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According to the Public Healthcare Code, contributing to primary care is one of the pharmacist's key missions. Accessibility without appointment and the territorial network of pharmacies make the pharmacist an essential player in the management of unscheduled care, which remains an important gateway for users into the primary care system. This type of requests, daily in pharmacies, has not been yet the subject of a qualitative or quantitative evaluation. The Grand-Est Region, regrouping nearly 8% of French pharmacies, wanted to conduct a specific survey to quantify and assess the unscheduled care requests addressed to pharmacists on its territory.The survey by URPS Pharmacists and ARS Grand-Est was conducted by Tous Pour la Santé over a period of 12months from November 2020 to November 2021. Participation in the study was on a voluntary basis. The main objective of this study was to define the typology of unscheduled care requests addressed to the Region pharmacies and to characterize the responses provided.One hundred and eighty-nine pharmacies (nearly 12% of Grand Est pharmacies, the participation rate could certainly have been higher if the study had not been conducted during the COVID-19 pandemic), representing 11,010 unscheduled care requests, took part in the survey. Despite the profession's massive desire to get involved in handling unscheduled care requests, the survey revealed a lack of specific training for pharmacists on this subject and an all-too-rare update from the AFGSU. User requests concern both daily healthcare needs and more specific chronic patients' needs. They evolve according to the profile of the applicant, the seasons, the days of the week and the type of pharmacy concerned. All ages are represented, including young adults. The average duration of care by the pharmacy team was 8minutes per request, even though in 20% of cases this did not lead to any delivery of product and in 11% of cases to no remuneration for the pharmacist.This survey confirmed the role of the pharmacist in responding to unscheduled care requests as a first-line actor and referral agent in the health system. The implementation of shared multiprofessional protocols, including first and foremost general practionners, and the recognition of the contribution of pharmacy teams would allow to define a framework to optimize the patient's journey through the healthcare system.

Resume Reseau citoyen d’observateurs des plantes a pollen allergisant, Pollin’air a pour objectif de permettre aux personnes allergiques d’etre prevenues de l’emission des pollens allergisants en temps reel et de maniere geolocalisee. Il a ete initie en juillet 2016 grâce au partenariat entre Air Lorraine (Atmo Grand Est depuis 2017), l’Observatoire regional de la sante et des affaires sociales en Lorraine (ORS Grand Est depuis 2018), le laboratoire d’hydrologie et climatologie medicales de la faculte de medecine de Nancy, le jardin botanique Jean-Marie Pelt (Villers-les-Nancy), l’Agence regionale de sante de Lorraine (desormais ARS Grand Est), l’Union regionale des professionnels de sante pharmaciens de Lorraine (desormais URPS pharmaciens Grand Est) et la Metropole du Grand Nancy. Pollin’air est un reseau participatif qui met en relation des sentinelles benevoles qui observent la pollinisation des especes vegetales a risque allergique et les personnes allergiques, via une plateforme numerique. Grâce aux informations fournies par les premiers, les secondes peuvent adapter leurs comportements de maniere precoce et reduire les effets sanitaires lies aux periodes de pollinisation. Les professionnels de sante peuvent ajuster leurs strategies diagnostiques et therapeutiques. L’observation phenologique de 25 especes allergisantes (floraison, pollinisation, fin de pollinisation) est realisee par les sentinelles des pollens sur le territoire lorrain, les informations sont collectees, en temps reel et de maniere geolocalisee, sur le site www.pollinair.fr sur une carte interactive. Les personnes allergiques peuvent recevoir des alertes personnalisees en fonction de leur allergie et de leur localisation geographique. Pollin’air permet d’acquerir des donnees phenologiques a grande echelle. Il apporte une information qualitative specifique de l’espece vegetale et geolocalisee. D’importantes variations geographiques de pollinisation sont mises en evidence sur le territoire allant jusqu’a 1 mois pour l’armoise. L’analyse des dates de diffusion de l’information pollinique relevees par les 3 outils de surveillance utilises a Nancy montre que veille phenologique realisee au jardin botanique donne l’information la plus precoce 6 fois sur 14, le reseau Pollin’air dans 5 cas et le Reseau national de surveillance aerobiologique (RNSA) dans 3 cas Les enquetes de satisfaction realisees aupres des sentinelles et des personnes allergiques montrent l’acquisition de connaissances tant en botanique que sur les allergies par les participants, l’adhesion de 9 personnes allergiques sur 10 a la proposition d’adapter leur comportement et leur traitement a l’actualite pollinique. Ce reseau participatif a permis de creer une dynamique collective et intergenerationnelle autour de l’enjeu de sante publique que constitue l’allergie aux pollens, en federant professionnels de sante, botanistes, experts de l’air, collectivites et citoyens.

Background The management of osteoporosis requires a restrictive drug treatment over several years and lifestyle changes: maintaining a suitable physical activity, a sufficient calcium intake and maintenance of ground balance. Unfortunately, treatment adherence at one year doesn’t exceed 50%. The education of the patient allows to take care of himself in his therapeutic approach but requires a relay to continue the follow-up over several years. Objectives To improve the follow-up of the patient, we created a cooperation between the doctor and the pharmacist. Methods We suggested to patients treated for osteoporosis by diphosphonate, denosumab or teriparatide to participate at two half-day TPE sessions, one year apart. It’s taught that osteoporosis requires at least 5 years of treatment, and must be associated with the absorption of three daily dairy products, maintaining physical activity and preventing falls. A follow-up notebook that contains 6 doctor and 6 pharmacist questionnaires is given to each patient participating in a TPE session. The patient sends his book to the doctor, and then to the pharmacist twice a year for three years. The pharmacist questionnaire explains the drug intake. The doctor questionnaire evokes lifestyle changes. This one is completed by the patient in the waiting room and is discussed with the doctor during the consultation. Each completed questionnaire provides a financial compensation to the health professional. The program is funded by the Regional Health Agence of Lorraine and by the Regional Union of Health Professionals (doctors and pharmacists). Inclusions started in January 2013. We studied the results of the 3 year questionnaires for 94 patients included in 2013 and 2014. Results Among the 94 patients, only 49 continue their treatment at 3 years. Patients who stopped treatment, 4 died, 1 presented an atypical fracture of the femoral shaft, 6 stopped due to dental treatment, 4 had a contraindication to any anti-osteoporosis treatment, 1stopped treatment due to multiple sclerosis 11 left the program, 2 had poorly tolerated the infusion and 1 discontinued treatment because of improved bone mineral density (BMD). Among the 49 patients who continue their treatment, 13 returned a doctor and pharmacist questionnaire at 3 years. There are 4 doctors and 2 pharmacists who refused to fill out the questionnaire, 20 patients didn’t agree to respond to our request for news about their health condition and 4 patients lost to follow-up. The study of 13 questionnaires received shows that at 3 years, 38% of patients continue to consume 3 daily dairy products against 56% at 6 months. Nearly 70% of patients maintained their physical activity, 8% improved and 8% decreased it. It also shows that 46% of patients walk more than 30 min per day. The ground balance is satisfactory for 62% of patients compared to 71% at 6 months. Regarding compliance, at 6 months and 3 years, only 69% of patients never forget their treatment and 15% wanted to stop it. During the 3 years of follow-up, all patients were re-contacted at least once. Conclusions 52% of patients included continue the treatment at 3 years. 21% refuse to participate in the program. The doctor/pharmacist collaboration around the patient requires time and understanding. Patients recall and their participation in a research program improves their adherence to treatment and lifestyle changes. Disclosure of Interest None declared

Background The management of osteoporosis requires drug treatment and changes in lifestyle. Adherence to medication does not exceed 50% at one year. Changes in lifestyle are rarely explored. Therapeutic requires a relay to continue the follow-up over several years Objectives To improve the follow-up of the patient, we have created cooperation between the attending physician and the pharmacy pharmacist initiated by the patient himself Methods We proposed a therapeutic patient education for patients treated for osteoporosis to participate in two half-day ETP sessions a year apart. Educational objectives are: The treatment of osteoporosis requires at least 5 years of treatment, and must be associated with the absorption of three dairy products per day, maintaining physical activity and preventing falls. Each patient participating in a therapeutic education session receives a follow-up notebook containing six doctor questionnaires and six pharmacist questionnaires. The patient remains the owner of the notebook. We were able to study the results of the 2-year questionnaires for 72 patients included in 2013 and 2014. Results 53/72 patients continue their treatment at 2 years. 4 patients died, 1 had an atypical fracture of the femoral shaft, 6 stopped treatment due to dental treatment, 3 had contraindications to any anti-osteoporotic treatment, 1 decided to discontinue treatment due to d Multiple Sclerosis, 11 decided to leave the program. 3 patients were lost to follow-up, ie 14/72 patients of whom we no longer have any news. Of the 53 patients who continued treatment, 24 sent back a doctor and pharmacist questionnaire to 2 years. 4 doctors and 2 pharmacists refused to complete the questionnaires. The study of pharmacist questionnaires received at 2 years shows that 83% of patients continue to consume 3 dairy products per day compared to 73% at 6 months, 65% maintained physical activity, 17% improved it, 9% decreased. The ground balance was satisfactory for 78% of patients compared with 71% at 6 months. 71% never forget their treatment, compared with 69% at 6 months. 8% wanted to stop their treatment, stable figure compared to questionnaires received at 6 months. All patients knew what their treatment was for at one year and 96% met the conditions for taking the medication. 69% do not forget it at two years against 86% at one year, thanks to the intervention of the pharmacist. Only 6% wanted to stop the treatment at two years due to side effects, 17% to 1 year, but did not stop after consultation with the doctor and/or pharmacist. During the two-year follow-up, all patients were phone called at least once by a secretary, mostly several times. The notebook is driven by the patient himself, many oh them report to the nurse that it give them an active role which afoord them to continue the treatment Conclusions 58% of the patients enrolled continue treatment at two years, 15% have stopped the treatment as a side effect. An active role given to the patient and a collaboration between physicians and pharmacists thus promote adherence to treatment and also changes in lifestyle Disclosure of Interest None declared

Introduction Dans le but d’informer de l’emission des pollens allergisants en temps reel et de maniere geolocalisee, Atmo Grand Est et ses partenaires ont mis en place un pollinier et un reseau citoyen d’observateurs des plantes en Lorraine, Pollin’air. Ce projet innovant s’inscrit dans les actions du PRSE2 et 3. Methodes Les observateurs sentinelles sont recrutes par courrier, reseaux sociaux et professionnels, medias, associations environnementales et botaniques, conferences et manifestations. Ils s’inscrivent sur le site http ://www.pollinair.fr/ accessible par ordinateur, smartphone et tablette numerique. Ils identifient, geolocalisent et photographient les plantes dont ils vont assurer la surveillance parmi une liste de 25 especes allergisantes. La coordinatrice du reseau valide les donnees. Le Guide des sentinelles, mis a disposition a l’inscription et disponible sur internet, presente les plantes et les stades d’observation. Les observateurs signalent les dates de debut et fin de pollinisation. Une alerte est envoyee lors de la floraison des plantes dans le pollinier du Jardin botanique J.-M. Pelt (54) pour mobiliser les observateurs. Les internautes peuvent consulter la carte interactive de pollinisation et s’inscrire pour recevoir des informations personnalisees. Un questionnaire a ete adresse aux sentinelles a la fin de la saison afin de recueillir leurs avis et d’evaluer les outils. Resultats En 2017, 109 observateurs ont ete recrutes, 362 observations de plantes ont ete enregistrees, 207 internautes ont demande une information personnalisee. Le site internet a ete visite 21 399 fois pendant la saison. Le questionnaire a ete complete par 27 sentinelles. Les outils, le suivi et les echanges avec l’equipe Pollin’air sont juges positivement. Quatre-vingt-seize pour cent des repondants declarent poursuivre leur mission. Conclusion Les donnees geolocalisees de pollinisation des especes allergisantes, transmises par les sentinelles, permettent la mise en œuvre d’actions preventives et personnalisees aupres des abonnes. Le dispositif numerique de recueil et de diffusion de l’information rend les donnees accessibles en temps reel. Ce projet pilote s’etendra au Grand Est et aux regions souhaitant rejoindre le reseau en 2018.

To understand the brain areas associated with visual awareness and their anatomical interconnections, we studied binocular rivalry with functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). Binocular rivalry occurs when one image is viewed by one eye and a different image by the other; it is experienced as perceptual alternations between the two images. Our first experiment addressed problems with a popular comparison condition, namely permanent suppression, by comparing rivalry with binocular fusion instead. We found an increased fMRI signal in right frontal, parietal, and occipital regions during rivalry viewing. The pattern of neural activity differed from findings of permanent suppression comparisons, except for adjacent activity in the right superior parietal lobule. This location was near fMRI signal changes related to reported rivalry alternations in our second experiment, indicating that neighbouring areas in the right parietal cortex may be involved in different components of rivalry. In our second experiment, we used probabilistic tractography to detect white matter fibres between right-hemispheric areas that showed event-related fMRI signal changes time-locked to reported perceptual alternations during rivalry viewing. Most of these functionally defined areas were linked by probabilistic fibre tracts, some of which followed long-distance connections such as the inferior occipitofrontal fasciculus. Corresponding anatomical pathways might mediate communication within the functional network associated with changes in conscious perception during binocular rivalry.

We evaluated growth, maturity of the skeleton and formation of skeletal deformities and epiphysiolysis of the femoral head in 22 children with end-stage renal failure undergoing haemodialysis, CAPD (continuous ambulatory peritoneal dialysis) and after kidney transplantation. We found growth retardation and disturbances of skeletal maturity in 64% of the children and skeletal deformities in 45%. Children undergoing haemodialysis showed a higher rate of retardation in growth and skeletal maturity than those undergoing CAPD and kidney transplantation. A high level of cortisone and frequent rejections after renal transplantation also lead to poorer growth and skeletal maturity. Children suffering from congenital renal dysfunction showed a higher rate of skeletal deformities. During haemodialysis the level of PTH (parathyroid hormone) was significantly higher than during CAPD and after renal transplantation. Epiphysiolysis capitis femoris lenta was found in 3 children, two of which occurred on both sides. These children had a significantly higher average level of PTH than the other 19.

Different spatial representations are not stored as a single multipurpose map in the brain. Right brain-damaged patients can show a distortion, a compression of peripersonal and extrapersonal space. Here we report the case of a patient with a right insulo-thalamic disconnection without spatial neglect. The patient, compared with 10 healthy control subjects, showed a constant and reliable increase of her peripersonal and extrapersonal egocentric space representations - that we named spatial hyperschematia - yet left her allocentric space representations intact. This striking dissociation shows that our interactions with the surrounding world are represented and processed modularly in the human brain, depending on their frame of reference.

Background The management of osteoporosis requires multi-years drug treatment and lifestyle changes: maintenance of adapted physical activity, adequate dietary calcium intake, maintaining balance on the ground. It is admitted that adherence to medication does not exceed 50% at one year Objectives To improve patients follow-up, we have created cooperation between their family doctor and the City pharmacist initiated by the patient himself. Methods We proposed participation to therapeutic session education to each osteoporotic patient at the end of which we give him a logbook that contains 6 doctor questionnaires and 6 pharmacist questionnaires. The patient remains the owner of the diary, he transmit it to his doctors and his pharmacist twice a year over 3 years. The doctor questionnaire covers the changes in lifestyle; the pharmacist questionnaire covers the medication. Once a year, doctors and pharmacists meet to develop the protocol and addressing diagnostic and therapeutic innovations. The inclusions began in January 2013. We have been able to study the results of the questionnaires one (2014) and two (2015). A nurse and a secretaress call many time ech patient to remain them the project. We conducted a semi led interview with 10 doctors and 10 pharmacists to detect the brakes and levers of successful interprofessional cooperation. Results Cooperation physicians/pharmacists: the patient initiates cooperation doctors/pharmacists by providing logbook at regular intervals to both health professionals. Patients play a role in the initiation and continuation of their collaboration. We undertook an exploration work with the anthropological laboratory to investigate the change in the perception of its role by the patient over program. We included 48 patients in 2013. 36/48 continue their treatment at 2 years. Only 1 patient has stopped his treatment without medical reason. 4 patients discontinued treatment for dental care side, 2 for intolerance to any treatment. 9 continue their treatment althougt their physician or pharmacist don9t full the questionnaire. 5 don9t give any news about them. The analysis of 73 questionnaires received at one year and 32 questionnaires received at 2 years shows sufficient dietary calcium intake at 2 years to 81% against 84% at one year and a satisfactory for ground balance 75% against 90% at one year. All patients knew at one year the name of their treatment and 96% meet the conditions of the drug taken. 69% do not forget their treatment at two years against 86% at one year thank pharmacist intervention. Only 6% wanted to stop the treatment at 2 years because of side effects, of excessive stresses, lack of noticeable effect, against 17% at 1 year, but they have not stopped after consulting the doctor and/or pharmacist. 25% improved their level of physical activity at 2 years against 14% at one year, 69% were held against 76% at one year. Conclusions 75% patients continue their treatment at 2 years: the cooperation between doctor and pharmacist induced by the patient has a positive effect on adherence. Disclosure of Interest None declared

Twenty-four beagle dogs underwent a lower leg lengthening on the right side of 2.5 cm at a distraction rate of 2 times 0.5 mm per day using a circular fixator system. After a latency phase of 5 days and a distraction phase of 25 days, 12 dogs (30-day dogs) underwent electromyography (EMG) of the gastrocnemius muscle on the lengthened and on the control side. The remaining half of the dogs underwent EMG after a consolidation phase of 25 days following the end of distraction (55-day dogs). During every EMG, at least 20 different muscle potentials were analyzed, and the duration, amplitude, and number of phases were determined of each individual potential. The 30-day dogs had significantly longer potential phases on the lengthened side and insignificantly smaller amplitudes compared with the control side. Furthermore, we observed a slightly larger number of polyphasic potentials on the distraction side. In the 55-day dogs, no significant differences were observed in the various parameters between the lengthened and the control side. Comparing 30- and 55-day dogs, the duration of the potentials on the distraction side was not significantly shorter in the 55-day dogs, and the amplitude significantly higher. These findings could indicate combined neurogenous and myopathic alterations of the muscles during the early distraction phase which will be compensated during the later distraction period and the consolidation phase by reparative and reinnervation processes, leaving no lasting functional damage.

We evaluated growth, maturity of the skeleton and formation of skeletal deformities and epiphysiolysis of the femoral head in 22 children with end-stage renal failure undergoing haemodialysis, CAPD (continuous ambulatory peritoneal dialysis) and after kidney transplantation. We found growth retardation and disturbances of skeletal maturity in 64% of the children and skeletal deformities in 45%. Children undergoing haemodialysis showed a higher rate of retardation in growth and skeletal maturity than those undergoing CAPD and kidney transplantation. A high level of cortisone and frequent rejections after renal transplantation also lead to poorer growth and skeletal maturity. Children suffering from congenital renal dysfunction showed a higher rate of skeletal deformities. During haemodialysis the level of PTH (parathyroid hormone) was significantly higher than during CAPD and after renal transplantation. Epiphysiolysis capitis femoris lenta was found in 3 children, two of which occurred on both sides. These children had a significantly higher average level of PTH than the other 19.

Der Herr Franklin verstebt bier unter dem Unelektrischen, das im Glase ist, uberbaupt benjenigen Korper, dessen man sich bedienet, dem Glase an der sadungsfeite die Elektricitat zuzufuhren, und sie demselben an der ausern Seite zu rauben, aher fie von derselben abzuleiten, und welcher gewubnlich mit dem Namen der Belegung bezeichnet wird. Man bat sich Anfangs blos des Waffers bedienet; nachmals bat man gefunden, das man biezu alle unelektrischen Korper gebrauchen konne. Man fullet dabero Feilstaub oder Hagelkorner in die Glaser. Man bestreuet dieselben mit.Hammerschlag, oder uberziebt sie mit Goldblattern. Man darf dieselben ebenfalls nur mit einem etwas feuchten Tuche in und auswenbig bedecken. Die bequemste Art der Belegung, babe ich gefunden, sey diejenige, wenn man sie mit bunner Spiegelfolie, die man mit Gummiwasser befestigen kann, uberzieht. Diese Belegung ist nicht nur bald zu verfertigen, fondern ist auch dauerbafter und bequemer. Ueberdem aber hat man bey dem haufigen Jerspringen der Tadungeglaser den Vortheil, das man des Ueberzuges nicht zugleich mit dem Glase verlustig geht, sondern man kann dieselbe Belegung stets von einem Glase auf das andere bringen. Bey dem Belegen der GIaser, sie mag seyn welcher Art sie wolle, mus man sich des Vortheiles bedienen, das man dieselbe sich an beyden Seiten gleichweit erstreckren lasse. Denn aus wiederholten Versuchen, die ich hier der Kurze wegen ubergehe, habe ich gefunden: Das das Glas nicht weiter vollkommen elektrisiret werde, als sich die innere Belegung erjlrecket; und nichtweiter geladen werde, als ihm die Belegung von ausen die Blektricitât raubet, Die ubrigen Theile find ohne Wirkung, und dienen blas darzu, die beyden Belegungen von einander abbzusondern.