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National audience; During the joint SFRO/SFPM session of the 2019 congress, a state of the art of adaptive radiotherapy announced a strong impact in our clinical practice, in particular with the availability of treatment devices coupled to an MRI system. Three years later, it seems relevant to take stock of adaptive radiotherapy in practice, and especially the “online” strategy because it is indeed more and more accessible with recent hardware and software developments, such as coupled accelerators to a three-dimensional imaging device and algorithms based on artificial intelligence. However, the deployment of this promising strategy is complex because it contracts the usual time scale and upsets the usual organizations. So what do we need to deliver adapted treatment plans with an “online” strategy?

National audience; Intensity modulated radiotherapy combined with image guided radiotherapy has led to increase the precision of external beam radiotherapy. However, intra or inter-fraction anatomical variations are frequent during the treatment course and can cause under-dosing of the target volume and/or over-dosing of the organs at risk. Several adaptive radiotherapy (ART) strategies can be defined to compensate these anatomical variations. The purpose of this article is to provide an overview of available ART strategies: offline, online, hybrid (library of treatment plans) or in real-time, while considering the arrival of MR-Linac devices in radiotherapy departments. The tools required to these ART strategies such as auto-segmentation, deformable image registration, calculation of the daily dose or dose accumulation, are also described. Implementing an ART strategy requires a rigorous quality assurance process, at each stage and on the entire workflow, as well as prior organization and training from of all the trades. A strong multidisciplinary involvement is finally required in order to ensure ART treatments.

National audience; Adaptive radiotherapy (ART) is a complexe image-guided radiotherapy modality that comprises multiple planning to account for anatomical variations occurring during irradiation. Schematically, two strategies of RTA can be distinguished and combined according to tumor locations. One or more replanning can be proposed to correct systematic variations such as tumor shrinkage. A library of treatment plans with day-to-day plan selection from cone-beam CT imaging can also be proposed to correct random variations such as uterine motion or bladder/rectum volume changes. Because of strong anatomical variations occurring during irradiation, RTA appears therefore particularly justified in head and neck, lung, bladder, cervical and rectum and pancreas tumors, and to a lesser extent for prostate tumors and other digestive tumors. For these tumor locations, ART provides a fairly clear dosimetric benefit but a clinical benefit not yet formally demonstrated. ART cannot be proposed in a routine practice but must be evaluated medico-economically in the context of prospective trials. A rigorous quality control must be associated.

Intensity modulated radiotherapy combined with image guided radiotherapy has led to increase the precision of external beam radiotherapy. However, intra or inter-fraction anatomical variations are frequent during the treatment course and can cause under-dosing of the target volume and/or over-dosing of the organs at risk. Several adaptive radiotherapy (ART) strategies can be defined to compensate these anatomical variations. The purpose of this article is to provide an overview of available ART strategies: offline, online, hybrid (library of treatment plans) or in real-time, while considering the arrival of MR-Linac devices in radiotherapy departments. The tools required to these ART strategies such as auto-segmentation, deformable image registration, calculation of the daily dose or dose accumulation, are also described. Implementing an ART strategy requires a rigorous quality assurance process, at each stage and on the entire workflow, as well as prior organization and training from of all the trades. A strong multidisciplinary involvement is finally required in order to ensure ART treatments.

Sleep is a physiological condition essential to life, present in all living organisms with a neuronal and glial network. Its functions, not fully understood, include the conservation of energy, the regulation of our immune system and brain function through the modulation of synaptic plasticity and the elimination of substances accumulated during wakefulness. Sleep in human is characterized by two exclusive states, the non-REM and the REM -paradoxical- sleep, whose occurrence is driven by a cyclic organi zation. Sleep and wakefulness result from complex mechanisms involving a hetero geneous transition of different brain structures from one physiological state to another. The sleep duration and distribution of sleep over 24 hours are regulated by complex interconnected mechanisms, involving both the need for sleep accumulated during wakefulness -homeostatic process- and biological rhythm -mainly the circadian process- under the influence of external synchronizers like light-dark cycle. The propensity to sleep at a given moment is regulated by a physiological signal, sleepiness, in connection with the level of vigilance. The characteristics of sleep are relatively stable for a given individual because of a strong genetic determinism, but varies in duration and architecture according to age, individual habits, sleep schedules and environmental constraints. An understanding of the physiology of sleep is important for the clinician, allowing a better understanding of sleep dysfunction, responsible for various and frequent sleep disorders equiring appropriate care.Le sommeil est un état physiologique indispensable à la vie, présent chez tous les organismes vivants disposant d’un réseau neuronal et glial. Ses fonctions, non complètement élucidées, portent notamment sur la conservation de l’énergie, la régulation de notre système immunitaire et le fonctionnement cérébral via la modulation de la plasticité synaptique et l’élimination de substances accumulées lors de la veille. Le sommeil chez l’homme est marqué par deux états exclusifs, le sommeil lent et le sommeil paradoxal, dont l’apparition est régie par une organisation cyclique. L’endormissement et le réveil résultent de mécanismes complexes impliquant une transition hétérogène de différentes structures cérébrales d’un état physiologique vers l’autre. La durée et la répartition du sommeil au cours des 24 heures sont régulées par des mécanismes complexes étroitement intriqués, impliquant d’une part le besoin de sommeil accumulé au cours de la veille -processus homéostatique- et le rythme biologique -principalement le processus circadien- sous l’influence de synchroniseurs externes comme l’alternance lumière-obscurité. La propension au sommeil à un moment donné est régulée par un signal physiologique, la somnolence, en lien avec le niveau de vigilance de l’individu. Les caractéristiques du sommeil sont relativement stables pour un individu donné du fait d’un fort déterminisme génétique, mais varie toutefois en durée et en architecture selon l’âge, les habitudes individuelles, les horaires de sommeil et les contraintes environnementales. Une connaissance de la physiologie du sommeil est importante pour le clinicien, permettant une meilleure compréhension des dysfonctionnements du sommeil, responsables de pathologies diverses et particulièrement fréquentes nécessitant des prises en charge adaptées.

The occurrence of a pressure ulcer can be considered as an avoidable adverse event. Its consequences are not only very harmful for the patient, but also in terms of the costs induced and for the nursing teams faced with the failure of the prevention treatment. For these reasons, nurses, nurse assistants and the multidisciplinary team must work together around a pressure ulcer prevention strategy.

National audience; In external beam radiotherapy, the dose planning is currently based on computed tomography (CT) images. A relation between Hounsfield numbers and electron densities (or mass densities) is necessary for dose calculation taking heterogeneities into account. In image-guided radiotherapy process, the cone beam CT is classically used for tissue visualization and registration. Cone beam CT for dose calculation is also attractive in dose reporting/monitoring perspectives and particularly in a context of dose-guided adaptive radiotherapy. The accuracy of cone beam CT-based dose calculation is limited by image characteristics such as quality, Hounsfield numbers consistency and restrictive sizes of volume acquisition. The analysis of the literature identifies three kinds of strategies for cone beam CT-based dose calculation: establishment of Hounsfield numbers versus densities curves, density override to regions of interest, and deformable registration between CT and cone beam CT images. Literature results show that discrepancies between the reference CT-based dose calculation and the cone beam CT-based dose calculation are often lower than 3%, regardless of the method. However, they can also reach 10% with unsuitable method. Even if the accuracy of the cone beam CT-based dose calculation is independent of the method, some strategies are promising but need improvements in the automating process for a routine implementation.

In external beam radiotherapy, the dose planning is currently based on computed tomography (CT) images. A relation between Hounsfield numbers and electron densities (or mass densities) is necessary for dose calculation taking heterogeneities into account. In image-guided radiotherapy process, the cone beam CT is classically used for tissue visualization and registration. Cone beam CT for dose calculation is also attractive in dose reporting/monitoring perspectives and particularly in a context of dose-guided adaptive radiotherapy. The accuracy of cone beam CT-based dose calculation is limited by image characteristics such as quality, Hounsfield numbers consistency and restrictive sizes of volume acquisition. The analysis of the literature identifies three kinds of strategies for cone beam CT-based dose calculation: establishment of Hounsfield numbers versus densities curves, density override to regions of interest, and deformable registration between CT and cone beam CT images. Literature results show that discrepancies between the reference CT-based dose calculation and the cone beam CT-based dose calculation are often lower than 3%, regardless of the method. However, they can also reach 10% with unsuitable method. Even if the accuracy of the cone beam CT-based dose calculation is independent of the method, some strategies are promising but need improvements in the automating process for a routine implementation.

International audience; Excessive sleepiness is a common problem, defined by a complaint of excessive daytime sleepiness almost daily with an inability to stay awake and alert dosing periods at sleep, with episodes of irresistible sleep need or drowsiness or non-intentional sleep, or by a night's sleep time overly extended often associated with sleep inertia. This sleepiness is variable in terms of phenotype and severity to be specified by the out-patient clinic. It is considered to be chronic beyond three months and often responsible for significant functional impairment of school and professional performance, of the accidents and cardiovascular risk. We need to decipher the causes of excessive sleepiness: sleep deprivation, toxic and iatrogenic, psychiatric disorders (including depression), non-psychiatric medical problems (obesity, neurological pathologies...), sleep disorders (as for example the sleep apnea syndrome), and finally the central hypersomnias namely narcolepsy type 1 and 2, idiopathic hypersomnia, and Kleine-Levin syndrome. If careful questioning often towards one of these etiologies, need most of the time a paraclinical balance with a sleep recording to confirm the diagnosis. Patients affected with potential central hypersomnia must be referred to the Sleep Study Centers that have the skills and the appropriate means to achieve this balance sheet.

The actions carried out by the mobile wounds and cicatrisation team of Bordeaux university hospital help to harmonise professional practices, with benefits for the hospital, the caregivers and the patients. Within the team, this "mentoring system" also strengthens the expertise of individual nurses. The results obtained over the last two years show that the scheme provides real added value in terms of the quality of care, in a context of a constant search for efficiency.

The use of telemedicine in the treatment of pressure sores in palliative care. The benefit of telemedicine in nursing homes has been demonstrated notably in the case of pressure sores. It gives health professionals the possibility to establish valuable exchanges. A real support and trainingtool, it enables them to improve their skills and share good practices across geriatrics.

This contribution is about an educational intervention in a nursery school, designed to improve the way culturally and linguistically diverse pupils are welcomed and their languages and cultures taken into account. During an internship for a FSL diploma (Master 2), about ten Language Awareness sessions were implemented in two classes (to 3 and 4 year old children) in a suburban school near Grenoble (France). The aim was to work with the multilingual repertoire of the pupils, and to include parents. This project enabled their languages to be recognised, taken into account, and given legitimate status, whilst revealing untapped multilingual skills of various other members of the educational team., Cette contribution porte sur une intervention éducative en école maternelle, conçue pour améliorer l'accueil et la prise en charge des élèves dits « allophones ». Dans le cadre d'un stage de Master 2 professionnel Français Langue Étrangère, une dizaine de séances inspirées de l'Éveil aux langues ont été mises en oeuvre dans deux classes de petite et grande sections dans une école de banlieue près de Grenoble. L'objectif était de travailler avec le répertoire plurilingue des élèves, en lien avec les parents. Ce projet a permis de légitimer les langues des élèves, celles de leurs parents et les compétences plurilingues jusque-là cachées de différents membres de l'équipe éducative.

conference; International audience

Ce mémoire est le fruit d'une réflexion portant sur le plurilinguisme dans une classe de petite et de grande sections d'une école maternelle de Grenoble. Le travail réalisé dans ces deux classes sont des séances d'éveil aux langues conçues à partir de deux contes : Roule galette et le Petit Poucet dont le principal objectif a été de prendre en compte la diversité linguistique et culturelle des élèves allophones et des élèves issus de parents migrants. Après un point sur le monolinguisme en France, qui légitime l'apprentissage du français à l'école, la politique linguistique française tend à se tourner vers le bi-plurilinguisme. Après avoir défini la notion de bilinguisme, l'accent est mis sur le bi-plurilinguisme à l'école et plus particulièrement aux enjeux de l'entrée à l'école maternelle d'un élève allophone biplurilingue en devenir et au cadre juridique dans lequel s'inscrivent l'éducation et la scolarisation, deux droits fondamentaux pour les enfants. Une analyse des représentations qui émergent autour de la question de la diversité à l'école permet de rendre compte que la diversité linguistique et culturelle des élèves allophones n'est pas prise en compte à l'école maternelle. Les approches plurielles ainsi que les programmes sont autant d'outils qui favorisent l'ouverture vers la diversité linguistique en milieu scolaire. Le travail final de conception et d'expérimentation permet de dresser le bilan du projet.

Poster P263-POP1; National audience