Integrated obesity care management system -implementation and research protocol

<p>Abstract</p> <p>Background</p> <p>Nearly 50% of Canadians are overweight and their number is increasing rapidly. The majority of obese subjects are treated by primary care physicians (PCPs) who often feel uncomfortable with the management of obesity. The current research proposal is aimed at the development and implementation of an innovative, integrated, interdisciplinary obesity care management system involving both primary and secondary care professionals.</p> <p>Methods</p> <p>We will use both action and evaluative research in order to achieve the following specific objectives. The first one is to develop and implement a preceptorship-based continuing medical education (CME) program complemented by a web site for physicians and nurses working in Family Medicine Groups (FMGs). This CME will be based on needs assessment and will be validated by one FMG using questionnaires and semi structured interviews. Also, references and teaching tools will be available for participants on the web site. Our second objective is to establish a collaborative intra and inter-regional interdisciplinary network to enable on-going expertise update and networking for FMG teams. This tool consists of a discussion forum and monthly virtual meetings of all participants. Our third objective is to evaluate the implementation of our program for its ability to train 8 FMGs per year, the access and utilization of electronic tools and the participants' satisfaction. This will be measured with questionnaires, web logging tools and group interviews. Our fourth objective is to determine the impact for the participants regarding knowledge and expertise, attitudes and perceptions, self-efficacy for the management of obesity, and changes in FMG organization for obesity management. Questionnaires and interviews will be used for this purpose. Our fifth objective is to deliver transferable knowledge for health professionals and decision-makers. Strategies and pitfalls of setting up this program will also be identified.</p> <p>Conclusion</p> <p>This project is relevant to health system's decision-makers who are confronted with an important increase in the prevalence of obesity. It is therefore critical to develop strategies allowing the management of obesity in the 1^stline setting. Results of this research project could therefore influence health care organization in the field of obesity but also eventually for other chronic diseases.</p

Involvement of gut microbial fermentation in the metabolic alterations occurring in n-3 polyunsaturated fatty acids-depleted mice

<p>Abstract</p> <p>Backround</p> <p>Western diet is characterized by an insufficient n-3 polyunsaturated fatty acid (PUFA) consumption which is known to promote the pathogenesis of several diseases. We have previously observed that mice fed with a diet poor in n-3 PUFA for two generations exhibit hepatic steatosis together with a decrease in body weight. The gut microbiota contributes to the regulation of host energy metabolism, due to symbiotic relationship with fermentable nutrients provided in the diet. In this study, we have tested the hypothesis that perturbations of the gut microbiota contribute to the metabolic alterations occurring in mice fed a diet poor in n-3 PUFA for two generations (n-3/- mice).</p> <p>Methods</p> <p>C57Bl/6J mice fed with a control or an n-3 PUFA depleted diet for two generations were supplemented with prebiotic (inulin-type Fructooligosaccharides, FOS, 0.20 g/day/mice) during 24 days.</p> <p>Results</p> <p>n-3/-mice exhibited a marked drop in caecum weight, a decrease in lactobacilli and an increase in bifidobacteria in the caecal content as compared to control mice (n-3/+ mice). Dietary supplementation with FOS for 24 days was sufficient to increase caecal weight and bifidobacteria count in both n-3/+ and n-3/-mice. Moreover, FOS increased lactobacilli content in n-3/-mice, whereas it decreased their level in n-3/+ mice. Interestingly, FOS treatment promoted body weight gain in n-3/-mice by increasing energy efficiency. In addition, FOS treatment decreased fasting glycemia and lowered the higher expression of key factors involved in the fatty acid catabolism observed in the liver of n-3/-mice, without lessening steatosis.</p> <p>Conclusions</p> <p>the changes in the gut microbiota composition induced by FOS are different depending on the type of diet. We show that FOS may promote lactobacilli and counteract the catabolic status induced by n-3 PUFA depletion in mice, thereby contributing to restore efficient fat storage.</p

France’s proposal for Guidelines about setting Maximum Residue Limits in honey

contribution to session I Regulatory issues Background: Honey is produced in an environment potentially polluted by different sources of contamination, so it is necessary to set Maximum Residue Limits (MRLs). These MRLs should be fixed as low as possible in relation to Good Agricultural Practices (GAPs). The guidance provided in this Draft Working Document gives advice on: • when and for what kind of active substance a MRL has to be set in honey • how to propose a temporary MRL for a given active substance • how to design, prepare and realise supervised residue trials when necessary Results: The proposed approach is based on using the available data before an active substance or product is registered, and is divided into several successive steps, represented in a global decision-making scheme. The MRL will be set depending on the results obtained at each different step. Besides, the applicants will have the choice between different methods to set a provisional MRL in preregistration. Conclusion: The initial proposal was a protocol on field residue trials proposed by Germany. The approach used in this guidance document proposes also other possibilities for fixing MRL without conducting systematically field trials. This proposition will be discussed at European level. Keywords: Regulation 396/2005, MRL, honey, plant protection produc

Distinct Genetic Loci Control Plasma HIV-RNA and Cellular HIV-DNA Levels in HIV-1 Infection: The ANRS Genome Wide Association 01 Study

Previous studies of the HIV-1 disease have shown that HLA and Chemokine receptor genetic variants influence disease progression and early viral load. We performed a Genome Wide Association study in a cohort of 605 HIV-1-infected seroconverters for detection of novel genetic factors that influence plasma HIV-RNA and cellular HIV-DNA levels. Most of the SNPs strongly associated with HIV-RNA levels were localised in the 6p21 major histocompatibility complex (MHC) region and were in the vicinity of class I and III genes. Moreover, protective alleles for four disease-associated SNPs in the MHC locus (rs2395029, rs13199524, rs12198173 and rs3093662) were strikingly over-represented among forty-five Long Term HIV controllers. Furthermore, we show that the HIV-DNA levels (reflecting the HIV reservoir) are associated with the same four SNPs, but also with two additional SNPs on chromosome 17 (rs6503919; intergenic region flanked by the DDX40 and YPEL2 genes) and chromosome 8 (rs2575735; within the Syndecan 2 gene). Our data provide evidence that the MHC controls both HIV replication and HIV reservoir. They also indicate that two additional genomic loci may influence the HIV reservoir

Experience feedback committee in emergency medicine: a tool for security management

International audienc

New perspectives on the calculation of bioaccumulation metrics for active substances in living organisms

International audienceToday, only few ready-to-use and convenient decision-making tools are available in ecotoxicology concerning accumulation and effects of chemical substances on organisms, accounting for exposure situations that are known to be complex (routes of exposure, metabolism, mixtures, etc.). This paper presents new perspectives on the generic calculation of bioaccumulation metrics via the innovative web tool MOSAICbioacc (http://mosaic.univ-lyon1.fr/bioacc). MOSAICbioacc provides all kinds of bioaccumulation metrics associated with their uncertainty whatever the species-compound combination. MOSAICbioacc expects accumulation-depuration data as inputs, even with complex exposure and clearance patterns, to quickly perform their relevant analysis. MOSAICbioacc intends to facilitate the daily work of regulators, or any ecotoxicologist, who will freely benefit from a user-friendly online interface that automatically fits toxicokinetic models without need for users to invest in the technical aspects to get bioaccumulation metrics estimates. MOSAICbioacc also provides all results in a fully transparent way to ensure reproducibilit

Halftoning for High-contrast Imaging: Developments for the SPHERE and EPICS Instruments

International audienceControlling the amplitude of light is crucial for many scientific applications, such as in imaging systems, astronomical instruments or laser physics. We provide a brief overview of recent R&D activities at ESO using halftoning, the process of presenting a continuous image through use of dots. Customised filters with spatially varying transmission are produced using a binary array of metal pixels that offers excellent control of the local transmission. Applications to the production of an apodiser for the VLT SPHERE instrument and a mask for E-ELT EPICS are presented

Halftoning for High-contrast Imaging: Developments for the SPHERE and EPICS Instruments

International audienceControlling the amplitude of light is crucial for many scientific applications, such as in imaging systems, astronomical instruments or laser physics. We provide a brief overview of recent R&D activities at ESO using halftoning, the process of presenting a continuous image through use of dots. Customised filters with spatially varying transmission are produced using a binary array of metal pixels that offers excellent control of the local transmission. Applications to the production of an apodiser for the VLT SPHERE instrument and a mask for E-ELT EPICS are presented

Halftoning for High-contrast Imaging: Developments for the SPHERE and EPICS Instruments

International audienceControlling the amplitude of light is crucial for many scientific applications, such as in imaging systems, astronomical instruments or laser physics. We provide a brief overview of recent R&D activities at ESO using halftoning, the process of presenting a continuous image through use of dots. Customised filters with spatially varying transmission are produced using a binary array of metal pixels that offers excellent control of the local transmission. Applications to the production of an apodiser for the VLT SPHERE instrument and a mask for E-ELT EPICS are presented