Design de jeux pour la santé : utilisation de jeux sérieux pour favoriser l’adhésion aux exercices thérapeutiques chez des jeunes patients atteints de fibrose kystique

Mémoire en recherche-création. Master in research-creationVers l’âge de 7 ans, les patients atteints de fibrose kystique (FK) sont amenés à suivre une thérapie par pression expiratoire positive (PEP). Celle-ci consiste à réaliser une série d’exercices respiratoires répétitifs et méthodiques. Cependant, ces exercices peuvent être ennuyeux et démotivants pour des jeunes enfants et entrainent un taux d’adhésion quotidien de moins de 50%. Ce faible résultat affecte grandement la qualité et l’espérance de vie à long terme des patients, en plus d’avoir un impact social et familial considérable. Ces derniers utilisent les aspects ludiques et interactifs des jeux vidéo pour motiver et susciter l’engagement des sujets envers l’activité et son contenu. Ils ont déjà faits leurs preuves dans le domaine de la santé et de l’éducation en favorisant l’apprentissage ou la réhabilitation par exemple. Ce projet de recherche-création cherche à valider la possibilité d’utiliser des jeux spécialement conçus pour la thérapie PEP ainsi que l’intérêt des jeunes atteints de FK à les utiliser dans le cadre de leurs exercices thérapeutiques. L’objectif est de favoriser l’adhésion des jeunes envers cette thérapie et faciliter l’apprentissage et l’application des techniques associées. Cette approche ludique vise ultimement à améliorer la qualité de vie des jeunes atteints de FK dans la durée. Grâce à une collaboration entre des étudiants de l’Université de Montréal et des spécialistes en santé de la clinique de FK du CHU Ste-Justine, trois prototypes de jeux et un prototype d’interface électronique, utilisé pour contrôler les jeux et pour être compatibles avec l’appareil PEP le plus utilisé en Amérique du Nord (le PariPEP®), ont été conçus dans le cadre de ce projet. Les prototypes ont été testés sur place, à la clinique FK de l’hôpital pour enfants, dans le cadre d’une étude pilote effectuée auprès de 10 jeunes patients, toutes et tous âgés entre 8 et 10 ans.At around the age of 7 years old, younger patients diagnosed with cystic fibrosis (CF) are usually prescribed a new therapy using positive expiratory pressure (PEP). For PEP therapy, patients are required to perform a series of repetitive and methodical breathing exercises to improve lung capacity among other health benefits. However, these exercises can be boring and demotivating for young children. As a result, daily adherence rate to PEP therapy is less than 50%. In turn, this affects the quality of life and long-term health of patients as well as directly impacting their families. In the education and health sectors, serious games are already used with children to help them with learning, therapy and even physical rehabilitation. Serious games leverage the fun and interactive aspects of video games to motivate and improve the commitment of the player to learn the targeted material or adhere to a specific health behaviour. This research-creation project seeks to validate the efficacy of using games specially designed to help patients adhere to PEP therapy exercises more regularly. The objective is to encourage them to get involved in their daily exercises and to facilitate the learning and application of the breathing techniques. This playful approach ultimately aims to improve the quality of life of CF children over time. Leveraging a multi and interdisciplinary collaboration between students from University of Montreal and specialists from the CF clinic at CHU Ste-Justine, three games prototypes and an electronic device prototype, used to control the games, were developed for the most popular PEP device in North America (PariPEP®). The games and electronic device prototypes were tested at the CF clinic, within the hospital for children, as part of a pilot study with 10 young patients, aged from 8 to 10 years old

Rôles et mécanismes moléculaires de l'apoptose cardiovasculaire en réponse à des antihypertenseurs

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal

Dynein Light Chain Tctex-Type 1 Modulates Orexin Signaling through Its Interaction with Orexin 1 Receptor

Orexins (OX-A, OX-B) are neuropeptides involved in the regulation of the sleep-wake cycle, feeding and reward, via activation of orexin receptors 1 and 2 (OX1R, OX2R). The loss of orexin peptides or functional OX2R has been shown to cause the sleep disorder, narcolepsy. Since the regulation of orexin receptors remains largely undefined, we searched for novel protein partners of the intracellular tail of orexin receptors. Using a yeast two-hybrid screening strategy in combination with co-immunoprecipitation experiments, we found interactions between OX1R and the dynein light chains Tctex-type 1 and 3 (Dynlt1, Dynlt3). These interactions were mapped to the C-terminal region of the dynein light chains and to specific residues within the last 10 amino acids of OX1R. Hence, we hypothesized that dynein light chains could regulate orexin signaling. In HEK293 cells expressing OX1R, stimulation with OX-A produced a less sustained extracellular signal-regulated kinases 1/2 (ERK1/2) activation when Dynlt1 was co-expressed, while it was prolonged under reduced Dynlt1 expression. The amount of OX1R located at the plasma membrane as well as the kinetics and extent of OX-A-induced internalization of OX1R (disappearance from membrane) were not altered by Dynlt1. However, Dynlt1 reduced the localization of OX1R in early endosomes following initial internalization. Taken together, these data suggest that Dynlt1 modulates orexin signaling by regulating OX1R, namely its intracellular localization following ligand-induced internalization

Wind redistribution of snow impacts the Ka- and Ku-band radar signatures of Arctic sea ice

Wind-driven redistribution of snow on sea ice alters its topography and microstructure, yet the impact of these processes on radar signatures is poorly understood. Here, we examine the effects of snow redistribution over Arctic sea ice on radar waveforms and backscatter signatures obtained from a surface-based, fully polarimetric Ka- and Ku-band radar at incidence angles between 0∘ (nadir) and 50∘. Two wind events in November 2019 during the Multidisciplinary drifting Observatory for the Study of Arctic Climate (MOSAiC) expedition are evaluated. During both events, changes in Ka- and Ku-band radar waveforms and backscatter coefficients at nadir are observed, coincident with surface topography changes measured by a terrestrial laser scanner. At both frequencies, redistribution caused snow densification at the surface and the uppermost layers, increasing the scattering at the air–snow interface at nadir and its prevalence as the dominant radar scattering surface. The waveform data also detected the presence of previous air–snow interfaces, buried beneath newly deposited snow. The additional scattering from previous air–snow interfaces could therefore affect the range retrieved from Ka- and Ku-band satellite altimeters. With increasing incidence angles, the relative scattering contribution of the air–snow interface decreases, and the snow–sea ice interface scattering increases. Relative to pre-wind event conditions, azimuthally averaged backscatter at nadir during the wind events increases by up to 8 dB (Ka-band) and 5 dB (Ku-band). Results show substantial backscatter variability within the scan area at all incidence angles and polarizations, in response to increasing wind speed and changes in wind direction. Our results show that snow redistribution and wind compaction need to be accounted for to interpret airborne and satellite radar measurements of snow-covered sea ice

Wind redistribution of snow impacts the Ka- and Ku-band radar signatures of Arctic sea ice

Wind-driven redistribution of snow on sea ice alters its topography and microstructure, yet the impact of these processes on radar signatures is poorly understood. Here, we examine the effects of snow redistribution over Arctic sea ice on radar waveforms and backscatter signatures obtained from a surface-based, fully polarimetric Ka- and Ku-band radar at incidence angles between 0∘ (nadir) and 50∘. Two wind events in November 2019 during the Multidisciplinary drifting Observatory for the Study of Arctic Climate (MOSAiC) expedition are evaluated. During both events, changes in Ka- and Ku-band radar waveforms and backscatter coefficients at nadir are observed, coincident with surface topography changes measured by a terrestrial laser scanner. At both frequencies, redistribution caused snow densification at the surface and the uppermost layers, increasing the scattering at the air–snow interface at nadir and its prevalence as the dominant radar scattering surface. The waveform data also detected the presence of previous air–snow interfaces, buried beneath newly deposited snow. The additional scattering from previous air–snow interfaces could therefore affect the range retrieved from Ka- and Ku-band satellite altimeters. With increasing incidence angles, the relative scattering contribution of the air–snow interface decreases, and the snow–sea ice interface scattering increases. Relative to pre-wind event conditions, azimuthally averaged backscatter at nadir during the wind events increases by up to 8 dB (Ka-band) and 5 dB (Ku-band). Results show substantial backscatter variability within the scan area at all incidence angles and polarizations, in response to increasing wind speed and changes in wind direction. Our results show that snow redistribution and wind compaction need to be accounted for to interpret airborne and satellite radar measurements of snow-covered sea ice

A Discrete Event Simulation model to evaluate the treatment pathways of patients with Cataract in the United Kingdom

Background The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. Methods We developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams. Results Four scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. Conclusions Using new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.Peer reviewedFinal Published versio

Components of SurA Required for Outer Membrane Biogenesis in Uropathogenic Escherichia coli

Background: SurA is a periplasmic peptidyl-prolyl isomerase (PPIase) and chaperone of Escherichia coli and other Gramnegative bacteria. In contrast to other PPIases, SurA appears to have a distinct role in chaperoning newly synthesized porins destined for insertion into the outer membrane. Previous studies have indicated that the chaperone activity of SurA rests in its ‘‘core module’ ’ (the N- plus C-terminal domains), based on in vivo envelope phenotypes and in vitro binding and protection of non-native substrates. Methodology/Principal Findings: In this study, we determined the components of SurA required for chaperone activity using in vivo phenotypes relevant to disease causation by uropathogenic E. coli (UPEC), namely membrane resistance to permeation by antimicrobials and maturation of the type 1 pilus usher FimD. FimD is a SurA-dependent, integral outer membrane protein through which heteropolymeric type 1 pili, which confer bladder epithelial binding and invasion capacity upon uropathogenic E. coli, are assembled and extruded. Consistent with prior results, the in vivo chaperone activity of SurA in UPEC rested primarily in the core module. However, the PPIase domains I and II were not expendable for wild-type resistance to novobiocin in broth culture. Steady-state levels of FimD were substantially restored in the UPEC surA mutant complemented with the SurA N- plus C-terminal domains. The addition of PPIase domain I augmented FimD maturation into the outer membrane, consistent with a model in which domain I enhances stability of and/or substrat