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Nutrition clinique pratique Chez l’adulte et l’enfant: (Seconde édition)

Le goût sucré est inné. Il a précédé le sucre et a été recherché depuis l’Antiquité sous forme d’ersatz, comme le miel ou les fruits secs. Découvert par les Croisés au XIIe siècle, le sucre et son goût ont eu du mal à percer en Occident. Délaissé au Moyen-Âge au profit du goût acide, il n’éveille l’intérêt des classes aisées qu’après le développement de la culture de la canne dans les Îles. Le goût sucré retrouve une place honorable au moment du dessert et pour faciliter la consommation du café et du chocolat. Sa véritable expansion et sa démocratisation datent du XIXe siècle, à la suite de l’accroissement de la production de sucre à partir de la betterave sucrière. Peu à peu, le goût sucré devient indispensable en raison du plaisir qu’il procure. Les progrès de la chimie parviennent à le dissocier du sucre, en synthétisant des édulcorants. Le goût sucré a réinvesti la cuisine, et les consommateurs ne craignent plus de l’associer aux goûts salé et acide, ou de consommer des boissons sucrées au cours des repas. Son retour en force, favorisé par les produits industriels, inquiète, car il est dénoncé comme l’un des marqueurs de l’alimentation surabondante et déstructurée qui conduit à l’obésité.As sweetness is inherited, humans have for ever been in the search of sugar. In the Ancient times, honey and dried fruits were used as the first substitutes for sugar. After its discovery in the 17th century during the crusades, sugar has been submitted to many hurdles before its dissemination in the Western countries. After it had been neglected in the Middle-Age and supplanted by the acid taste, its increased consumption was particularly marked in the upper classes of the society, concomitantly to the intensified farming of cane sugar in tropical islands. The attraction for sweetness was primarily enjoyed as a desert at meal times for facilitating the consumption of such hot drinks as coffee and chocolate. Its worldwide dissemination really started in the 20th century when its production was extended to that of beet sugar. Sweetness progressively became mandatory for those who appreciated its pleasant taste. The endless story of chemical sciences was the starting point for individualizing sweetness from sugar, the link in the chain being the synthesis and production of artificial sweeteners. Sweetness was further considered a natural and popular component of cooking and nowadays all consumers do not hesitate to use it in combination with either salted or acidic foods and soft drinks during meal periods. Its return in strength, which is facilitated by the progression of industrial products, is of concern since it is denunciated as one of the key markers of an exaggerated and unstructured eating behavior, one of the main causative factors of obesity.

Efficacy of a Novel Treatment Serum in the Improvement of Photodamaged Skin

SynopsisA novel treatment serum formulated to target multiple pathways in the anti-ageing cascade was tested both in vitro and in clinical settings. In vitro testing was performed to assess the ability to stimulate key proteins and genes fundamental to the anti-ageing cascade. The antioxidant potential of the formulation was studied in a UV-irradiation clinical study. A 12-week, open-label, single-centre study was conducted to determine whether this uniquely formulated topical treatment serum could improve visible signs of facial photodamage. Clinical evaluations showed statistically significant reductions in fine wrinkles and coarse wrinkles and improvements in skin texture, tone and radiance starting at week 4 with continued improvements at weeks 8 and 12. Subject self-assessments confirmed that the beneficial effects of the treatment serum were readily observed by the users. The treatment serum was well tolerated with no treatment-related adverse events reported during the 12-week study. Use of this novel treatment serum produced significant improvements in the visible signs of facial photodamage.RésuméUn nouveau sérum de traitement conçu pour cibler de multiples voies dans la cascade anti-âge a été testé à la fois in vitro et dans les conditions cliniques. Les tests in vitro ont été réalisés afin d'évaluer la capacité de stimuler les protéines et les gènes clés fondamentales de la cascade anti-vieillissement. Le potentiel antioxydant de la formulation a été étudié dans une étude clinique utilisant le rayonnement UV. Une étude de douze semaines, en mode ouvert, monocentrique a été menée afin de déterminer si ce sérum spécialement formulé pour le traitement topique peut améliorer les signes visibles du photo-vieillissement du visage. Des évaluations cliniques ont montré une réduction statistiquement significative des rides et des ridules secondaires et l'amélioration de la texture de la peau, du tonus et d'éclat à partir de la semaine 4 avec des améliorations continues aux semaines 8 et 12. Les autoévaluations par les sujets ont confirmé que les effets bénéfiques du sérum de traitement étaient facilement observés par les utilisateurs. Le sérum de traitement a été bien toléré avec aucun événement indésirable rapporté au cours de l'étude de 12 semaines. L'utilisation de ce nouveau sérum de traitement produit des améliorations significatives dans les signes visibles du photovieillissement du visage.

Aspirations and wellbeing in Romanian and US undergraduates

Updating cross-cultural research of the past decade on the relationship between life aspirations and wellbeing, we compared Romanian (N=69) and US (N=64) undergraduates on the contribution of the importance and likelihood of attaining intrinsic and extrinsic aspirations to psychological maladjustment and life satisfaction, and on the qualitative meaning they assign to financial success. Similarly to prior studies, we found that extrinsic and intrinsic aspirations tended to be either negatively or positively correlated with life satisfaction, respectively; however, wealth predicted life satisfaction for Romanian students. Unlike previous research, we found generally negative relationships between intrinsic aspirations and psychological maladjustment. Although there were no differences between Romanian and US undergraduates on extrinsic and intrinsic orientation, on the overall importance of attaining aspirations, or on specific extrinsic and intrinsic aspirations, Romanian students expressed weaker expectations of fulfilling intrinsic aspirations than did US students. Finally, the groups produced similar rankings of aspirations and assigned similar meaning to financial success. The results favored a social cognitive rather than a self-determination model of psychological wellbeing in that expectations for attaining aspirations were more often predictive of life satisfaction than were their content. We interpret these findings and their convergence and departure from earlier research in terms of political economic, demographic, and cultural factors. We encourage future cross-cultural investigations of the social construction of aspirations, subsidiation of seemingly contradictory aspirations to each other, and cognitive and ecological mediation of the complex relationship of aspirations to psychological functioning.

The Singular Banlieue

The Singular Banlieue Anna-Louise Milne Three press cuttings, and a question: When interviewed about Nicholas Sarkozy’s new “grand Paris” initiative that seeks to define the shape of Paris in the twenty-first century, the British architect Richard Rodgers declared that he knows of no other “big city where the heart is so detached from its arms and its legs” by the “staggering psychological barrier” between the banlieue and the city.1 In a provocative plea published in the new-look glossy supplement that Le Monde recently launched, Antoine Compagnon, professor at the Collège de France and Columbia University, called for a less defensive attitude to the prospects for the French novel. He invoked translation as the international court of approval that best indicates significant new directions, just as the art market discerned the importance of Impressionism and Surrealism, claiming that “sans la banlieue et la francophonie qui le revivifient, le roman français traverserait un passage à vide.” Faïza Guène and Azouz Begag are interesting to readers, he suggested, because they tell of “la réalité française du XXIe siècle,” and that reality is “l’immigration, les ratés de l’assimilation et de l’intégration, l’embrasement des cités, les échecs de l’école.”2 In the context of the political and media furore provoked by the twenty-three-year-old son of the President, Jean Sarkozy, when he stood for election as the President of the board responsible for the management and development of the Défense business district, on the western edge of Paris, attention turned momentarily to Sarkozy’s other son, Pierre, a producer of rap and rap-related music. Operating under the pseudonym Mosey, he does his business as anonymously as possible, knowing that in la banlieue his real name meets with rage.3 What is going on behind the singular designation of “la banlieue”? Sociologists and historians would probably reply quite rightly that this question should be passed over, rejected for the lack of engagement it expresses with the vast disparity in social and economic situations hidden by the catch-all media figure of la banlieue. But if we are going to ask how we are to think “today” in France, then media figures are what we are about. “Aujourd’hui en France” is a product of the mass media; in fact—although this may be an inadvertent allusion for this collective issue of L’Esprit Créateur—Aujourd’hui en France is the title of a daily newspaper, the regional re-branding of Le Parisien, the daily paper that has played such a significant role in constituting “Paris” and “la banlieue” as figures in the popular imagination. Admittedly, I am presuming that to “think” today we need first to “figure” today, which means to say that our “object” has no self-evidence and must [End Page 53] rather be approached as our construction. In other words, somewhere in the background of the question of how to think “today” in France is the foreground of this collective endeavour, hereby instantiated, of “thinking” in France, and “à partir de la France,” today. We cannot avoid the question of what sort of processes our thinking draws on today, and relatedly what sort of disciplinary and institutional consequences they have. In short, when we try to think about la banlieue today, we have also to think about with whom we do that thinking and via what sort of interdisciplinary and social associations and networks. But before scare quotes proliferate scarily, let us return to the figures of “today” and “la banlieue” and consider their rhetoricity, which is also their density. The notion of la banlieue really started to figure as a topos in French journalism from the 1920s on, when the postwar housing shortage prompted the wildfire development of unregulated property deals in the still largely rural areas around the city, generating the social and economic conditions that would lead to the durable installation of a red belt of Communist political representation around Paris. From the off, the term was associated with problems of security, skirmishes between the sparse police forces and the uncountable, shifty local elements, always more...

ESPECIALIZACIÓN DEL DISCURSO: UNA CARACTERIZACIÓN DESDE EL SISTEMA DE LA OBLIGACIÓN

espanolEste estudio de alcance descriptivo, enmarcado en la Gramatica Sistemico-Funcional (GSF) (Matthiessen, 2006, 2007; Caffarel, Martin & Matthiessen, 2004), tiene por objetivo ca-racterizar el discurso especializado oral y escrito, a partir de la variacion probabilistica que presentan las configuraciones lexicogramaticales realizadoras de la obligacion en espanol. Para alcanzar este objetivo se toma como contexto de observacion un corpus multirregistro CARACTERIZADO EnglishFrom a Systemic Functional Grammar (SFG) approach, the present descriptive study (Matthiessen, 2006, 2007; Caffarel, Martin & Matthiessen, 2004) is aimed at characterize the specialized oral and written discourse, from the probabilistic variation that present of the realizations of the obligation system in Spanish, which tend to become critical features when characterizing oral and rather specialized written language. To achieve our objective, we take as context of observation a multiregister corpus, characterized by the crossing of the oral/writing and degree of specialization variables, that is, from the register construct perspective (Halliday, 1982a), mode and field respectively. The automatic exploitation will be carried out through the linguistic tagger and query interface, El Grial (Parodi, 2007), which allows us to access the absolute frequency of instantiation of each term in the systemic network of obligation. Upon this frequency, we estimate the conditioned probability of occurrence and, upon the latter, the obligation system variation in the corpus context. For this last calculus, we assume an error estimation of 5%. Results show that there is a direct proportional correlation between the degree of specialization and the degree of obligation present in the different registers of the corpus.

Unsafe abortion in urban and rural Tanzania: method, provider and consequences

To describe unsafe abortion methods and associated health consequences in Tanzania, where induced abortion is restricted by law but common and known to account for a disproportionate share of hospital admissions. Cross-sectional study of women admitted with alleged miscarriage: 278 in rural Tanzania and 473 in urban Tanzania. Women who had undergone a clandestinely induced abortion were identified by an empathetic approach and interviewed in detail about the procedure. Information about complications was obtained from the patient file. Sixty-two per cent in rural Tanzania and 63% in urban Tanzania stated that they had had an unsafe induced abortion. The abortion had been induced by an unskilled provider in 46% of rural women and 60% of urban women. Herbs and roots had commonly been used for induction, in 42% of rural and 54% of urban women. The method most often associated with abortion complications was catheter/roots, whereas the method least often associated with complications was herbs. The large number of women identified as having had unsafe abortion together with the prevalent use of herbs calls for attention.

Las huellas de la Guerra Civil: mito y trauma en la narrativa de la España democrática (review)

MORENO-NUNO, CARMEN. Las huellas de la Guerra Civil: mito y trauma en la narrativa de la Espana democratica. Madrid: Libertarias, 2006. 429 pp.Carmen Moreno-Nuno's Huellas de la Guerra Civil is an elegantly composed and theoretically inflected study of decidedly Spanish preoccupations that cleaved Peninsular Hispanism in the wake of what we know of as the (unfortunately coined) recuperation of memory. These concerns involve, among other issues, the complex relationship between history and in which selfconstituted ideological communities are invested with the power to articulate conceptions of the past, and how the judicial and executive organisms of the Spanish state can address the losses and injustices suffered by all victims of the Spanish Civil War (and the Francoist dictatorship). The contours of the historical landscape have shifted significantly against the at times rhetorically violent agitation of disparate voices sounding from multiple directions, each insisting on its own version of what constitutes the epistemes of the past. It is thus inevitable that Moreno-Nuno's beautifully written study is buttressed by a sense of political urgency - now both complicated and attenuated - associated with the first few years of the Spanish twenty-first century. If the contextualization of her readings refers us back to the immediate aftermath of 2000, with the first nonclandestine exhumation of a mass grave, Moreno-Nuno's close readings stand the test of time.The book posits the notion that fictional incursions into the memory of the war and the postwar period correspond to one of two (or sometimes both) historicoaffective approaches to reconstructions of a disastrous recent past: trauma and myth. The author makes a convincing case that four novels and one short story participate in the recuperation of memory, in effect prefiguring, even propelling, the boom that would land ten to twenty years after the publication of the texts that form the subject of this study: El siglo (1983) by Javier Marias, El pianista (1985) by Manuel Vazquez Montalban, Luna de lobos (1985) by Julio Llamazares, El jinete polaco (1991) by Antonio Munoz Molina, and the short story Ucronia (1994) by Manuel Talens. Moreno-Nuno has chosen these works, she explains, because in them we find a deconstruction oflos mecanismos falsificadores del mito a partir de la representacion del horror de la Historia. En estos relatos, la representacion del mito coexiste con una representacion del trauma. . . . Todos ellos subvierten los discuros mitologizadores acerca del pasado que predominan en la Espana democratica, sacando a la luz la falsedad que acompana a la instrumentalizacion politica del mito. (97)An exhaustive arsenal of theory on myth and trauma is put to work in the first two chapters of the book, although such painstakingly deliberated coverage of these themes is indicative of the main weakness of Huellas de la Guerra Civil: repetition and discursive padding that delays, frustratingly, the sensitive and sophisticated analyses of the primary texts.It is in chapter three where the author shows us how disassembled appendages of myth (in this case the triumphalist rhetoric employed to construct upstanding Francoist functionaries) are reconstructed in the service of trauma narrative. Here Moreno-Nuno discusses Javier Marias's long-neglected novel El siglo, an autobiographically inflected work that features a Francoist informer (delator) as its protagonist. Moreno-Nuno prefaces the chapter with an informative summary of Marias's literary and personal biography. She argues that Javier Marias - after an early rejection of the Spanish Civil War as a subject of literary interest for him and his literary cohort (what by way of Marianne Hirsch we have come to think of as the post-memorial generation of the Spanish Civil War) eventually comes to embrace the war as the leitmotif of his fiction. …

Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies

This study was carried out to assess whether delaying umbilical cord clamping is effective in improving the haematological status of term infants living in a malaria-endemic area, and whether this is associated with complications in infants and mothers. We randomly assigned women delivering term babies in Mpongwe Mission Hospital, Zambia, to delayed cord clamping (DCC, n = 46) or immediate cord clamping (controls, n = 45) and followed their infants on a bi-monthly basis until the age of 6 months. We compared the haemoglobin (Hb) change from cord values and the proportion of anaemic infants. Secondary outcomes related to infant and maternal safety. Throughout the observation period infant Hb levels in both groups declined, but more rapidly in controls than in the DCC group [difference in Hb change from baseline at 4 months 1.1 g/dl, 95% confidence interval (CI) 0.2; 2.1]. By 6 months, this difference had disappeared (0.0 g/dl, 95% CI -0.9; 0.8). The odds ratio for iron deficiency anaemia in the DCC group at 4 months was 0.3 (95% CI 0.1; 1.0), but no differences were found between the groups at 6 months. No adverse events were seen in infants and mothers. Our findings indicate that DCC could help improve the haematological status of term infants living in a malaria-endemic region at 4 months of age. However, the beneficial haematological effect disappeared by 6 months. This simple, free and safe delivery procedure might offer a strategy to reduce early infant anaemia risk, when other interventions are not yet feasible.

'Porto Rico': The View from National Geographic , 1899–1924

Starting with the 1898 invasion, Puerto Rico, along with the other new possessions, became a focus of press attention. The 1898 war has been affirmed as the first modern war in the sense that it was recorded by the most important new visual media including photography. This article will argue that, in the ideological war between the US and Spain, the press and photography served as important instruments of international and national legitimation. During the transitional period between colonizers covered by this article, photography plays its part by distancing the new colonizer from sugar's past in preparation for sugar's future on the island. The emergence of new print media anticipates the projection from the New Deal period onwards and throughout the Cold War of Puerto Rico as a showcase for US foreign policy and free-market capitalism.A partir de la invasion de 1898, Puerto Rico, junto con las otras colonias nuevas, llamo la atencion de la prensa. La guerra de 1898 se ha considerado la primera guerra ...

Kateb Yacine and the Ruins of the Present

Several years before his death, the Algerian writer Kateb Yacine (19291989) recalled the early phase of his career in Paris, saying that le jour oui il y a eu des embuscades en Algerie, le jour oui il y a eu des morts franqais en Algerie, oui il y a eu le sang, a partir de la le public a commence a s'interesser a l'Algerie. Les 6diteurs ont commence faire automatiquement la chasse aux Algeriens. Dib et moi nous avons et6 publies grace a l'actualite, aux embuscades qu'il y a eu dans France-Soir tous les jours. [the day there were ambushes in Algeria, the day there were French casualties, the day there was blood, then the public began to be interested in Algeria. Editors began to hunt automatically for Algerians. Dib and I were published thanks to current events, the ambushes that were going on every day in the pages of France-Soir.] (Corpet, Dichy and Djaider 60)1 Kateb attributes his entry on the Paris scene, and the arrival of Algerian literature generally, to a violent intervention of history. In his thinking, this constituted a relation of cause and effect between political struggle and literary style, two of his life-long commitments; it also suggests a relationship between history and the means of its expression. Still, the relationship between Kateb's work and the history surrounding it needs clarification. After all, the first significant cluster of Francophone Algerian authors studied in the academy today, called the generation de '52 (or '54, if the speaker wishes to emphasize the start of the war) of Mohamed Dib, Mouloud Mammeri, and Mouloud Feraoun, seems to have emerged with the gradual attainment of literary proficiency in French, concurrent with the coalescence of a sense of potential autonomy and political cohesion, rather than with the suddenness of an ambush. Furthermore, these authors published their first work before the actual outbreak of the hostilities of which Kateb speaks in the interview cited.2 Did the advent of Algerian literature in French, and Kateb's own publication, really depend on editors hunting Algerians, much as the Army was doing? This cause would seem better suited to explain the appearance, from 1954 on, of a variety of temoignages [eyewitness accounts] of the war itself, than to explain the publication of a complex and difficult novel

Resistance to sulphadrug-based antifolate therapy in malaria: are we looking in the right place?

Sulphadrug treatment failure in malaria therapy cannot solely be ascribed to the build-up of genetic resistance within the parasitic genome. Although numerous in vitro studies have tried to determine the exact genetic markers that could predict treatment outcome in patients, this research has not been conclusive. Sulphadrugs work by competitive inhibition with pABA at one point of the pathway to de novo folate synthesis. However, evidence suggests that the malaria parasite is capable of overcoming this competitive inhibition by switching over to other metabolic pathways, like direct folate salvage from a person's bloodstream. In other words, increased folic acid administration, via diet or supplementation, may have reduced the effectiveness of sulphadrugs more than genetic mutations. Although in vitro studies are valuable for understanding disease mechanisms, we should not forget that the human being is infinitely more complex than any laboratory model.

Alternative methods for ray tracing in uniaxial media. Application to negative refraction

In previous papers [C. Bellver-Cebreros, M. Rodriguez-Danta, Eikonal equation, alternative expression of Fresnel's equation and Möhr's construction in optical anisotropic media, Opt. Commun. 189 (2001) 193; C. Bellver-Cebreros, M. Rodriguez-Danta, Internal conical refraction in biaxial media and graphical plane constructions deduced from Möhr's method, Opt. Commun. 212 (2002) 199; C. Bellver-Cebreros, M. Rodriguez-Danta, Refracción cónica externa en medios biáxicos a partir de la construcción de Möhr, Ópt. Pura Appli. 36 (2003) 33], the authors have developed a method based on the local properties of dielectric permittivity tensor and on Möhr's plane graphical construction in order to study the behaviour of locally plane light waves in anisotropic media. In this paper, this alternative methodology is compared with the traditional one, by emphasizing the simplicity of the former when studying ray propagation through uniaxial media (comparison is possible since, in this case, traditional construction becomes also plane). An original and simple graphical method is proposed in order to determine the direction of propagation given by the wave vector from the knowledge of the extraordinary ray direction (given by Poynting vector). Some properties of light rays in these media not described in the literature are obtained. Finally, two applications are considered: a description of optical birefringence under normal incidence and the study of negative refraction in uniaxial media.

Le commerce extérieur et intra-Union Européenne de matériaux et produits de récupération: Statistiques et essai d'analyse structurelle

On the basis of statistics from Eurostat, the paper is relating at first for the year 2001 the main exchanges (flows) intra-EU and with the rest of the world (extra-EU), including by countries (for the main countries which are concerned), tonnage and value, by categories of recovered materials and products; a synoptic table is established, the results are summarized and first comments are provided. Moreover the evolution from 1995 to 2001 is related.The available data (even if their reliability is questionable) allow to bring to the fore structural characteristics and some changes:– the part of the metals is paramount (nearly 80%): ferrous in tonnage and value and non-ferrous in value; wastepaper is another important material in the exchanges;– the trade balance with the rest of the world which was in deficit in 1995 has become in excess: it remains in deficit for the metals but has become in excess or the excess increases for most of the other materials and products, due to increasing exports;– concerning the metals, EU imports mainly from other European (extra-EU) countries, while it exports (mainly non-ferrous) to Asia, notably China;– Asia (in particular China) is the major destination for the exports of wastepaper and plastics too;– the textiles show a contrasted picture: exports of old clothes but imports of wiping rags (by-products from sorting old clothes);– EU exports used and retreaded tyres;– EU exports mainly to less developed countries; the exchanges with North America and Japan (mainly imports)are weak.The objectives of the second part of the paper are to go deeper into the analyses and to try to explain the exchanges: do they confirm the main theories of international trade? To what extent is EU appearing as an economic entity? Moreover the effects of some of these exchanges are questioned and some prospective views are provided.The essay to explain the causes of the exchanges has permitted to point out the possible influence of some factors: the scarcity of some natural resources (notably deposits of ores), the labour cost, the level of wealth, the economic growth of the country (notably for the exports to Asia).From 1995 to 2001, the extra-EU exchanges (particularly the exports) have increased more strongly than the intra-EU exchanges. However the intra-EU exchanges remain clearly higher than the extra-EU exchanges, may be not only for geographical reasons (in particular transportation cost) but also for other economic reasons: multilateral or crossed exchanges between EU countries are concerning a same (category of) material; but possible differences of “quality” would have to be introduced.Exports of “secondary materials” may have some negative effects on the economy of the exporting country: “loss of earnings”, and possible perverse effects, i.e. “backlash” or “boomerang” effect.Some influent factors have been brought out but – quite obviously - the whole economic map of the world exchanges cannot be explained. At last the planned enlargement of EU to Eastern European countries may involve - owing to a complementarity - a gain in economic autonomy or self - reliance. À partir de la base de données Eurostat, l'article s'attache d'abord à retracer, pour l'année 2001, l'essentiel des courants d'échanges, intra-UE et avec le reste du monde, y compris par pays (pour les principaux pays concernés), en tonnage et en valeur, par catégories de matériaux et produits de récupération, à les présenter de façon synoptique et à fournir un premier commentaire des résultats, en 2001. De plus, les changements de 1995 à 2001 sont repérés. La seconde partie vise à approfondir l'analyse et à tenter d'expliquer ces échanges : les principales théories du commerce international s'appliquent-elles bien aux matériaux et produits de récupération ? Dans quelle mesure l'UE apparaît-elle, à travers ces échanges, comme une entité économique ? S'y ajoutent des questionnements sur les conséquences de certains échanges et quelques vues prospectives.

Proximité et innovation

Qu'est-ce que la proximité et quelles en sont les formes distinctes ? Dans cet article, après avoir clarifié ce concept, cinq formes de proximité sont d'abord présentées, qui répondent aux dimensions suivantes : cognitive, organisationnelle, sociale, institutionnelle et géographique. Pour chacune de ces cinq dimensions, sont ensuite analysés les impacts aussi bien positifs que négatifs de la proximité sur l'économie, en particulier sur l'apprentissage et l'innovation. Enfin, à partir de la constatation de l'existence de liens entre les différentes formes de proximité, on se demande quelles pourraient être les combinaisons possibles et de ces dernières dans le but d'améliorer les processus d'apprentissage et de production d'innovations. Quelques pistes de réflexion sont formulées à ce sujet.

Safety and tolerability of aripiprazole in patients with schizophrenia stratified by race

L’objectif de cet article est d’exposer une stratégie de réintroduction de la clozapine associée au filgrastim après un épisode de neutropénie entrainant l’arrêt de la clozapine, autour d’un cas. B.N., âgé de 35 ans, originaire de la Martinique, souffrant d’une schizophrénie résistante, pour laquelle il est « ultra répondeur » à la clozapine. En rupture de traitement, après quatre années de stabilité clinique sous clozapine, B.N. a présenté lors de trois réintroductions de la clozapine (2008, 2010 et 2011), trois épisodes de neutropénie. Nous avons donc réalisé une quatrième réintroduction sous couverture de filgrastim (G-CSF) 0,6 mg/semaine. L’amélioration à été notée dès le huitième jour. Après huit semaines de traitement, le patient est stabilisé sous clozapine 300 mg/j. L’évolution est clairement favorable, la PANNS est passée de 158 à 90. Il n’a pas été constaté de nouvel épisode de neutropénie, avec au plus bas 1,9 G/L neutrophiles. La posologie de filgrastim a donc pu être réduite à partir de la septième semaine à 0,3 mg/semaine avec poursuite d’une surveillance hebdomadaire de la NFS pendant la durée du traitement. La tolérance est satisfaisante, avec amélioration des anomalies induites par le traitement antérieur, c’est-à-dire du bilan lipidique, de la glycémie, de la pression artérielle et de l’intervalle QT à l’ECG. Nous avons également soulevé un biais de notoriété de la clozapine qui n’est souvent pas l’unique facteur étiologique à la neutropénie (autres médicaments hématotoxiques, rythme circadien, neutropénie transitoire, neutropénie ethnique).The frequency of agranulocytosis induced by psychoactive drugs is estimated the first year of around 0.8% under clozapine, against 0.13% under chlorpromazine (King and Wager, 1998 [3]). It is associated with a mortality rate of 5 to 10%, and requires heavy treatment, usually in an intensive care unit. The objective of this paper is to present a practical therapeutic answer (clozapine rechallenge with filgrastim) through a case report following a neutropenia episode preventing clozapine use.B.N. aged 35, native of Martinique, shows a resistant schizophrenia disorder “ultra sensitive” to clozapine. Without any treatment, after 4 years in stable clinical state under clozapine, B.N. suffered three neutropenia episodes when absorbing clozapine (2008, 2010 and 2011). First, a literature survey was conducted along with a consultation of the head of pharmacovigilance regional center and the hematology referee. Then, a 4th clozapine treatment was decided under cover of filgrastim (G-CSF), the role of which is to limit the risk of a new neutropenia.After stopping all psychoactive drugs, except morphine, the subject benefited from a first 0.3 mg filgrastim injection, the day before re-introducing 25 mg clozapine. Before treatment: Leucocytes = 4.8 G/L while absolute neutrophils count = 2.4 G/L. Filgrastim injections were carried out at a rate of two 0.3 mg injections per week. Clozapine was increased to reach 25 mg every 3 days and electroconvulsivotherapy continued fortnightly while supervision was double: on the first hand, daily and clinical search for an increase in body temperature and signs of treatment intolerance, and on the other hand biological surveillance with NFS three times a week besides weekly clozapinemia. The well-informed consent of the patient was obtained.Signs of improvement were noticed as early as the 8th day and after 8 weeks of treatment and 31 sessions of ECT, the patient was stabilized under clozapine at 300 mg per day. The evolution is clearly favorable, as PANNS evolved from 158 to 90. Neutropenia episodes were not observed with a lowest measured rate of 1.9 G/L neutrophils. The filgrastim dosage was then reduced to 0.3 mg per week from the 7th week onwards, along with the pursuit of a weekly NFS supervision throughout the treatment. Tolerance is satisfying, with an improvement in lipid check, glycaemia, blood pressure and QT intervals during ECG.The B.N. case isn’t an isolated one as several articles refer to filgrastim use, combined with clozapine. This confirms the role of hematopoietic cytokines (mainly G-CSF) in neutropenia episodes induced by clozapine. Filgrastim dosage appears to be an important point with regards to the risk of a new neutropenia episode. Let's mention also that it is not a harmless treatment, it could hide the occurrence of neutropenia, besides it's expensive and invasive. Clinical and biological supervision is essential as the probability of an enhanced malignant hemopathy is low but nonetheless present. We also noticed a “biased notoriety of the clozapine”, with the association with other hematotoxic molecules, the existence of a circadian rhythm of neutrophils or G-CSF, along with transitional or ethnical neutropenia. These points should be discussed thoroughly before exclusively accusing clozapine; this in turn would have consequences regarding the possibility of treatment resumption. Finally, association with lithium is also an option; several cases have already been reported.

Changing Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous Left Coronary Artery Originating From the Pulmonary Artery.

HomeCirculationVol. 103, No. 16Changing Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous Left Coronary Artery Originating From the Pulmonary Artery Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBChanging Electrocardiographic Patterns During Medical Treatment in a Patient With Anomalous Left Coronary Artery Originating From the Pulmonary Artery Dona Brekke, Curt G. DeGroff and Michael Schaffer Dona BrekkeDona Brekke From Pediatric Cardiology, University of Colorado Health Science Center, The Children’s Hospital, Denver. Search for more papers by this author , Curt G. DeGroffCurt G. DeGroff From Pediatric Cardiology, University of Colorado Health Science Center, The Children’s Hospital, Denver. Search for more papers by this author and Michael SchafferMichael Schaffer From Pediatric Cardiology, University of Colorado Health Science Center, The Children’s Hospital, Denver. Search for more papers by this author Originally published24 Apr 2001https://doi.org/10.1161/01.CIR.103.16.e85Circulation. 2001;103:e85–e86A6-month-old child with clinical signs of heart failure and cardiomegaly on chest radiograph was referred for evaluation. An echocardiogram and angiogram demonstrated an anomalous left coronary artery originating from the pulmonary artery (ALCAPA). After 3 days of intensive medical management including intravenous inotropes and diuretics, significant differences were found in the ECGs on the day of admission (Figure 1) versus before surgery on day 3 after admission (Figure 2).Typical findings on the ECG for patients with ALCAPA have previously been well described. The abrupt loss of the R wave in the midprecordial leads associated with ALCAPA is not seen on the presenting ECG (Figure 1) but is seen on day3 (Figure 2). Prominent Q waves associated with ALCAPA in leads I and aVL are not present in the first ECG (Figure 1); they become prominent, however, on day 3 (Figure 2). Conversely, typical prominent Q waves in lead V6 associated with ALCAPA are evident on the first ECG (Figure 1) but not on the ECG taken on day 3 (Figure 2).Previous studies have indicated that individual patients with ALCAPA can present with any combination of the findings mentioned. Such ECG changes in the course of medical therapy, however, have not been reported. We speculate that such changes occurred as a result of decreased pulmonary pressures (confirmed by echocardiogram), encouraging a dynamic coronary steal phenomenon. Download figureDownload PowerPoint Figure 1. ECG from day 1 of presentation in patient with ALCAPA. Typical prominent Q waves are present in lead V6. Conversely, typical abrupt loss of R waves in midprecordial leads and prominent Q waves in leads I and aVL associated with ALCAPA are not present.Download figureDownload PowerPoint Figure 2. ECG of patient on day 3 of presentation after medical management. Typical abrupt loss of R waves in midprecordial leads associated with ALCAPA is clearly seen. Typical prominent Q waves in leads I and aVL are present. Conversely, typical prominent Q waves in lead V6 (Figure 1) are not present. Note, Figure 1 is at full standard (10 mm/mV), and Figure 2 is at half standard (5 mm/mV).FootnotesCorrespondence to Curt G. DeGroff, MD, Cardiovascular Flow Dynamics Laboratory, UCHSC, The Children’s Hospital, 1056 E 19th Ave, B100, Denver, CO 80218. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hoffman J (2012) Electrocardiogram of Anomalous Left Coronary Artery From the Pulmonary Artery in Infants, Pediatric Cardiology, 10.1007/s00246-012-0599-7, 34:3, (489-491), Online publication date: 1-Mar-2013. Ramírez S, Curi-Curi P, Calderón-Colmenero J, García J, Britton C, Erdmenger J, Buendía A and Cervantes-Salazar J (2011) Outcomes of Coronary Reimplantation for Correction of Anomalous Origin of Left Coronary Artery From Pulmonary Artery, Revista Española de Cardiología (English Edition), 10.1016/j.rec.2011.04.014, 64:8, (681-687), Online publication date: 1-Aug-2011. Ramírez S, Curi-Curi P, Calderón-Colmenero J, García J, Britton C, Erdmenger J, Buendía A and Cervantes-Salazar J (2011) Resultados del reimplante coronario para la corrección del origen anómalo de la coronaria izquierda a partir de la arteria pulmonar, Revista Española de Cardiología, 10.1016/j.recesp.2011.04.015, 64:8, (681-687), Online publication date: 1-Aug-2011. Cohen M and Berger S (2010) The electrocardiogram as an adjunct in diagnosing congenital coronary arterial anomalies, Cardiology in the Young, 10.1017/S1047951110001101, 20:S3, (59-67), Online publication date: 1-Dec-2010. El-Feky M and Weerakkody Y (2010) Anomalous left coronary artery from the pulmonary artery Radiopaedia.org, 10.53347/rID-9750 April 24, 2001Vol 103, Issue 16 Advertisement Article InformationMetrics Copyright © 2001 by American Heart Associationhttps://doi.org/10.1161/01.CIR.103.16.e85 Originally publishedApril 24, 2001 PDF download Advertisement

Determination, through titration with NO, of the concentration of oxygen atomsin the flowing afterglow of Ar-O2 and N2-O2 plasmas used for sterilizationpurposes

Les méthodes existantes de titrage de N et O d'une post-décharge aumoyen de l'intensité d'émission de la molécule NO excitée ne permettant pasd'aller au-delà de x = 5% dans un mélange xO2-(100%-x)N2, nous présentons unedémarche valable pour x⩽20%. Cette technique est fondée sur la mesure del'intensité d'émission de NO2(A), en fonction du débit de NO introduit, enrelation avec une dérivation analytique des équations des concentrations [N]et [O]. La concentration d'oxygène atomique obtenue par cette méthode estvalidée de façon indépendante à partir de la mesure du rapport des intensitésd'émission de NO(B) et de N2(B, 11) (celle-ci détectable pour x⩽8%). Enfin,la méthode proposée est mise en oeuvre pour apprécier l'influence de la valeurde la concentration d'oxygène atomique sur le temps de stérilisation dans unepost-décharge en flux à partir d'un plasma de N2-O2.\\engabstract Existing titration methods of N and O in an afterglow based on theemission intensity of the excited NO molecule cannot be used at x valuesexceeding 5% in the xO2-(100%-x)N2 mixture. Our technique extends the x rangeto 20%. It utilizes the emission intensity measurement of NO2(A), as afunction of the introduced NO flow, in relation with analytically derivedequations for the O and N concentrations. The atomic oxygen concentrationobtained in this way is validated independently through measurements of theemission intensity ratio of NO(B) and N2(B, 11) (detectable for x⩽8%).Finally, the proposed method is used to assess the influence of the oxygenatom concentration on the sterilization time in the flowing afterglow of anN2-O2 plasma.

Barthesian Discourse: Having Your Cake and Eating It Too

When Philippe Sollers set out in May 1980, shortly after Roland Barthes' death, to write a succinct preface to the new, abridged edition of the seminal collective work of Tel Quel known as Theorie d'ensemble (originally published in 1968), (1) it was appropriate that he should try to summarize some of the major aims of the volume's contributors. In his words, the book's essence port[ait] sur un reve: unifier la reflexion et declencher a partir de la generalisee.(7) Born of a no doubt utopian critical dream of unifying the many contemporary varieties of structuralism in vogue at the time, and closely connected to the infamous evenements de mai 68, Theorie d'ensemble does indeed read (still) like a compendium of the major provocative ideas of that era. Even in an abridged format, the volume unfolds like a series of usually deliberate attempts to subvert various institutional powers and instances within the literary arena. As it happens, Sollers ends his preface by giving hommage to a towering figure whose essay appears second only to one by Michel Foucault in both the new and old editions of the collection. Clearly, he wished thereby to place this entire methodological and theoretical crucible (creuset), as he calls it, sous le signe de quelqu'un dont la complicite a tellement compte dans ces jours de mutation aventureuse, quelqu'un qui vient de nous quitter mais dont le style d'intervention, par son ampleur, sa justesse, sa mesure, nous aidait et nous aidera encore a aller plus loin: Roland Barthes. (7) Taking Sollers' assessment seriously, I should like to suggest that Barthes's work as a whole must be read as an on-going quest for a subversion generale. In doing so, I am hardly going out on a weak limb inasmuch as in countless other studies practically every other critic who has ever written on Barthes documents similar, subversive stylistic proclivities. In her recent book Sens et non-sens de la revolte, (2) Julia Kristeva, for instance, rereads the early writings of Barthes (beginning with Le Degre zero de l'ecriture and Mythologies) with an eye towards this very tendency, which she effectively extends to the rest of the Barthesian corpus. Emphasizing the ever-present semi ological project that underlies all of Barthes' texts--which she first defines, after Saussure, not as a simple formalisation, mais recherche des lois dialectiques de la signifiance--Kristeva immediately goes on to insist that Barthes' real goal was une desubstantification de l'idealite signifiante. C'est dire que la portee de ces textes est d'abord negative. (436) In other words, from at least two of his closest acquaintances, Sollers and Kristeva, we get the distinct impression that Barthes was a rebel with seemingly countless causes. Unwilling to accept set categories and structures, Barthes was a writer whose subjectivity: defini[e] dans le topos de sa communication avec l'autre, commence par nier cette communication pour pouvoir formuler un autre dispositif. Negatif du premier dit naturel, ce nouveau langage est par consequent non plus communicatif, mais, dironsnous, transformatif, quand il n'est pas mortel aussi bien pour le je que pour l'autre. (436) It would appear, then, that Barthes was concerned primarily with breaking or transforming our reading and writing habits, with forcing us not to look backwards, as it were, at what texts (in the widest acceptation of that term) have always been said to express, but to look ahead instead to what else they might be saying. Literary language, in particular, was significant to Barthes not because it reminds us of things we already know, but because of what it can tell us now and in the future about other impulses, forces, and significations, which are discreetly at work within what he calls ecriture. Thus, with regard to his specific study of mythologies, for example, Kristeva points out that: A l'oppose d'un structuralisme qui cherchait dans le mythe les structures permanentes de l'esprit humain [an allusion to the kind of early structuralist project of, say, a Levi-Strauss], c'est la surdetermination sociale et historique que Barthes vise a travers le phenomene discursif. …

In Situ Ultrasonic Study of High-Alumina Castables

Young's modulus changes in high-alumina castables were non-destructively measured from room temperature to 1600°C using a laboratory-made ultrasonic apparatus. Besides Young's modulus experiments, quantitative X-ray diffraction, dilatometry, surface area and porosimetry tests were used to investigate hydrate decomposition, phase changes, sintering phenomena and effect of silica-fume addition. Elastic moduli of calcium aluminates were measured as a function of porosity and extrapolated to zero-porosity. Non-destructive measurement of Young's modulus is a valuable technique for studying the influence of heat treatments and the role of additives on the castable behavior.On a mesuré par technique non destructive, à partir de la température ambiante jusqu'à 1600°C, les changements du module d'Young de bétons à teneur élevé en alumine, en utilisant un appareil ultrasonore fabriqué au laboratoire. En plus des expériences de module d'Young, on a utilisé la diffraction quantitative des rayons X, la dilatométrie, la surface spécifique ainsi que la porosimétrie pour examiner la décomposition des hydrates, les changements de phases, les phénomènes de frittage ainsi que l'effet de l'addition de fumée de silice. On a mesuré les modules d'élasticité d'aluminates de calcium en fonction de la porosité et on a extrapolé pour une porosité nulle. La mesure non destructive du module d'Young est une technique valable pour l'étude de l'influence des traitements thermiques et du rôle des additifs sur le comportement des bétons.

A derivation of thermodynamic principles

A detailed macroscopic description as in continuum mechanics, and just the concept of microstate, have been used to derive thermodynamics from mechanics. In opposition to statistical physics, the derivation lays emphasis on a definite prescription for macrostates (and non-equilibrium entropy), and uses basic features of the macrostate concept: complementary descriptions, involving either conservative and additive quantities or densities; scale-free character; reference to finite velocities and regions distant in space, thus introducing time indirectly. On the other hand, the derivation keeps the particle substratum (limit of number of particles taken at fixed densities), and makes no ergodic-type considerations.Resumen. Se introduce la detallada descripción macroscópica de la mecánica de medios continuos, junto al simple concepto de microestado, para derivar la termodinámica a partir de la mecánica. En oposición a la física estadística, la derivación enfatiza una prescripción precisa para macroestados (y la entropía fuera del equilibrio) y utiliza rasgos básicos del concepto de macroestado: descripciones complementarias que involucran densidades ó cantidades conservativas y aditivas; ausencia de escala absoluta; referencia a velocidades finitas y regiones distantes en el espacio, lo que reintroduce el tiempo indirectamente. Por el contrario, la derivación mantiene la estructura de partículas del medio (límite de número de partículas tomado a densidad constante) y evita consideraciones de tipo ergódico.