Up until , it was difficult to capture live sound and image simultaneously outside controlled studio environments and consequently films were generally overdubbed during post-production. Using a lightweight sound recorder that was synched to an equally lightweight and completely soundproofed 16mm reflex camera rather than the glossier 35mm camera, and hand holding it or shoulder mounting as opposed to having it fixed on a tripod, Rouch recorded on-the-spot synched dialogue that introduced the complexities of spontaneous speech generated by regular people in ordinary situations to a commercial cinema that had been characterised by mannered, literary dialogues delivered by trained actors in studios.
This imparted an incredible sense of reality, spontaneity and veracity to the filmed material and the camera with which it was shot, known as the Eclair-Nagra, became the system of choice for documentary filmmakers for the next twenty years, until its replacement by video and nowadays the digicam. In keeping with the assertion that cinema is a tool of subjective expression, Chris Marker, Alain Renais and Roberto Rossellini developed a personal, poetic style of documentary. To this effect, as early as Moi,un noir , Rouch introduced reflexivity in his film by inviting his subjects to participate in the making of the film, more specifically to improvise an accompanying narration based on a rough cut of the filmed images.
Through more and more complex and intertwined layers of documentary and fiction, the people in the film get to act out their deepest fantasies, producing something that is at once totally unreal and the most concrete expression of who they are. On this subject, Rouch himself was of the opinion that fiction is the only way to penetrate reality, there being almost no boundary between documentary and fiction films.
This idea was to have a tremendous influence on the French New Wave filmmakers, as this essay will show further. Also, far as film theory is concerned, Chronique had far-reaching consequences, its attempts at transparency setting off virulent debates at the time about the relationship between cinema, reality and truth Dilorio Rouch and Morin filmed their subjects for more than six months, accumulating over twenty-four hours of raw material which was edited into a ninety-minute feature.
Rouch Rouch replaced him with the Canadian cameraman Michel Brault, whose film Les Raquetteurs made a strong impact on Rouch due to its unusually fluid camerawork, certain sequences having been filmed while walking. Thus Chronique contains two categories of scenes: the initial fixed-camera sequences Viguier shot with a tripod-mounted Arriflex camera, and the later mobile ones filmed by Brault with the Coutant-Eclair. As such, the film constitutes a precious document of French cinema in a state of change. Rouch however was more critical of what he produced, both in theory and in practice.
Were you truthful or acting for the camera? Thus the central issue of the film is neither truth nor falsehood but the permeable border between life and art. Godard firmly believed that all great films are characterised by the mix of documentary and fiction and would later incorporate themes and techniques found in Moi, un noir into his own feature films. Filmmaking was still based on the reconstruction of a proper scenario rather than as a spontaneous response to developing events in the real world Dilorio An intentional technique of making the camera shake to convey veracity was introduced.
As a consequence, film shooting became casual and fun, witnessing a return to the early cinematic practice of a two-person crew: the cinematographer and camera-operator. They took to the street and shot their films there, offering us a genuine record of Parisian life in the s when France was on the brink of an economic boom that made everyone enthral to the new rave of consumerism.
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The camera used on the project, a 35mm Cameflex, was noisy, relatively heavy and easily visible. Thus, to shoot Belmondo and Jean Seberg on the Champs Elisees, Godard had to hide his cinematographer Raul Coutard inside a mail-delivery pushcart and physically drag him up and down the street. Coutard was a war reporter, which meant that he knew how to seize images in a split second and was familiar with the fastest and the most light-sensitive of stocks.
Even when tackling a musical comedy, the most unrealistic of genres Une femme est une femme , Godard chose to shoot in the most realistic of settings: in the apartment of an old couple in Strasbourg Saint Denis, one of the less fashionable quarters of Paris. In the end, due to the couple changing their minds at the last moment, Godard was forced to shoot in a studio MacCabe As studio shooting could not be further from a Bazinian aesthetic, Godard decided to reproduce the conditions of location shooting in the studio.
Thus the apartment he initially wished to shoot in was meticulously reconstructed, with immovable walls and ceilings and a real door. As to the sound, Godard recorded the real sound of the crew working and added it to the soundtrack, which again shows his great determination to capture reality in his films. Like them, he is interested in capturing the fleeting moment, the very thing that makes cinema so beautiful and the reason for which it was invented.
To the Rouchian observation of Paris, Godard added a hatred of perfection in shooting: he would knock the camera sideways if the shot had the appearance of a perfectly organised shot MacCabe , perfection being obviously at the opposite side of the spectrum of a realist aesthetic.
As already mentioned, Chronique is based on the Vertovian belief that cinema is truth, an idea that is introduced at the beginning of the film, but only to be subversively questioned at the end. Thus Chronique very seriously questions all attempts to claim truth status for representations of seen and heard phenomenal reality, including those of direct cinema to have automatic access to reality.
From this point of view, any work of art includes its own critique, its own interpretation and biased understanding of reality. This makes the concepts of naturalism and realism, that are based on the idea that art can express the objective truth, seem inadequate or even a fallacy.
For instance, Antonioni believed that the truth can be better served by intelligent fiction than by recording factual reality. However a distinction should be made between the truth of something that already happened and the truth caught on the wing, as it expresses itself in the present, this latter notion being what the New Wave filmmakers wanted to capture above all. With his insistence that the raw material of any fiction must be drawn from the historical record and that the transformations of that material must form part of the subject matter of the work of art, Brecht sketched out one of the most powerful of modernist aesthetics.
Also Godard repeatedly insisted that the film is not about a prostitute, it is a film about a woman, prostitution being used as a metaphor for social situations and social exchanges in general Bergala She will fail however to do so and this is not a coincidence. In any work of art, form and content inform each other and work together to express the same idea and in a perfectly realised work of art, form is content. When we look at the film in more detail, other nuances that point in the same direction become apparent.
Thus the sense of intimacy is subverted and gradually replaced by a feeling of detachment, both of the main character and of the spectator. I like to think that I am a workman. To this effect, another sequence is extremely revealing: the scene between Nana and the philosopher Brice Parain, invited to play himself and who therefore appears in the fiction as himself. Similarly to the conclusion reached by the participants at the end of Chronique , Godard demonstrates that within the frame of the camera it is impossible not to act, which calls into question the authenticity of any subject.
The soundtrack in Vivre sa vie is also treated in a very unrealistic manner. Throughout the film, Godard used music in a very interesting way and and an analysis of the timing of the visual and aural sequences suggests that he aimed to give his raw material a high degree of form, to impose abstraction on realistically shot material e.
This carefully worked-out choreography for the camera is abstract in the sense that it does not correspond to any dramatic or expressive necessity. From Vivre sa vie onwards Godard does not content himself with simply capturing and glorifying everyday life. Like all great artists, Godard is successful at reconciling these opposites, reality and abstraction, and his greatest films are built on the unavoidable tensions between the two Roud Writing with the camera.
Similar to Rouch and Godard, Varda also strongly believed in the power of the real. It faudrait cinq cameras qui marchent tout le temps et filment tout. This derives from her natural inclination for documentaries. Her films are solidly anchored in reality, she pays attention to the way people live and seems on the lookout for revealing details of their lives.
This lends an objectivity to her feature films and makes them reflect contemporary issues and concerns.
Moreover, many scenes were shot at the exact diegetic time, which means that the light was as realistic as possible e. This evidence was complemented and confirmed by primary data obtained through personnal communication with French diabetes experts from the Assistance Publique-Hopitaux de Paris AP-HP. The search strategy yielded articles, of which were excluded because they did not meet the inclusion criteria or they were superceded by more recent or more complete national data.
In the absence of an ongoing cohort or registry in France, the incidence of diabetes new cases per year is difficult to estimate.
However, data from the SHI funds provide a precise picture of the patients currently treated for diabetes. A type 1 diabetes registry was maintained from until and found an incidence rate of 9. Type 1 incidence has doubled in 30 years for the 0—15 age group and doubled in 15 years for the 0—5 age cohort. Incidence of combined type 1 and type 2 diabetes has been estimated based upon new admissions to the ALD program. The incidence rate of ALD admissions for diabetes reached per inhabitants in , which corresponds to approximately new cases [ 4 ].
Since , diabetes has had the highest prevalence among all ALD conditions, and the number of patients covered has doubled in the past 10 years [ 8 ]. From — a national program for type 2 diabetes focused on prevention, screening, the quality and organization of treatment, epidemiology and patient education and led to ongoing initiatives [ 12 ]. In addition, a national plan to improve the quality of life of persons with chronic diseases — has emphasized therapeutic education and improved epidemiological data collection as priorities [ 13 ]. Based upon random samplings of adult SHI beneficiaries who had received at least three reimbursements for oral antidiabetic medications or insulin over a month period, the ENTRED studies supplemented these data with hospitalization records, telephone interviews of physicians, as well as postal surveys of diabetic patients and their treating physicians.
Although the ENTRED studies were limited to patients who were treated pharmaceutically for diabetes, they have yielded important insights, particularly regarding the evolution of diabetes and related complications in France. In , Overweight increases the risk of developing type 2 diabetes three times, and obesity increases that risk seven times. In addition to addressing overweight and obesity, the expert committee for PNNS — has proposed more aggressive screening of persons with pre-diabetes, in particular those with glucose intolerance [ 16 ].
Currently, oral glucose testing fasting or non fasting in France is generally limited to pregnant women in order to diagnose gestational diabetes. The French government has recognized the critical role of the patient in managing chronic diseases such as diabetes. The project, which began as a pilot in and was expanded nationwide in early , has to date provided services to patients Participation is voluntary, and the services offered include telephone advice by specially-trained nurses as well as Internet-based support to ensure regular contacts with patients.
While such educational programs have been offered by a number of diabetes provider networks in France, the programming, financing and participation are heterogeneous. Only 2. The law sets standards for TPE programs, which are now subject to authorization by the regional health agencies. The education itself can take place one-on-one or in a group setting or both and must be evaluated to ensure that the objectives are met.
However, the financing mechanism for this initiative has not yet been defined. The National health authority is developing new tools for health professionals and patients with chronic diseases to facilitate the design of personalized patient pathways [ 21 ].
To date, guides and associated tools for four chronic diseases have been published and another four are being prepared, although diabetes is not among them. In France, screening for type 2 diabetes is done based on clinical signs e. Screening is done via a fasting serum glucose test.
The overall opportunistic screening rate over two years was Among those over age 45, the screening rate increased to Populations that may be missed by this targeted screening approach include those who do not use medical services and at-risk populations, such as homeless people. Treating diabetes is complicated because of the need to normalize the glycemic level and to address any cardiovascular risk factors or existing complications, while taking into consideration the individual needs and characteristics of the patient.
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Clinical treatment recommendations for type 2 diabetes have existed in France since , with the most recent revision issued in January [ 24 ]. The general philosophy behind the guidelines is that treatment should be individualized and thus evolve over time based on regular re-evaluation of all aspects of treatment: life style, therapeutic education and medication. Physicians appear to have a good awareness of the recommendations, [ 25 ] but they do not strictly apply them in managing their patients with type 2 diabetes [ 26 ].
Thus regular monitoring is essential to ensure appropriate and timely treatment of diabetes and its complications. There are only 1. The majority of endocrinologists In addition, pay-for-performance P4P incentives have been implemented to promote quality and efficiency in primary care. They do not change the basis of fee-for-service payment but offer additional remuneration to GPs meeting defined objectives.
Journée mondiale du diabète, 14 novembre 2014
Access to paramedical professionals appears to be limited. Such visits were generally related to insulin treatment and thus late in the evolution of type 2 diabetes. Dietitian visits are not covered by SHI, and consultations with podiatrists have only recently become covered for patients with grade 2—3 lesions [ 29 ]. There are no nurse practitioners in France.
With respect to diabetic eye disease, there is a lack of qualified professionals for ophthalmological screening, in part because there are no optometrists in France [ 30 ].