Interhemispheric visual integration in humans explored by multimodal brain imaging

Résumé: Les récents progrès techniques de l'imagerie cérébrale non invasives ont permis d'améliorer la compréhension des différents systèmes fonctionnels cérébraux. Les approches multimodales sont devenues indispensables en recherche, afin d'étudier dans sa globalité les différentes caractéristiques de l'activité neuronale qui sont à la base du fonctionnement cérébral. Dans cette étude combinée d'imagerie par résonance magnétique fonctionnelle (IRMf) et d'électroencéphalographie (EEG), nous avons exploité le potentiel de chacune d'elles, soit respectivement la résolution spatiale et temporelle élevée. Les processus cognitifs, de perception et de mouvement nécessitent le recrutement d'ensembles neuronaux. Dans la première partie de cette thèse nous étudions, grâce à la combinaison des techniques IRMf et EEG, la réponse des aires visuelles lors d'une stimulation qui demande le regroupement d'éléments cohérents appartenant aux deux hémi-champs visuels pour en faire une seule image. Nous utilisons une mesure de synchronisation (EEG de cohérence) comme quantification de l'intégration spatiale inter-hémisphérique et la réponse BOLD (Blood Oxygenation Level Dependent) pour évaluer l'activité cérébrale qui en résulte. L'augmentation de la cohérence de l'EEG dans la bande beta-gamma mesurée au niveau des électrodes occipitales et sa corrélation linéaire avec la réponse BOLD dans les aires de VP/V4, reflète et visualise un ensemble neuronal synchronisé qui est vraisemblablement impliqué dans le regroupement spatial visuel. Ces résultats nous ont permis d'étendre la recherche à l'étude de l'impact que le contenu en fréquence des stimuli a sur la synchronisation. Avec la même approche, nous avons donc identifié les réseaux qui montrent une sensibilité différente à l'intégration des caractéristiques globales ou détaillées des images. En particulier, les données montrent que l'implication des réseaux visuels ventral et dorsal est modulée par le contenu en fréquence des stimuli. Dans la deuxième partie nous avons a testé l'hypothèse que l'augmentation de l'activité cérébrale pendant le processus de regroupement inter-hémisphérique dépend de l'activité des axones calleux qui relient les aires visuelles. Comme le Corps Calleux présente une maturation progressive pendant les deux premières décennies, nous avons analysé le développement de la fonction d'intégration spatiale chez des enfants âgés de 7 à 13 ans et le rôle de la myelinisation des fibres calleuses dans la maturation de l'activité visuelle. Nous avons combiné l'IRMf et la technique de MTI (Magnetization Transfer Imaging) afin de suivre les signes de maturation cérébrale respectivement sous l'aspect fonctionnel et morphologique (myelinisation). Chez lés enfants, les activations associées au processus d'intégration entre les hémi-champs visuels sont, comme chez l'adulte, localisées dans le réseau ventral mais se limitent à une zone plus restreinte. La forte corrélation que le signal BOLD montre avec la myelinisation des fibres du splenium est le signe de la dépendance entre la maturation des fonctions visuelles de haut niveau et celle des connections cortico-corticales. Abstract: Recent advances in non-invasive brain imaging allow the visualization of the different aspects of complex brain dynamics. The approaches based on a combination of imaging techniques facilitate the investigation and the link of multiple aspects of information processing. They are getting a leading tool for understanding the neural basis of various brain functions. Perception, motion, and cognition involve the formation of cooperative neuronal assemblies distributed over the cerebral cortex. In this research, we explore the characteristics of interhemispheric assemblies in the visual brain by taking advantage of the complementary characteristics provided by EEG (electroencephalography) and fMRI (Functional Magnetic Resonance Imaging) techniques. These are the high temporal resolution for EEG and high spatial resolution for fMRI. In the first part of this thesis we investigate the response of the visual areas to the interhemispheric perceptual grouping task. We use EEG coherence as a measure of synchronization and BOLD (Blood Oxygenar tion Level Dependent) response as a measure of the related brain activation. The increase of the interhemispheric EEG coherence restricted to the occipital electrodes and to the EEG beta band and its linear relation to the BOLD responses in VP/V4 area points to a trans-hemispheric synchronous neuronal assembly involved in early perceptual grouping. This result encouraged us to explore the formation of synchronous trans-hemispheric networks induced by the stimuli of various spatial frequencies with this multimodal approach. We have found the involvement of ventral and medio-dorsal visual networks modulated by the spatial frequency content of the stimulus. Thus, based on the combination of EEG coherence and fMRI BOLD data, we have identified visual networks with different sensitivity to integrating low vs. high spatial frequencies. In the second part of this work we test the hypothesis that the increase of brain activity during perceptual grouping depends on the activity of callosal axons interconnecting the visual areas that are involved. To this end, in children of 7-13 years, we investigated functional (functional activation with fMRI) and morphological (myelination of the corpus callosum with Magnetization Transfer Imaging (MTI)) aspects of spatial integration. In children, the activation associated with the spatial integration across visual fields was localized in visual ventral stream and limited to a part of the area activated in adults. The strong correlation between individual BOLD responses in .this area and the myelination of the splenial system of fibers points to myelination as a significant factor in the development of the spatial integration ability.

Liming in Agricultural Production Models with and Without the Adoption of Crop-Livestock Integration

ABSTRACT Perennial forage crops used in crop-livestock integration (CLI) are able to accumulate large amounts of straw on the soil surface in no-tillage system (NTS). In addition, they can potentially produce large amounts of soluble organic compounds that help improving the efficiency of liming in the subsurface, which favors root growth, thus reducing the risks of loss in yield during dry spells and the harmful effects of “overliming”. The aim of this study was to test the effects of liming on two models of agricultural production, with and without crop-livestock integration, for 2 years. Thus, an experiment was conducted in a Latossolo Vermelho (Oxisol) with a very clayey texture located in an agricultural area under the NTS in Bandeirantes, PR, Brazil. Liming was performed to increase base saturation (V) to 65, 75, and 90 % while one plot per block was maintained without the application of lime (control). A randomized block experimental design was adopted arranged in split-plots and four plots/block, with four replications. The soil properties evaluated were: pH in CaCl2, soil organic matter (SOM), Ca, Mg, K, Al, and P. The effects of liming were observed to a greater depth and for a long period through mobilization of ions in the soil, leading to a reduction in SOM and Al concentration and an increase in pH and the levels of Ca and Mg. In the first crop year, adoption of CLI led to an increase in the levels of K and Mg and a reduction in the levels of SOM; however, in the second crop year, the rate of decline of SOM decreased compared to the decline observed in the first crop year, and the level of K increased, whereas that of P decreased. The extent of the effects of liming in terms of depth and improvement in the root environment from the treatments were observed only partially from the changes observed in the chemical properties studied.

Integration of Bridge Damage Detection Concepts and Components (3 volumes), TR-636, 2013

This work is divided into three volumes: Volume I: Strain-Based Damage Detection; Volume II: Acceleration-Based Damage Detection; Volume III: Wireless Bridge Monitoring Hardware. Volume I: In this work, a previously-developed structural health monitoring (SHM) system was advanced toward a ready-for-implementation system. Improvements were made with respect to automated data reduction/analysis, data acquisition hardware, sensor types, and communication network architecture. The statistical damage-detection tool, control-chart-based damage-detection methodologies, were further investigated and advanced. For the validation of the damage-detection approaches, strain data were obtained from a sacrificial specimen attached to the previously-utilized US 30 Bridge over the South Skunk River (in Ames, Iowa), which had simulated damage,. To provide for an enhanced ability to detect changes in the behavior of the structural system, various control chart rules were evaluated. False indications and true indications were studied to compare the damage detection ability in regard to each methodology and each control chart rule. An autonomous software program called Bridge Engineering Center Assessment Software (BECAS) was developed to control all aspects of the damage detection processes. BECAS requires no user intervention after initial configuration and training. Volume II: In this work, a previously developed structural health monitoring (SHM) system was advanced toward a ready-for-implementation system. Improvements were made with respect to automated data reduction/analysis, data acquisition hardware, sensor types, and communication network architecture. The objective of this part of the project was to validate/integrate a vibration-based damage-detection algorithm with the strain-based methodology formulated by the Iowa State University Bridge Engineering Center. This report volume (Volume II) presents the use of vibration-based damage-detection approaches as local methods to quantify damage at critical areas in structures. Acceleration data were collected and analyzed to evaluate the relationships between sensors and with changes in environmental conditions. A sacrificial specimen was investigated to verify the damage-detection capabilities and this volume presents a transmissibility concept and damage-detection algorithm that show potential to sense local changes in the dynamic stiffness between points across a joint of a real structure. The validation and integration of the vibration-based and strain-based damage-detection methodologies will add significant value to Iowa’s current and future bridge maintenance, planning, and management Volume III: In this work, a previously developed structural health monitoring (SHM) system was advanced toward a ready-for-implementation system. Improvements were made with respect to automated data reduction/analysis, data acquisition hardware, sensor types, and communication network architecture. This report volume (Volume III) summarizes the energy harvesting techniques and prototype development for a bridge monitoring system that uses wireless sensors. The wireless sensor nodes are used to collect strain measurements at critical locations on a bridge. The bridge monitoring hardware system consists of a base station and multiple self-powered wireless sensor nodes. The base station is responsible for the synchronization of data sampling on all nodes and data aggregation. Each wireless sensor node include a sensing element, a processing and wireless communication module, and an energy harvesting module. The hardware prototype for a wireless bridge monitoring system was developed and tested on the US 30 Bridge over the South Skunk River in Ames, Iowa. The functions and performance of the developed system, including strain data, energy harvesting capacity, and wireless transmission quality, were studied and are covered in this volume.

Neuroscience robotics to investigate multisensory integration and bodily awareness.

Humans experience the self as localized within their body. This aspect of bodily self-consciousness can be experimentally manipulated by exposing individuals to conflicting multisensory input, or can be abnormal following focal brain injury. Recent technological developments helped to unravel some of the mechanisms underlying multisensory integration and self-location, but the neural underpinnings are still under investigation, and the manual application of stimuli resulted in large variability difficult to control. This paper presents the development and evaluation of an MR-compatible stroking device capable of presenting moving tactile stimuli to both legs and the back of participants lying on a scanner bed while acquiring functional neuroimaging data. The platform consists of four independent stroking devices with a travel of 16-20 cm and a maximum stroking velocity of 15 cm/s, actuated over non-magnetic ultrasonic motors. Complemented with virtual reality, this setup provides a unique research platform allowing to investigate multisensory integration and its effects on self-location under well-controlled experimental conditions. The MR-compatibility of the system was evaluated in both a 3 and a 7 Tesla scanner and showed negligible interference with brain imaging. In a preliminary study using a prototype device with only one tactile stimulator, fMRI data acquired on 12 healthy participants showed visuo-tactile synchrony-related and body-specific modulations of the brain activity in bilateral temporoparietal cortex.

Measurement of multi-segment foot joint angles during gait using a wearable system.

Usually the measurement of multi-segment foot and ankle complex kinematics is done with stationary motion capture devices which are limited to use in a gait laboratory. This study aimed to propose and validate a wearable system to measure the foot and ankle complex joint angles during gait in daily conditions, and then to investigate its suitability for clinical evaluations. The foot and ankle complex consisted of four segments (shank, hindfoot, forefoot, and toes), with an inertial measurement unit (3D gyroscopes and 3D accelerometers) attached to each segment. The angles between the four segments were calculated in the sagittal, coronal, and transverse planes using a new algorithm combining strap-down integration and detection of low-acceleration instants. To validate the joint angles measured by the wearable system, three subjects walked on a treadmill for five minutes at three different speeds. A camera-based stationary system that used a cluster of markers on each segment was used as a reference. To test the suitability of the system for clinical evaluation, the joint angle ranges were compared between a group of 10 healthy subjects and a group of 12 patients with ankle osteoarthritis, during two 50-m walking trials where the wearable system was attached to each subject. On average, over all joints and walking speeds, the RMS differences and correlation coefficients between the angular curves obtained using the wearable system and the stationary system were 1 deg and 0.93, respectively. Moreover, this system was able to detect significant alteration of foot and ankle function between the group of patients with ankle osteoarthritis and the group of healthy subjects. In conclusion, this wearable system was accurate and suitable for clinical evaluation when used to measure the multi-segment foot and ankle complex kinematics during long-distance walks in daily life conditions.

Issue review : Iowa State Patrol and the Office of Motor Vehicle Enforcement potential integration.

This issue review analyzes the duties and responsibilities of troopers in the Iowa State Patrol, or ISP, and Motor Vehicle Enforcement, MVE, officers in the Department of Transportation, or DOT, as well as the differences such as funding, pay and pension. In addition, this issue review discusses the proposal for a potential integration of the offices under one system.

GPS to LRM: Integration of Spatial Point Features with Linear Referencing Methods, 2001

Global positioning systems (GPS) offer a cost-effective and efficient method to input and update transportation data. The spatial location of objects provided by GPS is easily integrated into geographic information systems (GIS). The storage, manipulation, and analysis of spatial data are also relatively simple in a GIS. However, many data storage and reporting methods at transportation agencies rely on linear referencing methods (LRMs); consequently, GPS data must be able to link with linear referencing. Unfortunately, the two systems are fundamentally incompatible in the way data are collected, integrated, and manipulated. In order for the spatial data collected using GPS to be integrated into a linear referencing system or shared among LRMs, a number of issues need to be addressed. This report documents and evaluates several of those issues and offers recommendations. In order to evaluate the issues associated with integrating GPS data with a LRM, a pilot study was created. To perform the pilot study, point features, a linear datum, and a spatial representation of a LRM were created for six test roadway segments that were located within the boundaries of the pilot study conducted by the Iowa Department of Transportation linear referencing system project team. Various issues in integrating point features with a LRM or between LRMs are discussed and recommendations provided. The accuracy of the GPS is discussed, including issues such as point features mapping to the wrong segment. Another topic is the loss of spatial information that occurs when a three-dimensional or two-dimensional spatial point feature is converted to a one-dimensional representation on a LRM. Recommendations such as storing point features as spatial objects if necessary or preserving information such as coordinates and elevation are suggested. The lack of spatial accuracy characteristic of most cartography, on which LRM are often based, is another topic discussed. The associated issues include linear and horizontal offset error. The final topic discussed is some of the issues in transferring point feature data between LRMs.

Fusarium wilt incidence and common bean yield according to the preceding crop and the soil tillage system

The objective of this work was to evaluate the effects of preceding crops and tillage systems on the incidence of Fusarium wilt (Fusarium oxysporum f. sp. phaseoli) and common bean (Phaseolus vulgaris) yield. The cultivar BRS Valente was cultivated under center‑pivot irrigation in the winter seasons of 2003, 2004 and 2005, after several preceding crops established in the summer seasons. Preceding crops included the legumes Cajanus cajan (pigeon pea), Stylosanthes guianensis, and Crotalaria spectabilis; the grasses Pennisetum glaucum (millet), Sorghum bicolor (forage sorghum), Panicum maximum, and Urochloa brizantha; and a consortium of maize (Zea mays) and U. brizantha (Santa Fé system). Experiments followed a strip‑plot design, with four replicates. Fusarium wilt incidence was higher in the no‑tillage system. Higher disease incidences corresponded to lower bean yields in 2003 and 2004. Previous summer cropping with U. brizantha, U. brizantha + maize consortium, and millet showed the lowest disease incidence. Therefore, the choice of preceding crops must be taken into account for managing Fusarium wilt on irrigated common bean crops in the Brazilian Cerrado.

Building Environmental Management System for Laboratory Products Manufacturing Company according ISO 14001-standard

Tutkielman tavoitteena on rakentaa toimiva ympäristöjärjestelmä Thermo Fisher Scientific Oy:lle. Tutkimuksen tarkoituksena on myös löytää kahdelle täysin erilaiselle toiminnalle yhtenäinen ympäristöjärjestelmä, jonka avulla pystytään ottamaan huomioon molempien toimipaikkojen hieman erilaiset vaatimukset. Lisäksi tavoitteena on muodostaa ympäristöjärjestelmälle oma organisaatio, jonka avulla ympäristöjärjestelmän integrointi yrityksen prosesseihin voidaan suorittaa sujuvasti. Aluksi tutkimusongelmaa lähestytään teoreettisesta näkökulmasta,jossa tarkastellaan ympäristöjärjestelmän historiaa, rakennetta, etuja sekä ISO 14001–standardin rakennetta ja sen etenemistä ympäristöjärjestelmän rakentamisen yhteydessä aina kolmannen osapuolen sertifiointiin asti. Empiria osa alkaa alustavalla ympäristökatselmuksella, jossa selvitetään ympäristöasioiden hoidon nykytaso ja luodaan pohja koko ympäristöjärjestelmän luomiselle, jonka vankimpana perustana on ympäristöpolitiikka. Johdon hyväksymä ympäristöpolitiikka varmistaa johdon sitoutumisen järjestelmään. Ympäristöjärjestelmän toimintarakenteen muodostaminen kahdelle erilaiselle toiminnalle onnistui tutkimuksessa kiitettävästi. Se miten ympäristöjärjestelmä toimii todellisuudessa, tullaan näkemään käytännön kokemuksien yhteydessä.

Processus intégratifs et gouvernance clinique dans la psychiatrie institutionnelle [Integration processes and clinical governance in the psychiatric network]

The Swiss Medical Insurance Act (LAMaL) requires the planning of psychiatric care. This necessitates a coordination between the Department of Public Health and the institutional governance. Given the difficulties to draw comparisons between a wide range of systems in a federal country, the Swiss Conference of the State Directors of Health (CDS) proposed as a first step that each canton present some of the key programs they had developed. In the canton Vaud, the implementation of mobile community treatment teams and of an early intervention program for psychosis was chosen. The main challenges faced were to go past traditional divides within the organisation of the Swiss Health system and to conciliate the requirements of public health with the needs of treating teams, in order to promote early intervention in mental health disorders.

Managing Subsidiary Integration During Corporate Expansion in Russia

Kansallisten rajojen yli laajentuvat yritykset kohtaavat kasvavia paineita yhtenäistää eri yksiköiden toimintatapoja, prosesseja ja järjestelmiä. Hyvin toteutettuna organisaation sisäinen integrointi voi johtaa tytäryritysten tuottavuuden parantumiseen ja strategisiin mittakaavaetuihin, kun taas huonosti toteutettuna integrointi voi johtaa lisääntyviin konflikteihin ja emoyhtiön kontrollin katoamiseen. Integroinnin kannalta Venäjälle perustettavat tytäryritykset asettavat suuria haasteita. Kasvava ja kehittyvä kansantalous on jatkuvassa muutoksessa kohti edistyneempiä ja tuottavampia toimintamalleja, mutta toisaalta yritystoiminnantaustalla vaikuttaa edelleenkin Neuvostoajan perinnöt, jotka muokkaavat yritysten johtamisrakenteita ja prosesseja. Nämä taustavaikuttajat vaikeuttavat kansainvälisen yrityksen yhtenäistämistä, mutta toisaalta tarjoavat suuria mahdollisuuksia yrityksille, jotka oppivat elämään Venäjän markkinoiden ehdoilla. Tämä tutkimus käyttää apunaan konstruktiivista tutkimustyötä ratkoakseenYIT:n Venäjälle perustettavien yritysten integrointiin liittyviä ongelmia ja mahdollisuuksia. Työn lopputuloksena syntyy oppimiseen pohjautuva integraatiostrategia ja tätä strategiaa tukeva integroinnin johtamisjärjestelmä.

The Value System of Consumer Board Packaging

Olemassa olevien teollisuuden rakenteiden ja arvoketjujen muutos on usein onnistuneiden liiketoimintainnovaatioiden takana. Yritysten tulisikin olla tietoisia rakenteista, jotka määrittelevät arvon jakaantumista niiden arvoketjuissa. Tämän työn tavoitteena oli tutkia ja arvioida kartongin pakkausketjujen rakenteita kartongintuottajalta aina kauppiaalle asti. Työn kuluessa yritysketjujen arviointia varten oli kehitettävä uudenlainen analysointityökalu. Työssä käsitellyt kartonkipakkausketjut olivat nestekartonkipakkaaminen, elintarvikepakkaaminen, lääkepakkaaminen sekä graafisten kartonkien ketju. Jokaista edellä mainituista ketjuista arvioitiin käyttämällä kehitettyä analysointityökalua. Työn merkittävin tulos on kehitetty työkalu, jolla pakkausketjuja sekä myös muita yritysketjuja on mahdollista analysoida. Kehitettyä työkalua käyttämällä oli mahdollista tehdä johtopäätöksiä vertikaalin integraation mahdollisuudesta sekä pakkausketjujen suotuisuudesta uusille bisnesmalleille. Sekä analysointityökalua että saatuja johtopäätöksiä voidaan käyttää hyväksi, kun kartongintuottaja suunnittelee tulevaisuuden toimenpiteitä.

On the existence and function of galanin receptor heteromers in the central nervous system

Galanin receptor (GalR) subtypes 1-3 linked to central galanin neurons may form heteromers with each other and other types of G protein-coupled receptors in the central nervous system (CNS). These heteromers may be one molecular mechanism for galanin peptides and their N-terminal fragments (gal 1-15) to modulate the function of different types of glia-neuronal networks in the CNS, especially the emotional and the cardiovascular networks. GalR-5-HT1A heteromers likely exist with antagonistic GalR-5-HT1A receptor-receptor interactions in the ascending midbrain raphe 5-HT neuron systems and their target regions. They represent a novel target for antidepressant drugs. Evidence is given for the existence of GalR1-5-HT1A heteromers in cellular models with trans-inhibition of the protomer signaling. A GalR1-GalR2 heteromer is proposed to be a galanin N-terminal fragment preferring receptor (1-15) in the CNS. Furthermore, a GalR1-GalR2-5-HT1A heterotrimer is postulated to explain why only galanin (1-15) but not galanin (1-29) can antagonistically modulate the 5-HT1A receptors in the dorsal hippocampus rich in gal fragment binding sites. The results underline a putative role of different types of GalR-5-HT1A heteroreceptor complexes in depression. GalR antagonists may also have therapeutic actions in depression by blocking the antagonistic GalR-NPYY1 receptor interactions in putative GalR-NPYY1 receptor heteromers in the CNS resulting in increases in NPYY1 transmission and antidepressant effects. In contrast the galanin fragment receptor (a postulated GalR1-GalR2 heteromer) appears to be linked to the NPYY2 receptor enhancing the affinity of the NPYY2 binding sites in a putative GalR1-GalR2-NPYY2 heterotrimer. Finally, putative GalR-α2-adrenoreceptor heteromers with antagonistic receptor-receptor interactions may be a widespread mechanism in the CNS for integration of galanin and noradrenaline signals also of likely relevance for depression

Integration and Implementation of Accounting Information Systems in Global Companies Case: The UPM-Kymmene Group

Tämän tutkielman tavoitteena on perehtyä globaalin yrityksen laskentatoimen tietojärjestelmien yhtenäistämiseen ja käyttöönottoon esimerkkinä UPM-Kymmene konsernin projekti. Tutkielmassa sovelletaan hermeneuttista tutkimusotetta. Teoreettisesti aihetta tarkastellaan globalisoitumisen ja laskentatoimen tietojärjestelmille asetettavien vaatimusten pohjalta, sekä järjestelmän muutosprosessin eri vaiheissa huomioon otettavien muuttujien perusteella. Yhtenäisen laskentatoimen tietojärjestelmän tuomat edut globaalille yritykselle ovat ilmeisiä. Ennen yhtenäisen projektin kehittelyä on olennaista tutkia lähtökohdat projektin onnistumiselle ja suunnitella projektin eri vaiheet huolella. Tutkielmassa havaitaan myös, että globaalissa yrityksessä tulee huomioida eri yrityskulttuurit sekä tulosyksiköiden erilaiset toimintatavat. Johtopäätöksenä todetaan, että sekä yritysjohdon että tulosyksiköiden sitoutuneisuus projektiin ja yhtenäiset tavoitteet ovat oleellisia projektin onnistumisen kannalta.

Institutional legacies, employment and professional integration of non EU/EEA doctors in France

Internationally, policies for attracting highly-skilled migrants have become the guidelines mainly used by the Organisation for Economic Co-operation and Development (OECD) countries. Governments are implementing specific procedures to capture and facilitate their mobility. However, all professions are not equal when it comes to welcoming highly-skilled migrants. The medical profession, as a protective market, is one of these. Taking the case of non-EU/EEA doctors in France, this paper shows that the medical profession defined as the closed labour market, remains the most controversial in terms of professional integration of migrants, protectionist barriers to migrant competition and challenge of medical shortage. Based on the path-dependency approach, this paper argues that non-EU/EEA doctors' issues in France derive from a complex historical process of interaction between standards settled in the past, particularly the historical power of medical corporatism, the unexpected long-term effects of French hospital reforms of 1958, and budgetary pressures. Theoretically, this paper shows two significant findings. Firstly, the French medical system has undergone a series of transformations unthinkable in the strict sense of a path-dependence approach: an opening of the medical profession to foreign physicians in the context of the Europeanisation of public policy, acceptance of non-EU/EEA doctors in a context of medical shortage and budgetary pressures. Secondly, there is no change of the overall paradigm: significantly, the recruitment policies of non-EU/EEA doctors continue to highlight the imprint of the past and reveal a significant persistence of prejudices. Non-EU/EEA doctors are not considered legitimate doctors even if they have the qualifications of physicians which are legitimate in their country and which can be recognised in other receiving countries.