn our presentation, taking into account the difficulties that were raised in French programs and the lessons of practical experiences at work in other countries, we propose recommendations for larger and more effective implementations of peer support programs in France. As this new kind of care is emerging and seems promising in terms of benefits for not only the users but also the peer supporters and the teams of health professionals, we also insist on the need for a systematic scientific and objective evaluation of the programs.

Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial

Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only. Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral subthalamic stimulation plus medical therapy and was increased by 21% (245·8 mg/day [40·4]) in those assigned medical therapy alone (p<0·0001). Neuropsychiatric fluctuations decreased with bilateral subthalamic stimulation plus medical therapy during 2-year follow-up (mean change -0·65 points [SE 0·15]) and did not change with medical therapy alone (-0·02 points [0·15]); the between-group difference in change from baseline was significant (p=0·0028). At 2 years, the Ardouin scale subscore for hyperdopaminergic behavioural disorders had decreased with bilateral subthalamic stimulation plus medical therapy (mean change -1·26 points [SE 0·35]) and had increased with medical therapy alone (1·12 points [0·35]); the between-group difference was significant (p<0·0001). Mean change from baseline at 2 years in the Ardouin scale subscore for hypodopaminergic behavioural disorders, the Starkstein Apathy Scale score, and the Beck Depression Inventory score did not differ between treatment groups. Antidepressants were stopped in 12 patients assigned bilateral subthalamic stimulation plus medical therapy versus four patients allocated medical therapy alone. Neuroleptics were started in nine patients assigned medical therapy alone versus one patient allocated bilateral subthalamic stimulation plus medical therapy. During the 2-year follow-up, two individuals assigned bilateral subthalamic stimulation plus medical therapy and one patient allocated medical therapy alone died by suicide. In a large cohort with Parkinson's disease and early motor complications, better overall behavioural outcomes were noted with bilateral subthalamic stimulation plus medical therapy compared with medical therapy alone. The presence of hyperdopaminergic behaviours and neuropsychiatric fluctuations can be judged additional arguments in favour of subthalamic stimulation if surgery is considered for disabling motor complications. German Federal Ministry of Education and Research, French Programme Hospitalier de Recherche Clinique National, and Medtronic.

A quality improvement program to improve nutritional status of children with Cystic Fibrosis aged 2-12\xa0years old over a 3\xa0year period at CF center Roscoff, Brittany

BackgroundThe Cystic Fibrosis (CF) center in Roscoff (Brittany) has been involved in therapeutic education programs (TEP) since 2006 and took part in the pilot phase of the French quality improvement program (QIP) since 2011. The aim was to improve the nutritional status of children with cystic fibrosis aged 2-12 years old in order to optimize their health status as they enter adolescence.MethodsA multidisciplinary quality team was created in order to select and address a specific health problem among our pediatric population. Following analysis of yearly indicators for our CF center, our team chose to improve quality of care concerning nutritional status of children aged 2-12 years old. Factors influencing efficacy were studied, tools were developed to implement a new nutritional program, results were analyzed on a real-time basis.ResultsOver the 3 year period, all patients from 2 years of age, were monitored with the new follow-up program (2012: N = 34; 2014: N = 44). Each patient was followed up at every clinic visit, their BMI z-score was calculated to decide their nutritional risk and personalize their follow-up program consequently. Between 1/1/2012 and 31/12/2014, the mean BMI z-score of the open cohort improved from −0.49 to −0.22.ConclusionsSince 2014, focus on nutrition using the newly-adapted program has become routine practice at each follow-up visit. Patients and parents expressed a high level of satisfaction (75% very satisfied). The follow-up program aimed at improving nutritional status for children aged 2-12 years old was successfully implemented and integrated into routine practice; it was therefore extended to all children with CF (1 month - 18 years) in our center. The relationship among professional and patients and parents was strengthened.

Analytical measurements of fission products during a severe nuclear accident

The Fukushima accident emphasized the fact that ways to monitor in real time the evolution of a nuclear reactor during a severe accident remain to be developed. No fission products were monitored during twelve days; only dose rates were measured, which is not sufficient to carry out an online diagnosis of the event. The first measurements were announced with little reliability for low volatile fission products. In order to improve the safety of nuclear plants and minimize the industrial, ecological and health consequences of a severe accident, it is necessary to develop new reliable measurement systems, operating at the earliest and closest to the emission source of fission products. Through the French program ANR « Projet d’Investissement d’Avenir », the aim of the DECA-PF project (diagnosis of core degradation from fission products measurements) is to monitor in real time the release of the major fission products (krypton, xenon, gaseous forms of iodine and ruthenium) outside the nuclear reactor containment. These products are released at different times during a nuclear accident and at different states of the nuclear core degradation. Thus, monitoring these fission products gives information on the situation inside the containment and helps to apply the Severe Accident Management procedures. Analytical techniques have been proposed and evaluated. The results are discussed here.

FRENCH LEARNING FOR CUSTOMS IN THE FRAME OF A HYBRID DEVICE

This article analyzes the teaching of French and methods in the context ofmultilingualism. We present the flagship of vectors which direct the choice of methods byfocusing on active approaches and techniques, especially on the hybrid method blendedlearning. In the context of globalization and multilingualism these language skills are veryimportant for Customs officials. The main purpose of this article is the teaching of modernlanguages to adults, including specialized French customs. We analyze the programs offeredby Customs Training Centre located in Vilnius by focusing on the comprehensive study ofcombined learning program in French because this method participates actively in therealization of the policy of multilingualism through the cooperation between the teacher andthe learner. This method facilitates a more rapid and effective integration of participants inthe professional and social life as well as a broader multidisciplinary approach through theuse of new technologies and authentic documents of various fields: from the customschecking vehicles to ethical issues in Customs. It also has 5 components of the lexicalacquisition accompanying the vocational training of customs in French: linguistic, discursive,referential, social, cultural and strategic. DOI: http://dx.doi.org/10.1515/sm-2017-0015

1 Is the CF French newborn screening programme efficient in identifying affected infants from Western and Central Africa?

1 Is the CF French newborn screening programme efficient in identifying affected infants from Western and Central Africa?