Réseau de prise en charge de la lombalgie chronique

ObjectifsIls sont d’étudier l’efficience d’un réseau de santé de maintien dans l’emploi pour les patients lombalgiques chroniques, d’appréhender la réalisation des aménagements du poste de travail des lombalgiques ayant une inadéquation santé/travail et également d’apprécier la communication interprofessionnelle entre le médecin du travail et les autres intervenants du réseau. Méthodes Étude descriptive et rétrospective, réalisée par questionnaires envoyés aux 53 médecins du travail de 88 patients inclus dans le réseau Lombaction. Étaient inclus dans l’étude tous les lombalgiques chroniques adressés initialement à la consultation pluridisciplinaire du réseau par leur médecin du travail, leur médecin traitant ou leur médecin rééducateur, et ayant ensuite bénéficié d’un programme de réentraînement à l’effort dans le cadre du réseau en 2006. Résultats Soixante cinq questionnaires ont été remplis par 43 médecins du travail (soit 73,9 % de réponses). Les indicateurs de santé au travail montrent le caractère handicapant des lombalgies présentées par les patients. Le maintien dans l’emploi est majoritairement obtenu grâce soit à une amélioration clinique liée au programme Lombaction de réentraînement à l’effort, soit à un aménagement du poste de travail ou à la combinaison des deux. Une intervention ergonomique, afin de contribuer à l’effort de maintien dans l’emploi, est vivement souhaitée par les médecins du travail. Toutefois le réseau Lombaction souffre d’un manque de communication entre les différents intervenants, qui nuit à l’interdisciplinarité requise à tout réseau de santé. Conclusion La prise en charge des lombalgiques chroniques par le réseau Lombaction se doit d’être interdisciplinaire au-delà de la consultation pluridisciplinaire d’inclusion. Cela nécessite du temps et une confiance partagée entre les différents acteurs de ce réseau de santé. L’information au sein du réseau promue par le coordinateur du réseau, en particulier sur les missions de chacun des intervenants, doit contribuer à décloisonner le programme Lombaction et à parfaire l’interdisciplinarité au profit des patients

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International audienceThe GANIL facility consists of three successive cyclotrons. The tuning of these cyclotrons and of the transfer beam lines isachieved in about 24 hours. Reducing this setting time would enable to increase the time allocated to physics experiments.New tools are realized for automatic beam tuning. These tools are expected to make the tuning easier, shorter and morereproducible

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International audienceThe GANIL facility consists of three successive cyclotrons. The tuning of these cyclotrons and of the transfer beam lines isachieved in about 24 hours. Reducing this setting time would enable to increase the time allocated to physics experiments.New tools are realized for automatic beam tuning. These tools are expected to make the tuning easier, shorter and morereproducible

Effectiveness of three treatment strategies on occupational limitations and quality of life for patients with non-specific chronic low back pain: Is a multidisciplinary approach the key feature to success: study protocol for a randomized controlled trial

BACKGROUND: Chronic low back pain (cLBP) is a significant public health problem, being the primary cause of work absenteeism, as well as affecting sufferers\u27 quality of life, in industrialized society. International guidelines recommend intensive multidisciplinary approaches for patients with cLBP. However, these costly and time-consuming programs can only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements. Lighter programs may be an alternative to full time hospital-based programs with valuable results in terms of disability and occupational activity for cLBP patients. It is therefore important to define both what the determining components of management to improve activity restriction are and how to treat a larger number of patients more effectively at a lower cost. The aim of this study is to compare three programs with various levels of intensity and multidisciplinary. METHODS/DESIGN: This paper describes the protocol for a prospective, randomized, controlled, clinical trial in working aged patients with cLBP. Three treatment strategies are compared: (1) intensive and multidisciplinary program conducted in a rehabilitation center; (2) less intensive outpatient program conducted by a private physiotherapist; (3) mixed strategy combining the same out program with a multidisciplinary intervention. The primary outcome of the trial is the impact of the mixed strategy on being able to work compared to hospital centered-program and out program. The secondary outcome is the impact of the mixed strategy on quality of life and social ability compared to the two others programs. The intervention part of the trial programs will take 5 weeks and observational follow-up will take 12 months. The sample size will be 180 participants (60 for each arm). The project has been approved by the Ethical Committee of Angers Hospital, France. DISCUSSION: On the hypothesis that a multidisciplinary approach is the key feature to programs success in reducing social and occupational impairment in cLBP patients, we suggest that it is possible to achieve the same results with less intensive strategies if a multidisciplinary approach is maintained. TRIAL REGISTRATION: Current Controlled Trials NCT02030171

Biogeographical Patterns of Species Richness and Abundance Distribution in Stream Diatoms Are Driven by Climate and Water Chemistry

In this intercontinental study of stream diatoms, we asked three important but still unresolved ecological questions: (1) What factors drive the biogeography of species richness and species abundance distribution (SAD)? (2) Are climate-related hypotheses, which have dominated the research on the latitudinal and altitudinal diversity gradients, adequate in explaining spatial biotic variability? and (3) Is the SAD response to the environment independent of richness? We tested a number of climatic theories and hypotheses (i.e., the species-energy theory, the metabolic theory, the energy variability hypothesis, and the climatic tolerance hypothesis) but found no support for any of these concepts, as the relationships of richness with explanatory variables were nonexistent, weak, or unexpected. Instead, we demonstrated that diatom richness and SAD evenness generally increased with temperature seasonality and at mid- to high total phosphorus concentrations. The spatial patterns of diatom richness and the SADmainly longitudinal in the United States but latitudinal in Finlandwere defined primarily by the covariance of climate and water chemistry with space. The SAD was not entirely controlled by richness, emphasizing its utility for ecological research. Thus, we found support for the operation of both climate and water chemistry mechanisms in structuring diatom communities, which underscores their complex response to the environment and the necessity for novel predictive frameworks.Peer reviewe

Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial.

STUDY DESIGN: Randomized parallel group comparative trial with a 1-year follow-up period. OBJECTIVE: To compare in a population of patients with chronic low back pain, the effectiveness of a functional restoration program (FRP), including intensive physical training and a multidisciplinary approach, with an outpatient active physiotherapy program at 1-year follow-up. SUMMARY OF BACKGROUND DATA: Controlled studies conducted in the United States and in Northern Europe showed a benefit of FRPs, especially on return to work. Randomized studies have compared these programs with standard care. A previously reported study presented the effectiveness at 6 months of both functional restoration and active physiotherapy, with a significantly greater reduction of sick-leave days for functional restoration. METHODS: A total of 132 patients with low back pain were randomized to either FRP (68 patients) or active individual therapy (64 patients). One patient did not complete the FRP; 19 patients were lost to follow-up (4 in the FRP group and 15 in the active individual treatment group). The number of sick-leave days in 2 years before the program was similar in both groups (180 ± 135.1 days in active individual treatment vs. 185 ± 149.8 days in FRP, P = 0.847). RESULTS: In both groups, at 1-year follow-up, intensity of pain, flexibility, trunk muscle endurance, Dallas daily activities and work and leisure scores, and number of sick-leave days were significantly improved compared with baseline. The number of sick-leave days was significantly lower in the FRP group. CONCLUSION: Both programs are efficient in reducing disability and sick-leave days. The FRP is significantly more effective in reducing sick-leave days. Further analysis is required to determine if this overweighs the difference in costs of both programs

HUWE1 E3 ligase promotes PINK1/PARKINindependent mitophagy by regulating AMBRA1 activation via IKKa

The selective removal of undesired or damaged mitochondria by autophagy, known as mitophagy, is crucial for cellular homoeostasis, and prevents tumour diffusion, neurodegeneration and ageing. The pro-autophagic molecule AMBRA1 (autophagy/beclin-1 regulator-1) has been defined as a novel regulator of mitophagy in both PINK1/PARKIN-dependent and -independent systems. Here, we identified the E3 ubiquitin ligase HUWE1 as a key inducing factor in AMBRA1-mediated mitophagy, a process that takes place independently of the main mitophagy receptors. Furthermore, we show that mitophagy function of AMBRA1 is post-translationally controlled, upon HUWE1 activity, by a positive phosphorylation on its serine 1014. This modification is mediated by the IKKα kinase and induces structural changes in AMBRA1, thus promoting its interaction with LC3/GABARAP (mATG8) proteins and its mitophagic activity. Altogether, these results demonstrate that AMBRA1 regulates mitophagy through a novel pathway, in which HUWE1 and IKKα are key factors, shedding new lights on the regulation of mitochondrial quality control and homoeostasis in mammalian cells

MONOBOB II : Latest results of monocharged ions source for SPIRAL2 project

Original publication available at http://www.jacow.orgInternational audienceAmong the sources which can be installed in the radioactive ion production module of SPIRAL II, a singly-charged ECRIS has been chosen to produce ions from gaseous elements. Its characterization is under way on a test bench at GANIL. Extraction, transport and response time results are presented

Permanent magnets under irradiation and radiocative alkali ion beam development for SPIRAL1

International audienceUp to now, eighteen Target Ion Source Systems (TISSs) have been built and used for the production of radioactive ion beams on SPIRAL 1 facility, based on the Isotope- Separator-On-Line (ISOL) method. The TISSs are composed of thick carbon targets and of fully permanentmagnet Electron Cyclotron Resonance Ion Sources (ECRISs) of the Nanogan III type. After irradiation and a decay period of two years, the irradiated TISSs are dismounted and if their magnetic fields are still suitable, the ECRIS are used with a new target. Thereby thirty-two runs have been performed using new or renewed TISSs. , After irradiation, the measured magnetic field sometimes reveals magnet damage. Our experience is reported here. In the second section, we present the progress on the NanoNaKE setup, which aims to extend the radioactive ion beams in SPIRAL 1 to the alkali elements, by connecting a surface-ionization source to the Nanogan III ECRIS via a compact 1+ ion beam line. The main issues and difficulties are discussed and the preliminary solutions are described