La coopération inter-hospitalière, un nouvel élan pour la psychiatrie ? Étude de cas : la coopération entre l'ESP de Ville Évrard et le CHU de Ouagadougou

Depuis une vingtaine d’année, il existe entre l’Établissement Public de Santé mentale (EPS) de Ville Évrard et le Centre Hospitalier Université (CHU) de Ouagadougou (Burkina Faso), une coopération inter-hospitalière concernant la psychiatrie. Elle se concrétise, entre autre, par la mise en place de formations, des voyages annuels dans chacun des pays, l’envoie de stagiaires, etc. En s’appuyant sur une enquête ethnographique au sein de La Causerie, centre d’ethnopsychiatrie au sein de l’EPS de Ville Évrard, il s’agit de comprendre dans une première partie toute la complexité de cette coopération décentralisée. Ceci passe tout d’abord par une analyse de sa façade officielle (c’est-à-dire la manière dont elle est présentée dans les différents documents officiels : conventions de jumelage, plan d’action) puis, et surtout, par ses effets « non officiels », ou encore « pervers », pour reprendre une expression du sociologue Raymond Boudon. En effet, cette coopération est beaucoup plus que ce qu’elle prétend être : elle peut avoir une influence sur les pratiques professionnelles des praticiens, être utilisée comme un outil de légitimation auprès des patients (particulièrement ceux qui font appel à des explications dites traditionnelles pour expliquer leurs troubles, tel que l’envoûtement, la possession, la sorcellerie, etc.) via l’acquisition de savoirs non occidentaux, mais aussi auprès des pairs afin de légitimer une méthode, celle de l’ethnopsychiatrie. J’ai pu ainsi constater que coopération et ethnopsychiatrie sont étroitement liées.De façon plus générale, la réflexion sur cette coopération s’inscrit dans le champ plus large du développement. En nous appuyant sur ses conséquences et sur la pensée de l’économiste Amartya Sen, il s’agit de se questionner sur cette notion, tant controversée, qu’est le développement. Il s’agit de poursuivre dans cette perspective, en se centrant de façon plus spécifique sur la psychiatrie, tant ce domaine nous interroge sur ce que serait la normalité, le développement dans ce secteur, etc. Enfin, cette coopération semble jouer le rôle de substitut de l’action publique dans le domaine de la santé mentale, en France ainsi qu’au Burkina Faso, qui est selon la politiste Sandra Philippe « un espace d’action inoccupé » (à cela, plusieurs raisons, telles que la difficulté de définir ce qu’est la santé mentale, la stigmatisation de ce secteur, etc.). Elle permet en France d’acquérir des méthodes de soins, des savoirs jugés et considérés comme traditionnels, non scientifiques, mais permettant de travailler auprès d’un certain public (qu’il soit d’origine française ou étrangère) et au Burkina Faso de mettre en place des structures (ouverture des urgences psychiatriques, d’un centre de pédopsychiatrie, formation de soignants aux méthodes françaises etc.) et d’enrichir aussi leurs méthodes de travailler. Ce mémoire a donc pour objectif de mener une réflexion sur plusieurs domaines, la psychiatrie, l’ethnopsychiatrie, le développement, la coopération décentralisée qui, dans ce cas bien précis, interagissent les uns avec les autres

Concurrent trastuzumab with adjuvant radiotherapy in HER2-positive breast cancer patients: acute toxicity analyses from the French multicentric study

Background: Trastuzumab (T) combined with chemotherapy has been recently shown to improve outcome in HER2-positive breast cancer (BC). The aim of this study was to evaluate the toxic effects of concurrent radiation therapy (RT) and T administration in the adjuvant setting. Patients and methods: Data of 146 patients with stages II-III HER2-positive BC were recorded. Median age was 46 years. In all, 32 (23%) and 114 (77%) patients received a weekly and a 3-week T schedule, respectively. A median dose of 50 Gy was delivered after surgery. Internal mammary chain (IMC) was irradiated in 103 (71%) patients. Results: Grade >2 dermatitis and esophagitis were noted in 51% and 12%, respectively. According to the Common Toxicity Criteria v3.0 scale and HERA (HERceptin Adjuvant) trial criteria, respectively, 10% and 6% of the patients had a grade ≥2 of left ventricular ejection fraction (LVEF) decrease after RT. Multivariate analyses revealed two independent prognostic factors: weekly T administration (for LVEF decrease) and menopausal status (for dermatitis). Higher level of T cumulative dose (>1600 mg) was only borderline of statistical significance for acute esophagitis toxicity. Conclusion: We showed that weekly concurrent T and RT are feasible in daily clinical practice with, however, a decrease of LVEF. Cardiac volume sparing and patient selections for IMC irradiation are highly recommended. Longer follow-up is warranted to evaluate late toxic effect

Modal analysis of a scale model of QD0

The last focusing magnets of the future Compact Linear Collider (CLIC) are critical elements needed to reach the desired luminosity. Designed to guide the nanometer sized focused beams, they need to be as stiff as possible to avoid any unwanted ground motion vibration amplification. Following our recent study concerning CLIC's ground motion mitigation techniques such as the active seismic isolator, the next step is to build a real scale prototype of the QD0. This mock-up is needed to validate experimentally the proposed control strategy. Such a prototype isn't yet available, hence this first study with a scale model of QD0. In this paper, modal analysis is used to analyze the dynamic characteristics of the structure of the prototype. This analysis identifies mode shapes, frequency and damping parameters. The purpose of this paper is to provide model verification by comparing experimental and theoretical modal analysis. The knowledge of these modes would later allow to validate experimentally ground motion vibration damping on that scale model of QD0, and finally on the real scale mock-up of QD0 by predicting the effect of design change

The history of written language disorders: reexamining Pitres’ case (1884) of pure agraphia

The first clinical description of pure agraphia was reported by the French neurologist Pitres in 1884. Pitres used the case study evidence to argue for modality-specific memory representations and the localization of writing. This article reviews Pitres’s contribution to the study of acquired writing disorders, the components of writing models and the cerebral localization which subserve writing, in light of the views entertained by his contemporaries and current authors. Although numerous cases have been reported throughout this century, the view that writing can be impaired while other language functions and motor activities remain intact is still challenged

Low exposure long-baseline neutrino oscillation sensitivity of the DUNE experiment

The Deep Underground Neutrino Experiment (DUNE) will produce world-leading neutrino oscillation measurements over the lifetime of the experiment. In this work, we explore DUNE\u27s sensitivity to observe charge-parity violation (CPV) in the neutrino sector, and to resolve the mass ordering, for exposures of up to 100 kiloton-megawatt-calendar years (kt-MW-CY), where calendar years include an assumption of 57% accelerator uptime based on past accelerator performance at Fermilab. The analysis includes detailed uncertainties on the flux prediction, the neutrino interaction model, and detector effects. We demonstrate that DUNE will be able to unambiguously resolve the neutrino mass ordering at a 4σ (5σ) level with a 66 (100) kt-MW-CY far detector exposure, and has the ability to make strong statements at significantly shorter exposures depending on the true value of other oscillation parameters, with a median sensitivity of 3σ for almost all true δCP values after only 24 kt-MW-CY. We also show that DUNE has the potential to make a robust measurement of CPV at a 3σ level with a 100 kt-MW-CY exposure for the maximally CP-violating values δCP=±π/2. Additionally, the dependence of DUNE\u27s sensitivity on the exposure taken in neutrino-enhanced and antineutrino-enhanced running is discussed. An equal fraction of exposure taken in each beam mode is found to be close to optimal when considered over the entire space of interest

Concurrent trastuzumab with adjuvant radiotherapy in HER2-positive breast cancer patients: acute toxicity analyses from the French multicentric study

BACKGROUND: Trastuzumab (T) combined with chemotherapy has been recently shown to improve outcome in HER2-positive breast cancer (BC). The aim of this study was to evaluate the toxic effects of concurrent radiation therapy (RT) and T administration in the adjuvant setting. PATIENTS AND METHODS: Data of 146 patients with stages II-III HER2-positive BC were recorded. Median age was 46 years. In all, 32 (23%) and 114 (77%) patients received a weekly and a 3-week T schedule, respectively. A median dose of 50 Gy was delivered after surgery. Internal mammary chain (IMC) was irradiated in 103 (71%) patients. RESULTS: Grade >2 dermatitis and esophagitis were noted in 51% and 12%, respectively. According to the Common Toxicity Criteria v3.0 scale and HERA (HERceptin Adjuvant) trial criteria, respectively, 10% and 6% of the patients had a grade >/=2 of left ventricular ejection fraction (LVEF) decrease after RT. Multivariate analyses revealed two independent prognostic factors: weekly T administration (for LVEF decrease) and menopausal status (for dermatitis). Higher level of T cumulative dose (>1600 mg) was only borderline of statistical significance for acute esophagitis toxicity. CONCLUSION: We showed that weekly concurrent T and RT are feasible in daily clinical practice with, however, a decrease of LVEF. Cardiac volume sparing and patient selections for IMC irradiation are highly recommended. Longer follow-up is warranted to evaluate late toxic effects

MRI assessment of the effects of acetazolamide and external lumbar drainage in idiopathic Normal Pressure Hydrocephalus

BACKGROUND: The objective was to identify changes in quantitative MRI measures in patients with idiopathic normal pressure hydrocephalus (iNPH) occurring in common after oral acetazolamide (ACZ) and external lumbar drainage (ELD) interventions. METHODS: A total of 25 iNPH patients from two clinical sites underwent serial MRIs and clinical assessments. Eight received ACZ (125-375 mg/day) over 3 months and 12 underwent ELD for up to 72 hours. Five clinically-stable iNPH patients who were scanned serially without interventions served as controls for the MRI component of the study. Subjects were divided into responders and non-responders to the intervention based on gait and cognition assessments made by clinicians blinded to MRI results. The MRI modalities analyzed included T1-weighted images, diffusion tensor Imaging (DTI) and arterial spin labelling (ASL) perfusion studies. Automated threshold techniques were used to define regions of T1 hypo-intensities. RESULTS: Decreased volume of T1-hypointensities and decreased mean diffusivity (MD) within remaining hypointensities was observed after ACZ and ELD but not in controls. Patients responding positively to these interventions had more extensive decreases in T1-hypointensites than non-responders: ACZ-responders (4,651 ± 2,909 mm(3)), ELD responders (2,338 ± 1,140 mm(3)), ELD non-responders (44 ± 1,188 mm(3)). Changes in DTI MD within T1-hypointensities were greater in ACZ-responders (7.9% ± 2%) and ELD-responders (8.2% ± 3.1%) compared to ELD non-responders (2.1% ± 3%). All the acetazolamide-responders showed increases in whole-brain-average cerebral blood flow (wbCBF) estimated by ASL (18.8% ± 8.7%). The only observed decrease in wbCBF (9.6%) occurred in an acetazolamide-non-responder. A possible association between cerebral atrophy and response was observed, with subjects having the least cortical atrophy (as indicated by a positive z-score on cortical thickness measurements) showing greater clinical improvement after ACZ and ELD. CONCLUSIONS: T1-hypointensity volume and DTI MD measures decreased in the brains of iNPH patients following oral ACZ and ELD. The magnitude of the decrease was greater in treatment responders than non-responders. Despite having different mechanisms of action, both ELD and ACZ may decrease interstitial brain water and increase cerebral blood flow in patients with iNPH. Quantitative MRI measurements appear useful for objectively monitoring response to acetazolamide, ELD and potentially other therapeutic interventions in patients with iNPH

Reconstruction of interactions in the ProtoDUNE-SP detector with Pandora

The Pandora Software Development Kit and algorithm libraries provide pattern-recognition logic essential to the reconstruction of particle interactions in liquid argon time projection chamber detectors. Pandora is the primary event reconstruction software used at ProtoDUNE-SP, a prototype for the Deep Underground Neutrino Experiment far detector. ProtoDUNE-SP, located at CERN, is exposed to a charged-particle test beam. This paper gives an overview of the Pandora reconstruction algorithms and how they have been tailored for use at ProtoDUNE-SP. In complex events with numerous cosmic-ray and beam background particles, the simulated reconstruction and identification efficiency for triggered test-beam particles is above 80% for the majority of particle type and beam momentum combinations. Specifically, simulated 1 GeV/c charged pions and protons are correctly reconstructed and identified with efficiencies of 86.1 ± 0.6 % and 84.1 ± 0.6 %, respectively. The efficiencies measured for test-beam data are shown to be within 5% of those predicted by the simulation

Highly-parallelized simulation of a pixelated LArTPC on a GPU

The rapid development of general-purpose computing on graphics processing units (GPGPU) is allowing the implementation of highly-parallelized Monte Carlo simulation chains for particle physics experiments. This technique is particularly suitable for the simulation of a pixelated charge readout for time projection chambers, given the large number of channels that this technology employs. Here we present the first implementation of a full microphysical simulator of a liquid argon time projection chamber (LArTPC) equipped with light readout and pixelated charge readout, developed for the DUNE Near Detector. The software is implemented with an end-to-end set of GPU-optimized algorithms. The algorithms have been written in Python and translated into CUDA kernels using Numba, a just-in-time compiler for a subset of Python and NumPy instructions. The GPU implementation achieves a speed up of four orders of magnitude compared with the equivalent CPU version. The simulation of the current induced on 103 pixels takes around 1 ms on the GPU, compared with approximately 10 s on the CPU. The results of the simulation are compared against data from a pixel-readout LArTPC prototype