Optical emission spectroscopy as a process-monitoring tool in plasma enhanced chemical vapor deposition of amorphous carbon coatings - multivariate statistical modelling

Production of Diamond-Like Carbon (DLC) nanocoatings using plasma enhanced chemical vapor deposition is studied by Optical Emission Spectroscopy (OES) as a plasma diagnostic technique. The objective of the current research is to establish a predictive model of DLC properties using a multivariate analysis method. This model is based on OES data instead of process parameters, which are reactor dependent and accordingly, their effect on the plasma deposition process may vary from one reactor to another. The predictive potential of OES is evaluated using partial least square regression (PLSR) analysis. The results show that OES derived data are capable of replacing some process parameters to predict the DLC properties. The perspective of PLSR modelling and OES application for the development and monitoring of a structurally graded DLC coating is also discussed

Translational Control through eIF2alpha Phosphorylation during the Leishmania Differentiation Process

The parasitic protozoan Leishmania alternates between an invertebrate and a mammalian host. Upon their entry to mammalian macrophages, Leishmania promastigotes differentiate into amastigote forms within the harsh environment of the phagolysosomal compartment. Here, we provide evidence for the importance of translational control during the Leishmania differentiation process. We find that exposure of promastigotes to a combined elevated temperature and acidic pH stress, a key signal triggering amastigote differentiation, leads to a marked decrease in global translation initiation, which is associated with eIF2α phosphorylation. Interestingly, we show that amastigotes adapted to grow in a cell-free medium exhibit lower levels of protein synthesis in comparison to promastigotes, suggesting that amastigotes have to enter a slow growth state to adapt to the stressful conditions encountered inside macrophages. Reconversion of amastigotes back to promastigote growth results in upregulation of global translation and a decrease in eIF2α phosphorylation. In addition, we show that while general translation is reduced during amastigote differentiation, translation of amastigote-specific transcripts such as A2 is preferentially upregulated. We find that A2 developmental gene regulation is triggered by temperature changes in the environment and that occurs mainly at the level of translation. Upon elevated temperature, the A2 transcript is stabilized through its association with polyribosomes leading to high levels of translation. When temperature decreases during amastigote to promastigote differentiation, the A2 transcript is not longer associated with translating polyribosomes and is being gradually degraded. Overall, these findings contribute to our better understanding of the adaptive responses of Leishmania to stress during its development and highlight the importance of translational control in promastigote to amastigote differentiation and vice-versa

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Silver-containing diamond-like carbon deposited by plasma as versatile antibacterial coatings

Les infections associées au milieu hospitalier demeurent une cause majeure de mortalité et de morbidité dans le monde, malgré plusieurs décennies dédiées à promouvoir une meilleure surveillance et des méthodes de désinfection plus complètes. La capacité des bactéries pathogènes à survivre sur des substrats solides a été identifiée comme un facteur clé de la pathogenèse de ces infections, en multipliant les sources de transmission et de contamination. Au niveau de la recherche, cette situation s’est récemment traduite par un intérêt marqué pour le développement de revêtements antibactériens novateurs pouvant constituer une ligne de défense complémentaire contre la colonisation bactérienne de surfaces, pourvu qu’ils puissent résister à l’environnement rigoureux des établissements de santé. Dans cette thèse, nous avons émis l'hypothèse qu'un revêtement antibactérien avec une stabilité supérieure pouvait être déposé en utilisant un procédé plasma modulable, de sorte que les propriétés du revêtement résultant pourraient être adaptées aux exigences de différentes situations ou applications. Par conséquent, des revêtements nanocomposites de carbone amorphe adamantin contenant de l'argent (Ag-DLC) ont été développés et étudiés comme plate-forme polyvalente pour des surfaces antibactériennes. L’intérêt de ce matériau réside dans la combinaison des excellentes propriétés mécaniques, de la résistance à l'usure et de l'inertie chimique du carbone amorphe adamantin avec les propriétés antibactériennes à large spectre des nanomatériaux d'argent au sein d’un même revêtement déposé par plasma. Ce travail a d'abord identifié les défis de conception spécifiquement associés au développement de revêtements antibactériens pour le milieu hospitalier. Des analyses approfondies des revêtements Ag-DLC ont ensuite démontré une bonne efficacité antibactérienne in vitro ainsi qu’une stabilité des propriétés, de la structure et de l’état chimique des revêtements dans le temps. L'étendue de la polyvalence des revêtements Ag-DLC a été évaluée au travers de l’identification des mécanismes de croissance principaux, permettant d’obtenir des informations essentielles sur la façon dont les propriétés des films, telles que la dureté, la teneur et la distribution d’argent, pouvaient être contrôlées en ajustant des paramètres spécifiques du dépôt plasma. De plus, un traitement de surface in situ a été développé pour surmonter les problèmes de délamination et a montré la capacité de favoriser l'adhérence de revêtements DLC sur des substrats métalliques. Dans l'ensemble, cette étude a mis en évidence l'importance de la stabilité dans l'application des revêtements antibactériens et a démontré le vaste potentiel des procédés plasma pour le dépôt de revêtements antibactériens stables avec des propriétés adaptables.Healthcare-associated infections remain a major cause of mortality and morbidity worldwide, with a substantial financial burden on society, despite decades of monitoring and disinfection efforts. The ability of pathogenic bacteria to survive on solid substrates has emerged as a key contributing factor in the pathogenesis of these infections by multiplying the sources of transmission and contamination. This has prompted investigations into the development of innovative antibacterial coatings, which could provide a complementary barrier against bacterial colonization of surfaces provided that they can withstand the harsh operating environment of healthcare facilities. In this thesis, we hypothesized that an antibacterial coating with superior stability could be deposited using a tailorable plasma process, so that the resulting coatings’ properties could be adapted to match the requirements of different situations or applications. Therefore, silver-containing diamond-like carbon (Ag-DLC) nanocomposite coatings were developed and investigated as a versatile platform material for antibacterial surfaces. The interest of this material lies in the combination of the excellent mechanical properties, wear-resistance and chemical inertness of diamond-like carbon with the broad-spectrum antibacterial properties of silver nanomaterials in a single, plasma-deposited coating. This work first identified the specific design challenges associated with the development of antibacterial coatings for healthcare environments. Thorough investigations of Ag-DLC coatings then revealed good antibacterial efficacy in vitro as well as stability of the coatings’ properties, structure, and chemistry over time. The extent of the tailorability of Ag-DLC coatings was also assessed through the identification of the main growth mechanisms, providing insights on how the film’s properties, such as the hardness, silver content, and silver distribution, could be controlled by adjusting specific plasma deposition parameters. Furthermore, an in situ interface plasma treatment was developed to overcome delamination issues and showed the ability to promote the adhesion of high stress DLC coatings on metallic substrates. Overall, this study highlighted the importance of stability in the application of antibacterial coatings and demonstrated the vast potential of plasma processes for the deposition of stable antibacterial coatings with tunable properties

Intégration des considérations sociales en zone périphérique des aires protégées : le cas du parc national de Frontenac

Considérant que la région périphérique des aires protégées joue un rôle important pour l’intégrité écologique de ces dernières et qu’elle est souvent hors du contrôle des gestionnaires, cette étude vise le développement d’un cadre méthodologique permettant de mieux orienter la mise en place des projets de zones périphériques, tout en favorisant la mobilisation des populations locales. La méthode s’appuie sur trois concepts centraux et englobants : le capital social, le niveau de patrimonialisation et le type de relation avec la nature. Celle-ci a été conçue de sorte à pouvoir être appliquée dans plusieurs contextes et régions, mais elle a été testée en périphérie du parc national de Frontenac. Les résultats amènent les gestionnaires de l’environnement à mieux comprendre les enjeux citoyens et leur relation avec le territoire, ce qui leur permettra d’orienter plus aisément les activités de concertation et de sensibilisation entourant le développement de projets de conservation de la nature. Le cadre méthodologique vise une mobilisation accrue des citoyens en faveur des projets, améliorant à la fois les chances de réussite et la durabilité des actions proposées.The peripheral zone around protected areas is important for ensuring their ecological integrity, but is often outside the control of managers. The present study aimed to develop a methodological framework to better guide the implementation of conservation projects in such regions and enhance support for them from within the local community. The approach used is based on three central concepts: social capital, heritagization, and the nature of the relationship that residents have with their natural surroundings. The framework was developed to allow its implementation in different regions and under different contexts, and was tested in the zone bordering the parc national de Frontenac (Québec, Canada). The results provide environmental managers with a better understanding of local social issues and the relationship citizens have with their natural surroundings, making it easier to consult residents and orient awareness activities about proposed nature conservation projects. As the framework developed aims to increase citizen support for such projects, it should enhance the success and sustainability of the actions proposed

Moving Toward Indigenous-Centred Perinatal Care in Urban Quebec

This article explores Abinodjic, an initiative of the Native Friendship Centre in Val-d’Or, Quebec, Canada, which aims to move toward Indigenous-centred perinatal care for Indigenous mothers and families. Drawing on the findings of a three-year collaborative developmental evaluation, this article describes the emergence and relevance of a model of perinatal care in which Mino Pimatisi8in (a wholistic view of well-being) is the overarching goal, and where parental experiences, healthy lifestyles, support networks, and cultural knowledges are four interdependent areas of intervention that support children’s well-being, in the context of culturally safe services and approaches. We discuss three key elements significant to the initiative: (a) valuing Indigenous ways of being, (b) centring relationships and supporting the social networks, and (c) being advocates, both directly for community members as well as for Indigenous Peoples generally within the health and social services system. Findings demonstrate the importance of situating perinatal care within a continuum of Indigenous-led social and health services, and providing specific outreach, support, and guidance that are relational, strengths-based, and empowering for Indigenous families