[A guide to psychiatric prescribing in pregnancy, postpartum and breastfeeding]. / Guide de prescription psychiatrique pendant la grossesse, le postpartum et l'allaitement.

Perinatal psychopharmacology is an emerging specialty that is gradually developing alongside perinatal psychiatry. The management of psychiatric disorders during the perinatal period is a challenge for perinatal practitioners due to the multiple changes occurring during this crucial period. This little-known specialty still suffers from inappropriate considerations on the impact of psychotropic treatments on the mother and the infant during pregnancy and postpartum, which can promote a deficiency in perinatal psychic care. However, the risks associated with insufficient management of mental health are major, impacting both the mental and physical health of the mother and the infant. In this paper, we propose a perinatal psychopharmacology prescription guide based on available scientific evidence and international and national recommendations. We thus propose a decision-making process formalized on simple heuristics in order to help the clinician to prescribe psychotropic drugs during the perinatal period.

Low thoracic skeletal muscle index is associated with negative outcomes in 244 patients with respiratory COVID-19.

BACKGROUND: Sarcopenia is associated with negative outcomes in intensive care unit (ICU) patients and during chronic diseases. We aimed to evaluate if low skeletal muscle index (SMI) measured by computed tomography (CT) at the thoracic level is associated with poor outcomes in hospitalized patients with respiratory COVID-19. METHODS: Patients admitted to the hospital between March 1st and June 9, 2020 with a confirmed diagnosis of respiratory COVID-19 in the Emergency Department were included in this retrospective cohort study. SMI was assessed from a transverse CT image at the T12 level. We analysed the association between thoracic SMI and mortality, ICU admissions, infections, length of stay and gravity scores. RESULTS: We included 244 patients, whose median age was 62 (20-95) years, mean body mass index was 28,6 kg/m2, and 34% were obese patients. 102 patients (41,8%) had low thoracic SMI. On multivariable analysis, low thoracic SMI was associated with more infections (OR = 1,88 [1,06-2,98]) and increased length of stay (OR = 1,87 [1,14-3,49]) but not with mortality (OR = 1.37 [0.54-3.52]), whereas it was inversely associated with ICU admission (OR = 5,56 [1,96-16,67]. CONCLUSION: Low SMI measured by CT at the thoracic level T12 is associated with negative outcomes in patients with respiratory COVID-19.

[The invisible pregnancy: Clinical characteristics and perspectives about denial of pregnancy]. / La grossesse invisible : caractéristiques cliniques et perspectives autour du déni de grossesse.

Denial of pregnancy is a public health problem due to maternal, fetal, and neonatal morbidity, affecting both physical and mental health. It generally involves an absence of the physical signals associated with pregnancy such as abdominal swelling, amenorrhea, weight gain, or even perception of fetal movements. Despite the potential consequences for mother and child, there is still little data on its clinical features and the neurocognitive mechanisms involved. In this paper, we provide an update on the clinical, socio-demographic, and psychopathological characteristics of pregnancy denial based on contemporary scientific literature. We first define denial of pregnancy by referring to the history of the concept, previous definitions, and nosographic classifications. We then detail the clinic of denial by distinguishing the physical and psychological symptoms of this disorder, then the socio-demographic, gynecological, and psychiatric characteristics. We describe the consequences of denial on the mother, infant, and the dyad, referring to situations of cryptic neonaticide. Finally, we show the importance of perinatal neuroscience research on maternal interoception to understand the mechanisms involved in denial of pregnancy, and improve their medical management in clinical practice.

[Creation and functioning of Covid-19 pre-hospital triage centres : experience of french-speaking GP-coordinators]. / Face à la COVID-19. Création et fonctionnement des centres de tri pré-hospitaliers : expérience des médecins généralistes coordinateurs francophones.

Pre-hospital triage centres were created during the first wave of Covid-19 in March 2020. The intention was to examine patients in appropriate sanitary conditions and prevent emergency departments from overcrowding. This study describes triage centres in the Federation Wallonia-Brussels. The aim of the study was to collect key aspects of triage centres, implementation and information about the daily functioning interpreted positively or negatively by the GP-coordinators in charge of their management. This study was divided into two parts : an online questionnaire and semi-structured interviews. Overall, 14 questionnaires and 6 interviews were collected among the 44 initially contacted GP-coordinators. Our results point to a highly heterogeneous organisation of the triage centres, nevertheless adapted to local contexts, as well as a gap between local effective dynamics and challenges regarding federal/regional cooperation. This study may help for further crisis management plans.

Lors de la première vague de l'épidémie COVID-19, en mars 2020, des centres de tri (CDT) pré-hospitaliers ont été créés. Leur objectif était double : examiner les patients dans les conditions sanitaires adéquates et limiter l'afflux de patients aux urgences. L'étude vise à décrire ces CDT en Fédération Wallonie-Bruxelles. L'objectif était de relever, auprès des médecins généralistes (MG) coordinateurs de ces centres, les éléments ressentis comme positifs et négatifs dans la mise en place et le fonctionnement quotidien des CDT afin d'améliorer le dispositif pour de futures implémentations. Cette étude comportait deux volets : un questionnaire en ligne et des entretiens semi-structurés. Sur les 44 MG coordinateurs contactés, 14 questionnaires et 6 entretiens ont été récoltés. Nous avons mis en évidence une organisation très hétérogène des CDT, adaptée au contexte local, ainsi qu'un décalage entre la dynamique locale, décrite comme efficace, et les difficultés de coopération avec les niveaux fédéral et régional. Les résultats de cette étude pourraient aider dans l'implémentation de prochains plans de prise en charge en période de crise sanitaire.

[Psychiatry without mind?] / Une psychiatrie sans esprit ?

Philosophy of Mind is currently one of the most prolific fields of research in philosophy and has witnessed a progressive hybridization with cognitive science. It focuses on fundamental questions to neuroscience and psychiatry, such as the nature of mental states and cognitive processes, or the relationships between mental states and the world. Anticipating the accumulation of experimental data from neuroscience, it provides a framework for the generation of theories in cognitive science. Philosophy of mind has thus laid the foundations of the conceptual space within which cognitive sciences have spread: a large part of contemporary theories in cognitive science result from a hybridization of conceptions forged by philosophers of mind and data produced by neuroscientists. Yet contemporary psychiatry is still reluctant to feed on the philosophy of mind, other than through the fragments that emerge from neuroscience. In this paper, we describe the evolution of contemporary philosophy of mind, and we detail its contributions around three central themes for psychiatry: naturalization of mind, mental causality, and subjectivity of mental states. We show how philosophy of mind provide the conceptual framework to link different levels of explanation in psychiatry: from biological to functional, from neurophysiology to cognition, from matter to mind.

[Impact of the Lubrizol Rouen plant fire of September 26, 2019 on ophthalmic emergency room visits]. / Impact de l'incendie de l'usine Lubrizol à Rouen le 26 septembre 2019 sur la fréquentation des urgences ophtalmologiques.

INTRODUCTION: A fire at the Lubrizol chemical factory in Rouen on September 26, 2019 generated a huge column of smoke directed northeast toward the city. As the eye might be particularly affected by the smoke and other toxic emissions from the fire, we assessed the impact of this industrial and ecological disaster on irritative eye surface disease in the week following the accident. MATERIALS AND METHODS: We retrospectively collected the medical data of the patients who presented to the Ophthalmology Emergency Department (OED) of Rouen University Hospital (the only OED open during the days following the accident) during the week following the fire (W1). We compared these data with those of patients who presented during the week before the fire (W-1). We also collected data on patients presenting to the ED in general during W-1 and W1, including the number of visits directly related to the fire. RESULTS: 361 patients presented to the OED during W1 following the fire, compared with 384 in W-1. Of these patients, 83 (23%) had ocular surface disease in W1, versus 76 (20%) in W-1. Conjunctivitis was found in 54 patients in W1 (39 viral, 9 allergic, 6 undetermined) versus 44 in W-1 (27 viral, 12 allergic, 5 undetermined). A dry irritative syndrome was present in 29 patients in W1 versus 32 in W-1. Only 4 patients directly attributed their symptoms to the fire: 2 viral conjunctivitis, 1 allergic conjunctivitis and 1 worried patient (at D2, D5, D7 and D7 following the fire respectively). DISCUSSION: The number of emergency eye consultations did not change in the week following the Lubrizol factory fire (except for a decrease the day of the accident, related to the lock-down). There was a higher number of consultations in W1 for conjunctivitis, mostly viral in appearance and probably not directly related to the fire. The number of consultations for dry irritative syndrome was comparable between the two periods. Despite major media coverage of the event at the national level and a very high level of concern among the population, the fire does not seem to have had an effect on OED activity at Rouen University Hospital, nor on general ED visits. The stay-at-home order on the first day may have had a protective effect, avoiding direct exposure to smoke. The long-term consequences of the soot deposits on the ground as the smoke cloud passed over remain undetermined and are under surveillance. A review of the literature on the ocular consequences of industrial accidents is presented. CONCLUSION: The Ophthalmology Emergency Department did not record increased activity in the week following the Lubrizol Rouen fire, and ocular surface disease did not give rise to more consultations than the week before the fire. This suggests that there was no or minimal immediate ocular toxicity of the smoke from the fire.

Progressive clinical case-based multiple-choice questions: An innovative way to evaluate and rank undergraduate medical students.

INTRODUCTION: In France, at the end of the sixth year of medical studies, students take a national ranking examination including progressive clinical case-based multiple-choice questions (MCQs). We aimed to evaluate the ability of these MCQs for testing higher-order thinking more than knowledge recall, and to identify their characteristics associated with success and discrimination. METHODS: We analysed the 72 progressive clinical cases taken by the students in the years 2016-2019, through an online platform. RESULTS: A total of 72 progressive clinical cases (18 for each of the 4 studied years), corresponding to 1059 questions, were analysed. Most of the clinical cases (n=43, 60%) had 15 questions. Clinical questions represented 89% of all questions, whereas basic sciences questions accounted for 9%. The most frequent medical subspecialties were internal medicine (n=90, 8%) and infectious diseases (n=88, 8%). The most frequent question types concerned therapeutics (26%), exams (19%), diagnosis (14%), and semiology (13%). Level 2 questions ("understand and apply") accounted for 59% of all questions according to the Bloom's taxonomy. The level of Bloom's taxonomy significantly changed over time with a decreasing number of level 1 questions ("remember") (P=0.04). We also analysed the results of the students among 853 questions of training ECNi. Success and discrimination significantly decreased when the number of correct answers increased (P<0.0001 both). The success, discrimination, mean score, and mean number of discrepancies did not differ according to the diagnosis, exam, imaging, semiology, or therapeutic type of questions. CONCLUSION: Progressive clinical case-based MCQs represent an innovative way to evaluate undergraduate students.

[Resilience and responsiveness of general practice during the COVID-19 pandemic]. / Résilience et réactivité de la médecine générale durant la pandémie COVID-19.

The COVID-19 pandemic has forced general practice to react and adapt its modus operandi in various ways. We describe most important practical adaptations according to the chronology imposed by the different phases of this unprecedented crisis, during the first three quarters of 2020. The Belgian health system and all its components have been put under tension. General medicine has been able to build on its strengths but has also suffered from certain weaknesses. Initial lessons must be learnt in order to better respond to the challenges of tomorrow.

La pandémie COVID-19 a imposé à la médecine générale de nombreuses réactions et adaptations de son mode de fonctionnement. Nous les décrivons dans cet article, selon la chronologie imposée par les différentes phases de cette crise inédite, durant les trois premiers trimestres de 2020. Le système de santé belge a été mis sous tension, dans toutes ses composantes. La médecine générale a pu s'appuyer sur ses forces, mais a également souffert de certaines faiblesses. Des premiers enseignements doivent être tirés pour mieux répondre aux défis de demain.

[Pre-hospitalization unit: A simple organization and a place for internists to improve the non-scheduled hospitalization stream from emergencies]. / Unité d'attente d'hospitalisation : une organisation simple et une place pour les internistes pour améliorer la filière d'hospitalisation non programmée à partir des urgences.

INTRODUCTION: The adult emergency department at Rouen University hospital (CHU) welcomes over 100.000 patients per year. In order to streamline unscheduled hospital admissions from the emergency room (ER), a 20-bed pre-hospitalization unit and a centralized bed management system (bed manager, bed manager software, dedicated beds) have been put into place. PATIENTS AND METHODS: Emergency admissions have increased by (+3.5% between 2017 and 2018) with 20% direct hospitalization from the ER to other conventional units (2/3 in medicine, 1/3 in surgery). In 2018, 3450 patients, of which 54% aged over 75 years have been admitted in the pre-hospitalization unit with an average length of stay of 1.3±1.4 days: 35.4% stayed less than 24hours and 34.8% more than 48hours of which 5.2% stated more than 4 days, 132 patients (3.8%) died, 805 patients (23.3%) were discharged at home, 220 (6.4%) transferred to another facility, and 2287 (66.3%) were secondarily hospitalized in another hospital unit: more than 9 times out of 10 in a medicine unit (internal medicine 30%, geriatrics 27.9%, respiratory medicine 12.2%). This unscheduled emergency hospitalization allowed a daily hospitalization of 50 short stay inpatients beds. It has to be noted that the number of available inpatient beds clearly decreases during the week-ends. The main pathologies were respiratory infections (14.2%), heart diseases (9.7%), metabolic disorders (3.9%), and urinary tract infections (13.6%). CONCLUSION: This pre-hospitalization unit associated with a centralized bed management system has clearly improved the unscheduled hospital admissions, in particular concerning the emergency medical sector. The lack of inpatient beds at the week-end and the management of epidemic periods still remain a challenge that has to be taken up.

Secondary findings from next generation sequencing: Psychological and ethical issues. Family and patient perspectives.

Access to active search for actionable secondary findings (SF) in diagnostic practice is a major psychological and ethical issue for genomic medicine. In this study, we analyzed the preferences of patients and their families regarding SF and identified the reporting procedures necessary for informed consent. We interviewed parents of patients with undiagnosed rare diseases potentially eligible for exome sequencing and patients affected by the diseases listed in the ACMG recommendations. Four focus groups (FG) were formed: parents of patients with undiagnosed rare diseases (FG1, n = 5); patients with hereditary cancers (FG2, n = 10); patients with hereditary cardiac conditions (FG3, n = 3); and patients with metabolic diseases (FG4, n = 3). Psychologists presented three broad topics for discussion: 1. Favorable or not to SF access, 2. Reporting procedures, 3. Equity of access. Discussions were recorded and analyzed using simplified Grounded Theory. Overall, 8 participants declared being favorable to SF because of the medical benefit (mainly FG1); 11 were unfavorable because of the psychological consequences (mainly FG2, FG3, FG4); 2 were ambivalent. The possibility of looking for SF in minors was debated. The 4 key information-based issues for participants ranked as follows: explanation of SF issues, autonomy of choice, importance of a reflection period, and quality of interactions between patients and professionals. Examining equity of access to SF led to philosophical discussions on quality of life. In conclusion, individual experience and life context (circumstances) were decisive in participants' expectations and fears regarding access to SF. Additional longitudinal studies based on actual SF disclosure announcements are needed to establish future guidelines.

Molecular dynamics study of nanoconfined TIP4P/2005 water: how confinement and temperature affect diffusion and viscosity.

In the past few decades great effort has been devoted to the study of water confined in hydrophobic geometries at the nanoscale (tubes and slit pores) due to the multiple technological applications of such systems, ranging from drug delivery to water desalination devices. To our knowledge, neither numerical/theoretical nor experimental approaches have so far reached a consensual understanding of structural and transport properties of water under these conditions. In this work, we present molecular dynamics simulations of TIP4P/2005 water under different nanoconfinements (slit pores or nanotubes, with two degrees of hydrophobicity) within a wide temperature range. It has been found that water is more structured near the less hydrophobic walls, independently of the confining geometries. Meanwhile, we observe an enhanced diffusion coefficient of water in both hydrophobic nanotubes. Finally, we propose a confined Stokes-Einstein relation to obtain the viscosity from diffusivity, whose result strongly differs from the Green-Kubo expression that has been used in previous works. While viscosity computed with the Green-Kubo formula (applied for anisotropic and confined systems) strongly differs from that of the bulk, viscosity computed with the confined Stokes-Einstein relation is not so much affected by the confinement, independently of its geometry. We discuss the shortcomings of both approaches, which could explain this discrepancy.

Nasomaxillary fracture: Retrospective review of 11 consecutive patients and literature review.

PURPOSE: Nasomaxillary fractures can be mistaken for fractures confined to the nasal bones, resulting in inappropriate treatments that jeopardize patient outcomes. Our purpose here was to provide information on nasomaxillary fractures via a retrospective study and literature review. MATERIAL AND METHODS: We retrospectively collected clinical, computed tomography (CT), therapeutic, and outcome data in consecutive patients managed for unilateral impacted nasomaxillary fractures at our centre over a 5-year period (2013-2017). Long-term outcomes were further assessed by administering scoring tools for subjectively assessed cosmesis, nasal obstruction, and pain during a telephone interview. RESULTS: The 11 included patients had a mean age of 33.4 years. The clinical manifestations included nasal asymmetry in all 11 patients and infra-orbital rim step-off deformity in 9 patients. Consistent CT findings were involvement of the nasal bone, canine pillar, and anterior maxillary bone; and presence of blood within the maxillary sinus. The treatment in 8 patients consisted in open reduction and internal fixation via the intraoral approach, with or without an added infra-orbital approach; 1 patient was managed by endonasal reduction and 2 patients declined reduction. Almost 1 year after surgery, the cosmetic outcome was good (mean score, 22/25) and few patients reported nasal obstruction (mean score, 3.6/20) or pain (mean score, 1.6/10). CONCLUSION: Nasomaxillary fracture is a specific entity that must be differentiated from nasal bone fracture. Open reduction and internal fixation via the intraoral approach, with an added infra-orbital approach if needed, provides good outcomes.

Pesticide residues in Tunisian table grapes and associated risk for consumer's health.

Sixty-four table grape samples from different regions of Tunisia were collected during three consecutive years (2015-2017). The presence of 96 pesticides, including dithiocarbamates, was assessed. Pesticides identification and quantification were performed by liquid or gas chromatography, coupled to tandem mass spectrometry. All samples contained multiple residues (4 to 24 residues), with an average of 11.6 residues per sample. Individual concentrations of pesticides in grapes ranged from 0.01 to 5.86 mg kg-1. For at least one chemical compound, exceedances of the European Maximum Residue Limits were found in 94% of the samples. To assess the potential risk of pesticides through consumption of grapes, the acute exposure was estimated by the determination of predicted short term intake which is expressed as a percentage of Acute Reference Dose (ARfD), for non-compliances of pesticides. The exceedance of ARfD was associated with carbofuran, carbendazim, chlorpyrifos, deltamethrin, dimethoate and omethoate. Consequently, these pesticides could present a risk for consumer's health.

Secondary findings from whole-exome/genome sequencing evaluating stakeholder perspectives. A review of the literature.

With the development of next generation sequencing, beyond identifying the cause of manifestations that justified prescription of the test, other information with potential interest for patients and their families, defined as secondary findings (SF), can be provided once patients have given informed consent, in particular when therapeutic and preventive options are available. The disclosure of such findings has caused much debate. The aim of this work was to summarize all opinion-based studies focusing on SF, so as to shed light on the concerns that this question generate. A review of the literature was performed, focusing on all PubMed articles reporting qualitative, quantitative or mixed studies that interviewed healthcare providers, participants, or society regarding this subject. The methodology was carefully analysed, in particular whether or not studies made the distinction between actionable and non-actionable SF, in a clinical or research context. From 2010 to 2016, 39 articles were compiled. A total of 14,868 people were interviewed (1259 participants, 6104 healthcare providers, 7505 representatives of society). When actionable and non-actionable SF were distinguished (20 articles), 92% of respondents were keen to have results regarding actionable SF (participants: 88%, healthcare providers: 86%, society: 97%), against 70% (participants: 83%, healthcare providers: 62%, society: 73%) for non-actionable SF. These percentages were slightly lower in the specific situation of children probands. For respondents, the notion of the «patient's choice¼ is crucial. For healthcare providers, the importance of defining policies for SF among diagnostic lab, learning societies and/or countries is outlined, in particular regarding the content and extension of the list of actionable genes to propose, the modalities of information, and the access to information about adult-onset diseases in minors. However, the existing literature should be taken with caution, since most articles lack a clear definition of SF and actionability, and referred to hypothetical scenarios with limited information to respondents. Studies conducted by multidisciplinary teams involving patients with access to results are sadly lacking, in particular in the medium term after the results have been given. Such studies would feed the debate and make it possible to measure the impact of such findings and their benefit-risk ratio.

Ultralow-temperature device dedicated to soft X-ray magnetic circular dichroism experiments.

A new ultralow-temperature setup dedicated to soft X-ray absorption spectroscopy and X-ray magnetic circular dichroism (XMCD) experiments is described. Two experiments, performed on the DEIMOS beamline (SOLEIL synchrotron), demonstrate the outstanding performance of this new platform in terms of the lowest achievable temperature under X-ray irradiation (T = 220 mK), the precision in controlling the temperature during measurements as well as the speed of the cooling-down and warming-up procedures. Moreover, owing to the new design of the setup, the eddy-current power is strongly reduced, allowing fast scanning of the magnetic field in XMCD experiments; these performances lead to a powerful device for X-ray spectroscopies on synchrotron-radiation beamlines facilities.

Element specific determination of the magnetic properties of two macrocyclic tetranuclear 3d-4f complexes with a Cu3Tb core by means of X-ray magnetic circular dichroism (XMCD).

We apply X-ray magnetic circular dichroism to study the internal magnetic structure of two very promising star shaped macrocyclic complexes with a CuII3TbIII core. These complexes are rare examples prepared with a macrocyclic ligand that show indications of SMM (Single Molecule Magnet) behavior, and they differ only in ring size: one has a propylene linked macrocycle, [CuII3TbIII(LPr)(NO3)2(MeOH)(H2O)2](NO3)·3H2O (nickname: Cu3Tb(LPr)), and the other has the butylene linked analogue, [CuII3TbIII(LBu)(NO3)2(MeOH)(H2O)](NO3)·3H2O (nickname: Cu3Tb(LBu)). We analyze the orbital and spin contributions to the Cu and Tb ions quantitatively by applying the spin and orbital sum rules concerning the L2 (M4)/L3 (M5) edges. In combination with appropriate ligand field simulations, we demonstrate that the Tb(iii) ions contribute with high orbital magnetic moments to the magnetic anisotropy, whereas the ligand field determines the easy axis of magnetization. Furthermore, we confirm that the Cu(ii) ions in both molecules are in a divalent valence state, the magnetic moments of the three Cu ions appear to be canted due to 3d-3d intramolecular magnetic interactions. For Cu3Tb(LPr), the corresponding element specific magnetization loops reflect that the Cu(ii) contribution to the overall magnetic picture becomes more important as the temperature is lowered. This implies a low value for the 3d-4f coupling.

PASTRAB: a model for simulating intake regulation and growth of rabbits raised on pastures.

Given the very recent investment in research on organic rabbit production, many knowledge gaps remain. Simulation models based on data from experiments and farms may help generate general principles for organic rabbit production. Our goals were to (i) develop a model to simulate intake regulation and growth of rabbits raised on pastures, (ii) validate this model under a diversity of conditions and (iii) conduct a simulation experiment to predict the potential to decrease the supply of complete feed by increasing the grazing area per rabbit. The model developed (PASTRAB) simulates organic rabbit fattening on pastures in four main submodels that represent dynamics of (i) herbage standing biomass, fill and feed values; (ii) intake of herbage, complementary feed (i.e. complete pellets, cereal-legume grain mixtures) and hay as regulated by herbage allowance, fill and feed values of feedstuffs and rabbit physiological parameters; (iii) conversion of rabbit intake into live weight gain; and (iv) rabbit mortality. The model also calculates gross margin per rabbit sold. Model accuracy was assessed by considering the fit between observed and predicted herbage intake, which was low, with a relative root mean square error (rRMSE) of 51% and 66% on grass-based and legume-based pastures, respectively. However, the standard deviations of observed herbage intake were similar to the root mean square error of predicted herbage intake, indicating that it would have been difficult to improve model calibration. The fit between observed and predicted rabbit live weight was acceptable, with an rRMSE of 11% and 10% for grass-based and legume-based pastures, respectively. Simulated scenarios showed that a decrease in complementary feed combined with an increase in the grazing area per rabbit had little impact on average daily growth and gross margin per rabbit but increased herbage use efficiency. With 90 g of complementary feed per day and grazing of 0.4 m²/rabbit per day, herbage use efficiency was 22%, with average daily growth of 21.6 g/day and gross margin of 18.80 €/rabbit. With no complementary feed and grazing of 1.2 m²/rabbit per day, average daily growth decreased (19.2 g/day), but herbage use efficiency reached 100% and gross margin reached 19.20 €/rabbit. We used PASTRAB in participatory workshops with farmers so that the latter could explore adaptations to their current practices. Overall, farmers considered the model predictions realistic, and some of them decided to adapt some of their management practices immediately after the workshops.

[Echography at the point of care : stethoscope of the future for the General Practitioner ?] / L'échographie en situation de soin : stéthoscope du futur pour le médecin généraliste ?

Ultrasound is presently emerging not only as a specialist-delegated diagnostic procedure, but also as a tool used by clinicians for guiding decision. If this paradigm shift has taken roots in places like emergency departments, initiatives are also set up here and there in general practice. The aim of this article is , through a literature review, to identify possible indications of ultrasound performed by the general practitioner and to initiate a discussion about the obstacles and opportunities associated with its introduction in Belgian General Practice settings.

L'échographie ne se profile plus seulement comme un acte diagnostique délégué à un spécialiste, mais comme un outil utilisé en situation de soin par le clinicien pour guider la décision. Si ce changement de paradigme a bien pris pied dans une discipline comme les urgences, par exemple, des initiatives émergent ça et là pour adopter ce nouvel outil en médecine générale. Cet article se propose, à travers une revue de la littérature, de recenser les indications possibles de l'échographie réalisée par le médecin généraliste; puis, d'amorcer une discussion sur les freins et les opportunités associées à son introduction dans le contexte de la médecine générale belge.

Nanoscale Dynamics versus Surface Interactions: What Dictates Osmotic Transport?

The classical paradigm for osmotic transport has long related the induced-flow direction to the solute membrane interactions, with the low-to-high concentration flow a direct consequence of the solute rejection from the semipermeable membrane. In principle, the same was thought to occur for the newly demonstrated membrane-free osmotic transport named diffusio-osmosis. Using a recently proposed nanofluidic setup, we revisit this cornerstone of osmotic transport by studying the diffusio-osmotic flows generated at silica surfaces by either poly(ethylene)glycol polymers or ethanol molecules in aqueous solutions. Strikingly, both neutral solutes yield osmotic flows in the usual low to high concentration direction, in contradiction with their propensity to adsorb on silica. Considering theoretically and numerically the intricate nature of the osmotic response that combines molecular-scale surface interaction and near-wall dynamics, these findings are rationalized within a generalized framework. These elements constitute a step forward toward a finer understanding of osmotically driven flows, at the core of rapidly growing fields ranging from energy harvesting to active matter.