NCube/papyrus huggingface dataset:
Doppler renal resistance index for the prediction of response to passive leg-raising following cardiac surgery

Purpose: Doppler-based renal resistance index (RI) can be measured at the bedside of critically illpatients. This study was designed to assess if the RI predicted an increase in cardiac output (CO)following passive leg-raising (PLR) in patients admitted to the intensive care unit after cardiacsurgery.Methods: During this single center prospective study, Doppler assessment of RI and measure-ments of CO using the thermodilution method were performed, after surgery, in the intensive careunit before and after PLR. A positive response to PLR was defined as a 10% increase in CO.Results: We included 30 patients. The mean RI was higher before (0.694 60.069) than after PLR(0.679 6 0.069) (P 5 .02) with a median change of 20.012 (IQR: 20.042;0.000). Following PLR, 9patients (30%) had a >10% increase in CO. In patients with a positive PLR response, the decreasein the RI during PLR was more pronounced than in patients who did not respond to PLR (PLR 60.042 (IQR: 20.051; 20.040) vs PLR 620.008 (IQR: 20.032; 0.015) (P 5 .004). There was a sig-nificant negative association between RI change in response to PLR and a 10% increase in COfollowing PLR (OR: 1.63 (CI:1.07–2.47) (P 5 .02) per 20.01 change).Conclusion: An increase in CO following PLR was associated with a significant decrease in RI. Var-iations of RI in response to PLR should be further studied as a tool to predict fluid responsiveness.However, their clinical utility could be limited by the small magnitude of the variations.

Keyphrases: Cardiac surgery, Doppler ultrasonography, Fluid responsiveness, Passive leg-raising, Point-of-careultrasound, Renal artery, Resistance index
Assessment of left ventricular diastolic function by transesophageal echocardiography before cardiopulmonary bypass : clinical implications of a restrictive profile

Objective Left ventricular (LV) diastolic function can be assessed by transesophageal echocardiography before cardiopulmonary bypass in the setting of cardiac surgery. The objective of this study was to determine whether the assessment of LV diastolic dysfunction (LVDD) improves mortality risk prediction.  Design Retrospective single-center cohort study.  Setting Single tertiary cardiac surgery center.  Participants Data from patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) and for which an evaluation for LVDD was performed before CPB between February 1999 and November 2015.  Interventions Cases were reviewed retrospectively from a transesophageal echocardiography hemodynamic database. LV diastolic function was graded as normal, impaired relaxation (grade 1), pseudo-normalization (grade 2), or restrictive (grade 3) determined by mitral inflow waves, tissue Doppler imaging of the mitral annulus, and pulmonary venous flow. The main outcome was in-hospital mortality.  Measurements and Main Results A total of 760 patients were included, 144 (18.9%) patients with normal diastolic function, 331 (43.6%) patients with grade 1 LVDD, 218 (28.7%) patients with grade 2 LVDD, and 67 (8.8%) patients with grade 3 LVDD. In-hospital mortality occurred in 31 patients (4.1%). The presence of grade 3 LVDD was associated with an increased likelihood of in-hospital mortality (odds ratio [OR]: 19.39, confidence interval [CI]: 2.37-158.48, p = 0.006). In contrast, LV systolic dysfunction was not independently associated with increased mortality. When added to the Parsonnet score, the addition of diastolic function resulted in a net reclassification improvement of in-hospital mortality (NRI: 0.419 CI: 0.049-0.759, p = 0.02), and in integrated discrimination improvement (IDI: 0.0179 CI: 0.0049-0.031, p = 0.007). Difficult separation from CPB was observed more frequently in patients with grade 3 LVDD (62.9% v 36.1%, p = 0.01).  Conclusions In contrast to LV systolic dysfunction, restrictive LVDD is associated with an increased risk of in-hospital mortality in cardiac surgical patients. Further studies should explore how this information may be used by the attending anesthesiologist to tailor perioperative management.

Keyphrases: Left ventricular restrictive diastolic dysfunction, Difficult separation from cardiopulmonary bypass, Outcome, Diastolic dysfunction
Dopaminergic mechanisms underlying the expression of antipsychotic-induced dopamine supersensitivity in rats

Antipsychotic treatment can produce a dopamine-supersensitive state, potentiating the response to dopamine receptor stimulation. In both schizophrenia patients and rats, this is linked to tolerance to ongoing antipsychotic treatment. In rodents, dopamine supersensitivity is often confirmed by an exaggerated psychomotor response to d-amphetamine after discontinuation of antipsychotic exposure. Here we examined in rats the dopaminergic mechanisms mediating this enhanced behavioural response, as this could uncover pathophysiological processes underlying the expression of antipsychotic-evoked dopamine supersensitivity. Rats received 0.5 mg/kg/day haloperidol via osmotic minipump for 2 weeks, before treatment was discontinued. After cessation of antipsychotic treatment, rats showed a supersensitive psychomotor response to the D2 agonist quinpirole, but not to the D1 partial agonist SKF38393 or the dopamine reuptake blocker GBR12783. Furthermore, acute D1 receptor blockade (using SCH39166) decreased the exaggerated psychomotor response to d-amphetamine in haloperidol-pretreated rats, whereas acute D2 receptor blockade (using sulpiride) enhanced it. Thus, after discontinuation of antipsychotic treatment, D1- and D2-mediated transmission differentially modulate the expression of a supersensitive response to d-amphetamine. This supersensitive behavioural response was accompanied by enhanced GSK3β activity and suppressed ERK1/2 activity in the nucleus accumbens (but not caudate-putamen), suggesting increased mesolimbic D2 transmission. Finally, after discontinuing haloperidol treatment, neither increasing ventral midbrain dopamine impulse flow nor infusing d-amphetamine into the cerebral ventricles triggered the expression of already established dopamine supersensitivity, suggesting that peripheral effects are required. Thus, while dopamine receptor-mediated signalling regulates the expression of antipsychotic-evoked dopamine supersensitivity, a simple increase in central dopamine neurotransmission is insufficient to trigger this supersensitivity.

Keyphrases: Schizophrenia, Rat, D1 receptor, D2 receptor, Dopamine transporter, Mesocorticolimbic system
Jean Stanislas Mittié et la syphilis

Jean-Stanislas Mittié, un médecin de la région parisienne, développe et tente de faire approuver un remède végétal contre la syphilis entre 1777 et 1795. Le mémoire présenté ici propose une analyse des différents documents textuels qui entourent ses démarches afin de relever l’impact qu’aura la fin de l’Ancien Régime et la Révolution française sur sa pratique médicale. Son parcours permet de mettre en relief les transformations qui ont lieu dans les structures de pouvoir qui régissent la médecine au XVIIIe siècle, sur le plan institutionnel, politique, et culturel. Jean-Stanislas Mittié, a medical doctor from the Paris region, develops and attempts to gain approval for a vegetal cure to syphilis between 1777 and 1795. The present memoir proposes an analysis of the various textual documents surrounding his endeavours in order to assess the impact of the end of the Ancien Régime and the French Revolution on his medical practice. His individual story reveals the important transformations of institutional, political and cultural power structures regulating medicine at the end of the 18th century.

Keyphrases: Jean-Stanislas Mittié, Révolution française, médecine, syphilis, Jean-Stanislas Mittié, syphilis, French revolution, Medicine
Modèle épidémiologique compartimental à délai pour le virus de la dengue

La dengue est une infection virale qui touche de 100 à 400 millions d'individus chaque année. Selon l'OMS, « la dengue sévère est l’une des principales maladies graves et causes de décès dans certains pays d’Asie et d’Amérique latine ». Il est justifiable de modéliser la propagation de cette maladie dans une population à l'aide de modèles mathématiques compartimentaux. Les travaux de Forshey et al. sur la fièvre dengue semblent indiquer la possibilité qu'une infection à la dengue ne donne pas une immunité à long terme contre les différents sérotypes du virus, et qu'une réinfection homotypique à la dengue serait commune. Nous étudions un modèle SIRS de la dengue qui prend en compte cette perte d'immunité via un système d'équations différentielles à délai. Nous caractérisons les états stationnaires et leur stabilité en termes des différents paramètres considérés, notamment les taux de reproduction de base associés à chacun des sérotypes de la dengue. Nous étudions les bifurcations du système en ses principaux paramètres, notamment les bifurcations de Hopf émergeant de la présence d'un délai dans le système d'équations différentielles. Des simulations numériques du modèle sont présentées afin de représenter les différents régimes du modèle à l'étude. Dengue is a viral infection affecting from 100 to 400 million people each year. According to the WHO, "severe dengue is a leading cause of serious illness and death in some Asian and Latin American countries". This justifies the modelling of this illness's propagation in a population using mathematical compartmental models. Results of Forshey et al. on dengue fever seem to indicate the possibility that a dengue infection does not yield a long term immunity against the different dengue serotypes, and that an homotypical reinfection could be common. We study a SIRS model for the dengue virus that takes into account this loss of immunity via a system of delay differential equations. We characterize the stationary states and their stability in terms of the different parameters considered, in particular the basic reproduction ratios associated to each dengue serotype. We study the system's bifurcations in its main parameters, especially the Hopf bifurcations arising from the presence of a delay in the system of differential equations. Numerical simulations of the model are presented to represent the model's different regimes.

Keyphrases: modèles compartimentaux, épidémiologie, dengue, équations différentielles à délai, équations différentielles à retard, bifurcation de Hopf, dengue, compartmental models, epidemiology, delay differential equations, retarded differential equations, Hopf bifurcation
La rivalité entre les croyants d'Allah : l'Iran et l'Arabie saoudite

Cette recherche est de traiter la relation tendue et les interactions de différents niveaux entre l’Iran et l’Arabie saoudite. En effet, l’étude s’interroge sur les causes de cette liaison rigide depuis l’arrivée au pouvoir de Mollahs chiites en Iran en 1979, et les différentes perspectives de l’Islam mises en œuvre selon les deux États théocratiques. Ces deux puissances régionales et majeures dans le monde arabo-musulman essaient chacune à sa manière de propager son idéologie dans le monde islamique et même au-delà. Cependant, l’arrivée de Mohamed ben Salman en Arabie saoudite dont l’ascension politique, en tant que prince héritier, a mené à des offensives tous azimuts contre l’Iran, mais aussi contre certains alliés. In fine, dans les circonstances actuelles, il est difficile d’avoir une entente entre les deux pays. La confiance est absente et l’interprétation différente de la religion complique la relation entre l’Iran imamite et l’Arabie saoudite wahhabite. This research is to address the strained relationship and interactions of different levels between Iran and Saudi Arabia. Indeed, the study questions the causes of this rigid bond since the Shiite Mullahs came to power in Iran in 1979, and the different perspectives of Islam being implemented by the two theocratic states. These two regional and major powers in the Arab-Muslim world are each trying in their own way to propagate their ideology in the Islamic world and even beyond.   However, the arrival of Mohamed bin Salman in Saudi Arabia whose political rise as crown prince has led to all-out offensives against Iran, but also against certain allies. Ultimately, under the current circumstances, it is difficult to reach an understanding between the two countries. Confidence is lacking and the different interpretation of religion complicates the relationship between Imamate Iran and Wahhabi Saudi Arabia.

Keyphrases: Iran, Arabie saoudite, Wahhabisme, Wilaya el-Faquih, Conflit, Chiisme, Sunnisme, Iran, Khomeiny, Saudi Arabia, Khomeini, Wahhabism, Conflict, Shiism, Sunnism
Vingt ans après l'arrêt Harper: l'évolution constitutionnelle du plafonnement des dépenses électorales des tierces parties

Ce mémoire cherche à déterminer si la logique de la majorité de la Cour suprême dans l’arrêt Harper c. Canada (Procureur général) demeure valide aujourd’hui, près de deux décennies après que cet arrêt, qui avalise le régime de plafonnement des dépenses électorales des tierces parties, ait été rendu. À cette fin, le régime de plafonnement prévu par la Loi électorale du Canada est examiné en détail, de même que les motifs de la majorité. Ces préliminaires achevés, le cœur de l’analyse est entamé. Trois phénomènes sont étudiés pour déterminer si le raisonnement de la majorité dans Harper doit être remis ou non en question : l’avènement d’une dynamique de « campagne permanente », la monté des technologies de l’information et le déclin des partis politiques. Il est conclu que la logique déployée dans l’arrêt Harper demeure valide, mais qu’elle appelle certains changements à la Loi électorale actuelle. À cet effet, les plafonds préélectoraux des tiers devraient être éliminés et l’usage de sites internet personnels ou de compte de médias sociaux devrait être assujetti à un régime de plafonnement. This work seeks to determine whether the reasoning of the Supreme Court majority in Harper v. Canada (Attorney General), which validates third parties’ spending limits during the election period,still avails almost two decades after being rendered. The limits on third parties' spending as established by the Canada Election Act are examined in detail. The majority’s reasons are also discussed at length. Then, the core analysis begins. Three new social phenomena are examined to determine whether the Court’s reasoning in Harper should be called into question. These phenomena are: the advent of a “permanent campaign” in Canada, the rise of new information technologies and the decline of political parties. It is concluded that Harper’s logic remains highly compelling, though it may entail some modifications to the current electoral law, such as the abolition of pre-electoral spending limits and the application of some form of limitation to electoral spending regarding personal web sites and social media account.

Keyphrases: Dépenses électorales des tierces parties, Harper c. Canada (Procureur général), Liberté d’expression, Droits démocratiques, Campagne permanente, Communications électorales, Primauté des partis politiques, Third party election spending, Harper v. Canada (Attorney General), Freedom of speech, Democratic rights, Permanent campaign, Election communications, Primacy of Political parties
Training persons with early-stage Alzheimer’s disease how to use an electronic medication management device : development of an intervention protocol

Background/Objectives: Medication management is challenging for persons with Alzheimer’s disease (AD) and their caregivers. Electronic medication management devices (eMMDs) are specifically designed to support this task. However, theory-driven interventions for eMMD training with this population are rarely described. This study aimed to develop and assess the appropriateness of an intervention protocol to train persons with early-stage AD how to use an eMMD.  Methods: Interviews with three categories of participants [persons with early-stage AD (n = 3), caregivers (n = 3), and clinicians (n = 3)] were conducted to understand medication management needs, perceived usefulness of an eMMD, and to explore training strategies. Subsequently, this knowledge was integrated in an intervention protocol which was validated with the three clinicians. A content analysis led to iterative modifications to maximize the acceptability and coherence of the intervention protocol in a homecare context.  Results: The final intervention protocol specifies the expertise required to provide the training intervention and the target population, followed by an extensive presentation of eMMD features. Specific learning strategies tailored to the cognitive profile of persons with AD with step-by-step instructions for clinicians are included. Finally, it presents theoretical information on cognitive impairment in AD and how eMMDs can support them.  Conclusions: This intervention protocol with its theoretical and pragmatic foundation is an important starting point to enable persons with early-stage AD to become active users of eMMDs. Next steps should evaluate the immediate and long-term impacts of its implementation on medication management in the daily lives of persons with AD and their caregivers.

Keyphrases: Self care, Rehabilitation, Information technology, Medication therapy management, Alzheimer’s disease
Implementation of a sexuality interview guide in stroke rehabilitation : a feasibility study

Background: Although people who sustain a stroke can experience sexual difficulties, few address them during rehabilitation. Objectives: Explore the feasibility of implementing a Sexuality Interview Guide (SIG) in stroke rehabilitation and describe the factors perceived as influencing its implementation. Materials and Methods: Using a mixed research design, the SIG was implemented for four months in a rehabilitation hospital. The frequency with which clinicians addressed sexuality and their level of comfort pre-post implementation was measured. Perceived factors influencing implementation were determined through individual interviews and focus groups with five stroke clients, 15 clinicians and a coordinator. A paired-specimen Wilcoxon test was used to explore differences in pre- post-level of comfort. Qualitative data was analyzed by two independent evaluators using thematic analysis. Results: The SIG was used 28 times and clinicians' level of comfort in addressing sexuality improved significantly (p = 0.001). The factors perceived as influencing implementation were: the acceptability of the SIG, the individual characteristics, the context of the rehabilitation hospital and the implementation process. Conclusion: This study showed that the SIG can be used in stroke rehabilitation and that, with sufficient financial and human resources, and training for clinicians, it would be feasible to implement it in usual care.

Keyphrases: Sexuality, Stroke, Knowledge translation, Implementation, Mixed methods, Rehabilitation
A novel computerized assessment of manual spatial exploration in unilateral spatial neglect

Unilateral spatial neglect is a neuropsychological syndrome commonly observed after stroke and defined by the inability to attend or respond to contralesional stimuli. Typically, symptoms are assessed using clinical tests that rely upon visual/perceptual abilities. However, neglect may affect high-level representations controlling attention in other modalities as well. Here we developed a novel manual exploration test using a touch screen computer to quantify spatial search behaviour without visual input. Twelve chronic stroke patients with left neglect and 27 patients without neglect (based on clinical tests) completed our task. Four of the 12 “neglect” patients exhibited clear signs of neglect on our task as compared to “non-neglect” patients and healthy controls, and six other patients (from both groups) also demonstrated signs of neglect compared to healthy controls only. While some patients made asymmetrical responses on only one task, generally, patients with the strongest neglect performed poorly on multiple tasks. This suggests that representations associated with different modalities may be affected separately, but that severe forms of neglect are more likely related to damage in a common underlying representation. Our manual exploration task is easy to administer and can be added to standard neglect screenings to better measure symptom severity.

Keyphrases: Neglect, Manual, Stroke, Cancellation, Spatial attention
Analyse de l’évolution de situations de crise nécessitant le déploiement d’opérations FILET II à la Sûreté du Québec

Le présent rapport de stage vise les interventions policières en contexte de crise spécifiquement celles nécessitant le déploiement d’une opération FILET II à la Sûreté du Québec. L’intérêt de ce projet de recherche découle d’un besoin du milieu de stage d’obtenir de nouveaux résultats statistiques concernant l’évolution temporelle du phénomène depuis 1990. L’objectif général du projet se veut d’analyser le traitement des cas effectué depuis cette date et tout particulièrement, les proportions d’issues pacifiques obtenues d’une année à l’autre.  Il sera question d’analyser quelles manifestations de violence sont présentes et quels facteurs secondaires sont susceptibles d’influencer le déroulement des situations de crise et la résolution de celles-ci. L’ensemble des analyses ont tenu compte de la mise en place du modèle de négociation SINCRO en 2001 de même que l’application d’un tri des cas en 2013. Les données utilisées dans la présente étude réfèrent à 781 événements ayant eu lieu entre 1990 et 2019. Les analyses descriptives ont démontré que les fluctuations les plus importantes sont observées au niveau des manifestations de violence, des antécédents d’abus de substances et de l’intoxication lors de l’événement. Les analyses bivariées et multivariées de type autorégressives (AREG) ont quant à elles permis d’observer que les deux changements organisationnels n’ont pas eu d’effet direct sur les issues pacifiques des situations de crise. Le modèle SINCRO aurait cependant diminué globalement la violence auto-agressive des individus en détresse et surtout lors de cas impliquant des individus présentant des antécédents psychiatriques connus. Le tri appliqué aux cas pris en charge par l’appareil policier aurait quant à lui modifié les composantes des situations de crise traitées et se serait accompagné d’une hausse de violence envers les policiers prédite par les antécédents d’abus de drogues et l’intoxication aux stupéfiants.

Keyphrases: Situation de crise, Intervention policière, Trouble de santé mental, Négociation
Risk factors associated with driving after cannabis use among Canadian young adults

This study identifid the most prominent risk factors associated with driving after cannabis use (DACU). 1,126 Canadian drivers (17–35 years old) who have used cannabis in the past 12 months completed an online questionnaire about sociodemographic information, substance use habits, cannabis effect expectancies, driving behaviours and peers’ behaviours and attitudes concerning DACU. A hierarchical logistic regression allowed identifying variables that were associated with DACU. Income (CA$30,000–CA$69,000), weekly-to-daily cannabis use, higher level of cannabis-related problems, expectation that cannabis facilitates social interactions, drunk driving, belief that DACU is safe, general risky driving behaviours, having a few friends who had DACU and injunctive norms predicted past 12-month DACU. Older age, holding negative expectations concerning cannabis, driving aggressively and perceived accessibility of public transportation decreased the probability of DACU. With restricted resources, programmes will be more efficient by targeting Canadian young adults most inclined to DACU by focussing on these risk factors.

Keyphrases: Cannabis, Driving under the influence, Automobile driving, Risk factors, Risk-taking, Canada