Résumé Les professionnels de la psychiatrie et de la justice sont amenés à se rencontrer depuis de nombreuses années. Si les psychiatres apportent depuis longtemps leur contribution à la justice en ...tant qu’experts ou médecins coordonnateurs, à une place clairement définie, les relations sont parfois plus complexes dans deux domaines parfois source de questionnement dans nos pratiques. Nous aborderons l’articulation santé justice dans la prise en charge des obligations et injonctions de soin où nécessaire articulation et respect sans faille du secret professionnel et de la thérapie, amènent des relations parfois tendues qui nécessitent quelques aménagements. Nous aborderons ensuite l’application de la loi de juillet 2011 qui a instauré la judiciarisation garante du respect des droits du patient. Ces nouvelles dispositions, attendues majoritairement par notre profession, ne sont pourtant pas sans poser question, lorsque le juge ne s’en tient pas à juger sur la forme et le respect de la procédure mais s’invite sur le terrain de la clinique, allant jusqu’à remettre en question la poursuite d’une hospitalisation ou proposer la modification du projet de soin en préconisant la mise en place de soins sans consentement ambulatoires. Connaître les prérogatives, les contraintes de chacun mais aussi les limites de son champ d’intervention, peut permettre d’éviter les malentendus source de tension. La mise en place de temps de rencontre formalisés, comme les tables rondes santé justice, sur des questions théoriques et pratiques permet une connaissance mutuelle dans le respect des places de chacun. Enfin, la présence de juriste au sein des établissements psychiatriques peut également être une interface pertinente.
Entre harmonisation des pratiques et spécificité, les échanges en psychiatrie se développent à l’échelle européenne avec l’élaboration de nouveaux programmes mettant en œuvre des relations de ...partenariat autour de problématiques spécifiques. Si la législation est souvent différente, nous pouvons retrouver des préoccupations communes centrées autour de la clinique et des pratiques professionnelles. Notre propos déclinera les enjeux généraux, les valeurs réaffirmées des 2005 par les conférences françaises et allemandes autour du secteur, les notions de gestion du risque, la place des usagers, l’hospitalisation sous contrainte. Comment construire ces liens indispensables pour permettre de penser avec les différents acteurs une psychiatrie européenne ? Dans un premier temps, le Dr C. Müller, Président de la conférence, reprendra l’historique d’un mouvement débuté il y a bientôt 10 ans entre la France et l’Allemagne et bientôt rejoint par l’Espagne et l’Italie. Il évoquera également les liens entre la conférence des présidents de CME et l’ANPCME. Le Dr Cazenave fera une présentation succincte de l’ANPCME et évoquera ensuite les rencontres effectuées au sein des différents pays ainsi que les thématiques spécifiques issues de ces échanges à l’origine de l’élaboration d’un programme d’échange entre les professionnels du champ de la psychiatrie. Le Dr Loriant abordera enfin la mise en œuvre concrète d’un projet Erasmus+, les partenariats indispensables en France et à l’étranger, les écueils à éviter. La souplesse de rencontres informelles se heurte à la nécessaire reconnaissance de l’apport d’un dimensionnement officiel à l’échelon européen et aux contraintes budgétaires. En effet, si les échanges informels permettent de mieux connaître nos points communs et nos différences dans la pratique, la construction d’une pensée commune aux différents partenaires européens dans un souci d’harmonisation des pratiques, nécessite de poursuivre des échanges réguliers et protocolisés assortis d’une évaluation rigoureuse qui ne peut se faire que dans un cadre formalisé.
Aims
To validate strategies to prevent exercise‐induced hypoglycaemia via insulin‐dose adjustment in adult patients with type 1 diabetes (T1D) on pump therapy.
Methods
A total of 20 patients randomly ...performed four 30‐min late post‐lunch (3 h after lunch) exercise sessions and a rest session: two moderate sessions 50% maximum oxygen consumption (VO2max) with 50 or 80% basal rate (BR) reduction during exercise + 2 h and two intense sessions (75% VO2max) with 80% BR reduction or with their pump stopped. Two additional early post‐lunch sessions (90 min after lunch) were analysed to compare hypoglycaemia incidence for BR reduction versus bolus reduction.
Results
In all, 100 late post‐lunch sessions were analysed. Regardless of exercise type and BR reduction, no more hypoglycaemic events occurred in the period until the next morning than occurred after the rest sessions. In the afternoon, no more hypoglycaemic events occurred with 80% BR reduction/moderate exercise or with pump discontinuation/intense exercise than for the rest session, whereas more hypoglycaemic events occurred with 50% BR reduction/moderate exercise and 80% BR reduction/intense exercise. After early post‐lunch exercise (n = 37), a trend towards fewer hypoglycaemic episodes was observed with bolus reduction versus BR reduction (p = 0.07). Mean blood glucose fell by ∼3.3 mmol/l after 30 min of exercise, irrespective of dose reduction, remaining stable until the next morning with no rebound hyperglycaemia.
Conclusion
In adults with T1D, to limit the hypoglycaemic risk associated with 30 min of exercise 3 h after lunch, without carbohydrate supplements, the best options seem to be to reduce BR by 80% or to stop the pump for moderate or intense exercise, or for moderate exercise 90 min after lunch, to reduce the prandial bolus rather than the BR.
The scattering trans-Neptunian Objects (TNOs) can be measured to smaller sizes than any other distant small-body population. We use the largest sample yet obtained, 68 discoveries, primarily by the ...Outer Solar System Origins Survey (OSSOS), to constrain the slope of its luminosity distribution, with sensitivity to much fainter absolute H-magnitudes than previous work. Using the analysis technique in Shankman et al., we confirm that a single slope for the H-distribution is not an accurate representation of the scattering TNOs and Centaurs, and that a break in the distribution is required, in support of previous conclusions. A bright-end slope of b = 0.9 transitioning to a faint-end slope f of 0.4-0.5 with a differential number contrast c from 1 (a knee) to 10 (a divot) provides an acceptable match to our data. We find that break magnitudes Hb of 7.7 and 8.3, values both previously suggested for dynamically hot Kuiper Belt populations, are equally non-rejectable for a range of f and c in our statistical analysis. Our preferred divot H-distribution transitions to f = 0.5 with a divot of contrast c = 3 at Hb = 8.3, while our preferred knee H-distribution transitions to f = 0.4 at Hb = 7.7. The intrinsic population of scattering TNOs required to match the OSSOS detections is 3 × 106 for Hr < 12, and 9 × 104 for Hr < 8.66 (D 100 km), with Centaurs having an intrinsic population two orders of magnitude smaller.
Stroma in the tumor microenvironment plays a critical role in cancer progression, but how it promotes metastasis is poorly understood. Exosomes are small vesicles secreted by many cell types and ...enable a potent mode of intercellular communication. Here, we report that fibroblast-secreted exosomes promote breast cancer cell (BCC) protrusive activity and motility via Wnt-planar cell polarity (PCP) signaling. We show that exosome-stimulated BCC protrusions display mutually exclusive localization of the core PCP complexes, Fzd-Dvl and Vangl-Pk. In orthotopic mouse models of breast cancer, coinjection of BCCs with fibroblasts dramatically enhances metastasis that is dependent on PCP signaling in BCCs and the exosome component, Cd81 in fibroblasts. Moreover, we demonstrate that trafficking in BCCs promotes tethering of autocrine Wnt11 to fibroblast-derived exosomes. This work reveals an intercellular communication pathway whereby fibroblast exosomes mobilize autocrine Wnt-PCP signaling to drive BCC invasive behavior.
Display omitted
► Fibroblast exosomes promote BCC protrusive activity, motility, and invasion ► PCP signaling is required for exosome stimulation of BCC motility and invasion ► Core PCP pathway components distribute asymmetrically in exosome-stimulated BCCs ► BCC-produced Wnt tethers to fibroblast exosomes upon their internalization by BCCs
Wnt signals from stromal fibroblasts transmitted in exosomes activate the planar cell polarity pathway in breast cancer cells, promoting invasive behavior, suggesting one mechanism by which the tumor microenvironment can stimulate malignancy in a primary tumor.
Highlights • Astrocytes adjust local energy production to neuronal energy needs. • The “neurometabolic coupling” (NMC) mechanisms interact with sleep regulation. • Astrocyte network plays a role in ...sleep/NMC interactions. • Astrocytic NMC fit the “local and use dependent” sleep hypothesis.
One of the key challenges for future electronic memory and logic devices is finding viable ways of moving from today's two-dimensional structures, which hold data in an x-y mesh of cells, to ...three-dimensional structures in which data are stored in an x-y-z lattice of cells. This could allow a many-fold increase in performance. A suggested solution is the shift register--a digital building block that passes data from cell to cell along a chain. In conventional digital microelectronics, two-dimensional shift registers are routinely constructed from a number of connected transistors. However, for three-dimensional devices the added process complexity and space needed for such transistors would largely cancel out the benefits of moving into the third dimension. 'Physical' shift registers, in which an intrinsic physical phenomenon is used to move data near-atomic distances, without requiring conventional transistors, are therefore much preferred. Here we demonstrate a way of implementing a spintronic unidirectional vertical shift register between perpendicularly magnetized ferromagnets of subnanometre thickness, similar to the layers used in non-volatile magnetic random-access memory. By carefully controlling the thickness of each magnetic layer and the exchange coupling between the layers, we form a ratchet that allows information in the form of a sharp magnetic kink soliton to be unidirectionally pumped (or 'shifted') from one magnetic layer to another. This simple and efficient shift-register concept suggests a route to the creation of three-dimensional microchips for memory and logic applications.
Plastic pollution is a pervasive and growing problem. To estimate the effectiveness of interventions to reduce plastic pollution, we modeled stocks and flows of municipal solid waste and four sources ...of microplastics through the global plastic system for five scenarios between 2016 and 2040. Implementing all feasible interventions reduced plastic pollution by 40% from 2016 rates and 78% relative to "business as usual" in 2040. Even with immediate and concerted action, 710 million metric tons of plastic waste cumulatively entered aquatic and terrestrial ecosystems. To avoid a massive build-up of plastic in the environment, coordinated global action is urgently needed to reduce plastic consumption; increase rates of reuse, waste collection, and recycling; expand safe disposal systems; and accelerate innovation in the plastic value chain.
Summary
The association between socioeconomic status (SES) and hip fracture (HF) incidence was analyzed in France in 2008. In men and women, a decrease in HF incidence was observed as the social ...deprivation index increased. This result may be partly due to the protective effect of increasing body weight against HF.
Introduction
Regional variations in hip fracture (HF) incidence exist worldwide. Reasons for these variations remain unknown. As regional variations have also been observed for socioeconomic status, we analyzed the association between socioeconomic deprivation (SED) and HF incidence in France in 2008.
Methods
From the French Hospital National Database, we selected all HF encoded as primary diagnosis in persons aged 30 years and over. The recently published French version of the European Deprivation Index (EDI) was used for SED analysis, and an EDI score was measured for the year 2007 in each French local municipality. The EDI score was categorized in quintiles. Poisson regression was performed to examine the association between HF incidence and EDI adjusted for age and sex. The population attributable fraction (PAF) was measured to calculate the proportion of excess cases of HF associated with social affluence.
Results
In 2008, 83,538 HF were reported in France of which 59,143 were included in this study. Among them, 44,401 fractures occurred in women (75%) and 14,742 in men (25%). In both men and women, there was a decrease in the HF incidence with increasing SED index. In Poisson regression, the interaction of age class and sex was significant (
p
< 0.0001) and the EDI in quintiles was significantly associated with the incidence of HF (
p
< 0.0001). A higher number of people living in affluent residential areas corresponded to a higher risk of HF. The risk of HF is 2.42 times higher for those living in the most affluent group compared to those living in the most underprivileged group. The value of the PAF was calculated at 27.1%.
Conclusion
Social disparities in HF incidence exist in France with the most deprived municipalities having the lowest incidence. Prior knowledge demonstrates the strong relationships between body weight and HF risk as well as between body weight and the SED. The link found in our study between EDI and HF incidence as well as regional and temporal variations in HF incidence may be partly due to the protective effect of increased body weight against HF.
Abstract Non-alcoholic fatty liver disease (NAFLD) is very common in patients with type 2 diabetes (T2D), with approximately two-thirds having a diagnosis of the disease. Currently, the only ...validated treatment for NAFLD is weight loss. A number of studies of animal models and human trials have evaluated the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on liver fat content and suggest that the treatment could represent a new alternative for NAFLD management. In this review, our focus is on the main studies regarding the effects of GLP-1RAs on NAFLD. Also, the mechanisms that might explain their beneficial effects on liver diseases are analyzed.
PDF
