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Feasibility, acceptability, and preliminary effects of PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP): a mixed methods study
No full textAbstract Background Hip fractures represent sentinel events in older adults’ lives that can lead to a loss of function and permanent disability. Our team developed an evidence-based pathway intervention: PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP). The goal of the pathway is to facilitate early transfer of hip fracture patients to geriatric rehabilitation without having a negative impact on their rehabilitation outcomes. The purpose of this study was to pilot PATH4HIP with post-operative geriatric hip fracture patients during their transition from hospital to rehabilitation to home. Methods We conducted a mixed methods feasibility study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to evaluate the feasibility, acceptability, and preliminary effects of PATH4HIP. Quantitative data were accessed through administrative databases, and qualitative data were collected from patients, caregivers, and clinicians to report on the five RE-AIM domains. Results A total of 317 hip fracture patients were screened between January and September 2022, and 152 met the study eligibility criteria. Reach was achieved, with 77.0% of eligible patients (n = 117) agreeing to participate (progression criteria of ≥ 75.0%). Effectiveness outcomes including rehabilitation length of stay, functional gains, discharge to the community, and 30-day emergency department return rates were comparable to previously reported data for this population. Adoption was also high, with 76.9% of enrolled patients (n = 90) completing the pathway. Implementation was carried out with minimal protocol variations; however, only 48.9% of patients (n = 44) were discharged from acute care by post-operative day 6 (progression criteria of ≥ 75.0%), falling short due to challenges associated with the COVID-19 pandemic. Finally, participants indicated that the PATH4HIP intervention was acceptable, supporting its Maintenance. Conclusion The study confirmed the feasibility and acceptability of the pathway, while key rehabilitation outcomes were not negatively affected. This pathway design prioritized best practices for hip fracture care and collaboration across health care sectors. This intervention was low cost as it used existing resources to improve use of surgical beds, while enhancing post-surgery hip fracture care. Further research is needed to examine the implementation of this intervention on a larger scale
Expérience des parents 2ELGBTQIA+ francophones vivant en situation linguistique minoritaire pendant la transition à la parentalité
No full textLa transition à la parentalité constitue un événement de vie majeur, amorcé bien avant la conception et s'étendant parfois sur plusieurs années après la naissance de l'enfant. Elle englobe les périodes antepartum, périnatale et postnatale, y compris l'allaitement. Si la littérature a documenté cette transition dans divers contextes, peu d'études ont porté attention aux expériences spécifiques des personnes bispirituelles, lesbiennes, gaies, trans, queer, intersexe et autres (2ELGBTQIA+) d'expression française vivant en situation linguistique minoritaire. Cette population, à la fois hétérogène et marginalisée, fait face à des défis singuliers liés à la reconnaissance identitaire, à l'accès aux soins et à l'affirmation linguistique, en particulier dans les provinces canadiennes hors Québec.
Les infirmières jouent un rôle central dans l'accompagnement des familles durant cette transition, mais elles rapportent souvent un inconfort face aux enjeux de sexualité et de diversité de genre, lié à un manque de formation et de ressources adaptées. Dans un contexte où les francophones en situation minoritaire doivent composer avec des services peu accessibles ou culturellement inadéquats, l'expérience des parents 2ELGBTQIA+ francophones demeure largement absente dans les recherches en santé.
Ancrée dans une posture critique, cette thèse mobilise les travaux d'Henri Lefebvre (production de l'espace), de Gloria Anzaldúa (fronteras, nepantla) et de Deborah Lupton (cultures du risque) pour interroger la manière dont les espaces dominants sont produits et vécus par les familles 2ELGBTQIA+, et comment ces dernières participent à leur transformation à travers la création d'espaces différentiels. L'étude adopte un devis exploratoire qualitatif, fondé sur l'analyse phénoménologique interprétative (API), afin de cerner l'expérience vécue de la transition à la parentalité chez 12 personnes 2ELGBTQIA+ francophones vivant au Manitoba. Un questionnaire sociodémographique et des entrevues semi-structurées ont permis de documenter leurs trajectoires complexes.
L'analyse révèle quatre thèmes majeurs : (1) la transition à la parentalité, (2) la conciliation des rôles, (3) la navigation de l'espace, et (4) la création d'un espace. Les récits mettent en lumière une pluralité de parcours parentaux, marqués par des seuils émotionnels, sociaux et identitaires. La décision de devenir parent émerge tantôt d'un processus délibéré, tantôt d'un surgissement contextuel, révélant une tension constante entre agentivité individuelle et contingences sociopolitiques. La période antepartum est vécue comme un espace liminaire d'anticipation, où les participant.e.s projettent leur rôle parental tout en affrontant les contraintes institutionnelles, corporelles et affectives.
Les expériences entourant l'accouchement et les soins périnataux révèlent une confrontation aux normes biomédicales et hétéromononormatives, où les participant.e.s doivent négocier leur autonomie corporelle face aux impératifs cliniques. La période postnatale (jusqu'aux deux ans de l'enfant) est marquée par une redéfinition intense des identités conjugales, professionnelles, parentales et linguistiques, souvent exacerbée par des facteurs tels que l'isolement, la précarité et les transitions de vie.
La conciliation des rôles représente un défi permanent : les configurations familiales doivent être constamment ajustées pour dépasser les scripts hétéronormatifs. Celles et ceux qui ont pu co-construire librement des rôles parentaux fondés sur leurs forces individuelles et les exigences du quotidien rapportent une plus grande cohérence et agentivité, tandis que la reproduction des normes de genre traditionnelles engendre fréquemment tensions et détresse.
La navigation de l'espace dévoile des obstacles systémiques : les familles doivent composer avec un accès limité à des services de santé et de soutien affirmatifs, francophones, inclusifs et culturellement sécuritaires. L'insécurité linguistique traverse les récits comme un enjeu fondamental, influençant autant l'accès aux soins que l'affirmation identitaire en tant que personne 2ELGBTQIA+ francophone.
Face à ces défis, les participant.e.s déploient des stratégies créatives de résistance : création d'espaces sans jugement, redéfinition des rôles au sein du foyer, recours à la famille choisie, ou encore transformation de la maison en espace accueillant et inclusif. Ces gestes, à la fois politiques et relationnels, traduisent une volonté d'habiter le monde autrement, de revendiquer leur légitimité parentale, et de tracer la voie à des modèles familiaux pluriels et émancipateurs.
En somme, cette étude révèle que la parentalité pour les personnes 2ELGBTQIA+ francophones en contexte minoritaire ne peut être pensée uniquement comme une expérience individuelle : elle s'inscrit dans une dynamique de lutte, de résilience et d'innovation sociale. Les résultats plaident pour une transformation des pratiques en santé, notamment à travers la mise en place de services spécialisés, pérennes et intersectionnels, qui reconnaissent pleinement les réalités des familles francophones 2ELGBTQIA+ Pour que la parentalité devienne une perspective tangible, joyeuse et légitime dès l'enfance, il est impératif d'ancrer ces trajectoires dans des espaces réellement inclusifs, où les personnes ayant la diversité des vécus puissent s'épanouir
Mitochondrial Bioenergetics and Supercomplexes in Heart Failure: Mechanisms and Therapeutic Approaches
No full textHeart failure affects over 50 million people worldwide with increasing rates attributable to an aging population, improved survival following cardiovascular events, and high prevalence of risk factors. Many pharmacological approaches exist for disease management requiring complex individualized care that is further complicated by comorbidities. Given this landscape, characterizing the underlying mechanisms that contribute to reduced cardiac function at each disease stage is critical to design new and complementary therapeutic approaches. Changes in mitochondrial metabolism are evident throughout the progression of heart failure and largely include irregular substrate metabolism, alterations in mitochondrial energetics, reactive oxygen species signaling, and an imbalance in mitochondrial dynamics. This thesis explores novel bioenergetic aspects of mitochondrial supercomplexes and characterizes cardioprotective interventions and mitochondrial mechanisms involved in heart failure.
First, we investigated the formation of mitochondrial supercomplexes, higher-order structures of the electron transport chain, which are thought to improve oxidative phosphorylation efficiency and limit mitochondrial reactive oxygen species emission. We hypothesized that interaction sites between complex I and complex III are critical for supercomplex formation. By designing a cell culture model with point mutations disrupting these interactions, we identified the role of NDUFB4, a non-catalytic subunit in supercomplex formation and characterized the bioenergetic, redox and metabolic changes induced by altered supercomplex formation.
Furthering this work, we explored supercomplex formation in the heart where decreased assembly has been observed in cardiovascular diseases. Using a complexome profiling approach, which combines Native gel electrophoresis and mass spectrometry, we characterized the proteome composition of mitochondrial supercomplexes in a murine model of heart failure. We identified changes in the relative abundance of electron transport chain proteins, redox-related proteins, ribosome proteins and metabolic proteins within supercomplex bands.
Next, we explored the involvement of a mitochondrial inner membrane protein, optic atrophy protein-1 (OPA1), in human heart pathology. Bioinformatic analyses of histological and transcript data indicated that OPA1 expression levels vary in the human heart, where elevated OPA1 transcript levels were correlated with fatty acid, branch chain amino acid and contractile gene signatures. Complementary in vivo work employing a 1.5-fold whole body OPA1 overexpression mouse model identified a protective effect of OPA1 in improving cardiac function in response to pressure-overload induced heart failure.
Finally, we sought to explore cardioprotection and metabolic changes induced by glucagon-like peptide-1 receptor (GLP-1R) agonists. Using a high-fat high-cholesterol diet model combined with a myocardial infarction (MI) model, we evaluated the impact of the GLP-1R agonist, semaglutide, in mediating changes in cardiac function, myocardial metabolic remodeling, and reactive oxygen species emission. We identified time-dependent effects on cardioprotection with post-MI treatment improving exercise capacity but not cardiac function, whereas pre-MI treatment attenuated decreases in cardiac function. No changes in ex vivo cardiac mitochondrial bioenergetic capacity or reactive oxygen species emission were induced with either treatment paradigm.
Overall, this thesis work has advanced our understanding of mitochondrial supercomplex formation and how the mitochondrial complexome changes in heart failure. Moreover, we identify both genetic (OPA1) and therapeutic (GLP-1R agonist) interventions that confer cardioprotection in murine heart failure models and characterize the involvement of mitochondrial pathways in heart failure
Empowerment psychologique chez les infirmières et infirmiers de secteur psychiatrique français (1969-2000) : une histoire par le bas
No full textCette thèse en sciences infirmières explore le processus d'empowerment psychologique des infirmier·ères de secteur psychiatrique (ISP) en France, entre 1969 et 2000. Inscrite dans un contexte historiographique où la profession infirmière en psychiatrie demeure largement occultée, cette recherche vise à restituer les trajectoires singulières d'ISP en s'ancrant dans l'exemple institutionnel de l'hôpital Sainte-Marie de Clermont-Ferrand. Mobilisant une approche interdisciplinaire articulant l'histoire sociale, la sociologie et la psychologie communautaire au sein des sciences infirmières, elle s'inscrit dans une perspective d'history from below, attentive aux formes d'expression subalternes du pouvoir d'agir.
L'enquête repose sur une analyse croisée de récits de vie, d'archives institutionnelles, de documents personnels et de matériaux professionnels issus du terrain. Le cadre théorique de l'empowerment psychologique, tel que formulé par Marc Zimmerman, est mobilisé de manière critique pour analyser les dynamiques d'autonomisation professionnelle élaborées par les ISP dans un contexte institutionnel en mutation profonde au cœur de la politique de sectorisation psychiatrique française.
Les résultats mettent en évidence la diversité, la complexité et la portée historique des stratégies infirmières visant à conquérir une reconnaissance professionnelle, à expérimenter des pratiques cliniques alternatives et à structurer des formes collectives d'organisation autonome. Ces dynamiques, historiquement situées, permettent de nuancer les représentations dominantes d'une profession cantonnée à un rôle d'exécutante, soumise aux logiques médicales et gestionnaires. Par ailleurs, l'étude souligne que la disparition du diplôme spécifique des ISP en 1992 constitue un moment charnière, perçu à la fois comme une perte symbolique d'autonomie et comme une opportunité de recomposition identitaire collective. En interrogeant la fécondité du cadre de l'empowerment psychologique dans le champ spécifique de la psychiatrie infirmière française, cette thèse propose une lecture située, critique et historiquement ancrée du pouvoir d'agir infirmier. Elle contribue à la consolidation d'une histoire infirmière francophone, tout en éclairant les tensions contemporaines liées à la redéfinition du rôle infirmier en psychiatrie
Preoperative MRI-Measured Membranous Urethral Length as a Predictor for Urinary Continence after Prostate Cancer Surgery
No full textThis thesis addresses prediction of post-prostatectomy urinary continence, which is of major importance to patients and clinicians. Urinary incontinence significantly impacts quality of life, and some patients may choose non-surgical treatments if their risk of post-surgery incontinence is unacceptably high. The membranous urethra is a small segment of the urethra surrounded by pelvic floor musculature. In theory, a longer membranous urethra on pre-operative imaging may signify a more robust sphincter complex and a lower probability of involuntary urinary leakage after surgery. In practice, data from several studies suggest MRI-measured membranous urethral length (MUL) is one of few predictors of post-prostatectomy continence. However, it is currently not clear how to use MUL when counseling patients since proposed prediction models have never been externally validated. To address this issue, we systematically reviewed the existing literature, and performed a meta-analysis, allowing us to conclude, with a moderate degree of confidence, that longer MUL is predictive of urinary continence after prostatectomy. We also observed that MUL measurement techniques vary between studies, posing a significant risk for miscalibration when applied to clinical practice. We then externally validated a published continence prediction model, by Jeong et al. We observed that the model has good calibration and discrimination when continence is defined as 0-1 incontinence pad/24h but does not perform well in predicting complete urinary continence (no incontinence pads needed). In conclusion, we now know the benefits and limits of a MUL prediction model that can be applied to our future patients
Lifestyle trajectories of boys and girls during the transition to secondary school in British Columbia, Canada, before and during the COVID-19 pandemic
No full textAbstract Background The transition to secondary school is a critical period for adolescents, marked by increased autonomy and substantial changes in their physical and social environments, which can negatively influence lifestyle habits. The COVID-19 pandemic also affected these routines, but it remains unclear how adolescents’ behaviors shifted as they moved to secondary school during the pandemic. Objectives We examined changes in adolescents’ lifestyle behaviors (screen time, sleep, sedentary time, physical activity (PA), and diet) during the transition to secondary school and explored whether changes were moderated by the pandemic or child gender. Methods A sample of 689 adolescents had their health behaviors measured via self-report, 24-hour dietary recalls, and accelerometry at two time points: the final year of elementary school (grade 7) and the first year of secondary school (grade 8). 42% of the sample completed all data collection before the pandemic, and 58% during the pandemic. Covariate-adjusted mixed-effects models assessed behavioral trajectories over time, including 3-way interactions between time, pandemic exposure, and gender. Results The transition to secondary school was generally associated with increased sedentary time and screen time, and reduced light PA, MVPA, likelihood of meeting sleep recommendations, and fruit and vegetables intake. However, some effects varied significantly by gender and cohort. For example, girls consistently had lower odds of meeting sleep recommendations and engaged in less MVPA than boys, while the pandemic cohort showed decreases in sedentary time and screen use (but remained above pre-pandemic levels), and increases in weekday fruit and vegetables intake. Conclusions The transition to secondary school was associated with less healthy lifestyles, with variations by gender and pandemic exposure. To develop targeted interventions that promote positive habits during this critical life stage, it is necessary to identify the mechanisms driving these changes, as they may also reflect other developmental or environmental influences coinciding with the transition. Importantly, interventions should also address behavioral changes that occurred during the pandemic, particularly increases in recreational screen time that may persist into adulthood
Integrated bioinformatic and in vivo analysis confirms the cardioprotective role of OPA1
No full textAbstract Background OPA1 is an inner mitochondrial membrane protein that mediates diverse signaling processes. OPA1 is important for cardiac function and protects against cardiac insults such as ischemia/reperfusion injury. We sought to further assess OPA1 in cardiac pathologies, hypothesizing that OPA1 will function in a protective manner in chronic heart failure. Methods Integrated analyses of publicly available histological and transcriptomic data were used to identify functional associations between OPA1 and other genes of interest. To experimentally assess these associations, mice with a 1.5-fold whole body OPA1 overexpression (OPA1-OE) were subjected to a modified transverse aortic constriction surgery and underwent 2-dimensional and 4-dimensional echocardiography along with molecular analyses including high-resolution respirometry, enzymatic activities, flow cytometry and transcript level analyses. Results Bioinformatic analyses of histological and transcript data from the GTEx database indicated that OPA1 expression levels vary in the human heart, where elevated OPA1 transcript levels were associated with fatty acid, branch chain amino acid and cardiac contractile gene signatures. These functional associations were further supported by in vivo findings showing that OPA1-OE mice displayed improved 2D ejection fraction, end systolic volume, end diastolic volume and 4D cardiac functional parameters including global peak circumferential and surface area strain compared to WT mice. As well, OPA1-OE mice displayed sustained transcript levels of fatty acid, branch chain amino acid and contractile markers and no induction of fibrotic transcript markers. Conclusion These results further demonstrate the important role of OPA1 in supporting optimal cardiac function and highlight potentially protective contractile and metabolic signaling pathways
Statistical Machine Learning for Automata-Based Modelling of Simulink Autopilot System
No full textAircraft autopilot controllers are often developed as Simulink models. Verifying such controllers is challenging because their behaviour is mainly observed through numeric simulation traces, and there is no explicit behavioural model showing how the controller responds under different conditions. In this thesis, we use automata learning to derive state machines from simulation data to support analysis and verification of a Simulink-based aircraft autopilot. A key difficulty is that standard automata learning assumes a finite alphabet, whereas the model’s inputs and outputs are numeric signals.
We address this with an ML-enhanced passive automata-learning approach (MELA) that combines machine learning with automata learning. Feature-importance analysis selects informative signals, and decision tree based range abstraction partitions their numeric ranges into intervals. These intervals are then used to abstract the time-series traces before applying passive automata learning. We apply this pipeline to a closed-loop Simulink aircraft autopilot and learn Moore machines that capture its behaviour.
Our evaluation compares MELA with a Manual baseline that uses the same data generation and learning procedures but relies on manually chosen variables and numeric abstractions. Across four learning sets and six abstraction configurations, MELA reduces the number of states and transitions in the learned automata by an average of 11.6% and improves accuracy by an average of 18.5% compared to the Manual baseline. The learned state machines support verification and exploration: by expressing the autopilot's requirements as temporal queries and evaluating them on the models, we can check whether these requirements are satisfied and identify behaviours that were not known in advance
Construire la représentation de l'enfermement dans nos sociétés modernes : Analyse d'un corpus filmique situé et performatif
No full textLes représentations filmiques occupent une place centrale dans la construction de nos imaginaires collectifs. Interroger la manière dont les productions de nos sociétés modernes, en mettant en scène l'enfermement, participent à façonner les représentations sociales qui lui sont associées, c'est questionner bien plus que la prison elle-même. À travers un corpus de six films de fiction, choisis pour leur diversité et analysés au prisme de dimensions spatiales, relationnelles et symboliques, ce travail explore comment ces récits influencent notre façon de voir, comprendre, justifier et légitimer l'enfermement. Une occasion de prendre conscience de la force de ces images et, peut-être, de les envisager sous un autre regard
Flexible Salt Marsh Vegetation: Model-Driven Replication of Stem Biomechanics across Seasonal and Regional Scales
No full textCoastal protection strategies have shifted from structural measures toward more integrated approaches that combine traditional engineering elements with nature-based solutions provided by coastal ecosystems. Among these coastal ecosystems, salt marshes play a key role by offering multiple ecosystem services such as wave energy dissipation, sediment stabilization, and erosion reduction. A critical process governing their protective function is the near-stem flow field, which describes the local interaction between vegetation and hydrodynamic forcing. However, the influence of seasonal and regional variations in the biomechanical properties of salt-marsh vegetation on these flow dynamics remains largely unexplored. This thesis addresses this gap by incorporating in situ measured biomechanical properties of live stems into physical and numerical modeling approaches, enabling a detailed analysis of the fluid–vegetation interaction.
The replication of live vegetation properties in physical hydrodynamic experiments is enhanced in accuracy compared to traditional surrogate materials with 3D printing utilizing flexible filament. The developed surrogates are tested in a flume under unidirectional and oscillatory flow conditions, with particle image velocimetry enabling the measurement of the flow field alterations and the stem-induced turbulence. Next, this thesis employs the fluid-structure interaction solver in the open-source model REEF3D::CFD to quantify the role of salt marsh vegetation in coastal protection numerically, implementing a two-way coupling between vegetation stems and hydrodynamic forcing from unidirectional and oscillatory flow conditions. This extends one-way coupling approaches and provides more accurate solutions compared to previous fluid-structure interaction solvers to model flexible submerged vegetation. The application of field data from various European salt marsh studies at different times during the growing season, together with the first measurements of
biomechanical stem properties from a Canadian salt marsh, enables an assessment of both seasonal and regional effects on the stem-induced flow field alterations.
The 3D printed surrogate stems have been confirmed as similar to the in situ measured biomechanical stem properties of live vegetation through a statistical evaluation. The fluid-structure interaction solver has been validated to replicate stem motion and forces of flexible vegetation within a maximum deviation of 10% for most tested conditions. Based on the provided extensive validation, the solver was shown to be a valuable approach to simulate various stiffnesses. The results from both numerical and physical modeling suggest that the stem-induced turbulence varies to a greater extent between the different replicated plant species than the seasonal influence within a species. Due to seasonal variations of the stems’ flexural stiffnesses across the investigated species and regions, distinctions regarding the stem bending and extent of motion have been observed, resulting in seasonal differences
for the derived drag coefficients.
In conclusion, the accurate replication of in situ measured biomechanical stem properties in model approaches reveals the difference in flow field alterations depending on the season and region of a salt marsh. Drag coefficients provided through single-stem simulations enable future investigations of the seasonal and regional variation of salt marshes in a simplified model at the meadow scale. Numerical models would then allow for an assessment of ecosystem services, such as the wave attenuation capacity. By incorporating seasonal field data in modeling strategies, this study enhances the understanding of fluid-vegetation interaction, contributing to reliable nature-based coastal protection strategies