NCube/papyrus huggingface dataset:
The Implementation of an Organizational Committee for Patient Engagement in the Context of Mental Health : A Case Study

Objective: There is a need for structure for patient engagement to function within mental healthcare organizations. Despite this, little is known about how to implement these kinds of structures, and even less on a strategic level. The aim is to study the implementation of a strategic organizational committee for patient engagement through its initiation and operationalization process, the factors that are facilitating or limiting the implementation, and the perceived consequences within the organization. Method: A qualitative approach has been used in this study. A single case study has been carried out with semi-structured interviews, focus groups and organizational documents as data sources. The participants were different actors (service users, managers on different levels, researchers, clinician, members of top management and user’s committee) taking part in the patient engagement. Results: The initiation process included a need for formalization, and the introduction of a vision of full citizenship, while the operationalization process contained the composition and role of the committee, the elaboration of a frame for the participation, and its ongoing application including evaluation. Several facilitating factors were identified, including top management support, leadership, and a vision behind the participation. The limiting ones mainly concerned resistance towards the participation and the existence of stigma. The consequences included increased and improved patient engagement, and reduced stigma within the organization. Conclusion: This study illustrates the process of implementation of a strategic organizational committee for patient engagement including multiple elements, actors, and influencing factors. It highlights the importance of leadership by many actors and a vision behind the participation, to successfully frame the patient engagement.

Keyphrases: Structure, Patient engagement, Patient partner, Mental health, Implementation, Committee
A mixed method review and quality criteria analysis : towards improving decision aids and informing care models in prenatal testing

Introduction: The clinical prognostic uncertainties and moral dilemmas associated with technological advances of prenatal testing impact the experiences and decision-making of women and couples. While the validity of the norms of ‘autonomous consent’ and ‘non-directive’ counseling is being questioned, decision aids are promoted to enhance informed decision-making. The goals of this thesis are to develop a model of the experiences of women and couples in prenatal testing so as to identify factors that may improve experiences, decision-making, the role of decision aids and inform the care model. Methods: A model of the experiences of prenatal testing is developed through a meta-ethnography of qualitative studies and a narrative synthesis of the themes explored in quantitative studies. A prenatal testing (PT) decision tool is critically assessed using the International Patient Decision Aids Standards (IPDAS) quality criteria for decision aids. Results: A conceptual framework of the experiences of women and couples in prenatal diagnosis is constructed and complemented by a narrative thematic analysis showing that decision-making is rarely informed and that the norms of an ‘autonomous decision’ and a ‘non-directive’ counselling are problematic for women. Decision aids improve knowledge scores, but do no modify risk perception or anxiety levels. A PT tool increases preference based informed decision-making, but quality criteria are not always applicable and their role in quality decision-making is unclear. Discussion and conclusion: The results highlight macro, meso and micro-level factors that may improve the experiences of women and couples and inform decision-making processes as well as the use of decision aids. A paradigm shift towards the concept of relational autonomy in the prenatal diagnosis model of care is suggested. Advances in prenatal testing require a re-evaluation of the norms of practice and care model. The role of decision aids requires further elucidation.

Keyphrases: Prenatal testing, Meta-ethnography, Informed decision making, Decision aids, Relational autonomy
Les modèles de dotation en soins infirmiers dans un contexte de soins aigus

The Quebec health care system faces great challenges when it comes to nurse staffing. Having to provide for a growing demand in services while dealing with a decreasing qualified labor force generates a lower quality and less secure standard of care. This creates extensive costs for health organizations. Staffing is considered a corner stone of human resources management but there is no clear and established practice that ensures optimal, realistic and efficient nurse staffing. Many studies have examined staffing from only a single perspective which has resulted in the overlooking of other important staffing considerations and a narrow vision of nurse staffing. The aim of this study was to identify the staffing models used in hospital acute care units in one of the biggest regions in Quebec while concurrently considering the three dimensions of nurse staffing: resource levels, staff mix and team stability. According to a descriptive quantitative design, the necessary variables for staffing operationalization were collected directly from the human resources departments of the four hospital centers for a total of 40 units of care which were studied for the target period between Janurary 11, 2016 and March 7, 2016. Staffing models were identified with a multiple factorial analysis and a hierarchical ascendant classification, used to generate a limited number of nurse staffing models. based on the configurational approach. This study’s results are a description of nurse staffing characteristics in the short-term hospitalization care units. Four different nurse staffing models emerged from the studied hospital centers: the least resourced model, the moderately resourced basic model, the moderately resourced professional model and the most resourced model. This representation of staffing models introduces new data for nursing workforce planning. The results provide human resources managers with data to compare to their staffing model or to other identified models and to other care units associated models in the studied sample. Moreover, because this study leads to a picture of the actual staffing situation it provides valuable information to optimize nurse staffing planning. Prior to this study, there were to our knowledge no staffing model classifications that considered all staffing dimensions simultaneously.

Keyphrases: Administration, Staffing, Nursing, Acute care, Models, Management
Perceptions de professionnels envers l’introduction de l’approche palliative chez les personnes vivant avec la sclérose en plaques à domicile

The diagnosis of multiple sclerosis (MS) has important implications for people affected by its incurable and degenerative nature. MS, resulting in significant functional losses, often requires the involvement of professionals from local community service centres. In recent years, the palliative approach has been described for professionals in their end-of-life support. However, no identified literature links MS to the community-based palliative approach. This qualitative descriptive study has been designed to describe the perceptions of professionals working at home with regard to the introduction of palliative approach in the care trajectory of people living with advanced MS. Based on the nursing model for chronic disease management based upon the trajectory framework of Corbin and Strauss's (1991), focus groups and individual interviews were conducted with occupational therapists, nurses and social workers. The method of analysis by analytical questioning of Paillé and Mucchielli (2012) was used for data analysis. In summary, the data analysis has allowed us to describe the professionals' views of introducing a palliative approach into their care of people with MS as 1) being supportive, 2) opening the discussion with the person and his family about their needs and their desires at the end of life and 3) adapting professional interventions to people and families’ needs and objectives. However, professionals had several difficulties introducing these elements, considering the characteristics of the disease, the absence of prognosis and the risk of loosing hope. They described a duality in which they consider it mandatory to introduce the palliative approach, but do not feel comfortable integrating it systematically into the delivery of their care. Recommendations for nursing management, practice, education and research were issued as a result of this study.

Keyphrases: Palliative approach, Multiple sclerosis, Home-based professionals, Home-based care
Mesure et validation d'indicateurs de performance des services infirmiers en première ligne : utilisation d'un cas traceur en soins de plaies

Better use of nursing resources is a promising avenue for improving the performance of primary care services. Measuring the performance of nursing services is a central component in improving their organization and the quality of care delivered in this sector. The aim of this study was to measure and validate primary care nursing performance indicators from a tracer case in wound care and to assess the reliability of clinical-administrative data used to measure indicators from clinical records. This study adopted a correlational longitudinal design. Data were collected over a one-year period in a Local community services centre (CLSC) using clinical-administrative data contained in the I-CLSC electronic database. The episode of care was the unit of analysis. Eight indicators were measured, including five process indicators: 1) nursing follow-up; 2) relational continuity; 3) teaching; 4) initial assessment; and 5) consultation with a specialized nurse, and three outcome indicators: 1) frequency; 2) duration; and 3) intensity. Measurement and validation objectives were performed using a sample of 482 episodes of wound care lasting more than seven days. The reliability study was based on a sub-sample of 107 episodes. Descriptive and correlational analyzes were performed. Validation results demonstrated very strong associations between nursing follow-up and continuity indicators and the three outcome indicators. Reliability results demonstrated a high concordance between clinical records and clinical-administrative data for six of the eight indicators. In conclusion, valid and relevant process indicators in primary care nursing can be measured on a regular basis by managers using reliable and easily accessible clinical-administrative data.

Keyphrases: performance measurement, nursing services, process indicator, outcome indicator, primary care, clinical-administrative data, wound care, quality of care
Regulation and impact of adaptor protein SQSTM1/p62 in the replication cycle of Respiratory Syncytial Virus in Airway Epithelial Cells

Introduction: Human respiratory syncytial virus (RSV) causes a high rate of morbidity and mortality worldwide in children, immunocompromised and elderly people. There is an urgent need for effective antiviral treatments and vaccines for RSV. Airway epithelial cells (AECs) are the primary target of RSV and constitute the first line of defense through distinct mechanisms, including intrinsic antiviral responses. The p62/SQSTM1 protein has multiple cellular functions including cell signaling and sequestration of specific ubiquitinated cargo (i.e. proteins/organelles and intracellular bacteria) for autophagic degradation. The replication of several viruses has been shown to be sensitive to p62 levels. The goal of our study is to investigate the role of p62 in the regulation of RSV replication. Methods and Results: Analysis of p62 expression in A549 cells showed that p62 is induced and phosphorylated during early stages of RSV infection, followed by degradation at later times. P62 silencing diminished the intracellular accumulation of viral proteins, while causing increased release of infectious virions. Additionally, we observed that the stable expression of Microtubule-associated protein 1A/1B-light chain 3 (LC3), which recruits p62 and its cargos to the autophagosome for autophagy degradation, reduces recRSV-GFP replication. Studies are currently undertaken to determine the molecular mechanisms involved in p62-dependent regulation of RSV replication. Conclusion: Our results highlight a key role of p62 in the replication of RSV. These studies will help to define whether p62 might represent a potential therapeutic target to fight RSV infection.

Keyphrases: p62/SQSTM1, Respiratory syncytial virus, RSV, Airway epithelial cells, Antiviral response, UPS, Autophagy, Viral replication
L'implantation valvulaire aortique par cathéter : évolution des résultats cliniques suite aux avancées technologiques et techniques

Context: Transcatheter aortic valve implantation (TAVI) is a relatively young procedure intended to treat patients with severe aortic stenosis who are at high risk for conventional surgery, or inoperable. This procedure underwent multiple technological improvements (successive generations of devices) and multiple technical improvements (simplification of various steps in the procedure).  Objective: We intend to describe the clinical impact of a technological improvement (the transition from the second to the third generation of the Edwards device in a high-volume center) and that of a technical improvement (TAVI without pre-dilatation, known as direct TAVI). Methods: We first describe, through a meta-analysis, the state of TAVI at the beginning of its widespread use, in 2012. Next, we describe, through a single-center retrospective study, the clinical impact of the transition from the second to the third generation of the Edwards device in 507 patients. Finally, in a retrospective study with matching, we tested three pre-dilatation strategies: systematic pre-dilatation, selective pre-dilatation, and direct TAVI. Results: In the article describing the initial TAVI experience, the 30-day mortality rate was between 5 and 18%. One-year mortality was estimated at 23% by meta-analysis (random effects model). Stroke rate at 30 days was between 0 and 6.7% and major vascular complication rate was between 2 and 16%. The transition from SAPIEN XT to SAPIEN 3 resulted in a non-significant reduction in 30-day mortality (from 8.7 to 3.5%; p=0.21) and 30-day stroke rate (from 2.8 to 1.4%; p=0.6), and a significant reduction in major vascular complications (from 9.9 to 2.8%; p<0.0001). However, there was a significant increase in permanent pacemaker rate (from 9.8 to 17.3%; p=0.03). Next, we found no adverse effect of performing direct TAVI in terms of mortality or vascular complications at 30 days. We found a trend towards a reduction in stroke rate with direct TAVI (3 vs. 1%; p=0.11), particularly in patients with mildly or moderately calcified valves. However, in those with extensive valvular calcification, the risk of device malposition was numerically higher. In all three studies presented, there was little variation in 1-year mortality (20 to 25%).  Conclusions: Short-term adverse events were reduced by the transition towards the third-generation Edwards device. Direct TAVI is feasible and safe. However, both of these improvements have limitations and should be considered carefully.

Keyphrases: TAVI, Edwards SAPIEN XT, Edwards SAPIEN 3, Transcatheter aortic valve implantation, Aortic valvuloplasty, Technological improvement, Technical improvement
L’influence d’une surface nanoporeuse de titane sur l’activité de cellules ostéoblastiques

To improve the performance and integration of biomaterials in the host tissue, the focus is presently on exploiting nanotechnology approaches to produce biomaterials with bioactive surfaces. It is known that the cell-biomaterial interactions determine the response of the host tissue and therefore the success of implants. Topography is a key factor that influences the functional activity of cells; however, the mechanisms implicated remain unclear. Our group has exploited a simple chemical treatment to create unique nanoporous titanium surfaces that selectively influence cell behaviour and favor osteogenic activity both in vitro and in vivo. In this work, we have reduced treatment time in order to obtain a monoplanar nanostructured surface, and we have evaluated its influence on the formation of focal adhesions, filopodia, and on gene expression for different cell adhesion and signaling proteins by MC3T3-E1 pre-osteoblastic cells. Commercially pure titanium (cp-Ti) was treated with a mixture of H2SO4/H2O2 (50/50 v/v) for 1.5h. Characterization by high-resolution field-emission scanning electron microscopy and atomic force microscopy characterization showed the formation of a nanoporous surface with a mean pore diameter of 20 ± 5 nm. Cells were cultured and plated on polished (control) and nanotextured discs for periods of 6, 24 and 72 hours. Immunofluorescence analysis of vinculin expression revealed the formation of more focal adhesions by cells seeded on nanostructured surfaces. Quantitative PCR likewise showed significant increase of gene expression for various focal adhesion markers, including paxillin, talin, and different integrins such as integrin α1, β1 and α5. As compared to controls, scanning electron microscopy of cells on the treated surface revealed the presence of more filopodia. These uniquely displayed very small lateral membrane protrusions between 10-15 nm that appeared to follow the walls of the nanopores. Together with the increase in focal adhesions, the abundance of filopodia and associated protrusions could contribute to the adhesive interaction with the surface and modify the nanoscale biomechanical relationships to trigger cellular cascades regulating cell proliferation.

Keyphrases: Nanotopography, Filopodia, Focal adhesions, Gene expression
La procédure de Ross : propriétés biomécaniques de l'artère pulmonaire en fonction du phénotype valvulaire aortique

The Ross procedure: biomechanical properties of the pulmonary artery according to aortic valve phenotype  Pierre Olivier Dionne, Evan Wener, Alexander Emmott, Raymond Cartier, Rosaire Mongrain, Richard Leask and Ismail El-Hamamsy OBJECTIVES: The aim of this study is to determine whether patients undergoing the Ross procedure with bicuspid aortic valves have different pulmonary artery biomechanical properties from those with tricuspid valves.  METHODS: Thirty-two pulmonary arteries and 20 aortas were obtained from patients undergoing the Ross procedure at the time of surgery, from a cohort of 32 patients. Histological analysis and ex vivo equi-biaxial tensile testing completed within 8 hours of surgery were used to evaluate differences in patient groups and between the pulmonary artery and the ascending aorta.  RESULTS: There was no difference in thickness among pulmonary arteries when compared according to aortic valve phenotype (P = 0.94). There was no difference in the tensile tissue properties among aortas and pulmonary arteries when compared according to aortic valve phenotype, in either the circumferential or longitudinal axis. When compared according to the main surgical indication, pulmonary artery walls from patients with pure aortic regurgitation were less stiff than their counterparts (P = 0.002). There was no difference in the number of elastic lamellae in pulmonary artery specimens from the three different aortic valve phenotypes (Tricuspid, bicuspid or unicuspid), as well as in the aortic specimens.  CONCLUSION: No significant differences were observed in the biomechanical properties of pulmonary arteries when compared according to aortic valve phenotype.

Keyphrases: Dilatation, Ross procedure, Pulmonary artery, Biomechanics
Role of Histone H3 Lysine 56 Acetylation in the Response to Replicative stress

In Saccharomyces cerevisiae, histone H3 lysine 56 acetylation (H3K56ac) occurs on all newly synthesized histones H3 that are deposited behind DNA replication forks. H3K56ac plays critical role in chromatin assembly during DNA replication and repair. H3K56ac is also required for genome stability and stabilization of stalled replication fork. Cells lacking H3K56ac are sensitive to methyl methane sulfonate and other drugs that cause replicative stress.  In this thesis, we investigated the links between the replisome protein Ctf4 and the H3K56 acetyltransferase Rtt109. Deletion of CTF4 partially rescued the sensitivity of rtt109Δ cells to methyl methane sulfonate. Genetic analyses also showed that Ctf4, Rtt109, and the Rtt101-Mms1-Mms22 complex act in the same pathway to response to replicative stress. ctf4Δ and rtt109Δ cells displayed intense foci of the single-stranded DNA binding complex RPA during replicative stress, suggesting formation of excess single-stranded DNA regions at stalled replication forks, leading to hyper activation of DNA damage checkpoints. These mutants accumulated anaphase bridges and persistent foci of the homologous recombination proteins Rad51 and Rad52 in response to genotoxins, suggesting that abnormal DNA structure formed at stalled replisome may compromise their recovery. Deletion of HR genes (RAD51, RAD52, RAD54, RAD55 and MUS81) together with ctf4Δ and rtt109Δ presents synergistic sensitivity to MMS, suggesting that H3K56ac deficient cells use HR to repair the damages caused by replicative stress. Overall our results demonstrate that H3K56ac deficient cells cannot recover MMS- induced damages because HR is compromised in these mutants.

Keyphrases: Ctf4, Rtt109, MMS, Histone H3 Lysine 56 acetylation, Chromatin structure, Post-translational histone modifications, DNA replication, DNA replication coupled chromatin assembly, DNA damage response pathway, Homologous recombination
Financement de l’arbitrage par un tiers : émergence d’une lex mercatoria expliquée par la mondialisation

Third party funding is not a new topic. At the beginning, it was felt as a vicious way to provide a funder an abusive interest. This is the reason why it was first condemned and rejected. Although this might be true, the perception has changed. It is now approved and frequently used in international trade. The Funder is, de facto, considered as the help that gives access to arbitration regardless the financial abilities of the opponents in international commercial litigation. Regulating third party funding is concretely under the responsibilities of the funder and the funded parts. Each State has its own intervention style even though common ground can be noticed. The real difficulty is that in arbitration, thirdparty funding cannot be regulated exclusively by national nor international conventional rules. At this point, lex mercatoria appears to be an alternative manner to establish a homogeneous model. As an international regime, lex mercatoria is the most relevant regulation that leads to this practical normalization. According to regime theory, lex mercatoria and international regime reveal exactly the same structure. As far as lex mercatoria is concerned, it shapes an international regime composed by a set of implicit or explicit regulations (principles, norms, rules and decisionmaking procedures). Around those regulations, all international actors involved in international commercial arbitration contribute to the development of a general and nonstate guideline that frames the practice of third-party funding. All things considered, the rise of lex mercatoria is obvious in the field of third-party funding. Globalization process is well able to explain this appearance of an international regime of lex mercatoria since multilateral cooperation emerges to standardize third-party funding in international commercial arbitration.

Keyphrases: lex mercatoria, International commercial arbitration, third party funding, lex mercatoria, globalization, international regime