Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France.

OBJECTIVES: Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system. METHODS: A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace. RESULTS: Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work. CONCLUSION: The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided

The Permian-Triassic boundary and Early Triassic sedimentation in Western European basins: an overview

At the scale of the peri-Tethyan basins of western Europe, the “Buntsandstein” continental lithostratigraphic units are frequently attributed to the “Permian-Triassic” because, in most cases, the lack of any “Scythian” (i.e. Early Triassic) biochronological evidence makes it very difficult to attribute the basal beds of the cycle to the Permian or to the Triassic. A careful recognition of unconformities and sedimentary indications of clearly arid climate provide powerful tools for correlation within non-marine successions that are devoid of any biostratigraphic markers, at least on the scale of the West European Plate. From a review of the “Buntsandstein” series of several basins we can characterize the Permian-Triassic boundary and the beginning of Triassic sedimentation at the scale of Western Europe. We clearly show that, except for the Central Germanic Basin, an unconformity can be observed between the Permian and the Triassic. Apart from the Germanic Basin, there is a total lack of typically “Scythian” fossils in the rest of West European basins, and the oldest biochronological markers yielded by these units are palynomorphs allowing to assign an Anisian age generally to the upper part of the “Buntsandstein”, but also its lowermost in a few cases. In the peri-Tethyan basins of western Europe, the Permian-Triassic boundary corresponds to an unconformity overlain by conglomerates containing ventifacts (followed by fluvial sandstones, sometimes rich in paleosols and sometimes totally devoid), which are attributed mainly to the lower Olenekian, i.e. Smithian. Alternatively, the succession passes up directly into fluvial sandstones containing the first paleosols, and then plant debris and palynomorphs attributed to the Anisian. In this way, the lack of typically Early Triassic fossils in most of the peri-Tethyan basins, at the scale of the west European Plate, can be explained by a true stratigraphic hiatus in the earliest Triassic (i.e. Induan) and by arid conditions unfavourable for the development of flora and fauna and their preservation during the Olenekian.En las cuencas peritéthicas de Europa occidental, la unidad litoestratigráfi ca continental “Buntsandstein” es frecuentemente atribuida al “Pérmico-Triásico”, porque, en la mayoría de los casos, la falta de elementos biocronológicos “scythienses” complica la atribución de los niveles basales al Pérmico o al Triásico. Un cuidadoso examen de las discordancias, y el uso de indicadores sedimentarios de climas claramente áridos constituyen herramientas fundamentales para la correlación de estas unidades no marinas, desprovistas de cualquier marcador bioestratigráfi co, al menos en el Oeste de la Placa Europea. La revisión de las series “Buntsandstein” de varias cuencas nos ha permitido caracterizar el límite Pérmico-Triásico y el comienzo de la sedimentación durante el Triásico inferior en el oeste de Europa, demostrando claramente que, excepto en la Cuenca Germánica Central, se puede observar una discordancia entre las series pérmicas y triásicas. Excepto en esta Cuenca Germánica, existe una falta total de fósiles típicamente “scythienses”, y los elementos bioestratigráfi cos más antiguos encontrados son conjuntos de palinomorfos que permiten asignar a los niveles superiores de las series “Buntsandstein” una edad Anisiense, en algunos cortes los niveles inferiores. En las cuencas peritéthicas de Europa occidental, el límite Pérmico-Triásico se corresponde con una discordancia que se recubre por conglomerados con ventifactos (seguidos por areniscas fl uviales, a veces ricas en paleosuelos y a veces totalmente desprovistas de ellos), atribuidos principalmente al Olenekiense inferior (Smithiense), o directamente areniscas fluviales donde aparecen los primeros paleosuelos, así como restos de plantas y palinomorfos, atribuidos al Anisiense. De esta forma en el Oeste de la Placa Europea, la falta de fósiles característicos del Triásico Inferior, en la mayoría de las cuencas perithéticas, puede explicarse por un importante hiato estratigráfi co durante el Triásico Inferior (Induense) y por unas condiciones áridas, desfavorables para la vida y la preservación de fósiles durante el Olenekiense

Three-loop electroweak corrections to the W-boson mass and sin^2 theta_eff in the large Higgs mass limit

We present an analytical calculation of the leading three-loop radiative correction to the S-parameter in the Standard Model in the large Higgs mass limit. Numerically, S^(3) = 1.1105*g^4/(1024 pi^3)*m_H^4/M_W^4. When combined with the corresponding three-loop correction to the rho-parameter, this leads to shifts of Delta^(3) sin^2 theta_eff = 4.6*10^-9*m_H^4/M_W^4 in the effective weak mixing angle and Delta^(3) M_W = -6.3*10^-4*MeV*m_H^4/M_W^4 in the W boson mass. For both of these observables, the sign of the three-loop correction is equal to that of the one-loop correction.Comment: 12 pages, two Figure

Statistiques de pêche en lagune Ebrié (Côte d'Ivoire): 1976 et 1977

In the Ebrié lagoon fishes are mostly caught by means of 6 kinds of fishing gear: small and large mesh gillnets (respectively 1.5-2 and 6.5-8 inches stretched mesh), cast-nets and multi-hooked lines for individual fishermen, and beach seines and ring-nets for collective fishing. Statistical data gathered during 1977 allowed an estimation of total catches: about 6700 tons. The bulk of the catch, 4800 tons, came from beach nets and ring nets, the contribution of which is nearly the same. Individual fishing gear, small mesh gillnets repesenting the main part, account for 25 to 30% of total catch; about 1900 tons for year 1977. Six species, or species groups, comprise more than 85% of the catch. In the Abidjan area, where marine influence is the more noticeable, ring nets are more numerous and their catches increased since 1975. On the other hand, fish captures in unsalted and brackish waters seem to show a stagnancy and a decrease in fish lengths; this phenomenon is probably in connection with beach-seine excessive fishing effort and/or their small meshes (one inch stretched)

Elastase-2, a tissue alternative pathway for angiotensin II generation, plays a role in circulatory sympathovagal balance in mice

In vitro and ex vivo experiments indicate that elastase-2 (ELA-2), a chymotrypsin-serine protease elastase family member 2A, is an alternative pathway for angiotensin II (Ang II) generation. However, the role played by ELA-2 in vivo is unclear. We examined ELA-2 knockout (ELA-2KO) mice compared to wild-type (WT) mice and determined whether ELA-2 played a role in hemodynamics [arterial pressure (AP) and heart rate (HR)], cardiocirculatory sympathovagal balance and baroreflex sensitivity. The variability of systolic arterial pressure (SAP) and pulse interval (PI) for evaluating autonomic modulation was examined for time and frequency domains (spectral analysis), whereas a symbolic analysis was also used to evaluate PI variability. In addition, baroreflex sensitivity was examined using the sequence method. Cardiac function was evaluated echocardiographically under anesthesia. The AP was normal whereas the HR was reduced in ELA-2KO mice (425 ± 17 vs. 512 ± 13 bpm from WT). SAP variability and baroreflex sensitivity were similar in both strains. The LF power from the PI spectrum (33.6 ± 5 vs. 51.8 ± 4.8 nu from WT) and the LF/HF ratio (0.60 ± 0.1 vs. 1.45 ± 0.3 from WT) were reduced, whereas the HF power was increased (66.4 ± 5 vs. 48.2 ± 4.8 nu from WT) in ELA-2KO mice, indicating a shift toward parasympathetic modulation of HR. Echocardiographic examination showed normal fractional shortening and an ejection fraction in ELA-2KO mice; however, the cardiac output, stroke volume, and ventricular size were reduced. These findings provide the first evidence that ELA-2 acts on the sympathovagal balance of the heart, as expressed by the reduced sympathetic modulation of HR in ELA-2KO mice

Development of a polygenic risk score to improve screening for fracture risk: A genetic risk prediction study

Background Since screening programs identify only a small proportion of the population as eligible for an intervention, genomic prediction of heritable risk factors could decrease the number needing to be screened by removing individuals at low genetic risk. We therefore tested whether a polygenic risk score for heel quantitative ultrasound speed of sound (SOS)—a heritable risk factor for osteoporotic fracture—can identify low-risk individuals who can safely be excluded from a fracture risk screening program. Methods and findings A polygenic risk score for SOS was trained and selected in 2 separate subsets of UK Biobank (comprising 341,449 and 5,335 individuals). The top-performing prediction model was termed “gSOS”, and its utility in fracture risk screening was tested in 5 validation cohorts using the National Osteoporosis Guideline Group clinical guidelines (N = 10,522 eligible participants). All individuals were genome-wide genotyped and had measured fracture risk factors. Across the 5 cohorts, the average age ranged from 57 to 75 years, and 54% of studied individuals were women. The main outcomes were the sensitivity and specificity to correctly identify individuals requiring treatment with and without genetic prescreening. The reference standard was a bone mineral density (BMD)–based Fracture Risk Assessment Tool (FRAX) score. The secondary outcomes were the proportions of the screened population requiring clinical-risk-factor-based FRAX (CRF-FRAX) screening and BMD-based FRAX (BMD-FRAX) screening. gSOS was strongly correlated with measured SOS (r2 = 23.2%, 95% CI 22.7% to 23.7%). Without genetic prescreening, guideline recommendations achieved a sensitivity and specificity for correct treatment assignment of 99.6% and 97.1%, respectively, in the validation cohorts. However, 81% of the population required CRF-FRAX tests, and 37% required BMD-FRAX tests to achieve this accuracy. Using gSOS in prescreening and limiting further assessment to those with a low gSOS resulted in small changes to the sensitivity and specificity (93.4% and 98.5%, respectively), but the proportions of individuals requiring CRF-FRAX tests and BMD-FRAX tests were reduced by 37% and 41%, respectively. Study limitations include a reliance on cohorts of predominantly European ethnicity and use of a proxy of fracture risk. Conclusions Our results suggest that the use of a polygenic risk score in fracture risk screening could decrease the number of individuals requiring screening tests, including BMD measurement, while maintaining a high sensitivity and specificity to identify individuals who should be recommended an intervention

Allocentric coding: spatial range and combination rules

International audienceWhen a visual target is presented with neighboring landmarks, its location can be determined both relative to the self (egocentric coding) and relative to these landmarks (allocentric coding). In the present study, we investigated (1) how allocentric coding depends on the distance between the targets and their surrounding landmarks (i.e. the spatial range) and (2) how allocentric and egocentric coding interact with each other across targets-landmarks distances (i.e. the combination rules). Subjects performed a memory-based pointing task toward previously gazed targets briefly superimposed (200ms) on background images of cluttered city landscapes. A variable portion of the images was occluded in order to control the distance between the targets and the closest potential landmarks within those images. The pointing responses were performed after large saccades and the reappearance of the images at their initial location. However, in some trials, the images' elements were slightly shifted (±3°) in order to introduce a subliminal conflict between the allocentric and egocentric reference frames. The influence of allocentric coding in the pointing responses was found to decrease with increasing target-landmarks distances, although it remained significant even at the largest distances (⩾10°). Interestingly, both the decreasing influence of allocentric coding and the concomitant increase in pointing responses variability were well captured by a Bayesian model in which the weighted combination of allocentric and egocentric cues is governed by a coupling prior

Conservation conundrum – red listing of subtropical-temperate coastal forested wetlands of South Africa

Africa’s range-restricted and transitional subtropical-temperate coastal forested wetlands are facing interlinking threats of climate and anthropogenic pressures. We assessed their conservation status using the criteria of the International Union for Conservation of Nature (IUCN). Their total areal extent was hind-casted to the reference epoch 2000, followed by the quantification of subsequent total losses in areal extents for the epochs 2005, 2008, 2011 and 2017. South Africa had 120 km2 of coastal swamp and floodplain forests in 2000 of which the majority (116.5 km2) occurred on the Maputaland Coastal Plain (MCP). By 2011, 20% of the areal extent was lost, and at the lowest rate of decline we estimate that ≥ 80% of the rest will be lost in the next 50 years. An ecosystem collapse assessment therefore indicated that the habitat is very likely Critically Endangered. Fragmentation and types of transformations were used as degradation indices to show functional collapse. These results showed that forest patches became increasingly fragmented, from 511 to 1 145 patches between 2000 and 2017 and that > 23% of the areal extent showed severe transformation. Several faunal species, with a close association to the forested wetlands of the MCP, are considered threatened with numbers declining because of transformation to timber plantations or agriculture and coupled with a prolonged drought. Of these, a sub-species of the Samango monkey, Cercopithecus mitis erythrarchus, considered to be a primary ecosystem engineer of the habitat, was red listed with a restricted distribution, being endemic, Near Threatened and declining. Also under pressure, because of habitat fragmentation and degradation is the Peregrine crab (Varuna litterata), a euryhaline species requiring connectivity across the land-seascape, ranging from freshwater forested wetlands to estuarine and off-shore environments. Functionally, these coastal forested wetlands are therefore also considered Critically Endangered. The final IUCN conservation status of South Africa’s subtropical-temperate coastal forested wetlands are recommended to be very likely Critically Endangered. Irrespective of 62% of the areal extent of these forested wetlands being within protected areas, severe degradation (metrics of fragmentation and transformation) were observed even inside these areas for the past two decades. The conservation conundrum is that despite existing legislation and management measures, there has been no stop or reversal of the negative trends to date. As a supplementary method, we therefore recommend a transdisciplinary community-based approach to conservation practice, continued and improved monitoring of the habitat losses, the identifying priority areas for rehabilitation and addressing data deficiencies in important species associations.CSIR’s Parliamentary Grant Project P1BEO00/P1CCS02, titled “Marine Observational and Predictive System Capabilities (MAROPS)”; as well as the African Union Commission (AUC) Global Monitoring for Environment and Security (GMES) MARCOSOUTH (K8MARCO). The Department of Science and Innovation (DSI) and National Research Foundation (NRF) Chair in Shallow Water Ecosystems (UID 84375) supported time of Prof. Janine Adams.https://www.elsevier.com/locate/ecolindam2022Geography, Geoinformatics and Meteorolog

Sustained IFN signaling is associated with delayed development of SARS-CoV-2-specific immunity.

Plasma RNAemia, delayed antibody responses and inflammation predict COVID-19 outcomes, but the mechanisms underlying these immunovirological patterns are poorly understood. We profile 782 longitudinal plasma samples from 318 hospitalized patients with COVID-19. Integrated analysis using k-means reveals four patient clusters in a discovery cohort: mechanically ventilated critically-ill cases are subdivided into good prognosis and high-fatality clusters (reproduced in a validation cohort), while non-critical survivors segregate into high and low early antibody responders. Only the high-fatality cluster is enriched for transcriptomic signatures associated with COVID-19 severity, and each cluster has distinct RBD-specific antibody elicitation kinetics. Both critical and non-critical clusters with delayed antibody responses exhibit sustained IFN signatures, which negatively correlate with contemporaneous RBD-specific IgG levels and absolute SARS-CoV-2-specific B and CD4 <sup>+</sup> T cell frequencies. These data suggest that the "Interferon paradox" previously described in murine LCMV models is operative in COVID-19, with excessive IFN signaling delaying development of adaptive virus-specific immunity