NCube/papyrus huggingface dataset:
Prédiction de la capacité de marche à un an lors de la phase aiguë du traumatisme chez les patients blessés médullaires traumatiques

Traumatic spinal cord injury (TSCI) has important neurological consequences including impaired walking ability. Predicting early the ability to walk again after the trauma has inspired the development of multiple clinical prediction rules. Simple and accurate, they do predict walking on short indoor distances but do not consider the quality of walking. Moreover, the usefulness and added value of these rules have never been evaluated and compared to the unstructured clinical judgment of the physicians for whom they are intended.  The objective of this thesis was to identify elements of the acute INSCSCI (International Standards for Neurological Classification of Spinal Cord Injury) standardized evaluation that would allow the development of a clinical prediction rule for outdoor independent community walking one year after a TSCI, ensuring good internal and external validity as well as clinical usefulness when compared to clinical judgment. The strength of the strongest lower limb and preserved light touch sensation are the best predictors of independent walking. A clinical prediction rule was developed to meet the objective: this rule is relevant; generalizable; simple; takes into consideration the quality of walking; and is focused on community living, social participation and quality of life.  The performance of a clinical prediction rule for indoor walking is statistically similar to that of clinicians using their unstructured judgment, but can vary depending on different factors.  This research recommends the use of clinical prediction rules as a decision aid in patients who have undergone a TSCI, including the one developed for independent functional community walking.

Keyphrases: spinal cord, spinal cord injury, trauma, functional recovery, clinical prediction rule, walking
Évaluation des complications en chirurgie cardiaque : vers une évaluation globale des procédures chirurgicales

This memoir addresses the challenge of outcome reporting in cardiac surgery. Postoperative complications are of varying etiology and severity, can affect several physiological systems and require different degrees of treatment. They are an important source of morbidity for the patient but are not always optimally presented in clinical trials.  Indeed, complications are currently reported in studies in a heterogeneous manner, which hampers research by complicating study comparisons, systematic reviews and meta-analyses. Many individual complications have classification systems that are used sporadically in some articles in cardiac surgery, but these are not widely used. On the other hand, universal classifications that apply to all potential complications have been adopted in the surgical literature, but none have been implemented in cardiac surgery yet.   The study conducted as part of this work adapted and applied the Clavien-Dindo Complications Classification (CDCC) and the Comprehensive Complication Index (CCI) for the first time in cardiac surgery. My study shows that the important comorbidities in cardiac surgery and more complex surgeries are predictive of the severity of complications according to both scales. Moreover, the CCD and CCI also correlate with the lengths of stay in the intensive care unit and hospital after cardiac surgery.   In conclusion, the CDCC and CCI reliably represent the complexity of the postoperative evolution in cardiac surgery. This could address the inconsistency with which complications are currently presented in surgical trials and standardize the way adverse outcomes are reported in cardiac surgery. This would have multiple applications in quality of care improvement initiatives, in evaluations of procedures and processes, and in advancement of research.

Keyphrases: Comprehensive Complication Index, Morbidity, Postoperative complications, Outcome reporting, Cardiac surgery, Coronary artery bypass graft surgery, Cardiac valve replacement, Clavien-Dindo Complications Classification
Développement et validation de contenu d’un programme de rééducation du membre supérieur post AVC en ergothérapie

Background. Task-Oriented Training (TOT) is the recommended approach for upper extremity rehabilitation after a stroke. To date, no program have operationalized all the key components of TOT into a valid upper extremity clinical rehabilitation process post stroke in occupational therapy. Objectives. 1) To determine the content validity of an upper extremity rehabilitation program post stroke in occupational therapy and 2) to propose a logic model reaching consensus among experts and patients. Methods. A logic model of an upper extremity rehabilitation program post stroke in occupational therapy was developed and validated. Two research methods were used to validate the content and to achieve a consensus of experts and patients : 1) Delphi method : 14 experts examined audiovisual capsules of the intervention and completed two questionnaires to validate the objectives, the nature of the intervention, the resources, the activities and the outputs; 2) Nominal group technique : six patients with experience of the intervention generated the outcomes. The content validity index, two interrater agreement statistics and a content analysis were used for data analysis. Results. Almost 93 % of the content of the upper extremity rehabilitation program post stroke in occupational therapy obtained a satisfactory validity index, including 82 % reaching consensus among experts and patients in a revised logic model. Conclusion. The revised logic model now offers a common, albeit incomplete, vision of an upper extremity rehabilitation program post stroke based on the TOT in occupational therapy. Activities and outputs of the evaluation should be validated during a subsequent implementation phase. Knowledge translation on the modalities to promote self-efficacy is also to be planned to reassess its role in the intervention program.

Keyphrases: Intervention program, Logic model, Stroke, Upper extremity rehabilitation, Task-Oriented Training, Occupational therapy
Importance du sommeil chez des patients orthopédiques avec fracture, une revue de la littérature

Sleep disturbances are highly relevant in the orthopedic field, as they can increase the risks of falls, decrease bone density, and lead to poor fracture and health outcomes in patients with fractures. It is estimated that between 20% to 40% of patients presenting one fracture will report difficulty to sleep 3 months following trauma. However, the impact of sleep in the acute phase following fracture is less studied. Therefore, this present thesis aimed to propose a clinical research project evaluating the impact of sleep on the recuperation of patients in the acute phase following fracture. To this end, we will use an actigraphy watch over a 14-day period following fracture to collect various sleep parameters, in combination with questionnaires on sleep quality, pain intensity and function of the fractured limb. A longitudinal follow-up (>3 months) will allow evaluating if sleep difficulties persist over time, using aforementioned questionnaires. The second part of this thesis presents a detailed narrative review of the literature describing the impact of sleep disturbances on falls, motor vehicle accidents and fractures in addition to their impact on fracture outcomes and the underlying physiopathological mechanisms. We observed that not only optimal sleep quality is essential in prevention of motor vehicule accident, but is also a key element to recovery after an orthopedic trauma. Futur research will allow a better understanding of sleep and bone relation.

Keyphrases: orthopedic trauma, sleep-wake, injuries, circadian clock, osteoporosis, treatment, chronic pain
L'effet de l'âge gestationnel sur l'incidence, l'étiologie, le traitement et le pronostic de la cholestase néonatale

Background and Aims: Cholestasis is a frequent neonatal disease that has a wide range of etiologies. Appropriate diagnosis is essential to clinical management, treatment choices and improvement of outcomes. Most references discuss neonatal cholestasis as one entity. The goal of this study was to determine if the clinical profile, management and outcome of cholestasis differ according to gestational age (GA). Methods: Medical records of infants with cholestasis in the division of neonatology at CHU Sainte Justine, between January 2014 and December 2017, were retrospectively reviewed. Cholestasis was defined as two or more consecutive conjugated bilirubin values ≥ 34μmol/L. The cohort was stratified into two groups: extremely to very preterm (< 32 weeks GA) and moderate to late preterm and term (≥ 32 weeks GA). Results: 125 of 3,277 patients developed cholestasis. Overall incidence of cholestasis was 4%. Incidence was 5 times higher in neonates < 32 weeks GA compared to neonates ≥ 32 weeks GA. Cholestasis was associated with parenteral nutrition in 91% of patients with GA < 32 weeks and 40% of patients with GA ≥ 32 weeks (p < 0.01). While ursodiol treatment was prescribed more to cholestatic neonates ≥ 32 weeks GA, fish oil lipid was administered more to neonates < 32 weeks GA, among patients receiving parenteral nutrition. Conclusions: Neonatal cholestasis was associated with two different clinical profiles based on GA. We recommend diagnostic tests and clinical management of neonatal cholestasis be adapted to GA. A GA-based approach to the evaluation of an infant with conjugated hyperbilirubinemia is proposed.

Keyphrases: Gestational age, Lipid emulsions, Neonatal cholestasis, Parenteral nutrition, Prematurity, Ursodeoxycholic acid
Évaluation de l’implantation d’un guide de bonnes pratiques pour la gestion des allergies alimentaires en phase pilote en milieu scolaire primaire à Montréal

Context: A food allergy is an excessive reaction of the immune system in the presence of a certain food or food additive. Among school-aged children, its prevalence varies between 1 and 10%. Knowing it is impossible to guaranty that a school is allergen-free and that very diversified allergy management practices are currently in place, a Best practice guide for the management of food allergy in Montreal primary schools has been developed. Objectives: The general objective was to evaluate the implementation of the Guide based on the providers’ experience involved in the pilot phase. The implementation context, facilitators and limits, reasons of non-implementation, adaptations, level of implementation, and providers’ participation and satisfaction were also documented. Methodology: The data was collected in 10 primary schools among 3 Montreal school boards following a mixed research method: qualitative methods were used with semi-directed interviews and observations, as well as quantitative methods with self-administered questionnaires. Results: Even though the Guide was not entirely implemented in participating schools, some improvement was noted. For example, a better awareness regarding food allergies among the school staff and the addition of new preventive measures were noticed. Also, because of the pilot-project, food allergy management is no longer associated with banning nuts and peanuts anymore, but with the importance of prevention in a more global way. Conclusion: The collected data will allow the improvement of the Guide in order to spread the best practice in food allergy management among all Montreal primary schools. We can also reasonably hope for its adoption at the provincial level.

Keyphrases: anaphylaxie, food allergies, anaphylaxis, primary schools, children, pilot-project
La stéatose hépatique et ses effets sur la régulation du métabolisme du cholestérol 
chez le rat

Background: The present study was designed to test the hypothesis that excessive fat accumulations impair cholesterol metabolism mainly through alterations in the LDL-receptor (LDL-R) pathway in liver. Method: Rats were either submitted to standard (SD), high fat (HFD; 60% kcal) or western (WD; 40% fat + 35% sucrose (17.5% fructose)) diets for 2 or 6 weeks. Results: Weight gain (~ 40g) was observed only following 6 weeks of the obesogenic diets (P < 0.01). Compared to the 2-week treatment, obesogenic diets tripled fat pad weight (~ 20 vs 7 g) after 6 weeks. Hepatic triglyceride (TG) levels were greater in response to both the WD and HFD compared to the SD (P < 0.01) at 2 and 6 weeks and their concentrations were greater (P < 0.05) in WD than HFD at 2 weeks. Plasma cholesterol levels were higher (P < 0.05) in animals submitted to WD compare to SD and HFD. After 2 and 6 weeks, liver expression of LDL-R, PCSK9 and SREBP2, involved in LDL-cholesterol uptake, was lower in animals submitted to WD than in others treated with HFD or SD (P < 0.01). Similarly, LRP1 and ACAT2 mRNA levels were lower (P < 0.01) among WD compared to SD-fed rats. Expression of the gene coding the main regulator of endogenous cholesterol synthesis, HMGCoAR was reduced in response to WD compared to SD and HFD at 2 (P < 0.001) and 6 (P < 0.05) weeks. Being enriched in fructose, the WD strongly promoted the expression of ChREBP and ACC, two key regulators of de novo lipogenesis. Conclusion: These results show that the WD promptly increased TG levels in the liver by potentiating dietary fat storage and de novo lipogenesis. This effect impaired hepatic cholesterol uptake via the LDL-R axis and promoted a rapid increase in plasma cholesterol levels.

Keyphrases: LDL-R, PCSK9, fructose diet, liver cholesterol metabolism
Évaluation de la surface frontale comme élément d’amélioration de l’aérodynamisme en cyclisme

Introduction : In the cycling world, aerodynamic resistance is the principal force that oppose a moving cyclist and is most important at 10 m/s. Drag area (CDAP) is an important factor of this force and depends of the frontal area (AP). This project wants to evaluate the reliability and the validity of an accessible method of measurements of the frontal area (AP). Method : 14 cyclists were selected : 31  14 years; 177,21  6,73 cm; 74,83  8, 97 kg and divided in two groupes, amateurs et experts. The digital method is used for the evaluation of Ap and a linear regression is used with MATLAB_R2019 for finding CDAP. Résults : the obtained frontal area AP = P1, 0,433  0,05  m2; P2, 0,413  0,04 m2; P3, 0,387  0,05 m2 with an ICC intra-operator; 0,998, and an ICC inter-operator; 0,523 (p < 0,05). Pour CDAP = P1, 0,414  0,07 m2; P2, 0,435  0,14 m2; P3, 0,399  0,12  m2 with a correlation variation of R = 0,10 à 0, 34. Conclusion : Measuring Ap with a simple method is reliable and present good validity, but the precision will vary with the expertise of the operator. The weak correlation between AP and CDAP show that AP shouldn’t be the only variable that we have to rely to reduce CDAP. In the end, the evaluation of frontal area with a simple digital method could increase aerodynamic performance in cyclist. Although, further research on optimising aerodynamic evaluation tools would allow to obtain results that are more precise.

Keyphrases: performance, sports, Cycling, aerodynamic, frontal area
Les conséquences des commotions cérébrales sur le contrôle de la fréquence cardiaque par le système nerveux autonome durant une tâche cognitive

Most studies have focused on the consequences of concussions on the brain itself. However, the brain performs many functions, including regulating heart rate. Therefore, researchers have begun studying the consequences of these concussions on the brain’s heart rate regulation during physical exertion. Most athletes who sustain a concussion need to plan for their return to play as well as a return to work or school. The purpose of this research project was to study the consequences of concussions on the brain’s regulation of heart rate during cognitive effort. This study involved 11 university athletes who sustained a concussion, as well as 14 athletes with no history of concussion. Concussed athletes were assessed an average of 14.6 days (± 7.4 days) after their injury. The participants’ heart rate was recorded at rest and during cognitive effort, which consisted of a switch task. Short segments lasting two minutes at rest and during cognitive task were analyzed. The results show a significant increase in the approximate entropy in the control group during the cognitive task (ρ <0.05), while no difference was observed between the approximate entropy at rest and during the cognitive task in the concussed athletes. These results suggest that neurological deficits related to heart rate regulation may be observed during cognitive task in athletes who recently sustained a concussion.

Keyphrases: cognition, concussion, mild traumatic brain injury, heart rate variability, autonomic nervous system, executive functions, switch task
Classification moléculaire des Tumeurs de Wilms par analyse RNA-Seq

Wilms' tumor (TW) is a kidney cancer found mainly in children aged from 2 to 4 years old. It represents 90% of pediatric kidney cancers. The TW survival rate is over 90%. The latter is made possible by stratifying patients according to the risk of relapse. TW are classified into different risk groups according to stage, histology, tumor size and more recently the loss of heterozygosity at loci 1p and 16q. Two regions are important in the genetics of WT, WT1 and WT2. WT1 is a gene that encodes an important transcription factor in different phases of renal development. WT1 abnormalities are found in some human syndromes such as WAGR and Denys-Drash which are associated with the emergence of TW. WT2 is a locus present in the chromosomal region 11p15 where a loss of heterozygosity leads to a uniparental disomy. This leads to an increased risk of WT due to an overexpression of IGF2 which is linked to the proliferation of organs and members. Despite this genetic portrait, there are no molecular subgroups which allow classification of TW as observed in other childhood cancers, including leukemia. We propose to determine a stratification of WT using a molecular signature based on expression profiles in their proper risk group. To test this hypothesis, we analyzed the transcriptome of a cohort of 130 WT patients. The hierarchical clustering of the of the sample’s expressions profiles identified two potential WT subgroups. One of these subgroups can be described by a lower expression of WT1 and overexpression of genes for early muscle development in children and show a higher risk of relapse. These results show that clustering tools based on a molecular signature could allow treatment adjustment (i.e. precision medicine) and thus increase the survival rate.

Keyphrases: Classification, Wilm’s tumor, Pediatric cancer, Kidney, Classification
Modelling causality in law = Modélisation de la causalité en droit

The machine learning community’s interest in causality has significantly increased in recent years. This trend has not yet been made popular in AI & Law. It should be because the current associative ML approach reveals certain limitations that causal analysis may overcome. This research paper aims to discover whether formal causal frameworks can be used in AI & Law. We proceed with a brief account of scholarship on reasoning and causality in science and in law. Traditionally, normative frameworks for reasoning have been logic and rationality, but the dual theory has shown that human decision-making depends on many factors that defy rationality. As such, statistics and probability were called for to improve the prediction of decisional outcomes. In law, causal frameworks have been defined by landmark decisions but most of the AI & Law models today do not involve causal analysis. We provide a brief summary of these models and then attempt to apply Judea Pearl’s structural language and the Halpern-Pearl definitions of actual causality to model a few Canadian legal decisions that involve causality. Results suggest that it is not only possible to use formal causal models to describe legal decisions, but also useful because a uniform schema eliminates ambiguity. Also, causal frameworks are helpful in promoting accountability and minimizing biases.

Keyphrases: Causality, Reasoning, Law, Structural Causal Model, Actual Causality, DAG, SCM, ML, AI, AI & Law
Vers une théorie des fins de non-recevoir en droit privé québécois

The fin de non-recevoir (bar to an action) is a legal concept that results in the total and definitive paralysis of an otherwise available right of action. Despite its devastating effects and growing popularity, nearly forty years after its recognition by the Supreme Court, its contours remain blurry and its substance, ambiguous. The legal community cannot agree on the definition or conditions of this poorly understood and under-theorized doctrine.   This thesis builds on a comparative historical analysis of French, English, and Quebecois sources and a systematic review of recent cases to lay the groundwork for a theory of fins de non-recevoir in Quebec private law. Along the political and economic transformations that shaped their history, it traces the emergence of judicially created barriers to legal actions as a unique, hybrid mechanism in the midst of law, keeper of its coherence and enforcer of its guiding principles. This thesis further introduces a crucial distinction between absolute and discretionary bars and establishes a novel conceptual framework that explains and justifies the various bars that may be invoked—whether as sanctions, remedies, or balancing measures—and systematizes how and when they may apply.   Theorizing unwritten bars to actions allows us to move beyond the paradoxical opposition between general principles and codified law. It prevents arbitrariness from taking hold of vital spaces in the judicial system. It clarifies the role of general principles of law in bringing about a substantive—not merely procedural—form of justice.

Keyphrases: bonne foi, obligations, bars to actions, civil law, comparative law, comparative legal history, equity, genealogy, general principles of law, good faith, jurisprudence
International investment arbitration and the rule of law : the issue of legal certainty in arbitral jurisprudence dealing with human rights’ protection of local populations.

Initially  outside  of  its  scope  of  application,  international investment  arbitration  is increasingly facing human rightsprotection issues. The development of investments dealing with public services has led to violations of socio-economic rights for host States’ populations. When States  tried  to  adopt  regulations  toprotect  those  rights,  they  were  brought  to  arbitration  for breaching their Bilateral Investment Treaty obligations. The human rights case law in investment arbitration  is  developing  and  quickly  evolving.  Nevertheless,  its  analysis  enables  to  highlight important legal certainty issues, rendering difficult the protection of economic, social,and cultural rights. Facing this, the legitimacy of the system is disputed and the protection of the rule of law by international investment arbitration is seriously challenged.

Keyphrases: International Investment Arbitration, Legal Certainty, Human Rights, Economic, Social and Cultural Rights, Rule of Law