Suchergebnisse

The delivery of primary care in multi-professional health care centres (MSPs) has met with growing interest over the past few years. These types of care organisations have been presented as a solution to the challenges associated with population ageing, the increasing prevalence of chronic diseases, the rise of inequalities in healthcare and of healthcare expenditures. MSPs contribute to the questioning of the French health care system, based historically on a curative and hospital-centred model complemented by a self-employed, isolated and city-concentrated system of medical practice. The need to give primary care a central place in the system has become an objective shared by public institutions and by some self-employed healthcare professionals (HCPs). It is associated with the aim of restructuring primary care in order to emphasize a prevention-based approach, in a more collective, coordinated, population-based and territory-based approach of public health. How are primary care practices being transformed within these MSPs? In the dynamics observed, what are the place and role played by preventive and educational practices? These questions are explored with a posture of "committed" research, based on a methodological and political reflection, involving medical, public health and sociological approaches. An analysis of the literature enables this research to place the development of MSPs in a continuum of organisational innovations, favoured by the decreasing number of doctors, the uneven distribution of HCPs and the territorialisation of healthcare provision. In order to seize - in a simultaneous and dynamic way - the current transformations and arrangements observed in MSPs and the meaning they have for the actors involved, the research is based on an ethnographical monograph of a project of MSP followed over a long period, and on interviews held with actors practicing in four different MSPs. The sociology of innovation enables us to highlight the "ways of doing things" and the translation operations that ...

The spatial reconstruction of the production, trade, transformation and consumption flows of a specific material, can become an important decision-help tool for improving resource management and for studying environmental pressures from the producer's to the consumer's viewpoint. One of the obstacles preventing its actual use in the decision-making process is that building such studies at various geographical scales proves to be costly both in time and manpower. In this article, we propose a semi-automatic methodology to overcome this issue: we describe our multi-scalar model and its data-reconciliation component and apply it to cereals flows. Namely, using official databases (Insee, Agreste, FranceAgriMer, SitraM) as well as corporate sources, we reconstructed the supply chain flows of the 22 French regions as well as the flows of four nested territories: France, the Rhône-Alpes région, the Isère département and the territory of the SCOT of Grenoble. We display the results using Sankey diagrams and discuss the intervals of confidence of the model's outputs. We conclude on the perspectives of coupling this model with economic, social and environmental aspects that would provide key information to decision-makers.

This project seeks to evaluate the success and degree of implementation of the Climate Change Action Plan for the Florida Reef System 2010-2015 (CCAPFRS). This Action Plan identifies interdisciplinary actions to be incorporated into reef management plans in order to address a myriad of climatic and non-climatic stressors to the reef system, minimize risks to coral reef dependent people and industries, and target scientific research priorities for strategic management. As we are now in the final year of the Action Plan, the status and degree of implementation of the plan's 40 recommendations has been unknown until now. A qualitative evaluation was designed due to a lack of monitoring, established benchmarks, and specific measures in the plan. Through stakeholder interviews, surveys, and independent Internet research, this project assessed to what degree the recommended actions had been implemented and developed a scorecard to consolidate information on management strategies underway that contribute to the general success of the Action Plan. The scorecard enhances communication among stakeholder groups and various governmental and state agencies regarding collective progress, and serves as a blueprint for a subsequent plan moving forward. This review process demonstrated the great benefits and value of monitoring and evaluation of action plans with application worldwide. Overall, it was found the plan is in a fairly good degree of implementation, with 80% of the plan's 40 action items addressed to some degree. The most success was found in research goals, and the area most in need regards fisheries management. Some priorities changed over time. There has been a strong monitoring and reporting network built in the region, with several programs utilizing "eyes and ears on the water". The capacity to respond and monitor coral bleaching events has also greatly increased.

In sub-Saharan Africa, nearly 10 million km² of land, the most fertile for animal and agricultural productions, are infested with tsetse flies limiting all development initiatives for sustainable agriculture. Tsetse flies transmit trypanosomes that cause human and animal african trypanosomosis, a debilitating disease of humans (sleeping sickness) and livestock (nagana). In 2000, the African Heads of State and Government decided to increase efforts to address the tsetse and trypanosomosis problem on the African continent and created the Pan-African Tsetse and Trypanosomosis Eradication Campaign (PATTEC). In this context, the Government of Senegal initiated a tsetse eradication program in the Niayes area using a Glossina palpalis gambiensis strain originating from Burkina Faso. The objective of this thesis was to optimize the use of the sterile insect technique (SIT) in West Africa in order to control the tsetse flies. A system to transport mature pupae over long distances has been developed and validated for male G. p. gambiensis pupae produced and irradiated either in Bobo-Dioulasso, Burkina Faso or in Bratislava, Slovakia (irradiation done in Seibersdorf, Austria) and then transported by air to Dakar, Senegal. The system, constituted of an insulated box and S8 packs, allowed the maintenance of pupae at a temperature of 10 ± 3°C and their transport during 2-3 days to the emergence center of ISRA, where they molted into sterile males which were used for the sterile insect technique.A quality control was carried out on a sample of 50 pupae from each batch (at least 2 batches per shipment) to determine the flight ability of sterile males and their survival under stress conditions (without feeding). The remaining emerging pupae were released in the target area of the eradication programme and were considered as control group. The described protocol for quality control will allow accurate monitoring of the quality of sterile males used in operational eradication programs organized in the context of PATTEC.A molecular ...

Intracranial cerebral aneurisms (ICA) are a frequent extra-renal manifestation of autosomal dominant polycystic kidney disease (ADPKD). Its main complication is subarachnoid haemorrhage, which is associated with a high morbidity and mortality. Aneurysms can be screened using time-of-flight magnetic resonance imagery (MRI) without gadolinium enhancement.A web-based survey was conducted among 420 French-speaking nephrologists to determine the determinants of screening for ICA in ADPKD patients. Patients consulting for ADPKD at Necker hospital had a targeted ICA screening using MRI. They were followed-up prospectively for subarachnoid haemorrhage, and the results of the screening MRI, if performed, were recorded. ICA screening practices were very heterogeneous among the nephrologists who participated to our study, apart from a few consensual indications such as in case of family history of subarachnoid haemorrhage. After targeted screening, the rate of aneurisms detected was high. However, subarachnoid haemorrhage occurred mostly in the population not targeted by this screening. Benefits of ICA screening in ADPKD have never been evaluated with a prospective, controlled study, and systematic screening is not recommended according to expert opinions. This study shows the necessity to evaluate the benefits of systematic versus targeted screening of ICA in this population using a randomised controlled trial. It will help to predict the rate of events and therefore to determine the number of subjects to include in such study. ; Les anévrismes cérébraux sont des manifestations extra-rénales fréquentes dans la polykystose rénale autosomique dominante, dont la complication principale, la rupture anévrismale, présente une grande sévérité. Les anévrismes peuvent être dépistés à partir d'angio-IRM (ARM) cérébrales sans injection de produit de contraste. Une enquête des pratiques sur le dépistage des anévrismes a été conduite auprès de 420 néphrologues francophones qui ont répondu par email à un questionnaire sur leurs pratiques de prescription des ARM de dépistage. De plus, les patients polykystiques suivis en consultation à Necker ont fait l'objet d'une politique de dépistage ciblé et d'un suivi prospectif ; les résultats des ARM de dépistage et la survenue d'évènements neurologiques ont été surveillés. Les pratiques de dépistage paraissent très hétérogènes parmi les néphrologues interrogés, en dehors de quelques indications consensuelles, comme en cas d'antécédent familial d'hémorragie méningée. La réalisation d'un dépistage ciblé permet de mettre en évidence un taux élevé d'anévrisme sur les examens de dépistage. Toutefois, les ruptures d'anévrismes surviennent essentiellement dans la population non ciblée par ce dépistage dans notre étude. Le bénéfice du dépistage de ces anévrismes n'a jamais été étudié de façon prospective et contrôlée, et fait l'objet de recommandations basées sur des avis d'experts. Cette étude montre la nécessité d'évaluer à l'aide d'une étude contrôlée et randomisée le bénéfice d'un dépistage systématique par rapport à un dépistage ciblé des anévrismes dans cette population, et aidera à prévoir le taux d'événement attendu pour déterminer le nombre de sujets à inclure.

The delivery of primary care in multi-professional health care centres (MSPs) has met with growing interest over the past few years. These types of care organisations have been presented as a solution to the challenges associated with population ageing, the increasing prevalence of chronic diseases, the rise of inequalities in healthcare and of healthcare expenditures. MSPs contribute to the questioning of the French health care system, based historically on a curative and hospital-centred model complemented by a self-employed, isolated and city-concentrated system of medical practice. The need to give primary care a central place in the system has become an objective shared by public institutions and by some self-employed healthcare professionals (HCPs). It is associated with the aim of restructuring primary care in order to emphasize a prevention-based approach, in a more collective, coordinated, population-based and territory-based approach of public health. How are primary care practices being transformed within these MSPs? In the dynamics observed, what are the place and role played by preventive and educational practices? These questions are explored with a posture of "committed" research, based on a methodological and political reflection, involving medical, public health and sociological approaches. An analysis of the literature enables this research to place the development of MSPs in a continuum of organisational innovations, favoured by the decreasing number of doctors, the uneven distribution of HCPs and the territorialisation of healthcare provision. In order to seize - in a simultaneous and dynamic way - the current transformations and arrangements observed in MSPs and the meaning they have for the actors involved, the research is based on an ethnographical monograph of a project of MSP followed over a long period, and on interviews held with actors practicing in four different MSPs. The sociology of innovation enables us to highlight the "ways of doing things" and the translation operations that ...

A discourse focused on the Other is firmly anchored in medical discourse. But what Other is being spoken about? What identity are we talking about when considering the otherness, recognition and vulnerability of the recipient of care? Whom are we recognising? Here, we will be exploring the relational balance within the patient-carer relationship in the field of dentofacial orthopedics. A structural approach to social representations, using concept maps, will be adopted in order to examine the relationship of the therapeutic partners to the concept of care provision - a symbolic component of the treatment process which is difficult to define explicitly. Introducing the notion of care provision means placing an emphasis on the ethical, technical and political content of the care relationship. The notion of the favourable reception of the patient, a central element of the relationship which is revealed by an analysis of representations based on questionnaires, highlights the role of identity in the contemporary reconfiguration of the care relationship - a hybrid model which combines a modulated form of medical paternalism and comparative emancipation. This original perspective enables us to examine these various value registers, which illustrate and testify to the notion of the individual. This dialectic of sameness and the Other, of the identity and the recognition of the participants, thus gives rise to a debate, simultaneously theoretical, ethical and political, focused on the relational space associated with care. ; Le discours sur l'Autre s'ancre dans le discours médical. Mais de quel Autre s'agit-il ? De quelle identité parlons nous dès lors qu'il s'agit d'altérité, de reconnaissances et de vulnérabilités du sujet de soin ? Qui reconnaît-on ? Nous explorons ici les équilibres relationnels au sein de la relation soignant-soigné en Orthopédie dento-faciale hospitalière. A travers une l'approche structurale des représentations sociales, via l'utilisation de cartes conceptuelles, est interrogé le rapport des ...

In sub-Saharan Africa, nearly 10 million km² of land, the most fertile for animal and agricultural productions, are infested with tsetse flies limiting all development initiatives for sustainable agriculture. Tsetse flies transmit trypanosomes that cause human and animal african trypanosomosis, a debilitating disease of humans (sleeping sickness) and livestock (nagana). In 2000, the African Heads of State and Government decided to increase efforts to address the tsetse and trypanosomosis problem on the African continent and created the Pan-African Tsetse and Trypanosomosis Eradication Campaign (PATTEC). In this context, the Government of Senegal initiated a tsetse eradication program in the Niayes area using a Glossina palpalis gambiensis strain originating from Burkina Faso. The objective of this thesis was to optimize the use of the sterile insect technique (SIT) in West Africa in order to control the tsetse flies. A system to transport mature pupae over long distances has been developed and validated for male G. p. gambiensis pupae produced and irradiated either in Bobo-Dioulasso, Burkina Faso or in Bratislava, Slovakia (irradiation done in Seibersdorf, Austria) and then transported by air to Dakar, Senegal. The system, constituted of an insulated box and S8 packs, allowed the maintenance of pupae at a temperature of 10 ± 3°C and their transport during 2-3 days to the emergence center of ISRA, where they molted into sterile males which were used for the sterile insect technique.A quality control was carried out on a sample of 50 pupae from each batch (at least 2 batches per shipment) to determine the flight ability of sterile males and their survival under stress conditions (without feeding). The remaining emerging pupae were released in the target area of the eradication programme and were considered as control group. The described protocol for quality control will allow accurate monitoring of the quality of sterile males used in operational eradication programs organized in the context of PATTEC.A molecular ...

В статье рассматриваются проблемы охраны персональных данных граждан в России. Предлагаются меры по совершенствованию действующего уголовного законодательства. ; In the article the problems of protection of personal data of citizens in Russia are considered. Measures for improvement of the existing criminal legislation are offered.

A discourse focused on the Other is firmly anchored in medical discourse. But what Other is being spoken about? What identity are we talking about when considering the otherness, recognition and vulnerability of the recipient of care? Whom are we recognising? Here, we will be exploring the relational balance within the patient-carer relationship in the field of dentofacial orthopedics. A structural approach to social representations, using concept maps, will be adopted in order to examine the relationship of the therapeutic partners to the concept of care provision - a symbolic component of the treatment process which is difficult to define explicitly. Introducing the notion of care provision means placing an emphasis on the ethical, technical and political content of the care relationship. The notion of the favourable reception of the patient, a central element of the relationship which is revealed by an analysis of representations based on questionnaires, highlights the role of identity in the contemporary reconfiguration of the care relationship - a hybrid model which combines a modulated form of medical paternalism and comparative emancipation. This original perspective enables us to examine these various value registers, which illustrate and testify to the notion of the individual. This dialectic of sameness and the Other, of the identity and the recognition of the participants, thus gives rise to a debate, simultaneously theoretical, ethical and political, focused on the relational space associated with care. ; Le discours sur l'Autre s'ancre dans le discours médical. Mais de quel Autre s'agit-il ? De quelle identité parlons nous dès lors qu'il s'agit d'altérité, de reconnaissances et de vulnérabilités du sujet de soin ? Qui reconnaît-on ? Nous explorons ici les équilibres relationnels au sein de la relation soignant-soigné en Orthopédie dento-faciale hospitalière. A travers une l'approche structurale des représentations sociales, via l'utilisation de cartes conceptuelles, est interrogé le rapport des ...

A discourse focused on the Other is firmly anchored in medical discourse. But what Other is being spoken about? What identity are we talking about when considering the otherness, recognition and vulnerability of the recipient of care? Whom are we recognising? Here, we will be exploring the relational balance within the patient-carer relationship in the field of dentofacial orthopedics. A structural approach to social representations, using concept maps, will be adopted in order to examine the relationship of the therapeutic partners to the concept of care provision - a symbolic component of the treatment process which is difficult to define explicitly. Introducing the notion of care provision means placing an emphasis on the ethical, technical and political content of the care relationship. The notion of the favourable reception of the patient, a central element of the relationship which is revealed by an analysis of representations based on questionnaires, highlights the role of identity in the contemporary reconfiguration of the care relationship - a hybrid model which combines a modulated form of medical paternalism and comparative emancipation. This original perspective enables us to examine these various value registers, which illustrate and testify to the notion of the individual. This dialectic of sameness and the Other, of the identity and the recognition of the participants, thus gives rise to a debate, simultaneously theoretical, ethical and political, focused on the relational space associated with care. ; Le discours sur l'Autre s'ancre dans le discours médical. Mais de quel Autre s'agit-il ? De quelle identité parlons nous dès lors qu'il s'agit d'altérité, de reconnaissances et de vulnérabilités du sujet de soin ? Qui reconnaît-on ? Nous explorons ici les équilibres relationnels au sein de la relation soignant-soigné en Orthopédie dento-faciale hospitalière. A travers une l'approche structurale des représentations sociales, via l'utilisation de cartes conceptuelles, est interrogé le rapport des ...

The spatial reconstruction of the production, trade, transformation and consumption flows of a specific material, can become an important decision-help tool for improving resource management and for studying environmental pressures from the producer's to the consumer's viewpoint. One of the obstacles preventing its actual use in the decision-making process is that building such studies at various geographical scales proves to be costly both in time and manpower. In this article, we propose a semi-automatic methodology to overcome this issue: we describe our multi-scalar model and its data-reconciliation component and apply it to cereals flows. Namely, using official databases (Insee, Agreste, FranceAgriMer, SitraM) as well as corporate sources, we reconstructed the supply chain flows of the 22 French regions as well as the flows of four nested territories: France, the Rhône-Alpes région, the Isère département and the territory of the SCOT of Grenoble. We display the results using Sankey diagrams and discuss the intervals of confidence of the model's outputs. We conclude on the perspectives of coupling this model with economic, social and environmental aspects that would provide key information to decision-makers.

A discourse focused on the Other is firmly anchored in medical discourse. But what Other is being spoken about? What identity are we talking about when considering the otherness, recognition and vulnerability of the recipient of care? Whom are we recognising? Here, we will be exploring the relational balance within the patient-carer relationship in the field of dentofacial orthopedics. A structural approach to social representations, using concept maps, will be adopted in order to examine the relationship of the therapeutic partners to the concept of care provision - a symbolic component of the treatment process which is difficult to define explicitly. Introducing the notion of care provision means placing an emphasis on the ethical, technical and political content of the care relationship. The notion of the favourable reception of the patient, a central element of the relationship which is revealed by an analysis of representations based on questionnaires, highlights the role of identity in the contemporary reconfiguration of the care relationship - a hybrid model which combines a modulated form of medical paternalism and comparative emancipation. This original perspective enables us to examine these various value registers, which illustrate and testify to the notion of the individual. This dialectic of sameness and the Other, of the identity and the recognition of the participants, thus gives rise to a debate, simultaneously theoretical, ethical and political, focused on the relational space associated with care. ; Le discours sur l'Autre s'ancre dans le discours médical. Mais de quel Autre s'agit-il ? De quelle identité parlons nous dès lors qu'il s'agit d'altérité, de reconnaissances et de vulnérabilités du sujet de soin ? Qui reconnaît-on ? Nous explorons ici les équilibres relationnels au sein de la relation soignant-soigné en Orthopédie dento-faciale hospitalière. A travers une l'approche structurale des représentations sociales, via l'utilisation de cartes conceptuelles, est interrogé le rapport des ...

International audience ; At a time when the work horse was subjected to heavy work such as pulling heavy loads, the adherence of his hoofs to the ground was a condition for the effectiveness of the animal machine. Horse shoes didn't vary in the Middle Ages, the horses being shod systematically with corrugated outer rim and fixed crampons shoes. Horse shoeing diversified considerably from the Renaissance and enjoyed its greatest variety in the nineteenth century, at a time when horses were selected to meet specialized stains. Hauling horse had shoes preserving them from injuries caused by the stones in the riverbeds; military horses were equipped with mobile spikes. In the field of civil traction, shoes often remained solid but the search for efficiency led inventors to propose highly innovative systems which were lighter and enhanced adherence. The transport companies that developed in Paris in the second half of the nineteenth century, and for which shoeing was a major economic and security issue, promoted innovations in this technical field. The horse shoe of Charlier, a variation of the shoes proposed by Lafosse during the XVIIIth century, enjoyed some success in the late 1860s. It was made of a thin metal rod embedded in the rim of the hoof, allowing the contact of the horn of the hoof with the ground while limiting its wear. Before being adopted, this innovation provoked controversy and conflict between the most influential veterinarians of the capital. ; À une époque où le cheval de travail était soumis à des travaux de force comme la traction de charges lourdes, l'adhérence de ses pieds au sol était une condition de l'efficacité de la machine animale. Si la ferrure a été assez peu variée au Moyen Âge, les chevaux étant ferrés systématiquement avec des fers à rive externe ondulée et à crampons fixes, elle s'est ensuite considérablement diversifiée à partir de la Renaissance et a connu sa plus grande variété au XIXe siècle, à une époque où les chevaux étaient sélectionnés pour répondre à des tâches ...

International audience ; At a time when the work horse was subjected to heavy work such as pulling heavy loads, the adherence of his hoofs to the ground was a condition for the effectiveness of the animal machine. Horse shoes didn't vary in the Middle Ages, the horses being shod systematically with corrugated outer rim and fixed crampons shoes. Horse shoeing diversified considerably from the Renaissance and enjoyed its greatest variety in the nineteenth century, at a time when horses were selected to meet specialized stains. Hauling horse had shoes preserving them from injuries caused by the stones in the riverbeds; military horses were equipped with mobile spikes. In the field of civil traction, shoes often remained solid but the search for efficiency led inventors to propose highly innovative systems which were lighter and enhanced adherence. The transport companies that developed in Paris in the second half of the nineteenth century, and for which shoeing was a major economic and security issue, promoted innovations in this technical field. The horse shoe of Charlier, a variation of the shoes proposed by Lafosse during the XVIIIth century, enjoyed some success in the late 1860s. It was made of a thin metal rod embedded in the rim of the hoof, allowing the contact of the horn of the hoof with the ground while limiting its wear. Before being adopted, this innovation provoked controversy and conflict between the most influential veterinarians of the capital. ; À une époque où le cheval de travail était soumis à des travaux de force comme la traction de charges lourdes, l'adhérence de ses pieds au sol était une condition de l'efficacité de la machine animale. Si la ferrure a été assez peu variée au Moyen Âge, les chevaux étant ferrés systématiquement avec des fers à rive externe ondulée et à crampons fixes, elle s'est ensuite considérablement diversifiée à partir de la Renaissance et a connu sa plus grande variété au XIXe siècle, à une époque où les chevaux étaient sélectionnés pour répondre à des tâches ...