Bildungspolitik in Frankreich

Ziel dieses Artikels ist es, die wesentlichen bildungspolitischen Erfahrungen der letzten Jahrzehnte in Frankreich darzustellen und im Hinblick auf die bildungspolitische Debatte in Deutschland zu bewerten. Die allgemeinen Ziele der Bildungspolitik - wie z.B. die Anhebung des Bildungsniveaus, die Verwirklichung sozialer Chancengleichheit, die Anpassung an den wirtschaftlichen und gesellschaftlichen Wandel - sowie ein großer Teil der Herausforderungen an das französische Bildungssystem - wie z.B. die Bildungsexpansion, die Heterogenität der Schüler- und Studentenbevölkerung, die hohe Arbeitslosigkeit sowie steigende Kosten - gelten zum Teil auch für Deutschland. Somit zeigen die in Frankreich ergriffenen Maßnahmen alternative Wege, auf ähnliche Herausforderungen zu reagieren

Atomic oxygen studies on polymers

The purpose was to study the effects of atomic oxygen on the erosion of polymer based materials. The development of an atomic oxygen neutral beam facility using a SURFATRON surface wave launcher that can produce beam energies between 2 and 3 eV at flux levels as high as approx. 10 to the 17th power atoms/cm (2)-sec is described. Thin film dielectric materials were studied to determine recession rates and and reaction efficiencies as a function of incident beam energy and fluence. Accelerated testing was also accomplished and the values of reaction efficiency compared to available space flight data. Electron microscope photomicrographs of the samples' surface morphology were compared to flight test specimens

Incidence of depression and associated factors in patients with type 2 diabetes in Quebec, Canada

It has been reported that the risk of depression is higher among people with type 2 diabetes compared with a nondiabetic population. Among diabetic patients, depression has been associated with worse self-care behaviors, poor glycemic control, and an increased risk of diabetes complications. Identifying factors associated with the occurrence of depression may help physicians identify earlier diabetic patients at a high risk of developing depression, improve prevention, and accelerate proper treatment. To our knowledge, very few population-based studies have reported on the incidence of clinically diagnosed depression as a consequence of type 2 diabetes over a long follow-up period. The objective of this study was to estimate the incidence of clinically diagnosed depression among type 2 diabetic patients newly treated with oral antidiabetic drugs (ADs) and to identify factors associated with the occurrence of depression. Administrative claims data from the public health insurance plan were used to identify a cohort of new oral AD users aged ≥18 years between 2000 and 2006. Patients were followed from oral AD treatment initiation until the diagnosis of depression, ineligibility for the public drug plan, death, or the end of the study, whichever came first. Incidence rates were determined using person-time analysis. Factors associated with depression were identified using multivariable Cox regression analysis. We identified 114,366 new oral AD users, of which 4808 had a diagnosis of depression. The overall incidence rate of depression was 9.47/1000 person-years (PYs) (10.72/1000 PYs for women and 8.27/1000 PYs for men). The incidence of depression was higher during the year after oral AD treatment initiation. Independent factors associated with depression included having had mental disorders other than depression, hospitalization, a higher number of different drugs taken and of physicians visited during the year before oral AD initiation. Moreover, we observed a statistically significant age-by-socioeconomic status interaction. The incidence of diagnosed depression is higher during the first year after oral AD treatment initiation. Clinicians could pay particular attention to women, patients starting an AD at a young age, those with a low socioeconomic status, and especially those with a history of anxiety or dementia

Factors associated with antidiabetic medication non-adherence in patients with incident comorbid depression

Aim To identify factors associated with antidiabetic drug (AD) non-adherence among patients with type 2 diabetes and depression. Study Design and Settings We conducted a population-based retrospective cohort study among new AD users with a diagnosis of depression following AD initiation. We used public health insurance data from Quebec. The dependent variable was non-adherence (i.e., < 90% of days covered by ≥ 1 AD) in the year after a depression diagnosis. Different sociodemographic, clinical and medication-related variables were assessed as potential factors of non-adherence to AD treatment. We performed univariate and multivariate logistic regressions. Results We identified 3106 new users of ADs with a diagnosis of depression between 2000 and 2006. Of these individuals, 52% were considered non-adherent to their ADs. Baseline non-adherence, younger age, the addition of another AD to the initial treatment, < 4 drug claims, visits with several different physicians, high socioeconomic status, and a small number of diabetes complications were associated with AD non-adherence. Conclusions The factors identified in the present study may help clinicians recognize patients with type 2 diabetes and incident depression at increased risk for non-adherence. In these patients, close follow-up and targeted interventions could help improve adherence to AD treatment, improve glycemic control and reduce complications

Impact of a Community Pharmacist-Delivered Information Program on the Follow-up of Type-2 Diabetic Patients: A Cluster Randomized Controlled Study.

Low-quality communication between patients and care providers and limited patient knowledge of the disease and the therapy are important factors associated with poor glycemic control in patients with type 2 diabetes. We conducted a multicenter study to determine whether structured and tailored information delivered by pharmacists to type 2 diabetic patients could improve patient treatment adherence, hemoglobin A1c (HbA1c) levels and knowledge about diabetes. One hundred seventy-four pharmacies were randomized to deliver an educational program on diet, drug treatment, disease and complications during three 30-min interviews over a 6-month period, or to provide no intervention, to type 2 diabetic patients treated with oral antidiabetic agents. Medication adherence was assessed by measuring the medication possession ratio and diabetes control by collecting HbA1c values. Levels of patient treatment self-management and disease knowledge were assessed using self-questionnaires. Three hundred seventy-seven patients were analyzed. The medication possession ratio, already very high at baseline in the intervention (94.8%) and control (92.3%) groups, did not vary significantly after 6 months with no difference between the two groups. Significant decreases in HbA1c were observed in both groups at 6 months (p < 0.001) and 12 months (p < 0.01), with significantly greater changes from baseline in the intervention group than in the control group at 6 months (- 0.5% vs. - 0.2%, p = 0.0047) and 12 months (- 0.6% vs. - 0.2%, p = 0.0057). Patients in the intervention group showed greater improvement in their ability to self-manage treatment (+ 4.86 vs. + 1.58, p = 0.0014) and in the extent of their knowledge about diabetes (+ 0.6 vs. + 0.2, p < 0.01) at 6 months versus baseline compared with the control group. Tailored information provided by the pharmacist to patients with type 2 diabetes did not significantly improve the already high adherence rates, but was associated with a significant decrease in HbA1c and an improvement of patient knowledge about diabetes. ISRCTN33776525. MSD France

Lower limb biomechanics during drop jump landing in individuals with chronic ankle instability

ABSTRACT Context: Individuals with chronic ankle instability (CAI) exhibit impaired lower limb biomechanics during unilateral drop jump landing on a flat surface. However, lower limb biomechanical adaptations during unilateral drop jump landing on more challenging surfaces such as unstable or inclined are yet to be described. Objective: Determine how unilateral drop jump landing surfaces (flat, unstable and inclined) influence lower limb EMG, kinematics and kinetics in individuals with CAI. Design: Descriptive laboratory study. Setting: Biomechanics laboratory. Patients or Other Participants: Twenty-two young adults with CAI Interventions: Participants completed five trials of unilateral drop jump landing from a 46 cm height platform on flat (DROP), unstable (FOAM) and laterally inclined (WEDGE) surfaces. Main outcome measure(s): EMG of gluteus medius, vastus lateralis, gastrocnemius medialis, peroneus longus and tibialis anterior muscles were recorded. Knee and ankle angles and moments were calculated using a three-dimensional motion analysis system and a force plate. Biomechanical variables were compared between tasks using one-dimensional statistical nonparametric mapping. Results: During DROP, greater ankle dorsiflexion angles, knee extension moments and vastus lateralis muscle activity (FOAM only) were observed compared to FOAM and WEDGE. Greater ankle inversion angles were observed during FOAM and WEDGE compared to DROP. Peroneus longus muscle activity was greater during DROP compared to FOAM. During FOAM, greater ankle inversion and knee extension angles, ankle inversion and internal rotation moments as well as smaller peroneus longus muscle activity were observed compared to WEDGE. Conclusions: The greater ankle inversion and plantarflexion angles as well as the lack of increase in peroneus longus muscle activation during FOAM and WEDGE could increase the risk of recurrent LAS in individuals with CAI. The results of this study improve our understanding of lower limb biomechanics changes when landing on more challenging surfaces and will help clinicians better targeting deficits associated with CAI during rehabilitation

Lower limb biomechanics in individuals with chronic ankle instability during gait: a case-control study

Individuals with chronic ankle instability (CAI) exhibit many biomechanical changes to lower limbs during walking. However, only a few studies have investigated the differences in lower limb biomechanics of individuals with CAI compared to healthy controls using a comprehensive approach including kinematic, kinetic and electromyography (EMG) measures. Consequently, the theoretical framework explaining the biomechanical adaptations in individuals with CAI is mostly based on the results of studies including heterogenous methods and participants’ specificities (e.g., level of disability). More studies using a comprehensive approach are needed to better understand the biomechanical adaptations associated with CAI. The objective of this case-control study was to identify the kinematic, kinetic and EMG differences between individuals with CAI and healthy controls during walking

Neutron to proton ratios of quasiprojectile and midrapidity emission in the 64^{64}Zn + 64^{64}Zn reaction at 45 MeV/nucleon

Simultaneous measurement of both neutrons and charged particles emitted in the reaction $^{64}$Zn + $^{64}$Zn at 45 MeV/nucleon allows comparison of the neutron to proton ratio at midrapidity with that at projectile rapidity. The evolution of N/Z in both rapidity regimes with increasing centrality is examined. For the completely re-constructed midrapidity material one finds that the neutron-to-proton ratio is above that of the overall $^{64}$Zn + $^{64}$Zn system. In contrast, the re-constructed ratio for the quasiprojectile is below that of the overall system. This difference provides the most complete evidence to date of neutron enrichment of midrapidity nuclear matter at the expense of the quasiprojectile

Prévenir les troubles musculosquelettiques chez les soignants : connaître les expositions et étude des outils d’aide à la manutention

ObjectifsDans le cadre de la Caisse nationale de retaite des agents des collectivités locales (CNRACL), la démarche d’évaluation et de prévention des risques vise à conduire à une démarche spécifique au milieu hospitalier et à construire des outils d’évaluation des risques dans le réseau des CHU français. Les études menées sur la prévention des troubles musculosquelettiques (TMS) associent principalement les compétences en ergonomie, épidémiologie et médecine du travail des CHU d’Angers et de Grenoble. Méthode Une première étude épidémiologique a permis d’identifier les facteurs de risque de TMS et de lombalgie en milieu hospitalier ; une seconde s’est intéressée à l’évaluation des outils d’aide à la manutention des patients en milieu de soins sous un angle ergonomique. Résultats Les salariés du secteur santé sont en moyenne exposés à 2,4 facteurs de risque des 19 répertoriés (3,5 pour le reste du réseau) et ne souffrent pas plus de TMS des membres supérieurs que les autres salariés de la région des Pays-de-la-Loire. En revanche, les expositions aux manutentions manuelles de charges lourdes liées aux soins aux patients sont plus fréquentes. Les aides techniques pour la manutention étudiées ne répondent pas aux critères de dépendance du patient ou aux conditions organisationnelles du service. Du point de vue psychologique, le rapport du patient au matériel ainsi que l’usage du corps du soignant dans la relation aux soins doivent être pris en compte. Conclusion L’approche biomécanique a fait l’objet de cette première investigation. Il s’agit d’une démarche de prévention pluridisciplinaire intégrée dans la politique d’établissement

The effect of introducing IGRA to screen French healthcare workers for tuberculosis and potential conclusions for the work organisation

INTRODUCTION: In France, pre-employment screening for tuberculosis (TB) is performed for healthcare workers (HCW). Screening is repeated when exposure to TB patients or infectious material occurs. The results of these TB screenings were analysed in a retrospective analysis. METHOD: Tuberculin skin tests (TST) and interferon-gamma release assays (QuantiFERON® Gold In-Tube - QFT) were used to perform the TB screenings. The screening results of 637 HCWs on whom QFT was performed were taken from the records of the University Hospital of Nantes. RESULTS: In three (0.5%) HCW, the QFT was indeterminate. In 22.2%, the QFT was positive. A second QFT was performed in 118 HCWs. The reversion rate was 42% (5 out of 17). The conversion rate was 6% (6 out of 98). A TST was performed on 466 (73.5%) of the HCWs. Results for TST > 10 mm were 77.4%. In those with a TST < 10 mm, QFT was positive in 14% and in those with a TST ≥ 10 mm, QFT was positive in 26.7%. Depending on the definition for conversion in the QFT, the annual attack rate was 4.1% or 7.3%. X-ray and pneumology consultation was based on positive QFT rather than TST alone (52 out of 56). No active TB was detected. CONCLUSION: The TST overestimated the prevalence of LTBI in this cohort. The decision about X-ray and consultation regarding preventive treatment should be based on the QFT rather than the TST results. The high reversion rate should be taken into consideration when consulting with HCWs regarding preventive treatment. The high conversion rate seems to indicate that preventive measures such as wearing masks should be improved