L'Abbittibbi et le Témiskaming hier et aujourd'hui

Ouvrage contenant les études suivantes: Benoît-Beaudry Gourd, «La colonisation et le peuplement du Témiscamingue et de l'Abitibi 1880-1950. Aperçu historique». Jean Laflamme, «Un camp de concentration en Abitibi durant la grande guerre». Roger Barrette, «Le plan Vautrin et l'Abitibi-Témiscamingue 1934-1936». Gilbert Saint-Laurent, «Prémices du transport d'écoliers du Québec. L'exemple de la Commission scolaire de Guérin, Comté de Témiscamingue, 1909-1950». Yves Côté, «L'évolution et la régression d'une ville minière: Duparquet». Jacques Meunier, «Réflexion en marge de la marginalité». Laurent Deshaies, «Le développement économique de l'Abitibi-Témiscamingue. Essai de prospective ou esquisse d'une géographie du futur de la région. Première partie». Bibiane Plourde-Savard et Noël Savard, «L'industrie manufacturière du Nord-Ouest québécois». Jean De Denus, «Le conseil régional de développement de l'Abitibi-Témiscamingue. Un organisme-tampon?». Michel Poudrier, «Classes sociales des étudiants du CEGEP du Nord-Ouest.

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease

BACKGROUND: The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein (HDL) cholesterol level, reduces the low-density lipoprotein (LDL) cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease. METHODS: In a multicenter, randomized, double-blind, placebo-controlled phase 3 trial, we enrolled 12,092 patients who had at least one of the following conditions: an acute coronary syndrome within the previous 30 to 365 days, cerebrovascular atherosclerotic disease, peripheral vascular arterial disease, or diabetes mellitus with coronary artery disease. Patients were randomly assigned to receive either evacetrapib at a dose of 130 mg or matching placebo, administered daily, in addition to standard medical therapy. The primary efficacy end point was the first occurrence of any component of the composite of death from cardiovascular causes, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina. RESULTS: At 3 months, a 31.1% decrease in the mean LDL cholesterol level was observed with evacetrapib versus a 6.0% increase with placebo, and a 133.2% increase in the mean HDL cholesterol level was seen with evacetrapib versus a 1.6% increase with placebo. After 1363 of the planned 1670 primary end-point events had occurred, the data and safety monitoring board recommended that the trial be terminated early because of a lack of efficacy. After a median of 26 months of evacetrapib or placebo, a primary end-point event occurred in 12.9% of the patients in the evacetrapib group and in 12.8% of those in the placebo group (hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.11; P=0.91). CONCLUSIONS: Although the cholesteryl ester transfer protein inhibitor evacetrapib had favorable effects on established lipid biomarkers, treatment with evacetrapib did not result in a lower rate of cardiovascular events than placebo among patients with high-risk vascular disease. (Funded by Eli Lilly; ACCELERATE ClinicalTrials.gov number, NCT01687998 .)

Vulnerable populations and COVID-19 : need for innovation and cooperation to address health and social needs

La crise liée au Covid-19 a fragilisé les populations en situation préalable de précarité. L’émergence de l’insécurité alimentaire et de logement a poussé les acteurs de la santé, du travail social et les autorités à mettre en place des mesures innovantes et intersectorielles permettant de répondre rapidement et efficacement aux besoins essentiels de ces populations. Cet article présente trois de ces mesures, à savoir une équipe mobile interprofessionnelle de dépistage, un dispositif d’hébergement et d’encadrement sanitaire pour les personnes sans-abri et un programme de distribution alimentaire à large échelle. Ces trois exemples illustrent la nécessité d’une approche transversale et collaborative et le besoin d’agir sur les déterminants sociaux et politiques sous-tendant ces vulnérabilités.The COVID-19 crisis has rapidly increased the vulnerability of groups of population already facing precarious living conditions. The emergence of food and housing insecurity have forced health and social actors along with the local authorities to implement innovative responses in order to respond to these unmet needs. This article presents some of these responses, such as an interdisciplinary mobile COVID-19 screening team, an emergency housing program and a large-scale food assistance program. These examples highlight the need for an intersectoral, coordinated and collaborative response simultaneously targeting different domains of insecurity in parallel to actions on the underpinning social and political determinants of these vulnerabilities

L’inclusion en emploi des personnes des groupes sous-représentés au Québec : des parcours semés d’embûches

Cet article a pour objectif de décrire et de comprendre l’expérience des membres des groupes sous-représentés au regard de leur accès à l’emploi et de leur inclusion dans les milieux de travail au Québec. Recourant à un devis de recherche exploratoire, des entretiens semi-dirigés ont été réalisés auprès de 12 personnes appartenant à des groupes sous-représentés (femmes, minorités visibles, personnes handicapées, personnes LGBTQ+). Les résultats mettent d’abord en lumière les situations d’exclusion auxquelles sont confrontées ces personnes. Elles se manifestent par la non-reconnaissance de la valeur des individus dans le milieu de travail, qui résulte en un faible sentiment d’appartenance des personnes à leur organisation. Parmi les différentes stratégies individuelles déployées, certaines conduisent davantage à l’assimilation et à la différenciation qu’à l’inclusion. Si les raisons pour lesquelles les personnes participantes considèrent être dans des situations d’exclusion, d’assimilation ou de différenciation sont nombreuses, il semble qu’elles reposeraient essentiellement, selon les personnes rencontrées, sur des biais inconscients des employeurs. Pour favoriser l’inclusion, les résultats révèlent l’importance de l’ouverture à la diversité, du soutien organisationnel ainsi que de la sensibilisation et de la formation pour lutter contre les préjugés inconscients. La contribution principale de cet article réside dans la mise en évidence des expériences et des situations communes des personnes appartenant pourtant à des groupes différents, en leur donnant la parole.The aim of this article is to describe and understand the experience of members of diversity groups with regard to their access to employment and inclusion in Quebec workplaces. Using an exploratory research design, we conducted semi-structured interviews with 12 people from under-represented groups (women, visible minorities, people with disabilities, LGBTQ+ people). The results highlight the situations of exclusion faced by people from diverse backgrounds, such as not being recognized in the workplace. Often, this then manifests in a weak(er) sense of belonging of to their organization. Among the various strategies deployed to counteract this trend, some lead to assimilation and differentiation more so than to inclusion. Most participants attributed their situations of exclusion, assimilation or differentiation to the unconscious biases on the part of their employers, albeit they likewise mentioned many other reasons. According to the results, inclusion hinges significantly on openness to diversity, organizational support, awareness-raising and training in combating unconscious bias. The main contribution of this article lies in highlighting the common experiences and situations of people belonging to different groups, by giving them a voice

CellsFromSpace: a fast, accurate, and reference-free tool to deconvolve and annotate spatially distributed omics data

International audienceAbstract Motivation Spatial transcriptomics enables the analysis of cell crosstalk in healthy and diseased organs by capturing the transcriptomic profiles of millions of cells within their spatial contexts. However, spatial transcriptomics approaches also raise new computational challenges for the multidimensional data analysis associated with spatial coordinates. Results In this context, we introduce a novel analytical framework called CellsFromSpace based on independent component analysis (ICA), which allows users to analyze various commercially available technologies without relying on a single-cell reference dataset. The ICA approach deployed in CellsFromSpace decomposes spatial transcriptomics data into interpretable components associated with distinct cell types or activities. ICA also enables noise or artifact reduction and subset analysis of cell types of interest through component selection. We demonstrate the flexibility and performance of CellsFromSpace using real-world samples to demonstrate ICA’s ability to successfully identify spatially distributed cells as well as rare diffuse cells, and quantitatively deconvolute datasets from the Visium, Slide-seq, MERSCOPE, and CosMX technologies. Comparative analysis with a current alternative reference-free deconvolution tool also highlights CellsFromSpace’s speed, scalability and accuracy in processing complex, even multisample datasets. CellsFromSpace also offers a user-friendly graphical interface enabling non-bioinformaticians to annotate and interpret components based on spatial distribution and contributor genes, and perform full downstream analysis. Availability and implementation CellsFromSpace (CFS) is distributed as an R package available from github at https://github.com/gustaveroussy/CFS along with tutorials, examples, and detailed documentation

Transmission et héritages de la littérature québécoise

La cohésion de la littérature québécoise semble aujourd'hui aller de soi. Il s'agit pourtant d'un tissage mouvant et continuel de liens avec le passé. Ce livre en fait la démonstration selon trois perspectives contrastées mais complémentaires. Dans une première partie, on s'intéresse à des phénomènes tels que la fabrication de l'histoire littéraire, l'inclusion ou non des œuvres de langue anglaise ou des francophonies canadiennes. La deuxième partie examine l'oubli sélectif de certaines œuvres, comme les textes du XIXe siècle, ceux d'auteurs dits mineurs ou encore de genres moins canoniques, comme le théâtre. La dernière partie présente les cas particuliers d'héritages littéraires représentés dans les œuvres elles-mêmes sous la forme de jeux intertextuels, de mises en scène d'auteurs et de lecteurs ou de problèmes d'herméneutique littéraire. Ces trois perspectives font ainsi ressortir les figures, les lieux de mémoire ou les récits qui accompagnent nécessairement la littérature québécoise