Les habitats riverains du sud de la Jamésie, Québec

Selon la nature des dépôts, l'amplitude des fluctuations d'eau annuelles et les conditions d'exposition, l'aspect des rives se modifie. Ainsi, dans la partie sud de la Jamésie, neuf « types d'habitats riverains » ont pu être mis en évidence en bordure des lacs et des rivières. Cette étude donne un aperçu global de leur morphologie, de leur végétation et de leur importance relative dans le paysage. Elle insiste sur les principales hydrosères formées à partir des 28 groupements végétaux recensés sur le territoire. Certains groupements s'associent à un seul type de rive alors que d'autres, très répandus, en occupent plusieurs. Un potentiel faunique approximatif, déterminé à partir des observations faites sur le terrain et de la documentation existante, accompagne également la description de chaque habitat riverain. Cette étude présente aussi un côté pratique puisqu'elle fournit une clé d'identification permettant de reconnaître par photo-interprétation les neuf types d'habitats riverains retenus. À l'aide de cette clé et de contrôles terrestres, la cartographie de ces unités devient réalisable, offrant ainsi la possibilité de quantifier l'espace occupé par ces milieux dans un territoire donné. Une synthèse régionale peut par la suite être dégagée sur la base de la représentativité de chaque type d'habitat riverain. Utilisée dans la partie sud de la Jamésie, cette classification pourrait être transposée dans toute autre région dont les caractéristiques biophysiques sont comparables.Aspect of shorelines is generally related to superficial deposits, water level fluctuations and exposure to wave action. In the southern part of the James Bay Territory, nine types of riparian habitats are described at the margin of rivers and lakes. This study presents a global view of their morphology, vegetation and spatial relative importance. Main hydroseres are defined from 28 vegetation associations recognized in the territory. Some groups are related to only one shore type, while others are well distributed and belong to several habitats. Riparian habitats potentials for fauna are also evaluated from field observations and a literature review. One practical aspect of this work is the presentation of a photo-interpretation key of nine types of riparian habitats. With the aid of this key and field observations, cartography of these units become feasible and it is possible to determine the area covered by each type of habitat within a given territory. A regional synthesis is also presented by using representativity of each riparian habitat type. Field-tested, this classification of habitats could be transposed to any territory with comparable biophysical characteristics.Je nach der Natur der Ablagerungen, der Ausdehnung der jâhrlichen Wasserspiegelvariation und der Aussetzung zur Wellentàtigkeit, veràndert sich das Aussehen der Kùstenlinie. So konnten im sùdlichen Teil der Jamésie neun verschiedene Ha-bitatstypen gezeigt werden, die an Ufern von Seen und Flùssen liegen. Dièse Forschungsarbeit gibt eine allgemeine Auffassung ihrer Morphologie, ihrer Vegetation und ihrer verhaltnismàssigen Wichtigkeit in der Landschaft. Die Haup-thydroseren wurden aus den 28 Pflanzenverbindungen, die im Gebiet erkannt wurden, definiert. Gewisse Gruppierungen sind mit einem bestimmten Ufertyp verbunden, wàhrend andere, sehr verbreitete, verschiedene Kùstentypen bewohnen. Ein annàherndes BiId der Fauna, aus direkten Beobachtungen im Forschungsgebiet und der gegebenen Dokumentation stammend, ist ebenso von einer Beschreibung der einzelnen Uferhabitate begleitet. Dièse Forschungsarbeit hat auch eine praktische Seite, denn sie gibt einen Schlùssel zur Bestimmung der neun erkannten Kùstenhabitats Typen, durch Photointerpretation. Mit Hilfe dieses Schlùssels, und Erdkontrollen, wird die Kartographie dieser Einheiten ausfùhrbar, und ergibt die Môglichkeit zur Quantifikation des Raumes, den dièse Milieux in einem gegebenen Territorium einnehmen. Eine régionale Synthèse kann danach noch auf Grund der Verteilung jedes Kùstenhabitat Types bestimmt werden. Hauptsàchlich im sùdlichen Teil der Jamésie benutzt, làsst sich dièse Klassifikation dann auch auf andere Regionen mit àhnlichen biophysischen Karakteristiken ùbertragen

Les Inuit en ville. Communication et fictions autour des soins interculturels

Les Inuit en villeCommunication et fictions autour des soins interculturelsLa majorité des commentaires concernant les transferts médicaux des Inuit présument une adaptation difficile au contexte des soins. Par contre, un examen rapide des activités des patients au Sud permet de constater que ces analyses évoquent de faux problèmes et minimisent l'impact des réseaux de communication.Inuit in TownCommunication and Fictions around Intercultural CareThe majority of thé observations concerning thé Inuit's médical évacuations présume a difficult adaptation to thé health care context. However, a rapid overview of thé patients' activities in thé South suggests that thèse analyses evoke false problems and minimize thé communication network's impact

Gene Expression Profiling and Molecular Characterization of Antimony Resistance in Leishmania amazonensis

Leishmania are unicellular microorganisms that can be transmitted to humans by the bite of sandflies. They cause a spectrum of diseases called leishmaniasis, which are classified as neglected tropical diseases by the World Health Organization. The treatment of leishmaniasis is based on the administration of antimony-containing drugs. These drugs have been used since 1947 and still constitute the mainstay for leishmaniasis treatment in several countries. One of the problems with these compounds is the emergence of resistance. Our work seeks to understand how these parasites become resistant to the drug. We studied antimony-resistant Leishmania amazonensis mutants. We analyzed gene expression at the whole genome level in antimony-resistant parasites and identified mechanisms used by Leishmania for resistance. This work could help us in developing new strategies for treatment in endemic countries where people are unresponsive to antimony-based chemotherapy. The identification of common mechanisms among different species of resistant parasites may also contribute to the development of diagnostic kits to identify and monitor the spread of resistance

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

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