Conflits patrimoniaux et régulation urbaine

Le patrimoine apparaît souvent comme une notion consensuelle instituant, à partir d'un rapport partagé à l'histoire et à la mémoire, un nouveau type de bien commun. C'est une valeur qui semble aujourd'hui présente dans toute la société. Cet article propose de considérer l'intérêt de l'étude des conflits pour l'analyse des processus de patrimonialisation

Difficultés d’une gestion touristique durable : Dzanga-Sangha en République Centrafricaine

International audienceThe article seeks to interrogate the model of World Heritage by touristic management in the context of sustainable development. The example of the Dzanga-Sangha project in southwestern Central African Republic is used as a framework for this analysis. Management by ecotourism of World Heritage areas, classified for their rich biodiversity and the intangible culture of pygmies associated with in the forest, shows a range of limitations. They are linked to the type of project governance. In order to be sustainable, development and management processes of cultural and natural heritage should for example ensure better participation of local communities in their entirety.L'article veut interroger le modèle du patrimoine mondial mis en tourisme dans le cadre du développement durable. L'exemple centrafricain du projet de Dzanga-Sangha au Sud-Ouest de la République centrafricaine sert de cadre pour cette analyse. La mise en valeur par l'écotourisme des espaces classés au patrimoine mondial pour la richesse de leur biodiversité et la culture immatérielle des pygmées associée à la forêt montre un certain nombre de limites liées notamment au type de gouvernance du projet. Pour qu'ils soient durables, les processus de valorisation et de gestion des patrimoines culturels et naturels devraient par exemple veiller à mieux assurer la participation des communautés locales dans leur ensemble

A one-year follow-up study of the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT) in relapsing-remitting multiple sclerosis : an appraisal of comparative longitudinal sensitivity

Altres ajuts: We also thank Ignasi Gich from Department of Epidemiology, Hospital de la Santa Creu i Sant Pau for his advice on statistical analysis.Neuropsychological batteries are infrequently used to assess cognitive impairment in multiple sclerosis because they are time-consuming and require trained personnel. The Symbol Digit Modalities Test (SDMT) is suggested to be a useful screening tool to measure cognitive impairment in multiple sclerosis patients and is more valid and reliable over time than the Paced Auditory Serial Addition Test (PASAT). The purpose of this study was to evaluate which of these tests was more sensitive to cognitive impairment at one-year follow-up. A total of 237 patients with relapsing-remitting multiple sclerosis and 57 healthy controls underwent a complete neuropsychological assessment. One year later, we assessed 196 patients using the Brief Repeatable Battery of Neuropsychological Tests. We also administered other executive function and prospective memory tests, together with fatigue and depression questionnaires. A total of 33.8% of patients were classified as cognitively impaired. The SDMT and the PASAT 3 seconds test (PASAT3) had a sensitivity of 0.809 and 0.783, respectively, thereby classifying patients as cognitively impaired. Analysis of 196 patients one year later showed 31.6% had cognitive impairment compared with 27.6% at the first assessment. The sensitivity to detect cognitive impairment after one year was 0.824 for SDMT and 0.796 for PASAT3. When the predictors were removed from the comparative standard battery, SDMT still showed a slightly higher sensitivity. Both SDMT and PASAT3 correlated significantly with all tests, but SDMT showed higher correlation values. Furthermore, SDMT was completed by all subjects while PASAT3 was completed by 86.9% of patients and 94.7% of controls. SDMT is simpler to administer than PASAT3 and may be slightly more sensitive to MS cognitive impairment. It could thus be a suitable test to assess cognitive impairment routinely in people with relapsing-remitting multiple sclerosis

Introduction

Comment et pourquoi invente-t-on aujourd’hui du patrimoine en Égypte et au Soudan ? Telle est la question que nous proposons d’explorer dans le cadre de ce numéro d’Égypte Monde Arabe. Cette question se pose aujourd’hui avec d’autant plus d’acuité qu’au sein de la masse bibliographique consacrée ces dernières décennies aux processus contemporains de patrimonialisation, l’on manque encore cruellement de travaux permettant de saisir la manière dont les sociétés, sur ces deux terrains, inventent..

Growth responses of neotropical trees to logging gaps

International audienc

J Clin Apher

Introduction No randomized controlled clinical trial of therapeutic plasma exchanges (TPE) has yet been performed for moderate‐to‐severe relapses of multiple sclerosis (MS). Objective To compare TPE to sham‐TPE in patients with a recent steroid‐resistant moderate‐to‐severe MS relapse. Methods Patients presenting with an MS relapse of less than 2 months without improvement and 15 days after a course of steroids were randomized. Specific criteria were used for each relapse type to define moderate‐to‐severe disability. The primary endpoint was the proportion of patients with at least a moderate improvement based on objective and functional evaluation after 1 month. Results Thirty‐eight patients were randomized. The intention‐to‐treat analysis included 14 patients in the TPE group and 17 in the Sham‐TPE group. The proportion of patients with at least moderate improvement at 1 month did not differ between the groups (P = .72), although 57.1% of the TPE group had full recovery compared with 17.6% of the sham group. Considering optic neuritis (ON), a significant difference in the proportion of different levels of improvement was observed in favor of the TPE group (P = .04). The combined Kurtzke's functional systems scores were significantly more improved in the TPE group than in the sham‐TPE group at months 1 (P < .01), 3 (P < .05), and 6 (P < .05). No major side effects were observed. Conclusions A significant difference between TPE and Sham‐TPE at the primary endpoint was only observed in patients with ON. Neurological function improved significantly more often in the TPE group than in the sham‐TPE group

Increased risk of multiple sclerosis relapse after in vitro fertilisation

Michel, Laure Foucher, Yohann Vukusic, Sandra Confavreux, Christian de Seze, Jerome Brassat, David Clanet, Michel Clavelou, Pierre Ouallet, Jean-Christophe Brochet, Bruno Pelletier, Jean Labauge, Pierre Lebrun, Christine Lepage, Emmanuelle Le Frere, Fabienne Jacq-Foucher, Marylene Barriere, Paul Wiertlewski, Sandrine Laplaud, David-Axel Club Francophone de la Sclerose En Plaques (CFSEP) Research Support, Non-U.S. Gov't England Journal of neurology, neurosurgery, and psychiatry J Neurol Neurosurg Psychiatry. 2012 Aug;83(8):796-802. Epub 2012 Jun 11.BACKGROUND: Exogenous sexual steroids together with pregnancy have been shown to influence the risk of relapses in multiple sclerosis (MS). Treatments used during assisted reproductive techniques may consequently influence the short term evolution of MS by modifying the hormonal status of the patient. The objective of this study was to determine if there was an increased risk of developing exacerbations in women with MS after in vitro fertilisation (IVF). METHODS: MS and IVF data were either automatically extracted from 13 French university hospital databases or obtained from referring neurologists. After matching databases, patient clinical files were systematically reviewed to collect information about MS and the treatments used for IVF. The association between IVF and the occurrence of MS relapses was analysed in detail using univariate and multivariate statistical tests. FINDINGS: During the 11 year study period, 32 women with MS had undergone 70 IVF treatments, 48 using gonadotrophin releasing hormone (GnRH) agonists and 19 using GnRH antagonists. A significant increase in the annualised relapse rate (ARR) was observed during the 3 month period following IVF (mean ARR 1.60, median ARR 0) compared with the same period just before IVF (mean ARR 0.80, median ARR 0) and to a control period 1 year before IVF (mean ARR 0.68, median ARR 0). The significant increase in relapses was associated with the use of GnRH agonists (Wilcoxon paired test, p=0.025) as well as IVF failure (Wilcoxon paired test, p=0.019). INTERPRETATION: An increased relapse rate was observed in this study after IVF in patients with MS and may be partly related both to IVF failure and the use of GnRH agonists