Étude de l’impact de déterminants psycho-socio-environnementaux sur la santé physique et mentale des femmes enceintes vivant dans un contexte linguistique et culturel minoritaire

La barrière linguistique réduirait le recours aux services préventifs, l’accès aux services basés sur la communication et augmenterait le recours aux services d’urgence. Les femmes sont particulièrement à risque à cause de leurs besoins accrus de services de santé et de soutien psychosociaux durant la grossesse, l’accouchement et la période du post-partum. Cette étude vise à recueillir de l’information sur les expériences de maternité des femmes francophones (Canadiennes et immigrantes) du Nouveau-Brunswick et de l’Alberta. Les résultats de cette étude seront utilisés pour améliorer les soins de santé et l’accès à l’information pour les femmes enceintes en situation linguistique et culturel minoritaire.Linguistic barriers may reduce the use of preventative services and access to communication-based services, and increase the use of emergency care. Women are particularly at risk owing to their increased need for health services and psychosocial support during pregnancy, birth and the post-partum period. We gathered information on the maternity experiences of Francophone women (Canadians and immigrants) in New Brunswick and Alberta. The results of the study will be used to improve health care and access to information for pregnant women in linguistic and cultural minority situations

Identifying spatial patterns of Mediterranean landscapes from geostatistic analysis of remotely-sensed data

The basic tool of geostatistics, the semi-variograms, has been used for quantifying spatial structures of soil and vegetation, as depicted by multi-resolution remotely-sensed images. Experimental semi-variograms of two contrasting Mediterranean landscapes were analysed by reference to simple theoretical models (spherical, exponential, allometric). A more general approach based on the superposition of spherical models of similar sills and varying ranges of influences is proposed for the interpretation of complex spatial patterns of natural vegetated landscapes. (Résumé d'auteur

Testing an area-weighted model for albedo or surface temperature of mixed pixels in mediterranean woodlands

International audienceWe have tested the following assumption for a spatially complex area of natural vegetation in Southern France. The spectral response of a mixed pixel is a linear combination of the individual responses of its components. The test has been done with HCMM data: each pixel (500m spatial resolution) has been characterized by its components defined as physiognomical vegetation units. Results from the analysis of multitemporal HCMM data indicate that the assumption is verified for albedos and surface temperatures

Microstructure Evolution in an Aluminum Cladded Sheet during Vacuum Brazing

Microstructure evolution of a 3003 sheet cladded with 4004 brazing alloy is investigated during slow heating (1K/min) under secondary vacuum up to isothermal brazing temperature (590°C). Optical and scanning microscopies, EDS chemical analysis and EBSD orientation mapping are used. Experimental results are discussed in the light of thermodynamic calculations using Thermo-Calc. Comparisons show good agreement as long as Mg vaporization does not take place

Numerical Simulation of Brazing Aluminium Alloys with Al–Si Alloys

Joining parts using low-melting temperature alloys has long been used for manufacturing complex components such as heat exchangers made of aluminium alloys. Investigations of the process have shown that core/ clad interaction during heating and brazing can lead to a significant decrease in the amount of liquid available for joint formation. This study presents a transient one-dimensional model for the process that takes into account the diffusion of silicon and the movement of the core/clad interface, with the model equations being implemented in the finite element software COMSOL Multiphysics; the results are compared to literature experimental data. Silicon profiles in the core are well described, while there appears a significant difference between predicted and experimental values of remaining clads which suggest a strong effect of silicon diffusion and liquid penetration at core grain boundaries

Numerical Benchmark for High-Reynolds-Number Supercritical Flows with Large Density Gradients

Because of the extreme complexity of physical phenomena at high pressure, only limited data are available for solver validation at device-relevant conditions such as liquid rocket engines, gas turbines, or diesel engines. In the present study, a two-dimensional direct numerical simulation is used to establish a benchmark for supercritical flow at a high Reynolds number and high-density ratio at conditions typically encountered in liquid rocket engines. Emphasis has been placed on maintaining the flow characteristics of actual systems with simple boundary conditions, grid spacing, and geometry. Results from two different state-of-the-art codes, with markedly different numerical formalisms, are compared using this benchmark. The strong similarity between the two numerical predictions lends confidence to the physical accuracy of the results. The established database can be used for solver benchmarking and model development at conditions relevant to many propulsion and power systems

Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey

BACKGROUND: Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits. METHODS: We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services. Parents presenting with a neonate to the emergency department in 5 large academic hospitals in Ontario were surveyed between December 2013 and June 2015. We used descriptive statistics to report survey data and explored correlations between factors. RESULTS: A total of 1533 surveys were completed. The most common reasons for presenting were jaundice (441 [28.8%]) and feeding issues (251 [16.4%]). The majority of respondents (73.9% [1104/1494]) had received advice before going to the emergency department. In most cases (86.4% [954/1104]), this was from a health care provider, who frequently advised going to the emergency department. Although most parents (86.8% [1280/1475]) reported high confidence in caring for a sick or injured child, 42.3% (643/1519) were unsure of the severity, and most (90.4% [578/639]) of these parents felt that the infant required assessment immediately or the same day. Of parents who felt the condition was not serious, 83.2% (198/238) thought that same-day evaluation was required. Nearly half of respondents (44.4% [621/1400]) said they would have gone to their health care provider with a same-day appointment, and 28.1% (344/1225) would have gone to their care provider with a next-day appointment. INTERPRETATION: Parents\u27 reported confidence in caring for sick or injured infants does not match the perceived urgency of neonatal conditions, which likely contributes to emergency department overuse. Any system to decrease nonurgent emergency department use by neonates would need to be immediately responsive, providing same-day help

Influence of Common Non-Synonymous Toll-like Receptor 4 Polymorphisms on Bronchopulmonary Dysplasia and Prematurity in Human Infants

Bronchopulmonary dysplasia (BPD) is a common chronic lung disease and major risk factor for severe respiratory syncytial virus (RSV) infection among preterm infants. The Toll-like receptor 4 (TLR4) is involved in oxidative injury responses in the lungs. Two non-synonymous single nucleotide polymorphisms in the TLR4 gene have been associated with RSV infection in children. However, it is unclear to what extent this association is confounded by BPD or prematurity. In this study, we analyzed two population-based cohorts of preterm infants at risk for BPD as well as ethnicity-matched infants born at term, to test whether the TLR4 polymorphisms Asp299Gly (rs4986790) and Thr399Ile (rs4986791) are independently associated with BPD or premature birth. In a Canadian cohort (n = 269) composed of a majority of Caucasian preterm infants (BPD incidence of 38%), the TLR4-299 heterozygous genotype was significantly under-represented in infants without BPD (1.6% of infants versus 12% in infants with severe BPD) after adjusting for twins, ethnicity, gestational age, birth weight and gender (p = 0.014). This association was not replicated in a Finnish cohort (n = 434) of premature singletons or first-born siblings of Caucasian descent, although the incidence of BPD was substantially lower in this latter population (15%). We did not detect a significant association (>2-fold) between TLR4 genotypes and prematurity (p>0.05). We conclude that these TLR4 genotypes may have, at best, a modest influence on BPD severity in some populations of high-risk preterm infants. Further studies are warranted to clarify how clinical heterogeneity may impact genetic susceptibility to BPD

Innovative approaches to investigator-initiated, multicentre paediatric clinical trials in Canada

Data from clinical trials are needed to guide the safe and effective use of medicines in children. Clinical trials are challenging to design and implement in all populations, and children present additional considerations. Several regions including the UK, USA and Europe have established clinical trial infrastructure to capitalise on expertise and promote clinical trials enrolling children. Our objective is to describe the partnerships and operational considerations for the development of paediatric clinical trials infrastructure in Canada. We describe the design and conduct of four emergency room paediatric trials, with four separate sponsors, across four provinces in parallel. Operations discussed include multisite contract development, centralised risk-based data monitoring, ethical review and patient engagement. We conclude with lessons learnt, additional challenges and potential solutions to facilitate drug development for children in Canada

Prospective assessment of inter-rater reliability of a neonatal adverse event severity scale

Introduction: To ensure the quality of clinical trial safety data, universal data standards are required. In 2019 the International Neonatal Consortium (INC) published a neonatal adverse event severity scale (NAESS) to standardize the reporting of adverse event (AE) severity. In this study the reliability of AE severity grading with INC NAESS was prospectively assessed in a real-world setting. Methods: Severity of AEs was assessed by two independent observers at each of four centers across the world. In each center two series of 30 neonatal adverse events were assessed by both observers: in a first phase with a generic (Common Terminology Criteria for Adverse Events, CTCAE) severity scale not specific to neonates, and in a second phase with INC NAESS (after a structured training). Intraclass correlation coefficients (ICC) were calculated to express inter-rater agreement in both phases, and bootstrap sampling was used to compare them. Results: 120 AEs were included in each of both phases. The ICC with the use of INC NAESS in phase 2 was 0.69. This represents a significant but modest improvement in comparison to the initial ICC of 0.66 in phase 1 (confidence interval of ratio of ICC in phase 2 to phase 1 = 1.005–1.146; excludes 1). The ICC was higher for those AEs for which a diagnosis specific AE severity table was available in INC NAESS (ICC 0.80). Discussion: Good inter-rater reliability of the INC NAESS was demonstrated in four neonatal intensive care units (NICUs) across the globe. The ICC is comparable to what is reported for scales with similar purposes in different populations. There is a modest, but significant, improvement in inter-rater agreement in comparison to the naïve phase without INC NAESS. The better performance when reviewers use AE-specific NAESS tables highlights the need to expand the number of AEs that are covered by specific criteria in the current version of INC NAESS.</p