Analyse de la relation entre le revenu et la mortalité : un commentaire méthodologique

La région urbaine de l’Outaouais (Gatineau) a un revenu moyen plus élevé que le Québec urbain; cependant, ses indicateurs de santé sont moins favorables. Cette situation, contraire à ce que l’on retrouve le plus souvent au niveau de la santé des populations, est désignée par l’expression « paradoxe outaouais ». Nous avons pu analyser l’impact des choix méthodologiques sur l’évaluation de la relation entre le revenu et la santé, au niveau de la ville et au niveau du quintile de revenu. Selon que l’unité de référence est le Québec urbain ou la RMR Ottawa-Gatineau, le paradoxe se réalise ou disparaît. Selon la partition utilisée, le gradient de l’espérance de vie ainsi que l’écart entre Ottawa et Gatineau varient de manière appréciable. Nos résultats montrent que les choix méthodologiques jouent un rôle important et doivent par conséquent être faits avec soin.The Outaouais urban area (Gatineau) has a higher average income compared to the rest of urban Quebec, but its health indicators are less favourable. This situation, contrary to what is usually expected for population health, has been called “the Outaouais paradox”. We have been able to analyse the impact of methodological choices on the evaluation of the relationship between income and health, at the city level and at the income quintile level. If the reference unit is urban Quebec the paradox appears, but if the reference unit is the Ottawa-Gatineau CMA, the paradox disappears. Depending on the partition used, the life expectancy gradient as well as the gap between Ottawa and Gatineau differ substantially. Our results show that methodological choices play an important role and must thus be done cautiously

Analysis and management of medical and organizational risks related to venous central catheterization in intensive care units

http://sra-e-2006.ijs.si/files/contributions/500/504_Aurelie_Pourreau.pdfInternational audienc

2,5-Thiophene Substituted Spirobisiloles - Synthesis, Characterization, Electrochemical Properties and Performance in Bulk Heterojunction Solar Cells

International audienceNew spirobisilole molecules containing thienyl (DTSBS) and bis-thienyl (BBTSBS) electron donor groups have been synthesized for use as the donor material in bulk-heterojunction solar cells together with PCBM. The spectroscopic, electrochemical and thermal properties of DTSBS and BBTSBS have been investigated. All these new spirobisiloles exhibit excellent thermal stability. Cyclic voltammetry measurements revealed reversible and irreversible oxidation and irreversible reduction processes. The highest occupied and lowest unoccupied molecular orbital (HOMO/LUMO) energy levels were determined from electrochemical measurements and DFT calculations. The HOMO/LUMO energy levels were estimated to lie in the range -5.2 to -2.3 eV for DTSBS and -4.9 to -2.6 eV for BBTSBS. For both compounds, electropolymerization processes occur at potentials higher than 1.5 V leading to low band gap electrogenerated polymers. Spin-coating-deposited bulk-heterojunction solar cells fabricated with the novel spirobisiloles as donor and PCBM as acceptor displayed open-circuit voltages up to 0.4 V, short-circuit currents around 0.5 mA.cm-2, and power conversion efficiencies approaching 0.1 %

Temperature dependence of the zero-phonon linewidth in quantum dots: An effect of the fluctuating environment

We report systematic measurements on the broadening of the emission spectrum of single quantum dots as a function of temperature and incident power. Spectral diffusion effects in the motional narrowing regime provide a quantitative interpretation of our experimental results. We show that, at low incident power, the thermal activation of spectral diffusion results in a Lorentzian zero-phonon line with a width that increases linearly with temperature. Our study provides a unified interpretation to the widely debated issue of the dispersion of the data on the temperature dependence of this zero-phonon linewidth. Our explanation is based on an original model where acoustic phonons interact with carriers outside the quantum dot

Proposition d'un modèle organisationnel de prévention des risques d'infections associées aux soins

International audienceAlors que les infections associées aux soins (IAS) continuent à provoquer de nombreux décès en France et partout dans le monde, il est désormais essentiel d'évaluer l'efficacité des diverses stratégies de prévention mises en place. Nous proposons dans cet article, pour répondre aux appels de Zingg et al. (2015) et de Jacob et al. (2018), une nouvelle façon d'évaluer ces stratégies en intégrant dans la réflexion, le contexte organisationnel et le contexte clinique (état et parcours de soins du patient) dans lesquels elles sont mises en place. Cette nouvelle approche configurationnelle de la prévention des risques infectieux consiste à chercher des configurations cohérentes entre des types de stratégies de prévention, des contextes organisationnels et des contextes cliniques qui mènent à un risque infectieux plus faible. Elle repose donc sur un modèle organisationnel de prévention des risques infectieux qui dépasse l'approche classique en « silo » de la gestion des risques où chacun évalue le risque de sa propre action, pour aller vers une approche qui met l'accent sur la coordination des soins ou « care management » et les facteurs qui la favorisent : culture organisationnelle, existence de champions de bonnes pratiques, empowerment des patients et du personnel… Cette approche configurationnelle d'un modèle organisationnel de prévention des risques infectieux est appliquée dans le cadre d'un projet de l'Institut PRESAGE de Prévention et de Santé Globale, qui réunit des chercheurs de différentes disciplines (juristes, économistes, gestionnaires, psychologues…) et des praticiens de différents horizons (médecins, infirmières, cadres de santé) afin d'explorer de nouvelles solutions pour réduire le risque infectieux, ces solutions pouvant relever notamment de l'organisation et de la coordination des soins

Impact of classic and paradoxical low flow on survival after aortic valve replacement for severe aortic stenosis

BackgroundLow flow (LF) can occur with reduced (classic) or preserved (paradoxical) left ventricular ejection fraction (LVEF). ObjectivesThe objective of this study was to compare outcomes of patients with low ejection fraction (LEF), paradoxical low flow (PLF), and normal flow (NF) after aortic valve replacement (AVR). MethodsWe examined 1,154 patients with severe aortic stenosis (AS) who underwent AVR with or without coronary artery bypass grafting. ResultsAmong these patients, 206 (18%) had LEF as defined by LVEF of 35 ml · m2. Aortic valve area was lower in low flow/LVEF groups (LEF: 0.71 ± 0.20 cm2 and PLF: 0.65 ± 0.23 cm2 vs. NF: 0.77 ± 0.18 cm2; p < 0.001). The 30-day mortality was higher (p < 0.001) in LEF and PLF groups than in the NF group (6.3% and 6.3% vs. 1.8%, respectively). SVi and PLF group were independent predictors of operative mortality (odds ratio [OR]: 1.18, p < 0.05; and OR: 2.97, p = 0.004; respectively). At 5 years after AVR, overall survival was 72 ± 4% in LEF group, 81 ± 2% in PLF group, and 85 ± 2% in NF group (p < 0.0001). ConclusionsPatients with LEF or PLF AS have a higher operative risk, but pre-operative risk score accounted only for LEF and lower LVEF. Patients with LEF had the worst survival outcome, whereas patients with PLF and normal flow had similar survival rates after AVR. As a major predictor of perioperative mortality, SVi should be integrated in AS patients’ pre-operative evaluation

CoMMA Corporate Memory Management through Agents Corporate Memory Management through Agents: The CoMMA project final report

This document is the final report of the CoMMA project. It gives an overview of the different search activities that have been achieved through the project. First, a description of the general requirements is proposed through the definition of two scenarios. Then it shows the different technical aspects of the projects and the solution that has been proposed and implemented

The efficacy of therapeutic plasma exchange in COVID-19 patients on endothelial tightness in vitro is hindered by platelet activation

Coronavirus disease (COVID)-19 is characterised in particular by vascular inflammation with platelet activation and endothelial dysfunction. During the pandemic, therapeutic plasma exchange (TPE) was used to reduce the cytokine storm in the circulation and delay or prevent ICU admissions. This procedure consists in replacing the inflammatory plasma by fresh frozen plasma from healthy donors and is often used to remove pathogenic molecules from plasma (autoantibodies, immune complexes, toxins, etc.). This study uses an in vitro model of platelet-endothelial cell interactions to assess changes in these interactions by plasma from COVID-19 patients and to determine the extent to which TPE reduces such changes. We noted that exposure of an endothelial monolayer to plasmas from COVID-19 patients post-TPE induced less endothelial permeability compared to COVID-19 control plasmas. Yet, when endothelial cells were co-cultured with healthy platelets and exposed to the plasma, the beneficial effect of TPE on endothelial permeability was somewhat reduced. This was linked to platelet and endothelial phenotypical activation but not with inflammatory molecule secretion. Our work shows that, in parallel to the beneficial removal of inflammatory factors from the circulation, TPE triggers cellular activation which may partly explain the reduction in efficacy in terms of endothelial dysfunction. These findings provide new insights for improving the efficacy of TPE using supporting treatments targeting platelet activation, for instance

A value-based comparison of the management of ambulatory respiratory diseases in walk-in clinics, primary care practices, and emergency departments : protocol for a multicenter prospective cohort study

Background: In Canada, 30%-60% of patients presenting to emergency departments are ambulatory. This category has been labeled as a source of emergency department overuse. Acting on the presumption that primary care practices and walk-in clinics offer equivalent care at a lower cost, governments have invested massively in improving access to these alternative settings in the hope that patients would present there instead when possible, thereby reducing the load on emergency departments. Data in support of this approach remain scarce and equivocal. Objective: The aim of this study is to compare the value of care received in emergency departments, walk-in clinics, and primary care practices by ambulatory patients with upper respiratory tract infection, sinusitis, otitis media, tonsillitis, pharyngitis, bronchitis, influenza-like illness, pneumonia, acute asthma, or acute exacerbation of chronic obstructive pulmonary disease. Methods: A multicenter prospective cohort study will be performed in Ontario and Québec. In phase 1, a time-driven activity-based costing method will be applied at each of the 15 study sites. This method uses time as a cost driver to allocate direct costs (eg, medication), consumable expenditures (eg, needles), overhead costs (eg, building maintenance), and physician charges to patient care. Thus, the cost of a care episode will be proportional to the time spent receiving the care. At the end of this phase, a list of care process costs will be generated and used to calculate the cost of each consultation during phase 2, in which a prospective cohort of patients will be monitored to compare the care received in each setting. Patients aged 18 years and older, ambulatory throughout the care episode, and discharged to home with one of the aforementioned targeted diagnoses will be considered. The estimated sample size is 1485 patients. The 3 types of care settings will be compared on the basis of primary outcomes in terms of the proportion of return visits to any site 3 and 7 days after the initial visit and the mean cost of care. The secondary outcomes measured will include scores on patient-reported outcome and experience measures and mean costs borne wholly by patients. We will use multilevel generalized linear models to compare the care settings and an overlap weights approach to adjust for confounding factors related to age, sex, gender, ethnicity, comorbidities, registration with a family physician, socioeconomic status, and severity of illness. Results: Phase 1 will begin in 2021 and phase 2, in 2023. The results will be available in 2025. Conclusions: The end point of our program will be for deciders, patients, and care providers to be able to determine the most appropriate care setting for the management of ambulatory emergency respiratory conditions, based on the quality and cost of care associated with each alternative