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A 2015 Life Cycle Assessment (LCA) study on germanium included the sourcing from fly ashes from coal combustion and its recycling from photovoltaic production scrap. Germanium is also produced as a byproduct from zinc production, typically present at levels above 75 ppm in zinc ores, and this is the second globally most important primary source for germanium. This life cycle assessment study evaluates primary germanium from three zinc ore production systems. In total 15 life cycle indicators were calculated and economic allocation applying a 25% cut-off value is used as the baseline scenario. This allocation scenario is selected as it best fits the economic reality of germanium as byproduct from zinc production. A representative mix of the three germanium production systems as byproduct from zinc is created. Its global warming value is 852 kg CO2-eq/kg germanium crystals. This value is in the mid to lower range from other germanium sources, i.e., 5771 kg CO2-eq/kg germanium crystals for germanium sourced from coal and 280 kg CO2-eq/kg germanium crystals for germanium sourced from recycling. Mineral and fossil non-renewable resources depletion might be seen as a relevant indicator for germanium, given it is on the US and EU list of critical materials. However, resource depletion results differ by 6 orders of magnitude for different depletion indicator methods. All LCAs on germanium were critically reviewed per ISO standard 14040/44 and the reviewers concluded that results from the studies can be compared.

In the last decade, entertainment industries have been creating multi-sensory experiences using haptic stimulation delivered via vibro-kinetic (VK) seats that produce vibration and motion coincidental with audiovisual content. However, the effects of VK stimulation during purely auditory experiences remains unclarified. We addressed this scientific shortcoming by investigating the effects of high fidelity VK (HFVK) stimulation, on psychophysiological indices of emotional valence and arousal. The HFVK stimulation was delivered to 24 healthy participants through an HFVK enhanced seat during active music listening. Participants listened to six popular songs randomly chosen from a pool of 15 songs, with the songs presented randomly with or without HFVK stimulation. Psychological emotional valence and arousal were indexed based on two items of the Self-Assessment Manikin (SAM) scale. Physiological emotional valence and arousal were respectively indexed based on micro facial expressions and electrodermal activity. Our results revealed that psychological and physiological valence, and psychological arousal were higher with HFVK stimulation compared to a control condition where the chair was static. A post-experiment questionnaire further revealed greater subjective appreciation for the HFVK stimulation condition compared to the control condition. Overall, our results highlight the potential for HFVK technologies to enhance auditory listening experiences.

Manufacturing companies are under pressure from consumers and legislation to reduce their environmental impacts. In some sectors where competition is particularly fierce, the ability to offer a product with a lighter environmental impact than the competition can be useful in significantly increasing market share. The forest industry, which harvests and processes wood, a renewable resource, also aims at being part of this trend towards transparency. Life cycle assessment (LCA) is often used to quantify the environmental footprint of harvested wood products (HWP). Based on a primary data inventory of four years of activity, this study presents an LCA of the portfolio of an innovative forest products manufacturer. The functional unit of that assessment is a cubic meter. A sensitive analysis on an economic allocation was also conducted. Because of loops in the studied system and flow conservation constraint, results of the portfolio LCA was verified using an organizational footprint assessment. From the material flow and the half-life of products, a bottom-up accounting method is suggested for integrating HWP in national greenhouse gas (GHG) inventories.

Resume Objectifs Evaluer l’interet du passage d’un anti-TNFα a un autre chez des patients atteints de polyarthrite rhumatoide (PR) en fonction du motif de changement (echec primaire, echappement ou intolerance) et en fonction du sens de rotation [anticorps monoclonal (mAc) vers recepteur (sR) ou sR vers le mAc]. Methodes Entre 2000 et 2008, 356 patients atteints de PR ont recu un anti-TNFα [infliximab (IFX), etanercept (ETA) ou adalimumab (ADA)]. L’activite de la maladie etait evaluee de facon standardisee au cours de cette etude retrospective. Les donnees demographiques, cliniques et biologiques etaient recueillies a l’introduction du premier anti-TNFα et au moins 6 mois plus tard pour evaluer la reponse a cet anti-TNFα en fonction des criteres de reponse EULAR. Un echec primaire, un echappement ou une intolerance au premier anti-TNFα induisait le passage a un autre anti-TNFα, dont la reponse etait evaluee 6 mois plus tard. Un score de propension mesurait ensuite toute interaction avec les variables de depart. Resultats Parmi les 356 patients atteints de PR, 38 sont passes de l’IFX ou de l’ADA a l’ETA, 26 de l’ETA a l’IFX ou de l’ADA, et 8 d’un mAc (IFX ou ADA) a l’autre. Les parametres cliniques des switchers (patients ayant change d’anti-TNFα) et non-switchers etaient comparables. Les switchers changeaient de biomedicaments en raison d’un echec primaire (36,1 %), d’un echappement (33,3 %), ou d’une intolerance (30,6 %), sans afference entre ces sous-groupes. Quels que soient la raison du changement ou le sens de la rotation, les patients repondaient davantage au second anti-TNFα qu’au premier (p Conclusion Le passage d’un TNFα a un autre est plus souvent benefique pour les patients atteints de PR quand on passe d’un mAc au sR dirige contre un anti-TNFα.

This paper investigates the effect of vibro-kinetic (VK) technology on psychophysiological states of users in a virtual reality context. Specifically, we investigate whether a VK seat, i.e., a seat using movement and vibration synchronized with a given media, induces psychophysiological states aligned with an optimal immersive virtual reality (VR) experience. We test our hypotheses with subjects in a seated position while experiencing a passive vehicular movement with a VR headset. Using a between-subject experiment, 45 participants were randomly assigned to a VK or a non-VK condition. Users' psychophysiological states were measured using electrodermal activity, heart rate, and user perceptions. We find evidence that VK significantly enhances the physiological activation of the user throughout the experience. Also, we find that VK seems to create a psychological state that requires less conscious autoregulation, which could suggest that users experience less cybersickness in this condition.

In this paper, we investigate the effect of a vibro-kinetic seat, i.e., a seat using movement and vibration synchronized with a given media, on psychophysiological states and head movements of users immersed in virtual reality. The aim of this study is to explore the extent to which a vibro-kinetic seat can contribute to create a more immersive virtual reality experience than with a classic seat, including fewer cybersickness discomfort symptoms. We test our hypothesis with a between-subject design where we assigned 45 participants to a specific condition: Vibro-kinetic condition (with the seat moving according to the virtual reality experience) or non-vibro-kinetic condition (where the seat was motionless). Users’ physiological states were captured using electrodermal activity and heart rate variability. Users’ head movements were captured using automatic video detection. The results suggest that the vibro-kinetic condition leads to more immersion and a better psychophysiological state to livirtual learning environmentve a more optimal virtual reality experience without cybersickness symptoms. Also, based on the head movement detection, the vibro-kinetic seat seems to contribute to increasing head movements for a large number of users, an indication of the increased presence feeling in virtual reality. Moreover, users in the vibro-kinetic condition live an enhanced experience and are more immersed in the VR experience.

International audience; Objectives : To evaluate the benefits for rheumatoid arthritis (RA) patients of switching from one tumor necrosis factor inhibitor (TNFi) to another based on reason for change (primary failure, escape or intolerance) and molecule-switching order.Methods : Between 2000 and 2008, 356 RA patients prescribed a TNFi (infliximab [IFX], etanercept [ETA] or adalimumab [ADA]) and undergoing standardized evaluation were included in this retrospective study. Detailed demographic, clinical and biological data were collected before first biologic use and ≤ 6 months later to evaluate response based on EULAR-criteria. Primary failure, escape or intolerance of first TNFi triggered switch to another TNFi, the response of which was evaluated 6 months later. Propensity score then measured any interaction with baseline variables.Results : Of the 356 RA patients, 38 switched from IFX/ADA to ETA, 26 from ETA to IFX/ADA, and eight from one monoclonal antibody (mAb; IFX/ADA) to another. Clinical parameters for switchers and non-switchers were comparable. Switchers changed therapies because of primary failure (36.1%), escape (33.3%), or intolerance (30.6%), with no difference found in these subgroups. More switchers responded to the second TNFi than the first (P < 0.01), respectively, regardless of switch (ETA to IFX/ADA: 50 vs. 23.1% [P < 0.05]; IFX/ADA to ETA: 57.9 vs. 15.8% [P < 0.001]) or reason for changing. In addition, DAS28 decreased more with the second antagonist (P < 0.001) and regardless of molecules switched (P < 0.01). Survival of the second TNFi was significantly longer with switch from mAb to the soluble receptor than vice versa (P < 0.05).Discussion : Overall, any switching from one TNFi to another, especially mAb to soluble receptor, was often beneficial for RA patients.

Watching a film in a movie theater can be an immersive experience, but to what extent does the experience differ when the moviegoer is using a vibro-kinetic seat, i.e., a seat providing motion and vibration feedback synchronized with the movie scenes? This paper seeks to measure the effect of a multi-sensory cinema experience from a psychophysiological standpoint. Using electroencephalography, galvanic skin response, heart rate, and facial micro-expression measures, this study compares the difference between two movie viewing experiences, i.e. one without movement and one with artistically enhanced vibro-kinetic feedback. Results of a within-subject experiment suggest that there are significant differences in psychophysiological states of users. Users exhibit more positive emotions, greater arousal, and more cognitive immersion in the vibro-kinetic condition. Therefore, multi-sensory stimulation, in the context of cinema, appears to produce an enhanced experience for spectators.

Nail involvement has rarely been recognized in systemic sclerosis (SSc). Indeed, only a few small series have assessed nail changes in SSc, most of which are case reports.The aims of the current case-control study were to: (1) determine the prevalence of fingernail changes in SSc; and (2) evaluate the correlation between fingernail changes and other features of SSc.In all, 129 patients with SSc and 80 healthy control subjects underwent routine fingernail examination.The prevalence of fingernail changes was 80.6% in SSc. Patients with SSc more frequently exhibited: trachyonychia (P = .006), scleronychia (P .0001), thickened nails (P .0001), brachyonychia (P = .0004), parrot beaking (P .0001), pterygium inversum unguis (P .0001), splinter hemorrhages (P .0001), and cuticle abnormalities (P .0001) than healthy control subjects. The presence of fingernail changes was associated with digital ulcers (P .0001), calcinosis cutis (P = .004), and higher values of mean nailfold videocapillaroscopy score (P = .0009).The cohort originated from a single center.This study underlines that fingernail changes are correlated with more severe forms of SSc characterized by digital microangiopathy, including digital ulcers and calcinosis cutis. Nail changes should be systematically checked in all patients with SSc, and may be included in the American College of Rheumatology/European League Against Rheumatism classification criteria for SSc.

BACKGROUND Management of patients with well-differentiated thyroid carcinoma (WDTC) and positive thyroglobulin (Tg)/negative iodine-131 whole body scintigraphy (WBS) remains challenging. Here, we investigate the specific role of diffusion-weighted magnetic resonance imaging of the neck (DW-MRI) as compared to rhTSH stimulated FDG-PET/CT in such patients. METHODS Patients with WDTC, positive Tg/negative WBS were prospectively enrolled in the study. FDG-PET/CT and neck DW-MRI were performed on the same day after rhTSH stimulation. Neck-US was performed 24 hours after FDG-PET/CT and MRI to guide fine-needle aspiration (FNA). Patients with positive FNA underwent surgery. Patient with negative workup underwent new explorations at 6 and 18 months. RESULTS A total of 86 FDG-PET/CT and 83 DW-MRI tests were performed in 40 patients (23 females; 17 males; 52±16 years). For detection of neck recurrences, sensitivity was equivalent for FDG-PET/CT and to DW-MRI at baseline (46% vs. 43%), at 6 months (30% vs. 20%) and at 18 months (11 vs. 10%). The comparison with a non-weighted Kappa test shows significant concordance between FDG-PET/CT and DW-MRI (K=0.741±0.062; P

Resume Objectif Valider les criteres ACR/EULAR de 2010 de polyarthrite rhumatoide (PR), en tenant compte de la definition recente de « maladie erosive », selon l’EULAR, sur 310 patients de la cohorte VErA (arthrites tres precoces). Methodes La pertinence des criteres de 2010 a d’abord ete testee en appliquant successivement de maniere stricte ses trois elements : ≥ 1 synovite clinique/autre maladie (s)/score ≥ 6/10 puis la grille d’erosion typique en l’absence d’un score ≥ 6. Nous avons teste successivement : absence d’erosion (S1), plus d’une erosion (S2), maladie erosive selon la definition de l’EULAR (S3). Deux definitions de la PR ont ete utilisees : diagnostic d’experts a 6 ans et maladie erosive selon l’EULAR a 2 ans. Resultats L’âge median a l’inclusion etait de 52 ans ; la duree mediane de 4,2 mois. Les criteres ACR/EULAR de 2010, prenant en compte la maladie erosive definie selon l’EULAR, appliques a l’inclusion, permettaient de classer un nombre comparable de patients en utilisant les criteres de 1987 (p = 0,27). Avec le diagnostic d’experts a 6 ans, un nombre plus important de patients etaient reconnus comme etant atteints de PR avec S2 qu’avec les criteres ACR de 1987 (p Conclusions En utilisant la cohorte VErA, l’application stricte des criteres ACR/EULAR de 2010 associes a la nouvelle definition de la maladie erosive de l’EULAR etait legerement (mais pas significativement) plus performante que les criteres ACR de 1987.

Objective To assess the role of Toll-like receptors (TLRs) in antiphospholipid antibody (aPL)–mediated vascular abnormalities in patients with primary arterial antiphospholipid syndrome (APS). Methods Forty-eight subjects participated in the study. Arterial function and structure and TLR pathway activation were determined in patients with primary arterial APS and matched controls. The pathogenic effects of aPL isolated from patients were assessed in wild-type (WT) and TLR-knockout mice. Results APS patients had endothelial dysfunction, arterial stiffening, and hypertrophy, as evidenced by decreased brachial artery endothelium-dependent flow-mediated dilation (FMD) and increased aortic pulse wave velocity and carotid intima-media thickness (IMT), as compared with controls. Plasma samples from APS patients revealed decreased nitric oxide (NO) availability and a pro-oxidative, proinflammatory, and prothrombotic state illustrated by a decrease in nitrite and an increase in lipid peroxidation, tumor necrosis factor α levels, and tissue factor (TF) levels. Furthermore, TLR pathway activation was found in APS patients with increased TLR-2 and TLR-4 messenger RNA expression and increased protein levels of the activated TLR transduction protein interleukin-1 receptor–associated kinase 1 in peripheral blood mononuclear cells. Moreover, agonist-stimulated cell-surface expression of TLR-2 and TLR-4 in circulating monocytes was higher in APS patients than in controls. These changes were positively associated with IMT and negatively associated with FMD. Finally, aPL injection decreased mesenteric endothelium-dependent relaxation and increased TF expression in WT mice but not in TLR-2– or TLR-4–knockout mice. Conclusion This translational study supports the notion that TLR-2 and TLR-4 play a role in mediating vascular abnormalities in patients with primary arterial APS. TLRs thus constitute a promising pharmacologic target for preventing cardiovascular complications in APS.

International audience; BACKGROUND: The aims of the present study were to determine both clinical manifestations and outcome of anti-PL7 patients with antisynthetase syndrome (ASS). METHODS: The medical records of 15 consecutive anti-PL7 patients with biopsy proven ASS were retrospectively analyzed without prior selection. RESULTS: Anti-PL7 patients exhibited polymyositis (n=14) and dermatomyositis (n=1); extra-pulmonary manifestations of ASS included: Raynaud's phenomenon (40%), mechanic's hands (33.3%), joint impairment (26.7%), pericardial effusion (20%) and esophageal/gastrointestinal involvement (20%). The outcome of myositis was as follows: remission/improvement (91.7%) and deterioration (8.3%). Fourteen patients (93.3%) experienced interstitial lung disease (ILD). ILD preceded ASS diagnosis (n=5), was identified concomitantly with ASS (n=8) and occurred after ASS diagnosis (n=1). Patients could be divided into 3 groups according to their presenting lung manifestations: acute onset of lung disease (n=1), progressive onset of lung signs (n=11) and asymptomatic patients exhibiting abnormalities consistent with ILD on PFT and HRCT-scan (n=2). No patient had resolution of ILD, whereas 64.3% and 35.7% experienced improvement and deterioration of ILD, respectively. ILD resulted in respiratory insufficiency requiring O2 therapy in 14.3% of cases. Two patients died. Predictive parameters of ILD deterioration were: DLCO

Objective To assess the outcome of interstitial lung disease (ILD) in anti–Jo-1 patients with antisynthetase syndrome, determine predictive variables of ILD deterioration in these patients, and compare features of anti–Jo-1 patients with and without ILD. Methods Ninety-one anti–Jo-1 patients were identified by medical records search in 4 medical centers. All of these patients had undergone pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) scans. Results Sixty-six patients (72.5%) had ILD. Patients could be divided into 3 groups according to their presenting lung manifestations: acute onset of lung disease (n = 12), progressive onset of lung signs (n = 35), and asymptomatic patients exhibiting abnormalities consistent with ILD on PFTs and HRCT scans (n = 19). Sixteen patients had resolution of ILD; 39 and 11 patients experienced improvement and deterioration of ILD, respectively. ILD led to decreased functional status, since 29.8% of patients exhibited a marked reduction of activities due to ILD and 13.6% had respiratory insufficiency requiring oxygen therapy; 5 of 6 patients died due to ILD complications. Predictive parameters of ILD deterioration were HRCT scan pattern of usual interstitial pneumonia, respiratory muscle involvement, and age ≥55 years. Furthermore, anti–Jo-1 patients with ILD, compared with those without, more frequently exhibited mechanic's hands and lower creatine kinase levels. Conclusion Our findings confirm that ILD is a frequent complication in anti–Jo-1 patients, resulting in high morbidity. We suggest that patients with predictive factors of ILD deterioration may require more aggressive therapy. Finally, anti–Jo-1 patients with ILD, compared with those without, may exhibit a particular clinical phenotype.

International audience; OBJECTIVE: To evaluate the prevalence of baseline abnormalities in standard laboratory tests in patients with early arthritis and their impact on selection of disease-modifying antirheumatic drugs according to American College of Rheumatology (ACR) recommendations and/or of nonsteroidal anti-inflammatory drugs. METHODS: In three cohorts of patients with early arthritis (the ESPOIR, VErA, and Brittany cohorts), we evaluated the prevalence of anemia (hemoglobinN or>2N), and systemic inflammation (erythrocyte sedimentation rate [ESR]>20 and C-reactive protein [CRP]>6). RESULTS: We evaluated 1393 patients (1018 women and 375 men). Anemia was present in 363/1366 (26.5%) patients, leukopenia in 18/1372 (1.3%), and thrombocytopenia in 13/1371 (0.9%). ESR elevation was seen in 50.4% of patients and CRP elevation in 62.7%. The level of AST was above normal in 4% and of ALT in 10% of patients. No patient had severe renal dysfunction, 5.6% had moderate renal dysfunction, and 42.6% had mild renal dysfunction. Among the 1094 patients who had undergone all the tests, only 18 (1.64%, 95% confidence interval, 1-2.64) had a formal contraindication to methotrexate therapy according to ACR recommendations (4 had leukopenia, 12 had high ALT levels, and 2 had high ALT and AST levels). CONCLUSION: Patients with recent-onset arthritis often have anemia, mild or moderate renal dysfunction, and abnormal liver function. However, fewer than 2% have laboratory test abnormalities contraindicating methotrexate therapy.

This study evaluates the potential environmental benefits of using an electric over a conventional vehicle in the province of Québec, Canada, a province characterised with an electric grid mix mostly based on hydroelectricity. To do so, we applied an environmental life cycle assessment approach whose results suggest that use of the electric vehicle should be promoted in the province of Québec but only if the vehicle lifetime is optimised.

International audience; ObjectivesTo date, no studies have yet assessed the characteristics of non-HCV patients with low level of cryoglobulin (≤ 0.05 g/L). The aims of the current study were thus to: 1) determine the prevalence of cryoglobulin ≤ 0.05 g/L in patients with non-HCV cryoglobulin; and 2) compare clinical features and long term outcome, including organ complications and mortality rate, between non-HCV patients with cryoglobulin level ≤ 0.05 g/L and those exhibiting cryoglobulin level > 0.05 g/L.MethodsAmong 6379 cryoglobulin testing, cryoglobulin was detected in 618 patients (9.69% of cases); of these 618 patients, 453 non-HCV patients were included in the study. The medical records of these patients were reviewed.ResultsOf the 453 non-HCV cryoglobulin-positive patients, 265 (58.6%) exhibited cryoglobulin level ≤ 0.05 g/L. We showed that patients with cryoglobulin level ≤ 0.05 g/L had: 1) less commonly: palpable purpura (p < 0.001), digital ulcers (p = 0.006), peripheral neurologic involvement (p = 0.03) and renal impairment (p = 0.03); and 2) lower median values of ESR (p < 0.001) and C-reactive protein (p = 0.001). The patients with cryoglobulin level ≤ 0.05 g/L less often experienced infections (p = 0.04) and hematological malignancies (p = 0.01); both groups did not differ regarding prevalence of connective tissue diseases and solid tumors. Mortality rate was as high as 13.6% in patients with cryoglobulin level ≤ 0.05 g/L; death was mainly due to: solid tumors (16.6%), cardiovascular complications (13.8%), hematological malignancies (11.1%), infections (8.3%), pulmonary/renal complications of cryoglobulin (8.3%) and connective tissue diseases (8.3%).ConclusionOur study shows a high prevalence of cryoglobulin level ≤ 0.05 g/L in clinical practice. Our findings further underscore that non-HCV cryoglobulin level ≤ 0.05 g/L may be responsible for severe renal and neurological complications, leading to high morbidity and mortality in these patients. Thus, our data suggest that both appropriate therapy and close follow-up may be required to improve such patients' outcome.

Objectives: Some patients with chronic low back pain are not eligible to intensive rehabilitation program because of the intensity of their pain. We assessed the value of an educational program in a rehabilitation program over a week in chronic low back pain. Methods: Patients aged 18 to 75 years with chronic low back pain were included. The rehabilitation program took place during a five-day hospitalisation in the rheumatology department of the Rouen University Hospital involving patients receiving multidisciplinary management with collective and individual workshops with special focus on education along with structured rehabilitation exercises. On the fifth day, patients and caregivers established goals to achieve within the six-month period. Patients had a follow-up visit six months later. The objective was to evaluate whether or not the goals were achieved at 6 months later. Results: Ninety-nine patients were included, and 78 were re-evaluated after six months. The patients achieved 74% of the goals that they had established, with significant behavioural changes. Clinically and functionally: significant decrease in pain VAS during the program, significant decrease in the fingertip-to-floor distance during the program and at the 6 months follow-up, significant improvement in the functional questionnaire. Conclusion: With to the educational part of their program, the patients achieved a mean of 74% of the goals. Moreover, the training course improved pain and function. For patients with a high level of pain and/or disability our short program with multidisciplinary management and an educational approach seems to be interesting as a first step before a more intensive rehabilitation.

Resume Objectif Les recommandations de la Haute Autorite de sante (HAS) sur la prise en charge therapeutique de la polyarthrite rhumatoide (PR) ont ete diffusees en 2007. Aucune etude n’a evalue l’impact de ces recommandations en pratique courante. L’objectif de notre etude monocentrique, observationnelle etait d’evaluer leur impact en pratique courante. Methodes Ont ete inclus des patients atteints de PR traites par immunotherapie entre 2006 et 2009. Les criteres choisis pour considerer qu’un patient avait atteint l’objectif therapeutique de la HAS etait un DAS28 inferieur ou egal a 3,2 et une corticotherapie inferieure ou egale a 5 mg/jour. L’impact des recommandations a ete mesure en comparant les pourcentages de patients repondant a l’objectif therapeutique de la HAS avant (periode A) et apres (periode B) leur diffusion. Resultats Les caracteristiques clinico-biologiques des 334 patients inclus (periode A = 279 ; periode B = 253) etaient : âge = 54 ans (18–83) ; anciennete de la PR = sept ans (0–53) ; DAS28 = 5,4 (2–8) ; corticotherapie = 7 mg/j (0–60). La proportion de patients repondant aux recommandations etait plus importante au cours de la periode B qu’au cours de la periode A (56 % versus 44 %, p = 0,007). Les pourcentages de patients pour lesquels les schemas therapeutiques de la HAS avaient ete suivis etaient de 71 % et 61 % respectivement au cours des periodes B et A (p = 0,24). Conclusion Cette etude montre qu’une majorite de patients a atteint l’objectif therapeutique de la HAS. L’augmentation de la proportion de patients remplissant l’objectif therapeutique entre les deux periodes suggere une prise en compte de ces objectifs bien que les schemas therapeutiques fussent deja suivis.

Purpose: The objective of this study is to discuss the implications of product loss rates in terms of the environmental performance of bottled wine. Wine loss refers to loss occurring when the consumer does not consume the wine contained in the bottle and disposes of it because of taste alteration, which is caused by inadequate product protection rendering the wine unpalatable to a knowledgeable consumer. The decision of whether or not to drink the wine in such cases is guided by subjective consumer taste perception and wine quality expectation (drinking the bottle or disposing of the wine down the drain and replacing it with a new bottle). This study aims to illustrate the importance of accurately defining system boundaries related to wine packaging systems. Methods: The environmental impacts resulting from wine loss rates as related to two types of wine bottle closures—natural cork stoppers and screw caps—have been estimated based on literature review data and compared to the impact of the respective closure system. The system studied relates to the functional unit “a 750 mL bottle of drinkable wine” and includes bottled wine, bottle and closure production, wine production, wine loss and wine poured down the drain. Results: The range of wine alteration rates due to corked wine is estimated to be 2–5% based on interviews with wine experts. Consumer behavior was assessed through a sensitivity study on replacement rates. When the increase in loss rate with the cork stopper is higher than 1.2% (corresponding to 3.5% corked wine multiplied by a consumer replacement rate of 35%), the influence of losses on the impact results is higher than that of the closure material itself. The different closures and associated wine losses represent less than 5% of the total life cycle impact of bottled wine.

Objective To determine the prevalence of delayed gastric emptying using the 13C–octanoic acid breath test in unselected patients with systemic sclerosis (SSc), to evaluate whether findings of the 13C–octanoic acid breath test are associated with clinical digestive manifestations, gastric mucosal abnormalities detected by gastroscopy, motor activity dysfunction detected by antroduodenal manometry, and esophageal motor impairment and extradigestive manifestations of SSc, and to develop a risk prediction score of gastric emptying in SSc. Methods Consecutive patients with SSc (n = 57) underwent the 13C–octanoic acid breath test. All of the patients with SSc completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. Results The prevalence of delayed gastric emptying was 47.4% in patients with SSc. A marked correlation was observed between a GSS of digestive symptoms ≥5 and the presence of delayed gastric emptying (P < 0.00001). The sensitivity of a GSS ≥5 for predicting delayed gastric emptying was as high as 0.93, while the specificity was 0.73. Moreover, a GSS ≥5, mucosal gastric abnormalities, severe esophageal motor impairment, and interstitial lung disease were factors that were independently associated with the presence of delayed gastric emptying, and these variables were used to create a risk prediction score. The area under the receiver operating characteristic curve for the risk prediction score was 0.90; the sensitivity of this score for the prediction of delayed gastric emptying was 0.93, while the specificity was 0.77. Conclusion The results indicate that delayed gastric emptying occurs often in patients with SSc. Interestingly, using risk models with routine clinical characteristics, a simple risk prediction score can be calculated, allowing prediction of the occurrence of delayed gastric emptying in patients with SSc.

Objectives The aims of the present study were to (1) assess clinical features and long-term outcome in anti-Jo1-positive patients with anti-Ro52 antibody; (2) compare characteristics of anti-Jo1-positive patients with and without anti-Ro52 antibody; and (3) compare features of anti-Ro52-positive patients with and without anti-Jo1 antibody. Methods The medical records of 89 consecutive anti-Jo1-positive patients with antisynthetase syndrome (ASS) were reviewed; 36 of these patients had coexistent anti-Ro52 antibody. Furthermore, the medical records of 13 consecutive anti-Ro52-positive patients without anti-Jo1 antibody were also reviewed. Results Nine anti-Jo1-positive patients (25%) with anti-Ro-52 antibody achieved remission of ASS, whereas 19 other patients (52.8%) improved and 8 patients (22.2%) worsened their clinical status. Anti-Jo1-positive patients with anti-Ro52 antibody experienced ASS-related complications: interstitial lung disease ( n = 28), esophageal dysfunction ( n = 9), and joint manifestations ( n = 25), including periarticular hydroxyapatite calcifications and erosions of metacarpophalangeal and interphalangeal joints and wrists ( n = 3); 7 anti-Ro52-positive patients (19.4%) had cancer. Anti-Jo1-positive patients with anti-Ro52 antibody, compared with those without, more commonly experienced deterioration of myositis and joint involvement, symptomatic form of ILD, and cancer; they also had decreased survival rate ( P = 0.05). We further found that anti-Ro52-positive patients with anti-Jo1 antibody, compared with those without, were younger and more frequently exhibited ILD with poorer prognosis. Conclusions Our series underlines that the presence of anti-Ro52 antibody is associated with a particular phenotype of ASS, leading to more severe myositis and joint impairment. Moreover, the coexistence of anti-Ro52 antibody seems to be associated with an increased risk of cancer. We therefore suggest that anti-Jo1-positive patients should routinely undergo the search for anti-Ro52 antibody, as this autoantibody appears to impact patients' prognosis.

Summary Objective To report our experience using rituximab as therapy for refractory antisynthetase syndrome (ASS)-associated interstitial lung disease. Methods We retrospectively evaluated the medical records of 7 ASS patients with refractory interstitial lung disease, which had previously failed to respond to prednisone and/or other cytotoxic drugs. All 7 patients received rituximab therapy, i.e.: 1 g at days 0 and 14 and at 6-month follow-up. Data on pulmonary symptoms, pulmonary function tests and high resolution computed tomography (HRCT) scan of the lungs were collected: 1) before rituximab initiation; and 2) at 6-month and one-year follow-up after the first infusion of rituximab. Results At one-year follow-up, ASS patients had resolution ( n = 2) or improvement of pulmonary clinical manifestations. Patients also exhibited significant improvement of interstitial lung disease parameters: 1) on pulmonary function tests: FVC ( p = 0.03) and DLCO ( p = 2 × 10 −5 ); 2) and HRCT-scan of the lungs. Due to clinical resolution/improvement of interstitial lung disease, the median daily dose of oral prednisone could be reduced in these 7 ASS patients at one-year follow-up, compared with baseline (20 mg/day vs. 9 mg/day; p = 0.015). Conclusion Our findings suggest that rituximab may be a helpful therapy for refractory interstitial lung disease in patients with ASS.

Objective This study was undertaken to assess the characteristics and outcome of interstitial lung disease (ILD) in polymyositis/dermatomyositis (PM/DM) and to determine variables predictive of ILD deterioration in PM/DM. Methods Among 348 consecutive patients with PM/DM, 107 patients with ILD were identified by medical records search in 4 medical centers. All patients underwent pulmonary function tests (PFTs) and pulmonary high-resolution computed tomography (HRCT) scan. Results ILD onset preceded PM/DM clinical manifestations in 20 patients, was identified concurrently with PM/DM in 69 patients, and occurred after PM/DM onset in 18 patients. Patients with ILD could be divided into 3 groups according to their presenting lung manifestations: patients with acute lung disease (n = 20), patients with progressive-course lung signs (n = 55), and asymptomatic patients with abnormalities consistent with ILD evident on PFTs and HRCT scan (n = 32). We observed that 32.7% of the patients had resolution of pulmonary disorders, whereas 15.9% experienced ILD deterioration. Factors that predicted a poor ILD prognosis were older age, symptomatic ILD, lower values of vital capacity and diffusing capacity for carbon monoxide, a pattern of usual interstitial pneumonia on HRCT scan and lung biopsy, and steroid-refractory ILD. The mortality rate was higher in patients with ILD deterioration than in those without ILD deterioration (47.1% versus 3.3%). Conclusion Our findings indicate that ILD results in high morbidity in PM/DM. Our findings also suggest that more aggressive therapy may be required in PM/DM patients presenting with factors predictive of poor ILD outcome.

Summary Objectives: The aims of this prospective study were to identify, in vitamin K antagonist (VKA)-treated patients, factors associated with INR values: (i) greater than 6.0. and (ii) ranging from 4.0 to 6.0 complicated with bleeding. We also assessed VKA-related morbidity in these patients. Methods: During a 6-month period, 3090 consecutive patients were referred to our Department of Internal Medicine, including 412 VKA-treated patients. At admission, the medical records of VKA-treated patients were reviewed for type, duration and indication of VKA therapy, previous medical history of VKA-related hemorrhage, comorbidities and concomitant medications. Results: Forty of the 412 VKA-treated patients (9.7%) exhibited oral anticoagulant related overcoagulation. VKA overcoagulation was associated with high morbidity, leading to major bleeding in 27.5% of cases; moreover, 12.5% of these patients died, death being mainly due to major bleeding. Under multivariate analysis, significant factors for VKA-related overcoagulation were as follows: previous medical history of VKA therapy-related hemorrhage (P = 0.00001) and INR levels over therapeutic range (P = 0.0006), chronic liver disease (P = 0.03), therapy with amiodarone (P = 0.009); in contrast, statin therapy was found to be a protective factor of VKA overcoagulation (P = 0.008). Conclusion: The knowledge of predictive factors of VKA-related overcoagulation seems of utmost importance to improve patients’ management. Our study underlines the fact that the potential of drug interaction should be taken into account when choosing amiodarone for patients receiving VKAs. Interestingly, long-term (>6 month) statin therapy may be a protective factor of VKA overcoagulation. Our findings, therefore, suggest that there may be no need to switch long-term users of VKA and statin to a safer alternative therapy.

The inflammation which occurs around the silicone prosthesis is a complex process that can provoke the failure of the device and compromise the health of the implanted patient. Toll-like receptors (TLRs), which are transmembrane proteins, are now known to act in the innate immune response and in endogenous inflammation. The aim of our study was to assess the role of TLR4 in the foreign body reaction to a silicone shell prosthesis. Disks of shell silicone prosthesis were implanted in the subcutaneous tissue of C57BL6-TLR4-/- and C57BL6-WT mice. At day 14, inflammatory cell infiltrate and vessel sections around the prosthesis were less numerous in TLR4-/- than in WT mice. A histomorphometric analysis showed that the capsule around the implant was 1.96-fold less thick in depleted TLR4 than in wild-type mice. In addition, vascular endothelial growth factor and transforming growth factor 1 were underexpressed in the surrounding tissue of the prosthesis in TLR4-/- mice. Our study suggests, from this foreign body response model against silicone in mice, that TLR4 plays a key role in the reaction process around silicone implants.

The colour-word Emotional Stroop task (ES task) has been proposed to assess the interferences between emotion and attention. Using this task, first, we examined how attention (using reaction times) can be modified by emotionally relevant words in schizophrenics as compared with controls as a function of the emotional significance of the word; second, we tested the assumption that schizophrenics with the most negative symptoms will show higher impairment in relationship to negative emotional words. In general, schizophrenics were slower to react. In both groups, mean reaction times were slower for emotional as compared with neutral words. No significant differences were observed between negative and positive words either in schizophrenics (n = 21) or in controls (n = 20). Even in the most negative schizophrenic patients, there were no differences between negative and positive words. There were no significant interactions between type of stimulus and any clinical variables (PANSS negative or non negative categorization, etc.). Also, there were no statistically significant correlations between reaction times and neuroleptic dosage or anhedonia scores. In conclusion, schizophrenia patients showed the same degree of interference from emotional words as compared with controls. Moreover, patients with a higher level of negative symptoms did not differently experience positive and negative words.

Objectives. Several paradoxical adverse events (PAEs), e.g. IBDs, acute anterior uveitis (AAU) and psoriasis, have been described in patients taking anti-TNF drugs. This retrospective study aimed to describe the different PAEs that have occurred in a population of SpA patients treated with anti-TNF drugs, and to determine whether they are drug specific. Methods. Since 2000, we have followed 296 patients with SpA [198 AS, 21 SpA associated with IBD (9 ulcerative colitis, 12 Crohn’s disease) and 77 psoriatic arthritis] treated with at least one anti-TNF drug (infliximab, etanercept or adalimumab), and 112 SpA patients treated only with conventional DMARDs who served as controls. Considering the cumulative time of exposure to each anti-TNF agent, the frequencies of new-onset PAEs in exposed patients were calculated. Results. Respective cumulative exposure times were 287, 290 and 62 patient-years for infliximab, etanercept and adalimumab. We observed the following PAEs: five psoriasis (three under infliximab and one with etanercept or adalimumab), three AAU (1/100 patient-years, all under etanercept) and four IBD (three under etanercept and one under infliximab). There was no significant association among any of these PAEs and a specific anti-TNF agent; nor significant difference in the overall PAEs among patients receiving anti-TNF drugs or controls (P ¼ 0.303), the latter experiencing two psoriasis and three AAU. Conclusions. Undesirable side effects—IBD, AAU and psoriasis—may appear with anti-TNF drugs. Even if they are, a priori, paradoxical, no evidence supports any PAEs to be anti-TNF agent-specific in SpA.

The aim of this study was to evaluate the usefulness of serum osteocalcin (OC) levels in multiple myeloma (MM) in order to assess its significance and activity, and to predict its course. Serum OC was measurement in 117 patients with MM and 116 healthy controls matched for age and sex. Serum OC levels were weakly correlated with Karnofsky index (r=0.22; p

To investigate the involvement of angiogenesis markers in very early arthritis patients and their relevance to predict further joint destruction.Levels of Vascular Endothelial Growth Factor (VEGF), angiopoietin-1 (Ang-1), and soluble Fms-like tyrosine kinase-1 (sFlt-1) were measured by ELISA in serum samples from 310 patients having polyarthritis, evolving for less than 6 months (VErA cohort). Each angiogenesis marker was measured at baseline and one year later. X-rays of hands and feet were carried out at inclusion and after 1 year and read using the van der Heidje-modified Sharp method.At baseline and after 1 year, VEGF levels were correlated with clinical and biological parameters of inflammation. We also observed a positive correlation between sFlt-1 levels and biological inflammation (Erythrocyte Sedimentation Rate (ESR): r=0.17, p=0.006; C Reactive Protein: r=0.14, p=0.02). Angiopoietin-1 levels were correlated with ESR (r=0.12, p=0.04). Interestingly, only VEGF levels measured at baseline were correlated with Disease Activity Score measured 1 year later. Relationship between angiogenesis markers and radiographic progression was also evaluated. VEGF and Ang-1 levels measured at inclusion were related with Sharp score after one year (VEGF: r=0.21, p0.001; Ang-1: r=0.24, p0.001; Spearman's test). Moreover, VEGF levels were higher in patients with radiographic progression (p=0.002).Serum concentrations of VEGF, sFlt-1 and angiopoietin-1 were correlated to parameters of inflammation and to bone destruction in early arthritis. These results contribute to demonstrate that angiogenesis reflects disease severity and angiogenesis markers might become a new useful tool to evaluate disease activity and to estimate outcome for patients with inflammatory arthritis.

The deleterious effect of fructose, which is increasingly incorporated in many beverages, dairy products, and processed foods, has been described; fructose malabsorption has thus been reported in up to 2.4% of healthy subjects, leading to digestive clinical symptoms (eg, pain, distension, diarrhea). Because digestive involvement is frequent in patients with systemic sclerosis (SSc), we hypothesized that fructose malabsorption could be responsible for intestinal manifestations in these patients. The aims of this prospective study were to: determine the prevalence of fructose malabsorption, in SSc; predict which SSc patients are at risk of developing fructose malabsorption; and assess the outcome of digestive symptoms in SSc patients after initiation of standardized low-fructose diet. Eighty consecutive patients with SSc underwent fructose breath test. All SSc patients also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. The prevalence of fructose malabsorption was as high as 40% in SSc patients. We also observed a marked correlation between the presence of fructose malabsorption and: higher values of GSS score of digestive symptoms (P = 0.000004); and absence of delayed gastric emptying (P = 0.007). Furthermore, in SSc patients with fructose malabsorption, the median value of GSS score of digestive symptoms was lower after initiation of standardized low-fructose diet (4 before vs. 1 after; P = 0.0009). Our study underscores that fructose malabsorption often occurs in SSc patients. Our findings are thus relevant for clinical practice, highlighting that fructose breath test is a helpful, noninvasive method by: demonstrating fructose intolerance in patients with SSc; and identifying the group of SSc patients with fructose intolerance who may benefit from low-fructose diet. Interestingly, because the present series also shows that low-fructose diet resulted in a marked decrease of gastrointestinal clinical manifestations in SSc patients with fructose malabsorption, our findings underscore that fructose malabsorption may play a significant role in the onset of gastrointestinal symptoms in these patients. Finally, we suggest that fructose malabsorption may be due to reduced fructose absorption by enterocytes, impaired enteric microbiome, and decreased intestinal permeability.

Background Occupational exposure is reported as playing a substantial causative role in systemic sclerosis (SSc). Objective We sought to compare the characteristics of SSc in patients with and without occupational exposure to crystalline silica/solvents. Methods In all, 142 patients with SSc were enrolled in this prospective study. An expert committee performed blind evaluation of occupational exposure to crystalline silica/solvents. Results Patients exposed to crystalline silica more often exhibited: diffuse cutaneous SSc ( P = .02), digital ulcers ( P = .05), interstitial lung disease ( P = .0004), myocardial dysfunction ( P = .006), and cancer ( P = .06). Patients exposed to solvents more frequently developed: diffuse cutaneous SSc ( P = .001), digital ulcers ( P = .01), interstitial lung disease ( P = .02), myocardial dysfunction ( P = .04), and cancer ( P = .003); in addition, these patients were more frequently anti-Scl 70 positive and anticentromere negative. Under multivariate analysis, significant factors for SSc associated with exposure to silica/solvents were: male gender (odds ratio 19.31, 95% confidence interval 15.34-69.86), cancer (odds ratio 5.97, 95% confidence interval 1.55-23.01), and digital ulcers (odds ratio 2.42, 95% confidence interval 1.05-5.56). Limitations The cohort originated from a single geographic region. Conclusion Occupational exposure to crystalline silica/solvents is correlated with more severe forms of SSc characterized by: diffuse cutaneous involvement, interstitial lung disease, general microangiopathy (digital ulcers and myocardial dysfunction), and association with cancer. Occupational exposure should be systematically checked in all patients with SSc, as exposed patients seem to develop more severe forms of SSc.

Fecal calprotectin (FC) is a simple, non-invasive and reproducible test, which has been described to be highly elevated in patients with active inflammatory bowel diseases. Recently, few authors have reported increased levels of FC in SSc patients, although the relationship between FC levels and the degree of gastrointestinal involvement has not yet been determined in patients with SSc. Thus, this prospective study aimed to: 1) determine the prevalence of increased fecal calprotectin (FC) levels in unselected patients with systemic sclerosis (SSc); 2) make prediction about which SSc patients exhibit increased levels of FC; and 3) evaluate the correlation between increased levels of FC and digestive symptoms, and gastrointestinal involvement, including the presence of small intestinal bacterial overgrowth (SIBO) using glucose H2/CH4 breath test. 125 consecutive patients with SSc underwent FC levels and glucose H2/CH4 breath test. All of the patients with SSc also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. 93 (74.4%) patients had abnormal levels of FC (>50 μg/g); 68 patients (54.4%) exhibited highly elevated levels of FC (>200 μg/g). A marked correlation was found between abnormal FC levels and GSS score of digestive symptoms, esophageal involvement and delayed gastric emptying. Moreover, we found a strong association between abnormal levels of FC and the presence of SIBO on glucose H2/CH4 breath test, with the higher correlation between the presence of SIBO and the level of FC ≥275 μg/g with an area under the receiver operating characteristic curve of 0.97 ± 0.001 (CI: 0.93-0.99; p

To validate the 2010-ACR/EULAR criteria for rheumatoid arthritis (RA), taking into account the recent EULAR definition of "erosive disease", on the 310 patients comprising the very early arthritis cohort (VErA).2010-criteria performances were tested by first strictly applying its three items successively: ≥ 1 clinical synovitis/another disease(s)/score ≥ 6/10), then the typical erosion grid without obtaining a score of ≥ 6 to diagnose RA. We tested successively: no erosion (S1), ≥ 1 erosion(s) (S2), EULAR-defined erosive disease (S3). Two gold standards were used: expert diagnosis at six years and EULAR erosive disease at two years.At inclusion, median age was 52 years; median RA duration 4.2 months. 2010-ACR/EULAR criteria, including EULAR-defined erosive disease applied at baseline, classified comparable numbers of patients as the 1987 criteria (P=0.27). Using expert diagnosis at six years, more patients were classified as RA with S2 than 1987-ACR criteria (P0.04). In contrast, sensitivity and specificity indicated that 2010-ACR/EULAR-S3 criteria performed slightly but not significantly better than 1987-ACR criteria. On ROC curves, a score ≥ 6 correctly classified RA. When EULAR-defined erosion at two years was the gold standard, the 1987-ACR, the 2010-S1, -S2 and -S3 criteria performed comparably.Using the very early community-based, conservatively treated VErA cohort, the strict application of 2010-ACR/EULAR criteria using the new EULAR definition of erosive disease or not performed slightly but not significantly better than the 1987-ACR criteria.

Purpose To assess preoperative and postoperative infra-clinical macular changes in macula-off retinal detachment (RD) using third-generation optical coherence tomography (OCT3). Design Prospective observational cohort study. Methods Twenty-two nonconsecutive eyes of 22 patients with macula-off RD underwent best-corrected visual acuity measurement and OCT3 scans through the fovea before and after successful surgery. The relationship between preoperative and postoperative OCT macular characteristics, postoperative infra-clinical foveal detachment, and final visual acuity (FVA) were assessed using Kruskal-Wallis multiple comparison test and Mann-Whitney U test, respectively. Results Preoperative cystic cavities in the inner nuclear layer of the detached retina, postoperative abnormal macular profile, and postoperative lack of the junction line between photoreceptor cell inner and outer segments on OCT3 were associated with a poorer FVA ( P = .001, P = 10 −4 and P = .015, respectively). In contrast, postoperative infra-clinical foveal detachment did not influence FVA ( P = .88). Conclusions Morphologic macular analysis using OCT3 provide some new insights to understand incomplete visual recovery after successful macula-off RD surgery.

Abnormal sensory gating in schizophrenia has frequently been reported. The strength of central inhibitory pathways was measured using the P50 component of the auditory evoked potential in a conditioning-testing paradigm. The relationships between a relative decrease in P50 amplitude to repeated auditory stimuli and clinical symptoms remain controversial. Using the Positive and Negative Syndrome Scale, we studied the P50 auditory conditioning-testing paradigm in 81 schizophrenic subjects, categorized into subgroups with and without prominent negative symptoms, in comparison with 88 control subjects. We found increased ratios of testing stimuli to conditioning stimuli in both schizophrenic subgroups relative to findings in the control group. In addition, we found significantly increased mean latencies of the P50 responses to conditioning (C) and testing (T) stimuli and significantly increased T/C ratios in the subgroup with negative symptoms compared with the subgroup with non-negative symptoms.

The authors evaluated concordance rates among three electrophysiological measures in patients with schizophrenia, nonschizophrenic first-degree relatives of schizophrenia patients, and healthy comparison subjects. The purpose of the study was to provide data for defining a common endophenotype for genetic studies of schizophrenia and for improving the criteria for diagnosis.P50 event-related potential inhibition, antisaccade, and smooth pursuit eye tracking paradigms were measured. Data for all three paradigms were available for 81 patients with schizophrenia, 25 parents of patients with schizophrenia, and 60 healthy comparison subjects.The schizophrenia patients and the patients' parents showed a high rate of inhibitory deficits measured by the P50 inhibition and antisaccade paradigms. Both groups had a high prevalence of eye tracking dysfunction. Smooth pursuit gain and the error rate in the antisaccade paradigm were significantly correlated in the schizophrenia patients and the parents, whereas P50 inhibition showed no correlation with smooth pursuit gain or antisaccade paradigm measurements.Despite superficial similarities, two paradigms designed to measure central inhibition processes (antisaccade and P50 inhibition) do not appear to reflect the same neurobiological substrates. In contrast, the convergence in performance data for the antisaccade and eye tracking paradigms suggests that the neural circuitry underlying these tasks may overlap. P50 inhibition and antisaccade errors were the optimal paradigms for discrimination between comparison subjects, patients with schizophrenia, and the parents of patients with schizophrenia.

PURPOSE To determine whether preoperative optical coherence tomography (OCT) is useful in predicting postoperative visual outcome for patients with primary macula-off rhegmatogenous retinal detachment (RD). METHODS This prospective study included 20 nonconsecutive eyes with macula-off RD and successful reattachment of the retina. Preoperative 5-mm OCT was performed through the center of the fovea. The relationship among preoperative OCT findings, main preoperative clinical variables, and final postoperative visual acuity was statistically analyzed. RESULTS Final postoperative visual acuity was negatively correlated with three preoperative OCT variables: height of RD at the central fovea (r=0.79; P

The subject of this study is a spent pot lining (SPL) landfill. The aim of this study was to identify the site remediation option, among four alternatives, that minimizes overall environmental impacts based on: 1) a comparative life cycle assessment (LCA); and 2) modeling of contaminant transport in groundwater. The four options were: leaving the landfill in place (Option 1); excavation of the landfill, with on-site disposal of the excavated materials in a secure cell (Option 2); excavation of the landfill, with treatment of the SPL fraction (Option 3); and excavation of the landfill, with incineration of the SPL fraction in a cement kiln (Option 4). The LCA was performed following the guidelines provided by the International Standard Organization (ISO). Furthermore, to improve the relevance of LCA to site remediation sector, impacts caused by residual in-situ contamination were assessed by applying a simulation of contaminant transport in groundwater, using site-specific data. The LCA identified...

The potential environmental impacts associated with two landfill technologies for the treatment of municipal solid waste (MSW), the engineered landfill and the bioreactor landfill, were assessed using the life cycle assessment (LCA) tool. The system boundaries were expanded to include an external energy production function since the landfill gas collected from the bioreactor landfill can be energetically valorized into either electricity or heat; the functional unit was then defined as the stabilization of 600 000 tonnes of MSW and the production of 2.56x108 MJ of electricity and 7.81x108 MJ of heat. Only the life cycle stages that presented differences between the two compared options were considered in the study. The four life cycle stages considered in the study cover the landfill cell construction, the daily and closure operations, the leachate and landfill gas associated emissions and the external energy production. The temporal boundary corresponded to the stabilization of the waste and was represented by the time to produce 95% of the calculated landfill gas volume. The potential impacts were evaluated using the EDIP97 method, stopping after the characterization step. The inventory phase of the LCA showed that the engineered landfill uses 26% more natural resources and generates 81% more solid wastes throughout its life cycle than the bioreactor landfill. The evaluated impacts, essentially associated with the external energy production and the landfill gas related emissions, are on average 91% higher for the engineered landfill, since for this option 1) no energy is recovered from the landfill gas and 2) more landfill gas is released untreated after the end of the post-closure monitoring period. The valorization of the landfill gas to electricity or heat showed similar environmental profiles (1% more raw materials and 7% more solid waste for the heat option but 13% more impacts for the electricity option). The methodological choices made during this study, e.g. simplification of the systems by the exclusion of the identical life cycle stages, limit the use of the results to the comparison of the two considered options. The validity of this comparison could however be improved if the systems were placed in the larger context of municipal solid waste management and include activities such as recycling, composting and incineration.

Contexte : La faculte de medecine de Rouen a mis en place un enseignement facultatif dedie a l'apprentissage des habiletes de communication, dont l'impact sur des etudiants de deuxieme annee avait ete evalue une premiere fois, faisant apparaitre le benefice tire de l'assiduite au cours. But : Cette etude complementaire a pour but de confirmer et d'affiner les resultats de la premiere etude en introduisant des exigences supplementaires : une cohorte differente, l'integralite de la sequence pedagogique, une distinction plus fine des etudiants selon leur assiduite au cours. Methode : Tous les etudiants d'une meme promotion ont ete evalues en amont et en aval d'une sequence pedagogique. La difference des resultats obtenus par chacun, aux deux tests, a ete etudiee en fonction de l'assiduite au cours. Resultats : Non seulement, l'evolution des scores realises dependait de l'assiduite au cours ; mais plus l'assiduite etait elevee, plus l'evolution du score etait importante. Conclusion : Un enseignement de la communication orale permet aux etudiants en medecine d'ameliorer leur competence dans cet aspect de la relation humaine, et ce en proportion de leur assiduite au cours.