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This study examines why Denmark is considered the leader among the Nordic countries and globally when it comes to childcare. In terms of programmatic success, Denmark is a pioneer in nationwide ECEC (early childhood education and care), including social investment, which focuses on learning capabilities and skills of children. The implementation of ECEC nationwide is well organized, and the take-up of ECEC is evenly spread geographically and across social classes. Danish ECEC is also a clear political success, as political parties from the left to the right of the political spectrum, and at central and local levels of government, have supported ECEC, from the 1970s onwards; furthermore, stakeholders have been involved in setting agendas for continued high-quality ECEC as part of Danish family-, childcare- and labour market policy. Linked to the political success, Danish ECEC has also been a clear process success, with incremental reforms by broad-based coalitions, which have been carried out without major obstacles. The Danish system of ECEC has endured over several decades, despite changes at the margin due to challenges, including financial crises. The endurance is likely to continue well into the future, because of the cap on parental own contribution to the costs of ECEC, and because there has been a political decision to have a minimum threshold for quality of care in 2019. Across both sides of the Atlantic, in the EU context and in the US, childcare in Denmark is considered as a poster-child.

Background Postoperative cardio-surgical haemostatic management is centre-specific and experience-based, which leads to a variability in patient care. This study aimed to identify which postoperative haemostatic interventions may reduce the need for reoperation after cardiac surgery in adults. Methods A retrospective case-control study in a tertiary centre. Adult, elective, primary cardiac surgical patients were selected (n = 2098); cases (n = 42) were patients who underwent reoperation within 72 h after the initial surgery. Interventions administered to control surgical bleeding were compared for the need to re-operate using multiple logistic regression. Results Rate of cardiac surgical reoperation was 2% in the study population. Three variables were found to be associated with cardiac reoperation: preoperative administration of fresh frozen plasma (OR 5.45, CI 2.34-12.35), cumulative volume of chest tube drainage and cumulative count of packed red blood cells transfusion on ICU (OR 1.98, CI 1.56-2.51). Conclusion No significant difference among specific types of postoperative haemostatic interventions was found between patients who needed reoperation and those who did not. Perioperative transfusion of fresh frozen plasma, postoperative transfusion of packed cells and cumulative volume of chest tube drainage were associated with reoperation after cardiac surgery. These variables could help predict the need for reoperation.

This chapter focuses on why and how social investment has developed at the European Union level. The chapter identifies five main sequences in the development of the European social investment strategy. The perspective proposed by the EU institutions started with a focus on labor market participation (hence focusing on the skill mobilization function of social investment) before being broadened in 2000 to a perspective that included skill creation as much as skill mobilization and preservation. It then changed again toward a return to workforce mobilization and experienced a specific “social investment moment” with the Social Investment Package, before being embedded within a broader pillar of social rights. Two main dynamics explain the metamorphoses of the EU’s approach to social investment. First, there is an “internal” dynamic, consisting of internal battles within the European institutions between European “economically oriented” actors and “socially oriented” ones. Second, the changes in emphasis on social investment in the EU over time reflect political priorities in member states. The higher the number of left-leaning governments within the EU, the more inclusive and broad are the proposed social investment perspectives. Conversely, the higher the number of right-leaning governments, the more concentration on stratified and targeted social investment, focused merely on workforce mobilization.

International audience; Autism spectrum disorder (ASD) is characterized by early onset of behavioral and cognitive alterations. Low plasma levels of oxytocin (OT) have also been found in ASD patients; recently, a critical role for the enzyme CD38 in the regulation of OT release was demonstrated. CD38 is important in regulating several Ca 2+-dependent pathways, but beyond its role in regulating OT secretion, it is not known whether a deficit in CD38 expression leads to functional modifications of the prefrontal cortex (PFC), a structure involved in social behavior. Here, we report that CD38 2/2 male mice show an abnormal cortex development, an excitation-inhibition balance shifted toward a higher excitation, and impaired synaptic plasticity in the PFC such as those observed in various mouse models of ASD. We also show that a lack of CD38 alters social behavior and emotional responses. Finally, examining neu-romodulators known to control behavioral flexibility, we found elevated monoamine levels in the PFC of CD38 2/2 adult mice. Overall, our study unveiled major changes in PFC physiologic mechanisms and provides new evidence that the CD38 2/2 mouse could be a relevant model to study pathophysiological brain mechanisms of mental disorders such as ASD.-Martucci, L. A multiscale analysis in CD38-/-mice unveils major prefrontal cortex dysfunctions. FASEB J. 33, 000-000 (2019). www.fasebj.org KEY WORDS: behavior • oxytocin • autism • monoamines • excitation Autism spectrum disorder (ASD) covers a group of neu-rodevelopmental disorders characterized by behavior-al and cognitive disturbances with early-onset deficits in language acquisition and social interaction. ASD is highly inherited but the genetic determinants are poorly understood. The genetic basis of ASD has been associated with copy-number variations or single-nucleotide poly-morphism (SNP) in genes involved in brain development, synapse formation, or cell signaling (1). ASD is frequently associated with excessive cortical growth (2), and a current hypothesis is that the behavioral defects observed in ASD are due to impairments in synaptic functioning and plasticity (1, 3-5). For example, some mutations affect gluta-matergic synaptic transmission such as for the SH3 and multiple ankyrin repeat domain (SHANK) proteins (4-6) or the neuroligins (3, 7). One important consequence of these mutations is that the mechanisms of synaptic plasticity are altered and affect ionotropic NMDA receptors or metabotropic glutamate receptors regulating learning processes and cognitive functions (8, 9). Recently, the hypothesis of an increase in the excitation-inhibition (E-I) ratio in neuronal circuits emerged as a common patho-physiological principle that could explain the genesis of cognitive and social behavior deficits in ASD (10).

Introduction Peu d’etudes s’interessent a l’aspect scanographique des pneumopathies aigues communautaires (PAC) a Coxiella burnetii (Cb). Celles qui existent correspondent a des cas rapportes ou a de petites series de cas (maximum 38 patients) et montrent des resultats heterogenes. Elles meritent d’etre completees par des etudes de plus grande taille, afin de guider au mieux les cliniciens dans les regions d’endemie ou la confirmation serologique prend du temps (par exemple, en Guyane francaise). Materiels et methodes Nous avons mene une etude observationnelle retrospective monocentrique. Tous les patients atteints de PAC a Cb ayant beneficie d’un scanner thoracique au centre hospitalier de Cayenne (Guyane francaise) au moment du diagnostic, entre 2013 et 2017, ont ete inclus. Tous les patients atteints de PAC a Streptococcus pneumoniae (Sp) exploree par scanner thoracique au cours de la meme periode ont ete recrutes a des fins de comparaison. Le diagnostic reposait sur des signes cliniques de pneumopathie, associes a l’apparition d’IgM de phase II anti-Cb > 200 entre 7 et 21 jours apres l’apparition des symptomes pour Cb, et sur une hemoculture et/ou une culture de prelevement respiratoire et/ou une antigenurie positive pour Sp. Tous les scanners thoraciques ont ete analyses par un radiologue expert, en aveugle du diagnostic, a l’aide d’une grille standardisee. Resultats Nous avons inclus 111 patients, dont 66 hommes (59 %). Parmi eux, on comptait 75 PAC a Cb et 36 PAC a Sp. L’âge median etait de 52 ans [EIQ = 38–62]. On retrouvait plus d’hommes parmi les patients atteints de PAC a Cb (67 % vs 44 %, p = 0,03), tandis que l’âge median n’etait pas significativement different entre les deux sous-groupes. L’analyse des scanners thoraciques des PAC a Cb a retrouve 67 condensations alveolaires (89 %), 52 opacites en verre depoli (69 %), 30 cas d’adenopathie(s) (40 %), 25 cas d’epanchement pleural (33 %), 16 cas de reticulation(s) (21 %) et 12 atelectasies (16 %). Nous avons trouve des nombres significativement plus eleves de condensations alveolaires (89 % contre 75 % ; p = 0,05) et d’opacites en verre depoli (69 % contre 30 % ; p Conclusion Nous presentons ici la plus grande serie jamais decrite de PAC a Cb explorees par scanner thoracique. De meme que certains signes cliniques ou resultats de biologie standard, la presence d’opacites en verre depoli et/ou d’adenopathies au scanner thoracique lors d’une PAC devrait motiver l’ajout d’un medicament actif sur Cb (comme la doxycycline) au lieu d’une monotherapie anti-pneumococcique, dans les regions endemiques pour la fievre Q.

Purpose To report combined central arterial and venous occlusions secondary to bilateral leukemic interfascicular optic nerve infiltration in a 56-year-old man. This was the sole presentation of a relapse in T/Myeloid mixed-phenotype acute leukemia after 5 months of remission. Methods Case report with clinical photography. Results A 56-year-old man reported to be in complete remission of T/Myeloid mixed-phenotype acute leukemia (MPAL) presented with sudden painless loss of vision in his left eye. Fundoscopy showed unilateral severe optic disc swelling with characteristic findings of a central retinal vein occlusion (CRVO), namely, intra- and preretinal haemorrhages and cotton-wool spots, as well as the features of a central retinal artery occlusion (CRAO) resulting in a pale, edematous retina and a characteristic cherry-red spot. Blood, cerebrospinal fluid evaluation and bone marrow analysis were performed in combination with medical imaging. No evidence of leukemic relapse was found. An optic nerve biopsy was indicated, due to decompensation of the contralateral eye, and ultimately confirmed leukemic infiltration. Discussion Regardless of no hematological and non-specific imaging findings, optic nerve biopsy may be crucial for clinical decision making in a patient with acute complete vision loss and a history of leukemia.

The contribution addresses – through actor-centred historical institutionalism – why and how social investment (SI) emerged at the European Union (EU) level. SI policies built on the institutional basis of the policy co-ordination processes in employment and social inclusion, which originated in the late 1990s and early 2000s. The pre-existent processes represented the necessary but not sufficient condition for the EU SIP to materialise. The decisive factor was the activity of three types of entrepreneurs – intellectual, bureaucratic and political – that enabled the crystallization of the EU Social Investment package (SIP) through issue-framing, institutional alignment and consensus-building. Despite this, the SIP of 2013 ended as a ‘social investment moment’ that rapidly lost momentum because no additional measures such as indicators or funds were integrated with SIP. Furthermore, the Commission’s political priorities changed and the key entrepreneurs that had been active for the materialisation of the SIP were no longer centre stage. The continued presence of former influential entrepreneurs in the EU policy arena, although in different roles, may enable integration of EU SI into new EU social policy initiatives.

Introduction De recentes etudes ont montre un manque de connaissances et des idees recues sur le cancer du poumon aupres du grand public et des medecins. Nous avons voulu approfondir ce sujet en France. Methodes Une enquete en ligne a ete menee aupres de la population francaise (n = 6001), et des medecins (generalistes, n = 273 ; pneumologues, n = 97 ; oncologues, n = 67). Le grand public a ete interroge sur la prevalence du cancer du poumon, sa severite, son diagnostic, sa prise en charge, sa dimension sociale tandis que les questions posees aux medecins concernaient leur perception des connaissances des Francais. Resultats Les medecins surevaluent les connaissances du grand public concernant les facteurs de risques du cancer du poumon (81 % estiment que les Francais sont bien informes a ce sujet [n = 354], alors que seulement 56 % des Francais [n = 3361] declarent l’etre). A l’inverse, les medecins sous-evaluent les connaissances du grand public concernant les symptomes du cancer du poumon : selon eux, une majorite de Francais identifie surtout les crachats de sang (82 % ; n = 358) et l’apparition d’une toux (54 % ; n = 236) alors que 27 % des Francais (n = 1620) citent egalement les bronchites a repetition ou l’asthenie (n = 1620 ; 27 %) et 21 % (n = 1260) des douleurs importantes dans la poitrine. Les medecins (91 % ; n = 398) surevaluent aussi la stigmatisation des patients souffrant d’un cancer du poumon au sein de la societe : alors que 85 % des Francais (n = 5101) estiment que ces patients sont comme les autres patients atteints d’un cancer, seuls 55 % des medecins (n = 240) estiment qu’une majorite de Francais serait d’accord avec cette affirmation. Interroges sur la qualite de la prise en charge de ce cancer en France, grand public comme medecins l’evaluent satisfaisante (respectivement 71 % ; n = 4261 et 88 % ; n = 385). L’etude montre aussi des perceptions differentes concernant les differents types de therapies : si 46 % des medecins (n = 201) citent le cancer du poumon parmi les trois dans lesquels il y a eu le plus de progres medicaux, seuls 21 % (n = 1260) des Francais le citent. Interroges sur les principales innovations therapeutiques dans le cancer du poumon, les medecins citent avant tout l’immunotherapie (68 % ; n = 297), les Francais citant avant tout les chimiotherapies (52 % ; n = 3120). Conclusion Notre etude met en lumiere de substantielles differences entre les connaissances du grand public concernant le cancer du poumon et la perception de cette connaissance par les professionnels de sante.

Published online: 22 Mar 2018 In all advanced democracies, policies related to the welfare state are the largest part of public policy activity. Cross-pressured by globalization, deindustrialization, rising public debts, demographic changes, permanent austerity and the rise of 'new social risks', welfare states in post-industrial democracies have entered a new phase of consolidation and transformation since the 1980s. Against early fears, retrenchment has not been 'the only game in town'. Rather, many countries have expanded new welfare policies such as 'social investments'. This collection adds to the recent literature on the emergence of the 'social investment state' in several ways: (1) it assesses to what degree social investment policies have become established across countries and at the EU level; (2) it demonstrates that and why the politics of social investment are different from those of compensatory social policies on the micro and macro level; and (3) it points at important socio-economic effects of social investments.