Un espace à construire pour le désir...

Question de femme ou question d'être? Y a-t-il un être au féminin ou une manière d'être femme? Des femmes interrogent la psychanalyse. Cet article propose un retour sur la notion de castration et sur les développements entourant la signification du phallus. L'expérience de la castration est présentée comme étant étroitement liée au processus de la sexuation et à la constitution même du sujet parlant. Cet article tente de faire état de la position féminine, qui questionne la castration. La psychanalyse n'apporte pas une réponse, elle pose une limite : celle de l'ordre symbolique dans lequel l'être parlant est inscrit. En deçà de cette limite de la castration, il reste à construire pour chaque femme et chaque homme, dans le Québec contemporain, un espace pour le désir.It is a matter of being woman or simply of being? Is there actually a feminine way to be? Here, women put psychanalysis into question. This article suggests a return to the notion of castration and to the developments surrounding the significance of the phallus. The castration experience is presented as being closely liked to the process of sexualization and to the individual's self-realization. The authors advance the woman's point of view, which questions castration. They find that psychoanalysis does not provide an answer, but imposes a limit: that of a symbolic order in which the individual must fit. Within the limiting phenomenon of castration, there remains the need for every man and woman in contemporary Québec society to share a sense of desire

Charakterisierung von Habitaten des Schweinswals (Phocoena phocoena) in deutschen Gewässern

The harbour porpoise (Phocoena phocoena) is an important top predator and as such an indicator species for its environment. Before the beginning of the 21st century, little data existed on distribution and abundance of harbour porpoises in German waters of North and Baltic Sea. As a consequence, virtually nothing was known about important habitats, seasonal differences in distribution and environmental variables determining its distribution. Studies of habitat characteristics of harbour porpoises have been driven both by the need to support conservation and management actions and the increasing availability of suitable tools (e.g. GIS, remote sensing, regression modelling techniques). This thesis aimed to characterise the habitat of harbour porpoises in German waters by estimating abundance, examining spatial and seasonal patterns in distribution, deriving habitat prediction models and investigating the feeding ecology of porpoises in order to infer on predator-prey dynamics. A comprehensive database was set up based on results of aerial surveys conducted year-round in the course of five consecutive years (2002-2006), following standard line transect methodology. Robust abundance estimates for different surveys, that accounted for animals missed on the transect lines, could be derived for the Baltic and the North Sea. In the Baltic Sea, these estimates are especially important to evaluate the effect of bycatch that was found to be a major threat to porpoises throughout the western Baltic Sea. In the North Sea, presented abundance estimates will serve as a baseline for management decisions with respect to the projected construction of large offshore wind farms and its possible impacts on porpoises. Important habitats were detected in offshore waters of the German North Sea: in spring, the two hot spots 'Borkum Reef Ground' and 'Sylt Outer Reef' (SOR) were identified as key foraging areas for harbour porpoises. In summer, the large hot spot SOR persisted, causing a strong north-south density gradient. In autumn, porpoises were more evenly distributed and density was lower than during spring and summer. Differences in these seasonal hot spots were investigated in relation to several static (e.g. depth, slope) and dynamic (e.g. sea surface temperature, chlorophyll) predictors by applying generalised additive models (GAM) and mixed models (GAMM). The key habitat descriptors as selected by the models varied between seasons. Predictors explaining most of the variance were the hydrographical parameter 'residual currents' and proxies for primary production and fronts (chlorophyll and nutrients) as well as the interaction 'distance to coast/water depth'. In order to address possible seasonal dietary shifts, two methods, the traditional method of stomach content analysis and the new method of quantitative fatty acid signature analysis (QFASA) were applied to elucidate the feeding ecology of harbour porpoises in German waters. A multivariate analysis revealed significant seasonal and between-year fluctuations in the relative importance of prey species: in spring, mainly sandeel, goby and herring contributed with high masses whereas cod was most important in summer. Cod seemed to be an important prey item throughout the study period. Goby and flatfish species appeared to be more important before 2001, whereas in the period 2002-2006 sandeel, herring and sprat contributed more to the diet. In conclusion, this thesis discovered important temporal and spatial patterns of habitat use and elucidated its underlying causes as harbour porpoise density were set in relation to the German Bight environment. This thesis could fill addressed gaps in knowledge and improved our understanding of harbour porpoise ecology in German waters and possibly beyond.Der Schweinswal (Phocoena phocoena) ist ein wichtiger Top-Prädator und als solcher eine Indikatorart für seinen Lebensraum. Vor Beginn des 21. Jhs. standen nur wenige Daten zur Verteilung und Abundanz von Schweinswalen in deutschen Gewässern der Nord- und Ostsee zur Verfügung. Demzufolge existierten große Wissenslücken über wichtige Habitate, Unterschiede in saisonalen Verteilungsmustern sowie zu Umwelteigenschaften für die Erklärung der raum-zeitlichen Verteilung. Sowohl die Notwendigkeit, Schutz- und Managementmaßnahmen zu unterstützen, als auch eine zunehmende Verfügbarkeit geeigneter Visualisierungs- und Statistikmethoden (z.B. GIS, Fernerkundung, Regressions-modelle), förderten die Erarbeitung wissenschaftlicher Studien zur Habitatcharakterisierung des Schweinswals. Ziel und Hauptaugenmerk der vorliegenden Studie ist die Charakterisierung des Habitats des Schweinswals in deutschen Gewässern: Hierzu wurden Bestände abgeschätzt, raum-zeitliche Verteilungsmuster untersucht, Habitatmodelle erstellt und, um Rückschlüsse auf die Dynamik der Prädator-Beute-Beziehung ziehen zu können, die Nahrungsökologie der Schweinswale erforscht. Basierend auf Erfassungen von Schweinswalen mittels Flugzählungen, die im Verlauf von fünf Jahren (2002-2006) nach der Linientransekt-Methode durchgeführt wurden, ließ sich eine umfassende Datenbank aufbauen. Es konnten belastbare Bestandsschätzungen für Nord- und Ostsee ermittelt werden, wobei die nicht erfassten Tiere auf den Transektlinien berücksichtigt wurden. Für die Ostsee sind diese Schätzungen besonders wertvoll, um den Effekt von Beifang zu bewerten, der – wie gezeigt wird – eine große Bedrohung für Schweinswale in der westlichen Ostsee darstellt. In der Nordsee dienen die ermittelten Bestandsgrößen als Basislinie, um den möglichen Effekt der geplanten Konstruktion der Offshore-Windkraftanlagen auf Schweinswale abzuschätzen. Im Verlauf der Studie konnten wichtige Habitate für Schweinswale im Offshore-Bereich der Nordsee bestimmt werden: So scheinen im Frühling v.a. die Bereiche um den Borkum Riffgrund und das Sylter Außenriff eine Schlüsselrolle als Nahrungsgründe einzunehmen. Im Sommer stellte sich ein ausgeprägter Nord-Süd Dichtegradient ein, der besonders durch eine sehr hohe Dichte im Sylter Außenriff bedingt wurde. Im Gegensatz dazu war die Verteilung im Herbst wesentlich gleichmäßiger und die Dichte im Vergleich zu Frühling und Sommer am geringsten. Diese jahreszeitlichen Unterschiede in der Schweinswaldichte wurden weitergehend untersucht und durch die Anwendung von verallgemeinerten additiven Modellen (generalised additive models GAM) und gemischten Modellen (mixed models GAMM) zu statischen und dynamischen Habitatvariablen (e.g. Wassertiefe, Meeresoberflächentemperatur) in Beziehung gesetzt. Die von den Modellen selektierten Variablen variierten zwischen den Jahreszeiten. Der Großteil der Varianz wird durch die hydrographischen Parameter "Restströmung", die proxies für Primärproduktion und Fronten (Chlorophyll und Nährstoffe) sowie durch die Interaktion "Abstand zur Küste/Wassertiefe" erklärt. Um mögliche saisonal bedingte Unterschiede in der Nahrungswahl zu untersuchen, wurden die folgenden Methoden angewandt: zum einen die traditionelle Methode der Mageninhaltsanalyse und zum anderen die (relativ) neue Methode der quantitativen Fettsäureanalyse. Eine multivariate Analyse wies auf signifikante jahreszeitliche sowie inter-annuelle Unterschiede bei der relativen Wichtigkeit der Beutearten hin: waren dies im Frühling vor allem Sandaal, Grundel und Hering, so stellte im Sommer der Dorsch die wichtigste Beuteart. In allen untersuchten Jahren erscheint Dorsch als wichtige Nahrungsart zu fungieren. Grundel und Plattfische erschienen hingegen verstärkt vor 2001 in der Nahrung der Schweinswale, die Zeit von 2002 bis 2006 wurde zunehmend von Sandaal, Hering und Sprotte bestimmt. Insgesamt konnte die Studie sowohl wichtige raum-zeitliche Muster in der Habitatnutzung der Schweinswale aufdecken als auch die zugrundeliegenden Faktoren beleuchten, indem die Schweinswaldichte in Beziehung zu Umweltfaktoren der Deutschen Bucht gesetzt wurde. Zudem ließen sich nicht nur die erwähnten Wissenslücken füllen, sondern insgesamt das Verständnis der Schweinswalökologie in deutschen Gewässern verbessern

Brief survey on current Swiss hospitals satisfaction practices & Literature review on international large-scale initiatives evaluating inpatient satisfaction

The ANQ (Swiss National Association for Quality Development in Hospitals and Clinics) has been conducting annual satisfaction surveys for inpatients in acute care settings since 2011. Within a few years, similar surveys were developed and implemented in other settings, for parents of hospitalized children in acute hospitals, adult inpatients in rehabilitation and in psychiatric clinics. The implementation of patient surveys is a mandatory component of the National Measurement Plan to promote and maintain the quality of care in Swiss hospitals. The ANQ surveys are very brief and actually carried out once every two years during one to three months. The findings are used for monitoring temporal changes, for benchmarking among providers and are published in a transparent way to inform the public. However, the usefulness of these results for quality improvement in hospitals is somewhat limited because the selected questions are of a general nature and not suitable to identify precisely potential areas for improvement, a near real-time analysis is not possible and the limited collection period reduces the sample size for small hospital sites. Therefore, hospitals and clinics who would like to monitor and improve patient care have to carry out their own surveys. The purpose of this brief survey among Swiss hospitals and clinics was to make an inventory of existing satisfaction/care experiences surveys, to find out which instruments are used, which methods are applied, and how the findings of the surveys are used to improve inpatient care

Variation of blubber thickness for three marine mammal species in the southern Baltic Sea

Evaluating populational trends of health condition has become an important topic for marine mammal populations under the Marine Strategy Framework Directive (MSFD). In the Baltic Sea, under the recommendation of Helsinki Commission (HELCOM), efforts have been undertaken to use blubber thickness as an indicator of energy reserves in marine mammals. Current values lack geographical representation from the entire Baltic Sea area and a large dataset is only available for grey seals (Halichoerus grypus) from Sweden and Finland. Knowledge on variation of blubber thickness related to geography throughout the Baltic Sea is important for its usage as an indicator. Such evaluation can provide important information about the energy reserves, and hence, food availability. It is expected that methodological standardization under HELCOM should include relevant datasets with good geographical coverage that can also account for natural variability in the resident marine mammal populations. In this study, seasonal and temporal trends of blubber thickness were evaluated for three marine mammal species—harbor seal (Phoca vitulina), grey seal (Halichoerus grypus) and harbor porpoise (Phocoena phocoena)—resident in the southern Baltic Sea collected and investigated under stranding networks. Additionally, the effects of age, season and sex were analyzed. Seasonal variation of blubber thickness was evident for all species, with harbor seals presenting more pronounced effects in adults and grey seals and harbor porpoises presenting more pronounced effects in juveniles. For harbor seals and porpoises, fluctuations were present over the years included in the analysis. In the seal species, blubber thickness values were generally higher in males. In harbor seals and porpoises, blubber thickness values differed between the age classes: while adult harbor seals displayed thicker blubber layers than juveniles, the opposite was observed for harbor porpoises. Furthermore, while an important initial screening tool, blubber thickness assessment cannot be considered a valid methodology for overall health assessment in marine mammals and should be complemented with data on specific health parameters developed for each speciesinfo:eu-repo/semantics/publishedVersio

Evaluating strategies for managing anthropogenic mortality on marine mammals : an R implementation with the package RLA

Funding: ADERA provided support for salaries (MA).Bycatch, the undesirable and non-intentional catch of non-target species in marine fisheries, is one of the main causes of mortality of marine mammals worldwide. When quantitative conservation objectives and management goals are clearly defined, computer-based procedures can be used to explore likely population dynamics under different management scenarios and estimate the levels of anthropogenic removals, including bycatch, that marine mammal populations may withstand. Two control rules for setting removal limits are the Potential Biological Removal (PBR) established under the US Marine Mammal Protection Act and the Removals Limit Algorithm (RLA) inspired from the Catch Limit Algorithm (CLA) developed under the Revised Management Procedure of the International Whaling Commission. The PBR and RLA control rules were tested in a Management Strategy Evaluation (MSE) framework. A key feature of PBR and RLA is to ensure conservation objectives are met in the face of the multiple uncertainties or biases that plague real-world data on marine mammals. We built a package named RLA in the R software to carry out MSE of control rules to set removal limits in marine mammal conservation. The package functionalities are illustrated by two case studies carried out under the auspices of the Oslo and Paris convention (OSPAR) (the Convention for the Protection of the Marine Environment of the North-East Atlantic) Marine Mammal Expert Group (OMMEG) in the context of the EU Marine Strategy Framework Directive. The first case study sought to tune the PBR control rule to the conservation objective of restoring, with a probability of 0.8, a cetacean population to 80% of carrying capacity after 100 years. The second case study sought to further develop a RLA to set removals limit on harbor porpoises in the North Sea with the same conservation objective as in the first case study. Estimation of the removals limit under the RLA control rule was carried out within the Bayesian paradigm. Outputs from the functions implemented in the package RLA allows the assessment of user-defined performance metrics, such as time to reach a given fraction of carrying capacity under a given level of removals compared to the time needed given no removals.Publisher PDFPeer reviewe

Detectable Viral Load in Late Pregnancy among Women in the Rwanda Option B+ PMTCT Program: Enrollment Results from the Kabeho Study.

There are limited viral load (VL) data available from programs implementing Option B+, lifelong antiretroviral treatment (ART) to all HIV-positive pregnant and postpartum women, in resource-limited settings. Extent of viral suppression from a prevention of mother-to-child transmission of HIV program in Rwanda was assessed among women enrolled in the Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV (Kabeho) Study. ARV drug resistance testing was conducted on women with VL\u3e2000 copies/ml. In April 2013-January 2014, 608 pregnant or early postpartum HIV-positive women were enrolled in 14 facilities. Factors associated with detectable enrollment VL (\u3e20 copies/ml) were examined using generalized estimating equations. The most common antiretroviral regimen (56.7%, 344/607) was tenofovir/lamivudine/efavirenz. Median ART duration was 13.5 months (IQR 3.0-48.8); 76.1% of women were on ART at first antenatal visit. Half of women (315/603) had undetectable RNA-PCR VL and 84.6% (510) had36 months compared to those on ART 4-36 months (72/191, 37.7% versus 56/187, 29.9%), though the difference was not significant. The odds of having detectable enrollment VL decreased significantly as duration on ART at enrollment increased (AOR = 0.99, 95% CI: 0.9857, 0.9998, p = 0.043). There was a higher likelihood of detectable VL for women with lower gravidity (AOR = 0.90, 95% CI: 0.84, 0.97, p = 0.0039), no education (AOR = 2.25, (95% CI: 1.37, 3.70, p = 0.0004), nondisclosure to partner (AOR = 1.97, 95% CI: 1.21, 3.21, p = 0.0063) and side effects (AOR = 2.63, 95% CI: 1.72, 4.03, p36 months with genotyping available. Most women were receiving ART at first antenatal visit, with relatively high viral suppression rates. Shorter ART duration was associated with higher VL, with a concerning increasing trend for higher viremia and drug resistance among women on ART for \u3e3 years

The organization of care in pediatric radiotherapy across SIOP Europe affiliated centers:A multicenter survey in the framework of the 'Joint Action on Rare Cancers' project

BACKGROUND/PURPOSE: To reduce inequalities among SIOPE-affiliated countries, standard and optional levels to deliver 'Good Clinical Practice' compliant treatment in pediatric radiation oncology have been published. The aim of this project was to map the availability of pediatric radiotherapy resources across SIOPE-affiliated radiotherapy departments.MATERIALS/METHODS: An online survey with 34 questions was distributed to 246 radiotherapy departments across 35 SIOPE-affiliated countries. In addition to demographic data, 15 general items related to the organization of the radiotherapy process, and 10 radiotherapy-specific items were defined. For each of the 25 items, sum scores were calculated per center and country. Mann-Whitney U tests were used to analyze associations.RESULTS: Between March-June 2019, 121 departments (49 %) out of 31 countries (89 %) completed the survey. At center level, involvement of core disciplines in tumor boards (28 %), and integration of dedicated pediatric radiation therapy technologists (24 %) are limited, while rare &amp; complex brachytherapy procedures are performed in many centers (23 %). For general and radiotherapy-specific items respectively, a relevant variation of sum scores was observed across countries (Δgeneral: ≤10 points; ΔRT_specific: ≤5 points) and among centers within a country (Δgeneral: ≤9 points; ΔRT_specific: ≤6 points). Sum scores for general and radiotherapy-specific items were higher in countries with a high-income (p &lt; 0.01) and higher health development index (p &lt; 0.01). A larger annual number of irradiated pediatric patients was associated with higher sum scores for general items (p &lt; 0.01).CONCLUSION: This survey demonstrates the disparities in organization of pediatric radiotherapy departments between SIOPE-affiliated countries and centers within the same country. Investment is needed to reduce inequalities in pediatric radiotherapy care.</p

Cobomarsen, an oligonucleotide inhibitor of miR-155, slows DLBCL tumor cell growth in vitro and in vivo

MicroRNA-155, is an oncogenic miRNA, highly expressed in B-cell malignancies, particularly in the non-Germinal Center B-cell or activated B-cell subtype of Diffuse Large B-cell Lymphoma (non-GCB/ABC-DLBCL), where it is considered a potential diagnostic and prognostic biomarker. Thus, miR-155 inhibition represents an important therapeutic strategy for B-cell lymphomas. In this study, we tested the efficacy and pharmacodynamic activity of an oligonucleotide inhibitor of miR-155, cobomarsen, in ABC-DLBCL cell lines and in corresponding xenograft mouse models. In addition, we assessed the therapeutic efficacy and safety of cobomarsen in a patient diagnosed with aggressive ABC-DLBCL

International forum. an investigation of iron status in blood donors

No abstract availabl

Treatment outcomes and roles of transplantation and maintenance rituximab in patients with previously untreated mantle cell lymphoma: Results from large real-world cohorts

PURPOSE: Commonly used first-line (1L) treatments for mantle cell lymphoma include high-dose cytarabine-based induction followed by autologous stem-cell transplant (ASCT) for younger patients and several chemoimmunotherapy regimens for older patients. Continuous debates exist on the role of ASCT in younger patients and maintenance rituximab (MR) after bendamustine plus rituximab (BR). METHODS: Retrospective data from 4,216 patients with mantle cell lymphoma in the Flatiron Health electronic record-derived deidentified database diagnosed between 2011 and 2021, mostly in US community oncology settings, were evaluated for treatment patterns and outcomes. The efficacy findings with ASCT and MR were validated in an independent cohort of 1,168 patients from 12 academic centers. RESULTS: Among 3,614 patients with documented 1L treatment, BR was the most used. Among 1,265 patients age \u3c 65 years, 30.5% received cytarabine-based induction and 23.5% received ASCT. There was no significant association between ASCT and real-world time to next treatment (hazard ratio [HR], 0.84; 95% CI, 0.68 to 1.03; CONCLUSION: In this large cohort of patients treated primarily in the US community setting, only one in four young patients received cytarabine or ASCT consolidation, suggesting the need to develop treatments that can be delivered effectively in routine clinical practice. Together with the validation cohort, data support future clinical trials exploring regimens without ASCT consolidation in young patients, whereas MR should be considered for patients after 1L BR and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone