Search

Daily use of mouthwash is generally recommended to control dental plaque development and limit further adhesion of oral bacteria. To this purpose, Chlorhexidine di-gluconate (CHG)-containing products are still the most used antiseptic in oral health. The aim of this study was to compare the antimicrobial and antibiofilm activity of three different mouthwash commercial formulations containing CHG at the same concentration (0.2%) on the main etiological agent of dental plaque, Streptococcus mutans (S. mutans). Liquid Chromatography coupled with tandem mass spectrometry (LC-MS/MS) was used to confirm the CHG concentration in the commercial formulations. The Minimal Inhibitory Concentration (MIC) and Minimal Bactericidal concentration (MBC) were measured to evaluate the antimicrobial activity of mouthwashes on planktonic cells. The biofilm prevention concentration (BPC) and CHG formulation activity towards mature biofilm were investigated. Both total cell titer and viability in S. mutans pregrown biofilms were evaluated after treatment with formulations at different time points and concentrations, using Crystal Violet (CV) and tetrazolium dye assay (MTT). The Shapiro–Wilk and Levene tests were used to evaluate the normality and overall homogeneity of the datasets, respectively. The chi-square test, Fischer’s exact test and Student’s t-test were used to evaluate the inhibitory capacity of the commercial formulations in CV and MTT assays. Results showed that even though only slight differences in MIC and MBC values were found on planktonic bacteria, the antibiofilm effect of the different formulations exhibited wide variation when mature biofilms were treated. In addition, results were discussed based on the different compositions of the three formulations, suggesting that herbal extracts, when present in mouthwash formulations, may not always have a beneficial effect, especially when mature biofilms are concerned.

La formaldeide o aldeide formica è un gas prodotto e commercializzato sotto forma di soluzione acquosa, con il nome di “formalina” ed è utilizzata nelle strutture sanitarie per conservare cellule e tessuti asportati per finalità diagnostiche e terapeutiche. Il processo in cui un campione biologico viene trattato con formaldeide si definisce “fissazione” e consente di mantenere inalterata nel tempo la morfologia cellulare e l’architettura del tessuto, impedendone la degenerazione post-necrotica; in tal modo si può conservare il campione biologico fino al momento della diagnosi definitiva o a tempo indeterminato per diverse finalità (diagnostiche, scientifiche, medico-legali, etc.). La nuova normativa impone al datore di lavoro (nel caso specifico, l’ospedale) l’obbligo di effettuare una meticolosa valutazione dei danni connessi all’utilizzo di questa sostanza, al fine di definire se il livello di rischio sia rilevante per la salute dei lavoratori esposti. Per ridurre la possibilità di incorrere in effetti dannosi è opportuno mantenere un livello di esposizione dei lavoratori al di sotto dei valori limite di soglia stabiliti, tramite la messa in essere di misure tecniche e procedurali (art. 235 T.U. SSL). In questo lavoro si analizzano le motivazioni per le quali la formaldeide è stata considerata tossica, ovvero le acquisizioni scientifiche sugli effetti che può avere sull’organismo (in particolare il rischio cancerogeno) e quali siano gli obblighi del datore di lavoro per la salvaguardia dei lavoratori esposti, secondo quanto previsto dal decreto legislativo 81/08; si descrive, inoltre, lo studio sperimentale condotto nell’AOU San Giovanni di Dio e Ruggi d’Aragona di Salerno, in risposta alla normativa, per stabilire il livello di esposizione dei lavoratori alla formaldeide e limitare il rischio tossico connesso; studio rivolto con particolare attenzione agli infermieri che lavorano in sala operatoria e a tutti i lavoratori dell’Anatomia Patologica. Si presentano, infine, le strategie operative possibili oltre che necessarie per adeguare l’ospedale alla nuova normativa di legge e tutelare i lavoratori dal rischio chimico derivante dalla formaldeide.

Exercise training (ET) is a natural activator of silent mating type information regulation 2 homolog 1 (SIRT1), a stress-sensor able to increase the endogenous antioxidant system. SIRT1 activators include polyphenols and vitamins, the antioxidant properties of which are well-known. Antioxidant supplements are used to improve athletic performance. However, they might blunt ET-related benefits. Middle-distance runners (MDR) taking (MDR-S) or not taking antioxidant supplements (MDR-NoS) were compared with each other and with sedentary subjects (CTR) to evaluate the ET effects on SIRT1 levels and oxidative stress, and to investigate whether an exogenous source of antioxidants could interfere with such effects. Thirty-two MDR and 14 CTR were enrolled. MDR-S took 240 mg vitamin C and 15 mg vitamin E together with mineral salts. SIRT1 mRNA and activity were measured in PBMCs. Total oxidative status (TOS) and total antioxidant capacity (TEAC) were determined in plasma. MDR showed higher levels of SIRT1 mRNA (p = 0.0387) and activity (p = 0.0055) than did CTR. MDR-NoS also showed higher levels than did MDR-S without reaching statistical significance. SIRT1 activity was higher (p = 0.0012) in MDR-NoS (1909 ± 626) than in MDR-S (1276 ± 474). TOS did not differ among the groups, while MDR showed higher TEAC levels than did CTR (2866 ± 581 vs. 2082 ± 560, p = 0.0001) as did MDR-S (2784 ± 643) and MDR-NoS (2919 ± 551) (MDR-S vs. CTR, p = 0.0007 and MDR-NoS vs. CTR, p = 0.003). TEAC (β = 0.4488356, 95% CI 0.2074645 0.6902067; p < 0.0001) and the MDR-NoS group (β = 744.6433, 95% CI 169.9954 1319.291; p= 0.012) predicted SIRT1 activity levels. Antioxidant supplementation seems to hinder the role of ET as a natural activator of SIRT1.

Background: Adverse health events associated with the exposure of healthcare workers to antineoplastic drugs are well documented in literature and are often related to the chemical contamination of work surfaces. It is therefore crucial for healthcare professionals to validate the efficiency of safety procedures by periodic biological and environmental monitoring activities where the main methodological limitations are related to the complexity, in terms of chemical-physical features and chemical-biological stability, of the drugs analyzed. Materials and methods: Here we describe the evaluation and application of a UHPLC-MS/MS based protocol for the environmental monitoring of hospital working areas potentially contaminated with methotrexate, iphosphamide, cyclophosphamide, doxorubicin, irinotecan, and paclitaxel. This methodology was used to evaluate working areas devoted to the preparation of chemotherapeutics and combination regimens at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno (Italy). Results: Our analyses allowed to uncover critical aspects in both working protocols and workspace organization, which highlighted, among others, cyclophosphamide and iphosphamide contamination. Suitable adjustments adopted after our environmental monitoring campaign significantly reduced the exposure risk for healthcare workers employed in the unit analyzed. Conclusion: The use of sensitive analytical approaches such as LC-MS/MS coupled to an accurate wiping procedure in routine environmental monitoring allows to effectively improve chemical safety for exposed workers.

Ruxolitinib is a JAK 1/2 inhibitor approved in 2011 by the Food and Drug Administration (FDA) for the treatment of patients with myelofibrosis. Currently, side effects related to the use of ruxolit...

Background: The safety of healthcare workers exposed to formaldehyde remains a great matter of concern for healthcare management units. This work aimed at describing the results of a combined monitoring approach (environmental and biological) to manage occupational exposure to formaldehyde in a hospital setting. Design and Methods: Environmental monitoring of working spaces and biological monitoring of urinary formaldehyde in 16 exposed healthcare workers of the Anatomic Pathology Unit of a University Hospital in Southern Italy was performed on a fouryear timescale (2016-2019). Results: Values of aero-dispersed formaldehyde identified were on average low; although workers’ urinary formaldehyde levels were also minimal, the statistical analysis highlighted a slight weekly accumulation. Conclusions: Our data confirm that both environmental and biological monitoring are important to identify risk situations, in particular when values of hazardous compounds are below the accepted occupational exposure levels. Significance for public health Health workers' regular exposure to formaldehyde may be responsible for long-term health issues; unfortunately, threshold limits of this compound are not harmonized between different government agencies. The combination of environmental and biological monitoring thus becomes an invaluable tool to preserve worker's safety and effectively assess chemical risk in hospital settings.

Therapeutic drug monitoring (TDM) is a recognized method to improve the quality of use of antiepileptic drugs, such as perampanel (PRP). It is the first compound in the class of selective non-competitive antagonists of AMPA receptors approved in 2012 in Europe and United States for adjunctive therapy of partial seizures. Although several studies have recently underlined that a general reference range for PRP plasmatic concentration might be difficult to propose, TDM of this drug is important in specific clinical situations, as hepatic or renal impairment or co-administration with enzyme-inducing antiepileptics. Several methods have been described in literature for the determination of PRP in different biological matrices, which include the use of liquid chromatography methods coupled with ultraviolet, fluorescence, mass or tandem-mass spectrometry detection. Here we describe the development and validation of a novel method for the measurement of PRP in plasma samples, based on a HPLC-UV/FL double detection approach and using ketoprofen as internal standard. PRP concentration in a small subset of plasma samples of treated patients was evaluated using both our approach and a commercially available CE-IVD LC-MS/MS method. The results obtained were compared, and confirmed the possibility to use our method as an alternative to LC-MS/MS in clinical routine.

Fluoropyrimidines (FP) are mainly metabolised by dihydropyrimidine dehydrogenase (DPD), encoded by the DPYD gene. FP pharmacogenetics, including four DPYD polymorphisms (DPYD-PGx), is recommended to tailor the FP-based chemotherapy. These polymorphisms increase the risk of severe toxicity; thus, the DPYD-PGx should be performed prior to starting FP. Other factors influence FP safety, therefore phenotyping methods, such as the measurement of 5-fluorouracil (5-FU) clearance and DPD activity, could complement the DPYD-PGx. We describe a case series of patients in whom we performed DPYD-PGx (by real-time PCR), 5-FU clearance and a dihydrouracil/uracil ratio (as the phenotyping analysis) and a continuous clinical monitoring. Patients who had already experienced severe toxicity were then identified as carriers of DPYD variants. The plasmatic dihydrouracil/uracil ratio (by high-performance liquid chromatography (HPLC)) ranged between 1.77 and 7.38. 5-FU clearance (by ultra-HPLC with tandem mass spectrometry) was measured in 3/11 patients. In one of them, it reduced after the 5-FU dosage was halved; in the other case, it remained high despite a drastic dosage reduction. Moreover, we performed a systematic review on genotyping/phenotyping combinations used as predictive factors of FP safety. Measuring the plasmatic 5-FU clearance and/or dihydrouracil/uracil (UH2/U) ratio could improve the predictive potential of DPYD-PGx. The upfront DPYD-PGx combined with clinical monitoring and feasible phenotyping method is essential to optimising FP-based chemotherapy.

Exposure of healthcare workers to anticancer drugs requires the combined action of environmental and biological monitoring to assess the effective level of exposure to these chemicals, to improve awareness and to avoid adverse health effects on this category of workers. Cancer chemotherapeutic drugs show different mechanisms of action due to diverse chemical structures; consequently, they differ in hydrophobicity, pharmacokinetics and pharmacodynamics. Therefore, the appearance, accumulation and elimination of each of these molecules in body fluids and tissues might be extremely variable; this prompts the need for a rapid and versatile analytical protocol for the biological monitoring of possible exposure of workers involved in the manipulation, administration and disposal of cancer chemotherapeutic drugs. In this paper we describe the development, optimization and validation of a UHPLC–MS/MS method for the simultaneous quasi-quantitative analysis of eight widely used antineoplastic drugs, which can be used for the analysis of both urine and blood samples. This methodology was applied to the biological monitoring of healthcare workers exposed to different extents to antiblastic drugs at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno (Italy), and allowed to identify two subjects exposed to irinotecan out of a total of fifteen workers analyzed.

Epilepsy is a widely diffused neurological disorder including a heterogeneous range of syndromes with different aetiology, severity and prognosis. Pharmacological treatments are based on the use, either in mono- or in polytherapy, of antiseizure medications (ASMs), which act at different synaptic levels, generally modifying the excitatory and/or inhibitory response through different action mechanisms. To reduce the risk of adverse effects and drug interactions, ASMs levels should be closely evaluated in biological fluids performing an appropriate Therapeutic Drug Monitoring (TDM). However, many decisions in TDM are based on the determination of the total drug concentration although measurement of the free fraction, which is not bound to plasma proteins, is becoming of ever-increasing importance since it correlates better with pharmacological and toxicological effects. Aim of this work has been to review methodological aspects concerning the evaluation of the free plasmatic fraction of some ASMs, focusing on the effect and the clinical significance that drug-protein binding has in the case of widely used drugs such as valproic acid, phenytoin, perampanel and carbamazepine. Although several validated methodologies are currently available which are effective in separating and quantifying the different forms of a drug, prospective validation studies are undoubtedly needed to better correlate, in real-world clinical contexts, pharmacokinetic monitoring to clinical outcomes.

International audience; "Nocturnal skyscapes. You know the Pyrenees by day - come see them by night... ": thus the title of an exhibition of photographs set up in 2012 by the Pays de Lourdes et des Vallées des Gaves (Hautes-Pyrénées département) to help raise public awareness about the project for the Pic du Midi International Dark Sky Reserve (IDSR), mainly among the local population and stakeholders in the areas concerned.Although its evocative title might suggest otherwise, this is rather more than an exhibition on the iconic sites of the Pyrenees seen at night. What it seems to do is to bring out new landscapes that are not just "mountainscapes at night", or simply night-time versions of landscapes seen by day.The night skies that characterise these landscapes therefore represent an new category, they need to be considered in their entirety as conveying a meaning that encompasses all that is both construed and material in our relationships with landscape. As in many areas with similar projects either in place (North America, Europe) or emerging (the Cévennes and Mercantour national parks in France, for example), the creation of the Pic du Midi IDSR will have helped to bring a new kind of "landscape object" (Besse, 2009) into being in the Pyrenean region.

International audience; « Paysages célestes nocturnes. Vous connaissez les Pyrénées le jour, découvrez-les la nuit... » est le titre d'une exposition de photographies créée en 2012 par le Pays de Lourdes et des Vallées des Gaves (Hautes-Pyrénées) pour sensibiliser aux enjeux du projet de la Réserve internationale de ciel étoilé (RICE) du Pic du Midi. Un examen attentif des clichés qui la composent montre que cette exposition ne propose pas une simple redécouverte des sites emblématiques des Hautes-Pyrénées vus de nuit sous les étoiles. Elle semble mettre en scène de nouveaux paysages montagnards qui ne sont pas uniquement des « paysages nocturnes » et qui ne relèvent pas non plus d'une banale « nocturnisation » des paysages diurnes. Cet article veut montrer que la dimension céleste qui les caractérise marque une réelle extension catégorielle et qu'elle doit être envisagée dans sa totalité comme porteuse d'un sens qui englobe l'idéalité et la matérialité de tout rapport au paysage. Comme dans de nombreux territoires où des projets similaires ont vu le jour (Amérique du Nord, Europe) ou sont en gestation (Parcs nationaux des Cévennes et du Mercantour par exemple), la création de la RICE du Pic du Midi aurait donc contribué à l'émergence d'un nouvel « objet paysager » (Besse, 2009). Le cas pyrénéen fournit donc ici le double exemple d'un processus d'artialisation in visu (Roger, 1998) et d'utilisation d'une catégorie spécifique de paysage comme outil d'une « action collective territorialisée » (Challéat, 2016).; "Nocturnal skyscapes. You know the Pyrenees by day - come see them by night... ": thus the title of an exhibition of photographs set up in 2012 by the Pays de Lourdes et des Vallées des Gaves (Hautes-Pyrénées département) to help raise public awareness about the project for the Pic du Midi International Dark Sky Reserve (IDSR), mainly among the local population and stakeholders in the areas concerned.Although its evocative title might suggest otherwise, this is rather more than an exhibition on the iconic sites of the Pyrenees seen at night. What it seems to do is to bring out new landscapes that are not just "mountainscapes at night", or simply night-time versions of landscapes seen by day.The night skies that characterise these landscapes therefore represent an new category, they need to be considered in their entirety as conveying a meaning that encompasses all that is both construed and material in our relationships with landscape. As in many areas with similar projects either in place (North America, Europe) or emerging (the Cévennes and Mercantour national parks in France, for example), the creation of the Pic du Midi IDSR will have helped to bring a new kind of "landscape object" (Besse, 2009) into being in the Pyrenean region.

Background/objective The objectives of this paper are to assess the extent of and the factors associated with hydroxychloroquine (HCQ) non-adherence in systemic lupus erythematosus (SLE) patients with prolonged inactive disease and to investigate relationships between blood HCQ concentration and quality of life (QoL). Methods Consecutive SLE patients, in remission for at least one year and taking a stable dose of HCQ were investigated. At study entry (T0) and six months later (T6) a blood venous sample was taken to measure whole blood concentration of [HCQ] and desethylchloroquine ([DCQ]). Moreover, at T0 each patient completed validated questionnaires assessing QoL, disability, anxiety, depression and visual analogue scales for fatigue, pain, general health (GH), and self-assessment of disease activity. Results Eighty-three patients with a median [HCQ] of 327 ng/ml were enrolled. At T0, 24 (29%) were defined as non-adherent ([HCQ] 100 ng/ml). At multiple logistic regression analysis the physical summary of SF-36 ( p = 0.038), and the concomitant use of immunosuppressants ( p = 0.010) were independently associated with non-adherence. A significant increase of HCQ adherence was observed at T6 ( p 0.05). Conclusions A better health status and the concomitant prescription of immunosuppressants represent risk factors for HCQ non-adherence in SLE patients in remission. Monitoring HCQ levels might represent an important opportunity to improve adherence.

Il existe aujourd’hui dans le monde 44 parcs et reserves de ciel etoile labellises sous les appellations anglophones « dark sky park », « dark sky reserve » ou « starlight reserve ». Tres rarement crees ex-nihilo, ces parcs et reserves sont le plus souvent delimites dans le perimetre d’espaces deja proteges (monument naturel, parc national, reserve de biosphere...) dont ils elargissent la portee des mesures de protection pour y inclure le ciel etoile et l’environnement nocturne. Leur creation illustre l’emergence de nouvelles formes de protection et de mise en valeur du patrimoine naturel dont les concepts se diffusent assez rapidement dans les pays europeens.

Hydroxychloroquine (HCQ) is an old antimalarial drug that has proven to be a safe and effective treatment for systemic lupus erythematosus (SLE) and other autoimmune diseases. Since hematic concentration of HCQ is closely related to the therapeutic response, monitoring the levels of the drug and its metabolites in the blood of HCQ-treated patients helps the clinician in the evaluation of partial or complete unresponsiveness to treatment. We developed and validated a novel ion-pairing HPLC-FL method for the simultaneous dosage of HCQ, and its major metabolites desethylhydroxychloroquine, desethylchloroquine and bisdesethylchloroquine, after extraction from whole blood. This methodological approach was used for the analysis of real samples obtained from patients affected by SLE and undergoing HCQ treatment. The same samples were also analyzed using a previously validated LC/MS/MS method and data obtained with the two approaches were in substantial agreement with each other. Results presented in this work indicate that this approach can be successfully used to monitor the level of HCQ and its metabolites in the blood of various categories of patients (i.e. low and high responders, or those not adhering to the therapy). Comparison of HPLC-FL and LC/MS/MS data confirmed the efficacy of the proposed method for routine clinical analyses.

Quality of the environment, noise pollution and «housing space capital» in urban milieu : the example of Pau. In urban space, the mixture of functions and the density of ground occupation create many problems between neighbours that affect the living environment and the quality of life in some central and suburban districts. The noise pollution in the day and night linked up to the car traffic or, at times, to the attendance of feasts are part of the source of nuisance the most frequently felt by local inhabitants. When crossing the preoccupations of human and social geography with the methods of geomatic analysis, the study in this paper shows what can be the interest and the modalities of an infra-urban geographic approach of exposure to noise and its incidences on the urban space of a middle-sized provincial town, rather well- known for the quality of its environment., Dans l'espace urbain, la mixité des fonctions et la densité d'occupation des sols posent de nombreux problèmes de voisinage qui affectent le cadre et la qualité de vie de certains quartiers centraux et péricentraux. Les nuisances sonores diurnes et nocturnes liées à la circulation automobile ou, ponctuellement, à la fréquentation des espaces festifs font partie des sources de gène les plus fréquemment ressenties par les résidents. En croisant les préoccupations de la géographie humaine et sociale avec les méthodes d'analyse de la géomatique, l'étude présentée dans ce texte montre quels peuvent être l'intérêt et les modalités d'une approche géographique infra-communale de l'exposition au bruit et de ses incidences sur l'espace urbain d'une ville moyenne de province, plus connue pour la qualité de son cadre de vie., Calidad del marco de vida, ruidos ambientales y estrategias residenciales en las ciudades : el ejemplo de Pau (Francia). En el espacio urbano, el carácter mixto de las Junciones y la densidad de ocupación del espacio plantean numerosos problemas de vecindad que degradan el marco y la calidad de vida de ciertos barrios céntricos y pericéntricos. Los ruidos ambientales diurnos y nocturnos causados por el tráfico automóvil o, más puntualmente, por los espacios festivos forman parte de las fuentes de molestia más mencionadas por los vecinos. Asociando las preocupaciones de la geografía humana y social con métodos de análisis de la cartografía, el estudio presentado en este texto quiere mostrar cuales son los intereses y las modalidades de un enfoque geográfico dentm de los municipios del ruido y de las concecuencias que acarrea en el espacio urbano de una ciudad media más bien famosa por su marco de vida., Charlier BrunoCharlier Bruno. Qualité du cadre de vie, nuisances sonores et «capital spatial d'habitat» en milieu urbain : l'exemple de Pau. In: Sud-Ouest européen, tome 17, 2004. Nuisances urbaines (Coordonné par Jean-Noël Salomon) pp. 27-40.

Before the International Year of Astronomy in 2009, the night sky protection was not understood or not known outside the background of the professional and amateur astronomers. But this international event suddenly publicized the night sky protection as a framework of thought and action whose content exceeds the astronomy background for integrate environnemental and sustainable development issues.Since then, the night sky protection is implemented by labels that recognize in particular parc and dark sky reserve. In 2009, there were two areas of night sky protection certified. In 2016, there were more than eighty areas of night sky protection mainly located in North America and Europe. This dissemination and this dazzling developpement attests of the gradual institutionalization of this singularity.Protagonist and observer of this reality, we propose in this PhD an analysis of the social dimension of the dynamics at work in the protection of the night sky, firstly for define and understand this item, secondly to apprehend the tools by which it is realized, and finally to determinate the limits ands the stakes of its implementation.; Avant l’Année Mondiale de l’Astronomie en 2009, l’idée de protection du ciel étoilé faisait très rarement écho en termes de sens et d’applications au-delà du milieu initié des astronomes professionnels et amateurs. Mais cet évènement international a soudain médiatisé la protection du ciel étoilé sous la forme d’un cadre de pensée et d’action dont le contenu et les perspectives dépassent largement la sphère astronomique pour s’insérer dans les problématiques liées à l’environnement et au développement durable. Depuis lors, la protection du ciel étoilé a pris pied sur la scène publique en étant mise en œuvre à partir de labels qui reconnaissent notamment des parcs et réserves de ciel étoilé. Ces espaces labellisés sont passés de deux exemples en 2009 à plus de quatre-vingts en 2016 essentiellement répartis en Amérique du Nord et en Europe. La diffusion et le développement fulgurants de la protection du ciel étoilé attestent de l’institutionnalisation progressive de cette singularité. Acteur et observateur de cette réalité, nous proposons dans cette thèse une analyse de la dimension sociale des dynamiques à l’œuvre dans la construction de la protection du ciel étoilé, d’une part pour comprendre et définir cet objet, d’autre part pour appréhender les outils par lesquels il se réalise et enfin pour déterminer les enjeux et limites de sa mise en œuvre.

Ce mémoire a été réalisé dans le cadre d'un stage d'étude de 5 mois dans les services Éducation à l'Environnement et Biodiversité du Conseil départemental des Pyrénées-Atlantiques. Le territoire sur lequel s’est déroulée la collecte d’informations quantitatives et qualitatives auprès des acteurs locaux correspond à celui du département des Pyrénées-Atlantiques (Nouvelle Aquitaine). Il s'agissait de dresser un état des lieux des outils pédagogiques d'Éducation à l'Environnement et au Développement Durable (EEDD) existants. Depuis les premières conférences organisées par l’UNESCO, le PNUE puis l’ONU, il y a une quarantaine d’années, les notions liées à l'EEDD ont évolué de même que les objectifs de ces outils pédagogiques. Les acteurs locaux, régionaux et nationaux conçoivent, développent et/ou diffusent des outils pédagogiques qui sont distribués au sein de réseaux et sont parfois échangés entre ces structures. Certains outils abordent des thématiques communes à l’ensemble du territoire alors que d’autres vont être circonscrits à certaines zones géographiques puisque abordant des problématiques spécifiques et locales. Ce mémoire cherche à savoir comment s’organise la conception des outils pédagogiques au sein des réseaux d’échelles multiples, pour quelle utilité et quelles adaptabilités ces outils peuvent bénéficier.