N Gendron

D M Smadja
email: david.smadja@aphp.fr

L Mauge

Auteur Correspondant D Smadja

When and what thrombophilia testing should be performed?

Disponible en ligne sur ScienceDirect le xxx L a maladie veineuse thromboembolique (MVTE) est une maladie multifactorielle résultant de l'interaction entre des facteurs de risque environnementaux, cliniques et biologiques. La thrombophilie biologique correspond à la présence d'un facteur de risque biologique acquis ou constitutionnel prédisposant aux thromboses.

CHEZ QUI ET QUAND RÉALISER UN BILAN DE THROMBOPHILIE ?

Le bilan de thrombophilie peut être utile pour le propositus (appréciation du rapport bénéfice/ risque dans la durée du traitement anticoagulant, nécessité d'augmenter parfois les doses d'héparine pour obtenir une héparinothérapie efficace en cas de déficit en antithrombine) et pour les apparentés asymptomatiques, en particulier les femmes en âge de procréer (prévention de la thrombose pendant la grossesse et le post-partum). Il est recommandé de ne pas réaliser de bilan de thrombophilie constitutionnelle systématique après un premier épisode de MVTE [START_REF] Sanchez | Recommendations of good practice for the management of thromboembolic venous disease in adults[END_REF] notamment après 50 ans que la thrombose soit provoquée ou non. Ainsi, il est suggéré de réaliser un bilan de thrombophilie constitutionnelle chez les patients ayant un premier épisode de thrombose veineuse profonde (TVP) proximale ou d'embolie pulmonaire (EP) non provoqué avant l'âge de 50 ans et avec une histoire familiale au premier degré de thromboses ainsi que chez les patients avec un évènement thromboembolique veineux récidivant (au moins un épisode de TVP proximale ou d'EP et au moins un épisode non provoqué, avant 50 ans) ou encore chez les patients ayant une thrombose veineuse non provoquée dans des sites atypiques. Dans les autres situations, compte tenu de la complexité d'analyse des dossiers et des conséquences thérapeutiques éventuelles, il est suggéré d'avoir un avis d'un centre expert en thrombose multidisciplinaire. Lorsqu'un bilan de thrombophilie constitutionnelle est indiqué, il est suggéré de rechercher, dans un laboratoire spécialisé, les anomalies suivantes : déficits en antithrombine (AT), protéine C (PC), protéine S(PS), mutations Leiden du FV (FVL) (nomenclature HGVS : F5 c.1601 G>A p.(Arg534Gln) ) et G20210A (HGVS : c. *97G>A) du gène F2, entre le 3 e et le 6 e mois après le diagnostic de thrombose. En cas de déficit en inhibiteur (AT, PC, PS), il est suggéré de déterminer le phénotype de manière précise, voire le génotype. En cas de thrombophilie constitutionnelle sévère identifiée chez le propositus (déficit en AT, PC, PS, double hétérozygote ou homozygote FVL et F2 G20210A) (Tableau I), il est suggéré de la rechercher chez les apparentés asymptomatiques. Il est alors recommandé d'adresser le sujet dans un centre expert en thrombose agréé. Des anomalies biologiques acquises sont également associées à un risque accru de thrombose. Ainsi, il est suggéré de rechercher un syndrome des antiphospholipides (SAPL) chez les patients de moins de 50 ans en cas de premier épisode de TVP proximale ou d'embolie pulmonaire non provoqué ou de thromboses de siège inhabituel ou de MVTE récidivante. Il est suggéré de rechercher un SAPL chez les patients en cas de TVP (proximale ou distale) ou d'embolie pulmonaire, quel que soit le contexte de survenue, en cas d'association à une nécrose cutanée ou en cas d'antécédent de pathologie vasculaire placentaire. Dans le cas d'un premier épisode non provoqué de MVTE avec une numération formule sanguine normale, il est suggéré de ne pas réaliser de recherche des mutations associées aux syndromes myéloprolifératifs, sauf en cas de thromboses de sites atypiques. De plus, il est suggéré de rechercher une hémoglobinurie paroxystique nocturne (HPN) en cas de thrombose de sites atypiques associée à des signes d'hémolyse et/ou à une cytopénie. Il n'y a généralement pas d'urgence à réaliser un bilan de thrombophilie. Il n'est pas recommandé de le faire à la phase aiguë de la thrombose (risque d'anomalies acquises), ni sous traitement anticoagulant (interférences avec les tests). Par ailleurs, dans certaines conditions physiologiques ou pathologiques, les dosages des inhibiteurs de la coagulation peuvent être impactés (déficits acquis ou interférences) (Tableau II). Cependant, la mise en évidence d'un SAPL ou d'un déficit en AT peut modifier l'attitude thérapeutique et nécessiter d'être identifiée rapidement. On peut donc être amené dans certains contextes à rechercher une thrombophilie chez un patient traité. Il est alors capital de renseigner le traitement en cours. La recherche d'un anticoagulant circulant de type lupique reste cependant délicate sous traitement anticoagulant : recherche possible sous héparine selon les réactifs, perte de sensibilité des tests sous AVK, risque élevé de faux positifs sous anticoagulant oral direct (AOD). Il est alors conseillé de réaliser les analyses auprès d'un centre expert.

QUEL BILAN DE THROMBOPHILIE RÉALISER POUR RECHERCHER UN FACTEUR DE RISQUE CONSTITUTIONNEL OU ACQUIS ?

La fréquence et le risque thromboembolique de première thrombose ou de récidive dépendent du type de thrombophilie (sévère ou non sévère) et sont détaillés dans le Tableau I. Les risques de thrombose étant cumulables, le bilan de thrombophilie comprend la recherche de plusieurs facteurs de risque biologiques, qu'ils soient associés à un haut ou un faible risque de récidive. Il comprend :

une numération et formule sanguine qui permettra de déceler un syndrome myéloprolifératif ou une anémie ; un bilan de coagulation de routine avec un TP et un Déficit en PS 0,03-0,5 % 1-2 % 1-10 1,0-1,4

Thrombophilie non sévère

FVL (hétérozygote) 3-7 % 20 % 3-5 1,2-1,4 F2 G20210A (hétérozygote) 0,7-4 % 6 % 2-3 0,7-1,4
a À noter que les premiers évènements thromboemboliques veineux peuvent se manifester après 50 ans chez les patients ayant une thrombophilie sévère.

En cas de thrombose veineuse non provoquée de sites atypiques, par exemple, une recherche de la mutation JAK2 (V617F) et/ou une recherche d'HPN (quantification de l'expression membranaire de protéines GPl-dépendantes des leucocytes et/ou des globules rouges par cytométrie en flux) peuvent être réalisées.

CONCLUSION

Le risque de thrombose étant multifactoriel, la réalisation d'un bilan de thrombophilie ne doit pas être systématique et il n'y a généralement pas d'urgence à le réaliser. Nous rappelons qu'il est recommandé d'adresser les patients dans un centre expert de thrombose agréé. Malgré la recherche de facteurs de risque biologiques, une grande partie des thrombophilies cliniques reste inexpliquée. La découverte récente de nouveaux polymorphismes associés au risque de thrombose par des approches de type GWAS (étude d'association pangénomique) ouvre de nouvelles pistes physiopathologiques à explorer.

Déclaration de liens d'intérêts

Les auteurs déclarent ne pas avoir de liens d'intérêts.

Tableau II. Dosages des inhibiteurs de la coagulation : antithrombine, protéine C, protéine S.

  Tableau I. Fréquence et risque thromboembolique des thrombophilies constitutionnelles.

		Prévalence dans la	Prévalence dans la	Risque relatif (RR)	RR de récidive
		population générale	population avec MVTE	de thrombose a	de MVTE
	Thrombophilie sévère
	Déficit en AT	0,02 %	1 %	15	1,9-2,6
	FVL (homozygote)	0,02 %	<2 %	10	1,2 (0,5-2,6)
	Double hétérozygote	0,1%	<2 %	10	1,0 (0,6-1,9)
	(FVL et F2G20210A)
	Déficit en PC	0,2-0,4 %	3 %	4-6	1,4-1,8
					TCA,
			sauf patient sous AOD ;
			le dosage d'activité des inhibiteurs de la coagulation : AT, PC
			et PS. En cas de déficit, il faut exclure une cause acquise et
			contrôler l'anomalie. Si une suspicion de déficit constitution-
			nel est confirmée, un typage plasmatique doit être réalisé.
			L'intérêt du génotypage a été montré récemment pour l'AT
			notamment, car il apporte des informations supplémentaires
			sur le caractère thrombogène des mutations, notamment
			dans le groupe HBS [2]. Il peut également permettre de
			diagnostiquer des mutations thrombogènes non associées
			à des déficits francs en inhibiteurs par les tests plasmatiques
			et d'aider au conseil génétique dans les formes récessives
			par exemple ;
			la recherche des mutations FVL et F2 G20210A (consen-
			tement nécessaire) ;
			la recherche d'un anticorps antiphospholipides (pour le diag-
			nostic de SAPL) qui inclus la recherche d'un anticoagulant
			circulant de type lupique, d'anticorps IgG anticardiolipine et
			anti-b2-glycoprotéine-I (b2GP1). La présence d'un anticoa-
			gulant circulant de type lupique et/ou d'anticorps anticardio-
			lipine et/ou d'anti-b2GP1 sur 2 prélèvements réalisés à au
			moins 12 semaines d'intervalle dans les 5 ans suivant une
			thrombose veineuse ou artérielle ou des complications obs-
			tétricales définit le SAPL.

  Pour le dosage de la protéine S, la méthode théoriquement la plus pertinente, à utiliser en première intention parce qu'elle est susceptible de dépister tous les types de déficits, est celle qui évalue l'activité de la protéine. Il a cependant pendant longtemps été recommandé d'utiliser la mesure de la PSL (protéine S libre) en première intention à cause du manque de spécificité des mesures d'activité. Avec les réactifs actuels, ces interférences sont atténuées et cette mesure peut être plus largement proposée. c Selon les réactifs utilisés.Pour citer cet article : Gendron N, et al. Quand et quel bilan de thrombophilie réaliser ? Arch Mal Coeur Vaiss Prat (2020), https://doi.org/10.1016/j.amcp.2020.03.008

	Quand et quel bilan de thrombophilie réaliser ?	Dossier / Fiche technique
		Antithrombine	Protéine S	Protéine C
	Test de dépistage d'un déficit a Activité cofacteur de l'héparine	Activité cofacteur de la PC	Activité anticoagulante
			activée b
	Valeurs de référence	80-120 % (à partir de	Homme 60 %	70-140 % (à partir de 15 ans)
		6 mois-1 an)
			Femme < 50 ans 50 %
			Femme > 50 ans 55 % (à partir
			de 6 mois)
	Interférences dans les	AOD (en fonction du réactif	Taux élevés de FVIII c
	dosages	utilisé et de l'AOD)
			Facteur V Leiden c
			Présence d'anticoagulant
			circulant de type lupique
			Héparines c , AOD
	Déficits acquis	Atteinte hépatique	Atteinte hépatique	Atteinte hépatique
		Phase aiguë la thrombose	AVK ou hypovitaminose K	AVK ou hypovitaminose K
		CIVD	Phase aiguë la thrombose	Phase aiguë la thrombose
		Syndrome néphrotique	CIVD	CIVD
		Traitement par HNF	Syndrome néphrotique	Syndrome néphrotique
		Traitement par L-asparaginase	Grossesse	Auto-anticorps
			Oestroprogestatifs
			Auto-anticorps
	Types de déficits	Type I : quantitatif	Type I : quantitatif	Type I : quantitatif
	constitutionnels
		Type II : qualitatif (IIRS [reactive	Type II : qualitatif	Type II : qualitatif (II AM : défaut
		site] : anomalie du site		de l'activité amidolytique de la
		réactionnel ; IIHBS [heparin-		PC ; II AC : défaut de l'activité
		binding site] : défaut de liaison		anticoagulante de la PC non lié
		à l'héparine ; IIPE [pleiotropic] :		à un défaut de l'activité
		modification de la stabilité de la		amidolytique)
		protéine)
				3

AOD : anticoagulant oral direct ; CIVD : coagulation intravasculaire disséminée ; HNF : héparine non fractionnée. Caractères en gras : classification des types de déficits. Caractères en italique : terme en anglais. a Méthode recommandée pour dépister tous les types de déficits. b

N. Gendron et al. Dossier / Fiche technique 2 Pour citer cet article : Gendron N, et al. Quand et quel bilan de thrombophilie réaliser ? Arch Mal Coeur Vaiss Prat (2020), https://doi.org/10.1016/j.amcp.2020.03.008


Fabrice Pataut

Charles Sanders

TRUTH AND MODALITIES (I) 1

Keywords: NAMES. Bivalence, Contingency, Disquotation, Knowability, Modalities, Necessity, Possibility, Semantic Realism, Truth ; Bernays (Paul), Dummett

I contrast two construals of the thesis that truth is independent of verifiability in principle: a modal one and a non modal one. I argue in favor of the modal construal and then, on that basis, that independence holds across the board, i.e., even for statements that are verifiable by us relative to familiar, customary, non-skeptical standards.

Realism and independence

In what might turn out to be the fundamental sense of the word "realist," inherited from Michael Dummett, a realist about a given class of statements holds that the statements of that class could be true even though we ignore that they are. Their truth, the realist claims, is independent of our ability to recognize the fact by the appropriate means (see, e.g., Dummett [1973] 1978).

This formulation of the doctrine raises a crucial issue for both realists and their opponents. Should the realist be ready to argue for the independence claim and the antirealist for its rejection even when we happen to be able to acknowledge the truth of the statements of some disputed class? Or, on the contrary, should the realist restrict its scope so that the claim applies to pro tempora undecided statements only, and the antirealist rest content with it as far as statements that are verifiable by normal, customary, non-skeptical standards are concerned? Dummett and most of his opponents share the conception that the realism vs. antirealism debate exists for pro tempora undecided statements only and that decidable or verifiable statements are immune to the disagreement, so that whenever, e.g., proofs are available in mathematics, or data (behavioral or otherwise) may be gathered for statements about the mental states of others, or evidence pro or con may be recovered now or at some later time for statements about the past, the statements belonging to these particular classes are immune to the disagreement. This, I shall argue, is mistaken.

If the modal construal of the realist doctrine is chosen, the realist is de facto committed to the view that the statements of some disputed class, if true, are so whether or not we are in a position to acknowledge their truth or are able to put ourselves in that position. At first blush, it seems that this is what independence means, implies or is about, and that the realist's contentious claim must accordingly be construed as holding across the board, i.e., for classes of decidable statements and for classes of pro tempora undecided ones alike without discrimination. The claim to the effect that the two cases are substantially dissimilar would be invidious and the reason for this lies in our understanding of the notion of independence. Independence is a matter of autonomy or self-sufficiency. For a thing A (say, truth) and another thing B (say, its recognizability by us) to be independent from each other, it must the case that A could obtain, or be instantiated, or make sense, without B also obtaining, or being instantiated, or making sense.

In the case we're considering here, it isn't so obvious the converse should hold. It might seem on the contrary that if B obtains, A thereby does simply because when the appropriate recognitional abilities with respect to truth are correctly activated, or could be, truth is thereby secured, or could be (provided skepticism isn't an option). If it turns out that some statement is true once our inquiry has reached completion, or would should we decide to inquire, then its truth isn't independent from its actual recognition or in principle recognizability by us (at least not anymore). In other words, one might complain that whenever the appropriate capacities are successfully activated, or may be, dependence, rather than independence, is our lot. Now if one is generous and lenient rather that strict and inflexible with respect to the notion that should replace truth or constrain it in the antirealist perspective, a different conclusion might be drawn. If one takes truth to be truth à la Peirce in the long run of scientific discovery (see [START_REF] Peirce ( | What Pragmatism Is[END_REF] 1998), it still might be argued that since B doesn't yet obtain and will obtain only in an idealized epistemic state we still are very far from, A is in a perfectly legitimate sense independent from B. Only a strict construal of the antirealist position according to which truth is to be acknowledged in a finite number of steps, say by way of verification in polynomial time so that the feasibility of the verification is garanteed, would warrant the conclusion to the effect that the converse also holds.

Although the disagreement about the weak vs. the exacting construals is a genuine one as far as the strength of the position to be defended by Dummett's antirealist is concerned, it would be a mistake to argue that the dissent threatens in any way the workableness or intelligibility of the opponent's position. A realist defending the modal claim isn't disputing the truth of actually verified statements (whether or not the verification is carried out in polynomial time, or in some non polynomial yet suitably short time). The crucial point, rather, is that statements that are either conclusively verifiable in the long run of our inquiry, or actually verified by us in some specified short span of time, logically could be true even though not (as in fact they are), either verifiable in principle or actually verified by us hic et nunc (see, e.g., Loar 1987: 85) 2 .

If that is so, then it would seem that for any s of some disputed class:

(1) ◊ (s is true • s is unverifiable by us) holds just because there is no link or connection, either conceptual or practical between truth and its recognition. The two are mutually independent in two different albeit related ways : in the sense that no notion or concept of recognition, either feasible or in principle, may be extracted from the notion of truth, as if were analytically, and in the sense that no practical use or exercise of recognitional capacities fitted for s's area of discourse may constrain truth (or allow us to eschew it altogether).

Several points might be at stake here, related either to concepts or practices, and we must accordingly distinguish between them.

First, there is the claim that no inconsistency, or logical contradiction, or paradox, is implied in our holding (1) or follows from it: (1) is consistent with the laws of logic and nothing downright illogical follows, either from its assertion or from what logically follows from it. 3 Secondly, there is the contention that no entrenched cognitive shortcoming makes it impossible for us to grasp one (the truth of s) without 2. Whether or not this also commits us to the view that truth is a substantial property, over and above disquotation, is a further problem I shall consider later on. 3. There is, of course, a disagreement regarding which laws have to be counted as the laws of logic, so that one might object that what is consistent with the laws of some logic, or what logically follows from them, turns out to be inconsistent with the laws of another one and not follow at all from its laws. I shall go back to this crucial point of this particular formulation or aspect of the independence claim later on. thereby grasping the other (the verifiability of s by us). 4 This may be construed as a negative claim about concept formation: there is no reason to believe that we cannot form a bona fide concept of truth not constrained by whatever appropriate epistemic notion would constrain it in the antirealist perspective, given the area of discourse the statement belongs to, e.g., proof in the mathematical case.

One may also give a Kantian flavour to the debate and turn it into a debate over whether or not it is necessary for us to conceive of truth, or to represent truth as being constitutively linked to the conditions of its recognizability by us. Under that construal of the realist proposal, the advocate of (1) would be opposing a Kantian or neo-Kantian point to the effect that in order for truth to be a proper object of cognition, some a priori conditions have to be met regarding its accessibility to us. In yet other words, the advocate of (1) would be rejecting the view that in order for the truth of any s to be grasped at all, the following epistemic necessity should hold:

(2) (s is true → s is verifiable by us).

The modal notion to be rejected by the realist would have to be epistemic because the necessity at play here would have to be unpacked as a notion that embeds the conditions that have to be satisfied or fulfilled in order for 4. This formulation is the one closest to Dummett's concern. Dummett's antirealist claims that our understanding of a statement, or of a statement's meaning consists in a mastery of its verifiability conditions, so that we have no bona fide grasp or understanding of its verification-transcendent truth conditions, i.e., of what it would be like for that statement to be true independently of our possibly acknowledging its truth. See, e.g., Dummett [1973] 1978 and Loar 1987, especially at pages 85-86. truth be known or grasped at all by us (as opposed to a notion that would have to be grasped by other beings with a different cognitive set up), so that a bona fide notion of truth must abide by (2).

One might want to recall here the Kantian distinction between the conceptual properties that objects of kind X possess in general (as opposed to the individual properties that some particular instances of X don't share with other particulars of the same kind) from the intuitional properties that all X possess insofar as they are objects of our intuition. The Kantian point is that these so-called intuitional properties may not be extracted, either from the general concept or from the individual instances. The neo-Kantian point would be that for the truth of any s to be grasped or acknowledged at all, the truth-conditions of s must possess properties that allow these conditions to be the object of our cognition (whether or not of an intuitional kind). So there is no choice: the modal operator in (2) must be read as epistemic. In yet other words, given the relevant information we are able to gather about how the world is, i.e., given the way the truth-conditions of our statements about the world are fulfilled when they are, our claims regarding these conditions must be construed as being about how things must be given our information about how the world in fact is, rather than claims about how things must be in all the various ways the world could have been.

There are of course crucial differences between these standpoints, to which I shall return. For the time being one might perhaps unpack the realist standpoint at stake in the debate in the following way. One difficulty in this respect is due to the difference between the view according to which the concept of verifiability in principle, or of actual verification, is already included in the notion of truth, and the view according to which the capacities that have to be activated in order to establish truth constrain the semantic notion. The first one might be called a containment view, the second, a recognitional view.

Independence with respect to the possibility of truth determination doesn't as it were vanish, when, as a matter of contingency, the possibility becomes actualized, i.e., when we happen to possess the abilities which must be activated in order for us to decide the truth of statements of a given class and when we succeed in carrying out proofs, or in gathering empirical evidence.

The possibility of recognition, verification or acknowledgement is a genuine or natural one (provided that we disregard skeptical standards) and there is no reason to think that it may (or indeed must) always be activated, or that we can't make sense of evidential relations between us and the truth of some s breaking down so that s's truth conditions are divorced from its assertability conditions.

If that line of argument is correct, the realist is indeed committed to the view that what makes the statements of the disputed class true is something which is not intrinsically connected to the means of recognition we must appeal to when acknowledging truth, i.e., proofs in the mathematical case and the identification and gathering of defeasible, partial and gradual evidence in the empirical case. This lack of constitutive or intrinsic connection between the truth-makers of statements and our human capacities of recognition might perhaps be illustrated by the platonist standpoint in the philosophy of mathematics when, e.g., mathematical statements of an axiomatized theory are taken as privileged examples.

Paul Bernays, comparing Euclid's axiom system to Hilbert's, writes:

[…] Euclid speaks of figures to be constructed,* whereas, for Hilbert, system of points, straight lines, and planes exist from the outset. Euclid postulates: One can join two points by a straight line; Hilbert states the axiom: Given any two points, there exists a straight line on which both are situated. "Exists" refers here to existence in the system of straight lines.

This example shows already that the tendency of which we are speaking consists in viewing the objects as cut off from all links with the reflecting subject.

Since this tendency asserted itself especially in the philosophy of Plato, allow me to call it "platonism."

* The italics are provided by Charles Parsons in his translation from the French.

Paul Bernays [1935] 1983 : 258-259 Should anyone holding (1) and rejecting (2) follow that tendency and view both the objects and the statements about them as cut off from all links with the abilities we have at our disposal in our capacity as reflecting subjects?

Dummett's antirealist quite naturally resists the inclination Bernays writes about here. The question we're asking now is whether his opponent should be in agreement with him when considering classes of decidable or verifiable statements.

Dummett's views on meaning strongly suggest that he should. This is where what I've called the recognitional view, as opposed to the containment view, comes into the picture. If, as Dummett's contends, our understanding of the meaning of any statement whatsoever, either decidable or not, consists in a mastery of its verifiability conditions, it follows that we cannot have any mastery or bona fide understanding of what it would be like for a statement to be both true and unverifiable by us. There is just no way for us to master such conditions, or indeed form in any way a bona fide concept of them.

Part of the explanation of why a Dummettian antirealist will reject the modal claim under any construal comes from the way the satisfiability of the manifestability requirement for the decidable cases is construed. We may agree with Dummett's antirealist that when the statements are decidable, our grasp or mastery of their verifiability conditions is exhaustively manifested by our actually deciding the statements or by showing that we are in a position to do so. This is obviously not something we may do when the statements are pro tempora undecidable. A knowledge that a statements's truth-conditions are satisfied, no matter how it may be manifested, cannot be equivalent to a knowledge that the very same conditions could be fulfilled unbeknownst to us.

In yet other words, we cannot achieve a mastery of the verification-conditions of either (1), or of the non-modal (3) (s is true • s is unverifiable by us).

The proposal, as offered by Dummett in Dummett [1973] 1978, is neverthless unsatisfactory as far as independence is concerned for the following reason.

The observation that the first knowledge or mastery may be manifested in a certain way gives us no clue as to how the second might be manifested. If we unpack the contrast put before us at the disadvantage of the pro tempora undecided cases, what we are being offered is a remark to the effect that a knowledge or a mastery of the truth-conditions of particular instances of "it is possible that s is true although we ignore it" is not something that may be construed on a par with a knowledge or a mastery of the truth-conditions of instances of s when s is decidable. It cannot indeed because if we were to look for a justification of our inability to verify s, we would have to begin by attempting to verify s. Our failure to decide the pro tempora undecided s should lead us to conclude that the negation of s holds. Once the negation of s is established, the road to an establishment of the independence of the truth of s is closed. It isn't possible to show that s is absolutely neither provable nor refutable: intuitionistic negation forbids this. 5 In other words, there is no way of manifesting a mastery or knowledge of the truth-conditions of instances of the modal claim that could satisfy Dummett's antirealist 5 See Dummett 1977: 17. constraints on truth given the intuitionistic reading of negation is presupposed (as opposed to justified).

Another important point must be stressed concerning the neo-Kantian construal of (2) in relation to the logical constant for negation. What is claimed here is that the only bona fide notion of "the truth of s" we may grasp, for any s, is one according to which these conditions are constrained by knowledge. There are no "things in themselves" embedded in such conditions. We might perhaps be able to think of them somehow as things in themselves, but we cannot cognize them as things in themselves (see [START_REF] Kant | Critique of Pure Reason[END_REF]Kant [ , 1787] ] 1997: A35/B51, B69, B36, A360 and Allison 2004). Just as we credit ourselves with a grasp of the meaning of a classical constant we, as a matter of fact, can't achieve when making inferences using classical negation, e.g., when eliminating double negation, we credit ourselves with a knowledge we do not possess when we credit ourselves with a grasp of the possibly verification transcendent truth conditions of our statements, whether atomic or complex (i.e., built up from atomic statements by a finite application of rules governing the logical constants). We might able to think or to represent such meaning and conditions as cut off from the way we fix the meaning and grasp the conditions, but the thought or representation thereby obtained is without any genuine cognitive content.


For people of recent immigrant background the challenges of access to vegetable gardens are increased tenfold by the difficulties of accessing products corresponding to their food crops (not marketed or too expensive).

It is these differences in gardening practices that elicit the most hostile reactions, since they do not correspond to the standardized plot shapes sought by local associations and communities (the main argument for dismissing these households from the association).

In order to cultivate the fruits and vegetables of the country of origin (mainly Spain, Portugal, Maghreb and Southeast Asia), the pedo-climatic conditions are artificially reproduced : construction of large greenhouses, covering of the plot, collectivization of the plot...

"The portuguese come with their

cinder blocks, it concretes everything and then hello the price of the work to destroy" "(water bindweed) is 17€ a bunch and only on the parisian markets [...] here I have 5m² and for almost nothing, I bought the seeds from Cambodia"

Pluvinage M., Weber F., 1992, Les jardins populaires : pratiques culturales, usages de l'espace, enjeux culturels, Ministère de la culture, 211 p.

Indicative bibliography

The case of allotment gardens of three north-western France agglomerations Between the fight against inequalities in access to quality food and the response to the diversity of food cultures: what place for vegetable production?

Conclusion

Interrogating the functions attributed to plots through spatial analysis

When they were created by the Catholic Church at the end of the 19th century, allotments had three objectives : to fix the populations resulting from the rural exodus thanks to a new attachment to the land, to provide food aid to modest households and to stop the spread to epidemics.

Allotment/worker gardens

Clustering of separate vegetable plots at a distance from the houses. 11% of recreational plots (less than 40% of the surface is cultivated). 51% of food plots (more than 60% of the surface is cultivated). 12% of plots that tend towards recreation (between 40% and 50% of the surface is cultivated).

16% of plots that tend towards food crops (between 50% and 60% of the surface is cultivated).

During the last century, the profiles of the beneficiaries have changed considerably : from a relatively homogeneous group of workers to a more diverse public with the arrival of more privilegied social categories. These evolutions modify the functions attributed to the garden plots as well as the consideration by the public authorities.

During each crisis (economic, social, wartime), the food function of these spaces are reinvested. In the current context of general inflation of consumer prices, the question of food insecurity is again at the heart of social concerns.

From a scientific point of view, allotments are studied through the prism of the sociological profiles of the beneficiaries (Pluvinage et al., 1992) and the functions attributed to the plots (Guyon, 2008). Their food function has been reexamined since the 2008 crisis (Pourias, 2014& Marie, 2019).

The idea here is to question the allotment gardens as a potential corrective lever of the inequalities of access to food. Particular attention will be paid to people of recent immigrant origin whose food insecurity is increased tenfold by the difficulties of access to products corresponding to their food cultures.

Rouen (Jégat, 2021) Some characteristic differences of the gardeners surveyed (Jégat, 2021) Some characteristic differences of the study areas (Jégat, 2021) 72% of respondents see their plots primarily as a space for growing vegetables.

Research context

Alençon

Vegetable production leads to a change in eating practices. The sociological profiles of the beneficiaries surveyed seem relatively homogeneous : men (75%), retired (71%) and belonging to the working classes (69%). We then see a marginalization of beneficiaries with social or cultural differences(women, households from more privilegied social categories, people from recent immigration and youg working people), notably due to a different vision of the garden(representation of the beautiful garden and its functions, distribution of roles in the household, types of production, etc).

Sampling for a questionnaire survey of 592 allotment holders in the three study agglomerations (direct award in 2021 and 2022).

While the food functions of urban agriculture are often forgotten in favor of its social and environmental functions, the poster attempts to recall its centrality for modest households from the working classes.

For beneficiaries of recent immigration, the importance of access to a vegetable plot is tenfold : access to better quality products than those available through the market, products corresponding to the food culture & social integration in the neighborhood via the cultural community. For these households, access to a garden is complicated by various obstacles : acceptance by the gardening community of specific cultivation practices, access to the association (language barrier) and preservation of garden plots large enough to accomodate production. In spite of the evolutions of the last decades, the allotment gardens still seem to meet their basic objective: to facilitate the access to good quality food products to modest housholds coming from the working classes. During the last 20 years, the site will be qualified as a "lawless zone" by the residents (mafia-like management, sale of plots of land, thefts, illicit businesses, etc.). This lack of regulation leads to a picturesque spatial appropriation by the beneficiaries: constructions, collectivization of land, sale, etc.

In 2020, the "Régie de quartier" (city policy) will take over the management of these spaces. To meet the influx of requests, a major transformation of the site is envisaged (division of plots, opening up, collective spaces, etc.). For the current beneficiaries, more than 90 % of whom are recent immigrants, the futur is feared: for them, the garden is a space for "intensive" vegetable cultivation. Indeed, each year more than 30 tons of vegetables are produced in these allotments (according to Marie, 2019).

Distribution of the functions attributed to the allotment plots in the three agglomerations

To question the food function of allotments. Three main parts : appropriation of the plot, vegetable production and collection of social properties.

Allotment gardeners : a socially homogeneous population?

Distribution of respondents in each study site 71 groups of gardens : 37 in Rouen, 24 in Caen and 10 in Alençon.

3025 garden plots or 75 hectares.

57% of the cultivable area (72ha) is cultivated (41ha) : 60% in Rouen, 53% in Caen & 48% in Alençon.

Census of allotment sites from aerial images.

Crop ratio calculations at the plot, site and study land scales.

68% are used for food production (at least half of the cultivable area is cultivated) versus 22% for recreation (less than half of the cultivable area is cultivated) ; 10% are not allocated (not cultivated).

Distinction of the functionnal trend of each plot.

Cultivated area (vegetable gardens + greenhouses)

Cultivable area (plot -hut) Digitalization of each plot & of the vegetable gardens, huts and greenhouses.

x 100

The importance of the food-producing function varies between the fields, but also within them, in relation to the sociological profiles of the beneficiaries and local public policies (see table below).

≠

  shared gardens & community gardens. s 9% of unallocated plots (no crops).

  of «let it happen» by the garden associations Territorial food project, «prorecreation» actions Territorial food project(actions aimed at the CSP+) & old model in the working class communes Context 50,000 inhabitants, aging populationstill linked to rural areas. 200,000 inhabitants, reduced industrial past. 450,000 inhabitants, persistence of industry.

  Tropical greenhouse & onion monoculture(Jégat, 2021) Created in the 1970s for the workers of the adjoining factory (Moulinex), the allotment gardens of the Perseigne neighboorhood (Alençon) have more than 150 plots of 400m².

Tendfold challenges for immigrant gardeners?

		% from an			% more than
						% foodcrops
		agricultural	% retired	% family activity	300€/year for
						production
		background			the garden
	Born in France(469 enq)	14%	75%	18%	16%	86%
	Born outside(121 enq)	47%	54%	32%	25%	79%
	Men(446 enq)	20%	74%	18%	18%	88%
	Women(146 enq)	23%	62%	30%	18%	74%
	Overall(592 enq)	18%	71%	21%	17%	84%

Marie M., 2019, "Estimation de la contribution de la production potagère domestique au système alimentaire local", Vertigo -la revue électronique en sciences de l'environnement, n°19, 22 p. Hochedez C., 2020, "La nature jardinée à l'épreuve de la société suédoise multiculturelle. Espaces et pratiques de la nature urbaine à Malmö et Göteborg (Suède)", Annales de géographie, n°736, p. 55-83 Pourias J., 2014, Production alimentaire et pratiques culturales en agriculture urbaine. Analyse agronomique de la fonction alimentaire des jardins associatifs urbains à Paris et Montréal, Thèse de doctorat en sciences agronomiques, AgroParisTech et Université de Quebec, 292 p.