Évaluation préliminaire de l’efficacité de la duloxétine dans le déficit de l’attention chez l’adulte : essai randomisé contrôlé

Le trouble du déficit de l’attention avec ou sans hyperactivité (TDAH) est de plus en plus reconnu chez l'adulte. Les psychostimulants représentent la première ligne de traitement, mais ceux-ci ne sont parfois pas tolérés, peuvent être contrindiqués ou ne pas être efficaces. Les médicaments non stimulants constituent une alternative mais ont été insuffisamment explorés. Cette thèse présente un essai clinique randomisé contrôlé de 30 sujets souffrant de TDAH qui ont reçu soit la duloxétine 60 mg par jour ou le placebo pendant une période de 6 semaines. Le Conners’ Adult ADHD Rating Scale (CAARS) et le Clinical Global Impression scale (CGI) ont été utilisés pour mesurer la sévérité des symptômes et l'amélioration clinique. Le Hamilton Anxiety Rating Scale (HARS) et le Hamilton Depression Rating Scale (HDRS) ont été choisis pour vérifier l'impact sur la symptomatologie anxio-dépressive. Les résultats démontrent que les sujets ayant reçu la duloxétine avait un score au CGI-Severity (CGI-S) inférieur au groupe contrôle à 6 semaines de traitement et une amélioration plus importante au CGI-Improvement (CGI-I). Ce groupe démontre également des diminutions supérieures des scores à plusieurs sous-échelles du CAARS. Aucun effet n'a été observé sur le HARS et le HDRS. Le taux de retrait du bras duloxetine remet par contre en question la dose initiale choisie dans ce protocole. La duloxétine semble donc une option prometteuse dans le traitement du TDAH chez l'adulte et la réplication des données cliniques serait la prochaine étape pour confirmer ces résultats.Attention-deficit/hyperactivity disorder (ADHD) is increasingly recognized in adults. Stimulants are first-line treatment options but can be ineffective, poorly tolerated or contraindicated in some patients. For these patients, non-stimulants can be an interesting option; however, this heterogeneous class has been insufficiently studied. This thesis presents the results of a pilot study. In this randomized controlled clinical trial, thirty adults with ADHD received either placebo or duloxetine 60 mg daily for 6 weeks. The Conners’ Adult ADHD Rating Scale (CAARS) and the Clinical Global Impression scale (CGI) were chosen to assess symptom severity and clinical improvement. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used to measure the effect on anxiety and depressive symptoms. In summary, the duloxetine group showed a lower score on CGI-Severity at week 6, greater improvement on CGI-Improvement and greater decreases on multiple subscales of the CAARS. There was no treatment group effect on HDRS or HARS scores. Tolerability was an issue with participants in the duloxetine group and the dose titration schedule chosen in this study should be revised. This is the first clinical trial of duloxetine in adults with ADHD. This medication seams to improve symptoms in this condition but further studies are required to replicate these findings in larger samples of ADHD adults

L'influence des méthodes de recrutement externes sur la satisfaction générale au travail, la satisfaction à l'égard de la rémunération et la rétention

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Behaviour of thick concrete members with unbonded transverse reinforcement

One commonly used method to increase the shear capacity of existing concrete structures consists of adding vertical steel bars anchored to the structure by means of mechanical anchorages, such as expansion torque controlled anchorages or steel anchorage plates. If the drilled holes are not filled with adhesive then the bars are unbonded along their length. In order to study the behaviour of concrete members with unbonded transverse reinforcement, thick concrete beams (width of 610 mm and height of 750 mm) were loaded until shear failure. It has been observed that their shear capacity is closely related to the shear cracking behaviour. At shear cracking, the propagation of one large diagonal crack is required to activate the vertical unbonded bars, thereby reducing the aggregate interlock shear capacity along the cracks. Beams containing at least minimum amounts of conventional stirrups experience several diagonal cracks at shear failure, whereas a beam with unbonded bars tends to have one dominant crack and can therefore experience the size effect in shear. A finite element (FE) model was also used to study the parameters influencing the behaviour of concrete members with unbonded transverse bars. The finite element results show very good agreement with the experimental results

Behaviour of thick concrete members with unbonded transverse reinforcement

One commonly used method to increase the shear capacity of existing concrete structures consists of adding vertical steel bars anchored to the structure by means of mechanical anchorages, such as expansion torque controlled anchorages or steel anchorage plates. If the drilled holes are not filled with adhesive then the bars are unbonded along their length. In order to study the behaviour of concrete members with unbonded transverse reinforcement, thick concrete beams (width of 610 mm and height of 750 mm) were loaded until shear failure. It has been observed that their shear capacity is closely related to the shear cracking behaviour. At shear cracking, the propagation of one large diagonal crack is required to activate the vertical unbonded bars, thereby reducing the aggregate interlock shear capacity along the cracks. Beams containing at least minimum amounts of conventional stirrups experience several diagonal cracks at shear failure, whereas a beam with unbonded bars tends to have one dominant crack and can therefore experience the size effect in shear. A finite element (FE) model was also used to study the parameters influencing the behaviour of concrete members with unbonded transverse bars. The finite element results show very good agreement with the experimental results

Development of Real-Time Isothermal Amplification Assays for On-Site Detection of Phytophthora infestans in Potato Leaves

Real-time loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA) assays were developed targeting the internal transcribed spacer 2 region of the ribosomal DNA of Phytophthora infestans, the potato late blight causal agent. A rapid crude plant extract (CPE) preparation method from infected potato leaves was developed for on-site testing. The assay's specificity was tested using several species of Phytophthora and other potato fungal and oomycete pathogens. Both LAMP and RPA assays showed specificity to P. infestans but also to the closely related species P. andina, P. mirabilis, P. phaseoli, and P. ipomoeae, although the latter are not reported as potato pathogen species. No cross-reaction occurred with P. capsici or with the potato pathogens tested, including P. nicotianae and P. erythroseptica. The sensitivity was determined using P. infestans pure genomic DNA added into healthy CPE samples. Both LAMP and RPA assays detected DNA at 50 fg/μl and were insensitive to CPE inhibition. The isothermal assays were tested with artificially inoculated and naturally infected potato plants using a Smart-DART platform. The LAMP assay effectively detected P. infestans in symptomless potato leaves as soon as 24 h postinoculation. A rapid and accurate on-site detection of P. infestans in plant material using the LAMP assay will contribute to improved late blight diagnosis and early detection of infections and facilitate prompt management decisions

Influence of Alkali-Silica reaction (ASR) on aggregate interlock and shear-friction behavior of reinforced concrete members

Alkali-silica reaction (ASR) is one of the most damaging mechanisms affecting concrete structures worldwide. ASR effects on the durability and serviceability of damaged concrete are widely known and fairly well understood. However, the structural implications are still unclear, and a number of contradictory data are found in the literature, especially regarding shear behavior. The influence of ASR distressed reinforced concrete on aggregate interlock is presented in this paper. Push-off specimens having different transverse reinforcement ratios were fabricated with ASR reactive coarse aggregates. The specimens were monitored over time and displayed different levels of expansion. Results indicated that ASR-induced expansion and damage were affected by the transverse reinforcement ratio. However, little to no aggregate interlock reduction was observed on ASR-affected specimens up to moderate expansion levels (about 0.12%). It was found that there were two controlling and competing mechanisms that affected aggregate interlock for ASR-affected specimens: the beneficial effects of chemical prestressing and the detrimental ASR-induced damage

Four decades of military posttraumatic stress:Protocol for a meta-analysis and systematic review of treatment approaches and efficacy

Background: Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations. Objective: This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD. Methods: This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature wasconducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation &amp; Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes. Results: The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12, 002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12, 002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021. Conclusions: This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations.</p

Four decades of military posttraumatic stress:Protocol for a meta-analysis and systematic review of treatment approaches and efficacy

Background: Over 85% of active members of the Canadian Armed Forces have been exposed to potentially traumatic events linked to the development of posttraumatic stress disorder (PTSD). At the time of transition to civilian life, as high as 1 in 8 veterans may be diagnosed with PTSD. Given the high prevalence of PTSD in military and veteran populations, the provision of effective treatment considering their unique challenges and experiences is critical for mental health support and the well-being of these populations. Objective: This paper presents the protocol for a meta-analysis and systematic review that will examine the effectiveness of treatment approaches for military-related PTSD. Methods: This PROSPERO-preregistered meta-analysis is being conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane guidelines. A comprehensive search of the literature wasconducted using the databases PsycInfo, Medline, Embase, CINAHL, and ProQuest Dissertation &amp; Theses. Effect sizes will be computed based on changes in PTSD symptom scores over time across studies using validated PTSD scales. A multilevel meta-analysis will examine the overall effects, between-study effects, and within-study effects of available evidence for PTSD treatments in military populations. Effect sizes will be compared between pharmacotherapeutic, psychotherapeutic, and alternative/emerging treatment interventions. Finally, meta-regression and subgroup analyses will explore the moderating roles of clinical characteristics (eg, PTSD symptom clusters), treatment approaches (eg, therapeutic orientations in psychotherapy and alternative therapies and classifications of drugs in pharmacotherapy), as well as treatment characteristics (eg, length of intervention) on treatment outcomes. Results: The literature search was completed on April 14, 2021. After the removal of duplicates, a total of 12, 002 studies were screened for inclusion. As of July 2021, title and abstract screening has been completed, with 1469 out of 12, 002 (12.23%) studies included for full-text review. Full review is expected to be completed in the summer of 2021, with initial results expected for publication by early winter of 2021. Conclusions: This meta-analysis will provide information on the current state of evidence on the efficacy and effectiveness of various treatment approaches for military-related PTSD and identify factors that may influence treatment outcomes. The results will inform clinical decision-making for service providers and service users. Finally, the findings will provide insights into future treatment development and practice recommendations to better support the well-being of military and veteran populations.</p

Stem Cells, Self-Renewal, and Lineage Commitment in the Endocrine System

The endocrine system coordinates a wide array of body functions mainly through secretion of hormones and their actions on target tissues. Over the last decades, a collective effort between developmental biologists, geneticists, and stem cell biologists has generated a wealth of knowledge related to the contribution of stem/progenitor cells to both organogenesis and self-renewal of endocrine organs. This review provides an up-to-date and comprehensive overview of the role of tissue stem cells in the development and self-renewal of endocrine organs. Pathways governing crucial steps in both development and stemness maintenance, and that are known to be frequently altered in a wide array of endocrine disorders, including cancer, are also described. Crucially, this plethora of information is being channeled into the development of potential new cell-based treatment modalities for endocrine-related illnesses, some of which have made it through clinical trials