The resistible decline of European science

Using a new data set that allows us to analyze precisely the research output in all fields of science, we show that the gap in scientific performance between Europe, especially continental Europe, and Anglo-Saxon countries, especially the USA, is large. We measure research quality by the number of highly cited researchers in nineteen selected scientific fields. After controlling for different variables, such as par capita GDP and outlays in R&D, the differences in productivity between Anglo-Saxon countries and other countries are explained, not surprisingly, by the importance of English proficiency, but also by the quality of institutions and of governance of the countries in the studied sample, the latter being in all likelihood highly correlated with the governance quality of research institutions

The resistible decline of European science

Using a data set of highly cited researchers in all fields of science, we show that the gapin scientific performance between Europe, especially continental Europe, and the USAis large. We model the number of highly cited researchers in a sample of countries as afunction of physical and human capital and a country-specific, factor-augmentingHicks-neutral productivity term. We find that differences in productivity betweenAnglo-Saxon countries and other countries are not solely due to differences in the levelsof inputs. Not surprisingly, our results reveal the importance of English proficiency.However, they also show that the governance and design of research institutions thatcharacterize Anglo-Saxon countries, as well as a few other countries that have similarinstitutions, is another critical factor for research output.research performance, citations, knowledge economies, university governance

Influence of rectal prolapse on the asymmetry of the anal sphincter in patients with anal incontinence

BACKGROUND: Anal sphincter defects have been shown to increase pressure asymmetry within the anal canal in patients with fecal incontinence. However, this correlation is far from perfect, and other factors may play a role. The goal of this study was to assess the impact of rectal prolapse on anal pressure asymmetry in patients with anal incontinence. METHODS: 44 patients, (42 women, mean age: 64 (11) years), complaining of anal incontinence, underwent anal vector manometry, endo-anal ultrasonography (to assess sphincter defects) and pelvic viscerogram (for the diagnosis of rectal prolapse). Resting and squeeze anal pressures, and anal asymmetry index at rest and during voluntary squeeze were determined by vector manometry. RESULTS: Ultrasonography identified 19 anal sphincter defects; there were 9 cases of overt rectal prolapse, and 14 other cases revealed by pelvic viscerogram (recto-anal intussuception). Patients with rectal prolapse had a significantly higher anal sphincter asymmetry index at rest, whether patients with anal sphincter defects were included in the analysis or not (30 (3) % versus 20 (2) %, p < 0.005). Among patients without rectal prolapse, a higher anal sphincter asymmetry index during squeezing was found in patients with anal sphincter defects (27 (2) % versus 19 (2) %, p < 0.03). CONCLUSIONS: In anal incontinent patients, anal asymmetry index may be increased in case of anal sphincter defect and/or rectal prolapse. In the absence of anal sphincter defect at ultrasonogaphy, an increased anal asymmetry index at rest may point to the presence of a rectal prolapse

Effectiveness of non-pharmacological interventions for irritable bowel syndrome : a systematic review

Introduction. Given the complexity of the therapeutic management of irritable bowel syndrome (IBS), alternative non-pharmacological therapies are frequently offered to patients. The aim of this study was to conduct a systematic review in order to establish the current evidence base for non-pharmacological interventions (body-directed and mind-body therapies) in the management of IBS. Materials and Methods. The literature was searched in several electronic databases (PubMed (including Medline), Web of Science (Clarivate Analytics), Scopus (Elsevier), ScienceDirect (Elsevier), Cochrane Library (Wiley), and Wiley Online Library (Wiley)) for randomized controlled trials (RCTs) published in the English language from 1990 to 2020. Effectiveness outcomes were examined through the change in overall IBS symptoms or abdominal pain up to 12 months after treatment. Results. 11 studies (parallel-group RCTs) were identified that enrolled 1590 participants in total. Body-directed therapies (acupuncture and osteopathic medicine) showed a beneficial effect compared with standard medical treatment for overall IBS symptoms at 6 months follow-up, while no study found any difference between body-directed and sham therapies for abdominal pain or overall IBS symptoms. It was not possible to conclude whether hypnotherapy was superior to standard medical treatment or supportive therapy for overall IBS symptoms or abdominal pain due to discordant results. Conclusions. Although body-directed therapies such as acupuncture and osteopathic medicine may be beneficial for overall IBS symptoms, higher-quality RCTs are needed to establish the clinical benefit of non-pharmacological interventions for IBS. An important challenge will be the definition of the optimal control groups to be used in non-pharmacological trials

The resistible decline of European science

Using a data set of highly cited researchers in all fields of science, we show that the gap in scientific performance between Europe, especially continental Europe, and the USA is large. We model the number of highly cited researchers in a sample of countries as a function of physical and human capital and a country-specific, factor-augmenting Hicks-neutral productivity term. We find that differences in productivity between Anglo-Saxon countries and other countries are not solely due to differences in the levels of inputs. Not surprisingly, our results reveal the importance of English proficiency. However, they also show that the governance and design of research institutions that characterize Anglo-Saxon countries, as well as a few other countries that have similar institutions, is another critical factor for research output

Les Credit Default Swaps : réflexions sur le droit européen des marchés financiers et ses effets extraterritoriaux

Les Credit Default Swaps (CDS) sont au cœur de l'attention de nombreux législateurs pour leur rôle présupposé dans les crises financières des subprimes de 2008 et des dettes souveraines de la zone euro de 2011. Ce dérivé de crédit a par suite fait l'objet de nombreuses réglementations, notamment aux niveaux européen et américain. La thèse est consacrée à la qualification juridique des CDS sous l'angle du droit civil, afin d'évaluer la portée de l'ensemble des normes imposées par le droit réglementaire d'une part, et d'appréhender particulièrement les arbitrages réalisés par le législateur européen d'autre part. La dualité du droit privé et public sert de fil conducteur à l'étude afin de mettre en exergue la nature de la relation entre dispositions civiles et administratives applicables à ce contrat. Une attention particulière est donnée à la Suisse en raison des effets extraterritoriaux du droit de l'UE.</p

Titration morphinique en traumatologie d'urgence (comparaison de deux protocoles)

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Le reflux duodéno-gastro-oesophagien (données actuelles, apport de la détection de bilirubine par spectrophotométrie)

L'objectif de ce travail a été de faire le point sur les connaissances actuelles concernant les mécanismes physiopathologiques, les moyens diagnostiques et thérapeutiques du reflux duodéno-gastro-oesophagien et de rapporter nos travaux de recherche et d'évaluation clinique concernant cette entité pathologique. La première partie est consacrée au reflux duodéno-gastrique primaire et à la méthode de détection de la bilirubine par spectrophotométrie. Nous rapportons notre expérience acquise dans l'unité de chirurgie oeso-gastrique du Pr Collard à l'Université Catholique de Louvain (Cliniques Universitaires Saint-Luc) à Bruxelles. La deuxième partie est consacrée au reflux biliaire secondaire en cas de pathologie biliaire ou après chirurgie oeso-gastro-duodénale. Nous rapportons notre expérience concernant le reflux biliaire postopératoire en fonction de différents types de montages chirurgicaux après chirurgie gastrique. La troisième partie est consacrée aux lésions d'endobrachyoesophage. Le rôle du reflux biliaire dans la genèse et la transformation des lésions d'endobrachyoesophage est précisé ainsi que l'impact des différents montages chirurgicaux anti-reflux sur les lésions d'endobrachyoesophage. Nous détaillons également un projet de recherche expérimentale débuté chez l'animal à la recherche de marqueurs diagnostiques précoces (p63, Cox-2) de dégénérescence de la muqueuse d'endobrachyoesophage en adénocarcinome de l'œsophageLYON1-BU.Sciences (692662101) / SudocSudocFranceF

Improvement with Infliximab of a Disseminated Sarcoidosis in a Patient with Crohn’s Disease

Sarcoidosis and Crohn’s disease are systemic granulomatous disorders affecting the lung and the intestine, respectively, with variable involvement of other organs and are seldom associated. While anti-TNFα is a recognized treatment of Crohn’s disease, its usage is discussed in sarcoidosis. A 42-year-old man presented with an 11-year-long history of Crohn’s disease; upon discovery of an abnormal chest CT scan the diagnosis of multivisceral sarcoidosis was made and, later, a treatment with an anti-TNFα agent, infliximab, was started, because of worsening Crohn’s disease recurrences. CT scan demonstrated net regression of pulmonary opacities and hepatosplenic lesions. Pathologies obtained from the intestinal tract and the bronchi of the patient were, respectively, characteristic of Crohn’s disease and sarcoidosis leading to the diagnosis of both diseases. We report a rare case of steroid resistant Crohn’s disease associated with multivisceral sarcoidosis, treated successfully by an anti-TNFα agent, infliximab