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1. Massive Star Cluster Formation with Binaries. I. Evolution of Binary Populations

Author

Cournoyer-Cloutier, Claude, Sills, Alison, Harris, William E., Polak, Brooke, Rieder, Steven, Andersson, Eric P., Appel, Sabrina M., Mac Low, Mordecai-Mark, McMillan, Stephen, and Zwart, Simon Portegies

Subjects
Astrophysics - Astrophysics of Galaxies, Astrophysics - Solar and Stellar Astrophysics
Abstract

We study the evolution of populations of binary stars within massive cluster-forming regions. We simulate the formation of young massive star clusters within giant molecular clouds with masses ranging from 2 x 10$^{4}$ to 3.2 x 10$^{5}$ M$_{\odot}$. We use Torch, which couples stellar dynamics, magnetohydrodynamics, star and binary formation, stellar evolution, and stellar feedback through the AMUSE framework. We find that the binary fraction decreases during cluster formation at all molecular cloud masses. The binaries' orbital properties also change, with stronger and quicker changes in denser, more massive clouds. Most of the changes we see can be attributed to the disruption of binaries wider than 100 au, although the close binary fraction also decreases in the densest cluster-forming region. The binary fraction for O stars remains above 90%, but exchanges and dynamical hardening are ubiquitous, indicating that O stars undergo frequent few-body interactions early during the cluster formation process. Changes to the populations of binaries are a by-product of hierarchical cluster assembly: most changes to the binary population take place when the star formation rate is high and there are frequent mergers between sub-clusters in the cluster-forming region. A universal primordial binary distribution based on observed inner companions in the Galactic field is consistent with the binary populations of young clusters with resolved stellar populations, and the scatter between clusters of similar masses could be explained by differences in their formation history., Comment: 15 pages, 8 figures, 3 tables. Submitted to ApJ

Published
2024

2. Binary Disruption and Ejected Stars from Hierarchical Star Cluster Assembly

Author

Cournoyer-Cloutier, Claude, Karam, Jeremy, Sills, Alison, Zwart, Simon Portegies, and Wilhelm, Maite

Subjects
Astrophysics - Astrophysics of Galaxies
Abstract

We simulate mergers between star clusters embedded within their natal giant molecular cloud. We extract initial conditions from cloud-scale simulations of cluster formation and introduce different prescriptions for primordial binaries. We find that simulations that do not include primordial binaries result in a larger fraction of unbound stars than simulations which include a prescription for binaries based on observations. We also find a preferred direction of motion for stars that become unbound during the merger. Sub-cluster mergers within realistic gas environments promote binary disruption while mergers between idealized, gas-rich spherical clusters do not produce the same disruption. Binary systems with smaller semi-major axes are disrupted in simulations of sub-cluster mergers within their natal environment compared to simulations that do not include the realistic gas environment. We conclude that binary disruption and the production of an anisotropic distribution of unbound stars are the natural consequences of sub-cluster mergers during star cluster assembly., Comment: 13 pages, 8 figures. Re-submitted to ApJ following favourable referee report

Published
2024

3. Massive star cluster formation III. Early mass segregation during cluster assembly

Author

Polak, Brooke, Mac Low, Mordecai-Mark, Klessen, Ralf S., Zwart, Simon Portegies, Andersson, Eric P., Appel, Sabrina M., Cloutier, Claude Cournoyer, Glover, Simon C. O., and McMillan, Stephen L. W.

Subjects
Astrophysics - Astrophysics of Galaxies
Abstract

Mass segregation is seen in many star clusters, but whether massive stars form in the center of a cluster or migrate there dynamically is still debated. N-body simulations have shown that early dynamical mass segregation is possible when sub-clusters merge to form a dense core with a small crossing time. However, the effect of gas dynamics on both the formation and dynamics of the stars could inhibit the formation of the dense core. We aim to study the dynamical mass segregation of star cluster models that include gas dynamics and self-consistently form stars from the dense substructure in the gas. Our models use the Torch framework, which is based on AMUSE and includes stellar and magnetized gas dynamics, as well as stellar evolution and feedback from radiation, stellar winds, and supernovae. Our models consist of three star clusters forming from initial turbulent spherical clouds of mass $10^{4,5,6}\rm~M_\odot$ and radius $11.7\rm~pc$ that have final stellar masses of $3.6\times10^3\rm~M_\odot$, $6.5\times10^4\rm~M_\odot$, and $8.9\times10^5\rm~M_\odot$, respectively. There is no primordial mass segregation in the model by construction. All three clusters become dynamically mass segregated at early times via collapse confirming that this mechanism occurs within sub-clusters forming directly out of the dense substructure in the gas. The dynamics of the embedded gas and stellar feedback do not inhibit the collapse of the cluster. We find that each model cluster becomes mass segregated within $2~$Myr of the onset of star formation, reaching the levels observed in young clusters in the Milky Way. However, we note that the exact values are highly time-variable during these early phases of evolution. Massive stars that segregate to the center during core collapse are likely to be dynamically ejected, a process that can decrease the overall level of mass segregation again., Comment: Submitted to A&A. 8 pages, 4 figures

Published
2024

4. Massive Star Cluster Formation II. Runaway Stars as Fossils of Sub-Cluster Mergers

Author

Polak, Brooke, Mac Low, Mordecai-Mark, Klessen, Ralf S., Zwart, Simon Portegies, Andersson, Eric P., Appel, Sabrina M., Cournoyer-Cloutier, Claude, Glover, Simon C. O., and McMillan, Stephen L. W.

Subjects
Astrophysics - Astrophysics of Galaxies
Abstract

Two main mechanisms have classically been proposed for the formation of runaway stars. In the binary supernova scenario (BSS), a massive star in a binary explodes as a supernova, ejecting its companion. In the dynamical ejection scenario, a star is ejected during a strong dynamical encounter between multiple stars. We propose a third mechanism for the formation of runaway stars: the subcluster ejection scenario (SCES), where a subset of stars from an infalling subcluster is ejected out of the cluster via a tidal interaction with the contracting gravitational potential of the assembling cluster. We demonstrate the SCES in a star-by-star simulation of the formation of a young massive cluster from a $10^6\rm~M_\odot$ gas cloud using the Torch framework. This star cluster forms hierarchically through a sequence of subcluster mergers determined by the initial turbulent, spherical conditions of the gas. We find that these mergers drive the formation of runaway stars in our model. Late-forming subclusters fall into the central potential, where they are tidally disrupted, forming tidal tails of runaway stars that are distributed highly anisotropically. Runaways formed in the same SCES have similar ages, velocities, and ejection directions. Surveying observations, we identify several SCES candidate groups with anisotropic ejection directions. The SCES is capable of producing runaway binaries: two wide dynamical binaries in infalling subclusters were tightened through ejection. This allows for another velocity kick via subsequent via a subsequent BSS ejection. An SCES-BSS ejection is a possible avenue for the creation of hypervelocity stars unbound to the Galaxy. We expect nonspherical initial gas distributions to increase the number of calculated runaway stars. The observation of groups of runaway stars formed via the SCES can thus reveal the assembly history of their natal clusters., Comment: 11 pages, 10 figures. Accepted for publication in A&A. Abstract abridged for arXiv

Published
2024
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5. Massive Star Cluster Formation I. High Star Formation Efficiency While Resolving Feedback of Individual Stars

Author

Polak, Brooke, Mac Low, Mordecai-Mark, Klessen, Ralf S., Teh, Jia Wei, Cournoyer-Cloutier, Claude, Andersson, Eric P., Appel, Sabrina M., Tran, Aaron, Lewis, Sean C., Wilhelm, Maite J. C., Zwart, Simon Portegies, Glover, Simon C. O., Wang, Long, and McMillan, Stephen L. W.

Subjects
Astrophysics - Astrophysics of Galaxies
Abstract

The mode of star formation that results in the formation of globular clusters and young massive clusters is difficult to constrain through observations. We present models of massive star cluster formation using the Torch framework, which uses AMUSE to couple distinct multi-physics codes that handle star formation, stellar evolution and dynamics, radiative transfer, and magnetohydrodynamics. We upgrade Torch by implementing the N-body code PeTar, thereby enabling Torch to handle massive clusters forming from $10^6\rm\, M_\odot$ clouds with $\ge10^5$ individual stars. We present results from Torch simulations of star clusters forming from $10^4, 10^5$, and $10^6\rm M_\odot$ turbulent, spherical gas clouds (named M4, M5, M6) of radius $R=11.7$ pc. We find that star formation is highly efficient and becomes more so at higher cloud mass and surface density. For M4, M5, and M6 with initial surface densities $2.325\times 10^{1,2,3}\rm\, M_\odot\, pc^{-2}$, after a free-fall time of $t_{ff}=6.7,2.1,0.67$ Myr, we find that $\sim30\%$, 40%, and 60% of the cloud mass has formed into stars, respectively. The final integrated star formation efficiency is $32\%,\, 65\%$, and 85\% for M4, M5, and M6. Observations of nearby clusters similar to M4 have similar integrated star formation efficiencies of $\leq30\%$. The M5 and M6 models represent a different regime of cluster formation that is more appropriate for the conditions in starburst galaxies and gas-rich galaxies at high redshift, and that leads to a significantly higher efficiency of star formation. We argue that young massive clusters build up through short efficient bursts of star formation in regions that are sufficiently dense ($\ge 10^2 \rm\,M_\odot\,pc^{-2}$) and massive ($\ge10^5\rm\, M_\odot$). In such environments, the dynamical time of the cloud becomes short enough that stellar feedback cannot act quickly enough to slow star formation., Comment: Submitted to A&A

Published
2023
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7. Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study

Author

Daoust, Raoul, Paquet, Jean, Emond, Marcel, Iseppon, Massimiliano, Williamson, David, Yan, Justin W., Perry, Jeffrey J., Huard, Verilibe, Lavigne, Gilles, Lee, Jacques, Lessard, Justine, Lang, Eddy, and Cournoyer, Alexis

Subjects
Chronic pain -- Drug therapy -- Patient outcomes, Opioids -- Dosage and administration -- Complications and side effects, Prescription writing -- Evaluation, Health
Abstract

Background: Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids. Methods: In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period. Results: We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets). Interpretation: Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse. Trial registration: ClinicalTrials.gov, no. NCT03953534., Opioid overdoses killed 68 630 people in the United States (1) in 2020 and 7560 in Canada (2) in 2021, and these numbers are projected to continue to rise until [...]

Published
2024
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9. Introducing carbon assimilation in yeasts using photosynthetic directed endosymbiosis

Author

Yang-le Gao, Jason E. Cournoyer, Bidhan C. De, Catherine L. Wallace, Alexander V. Ulanov, Michael R. La Frano, and Angad P. Mehta

Subjects
Science
Abstract

Abstract Conversion of heterotrophic organisms into partially or completely autotrophic organisms is primarily accomplished by extensive metabolic engineering and laboratory evolution efforts that channel CO2 into central carbon metabolism. Here, we develop a directed endosymbiosis approach to introduce carbon assimilation in budding yeasts. Particularly, we engineer carbon assimilating and sugar-secreting photosynthetic cyanobacterial endosymbionts within the yeast cells, which results in the generation of yeast/cyanobacteria chimeras that propagate under photosynthetic conditions in the presence of CO2 and in the absence of feedstock carbon sources like glucose or glycerol. We demonstrate that the yeast/cyanobacteria chimera can be engineered to biosynthesize natural products under the photosynthetic conditions. Additionally, we expand our directed endosymbiosis approach to standard laboratory strains of yeasts, which transforms them into photosynthetic yeast/cyanobacteria chimeras. We anticipate that our studies will have significant implications for sustainable biotechnology, synthetic biology, and experimentally studying the evolutionary adaptation of an additional organelle in yeast.

Published
2024
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10. Experiential Learning of School Counselors-in-Training to Work with English Learners

Author

Shi, Qi, Cournoyer, Cielo, Randolph, Ashlei, Scheffenacker, Matthew, and Brown, Jasmine

Abstract

While the need for school counselors to support ELs is prominent, school counselors believed they were not well prepared to effectively work with EL students. To inform and strengthen our practice, we engaged in a practitioner inquiry study to understand the lived experiences of school counselors-in-training (SCITs) in an experiential learning activity to work with English Learners. Three themes emerged from the qualitative analysis of classroom observations, SCITs' reflection journal entries, and transcripts of a focus group: (a) SCITs' perceived challenges, (b) strategies used to overcome challenges and (c) how this experiential training benefited their future work as a school counselor. This study provides implications for our own practice, other counselor educators, school counselor practitioners, and policymakers.

Published
2022

11. Early Evolution and 3D Structure of Embedded Star Clusters

Author

Cournoyer-Cloutier, Claude, Sills, Alison, Harris, William E., Appel, Sabrina M., Lewis, Sean C., Polak, Brooke, Tran, Aaron, Wilhelm, Martijn J. C., Mac Low, Mordecai-Mark, McMillan, Stephen L. W., and Zwart, Simon Portegies

Subjects
Astrophysics - Astrophysics of Galaxies
Abstract

We perform simulations of star cluster formation to investigate the morphological evolution of embedded star clusters in the earliest stages of their evolution. We conduct our simulations with Torch, which uses the AMUSE framework to couple state-of-the-art stellar dynamics to star formation, radiation, stellar winds, and hydrodynamics in FLASH. We simulate a suite of $10^4$ M$_{\odot}$ clouds at 0.0683 pc resolution for $\sim$ 2 Myr after the onset of star formation, with virial parameters $\alpha$ = 0.8, 2.0, 4.0 and different random samplings of the stellar initial mass function and prescriptions for primordial binaries. Our simulations result in a population of embedded clusters with realistic morphologies (sizes, densities, and ellipticities) that reproduce the known trend of clouds with higher initial $\alpha$ having lower star formation efficiencies. Our key results are as follows: (1) Cluster mass growth is not monotonic, and clusters can lose up to half of their mass while they are embedded. (2) Cluster morphology is not correlated with cluster mass and changes over $\sim$ 0.01 Myr timescales. (3) The morphology of an embedded cluster is not indicative of its long-term evolution but only of its recent history: radius and ellipticity increase sharply when a cluster accretes stars. (4) The dynamical evolution of very young embedded clusters with masses $\lesssim$ 1000 M$_{\odot}$ is dominated by the overall gravitational potential of the star-forming region rather than by internal dynamical processes such as two- or few-body relaxation., Comment: 15 pages, 10 figures, to be published in MNRAS

Published
2023
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12. Radiation shielding of protoplanetary discs in young star-forming regions

Author

Wilhelm, Martijn J. C., Zwart, Simon Portegies, Cournoyer-Cloutier, Claude, Lewis, Sean C., Polak, Brooke, Tran, Aaron, and Mac Low, Mordecai-Mark

Subjects
Astrophysics - Earth and Planetary Astrophysics, Astrophysics - Solar and Stellar Astrophysics
Abstract

Protoplanetary discs spend their lives in the dense environment of a star forming region. While there, they can be affected by nearby stars through external photoevaporation and dynamic truncations. We present simulations that use the AMUSE framework to couple the Torch model for star cluster formation from a molecular cloud with a model for the evolution of protoplanetary discs under these two environmental processes. We compare simulations with and without extinction of photoevaporation-driving radiation. We find that the majority of discs in our simulations are considerably shielded from photoevaporation-driving radiation for at least 0.5 Myr after the formation of the first massive stars. Radiation shielding increases disc lifetimes by an order of magnitude and can let a disc retain more solid material for planet formation. The reduction in external photoevaporation leaves discs larger and more easily dynamically truncated, although external photoevaporation remains the dominant mass loss process. Finally, we find that the correlation between disc mass and projected distance to the most massive nearby star (often interpreted as a sign of external photoevaporation) can be erased by the presence of less massive stars that dominate their local radiation field. Overall, we find that the presence and dynamics of gas in embedded clusters with massive stars is important for the evolution of protoplanetary discs., Comment: 23 pages, 22 figures, 1 table, accepted for publication in MNRAS

Published
2023
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13. Early-Forming Massive Stars Suppress Star Formation and Hierarchical Cluster Assembly

Author

Lewis, Sean C., McMillan, Stephen L. W., Mac Low, Mordecai-Mark, Cournoyer-Cloutier, Claude, Polak, Brooke, Wilhelm, Martijn J. C., Tran, Aaron, Sills, Alison, Zwart, Simon Portegies, Klessen, Ralf S., and Wall, Joshua E.

Subjects
Astrophysics - Astrophysics of Galaxies, Astrophysics - Solar and Stellar Astrophysics
Abstract

Feedback from massive stars plays an important role in the formation of star clusters. Whether a very massive star is born early or late in the cluster formation timeline has profound implications for the star cluster formation and assembly processes. We carry out a controlled experiment to characterize the effects of early-forming massive stars on star cluster formation. We use the star formation software suite \texttt{Torch}, combining self-gravitating magnetohydrodynamics, ray-tracing radiative transfer, $N$-body dynamics, and stellar feedback to model four initially identical $10^4$ M$_\odot$ giant molecular clouds with a Gaussian density profile peaking at $521.5 \mbox{ cm}^{-3}$. Using the \texttt{Torch} software suite through the \texttt{AMUSE} framework we modify three of the models to ensure that the first star that forms is very massive (50, 70, 100 M$_\odot$). Early-forming massive stars disrupt the natal gas structure, resulting in fast evacuation of the gas from the star forming region. The star formation rate is suppressed, reducing the total mass of stars formed. Our fiducial control model without an early massive star has a larger star formation rate and total efficiency by up to a factor of three and a higher average star formation efficiency per free-fall time by up to a factor of seven. Early-forming massive stars promote the buildup of spatially separate and gravitationally unbound subclusters, while the control model forms a single massive cluster., Comment: 17 pages, 7 figures. Published in ApJ

Published
2022
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14. Occurrence of 40 sanitary indicators in French digestates derived from different anaerobic digestion processes and raw organic wastes from agricultural and urban origin

Author

Caroline Wybraniec, Benoit Cournoyer, Cécile Moussard, Marion Beaupère, Léa Lusurier, Françoise Leriche, Karine Fayolle, Nicolas Sertillanges, Claire-Sophie Haudin, Sabine Houot, Dominique Patureau, Geneviève Gagne, and Wessam Galia

Subjects
organic waste, anaerobic digestion, virulence genes, antibiotic resistance genes, mobile genetic elements, Microbiology, QR1-502
Abstract

This study investigated the sanitary quality of digestates resulting from the mesophilic anaerobic digestion (AD) of urban and agricultural organic wastes (OWs). 40 sanitary indicators, including pathogenic bacteria, antimicrobial resistance genes, virulence factor genes, and mobile genetic elements were evaluated using real-time PCR and/or droplet digital PCR. 13 polycyclic aromatic hydrocarbons (PAHs) and 13 pharmaceutical products (PHPs) were also measured. We assessed agricultural OWs from three treatment plants to study the effect of different AD processes (feeding mode, number of stages, pH), and used three laboratory-scale reactors to study the effect of different feed-supplies (inputs). The lab-scale reactors included: Lab1 fed with 97% activated sludge (urban waste) and 3% cow manure; Lab2 fed with 85% sludge-manure mixture supplemented with 15% wheat straw (WS); and Lab3 fed with 81% sludge-manure mixture, 15% WS, and 4% zeolite powder. Activated sludge favored the survival of the food-borne pathogens Clostridium perfringens and Bacillus cereus, carrying the toxin-encoding genes cpe and ces, respectively. Globally, the reactors fed with fecal matter supplemented with straw (Lab2) or with straw and zeolite (Lab3) had a higher hygienization efficiency than the reactor fed uniquely with fecal matter (Lab1). Three pathogenic bacteria (Enterococcus faecalis, Enterococcus faecium, and Mycobacterium tuberculosis complex), a beta-lactam resistance gene (blaTEM), and three mobile genetic elements (intI1, intI2, and IS26) were significantly decreased in Lab2 and Lab3. Moreover, the concentrations of 11 PAHs and 11 PHPs were significantly lower in Lab2 and Lab3 samples than in Lab1 samples. The high concentrations of micropollutants, such as triclosan, found in Lab1, could explain the lower hygienization efficiency of this reactor. Furthermore, the batch-fed reactor had a more efficient hygienization effect than the semi-continuous reactors, with complete removal of the ybtA gene, which is involved in the production of the siderophore yersiniabactin, and significant reduction of intI2 and tetO. These data suggest that it is essential to control the level of chemical pollutants in raw OWs to optimize the sanitary quality of digestates, and that adding co-substrate, such as WS, may overcome the harmful effect of pollutants.

Published
2024
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15. Subcutaneous checkpoint inhibition is equivalent to systemic delivery when combined with nelitolimod delivered via pressure-enabled drug delivery for depletion of intrahepatic myeloid-derived suppressor cells and control of liver metastases

Author

Diwakar Davar, Yujia Liu, Jason Laporte, Prajna Guha, Steven C Katz, Chandra C Ghosh, Lauren Cournoyer, Alizee Ballarin, Ilan B Layman, Molly Morrissey, Kayla Fraser, Shriya Perati, Bryan F Cox, Evgeny Yakirevich, Diana O Treaba, and Timothy D Murtha

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Background Toll-like receptor 9 (TLR9) agonists induce inflammatory responses that promote the killing of infectious micro-organisms, cancer cells and develop adaptive immune responses. Their ability as immunomodulators to enhance the activity of checkpoint inhibitors (CPI) in treating liver tumors is limited in part by the distinctive biology of intrahepatic myeloid-derived suppressor cells (MDSC) and challenges with tumor-specific therapeutic delivery. We have shown that the regional delivery of type C TLR9 agonist via pressure-enabled drug delivery (PEDD) system improves delivery to the tumor, enhances depletion of MDSCs and overall, stimulates the immune system in combination with or without CPI. Currently, CPIs are delivered intravenously, although there is a growing interest in its subcutaneous (SQ) administration. We compared nelitolimod formerly known as SD-101 administered using PEDD in combination with systemic (Sys) or SQ CPI in murine liver metastases (LM).Methods The LM model was developed by injecting MC38-Luc cells via the spleen of 8–12 week old male C57/BL6 mice followed by splenectomy. After a week, fluorescently labeled nelitolimod (10 µg/mouse) was delivered via PEDD and co-administered anti-programmed cell death-1 (α-PD-1) either via Sys or SQ. Tumor burden was monitored by in vivo imaging system. Serum cytokine levels were analyzed by Luminex. Tissues were harvested on Day 3 (D3) or Day 10 (D10) post-PEDD to enrich CD45+ cells and were analyzed via NanoString targeted transcriptomics (D3) or flow cytometry (FC, D10) to interrogate immune cell populations (D10). For NanoString analysis, the innate immune panels were selected, and for FC, MDSCs (CD11b+Gr1+), B cells (B220+), dendritic cells (DC, CD11c+), T (CD3+) cells, and M1-like macrophages (F4/80+CD38+Egr2−) were quantified.Results Nelitolimod delivered via PEDD resulted in changes in innate and adaptive immune cells within LM, including depletion of liver MDSC and increased M1-like macrophages in the liver, which are supportive of antitumor immunity. While CPI monotherapy failed to control tumor progression, nelitolimod and CPI combination improved LM control, survival and antitumor immunity beyond the nelitolimod monotherapy effect, irrespective of CPI delivery route.Conclusion The SQ route of CPI delivery was equivalent to Sys in combination with nelitolimod, suggesting SQ-CPI may be a rational choice in combination with PEDD of nelitolimod for liver tumor treatment.

Published
2024
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20. Haemophagocytic lymphohistiocytosis following the anti-PD-1 nivolumab in a patient with gastric cancer and ankylosing spondylitis

Author

Clara Long, Abdulrahman Al-Abdulmalek, Jonathan Lai, David G. Haegert, Stephane Isnard, Denis Cournoyer, and Jean-Pierre Routy

Subjects
hemophagocytic lymphohistiocytosis, immunotherapy, anti-pd1, gastric cancer, ankylosing spondylitis, Medicine
Abstract

Background: Autoimmune diseases are not contraindications for immune checkpoint inhibitors (ICI) therapy in patients with cancer. However, immune-related adverse events (irAEs) are frequently observed in patients receiving ICIs including dermatitis, thyroiditis, colitis, and pneumonitis. Thrombocytopenic purpura, aplasia, and haemophagocytic lymphohistiocytosis (HLH) are rarely observed during ICIs. Case description: We report the case of a male patient with pre-existing untreated HLA B27 and ankylosing spondylitis with gastric cancer and liver metastases. The 79-year-old man was treated with anti-HER2 trastuzumab and anti-PD-1 nivolumab. Seventeen days after the seventh cycle of treatment, he presented at the emergency department with acute fever, confusion, and hypotension. Laboratory results showed pancytopenia, and elevation of ferritin and triglyceride. No infections were detected. Although not seen in a bone marrow biopsy, clinical presentation, and absence of infection, together with an H-score of 263, indicated HLH. The patient was treated with dexamethasone for four days and discharged on a tapering dose of steroids. At the two-month follow-up, clinical presentation was normal and blood test almost normalised. At 8 months, no liver metastases were observed. Conclusions: In a patient with a pre-existing autoimmune condition, immunotherapy led to the development of HLH, which was controlled by glucocorticoid. Absence of the feature of haemophagocytosis in the bone marrow biopsy did not exclude the diagnosis, as HLH can occur in the spleen or in the liver. Glucocorticoid therapy did not prevent the anti-cancer effect of ICIs, and liver metastases disappeared 8 months post-HLH. This case warrants further research on the interplay between autoimmunity and ICI response, as well as ICI-induced irAEs.

Published
2024
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27. EXPLORATION OF MARITAL RELATIONSHIP PROJECTS AMONG PARENTS OF A CHILD WITH AN INTELLECTUAL DISABILITY

Author

Jean-Simon Fortin, Lise Lachance, Louis Cournoyer, Hugo Lamirande-Landry, Suzie McKinnon, and Louis Richer

Subjects
couples, parents, intellectual disability, personal project, The family. Marriage. Woman, HQ1-2044, Sociology (General), HM401-1281
Abstract

Parental stress in parents of a child with an intellectual disability may have an impact on their marital relationship. Achievement of marital projects is considered an important factor that sustains marital satisfaction and fulfils the need for relatedness essential to well-being. In this study, which explores marital relationship projects (MRPs) of these parents, 34 couples participated individually in semi-structured interviews using the personal projects analysis grid. In their 5 most important projects, 17 mothers and 17 fathers prioritized at least 1 MRP: mothers in particular reported that they wanted to spend more time with their partners, while fathers wished for opportunities to travel as a couple. The thematic analysis of parents’ appraisals of their MRPs gave rise to 4 categories: “determined optimists”, “determined sceptics”, “postponing optimists”, and “postponing sceptics”. Furthermore, 4 types of conjugal dynamic emerged: “continuity”, “when the time is right”, “it’s getting necessary”, and “it’s complicated”. Gaining knowledge about these parents’ MRPs and how they are appraised will make it possible to offer support and resources that will allow them to pursue their MRPs, leading to more fulfilled relationships.

Published
2024
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28. Impact of clinical variables on outcomes in refractory cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation

Author

Simon-Pierre Demers, Alexis Cournoyer, Olina Dagher, Pierre-Emmanuel Noly, Anique Ducharme, Hung Ly, Martin Albert, Karim Serri, Yiorgos Alexandros Cavayas, Walid Ben Ali, and Yoan Lamarche

Subjects
ECPR, cardiac arrest, extracorporeal circulation, cardiopulmonary resuscitation, cardiac intensive care, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

BackgroundIn the past two decades, extracorporeal resuscitation (ECPR) has been increasingly used in the management of refractory cardiac arrest (CA) patients. Decision algorithms have been used to guide the care such patients, but the effectiveness of such decision-making tools is not well described. The aim of this study was to compare the rate of survival with a good neurologic outcome of patients treated with ECPR meeting all criteria of a clinical decision-making tool for the initiation of ECPR to those for whom ECPR was implemented outside of the algorithm.MethodsAll patients who underwent E-CPR between January 2014 and December 2021 at the Montreal Heart Institute were included in this retrospective analysis. We dichotomized the cohort according to adherence or non-adherence with the ECPR decision-making tool, which included the following criteria: age ≤65 years, initial shockable rhythm, no-flow time

Published
2024
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29. Implementing Primordial Binaries in Simulations of Star Cluster Formation with a Hybrid MHD and Direct N-Body Method

Author

Cournoyer-Cloutier, Claude, Tran, Aaron, Lewis, Sean, Wall, Joshua E., Harris, William E., Mac Low, Mordecai-Mark, McMillan, Stephen L. W., Zwart, Simon Portegies, and Sills, Alison

Subjects
Astrophysics - Solar and Stellar Astrophysics, Astrophysics - Astrophysics of Galaxies
Abstract

The fraction of stars in binary systems within star clusters is important for their evolution, but what proportion of binaries form by dynamical processes after initial stellar accretion remains unknown. In previous work, we showed that dynamical interactions alone produced too few low-mass binaries compared to observations. We therefore implement an initial population of binaries in the coupled MHD and direct N-body star cluster formation code Torch. We compare simulations with, and without, initial binary populations and follow the dynamical evolution of the binary population in both sets of simulations, finding that both dynamical formation and destruction of binaries take place. Even in the first few million years of star formation, we find that an initial population of binaries is needed at all masses to reproduce observed binary fractions for binaries with mass ratios above the $q \geq 0.1$ detection limit. Our simulations also indicate that dynamical interactions in the presence of gas during cluster formation modify the initial distributions towards binaries with smaller primary masses, larger mass ratios, smaller semi-major axes and larger eccentricities. Systems formed dynamically do not have the same properties as the initial systems, and systems formed dynamically in the presence of an initial population of binaries differ from those formed in simulations with single stars only. Dynamical interactions during the earliest stages of star cluster formation are important for determining the properties of binary star systems., Comment: 15 pages, 14 figures, submitted to MNRAS and edited to address positive referee's report

Published
2020
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31. Workplace Aggression among Women Colleagues: An Action Research Study at a Small, Rural Community College

Author

Jennifer G. Cournoyer

Abstract

Women now comprise the majority of the higher education workforce; yet they still experience workplace aggression at alarming rates. The purpose of this action research study was to investigate workplace aggression among women colleagues at a small, rural community college. The study also sought to create a more supportive work environment for these women. Cycle 1 consisted of semi-structured interviews with sixteen full-time faculty and staff who identify as women. Data revealed that women had experienced both positive and negative relationships with women colleagues. Further, workplace aggression was linked to status and achievement, social and workplace hierarchies, and insecurity and competition. Based on these findings, and participants' suggestions for interventions, an action step consisting of a five-session professional development workshop was designed, implemented, and evaluated in Cycle 2. The goal was to create the supportive environment that women had identified while talking about positive relationships with women colleagues. Creating such an environment might have implications for increasing self-esteem and confidence and decreasing workplace aggression. The study concluded that group session work of this kind was moderately successful. However, it also revealed that more research is needed on the following: insecurity and confidence, hierarchies among women employees, the lack of safe space for women in the higher education workplace, and the implication these factors may have on workplace aggression. Recommendations for the research site included repeating the workshop series with a different group of participants, considering a volunteer mentorship network, and supporting more formal ways for women to report and mediate workplace aggression issues. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Published
2022

33. Dabrafenib and trametinib in Langerhans cell histiocytosis and other histiocytic disorders

Author

Eily Cournoyer, Justin Ferrell, Susan Sharp, Anish Ray, Michael Jordan, Christopher Dandoy, Michael Grimley, Somak Roy, Robert Lorsbach, Arnold C. Merrow, Adam Nelson, Allison Bartlett, Jennifer Picarsic, and Ashish Kumar

Subjects
Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

The standard treatment for Langerhans cell histiocytosis (LCH) is chemotherapy, although the failure rates are high. Since MAP-kinase activating mutations are found in most cases, BRAF- and MEK-inhibitors have been used successfully to treat patients with refractory or relapsed disease. However, data on long-term responses in children are limited and there are no data on the use of these inhibitors as first-line therapy. We treated 34 patients (26 with LCH, 2 with juvenile xanthogranuloma, 2 with Rosai-Dorfman disease, and 4 with presumed single site-central nervous system histiocytosis) with dabrafenib and/or trametinib, either as first line or after relapse or failure of chemotherapy. Sixteen patients, aged 1.3-21 years, had disease that was recurrent or refractory to chemotherapy, nine of whom had multisystem LCH with risk-organ involvement. With a median treatment duration of 4.3 years, 15 (94%) patients have sustained favorable responses. Eighteen patients, aged 0.2-45 years, received an inhibitor as first-line treatment. All of these have had sustained favorable responses, with a median treatment duration of 2.5 years. Three patients with presumed isolated central nervous system/pituitary stalk histiocytosis had stabilization or improvement of their disease. Overall, inhibitors were well tolerated. Five patients with single-system LCH discontinued therapy and remain off therapy without recurrence. In contrast, all four patients with multisystem disease who discontinued therapy had to restart treatment. Our data suggest that children suffering from histiocytoses can be treated safely and effectively with dabrafenib or trametinib. Additional studies are, however, needed to determine the long-term safety and optimal duration of therapy.

Published
2023
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34. The impact of treatment with avacopan on health-related quality of life in antineutrophil cytoplasmic antibody-associated vasculitis: a post-hoc analysis of data from the ADVOCATE trial

Author

Au Peh, Chen, Chakera, Aron, Cooper, Bruce, Kurtkoti, Jagadeesh, Langguth, Daman, Levidiotis, Vicki, Luxton, Grant, Mount, Peter, Mudge, David, Noble, Euan, Phoon, Richard, Ranganathan, Dwarakanathan, Ritchie, Angus, Ryan, Jessica, Suranyi, Michael, Rosenkranz, Alexander, Lhotta, Karl, Kronbichler, Andreas, Demoulin, Nathalie, Bovy, Christophe, Hellemans, Rachel, Hougardy, Jean-Michel, Sprangers, Ben, Wissing, Karl Martin, Pagnoux, Christian, Barbour, Sean, Brachemi, Soumeya, Cournoyer, Serge, Girard, Louis-Philippe, Laurin, Louis-Philippe, Liang, Patrick, Philibert, David, Walsh, Michael, Tesar, Vladimir, Becvar, Radim, Horak, Pavel, Rychlik, Ivan, Szpirt, Wladimir, Dieperink, Hans, Gregersen, Jon Waarst, Ivarsen, Per, Krarup, Elizabeth, Lyngsoe, Cecilie, Rigothier, Claire, Augusto, Jean-Francois, Belot, Alexandre, Chauveau, Dominique, Cornec, Divi, Jourde-Chiche, Noemie, Ficheux, Maxence, Karras, Alexandre, Klein, Alexandre, Maurier, Francois, Mesbah, Rafik, Moranne, Olivier, Neel, Antoine, Quemeneur, Thomas, Saadoun, David, Terrier, Benjamin, Zaoui, Philippe, Schaier, Matthias, Benck, Urs Tobias, Bergner, Raoul, Busch, Martin, Floege, Juergen, Grundmann, Franziska, Haller, Hermann, Haubitz, Marion, Hellmich, Bernhard, Henes, Joerg Christoph, Hohenstein, Bernd, Hugo, Christian, Iking-Konert, Christof, Arndt, Fabian, Kubacki, T, Kotter, Ina, Lamprecht, Peter, Lindner, Tom, Halbritter, Jan, Mehling, Heidrun, Schönermarck, Ulf, Venhoff, Nils, Vielhauer, Volker, Witzke, Oliver, Szombati, Istvan, Szucs, Gabriella, Garibotto, Giacomo, Alberici, Federico, Brunetta, Enrico, Dagna, Lorenzo, De Vita, Salvatore, Emmi, Giacomo, Gabrielli, Armando, Manenti, Lucio, Pieruzzi, Federico, Roccatello, Dario, Salvarani, Carlo, Harigai, Masayoshi, Dobashi, Hiroaki, Atsumi, Tatsuya, Fujimoto, Shoichi, Hagino, Noboru, Ihata, Atsushi, Kaname, Shinya, Kaneko, Yuko, Katagiri, Akira, Katayama, Masao, Kirino, Yohei, Kitagawa, Kiyoki, Komatsuda, Atsushi, Kono, Hajime, Kurasawa, Takahiko, Matsumura, Ryutaro, Mimura, Toshihide, Morinobu, Akio, Murakawa, Yohko, Naniwa, Taio, Nanki, Toshihiro, Ogawa, Noriyoshi, Oshima, Hisaji, Sada, Kenei, Sugiyama, Eiji, Takeuchi, Tohru, Taki, Hirofumi, Tamura, Naoto, Tsukamoto, Tatsuo, Yamagata, Kunihiro, Yamamura, Masahiro, van Daele, Paulus Leon Arthur, Rutgers, Abraham, Teng, Y.K. Onno, Walker, Robert, Chua, Ignatius, Collins, Michael, Rabindranath, Kannaiyan, de Zoysa, Janak, Svensson, My Hanna Sofia, Grevbo, Bard-Waldum, Kalstad, Synove, Little, Mark, Clarkson, Michael, Molloy, Eamonn, Agraz Pamplona, Irene, Anton, Jordi, Barrio Lucia, Vicente, Ciggaran, Secundino, Cinta Cid, Maria, Diaz Encarnacion, Montserrat, Fulladosa Oliveras, Xavier, Jose Soler, Maria, Marco Rusinol, Helena, Praga, Manuel, Quintana Porras, Luis, Segarra, Alfons, Bruchfeld, Annette, Segelmark, Marten, Soveri, Inga, Thomaidi, Eleni, Westman, Kerstin, Neumann, Thomas, Burnier, Michel, Daikeler, Thomas, Dudler, Jean, Hauser, Thomas, Seeger, Harald, Vogt, Bruno, Burton, James, Al Jayyousi, Reem, Amin, Tania, Andrews, Jacqueline, Baines, Laura Anne, Brogan, Paul, Dasgupta, Bhaskar, Doulton, Timothy William Ronald, Flossmann, Oliver, Griffin, Sian V., Harper, Janice Marian, Harper, Lorraine, Kidder, Dana, Klocke, Rainer, Lanyon, Peter Charles, Luqmani, Raashid, McLaren, John Stuart, Makanjuola, David Osagie, McCann, Liza, Nandagudi, Anupama C., Selvan, Shilpa, O'Riordan, Edmond, Patel, Mumtaz, Patel, Rajan Kantilal, Pusey, Charles Dickson, Rajakariar, Ravindra, Robson, Joanna C., Robson, Michael, Salama, Alan David, Smyth, Lucy, Sznajd, Jan, Taylor, Joanne, Sreih, Antonie G., Belilos, Elise, Bomback, Andrew S., Carlin, Jeffrey, Chang Chen Lin, Yih, Derebail, Vimal K., Dragoi, Serban, Dua, Anisha, Forbess, Lindsy, Geetha, Duvuru, Gipson, Patrick, Gohh, Reginald, Greenwood, Gregory Todd, Hugenberg, Steven T., Jimenez, Richard A.H., Kaskas, Marwan Omar, Kermani, Tanaz, Kivitz, Alan J., Koening, Curry, Langford, Carol A., Marder, Galina, Mohamed, Amr Ahmed El-Huesseini, Monach, Paul, Neyra, Nilda Roxana, Niemer, Gregory W., Niles, John, Obi, Reginald, Owens, Charles, Parks, Deborah L., Podoll, Amber S., Rovin, Brad, Sam, R, Shergy, William Julius, Silva, Arnold Lawrence, Specks, Ulrich, Spiera, Robert, Springer, Jason M., Striebich, Christopher Charles, Swarup, Areena, Thakar, Surabhi, Tiliakos, Athan N., Tsai, Yong, Waguespack, Dia R., Chester Wasko, Mary, Strand, Vibeke, Jayne, David R W, Horomanski, Audra, Yue, Huibin, Bekker, Pirow, and Merkel, Peter A

Published
2023
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35. Kidney and Cardiovascular Effects of Canagliflozin According to Age and Sex: A Post Hoc Analysis of the CREDENCE Randomized Clinical Trial

Author

Perkovic, Vlado, Mahaffey, Kenneth W., Agarwal, Rajiv, Bakris, George, Brenner, Barry M., Cannon, Christopher P., Charytan, David M., de Zeeuw, Dick, Greene, Tom, Jardine, Meg J., Heerspink, Hiddo J.L., Levin, Adeera, Meininger, Gary, Neal, Bruce, Pollock, Carol, Wheeler, David C., Zhang, Hong, Zinman, Bernard, Jardine, Meg, Li, Nicole, Kolesnyk, Inna, Aizenberg, Diego, Pecoits-Filho, Roberto, Cherney, David, Obrador, Gregorio, Chertow, Glenn, Chang, Tara, Hawley, Carmel, Ji, Linong, Wada, Takashi, Jha, Vivekanand, Lim, Soo Kun, Lim-Abrahan, Mary Anne, Santos, Florence, Chae, Dong-Wan, Hwang, Shang-Jyh, Vazelov, Evgueniy, Rychlík, Ivan, Hadjadj, Samy, Krane, Vera, Rosivall, László, De Nicola, Luca, Dreval, Alexander, Nowicki, Michał, Schiller, Adalbert, Distiller, Larry, Górriz, Jose L., Kolesnyk, Mykola, David, Wheeler, C., Guerrero, Rodolfo Andres Ahuad, Albisu, Juan Pablo, Alvarisqueta, Andres, Bartolacci, Ines, Berli, Mario Alberto, Bordonava, Anselmo, Calella, Pedro, Cantero, Maria Cecilia, Cartasegna, Luis Rodolfo, Cercos, Esteban, Coloma, Gabriela Cecilia, Colombo, Hugo, Commendatore, Victor, Cuadrado, Jesus, Cuneo, Carlos Alberto, Cusumano, Ana Maria, Douthat, Walter Guillermo, Dran, Ricardo Dario, Farias, Eduardo, Fernandez, Maria Florencia, Finkelstein, Hernan, Fragale, Guillermo, Fretes, Jose Osvaldo, Garcia, Nestor Horacio, Gastaldi, Anibal, Gelersztein, Elizabeth, Glenny, Jorge Archibaldo, Gonzalez, Joaquin Pablo, Colaso, Patricia del Carmen Gonzalez, Goycoa, Claudia, Greloni, Gustavo Cristian, Guinsburg, Adrian, Hermida, Sonia, Juncos, Luis Isaias, Klyver, Maria Isabel, Kraft, Florencia, Krynski, Fernando, Lanchiotti, Paulina Virginia, Leon de la Fuente, Ricardo Alfonso, Marchetta, Nora, Mele, Pablo, Nicolai, Silvia, Novoa, Pablo Antonio, Orio, Silvia Ines, Otreras, Fabian, Oviedo, Alejandra, Raffaele, Pablo, Resk, Jorge Hector, Rista, Lucas, Papini, Nelson Rodriguez, Sala, Jorgelina, Santos, Juan Carlos, Schiavi, Lilia Beatriz, Sessa, Horacio, Casabella, Tomas Smith, Ulla, Maria Rosa, Valdez, Maria, Vallejos, Augusto, Villarino, Adriana, Visco, Virginia Esther, Wassermann, Alfredo, Zaidman, Cesar Javier, Cheung, Ngai Wah, Droste, Carolyn, Fraser, Ian, Johnson, David, Mah, Peak Mann, Nicholls, Kathy, Packham, David, Proietto, Joseph, Roberts, Anthony, Roger, Simon, Tsang, Venessa, Raduan, Roberto Abrão, Costa, Fernando Augusto Alves da, Amodeo, Celso, Turatti, Luiz Alberto Andreotti, Bregman, Rachel, Sanches, Fernanda Cristina Camelo, Canani, Luis Henrique, Chacra, Antônio Roberto, Borges, João Lindolfo Cunha, Vêncio, Sérgio Alberto Cunha, Franco, Roberto Jorge da Silva, d’Avila, Domingos, Portes, Evandro de Souza, de Souza, Pedro, Deboni, Luciane Mônica, Fraige Filho, Fadlo, Neto, Bruno Geloneze, Gomes, Marcus, Kohara, Suely Keiko, Keitel, Elizete, Saraiva, Jose Francisco Kerr, Lisboa, Hugo Roberto Kurtz, Contieri, Fabiana Loss de Carvalho, Milagres, Rosângela, Junior, Renan Montenegro, de Brito, Claudia Moreira, Hissa, Miguel Nasser, Sabbag, Ângela Regina Nazario, Noronha, Irene, Panarotto, Daniel, Filho, Roberto Pecoits, Pereira, Márcio Antônio, Saporito, Wladmir, Scotton, Antonio Scafuto, Schuch, Tiago, de Almeida, Roberto Simões, Ramos, Cássio Slompo, Felício, João Soares, Thomé, Fernando, Hachmann, Jean Carlo Tibes, Yamada, Sérgio, Hayashida, Cesar Yoiti, Petry, Tarissa Beatrice Zanata, Zanella, Maria Teresa, Andreeva, Viktoria, Angelova, Angelina, Dimitrov, Stefan, Genadieva, Veselka, Genova-Hristova, Gabriela, Hristozov, Kiril, Kamenov, Zdravko, Koundurdjiev, Atanas, Lozanov, Lachezar, Margaritov, Viktor, Nonchev, Boyan, Rangelov, Rangel, Shinkov, Alexander, Temelkova, Margarita, Velichkova, Ekaterina, Yakov, Andrian, Aggarwal, Naresh, Aronson, Ronnie, Bajaj, Harpreet, Chouinard, Guy, Conway, James, Cournoyer, Serge, DaRoza, Gerald, De Serres, Sacha, Dubé, François, Goldenberg, Ronald, Gupta, Anil, Gupta, Milan, Henein, Sam, Khandwala, Hasnain, Leiter, Lawrence, Madore, François, McMahon, Alan, Muirhead, Norman, Pichette, Vincent, Rabasa-Lhoret, Remi, Steele, Andrew, Tangri, Navdeep, Torshizi, Ali, Woo, Vincent, Zalunardo, Nadia, Montenegro, María Alicia Fernández, Gonzalo Godoy Jorquera, Juan, Fariña, Marcelo Medina, Gajardo, Victor Saavedra, Vejar, Margarita, Chen, Nan, Chen, Qinkai, Gan, Shenglian, Kong, Yaozhong, Li, Detian, Li, Wenge, Li, Xuemei, Lin, Hongli, Liu, Jian, Lu, Weiping, Mao, Hong, Ren, Yan, Song, Weihong, Sun, Jiao, Sun, Lin, Tu, Ping, Wang, Guixia, Yang, Jinkui, Yin, Aiping, Yu, Xueqing, Zhao, Minghui, Zheng, Hongguang, Mendoza, Jose Luis Accini, Arcos, Edgar, Avendano, Jorge, Diaz Ruiz, Jorge Ernesto Andres, Ortiz, Luis Hernando Garcia, Gonzalez, Alexander, Triana, Eric Hernandez, Higuera, Juan Diego, Malaver, Natalia, de Salazar, Dora Inés Molina, Rosero, Ricardo, Alexandra Terront Lozano, Monica, Cometa, Luis Valderrama, Valenzuela, Alex, Vargas Alonso, Ruben Dario, Villegas, Ivan, Yupanqui, Hernan, Bartaskova, Dagmar, Barton, Petr, Belobradkova, Jana, Dohnalova, Lenka, Drasnar, Tomas, Ferkl, Richard, Halciakova, Katarina, Klokocnikova, Vera, Kovar, Richard, Lastuvka, Jiri, Lukac, Martin, Pesickova, Satu, Peterka, Karel, Pumprla, Jiri, Rychlik, Ivan, Saudek, Frantisek, Tesar, Vladimir, Valis, Martin, Weiner, Pavel, Zemek, Stanislav, Alamartine, Eric, Borot, Sophie, Cariou, Bertrand, Dussol, Bertrand, Fauvel, Jean-Pierre, Gourdy, Pierre, Klein, Alexandre, Le Meur, Yannick, Penfornis, Alfred, Roussel, Ronan, Saulnier, Pierre-Jean, Thervet, Eric, Zaoui, Philippe, Burst, Volker, Faghih, Markus, Faulmann, Grit, Haller, Hermann, Jerwan-Keim, Reinhold, Maxeiner, Stephan, Paschen, Björn, Plassmann, Georg, Rose, Ludger, Gonzalez Orellana, Ronaldo Arturo, Haase, Franklin Paul, Moreira Diaz, Juan Pablo, Ramirez Roca, Luis Alberto, Sánchez Arenales, Jose Antonio, Sanchez Polo, José Vicente, Juarez, Erick Turcios, Csecsei, Gyongyi, Csiky, Botond, Danos, Peter, Deak, Laszlo, Dudas, Mihaly, Harcsa, Eleonora, Keltai, Katalin, Keresztesi, Sandor, Kiss, Krisztian, Konyves, Laszlo, Major, Lajos, Mileder, Margit, Molnar, Marta, Mucsi, Janos, Oroszlan, Tamas, Ory, Ivan, Paragh, Gyorgy, Peterfai, Eva, Petro, Gizella, Revesz, Katalin, Takacs, Robert, Vangel, Sandor, Vasas, Szilard, Zsom, Marianna, Abraham, Oomman, Bhushan, Raju Sree, Deepak, Dewan, Edwin, Fernando M., Gopalakrishnan, Natarajan, Gracious, Noble, Hansraj, Alva, Jain, Dinesh, Keshavamurthy, C.B., Khullar, Dinesh, Manisha, Sahay, Peringat, Jayameena, Prasad, Narayan, Satyanarayana, Rao K., Sreedhar, Reddy, Sreelatha, Melemadathil, Sudhakar, Bhimavarapu, Chandra Vyasam, Ramesh, Bonadonna, Riccardo, Castellino, Pietro, Ceriello, Antonio, Chiovato, Luca, De Cosmo, Salvatore, Derosa, Giuseppe, Di Carlo, Alberto, Di Cianni, Graziano, Frascà, Giovanni, Fuiano, Giorgio, Gambaro, Giovanni, Garibotto, Giacomo, Giorda, Carlo, Malberti, Fabio, Mandreoli, Marcora, Mannucci, Edoardo, Orsi, Emanuela, Piatti, Piermarco, Santoro, Domenico, Sasso, Ferdinando Carlo, Serviddio, Gaetano, Stella, Andrea, Trevisan, Roberto, Veronelli, Anna Maria, Zanoli, Luca, Akiyama, Hitoshi, Aoki, Hiromi, Asano, Akimichi, Iitsuka, Tadashi, Kajiyama, Shizuo, Kashine, Susumu, Kawada, Toshio, Kodera, Takamoto, Kono, Hiroshi, Koyama, Kazunori, Kumeda, Yasuro, Miyauchi, Shozo, Mizuyama, Kazuyuki, Niiya, Tetsuji, Oishi, Hiroko, Ota, Satoshi, Sakakibara, Terue, Takai, Masahiko, Tomonaga, Osamu, Tsujimoto, Mitsuru, Wakasugi, Masakiyo, Wakida, Yasushi, Watanabe, Takayuki, Yamada, Masayo, Yanagida, Kazuhiro, Yanase, Toshihiko, Yumita, Wataru, Gaupsiene, Egle, Kozloviene, Dalia, Navickas, Antanas, Urbanaviciene, Egle, Abdul Ghani, Rohana, Kadir, Khalid Abdul, Ali, Norsiah, Che Yusof, Mohd Daud, Gan, Chye Lee, Ismail, Mastura, Kong, Wei Yen, Lam, Swee Win, Lee, Li Yuan, Loh, Chek Loong, Manocha, Anita Bhajan, Ng, Kee Sing, Ahmad, Nik Nur Fatnoon Nik, Ratnasingam, Vanassa, Shudim, Saiful Shahrizal Bin, Vengadasalam, Paranthaman, Abraira Munoz, Luis David, Salazar, Melchor Alpizar, Cruz, Juan Baas, Soto, Mario Burgos, Ramos, Jose Chevaile, Wong, Alfredo Chew, Correa Rotter, Jose Ricardo, Escalante, Tonatiu Diaz, Enriquez Sosa, Favio Edmundo, Lozano, Fernando Flores, Flota Cervera, Luis Fernando, Baron, Paul Frenk, Ballesteros, Cecilia Garcia, Gomez Rangel, Jose David, Herrera Jimenez, Luis Enrique, Irizar Santana, Sergio Saul, Flores, Fernando Jimenez, Molina, Hugo Laviada, Luna Ceballos, Rosa Isela, del Campo Blanco, Belia Martin, Franco, Guadalupe Morales, Moreno Loza, Oscar Tarsicio, Rocha, Cynthia Mustieles, Vera, Gregorio Obrador, Castellanos, Ricardo Orozco, Calcaneo, Juan Peralta, Reyes Rosano, Miguel Angel, Pattzi, Hiromi Rodriguez, Guzman, Juan Rosas, Rucker Joerg, Isabel Erika, Saavedra Sanchez, Sandra Berenice, Sanchez Mijangos, Jose Hector, Sanson, Pablo Serrano, Tamayo y Orozco, Juan Alfredo, Chavez, Eloisa Tellez, Cepeda, Alejandro Valdes, Carrillo, Luis Venegas, Mesa, Juan Villagordoa, Escobedo, Rolando Zamarripa, Baker, John, Noonan, Paul, Scott, Russell, Walker, Robert, Watson, Edward, Williams, Michael, Young, Simon, Abejuela, Zaynab, Agra, Jeimeen, Aquitania, Grace, Caringal, Clodoaido, Comia, Rhea Severina, Santos, Lalaine Delos, Gomez, Olivert, Jimeno, Cecilia, Tan, Gerry, Tolentino, Marsha, Yao, Christy, Yap, Yvette Ethel, Lallaine Ygpuara, Ma. Dovie, Bijata-Bronisz, Renata, Hotlos, Lucyna, Januszewicz, Andrzej, Kaczmarek, Barbara, Kaminska, Anna, Lazuka, Lech, Madej, Andrzej, Mazur, Stanislaw, Mlodawska-Choluj, Dorota, Nowicki, Michal, Orlowska-Kowalik, Grazyna, Popenda, Grazyna, Rewerska, Barbara, Sowinski, Dariusz, Angelescu, Liliana Monica, Anghel, Veronica, Avram, Rodica-Ioana, Busegeanu, Mihaela-Magdalena, Cif, Adriana, Cosma, Dana, Crisan, Carmen, Demian, Luiza Despina, Ferariu, Ioana Emilia, Halmagyi, Ildiko, Hancu, Nicolae, Munteanu, Mircea, Negru, Doru, Onaca, Adriana Gabriela, Petrica, Ligia, Popa, Amorin Remus, Ranetti, Aurelian-Emil, Serafinceanu, Cristian, Toarba, Cristina, Agafyina, Alina, Barbarash, Olga, Barysheva, Olga, Chizhov, Daniil, Dobronravov, Vladimir, Glinkina, Irina, Grineva, Elena, Khirmanov, Vladimir, Kolmakova, Elena, Koroleva, Tatiana, Kvitkova, Liudmila, Marasaev, Viacheslav, Mkrtumyan, Ashot, Morugova, Tatiana, Nagibovich, Galina, Nagibovich, Oleg, Nedogoda, Sergei, Osipova, Irina, Raskina, Tatiana, Samoylova, Yulia, Sazonova, Olga, Shamkhalova, Minara, Shutemova, Elena, Shwartz, Yuriy, Uriasyev, Oleg, Vorobyev, Sergey, Zateyshchikova, Anna, Zateyshshikov, Dmitry, Zykova, Tatyana, Antic, Slobodan, Djordjevic, Miodrag, Kendereski, Aleksandra, Lalic, Katarina, Lalic, Nebojsa, Popovic-Radinovic, Vesna, Babikova, Jana, Benusova, Olga, Buganova, Ingrid, Culak, Jan, Dzupina, Andrej, Dzuponova, Jana, Fulop, Peter, Ilavska, Adriana, Martinka, Emil, Ochodnicka, Zuzana, Pella, Daniel, Smatanova, Iveta, Ahmed, Fayzal, Badat, Aysha, Breedt, Johannes, Distiller, Lawrence, Govender, Vimladhevi, Govender, Ravendran, Joshi, Mukesh, Jurgens, Jaco, Latiff, Gulam, Lombard, Landman, Mookadam, Mohamed, Ngcakani, Nomangesi, Nortje, Hendrik, Oosthuizen, Helena, Pillay-Ramaya, Larisha, Prozesky, Hans, Reddy, Jeevren, Rheeder, Paul, Seeber, Mary, Cho, Young Min, Jeong, In-Kyung, Kim, Sin Gon, Kim, Yeong Hoon, Kwon, Hyuk-Sang, Kwon, Min Jeong, Lee, Byung-Wan, Lee, JungEun, Lee, Moon-Kyu, Nam, Moon-Suk, Oh, Kook-Hwan, Park, Cheol- Young, Park, Sun-Hee, Yoon, Kun Ho, Garcia, Pere Alvarez, Mercadal, Luis Asmarats, Barrios, Clara, Castro, Fernando Cereto, Guldris, Secundino Cigarran, Lopez, Marta Dominguez, Egido de los Rios, Jesus, Fresnedo, Gema Fernandez, Serrano, Antonio Galan, Garcia, Isabel, Gonzalez Martinez, Francisco Javier, Jodar Gimeno, Jose Esteban, Mendoza, Manuel Lopez, Marin, Tamara Malek, Portillo, Cristobal Morales, Munar Vila, Maria Antonia, Torres, Manuel Muñoz, Iglesias, Javier Nieto, Perez, Jonay Pantoja, Vera, Merce Perez, Portoles Perez, Jose M., Quesada Simón, María Angustias, Canonge, Rafael Simo, Gonzalez, Alfonso Soto, Riera, Manel Terns, Tinahones Madueno, Francisco Jose, Plaza, Mercedes Velo, Chang, Chwen-Tzuei, Chuang, Lee-Ming, Hsia, Te-Lin, Hsieh, Chang-Hsun, Lin, Chih-Ching, Lu, Yung- Chuan, Sheu, Wayne H-H, Barna, Olga, Bilyk, Svitlana D., Botsyurko, Volodymyr, Dudar, Iryna, Fushtey, Ivan, Godlevska, Olga, Golovchenko, Oleksandr, Gyrina, Olga, Kazmirchuk, Anatoliy, Komisarenko, Iuliia, Korzh, Oleksii, Kravchun, Nonna, Legun, Oleg, Mankovskyy, Borys, Martynyuk, Liliya, Mostovoy, Yuriy, Pashkovska, Nataliia, Pererva, Larysa, Pertseva, Tetyana, Samoylov, Oleksandr, Smirnov, Ivan, Svyshchenko, Yevgeniya, Tomashkevych, Halyna, Topchii, Ivan, Tryshchuk, Nadiya, Tseluyko, Vira, Vizir, Vadym, Vlasenko, Maryna, Zlova, Tetiana, Zub, Liliia, Abusnana, Salah, Railey, Mohamed, Abouglila, Kamal, Ainsworth, Paul, Ali, Zishan, Arutchelvam, Vijayaraman, Barnard, Maria, Bellary, Srikanth, Davies, Emyr, Davies, Mark, Davies, Simon, Dawson, Alison, El Kossi, Mohsen, English, Patrick, Fraser, Donald, Gnudi, Luigi, Gunstone, Anthony, Hall, Timothy, Hanif, Wasim, Jackson, Alan, Johnson, Andrew, Joseph, Franklin, Krishnan, Singhan, Kumwenda, Mick, MacDougall, Iain, Nixon, Paul, O'Hare, Joseph, Philip, Sam, Ramtoola, Shenaz, Saxena, Manish, Sennik, Davesh, Simon, Godwin, Singh, Baldev, Stephens, Jeffrey, Strzelecka, Anna, Symonds, Rehan, Turner, Wayne, Wahba, Mona, Wakeling, John, Wheeler, David, Winocour, Peter, Abdallah, Joseph, Abdullah, Raied, Abramowitz, Matthew, Acosta, Idalia, Aiello, Joseph, Akright, Laura, Akyea-Djamson, Ayim, Alappan, Rajendran, Alicic, Radica, Al-Karadsheh, Amer, Allison, Dale Crawford, Arauz-Pacheco, Carlos, Arfeen, Shahabul, Arif, Ahmed, Arvind, Moogali, Atray, Naveen, Awad, Ahmed, Barnhill, Peggy, Barranco, Elizabeth, Barrera, Carlos, Beacom, Matthew, Behara, Venkata, Belo, Diogo, Bentley-Lewis, Rhonda, Berenguer, Ramon, Bermudez, Lidia, Bernardo, Marializa, Biscoveanu, Mihaela, Bowman-Stroud, Cynthia, Brandon, Donald, Brusco, Osvaldo, Busch, Robert, Canaan, Yamil, Chilito, Alicia, Christensen, Tom, Christiano, Cynthia, Christofides, Elena, Chuateco, Caroucel, Cohen, Kenneth, Cohen, Robert, Cohen-Stein, Debbie, Cook, Charles, Coyne, Daniel, Daboul, Nizar, Darwish, Riad, Daswani, Adarsh, Deck, Kenneth, Desouza, Cyrus, Dev, Devasmita, Dhillon, Monika, Dua, Sohan, Eder, Frank, Elosegui, Ana Maria, El-Shahawy, Mohamed, Ervin, John, Esquenazi, Alberto, Evans, John, Fishbane, Steven, Frias, Juan, Galindo-Ramos, Eugenia, Galphin, Claude, Ghazi, Adline, Gonzalez, Enrique, Gorson, David, Gowda, Anupama, Greco, Barbara, Grubb, Stephen, Gulati, Rakesh, Hammoud, Jamal, Handelsman, Stuart, Hartman, Israel, Hershon, Kenneth, Hiser, Daniel, Hon, George, Jacob, Radu, Jaime, Maria, Jamal, Aamir, Kaupke, Charles, Keightley, Gerald, Kern, Elizabeth, Khanna, Rakhi, Khitan, Zeid, Kim, Sun, Kopyt, Nelson, Kovesdy, Csaba, Krishna, Gopal, Kropp, Jeffrey (Jay), Kumar, Amrendra, Kumar, Jayant, Kumar, Neil, Kusnir, Jorge, Lane, Wendy, Lawrence, Mary, Lehrner, Lawrence, Lentz, John, Levinson, Dennis, Lewis, Derek, Liss, Kenneth, Maddux, Andreas, Maheshwari, Hiralal, Mandayam, Sreedhar, Marar, Isam, Mehta, Bhasker, Middleton, John, Mordujovich, Jorge, Moreda, Ramon, Moustafa, Moustafa, Trenche, Samuel Mujica, Narayanan, Mohanram, Narvarte, Javier, Nassar, Tareq, Newman, George, Nichol, Brian, Nicol, Philip, Nisnisan, Josier, Nossuli, A. Kaldun, Obialo, Chamberlain, Olelewe, Sarah, Oliver, Michael, O'Shaughnessy, Andrew, Padron, John, Pankhaniya, Rohit, Parker, Reginald, Patel, Devesh, Patel, Gnyandev, Patel, Nina, Pavon, Humberto, Perez, Armando, Perez, Carlos, Perlman, Alan, Pettis, Karlton, Pharr, Walter, Phillips, Andrea, Purighalla, Raman, Quesada-Suarez, Luis, Ranjan, Rajiv, Rastogi, Sanjeev, Reddy, Jakkidi, Rendell, Marc, Rich, Lisa, Robinson, Michael, Rodriguez, Hector, Rosas, Sylvia, Saba, Fadi, Sankaram, Rallabhandi, Sarin, Ravi, Schreiman, Robert, Scott, David, Sekkarie, Mohamed, Sensenbrenner, John, Shakeel, Muhammad, Shanik, Michael, Shaw, Sylvia, Smith, Stephen, Solomon, Richard, Sprague, Amy, Spry, Leslie, Suchinda, Pusadee, Sultan, Senan, Surampudi, Prasanth, Sussman, Sherry, Tan, Anjanette, Terrelonge, Antonio, Thompson, Michael, Trespalacios, Fernando, Trippe, Bruce, Trueba, Pilar, Twahirwa, Marcel, Updegrove, John, Van Buren, Peter, Vannorsdall, Mark, Varghese, Freemu, Velasquez-Mieyer, Pedro, Ventrapragada, Sailaja, Vukotic, Goga, Wadud, Khurram, Warren, Mark, Watson, Henry, Watts, Ronald, Weiner, Daniel, Welker, James, Welsh, Jean, Williams, Shelley, Zaniewski-Singh, Michelle, Yi, Tae Won, Smyth, Brendan, Di Tanna, Gian Luca, Arnott, Clare, Cardoza, Kathryn, and Kang, Amy

Published
2023
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37. Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review

Author

Francis Charbonneau, Karina Chahinian, Emmanuel Bebawi, Olivier Lavigueur, Émilie Lévesque, Yoan Lamarche, Karim Serri, Martin Albert, Pierre-Emmanuel Noly, Alexis Cournoyer, and Yiorgos Alexandros Cavayas

Subjects
Cardiogenic shock, Extracorporeal membrane oxygenation, Extracorporeal life support, VA-ECMO, Adults, Biomarkers, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Purpose Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) can be used to restore organ perfusion in patients with cardiogenic shock until native heart recovery occurs. It may be challenging, however, to determine when patients can be weaned successfully from ECMO—surviving without requiring further mechanical support or heart transplant. We aimed to systematically review the medical literature to determine the biomarkers, hemodynamic and echocardiographic parameters associated with successful weaning of VA-ECMO in adults with cardiogenic shock and to present an evidence-based weaning algorithm incorporating key findings. Method We systematically searched PubMed, Embase, ProQuest, Google Scholars, Web of Science and the Grey literature for pertinent original research reports. We excluded studies limited to extracorporeal cardiopulmonary resuscitation (ECPR) as the neurological prognosis may significantly alter the decision-making process surrounding the device removal in this patient population. Studies with a mixed population of VA-ECMO for cardiogenic shock or cardiac arrest were included. We excluded studies limited to patients in which ECMO was only used as a bridge to VAD or heart transplant, as such patients are, by definition, never “successfully weaned.” We used the Risk of Bias Assessment tool for Non-Randomized Studies. The study was registered on the International prospective register of systematic reviews (PROSPERO CRD42020178641). Results We screened 14,578 records and included 47 that met our pre-specified criteria. Signs of lower initial severity of shock and myocardial injury, early recovery of systemic perfusion, left and right ventricular recovery, hemodynamic and echocardiographic stability during flow reduction trial and/or pump-controlled retrograde trial off predicted successful weaning. The most widely used parameter was the left ventricular outflow tract velocity time integral, an indicator of stroke volume. Most studies had a moderate or high risk of bias. Heterogeneity in methods, timing, and conditions of measurements precluded any meta-analysis. Conclusions In adult patients on VA-ECMO for cardiogenic shock, multiple biomarkers, hemodynamic and echocardiographic parameters may be used to track resolution of systemic hypoperfusion and myocardial recovery in order to identify patients that can be successfully weaned. Graphical Abstract

Published
2022
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38. Renal Recovery for Patients with ANCA-Associated Vasculitis and Low eGFR in the ADVOCATE Trial of Avacopan

Author

Peh, C. Au, Chakera, A., Cooper, B., Kurtkoti, J., Langguth, D., Levidiotis, V., Luxton, G., Mount, P., Mudge, D., Noble, E., Phoon, R., Ranganathan, D., Ritchie, A., Ryan, J., Suranyi, M., Rosenkranz, A., Lhotta, K., Kronbichler, A., Demoulin, N., Bovy, C., Hellemans, R., Hougardy, J., Sprangers, B., Wissing, K., Pagnoux, C., Barbour, S., Brachemi, S., Cournoyer, S., Girard, L., Laurin, L., Liang, P., Philibert, D., Walsh, M., Tesar, V., Becvar, R., Horak, P., Rychlik, I., Szpirt, W., Dieperink, H., Gregersen, J., Ivarsen, P., Krarup, E., Lyngsoe, C., Rigothier, C., Augusto, J., Belot, A., Chauveau, D., Cornec, D., Jourde-Chiche, N., Ficheux, M., Karras, A., Klein, A., Maurier, F., Mesbah, R., Moranne, O., Neel, A., Quemeneur, T., Saadoun, D., Terrier, B., Zaoui, P., Schaier, M., Benck, U., Bergner, R., Busch, M., Floege, J., Grundmann, F., Haller, H., Haubitz, M., Hellmich, B., Henes, J., Hohenstein, B., Hugo, C., Iking-Konert, C., Arndt, F., Kubacki, T., Kotter, I., Lamprecht, P., Lindner, T., Halbritter, J., Mehling, H., Schönermarck, U., Venhoff, N., Vielhauer, V., Witzke, O., Szombati, I., Szucs, G., Garibotto, G., Alberici, F., Brunetta, E., Dagna, L., De Vita, S., Emmi, G., Gabrielli, A., Manenti, L., Pieruzzi, F., Roccatello, D., Salvarani, C., Dobashi, H., Atsumi, T., Fujimoto, S., Hagino, N., Ihata, A., Kaname, S., Kaneko, Y., Katagiri, A., Katayama, M., Kirino, Y., Kitagawa, K., Komatsuda, A., Kono, H., Kurasawa, T., Matsumura, R., Mimura, T., Morinobu, A., Murakawa, Y., Naniwa, T., Nanki, T., Ogawa, N., Oshima, H., Sada, K., Sugiyama, E., Takeuchi, T., Taki, H., Tamura, N., Tsukamoto, T., Yamagata, K., Yamamura, M., van Daele, P., Rutgers, A., Teng, Y., Walker, R., Chua, I., Collins, M., Rabindranath, K., de Zoysa, J., Svensson, M., Grevbo, B., Kalstad, S., Little, M., Clarkson, M., Molloy, E., Pamplona, I. Agraz, Anton, J., Lucia, V. Barrio, Ciggaran, S., Cid, M. Cinta, Encarnacion, M. Diaz, Oliveras, X. Fulladosa, Soler, M. Jose, Rusinol, H. Marco, Praga, M., Porras, L. Quintana, Segarra, A., Bruchfeld, A., Segelmark, M., Soveri, I., Thomaidi, E., Westman, K., Neumann, T., Burnier, M., Daikeler, T., Dudler, J., Hauser, T., Seeger, H., Vogt, B., Jayne, D., Burton, J., Al Jayyousi, R., Amin, T., Andrews, J., Baines, L., Brogan, P., Dasgupta, B., Doulton, T., Flossmann, O., Griffin, S., Harper, J., Harper, L., Kidder, D., Klocke, R., Lanyon, P., Luqmani, R., McLaren, J., Makanjuola, D., McCann, L., Nandagudi, A., Selvan, S., O'Riordan, E., Patel, M., Patel, R., Pusey, C., Rajakariar, R., Robson, J., Robson, M., Salama, A., Smyth, L., Sznajd, J., Taylor, J., Merkel, P., Sreih, A., Belilos, E., Bomback, A., Carlin, J., Chen Lin, Y. Chang, Derebail, V., Dragoi, S., Dua, A., Forbess, L., Geetha, D., Gipson, P., Gohh, R., Greenwood, G.T., Hugenberg, S., Jimenez, R., Kaskas, M., Kermani, T., Kivitz, A., Koening, C., Langford, C., Marder, G., Mohamed, A., Monach, P., Neyra, N., Niemer, G., Niles, J., Obi, R., Owens, C., Parks, D., Podoll, A., Rovin, B., Sam, R., Shergy, W., Silva, A., Specks, U., Spiera, R., Springer, J., Striebich, C., Swarup, A., Thakar, S., Tiliakos, A., Tsai, Y., Waguespack, D., Wasko, M. Chester, Cortazar, Frank B., Niles, John L., Jayne, David R.W., Merkel, Peter A., Bruchfeld, Annette, Yue, Huibin, Schall, Thomas J., and Bekker, Pirow

Published
2023
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40. Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy

Author

Fragale, Guillermo, Karl, Alejandra, Losisolo, Patricia, Trimarchi, Hernán, Hoyos, Ivan Gonzalez, Lampo, Mauro Guillermo, Monkowski, Matias, De La Fuente, Jorge, Alvarez, Magdalena, Stoppa, Daniela, Chiurchiu, Carlos, Novoa, Pablo Antonio, Orias, Marcelo, Barron, Maria Belen, Giotto, Ana, Arriola, Mariano, Cassini, Evelin, Maldonado, Rafael, Dionisi, Maria Paula, Ryan, Jessica, Toussaint, Nigel, Luxton, Grant, Peh, Chen Au, Levidiotis, Vicki, Francis, Ross, Phoon, Richard, Fedosiuk, Elena, Toropilov, Dmitry, Yakubtsevich, Ruslan, Mikhailova, Elena, Bovy, Christophe, Demoulin, Nathalie, Hougardy, Jean-Michel, Maes, Bart, Speeckaert, Marijn, Laurin, Louis-Philippe, Barbour, Sean, Masse, Melanie, Hladunewich, Michelle, Reich, Heather, Cournoyer, Serge, Tennankore, Karthik, Lv, Jicheng, Liu, Zhangsuo, Wang, Caili, Li, Shaomei, Luo, Qun, Ni, Zhaohui, Yan, Tiekun, Fu, Ping, Cheng, Hong, Liu, Bicheng, Lu, Wanhong, Wang, Jianqin, Chen, Qinkai, Wang, DeGuang, Xiong, Zuying, Chen, Menghua, Xu, Yan, Wei, Jiali, Pai, Pearl, Chen, Lianhua, Rehorova, Jitka, Maixnerova, Dita, Safranek, Roman, Rychlik, Ivan, Hruby, Miroslav, Makela, Satu, Vaaraniemi, Kati, Ortiz, Fernanda, Alamartine, Eric, Daroux, Maite, Cartery, Claire, Vrtovsnik, Francois, Serre, Jean-Emmanuel, Stamellou, Eleni, Vielhauer, Volker, Hugo, Christian, Budde, Klemens, Otte, Britta, Nitschke, Martin, Ntounousi, Evangelia, Boletis, Ioannis, Papagianni, Aikaterini, Goumenos, Dimitrios, Stylianou, Konstantinos, Zermpala, Synodi, Esposito, Ciro, Cozzolino, Mario Gennaro, Viganò, Sara Maria, Gesualdo, Loreto, Nowicki, Michal, Stompor, Tomasz, Kurnatowska, Ilona, Kim, Sung Gyun, Kim, Yong-Lim, Na, Ki-Ryang, Kim, Dong Ki, Kim, Su-Hyun, Porras, Luis Quintana, Garcia, Eva Rodriguez, Pamplona, Irene Agraz, Segarra, Alfons, Goicoechea, Marian, Fellstrom, Bengt, Lundberg, Sigrid, Hemmingsson, Peter, Guron, Gregor, Sandell, Anna, Chen, Cheng-Hsu, Tokgoz, Bulent, Duman, Soner, Altiparmak, Mehmet Riza, Ergul, Metin, Maxwell, Peter, Mark, Patrick, McCafferty, Kieran, Khwaja, Arif, Cheung, Chee Kay, Hall, Matthew, Power, Albert, Kanigicherla, Durga, Baker, Richard, Moriarty, Jim, Mohamed, Amr, Aiello, Joseph, Canetta, Pietro, Ayoub, Isabelle, Robinson, Derrick, Thakar, Surabhi, Mottl, Amy, Sachmechi, Isaac, Fischbach, Bernard, Singh, Harmeet, Mulhern, Jeffrey, Kamal, Fahmeedah, Linfert, Douglas, Rizk, Dana, Wadhwani, Shikha, Sarav, Menaka, Campbell, Kirk, Coppock, Gaia, Luciano, Randy, Sedor, John, Avasare, Rupali, Lau, Wai Lang, Barratt, Jonathan, Lafayette, Richard, Kristensen, Jens, Stone, Andrew, Cattran, Daniel, Floege, Jürgen, Tesar, Vladimir, Zhang, Hong, Eren, Necmi, Paliege, Alexander, and Rovin, Brad H.

Published
2023
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41. Decision-Making Rationales among Quebec VET Student Aged 25 and Older

Author

Cournoyer, Louis and Deschenaux, Frédéric

Abstract

Each year, a large number of students aged 25 years and over take part in vocational and education training (VET) programs in the Province of Quebec, Canada. The life experiences of many of these adults are marked by complex psychosocial and professional events, which may have influenced their career decision-making processes. This paper aimed to identify key rationales guiding the decisions of adults aged 25 years and older to return to education based on a thematic analysis of 30 semi-structured interviews with students enrolled in a VET program. The analysis focused on two theoretical axes: one biographical and the other interactionist. The first involved personal life courses and professional projects undertaken by the student in the past. The second examined tensions and conflicts between context forces and adjustment strategies adopted by the student. The results revealed five decision-making rationales that characterized the vast majority of the students' experiences: (1) get out of a socioprofessional and economic slump; (2) know yourself better, personally and socially; (3) value the concrete and the practical; (4) take advantage of supporting conditions; and (5) reconcile proximity and the known. The relevance and implications of these findings for professionals and decision makers in vocational training are discussed.

Published
2017

42. Binary Disruption and Ejected Stars from Hierarchical Star Cluster Assembly

Author

Claude Cournoyer-Cloutier, Jeremy Karam, Alison Sills, Simon Portegies Zwart, and Maite J. C. Wilhelm

Subjects
Young star clusters, Star forming regions, Star clusters, Stellar dynamics, Binary stars, Astrophysics, QB460-466
Abstract

We simulate mergers between star clusters embedded within their natal giant molecular cloud. We extract initial conditions from cloud-scale simulations of cluster formation and introduce different prescriptions for primordial binaries. We find that simulations that do not include primordial binaries result in a larger fraction of unbound stars than simulations that include a prescription for binaries based on observations. We also find a preferred direction of motion for stars that become unbound during the merger. Subcluster mergers within realistic gas environments promote binary disruption, while mergers between idealized, gas-rich spherical clusters do not produce the same disruption. Binary systems with smaller semimajor axes are disrupted in simulations of subcluster mergers within their natal environment compared to simulations that do not include the realistic gas environment. We conclude that binary disruption and the production of an anisotropic distribution of unbound stars are the natural consequences of subcluster mergers during star cluster assembly.

Published
2024
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44. Impact of vitamin C on the reduction of opioid consumption after an emergency department visit for acute musculoskeletal pain: a double-blind randomised control trial protocol

Author

David Williamson, Marcel Émond, Alexis Cournoyer, Caroline Arbour, Raoul Daoust, Jean Paquet, Jean-Marc Chauny, Vérilibe Huard, and Dominique Rouleau

Subjects
Medicine
Abstract

Introduction Recent evidence has shown that vitamin C has some analgesic properties in addition to its antioxidant effect and can, therefore, reduce opioid use during recovery time. Vitamin C analgesic effect has been explored mostly during short-term postoperative context or in disease-specific chronic pain prevention, but never after acute musculoskeletal injuries, which are often seen in the emergency department (ED). The protocol’s primary aim is to compare the total morphine 5 mg pills consumed during a 2-week follow-up between patients receiving vitamin C or a placebo after ED discharge for an acute musculoskeletal pain complaint.Methods and analysis We will conduct a two-centre double-blind randomised placebo-controlled trial with 464 participants distributed in two arms, one group receiving 1000 mg of vitamin C two times a day for 14 days and another one receiving a placebo. Participants will be ≥18 years of age, treated in ED for acute musculoskeletal pain present for less than 2 weeks and discharged with an opioid prescription for home pain management. Total morphine 5 mg pills consumed during the 2-week follow-up will be assessed via an electronic (or paper) diary. In addition, patients will report their daily pain intensity, pain relief, side effects and other types of pain medication or other non-pharmacological approach used. Three months after the injury, participants will also be contacted to evaluate chronic pain development. We hypothesised that vitamin C, compared with a placebo, will reduce opioid consumption during a 14-day follow-up for ED discharged patients treated for acute musculoskeletal pain.Ethics and dissemination This study has received approval from the Ethics Review Committee from the ‘Comité d'éthique de la recherche du CIUSSS du Nord-de-l'Île-de-Montréal (No 2023–2442)’. Findings will be disseminated through scientific conferences and peer-reviewed journal publication. The data sets generated during the study will be available from the corresponding author on reasonable request.Trial registration number NCT05555576 ClinicalTrials.Gov PRS.

Published
2023
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49. Stakeholder engagement in developing a father-inclusive early life obesity prevention intervention: First Heroes

Author

Santana R. Silver, Rachel C. Whooten, Gracia M. Kwete, Haley Farrar-Muir, Rachel N. Cournoyer, Elizabeth A. Barth, Milton Kotelchuck, and Elsie M. Taveras

Subjects
Fatherhood, Stakeholder engagement, Community engagement, Obesity prevention, Social determinants of health, Maternal-child health, Gynecology and obstetrics, RG1-991
Abstract

Abstract Background Although paternal involvement in the perinatal period is associated with benefits for maternal-child health and reduced obesity risk, fathers are seldom included in perinatal or obesity prevention efforts. Engaging community leaders and fathers as stakeholders in intervention development is a critical step in designing a father-inclusive intervention that is efficacious and responsive to their needs. Methods We conducted a structured engagement study, including community stakeholder engagement and qualitative interviews with new fathers, to inform the development of a prospective randomized controlled trial that includes mothers and fathers as equal partners in infant obesity prevention. We interpreted stakeholder feedback through the Consolidated Framework for Implementation Research (CFIR) framework. Results Between September 2019 and April 2020, we held a Community Engagement meeting, formed a Community Advisory Board, and conducted 16 qualitative interviews with new fathers. Stakeholder engagement revealed insights across CFIR domains including intervention characteristics (relative advantage, complexity, design quality & packaging), outer setting factors (cosmopolitanism and culture), individual characteristics (including self-efficacy, state of change, identification with the organization) and process (engagement and adaptation). Stakeholders discussed the diverse challenges and rewards of fatherhood, as well as the intrinsic paternal motivation to be a loving, supportive father and partner. Both community leaders and fathers emphasized the importance of tailoring program delivery and content to meet specific parental needs, including a focus on the social-emotional needs of new parents. Conclusions A structured process of multidimensional stakeholder engagement was successful in improving the design of a father-inclusive perinatal obesity prevention interventions. Father engagement was instrumental in both reinforcing community ties and increasing our understanding of fathers’ needs, resulting in improvements to program values, delivery strategies, personnel, and content. This study provides a practical approach for investigators looking to involve key stakeholders in the pre-implementation phase of intervention development. Trial registration ClinicalTrials.gov, NCT04477577 . Registered 20 July 2020.

Published
2022
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50. Safety assessment of a redirection program using an electronic application for low-acuity patients visiting an emergency department

Author

Anne-Laure Feral-Pierssens, Judy Morris, Martin Marquis, Raoul Daoust, Alexis Cournoyer, Justine Lessard, Simon Berthelot, and Alexandre Messier

Subjects
Redirection, Low-acuity patients, Healthcare Use, Quality of care, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Emergency departments (EDs) are operating at or above capacity, which has negative consequences on patients in terms of quality of care and morbi-mortality. Redirection strategies for low-acuity ED patients to primary care practices are usually based on subjective eligibility criteria that sometimes necessitate formal medical assessment. Literature investigating the effect of those interventions is equivocal. The aim of the present study was to assess the safety of a redirection process using an electronic clinical support system used by the triage nurse without physician assessment. Methods A single cohort observational study was performed in the ED of a level 1 academic trauma center. All low-acuity patients redirected to nearby clinics through a clinical decision support system (February–August 2017) were included. This system uses different sets of medical prerequisites to identify patients eligible to redirection. Data on safety and patient experience were collected through phone questionnaires on day 2 and 10 after ED visit. The primary endpoint was the rate of redirected patients returning to any ED for an unexpected visit within 48 h. Secondary endpoints were the incidence of 7-day return visit and satisfaction rates. Results A total of 980 redirected low-acuity patients were included over the period: 18 patients (2.8%) returned unexpectedly to an ED within 48 h and 31 patients (4.8%) within 7 days. No hospital admission or death were reported within 7 days following the first ED visit. Among redirected patients, 81% were satisfied with care provided by the clinic staff. Conclusion The implementation of a specific electronic-guided decision support redirection protocol appeared to provide safe deferral to nearby clinics for redirected low-acuity patients. EDs are pivotal elements of the healthcare system pathway and redirection process could represent an interesting tool to improve the care to low-acuity patients.

Published
2022
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