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Introduction : La place de la nutrition artificielle en soins palliatifs oncologiques est controversée. Aucun bénéfice sur la qualité de vie ou la survie n’a été prouvé si l’espérance de vie à l’introduction ne dépasse pas 2-3 mois. Le médecin référent à domicile est le médecin traitant. Objectifs : Décrire les informations transmises au médecin traitant et sa place dans la prise en charge de la nutrition artificielle. Cerner dans quelle démarche s’inscrit cette nutrition ; observer le devenir des patients à 3 mois ; établir un lien entre les informations transmises et l’attitude du médecin traitant. Matériel et méthode : L’étude prospective a été menée à Clermont-Ferrand de Juin 2017 à Mai 2018. Les patients étaient majeurs, atteints d’une néoplasie métastatique et/ou en chimiothérapie au-delà d’une 3ème ligne. Aucune chirurgie n’était envisagée. Les patients étaient sous nutrition artificielle depuis moins de 3 mois, encadrés à domicile par une HAD ou un prestataire. Les comptes-rendus correspondants à l’introduction de la nutrition ont été étudiés. Les médecins traitants ont été interrogés 3 mois après le retour à domicile de leur patient. Résultats : 93 patients ont été inclus. 30 comptes-rendus (32,3%) n’ont jamais été rédigés. L’indication de la nutrition était présente dans 74,6% des courriers, le poids dans 54%, les marqueurs biologiques de dénutrition dans 22,2%,les scores pronostiques jamais, le mot « palliatif » dans 26,6%, et l’avis du patient dans 9,5%. 59,1% des patients étaient décédés à 3 mois. 85,5% d’entre eux ont gardé la nutrition jusqu’à la semaine précédant le décès. Le PS de l’OMS était présent dans 41,3% des courriers et était ≥2 pour 88,5% des patients. Parmi eux, 69,6% étaient décédés à 3 mois (p = 0,046). 82 médecins ont été interrogés. Le taux de réponse était de 88,2%. Pour 62%, l’objectif de la nutrition artificielle ne leur avait pas été exposé. 73,2% estimaient leur patient en soins palliatifs lors de l’introduction de la nutrition artificielle, qu’ils jugeaient pertinente dans 91,5% des cas. 33% de ceux qui avaient une formation aux soins palliatifs la jugeaient « non pertinente » (p

Existen suficientes estudios e investigaciones que demuestran que, en la economía de cualquier país, las empresas familiares son una de las fuentes de riqueza más importantes y que, además, generan mayor empleo. Sin embargo, muchas de estas empresas familiares desaparecen en la transición de la primera a la segunda generación, ya sea porque finaliza su actividad económica, porque pasan a manos de terceros o bien por una mala planificación en la sucesión del fundador o fundadores de las mismas. Esa atracción se inició a raíz de mi participación en el curso sobre gestión de la empresa familiar, organizado por la UMH durante el curso 2016-2017. Comencé a preocuparme, principalmente, por una de las causas, que impide el paso de una empresa a la segunda generación: la mala planificación en la sucesión. La voluntad de continuidad del fundador o fundadores de la EF, a través de sus descendientes, debe ser objeto de una profunda reflexión y de su correcta preparación. Mi mayor interés y motivación reside en la previsión del futuro de la empresa Demazières Luzuriaga s.l., fundada hace pocos años por mis dos hermanos, cuyo nombre comercial es Totimport. Es la empresa de mi familia y a ella quiero dedicarle mis mejores esfuerzos profesionales. El primer objetivo de este trabajo es el de profundizar en el concepto de EF, así como en sus aspectos más relevantes y diferenciadores de otras empresas no familiares. El segundo objetivo, de índole más práctica y personal, consistirá en aplicar dichos conocimientos a la EF Totimport se realizará un análisis de la misma, detectando los problemas que puedan existir, optimizando sus puntos fuertes, colaborando en la elaboración de los protocolos y asesorando con las propuestas de mejora necesarias para aumentar la rentabilidad, salvaguardar su patrimonio y asegurar su continuidad generacional. En el primer capítulo, se desarrollará la introducción del trabajo. En ella se expondrá, la motivación, los objetivos y la metodología empleada para su consecución. A continuación, en el capítulo 2, se tratará de recoger información de diversos especialistas en la materia, acerca del concepto de EF, sobre los aspectos que las diferencian de las no familiares, los elementos que las integran y las ventajas e inconvenientes que tienen este tipo de empresas. En el capítulo 3, se expondrán los factores, tanto de carácter familiar como empresarial, que se consideran relevantes para el éxito de la empresa. También se analizarán los conflictos que surgen en su seno, así como algunos de los métodos que existen para la resolución de los mismos. En el capítulo 4, se abordarán el protocolo familiar y la sucesión, como elementos determinantes en la continuidad de la empresa y que garantizan la transición a la segunda generación. El capítulo 5 tratará de aplicar la información recogida en los capítulos anteriores a una empresa concreta, en este caso a Totimport. Para finalizar, el capítulo 6 aportará las conclusiones del proyecto.

Biomarkers of hydration change in response to acute dehydration; however, their responsiveness to changes in fluid intake volume, without exercise or heat exposure, has not been adequately described. Moreover, patterns of circadian variation in hydration biomarkers have not been established. The study aims were to (1) assess the response of hydration biomarkers to changes in daily water intake; and (2) evaluate circadian variation in urinary and salivary biomarkers. Fifty-two adults (24.8 ± 3.1 years; 22.3 ± 1.6 kg/m2; 79 % female), grouped based on habitual fluid intake (low drinkers, n = 30, 2.0 L/day), completed a 5-day inpatient crossover trial. On days 1 and 2, low drinkers received 1.0 L/day of water while high drinkers received 2.5 L/day. On days 3 through 5, intake was reversed between groups. Plasma and saliva osmolality were assessed daily at predetermined times, and all urine produced over 24 h was collected in timed intervals. ANOVA with intake (1.0 vs. 2.5 L/day), day, and time revealed that (1) urine concentration (osmolality, specific gravity, color) and volume, but not plasma nor saliva osmolality, responded to changes in water intake; (2) urinary hydration biomarkers and saliva osmolality vary as a function of the time of day; and (3) urine osmolality measured in samples collected during the afternoon most closely reflects the corresponding 24 h value. Overall, urinary hydration biomarkers are responsive to changes in water intake, and stabilize within 24 h of modifying intake volume. Moreover, short afternoon urine collections may be able to replace 24 h collections for more convenience in hydration assessment.

Objectives The aim was to investigate the pharmacokinetics of intranasal sumatriptan (administered using a novel bi-directional powder delivery device) and study its effects on quantitative electroencephalography in patients with migraine. The safety profiles of the two formulations were also compared. Methods The pharmacokinetics of intranasal sumatriptan (10 mg and 20 mg) administered using a novel breath-actuated bi-directional powder delivery device were compared with subcutaneous sumatriptan (6 mg), along with an investigation of their effects on the electroencephalogram (EEG) following glyceryl trinitrate (GTN) challenge in 12 patients with migraine using a randomized, three-way cross-over design. Key findings Following intranasal delivery, median tmax was 20 min with both doses compared with 10 min after the subcutaneous dose. Mean ± SD values for Cmax were 96 ± 25, 11 ± 7 and 16 ± 6 ng/ml for subcutaneous, intranasal 10 mg and intranasal 20 mg formulations, respectively. Values for area under the curve were also lower with the intranasal doses. Intranasal and subcutaneous sumatriptan induced similar EEG changes characterized by reduced theta-power and increased beta-power. The majority of study participants were free of pain according to the headache severity score with all treatments from 15 min through to 8 h post-dose. All treatments were well tolerated and there were no reports of bitter aftertaste after intranasal delivery. Sumatriptan was rapidly absorbed after intranasal administration using the new device. Using the GTN challenge, sumatriptan powder delivered intranasally at a dose of 20 mg by the new device had effects similar to those of subcutaneous sumatriptan on EEG and reported headache pain, despite much lower systemic exposure. Conclusions Administration of sumatriptan intranasally at doses of 10 mg and 20 mg by the breath actuated bi-directional powder delivery device results in rapid absorption. Delivery to target sites beyond the nasal valve induced a similar EEG profile to subcutaneous sumatriptan 6 mg and prevented migraine attacks in patients following GTN challenge. Intranasal administration of sumatriptan powder with the breath actuated bi-directional powder delivery device was well tolerated.

Human models of anxiety are useful to develop new effective anxiolytics. The objective of this study was to use functional magnetic resonance imaging (fMRI) to test the hypothesis that a single dose of lorazepam modifies brain activation during an anxiety challenge. Eighteen healthy male subjects underwent fMRI associated with a challenge based on the anticipation of aversive electrical stimulations after pretreatment, either with placebo or with 1.0 mg of oral lorazepam. Anxiety was rated before fMRI and after, referring to the threat condition periods, using State Trait Anxiety Inventory (STAI) and Hamilton scales. The conditioning procedure induced anxiety, as indicated by clinical rating score changes. Lorazepam did not modify anxiety rating as compared to placebo. Lorazepam reduced cerebral activity in superior frontal gyrus, anterior insula/inferior frontal gyrus and cingulate gyrus. The current finding provides the first evidence of the modulatory effects of an established anxiolytic agent on brain activation related to anticipatory anxiety.

BACKGROUND: Melatonin is an important regulator of the sleep-wake cycle. A prolonged-release formulation of melatonin (PR-M) that essentially mimics the profile of the endogenous production of the hormone is effective in the treatment of insomnia in patients aged 55 years and older. Because hypnotics result in impairments of various cognitive skills, it is important to examine the cognitive effects associated with the use of PR-M. OBJECTIVES AND METHODS: The effects of therapeutic oral doses of PR-M (2 mg), zolpidem (10 mg) and their combination administered at bedtime on cognitive functions in healthy subjects aged 55 years and older (12 males + 4 females, age 59.4 +/- 3.2 years) were assessed in a randomized, double-blind, placebo-controlled, and four-way crossover study. Psychomotor functions, memory recall, and driving skills were assessed at 1 and 4 h following administration and the next morning. RESULTS: Compared to placebo, PR-M alone did not impaired performances on any cognitive tasks. Zolpidem significantly impaired psychomotor and driving performance 1 h and 4 h post-dosing, and early memory recall; these impairment were exacerbated with PR-M co-administration. No effects on next morning psychomotor or driving performance were observed except that the decline in memory recall after zolpidem was more pronounced in the next day. No pharmacokinetic interactions were found. CONCLUSIONS: This study extends previous researches showing impairment of cognitive functions by zolpidem within 5 h post-administration. Further, PR-M use was not found associated with impairment of psychomotor functions, memory recall, and driving skills, and point to a pharmacodynamic interaction between melatonin and GABA-A modulators. Language: en

This randomized, open-label, crossover study was conducted to compare the effects of a 24-hr nicotine patch and a 16-hr nicotine patch on morning smoking urges and sleep quality of dependent smokers during a short period of cigarette abstinence. A total of 20 smokers (9 women and 11 men) smoking at least 20 cigarettes/day completed the two smoke-free study periods. For each period, cigarette abstinence started on the first evening and a nicotine patch was applied the next morning (for 16 or 24 hr), after baseline measures; a second patch was applied the next morning, 1 hr before the end of the experimental period. Smoking urges, mood and behavior self-reports, psychomotor performance, and polysomnographic recordings were compared between the two types of nicotine patch according to changes from baseline. Both patches decreased morning smoking urges, although results were significantly superior for the 24-hr patch. Furthermore, the 24-hr patch was more effective than the 16-hr patch in reducing the positive reinforcing dimension of smoking urges. Regarding polysomnographic recordings, the proportion of slow wave sleep was significantly increased from baseline with the 24-hr patch compared with the 16-hr patch. As for psychomotor performance measured through the critical flicker fusion test, significant improvement in morning alertness was observed in the 24-hr patch group. In conclusion, the 24-hr nicotine patch formulation is more effective than the 16-hr formulation in alleviating morning smoking urges and more specifically the positive reinforcing factor. The present findings do not support the idea that nicotine delivery during bedtime might disturb sleep, but rather it improves restorative sleep and postwaking arousal.

The aim of this study was to assess the effectiveness of a new nicotine lozenge ( Nicopass 1.5 mg) in reducing smoking urge after an overnight abstinence. Twenty-four moderate smokers participated in a randomized, double-blind, placebo-controlled, 2-period crossover trial. The results showed that 1.5 mg-nicotine lozenge is superior to placebo in reducing smoking urge (p = 0.0001). In addition, nicotine lozenge, but not placebo, significantly improved vigilance and psychomotor performances (p0.05) and displayed a cardiac chronotropic effect. Thus, the 1.5-mg nicotine lozenge appears as an effective aid to alleviate acute tobacco withdrawal symptoms in moderate smokers.

In the present study, we investigated the effects of a single and a repeated (5 days) administration of naftidrofuryl, a serotonin 5-HT2 receptor inhibitor having neuroprotective properties, on functional brain physiology in male healthy elderly subjects, using quantitative electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Twelve subjects aged 60 ± 3.8 years completed the quantitative EEG study, where the effects of 400 and 600 mg were assessed, and 12 other subjects (aged 56 ± 4.7 years) completed the fMRI study, where the effect of 400 mg was assessed on the brain activation induced by the continuous performance test (CPT). Naftidrofuryl induced a transient reduction in alpha activity followed by a specific synchronisation of the 9.5- to 11-Hz EEG activity most pronounced after repeated administration. Such regimen also increased the CPT-induced brain activation visualized by way of fMRI. The results of the present study can be interpreted at the functional level that naftidrofuryl induced an improved level of vigilance or an increased capacity of alertness in healthy elderly subjects.

Objective To evaluate the effects of a change in water intake on mood and sensation in 22 habitual high-volume (HIGH; 2-4 L/d) and 30 low-volume (LOW

The present study evaluated, using a well-controlled dehydration protocol, the effects of 24 h fluid deprivation (FD) on selected mood and physiological parameters. In the present cross-over study, twenty healthy women (age 25 (se 0·78) years) participated in two randomised sessions: FD-induced dehydration v. a fully hydrated control condition. In the FD period, the last water intake was between 18.00 and 19.00 hours and no beverages were allowed until 18.00 hours on the next day (23–24 h). Water intake was only permitted at fixed periods during the control condition. Physiological parameters in the urine, blood and saliva (osmolality) as well as mood and sensations (headache and thirst) were compared across the experimental conditions. Safety was monitored throughout the study. The FD protocol was effective as indicated by a significant reduction in urine output. No clinical abnormalities of biological parameters or vital signs were observed, although heart rate was increased by FD. Increased urine specific gravity, darker urine colour and increased thirst were early markers of dehydration. Interestingly, dehydration also induced a significant increase in saliva osmolality at the end of the 24 h FD period but plasma osmolality remained unchanged. The significant effects of FD on mood included decreased alertness and increased sleepiness, fatigue and confusion. The most consistent effects of mild dehydration on mood are on sleep/wake parameters. Urine specific gravity appears to be the best physiological measure of hydration status in subjects with a normal level of activity; saliva osmolality is another reliable and non-invasive method for assessing hydration status.

Benzodiazepine effects on cholecystokinin tetrapeptide (CCK-4)-induced panic attack (PA) in humans are incompletely characterized, in particular on the neurofunctional level. This work explores the effects of lorazepam on brain activity and behavioral and physiological symptoms related to CCK-4-induced PA in healthy volunteers. Twenty-one male volunteers received 1 mg of lorazepam or placebo orally, 2 hours before an injection of 0.9% saline solution followed by 50 µg of CCK-4 during functional magnetic resonance imaging (fMRI) and heart rate recording. Panic attacks were defined using the panic symptom scale (PSS). In addition, the Y1-STAI (state anxiety) and the Bond & Lader Visual Analogue Scale (VAS) were used. Eleven subjects were classified as panickers. CCK-4 induced behavioral anxiety and cardiovascular effects along with cerebral activation in anxiety-related brain regions. Overall, lorazepam did not significantly modify the anxiogenic and cardiovascular effects of CCK-4. Regarding CCK-4-induced brain activation, lorazepam did not reduce activity in the insulae and cingulate gyrus of panickers. One milligram of lorazepam was not sufficient to reverse strong panicogenic effects, but decreased brain activity in the case of mild anxiety.

This chapter provides some guidance on how to manage sleep apnea in the elderly. It focuses on obstructive and central sleep apnea. Sleep disordered breathing includes obstructive sleep apnea (OSA), central sleep apnea including Cheyne-Stokes respiration (CSR), and sleep hypoventilation. The underlying mechanisms that promote the development of sleep apnea in the elderly can be classified into three broad categories, namely: (1) replication of the pathophysiology of sleep apnea in middle-aged adults; (2) physiological changes that are uniquely associated with aging; and (3) consequences of chronic medical disorders and/or medications. Elderly patients with sleep apnea can present with typical clinical features such as snoring, choking or gasping respirations, witnessed apneas, morning headaches, hypertension, and daytime sleepiness. After the identification and treatment of any underlying medical disorders that contribute to sleep apnea, such as hypothyroidism and acromegaly, weight reduction, and postural therapy can be considered.

The central activity of S 17092, a prolyl endopeptidase (PEP) inhibitor, was investigated by quantitative electroencephalography (qEEG) in 48 young healthy men participating in a double-blind, randomized, placebo-controlled, cross-over study. S 17092 (100, 200, 400 or 600 mg) and placebo were administered once daily for 10 days in a rising multiple-dose scheme. EEG recordings were performed before and repeatedly from 0.5 to 24 h after dose on day 1 and day 10. PEP activity in plasma was also measured for the same periods. S 17092 appeared as a potent inhibitor of PEP activity at all doses, after both single and repeated administrations. EEG changes after acute doses were slight and of short duration, mainly characterized by increased relative alpha 1 power, suggesting a vigilance-promoting EEG profile. After repeated doses and more strikingly after a superimposed dose, increases in relative alpha 1 power were still present with additional increase in relative delta power and decreases in absolute fast alpha, fast beta, theta powers and total power at all doses. These EEG findings suggest that S 17092 might possess some mood-stabilizing potential in addition to its cognition-enhancing properties.

Cyamemazine (Tercian) is an antipsychotic drug with anxiolytic properties. Recently, an in vitro study showed that cyamemazine possesses high affinity for serotonin 5-HT(2A) receptors, which was fourfold higher than its affinity for dopamine D(2) receptors (Hameg et al. 2003).The aim of this study is to confirm these previous data in vivo in patients treated with clinically relevant doses of Tercian.Eight patients received 37.5, 75, 150 or 300 mg/day of Tercian depending on their symptomatology. Dopamine D(2) and serotonin 5-HT(2A) receptor occupancies (RO) were assessed at steady-state plasma levels of cyamemazine with positron emission tomography (PET), using [(11)C]raclopride and [(11)C]N-methyl-spiperone, respectively. The effective plasma level of the drug leading to 50% of receptor occupancy was estimated by fitting RO with plasma levels of cyamemazine at the time of the PET scan.Cyamemazine induced near saturation of 5-HT(2A) receptors (RO=62.1-98.2%) in the frontal cortex even at low plasma levels of the drug. On the contrary, occupancy of striatal D(2) receptors increased with plasma levels, and no saturation was obtained even at high plasma levels (RO=25.2-74.9%). The effective plasma level of cyamemazine leading to 50% of D(2) receptor occupancy was fourfold higher than that for 5-HT(2A) receptors. Accordingly, individual 5-HT(2A)/D(2) RO ratios ranged from 1.26 to 2.68. No patients presented relevant increased prolactin levels, and only mild extrapyramidal side effects were noticed on Simpson and Angus Scale.This in vivo binding study conducted in patients confirms previous in vitro findings indicating that cyamemazine has a higher affinity for serotonin 5-HT(2A) receptors compared to dopamine D(2) receptors. In the dose range 37.5-300 mg, levels of dopamine D(2) occupancy remained below the level for motor side effects observed with typical antipsychotics and is likely to explain the low propensity of the drug to induce extrapyramidal side effects.

Animal studies suggested that acamprosate modulates neuronal hyperexcitability of acute alcohol withdrawal, acting through the glutamatergic neurotransmission. In the present study, we further investigated whether treatment with acamprosate could attenuate the post-alcohol withdrawal hyperexcitability or hyperarousal in humans using brain magnetoencephalography mapping of spontaneous fields. A double-blind, randomised, placebo-controlled study with a parallel group design comparing 2,000 mg/day of acamprosate versus placebo was conducted in alcohol-dependent subjects meeting DSM-IV criteria for alcohol dependence. Treatments were initiated 8 days before alcohol withdrawal and prolonged during the 15 following (abstinence) days. The study demonstrated that during alcohol withdrawal, acamprosate decreased the arousal level as reflected by alpha slow-wave index (ASI) measurement. This effect was mostly evidenced in left parietotemporal regions and, to a lesser extent, in the contiguous anterior, posterior and right-sided regions. In the placebo group, on the contrary, ASI measures increased between day 2 (acute withdrawal) and day 14 (prolonged withdrawal). The present results suggest a sustained effect of acamprosate on the hyperexcitability state due to alcohol withdrawal in alcohol-dependent patients and that acamprosate may have a protective effect when administered 8 days before alcohol withdrawal.

In the present study, we investigated the effects of a single and a repeated (5 days) administration of naftidrofuryl, a serotonin 5-HT2 receptor inhibitor having neuroprotective properties, on functional brain physiology in male healthy elderly subjects, using quantitative electroencephalography (EEG) and functional magnetic resonance imaging (fMRI). Twelve subjects aged 60 +/- 3.8 years completed the quantitative EEG study, where the effects of 400 and 600 mg were assessed, and 12 other subjects (aged 56 +/- 4.7 years) completed the fMRI study, where the effect of 400 mg was assessed on the brain activation induced by the continuous performance test (CPT). Naftidrofuryl induced a transient reduction in alpha activity followed by a specific synchronisation of the 9.5- to 11-Hz EEG activity most pronounced after repeated administration. Such regimen also increased the CPT-induced brain activation visualized by way of fMRI. The results of the present study can be interpreted at the functional level that naftidrofuryl induced an improved level of vigilance or an increased capacity of alertness in healthy elderly subjects.

This workshop deals with the concept of quantitative electroencephalography (QEEG) to characterize the central effects of drugs. For proper interpretation, the circumstances under which data are obtained play an important role. To infer the size of variability in standard practice, we elaborated some computations for "placebo-treatment" in healthy volunteers, which helps to determine the threshold of drug effect detection. Simple rules for interpretation of multiple statistical comparisons were proposed and validation of dose effects were carried out with accepted reference compounds. Furthermore, psychotropic agents with comparable therapeutic indications often present similar modifications in EEG spectral composition (pharmaco-EEG profile). To extrapolate this concept, quantified wake-EEG is a rapid, validated technique for early psychopharmacological investigation of new psychotropic compounds (Phase I, healthy volunteers). Classification of drug-induced changes in cerebral activity at this stage forms a useful decision instrument in planning the long-term clinical scenario of drug development (Phases II and higher).

A double blind study has been carried out on 60 women undergoing gynaecological surgery: they were divided into 2 groups who were given as premedication either midazolam: 10 mg, or diazepam: 15 mg intramuscularly. No significant differences between both groups concerning heart rate, blood pressure and respiratory rate were found. After 30 min sedation of anxiety was noted in 30 subjects (100%) after midazolam and in 20 subjects (67%) after diazepam (P less than 0.001). After 45 min good sedation was found in 19 patients (63%) after midazolam and in 4 patients (13%) afer diazepam (P less than 0.001). Amnesia related to preoperative period was more frequent in the midazolam group than in the diazepam group: 67% VS 13% (P less than 0.001). Amnesia of the immediate postoperative period was 100% in both groups. Midazolam as compared with diazepam can be regarded as a superior intramuscular premedicant. This superiority can been explained by a rapid and good resorption.

This manuscript combines a synthesis of my work and unpublished texts to discuss the dynamics of social practices, in relation to the sociology of social stratification, social change and eating practices. The first chapter gives an account of my background and early career as a sociologist. The second chapter looks back at my doctoral and post-doctoral research from the point of view of social stratification: my theoretical framework rooted in the work of Max Weber gives a central place to the tension between class position and social status. The third chapter draws on Andrew Abbott to highlight my processual conception of social change, which I have studied at the level of societies (post-communist transformation) and individuals (life course, practice change). In the fourth chapter, I discuss the theory of practices (as elaborated by Theodore Schatzki) in the light of my own research and sociological research which adopts a practice-based approach. The fifth chapter, in presenting how I have used quantitative techniques to implement this research programme, proposes to distinguish the causal method, which generally involves an individual making choices, the possibility of ignoring context and the centrality of causal relations in the social process, from the configurational method. The latter insists on the plurality of possible relations between social phenomena, the impossibility of ignoring the context, and the quantification work embedded in the social world. Chapter 6 mobilises all the concepts presented so far to study changes in consumption following job loss, in the epidemiological cohort Constances. The conclusion underscores the central role that consumption plays in the social dynamics of practices, inasmuch as consumption enacts the tension between class position on the (labour) market and social status derived from life conducts., Ce mémoire en vue de l’obtention de l’habilitation à diriger les recherches mêle synthèse de mes travaux et textes inédits pour discuter la dynamique des pratiques sociales, en liant sociologie de la stratification sociale, du changement social et des pratiques alimentaires. Le premier chapitre rend compte de mon parcours et de ma formation de sociologue. Le second chapitre revient sur mes travaux de thèse et post-thèse du point de vue de la stratification sociale : mon cadre de réflexion fondé sur Max Weber accorde une place centrale à la tension entre position de classe et statut social. Le troisième chapitre s’appuie sur Andrew Abbott pour mettre en lumière ma conception processuelle du changement social, que j’ai étudié à l’échelle des sociétés (transformation postcommuniste) et des individus (parcours de vie, changements de pratiques). Dans le quatrième chapitre je discute la théorie des pratiques à partir des travaux de Theodore Schatzki, de mes propres recherches qui mobilisent ce corpus théorique, et des recherches sociologiques qui se réclament d’une approche par les pratiques. Le cinquième chapitre aborde la façon dont j’ai mobilisé des méthodes quantitatives pour mettre en œuvre ce programme de recherche. Je propose de distinguer la méthode causale qui suppose généralement un individu faisant des choix, la possibilité de faire abstraction du contexte et la centralité des relations causales dans le processus social, de la méthode configurationnelle. Cette dernière insiste au contraire sur la pluralité des relations possibles entre phénomènes sociaux, sur l’impossibilité de faire abstraction du contexte, et sur le fait que les données quantitatives sont le résultat d’un travail de quantification inscrit dans le monde social. Le chapitre 6 mobilise l’ensemble des concepts présentés jusqu’ici pour étudier des changements de consommation suite à une perte d’emploi, dans la cohorte épidémiologique Constances. La conclusion souligne le rôle central que joue la consommation dans la dynamique sociale des pratiques, c’est-à-dire dans l’articulation entre pratiques et stratification sociale, dans la mesure où la tension entre la position de classe (sur le marché du travail) et le statut social repose largement sur la consommation, passage obligé de nombreuses pratiques constitutives des conduites de vie.

International audience; Le présent chapitre décrit et analyse des différentes façons dont la préoccupation de l'éthique est apparue dans le milieu des ingénieurs dans trois régions du monde. En France, " l'éthique de l'ingénierie " est un secteur de l'éthique professionnelle qui commence seulement à être étudié. Il s'est développé de façon indépendante de la déontologie, elle-même émergente - le premier code de déontologie rédigé par et pour des ingénieurs datant de 1997. Aux USA, un champ académique appelé engineering ethics existe depuis les années 1980. Celui-ci s'est appuyé sur la préexistence de nombreux et anciens codes of ethics - les premiers ayant été adoptés il y a près d'un siècle. Au Québec, enfin, la recherche éthique sur le champ de l'ingénierie est peu développée. En revanche, la déontologie, qui fait l'objet d'une codification précise, occupe une place centrale dans l'organisation de la profession, qui est réglementée depuis les années 1970, ainsi que dans la formation. L'approche comparative adoptée ici permet de mieux prendre conscience de l'influence des contextes culturels et juridiques sur la formalisation du souci de l'éthique qui traverse aujourd'hui le monde des ingénieurs.