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Background and Purpose—The study of silent stroke has been limited to imaging of chronic infarcts; acute incidental infarcts (AII) detected on brain magnetic resonance imaging have been less investigated. This study aims to describe prevalence and risk factors of AII in a community and a clinic-based population.Methods—Subjects were drawn from 2 ongoing studies: Epidemiology of Dementia in Singapore study, which is a subsample from a population-based study, and a clinic-based case–control study. Subjects from both studies underwent similar clinical and neuropsychological assessments and brain magnetic resonance imaging. Prevalence of AII from these studies was determined. Subsequently, risk factors of AII were examined using multivariable logistic regression models.Results—AII were seen in 7 of 623 (1.2%) subjects in Epidemiology of Dementia in Singapore (mean age, 70.9±6.8 years; 45% men) and in 12 of 389 (3.2%) subjects (mean age, 72.1±8.3 years; 46% men) in the clinic-based study. AII were present in 0.8% of subjects with no cognitive impairment, 1.9% of those with cognitive impairment not dementia, and 4.2% of subjects with dementia. Significant association of AII was found with cerebral microbleeds (≥5) in the Epidemiology of Dementia in Singapore (odds ratio, 6.76; 95% confidence interval, 1.28–35.65;P=0.02) and in the clinic-based cohort (odds ratio, 4.65; 95% confidence interval, 1.39–15.53;P=0.01). There was no association of AII with hypertension, diabetes mellitus, or hyperlipidemia.Conclusions—AII are more likely to be present in those with cognitive impairment. Although a cause–effect relationship between the presence of AII and cognitive impairment is plausible, the association may be because of under-reporting of symptoms by individuals with cognitive impairment. The association between AII and cerebral microbleeds may indicate cerebral vasculopathy, independent of traditional vascular risk factors.

Resume Le citrate de fentanyl trans-muqueux (ACTIQ) a ete specifiquement developpe pour fournir une analgesie rapide lors des acces douloureux paroxystiques (ADP) chez des patients recevant deja un traitement de fond morphinique pour des douleurs chroniques d’origine cancereuse. En effet, le citrate de fentanyl est tout d’abord absorbe par voie trans-muqueuse (25 % de la dose absorbee) entrainant un debut d’action rapide puis le reste est degluti faisant l’objet d’un cycle entero-hepatique permettant le maintien de l’effet antalgique pendant toute la duree de l’ADP. Il se presente sous la forme d’un comprime avec applicateur buccal. Afin de determiner la posologie optimale et de reduire au minimum les effets indesirables, il est necessaire de titrer individuellement la dose d’ACTIQ. Cette titration peut se faire selon deux methodes : progressive de proche en proche ou dynamique par palier sous surveillance etroite par des professionnels de sante. Une fois la dose efficace determinee, il convient de maintenir ce dosage pour traiter chaque crise douloureuse paroxystique. Cependant l’evolution de la maladie ou la survenue d’effets indesirables peut exiger une reevaluation et une adaptation ulterieure de la dose efficace d’ACTIQ. Son arret s’envisage parallelement a la diminution du traitement de fond, de facon progressive pour eviter l’apparition d’un syndrome de sevrage. L’efficacite et la facilite d’utilisation d’ACTIQ ont donc permis de realiser une avancee dans le traitement des ADP. A l’avenir ce compose pourrait trouver un interet dans d’autres indications.

Resume En geriatrie, le souci de soulager les patients est omnipresent lors de la realisation de soins et d’actes medicaux douloureux. Cependant les traitements antalgiques classiques presentent souvent des inconvenients chez ces patients polypathologiques et polymedicamentes. Cette etude porte sur une nouvelle methode encore peu repandue en geriatrie : l’utilisation du melange equimolaire de protoxyde d’azote-oxygene (MEOPA) au cours des gestes douloureux. L’objectif de ce travail est de montrer l’interet, les limites d’utilisation et la tolerance du MEOPA pour les actes douloureux chez les sujets âges, quel que soit leur etat intellectuel et les traitements en cours. Il s’agit d’une etude prospective chez 12 patients dont 9 presentent une demence. L’effet antalgique a ete evalue a l’aide de l’echelle ECPA. La realisation technique, la tolerance et l’efficacite antalgique du MEOPA ont ete jugees satisfaisantes. Les troubles intellectuels ne doivent pas constituer un facteur limitant a son utilisation.

Resume Objectifs La nevralgie du glosso-pharyngien represente entre 0,2 % et 1,3 % en proportion des nevralgies du nerf trijumeau. On parle de nevralgie essentielle lorsqu’un bilan para-clinique ne retrouve aucune etiologie. De nombreuses techniques lesionnelles et non-lesionnelles, par approche intra crânienne et extra crânienne sont decrites. Par voie percutanee, la cible est le ganglion d’Andersch dans le foramen jugulaire. Une evaluation clinique, neurophysiologique et fluoroscopique sont effectuees lors du geste realise sous anesthesie generale en ventilation spontanee. Un monitoring cardio-tensionnel permet d’eviter les complications par stimulation vagale. Le traitement est obtenu par thermocoagulation ou dans quelques cas apres un blocage anesthesique pratique a visee diagnostique. Patients Dix patients ont ete traites pour une nevralgie essentielle du glosso-pharyngien entre 1992 et 2004, d’âge moyen de 65 ans, de predominance feminine et a localisation gauche preferentielle depuis 7 ans et 9 mois en moyenne. 5 blocages et 8 thermocoagulations ont ete effectues. Resultats Parmi les 13 procedures, 4 n’apportent aucune amelioration, une n’est que partielle et 8 sont un succes. Le resultat est transitoire, avec une recidive dans 5 cas a 32 mois en moyenne. Actuellement, les patients traites sont asymptomatiques avec un suivi moyen de 39 mois, en excluant un deces et un perdu de vue. Conclusion Une lesion appliquee dans la portion nerveuse du foramen jugulaire a permis d’observer des complications majeures, toutefois, aucune mortalite n’est rapportee et cette procedure peut etre indiquee sans limite d’âge, contrairement a une chirurgie intracrânienne. Sans apporter des resultats a long terme aussi satisfaisants que la chirurgie intracrânienne, elle reste bien moins invasive, reproductible et sans risque dans des mains entrainees.

Foreign visitors are such important contributors to the American economy that tourism officials are working hard to reassure them that the U.S. is still a safe place to visit. The significant increase in foreign visitors over the past decade caused U.S. scholars to pay more attention to the unique challenges of cross-cultural service encounters. This exploratory study adds to that trend by attempting to measure the effect of intercultural sensitivity on the performance of hospitality employees in cross-cultural service encounters. The results indicate that employees with high intercultural sensitivity scored significantly (p < .05) higher on measures of service attentiveness, revenue contribution, interpersonal skills, job satisfaction, and social satisfaction as they relate to cross-cultural encounters. There was no significant difference in scores for motivation-to-work, job tenure, and primary rewards (compensation, recognition, etc.).

La lombalgie aiguë est la pathologie rhumatismale la plus fréquente en Afrique. L'épidémiologie et la présentation clinique ne diffèrent pas de celles observées sur les autres continents. En revanche, les aspects psycho-sociaux, la disponibilité des traitements, l'accès aux soins et le poids culturel des médecines traditionnelles sont autant de spécificités qui ont conduit à la réalisation du 1er consensus d'experts en rhumatologie pour la prise en charge du patient africain. Destiné aux praticiens, ce travail collaboratif multinational a pour objectif de fournir 11 recommandations de pratiques cliniques simples, fondées sur les preuves, et adaptées aux conditions de l'exercice médical en Afrique. Leur ambition est d'améliorer la prise en charge de la lombalgie aigue par une évaluation initiale clinique pertinente, une diminution des examens radiologiques inutiles, une prescription médicamenteuse adéquate et l'abandon de procédures invasives inappropriées.Key words: Lombalgie aigüe, Afrique, Recommandation

As part of the Chemistry-Aerosol Mediterranean Experiment (ChArMEx, http://charmex.lsce.ipsl.fr/), the CORSiCA (http://www.obs-mip.fr/corsica) and the ANR-ADRIMED programs, a large set of real-time measurements of carbonaceous aerosols was deployed in June 2013 at the Cape Corsica atmospheric supersite (http://gaw.empa.ch/gawsis/reports.asp?StationID=2076203042). Submicron organic aerosols (OA) were monitored every 30 min using an Aerosol Chemical Speciation Monitor (ACSM; Aerodyne Res. Inc. MA, USA); Fine (PM2:5) Organic Carbon (OC) and Elemental Carbon (EC) were measured every 2h using an OCEC Sunset Field Instrument (Sunset Lab, OR, USA) and every 12h using a low-vol (Leckel) filter sampler running at 2.3m3/h. Equivalent Black Carbon (BC) was monitored using two Aethalometers (models AE31 and AE33, Magee Scientific, US & Aerosol d.o.o., Slovenia) and a MAAP instrument (Thermo). Quality control of this large dataset was performed through chemical mass closure studies (using co-located SMPS and TEOM-FDMS) and direct comparisons with other real-time instruments running in parallel (Particle-Into- Liquid-Sampler-Ion-Chromatograph for ions, filter sampling,...). Source apportionment of OA was then performed using the SourceFinder software (SoFi v4.5, http://www.psi.ch/acsm-stations/me-2) allowing the distinction between hydrogen- and oxygen-like organic aerosols (HOA and OOA, respectively) and highlighting the major contribution of secondary OA in the Western Mediterranean during summer. Using this time-resolved chemical information, reconstruction of the optical aerosol properties were performed and compared with integrating nephelometer (Model 3563, TSI, US) and photoacoustic extinctiometer (PAX, DMT, US) measurements performed in parallel. Results of these different closure studies (chemical/physical/optical) are presented and discussed here in details. They highlight the central role of carbonaceous aerosols on the optical properties of aerosols at ground level in the Western Mediterranean Sea during summertime. Acknowledgements: Aerosol measurements performed at Cape Corsica Station were mainly funded by ANR, CNRS-INSU, ADEME, Collectivité Territoriale de Corse through EU-FEDER Operational program 2007-2013, CEA, METEO-FRANCE, MGR-KROP, AEROSOL D.O.O., ECOMESURE, and ENVICONTROL

International audience

International audience

I deas of leadership and of what constitutes leadership behavior represent one of the most difficult intercultural challenges within American joint ventures in the People's Republic of China. Chinese and Americans have acquired such contrasting sets of cultural understandings about leadership, each set backed by an impressive history, tradition, and body of literature, that at times they seem unalterably opposed.

Light, Ivan and Parminder Bhachu, eds. Immigration and Entrepreneurship: Culture, Capital, and Ethnic Networks. New Brunswick, NJ: Transaction Publishers, 1993. xiv + 381 pp. including index. $34.95 cloth. Oxfeld, Ellen. Blood, Sweat, and Mahjong: Family and Enterprise in an Overseas Chinese Community. Ithaca, NY: Cornell University Press, 1993. xiii + 291 pp. including references and index. $42.50 cloth, $16.95 paper.

As documented by the International Committee of the Red Cross, antipersonnel landmine injuries can be broadly divided into three types. Although most victims will have one of these types, the spectrum of injury often overlaps between types [1,2]. Type 1 injury, the most common type, results from stepping on a buried blast mine. The detonation results in traumatic amputation of the leg, either above or below the knee [3]. Associated with the amputation is soft-tissue damage to the contralateral limb, the extent of which is related to the size of the explosive charge in the mine. Large mines may also injure the perineum [4]. Type 2 injury results from triggering a fragmentation mine or being close to a blast mine explosion. This type of injury is characterized by multiple fragment wounds, usually concentrated in the lower limbs, but injury to the abdomen, upper body, and head can also occur [1,2]. Type 3 injury is caused when a blast mine detonates close to the hand or face. These injuries typically occur when handling a mine or when a mine clearance worker inadvertently detonates a mine in the process of disarming it in a prone or squatting position. This type of injury results in partial amputation of the arms and hands and blast or fragmentation wounds to the face, neck, and trunk [1,3]. We cannot address the treatment of all these types of landmine injuries here. Instead, we will restrict our comments to the nature and surgical treatment of Type 1 injuries, which are the most common. An important aspect of landmine injuries is that the sequelae are affected by the environments in which they occur. Such environments are often remote and austere locations where medical care is limited or nonexistent. This …

International audience; Although human pain involves unique features when compared with animal pain, as assessed by humans, it is obvious that the underlying neurobiological mechanisms fall along the lines of an evolutionary continuity. This article reviews the generic knowledge on pain that has been established by work done in humans and laboratory species. The degree to which this knowledge on pain can be transposed from man to farm animals (including mammals, gallinaceous and waterfowl (duck and geese species), fish and cephalopods) is examined based on arguments ranging from phylogenetic analysis to the work on emotion in animals and to current debates on the concept of conscience in relation to pain perception. The precautions that need to be taken and the questions raised by such transpositions are discussed

Objective Evaluation of acute pain in patients with language barriers is often difficult during humanitarian missions. Algoplus®, a behavioral scale validated for acute pain evaluation in Caucasians with verbal communication difficulties, was tested during a clinical mission in Cambodia in patients admitted to hospital for acute pain. Methods Patients (N = 33, 19 men and 14 women [38 ± 3 years old]) suffering from acute pain were admitted to Calmette Hospital, Phnom Penh, Cambodia during June 2010. Patients spoke Khmer only; a medical trainee who did no speak Khmer performed the Algoplus scale, and a bilingual Khmer pain specialist doctor asked the patient to score pain intensity on a numerical scale (0–10). The relevance of the scale and of each item (facial expression, complaints, look, body position, and atypical behavior yes/no) was studied. Internal consistency was assessed by Cronbach alpha analysis and convergent validity by correlation coefficient. The relationship between Algoplus items and pain intensity was analysed. Results Pain intensity (6.3 ± 2.2) and Algoplus scores (2.1 ± 1.2) are correlated (r = 0.61, P

The lightning station has been installed at the top of the Pic du Midi to observe and record the lightning attachment to an instrumented rod. Direct measurements of the lightning current and atmospheric electric field are recorded. Various video cameras are used to analyse the flash impacts to the rod and also to various parts of its surroundings. Our goal is to instrument mainly one Observatory building protected by means of a rod to record lightning impacts and, if any, notice some possible LPS by-passes, a direct evaluation of the protected zone. New results obtained during summer 2013 lightning season will be presented.

Background Many studies have demonstrated the efficacy of spinal cord stimulation (SCS) for chronic neuropathic radicular pain over recent decades, but despite global favourable outcomes in failed back surgery syndrome (FBSS) with leg pain, the back pain component remains poorly controlled by neurostimulation. Technological and scientific progress has led to the development of new SCS leads, comprising a multicolumn design and a greater number of contacts. The efficacy of multicolumn SCS lead configurations for the treatment of the back pain component of FBSS has recently been suggested by pilot studies. However, a randomized controlled trial must be conducted to confirm the efficacy of new generation multicolumn SCS. Evaluation medico-economique de la STImulation MEdullaire mulTi-colonnes (ESTIMET) is a multicentre, randomized study designed to compare the clinical efficacy and health economics aspects of mono- vs. multicolumn SCS lead programming in FBSS patients with radicular pain and significant back pain. Materials and methods FBSS patients with a radicular pain VAS score ≥ 50 mm, associated with a significant back pain component were recruited in 14 centres in France and implanted with multicolumn SCS. Before the lead implantation procedure, they were 1:1 randomized to monocolumn SCS (group 1) or multicolumn SCS (group 2). Programming was performed using only one column for group 1 and full use of the 3 columns for group 2. Outcome assessment was performed at baseline (pre-implantation), and 1, 3, 6 and 12 months post-implantation. The primary outcome measure was a reduction of the severity of low back pain (bVAS reduction ≥ 50%) at the 6-month visit. Additional outcome measures were changes in global pain, leg pain, paraesthesia coverage mapping, functional capacities, quality of life, neuropsychological aspects, patient satisfaction and healthcare resource consumption. Trial status Trial recruitment started in May 2012. As of September 2013, all 14 study centres have been initiated and 112/115 patients have been enrolled. Preliminary results are expected to be published in 2015. Trial registration Clinical trial registration information-URL: www.clinicaltrials.gov . Unique identifier NCT01628237

An increasing number of obese patients are undergoing surgery, particularly bariatric and orthopaedic surgery. The physiological differences between obese and normal-weight subjects may modify not only anaesthetic requirements during surgery but also post-operative analgesic management, raising a number of challenges in a critical period. In this review, we analyse studies of post-operative pain management with opioids in obese subjects. We discuss the genetic factors common to pain and obesity and the factors potentially modifying opioid pharmacokinetics and pharmacodynamics in obese patients, and we analyse the overall efficacy and safety of opioids for pain management during the post-operative period in obese patients. Both modifications to surgical methods and additional analgesic treatments to decrease the requirement for opioids may improve early rehabilitation and quality of care and reduce adverse effects in obese patients.

We read with great interest the recent publication by Lotsch et al. [1]; this article provides a valuable review of the pharmacodynamic and pharmacokinetic properties of fentanyl and its various non-intravenous formulations. Lotsch et al. highlight the kinetics of intranasal fentanyl that results in the rapid onset of analgesia that is seen clinically with these drugs. Table 2 provides a generally accurate presentation of the pharmacokinetic properties of the two available intranasal formulations, but with regards to fentanyl pectin nasal spray (FPNS), when describing the ‘Onset of Analgesia’, the table references a commentary by Curtiss [2] on the pivotal FPNS efficacy publication by Portenoy et al. [3], which does not include one of the critical findings of the original study. The original publication by the 043 study group [3] concluded that ‘‘FPNS significantly improved pain intensity (PI) scores as early as 5 minutes (P\0.05) (after dosing)’’ and ‘‘more patients showed a clinically meaningful pain reduction (C2-point reduction in PI) from 10 minutes onward (PB0.01).’’ This onset of analgesia in 5 minutes with meaningful pain relief in 10 minutes is one of the key advantages provided by the intranasal route and we thought it noteworthy to bring this to the reader’s attention.

La douleur est un phenomene complexe, une experience subjective. Complexe parce que la douleur comporte plusieurs composantes : la composante sensorielle, la douleur proprement dite ; la composante affectivo-emotionnelle qui charge le vecu de sa tonalite desagreable ; la composante cognitive, intellectuelle, qui permet de prendre conscience, comprendre et interpreter la sensation en tant que douleur ; et la composante comportementale qui constitue l’ensemble des comportements, gestes, attitudes en rapport avec cette douleur. Elle est une des plaintes frequemment rencontrees en medecine ; elle n’en est pas moins l’une des plus difficiles a prendre en charge en raison du grand nombre de causes possibles, de la variete des reactions individuelles et des facteurs subjectifs qui l’influencent. Et entendre la douleur de l’autre est souvent difficile. Elle a une repercussion sur l’ensemble de l’individu et le medecin y a souvent acces par l’intermediaire du discours du patient. Mais pour les patients atteints de pathologie mentale, ce processus est loin d’etre aise. Les limites imposees a leur sensibilite, a l’organisation de leur schema corporel et a leurs moyens de communication constituent de nombreux obstacles. Alors comment dechiffrer la douleur et l’evaluer ? Et dans quelle mesure peut-on proposer les echelles d’evaluation existantes a ces patients ? Dans bien des cas, le discours des patients n’est pas evident, voire meme absent.

Pendant trop longtemps la douleur a ete vecue comme une fatalite. Et pourtant, l’evolution des connaissances nous donne aujourd’hui les moyens permettant de reduire dans des proportions importantes la plupart des douleurs. Mais plus que les connaissances, ce sont les mentalites qui doivent evoluer. En effet, pendant des siecles la medecine ne s’etait preoccupee qu’avec «parcimonie« ou plutot un certain dedain de la douleur physique et de la souffrance des hommes. Pilier de notre civilisation judeo-chretienne et de notre ignorance, la douleur avait des vertus de redemption, d’exemple et de demonstration courageuse, et il n’en fallait pas beaucoup plus pour evoquer la fatalite: preuve incontestable de siecles d’obscurantisme, ou cette notion resonne non seulement comme un aveu d’impuissance mais comme une absence d’avenir. Les rapports a la douleur avec la religion ont certes change. Mais la necessite de la souffrance perdure, la souffrance comme matrice de rachat, comme porte de salut, comme marque de devotion. A la veille de sa mort, Monseigneur Veuillot, archeveque de Paris, qui souffrait d’un cancer avec des douleurs intenses, prononca des paroles etonnantes qui prenaient a contre-pied toute la pensee chretienne sur la souffrance: «Nous savons faire de belles phrases sur la souffrance. Moimeme j’en ai parle avec chaleur.

An experimental site devoted to the study of direct lightning impacts to lightning rods has been selected at the top of the Pic du Midi in the French Pyrenees. This site offers the exceptional opportunity of investigating lightning strokes to a complex structure of limited extension, intermediate between a large building at moderate altitude and a high-elevated structure such like the well-known instrumented telecommunication towers (Gaisberg, Peissenberg, Santis or CN Tower). At the Pic du Midi, the famous astronomical Observatory offers a unique scientific environment for lightning observations. Among various experiments, we will devote this paper to that installed at the top of the so-called DIMM platform. Several scientific sensors are here installed, such like measurements of lightning current, electric field, highspeed video and related recordings. This will enable to characterize both lightning attachment to an instrumented rod and lightning detection network efficiency at high altitude (about 2,900 m).

We have previously demonstrated that 2D 1H NMR is suitable for studying cerebral metabolism. The same technique was used to study the hind leg muscle of normal (C57BL10) and dystrophic (mdx) mice. The results were compared to preliminary results for cultured muscle cells to determine the origin of fatty acid signals.

An experimental site devoted to the study of direct lightning impacts to lightning rods has been selected at the top of the Pic du Midi in the French Pyrenees. This site offers the exceptional opportunity of investigating lightning strokes to a complex structure of limited extension, intermediate between a large building at moderate altitude and a high-elevated structure such like the well-known instrumented telecommunication towers (Gaisberg, Peissenberg, Santis or CN Tower). At the Pic du Midi, the famous astronomical Observatory offers an unique scientific environment for lightning observations (sprites, Meteorage) in collaboration with astronomers. Among various experiments, we will devote this paper to that installed at the top of the so-called DIMM platform. Several scientific sensors are here installed, such like measurements of lightning current, electric field, high-speed video and related recordings. This will enable to characterize both lightning attachment to an instrumented rod and lightning detection network efficiency at high altitude (about 2,900 m).