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This paper analyzes the concomitant link between the evolution of purchasing policy and the evolution of supply chain management. The duality of the mode of coordination of the suppliers depends on the relationship between the architect and the first-tier suppliers, according to the strategic degree of their competence. The contribution of this paper is to illuminate the plasticity, the adaptation of the purchasing strategy. The purchasing strategy therefore adapts to the nature of the equipment or systems outsourced, the stakes and expectations are not at all the same. The more complex the product manufactured by the subcontractor, the more the purchasing strategy will seek the mastery of a particular skill. The more standard the product, the more the purchasing strategy aims at reducing costs. The purpose of this paper is twofold. We will show, on the one hand, that there is within the same productive organization a duality of modes of coordination, On the other hand that there is an interaction between the purchasing strategy and these different modes of coordination.

In relatives of patients dying in intensive care units (ICUs), inadequate team support can increase the prevalence of prolonged grief and other psychological harm. We aimed to evaluate whether a proactive communication and support intervention would improve relatives' outcomes.

The solubilization of fatty acids by small amphiphiles such as butyl ethylene glycol, butyl or pentyl diethylene glycol, and hexyl triethylene glycol, also called hydrotropes, was demonstrated by the determination of their phase diagram. They were thus applied for the passive extraction at room temperature of lipids from Dunaliella salinamicroalgae. The extraction yield of the lipidic fraction (mainly coming from glycolipids), could reach up to 81%, depending of the nature of the hydrotrope and its concentration. In addition, their cloud point properties allow the easy separation of the organic fraction, and their low boiling points allow their recovery with a lower energetic cost than the energetic content of the solubilized lipids. They can also directly be used for the transesterification of the lipids to give the corresponding fatty esters, which may be used as biofuels.

To describe daily practices regarding safety monitoring of methotrexate prescribed at low-(i.e.≤30mg/week). To identify determinants of these practices. To assess association between monitoring and early methotrexate discontinuation.

We sought to assess the quality of dermatological systematic reviews (SRs) and identify factors that predict high methodological quality. We searched for all SRs published in 2017 using PubMed, Epistemonikos, and the Cochrane Database of SRs. We included studies identified as SRs or meta-analysis in the title or abstract and dealing with a dermatological topic. Study selection and data extraction were carried out and Preferred Reporting Items for SRs and Meta-Analyses and rating by A MeaSurement Tool to Assess SRs 2 were used independently by two authors. On the basis of A MeaSurement Tool to Assess SRs 2, confidence in SRs results was classified as high, moderate, low, or very low. We included 732 studies. We described a random sample of 140. The overall rating of confidence in the results according to a tool called A MeaSurement Tool to Assess SRs 2 was high or moderate for nine reviews (6%). A total of 20 reviews (15%) had a registered protocol. Independent factors associated with moderate or high rating of A MeaSurement Tool to Assess SRs 2 were publication in a journal where Preferred Reporting Items for SRs and Meta-Analyses was mandatory (OR [95% confidence interval] = 27.0 [1.4–528]) and journal impact factor (OR of 1.9 [1.3–3]) for each increase in one more point. The observation that 90% of published dermatology SRs are of very low quality is alarming. Review registration in the International Prospective Register of SRs and full reporting according to Preferred Items for SRs and Meta-Analyses should be mandatory for publication.

The synthesis of a tridentate NNN ligand incorporating an amidoquinoline and an iminophosphorane (LRH; R = Ph, Cy) was carried out. Coordination to PdIIand NiIIprecursors gave, as expected, square-planar complexes of the general formula [LRMCl]. The most surprising result came from the reaction of LPhHwith [Ni(COD)2], which gave a NiIIphenyl complex bearing a tridentate amidoquinoline-aminophosphine ligand. This rearrangement would result from a proton transfer assisted by the Ni0on stabilization by a phenyl substituent at the phosphorus, as suggested by DFT calculations and complementary experiments. This nickel phenyl complex formed the corresponding benzoyl complex under a CO atmosphere.

Les nævus éruptifs sont un phénomène rare caractérisé par l’apparition rapide et simultanée de multiples nævus. Il a été décrit dans différents contextes : immunodépression, médicaments immunosuppresseurs, thérapies ciblées, maladies bulleuses ou stimulation mélanocytaire chimique. Nous rapportons 3 observations de nævus éruptifs survenus après traitement par anti-TNF alpha.

Le règlement européen qui régit la mise sur le marché des dispositifs médicaux (DM) prévoit la mise en place progressive et obligatoire, au sein de l’Union européenne, d’un système d’identification unique (IUD) et d’une base de données européenne (EUDAMED) dans un objectif d’amélioration de la traçabilité et de la transparence du marché. Le déploiement de ces outils va fortement impacter les acteurs du dispositif médical (entreprises, établissements de santé, professionnels de santé, autorités compétentes…). Une analyse de type menaces/opportunités/forces/faiblesses (MOFF) conduite auprès des participants à la table ronde montre une réelle adhésion aux objectifs mais également l’existence de nombreuses interrogations relatives à la mise en place opérationnelle de ces outils. Un état des lieux de l’existant en matière d’outils de traçabilité et de bases de données utilisées en France a ensuite été réalisé pour mesurer les écarts entre les exigences du règlement européen et l’existant. Au final, EUDAMED et le système IUD vont devoir s’intégrer dans un écosystème complexe et peu interopérable. Une première étape essentielle pour faciliter cette intégration sera de multiplier les actions de pédagogie, de sensibilisation et d’information auprès des acteurs concernés. Plusieurs autres recommandations ont été formulées pour accompagner l’implémentation d’EUDAMED et du système IUD en France et permettre, ainsi, que leurs promesses puissent un jour devenir réalité.

The European regulation governing the placing on the market of medical devices (MD) provides for the gradual and mandatory phasing-in, within the European Union, of a unique device identification (UDI) system and a European database (EUDAMED) aimed at improving traceability and transparency of the market. The deployment of these tools will have a significant impact on the stakeholders of the medical device world (companies, health institutions, healthcare professionals, competent authorities, etc.). A strengths/weaknesses/opportunities/threats (SWOT) analysis conducted among the think tank participants shows real support for the objectives but also distinguishes a great deal of issues relating to the implementation of these tools. An inventory of the current traceability tools and databases used in France was then carried out to measure the gaps between the requirements of the European regulation and the current situation revealing that EUDAMED and the UDI system will ultimately have to slot into a complex and poorly interoperable ecosystem. An essential first step to facilitate this integration will be to increase the number of educational, awareness-raising and information initiatives for the stakeholders concerned. Several other recommendations were put forward to support the implementation of EUDAMED and the UDI system in France and thus enable their promises to crystallise in the future.

The Southern Ocean (SO) plays a fundamental role in global climate due to the presence of the intense eastward‐flowing Antarctic Circumpolar Current (ACC), one of the most important ocean current systems. The configuration of the frontal systems of the ACC is controlled by the orbital‐ and millennial‐scale variations of the Southern Hemisphere westerly winds (SHWW) and the SO upwelling. However, the reconstruction of paleoclimate and paleocurrent in the SO remains controversial possibly because of the complex interpretation of paleo‐proxies and the regional variations. Here, we present results from rock magnetic measurements and electron microscopic analyses on marine core MD11‐3353 over the past 150 Kyr, which is located in the Polar Front Zone, west of the Kerguelen Plateau. Our data sets indicate that magnetic mineral assemblages in the core are dominated by detrital magnetic minerals mixed with biogenic magnetic minerals (i.e., magnetofossils formed by magnetotactic bacteria) during the interglacial periods. Changes in the detrital magnetic mineral content indicate a strong modulation of the ACC intensity and the SHWW stress at the orbital scale over the last climatic cycle with an enhanced activity during the glacial periods. The increase in magnetofossils content during the interglacial periods indicates an enhanced nutrient supply from the SO upwelling resulting from the southward migration of the Antarctic Polar Front. Our results suggest that the variations of concentration and assemblage of magnetic minerals can be used as faithful proxies for reconstructing ocean circulation and upwelling changes in the South Indian Ocean over the past 150 Kyr. The Southern Ocean plays a critical role in climate, ocean circulation, oceanic carbon sequestration, and nutrient distribution, in particular via the Antarctic Circumpolar Current (ACC), the largest wind‐driven current on Earth. Reconstructing the past variability of the intensity and position of the ACC is challenging. Indeed, rather different results were obtained from different areas suggesting a strong regional dependence. In order to better decipher the mechanisms involved in the southern Indian sector, we performed detailed environmental magnetic analyses on a marine core collected west of the Kerguelen Plateau, presently under the influence of the ACC. Both detrital and biogenic magnetic minerals were identified over the past 150 Kyr, corresponding to the last climatic cycle. The temporal variations of detrital magnetic minerals suggest an enhanced intensity of the ACC during the glacial periods. In contrast, increased abundance of biogenic magnetic minerals during the interglacial periods indicates an increased nutrient supply associated with an enhanced Southern Ocean upwelling. Magnetic minerals in core MD11‐3353 record paleoenvironmental changes in the South Indian Ocean over the past 150 KyrAbundant detrital magnetic minerals illustrate an enhanced intensity of the Antarctic Circumpolar Current during the glacial periodsIncreased magnetofossils indicate an increased nutrient supply associated with the Southern Ocean upwelling during the interglacial periods Magnetic minerals in core MD11‐3353 record paleoenvironmental changes in the South Indian Ocean over the past 150 Kyr Abundant detrital magnetic minerals illustrate an enhanced intensity of the Antarctic Circumpolar Current during the glacial periods Increased magnetofossils indicate an increased nutrient supply associated with the Southern Ocean upwelling during the interglacial periods

ABSTRACTRadiocarbon (14C) measurements of foraminifera often provide the only absolute age constraints in marine sediments. However, they are often challenging as their reliability and accuracy can be compromised by reduced availability of adequate sample material. New analytical advances using the MIni CArbon DAting System (MICADAS) allow 14C dating of very small samples, circumventing size limitations inherent to conventional 14C measurements with accelerator mass spectrometry (AMS). Here we use foraminiferal samples and carbonate standard material to assess the reproducibility and precision of MICADAS 14C analyses, quantify contamination biases, and determine foraminiferal 14C blank levels. The reproducibility of conventional 14C ages for our planktic (benthic) foraminiferal samples from gas measurements is 200 (130) yr, and has good precision as illustrated by the agreement between both standards and their reference values as well as between small gas- and larger graphitized foraminiferal samples (within 100±60 yr). We observe a constant contamination bias and slightly higher 14C blanks for foraminifera than for carbonate reference materials, limiting gas (graphite) 14C age determinations for foraminifera from our study sites to ~38 (~42) kyr. Our findings underline the significance of MICADAS gas analyses for 14C on smaller-than-conventional sized foraminiferal samples for paleoclimate reconstructions and dating.

L’expérimentation du cannabis thérapeutique (CT) a débuté en mars 2021 dans notre centre agrée pour 3 indications : douleurs neuropathiques réfractaires aux thérapies (médicamenteuses ou non) accessibles, certaines épilepsies pharmacorésistantes et spasticité douloureuse de la sclérose en plaques ou autres. La dispensation du CT est réalisée en rétrocession (entretien patient spécifique) avec proposition systématique de création/consultation du dossier pharmaceutique (DP)

Concern has been raised over chemical-induced disruption of ovary development during fetal life resulting in long-lasting consequences only manifesting themselves much later during adulthood. A growing body of evidence suggests that prenatal exposure to the mild analgesic acetaminophen/paracetamol can cause such a scenario. Therefore, in this review, we discuss three recent reports that collectively indicate that prenatal exposure in a period of 13.5 days post coitumin both rats and mouse can result in reduced female reproductive health. The combined data show that the exposure results in the reduction of primordial follicles, irregular menstrual cycle, premature absence of corpus luteum, as well as reduced fertility, resembling premature ovarian insufficiency syndrome in humans that is linked to premature menopause. This could especially affect the Western parts of the world, where the age for childbirth is continuously being increased and acetaminophen is recommended during pregnancy for pain and fever. We therefore highlight an urgent need for more studies to verify these data including both experimental and epidemiological approaches.

Les tensions d’approvisionnements sont devenues le quotidien d’un pharmacien hospitalier avec une activité chronophage. Une procédure a été mise en place afin que l’information soit captée, vérifiée, analysée et transmise à tous les professionnels de santé.

Depuis les dernières années, une tendance s’observe, lorsqu’il est nécessaire de distaler les molaires supérieures, à utiliser de façon préférentielle des appareils uniquement intra-oraux sollicitant le moins possible la coopération du patient. Malheureusement, la plupart des appareils de distalisation molaire habituellement utilisés en cas d’absence de coopération, engendrent des effets secondaires indésirables tels que la perte d’ancrage. De façon à minimiser ou éviter cette perte d’ancrage, les mini-vis sont d’un grand intérêt depuis quelques années; ceci par leur caractère faiblement invasif chirurgicalement et par leur faible coût. En utilisant la région antérieure du palais comme site d’insertion, le taux d’échec est extrêmement bas; il n’y a pas de risque d’atteinte radiculaire et les appareils sont à distance des mouvements orthodontiques provoqués. Fondées sur une documentation clinique explicite, les applications pratiques et rationnelles du Beneslider associé à des attaches linguales sont présentées. Par cette procédure, les extractions à l’arcade supérieure et les forces réactives à l’arcade mandibulaire entraînant une vestibulo-version des incisives peuvent être évitées avec une thérapeutique utilisant un appareil invisible.

Mild analgesics (hereafter, analgesics) consisting of paracetamol and NSAIDs are among the most used pharmaceutical drugs worldwide as well as the most released into the environmentEpidemiological data indicate a connection between maternal intake of analgesics and congenital reproductive abnormalitiesAnalgesics can have endocrine-disruptive actions in animals and humans of both sexes, from fetal life to adulthoodMedical and public awareness (especially that of pregnant women) must be increased about the potential hazards of analgesic use

Dans le domaine de l’ancrage squelettique, le recours aux mini-implants orthodontiques ne cesse de se développer. Cependant, le principal problème reste leur taux relativement élevé de perte de 16,4 %. Si l’on analyse les publications traitant des causes de perte d’implants, il s’avère que l’insertion de mini-implants plus importants en taille dans la région antérieure et médiane du palais aboutit à une grande stabilité ainsi qu’à un taux élevé de succès. De plus, la stabilité du couplage mini-implant/suprastructure est déterminante dans le succès. L’utilisation de mini-implants dont la tête possède un pas de vis interne permet la mise en place vissée stable de différents types d’abutments (piliers). Grâce à de longues plaques perforées spéciales, il est possible de relier deux mini-implants entre eux et d’augmenter ainsi leur stabilité. Un système d’éléments préfabriqués permet l’élaboration rapide de différents types de mécaniques orthodontiques efficaces (systèmes mécaniques efficaces).

Tissue integrity relies on barriers formed between epithelial cells. In the testis, the barrier is formed at the initiation of puberty by a tight junction complex between adjacent Sertoli cells, thereby defining an adluminal compartment where meiosis and spermiogenesis occur. Claudin 11 is an obligatory protein for tight junction formation and barrier integrity in the testis. It is expressed by Sertoli cells, and spermatogenesis does not proceed beyond meiosis in its absence, resulting in male sterility. Sertoli cell maturation—arrest of proliferation and expression of proteins to support germ cell development—parallels tight junction assembly; however, the pathophysiology underlying the loss of tight junctions in the mature testis remains largely undefined. Here, using immunohistochemistry and microarrays we demonstrate that adult Cldn11−/−mouse Sertoli cells can proliferate while maintaining expression of mature markers. Sertoli cells detach from the basement membrane, acquire a fibroblast cell shape, are eliminated through the lumen together with apoptotic germ cells, and are found in epididymis. These changes are associated with tight junction regulation as well as actin-related and cell cycle gene expression. Thus, Cldn11−/−Sertoli cells exhibit a unique phenotype whereby loss of tight junction integrity results in loss of the epithelial phenotype.

The GATA4 transcription factor is an important developmental determinant for many organs, such as the heart, gut, and testis. Despite this pivotal role, our understanding of the transcriptional mechanisms that control the proper spatiotemporal expression of the GATA4gene remains limited. We have generated transgenic mice expressing a green fluorescent protein (GFP) marker under the control of rat Gata45′ flanking sequences. Several GATA4-expressing organs displayed GFP fluorescence, including the heart, intestine, and pancreas. In the gonads, while GATA4 is expressed in pregranulosa, granulosa, and theca ovarian cells, and Sertoli, Leydig, and peritubular testicular cells, the first 5 kb of Gata4regulatory sequences immediately upstream of exon 1 were sufficient to direct GFP reporter expression only in testis and, specifically, in Sertoli cells. Onset of GFP expression occurred after Sertoli cell commitment and was maintained in these cells throughout development to adulthood. In vitro studies revealed that the first 118 bp of the Gata4promoter is sufficient for full basal activity in several GATA4-expressing cell lines. Promoter mutagenesis and DNA-binding experiments identified two GC-box motifs and, particularly, one E-box element within this −118-bp region that are crucial for its activity. Further analysis revealed that members of the USF family of transcription factors, especially USF2, bind to and activate the Gata4promoter via this critical E-box motif.

En mars 2018, le recueil des indications des molécules onéreuses (m.o.) inscrites sur la liste en sus est devenu obligatoire pour le PMSI MCO. Depuis septembre 2018, les indications doivent être renseignées pour bénéficier du remboursement. Le code indication I999999 signifiant “hors AMM justifié” est accepté jusqu’en février 2019 comme code par défaut pour toute indication, masquant ainsi la vraie part d’“hors AMM justifié”. Parmi les indications des m.o. certaines ne sont plus remboursées, mettant ainsi en application la LFSS 2014, application jusque-là réservée à des cas particuliers (ex. Avastin 1). En 2018, le montant des m.o. en MCO s’élève à 3,4 milliards. Notre objectif est de décrire l’impact de ces obligations réglementaires sur les informations transmises via le PMSI, et plus globalement de comprendre le risque financier pour les établissements.