Occurrence of sectoral choroidal occlusive vasculopathy and retinal arteriolar embolization after superselective ophthalmic artery chemotherapy for advanced intraocular retinoblastoma.

BACKGROUND: : Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients. METHODS: : The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit. RESULTS: : Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a perioperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula. CONCLUSION: : Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.

Occurrence of sectoral choroidal occlusive vasculopathy and retinal arteriolar embolization after superselective ophthalmic artery chemotherapy for advanced intraocular retinoblastoma.

BACKGROUND:: Superselective ophthalmic artery chemotherapy (SOAC) has recently been proposed as an alternative to intravenous chemoreduction for advanced intraocular retinoblastoma. Preliminary results appear promising in terms of tumor control and eye conservation, but little is known regarding ocular toxicity and visual prognosis. In this study, we report on the vascular adverse effects observed in our initial cohort of 13 patients. METHODS:: The charts of 13 consecutive patients with retinoblastoma who received a total of 30 injections (up to 3 injections of a single agent per patient at 3-week interval) of melphalan (0.35 mg/kg) in the ophthalmic artery between November 2008 and June 2010 were retrospectively reviewed. RetCam fundus photography and fluorescein angiography were performed at presentation and before each injection. Vision was assessed at the latest visit. RESULTS:: Enucleation and external beam radiotherapy could be avoided in all cases but one, with a mean follow-up of 7 months. Sectoral choroidal occlusive vasculopathy leading to chorioretinal atrophy was observed temporally in 2 eyes (15%) 3 weeks to 6 weeks after the beginning of SOAC and retinal arteriolar emboli in 1 eye 2 weeks after injection. There was no stroke or other clinically significant systemic side effects except a peroperative transient spasm of the internal carotid artery in one patient. Vision ranged between 20/1600 and 20/32 depending on the status of the macula. CONCLUSION:: Superselective ophthalmic artery chemotherapy was effective in all patients with no stroke or other systemic vascular complications. Unlike intravenous chemoreduction, SOAC is associated with potentially sight-threatening adverse effects, such as severe chorioretinal atrophy secondary to subacute choroidal occlusive vasculopathy or central retinal artery embolism, not to mention the risk of ophthalmic artery obstruction, which was not observed in this series. Further analysis of the risks and benefits of SOAC will define its role within the therapeutic arsenal. Meanwhile, we suggest that SOAC should be given in one eye only and restricted to advanced cases of retinoblastoma, as an alternative to enucleation and/or external beam radiotherapy.

Automobile Corporate Networks in Europe : Sectoral Specialization of Central and Eastern European Cities

The global automobile industry is made up of very large corporations and their various subsidiaries containing different functions that create complex locational structures. The networks formed by the 19 largest automobile transnational corporations constitute an automobile "oligopoly" representing more than 90% (OICA, 2012) of the world's production. Since the mid-1990s, Central and Eastern European cities have become attractive for transnational corporations and particularly for the production functions in the automobile sector. This leads to a crucial question. Are strategic functions (such as R&D) within these networks also located in Central and Eastern Europe, or is the region still manufacturing-oriented in the automobile industry? This paper focuses on the patterns and the main factors influencing the role of some of these new central and Eastern European cities that have become integrated in the global value chain of the automobile industry. By analysing the various locations of the specialized functions within the corporations, this study aims to extend the research on global value chains (Gereffi and Korzeniewicz; 1994, Sturgeon, 2000; Krätke, 2014). The spatial patterns of the various functions and the ownerships networks of the automobile industry are constructed in order to identify the cities supporting it. In particular, the way that national metropolises bring their national territories into the globalization of the automobile industry is addressed. For example, are there some specific advantages of capital cities compared to cities that have less integration in globalization terms?

The de facto independence of regulatory agencies and its consequences for policy making and regulatory outcomes

This dissertation focuses on the practice of regulatory governance, throughout the study of the functioning of formally independent regulatory agencies (IRAs), with special attention to their de facto independence. The research goals are grounded on a "neo-positivist" (or "reconstructed positivist") position (Hawkesworth 1992; Radaelli 2000b; Sabatier 2000). This perspective starts from the ontological assumption that even if subjective perceptions are constitutive elements of political phenomena, a real world exists beyond any social construction and can, however imperfectly, become the object of scientific inquiry. Epistemologically, it follows that hypothetical-deductive theories with explanatory aims can be tested by employing a proper methodology and set of analytical techniques. It is thus possible to make scientific inferences and general conclusions to a certain extent, according to a Bayesian conception of knowledge, in order to update the prior scientific beliefs in the truth of the related hypotheses (Howson 1998), while acknowledging the fact that the conditions of truth are at least partially subjective and historically determined (Foucault 1988; Kuhn 1970). At the same time, a sceptical position is adopted towards the supposed disjunction between facts and values and the possibility of discovering abstract universal laws in social science. It has been observed that the current version of capitalism corresponds to the golden age of regulation, and that since the 1980s no government activity in OECD countries has grown faster than regulatory functions (Jacobs 1999). Following an apparent paradox, the ongoing dynamics of liberalisation, privatisation, decartelisation, internationalisation, and regional integration hardly led to the crumbling of the state, but instead promoted a wave of regulatory growth in the face of new risks and new opportunities (Vogel 1996). Accordingly, a new order of regulatory capitalism is rising, implying a new division of labour between state and society and entailing the expansion and intensification of regulation (Levi-Faur 2005). The previous order, relying on public ownership and public intervention and/or on sectoral self-regulation by private actors, is being replaced by a more formalised, expert-based, open, and independently regulated model of governance. Independent regulation agencies (IRAs), that is, formally independent administrative agencies with regulatory powers that benefit from public authority delegated from political decision makers, represent the main institutional feature of regulatory governance (Gilardi 2008). IRAs constitute a relatively new technology of regulation in western Europe, at least for certain domains, but they are increasingly widespread across countries and sectors. For instance, independent regulators have been set up for regulating very diverse issues, such as general competition, banking and finance, telecommunications, civil aviation, railway services, food safety, the pharmaceutical industry, electricity, environmental protection, and personal data privacy. Two attributes of IRAs deserve a special mention. On the one hand, they are formally separated from democratic institutions and elected politicians, thus raising normative and empirical concerns about their accountability and legitimacy. On the other hand, some hard questions about their role as political actors are still unaddressed, though, together with regulatory competencies, IRAs often accumulate executive, (quasi-)legislative, and adjudicatory functions, as well as about their performance.

Interactions between learning and immunity in Drosophila melanogaster

Learning and immunity are two adaptive traits with roles in central aspects of an organism's life: learning allows adjusting behaviours in changing environments, while immunity protects the body integrity against parasites and pathogens. While we know a lot about how these two traits interact in vertebrates, the interactions between learning and immunity remain poorly explored in insects. During my PhD, I studied three possible ways in which these two traits interact in the model system Drosophila melanogaster, a model organism in the study of learning and in the study of immunity. Learning can affect the behavioural defences against parasites and pathogens through the acquisition of new aversions for contaminated food for instance. This type of learning relies on the ability to associate a food-related cue with the visceral sickness following ingestion of contaminated food. Despite its potential implication in infection prevention, the existence of pathogen avoidance learning has been rarely explored in invertebrates. In a first part of my PhD, I tested whether D. melanogaster, which feed on food enriched in microorganisms, innately avoid the orally-acquired 'novel' virulent pathogen Pseudomonas entomophila, and whether it can learn to avoid it. Although flies did not innately avoid this pathogen, they decreased their preference for contaminated food over time, suggesting the existence of a form of learning based likely on infection-induced sickness. I further found that flies may be able to learn to avoid an odorant which was previously associated with the pathogen, but this requires confirmation with additional data. If this is confirmed, this would be the first time, to my knowledge, that pathogen avoidance learning is reported in an insect. The detrimental effect of infection on cognition and more specifically on learning ability is well documented in vertebrates and in social insects. While the underlying mechanisms are described in detail in vertebrates, experimental investigations are lacking in invertebrates. In a second part of my PhD, I tested the effect of an oral infection with natural pathogens on associative learning of D. melanogaster. By contrast with previous studies in insects, I found that flies orally infected with the virulent P. entomophila learned better the association of an odorant with mechanical shock than uninfected flies. The effect seems to be specific to a gut infection, and so far I have not been able to draw conclusions on the respective contributions of the pathogen's virulence and of the flies' immune activity in this effect. Interestingly, infected flies may display an increased sensitivity to physical pain. If the learning improvement observed in infected flies was due partially to the activity of the immune system, my results would suggest the existence of physiological connections between the immune system and the nervous system. The basis of these connections would then need to be addressed. Learning and immunity are linked at the physiological level in social insects. Physiological links between traits often result from the expression of genetic links between these traits. However, in social insects, there is no evidence that learning and immunity may be involved in an evolutionary trade-off. I previously reported a positive effect of infection on learning in D. melanogaster. This might suggest that a positive genetic link could exist between learning and immunity. We tested this hypothesis with two approaches: the diallel cross design with inbred lines, and the isofemale lines design. The two approaches provided consistent results: we found no additive genetic correlation between learning and resistance to infection with the diallel cross, and no genetic correlation in flies which are not yet adapted to laboratory conditions in isofemale lines. Consistently with the literature, the two studies suggested that the positive effect of infection on learning I observed might not be reflected by a positive evolutionary link between learning and immunity. Nevertheless, the existence of complex genetic relationships between the two traits cannot be excluded. - L'apprentissage et l'immunité sont deux caractères à valeur adaptative impliqués dans des aspects centraux de la vie d'un organisme : l'apprentissage permet d'ajuster les comportements pour faire face aux changements de l'environnement, tandis que l'immunité protège l'intégrité corporelle contre les attaques des parasites et des pathogènes. Alors que les interactions entre l'apprentissage et l'immunité sont bien documentées chez les vertébrés, ces interactions ont été très peu étudiées chez les insectes. Pendant ma thèse, je me suis intéressée à trois aspects des interactions possibles entre l'apprentissage et l'immunité chez la mouche du vinaigre Drosophila melanogaster, qui est un organisme modèle dans l'étude à la fois de l'apprentissage et de l'immunité. L'apprentissage peut affecter les défenses comportementales contre les parasites et les pathogènes par l'acquisition de nouvelles aversions pour la nourriture contaminée par exemple. Ce type d'apprentissage repose sur la capacité à associer une caractéristique de la nourriture avec la maladie qui suit l'ingestion de cette nourriture. Malgré les implications potentielles pour la prévention des infections, l'évitement appris des pathogènes a été rarement étudié chez les invertébrés. Dans une première partie de ma thèse, j'ai testé si les mouches, qui se nourrissent sur des milieux enrichis en micro-organismes, évitent de façon innée un 'nouveau' pathogène virulent Pseudomonas entomophila, et si elles ont la capacité d'apprendre à l'éviter. Bien que les mouches ne montrent pas d'évitement inné pour ce pathogène, elles diminuent leur préférence pour de la nourriture contaminée dans le temps, suggérant l'existence d'une forme d'apprentissage basée vraisemblablement sur la maladie générée par l'infection. J'ai ensuite observé que les mouches semblent être capables d'apprendre à éviter une odeur qui était au préalable associée avec ce pathogène, mais cela reste à confirmer par la collecte de données supplémentaires. Si cette observation est confirmée, cela sera la première fois, à ma connaissance, que l'évitement appris des pathogènes est décrit chez un insecte. L'effet détrimental des infections sur la cognition et plus particulièrement sur les capacités d'apprentissage est bien documenté chez les vertébrés et les insectes sociaux. Alors que les mécanismes sous-jacents sont détaillés chez les vertébrés, des études expérimentales font défaut chez les insectes. Dans une seconde partie de ma thèse, j'ai mesuré les effets d'une infection orale par des pathogènes naturels sur les capacités d'apprentissage associatif de la drosophile. Contrairement aux études précédentes chez les insectes, j'ai trouvé que les mouches infectées par le pathogène virulent P. entomophila apprennent mieux à associer une odeur avec des chocs mécaniques que des mouches non infectées. Cet effet semble spécifique à l'infection orale, et jusqu'à présent je n'ai pas pu conclure sur les contributions respectives de la virulence du pathogène et de l'activité immunitaire des mouches dans cet effet. De façon intéressante, les mouches infectées pourraient montrer une plus grande réactivité à la douleur physique. Si l'amélioration de l'apprentissage observée chez les mouches infectées était due en partie à l'activité du système immunitaire, mes résultats suggéreraient l'existence de connections physiologiques entre le système immunitaire et le système nerveux. Les mécanismes de ces connections seraient à explorer. L'apprentissage et l'immunité sont liés sur un plan physiologique chez les insectes sociaux. Les liens physiologiques entre les caractères résultent souvent de l'expression de liens entre ces caractères au niveau génétique. Cependant, chez les insectes sociaux, il n'y a pas de preuve que l'apprentissage et l'immunité soient liés par un compromis évolutif. J'ai précédemment rapporté un effet positif de l'infection sur l'apprentissage chez la drosophile. Cela pourrait suggérer qu'une relation génétique positive existerait entre l'apprentissage et l'immunité. Nous avons testé cette hypothèse par deux approches : le croisement diallèle avec des lignées consanguines, et les lignées isofemelles. Les deux approches ont fournies des résultats similaires : nous n'avons pas détecté de corrélation génétique additive entre l'apprentissage et la résistance à l'infection avec le croisement diallèle, et pas de corrélation génétique chez des mouches non adaptées aux conditions de laboratoire avec les lignées isofemelles. En ligne avec la littérature, ces deux études suggèrent que l'effet positif de l'infection sur l'apprentissage que j'ai précédemment observé ne refléterait pas un lien évolutif positif entre l'apprentissage et l'immunité. Néanmoins, l'existence de relations génétiques complexes n'est pas exclue.

L'exploitation des eaux souterraines en Syrie centrale : construction de diagnostics et politiques d'intervention

Syrian dry areas have been for several millennia a place of interaction between human populations and the environment. If environmental constraints and heterogeneity condition the human occupation and exploitation of resources, socio-political, economic and historical elements play a fundamental role. Since the late 1980s, Syrian dry areas are viewed as suffering a serious water crisis, due to groundwater overdraft. The Syrian administration and international development agencies believe that groundwater overexploitation is also leading to a decline of agricultural activities and to poverty increase. Action is thus required to address these problems.However, the overexploitation diagnosis needs to be reviewed. The overexploitation discourse appears in the context of Syria's opening to international organizations and to the market economy. It echoes the international discourse of "global water crisis". The diagnosis is based on national indicators recycling old Soviet data that has not been updated. In the post-Soviet era, the Syrian national water policy seems to abandon large surface water irrigation projects in favor of a strategy of water use rationalization and groundwater conservation in crisis regions, especially in the district of Salamieh.This groundwater conservation policy has a number of inconsistencies. It is justified for the administration and also probably for international donors, since it responds to an indisputable environmental emergency. However, efforts to conserve water are anecdotal or even counterproductive. The water conservation policy appears a posteriori as an extension of the national policy of food self-sufficiency. The dominant interpretation of overexploitation, and more generally of the water crisis, prevents any controversary approach of the status of resources and of the agricultural system in general and thus destroys any attempt to discuss alternatives with respect to groundwater management, allocation, and their inclusion in development programs.A revisited diagnosis of the situation needs to take into account spatial and temporal dimensions of the groundwater exploitation and to analyze the co-evolution of hydrogeological and agricultural systems. It should highlight the adjustments adopted to cope with environmental and economic variability, changes of water availability and regulatory measures enforcements. These elements play an important role for water availability and for the spatial, temporal, sectoral allocation of water resource. The groundwater exploitation in the last century has obviously had an impact on the environment, but the changes are not necessarily catastrophic.The current groundwater use in central Syria increases the uncertainty by reducing the ability of aquifers to buffer climatic changes. However, the climatic factor is not the only source of uncertainty. The high volatility of commodity prices, fuel, land and water, depending on the market but also on the will (and capacity) of the Syrian State to preserve social peace is a strong source of uncertainty. The research should consider the whole range of possibilities and propose alternatives that take into consideration the risks they imply for the water users, the political will to support or not the local access to water - thus involving a redefinition of the economic and social objectives - and finally the ability of international organizations to reconsider pre-established diagnoses.

Patients avec syndrome de Brugada et défibrillateur implanté : suivi clinique

Introduction :¦Le syndrome de Brugada (SB) se définit par une élévation du segment ST dans les dérivations précordiales droites (V1-V3) associée à une incidence élevée de mort subite par arythmies chez des patients sans cardiopathie structurelle. La prévention de la mort subite repose sur la pose d'un défibrillateur automatique implantable (DAI).¦Matériel et méthode :¦Cette étude est une analyse rétrospective de tous les patients avec SB implantés d'un DAI au CHUV entre 1998 et 2010. Le profil des patients, les complications, ainsi que les thérapies appropriées et inappropriées délivrées par le défibrillateur ont été évaluées. Une thérapie appropriée est définie par l'action appropriée du DAI (choc ou stimulation anti-tachycardie = ATP) en réponse à une TV ou une FV correctement détectée. La thérapie inappropriée est définie comme une thérapie délivrée par l'appareil en l'absence d'une arythmie ventriculaire.¦Résultats :¦Durant la période étudiée (01.01.1998 - 31.12.2010) nous avons collecté au total 23 patients soit 19 hommes (83%) et 4 femmes (17%) âgés de 12 à 60 ans (41 13 ans). Le rapport hommes/femmes est de 4.75. Le suivi quant à lui porte sur 21 patients: un patient, après échec de primo-implantation au CHUV, a été implanté d'un défibrillateur dans un autre canton et un second patient a été perdu de vue entre l'implantation et le premier contrôle prévu. Le suivi moyen des 21 patients restants est de 8432 mois (37-149 mois, médiane : 78 mois). Il y a eu au total 45 thérapies délivrées : 12 appropriées (8 chocs; 4 ATP) et 33 inappropriées. 18% des patients ont eu ≥ 1 thérapie appropriée alors que 43% ont eu ≥ 1 choc inapproprié. 14 des 23 patients (61%) ont eu ≥ 1 complication (9 avec chocs inappropriés, 7 avec complications opératoires après primo-implantations ou ré-interventions, 6 avec dysfonction de sonde ventriculaire et 1 avec explantation).¦Conclusion :¦Le profil de ce petit collectif de patients avec SB implantés d'un DAI au CHUV est comparable à celui décrit dans la littérature. Durant un suivi moyen de 7 ans après la primo-implantation, l'incidence d'arythmies ventriculaires malignes est faible, avec un taux annuel de 2.6%. Le taux de complication est quant à lui élevé (8.7%/an). Près des trois-quarts des thérapies délivrées par le DAI sont inappropriées et les patients avec thérapies inappropriées sont 2.4x plus fréquents que les patients avec thérapies appropriées.

Traumatismes du bassin [Pelvic trauma]

Les fractures du bassin, groupe polymorphe, sont liées au mécanisme traumatique. L'enjeu des fractures isolées du cotyle est principalement fonctionnel. Les radiographies standards, les scanner 3D et la classification de Letournel orientent le traitement. Ce dernier visera à rétablir une congruence articulaire prévenant la coxarthrose précoce. Les fractures du pelvis surviennent le plus souvent suite à des traumatismes violents, associés à des lésions viscérales, menaçant le pronostic vital. Le bilan radiologique s'intègre dans une prise en charge pluridisciplinaire grâce au scanner. La classification de Tile/AO permet la description des mécanismes et des lésions et une prise en charge adaptée. En cas de chocs hémodynamiques, la stabilisation externe, suivie si nécessaire de l'embolisation, à une place prépondérante. Pelvic trauma A great variety of very polymorphous lesions of pelvic trauma are deffering from each other by their context, their anatomical aspect and therapeutic implication. In the isolated acetabular fractures, function is mainly at stake. The management consists mainly of re-establishing a joint congruence to prevent early coxarthrosis. Pelvic fractures often occur in violent trauma and are associated with visceral lesions, putting vital prognosis at stake. In case of hemodynamic shock, external fracture stabilization when it is indicated associated to embolisation of pelvic bleeding if necessary and after external fixation are preponderant.

Looking for orders of magnitude : five essays in trade and the environment and economic geography

General Summary Although the chapters of this thesis address a variety of issues, the principal aim is common: test economic ideas in an international economic context. The intention has been to supply empirical findings using the largest suitable data sets and making use of the most appropriate empirical techniques. This thesis can roughly be divided into two parts: the first one, corresponding to the first two chapters, investigates the link between trade and the environment, the second one, the last three chapters, is related to economic geography issues. Environmental problems are omnipresent in the daily press nowadays and one of the arguments put forward is that globalisation causes severe environmental problems through the reallocation of investments and production to countries with less stringent environmental regulations. A measure of the amplitude of this undesirable effect is provided in the first part. The third and the fourth chapters explore the productivity effects of agglomeration. The computed spillover effects between different sectors indicate how cluster-formation might be productivity enhancing. The last chapter is not about how to better understand the world but how to measure it and it was just a great pleasure to work on it. "The Economist" writes every week about the impressive population and economic growth observed in China and India, and everybody agrees that the world's center of gravity has shifted. But by how much and how fast did it shift? An answer is given in the last part, which proposes a global measure for the location of world production and allows to visualize our results in Google Earth. A short summary of each of the five chapters is provided below. The first chapter, entitled "Unraveling the World-Wide Pollution-Haven Effect" investigates the relative strength of the pollution haven effect (PH, comparative advantage in dirty products due to differences in environmental regulation) and the factor endowment effect (FE, comparative advantage in dirty, capital intensive products due to differences in endowments). We compute the pollution content of imports using the IPPS coefficients (for three pollutants, namely biological oxygen demand, sulphur dioxide and toxic pollution intensity for all manufacturing sectors) provided by the World Bank and use a gravity-type framework to isolate the two above mentioned effects. Our study covers 48 countries that can be classified into 29 Southern and 19 Northern countries and uses the lead content of gasoline as proxy for environmental stringency. For North-South trade we find significant PH and FE effects going in the expected, opposite directions and being of similar magnitude. However, when looking at world trade, the effects become very small because of the high North-North trade share, where we have no a priori expectations about the signs of these effects. Therefore popular fears about the trade effects of differences in environmental regulations might by exaggerated. The second chapter is entitled "Is trade bad for the Environment? Decomposing worldwide SO2 emissions, 1990-2000". First we construct a novel and large database containing reasonable estimates of SO2 emission intensities per unit labor that vary across countries, periods and manufacturing sectors. Then we use these original data (covering 31 developed and 31 developing countries) to decompose the worldwide SO2 emissions into the three well known dynamic effects (scale, technique and composition effect). We find that the positive scale (+9,5%) and the negative technique (-12.5%) effect are the main driving forces of emission changes. Composition effects between countries and sectors are smaller, both negative and of similar magnitude (-3.5% each). Given that trade matters via the composition effects this means that trade reduces total emissions. We next construct, in a first experiment, a hypothetical world where no trade happens, i.e. each country produces its imports at home and does no longer produce its exports. The difference between the actual and this no-trade world allows us (under the omission of price effects) to compute a static first-order trade effect. The latter now increases total world emissions because it allows, on average, dirty countries to specialize in dirty products. However, this effect is smaller (3.5%) in 2000 than in 1990 (10%), in line with the negative dynamic composition effect identified in the previous exercise. We then propose a second experiment, comparing effective emissions with the maximum or minimum possible level of SO2 emissions. These hypothetical levels of emissions are obtained by reallocating labour accordingly across sectors within each country (under the country-employment and the world industry-production constraints). Using linear programming techniques, we show that emissions are reduced by 90% with respect to the worst case, but that they could still be reduced further by another 80% if emissions were to be minimized. The findings from this chapter go together with those from chapter one in the sense that trade-induced composition effect do not seem to be the main source of pollution, at least in the recent past. Going now to the economic geography part of this thesis, the third chapter, entitled "A Dynamic Model with Sectoral Agglomeration Effects" consists of a short note that derives the theoretical model estimated in the fourth chapter. The derivation is directly based on the multi-regional framework by Ciccone (2002) but extends it in order to include sectoral disaggregation and a temporal dimension. This allows us formally to write present productivity as a function of past productivity and other contemporaneous and past control variables. The fourth chapter entitled "Sectoral Agglomeration Effects in a Panel of European Regions" takes the final equation derived in chapter three to the data. We investigate the empirical link between density and labour productivity based on regional data (245 NUTS-2 regions over the period 1980-2003). Using dynamic panel techniques allows us to control for the possible endogeneity of density and for region specific effects. We find a positive long run elasticity of density with respect to labour productivity of about 13%. When using data at the sectoral level it seems that positive cross-sector and negative own-sector externalities are present in manufacturing while financial services display strong positive own-sector effects. The fifth and last chapter entitled "Is the World's Economic Center of Gravity Already in Asia?" computes the world economic, demographic and geographic center of gravity for 1975-2004 and compares them. Based on data for the largest cities in the world and using the physical concept of center of mass, we find that the world's economic center of gravity is still located in Europe, even though there is a clear shift towards Asia. To sum up, this thesis makes three main contributions. First, it provides new estimates of orders of magnitudes for the role of trade in the globalisation and environment debate. Second, it computes reliable and disaggregated elasticities for the effect of density on labour productivity in European regions. Third, it allows us, in a geometrically rigorous way, to track the path of the world's economic center of gravity.

Evidence for an overestimated vulnerability of adolescent rats to develop signs of drug addiction

Drug addiction is a multi-etiological disorder to which some individuals are more vulnerable an others. Whereas converging clinical and epidemiological studies report a peak of drug use ring adolescence, many behavioral traits characterizing teenagers have been proposed to contribute to this vulnerability, including a heightened sensation-seeking, an enhanced impulsivity d a larger influence exerted by peers. By many aspects, juvenile rodents display behavioral traits at resemble those of teenagers. However, the concept of increased vulnerability to drug addiction juvenile rats remains in debate. Indeed, only a few studies directly compared juvenile and adult fdents regarding behavioral predictors of drug abuse. Moreover, some key features of drug diction have never been investigated in juvenile rats yet. For this very reason, we conducted a arge-scale behavioral comparison of adult and adolescent rats with the aim of dissecting their espective behavioral traits and vulnerabilities to drug addiction. We first have shown that juvenile rats exhibited an enhanced motor impulsivity, and a loss of control over reward seeking assessed by a persistent reward taking despite adverse consequences mild electric footshocks]. We also report that juvenile rats displayed a higher anxiety profile, ind we discuss why these behaviors might represent key underpinning mechanisms leading to an enhanced vulnerability to drug abuse. Meanwhile, we collected clear cut observations that do not support such an interpretation. In Articular, juvenile and adult rats displayed identical novelty-induced habituation and preference at are considered to represent two potent predictors of cocaine initiation and compulsive intake, "pre strikingly, juvenile rats were less attracted by cues predicting reward in a Pavlovian utoshaping task, suggesting a lower propensity for cues or context to trigger the reinstatement of a^previously extinguished reward seeking behavior. Finally, using a paradigm assessing schedule- ciuced polydipsia, juvenile and adult rats exhibited similar compulsive drinking, under control conditions and following a chronic cocaine treatment as well. Hence, these observations call for a cautious interpretation of adolescent vulnerability to drug use. In particular, we underlined that even the most compulsive young rats did not consume ärger amounts of cocaine than adults, nor exhibited larger efforts in a cue-induced relapse aradigm, despite a transient increased motivation for lever-pressing. And further, despite a higher ensitivity to the behavioral effects of cocaine, juvenile rats did not differ from adults in their ropensity to constantly prefer saccharin over cocaine in a discrete-choice procedure, even after a ?'Id chronic stress procedure. Altogether, our results shape an objective overview of the juvenile rats' behavior in relation to oth drug and non-drug rewards, suggesting a heterogeneous and task-specific profile. Despite elements potentially underlying a real risk for substance use, adolescent rats do not exhibit a ehavioral repertoire suggesting increased vulnerability for compulsive drug abuse. Our conclusions strongly encourage deeper neurobiological investigations of the developing brain, and also open a debate on a possible overestimation of juvenile rats' and teenager's risk to develop aladaptive behaviors and drug addiction. - L'addiction aux drogues est une pathologie d'origine multifactorielle, à laquelle certains individus sont plus vulnérables que d'autres. De nombreuses études cliniques et épidémiologiques suggèrent une consommation excessive de drogues pendant l'adolescence, et plusieurs explications ont été avancées pour justifier cette tendance, parmi lesquelles on note une augmentation de la recherche de sensation, une impulsivité plus marquée et une plus forte influence de l'entourage. Le rat juvénile présente de nombreuses caractéristiques développementales similaires à l'adolescence humaine. En revanche, la vulnérabilité des rats juvéniles à l'abus de drogue est encore sujette à caution. En effet, peu d'études ont directement comparé des traits de comportements pouvant refléter un accroissement du risque d'abus chez les rats juvéniles par comparaison aux rats adultes. En outre, certaines caractéristiques fondamentales de l'addiction chez l'homme n'ont pas encore été étudiées chez le rat adolescent. Ce travail de thèse s'est donc donné pour objectif de comparer le comportement de rats adultes vis-à-vis de celui de rats adolescents, afin d'évaluer dans quelle mesure ces derniers seraient plus vulnérables à l'abus de drogues. Nos résultats indiquent que les rats juvéniles présentent une augmentation des comportements impulsifs, ainsi qu'une plus grande persistance à rechercher de manière compulsive une récompense en dépit de légers chocs électriques. Les rats juvéniles présentent également un profil anxieux plus élevé, ce qui peut constituer une autre source de vulnérabilité. Cependant, certaines caractéristiques comportementales ne suggèrent pas de vulnérabilité chez les rats juvéniles. Aucune différence entre rats adultes et adolescents n'a été trouvée pour l'habituation et la préférence pour la nouveauté, deux traits prédisant l'initiation et la prise compulsive de drogue. De plus, nous avons montré que les rats adolescents attribuent moins d'intérêt à des stimuli prédisant la disponibilité d'une récompense, suggérant une vulnérabilité plus faible à la rechute induite par les stimuli associés à la prise de drogue. Une étude complémentaire des comportements compulsifs indique une absence de différence entre rats adultes et adolescents, à la fois en condition basale ou après un traitement chronique à la cocaïne. L'étude des comportements de prise de drogue ne va pas non plus dans le sens d'une vulnérabilité des rats adolescents. Bien que les rats compulsifs sélectionnés pendant la période juvénile présentent une plus grande motivation à prendre de la cocaïne, ils ne diffèrent ni dans la quantité de cocaïne consommée, ni dans la rechute induite par les stimuli environnementaux. En dépit d'une sensibilisation comportementale plus importante, les rats adolescents présentent la même préférence que les adultes face à un choix entre une drogue et une récompense alternative, suggérant une résilience à la cocaïne comparable à celle des adultes. Enfin, cette résilience pour la cocaïne n'est pas affectée par un stress chronique lors de l'adolescence. En résumé, cette étude dresse un regard objectif sur les comportements en lien avec une vulnérabilité à l'abus de drogues chez le rat juvénile, suggérant que celle-ci est hétérogène et spécifique au protocole utilisé. En dépit de certains éléments de vulnérabilité, les rats adolescents ne présentent pas d'attirance excessive pour la cocaïne, ni de prédisposition à la consommation compulsive de cette drogue. L'ensemble de ces éléments pourra constituer une base solide pour l'investigation neurobiologique du cerveau en développement, et ouvre un débat sur une possible surestimation de la vulnérabilité des rats juvéniles et de leurs homologues humains aux pathologies psychiatriques telles que l'addiction aux drogues.

European Integration Without EU Membership : Models, Experiences, Perspectives

At the beginning of the 1990s, the concept of "European integration" could still be said to be fairly unambiguous. Nowadays, it has become plural and complex almost to the point of unintelligibility. This is due, of course, to the internal differentiation of EU membership, with several Member States pulling out of key integrative projects such as establishing an area without frontiers, the "Schengen" area, and a common currency. But this is also due to the differentiated extension of key integrative projects to European non-EU countries - Schengen is again a case in point. Such processes of "integration without membership", the focus of the present publication, are acquiring an ever-growing topicality both in the political arena and in academia. International relations between the EU and its neighbouring countries are crucial for both, and their development through new agreements features prominently on the continent's political agenda. Over and above this aspect, the dissemination of EU values and standards beyond the Union's borders raises a whole host of theoretical and methodological questions, unsettling in some cases traditional conceptions of the autonomy and separation of national legal orders. This publication brings together the papers presented at the Integration without EU Membership workshop held in May 2008 at the EUI (Max Weber Programme and Department of Law). It aims to compare different models and experiences of integration between the EU, on the one hand, and those European countries that do not currently have an accession perspective on the other hand. In delimiting the geographical scope of the inquiry, so as to scale it down to manageable proportions, the guiding principles have been to include both the "Eastern" and "Western" neighbours of the EU, and to examine both structured frameworks of cooperation, such as the European Neighbourhood Policy and the European Economic Area, and bilateral relations developing on a more ad hoc basis. These principles are reflected in the arrangement of the papers, which consider in turn the positions of Ukraine, Russia, Norway, and Switzerland in European integration - current standing, perspectives for evolution, consequences in terms of the EU-ization of their respective legal orders1. These subjects are examined from several perspectives. We had the privilege of receiving contributions from leading practitioners and scholars from the countries concerned, from EU highranking officials, from prominent specialists in EU external relations law, and from young and talented researchers. We wish to thank them all here for their invaluable insights. We are moreover deeply indebted to Marise Cremona (EUI, Law Department, EUI) for her inspiring advice and encouragement, as well as to Ramon Marimon, Karin Tilmans, Lotte Holm, Alyson Price and Susan Garvin (Max Weber Programme, EUI) for their unflinching support throughout this project. A word is perhaps needed on the propriety and usefulness of the research concept embodied in this publication. Does it make sense to compare the integration models and experiences of countries as different as Norway, Russia, Switzerland, and Ukraine? Needless to say, this list of four evokes a staggering diversity of political, social, cultural, and economic conditions, and at least as great a diversity of approaches to European integration. Still, we would argue that such diversity only makes comparisons more meaningful. Indeed, while the particularities and idiosyncratic elements of each "model" of integration are fully displayed in the present volume, common themes and preoccupations run through the pages of every contribution: the difficulty in conceptualizing the finalité and essence of integration, which is evident in the EU today but which is greatly amplified for non-EU countries; the asymmetries and tradeoffs between integration and autonomy that are inherent in any attempt to participate in European integration from outside; the alteration of deeply seated legal concepts, and concepts about the law, that are already observable in the most integrated of the non-EU countries concerned. These issues are not transient or coincidental: they are inextricably bound up with the integration of non-EU countries in the EU project. By publishing this collection, we make no claim to have dealt with them in an exhaustive, still less in a definitive manner. Our ambition is more modest: to highlight the relevance of these themes, to place them more firmly on the scientific agenda, and to provide a stimulating basis for future research and reflection.

Ablation des tachycardies ventriculaires chez les patients coronariens porteurs d'un défibrillateur interne

Contexte Le développement du défibrillateur automatique interne (DAI) a considérablement amélioré la survie des patients souffrant de tachycardies ventriculaires (TV) soutenues; cependant, ce traitement n'est pas curatif mais palliatif1. En effet, il ne permet pas d'éradiquer les TV mais les interrompt par diverses thérapies (stimulation ventriculaire; chocs). Plusieurs études ont montré que l'ablation des TV par radiofréquence permet de diminuer l'incidence des chocs délivrés par le DAI et ainsi d'améliorer la qualité de vie des patients2. Objectifs Notre objectif est de déterminer les résultats de l'ablation par radiofréquence à moyen terme, dans une population de patients souffrant d'une cardiopathie ischémique avec tachycardies ventriculaires soutenues et porteurs d'un DAI. Méthode Il s'agit d'une étude clinique rétrospective monocentrique comprenant des patients avec ancien infarctus, TV soutenue et porteurs d'un DAI hospitalisés pour ablation de la TV dans le Service de cardiologie du CHUV. Les données ont été obtenues à partir des dossiers cliniques archivés (Archimède), de la banque de données DAI et ablation (programmes filemaker) du service de cardiologie ainsi que de l'interrogation des mémoires des DAI. L'analyse de ces données a été réalisée à partir de tableaux Excel. Les moyennes et médianes des données récoltées ont été calculées ; les tests de Student et de Mann-Whitney ont été utilisés pour comparer les résultats avant et après ablation. Résultats Le collectif comprend 21 patients (19 hommes), âge moyen : 65 ± 11 ans. La fraction d'éjection du ventricule gauche est de 28±10%. La moyenne des thérapies du DAI en réponse aux TV au cours des six mois précédant l'ablation est de 65.1 ± 177.9 thérapies avec une médiane de 8 thérapies. Cette moyenne baisse à 11.5 ± 26.7 au cours des six mois qui ont suivi l'ablation et la médiane a chuté à 0 intervention du DAI. L'incidence des TV, décroit clairement après l'ablation. Cette diminution est statistiquement significative (p = 0.046). Après les six mois de suivi, 12 des 21 patients (57%) n'ont eu aucune récidive ; 4 patients (19%) ont eu une diminution du nombre de chocs. Au total, trois quarts des patients bénéficient donc de l'ablation. Conclusion Nos résultats démontrent une diminution spectaculaire et significative de l'incidence des TV post-infarctus après ablation par radiofréquence chez les porteurs de DAI.