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Emilie Laflamme,1 François Philippon,1 Kim O’Connor,1 Jean-François Sarrazin,1 Vincent Auffret,1 Vincent Chauvette,1 Michelle Dubois,2 Pierre Voisine,3 Sébastien Bergeron,1 Mario Sénéchal1 1Department of Cardiology, 2Research Center, 3Department of Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada Abstract: Guidelines for cardiac resynchronization therapy (CRT) have been established, but there may be a subgroup of patients not identified in these guidelines who may benefit from this therapy. We report a patient with a dynamic left ventricular dyssynchrony and severe mitral regurgitation caused by exercise successfully treated with CRT. Exercise testing should be considered in patients with left ventricular ejection fraction

Background: A reduction in the rate of death and hospitalisations in patients with heart failure (HF) with reduced ejection fraction receiving sacubitril/valsartan compared to enalapril was demonstrated in the PARADIGM-HF study. However, tolerability when initiating and optimising sacubitril/valsartan treatment in real clinical practice is unknown., Methods: We performed a prospective cohort study of clinical and biochemical parameters of the first 100 patients receiving sacubitril/valsartan in a tertiary HF clinic. Patients had titration of the molecule guided by an algorithm developed by pharmacists and cardiologists in the clinic. The objective was to evaluate the proportion of patients reaching the maximal dosage, the time to reach maximal dosage, and the rate of adverse events, as well as the required modification of other HF therapy during the sacubitril/valsartan titration., Results: Forty-six per cent of patients reached the sacubitril/valsartan maximal dose of 97/103 mg (200 mg) twice daily and 73% received at least 49/51 mg (100 mg) twice daily. Mean titration time was 30 ± 9 days. Symptomatic hypotension, renal dysfunction (increase in creatinine level > 30%) and hyperkalaemia (potassium level > 5.5 mmol/l) occurred in nine, four and 2% of patients, respectively. Background HF pharmacological treatment remained stable during the sacubitril/valsartan titration but daily dosage of furosemide was reduced by 13% ( p = 0.0005)., Conclusions: This algorithm is a safe and easy-to-use tool in daily clinical practice for the introduction and titration of sacubitril/valsartan. Almost half of the patients reached the maximal dose, with a tolerability profile in line with the original study.

High-rate wastewater processes are receiving a renewed interest to obtain energy positive/efficient water resource recovery facilities. An innovative treatment train combining a high-rate moving bed biofilm reactor (HR-MBBR) with an enhanced flotation process was studied. The two objectives of this work were 1) to maximize the conversion of soluble organics to particulate matter in an HR-MBBR and 2) to maximize the particulate matter recovery from the HR-MBBR effluent by green chemicals to enhance biogas production by anaerobic digestion. To achieve these objectives, lab-scale MBBRs fed with synthetic soluble wastewater were operated at organic loading rates (OLRs) between 4 and 34 kg COD m -3 reactor d -1 corresponding to hydraulic retention times (HRTs) between 6 and 54 min. Colloidal and soluble chemical oxygen demand (COD) removal efficiency in the HR-MBBR increased with HRT to reach a plateau of 85% at an HRT longer than 27 min. Carrier clogging observed at an OLR higher than 16 kg COD m -3 d -1 (HRT < 13 min) resulted in about 23% loss in colloidal and soluble COD removal efficiency. Thus, the recommended parameters were between 22 and 37 min and between 6 and 10 kg COD m -3 d -1 for the HRT and the OLR, respectively, to maximize the conversion of soluble organics to particulate matter. Total suspended solids (TSS) recovery of 58-85% and 90-97% were achieved by enhanced flotation using green and unbiodegradable chemicals, respectively, corresponding to a TSS effluent concentration below 14 and 7 mg TSS/L. Among the synthetic polymers tested, a high molecular weight and low charge density cationic polyacrylamide was found to give the best results with less than 2 mg TSS/L in the clarified effluent (97% TSS recovery). Green chemicals, although performing slightly less for solids separation than unbiodegradable chemicals, achieved a mean TSS concentration of 10 ± 3 mg/L in the clarified effluent., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Rationale: Optimal, early management following a spinal cord injury (SCI) can limit individuals' disabilities and costs related to their care. Several knowledge syntheses were recently published to guide health care professionals with regard to early interventions in SCI patients. However, no knowledge translation (KT) intervention, selected according to a behaviour change theory, has been proposed to facilitate the use of SCI guidelines in an acute care setting., Objectives: To develop theory-informed KT interventions to promote the application of evidence-based recommendations on the acute care management of SCI patients., Methods: The first four phases of the knowledge-to-action model were used to establish the study design. Knowledge selection was based on the Grading of Recommendations Assessment, Development and Evaluation system. Knowledge adaptation to the local context was sourced from the ADAPTE process. The theoretical domains framework oriented the selection and development of the interventions based on an assessment of barriers and enablers to knowledge application., Results: Twenty-nine recommendations were chosen and operationalized in measurable clinical indicators. Barriers related to knowledge, skills, perceived capacities, beliefs about consequences, social influences, and the environmental context and resources theoretical domains were identified. The mapping of behaviour change techniques associated with those barriers led to the development of an online educational curriculum, interdisciplinary clinical pathways as well as policies and procedures., Conclusions: This research project allowed us developing KT interventions according to a thorough behavioural change methodology. Exposure to the generated interventions will support health care professionals in providing the best care to SCI patients., (© 2015 John Wiley & Sons, Ltd.)