Robert Jütte (Ed.), Medical Pluralism. Past - Present - Future (Stuttgart, F. Steiner Verlag, 2013)

Initiée en anthropologie à la fin des années 1970, la notion de pluralisme médical se voit réappropriée par diverses disciplines des sciences humaines, à l'instar des treize contributions de cet ouvrage collectif édité par Robert Jütte. Historiens, sociologues et anthropologues y interviennent à la suite d'un colloque organisé en 2001 en Italie par l'Institut d'histoire de la médecine de la Fondation Robert Bosch et le Centre Italo-Tedesco pour l'Excellence européenne, en collaboration avec le Forum de dialogue Pluralismus in der Medizin. Encore très questionnée et souvent nuancée selon les contextes, la définition du pluralisme médical se situe quelque part entre le fait que différentes formes de soins existent simultanément et s'influencent les unes les autres, et le constat d'une popularité grandissante des médecines alternatives et complémentaires défiant l'hégémonie de la biomédecine - cette situation s'observant plus particulièrement dans les pays occidentaux. C'est dans ce dernier contexte que s'inscrit le volume, dont chacune des contributions examine le phénomène du pluralisme médical soit en Allemagne, en Italie, en France ou en Grande-Bretagne - avec une exception pour l'Inde. La profondeur diachronique adoptée par l'ouvrage, couvrant l'époque pré-moderne à nos jours, offre une exploration élargie des expériences thérapeutiques. Ainsi sont évoqués, d'une part, les tenants de la médecine dite orthodoxe ou conventionnelle, regroupant les praticiens officiels que sont les médecins académiques en première ligne, suivis des chirurgiens, barbiers, apothicaires et sages-femmes; d'autre part sont pris en compte les représentants des médecines complémentaires, alternatives, naturelles ou encore populaires - des homéopathes aux acupuncteurs en passant par les magnétiseurs et les magiciennes guérisseuses. La réflexion sur les concurrences et les complémentarités entre ces acteurs variés, qui fait consensus au sein des contributions, est développée sous divers aspects.

The risk factors for fractures and trabecular bone-score value in patients with endogenous Cushing's syndrome.

In a cohort study of 182 consecutive patients with active endogenous Cushing's syndrome, the only predictor of fracture occurrence after adjustment for age, gender bone mineral density (BMD) and trabecular bone score (TBS) was 24-h urinary free cortisol (24hUFC) levels with a threshold of 1472 nmol/24 h (odds ratio, 3.00 (95 % confidence interval (CI), 1.52-5.92); p = 0.002). INTRODUCTION: The aim was to estimate the risk factors for fracture in subjects with endogenous Cushing's syndrome (CS) and to evaluate the value of the TBS in these patients. METHODS: All enrolled patients with CS (n = 182) were interviewed in relation to low-traumatic fractures and underwent lateral X-ray imaging from T4 to L5. BMD measurements were performed using a DXA Prodigy device (GEHC Lunar, Madison, Wisconsin, USA). The TBS was derived retrospectively from existing BMD scans, blinded to clinical outcome, using TBS iNsight software v2.1 (Medimaps, Merignac, France). Urinary free cortisol (24hUFC) was measured by immunochemiluminescence assay (reference range, 60-413 nmol/24 h). RESULTS: Among enrolled patients with CS (149 females; 33 males; mean age, 37.8 years (95 % confidence interval, 34.2-39.1); 24hUFC, 2370 nmol/24 h (2087-2632), fractures were confirmed in 81 (44.5 %) patients, with 70 suffering from vertebral fractures, which were multiple in 53 cases; 24 patients reported non-vertebral fractures. The mean spine TBS was 1.207 (1.187-1.228), and TBS Z-score was -1.86 (-2.07 to -1.65); area under the curve (AUC) was used to predict fracture (mean spine TBS) = 0.548 (95 % CI, 0.454-0.641)). In the final regression model, the only predictor of fracture occurrence was 24hUFC levels (p = 0.001), with an increase of 1.041 (95 % CI, 1.019-1.063), calculated for every 100 nmol/24-h cortisol elevation (AUC (24hUFC) = 0.705 (95 % CI, 0.629-0.782)). CONCLUSIONS: Young patients with CS have a low TBS. However, the only predictor of low traumatic fracture is the severity of the disease itself, indicated by high 24hUFC levels.

Who's fault is it ? : An analysis of the press coverage of football betting scandals in France and the United Kingdom

Sport betting is a lucrative business for bookmakers, for the lucky (or wise) punters, but also for governments and for sport. While not new or even recent, the deviances linked to sport betting, primarily match-fixing, have gained increased media exposure in the past decade. This exploratory study is a qualitative content analysis of the press coverage of sport betting-related deviances in football in two countries (UK and France), using in each case two leading national publications over a period of five years. Data analysis indicates a mounting coverage of sport betting scandals, with teams, players and criminals increasingly framed as culprits, while authorities and federations primarily assume a positive role. As for the origin of sport betting deviances, French newspapers tend to blame the system (in an abstract way); British newspapers, in contrast, focus more on individual weaknesses, notably greed. This article contributed to the growing body of literature on the importance of these deviances and on the way they are perceived by sport organizations, legislators and the public at large.

Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in The Bethesda System for Reporting Thyroid Cytopathology.

BACKGROUND: Recent discussions have focused on redefining noninvasive follicular variant of papillary thyroid carcinoma (NI-FVPTC) as a neoplasm rather than a carcinoma. This study assesses the potential impact of such a reclassification on the implied risk of malignancy (ROM) for the diagnostic categories of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). METHODS: The study consisted of consecutive fine-needle aspiration biopsy (FNAB) cases collected between January 1, 2013 and June 30, 2014 from 5 academic institutions. Demographic information, cytology diagnoses, and surgical pathology follow-up were recorded. The ROM was calculated with and without NI-FVPTC and was presented as a range: all cases (ie, overall risk of malignancy [OROM]) versus those with surgical follow-up only. RESULTS: The FNAB cohort consisted of 6943 thyroid nodules representing 5179 women and 1409 men with an average age of 54 years (range, 9-94 years). The combined average ROM and OROM for the diagnostic categories of TBSRTC were as follows: nondiagnostic, 4.4% to 25.3%; benign, 0.9% to 9.3%; atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 12.1% to 31.2%; follicular neoplasm (FN), 21.8% to 33.2%; suspicious for malignancy (SM), 62.1% to 82.6%; and malignant, 75.9% to 99.1%. The impact of reclassifying NI-FVPTC on the ROM and OROM was most pronounced and statistically significant in the 3 indeterminate categories: the AUS/FLUS category had a decrease of 5.2% to 13.6%, the FN category had a decrease of 9.9% to 15.1%, and the SM category had a decrease of 17.6% to 23.4% (P < .05), whereas the benign and malignant categories had decreases of 0.3% to 3.5% and 2.5% to 3.3%, respectfully. The trend of the effect on the ROM and OROM was similar for all 5 institutions. CONCLUSIONS: The results from this multi-institutional cohort indicate that the reclassification of NI-FVPTC will have a significant impact on the ROM for the 3 indeterminate categories of TBSRTC. Cancer Cytopathol 2016;124:181-187. © 2015 American Cancer Society.

Prevalence of simple liver cysts and hemangiomas in cirrhotic and non-cirrhotic patients submitted to magnetic resonance imaging

Objective To determine the prevalence of liver cysts and hemangiomas in the general population and in cirrhotic patients. Materials and Methods Retrospective, observational, and cross-sectional study selecting consecutive magnetic resonance imaging studies performed in the period from February to July 2011. A total of 303 patients (187 women and 116 men) with mean age of 53.3 years were included in the present study. Patients with previously known liver lesions were excluded. The images were consensually analyzed by two observers in the search for simple liver cysts and typical liver hemangiomas, according to universally accepted imaging criteria. Lesions prevalence, diameters and location were determined in both cirrhotic and non-cirrhotic individuals. Results The authors observed prevalence of 8.6% for hemangiomas and 14.5% for simple cysts. No statistically significant difference was observed in relation to prevalence of hemangiomas and cysts among cirrhotic and non-cirrhotic patients (p = 0.954; p = 0.472). Conclusion In the present study, the prevalence of cysts and hemangiomas was higher than the prevalence reported by autopsy series. No influence of cirrhosis was observed on the prevalence and appearance of such incidental lesions.

Signaling in the Rhizosphere.

Signaling studies in the rhizosphere have focused on close interactions between plants and symbiotic microorganisms. However, this focus is likely to expand to other microorganisms because the rhizomicrobiome is important for plant health and is able to influence the structure of the microbial community. We discuss here the shaping of the rhizomicrobiome and define which aspects can be considered signaling. We divide signaling in the rhizosphere into three categories: (i) between microbes, (ii) from plants to microorganisms, and (iii) from microorganisms to plants. Signals act on diverse organisms including the plant. Mycorrhizal and rhizobial interkingdom signaling has revealed its pivotal role in establishing associations, and the recent discovery of signaling with non-symbiotic microorganisms indicates the important role of communication in shaping the rhizomicrobiome.

Le raisonnement clinique de l'infirmier(ère) expert(e) lors de l'évaluation de la douleur chez l'enfant ventilé et non communicant, sous analgésie et sédation, aux soins intensifs de pédiatrie

Dans le contexte des soins intensifs pédiatriques, la douleur est une préoccupation majeure et quotidienne pour l'équipe soignante. Les patients sont vulnérables de par leur condition et les multiples stimulations douloureuses auxquelles ils sont exposés. En dépit des données probantes démontrant l'importance d'une évaluation de la douleur, le traitement de celle-ci reste non optimal dans cette population vulnérable. Une douleur inadéquatement traitée peut causer de nombreuses complications à moyen et à long terme. L'évaluation de la douleur chez le patient ventilé et non communicant représente un défi important, rendu complexe par l'utilisation concomitante de médicaments sédatifs et analgésiques qui peuvent masquer ou altérer les comportements de la douleur. Il existe des outils d'évaluation adaptés à cette population vulnérable, mais l'interprétation des scores reste difficile. L'évaluation de la douleur demande aux infirmières des connaissances et compétences élevées à même d'être mobilisées lors d'un processus complexe lié au raisonnement clinique. Le but de cette étude descriptive et observationnelle est de déterminer les indicateurs utilisés par les infirmières expertes des soins intensifs de pédiatrie lors de l'évaluation de la douleur chez le patient ventilé et non communicant, sous analgésie et sédation. Un échantillon de convenance de dix infirmières expertes travaillant dans une unité de soins intensifs pédiatriques d'un hôpital universitaire de Suisse romande a participé à cette étude. Les données ont été récoltées par l'enregistrement de la verbalisation du raisonnement clinique au lit du patient, complété par une observation non participante et un entretien semi-structuré. Le développement d'un cadre théorique constitué d'un modèle de raisonnement clinique expert et d'une modélisation du décodage de la douleur a permis de réaliser une analyse de contenu des enregistrements. Les résultats montrent une utilisation importante des indicateurs physiologiques, en lien avec la stabilité clinique du patient qui est un critère essentiel pour la prise de décision lors de la gestion de la douleur. La difficulté à discriminer l'agitation résultant de la douleur ou d'autres causes est également omniprésente. Les expertes anticipent et préviennent la survenue de la douleur en s'appuyant sur leurs connaissances et les situations de patient déjà rencontrées. Le contexte clinique influence de manière prépondérante le raisonnement clinique et les indicateurs utilisés lors de l'évaluation et la gestion de la douleur. Celle-ci doit être évaluée de manière combinée avec la stabilité clinique du patient et son niveau de sédation. De futures recherches sont nécessaires pour confirmer ces résultats réalisés avec un échantillon de petite taille et un devis observationnel.

La defensa del comunal y de los usos colectivos, León (1800-1936): ¿una "economia moral"?

Peer-reviewed

Gondoolilaulu

Soitinnus: lauluääni, piano.

Determinação voltamétrica do herbicida glifosato em águas naturais utilizando eletrodo de cobre

The aim of this work was to investigate the copper electrode behavior in the voltammetric determination of glyphosate. The best conditions for this determination are phosphate buffer 0.05 mol L-1 and pH 7.3, and the peak potential is observed at 187 mV. LD and LQ values are 59 µg L-1 e 196 µg L-1, respectively. A water sample was analysed for glyphosate and identical results were obtained by using the analytical curve and the standard addition method. The comparison with a voltammetric method with Hg electrode, after a reaction with nitrite, showed quite concordant results for the analysis of the surface water sample. Therefore, the proposed method can be applied to direct determinations of the herbicide in waters, decreasing the time of analysis; besides, the method is in agreement with the "green chemistry" concept.

Ethnic Identity in an Intercultural Geography: an Empirical Study = L’identité ethnique dans une géographie interculturelle: une étude empirique

This study explored the ethnic identity among 331 emerging adults (144 mestizos and 187 indigenous) from the Intercultural University of Chiapas (México). Scholars suggest that ethnicity is much more salient for ethnic minority adolescents than for adolescents who are members of the ethnic majority. Our aim was to compare the results of the Multigroup Ethnic Identity Measure (MEIM) between the majority ethnic group and the minority group studied. Specifically, the following hypothesis was examined: adolescents who are members of the ethnic minority group (indigenous) will score significantly higher on ethnic identity than adolescents who are members of the ethnic majority group (mestizos). The results supported these hypothesis. We suggest that the effect of an intercultural educative model could explain these results

Le Constitutionnel : journal politique et littéraire

1817/07/06 (Numéro 187).

Le Constitutionnel : journal politique et littéraire

1816/07/05 (Numéro 187).

Character seditiosi civis

Dedicatio: David Lund, Hermannus Witte, Jonas Lostierna [ruots. runo], Otto Fridericus Stålhammar, Andreas Ljungman.

L'Univers

1867/10/23 (Numéro 187).