Bioarchaeological approaches to understanding the long-term development of mountain societies

Archaeologists do not always differentiate between human activities, practices and techniques within landscape archaeology. This problem is reflected in some research into the development of pastoralism in the Alps. Here, we develop a framework within a “position paper” that engages with these different processes by assessing recent developments in bioarchaeological and palaeoenvironmental methods. Over the last two decades, alpine research has moved beyond the mere characterisation of human activities toward the classification and interpretation of specific practices and techniques, changing how we study the development of alpine pastoralism. Research into the development of mid-/long-distance transhumance from the Provencal plains to the Western Alps has generated considerable interest over the last 20 years. Therefore, the PATHWAy (Pastoralism, TransHumance in the Western Alps) project focuses on studying the Iron Age to Medieval pastoral systems in the Western Alps and south-eastern France, which is today one of the main regions in Europe where transhumant pastoralism still takes place. Finally, this contribution aims to review how bioarchaeological methods, combined with “cultural” archaeology, inform detailed quotidian aspects of lifeways rather than impactful, mediatised generalising statements, such as mass population movements or simplistic generalisations about past diet

Nifurtimox plus Eflornithine for Late-Stage Sleeping Sickness in Uganda: A Case Series

African sleeping sickness (Human African Trypanosomiasis, or HAT), due to the parasite Trypanosoma brucei gambiense, threatens millions across remote and conflict-affected regions of sub-Saharan Africa, and causes about 15 000 reported cases every year. Untreated HAT progresses from stage 1 (infection of the blood and lymph) to stage 2 (invasion of the central nervous system), and ultimately death. Drugs for stage 2 are few. The historical mainstay, melarsoprol, is highly toxic and inefficacious in some areas due to parasite resistance. Eflornithine is the only viable alternative, already established as safe and efficacious, but difficult to administer and at risk of resistance if used in monotherapy. This paper reports on a series of 48 Ugandan patients treated with a novel combination of nifurtimox (a drug registered for Chagas disease) and eflornithine, 17 as part of a terminated trial, and 31 in a subsequent case series study. Despite the low sample size, findings are promising: no cases of treatment failure, no treatment terminations, and no HAT- or treatment-related deaths. Nifurtimox plus eflornithine may be the best treatment hope for stage 2 HAT patients in the next decade, while new drugs are developed. A larger, multi-centric trial of the combination is ongoing

Heterozygous Variants in KMT2E Cause a Spectrum of Neurodevelopmental Disorders and Epilepsy.

We delineate a KMT2E-related neurodevelopmental disorder on the basis of 38 individuals in 36 families. This study includes 31 distinct heterozygous variants in KMT2E (28 ascertained from Matchmaker Exchange and three previously reported), and four individuals with chromosome 7q22.2-22.23 microdeletions encompassing KMT2E (one previously reported). Almost all variants occurred de novo, and most were truncating. Most affected individuals with protein-truncating variants presented with mild intellectual disability. One-quarter of individuals met criteria for autism. Additional common features include macrocephaly, hypotonia, functional gastrointestinal abnormalities, and a subtle facial gestalt. Epilepsy was present in about one-fifth of individuals with truncating variants and was responsive to treatment with anti-epileptic medications in almost all. More than 70% of the individuals were male, and expressivity was variable by sex; epilepsy was more common in females and autism more common in males. The four individuals with microdeletions encompassing KMT2E generally presented similarly to those with truncating variants, but the degree of developmental delay was greater. The group of four individuals with missense variants in KMT2E presented with the most severe developmental delays. Epilepsy was present in all individuals with missense variants, often manifesting as treatment-resistant infantile epileptic encephalopathy. Microcephaly was also common in this group. Haploinsufficiency versus gain-of-function or dominant-negative effects specific to these missense variants in KMT2E might explain this divergence in phenotype, but requires independent validation. Disruptive variants in KMT2E are an under-recognized cause of neurodevelopmental abnormalities

Impact de la formation initiale en Education Thérapeutique du Patient sur la pratique éducative des infirmiers jeunes diplômés

Starting from questions about how nurses’ initial training in Therapeutic Patient Education (TPE) affects their own learning practices, the present study chose a descriptive mixed-methods (qualitative and quantitative) approach with the eventual aim of formulating and testing a model based on the seven dimensions of educative attitude developed by Pétré et al. This model enables the evaluation of the educational practices within a hospital department or healthcare institution. To this end, the young nursing diploma holders of La Source Nursing School’s class of 2020 (n = 115, two years of nursing practice) were invited to undergo a video interview and take an online questionnaire: nine interviews were performed, and the questionnaire response rate was 36.5%. We noted five key points: 1) A review of the relevant literature, especially those publications dealing with training about and the evaluation of TPE practices and methodologies, revealed a diverse mosaic of studies that were very difficult to compare. The same was true concerning educative attitudes within TPE, where we found a wide variety of definitions but a lack of evaluation frameworks or templates. 2) We noted the significant impact that initial training on TPE had had on questionnaire respondents’ perceptions and visions of that topic. We also observed that students retained a robust methodological foundation in TPE, despite them having to implement it in quite varied domains, including some that were not at all conducive to it. However, this led them to develop all sorts of ways to integrate TPE into their daily professional clinical practice—a testament to their ingenuity and capacity to implement TPE. 3) Inspired by the seven dimensions of educative attitude developed by Pétré et al., the present study validated a model to evaluate a hospital department’s or a healthcare institution’s educative attitude. Furthermore, when TPE is combined with empowerment, we obtain a very pertinent evaluation module allowing us to probe the reality of educational practice in the field. In the present evaluation, initial training represented 28% of students’ empowerment, whereas the realities of the field, which were modulated by the presence or absence of the seven dimensions, represented 72% of this opportunity to intervene. 4) Our findings led to us retaining the proposed evaluation model for future classes of students at La Source Nursing School, thus allowing us to build up a set of data for comparative analyses. With this perspective, a new questionnaire will be developed to incorporate the desired improvements. There are also a few other avenues for future reflection: how to use simulated patients; how to integrate the principles and attitudes of TPE throughout the entire corpus of subjects taught over the three-year nursing curriculum; how to expand the use of TPE in the field (exchanges, interviews, advice, etc.) to remove any potential barriers to its implementation; developing a continuing education module. 5) There appear to be broader, more all-encompassing nursing issues at play with regard to TPE. We could thus ask questions about whether the reality of TPE is at odds with 2 usual care, about its benefits and inconveniences as part of Bourdieu’s symbolic revolution, about its unavoidable flirtation with dialogic, and, in how it expresses educative attitude, about its slow search for a gender according to Y. Clot, that is to say, a healthcare profession of reference.Partie du questionnement quant à l’impact de la formation initiale en Education Thérapeutique du Patient (ETP) sur la pratique éducative des étudiants, l’étude a pris l’option d’une approche descriptive mixte (qualitative/quantitative) avec l’ambition de formater et tester un modèle s’appuyant sur les 7 dimensions de la posture éducative développé par Pétré et al. Ce modèle permet d’évaluer la pratique éducative à travers l’expression de la posture éducative au sein d’un service ou d’une structure. Dans ce but, les jeunes diplômés de l’école (promotion 2020, n=115, deux ans de pratique) ont été sollicités à travers un entretien par visioconférence et un questionnaire en ligne : 9 entretiens ont été réalisés et le taux de réponse au questionnaire est de 36.5%. Cinq points sont à relever : 1) La compilation des différentes publications, notamment celles relevant de la formation et l’évaluation de la pratique de l’ETP, et leurs méthodologies, atteste d’une mosaïque d’études mais sans liens de comparaison. De même pour la posture éducative en ETP où s’observe une polysémie de définitions mais dont les canevas d’évaluation restent pour le moins inexistants ; 2) On constate chez les répondants un fort impact de la formation initiale sur l’imaginaire et la vision concernant l’ETP et la présence d’un fondement méthodologique robuste qui, malgré le déploiement sur des terrains très variés et parfois même peu propices, leur a permis toutes sortes d’habiletés pour intégrer l’ETP dans leur pratique quotidienne, attestant de leur ingéniosité et leur capacité à la décliner dans leurs réalités professionnelles ; 3) L’étude a validé le modèle d’évaluation de la posture éducative d’un service ou d’une structure s’inspirant des 7 dimensions développées par Pétré et al. De plus, lorsqu’on le couple avec le pouvoir d’agir, on obtient un module d’évaluation très pertinent, permettant de sonder la vraie réalité de la pratique éducative sur le terrain. Dans le cas présent, la formation initiale représente 28% du pouvoir d’agir alors que les réalités du terrain, à travers la modulation de présence ou non des 7 dimensions, ont un poids de 72% sur cette possibilité d’action ; 4) Les résultats obtenus encouragent à retenir le modèle d’évaluation proposé pour les futures promotions d’étudiants à la Source, permettant d’obtenir au cours du temps une base de données comparatives. Dans cette perspective, un nouveau questionnaire intégrant les améliorations souhaitées sera élaboré. S’ajoutent quelques axes de réflexion : le recours à des patients-simulés, la manière d’intégrer les principes et attitudes de l’ETP dans l’ensemble des autres matières enseignées tout au long des 3 trois ans de formation, l’approfondissement du travail avec le terrain (échanges, entretiens, conseils etc.) pour aplanir les barrières potentielles, la mise sur pied d’un module de formation continue ; 5) Des enjeux plus vastes et de portée universelle semblent se jouer à propos de l’ETP. On peut ainsi s’interroger sur sa réalité de porte-à-faux quant au soin coutumier, son apport et inconfort comme révolution symbolique au sens de Bourdieu, son incontournable flirt avec la dialogique et, dans son expression de posture éducative, son tâtonnement à la recherche d’un genre, c’est-à-dire d’une référence-métier

Impact de la formation initiale en Education Thérapeutique du Patient sur la pratique éducative des infirmiers jeunes diplômés

Starting from questions about how nurses’ initial training in Therapeutic Patient Education (TPE) affects their own learning practices, the present study chose a descriptive mixed-methods (qualitative and quantitative) approach with the eventual aim of formulating and testing a model based on the seven dimensions of educative attitude developed by Pétré et al. This model enables the evaluation of the educational practices within a hospital department or healthcare institution. To this end, the young nursing diploma holders of La Source Nursing School’s class of 2020 (n = 115, two years of nursing practice) were invited to undergo a video interview and take an online questionnaire: nine interviews were performed, and the questionnaire response rate was 36.5%. We noted five key points: 1) A review of the relevant literature, especially those publications dealing with training about and the evaluation of TPE practices and methodologies, revealed a diverse mosaic of studies that were very difficult to compare. The same was true concerning educative attitudes within TPE, where we found a wide variety of definitions but a lack of evaluation frameworks or templates. 2) We noted the significant impact that initial training on TPE had had on questionnaire respondents’ perceptions and visions of that topic. We also observed that students retained a robust methodological foundation in TPE, despite them having to implement it in quite varied domains, including some that were not at all conducive to it. However, this led them to develop all sorts of ways to integrate TPE into their daily professional clinical practice—a testament to their ingenuity and capacity to implement TPE. 3) Inspired by the seven dimensions of educative attitude developed by Pétré et al., the present study validated a model to evaluate a hospital department’s or a healthcare institution’s educative attitude. Furthermore, when TPE is combined with empowerment, we obtain a very pertinent evaluation module allowing us to probe the reality of educational practice in the field. In the present evaluation, initial training represented 28% of students’ empowerment, whereas the realities of the field, which were modulated by the presence or absence of the seven dimensions, represented 72% of this opportunity to intervene. 4) Our findings led to us retaining the proposed evaluation model for future classes of students at La Source Nursing School, thus allowing us to build up a set of data for comparative analyses. With this perspective, a new questionnaire will be developed to incorporate the desired improvements. There are also a few other avenues for future reflection: how to use simulated patients; how to integrate the principles and attitudes of TPE throughout the entire corpus of subjects taught over the three-year nursing curriculum; how to expand the use of TPE in the field (exchanges, interviews, advice, etc.) to remove any potential barriers to its implementation; developing a continuing education module. 5) There appear to be broader, more all-encompassing nursing issues at play with regard to TPE. We could thus ask questions about whether the reality of TPE is at odds with 2 usual care, about its benefits and inconveniences as part of Bourdieu’s symbolic revolution, about its unavoidable flirtation with dialogic, and, in how it expresses educative attitude, about its slow search for a gender according to Y. Clot, that is to say, a healthcare profession of reference.Partie du questionnement quant à l’impact de la formation initiale en Education Thérapeutique du Patient (ETP) sur la pratique éducative des étudiants, l’étude a pris l’option d’une approche descriptive mixte (qualitative/quantitative) avec l’ambition de formater et tester un modèle s’appuyant sur les 7 dimensions de la posture éducative développé par Pétré et al. Ce modèle permet d’évaluer la pratique éducative à travers l’expression de la posture éducative au sein d’un service ou d’une structure. Dans ce but, les jeunes diplômés de l’école (promotion 2020, n=115, deux ans de pratique) ont été sollicités à travers un entretien par visioconférence et un questionnaire en ligne : 9 entretiens ont été réalisés et le taux de réponse au questionnaire est de 36.5%. Cinq points sont à relever : 1) La compilation des différentes publications, notamment celles relevant de la formation et l’évaluation de la pratique de l’ETP, et leurs méthodologies, atteste d’une mosaïque d’études mais sans liens de comparaison. De même pour la posture éducative en ETP où s’observe une polysémie de définitions mais dont les canevas d’évaluation restent pour le moins inexistants ; 2) On constate chez les répondants un fort impact de la formation initiale sur l’imaginaire et la vision concernant l’ETP et la présence d’un fondement méthodologique robuste qui, malgré le déploiement sur des terrains très variés et parfois même peu propices, leur a permis toutes sortes d’habiletés pour intégrer l’ETP dans leur pratique quotidienne, attestant de leur ingéniosité et leur capacité à la décliner dans leurs réalités professionnelles ; 3) L’étude a validé le modèle d’évaluation de la posture éducative d’un service ou d’une structure s’inspirant des 7 dimensions développées par Pétré et al. De plus, lorsqu’on le couple avec le pouvoir d’agir, on obtient un module d’évaluation très pertinent, permettant de sonder la vraie réalité de la pratique éducative sur le terrain. Dans le cas présent, la formation initiale représente 28% du pouvoir d’agir alors que les réalités du terrain, à travers la modulation de présence ou non des 7 dimensions, ont un poids de 72% sur cette possibilité d’action ; 4) Les résultats obtenus encouragent à retenir le modèle d’évaluation proposé pour les futures promotions d’étudiants à la Source, permettant d’obtenir au cours du temps une base de données comparatives. Dans cette perspective, un nouveau questionnaire intégrant les améliorations souhaitées sera élaboré. S’ajoutent quelques axes de réflexion : le recours à des patients-simulés, la manière d’intégrer les principes et attitudes de l’ETP dans l’ensemble des autres matières enseignées tout au long des 3 trois ans de formation, l’approfondissement du travail avec le terrain (échanges, entretiens, conseils etc.) pour aplanir les barrières potentielles, la mise sur pied d’un module de formation continue ; 5) Des enjeux plus vastes et de portée universelle semblent se jouer à propos de l’ETP. On peut ainsi s’interroger sur sa réalité de porte-à-faux quant au soin coutumier, son apport et inconfort comme révolution symbolique au sens de Bourdieu, son incontournable flirt avec la dialogique et, dans son expression de posture éducative, son tâtonnement à la recherche d’un genre, c’est-à-dire d’une référence-métier

Développer les compétences des soignants en entretien motivationnel par le coaching

Développer des compétences en entretien motivationnel (EM) permet aux soignants de préparer leur patient au changement en suscitant leur motivation

Farming and consumming lambs in medieval Provence (12th-14th c.) from a zooarchaeological, historical and isotopic perspective

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