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Stigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery.
Objectives
The objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SR
Methods
A total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness – SR subscale.
Results
Elevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; p = 0.004, OR = 2.89 (1.36–4.88); growth; p = 0.005, OR = 2.79 (1.30–4.43)). No moderating effects of age and education were found.
Conclusion
The present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.
La non-adhésion diminue largement l’efficacité des antidépresseurs [1,2], dont la représentation évolue dans un contexte particulièrement défiant et médiatiquement tendu.
Objectif
L’objectif de cette étude est de :
– évaluer l’adhésion aux antidépresseurs chez des patients hospitalisés pour épisode dépressif majeur ;
– explorer les représentations que les patients ont des antidépresseurs et de la dépression, ainsi que la perception de la stigmatisation aux troubles mentaux ;
– analyser la relation entre les attitudes face aux antidépresseurs et des paramètres sociodémographiques et cliniques.
Méthode
L’adhérence était évaluée chez 40 patients en utilisant la version courte du Drug Attitude Inventory (DAI-10), complétée par un questionnaire mesurant les connaissances, craintes, impact des média et stigmatisation liés aux antidépresseurs. Des entretiens d’investigation étaient ensuite menés à l’aide de celui-ci.
Résultats
L’âge moyen de l’échantillon est de 43 ans, dont 27 % d’homme. Il s’agit d’un premier épisode pour 40 % des patients. La médiane du DAI est de 3,5 (échelle de −10 à +10), et 30 % des patients ne sont pas adhérents. Les hommes de l’échantillon ont une plus mauvaise représentation des antidépresseurs (−2 VS 4 ; U de Mann-Whitney = 90,50 ; p = 0,0035). Soixante-dix pour cent des patients ont des craintes par rapport à leur antidépresseur (prise de poids et dépendance au premier rang). Vingt pour cent des patients n’ont pas dit à leur entourage qu’ils prenaient des médicaments contre la dépression.
Discussion
Une intervention à de multiples niveaux pourrait augmenter les connaissances des patients ainsi que de l’opinion publique [3]. Une collaboration spécifique entre journalistes et psychiatres permettrait une meilleure connaissance et une diffusion plus représentative des enjeux de santé mentale dans les média [4]. Des actions de santé publique et initiatives citoyennes pourraient aussi être profitables aux patients.
Conclusion
L’adhérence aux antidépresseurs peut largement être améliorée, la stigmatisation restant une barrière aux traitements et à la prise en charge.
The Personal and Social Performance (PSP) scale is a reliable and valid instrument that utilizes objective parameters for assessment of social functioning in patients with schizophrenia. The aim of this study was to determine the validity and reliability of the French version of PSP in a population of French schizophrenic patients.
Methods
Patients with DSM-IV diagnoses of schizophrenia and schizoaffective disorder were recruited and assessed in a cross-sectional design using the PSP, GAF, SOFS, PANSS, CGI severity. Internal consistency for the PSP was obtained and convergent validity was assessed using correlations between PSP, GAF and PANSS factors. Inter-rater reliability was evaluated with intra class correlation coefficient (ICC).
Results
147 in and out patients, at 5 French sites participated in this study. The Cronbach's alpha coefficient of the PSP was good (alpha=0.77). The PSP showed very good inter rater reliability (ICC = 0.90). Pearson correlation coefficient for association between PSP and GAF (r=0.85) and PSP and SOFS (r=- 0.78).are high proving good convergent validity for PSP. Pearson correlation coefficients are moderate when PSP is correlated with 4 of the five PANSS sub factors (r from -0.43 to -0.48). The anxious and depression factor (r=-0.17) showed low correlation with PSP. Spearman Rank correlation coefficient between PSP and CGI severity was r=-0.72.
Conclusions
Our results demonstrate that the PSP scale is a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in acute state.
Alors que la majorité des traitements antidépresseurs prescrits en France durent moins de 28 jours , moins de 2 % des travaux étudiant le traitement pharmacologique des troubles de l’humeur explorent les facteurs métapsychologiques associés à l’adhésion . Quelles sont les attitudes aux antidépresseurs des patients observants et demandeurs de soins ?
Objectif
L’objectif de cette étude était d’évaluer les attitudes aux antidépresseurs chez :
– des patients hospitalisés pour leur dépression ;
– ceux se rendant chez leur pharmacien pour chercher leur traitement.
Méthode
Les attitudes aux antidépresseurs étaient évaluées en utilisant la version courte du Drug Attitude Inventory (DAI-10), chez 98 patients : 40 hospitalisés de leur plein gré en psychiatrie et 58 venant chercher une prescription d’antidépresseur en officine.
Résultats
L’âge moyen de l’échantillon était de 43 ans, avec 69 % de femmes. Dans l’échantillon hospitalier, la médiane du DAI était de 3,5 (échelle de –10 à +10). Trente pour cent des patients avaient une attitude négative à l’antidépresseur prescrit, dont 10 % de l’échantillon ne connaissait pas le nom. Il s’agissait de la première prescription d’antidépresseur pour 30 % des patients. Dans le volet ambulatoire, la médiane du DAI n’était que faiblement plus positive (4), et 10 % des sujets avaient une attitude négative à l’antidépresseur qu’ils venaient chercher. Vingt pour cent des sujets déclaraient ne pas avoir de suivi de son trouble dépressif.
Discussion
Cette étude naturalistique met en relief l’ambivalence des patients face aux antidépresseurs. Tandis qu’un comportement montre un engagement fort dans les soins (être hospitalisé en milieu spécialisé, aller chercher une prescription au long cours), les connaissances sur les troubles les justifiant et les croyances envers les thérapeutiques prescrites restent précaires .
Conclusion
Cette ambivalence, reflet des attitudes de la société face à nos médicaments, pourrait être mieux explorée en pratique clinique quotidienne.
Self-stigma
is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD.
Methods.
A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment.
Results.
31.2% of the total sample had elevated self-stigma. The highest prevalence (43.8%) was found in borderline personality disorder and the lowest (22.2%) in ASD. In the multivariate analysis, elevated self-stigma was best predicted by early stages of personal recovery (moratorium, p = 0.001, OR = 4.0 [1.78–8.98]; awareness, p = 0.011, OR = 2.87 [1.28–6.44]), history of suicide attempt (p = 0.001, OR = 2.27 [1.37–3.76]), insight (p = 0.002, OR = 1.22 [1.08–1.38]), wellbeing (p = 0.037, OR = 0.77 [0.60–0.98]), and satisfaction with interpersonal relationships (p < 0.001, OR = 0.85 [0.78–0.93]).
Conclusions.
The present study has confirmed the importance of addressing self-stigma in SMI and ASD patients enrolled in psychiatric rehabilitation. The effectiveness of psychiatric rehabilitation on self-stigma and the potential mediating effects of changes in self-stigma on treatment outcomes should be further investigated.
Weaning is a critical transition phase in swine production in which piglets must cope with different stressors that may affect their health. During this period, the prophylactic use of antibiotics is still frequent to limit piglet morbidity, which raises both economic and public health concerns such as the appearance of antimicrobial-resistant microbes. With the interest of developing tools for assisting health and management decisions around weaning, it is key to provide robustness indexes that inform on the animals’ capacity to endure the challenges associated with weaning. This work aimed at developing a modelling approach for facilitating the quantification of piglet resilience to weaning. A total of 325 Large White pigs weaned at 28 days of age were monitored and further housed and fed conventionally during the post-weaning period without antibiotic administration. Body weight and diarrhoea scores were recorded before and after weaning, and blood was sampled at weaning and 1 week later for collecting haematological data. A dynamic model was constructed based on the Gompertz–Makeham law to describe live weight trajectories during the first 75 days after weaning, following the rationale that the animal response is partitioned in two time windows (a perturbation and a recovery window). Model calibration was performed for each animal. Our results show that the transition time between the two time windows, as well as the weight trajectories are characteristic for each individual. The model captured the weight dynamics of animals at different degrees of perturbation, with an average coefficient of determination of 0.99, and a concordance correlation coefficient of 0.99. The utility of the model is that it provides biologically meaningful parameters that inform on the amplitude and length of perturbation, and the rate of animal recovery. Our rationale is that the dynamics of weight inform on the capability of the animal to cope with the weaning disturbance. Indeed, there were significant correlations between model parameters and individual diarrhoea scores and haematological traits. Overall, the parameters of our model can be useful for constructing weaning robustness indexes by using exclusively the growth curves. We foresee that this modelling approach will provide a step forward in the quantitative characterisation of robustness.
The flora of Laos remains one of the least known within the Indo-Burma biodiversity hotspot. A floristic inventory was carried out in Phou Hin Poun National Biodiversity Conservation Area, an under-explored area of the Khammouane Limestone. This study provides a list of 27 taxa that are additions to the most recent country checklists. The Ebenaceae, Euphorbiaceae and Myrtaceae are the families with the highest species number. In this list, four species are endemic to Indochina (Cambodia, Laos and Vietnam): Cynometra dongnaiensis Pierre, Jasminum vidalii P.S.Green, Memecylon chevalieri Guillaumin and Pothos gigantipes Buchet ex P.C.Boyce. These results illustrate the paucity of our knowledge of the region surveyed and of the flora of Laos in general.
The objective was to study milk production, body reserve mobilization, metabolic and hormonal profiles, and ovarian cyclicity of Holstein-Friesian (HOLS) and Montbéliarde (MONT) cows under two low-input dairy production systems with seasonal spring calving: an extensive (EXT; 12 HOLS and 12 MONT) based on permanent diversified grasslands and zero concentrate, and a semi-extensive (SEMI; 12 HOLS and 10 MONT) based on established temporary grasslands and up to 4 kg/day of concentrate. Individual measurements were performed between −4 and 12 weeks of lactation. Cows in EXT secreted less milk (22.1 v. 24.4 kg/day), protein (660 v. 755 g/day) and energy (67.7 v. 74.4 MJ/day), had greater plasma β-hydroxybutyrate (BHBA) (0.97 v. 0.69 mM), lower glucose (59.0 v. 62.0 mg/dl) and IGF-1 (62 v. 71 ng/ml), lower milk fat concentration in fatty acids originating from de novo synthesis (e.g. ∑ 10:0 to 15:0) and greater concentration of those derived in part from mobilization of fat reserves (e.g. 18:0 and ∑>C16), and showed greater frequency of abnormal ovarian cycles compared with SEMI. Across production systems, HOLS produced more milk (24.7 v. 21.8 kg/day), protein (738 v. 674 g/day) and fat (939 v. 819 g/day), secreted more energy (75.1 v. 67.0 MJ/day), lost more body condition score (BCS) (1.41 v. 1.03) and reached a lower BCS nadir (1.12 v. 1.43), had greater plasma BHBA (0.91 v. 0.75 mM), lower insulin (15.9 v. 17.2 µIU/ml) and tended to have lower glucose (59.6 v. 61.4 mg/dl), had lower milk fat concentration in ∑ 10:0 to 15:0, tended to have higher ∑>C16 and tended to show more abnormal estrous cycles compared with MONT. Ultrasound measurements did not differentiate fat mobilization and were confounded by breed differences of skin thickness. The greater nutrient allowance in SEMI improved indicators of physiological status and ovarian function during early lactation compared with EXT, but did not attenuate body reserve mobilization because cows prioritized milk secretion. HOLS secreted more nutrients than MONT but lost more BCS, which negatively affected nutritional balance and tended to affect ovarian cyclicity during early lactation. Breed by system interactions were not observed except for a few variables.
We study the feeding and feedback of the nucleus of M51 by considering gravitational torques, responsible for gas inflow, in relation to the local distribution of dense gas.
Since contradictory data can be found in the literature, it is often difficult to assess the susceptibility of crevice corrosion of stainless steels in service conditions for a given marine application. The initiation and propagation of crevice corrosion in natural seawater were evaluated for five different duplex stainless steel grades together with some austenitic grades. A CREVCORR-type assembly was used to simulate crevice configurations involving the use of plastic crevice formers. The standard pressure applied on the crevice assembly was 3 N/mm2. Pressure of about 20 N/mm2 was also applied on some selected specimens in order to assess the effect of crevice geometry on crevice corrosion. The effect of environmental parameters (i.e. temperature, flowing conditions, residual chlorine, and dissolved oxygen content) and of surface roughness on the crevice corrosion initiation and propagation were investigated, allowing the assessment of limits of applications for some tested stainless steel grades. The less alloyed duplex stainless steels were evaluated in stagnant seawater at 5 °C and 20 °C. The duplex stainless steel UNS S32205, with PREN = 37, was also evaluated under the same conditions of exposure. The high alloyed stainless steels with PREN above 40 were evaluated in the expected most severe conditions of exposure, namely in 0.5 ppm-chlorinated seawater at 20 °C, in seawater at 30 °C (not chlorinated and with 0.5 ppm of residual chlorine) and in seawater at 50 °C (not chlorinated and with 0.5 ppm of residual chlorine). As expected the less alloyed duplex stainless steels showed limited crevice corrosion resistance in the tested media while UNS S32205 showed better resistance in the less severe tested condition of exposure. In demanding media it was shown that the limits of application of highly alloyed stainless steels are highly dependent on the crevice geometry (i.e. specimen roughness and applied pressure at gasket location).
Yttrium iron garnet (YIG) film made as a magneto-optical medium suffers from
the problem of crack formation, caused by the heating process. YIG thin film
is deposited by radio frequency rf magnetron sputtering; the obtained layer
is amorphous and it needs annealing to be crystallized. After heat-treatment
at 740 ○C of the sample realized on quartz substrate, we observe cracks
on the entire film surface. This is due to the large difference between the
thermal expansion coefficient (5.5 ×10-7 K-1 for quartz and 10 ×
10-6 K-1 for YIG). In this paper we present a new fabrication
method to reduce this problem, we make a multilayer to obtain at the end a
uniformly unique layer with excellent crystalline structure. Such films have
the possibility to reach a thickness of 500 nm. YIG films have been studied
by Rutherford backscattering spectrometry (RBS), optic ellipsometry and the
scan electron microscope. The RBS spectra were collected in channelling
geometry with incident particles energy 2 MeV and 3.5 MeV. The thickness and
the stoichiometric value of the thin films have been evaluated. Simulation
of all spectra indicates a constant composition. Ellipsometry method is well
adapted to model the thin film structure layers, and to measure the
thickness of the film and the complex index of refraction. The theoretical
ellipsometric value of the index of refraction is (2.22) while the
experimental value is ranging from 2.2 to 2.3 for a wavelength of 1550 nm.
A review of several studies examining the lay concept of successful ageing and related concepts leads to the conclusion that elders from different cultures appear to agree on most of the components identified in the literature. From the research emerges a multidimensional conceptualisation of ‘successful ageing’ that is described on the basis of physical, emotional, cognitive and social domains, and which coincides with most theoretical and empirical definitions. The main goal of the present research is to study similarities and differences between concepts of ‘successful ageing’ in several Latin American and European countries and in two different age groups, and also to examine whether a similar structure of the lay concept can be found across both continents. The results show minor differences at item levels among countries, continents and age groups, and a similar internal structure across them.
We used a factorial approach to distinguish maintenance from growth requirements for protein, lysine and methionine in the black tiger shrimp, Penaeus monodon. Juvenile P. monodon (initial weight 2·4 g) were fed during 6 weeks one of ten semi-purified diets based on casein and purified amino acids (AA) as N source. The diets contained four levels of crude protein (CP, from 5 to 54 % DM diet) with two levels (% CP) of lysine or methionine (normal or 30 % deficient). Requirements were determined using linear and non-linear regression models. We could thus obtain the first ever data on maintenance (N equilibrium) requirements for CP and AA in P. monodon. CP requirements for maintenance (4·5 g/kg body weight (BW) per d) represented approximately 19 % of the CP requirement for maximal N gain (23·9 g/kg BW per d). The marginal efficiency of utilisation reached a maximum of 38 % for N, 0·77 for lysine and 1·62 for methionine using N gain as response. Lysine requirements were 0·20 g/kg BW per d for N maintenance and 1·40 g/kg BW per d for maximal N gain. Methionine requirements were 0·11 g/kg BW per d for N maintenance and 0·70 g/kg BW per d for maximal N gain. The lysine (5·8 %) and methionine (2·9 %) requirements for maximal N gain, expressed as percentage of protein requirement, agree with literature data using a dose–response technique with smaller P. monodon. The observed interaction between dietary CP and methionine for N gain demonstrates that requirements for indispensable AA (expressed as % CP) cannot be evaluated separately from CP requirements.
By
Maureen F. Dollard, University of South Australia, Australia,
Pascale M. Le Blanc, Utrecht University and Research Institute for Psychology and Health, Netherlands,
Sarah J. Cotton, University of South Australia, Australia
Work stress is a major concern in all developing and industrialized countries, affecting not only employees but also organizations and society as a whole. Over the past decades, the workplace has changed substantially owing to globalization of economic activities, increased utilization of information and communication technology, growing diversity in the workplace (e.g. more women, and older and more highly educated people, as well as increased migration, particularly between the EU member states), flexible work arrangements, and changed organizational work patterns (e.g. Just in Time management) (European Foundation for the Improvement of Living and Working Conditions [EFILWC], 2005; Landsbergis, 2003; Le Blanc, de Jonge, and Schaufeli, in press). The impact of the global economy has also led to an increase in knowledge- and service-based organizations. One of the most striking developments, however, is the changing nature of work itself and increased workloads. Nowadays, for many employees, work poses primarily mental and emotional demands instead of physical ones (de Jonge and Dormann, 2003; de Jonge, Mulder, and Nijhuis, 1999).
These recent developments in working life are reflected by a marked increase in (scientific) research on work stress, its causes, and its consequences. Moreover, researchers, managers, and policy makers seek gold standards in the evidence base for policy and practice. Increasingly, cost-benefit analyses of work stress interventions are sought and there is a growing recognition that health and well-being measures are a quintessential component of organizational performance analysis.
A model of reproductive performance was developed to study the influences of breeding management decisions and animal characteristics on the reproductive performance and the calving distribution in a beef herd. In the model, reproductive performance is formalized as a sequence of events (parturition, ovulation, conception), each of which modifies the reproductive status of the simulated cow. With respect to reproduction, a cow can be in one of three possible states: open-not-cycling, open-cycling or pregnant. The length of the different intervals that are included between two successive reproductive events (calving to first cycle interval, length of oestrous cycles, calving–conception and calving intervals) is formalized using stochastic or empirical laws that may be influenced by numerous animal or environmental factors or by management decisions (feeding strategy, breeding season and length of the breeding period). Within the herd, cows are considered to differ from each other by their parity, calving date, body condition at calving and their bull exposure.
Calving to first oestrous interval (postpartum anoestrous interval (PPAI)) is expressed as the sum of three equations which formalize the respective effects of calving date, body condition score at calving (BCScalving) and the response to early bull exposure in interaction with BCScalving. The influences of these variables on reproductive performance were quantified by analysing data sets (three bibliographical and two experimental) or by expertise. Special attention was paid to the influence of calving date on PPAI and a biological interpretation of this effect is proposed. Probabilities of natural insemination success were estimated according to the number of oestrus and the number of matings.
The model was fitted to data from primiparous Charolais cows (n=139) bred at the experimental station Laqueuille (French National Institute for Agricultural Research (INRA)). Its ability to simulate PPAI was tested using an independent data set of primiparous Charolais cows (n=188) from the experimental farm Le Pin. The model only accounts for 39% of the observed inter-individual variability. However, the analysis of the mean square deviation components led to validation of the structure of the model. In particular, the assumption that the influence of calving date on PPAI can be attributed to a sensitivity of the reproductive function to the variation of the photoperiod during the month preceding parturition was confirmed. Simulations also revealed that fat cows could have similar anoestrus to thin cows when they are exposed early to a bull. Such a result emphasized the necessity to investigate further and better calibrate the combined effects of BCS at calving and bull exposure on PPAI.
Tracheal intubation may be more difficult in morbidly obese patients (body mass index >35 kg m−2) than in the non-obese. Recently, new video-assisted intubation devices have been developed. After some experience with videolaryngoscopy, we hypothesized that it could improve the laryngoscopic view in this specific population and therefore facilitate intubation. The aim of this study was to assess the benefit of a videolaryngoscope on the grade of laryngoscopy in morbid obesity.
Methods
We studied 80 morbidly obese patients undergoing bariatric surgery. They were randomly assigned to one of two groups. One group was intubated with the help of the videolaryngoscope and in the control group the screen of the videolaryngoscope was hidden to the intubating anaesthesiologist. The primary end-point of the study was to assess in both groups the Cormack and Lehane direct and indirect grades of laryngoscopy. The duration of intubation, the number of attempts needed as well as the minimal SPO2 reached during the intubation process were measured.
Results
Grade of laryngoscopy was significantly lower with the videolaryngoscope compared with the direct vision (P < 0.001). When the grade of laryngoscopy was higher than one with the direct laryngoscopy (n = 30), it was lower in 28 cases with the videolaryngoscope and remained the same only in two cases (P < 0.001). The minimal SPO2 reached during the intubation was higher with the videolaryngoscope but it did not reach statistical significance.
Conclusions
In morbidly obese patients, the use of the videolaryngoscope significantly improves the visualization of the larynx and thereby facilitates intubation.
This article examines the origins and evolution of the terroir approach as an organizing idea in development planning in West Africa. We consider the evolving meaning of the terroir concept in three distinct periods: as a research approach crafted in a French geographical school; as a site for research-development programmes, and, most recently, as a tool for conservation planning, territorial restructuring, and land privatization. An important shift in the meaning of the terroir concept is apparent in its evolving uses. For the terroir school, the terroir came to represent the socio-natural heritage of a group in which its social organization and pattern of resource use became inscribed in the landscape. The concept took on new meaning in the late-1980s as an appropriate location for on-farm research by agricultural development planners. The terroir became both an alternative research site and a setting for mobilizing rural populations to adopt new land management and farming techniques. The meaning of the concept shifted again in the 1990s with the advent of the gestion des terroirs approach. In the hands of conservation and development planners, the terroir was conceived of as a scale of intervention for a host of government, aid donor, and NGO programmes. In summary, a significant change in the meaning of the concept has taken place from one in which the notion of local heritage was dominant to one that emphasizes territory and boundary clarification.
A highlight science case for the European ELT is: First light - The First Galaxies and the Ionization State of the Early Universe. It aims at understanding the formation and evolution of the first sources of light at the end of the Dark Ages and of the re-ionization of the Universe. The corresponding instrument requirements are: a few tens of integral field units with spatial sampling $\sim$20mas and individual fields of ${\sim}1''$ over a wide field of view of $5' \times 5'$ or larger. Multi-Object Adaptive Optics is required to locally provide significant image quality enhancement. Spectroscopic observations are required in the near IR domain with a spectral resolution of a few 1000. MOMFIS is a preliminary instrument concept designed for OWL around this science case. The instrument concept and preliminary design are presented. Development efforts are estimated, as well as development risks and required R&D activities.