Qu'entend-on par technologie verte?

Version espagnole disponible dans la Bibliothèque numérique du CRDI: Tecnologias verdes : respeto a las comunidades y recursos localesVersion anglaise disponible dans la Bibliothèque numérique du CRDI: Green technology : local resources for community profi

Learning-by-Concordance (LbC): introducing undergraduate students to the complexity and uncertainty of clinical practice

Background: A current challenge in medical education is the steep exposure to the complexity and uncertainty of clinical practice in early clerkship. The gap between pre-clinical courses and the reality of clinical decision-making can be overwhelming for undergraduate students. The Learning-by-Concordance (LbC) approach aims to bridge this gap by embedding complexity and uncertainty by relying on real-life situations and exposure to expert reasoning processes to support learning. LbC provides three forms of support: 1) expert responses that students compare with their own, 2) expert explanations and 3) recognized scholars’ key-messages.Method: Three different LbC inspired learning tools were used by 900 undergraduate medical students in three courses: Concordance-of-Reasoning in a 1st-year hematology course; Concordance-of-Perception in a 2nd-year pulmonary physio-pathology course, and; Concordance-of-Professional-Judgment with 3rd-year clerkship students. Thematic analysis was conducted on freely volunteered qualitative comments provided by 404 students.Results:  Absence of a right answer was challenging for 1st year concordance-of-reasoning group; the 2nd year visual concordance group found radiology images initially difficult and unnerving and the 3rd year concordance-of-judgment group recognized the importance of divergent expert opinion.Conclusions: Expert panel answers and explanations constitute an example of “cognitive apprenticeship” that could contribute to the development of appropriate professional reasoning processes

Ecology, Biology and Genetics of <em>Millepora</em> Hydrocorals on Coral Reefs

Coral reefs are one of the most productive and diverse ecosystems on Earth. However, climate warming is occurring at an unprecedented rate and has negatively affected coral reefs worldwide. Evaluating the life history of reef-building species carries important implications for coral reef conservation. This chapter examines the taxonomy, biogeography, ecology, symbiosis, morphology and reproductive biology of Millepora hydrocorals, an important but relatively unstudied component of coral reefs. An emphasis is also placed on the influence of variable reef environments on Millepora life history traits, providing a fascinating opportunity to study the interplay between ecology and evolution. Special attention is given to ecological and evolutionary benefits of asexual versus sexual reproduction in the maintenance of genetic and phenotypic diversity. Lastly, this chapter discusses whether life-history strategies of Millepora hydrocorals and tolerance to different stressors can influence their ability to adapt and survive to future climate change, and other natural and anthropogenic disturbances

Pharmacogenetic meta-analysis of genome-wide association studies of LDL cholesterol response to statins

Statins effectively lower LDL cholesterol levels in large studies and the observed interindividual response variability may be partially explained by genetic variation. Here we perform a pharmacogenetic meta-analysis of genome-wide association studies (GWAS) in studies addressing the LDL cholesterol response to statins, including up to 18,596 statin-treated subjects. We validate the most promising signals in a further 22,318 statin recipients and identify two loci, SORT1/CELSR2/PSRC1 and SLCO1B1, not previously identified in GWAS. Moreover, we confirm the previously described associations with APOE and LPA. Our findings advance the understanding of the pharmacogenetic architecture of statin response

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

La chimie des aza-1 twistanes : synthèse de l'aza-1 twistane et d'un précurseur de l'aza-1 twistanone-5

Ce travail est un compte-rendu succinct de l'ensemble des travaux que nous avons accomplis au cours des quatre dernières années dans le Laboratoire de synthèse organique du département de chimie, sous la direction du professeur Deslongchamps. Dans une première partie, nous rapportons la synthèse de l'aza-1-cwistane. Nous faisons part ensuite des efforts que nous avons faits, dans le cadre général d'une synthèse de la quinine, en vue de fonctionnaliser l'aza-l-twistane et, plus particulièrement, de réaliser la synthèse de 1'aza-l-twistanone-5. Nous avons réalisé la synthèse d'un précurseur immédiat de 1'aza-l-twistanone-5. Nous avons confirmé la structure de tous les intermédiaires importants par des preuves de structures chimiques rigoureuses