International consensus (ICON) on treatment of Ménière's disease

Objective: To present the international consensus for recommendations for Ménière's disease (MD) treatment. Methods: Based on a literature review and report of 4 experts from 4 continents, the recommendations have been presented during the 21st IFOS congress in Paris, in June 2017 and are presented in this work. Results: The recommendation is to change the lifestyle, to use the vestibular rehabilitation in the intercritic period and to propose psychotherapy. As a conservative medical treatment of first line, the authors recommend to use diuretics and Betahistine or local pressure therapy. When medical treatment fails, the recommendation is to use a second line treatment, which consists in the intratympanic injection of steroids. Then as a third line treatment, depending on the hearing function, could be either the endolymphatic sac surgery (when hearing is worth being preserved) or the intratympanic injection of gentamicin (with higher risks of hearing loss). The very last option is the destructive surgical treatment labyrinthectomy, associated or not to cochlear implantation or vestibular nerve section (when hearing is worth being preserved), which is the most frequent option

Field line distribution of density at \u3ci\u3eL\u3c/i\u3e=4.8 inferred from observations by CLUSTER

For two events observed by the CLUSTER space- craft, the field line distribution of mass density ρ was inferred from Alfve ́n wave harmonic frequencies and compared to the electron density ne from plasma wave data and the oxy- gen density nO+ from the ion composition experiment. In one case, the average ion mass M≡ρ/ne was about 5amu (28 October 2002), while in the other it was about 3 amu (10 September 2002). Both events occurred when the CLUSTER 1 (C1) spacecraft was in the plasmatrough. Nevertheless, the electron density ne was significantly lower for the first event (ne =8 cm−3 ) than for the second event (ne =22 cm−3 ), and this seems to be the main difference leading to a dif- ferent value of M. For the first event (28 October 2002), we were able to measure the Alfve ́n wave frequencies for eight harmonics with unprecedented precision, so that the er- ror in the inferred mass density is probably dominated by factors other than the uncertainty in frequency (e.g., mag- netic field model and theoretical wave equation). This field line distribution (at L=4.8) was very flat for magnetic lati- tude |MLAT|20◦ but very steeply increasing with respect to |MLAT| for |MLAT|40◦. The total variation in ρ was about four orders of magnitude, with values at large |MLAT| roughly consistent with ionospheric values. For the second event (10 September 2002), there was a small local maxi- mum in mass density near the magnetic equator. The in- ferred mass density decreases to a minimum 23% lower than the equatorial value at |MLAT|=15.5◦, and then steeply in- creases as one moves along the field line toward the iono- sphere. For this event we were also able to examine the spa- tial dependence of the electron density using measurements of ne from all four CLUSTER spacecraft. Our analysis in- dicates that the density varies with L at L∼5 roughly like L−4, and that ne is also locally peaked at the magnetic equa- tor, but with a smaller peak. The value of ne reaches a den- sity minimum about 6% lower than the equatorial value at |MLAT|=12.5◦, and then increases steeply at larger values of |MLAT|. This is to our knowledge the first evidence for a local peak in bulk electron density at the magnetic equa- tor. Our results show that magnetoseismology can be a useful technique to determine the field line distribution of the mass density for CLUSTER at perigee and that the distribution of electron density can also be inferred from measurements by multiple spacecraft

Faire l’Union. La refondation des parties de droite après les élections de 2002

Un nouveau parti de droite, pour le moment dénommé UMP, a été mis en place entre des deux tours de l'élection présidentielle. Cet article se donne pour objectif d'analyser les enjeux de cette transformation. La genèse de l'UMP permet de saisir dans quelle mesure un parti poli-tique peut être conçu comme la connexion d'un ensemble de systèmes de coopération organisés autour de postes à conquérir. En effet, l'impératif d'unification de la droite française est lié au décalage persistant existant entre les systèmes de coopération législatif et présidentiel. Mais les questions soulevées par cette fusion partisane (l'UMP inclut le RPR, DL et une majeure partie de l'UDF) montrent que cette vision ne peut suffire et que les partis ne sont pas seulement des systèmes de coopération mais aussi des systèmes de production. Dès lors, leurs logiques d'organisation internes pèsent sur ce travail de transformation du social en politique, de la plu-ralité en homogénéité. Dans le cas de l'UMP, il s'agit d'abord de mettre en commun des modes de fonctionnement, en particulier de définir la place et la légitimité accordées respectivement aux adhérents et aux élus, mais aussi d'organiser l'expression de la pluralité idéologique par la mise en place de courants