Podcasts about leriche

Two artists in Port aux Basques are giving back to their hometown, partly inspired by post-tropical storm Fiona. Tuesday, Sept. 24 is the second anniversary of Fiona's landfall on the southwest coast. It claimed the life of one woman and destroyed houses and wharves that had existed for generations. This past summer, to brighten things up, Becca Leriche and James Coffin teamed up to paint a mural of a 125-foot giant squid.on a concrete wall in the town. Leriche and Coffin spoke with the CBC's Gavin Simms about art, healing, mental health and addiction... and community.

MILANO (ITALPRESS) - Una vettura di riferimento all'interno del segmento B e in grado di soddisfare tutte le richieste dei clienti fornendo un mix ben articolato di design, comfort e tecnologia. Così si presenta la nuova Captur, ultimo nato del marchio Renault. "Parliamo della macchina che ha rivoluzionato i codici del segmento B e per noi è una storia di successo: ne abbiamo vendute più di 300mila in Italia ed è stata per 5 anni l'auto più venduta sulla parte SUV del segmento B per i privati. Era quindi fondamentale riproporci in una veste dove mantenere le fondamenta di Captur e allo stesso tempo offrire una proposta stilistica e tecnologia ancora più al passo con i tempi" dice Elisabeth Leriche, Direttrice Marketing Renault Italia.xh7/tvi/gtr

durée : 00:47:40 - On n'arrête pas l'éco - par : Alexandra Bensaid - Au menu ce samedi : un reportage sur les banques d'affaires américaines à Paris, un détour par la Chine et sa régulation avortée des jeux vidéos, trois recommandations de livres... Et bien sûr un débat sur les annonces du gouvernement en réponse à la colère des agriculteurs. Assez quoi apaiser ? - réalisé par : Céline ILLA

Astrid Leriche is community manager bij 'LOOP Earplugs' en maakt als 'Studio Ansitru' kunstwerkjes in verschillende disciplines (crochet, cross-stitch, illustration, pixelart). We praten over neurodivergentie, webshops, Mechelse dialectwoorden, Godsdienst versus zedenleer, Amerikaanse ziekenzorg, staartjes van diertjes, en meer. Het was zo boeiend, dat Julian prompt vergat de dinosaurusvraag te stellen. Schande!Support the show

TRANSCRIPT   Listen to ASCO's Journal of Clinical Oncology essay, “Cemetery Rounds” by David Steensma, a hematologist-oncologist in Boston. The essay is followed by an interview with Steensma and host Dr. Lidia Schapira. Steensma describes the complex emotions that result from encountering graves of former patients on walks through a cemetery in his New England hometown. Narrator: Cemetery Rounds, by David Steensma, MD, FACP  In the summer of 1784, the body of a 4-month-old infant named Sally was the first to be laid in the earth of the hill next to my home. The gravedigger's backhoe still cuts into the ground about once a week in what has become the largest cemetery in this Massachusetts town. During the recent pandemic, the graveyard was an open place with no need to wear a mask, so I often walked its quiet paths in the evening to stretch my legs after long hours hunched over a computer. These unhurried ambles were a chance to reflect on the day's events and make plans for future days—and sometimes to ruminate on life and how it ends. Little Sally's simple slate marker, with a willow and urn carved above the names of her parents and a short, grim epitaph—“A pleasant plant, a blooming flower, Cut down & wither'd in an hour”—has been joined by thousands of other tombstones over the past two centuries. After a dozen years living in this Boston suburb, I now recognize some of the names on these memorials: Stones that mark the final resting place of people who were once friends or fellow members of the same Congregational church that Sally's family belonged to long ago, and stones with surnames shared by nearby schools and streets.  There are too many gravestones that recall young people who were once classmates of our children in the town's schools. Walking past those memorials means remembering moments of shock and sadness: news about car wrecks and ski accidents, suicides, sudden collapses on hockey or football fields, and the other disasters that take the lives of the young. Stones for the 21st century children are all in the newest part of the cemetery, with its memorials for those who died within living memory. In that part of the cemetery, visitors still often leave toys, Boston Bruins or New England Patriots pennants, lacrosse sticks, and horse reins.  Sally's stone, in contrast, is the oldest part of the cemetery. It is surrounded only by close cropped grass and stout trees. Once I saw a freshly cut flower laying on Sally's grave, and I wondered who left it. It is rare to see those ancient graves get special attention—a bracing reminder that no matter how bright our star might shine in our own era, we will all eventually be forgotten. The largest and most prominent gravestone in the cemetery recalls the grandson of a local eccentric. This boy drowned in New Hampshire's Lake Sunapee at age 17 while trying to save another teenager who had fallen from a boat. It was the second time a close family member of the man had drowned: In 1893, as a child, he watched his older sister slip beneath the swift water of the Annisquam River. He reacted to this pair of tragedies by declaring a lifelong war on gravity.  Grief is not always rational, although it may be productive. The eccentric man became wealthy—by predicting the 1929 stock market crash and by starting a successful business analysis firm—and he created a well-funded private foundation to understand and combat gravity. This Gravity Research Foundation sponsored important conferences attended by Albert Einstein and other luminaries and awarded prizes to Stephen Hawking, Freeman Dyson, and a half-dozen Nobel laureates in physics. Gravity, however, remains unconquered and incompletely understood. All of us will eventually be pulled into the earth by its unrelenting grip. A growing number of gravestones bear the names of people who were once my patients at a Boston cancer institute. Some days it is hard to see those stones on my evening walks, noticing name after name that once graced a clinic schedule or hospital rounding list, and to be so starkly reminded of how our best efforts ultimately failed them.  Most of the time, though, what I recall are the happier moments with these patients, which keeps these walks from being morbid. Cancer centers are not known for being joyous places, yet surprisingly, often there is laughter in clinic rooms or on morning hospital rounds. We oncologists celebrate milestones with our patients: remissions achieved, college degrees completed, new grandchildren, and long awaited weddings attended. We know that graves like these await all of us, but for a while, we can put that aside and not just live but thrive. In one corner of the cemetery, a small marble bench faces a stone that marks the final resting place of one memorable former patient: A young woman with a wicked sense of humor who, as a grieving relative said at her funeral, was wise beyond her years, and taken before her time. When I rested on that bench last night, I was reminded of what French vascular surgeon Ren´e Leriche wrote in 1951, at the end of his long career: Every surgeon carries within himself a small cemetery, where from time to time he goes to pray-a place of bitterness and regret, where he must look for an explanation for his failures. For me that cemetery is a physical place as well as metaphorical.  Yet when I think of her, I always smile, remembering who she was, and the happiness she brought to those around her. When she was alive, her hospital room was a place of laughter and hope rather than bitterness and regret. Even after a long day in the clinic, when I made hospital rounds in the evening, it was a joy to see her and discuss the events of the day. I do not know how she kept it up for so long in the face of so many disappointments and frustrations. Everything we tried to treat her cancer eventually failed her—every antibody, cell therapy, and drug after drug after drug. Even when new treatment regimens were declared at national meetings to be active, well tolerated, and worthy of further study, she always seemed to be one of those who had not responded or who suffered intolerable side effects. One door after another closed so that soon the only available doors were the ones that took her back home, with the support of a kind and skilled hospice team. At times, she could sense my sense of failure as I sat by her bedside and would try to reassure me as if the sorrow was mine instead of hers. It's all right, it will be OK. We did what we could. You did what you could. Now it's time to move on. Where did she get the strength? Eventually, as evening turned to night, it grew cold in the cemetery. I moved on, buoyed by her memory. Saying good night to Sally, I headed home. Dr. Lidia Schapira: Hello, and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Associate Editor for Art of Oncology and a Professor of Medicine at Stanford University. Today we're joined by Dr. David Steensma, who currently leads hematology early development for a biotech company in Cambridge, Massachusetts, and was for many years a faculty member in the Leukemia Program at Dana-Farber Cancer Institute and Harvard Medical School, and also a past Editor for Art of Oncology. In this episode, we'll be discussing his Art of Oncology article, “Cemetery Rounds.”  Our guest disclosures will be linked in the transcript. David, welcome to our podcast and thank you for joining us.  Dr. David Steensma: Thank you for having me. Dr. Lidia Schapira: I'd like to start by asking you a little bit about your process for writing. You have published beautiful essays in JCO and in other venues, and I know you've always been a writer. Talk a little bit about that, especially for some of our younger listeners  Dr. David Steensma: This is the first article that I've submitted to the Art of Oncology in a number of years, actually, and this one was a long time in gestation. One of the things that I found over the years is that whether I'm writing and how much progress I'm making is a really good barometer of where I'm at mentally. And I think the fact that this took the better part of three years to write probably illustrates how difficult these last few years have been for me as they have for so many of us. Sometimes writing happens very quickly. You get a germ of an idea, something maybe you've been mulling over for a long time and it all falls into place. But much more often, it's a process in which one is trying to express what is very difficult sometimes to say appropriately. Dr. Lidia Schapira: Some of your articles, including this one, have elements of history in it, and I think that's something that you've always been interested in, not only medical history but history in general, sort of what was happening at a time when somebody was ill or an illness was first described, or in this case, people were buried. Tell us a little bit about that, about combining your interest in history with your medical writing.  Dr. David Steensma: I think I like to tell stories and really always have. If I didn't do medicine, one of the other two alternatives was journalism. And I've always been interested in how things got to be the way that they are. So I think that naturally is reflected in the writing.  Dr. Lidia Schapira: I know you're also an avid reader, so what would I find now on your night table or on the desk alongside the medical journals that probably are unopened? Dr. David Steensma: Wow. I have some science. I have Ed Yong's amazing book about the microbiome. I just started reading I'm Glad My Mom Died by Jennette McCurdy, a former child actor, which has just got rave reviews, so reading about her difficult upbringing in this memoir and her mother's death from breast cancer. And so the third one over on the shelf over there that I have off is ASCO-SEP because I'm doing the 10-year medical oncology board renewal next week. I've been doing the LKA for hematology, but I've also kept up MedOnc and internal medicine. It was just too painful to think about all three. So I have all these NTRK and ROS1 inhibitors and pathways for advanced cervical cancer jumbling around in my head right now, which I'm sure a lot of our listeners could relate to. Dr. Lidia Schapira: I can relate to the anxiety I felt the last time I was recertified, and I swore it would be the last time. So thank you for spending a little time with us. Maybe it's a distraction from the other. Yeah.  I wanted to talk about “Cemetery Rounds.” We were so happy to get your paper after all these years. A reviewer said, “Oh, thank goodness, Steensma's writing again.” Tell us a little bit about this quiet, meditative practice of walking along the cemetery near your home, especially during the pandemic. Dr. David Steensma: Well, the pandemic did so many weird things, and just everything was different, from the way we bought food to the way that we caught up with loved ones to the way we structured our days. Everything changed, and one of the things we ended up doing was spending even more time in front of our computers. And I'm kind of fidgety, always have been. So by the end of the day, I'd had a lot of energy I needed to get out and thought about where I could walk nearby that was a good place to stretch my legs. And we lived right around the corner from an old cemetery and quite a large one, a cemetery that actually got quite busy during COVID, so I didn't really think about that part of it. But they brought in at the beginning of the pandemic, all kinds of extra materials for digging graves and cleared out some additional area. It was really quite striking just seeing that happen.  But one of the things I think I didn't prepare myself for mentally, walking through that cemetery, which is a beautiful place, very respectful, and well kept, was how many patients and other people I would recognize. And just walking past stone after stone with names that I recognized, people who had been my patient or those of colleagues that I'd interacted with on inpatient services over the years, a number of children who had been our kids' classmates in the town's public schools and who had sadly run into one tragedy or another. It was really quite striking how many of the people I felt like in a very old cemetery, how many names I recognized. There were a lot, of course, I didn't, but their surnames were on the streets nearby and the town founders. And this sort of made me reflect, particularly when I noticed that we don't normally see our patients' graves. We may attend their funerals or their memorial services, but even that often the last time we see them is when they're going home to a hospice setup or to an inpatient hospice or sometimes just at a last clinic visit, and then something sudden happens.   So this seemed like something that could have been very sad. But I think partly because of the tranquility of the place and the mindset of the pandemic, there was actually a lot of reflection of positive things, interactions with these patients - the happiness sometimes that we brought to each other, conversations that had been difficult, but also events that have been happy milestones that they got to see because of our care. And then also the hard realization that ultimately modern cancer care failed them that's why they were there. So just a lot to reflect on in a time when it seemed like death was all around anyway because of the pandemic. So I thought, gosh, this would be something I think people could relate to.  Dr. Lidia Schapira: It struck me that you describe your approaching these gravestones as an intimate space that we normally don't get to be part of, that sort of belongs to the family and the friends and the community, but the clinician is often not there. And it struck me also that the immediate thing you talk about was how therapies have failed them. And I just wondered if you could talk a little bit more about that. Maybe because we're both part of the same culture, it's so easy immediately to think that we did something wrong and that's why they ended up there. But can you reflect a little bit more about that particular aspect of our work? Dr. David Steensma: Yeah, just because an outcome was sad doesn't mean that mistakes were made, but may reflect the limitations of the science and art of medicine as they currently are. I think surgeons wrestle with this a lot. And in fact, I included a quote in the essay by Rene Leriche, a well-known French vascular surgeon in the 1950s, who talked about how each surgeon has their own personal cemetery of a place that they go to reflect from time to time. And that's something that in M&M conferences I was always shocked as a student and trainee just how brutal they were on each other and on themselves. It's part of this surgical culture. But I think surgery naturally lends itself to thinking that somehow you did something wrong.   And perhaps in medicine, we're a little bit more in touch with the fact that we followed the guidelines perfectly. We got advice from colleagues, patients were presented at conferences. We enrolled them in clinical trials of things that seemed interesting and promising and just that the disease just kept coming back. And so that's not necessarily a personal failure. And I think in that circumstance, there's maybe a little bit more space, a little bit more permission to connect with the memory of that person in a positive way and reflect on who they were and what they meant for their families and for the others that they interacted with. And so when I see these stones, I don't think, "Oh man, I really screwed up, and that's why they're here." Never, never. I think about, "Gosh, we tried so much, and he or she went through so much, and yet this was where they ended." Dr. Lidia Schapira: It seems to me a very healthy approach, certainly. And I loved the surgeon's quote here in the essay, that every surgeon carries within himself a small cemetery, not just the surgeon. I think, as you said, we do as well. I also love the framing of the fact that it's not so much guilt but sorrow that we carry for them and also that they affect our lives. I remember when you talked about your patients, I remember the article you published about Michaela, the little girl who played the cello on the Leukemia ward and got to be famous. And in this particular article, you talk about a young woman who somehow seemed to think that she needed to comfort you and reassure you that you did everything that you could. Those are such beautiful memories, and you have such a talent for sort of paying tribute to your current and past patients that this is really so beautiful to read. And with that, I just wanted to ask a personal question, if I may, and that is, do you miss the clinical work? Dr. David Steensma: I do, definitely. So, yes, I am always impressed by the strength of patients and of their families often, and people manifest that in different ways. But I've just seen so many amazing things over the years. When I decided that I wanted to try to influence cancer care and hematology care in a different way and move to direct hematology and early development in a research institute affiliated with a company, I, unfortunately, had to step back from seeing patients at Dana-Farber because it was considered a conflict of interest. It hadn't been until just a few months before but, you know, new rules. So I do miss that. And I've been thinking a lot about ways to get back to making those connections because, yes, it is meaningful to be developing new medicines, but there's something also very immediate about being there for a person in a time of need. And those relationships that you build, by far, that was the hardest part of making the job transition with so many patients that I had long-term relationships with; that was hard.  Dr. Lidia Schapira: So my last question is more philosophical. I am teaching a course for undergraduates that involves explaining how people experience illness. So I've been reading a lot of illness memoirs throughout my career, and I was looking for scholars who had worked on this and found, of course, Arthur Frank and his themes of how illness is portrayed by patients, stories of shipwrecks and catastrophes or quests or restitution of meaning. And I wondered if you had given any thought to the same sort of narratives that oncologists play in their heads of how they treat patients. What do you think are the most important themes in the way oncologists think of and remember the patients they've treated? Dr. David Steensma: One of the things that's special about oncology is that even though it's a profession that is very much scientifically based, that we connect with patients at a point in their narrative and often get to know them over months, years, and that narrative and who each of us is along that journey change over time. So I think that's what makes our field really compelling. At least it was very attractive to me. That's very much true. I think of other fields as well, where you do have longitudinal care of a patient, but there is something special about a cancer diagnosis and what that makes people think and how their families and people around them react. That I think, is unique.   It really is an honor to be with patients through this narrative, and Arthur Frank has written about that and about the sort of patient story and how that evolves. And I think that's a healthy way of thinking about what people go through. And we also have to remember it's their story that we're fortunate to be able to witness. And when you walk past a tombstone, you know maybe a little bit about how that story ends, but there's always a birth date and there's a death date, and there's a dash in between, and we know very often very little about that dash. Maybe we were a little part of it, but that encompasses their whole lived experience.  Dr. Lidia Schapira: I think that's a beautiful way to end this. I tend to think of us when we're in our clinician roles as co-editors of that story if we are invited to play that part, and that's such an honor and privilege.   David, thank you so much. I hope and ask that you please continue to write. We all have so much to learn from you.   Until next time thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Show Notes:  Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio:  Dr. David Steensma is a hematologist-oncologist in Boston, and formerly long-time faculty member in the leukemia program at Dana-Farber Cancer Institute and Harvard Medical School. Additional Reading: A Cello for Michayla, by Steensma

In this episode, we review the high-yield topic of Leriche Syndrome (Aortoiliac Occlusive Disease)⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Cardiovascular section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

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In today's podcast, host Luke O'Kelley talks to Nashville based guitarist, songwriter, and producer Clint Wells. Clint is a long time AirGigs member and has recorded and toured with artists like Rodney Atkins, Bob Schneider, Mindy Smith, Jessie Baylin, Laura Bell Bundy. Clint is also a songwriter with Rough Trade Publishing where he's written for artists like Jaida Dreyer, Mindy Smith, HudsonMoore, Elise Davis, The Hells, and LeRiche. In this episode we discuss: Clint's musical development, moving to Nashville, his approach to session work, fighting imposter syndrome, pushing yourself to grow without letting people down, his experience as a songwriter in Nashville, and more.To hire Clint to record guitars or produce a song you can contact him here. Check out Clint's original music here.Intro and outro music is by Daniel Hardin.

In French in this CDA S2#68 (Monday online), "Revival of the 3M Tower, a manifesto project, and more", an interview of Duncan Driffort and Antoine Leriche, young French architects - English in CDA S2#69 (Wednesday online), "Revival of the 3M Tower, a manifesto project", an interview of Duncan Driffort and Antoine Leriche, young French architects.En français dans le CDA S2#68 (lundi en ligne), "Renaissance de la Tour 3M, un projet manifeste, et plus", une interview de Duncan Driffort et Antoine Leriche, jeunes architectes - En anglais dans le CDA S2#69 (mercredi en ligne), ""Renaissance de la Tour 3M, un projet manifeste", une interview de de Duncan Driffort et Antoine Leriche, jeunes architectes.____Com d'Archi s'attache, sans restriction, à porter la voix de tous ceux qui font l'architecture et l'architecture d'intérieure aujourd'hui. Dans cette logique, Anne-Charlotte Depondt reçoit ici deux très jeunes architectes, qui représentent quelque chose de bien singulier. En effet, si Duncan Driffort et Antoine Leriche sont fraichement diplômés en architecture (depuis février 2021), dans ce numéro de Com d'Archi S2#68 nos deux protagonistes répondent à de nombreuses interrogations, dont les suivantes. Pourquoi choisir ce métier à une époque où l'architecte perd de son aura ? Comment se positionner lorsque l'on arrive sur le marché du travail en pleine crise Covid ? Et surtout, qu'est-ce qui peut motiver à choisir comme sujet de diplôme, la réhabilitation d'une « cathédrale des temps modernes », la tour 3M, vouée à la démolition ? Et reste encore un mystère à résoudre : où Antoine et Duncan ont-ils puisé la force de concevoir un projet de renaissance, a contrario d'un processus de démolition effectif ? Ma rencontre avec Duncan Driffort et Antoine Leriche en 2019, a représenté un formidable message d'espoir face à la destruction inéluctable de la tour 3M à Cergy, France, oeuvre de l'architecte Paul Depondt (sujet de ma thèse de doctorat). Destruction d'un patrimoine moderne remarquable, destruction effective à ce jour, et qui reste, à mes yeux, inacceptable, en dépit d'un gros travail de résilience. En faisant de cet exemple un projet manifeste, les jeunes architectes responsables (eux !?) pointent du doigt ce qui ne devrait jamais plus se reproduire, à savoir le sacrifice de "l'hyper" intelligence constructive, de la durabilité et du paysage, sur l'hôtel des intérêts financiers, augmenté de la non-culture et de l'effacement de la mémoire de la part du politique. Leur projet de réhabilitation et ses enjeux est ici précisément décrit. Bravo à eux pour leur bravoure qui fait d'eux, d'ores et déjà, de jeunes héros du temps présent. Un certain nombre de démolitions du même type se profilent à l'horizon, les opérateurs semblant ne pas savoir faire la différence entre le patrimoine remarquable et le tissu ordinaire du XXème siècle .Anne-Charlotte DepondtIci, un numéro de Com d'Archi cent pour cent a-typique et riche de sens !Portrait teaser DR © Duncan Driffort et Antoine LericheIngénierie son : Julien Rebours____Si le podcast COM D'ARCHI vous plaît n'hésitez pas :. à vous abonner pour ne pas rater les prochains épisodes,. à nous laisser des étoiles et un commentaire, :-),. à nous suivre sur Instagram @comdarchipodcast pour retrouver de belles images, toujours choisies avec soin, de manière à enrichir votre regard sur le sujet.Bonne semaine à tous ! Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Les fêtes de fin d'année sont bien souvent l'occasion d'une certaine abondance alimentaire avec des produits que l'on qualifie parfois « d'exception » : foie gras, saumon, crevettes, huitres, escargots, pintade... Cette consommation, si elle a un certain caractère exceptionnel, n'est pas anodine. Il est souvent difficile d'y voir clair dans l'impact que représente ce repas sur l'environnement, voire même sur notre santé. Dans cette épisode, nous nous penchons de plus près sur ce repas afin de vous amener, peut-être, à faire d'autres choix que ceux que vous auriez fait habituellement. Pour en parler, Fanny Giansetto reçoit Hélène Leriche. Hélène est docteur vétérinaire et docteur en écologie. Elle a été conseillère scientifique et responsable biodiversité à la Fondation Nicolas Hulot, période pendant laquelle elle a notamment étudié la question de l'impact environnementale de notre alimentation. Elle est actuellement responsable biodiversité-économie à l'association Orée. *** Pour nous soutenir: - Abonnez-vous à notre podcast; - Donner votre avis via des étoiles et des commentaires sur votre plateforme d'écoute préférée; - Parler d'Ecotable et de son podcast autour de vous; - Aller manger dans nos restaurants vertueux et délicieux ! *** Ecotable est une entreprise dont la mission est d'accompagner les acteurs du secteur de la restauration dans leur transition écologique. Elle propose aux restaurateurs une palette d'outils sur la plateforme https://impact.ecotable.fr/. Écotable possède également un label qui identifie les restaurants écoresponsables dans toute la France sur le site https://ecotable.fr/fr.

MARQUES AVENUE : https://www.marquesavenue.com/ ------------------------------------------- En partenariat avec : LA TOUR IMMO : https://www.latourimmo.com/ APSYS GROUP : https://www.apsysgroup.com/

Dans l'épisode du jour, Thierry Leriche nous fait part de son retour d'expérience en tant que développeur freelance et entrepreneur. Il nous livre dans ce podcast les différentes embûches auxquelles il a dû faire face, en tant que développeur et en tant qu'entrepreneur et créateur d'entreprise.  Il nous expliquera par exemple les difficultés rencontrées dans la mise en fonction du RGPD, les impacts des mouvements sociaux et de la crise sanitaire  sur la vie d'entreprise. Thierry Leriche te donnera également quelques conseils relatifs au conditions juridiques de création d'une entreprise (pacte d'associés notamment) et d'autres « astuces » à connaître qui te feront sûrement gagner du temps !  Pour suivre Thierry Leriche : https://www.linkedin.com/in/thierry-leriche/  Pour découvrir Force4disc : https://force4disc.com/  Deviens un Développeur Freelance Libre : https://artisandeveloppeur.fr/freelance-libre 

Un feedback, qu'il soit positif ou négatif doit être manié avec précaution. On n'aborde pas tous les évaluations de la même manière selon notre caractère ou notre manière de fonctionner.  Il existe toutefois différentes méthodes, mais y en a-t-il une idéale ?  Dans cet épisode on fait le point avec Thierry Leriche sur le feedback sandwich, le feedback positif de renforcement et le feedback négatif correctif. On verra ainsi différentes manières d'aborder ces éléments et surtout comment équilibrer ces renforcements.  Pour suivre Thierry Leriche : https://www.linkedin.com/in/thierry-leriche/  Pour découvrir Prolif 4 : https://profil4.com/  Deviens un Développeur Freelance Libre : https://artisandeveloppeur.fr/freelance-libre 

ANDRÉ PEPES ENTREVISTA O CIRURGIÃO VASCULAR DR. ACHILES LIMA PARA FALAR DE SÍNDROME DE LERICHE --- Send in a voice message: https://anchor.fm/saudeemfoco/message

We speak with Delta Waterfowl Canadian volunteer of the year, Cory LeRiche.

Yann Leriche, directeur général de Getlink, était l'invité de Stéphane Pedrazzi dans Good Morning Business, ce jeudi 21 juillet. Il est revenu sur la reprise du trafic passager entre la Grande-Bretagne et le continent européen, notamment les résultats de l'opérateur du tunnel sous la Manche qui sont multipliés par trois, sur BFM Business. Retrouvez l'émission du lundi au vendredi et réécoutez la en podcast.

In the aftermath of the U.S. Supreme Court decision to overturn Roe v. Wade and end the constitutional right to an abortion, half of women in the U.S. live in states where they are at imminent risk of losing abortion access.Against this backdrop, Vermont is moving to enshrine abortion rights in the state constitution. In November, Vermonters will vote on Proposal 5, the Reproductive Liberty Amendment, which states in part that “an individual's right to personal reproductive autonomy is central to the liberty and dignity to determine one's own life course and shall not be denied or infringed.” California voters are also considering a constitutional amendment to protect abortion rights this year.How will overturning Roe v. Wade change the landscape of abortion rights in Vermont and New England?For answers, we turned to two people who are on the front lines of the reproductive rights movement locally and nationally: Lucy Leriche, vice president of public policy for Vermont at Planned Parenthood of Northern New England, and James Duff Lyall, executive director of the Vermont chapter of the American Civil Liberties Union.“It's pretty devastating to go to bed feeling like a person and wake up the next day and all of a sudden discover that your country does not consider you a person anymore,” Leriche said. “That you are a vessel. That your function is kind of analogous to livestock in terms of the kinds of rights that you have over your own body. It's very personal. It's devastating, and it's infuriating.”“We can't normalize any of this," Lyall said. Fighting for reproductive rights is "going to take voting. It's going to take organizing. It's going to take local, state and federal activism and engagement, and sustained political engagement. "That's what the right has done for a very long time and very successfully. … That's the only way forward.”Disclosure: David Goodman is a board member of the ACLU of Vermont. 

Mention légales : Vos données de connexion, dont votre adresse IP, sont traités par Radio Classique, responsable de traitement, sur la base de son intérêt légitime, par l'intermédiaire de son sous-traitant Ausha, à des fins de réalisation de statistiques agréées et de lutte contre la fraude. Ces données sont supprimées en temps réel pour la finalité statistique et sous cinq mois à compter de la collecte à des fins de lutte contre la fraude. Pour plus d'informations sur les traitements réalisés par Radio Classique et exercer vos droits, consultez notre Politique de confidentialité.

In this episode of the Brawn Body Health and Fitness Podcast, Dan is joined by Dr. Brian LeRiche, PT, DPT, CSCS to discuss his company and online course series, Performance Redefined. This is an AMAZING discussion and top-notch course for all rehab and fitness professionals. Brian is an entrepreneurial physical therapist and owner of Performance Redefined. Besides seeing patients at his clinic, he has created The Performance Redefined online course and The PR Club. These platforms help him teach movement students and professionals how to raise their standards and redefine their professional and personal limits. For more on Brian and Performance Redefined, check out his social media pages @performance_redefined_ or find him on YouTube at https://www.youtube.com/channel/UCQtZ1hTS41tIkbV55taCRtQ. Do YOU want to save BIG on the Performance Redefined course? Use coupon code BRAWNBODY to save 15% at checkout! Click HERE to sign up if you are a current student: https://www.performanceredefined.net/a/2147509925/x9h83FF2 ... Click HERE to sign up if you are an active professional paying for the course in full: https://www.performanceredefined.net/a/2147510108/x9h83FF2 ... or Click HERE if you are an active professional paying for the course via the monthly payment option: https://www.performanceredefined.net/a/2147510109/x9h83FF2 To keep up to date with everything we are currently doing on the podcast, be sure to subscribe and follow @brawnbody on social media! This episode is brought to you by CTM band recovery products - the EXACT soft tissue recovery technology used by Dan. CTM Band was founded by Dr. Kyle Bowling, a sports medicine practitioner who treats professional athletes (and was a guest on the Brawn Body Podcast!). You can check out their website here: https://ctm.band/collections/ctm-band ... while you're there, be sure to use the coupon code "BRAWN10" for 10% off! This episode is also brought to you by Ice shaker! Use our affiliate link to help support future podcast episodes and development by clicking here: https://www.iceshaker.com?sca_ref=1520881.zOJLysQzKe Interested in purchasing a red-light therapy device?? Use the brand Dan recommends - hooga health! You can use the coupon code "brawn" to save BIG at checkout! Check out their website here: https://hoogahealth.com/ Make sure you SHARE this episode with a friend who could benefit from the information we shared! Check out everything we do, including blog posts, fitness programs, and more by clicking here: https://linktr.ee/brawnbodytraining Liked this episode? Leave a 5-star review on your favorite podcast platform! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/daniel-braun/message Support this podcast: https://anchor.fm/daniel-braun/support

Les fêtes de fin d'année sont bien souvent l'occasion d'une certaine abondance alimentaire avec des produits que l'on qualifie parfois « d'exception » : foie gras, saumon, crevettes, huitres, escargots, pintade et j'en passe. Cette consommation, si elle a un certain caractère exceptionnel, n'est pas anodine. Il est souvent difficile d'y voir clair dans l'impact que représente ce repas sur l'environnement, voire même sur notre santé.  Dans cette épisode, nous nous penchons de plus près sur ce repas afin de vous amener, peut-être, à faire d'autres choix que ceux que vous auriez fait habituellement.  Pour en parler, Fanny Giansetto reçoit Hélène Leriche. Hélène est docteur vétérinaire et docteur en écologie. Elle a été conseillère scientifique et responsable biodiversité à la Fondation Nicolas Hulot, période pendant laquelle elle a notamment étudié la question de l'impact environnementale de notre alimentation. Elle est actuellement responsable biodiversité-économie à l'association Orée. ***  Pour nous soutenir: -Participer à notre Masterclass: https://www.eventbrite.fr/e/billets-masterclass-sur-le-grill-decotable-changer-la-donne-avec-son-assiette-217820094767 - Donner votre avis via des étoiles et des commentaires sur votre plateforme d'écoute préférée - Parler d'Ecotable et de son podcast autour de vous - Aller manger dans nos restaurants vertueux et délicieux ! *** Ecotable est une entreprise dont la mission est d'accompagner les acteurs du secteur de la restauration dans leur transition écologique. Elle propose aux restaurateurs une palette d'outils sur la plateforme https://impact.ecotable.fr/. Écotable possède également un label qui identifie les restaurants écoresponsables dans toute la France sur le site https://ecotable.fr/fr.

Existe t-il un lien entre votre personnalité et votre façon d'aborder la gestion du temps ?  La réponse est OUI ! Nous sommes tous différents et par définition nous ne fonctionnons pas de la même façon et la gestion du temps ne déroge pas à cette règle. Dans cet épisode de podcast, j'accueille Thierry LERICHE un passioné de la méthode DISC et concepteur d'un site qui se spécialise sur ce modèle. Avec lui j'aborde les points suivants : 00:04:25 Qu'est ce que c'est exactement le modèle D.I.S.C ? 00:09:35 Comment peut-on l'utiliser ? 00:15:55 Quel est le rapport à l'organisation et la gestion du temps de chaque profil ?  00:23:40 Comment s'adapter aux types de profils notamment lors de la délégation ? 00:33:30 Qu'est ce que le profil naturel et le profil adapté ? 00:45:30 Présentation du site profil 4 et du test Bonnne écoute ! ------- Les ressources mentionnées ou suggérées par l'invité :  Le site profil 4 : https://www.profil4.com La documentation gratuite sur la méthode : https://www.profil4.com/documentation Le blog : https://profil4.wordpress.com/ Le test proffessionnel : https://www.profil4.com/test-disc-fleur-pro Le test gratuit : https://www.profil4.com/test-disc-gratuit Le partenaire "Les Outils du Manager" : https://outilsdumanager.com/ Le partenaire "Vecteur de Croissance" :  https://www.vecteurdecroissance.com/ Le livre "Pourquoi on ne se comprend pas?" d'Elodie Bancelin autour du DISC : https://amzn.to/34rapfv -------

durée : 00:28:40 - Avec Cécile Leblanc & Françoise Leriche - par : Philippe Venturini - Les milieux fréquentés par l'écrivain, ses pratiques et ses usages d'auditeur, ainsi que les multiples aspects du roman musical, profondément renouvelé qu'est À la recherche du temps perdu, sont examinés dans cet ouvrage. - réalisé par : Laurent Lefrançois

Welcome to Bonus Smoke Friday, This Week I interview Nikki LeRiche. She talks about her beginnings as a escort in Atlanta. How she changed and adjusted to the game changing over the years and how she moved into Adult film. She talks about why she don't do content trade shoots and how she get her male talent for shoots. We discuss her life as a Findom and how it works. She discuss her sessions where she peg men and how the ladies in the industry hate on each other. Plus more. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

Welcome to Bonus Smoke Friday, This Week I interview Nikki LeRiche. She talks about her beginnings as a escort in Atlanta. How she changed and adjusted to the game changing over the years and how she moved into Adult film. She talks about why she don't do content trade shoots and how she get her male talent for shoots. We discuss her life as a Findom and how it works. She discuss her sessions where she peg men and how the ladies in the industry hate on each other. Plus more. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

Welcome to Bonus Smoke Friday, This Week I interview Nikki LeRiche. She talks about her beginnings as a escort in Atlanta. How she changed and adjusted to the game changing over the years and how she moved into Adult film. She talks about why she don't do content trade shoots and how she get her male talent for shoots. We discuss her life as a Findom and how it works. She discuss her sessions where she peg men and how the ladies in the industry hate on each other. Plus more. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

Welcome to Bonus Smoke Friday, This Week I interview Nikki LeRiche. She talks about her beginnings as a escort in Atlanta. How she changed and adjusted to the game changing over the years and how she moved into Adult film. She talks about why she don't do content trade shoots and how she get her male talent for shoots. We discuss her life as a Findom and how it works. She discuss her sessions where she peg men and how the ladies in the industry hate on each other. Plus more. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

Welcome to Bonus Smoke Friday, This Week I interview Nikki LeRiche. She talks about her beginnings as a escort in Atlanta. How she changed and adjusted to the game changing over the years and how she moved into Adult film. She talks about why she don't do content trade shoots and how she get her male talent for shoots. We discuss her life as a Findom and how it works. She discuss her sessions where she peg men and how the ladies in the industry hate on each other. Plus more. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

Welcome to Bonus Smoke Friday, This Week I interview Nikki LeRiche. She talks about her beginnings as a escort in Atlanta. How she changed and adjusted to the game changing over the years and how she moved into Adult film. She talks about why she don't do content trade shoots and how she get her male talent for shoots. We discuss her life as a Findom and how it works. She discuss her sessions where she peg men and how the ladies in the industry hate on each other. Plus more. Sponsored By https://lsswirl.com/ Proud Member of The G.W. District Black Podcast Network https://www.shopgwdistrict.com/pages/podcast-network Porn/ Music/ Social Media https://allmylinks.com/pornrapstar Guest: Nikki LeRiche https://twitter.com/NikkiLeRiche onlyfans.com/nikkileriche http://AllMyLinks.com/nikkileriche --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/smokethisova/message Support this podcast: https://anchor.fm/smokethisova/support

Welcome to the weekly GRADitude episode! Gabby and Sarah sit down with Brian LeRiche today to talk about his journey to becoming a PT. Spoiler alert! Brian has successfully opened 2 gyms! Brian is a rock star who opened his first gym during his senior year of undergrad!! Brian also shares his journey with retaking the NPTE multiple times before seeing the coveted "passed" symbol. Check this episode out because Brian tells us the hard truth and isn't afraid to share his wisdom! Let us know what you think about the episode! Join the Student Physical Therapy Network on Facebook so you never miss out on anything from GRADitude again!! https://www.facebook.com/groups/studentphysicaltherapynetwork Want to join the SPT Secret Society? Click here: https://graditude.mykajabi.com/spt-secret-society Go to Physiomemes.com and use this code for 20% off your next order: GRADITUDE20 --- Support this podcast: https://anchor.fm/graditude/support

This episode I'm joined by Smoke Buddy, Nikki LeRiche, a Independent Porn star who came back to update us on her life. We begin with her now working a 9-5 and adjusting to having less time to shoot content. But thanks to her work of building her foundation so that the business is not so hurt. She discuss now becoming single and moving forward to heal so she can live her life to the fullest. We discuss Pegging. She describes one of her sessions where a man took an 11 inch dildo. She discuss the mental aspects of pegging from her mind to the sub, We even et into talking about cuckolds.Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

This episode I'm joined by Smoke Buddy, Nikki LeRiche, a Independent Porn star who came back to update us on her life. We begin with her now working a 9-5 and adjusting to having less time to shoot content. But thanks to her work of building her foundation so that the business is not so hurt. She discuss now becoming single and moving forward to heal so she can live her life to the fullest. We discuss Pegging. She describes one of her sessions where a man took an 11 inch dildo. She discuss the mental aspects of pegging from her mind to the sub, We even et into talking about cuckolds.Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

This episode I'm joined by Smoke Buddy, Nikki LeRiche, a Independent Porn star who came back to update us on her life. We begin with her now working a 9-5 and adjusting to having less time to shoot content. But thanks to her work of building her foundation so that the business is not so hurt. She discuss now becoming single and moving forward to heal so she can live her life to the fullest. We discuss Pegging. She describes one of her sessions where a man took an 11 inch dildo. She discuss the mental aspects of pegging from her mind to the sub, We even et into talking about cuckolds. Sponsored By https://lsswirl.com/ Proud Member of The G.W. District Black Podcast Network https://www.shopgwdistrict.com/pages/podcast-network Porn/ Music/ Social Media https://allmylinks.com/pornrapstar Guest: Nikki LeRiche https://twitter.com/NikkiLeRiche onlyfans.com/nikkileriche http://AllMyLinks.com/nikkileriche --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/smokethisova/message Support this podcast: https://anchor.fm/smokethisova/support

This episode I'm joined by Smoke Buddy, Nikki LeRiche, a Independent Porn star who came back to update us on her life. We begin with her now working a 9-5 and adjusting to having less time to shoot content. But thanks to her work of building her foundation so that the business is not so hurt. She discuss now becoming single and moving forward to heal so she can live her life to the fullest. We discuss Pegging. She describes one of her sessions where a man took an 11 inch dildo. She discuss the mental aspects of pegging from her mind to the sub, We even et into talking about cuckolds.Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

This episode I'm joined by Smoke Buddy, Nikki LeRiche, a Independent Porn star who came back to update us on her life. We begin with her now working a 9-5 and adjusting to having less time to shoot content. But thanks to her work of building her foundation so that the business is not so hurt. She discuss now becoming single and moving forward to heal so she can live her life to the fullest. We discuss Pegging. She describes one of her sessions where a man took an 11 inch dildo. She discuss the mental aspects of pegging from her mind to the sub, We even et into talking about cuckolds.Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

This episode I'm joined by Smoke Buddy, Nikki LeRiche, a Independent Porn star who came back to update us on her life. We begin with her now working a 9-5 and adjusting to having less time to shoot content. But thanks to her work of building her foundation so that the business is not so hurt. She discuss now becoming single and moving forward to heal so she can live her life to the fullest. We discuss Pegging. She describes one of her sessions where a man took an 11 inch dildo. She discuss the mental aspects of pegging from her mind to the sub, We even et into talking about cuckolds.Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarGuest: Nikki LeRichehttps://twitter.com/NikkiLeRicheonlyfans.com/nikkilerichehttp://AllMyLinks.com/nikkileriche--- Send in a voice message: https://anchor.fm/smokethisova/message

Dans le podcast d'aujourd'hui, Thierry Leriche nous parle de son aventure d'éditeur Saas. Il nous explique de quoi est partie son invention et comment, aujourd'hui, le « modèle DISC », un modèle de comportement et de communication inventé il y a plus de cent ans, a pu être adapté à la tech et devenir un outil incontournable en entreprise ou dans les relations humaines pour mieux s'adapter et mieux travailler ensemble.  Pour découvrir profil 4 : www.profil4.com/fr/  Pour suivre Thierry Leriche : www.linkedin.com/in/thierry-leriche/  Pour faire ton diagnostic de pratiques gratuit et comparer ton niveau à des centaines de développeurs : ad302.fr/8vijE3 

Quand on est freelance dev et que ça fonctionne bien, a-t-on encore le temps de coder pour le plaisir ?  Comment ne pas s'épuiser et gérer son temps entre ses projets en cours, la recherche de nouveaux clients et sa vie perso ?  Et pour aller plus loin, à partir de quand peut-on réellement choisir ses clients / projets et négocier des contrats à la hausse ?  On en parle dans l'épisode du jour avec Thierry Leriche.  Pour suivre Thierry Leriche : https://www.linkedin.com/in/thierry-leriche/ Pour découvrir Profil4 : https://www.profil4.com/fr/ Pour découvrir le cursus Artisan Développeur : https://ad302.fr/KmhYNl

In this episode I am joined by Nikki LeRiche. We discuss BDSM. We talk master/slave relationships. Poly relationships and Fetish shaming. We touch how BDSM and fetish has became mainstream with a lot of misinformation and misconceptions out there about the lifestyle. She talks about her husband and how he enjoys seeing her with other men and they practice Poly relationship dynamic. We discuss what influenced us to be Doms and to get into the lifestyle plus what it means to be a Dominate/ Alpha. Plus she reveals she is a lil/brat. This was a fun , sexy and hot episode. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarCheckout Her Full Interview before The Worldwide release athttps://www.patreon.com/SmokeThisOvaDark--- Send in a voice message: https://anchor.fm/smokethisova/message

In this episode I am joined by Nikki LeRiche. We discuss BDSM. We talk master/slave relationships. Poly relationships and Fetish shaming. We touch how BDSM and fetish has became mainstream with a lot of misinformation and misconceptions out there about the lifestyle. She talks about her husband and how he enjoys seeing her with other men and they practice Poly relationship dynamic. We discuss what influenced us to be Doms and to get into the lifestyle plus what it means to be a Dominate/ Alpha. Plus she reveals she is a lil/brat. This was a fun , sexy and hot episode. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarCheckout Her Full Interview before The Worldwide release athttps://www.patreon.com/SmokeThisOvaDark--- Send in a voice message: https://anchor.fm/smokethisova/message

In this episode I am joined by Nikki LeRiche. We discuss BDSM. We talk master/slave relationships. Poly relationships and Fetish shaming. We touch how BDSM and fetish has became mainstream with a lot of misinformation and misconceptions out there about the lifestyle. She talks about her husband and how he enjoys seeing her with other men and they practice Poly relationship dynamic. We discuss what influenced us to be Doms and to get into the lifestyle plus what it means to be a Dominate/ Alpha. Plus she reveals she is a lil/brat. This was a fun , sexy and hot episode. Sponsored By https://lsswirl.com/ Proud Member of The G.W. District Black Podcast Network https://www.shopgwdistrict.com/pages/podcast-network Porn/ Music/ Social Media https://allmylinks.com/pornrapstar Checkout Her Full Interview before The Worldwide release at https://www.patreon.com/SmokeThisOvaDark --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/smokethisova/support

In this episode I am joined by Nikki LeRiche. We discuss BDSM. We talk master/slave relationships. Poly relationships and Fetish shaming. We touch how BDSM and fetish has became mainstream with a lot of misinformation and misconceptions out there about the lifestyle. She talks about her husband and how he enjoys seeing her with other men and they practice Poly relationship dynamic. We discuss what influenced us to be Doms and to get into the lifestyle plus what it means to be a Dominate/ Alpha. Plus she reveals she is a lil/brat. This was a fun , sexy and hot episode. Sponsored Byhttps://lsswirl.com/Proud Member of The G.W. District Black Podcast Networkhttps://www.shopgwdistrict.com/pages/podcast-networkPorn/ Music/ Social Mediahttps://allmylinks.com/pornrapstarCheckout Her Full Interview before The Worldwide release athttps://www.patreon.com/SmokeThisOvaDark--- Send in a voice message: https://anchor.fm/smokethisova/message

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A propos de justice patriarcale… Où l’on apprend que si l’institution judiciaire peine à protéger les femmes et les enfants dans le cas de violences sexuelles, ce n’est peut-être pas le fruit du hasard ! Autour de « l’affaire Julie » et du combat mené par la famille Leriche suite aux multiples agressions sexuelles commises par des pompiers Une émission diffusée sur Radio St Ferréol @Crest, RDWA @Die, Radio Primitive @Reims, Radio Grenouille @Marseille, HDR @Rouen, Evasion dans le Finistère, RCV @Lille, Sauveterre-de-Guyenne en Gironde, Campus @Clermont-Ferrand, Radio Panik @Bruxelles, ARA au Luxembourg... Et ailleurs aussi ! Retrouvez aussi La p'tite Blan sur www.facebook.com/laptiteblan/ Pour aider Julie et la famille Leriche a réglé les frais de justice, une cagnotte va être mise en ligne prochainement : infos via twitter @corinne_leriche

Safety NL President & CEO Len Leriche - Harry Megann Helping Hand Award Winners by VOCM

L'épisode sort exceptionnellement vendredi mais il y a bien une raison à cela. Tout simplement c'est le dernier épisode de la saison 1. Ne soyez pas tristes nous allons revenir vite. Mais pour ce dernier épisode, nous vous avons préparer un morceau de choix : Seb Leriche, entraineur de Cesson-Rennes en Lidl Starligue. Seb est un jeune entraineur qui a franchi les échelons. Il nous fait découvrir son parcours, son envie, ce qui l'anime et ses convictions profondes avec une perpétuelle remise en question? Merci Seb pour cette magnifique conclusion de cette première saison riche en enseignement. Bonne chance à toi pour cette année si particulière. Bonne écoute et à très vite pour de nouvelles aventures.

This is a repost from 2018, an article caled Wired Into Pain: a history of the science of pain. I hope you enjoy it. I’ve also recorded an audio version to go with it!I am a Physiotherapist. Almost every person I see in clinic is in pain, and most already have an idea about what has caused their pain. If they are old enough, they might say ‘overuse’, or ‘wear and tear’; if they are younger, they might say ‘bad posture’ or ‘tight muscles’; if they have had a scan, they might say a ‘slipped disc’ or a ‘bone spur’. We accept these explanations prima facie. We consider pain to be a readout on the state of the body’s tissues. Or, as one doctor wrote in 1917, it is “the unerring medical compass that serves as a guide to the pathological lesion”.But it is only very recently that we have come to understand our aches and pains in this way. Since medieval times, until surprisingly recently, people commonly understood their pains in terms of their relationship to God, often as punishment for sin. Physical and emotional pain were entangled, along with mind, body and soul. This was the grim logic of medieval torture and self-flagellation: the truth of the soul could be accessed through the pain of the body.But, as historian Joanna Bourke records in her book The Story of Pain, this mixture of mind, body, soul and God also allowed people to feel pain as comforting: a “vigilant sentinel […] stationed in the frail body by Providence”, as one writer put it in 1832. For others, pain was redemptive: take, for example, the early nineteenth-century labourer Joseph Townend, who resolved himself to God after undergoing surgery without anaesthetic, and reflected at the end of his life on his “sincere thanks to the Almighty God” for his agonising conversion.Pre-modern physicians had a different perspective. Most understood pain according to humoural theory. Hippocrates and his disciple Galen considered all illness to be caused by an imbalance of the body’s humours — phlegm, yellow bile, black bile and blood — which ebb and flow in response changes in the body or its environment. This notion endured for many centuries. To one 18th century writer, pain was a consequence of “viscid blood [stopping] at every narrow passage in its progress”; to another, it was a “Nature throw[ing] a Mischief” about his body. Humoural theory is pre-scientific and seems quaint to us now. But, as Bourke points out, it accounts for an abundance of influences, from our personal temperament and our relationships to the alignment of the planets above our heads, on the pain that we feel.Over the coming centuries, at great cost to people suffering from pain, this insight was lost. This is the story of that loss; of how we arrived at the strange, wrong idea that pain is a straightforward “guide to the pathological lesion”; and of how an emerging re-understanding of pain shows us that it is more complex and more astonishing than we have thought for centuries.Descartes, dualism and the labelled line“The ghost in the machine” — Gilbert RyleIt is in the sixteenth century that we find the beginnings of the dominant modern understanding of the body and its pains. The rise of Protestantism and, amongst secular thinkers, of humanism, contributed to an increased focus on the individual and an understanding of the body as a natural, rather than a supernatural entity. Medicine became more interested in anatomy and the physical laws of nature. Vesalius published his On the Fabric of the Human Body, a compendium of illustrations of dissected cadavers based on the author’s strict, first-hand observations at a time when doctors were not accustomed to performing their own dissections. Later, physicians like William Harvey took principles from physics and astronomy to show that in many ways, our bodies can be understood as machines: pumps, pulleys and levers. Slowly, the body became less sacred and more scientific.It was in this spirit that, in 1641, the French polymath Renes Descartes published his Meditations on First Philosophy. This work contains a drawing that became the seminal image of pain for the next three hundred years. The picture shows a kneeling boy with one foot perilously close to a small campfire. The heat of the flame sends a signal (an “animal spirit”) up a channel to the boy’s pituitary gland, which Descartes reckoned was the seat of consciousness. There, the signal elicits pain, “just as pulling one end of a cord rings the bell at the other end”.This picture makes sense to us, it seems intuitively correct. But this is because in matters of pain we are most of us now, in the Western world at least, the children of Descartes. For pain scientists on the other hand, who have fought in recent decades to emancipate themselves from Descartes, this picture has has come to represent the original sin, the first big lie of the Western world’s understanding of pain.It’s crimes are twofold. First, it is the essence of an idea called dualism, which holds that mind and body are separate. The body feels pain, and passes this information on to the mind. For Cartesian dualists, the body is a machine and we are a kind of ghost in the machine, receiving information about its status.Second, the picture represents pain as being felt by a specific detector in the body, and passed up a specific pathway, the long hollow tube, to a specific location in the boy’s brain. Pain detectors, at the end of a pain pathway, that leads to a pain centre. This idea is called specificity theory, but in this post I’m going to use the term labelled line theory because although it is less common, I think it is more descriptive — a labelled line for pain.As it happens, Descartes’ idea was more subtle than the picture and its subsequent interpretations made out. In his defence, the historians Jan Frans van Dijkhuizen and Karl A.E. Enenkel point out that Descartes knew that pain is not merely perceived, like a mariner perceives his ship, but felt, as if the mind and body are “nighly conjoin’d […] so that I and it make up one thing”. Descartes knew that we don’t just have a body; we are a body. But this subtlety was lost: the picture of the little boy with his foot in the fire has a memetic power that has carried it, along with dualism and the labelled line, through the centuries.The nineteenth century“Nothing less than the social transformation of Western medicine” — Daniel GoldbergThis change came gradually. It was not until the nineteenth century, two hundred years after Descartes’ Meditations, that dualism and the labelled line for pain finally established their authority in medicine.They set in as part of a wider change in the history of medicine following the French Revolution that is sometimes now called the ‘Paris School’. The physicians of the Paris School transformed large teaching hospitals in the city to dedicate them, for the first time, to furthering scientific knowledge through rigorous observation of patients and cadavers, and the classification of disease. They explicitly rejected humoural theory, which held that illnesses are processes that are distributed around the body through the movement of viscous humours. Rather, physicians of the Paris School considered diseases to be the result of lesions localised to a single, solid organ.Influenced by the Paris School, Victorian physicians across the Western world began to search their suffering patients’ bodies for a local, solid lesion to blame for their pain. As one New York physician wrote in 1880, “we fully agree that there can be no morbid manifestations without a change in the material structure of the organs involved”. For the first time, doctors began to think like detectives on the hunt for the smoking gun, following clues provided by the body and its sensations (it is no coincidence that Arthur Conan Doyle was a doctor before he wrote the Sherlock Holmes stories, or that he made his character Watson one, too).This approach has tremendous diagnostic power. But, as we will see, even modern researchers find that our pain, particularly our chronic pain, resists reduction by detective work. How did Victorian physicians respond when their investigations failed to turn up a local lesion to explain pain? According to historian and medical ethicist Daniel Goldberg, many doubled down, hunting for anything they could find. As one surgeon put it, “any lesion anywhere in the body will do to account for an otherwise inexplicable pain”. And that meant any lesion: the surgeon Joseph Swann, or example, baffled by a woman’s 11-year history of pain in an apparently healthy knee, eventually attributed it to an imperfection he found, after much searching, in a nerve in her hand.Those that could not find a lesion anywhere explained unexplained pain as one inevitably must if one subscribes to the logic of dualism: if it’s not in the body, it must be in the mind. Goldberg tells the story of the surgeon Josiah Nott who, in 1872, took on the care of an American soldier whose leg was crushed in a railway accident. The leg had already been amputated by another surgeon at a point about halfway up the calf, but the soldier had developed phantom limb pains. The original surgeon, assuming there must be a local lesion at the end of a labelled line, had then amputated the stump, but to no avail. Nott, making the same assumption, took still more from the stump the next year, and still the patient felt no relief. Later that year, Dr. Nott operated again, removing tissues from three major nerves in the shank. This pattern continued until Nott had removed the poor soldier’s leg up to four inches above the knee, and his sciatic nerve up to the pelvis. When the patient’s pain returned after this final operation, Dr. Nott reasoned that he must have acquired an addiction to opioids which was inciting him to malinger (to exaggerate or feign his disease). Nott had, horribly literally, followed the assumed cause of the disease up a labelled line through the body and, not catching it, decided it must therefore be in the mind.This logic played out on a broad scale in physicians’ understanding of the now-forgotten condition “railway spine”, the widespread and mysterious back pain felt by the victims of train accidents. Initially, physicians thought that the trauma of a crash caused compression of nerve filaments that in turn caused pain. But as time wore on and their investigations repeatedly failed to find a tissue lesion to explain railway spine, even in cadavers, their suspicion grew that railway spine was not a ‘real’ condition at all. After all, weren’t most victims also seeking compensation from railway companies? By the beginning of the twentieth century, railway spine was known instead as “hysterical spine […] merely a psychical condition”. Dualism dictated once more that if we can’t find it in the body, it must be in the mind.1900 to 1965Anomalies, non-anomalies, and opening the gateAnomalies“[Pain] reveals only a minute proportion of illnesses and often, when it is one of their accompaniments, is misleading. On the other hand, in certain chronic cases it seems to be the entire disorder which, without it, would not exist.” — Rene Leriche, 1937The break from Cartesianism began at the end of the nineteenth century, when the great neuroscientist Santiago Ramon y Cajal showed that our nerves, spinal cord and brain are not one thing but composed of many smaller things (which came to be called neurons) linked by gap junctions (which came to be called synapses). Decades earlier, the English neuroscientist Charles Bell had suggested that the function of the nervous system is less straightforward than the labelled line in Descartes’s picture, and Cajal’s work was proof.As we can see by his extraordinary drawings, Cajal meticulously mapped the peripheral neurons in our arms and legs, running to the spinal cord, and the neurons running up the cord, and many of those in our brain. But, according to pain scientist and writer Fernando Cervero, the terminus for incoming peripheral neurons, the foremost part of the spinal cord that we now call the dorsal horn, was so dense and chaotic that it resisted even Cajal’s fastidious eye. He called the dorsal horn a maremagnum, a Spanish word that means ‘confused and disorganised crowd’, as in the bustle of a busy railway station. Cajal’s vision of a network of individual cells, with nodes of incomprehensible complexity, opened up the possibility that signals aren’t simply passed upwards in a linear fashion as Descartes had assumed, but are modulated along the way.The idea that inputs to the nervous system are modulated before they ‘become’ our sensations hints at an explanation for the odd persistent pains for which Victorian physicians could find no lesion. It also begins to explain the opposite phenomenon, lesions that cause no pain, which became unignorable during the brutal first decades of the twentieth century. Doctors like Rene Leriche, on the front line in the Great War, found that soldiers with dreadful wounds often felt no pain and could undergo surgery without anaesthetic. Leriche knew this was not willpower but “certain movements of the hormones, or of the blood”, a presciently non-Cartesian thought.During the Second World War, the American anaesthesiologist Henry Beecher built on Leriche’s observations by conducting a more methodical study at his post in Italy. He found that as many as three quarters of wounded soldiers felt little pain at the time of their injury. As one doctor put it, it was as if wounds and diseases “carry for the most part — most mercifully — their own anaesthetics with them”.One might think that such cases would have alerted the scientific community to the fact that our nervous systems are doing something more than passively relaying pain into our brains, as labelled line theory implied. But for scientists and doctors at large, anomalies that defied labelled line went on hiding in plain sight, “discovered” periodically and then easily forgotten as they had been in the Victorian era. Phantom limb pain, for example, was unignorable during the American Civil War, and then slipped once more from popular consciousness. The doctor and writer Oliver Sacks called these periods of forgetting scotoma, dark gaps in the scientific awareness in which the prevailing theory cannot explain common phenomena and instead shoves them in the attic to think about another day. The progress of science, wrote Sacks, is faltering and haphazard, “very far from a majestic unfolding”.Non-anomalies“Pain is the physiological adjunct of a protective reflex” — Charles Sherrington, writing in 1900“Pain remains a biological enigma — so much of it is useless, a mere curse” — Charles Sherrington, writing forty years later.(Quoted in Understanding Pain by Fernando Cervero)Rather than explaining anomalies, scientists studying pain at the beginning of the twentieth century focused on a series of discoveries that appeared, at first, to confirm labelled line theory. The British neuroscientist Charles Sherrington had coined the term “nociceptor” for the neurons that convey danger messages (elicited by things like heat, intense mechanical pressure or an incision to the skin) to the brain, and in the following decades researchers slowly but successfully identified and isolated these cells.Starting in 1912, American scientists performed the first anterolateral cordotomy, slicing through the part of the spinal cord that was theorized to carry danger messages to the brain and appearing to stop pain in its tracks. Later, the success of such operations would prove to be temporary, but the procedure did show that this part of the spinal cord houses Sherrington’s nociceptors. In 1927, the Americans Herbert Gasser and Joseph Erlanger established that different nerve fibers conduct signals at different velocities, and classified them according to their diameter as A, B and C fibers. A fibers were widest and conducted signals the quickest; C fibers were the most narrow and slow. They found that one sub-type of A fibers, A-delta fibers, conducted the relatively quick sensation of dull pain we feel when we stub our toe; and that C fibers conduct the slower, stinging pain that arrives later. Again, this neat distinction would later prove to be more complicated, but the discovery was further evidence for a labelled line of pain. Gasser and Erlanger were only able to look at conduction signals from a whole bundle of nerves and so it was not until 1958 that Ainsley Iggo was first to record individual A-delta and C fibers and isolate Sherrington’s nociceptors for the first time.Opening the gate“It may seem easy, but it was not” — Ronald MelzackDespite this series of discoveries in favour of labelled line, some researchers could not shake from their minds those confounding anomalies: pain without lesion, and lesion without pain. And so, at last, the science of pain began to wake from its scotoma. Some scientists began to propose a theory to compete with labelled line called pattern theory, which held that it is not the stimulation of specific nerves that causes the sensation of pain, but that the way in which nerves are stimulated, spatially and temporally. Pattern theory was vague, and had nowhere near the amount of evidence that supported labelled line theory, but it did hint at an answer to some of the anomalies that had been documented in the recent scientific literature, such as the way pain spreads beyond the site of an injury and the way rubbing a pain can make it temporarily feel better. Pattern theory was taken up in Oxford in the 1940s and 50s, where the brilliant British neuroscientist Pat Wall was beginning to develop ideas he would turn into gate control theory, a whole new model of pain.In 1959, Wall moved from Oxford to the Massachusetts Institute of Technology where he met Ronald Melzack. Melzack, a Canadian, had just arrived at M.I.T. to take up a post as assistant professor of Psychology, and found to his annoyance that he could not perform research on animals in the university’s Psychology building. So, Melzack decamped to Wall’s lab. The two quickly took up a discussion on the inadequacy of Cartesianism and decided to come up with a new theory to “entice spinal-cord physiologists away from [labelled line]”.From his previous research, Melzack knew the brain sends messages down the spinal cord to inhibit the messages coming up it, exerting a kind of ‘top-down’ control on incoming information. From his own experiments, inspired by pattern theory, Wall knew that different inputs into the nervous system are weighed against each other somehow in the spinal cord, competing to be ‘sent up’ to the brain. Despite their discussions, Melzack and Wall’s ideas remained inchoate until, in 1962, Melzack stumbled on the Dutchman Willem Noordenbos’s pattern-theory hypothesis that large A-fibers carrying touch signals might somehow inhibit small C-fibers carrying danger signals.Melzack calls this moment a “flash of insight”. Noordenbos had theorized that this modulation happened in the substantia gelatinosa, which is part of the terminus for incoming information at the spinal cord. Wall knew that large fibers and small fibers entered the substantia gelatinosa at opposite ends, and theorised that it was this setup that allowed the one to inhibit the other, like closing a figurative ‘gate’. The weight of signals from large and small fibers would determine what kind of message was allowed up to the brain.In 1963, Melzack moved to McGill University in Canada, but travelled South over the border when he could to visit Wall’s home in Boston where, over large amounts of duty free whiskey, the two put the finishing, definitive touches to their work. Their theory differed critically from Noordenbos’ because they proposed that the brain itself plays a role in processing at the substantia gelatinosa, by sending signals down the spinal cord to make the ‘gate’ more likely to open or close to danger signals. This was gate control theory.For the first time, science had a model that began to explain pain anomalies. According to gate control theory, for example, the brain of a soldier who has sustained an injury can send messages down the spinal cord to close the gate to incoming danger signals. Over fifty years have passed, and gate control theory has turned out to be wrong in lots of little ways, but right in one big way: it is modulation in the spinal cord and the brain, or the central nervous system, that explains why pain is so rarely the reliable sign of tissue status that Victorian scientists assumed it was.Neuromatrix theory“We need to go… to the brain” — Ronald Melzack“When you feel a pain in the leg that has been amputated, where is the pain? If you say it is in your head, would it be in your head if your leg had not been amputated? If you say yes, then what reason have you for ever thinking you have a leg?” — Bertrand RussellGate control theory was a great advance but Melzack and Wall knew their theory was incomplete. According to Oliver Sacks, it is by studying anomalies — phenomena not explained by the prevailing theory — that researchers wake from scotoma and begin revolutions in scientific understanding. So it was that Melzack’s interest in the anomaly of phantom limb pain led to neuromatrix theory, the next great boost that finally allowed pain science to escape to orbit of CartesianismIf people without limbs have phantom pain, Melzack reasoned, it follows that the origins of the pattern of pain lie not in the limb but in the brain. And not only pain, but the sensation of having a body in its entirety — its place in the world, its shape, its movements — is housed, in what Melzack came to understand as a series of loops and patterns of neurons, inside our brains. This brain architecture is the neuromatrix.Incoming information, then, is not what holds the essence of our sensations; it merely triggers the neuromatrix, already inscribed in the brain, to ‘produce’ the sensations we feel. If a boy puts his foot in a fire, the nerves do not tell a passive brain “here is pain”; the nerves simply say “here is an intense input”, and the neuromatrix does the rest.How do we get a neuromatrix? Melzack says it is inborn, but then shaped by experiences. So, your neuromatrix develops your own personal signatures for familiar pains, like the pain you might feel in your back when you bend. Crucially, the neuromatrix uses our thoughts and emotions to generate our sensations, as well as sensory information. This makes sense: think of a stroke on the leg from your partner and one from an unappealing stranger. The same sensory input feels different.So, if you believe the cause of your back pain is something threatening, like a suspected spinal cancer or a ‘slipped’ disc, it willfeelworse than if you believe it is something benign, like a muscle strain. If a conscripted soldier sustains a battlefield injury that means he will likely have to leave the trenches to convalesce behind the front lines, that wound may not feel as bad as it would for a factory worker, for whom it could mean a loss of livelihood. If you have just been made redundant, or become divorced, than the incoming danger signals from an incipiently arthritic hip might suddenly start triggering your neuromatrix to produce a deep aching pain in your joints.Pain is intimately integrated with meaning, and informed by the broader context of our lives. And there is no labelled line: pain is the output of a widely-distributed neural process that takes input from countless biological, psychological and social factors.The sensitive nervous system“Not under conditions of my choosing / Wired into pain / Rider on the slow train” — Adrienne RichResearchers have used the neuromatrix as a foundation to develop our understanding of pain. For example, towards the end of the 1970s, scientists began to establish that the endings of our danger messenger neurons, the ones Sherrington christened nociceptors, become more sensitive the more they are used, a process called peripheral sensitization. But perhaps the most remarkable development since Melzack proposed the neuromatrix was Clifford Woolf’s discovery of central sensitization.On completing his medical training in South Africa in the early 1980s, Clifford Woolf joined Pat Wall’s laboratory in London. He was not content with measuring the readouts from individual chains of neurons, and instead began to monitor broader bursts of activity which he thought would give him more insight into the pain system as a whole. He started to measure the output of the neurons that cause muscles to flex away from a dangerous stimulus (think of touching a hot stove and retracting your hand before you are even conscious of pain). Investigating on rats, he found that most of these cells responded to dangerous stimuli, such as heat and pinch, in a fairly narrow field — say, one toe. But, some cells had a very wide receptive field and would respond to even light, non-dangerous touch. Why would rats have neurons designed to elicit a withdrawal response to light touch?It took Woolf some months to realise that he was only finding these neurons at the end of the workday, when his rats had already been subjected to hours of pain-inducing stimuli. He calls this his “eureka moment”. He had not discovered that rats have certain neurons that are super sensitive across a wide receptive field: he had discovered that a rat’s nervous system becomes super sensitive across a wide receptive field when it has been exposed to prolonged danger. Woolf had discovered an ‘amplifier’ mechanism in the spinal cord. This phenomenon is central sensitization.Woolf was the first person to show that the nervous system is not hard-wired for pain but plastic. Prolonged nociception can change the behaviour and the architecture of the nervous system so that non-dangerous inputs (like light touch) are felt as painful, and dangerous inputs (like a pinprick) produce more pain than they otherwise would have done. To top it off, this whole pain experience also spreads beyond the original site of injury. The great physiotherapist Louis Gifford described central sensitization as like tapping X on your computer keyboard three times, and 10 X’s of different sizes and colours popping up on the screen.A mild and benign form of central sensitization is common and almost immediate after most injuries — after you burn your hand or sprain your ankle, it is your body’s way of protecting itself. But central sensitization can wear on and, in many cases, persist and get worse long after any injury has healed. If you or someone you know has widespread back pain that flares up with the slightest movement, or has osteoarthritis in their hip that seems to spread all the way down their leg, they might have central sensitization.Central sensitization can affect many different functions, not just pain. People with ongoing, maladaptive central sensitization can be tense and forgetful, and sensitive to bright lights, loud noises and chemicals. It is also a feature of irritable bowel syndrome, migraine and chronic fatigue syndrome, and often goes hand in hand with anxiety and depression.So long, labelled line: Grappling with complexity“Pain cannot easily be divided from the emotions surrounding it. Apprehension sharpens it, hopelessness intensifies it, loneliness protracts it by making hours seem like days. The worst pain is unexplained pain” — Hilary Mantel“The basic idea of pain modulation implies that the output can be different to the input at every stage in the transmission of pain signals throughout the brain” — Fernando CerveroCentral sensitization is just one discovery that has enhanced our understanding of pain. There are many more examples. Descending modulation is the ongoing process by which the brain sends signals down the spinal cord to simultaneously inhibit and facilitate incoming danger signals, a mechanism Leriche anticipated when he observed that battlefield wounds “carry […] their own anaesthetics with them”. In people with persistent pain, descending modulation may be set for a net facilitation of incoming danger messages. Researchers have also expanded our understanding to include the immune system, which aids and abets the nervous system as it produces pain. They have found out that nociceptors, far from lying waiting for an intense stimulus as Sherrington imagined, are actually firing regularly throughout the day, every time we use a pair of scissors, ride a bike or go on a long walk, without (if we are lucky) our neuromatrix producing the experience of pain. Conversely, clever experiments have shown that nociception is not even necessary for pain, giving credence to the stories of people who narrowly escape injury but, believing they have been hurt, writhe in agony. And, we know that stress, even the stress of early life events, plays a vital role in ongoing pain, and that our stress system and pain production system are intimately linked.The contrast between the byzantine, distributed complexity of the mechanisms of pain and the singular experience of pain — I feel it here — is remarkable. Scientists have made various attempts to simplify the mechanisms into something more understandable and more useful to lay people. The neuroscientist VS Ramachandran has said that “pain is an opinion on the organism’s state of health rather than a mere reflective response to an injury”, a stark contrast to the old-fashioned idea of pain as “the unerring medical compass that serves as a guide to the pathological lesion”.The scientists and physiotherapists Dave Butler and Lorimer Moseley put it elegantly:“We will experience pain when our credible evidence of danger related to our body is greater than our credible evidence of safety related to our body. Equally we won’t have pain when our credible evidence of safety is greater than our credible evidence of danger.”In other words, pain is not measuring damage, it is a protective strategy, just one of many (along with local and systemic inflammation, changes in movement like tensing or bracing, the feeling of stiffness, and so on) that the body enacts in response to credible evidence of danger.This evidence of danger often includes nociception (signals from tissue damage), but the neuromatrix uses many other sources, too. For example, if someone has back pain and a doctor tells you your x-ray shows “wear and tear” or “degeneration” in your spine, they have received a clear message of danger related to your body that is likely to make their pain worse. Indeed, people with back pain who get an MRI actually reduce their chances of recovery. On the other hand, if that person’s doctor (or physiotherapist!) tells them that the findings on their scan are normal age-related changes (or, better yet, doesn’t order a scan at all), that is a clear safety message. Safety messages can come from anywhere. Exercise can send safety messages to your neuromatrix, and so can a supportive workplace or having a friend around to talk to.ReflectionsSlow progress, hopes for the future and a note of cautionSlow progress“I am still not happy with what has been accepted” — Pat Wall, 1999Danger sharpens pain; safety soothes it. Why, then, do health professionals continue to give people with persistent pain credible evidence of danger? Apart from the obvious — that there is money in telling people their spines are crumbling and their pelvises are out of line, that they have muscle knots that need releasing and cores that need stabilizing — it is because, just as Descartes’ model of pain took almost three centuries to reach its zenith in Western culture, the neuromatrix, still only forty years old, has been accepted only falteringly even in medical circles, and hardly at all in the wider culture.Indeed, in many ways the twentieth century has doubled down on labelled line. Take, for example, the dominance of the orthopaedic understanding of low back pain, which the late Scottish doctor and historian Gordon Waddell called “the dynasty of the disc”. Waddell traces the tenuous association of the lumbar disc with low back pain to a fateful cluster of papers published at the beginning of the century by orthopods searching, like Victorian physicians had done before them, for a pot of gold at the (wrong) end of the labelled line. Even today, routine orthopaedic surgeries like lumbar fusion, knee arthroscopy and shoulder decompression are amongst the most low-value, least evidence-based treatments in healthcare, still performed largely because of inertia and unexamined Cartesianism.Many physiotherapists practice with the same habits. Like Joseph Swann, we might conduct a questionable root-cause analysis up or down a kinetic chain to find an ‘issue in the tissues’, settling on a pronated foot, a slumped posture or a valgus (in-falling) knee. Like Josiah Nott, when a patient has failed a course of ‘corrective’ exercise to ‘fix’ their body we might decide their problem is primarily ‘psycho-social’, a euphemism for in-their-mind. This is understandable, it takes great effort to shift from Cartesianism to the neuromatrix; I have been trying for years and I am still astonished when a new study is published showing, for example, that there are no major physical risk factors for a first episode of neck pain, but multiple psychological ones, like depression, and social ones, like role conflict. Still, it is imperative that medical professionals of all stripes challenge their colleagues who promote themselves as experts but who practice with unreconstructed Cartesianism.Hopes for the Future“While pain sufferers do not have the luxury of denying the reality of their pain, they can and do deny its legitimacy, thereby internalising the stigma so frequently directed at people in pain.” — Daniel GoldbergThe neuromatrix model has the potential to be immensely liberating for patients. For people with everyday predicaments of life like the back or shoulder pain we all get from time to time, there is the reassuring message that pain is not an indicator of damage and they are safe to move. In fact, movement, as opposed to protecting the painful joint, is the way to go in the long run. For people with more profound, widespread and recalcitrant pain, understanding why their pain is the way it is can help with the process of acceptance, and knowing pain is multifactorial can open up new therapeutic options to help calm down a sensitive nervous system.The neuromatrix could also militate against the way Cartesian thinking drives stigmatization of people with chronic pain. Cartesian dualism casts pain as a two-step sequence of events: the body senses pain, then the mind reacts. As recently as the 1980s, words like “hysterical” or “psychogenic” were used to describe people who appeared to be ‘over-reacting’ to their pain. It is this thinking that allows us to sort people into those who are responding appropriately to their pain, and those who are ‘being dramatic’. The saddest effect of this stigma is when patients internalise it, believing that they are not ‘coping’ properly with ‘a bit of back pain’.So patients and health professionals need to know that dualism is bogus: as Pat Wall himself put it, “the separation of sensation from perception was quite artificial… sensory and cognitive mechanisms operate as a whole”. Or, in the words of neuroscientist Fernando Cervero, “emotional, sensory and cognitive elements aren’t organised in a hierarchical way, but in a cooperative way […] interacting to generate the final pain experience”.A note of caution“Nineteenth century physicians drain[ed] pain of any intrinsic meaning altogether, making it little more than a sign or symptom of something else” — Joanna Burke“[The challenge is] to allow a rapprochement between the world of the clinician and the world of the person in pain” — Quinter et. al (2008).The neuromatrix and all its attendant discoveries have revolutionised how medical and health professionals should approach people in pain. It is a rare true paradigm shift. But there is danger in complacency. “Now is not a time for professional hubris or the proclamation of truth by a few”, warn the rheumatologists John Quintner and Milton Cohen. The battle to understand pain is only half won. It is all too easy to be drawn back into the orbit of dualism, not only between the mind and body, but between the clinician and the patient, or the researcher and the sufferer. Centuries-old habits die hard, and we have long made the person-in-pain an object of enquiry. But this can only take us so far; as Quinter and Cohen assert, “the pain of another person is irreducible to its neuronal correlates”. We can only really know pain through dialogue.It is difficult to talk properly about pain. Being in deep pain can be a harrowing, abject, solitary experience. And apart from anything else, often we just don’t have the words: Virginia Woolf, no stranger to pain, lamented that English has a rich vocabulary for love, but a meagre one for pain. The poet Emily Dickinson said that pain “has an element of blank”.But it can be done. Joletta Belton, a blogger with persistent pain, recently tweeted about the two clinicians who had helped her the most. “It wasn’t just their words” she wrote, “it was that they listened first. And understood. Listening matters […] I wasn’t interrupted or lectured, they didn’t try to ‘educate’ me or alter my narrative to suit their own […] I felt what I said was of value. I felt human, of worth. That’s invaluable.”It may seem strange to end a post about science with a note on the importance of listening, but in the context of the neuromatrix it makes perfect sense. Listening to people in pain is what’s needed to undo the damage that has been done, and take the progress that’s been made to the next level.Belton’s experience echoes a vignette reported by Joanna Bourke in The Story of Pain.During a medical consultation in 1730, an embarrassed patient found himself apologising to his physician for boring him with “so tedious a Tale”. The patient’s physician protested: “Your Story is so diverting, that I take abundance of delight in it, and your Ingenious way of telling it, gives me a greater insight into your distemper, than you imagine. Wherefore, let me beg of you to go on, Sir: I am all attention, and shall not interrupt you.”Selected bibliographyJournal ArticlesAllan, D. and Waddell, G. (1989). An historical perspective on low back pain and disability. Acta Orthopaedica Scandinavica, 60(sup234), pp.1–23.Arnaudo, E. (2017). Pain and dualism: Which dualism?. Journal of Evaluation in Clinical Practice, 23(5), pp.1081–1086.Baliki, M. and Apkarian, A. (2015). Nociception, pain, negative moods, and behavior selection. Neuron, 87(3), pp.474–491.Bourke, J. (2014). Pain sensitivity: an unnatural history from 1800 to 1965. Journal of Medical Humanities, 35(3), pp.301–319.Brodal, P. (2017). A neurobiologist’s attempt to understand persistent pain. Scandinavian Journal of Pain, 15(1).Cohen, M., Quintner, J., Buchanan, D., Nielsen, M. and Guy, L. (2011). Stigmatization of Patients with Chronic Pain: The Extinction of Empathy. Pain Medicine, 12(11), pp.1637–1643.Chapman, C., Tuckett, R. and Song, C. (2008). Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. The Journal of Pain, 9(2), pp.122–145.Eriksen, T., Kerry, R., Mumford, S., Lie, S. and Anjum, R. (2013). At the borders of medical reasoning: aetiological and ontological challenges of medically unexplained symptoms. Philosophy, Ethics, and Humanities in Medicine, 8(1), p.11.Goldberg, D. (2012). Pain without lesion: debate among American neurologists, 1850–1900. 19: Interdisciplinary Studies in the Long Nineteenth Century, 0(15).Goldberg, D. (2017). Pain, objectivity and history: understanding pain stigma. Medical Humanities, 43(4), pp.238–243.Iannetti, G. and Mouraux, A. (2010). From the neuromatrix to the pain matrix (and back). Experimental Brain Research, 205(1), pp.1–12.Kerry, R., Maddocks, M. and Mumford, S. (2008). Philosophy of science and physiotherapy: An insight into practice. Physiotherapy Theory and Practice, 24(6), pp.397–407.Latremoliere, A. and Woolf, C. (2009). Central sensitization: A generator of pain hypersensitivity by central neural plasticity. The Journal of Pain, 10(9), pp.895–926.Melzack, R. (1999). From the gate to the neuromatrix. Pain, 82, pp.S121-S126.Melzack, R. (2005). Evolution of the neuromatrix theory of Pain. The Prithvi Raj Lecture: Presented at the Third World Congress of World Institute of Pain, Barcelona 2004. Pain Practice, 5(2), pp.85–94.Melzack, R. and Katz, J. (2012). Pain. Wiley Interdisciplinary Reviews: Cognitive Science, 4(1), pp.1–15.Mendell, L. (2014). Constructing and deconstructing the gate theory of pain. Pain, 155(2), pp.210–216.Moayedi, M. and Davis, K. (2013). Theories of pain: from specificity to gate control. Journal of Neurophysiology, 109(1), pp.5–12.Moseley, G. and Butler, D. (2015). Fifteen years of explaining pain: the past, present, and future. The Journal of Pain, 16(9), pp.807–813.Moseley, G. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, 12(3), pp.169–178.Neilson, S. (2015). Pain as metaphor: metaphor and medicine. Medical Humanities, 42(1), pp.3–10.O’Sullivan, P., Caneiro, J., O’Keeffe, M. and O’Sullivan, K. (2016). Unraveling the complexity of low back pain. Journal of Orthopaedic & Sports Physical Therapy, 46(11), pp.932–937.Perl, E. (2007). Ideas about pain, a historical view. Nature Reviews Neuroscience, 8(1), pp.71–80.Quintner, J., Cohen, M., Buchanan, D., Katz, J. and Williamson, O. (2008). Pain Medicine and Its Models: Helping or Hindering?. Pain Medicine, 9(7), pp.824–834.Thacker, M. and Moseley, G. (2012). First-person neuroscience and the understanding of pain. The Medical Journal of Australia, 196(6), pp.410–411.Wiech, K. (2016). Deconstructing the sensation of pain: The influence of cognitive processes on pain perception. Science, 354(6312), pp.584–587.Woolf, C. (2007). Central sensitization. Anesthesiology, 106(4), pp.864–867.BooksCervero, F. (2014). Understanding pain. Boston: Mit Press.Butler, D. and Moseley, G. (2015). Explain pain. Adelaide: Noigroup Publications.Bourke, J. (2014). The story of pain. Oxford: Oxford Univ. Press.Moseley, G. and Butler, D. (2017). Explain pain supercharged. Adelaide: Noigroup Publications.Blog postsPain is weird by Paul IngrahamPain really is in the mind, but not in the way you think by Lorimer MoseleyCentral sensitization in chronic pain by Paul IngrahamMy own chronic pain story by Paul IngrahamEasing musculoskeletal pain Information leafletTell me your story by Joletta BeltonPodcasts and lecturesThe Pain Revolution by Lorimer MoseleyPain: past, present and future with Mick ThackerUnderstanding Pain in 2025 by Mick Thacker Subscribe at tomjesson.substack.com

D’où provient la motivation à faire de l’activité physique? Comment la conserver lorsqu’elle vacille ou la retrouver lorsqu’elle disparaît? Jean-Philippe Wauthier en discute avec Jérôme Leriche, enseignant en éducation physique au cégep. Mais d’abord, on prend des nouvelles de Joan Roch et de son périple Percé-Montréal à la course à pied.

Les fêtes de fin d’année sont bien souvent l’occasion d’une certaine abondance alimentaire avec des produits que l’on qualifie parfois « d’exception » : foie gras, saumon, crevette, huitre, escargot, pintade et j’en passe. Cette consommation, si elle a un certain caractère exceptionnel, n’est pas anodine. Il est souvent difficile d’y voir clair dans l’impact que représente ce repas sur l’environnement, voire même sur notre santé.  Dans cette épisode, nous nous penchons de plus près sur ce repas afin de vous amener, peut-être, à faire d’autres choix que ceux que vous auriez fait habituellement.  Pour en parler, nous sommes avec Hélène Leriche. Hélène est docteur vétérinaire et docteur en écologie. Elle a été conseillère scientifique et responsable biodiversité à la Fondation Nicolas Hulot, période pendant laquelle elle a notamment étudié la question de l’impact environnementale de notre alimentation. Elle est actuellement responsable biodiversité-économie à l’association Orée. Pour en savoir plus sur le label de restauration durable Ecotable et sa communauté, visitez notre site internet https://ecotable.fr/fr

On parle souvent des softskills, mais comment les développer ? Cela passe souvent par apprendre à mieux se connaître. Ca tombe bien ! Thierry nous parle du DISC dans l’épisode du jour. Thierry Leriche Fais les tests (50 sont offerts tous les jours de façon aléatoire), regarde la documentation (elle est en français, ce qui est assez rare), lis le blog (il a une approche moins conventionnelle du sujet) ou forme-toi : - https://profil4.com Artisan Développeur Forme-toi dans la Maison des compagnons pour progresser dans l'artisanat logiciel : - https://maison.artisandeveloppeur.fr Rejoins la communauté des artisans développeurs : - https://artisandeveloppeur.fr

LERICHE SYNDROME – Leriche syndrome is a triad of symptoms. The first is claudication or muscular pain in the calfs, buttocks, or groin due to decreased blood flow. The second is impotence due to decreased flow in the hypogastrics and internal iliacs. The final symptom is atrophy of the lower extremities and absence or diminished femoral pulses. Occlusion in Leriche syndrome is at the level of the aortoiliac bifurcation. Ankle-Brachial Index is a reliable screening tool, however, distal pulses may be present if the obstruction is chronic enough to have allowed for collateralization. Treatment targets symptom relief. Complete occlusion may require open aorto-bifemoral bypass.

Manon Leriche à 70% En plus d’occuper à temps plein un emploi de reporter et d’assistante-réalisatrice à Télévisions Quatre Saisons (TQS) dès 1986 et suite à sa rencontre avec le L’article 70 – 611 – Manon Leriche, 2019-04-08 est apparu en premier sur RadioH2O.

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don't we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don't we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don’t we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don't we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/medicine

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don’t we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don’t we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices

L1 SPS_UE5.S1-A3 Leriche_Vers une définition de la santé_THIAM-BO MOREL M. duration : 00:27:59

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don’t we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices

The prologue to The Human Body in the Age of Catastrophe: Brittleness, Integration, Science, and the Great War (University of Chicago Press, 2018) begins by provocatively invoking a question American physiologist Walter Cannon first asked in 1926: “Why don’t we die daily?” In the erudite chapters that follow, Stefanos Geroulanos and Todd Meyers explore how practitioners and theorists working during and after World War I tried to answer that very thorny problem in light of the challenges of wound shock. This functional disorder demanded that doctors, surgeons, and physiologists account for two medical realities: first, that wound shock was a whole-body, multi-systemic response to trauma; and second, that a fairly homogenous group—namely the young, male soldier-patient—responded to wound shock in highly variable and individuals ways. Whereas the historiography of World War I and trauma has largely focused on psychopathological models, Geroulanos and Meyers illuminate how the work of Henry Head, Réné Leriche, Kurt Goldstein and others enacted a wholesale transformation of the concept of the individual, one that would define medico-physiological individuality as an integrated and indivisible body, but one constantly on “the verge of collapse.” Learn more about your ad choices. Visit megaphone.fm/adchoices

Episode 10. LA CoMotion’s Director of Strategy Greg Lindsay and Yann Leriche, CEO of Transdev North America, chat about how shared autonomous transportation will transform cities. Transdev has a hands-on, experimental approach to inventing the future of mobility. Yann Leriche explains the need to work with cities and develop shared solutions in order to balance out the appeal for autonomous vehicles and the increase in traffic and congestion. Yann and Greg discuss the difference between Europe and the United States in public transit ridership. Transdev is sharing data with transit agencies and developing a global set of alternatives to the private car thanks to Mobility as a Service products.

Episode 10. LA CoMotion’s Director of Strategy Greg Lindsay and Yann Leriche, CEO of Transdev North America, chat about how shared autonomous transportation will transform cities. Transdev has a hands-on, experimental approach to inventing the future of mobility. Yann Leriche explains the need to work with cities and develop shared solutions in order to balance out the appeal for autonomous vehicles and the increase in traffic and congestion. Yann and Greg discuss the difference between Europe and the United States in public transit ridership. Transdev is sharing data with transit agencies and developing a global set of alternatives to the private car thanks to Mobility as a Service products.

Some companies look at the individual pieces, some companies look at the whole ecosystem. TransDev's Yann Leriche talks how they're approaching the future of mobility, with an eye on managing the whole system, top to bottom.

This episode covers Chapter 87 of Rosen’s Emergency Medicine   What is an atheroma and how is it formed? What are the classic symptoms of arterial insufficiency? Provide a differential diagnosis for chronic arterial insufficiency. What is blue toe syndrome? What is its significance? Differentiate between thrombotic and embolic limb ischemia based on clinical features What is the management of an acutely ischemic limb? List three disorders characterized by abnormal vasomotor response. Describe Raynaud's disease and how it’s treated? What is the most common site for arterial aneurysm in the leg? List four potential sites for upper extremity aneurysms, and their associated underlying causes. Name three types of visceral aneurysms and their associated conditions. List 6 ddx of occluded indwelling catheter + describe the management of suspected line infection. What are the two types of AV fistulas used for dialysis? How do you access an AV fistula? List 5 complications of dialysis fistulas + treatment List the 3 types of thoracic outlet syndrome. What are the typical symptoms of thoracic outlet syndrome? What is a simple bedside test for this condition? List 4 anatomic abnormalities associated with thoracic outlet syndrome. Wisecracks: Describe Buerger’s sign and ankle brachial index List clinical criteria for Buerger’s Disease (5) What is Leriche's syndrome? List 4 types of infective aneurysms Differentiate between arterial insufficiency ulcers and venous stasis ulcers

This episode covers Chapter 87 of Rosen’s Emergency Medicine   What is an atheroma and how is it formed? What are the classic symptoms of arterial insufficiency? Provide a differential diagnosis for chronic arterial insufficiency. What is blue toe syndrome? What is its significance? Differentiate between thrombotic and embolic limb ischemia based on clinical features What is the management of an acutely ischemic limb? List three disorders characterized by abnormal vasomotor response. Describe Raynaud's disease and how it’s treated? What is the most common site for arterial aneurysm in the leg? List four potential sites for upper extremity aneurysms, and their associated underlying causes. Name three types of visceral aneurysms and their associated conditions. List 6 ddx of occluded indwelling catheter + describe the management of suspected line infection. What are the two types of AV fistulas used for dialysis? How do you access an AV fistula? List 5 complications of dialysis fistulas + treatment List the 3 types of thoracic outlet syndrome. What are the typical symptoms of thoracic outlet syndrome? What is a simple bedside test for this condition? List 4 anatomic abnormalities associated with thoracic outlet syndrome. Wisecracks: Describe Buerger’s sign and ankle brachial index List clinical criteria for Buerger’s Disease (5) What is Leriche's syndrome? List 4 types of infective aneurysms Differentiate between arterial insufficiency ulcers and venous stasis ulcers

Dans la terre des indigènes Atikamekw The post Chloé Leriche – Avant Les Rues #TFF34 appeared first on Fred Film Radio.

Todd is back in Toronto after his stay in LA! We welcome back Todd. Talk about our upcoming PokerStars Tournamament. Special Guests Include, Lennox Lewis! Ari Goldkind, Roddy and Jay interview LeRiche and an amazing live performance from Bryce Avery! All this and more.

Olivier Leriche, who was previously the winemaker at Domaine de l'Arlot in Burgundy, is now the winemaker at Domaine des Accoles, the winery he owns with his wife in the south of France.

CAPÍTULO II EN LOS BUISSONNETS (1877-1881) Muerte de mamá Todos los detalles de la enfermedad de nuestra querida madre siguen todavía vivos en mi corazón. Me acuerdo, sobre todo, de las últimas semanas que pasó en la tierra. Celina y yo vivíamos como dos pobres desterradas. Todas las mañanas, venía a buscarnos la señora de Leriche y pasábamos el día en su casa. Un día, no habíamos tenido tiempo de rezar nuestras oraciones antes de salir, y por el camino Celina me dijo muy bajito: -«¿Tenemos que decirle que no hemos rezado...» -«Sí», le contesté, y entonces ella se lo dijo muy tímidamente a la señora de Leriche, que nos respondió: -«Bien, hijitas, ahora las haréis». Y dejándonos solas en una habitación muy grande, se fue... Entonces Celina me miró y dijimos: «¡Ay, no es como con mamá...! Ella nos hacía rezar todos los días...»