Douleurs et travail : aider le patient à garder un emploi

Introduction.— A significant part of the workers suffer from musculoskeletal pain (back pain,upper limb). Some of them are at risk to ose their job due to their health condition. Objective. — The aim of the article is to describe synthetically what actors and measure can be used in order to help a patient keep his/her job in spite of the pain. Results.— First place measures include a visit with the occupational physician before work resumption, part-time return to work and workplace accommodation.Second place measures require that a professional project is built by the patient supported by a knowledgeable person. These measures depend on the funding agency.They are devoted to compensate the work disability situation, and/or to provide the training required by the patient’s project. Discussion and conclusion. — Work disability prevention faces many challenges due to barriers between the stakeholders, scattering of the knowledge and the complexity of legislative issues.However, it remains possible provided the patient is committed and supported by a case manager in charge of coordinating the information and the stakeholders. Confidence and collaboration are key issues in the process.

Upscaling the porosity of the Callovo-Oxfordian mudstone from the pore scale to the formation scale; insights from the 3H-PMMA autoradiography technique and SEM BSE imaging

International audienceThe Callovo-Oxfordian mudstone (Meuse/Haute-Marne, France) is currently considered as the host rock barrier for a deep geological repository. The intimate relationships between the porosity and mineralogy of this host rock were investigated at the small scale (mu m-mm) and large scale (m-hm). At the small scale, we have adapted the H-3-PMMA autoradiographic method to inap the porosity of the Callovo-Oxfordian mudstone. The H-3-PMMA autoradiographic method was improved in terms of its spatial resolution. H-3-PMMA porosity maps were then compared to-homologous mineral maps (clay minerals, carbonates and tectosilicates) built from scanning electron microscopy images (using back-scattered electron imaging). Based on an inversion procedure, the specific porosity of each mineral group was estimated from the mineral and porosity maps. We found that the spatial distribution of porosity at the small scale is mainly controlled by the spatial distribution of the clay matrix (the average porosity of the clay matrix is 40-45%), whereas quartz and carbonate mineral grains have low porosities (0-4%). At the geological formation scale, the porosity and mineralogy distributions were determined by logging tool techniques (nuclear magnetic resonance and spectral gamma-ray). The coupled evolution of clay content and porosity with depth was analyzed according to the porosity/mineralogy relationship defined at the small scale. Finally, we modeled the evolution of the porosity of the Callovo-Oxfordian mudstone with depth by considering the clay content and the effect of physical compaction during burial

Growth and demise of the Jurassic carbonate platform in the intracratonic Paris Basin (France) : interplay of climate change, eustasy and tectonics

International audienceIt is usually very difficult to identify and quantify the relative influence of tectonics, eustasy and climateon carbonate system evolution from sedimentary records. In order to improve our understanding of these mechanisms, we have traced for the first time, the evolution of the eastern Paris Basin platform throughout the entire Jurassic period. This carbonate platform underwent eight successive growth and demise phases, with different depositional profiles ranging from ramps to flat-topped geometries. The eight carbonate growth periods are compared with the standard sea-level curves, local tectonic regimes and recently published oxygen-isotope and/or clay mineralogy databases. Prograding heterozoan facies along ramp profiles mark periods dominated by second-order eustatic sea-level rise, relatively cool sea surface temperatures, and mesotrophic and humid conditions (Hettangian, Pliensbachian, late Oxfordian, Tithonian). During these periods, variable detrital contents in the sedimentary succession hampered the efficiency of shallow-marine carbonate factories. Higher sea surface temperatures, oligotrophic and humid conditions associated with either eustatic sea-level rise or very high local subsidence occurred during the early Bajocian and the mid-Oxfordian. These seawater properties seem to have favoured the aggradation of scleractinian corals forming dome-shaped bioherm buildups. An oolitic and lime-mud carbonate system, deposited during the Bathonian second-order eustatic sea-level fall, is characterised by miliolid-rich micritic facies on a rimmed-ramp under stable, cooler and drier conditions. The secondorder maximum flooding associated with a sea surface temperature decline and/or a seawater eutrophication caused at least five carbonate demise periods (i.e. Toarcian, earliest late Bajocian, Callovian/ Oxfordian transition, earliest late Oxfordian and Kimmeridgian)

Consequences of individual chewing strategies on bolus rheological properties at the swallowing threshold

International audienceThe chewing process transforms food into bolus for a safe swallow. It is known that. humans adapt their chewing behavior to food product characteristics. This study. aimed at identifying individual chewing strategies of healthy consumers and determining. the respective consequences on bolus properties. For that purpose, the. chewing activity of 50 subjects was recorded during consumption of five model. cheeses. Boluses were collected at the swallowing threshold for rheological analyses. We found that 30% of subjects showed only slight adaptation of chewing activity to. product characteristics and thus produced boluses with different rheological properties. Among the 70% of subjects who adapted their chewing behavior, 57%. adapted their behavior via chewing time and 40% adapted their behavior via. chewing time and muscular contraction amplitude. Among the bolus rheological. parameters, only consistency was not influenced by chewing strategies. Hence, it. seemed to be a determinant factor of the swallowing threshold for these products

Time of administration of rabies immunoglobulins and adequacy of antibody response upon post-exposure prophylaxis: a descriptive retrospective study in Belgium.

: Data on rabies post-exposure prophylaxis (PEP) and the use of human rabies immunoglobulins (HRIG) in Belgium are scarce. The main objective of this study was to evaluate the timely administration of HRIG after rabies exposure. The secondary objective was to evaluate the adequate antibody response following PEP.&nbsp;: We reviewed all medical records from July 2017 to June 2018 of patients seeking care at, or referred to, the Institute of Tropical Medicine and the University Hospital, Antwerp for the administration of human rabies immunoglobulins following potential rabies exposure abroad or in Belgium. A timely response was defined as starting HRIG with a delay of ≤48 h and rabies vaccination in the first 7 days after exposure. Adequate antibody response was defined as a titer of &gt;5.0 IU/mL in case of bat-related exposure and &gt;3.0 IU/mL in case of exposure to other animals. Titers were measured 10 days after the last PEP vaccine dose, using the rapid fluorescent focus inhibition test (RFFIT).&nbsp;: Of the 92 cases treated with HRIG, 75 were evaluated. The majority of injuries were acquired in Asia (n = 26,34%) and in Western Europe (n = 18, 24%), of which 17 in Belgium. The five most frequently recorded countries overseas were Indonesia (n = 13), Thailand (n = 7), Morocco (n = 4), Peru (n = 3) and Costa Rica (n = 3). Administration of immunoglobulins was related to injuries by dogs (36%), monkeys (25%) or bats (22%). A timely response was observed in 16 (21,33%) and in 55 (73,33%) of subjects receiving HRIG (≤48 h) or rabies vaccine (&lt;7days) respectively. The mean time between exposure and the first administered dose of rabies vaccine and HRIG was 7.7 and 8.7 days, respectively. The mean delay for HRIG administration was 9.6 days and 6 days for abroad and inland risks, respectively. In 15 of 16 (94%) bat-related cases the antibody titer after full PEP was &gt;5.0 IU/ml. In 38 of 47 (81%) cases related to other animals the RFFIT titer was &gt;3.0 IU/ml. All low-responders received additional rabies injections.&nbsp;: This study showed a substantial time delay between the animal-related risk and the administration of HRIG, in particular when the injury occurred abroad. More targeted communication about the risks of rabies and preventable measures may reduce this delay. Furthermore, the antibody response was inadequate in some cases following full PEP administration according to the Belgian&nbsp;recommendation.</p