Résumé des recommandations de bonnes pratiques en physiothérapie en soins palliatifs chez les personnes âgées

Travail d'intégration réalisé dans le cadre du cours PHT-6113.Introduction : Avec le vieillissement de la population, le nombre de personnes nécessitant des soins palliatifs est croissant. L’équipe de soins palliatifs a pour but de diminuer la souffrance globale en fin de vie et regroupe plusieurs professionnels de la santé, dont le physiothérapeute. Objectif : Démontrer l’importance de la physiothérapie en soins palliatifs et proposer des mesures de résultats et interventions appropriées en physiothérapie pour répondre aux besoins de la clientèle. Méthodologie : Une revue de littérature a été effectuée en incluant les publications de 1980 jusqu’à aujourd’hui. Les moteurs de recherche utilisés sont : Pubmed, Medline, PEDro et Cinhal. Les aspects épidémiologiques, organisationnels et éthiques des soins palliatifs seront abordés. Les besoins bio-psycho-sociaux, les signes de fin de vie et phases du deuil seront décrits pour justifier l’importance du travail interdisciplinaire et le rôle du physiothérapeute. Les mesures de résultats et interventions spécifiques du physiothérapeute au niveau de la douleur, de l’oedème et des proches aidants seront analysées. Résultats : Il est démontré que la physiothérapie en soins palliatifs permet de soulager certains symptômes, dont la douleur, et d’améliorer la qualité de vie et la fonction. Ces bienfaits peuvent être obtenus grâce à des interventions multiples, dont l’exercice, les modalités antalgiques, le positionnement, l’enseignement et les recommandations. Conclusion : Cette revue de littérature démontre que le patient en soins palliatifs et sa famille peuvent bénéficier de l’intervention du physiothérapeute. Cette profession est donc importante pour améliorer la qualité de fin de vie et mérite une place dans l’équipe interdisciplinaire

Nonparametric plug-in classifier for multiclass classification of S.D.E. paths

We study the multiclass classification problem where the features come from the mixture of time-homogeneous diffusions. Specifically, the classes are discriminated by their drift functions while the diffusion coefficient is common to all classes and unknown. In this framework, we build a plug-in classifier which relies on nonparametric estimators of the drift and diffusion functions. We first establish the consistency of our classification procedure under mild assumptions and then provide rates of cnvergence under different set of assumptions. Finally, a numerical study supports our theoretical findings.Comment: 18 pages, 48 pages (including proofs and appendix), 2 figure

Stationary and non-stationary deconvolution to recover long-term transfer functions

To design a ground heat exchanger, simulations are frequently used. One way to perform simulations is to use the well-known g-functions to obtain the ground temperature. These functions are usually obtained by analytical or numerical models, which limits the precision or takes long simulation time. Recent advances show that the short-term g-functions can also be retrieved by a deconvolution algorithm. However, the known deconvolution algorithm is only validated for a set of operating parameters and duration of less than 10 days. A first objective of this article is to demonstrate that longer g-functions can be retrieved with such an algorithm. Then, a second objective is to extend the application of the deconvolution to consider time varying operating parameters throughout a ground heat exchanger's operation. To achieve those objectives, the deconvolution will be first applied to various numerical year-long simulations of a ground source heat pump system with stationary conditions. Then, an extended multi-signal deconvolution will be applied to a non-stationary thermal response test of 30 days. Both tests show adequate temperature reconstruction with RMSE of less than 0.05 °C and 0.2 °C for the first and second scenarios respectively

RED experiment: an assessment of boundary layer effects in a trade winds regime on microwave and infrared propagation over the sea, The

Includes bibliographical references (pages 1364-1365).The Rough Evaporation Duct experiment aimed to see if the effects of ocean waves account for errors in modeling the ranges at which radar and infrared can detect low-flying targets

Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a lifetime risk of one in 350 people and an unmet need for disease-modifying therapies. We conducted a cross-ancestry genome-wide association study (GWAS) including 29,612 patients with ALS and 122,656 controls, which identified 15 risk loci. When combined with 8,953 individuals with whole-genome sequencing (6,538 patients, 2,415 controls) and a large cortex-derived expression quantitative trait locus (eQTL) dataset (MetaBrain), analyses revealed locus-specific genetic architectures in which we prioritized genes either through rare variants, short tandem repeats or regulatory effects. ALS-associated risk loci were shared with multiple traits within the neurodegenerative spectrum but with distinct enrichment patterns across brain regions and cell types. Of the environmental and lifestyle risk factors obtained from the literature, Mendelian randomization analyses indicated a causal role for high cholesterol levels. The combination of all ALS-associated signals reveals a role for perturbations in vesicle-mediated transport and autophagy and provides evidence for cell-autonomous disease initiation in glutamatergic neurons. A cross-ancestry genome-wide association meta-analysis of amyotrophic lateral sclerosis (ALS) including 29,612 patients with ALS and 122,656 controls identifies 15 risk loci with distinct genetic architectures and neuron-specific biology

Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a lifetime risk of one in 350 people and an unmet need for disease-modifying therapies. We conducted a cross-ancestry genome-wide association study (GWAS) including 29,612 patients with ALS and 122,656 controls, which identified 15 risk loci. When combined with 8,953 individuals with whole-genome sequencing (6,538 patients, 2,415 controls) and a large cortex-derived expression quantitative trait locus (eQTL) dataset (MetaBrain), analyses revealed locus-specific genetic architectures in which we prioritized genes either through rare variants, short tandem repeats or regulatory effects. ALS-associated risk loci were shared with multiple traits within the neurodegenerative spectrum but with distinct enrichment patterns across brain regions and cell types. Of the environmental and lifestyle risk factors obtained from the literature, Mendelian randomization analyses indicated a causal role for high cholesterol levels. The combination of all ALS-associated signals reveals a role for perturbations in vesicle-mediated transport and autophagy and provides evidence for cell-autonomous disease initiation in glutamatergic neurons. A cross-ancestry genome-wide association meta-analysis of amyotrophic lateral sclerosis (ALS) including 29,612 patients with ALS and 122,656 controls identifies 15 risk loci with distinct genetic architectures and neuron-specific biology

Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology

A cross-ancestry genome-wide association meta-analysis of amyotrophic lateral sclerosis (ALS) including 29,612 patients with ALS and 122,656 controls identifies 15 risk loci with distinct genetic architectures and neuron-specific biology. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a lifetime risk of one in 350 people and an unmet need for disease-modifying therapies. We conducted a cross-ancestry genome-wide association study (GWAS) including 29,612 patients with ALS and 122,656 controls, which identified 15 risk loci. When combined with 8,953 individuals with whole-genome sequencing (6,538 patients, 2,415 controls) and a large cortex-derived expression quantitative trait locus (eQTL) dataset (MetaBrain), analyses revealed locus-specific genetic architectures in which we prioritized genes either through rare variants, short tandem repeats or regulatory effects. ALS-associated risk loci were shared with multiple traits within the neurodegenerative spectrum but with distinct enrichment patterns across brain regions and cell types. Of the environmental and lifestyle risk factors obtained from the literature, Mendelian randomization analyses indicated a causal role for high cholesterol levels. The combination of all ALS-associated signals reveals a role for perturbations in vesicle-mediated transport and autophagy and provides evidence for cell-autonomous disease initiation in glutamatergic neurons

Genome-wide Analyses Identify KIF5A as a Novel ALS Gene

To identify novel genes associated with ALS, we undertook two lines of investigation. We carried out a genome-wide association study comparing 20,806 ALS cases and 59,804 controls. Independently, we performed a rare variant burden analysis comparing 1,138 index familial ALS cases and 19,494 controls. Through both approaches, we identified kinesin family member 5A (KIF5A) as a novel gene associated with ALS. Interestingly, mutations predominantly in the N-terminal motor domain of KIF5A are causative for two neurodegenerative diseases: hereditary spastic paraplegia (SPG10) and Charcot-Marie-Tooth type 2 (CMT2). In contrast, ALS-associated mutations are primarily located at the C-terminal cargo-binding tail domain and patients harboring loss-of-function mutations displayed an extended survival relative to typical ALS cases. Taken together, these results broaden the phenotype spectrum resulting from mutations in KIF5A and strengthen the role of cytoskeletal defects in the pathogenesis of ALS.Peer reviewe

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701