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PURPOSE OF REVIEW Current immunosuppressive regimens used in kidney transplantation are sometimes ineffective and carry significant risks of morbidity and mortality. Cellular therapies are a promising alternative to prolong graft survival while minimizing treatment toxicity. We review the recently published breakthrough studies using cell therapies in kidney transplantation. RECENT FINDINGS The reviewed phase I and II trials showed that cell therapies are feasible and safe in kidney transplantation, sometimes associated with less infectious complications than traditional regimens. Regulatory T cells and macrophages were added to the induction regimen, allowing for lower immunosuppressive drug doses without higher rejection risk. Regulatory T cells are also a treatment for subclinical rejection on the 6 months biopsy. Other strategies, like bone marrow-derived mesenchymal cells, genetically modified regulatory T cells, and chimerism-based tolerance are also really promising. In addition, to improve graft tolerance, cell therapy could be used to prevent or treat viral infection after transplantation. SUMMARY Emerging data underline that cell therapy is a feasible and safe treatment in kidney transplantation. Although the evidence points to a benefit for transplant recipients, studies with standardized protocols, representative control groups, and longer follow-up are needed to answer the question definitively and guide future research.

The nucleolus is a dynamic nuclear structure which plays important roles in ribosome biogenesis and cellular stress response to stressors such as viral infection. The nucleolus and nucleolar proteins are essential for the progression of infection by several viruses. Consequently, viral infection often induces alterations in nucleolar structure and composition. Here, we applied a deep learning algorithm segmentation and nucleolin labeling to analyze the nucleolar changes induced by autonomous parvovirus infection. Our results show that the size of nucleoli decreases and nucleolin is released into the nucleoplasm in late infection. Analyses of ki-67, one of the NS2-associated nucleolar proteins and a key factor in nucleolar organization, showed that the interaction between ki-67 with DNA increases in infection. The infection initiated by a viral clone lacking an intact NS2 failed to decrease the nucleolar size, however, the orientation of the nucleoli was changed. Our results suggest that parvoviruses modify and exploit nucleoli and nucleolar proteins during infection, and NS2 protein might play a role in the regulation of these processes.Authors summaryAutonomous parvoviruses with small genomes and only a small number of encoded proteins depend on the cellular nuclear machinery for their efficient replication. The nucleolus is an active nuclear structure involved in the essential functions of cells including synthesis of ribosomal RNA and regulation of cell growth and cellular stress. Many viruses target the nucleoli to manipulate cellular antiviral defense and to facilitate their replication by recruiting nucleolar proteins. Capsids of dependoparvoviruses, such as AAV, are assembled in the nucleolus, however, much less is known about how autonomous parvoviruses interact with the nucleolus. Our results suggest that the progression of autonomous parvovirus infection results in structural alteration of nucleolar structure and redistribution of nucleolar proteins. Analyses of the nonstructural protein NS2 mutants in comparison to wild-type infection indicated that NS2 might play an important role in viral interactions with the nucleolus.

Introduction To prevent bleeding after native kidney biopsy (NKB), nephrologists often prescribe desmopressin, especially for patients with reduced estimated glomerular filtration rate (eGFR) at risk of uremia-related platelet dysfunction. However, only 1 randomized study has suggested a beneficial effect for desmopressin in patients with eGFR ≥60 ml/min per 1.73 m2. This retrospective cohort study aimed to evaluate desmopressin effect on postbiopsy bleeding in all patients, regardless of eGFR and other comorbidities. Methods In this retrospective cohort study, all adult patients who underwent an NKB from April 1, 2013, to April 30, 2018, in a tertiary hospital were identified. The association between desmopressin use and bleeding complications, including hemoglobin fall, transfusion, hematoma, symptomatic hematoma, urgent radiologic study, and hypotension, was analyzed using multivariable logistic regression models. Results A total of 413 native kidney biopsies were studied, 79% of which were performed after receiving desmopressin. Patients receiving desmopressin had worse chronic kidney disease (eGFR 28 vs. 45 ml/min per 1.73 m2; P < 0.001) and were more often hospitalized (48% vs. 32%; P = 0.009). Despite higher bleeding risk, patients using desmopressin had a similar likelihood of symptomatic hematomas (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.13–1.14) and a lower need for urgent radiologic studies (OR, 0.33; 95% CI, 0.11–0.98). Conclusion Patients at higher risk of bleeding using desmopressin before kidney biopsy had bleeding complications similar to those not using desmopressin. These results highlight potential important clinical and financial benefits of desmopressin use before kidney biopsy., Graphical abstract

The cause of podocyte injury in idiopathic nephrotic syndrome (INS) remains unknown. Although recent evidence points to the role of B cells and autoimmunity, the lack of animal models mediated by autoimmunity limits further research. We aimed to establish a mouse model mimicking human INS by immunizing mice with Crb2, a transmembrane protein expressed at the podocyte foot process.C3H/HeN mice were immunized with the recombinant extracellular domain of mouse Crb2. Serum anti-Crb2 antibody, urine protein-to-creatinine ratio, and kidney histology were studied. For signaling studies, a Crb2-expressing mouse podocyte line was incubated with anti-Crb2 antibody.Serum anti-Crb2 autoantibodies and significant proteinuria were detected 4 weeks after the first immunization. The proteinuria reached nephrotic range at 9-13 weeks and persisted up to 29 weeks. Initial kidney histology resembled minimal change disease in humans, and immunofluorescence staining showed delicate punctate IgG staining in the glomerulus, which colocalized with Crb2 at the podocyte foot process. A subset of mice developed features resembling FSGS after 18 weeks. In glomeruli of immunized mice and in Crb2-expressing podocytes incubated with anti-Crb2 antibody, phosphorylation of ezrin, which connects Crb2 to the cytoskeleton, increased, accompanied by altered Crb2 localization and actin distribution.The results highlight the causative role of anti-Crb2 autoantibody in podocyte injury in mice. Crb2 immunization could be a useful model to study the immunologic pathogenesis of human INS, and may support the role of autoimmunity against podocyte proteins in INS.

Quantification of the M-type phospholipase A2 receptor antibodies (anti-PLA2R) is now an essential tool for diagnosis and management of primary membranous nephropathy (MN). Since October 2018, Hôpital Maisonneuve-Rosemont (HMR) has been designated as Quebec's reference center for serum anti-PLA2R antibody testing by theTo describe the 2-step method of serum qualitative and quantitative anti-PLA2R antibody testing during its first year of use in Quebec and analyze its diagnostic value in the province's population.Retrospective cohort study.Single-center academic teaching hospital in Quebec, Canada.All patients who had a serum anti-PLA2R antibody test analyzed at HMR from October 1, 2018, to October 1, 2019, were included in the study.Serum anti-PLA2R antibodies were screened by indirect immunofluorescence tests. If results were positive or undetermined, it was followed by a quantitative enzyme-linked immunosorbent assay (ELISA) test. Both tests were based on a commercial kit developed by the same company.We calculated sensitivity, specificity, predictive value, and likelihood ratio for both tests, using kidney biopsy findings performed at HMR as the gold standard.In Quebec, a total of 1690 tests were performed among 1025 patients during the study year. A small proportion of these patients (8%) were followed at HMR. Patients tested at HMR and in the rest of Quebec had similar characteristics. Test validity was only characterized for patients tested at HMR. Sensitivity and specificity were, respectively, 58% and 100% for the qualitative test, and 71% and 100% for the quantitative test. The combined net sensitivity was 42% and the net specificity 100%. The net positive and negative predictive value were 100% and 84% respectively, whereas the net negative likelihood ratio was 0.58.As the detailed analysis was only possible in the small proportion of patients clinically followed at HMR, there is a possible selection bias. Another potential selection bias was the focus on patients who were selected to have a kidney biopsy, probably because of more severe disease, higher probability of glomerulonephritis, or lesser number of comorbidities. Given the retrospective nature of this study, there was no systematic kidney biopsy or serum PLA2R antibody testing performed. Finally, we were unable to provide detailed information on the timing between immunosuppressive therapy and anti-PLA2R results.Serum anti-PLA2R antibody testing was widely used in Quebec during its first year of availability. A 2-step approach, using a qualitative test first, followed by a quantitative test if the results are positive or undetermined, appears efficient to avoid useless quantitative testing in negative patients and to better characterize undetermined results on immunofluorescence.Due to the retrospective nature of this study, no trial registration was performed.La quantification des anticorps des récepteurs de la phospholipase A2 de type M (anti-PLA2R) est désormais un outil essentiel pour le diagnostic et la prise en charge de la glomérulonéphrite extra-membraneuse primaire (GEMp). Depuis octobre 2018, l’Hôpital Maisonneuve-Rosemont (HMR) a été désigné par l’Institut National d’Excellence en Santé et Services Sociaux (INESSS)—l’organisme règlementant l’usage des médicaments et des tests au Québec—comme le centre hospitalier de référence dans la province pour le dépistage des anticorps sériques anti-PLA2R.Décrire la méthode en deux étapes du test qualitatif et quantitatif des anticorps anti-PLA2R sériques au cours de sa première année d’utilisation au Québec et évaluer sa valeur diagnostique dans la population de la province.Étude de cohorte rétrospective.Un centre hospitalier universitaire du Québec (Canada).Ont été inclus tous les patients dont le test des anticorps sériques anti-PLA2R a été analysé à HMR entre le 1er octobre 2018 et le 1er octobre 2019.Les anticorps sériques anti-PLA2R ont été détectés par immunofluorescence indirecte. Les résultats positifs ou indéterminés ont été suivis d’un test ELISA quantitatif. Les deux tests ont été réalisés à l’aide de trousses commerciales développées par la même entreprise.Nous avons analysé la sensibilité, la spécificité, la valeur prédictive et le rapport de vraisemblance des deux tests avec comme référence des résultats de biopsie rénale obtenus à HMR.Au Québec, au cours de l’année de l’étude, 1 690 tests ont été effectués sur 1 025 patients; une faible proportion de ces patients (8 %) étaient suivis à HMR. Les patients, qu’ils aient été testés à HMR et ailleurs au Québec, présentaient des caractéristiques semblables. La validité du test n’a été caractérisée que pour les patients testés à HMR. La sensibilité et la spécificité s’établissaient respectivement à 58 % et à 100 % pour le test qualitatif, et à 71 % et 100 % pour le test quantitatif. La sensibilité nette combinée était de 42 % et la spécificité nette, de 100 %. Les valeurs prédictives nettes, positive et négative, étaient respectivement de 100 % et de 84 %, alors que le ratio net de probabilité négative était de 0,58.L’étude présente un possible biais de sélection puisque l’analyse détaillée n’était possible que pour la faible proportion de patients suivis à HMR. L’accent mis sur les patients sélectionnés pour une biopsie rénale, probablement en raison d’une maladie plus grave, d’une probabilité plus élevée de glomérulonéphrite ou d’un moins grand nombre de comorbidités, constitue un autre possible biais de sélection. Aucune biopsie rénale ou test d’anticorps de PLA2R sérique systématique n’a été effectué puisque l’étude est rétrospective. Enfin, il n’a pas été possible de fournir des informations détaillées sur le temps écoulé entre le traitement immunosuppresseur et les résultats du test d’anticorps anti-PLA2R.Le test d’anticorps sériques anti-PLA2R a été largement utilisé au Québec au cours de sa première année de disponibilité. Une approche en deux étapes, constituée d’un test qualitatif suivi d’un test quantitatif si le résultat est positif ou indéterminé, semble efficace pour éviter de procéder inutilement à des tests quantitatifs chez les patients négatifs et pour caractériser plus précisément les résultats indéterminés par immunofluorescence.L’essai n’a pas été enregistré puisqu’il s’agit d’une étude rétrospective.

Residual renal function and diuresis preservation are associated with improved volume control and lower mortality in peritoneal dialysis (PD). Loop diuretics are used to maintain diuresis, although their optimal dosage remains unclear. This study aimed to compare the pharmacodynamics of a 250-mg and a 500-mg dose of oral furosemide in PD patients. 12 patients with a diuresis > 100 mL per day were randomized in a crossover pattern to successively receive an oral dose of 250 mg and 500 mg of furosemide. Twelve-hour natriuresis and diuresis were measured before and after each furosemide dose. Fractional excretion of sodium (FENa) and absolute sodium excretion increased after each dose, although these rises were not statistically significantly different (5.8% (250 mg) vs. 6.9% (500 mg), p = 0.57 for FENa and 42.6 mmol/12h (250 mg) vs. 70.8 mmol/12h (500 mg), p = 0.07 for absolute sodium excretion). Urinary volume was significantly increased after the 500-mg dose, whilst the difference did not reach statistical significance after the 250-mg dose. Furthermore, the higher dose was associated with a greater increase in diuresis than the lower dose (226 mL (250 mg) vs. 522 mL (500 mg), p = 0.04). Furosemide could be used at oral single doses reaching 500 mg in PD patients requiring greater volume control.

We report a case of minimal change disease (MCD) with severe acute kidney injury (AKI) following the first injection of the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford-AstraZeneca against coronavirus disease 2019 (COVID-19). A 71-year-old man with a history of dyslipidemia and a baseline serum creatinine of 0.7mg/dL presented with nephrotic syndrome, AKI, and severe hypertension 13 days after receiving the Oxford-AstraZeneca vaccine. Refractory hyperkalemia and hypervolemia with oligoanuria prompted initiation of hemodialysis. His serum albumin was 2.6g/dL and his urinary protein-creatinine ratio was 2,321mg/mmol. Given a high suspicion for rapidly progressive glomerulonephritis, empirical glucocorticoid treatment was initiated (3 methylprednisolone pulses followed by high-dose prednisone). A kidney biopsy showed MCD and acute tubular injury. Kidney function and proteinuria subsequently improved, and hemodialysis was discontinued 38 days after the start of therapy. This case describes de novo MCD after the Oxford-AstraZeneca vaccine. It adds to the few published case reports of MCD after the Pfizer-BioNTech COVID-19 vaccine. Further reports and studies will be needed to elucidate whether MCD is truly associated with COVID-19 vaccination.

ObjectiveTo compare the mortality and morbidity of traumatically injured patients who received additional prehospital care by a doctor and critical care paramedic enhanced care team (ECT), with those solely treated by a paramedic non-ECT.MethodsA retrospective analysis of Trauma Audit and Research Network (TARN) data and case note review of all severe trauma cases (Injury Severity Score ≥9) in North East England from 1 January 2014 to 1 December 2017 who were treated by the North East Ambulance Service, the Great North Air Ambulance Service or both. TARN methods were used to calculate the number of unexpected survivors or deaths in each group (W score (Ws)). The Glasgow Outcome Scores were contrasted to evaluate morbidity.ResultsThe ECT group treated 531 patients: there were 17 unexpected survivors and no unexpected deaths. The non-ECT group treated 1202 patients independently: there were no unexpected survivors and 31 unexpected deaths. The proportion of patients requiring critical care interventions differed between the two groups 49% versus 33% (CI for difference 12% to 20%). In the ECT group, the Ws was 3.22 (95% CI 0.79 to 5.64). In the non-ECT group, the Ws was −2.97 (95% CI −1.22 to −4.71). The difference between the Ws was 6.18 (95% CI 3.19 to 9.17). There was no evidence of worse morbidity in the ECT group.ConclusionThis is the first UK ECT service to demonstrate a risk-adjusted mortality benefit in trauma patients with no detriment in morbidity: our results demonstrate an additional 3.22 survivors per 100 severe trauma casualties when treated by an ECT. The authors encourage other ECT services to conduct similar research.

Although employee motivation and psychological health at work have been found to be related, it remains unclear whether motivation precedes psychological health or vice versa, and to which extent different manifestations of mental health relate to different forms of motivation at work. Using the self-determination theory and the bidimensional theory of psychological health, this complete panel design study tested the directionality of the relationship between motivation at work and psychological health at work, with a dedicated focus on the specific predictive patterns observed between 4 types of motivation at work and positive and negative indicators of psychological health at work. Eight hundred and five Canadian workers completed questionnaires at 2 times, separated by a 6-month interval. Structural equation modelling analyses indicated that only identified regulation and psychological well-being at work have a fully reciprocal relationship. Only psychological well-being at work was positively ...

Background:Individuals with Parkinson’s disease (PD) often present with visual symptoms (e.g., difficulty in reading, double vision) that can also be found in convergence insufficiency (CI). Our objective was to estimate the prevalence of CI-type visual symptomatology in individuals with PD, in comparison with controls.Methods:Participants ≥50 years with (n=300) and without (n=300) PD were recruited. They were administered the Convergence Insufficiency Symptom Survey (CISS–15) over the phone. A score of ≥21 on the CISS–15, considered positive for CI-type symptomatology, served as the cutoff. Data from individuals (n=87 with,n=94 without PD) who were approached but who reported having a known oculovisual condition were analysed separately. Student’sttest and chi-square at the 0.05 level were employed for statistical significance.Results:A total of 29.3% of participants with versus 7.3% without PD presented with a score of ≥21 on the CISS–15 (p=0.001). Of the participants having a known oculovisual condition, 39.1% with versus 19.1% without PD presented with a score of ≥21 on the CISS–15 (p=0.01).Conclusions:The prevalence of CI-type visual symptoms is higher in individuals with versus without PD whether or not they have a coexisting oculovisual condition. These results suggest that PD per se places individuals with the disease at greater risk of visual symptomatology. These results further underline the importance of providing regular eye exams for individuals with PD.

Purpose To estimate the prevalence of visual impairment (VI) in a sub-population of Canadian long-term care facilities, i.e. residents affected by dementia. Methods This study was conducted in the long-term care facility units at the Institut universitaire de geriatrie de Montreal. All residents ≥65 years old (y.o.), having a clinical diagnosis of dementia, and able to understand French or English, were eligible for participation in the study. All residents participating in the study received a complete eye exam by an experienced optometrist. For the purpose of the study, VI was defined as a distance visual acuity (VA)

Cell proteomes are often characterized using electrophoresis assays, where all species of proteins in the cells are non-specifically labeled with a fluorescent dye and are spotted by a photodetector following their separation. Single molecule fluorescence imaging can provide ultrasensitive protein detection with its ability for visualizing individual fluorescent molecules. However, the application of this powerful imaging method to electrophoresis assays is hampered by the lack of ways to characterize the homogeneity of fluorescent labeling of each protein species across the proteome. Here, we developed a method to evaluate the labeling homogeneity across the proteome based on a single molecule fluorescence imaging assay. In our measurement using a HeLa cell sample, the proportion of proteins labeled with at least one dye, which we termed 'labeling occupancy' (LO), was determined to range from 50% to 90%, supporting the high potential of the application of single molecule imaging to sensitive and precise proteome analysis.

Background We recently reported that convergence insufficiency (CI)-type visual symptomatology was more prevalent in participants with Parkinson's disease (PD), compared to controls. The objective of this work was to determine the prevalence of a confirmed clinical diagnosis of CI in PD, compared to controls. Methods Participants with (n = 80) and without (n = 80) PD were recruited and received an eye exam. Published criteria were used to arrive at a clinical diagnosis of CI. The Convergence Insufficiency Symptom Survey (CISS-15) questionnaire was administered to each participant, with a score of ≥21 being considered positive for CI symptomatology. Student t test, chi-square, or nonparametric tests at the 0.05 level were used for statistical significance. Results A total of 43.8% of participants with versus 16.3% without PD had a clinical diagnosis of CI (P ≤ 0.001). A total of 53.8% of participants with versus 18.8% without PD had scores on the CISS-15 of ≥21 (P ≤ 0.001). Conclusions These results indicate that individuals with PD have a higher prevalence of CI and CI symptomatology than controls. These data provide evidence supporting the notion that treatment for symptomatic CI should be investigated in individuals with PD.

High-throughput chromosome conformation capture (Hi-C) technology enables the investigation of genome-wide interactions among chromosome loci. Current algorithms focus on topologically associating domains (TADs), that are contiguous clusters along the genome coordinate, to describe the hierarchical structure of chromosomes. However, high resolution Hi-C displays a variety of interaction patterns beyond what current TAD detection methods can capture. Here, we present BHi-Cect, a novel top-down algorithm that finds clusters by considering every locus with no assumption of genomic contiguity using spectral clustering. Our results reveal that the hierarchical structure of chromosome is organized as ‘enclaves’, which are complex interwoven clusters at both local and global scales. We show that the nesting of local clusters within global clusters characterizing enclaves, is associated with the epigenomic activity found on the underlying DNA. Furthermore, we show that the hierarchical nesting that links different enclaves integrates their respective function. BHi-Cect provides means to uncover the general principles guiding chromatin architecture.

Backgound An exercise program involving patients, caregivers, and professionals, entitled SPecific Retraining in INTerdisciplinarity (SPRINT), has been developed to prevent functional decline during hospitalization of older patients. Goal Assess the feasibility of implementing SPRINT in the context of a Geriatric Assessment Unit (GAU). Methods GAU’s health-care professionals were instructed with the SPRINT. All new patients were evaluated by a physiotherapist shortly after admission to validate the eligibility criteria and allocation category of exercises. Questionnaires on physical activities were filled out by professionals, patients, and caregivers at baseline and after intervention. Quantitative and qualitative information was collected on adherence to the program. Results SPRINT was applied to 19 of the 50 patients admitted during the three-month pilot study. A daily average of one exercise session per patient was performed, most frequently with a nurse (37%), physician (20%), care attendant (13%) or by the patient alone (22%). The caregivers participated only 4% of the time. Barriers and facilitators in applying SPRINT have been identified. Conclusions SPRINT appears relevant and applicable within GAUs. Future studies should be conducted to assess its safety and effectiveness in preventing hospital-related functional decline.

Fluorescence-based electrophoresis has been widely used for proteome analysis in which every protein species in cells is labeled with a fluorescent dye, separated by electric migration, and quantified using fluorescence detection. The ultimate limit of sensitivity for this approach could be reached by single-molecule fluorescence imaging and counting individual proteins, requiring exhaustive fluorescent labeling of proteins across molecular populations and species. However, it remains unclear how homogeneous the fluorescence labeling of individual protein molecules of each species is across the proteome. To address this question, we developed a method to measure the labeling homogeneity based on a single-molecule fluorescence counting assay. Our results reveal that the proportion of proteins labeled with at least one dye, called labeling occupancy (LO), was 35% for fluorescently labeled BSA using existing protocols. We then found that the LO could be improved to 82% under high pH and surfactant-rich conditions. Furthermore, when a proteome sample from a human cell lysate was analyzed, the total LO was 71%, whereby the values varied between 50 and 90% for low and high molecular weight proteome fractions, respectively. The results support the possibility of sensitive detection of proteins using single-molecule counting with fluorescent labeling at the proteome scale.

Abstract: The partnership represents a principle of action at the heart of public policies of various kinds. It can be defined as a formal association between organizations that decide to cooperate to achieve a common goal. The formative evaluation of quality conditions of the collaborative action is useful to support partners in improving their practice. This article describes first a tool available to achieve a collective diagnosis by members of a partnership investing voluntarily in an evaluation process and then presents a concrete application of it. It concludes by exposing some knowledge and lessons learned from the experience of the evaluation of a partnership for a comprehensive and integrated cross-sectoral school-community intervention.

OBJECTIVES: Second-hand smoke (SHS) can attain high concentrations in cars. To protect children’s health, nine Canadian provinces have enacted legislation prohibiting smoking in privately owned vehicles when children are present; Quebec is the only province with no such legislation. The objective of this study was to estimate the proportion of smokers in Quebec who smoke while travelling in a private vehicle in which children are present, and to compare the characteristics of smokers who do and do not smoke in cars. METHODS: In 2011–12, 754 daily smokers who recently travelled in a car with children completed a telephone survey in which they reported how frequently they smoked in a car, if there were smoking restrictions, and perceptions about the effectiveness of legislation prohibiting smoking in cars when children are present. RESULTS: Twenty-three percent of daily smokers smoked at least occasionally in their car when children were present. This proportion was higher among smokers who knew that there was no legislation in Quebec prohibiting smoking in cars, compared to smokers who believed that such legislation was already in effect (32% vs. 12%). Smokers with a university degree and those who reported that smoking was prohibited at home were less likely to expose children to SHS in cars. Most daily smokers (75%) believed that legislation would be effective. DISCUSSION: The results of this study suggest that legislation prohibiting smoking in cars is necessary to protect children from SHS, that such legislation would be effective, and that it may be relatively easy to implement.

Maple sap is a product of great economic value with a variable composition. Samples of maple sap were collected at different periods of the 2007 and 2008 seasons in various locations in Quebec (Canada). The aim of the study was to establish a typical chemical composition of maple sap by analyzing a large number of maple sap samples. Multiple factor analysis was also performed to help establish relationships among compounds. Results confirm that total soluble solids and sucrose concentration were higher near mid-season. The concentration of specific organic acids in sap could depend on the sugarbush (malic acid) or could be influenced by microbial activity (acetic and lactic acid). Phenolic compounds of interest were present mainly at the beginning of the season and decreased as the season progressed. The concentrations of the main minerals (K, Ca and Mg) increased over the sap flow season and the presence of calcium and magnesium seemed highly correlated. These results will help in establishing an update of mean values and ranges for many components of maple sap.

Contexte : Les stages realises en milieu pratique ont pris beaucoup d’importance ces dernieres annees dans le domaine de la sante et des services sociaux. Les milieux souffrent d’un manque croissant d’effectif dans beaucoup de disciplines. But : La presente revue vise a determiner l’impact de l’enseignement clinique sur la performance des etablissements. Methodes : Une revue systematique par l’interrogation de huit bases de donnees a ete realisee de facon a recenser et a evaluer la qualite methodologique des etudes quantitatives comparatives et les revues systematiques existantes publiees en anglais, en francais ou en espagnol. Resultats : Dix-neuf etudes primaires ont ete retenues (quatorze en medecine et cinq en physiotherapie) ainsi qu’une revue systematique. Les resultats indiquent que l’encadrement clinique lors de la formation medicale resulte en impacts positifs pour les patients et le milieu d’accueil des residents. Ils montrent que la supervision des residents conduit soit a un effet favorable, soit a l’absence de differences sur les habitudes de pratique en matiere d’utilisation des ressources, de respect des protocoles et de resultats cliniques. Les resultats de cinq etudes sur les impacts de stagiaires en physiotherapie font ressortir une augmentation de la productivite en ce qui a trait au nombre de patients traites et au temps de soins directs et indirects aux patients. Conclusion : La revue temoigne de la paucite des etudes sur le sujet. Elle fournit une reponse preliminaire moderee a solide pour indiquer que l’offre de stages peut presenter un bilan favorable quant aux impacts potentiels sur la performance organisationnelle.

Background: Health systems worldwide struggle to identify, adopt, and implement in a timely and system-wide manner the best—evidence-informed—policy-level practices. Yet, there is still only limited evidence about individual and institutional best practices for fostering the use of scientific evidence in policy-making processes The present project is the first national-level attempt to (1) map and structurally analyze—quantitatively—health-relevant policy-making networks that connect evidence production, synthesis, interpretation, and use; (2) qualitatively investigate the interaction patterns of a subsample of actors with high centrality metrics within these networks to develop an in-depth understanding of evidence circulation processes; and (3) combine these findings in order to assess a policy network’s “absorptive capacity” regarding scientific evidence and integrate them into a conceptually sound and empirically grounded framework. Methods: The project is divided into two research components. The first component is based on quantitative analysis of ties (relationships) that link nodes (participants) in a network. Network data will be collected through a multi-step snowball sampling strategy. Data will be analyzed structurally using social network mapping and analysis methods. The second component is based on qualitative interviews with a subsample of the Web survey participants having central, bridging, or atypical positions in the network. Interviews will focus on the process through which evidence circulates and enters practice. Results from both components will then be integrated through an assessment of the network’s and subnetwork’s effectiveness in identifying, capturing, interpreting, sharing, reframing, and recodifying scientific evidence in policy-making processes. Discussion: Knowledge developed from this project has the potential both to strengthen the scientific understanding of how policy-level knowledge transfer and exchange functions and to provide significantly improved advice on how to ensure evidence plays a more prominent role in public policies.

Introduction: This study reports a case series of orthoptic treatment (OT) for convergence insufficiency (CI) in individuals with Parkinson’s disease (PD). Method: We are reporting two cases of individuals with PD who completed OT for CI. Both had a confirmed diagnosis of CI, accompanied by CI-type symptomatology. They each underwent an OT program consisting of three office-based visits and 8 weeks of home-based exercises. Treatment outcome was based on the changes measured pre- versus post-OT on the near point of convergence, positive fusional vergences, and symptomatology score. Results: The two participants successfully completed therapy, gained ability to converge, had fewer symptoms, and were satisfied with the OT-induced changes they felt in their day-to-day lives. Conclusion: This case series show that OT for CI in PD is possible. Further research is required as these results demonstrate that OT has the potential to improve symptomatic CI in these patients. In the meantime, the positive results obtained in these two cases should encourage clinicians to consider OT (a therapy with no/minimal risk) for CI in patients with PD whose quality of life is affected by this binocular dysfunction.

Background Besides personal and professional experiences, long term care providers' own attitudes toward death may affect the care given to dying residents. Objectives To assess beliefs, values, and attitudes toward death, dying, palliative, and interdisciplinary care in long term care workers and identify any differences between different job categories and places of work. Design Descriptive cross-sectional survey study. Setting Five public long term care facilities. Participants One thousand one hundred seventy volunteers, clinical managers, and all categories of residential long term care workers. Measurements and Methods An anonymous paper or electronic self-administered survey questionnaire consisting of 24 items, answered on a 4-point bipolar Likert scale. Between-group differences were compared with the analysis of variance test after adjustment for the multiple post-hoc comparisons. Results Healthcare workers had a relatively positive attitude toward more than one-half of the selected aspects of interdisciplinary practice and end-of-life palliative care for long-term residents. However, attitudes were more mixed about 10 other aspects and a higher percentage of respondents indicated negative attitudes toward them. Overall, there are significant differences between upper-level professionals and managers (registered nurses, physicians, rehabilitation staff, and clinical managers) vs the hands-on caregivers (nursing assistants, patient assistants, and volunteers) with regard to some aspects of the care of the dying. Conclusions The results suggest that healthcare workers' attitudes need to be taken into account in long term care facilities. Patient assistants, volunteers, and nursing assistants seem most likely to above all benefit from training and support programs.

In Table 3, there were missing values in the Physical activity and Smoking status sections. The correct version of Table 3 is displayed here.

The bioavailability of a small silver nanoparticle (nAg; nominal size of 5 nm with a polyacrylate coating) by the green alga C. reinhardtii was investigated in order to assess the contributions of Ag(+) and nAg to cellular internalization. Upon exposure to nAg, Ag biouptake exceeded what was predicted based upon measured Ag(+) concentrations. Indeed, although Ag biouptake was greatly reduced when excess cysteine was added to the nAg, it was nonetheless significantly above control levels. For both exposures to nAg and Ag(+), expression levels of the Copper Transport Protein 2 (CTR2) indicated that Ag biouptake could be attributed to the internalization of Ag(+). Exposure to Ag(+) or nAg increased CTR2 expression, even when cysteine was present with the nAg. Darkfield microscopy coupled with hyperspectral imagery showed that the presence of silver nanoparticles inside the cells was more likely due to the rereduction of Ag(+) than to the internalization of nAg. The weight of evidence indicated that nAg increased Ag biouptake by locally increasing the surface concentrations of Ag(+).

Abstract: The use of results produced through an evaluation process is a real concern for evaluators, especially when the process has a formative purpose. Utilization focused-evaluation seeks to ensure that several conditions must be met to optimize the use of knowledge generated during the evaluation process. This article describes this approach as well as the conditions of transfer of knowledge that optimize the use of evaluation results by users. It provides a concrete example of an applied utilization-focused evaluation and highlights the success factors.

Objective The evaluation of visual acuity (VA) in cognitively impaired older individuals may be limited by a reduced ability to cooperate or communicate. The objective of this research was to assess VA in older institutionalized individuals with cognitive impairment, including severe dementia, using various acuity charts. Design, setting, participants, and measurements Three groups of 30 participants each were recruited: (1) young participants; (2) older participants with no history of cognitive or communication disorders; and (3) older participants with cognitive impairment, including severe dementia, residing in long term care facilities. The Mini-Mental State Examination was performed for each institutionalized subject. VA was measured using 6 validated charts [Snellen, Teller cards, Early Treatment Diabetic Retinopathy Study (ETDRS)-letters, -numbers, -Patty Pics, -Tumbling Es] presented in random order. Nonparametric tests were used to compare VA scores between charts, after Bonferroni-Holm corrections for multiple comparisons. Results Participants in groups 1 and 2 responded to all charts. A large proportion of participants with dementia responded to all charts (n = 19), whereas only one did not respond to any chart. In group 3, VA charts with the lowest scores were the Teller cards (20/65) and Patty Pics (20/62), regardless of the level of dementia, whereas the highest VA scores were obtained with the Snellen (20/35) and ETDRS-letter (20/36) charts. Across all groups, the ETDRS-letter chart was the only one whose scores did not differ from those obtained with the standard Snellen chart. Conclusions Visual acuity can be measured, and should at least be attempted, in older cognitively impaired individuals having a reduced ability to communicate.

There is a significant interest in determining the effects of nanomaterials on the environment and human health. Part or all of the toxicity attributed to silver nanoparticles (nAg) may be due to the release of free silver (Ag(+)). Therefore, it is necessary to have techniques that will allow the precise determination of free Ag(+) within suspensions of nAg particles. Among the different methods used for the determination of free metals in natural waters, the ion-exchange technique (IET), has promise to both distinguish Ag(+) from nAg and to attain the low detection limits required for the analysis of natural samples. In this paper, IET. centrifugal ultrafiltration and single particle inductively coupled plasma mass spectrometry (SP ICP-MS) were used to determine very low concentrations of free or dissolved Ag in commercial suspensions of nAg. Dilution of the silver nanoparticles played an important role in the measured Ag(+) concentrations. The relative release of Ag(+) from nAg increased as samples were increasingly diluted, implying that it is critical to determine Ag(+) concentrations under the precise conditions used for determinations of toxicological or environmental fate.

Rationale/Objective: To develop a screening and referral algorithm tool to help identify which older institutionalized individuals with dementia need an eye examination. Methods: The visual acuity (VA) screening test was developed on an iPad retina display. Three optotypes were used (letters, numbers, and tumbling E’s) to determine whether one works best with dementia. The screening VA results and algorithm decision were validated against those obtained by an optometrist performing a complete eye examination. Results: Of the 150 participants, 14.7% did not respond to any optotype, while 85.3% responded to letters, 84.0% to numbers, and 66.0% to tumbling E’s. The VA achieved was superior for letters. The concordance for the screening versus eye examination was >80% for VA and 90% for the algorithm. Conclusion: The results indicate that the tool was successful at identifying older individuals with dementia needing an eye examination.

The Interdisciplinary Study of Inequalities in Smoking (ISIS) is a cohort study investigating the joint effects of residents’ socio-demographic characteristics and neighbourhood attributes on the social distribution of smoking in a young adult population. Smoking is a behaviour with an increasingly steep social class gradient; smoking prevalence among young adults is no longer declining at the same rate as among the rest of the population, and there is evidence of growing place-based disparities in smoking. ISIS was established to examine these pressing concerns. The ISIS sample comprises non-institutionalized individuals aged 18–25 years, who are proficient in English and/or French and who had been living at their current address in Montréal, Canada, for at least 1 year at time of first contact. Two waves of data have been collected: baseline data were collected November 2011-September 2012 (n = 2093), and a second wave of data was collected January-June 2014 (n = 1457). Data were collected from respondents using a self-administered questionnaire, developed by the research team based on sociological theory, which includes questions concerning social, economic, cultural and biological capital, and activity space as well as smoking behaviour. Data are available upon request from [katherine.frohlich@umontreal.ca]. Refereed/Peer-reviewed

La lutte contre le commerce illicite du tabac représente un défi de taille dans le contrôle du tabagisme. Au Québec, comme ailleurs au pays, la vente de produits du tabac de contrebande a pour effet de restreindre l’efficacité de la taxation comme moyen pour réduire la consommation de tabac et limiter l’accessibilité au tabac chez les jeunes. Par ailleurs, les importantes pertes fiscales générées par le marché illégal des produits du tabac représentent autant de ressources financières qui ne peuvent être investies par les gouvernements dans les services de santé. L’élaboration de politiques publiques visant à contrecarrer la contrebande du tabac requiert la quantification précise et fiable de ce phénomène. Cet examen systématique visait à estimer la prévalence au Québec de l’achat et de la consommation de tabac illicite de 2005 à 2010 chez les fumeurs âgés de 15 ans et plus. Une recension et une analyse des données pertinentes ont été effectuées au moyen d’un outil objectif d’évaluation critique. Vingt-sept études ont été recensées et examinées, dont 18 témoignent d’une qualité acceptable relativement à la validité des méthodes ainsi qu’à l’interprétation et à l’applicabilité des résultats. L’analyse des données disponibles indique qu’il n’est pas possible de conclure à une variation annuelle statistiquement significative de la prévalence de l’achat et de la consommation de tabac illicite chez les fumeurs actuels québécois âgés de 15 ans et plus au cours des années 2005 à 2010, et que sa valeur oscillait entre 6 % et 28 %. Des suggestions sont proposées pour améliorer la qualité méthodologique de ce type d’études portant sur l’estimation de la prévalence de l’achat et de la consommation de tabac illicite., The fight against the illegal tobacco trade represents a considerable challenge for tobacco control efforts. In Quebec, as in the rest of the country, the sale of contraband tobacco products limits the efficacy of taxation as a means to reduce tobacco use and restrict youths’ access to tobacco. In addition, the significant tax losses generated by the illegal tobacco product trade represent financial resources that governments would otherwise be able to invest in health services. The preparation of public policies aimed at preventing tobacco contraband requires a precise and reliable quantification of the phenomenon. This systematic review seeks to estimate the prevalence of the purchase and consumption of illegal tobacco in Quebec from 2005 to 2010 amongst smokers aged 15 or older. Relevant data was reviewed and analysed using an objective critical evaluation instrument. Twenty-seven studies were listed and examined, 18 of which demonstrated acceptable quality regarding their methodology, the interpretation of results and applicability. Available data suggests that prevalence among smokers aged 15 or over did not show a statistically significant annual variation between 2005 and 2010 in Quebec, ranging from 6% to 28%. Suggestions are proposed to improve the methodological quality of studies designed to estimate the prevalence of the purchase and consumption of contraband tobacco., La lucha contra el comercio ilícito del tabaco representa un desafío importante para el control del tabaquismo. En Quebec, como en otras partes del país, la venta de productos del tabaco de contrabando circunscribe la eficacia de la percepción de impuestos como medida de reducción del consumo de tabaco y de restricción a la accesibilidad del tabaco para los jóvenes. Adicionalmente, las importantes pérdidas fiscales que ocasiona el mercado ilegal de productos del tabaco representan importantes recursos financieros que los Gobiernos no podrán invertir en los servicios de salud. El desarrollo de políticas públicas con el fin de contrarrestar el contrabando del tabaco requiere la cuantificación precisa y fiel de este fenómeno. Este examen sistemático procuraba evaluar la prevalencia en Quebec de la compra y del consumo de tabaco ilícito entre los fumadores de 15 años y más de 2005 a 2010. Se realizó una revisión y un análisis de las informaciones pertinentes mediante una herramienta objetiva de evaluación crítica. Se volvieron a censar y examinar veintisiete estudios, de los cuales 18 ofrecen una calidad aceptable con respecto a la validez de los métodos y a la interpretación de la aplicabilidad de los resultados. El análisis de los datos disponibles indica que no es posible concluir que existe una variación anual estadísticamente significativa de la prevalencia de la compra y del consumo de tabaco ilícito entre los fumadores quebequenses actuales de 15 años y más durante los años 2005 a 2010 y que su valor oscilaba entre 6% y 28%. Se proponen sugerencias para mejorar la calidad metodológica de este tipo de estudio sobre la evaluación de la prevalencia de la compra y del consumo de tabaco ilícito.

Introduction Secondhand smoke (SHS) can quickly attain high concentrations in cars, posing health risks to passengers and especially to children. This paper assesses whether there are social disparities in children9s exposure to SHS in privately owned vehicles. Methods On weekday mornings and afternoons from September to November 2011, trained observers were stationed at 100 selected street intersections in Montreal, Canada. For each car transporting at least one passenger aged 0–15 years travelling through the intersection, observers recorded the estimated age of the youngest child in the car, whether any occupant was smoking and the licence plate number of the car. Licence plate numbers were linked to an area material deprivation index based on the postal code of the neighbourhood in which the car was registered. Results Smoking was observed in 0.7% of 20 922 cars transporting children. There was an apparent dose–response in the association between area material deprivation level and children9s exposure to SHS in cars. Children travelling in cars registered in the most disadvantaged areas of Montreal were more likely to be exposed to SHS than children travelling in cars registered in the most advantaged areas (unadjusted OR=3.46, 95% CI 1.99 to 6.01). Conclusions This study revealed social disparities in children9s exposure to SHS in privately owned vehicles.

Spent potlining (SPL) is a hazardous waste produced by aluminum smelters. SPL is generated from the internal lining of Al cells, constituted of carbon and refractory bricks and replaced after five to eight years in service. It is classified as a hazardous waste because of its contamination with fluorides and cyanides and its reactivity with water, generating explosive gases. Nowadays, the aluminum industry has made some progress with the SPL issue by recognizing that landfilling is no longer acceptable by most local communities. In 2008, Rio Tinto inaugurated a new plant in Jonquiere (Quebec) for the treatment of 80 kt of SPL annually, based on the low-caustic leaching and liming process (LCL&L, patent no. US 6,596,252) developed in the early 1990s. This paper describes the advantages of the LCL&L technology, including valorization routes for its by-products and the successful ramp-up of the plant to its nominal capacity reached in 2014.

Objectives To assess quality-of-care processes and to examine whether care processes are associated with short-term postdischarge outcomes in older vulnerable hospitalized patients. Design Retrospective study. Setting Forty-nine Geriatric Assessment Units. Participants Patients aged 65 and older who were admitted to a Geriatric Assessment Unit for a fall with trauma. Measurements Three care processes (comprehensiveness, informational continuity, patient-centered care) assessed through chart audit; three-month postdischarge outcomes (emergency department visit, hospital readmission, and death) obtained from national databases. Results A total of 934 hospitalization records were included. Mean comprehensiveness and informational continuity scores were 55% ± 12% and 42% ± 16%, respectively. Items related to geriatric global assessment (eg, functional autonomy) were particularly overlooked. Patient-centered care was poorly provided, with only 24% of hospitalization records showing evidence of advance care directives and at least one patient/family meeting with the physician to discuss clinical evolution. For the three care processes, a large variability among Geriatric Assessment Units was observed. Better comprehensiveness of care was associated with lowered short-term mortality (OR = 0.73, 95% CI = 0.55–0.96, P = .023), whereas higher scores on informational continuity was associated with fewer emergency department visits (OR = 0.91, 95% CI = 0.82–1.00, P = .046), hospital readmissions (OR = 0.84, 95% CI = 0.74–0.94, P = .003), and mortality (OR = 0.72, 95% CI = 0.59–0.88, P = .002). Patient-centered care was not associated with any of the postdischarge outcomes. Conclusion A large gap between geriatric care principles and practice in Geriatric Assessment Units has been observed. Our results show that improvement in care processes may be translated to decreased short-term health services use and mortality.

Abstract: The government’s tobacco control policies are often multifaceted and large-scale in nature. The process and outcome evaluation of such programs generally requires a significant investment in time, money, and effort. A critical but often neglected step prior to conducting a successful evaluation is the evaluability assessment. This tool is a method for examining a given program to determine whether it meets the criteria for a meaningful evaluation. Even when it fails to do so, it still contributes to the improvement of the program. This article describes the principles of the evaluability assessment and provides an example of its application. It concludes by presenting some lessons learned from the evaluation of Quebec’s Quit Smoking Centres.

Abstract: This study examines the usefulness of the Montreal Service Concept framework of service quality measurement, when it was used as a predefined set of codes in content analysis of patients’ responses. As well, the study quantifies the interrater agreement of coded data. Two raters independently reviewed each of the responses from a mail survey of ambulatory patients about the quality of care and recorded whether or not a patient expressed each concern. Interrater agreement was measured in three ways: the percent crude agreement, Cohen’s kappa, and the coefficient of the generalizability theory. We found all levels of interrater code-specific agreement to be over 96%. All kappa values were above 0.80, except four codes associated with rarely observed characteristics. A coefficient of generalizability equal to 0.93 was obtained. All indices consistently revealed substantial agreement. We empirically showed that the content categories of the Montreal Service Concept were exhaustive and reliable in a well-defined content-analysis procedure.

Dans les études longitudinales, il devient diffi cile de déterminer les facteurs de risque de chutes, car l’exposition varie durant la période de suivi et les sujets peuvent subir un événement plus d’une fois. Or, les analystes font peu de cas de ces considérations et n’utilisent pas nécessairement les bonnes méthodes statistiques. En règle générale, on se concentre sur la proportion des personnes ayant fait une chute ou le temps écoulé jusqu’à la première chute. Dans un cas comme dans l’autre, on fait abstraction de l’hypothèse fondamentale de l’indépendance des événements et on écarte par le fait même des données pertinentes. Dans le présent article, nous examinons les méthodes en usage actuellement et nous proposons une extension du modèle de risques de Cox. Nous illustrons cette version étendue du modèle par une étude des facteurs de risque susceptibles d’être associés à des chutes parmi un groupe de 959 personnes âgées. Enfi n, nous comparons les résultats obtenus avec la méthode de Wei, Lin et Weissfeld (ci-après désignés WLW) et ceux obtenus avec plusieurs autres méthodes. Les facteurs d’exposition étudiés qu’ils soient fixes ou variables dans le temps comprennent les caractéristiques socio-démographiques, l’indice de masse corporelle (IMC), le risque nutritionnel, la consommation d’alcool, les dangers de l’environnement domiciliaire, la démarche et l’équilibre, et la consommation de médicaments. Notre étude révèle que les méthodes utilisées couramment pour analyser les facteurs de risque de chutes sont inadéquates, car elles créent un biais appréciable comparativement au modèle de WLW, qui utilise des covariables dépendantes du temps. Les résultats de notre étude montrent également qu’il peut être vain de modéliser la première survenue d’un événement, étant donné que le risque de survenue varie entre les chutes.

Objectifs: Evaluer la concordance entre les declarations des utilisateurs du service telephonique Info-Sante CLSC et les donnees consignees par les infirmieres quant aux recommandations de recourir a une autre ressource professionnelle de sante. Determiner le lien entre certaines covariables et l’inexactitude des declarations. Source des donnees: Il s’agit d’une analyse secondaire des donnees d’une enquete menee aupres d’un echantillon aleatoire de 4 696 utilisateurs a travers le Quebec. Methodologie: Les recommandations rapportees par les participants au cours d’une entrevue, conduite entre 48 et 120 heures apres leur appel, ont ete comparees aux donnees consignees par les infirmieres sur les fiches d’appel informatisees. L’association entre les discordances et les caracteristiques des appelants, le contexte de l’appel ainsi que leur satisfaction par rapport a l’intervention des infirmieres a ete estimee a l’aide de la regression logistique multinomiale et le calcul des rapports de cotes ajustes (RCa). Resultats: Des recommandations ont ete enregistrees par l’infirmiere dans 42 % des cas, alors que 39 % des participants disent en avoir recues. Les deux sources divergent dans 27 % des cas: 12 % sont des faux positifs et 15 % des faux negatifs. Le coefficient de kappa atteint 0,45. Les divergences sont associees a des caracteristiques telles que la perception de l’urgence de la situation (RCa = ~2,6), le fait de vivre seul (RCa = 2,5), les appels pour des problemes psychosociaux (RCa = 2,8). Discussion: Nos resultats montrent que les recommandations de recours faites par l’intermediaire du service telephonique sont souvent mal comprises par les utilisateurs. Ces resultats suggerent le besoin de mesures de controle de qualite afin d’ameliorer l’intervention des infirmieres et d’assurer une meilleure comprehension de leurs conseils.