NCube/papyrus huggingface dataset:
Feasibility and acceptability of a nursing
intervention with family caregiver on
self-care among heart failure patients :
a randomized pilot trial

Background: Self-care practices in heart failure (HF) contribute to quality of life, symptom stabilization, and extended life expectancy. However, adherence to practices such as liquid and salt restriction or symptom monitoring require high motivation on a daily basis. The aim was to assess the feasibility, acceptability, and potential effectiveness of a nursing intervention with family caregivers, aimed at improving self-care practice of HF patients. Methods: This pilot study involved 32 HF patient-caregiver dyads (16/group) randomized to an experimental (EG) or control group (CG). The intervention, based on the Self-Determination Theory, was designed to enhance patients’ autonomy and motivation in self-care practices, by involving their caregivers’ support. Five encounters were planned with the EG dyads—two face-to-face during hospitalization and three by telephone after discharge. The feasibility of delivering the protocol was evaluated as well as the acceptability of the intervention. The potential effectiveness of the intervention was assessed based on patient outcomes, including general self-care management and self-care specific to HF, perceived competence to manage HF, autonomous motivation (A-motivation, external extrinsic motivation, internal extrinsic motivation, and intrinsic motivation), and perceived support from the caregiver. Caregiver outcomes included level of support provided to the patient. Results: Despite recruitment challenges, the intervention was feasible, with 12 of the 16 dyads receiving all 5 encounters delivered per protocol. The 4 other dyads received the two hospital encounters, but at least 1 of the 3 post-discharge planned telephone encounters was not feasible because the patients had been re-hospitalized or was deceased. Participant’s satisfaction with the intervention was high. Outcomes favoring the EG include self-care specific to HF, internal extrinsic motivation, intrinsic motivation, and caregiver’s feeling that they provide a higher level of support. Conclusions: Caregiver involvement was found to be both a feasible and acceptable means of supporting self-care practice in HF patients. This approach presents a potential avenue for enhancing patients’ efforts in this regard. However, this pilot study offers preliminary findings only, which need to be replicated in a phase 3 clinical trial.

Keyphrases: Heart failure, Self-care, Family caregiver, Self-Determination, Theory, Nursing intervention
Genetically engineered E. coli Nissle attenuates hyperammonemia and prevents memory impairment in bile‐duct ligated rats

Hyperammonemia associated with chronic liver disease (CLD) is implicated in the pathogenesis of hepatic encephalopathy (HE). The gut is a major source of ammonia production that contributes to hyperammonemia in CLD and HE and remains the primary therapeutic target for lowering hyperammonemia. As an ammonia‐lowering strategy, Escherichia coli Nissle 1917 bacterium was genetically modified to consume and convert ammonia to arginine (S‐ARG). S‐ARG was further modified to additionally synthesize butyrate (S‐ARG+BUT). Both strains were evaluated in bile‐duct ligated (BDL) rats; experimental model of CLD and HE.  Methods One‐week post‐surgery, BDLs received non‐modified EcN (EcN), S‐ARG, S‐ARG+BUT (3x1011 CFU/day) or vehicle until sacrifice at 3‐ or 5‐weeks. Plasma (ammonia/pro‐inflammatory/liver‐function), liver fibrosis (hydroxyproline), liver mRNA (pro‐inflammatory/fibrogenic/anti‐apoptotic) and colon mRNA (pro‐inflammatory) biomarkers were measured post‐sacrifice. Memory, motor‐coordination, muscle‐strength, and locomotion were assessed at 5‐weeks.  Results In BDL‐Veh rats, hyperammonemia developed at 3‐ and further increased at 5‐weeks. This rise was prevented by S‐ARG and S‐ARG+BUT, whereas EcN was ineffective. Memory impairment was prevented only in S‐ARG+BUT vs BDL‐Veh. Systemic inflammation (IL‐10/MCP‐1/endotoxin) increased at 3‐ and 5‐weeks in BDL‐Veh. S‐ARG+BUT attenuated inflammation at both timepoints (except 5‐week endotoxin) vs BDL‐Veh, whereas S‐ARG only attenuated IP‐10 and MCP‐1 at 3‐weeks. Circulating (ALT/AST/ALP/GGT/albumin/bilirubin) and gene expression liver‐function markers (IL‐10/IL‐6/IL‐1β/TGF‐β/α‐SMA/collagen‐1α1/Bcl‐2) were not normalized by either strain. Colonic mRNA (TNF‐α/IL‐1β/occludin) markers were attenuated by synthetic strains at both timepoints vs BDL‐Veh.  Conclusion S‐ARG and S‐ARG+BUT attenuated hyperammonemia, with S‐ARG+BUT additional memory protection likely due to greater anti‐inflammatory effect. These innovative strategies, particularly S‐ARG+BUT, have potential to prevent HE.

Keyphrases: Ammonia, Arginine, Bile‐duct ligature, Butyrate, Cirrhosis, E. coli Nissle, Hepatic encephalopathy, Inflammation, Memory, Probiotics
Testing nursing students’ clinical judgment in a patient deterioration simulation scenario : development of a situation awareness instrument

Background: Situation awareness may be used to operationalize nursing students' clinical judgment of patient deterioration simulation scenarios.  Objectives: To develop and test an instrument to measure bachelor-level nursing students' situation awareness in a patient deterioration simulation scenario, using the Situation Awareness Global Assessment Technique (SAGAT).  Design: Instrument development and validation.  Settings: A faculty of nursing of a French-Canadian university.  Participants: 15 critical care experts and 234 bachelor-level nursing students from a critical care course.  Methods: The queries were developed from evidence and guidelines regarding nurses' assessment and response to patient deterioration and an inventory of nursing diagnosis. After expert content validation, the instrument was administered to three cohorts of nursing students in a high-fidelity simulation with a scenario of hypovolemic hemorrhagic shock. Difficulty, discrimination, and fidelity indices were computed. The impact of the instrument on student's performance was assessed with a post-simulation survey.  Results: The instrument comprised 31 queries, which obtained high content validity indices. Most showed satisfying difficulty, discrimination, and fidelity properties. Inadequate properties of the queries may be explained by the content of the simulation scenario, the assessment practices of nursing students, and their reliance on medical assistance. Students perceived that completing the instrument helped them realize what they forgot to assess in the simulation.  Conclusions: This instrument appears as a promising research tool, although it still needs to be tested with other populations and in other patient deterioration simulation scenarios.

Keyphrases: Patient deterioration, Research instrument, Instrument validation, Test construction, Reliability and validity, Simulations, Nursing students, Situation awareness
La Staatslehre de 1813 et la question de l’éducation chez Fichte

L’éducation occupe une place centrale dans la conception fichtéenne de l’État puisque c’est elle qui doit conduire à la libre reconnaissance de la légitimité de la loi. J’examine les lignes de force de la théorie de l’éducation de Fichte (primauté de l’enseignement oral, méthode socratique, méfiance vis-à-vis de l’écrit), et plus précisément en regard de l’enseignement universitaire (différences avec le modèle libéral de Humboldt et de Schleiermacher). Enfin, je pose la question : jusqu’à quel point une éducation civique fondée ultimement sur la doctrine de la science peut-elle être qualifiée d’« autoritaire »? Education is no doubt of central importance for Fiche’s conception of the state since it must lead in the end to the free acknowledgment of the legitimacy of the law. I examine the main tenets of the Fichtean theory of education (primacy of oral teaching, Socratic method, mistrust towards the written word), and in particular of his conception of the university (as opposed to the liberal model of Humboldt and of Schleiermacher). I finally ask the question: to what extent can a civic education ultimately based of the doctrine of science be characterized as “authoritarian?”

Keyphrases: Fichte, Humboldt, Schleiermacher, Éducation, Exposé oral, Liberté académique, Fichte, Humboldt, Schleiermacher, Education, Oral exposition, Academic freedom
Tissue-specificity of antibodies raised against TrkB and p75NTR receptors ; implications for platelets as models of neurodegenerative diseases

Platelets and neurons share many similarities including comparable secretory granule types with homologous calcium-dependent secretory mechanisms as well as internalization, sequestration and secretion of many neurotransmitters. Thus, platelets present a high potential to be used as peripheral biomarkers to reflect neuronal pathologies. The brain-derived neurotrophic factor (BDNF) acts as a neuronal growth factor involved in learning and memory through the binding of two receptors, the tropomyosin receptor kinase B (TrkB) and the 75 kDa pan-neurotrophic receptor (p75NTR). In addition to its expression in the central nervous system, BDNF is found in much greater quantities in blood circulation, where it is largely stored within platelets. Levels 100- to 1,000-fold those of neurons make platelets the most important peripheral reservoir of BDNF. This led us to hypothesize that platelets would express canonical BDNF receptors, i.e., TrkB and p75NTR, and that the receptors on platelets would bear significant resemblance to the ones found in the brain. However, herein we report discrepancies regarding detection of these receptors using antibody-based assays, with antibodies displaying important tissue-specificity. The currently available antibodies raised against TrkB and p75NTR should therefore be used with caution to study platelets as models for neurological disorders. Rigorous characterization of antibodies and bioassays appears critical to understand the interplay between platelet and neuronal biology of BDNF.

Keyphrases: Platelet, Neurotrophin receptors, Tropomyosin receptor kinase B, Brain-derived neurotrophic factor, Pan-neurotrophic receptor p75NTR
Articulating care and responsibility in design : a study on the reasoning processes guiding health innovators’ ‘care-making’ practices

This article explores how health innovation designers articulate care and responsibility when designing new health technologies. Towards this end, we draw on Tronto’s ethic of care framework and Responsible Research and Innovation (RRI) scholarship to analyse interviews with Canadian health innovators (n=31). Our findings clarify how respondents: 1) direct their attention to needs and ways to improve care; 2) mobilise their skill set to take care of problems; 3) engage in what we call ‘care-making’ practices by prioritising key material qualities; and 4) operationalise responsiveness to caregivers and care-receivers through user-centred design. We discuss the inclusion of health innovation designers within the care relationship as ‘care-makers’ as well as the tensions underlying their ways of caring and their conflicting responsibilities.

Keyphrases: Design practice, Ethics, Innovation, Care
Corporalité en performance électroacoustique : une approche

Ce mémoire de maîtrise synthétise la démarche de recherche qui a mené à la création des œuvres audiovisuelles Interférences (String Network), DATANOISE et Pharmacologie, ainsi qu’à deux études de musique fixée. Ce texte propose une réflexion sur les possibilités d’utilisation des technologies numériques en temps réel, dans un contexte de performance électroacoustique. Il vise à développer des stratégies afin de pouvoir interpréter et incarner physiquement les musiques numériques. Les notions de risque, de collaboration et de symbolique en musique sont abordées. Ce mémoire défend la création de dispositifs audiovisuels spécifiques comme élément constituant de l’œuvre artistique. Il tend vers une corporalité de l’œuvre électroacoustique, par la recherche d’adéquation entre la nature des outils utilisés, l’attitude corporelle de l’interprète, la symbolique des éléments visibles, et le contenu de la composition musicale. This Master’s thesis summarizes the the research process that led to the creation of audiovisual works Interférences (String Network), DATANOISE and Pharmacologie, as well as two studies of fixed music. This text proposes a reflection on the possibilities of using digital technologies in real time, in a context of electroacoustic performance. It aims to develop strategies to perform and embody digital music. The notions of risk, collaboration and symbolism in music are discussed. This thesis defends the creation of specific audiovisual devices as constituent element of the artistic work. It tends towards a corporality of the electroacoustic work, by the search of adequacy between the nature of the tools used, the bodily attitude of the interpreter, the symbolism of the visible elements, and the content of the musical composition.

Keyphrases: performance, électroacoustique, dispositif audiovisuel, corporalité, interprétation, risque, collaboration, performance, performance, collaboration, performance, electroacoustic, audiovisual device, corporality, risk
Reflective debriefing to promote novice nurses' clinical judgment after high-fidelity clinical simulation : a pilot test

Background: Novice nurses are increasingly beginning their career paths in critical care areas, where they are expected to care for patients whose lives are potentially threatened. They are unable to benefit from years of experience to facilitate their clinical decisions. Reflection after simulation could possibly improve nurses' clinical judgment in complex situations.  Design: An educational project was conducted to pilot-test a teaching intervention, which combined reflective debriefing with a simulated critical care experience.  Method: Five nurses beginning in an intensive care unit participated in the pilot test. Their perception of their learning and satisfaction with the reflective debriefing and the simulation were collected using open-ended questionnaires. A clinical nurse educator, a faculty member and the first author participated in a group discussion to review the time plan and the affective components of the teaching intervention.  Results: Participants reported that the reflective debriefing helped them understand their cognitive processes during the simulation and contributed to clinical judgment development and to their care prioritization and assessment capacities. Observers reported the time plan was adequate and that attention to participants' negative feelings was necessary.  Conclusion: The results of this pilot test provide preliminary information that reflective debriefing may be a safe and potentially effective way for novice critical care nurses to learn from a clinical experience and enhance clinical judgment.

Keyphrases: Clinical judgment, Clinical reasoning, Reflection, Debriefing, High-fidelity clinical simulation, Critical care
Anticipatory governance and moral imagination : methodological insights from a scenario-based public deliberation study

The fields of Responsible Research and Innovation (RRI) and participatory foresight seek to establish, and toinclude publics within, anticipatory governance mechanisms. While scenario-based methods can bring to thepublics’ attention the ethical challenges associated to existing technologies, there has been little empirical re-search examining how, in practice, prospective public deliberative processes should be organized to informanticipatory governance. The goal of this article is to generate methodological insights into the way suchmethods can stimulate the public's moral imagination regarding what may (or may not) happen in the future andwhat should (or should not) happen in the future. Our qualitative analyses draw on a public deliberation studythat included videos and online scenarios to support participants’ (n= 57) deliberations about fictional inter-ventions for genetically at-risk individuals. Our findings clarify how participants: (1) challenged key elements ofour scenarios; (2) extended several of their technical and moral prospects; (3) engaged personally with others,including our scenarios’ characters; and (4) mobilized the past creatively to reason about the future. Ourmethodology enabled participants to creatively and empathetically envision complex sociotechnical futures. Yet,important methodological limits should be acknowledged by those who design, implement and use public en-gagement methods to inform anticipatory governance.

Keyphrases: Anticipatory governance, Participatory foresight, Responsible research and innovation, Empirical ethics, Scenario-based methods, Health technology, Public engagement, Qualitative research, Online forums
Entre nature et liberté : le rôle des Lumières kantiennes

Le passage du §83 au §84 dans la Critique de la faculté de juger constitue à n’en pas douter un moment charnière dans l’architectonique de cette œuvre, dont l’une des motivations principales consiste à combler l’abîme qui sépare nature et liberté. Si la fin dernière (letzter Zweck) qu’assigne la nature à l’humanité comme espèce empirique réside dans le développement de la culture (§83), celle-ci rend sans doute apte à réaliser toutes sortes de fins, mais sans égard à la fin morale ultime (Endzweck) que doit atteindre l’humanité considérée du point de vue nouménal : la moralité (§84). Dans ce texte, je propose d’interpréter les Lumières kantiennes comme une instance médiatrice entre la nature et la liberté, entre la culture et la moralité. L’Aufklärung doit alors être comprise comme une critique de la culture qui se fonde sur une autonomie théorique pleinement assumée par l’individu, autonomie qu’il convient néanmoins de distinguer de l’autonomie de la volonté. The transition from §83 to §84 of the Critique of Judgment is without doubt a turning point in the architectonic of this work, whose goal is among others to bridge the gap between nature and freedom. If the final aim (letzter Zweck) assigned by nature to humanity as an empirical species is the development of culture (§83), we must admit that the latter enables one to attain any kind of ends, but without regard for the ultimate aim (Endzweck) that has to be reached by humanity seen from the noumenal point of view: morality (§84). In this paper, I interpret Kantian Enlightenment as a mediation between nature and freedom, or more precisely between culture and morality. Aufklärung must then be understood as a critique of culture based on a theoretical autonomy that is fully assumed by the individual, an autonomy however that must be distinguished from the autonomy of the will.

Keyphrases: Kant, Culture, Civilisation, Lumières, Aufklärung, Moralité, Kant, Culture, Aufklärung, Sittliche Einsicht, Enlightenment, Morality
Defining patient deterioration through acute care and intensive care nurses' perspectives

Aim: To explore variations between acute care and intensive care nurses’ understanding of patient deterioration according to their use of this term in published literature. Background: Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses’ help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains. Design: Dimensional analysis was used as a framework to analyze papers retrieved in a nursing focused database. Method: A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses’ perspectives on patient deterioration was conducted. Findings: No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses’ accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored. Conclusions: From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology toward critical illness. Contextual factors relating to acute care units appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modeling the concept of patient deterioration, which could be specific to acute care units. Relevance to Clinical Practice: The findings suggest it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issue

Keyphrases: Acute care nurses’ perspective, Dimensional analysis, Intensive care nurses’ perspective, Patient deterioration
Platelet quiescence in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery

BACKGROUND: The optimal antiplatelet strategy for patients with acute coronary syndromes who require coronary artery bypass surgery remains unclear. While a more potent antiplatelet regimen will predispose to perioperative bleeding, it is hypothesized that through “platelet quiescence,” ischemic protection conferred by such therapy may provide a net clinical benefit. METHODS AND RESULTS: We compared patients undergoing coronary artery bypass surgery who were treated with a more potent antiplatelet inhibition strategy with those with a less potent inhibition through a meta-analysis. The primary outcome was all-cause mortality after bypass surgery. The analysis identified 4 studies in which the antiplatelet regimen was randomized and 6 studies that were nonrandomized. Combining all studies, there was an overall higher mortality with weaker strategies compared with more potent strategies (odds ratio, 1.38; 95% CI, 1.03–1.85; P=0.03). CONCLUSIONS: Our findings support the concept of platelet quiescence, in reducing mortality for patients with acute coronary syndrome requiring coronary artery bypass surgery. This suggests the routine up-front use of potent antiplatelet regimens in acute coronary syndrome, irrespective of likelihood of coronary artery bypass graft.

Keyphrases: Acute coronary syndrome, Antiplatelet, Coronary artery bypass graft surgery
L’apprentissage de la participation à la réflexivité institutionnelle chez des intervenants en scolarisation à la maison

Les intervenants scolaires mandatés pour le suivi de la scolarisation à la maison sont placés au carrefour de conflits normatifs, politiques et pédagogiques. Ils les résolvent par diverses stratégies: l’intercompréhension, l’acceptation du désaccord, la recherche de l’intérêt de l’enfant et l’ingéniosité, mais aussi la négligence, l’abus de pouvoir, la protection de leur professionnalité, le caractère incontestable de leur jugement et la méfiance. La théorie de la gouvernance réflexive propose une approche de formation génétique pour soutenir la participation de ce type d’acteur à la réflexivité institutionnelle plutôt qu’à une forme de résistance. Les intervenants de quatre commissions scolaires québécoises ont participé à une démarche de recherche-formation visant à mieux comprendre le processus d’apprentissage de la participation à la réflexivité institutionnelle. Au terme de la démarche, les participants ont réalisé des apprentissages pragmatiques et des apprentissages génétiques, passant d’une posture d’intervenants mandataires à celle d’agents de changement. Nous découvrons les composantes de ce processus ainsi que leurs conditions de réussite.

Keyphrases: Instruction en famille, Gouvernance, Gestion du changement, Réflexivité, Recherche-formation