Podcasts about inrs

Play Episode Listen Later Mar 10, 2022 58:50

COVID-19: Tannic acid targets key stages in the fight against SARS-CoV-2 infection Natural polyphenol seems to inhibit the activity of three important molecular pathways involved in the SARS-CoV-2 infection Université de Montréal and McGill University, March 9, 2022 Professor Charles Ramassamy and his postdoctoral researcher Mohamed Haddad at Institut national de la recherche scientifique (INRS), in collaboration with scientists from Université de Montréal, McGill University, and Université du Québec à Montréal (UQAM), believe that tannic acid plays a role in inhibiting three important molecular pathways involved in the SARS-CoV-2 infection. Their work was published recently in the International Journal of Molecular Sciences (IJMS). Using a multidisciplinary approach, the teams showed that tannic acid inhibits the viral protein (RBD) of the British variant of SARS-CoV-2 from binding to its biological target, the ACE2 receptor. This receptor, which is found on the surface of many cells in the body, allows the virus to latch on and infect them. “Tannic acid binds to the RBD protein and prevents it from binding to the ACE2 receptor,” said Professor Ramassamy. He explained that in blocking the viral protein, tannic acid does not alter the physiological functions of ACE2 receptors, which have physiological functions in the body's respiratory, cardiovascular, and renal systems, among others. (NEXT) Mindfulness-based cognitive therapy benefits people with depression through promoting self-kindness University of Exeter, March 9, 2022 New research shows that Mindfulness-Based Cognitive Therapy (MBCT) can help promote self-kindness in people with a history of depression, thereby putting their bodies in a state of safety and relaxation. The research, led by the University of Exeter with collaboration from the universities of Oxford and Magdeburg, indicates that MBCT may help break the cycle of highly critical thoughts and feelings of worthlessness, which often lead people with depression to relapse. Participants treated with MBCT showed a pattern of being kind to themselves, along with body responses of reduced threat response, a state of safety and relaxation that is important for regeneration and healing. Previous research has shown that individuals with recurrent depression benefit particularly from MBCT when they learn to become more compassionate towards themselves. This increased self-compassion has been defined as the ability to be kind to ourselves in stressful times. (NEXT) Herbal compound prevents colon cancer in mice University of South Carolina School of Medicine, March 9, 2022 The active compound in Chinese herbs called emodin (naturally found in rhubarb and Japanese knotweed) can prevent colon cancer in mice, according to researchers at the University of South Carolina School of Medicine. Physiologists conducting this study say this is likely due to emodin's ability to reduce the number of pro-tumor macrophages (a type of immune cell that can promote tumorigenesis). The study is published ahead of print in the American Journal of Physiology-Gastrointestinal and Liver Physiology and has been chosen as an APSselect article for March. (NEXT) Resistance exercise may be superior to aerobic exercise for getting better ZZZs Iowa State University, March 3, 2022 Resistance exercise may be superior to aerobic exercise as a way to get better sleep, and sleep is important for cardiovascular health, according to new preliminary research . “It is increasingly recognized that getting enough sleep, particularly high-quality sleep, is important for health including cardiovascular health. Unfortunately, more than a third of Americans don't get enough sleep on a regular basis,” said study author Angelique Brellenthin, Ph.D., “Aerobic activity is often recommended to improve sleep, yet very little is known about the effects of resistance exercise versus aerobic exercise on sleep. For this study, researchers enrolled 386 adults who met the criteria for overweight or obesity, which was a body mass index from 25-40 kg/m². Participants were inactive and had elevated blood pressure, measuring from 120-139 mm Hg systolic (top number) and 80-89 mm Hg diastolic (bottom number). Participants were randomly assigned to a no-exercise group (for comparison) or one of three exercise groups (aerobic only, resistance only, or combined aerobic and resistance) for 12 months. Everyone in the exercise groups participated in supervised 60-minute sessions, three times a week, with the combination exercise group doing 30 minutes of aerobic and 30 minutes of resistance exercise. (NEXT) Vitamin A, D and E deficiency linked to repeat colds and flu in Chinese children: Case control study Harbin Children's Hospital (China), March 8, 2022 Low levels of vitamin A, D and E have been associated with Recurrent Respiratory Tract Infections (RRTI) among children living in Northern China, a new case control study reports. Writing in the journal PLOS One, researchers stated previous studies showed that the incidence of RRTIs among children in northern China ranged from 17.8% to 18.7% . They point out that numerous studies have focused on identifying the association between inadequate concentrations of vitamins A, D, and E and the incidence of RRTIs in Chinese children, but that the results have been contentious. They found that serum levels of vitamins A and E were significantly lower in the RRTI group than the control group. “The conditional logistic regression model and the receiver-operating characteristic curve showed that the insufficiency or deficiency of vitamins A, D, and E was positively correlated with RRTI occurrence (p < 0.05),” they added. “The incidence of insufficiency or deficiency for vitamins A, E, and D was 24.33%, 8.17%, and 19.33% in the control group but increased to 63.00%, 33.83%, and 56.50% in the RRTI group, respectively.” The researchers believe the study demonstrated that lower serum levels of vitamins A, D, and E are associated with RRTIs.

Quel est le rôle des émotions dans le choix des sanctions en contexte criminel?

quel sanctions motions entrevue le choix contexte criminel lussier inrs

Play Episode Listen Later Feb 9, 2022 14:47

Entrevue avec Carolyn Côté-Lussier, professeure d'études urbaines à l'INRS et professeure adjointe au Département de criminologie de l'Université d'Ottawa : une équipe de recherche de l'Institut national de la recherche scientifique (INRS), de l'Université d'Ottawa et de l'Université McGill s'est posé la question et nous arrive avec résultats. Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

L'intégrale du mercredi 09 février

Play Episode Listen Later Feb 9, 2022 109:22

Entrevue avec Carolyn Côté-Lussier, professeure d'études urbaines à l'INRS et professeure adjointe au Département de criminologie de l'Université d'Ottawa : quel est le rôle des émotions dans le choix des sanctions en contexte criminel? Une équipe de recherche de l'Institut national de la recherche scientifique (INRS), de l'Université d'Ottawa et de l'Université McGill s'est posé la question et nous arrive avec résultats. Chronique culturelle d'Anaïs Guertin-Lacroix : John Williams célèbre ses 90 ans. Steven Soderbergh ne comprend pas pourquoi "personne ne baise" dans les films de super-héros. La Rencontre Martineau-Dutrizac avec Richard Martineau : pas de SQDC dans Outremont. 25% des camionneurs ont des enfants à bord. Propos de Joël Lightbound. Entrevue avec Maria Mourani, ex-députée fédérale, docteure en criminologie : elle publie sa première chronique dans le Journal aujourd'hui. Fusillades à Montréal : elle se demande si les Hells et la mafia italienne ont perdu le contrôle sur les petits jeunes. Chronique de Geneviève Pettersen, animatrice à QUB radio de 13h à 15h30 : retour sur le point de presse d'hier. Passeport vaccinal. Télétravail. Chronique de Germain Goyer, Producteur de contenu automobile : Alfa Romeo Tonale : un nouveau VUS. Chevrolet Spark: une autre voiture abordable qui est abandonnée. Conduire une décapotable en hiver: résumé d'un récent essai de la Mazda MX-5 en plein mois de janvier. Segment d'actualité avec Alexandre Dubé : la pleine liberté s'en vient. La Rencontre Foisy-Robitaille, chronique politique provinciale et fédérale avec Antoine Robitaille, animateur de l'émission Là-Haut sur la colline à QUB radio, et Philippe-Vincent Foisy, animateur de l'émission matinale de QUB radio : un projet problématique pour la métropole montréalaise. Dans quelle situation se trouve Lightbound actuellement ? Propos controversés tenus par Jason Kenney. Entrevue avec Méganne Perry-Melançon, Députée de Gaspé pour le Parti québécois, Porte-parole du troisième groupe d'opposition en matière de développement régional et de ruralité : la députée de Gaspé a livré un plaidoyer en chambre hier pour dénoncer le fait que les projets de transports en région tardent à être mis en place par la CAQ, que ce soit le train en Gaspésie ou encore le service de transport aérien. Chronique de Patrick Déry, analyste en politiques publiques : retour à la vie normale? Joël Lightbound, vue de l'angle des politiques publiques. Le ministre Fitzgibbon et la spirale de l'engagement. Chronique sports avec JIC : une autre raclée pour le CH. L'immunité du duo Gorton-Hughes ne va pas durer longtemps. Une production QUB radio Février 2022 Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

covid-19 journal dans haut automobiles porte parti gasp steven soderbergh mercredi genevi chronique propos producteurs entrevue hells pettersen conduire passeport fitzgibbon jason kenney mazda mx caq lussier qub vus patrick d qub radio alfa romeo tonale sqdc jic outremont richard martineau inrs maria mourani chevrolet spark antoine robitaille benoit dutrizac philippe vincent foisy germain goyer alexandre dub

(15) Aide au diagnostic du stress

Horizon-IA

Play Episode Listen Later Dec 23, 2021 36:09

Selon l'Institut National de Recherche et de Sécurité (INRS), un tiers des travailleurs européens se plaignent de problèmes de santé liés à un travail stressant. Le stress chronique peut provoquer le burn out mais aussi contribuer aux maladies cardio-vasculaires, gastriques ou autres. Pour limiter les effets du stress, il est important d'en reconnaître les premiers signes pour pouvoir le réguler. Dans cet épisode, Alexandra Konig va nous expliquer comment l'IA peut identifier des signes précoces du stress dans la voix au téléphone. ______________________________________________________________________ Présentation de l'invité Alexandra Konig est Neuropsychologue chez Inria et au CHU de Nice. Elle appartient également au laboratoire Cobtek, un laboratoire d'université côte d'azur qui met les nouvelles technologies pour au service des maladies mentales. Notes de l'épisode Quelques articles sur le burn-out en France : Quelques chiffres ici et ici Un rapport de l'assemblée nationale sur le coût du burn out / stress au travail qu'on peut retrouve ici Si vous voulez en savoir plus sur le groupe de musique allemand Kraftwerk qu'Alexandra a cité en fin d'épisode, c'est par ici. Retrouvez nous sur Facebook, Twitter ou LinkedIn pour continuer la discussion. Si vous avez envie d'en savoir plus sur les applications intelligentes, abonnez vous à ce podcast sur Apple Podcasts, Google Podcasts ou sur votre plateforme d'écoute habituelle. Laissez-nous votre avis, c'est le meilleur moyen de nous soutenir et que d'autres personnes le découvrent plus facilement. N'hésitez pas à partager ce podcast avec votre entourage, on y gagne tous à avoir des clés de compréhension sur les applications intelligentes qui font de plus en partie de notre quotidien sans qu'on ne s'en rende toujours compte. Pour participer au podcast, nous suggérer des intervenants ou nous poser des questions, vous pouvez utiliser notre formulaire de contact. Hébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

The Gary Null Show - 10.20.21

On n'est pas obligé d'être d'accord - Sophie Durocher

Play Episode Listen Later Oct 20, 2021 60:22

Eating leafy greens could help prevent macular degeneration Westmead Institute for Medical Research (Australia), October 13, 2021 A new study has shown that eating vegetable nitrates, found mainly in green leafy vegetables and beetroot, could help reduce your risk of developing early-stage age-related macular degeneration (AMD). Researchers at the Westmead Institute for Medical Research interviewed more than 2,000 Australian adults aged over 49 and followed them over a 15-year period. The research showed that people who ate between 100 to 142 mgs of vegetable nitrates each day had a 35% lower risk of developing early AMD than people who ate less than 69mgs of vegetable nitrates each day. Lead Researcher Associate Professor Bamini Gopinath from the Westmead Institute and the University of Sydney said the link between vegetable nitrates and macular degeneration could have important implications. "This is the first time the effects of dietary nitrates on macular degeneration risk has been measured. "Essentially we found that people who ate 100 to 142 mgs of vegetable nitrates every day had a reduced risk of developing early signs of macular degeneration compared with people who ate fewer nitrates. "If our findings are confirmed, incorporating a range of foods rich in dietary nitrates - like green leafy vegetables and beetroot - could be a simple strategy to reduce the risk of early macular degeneration," Associate Professor Gopinath said. Spinach has approximately 20mg of nitrate per 100g, while beetroot has nearly 15mg of nitrate per 100g. The research did not show any additional benefits for people who exceeded 142mgs of dietary nitrate each day. It also did not show any significant connections between vegetable nitrates and late stage AMD, or between non-vegetable nitrates and AMD risk. One in seven Australians over 50 have some signs of macular degeneration. Age is the strongest known risk factor and the disease is more likely to occur after the age of 50. There is currently no cure for the disease. The research compiled data from the Blue Mountains Eye Study, a benchmark population-based study that started in 1992. It is one of the world's largest epidemiology studies, measuring diet and lifestyle factors against health outcomes and a range of chronic diseases. "Our research aims to understand why eye diseases occur, as well as the genetic and environmental conditions that may threaten vision," Associate Professor Gopinath concluded. Research review shows intermittent fasting works for weight loss, health changes University of Illinois Chicago, October 13, 2021 Intermittent fasting can produce clinically significant weight loss as well as improve metabolic health in individuals with obesity, according to a new study review led by University of Illinois Chicago researchers. "We noted that intermittent fasting is not better than regular dieting; both produce the same amount of weight loss and similar changes in blood pressure, cholesterol and inflammation," said Krista Varady, professor of nutrition at the UIC College of Applied Health Sciences and author of "Cardiometabolic Benefits of Intermittent Fasting." According to the analysis published in the Annual Review of Nutrition, all forms of fasting reviewed produced mild to moderate weight loss, 1 percent to 8 percent from baseline weight, which represents results that are similar to that of more traditional, calorie-restrictive diets. Intermittent fasting regimens may also benefit health by decreasing blood pressure and insulin resistance, and in some cases, cholesterol and triglyceride levels are also lowered. Other health benefits, such as improved appetite regulation and positive changes in the gut microbiome, have also been demonstrated. The review looked at over 25 research studies involving three types of intermittent fasting: Alternate day fasting, which typically involves a feast day alternated with a fast day where 500 calories are consumed in one meal. 5:2 diet, a modified version of alternate day fasting that involves five feast days and two fast days per week. Time-restricted eating, which confines eating to a specified number of hours per day, usually four to 10 hours, with no calorie restrictions during the eating period. Various studies of time-restricted eating show participants with obesity losing an average of 3 percent of their body weight, regardless of the time of the eating window. Studies showed alternate day fasting resulted in weight loss of 3 percent to 8 percent of body weight over three to eight weeks, with results peaking at 12 weeks. Individuals on alternate day fasting typically do not overeat or binge on feast days, which results in mild to moderate weight loss, according to the review. Studies for the 5:2 diet showed similar results to alternate day fasting, which surprised the study's reviewers. The subjects who participate in the 5:2 diet fast much less frequently than alternate-day fasting participants do, but the weight loss results are similar. Weight loss with alternate day and 5:2 fasting are comparable to more traditional daily calorie-restrictive diets. And, both fasting diets showed individuals were able to maintain an average of 7 percent weight loss for a year. "You're fooling your body into eating a little bit less and that's why people are losing weight," Varady said. Varady added the review set out to debunk some myths regarding intermittent fasting. Intermittent fasting does not negatively affect metabolism, nor does it cause disordered eating, according to the studies reviewed. "Fasting people are worried about feeling lethargic and not being able to concentrate. Even though you are not eating, it won't affect your energy," Varady said. "A lot of people experience a boost of energy on fasting days. Don't worry, you won't feel crappy. You may even feel better." The study review includes a summary of practical considerations for those who may want to try intermittent fasting. Among the considerations are: Adjustment time—Side effects such as headaches, dizziness and constipation subside after one to two weeks of fasting. Increased water intake can help alleviate headaches caused by dehydration during this time. Exercise—Moderate to high-intensity endurance or resistance training during food abstention can be done, and some study participants reported having more energy on fast days. However, studies recommend those following alternate day fasting eat their fasting day meal after exercise. Diet during fasting—There are no specific recommendations for food consumption during intermittent fasting, but eating fruits, vegetables and whole grains can help boost fiber intake and help relieve constipation that sometimes accompanies fasting. Alcohol and caffeine—For those using an alternate day or 5:2 fasting plan, alcohol is not recommended on fast days as the limited calories should be used on healthy foods that provide nutrition. There are several groups who should not intermittent fast, according to the studies. Those individuals include: Those who are pregnant or lactating. Children under 12. Those with a history of disordered eating. Those with a body mass index, or BMI, less than 18.5. Shift workers. Studies have shown they may struggle with fasting regimens because of shifting work schedules. Those who need to take medication with food at regimented times. "People love intermittent fasting because it's easy. People need to find diets that they can stick to long term. It's definitely effective for weight loss and it's gained popularity because there are no special foods or apps necessary. You can also combine it with other diets, like Keto," Varady said. Varady has recently been awarded a National Institutes of Health grant to study time-restricted eating for 12 months to see if it works long term. Antioxidants to prevent Alzheimer's disease A balanced intake of antioxidants could prevent the development of Alzheimer's disease. Institut National de la Recherche Scientifique (France), October 13, 2021 Research conducted by the Ph.D student Mohamed Raâfet Ben Khedher and the postdoctoral researcher Mohamed Haddad of the Institut national de la recherche scientifique (INRS) has shown that an oxidation-antioxidant imbalance in the blood is an early indicator of Alzheimer's disease, rather than a consequence. This breakthrough made by researchers under the supervision of the Professor Charles Ramassamy provides an avenue for preventive intervention: the antioxidants intake. The research team showed that oxidative markers, known to be involved in Alzheimer's disease, show an increase up to five years before the onset of the disease. The results of this study, published in the Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring (DADM) journal, suggest that oxidation may be an early marker of this disease that affects more than 500,000 Canadians. “Given that there is an increase in oxidative stress in people who develop the disease, we may regulate the antioxidant systems. For example, we could modulate the antioxidant systems, such as apolipoproteins J and D, which transport lipids and cholesterol in the blood and play an important role in brain function and Alzheimer's disease. Another avenue would be to increase the intake of antioxidants through nutrition”, says Professor Ramassamy. Accessible biomarkers Unlike the current set of invasive and expensive tests used to diagnose Alzheimer's disease, the oxidative markers discovered by Professor Ramassamy's research team can be detected by a blood test. These markers are found in plasma extracellular vesicles, which are pockets released by all cells in the body, including those in the brain. The research team focused specifically on the "sporadic" Alzheimer's disease, the most common form of the disease which results primarily from the presence of the APOE4 susceptibility gene. This same form of the disease had been studied by the team for other early markers. “By identifying oxidative markers in the blood of individuals at risk five years before the onset of the disease, we could make recommendations to slow the onset of the disease and limit the risks”, scientists noted. This breakthrough brings new hope to Alzheimer's research. Once the disease is symptomatic, it is difficult, if not impossible, to reverse it. Meditation training reduces long-term stress, according to hair analysis Max Planck Institute for Human Cognitive and Brain Sciences (Germany), October 11, 2021 Mental training that promotes skills such as mindfulness, gratitude or compassion reduces the concentration of the stress hormone cortisol in hair. This is what scientists from the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig and the Social Neuroscience Research Group of the Max Planck Society in Berlin have found out. The amount of cortisol in hair provides information about how much a person is burdened by persistent stress. Earlier positive training effects had been shown in acutely stressful situations or on individual days—or were based on study participants' self-reports. According to a study by the Techniker Krankenkasse, 23 percent of people in Germany frequently suffer from stress. This condition not only puts a strain on the well-being of those affected, but it is also linked to a number of physiological diseases, including diabetes, cardiovascular diseases and psychological disorders such as depression, one of the world's leading causes of disease burden (Global Burden of Disease Study, 2017). Therefore, effective methods are being sought to reduce everyday stress in the long term. One promising option is mindfulness training, in which participants train their cognitive and social skills, including attention, gratitude and compassion, through various meditation and behavioral exercises. Various studies have already shown that even healthy people feel less stressed after a typical eight-week training program. Until now, however, it has been unclear how much the training actually contributes to reducing the constant burden of everyday stress. The problem with many previous studies on chronic stress is that the study participants were usually asked to self-assess their stress levels after the training. However, this self-reporting by means of questionnaires could have distorted the effects and made the results appear more positive than they actually were. The reason for such a bias: The participants knew they were training their mindfulness, and a reduction in stress levels was a desired effect of this training. This awareness alone has an impact on subsequent information. "If you are asked whether you are stressed after a training session that is declared as stress-reducing, even addressing this question can distort the statements," explains Lara Puhlmann, doctoral student at the Max Planck Institute for Human Cognitive and Brain Sciences and first author of the underlying publication, which has now appeared in the journal Psychosomatic Medicine. Factors such as social desirability and placebo effects played a role here. Unlike pharmacological studies, for example, in which the study participants do not know whether they have actually received the active substance or not, so-called blinded studies are not possible in mental training. "The participants know that they are ingesting the 'antidote,'" says Puhlmann. "In mindfulness research, we are therefore increasingly using more objective, i.e. physiological, methods to measure the stress-reducing effect more precisely." The concentration of cortisol in hair is considered a suitable measure of exposure to prolonged stress. Cortisol is a hormone that is released when we are confronted with an overwhelming challenge, for example. In that particular situation, it helps put our body on alert and mobilize energy to overcome the challenge. The longer the stress lasts, the longer an increased concentration of cortisol circulates around our body—and the more it accumulates in our hair. On average, hair grows one centimeter per month. To measure the study participants' stress levels during the 9-month training, the researchers, in cooperation with the working group of Clemens Kirschbaum at the University of Dresden, analyzed the amount of cortisol every three months in the first three centimeters of hair, starting at the scalp. The mental training itself was developed as part of a large-scale longitudinal study on the effects of mental training, the ReSource project, led by Tania Singer, scientific director of the Social Neuroscience Research Group. This 9-month mental training program consisted of three 3-month sessions, each designed to train a specific skill area using Western and Far Eastern mental exercises. The focus was either on the factors of attention and mindfulness, on socio-affective skills such as compassion and gratitude, or on so-called socio-cognitive skills, in particular the ability to take perspective on one's own and others' thoughts. Three groups of about 80 participants each completed the training modules in different order. The training lasted up to nine months, 30 minutes a day, six days a week. Less stress, less cortisol And it really showed: After six months of training, the amount of cortisol in the subjects' hair had decreased significantly, on average by 25 percent. In the first three months, slight effects were seen at first, which increased over the following three months. In the last third, the concentration remained at a low level. The researchers therefore assume that only sufficiently long training leads to the desired stress-reducing effects. The effect did not seem to depend on the content of the training. It is therefore possible that several of the mental approaches studied are similarly effective in improving the way people deal with chronic everyday stress. In an earlier study from the ReSource project with the same sample, the researchers had investigated the effects of training on dealing with acute stressful situations. In this study, the participants were placed in a stressful job interview and had to solve difficult maths problems under observation. The results showed that people who had undergone socio-cognitive or socio-affective training released up to 51 percent less cortisol under stress than those who had not been trained. In this case, they did not measure the amount of cortisol in the subjects' hair, but instead acute cortisolsurges in their saliva. Overall, the researchers conclude that training can improve the handling of acute particularly stressful social situations as well as chronic everyday stress. "We assume that different training aspects are particularly helpful for these different forms of stress," says Veronika Engert, head of the research group "Social Stress and Family Health" at the Max Planck Institute for Human Cognitive and Brain Sciences. "There are many diseases worldwide, including depression, that are directly or indirectly related to long-term stress," explains Puhlmann. "We need to work on counteracting the effects of chronic stress in a preventive way. Our study uses physiological measurements to prove that meditation-based training interventions can alleviate general stress levels even in healthy individuals." Study: Moderate carbohydrate intake is a cardiovascular benefit for women Monash University (Australia), October 13, 2021 Women's heart health has been the focus of a recent study by Monash University, with researchers finding that proportional carbohydrate intake and not saturated fat was significantly associated with cardiovascular disease benefit in Australian women. Cardiovascular disease (CVD) is the leading cause of death in women. Poor diet is recognized as both an independent CVD risk factor and a contributor to other CVD risk factors, such as obesity, diabetes mellitus (DM), hypertension, and dyslipidaemia. The research found that in middle-aged Australian women, increasing the percentage of carbohydrate intake was significantly associated with reduced odds of CVD, hypertension, diabetes mellitus, and obesity. Furthermore, a moderate carbohydrate intake between 41.0 percent—44.3 percent of total energy intake was associated with the lowest risk of CVD compared to women who consumed less than 37 percent energy as carbohydrates. No significant relationship was demonstrated between proportional carbohydrate intake and all-cause mortality. In addition, increasing proportional saturated fat intake was not associated with cardiovascular disease or mortality in women; rather, increasing saturated fat intakecorrelated with lower odds of developing diabetes mellitus, hypertension, and obesity. The findings are now published in the British Medical Journal. The results contradict much of the historical epidemiological research that supported a link between saturated fat and CVD. Instead, the results mirror contemporary meta-analysis of prospective cohort studies where saturated fat was found to have no significant relationship with total mortality or CVD. While the cause of this inconsistency in the literature is unclear, it has been suggested that historical studies neglected to adjust for fiber, which is known to help prevent plaque from forming in the arteries. "Controversy still exists surrounding the best diet to prevent CVD," said Sarah Zaman, a former Monash University professor who is now an associate professor at the University of Sydney. "A low-fat diet has historically been the mainstay of primary prevention guidelines, but the major issue within our dietary guidelines is that many dietary trials have predominately involved male participants or lacked sex-specific analyses." She adds: "Further research is needed to tailor our dietary guidelines according to sex." The study's first author Sarah Gribbin, a Doctor of Medicine and BMedSc (Hons) student, says: "As an observational study, our findings only show association and not causation. Our research is purely hypothesis-generating. We are hoping that our findings will spark future research into sex-specific dietary research." The Heart Foundation, which is one of the study's funders, welcomed the focus on women and CVD, which has historically been under-researched. Heart Foundation manager, food and nutrition, Eithne Cahill, cautioned that "not all carbohydrates are created equal." "We know that quality carbohydrate foods such as vegetables and whole grains—including whole grain bread, cereals, and pasta—are beneficial for heart health, whereas poor quality carbohydrates such as white bread, biscuits, cakes, and pastries can increase risk," she said. "Similarly, different fats have different effects on heart health. That is why the Heart Foundation focuses on healthy eating patterns—that is, a combination of foods, chosen regularly over time—rather than a single nutrient or food. Include plenty of vegetables, fruit, and whole grains, and heart-healthy fat choices such as nuts, seeds, avocados, olives and their oils for cooking and a variety of healthy proteins especially seafood, beans and lentils, eggs and dairy." Anti-cancer effects found in natural compound derived from onions Kumamoto University (Japan), October 18, 2021 Research from Kumamoto University, Japan has found that a natural compound isolated from onions, onionin A (ONA), has several anti-ovarian cancer properties. This discovery is a result of research on the effects of ONA on a preclinical model of epithelial ovarian cancer (EOC) both in vivo and in vitro. This research comes from the same group that found ONA suppressed pro-tumor activation of host myeloid cells. According to a 2014 review of cancer medicines from the World Health Organization, EOC is the most common type of ovarian cancer and has a 5-year survival rate of approximately 40%. It has a relatively low lifetime risk that is less than 1%, but that can increase up to 40% if there is a family history of the disease. A majority of patients (80%) experience a relapse after their initial treatment with chemotherapy, therefore a more effective line of treatment is needed. Kumamoto University researchers found that ONA has several effects on EOC. The group's in vitro experiments showed that EOCs, which usually proliferate in the presence of pro-tumor M2 macrophages, showed inhibited growth after introduction of ONA. This was thought to be due to ONAs influence on STAT3, a transcription factor known to be involved in both M2 polarization and cancer cell proliferation. Furthermore, the team found that ONA inhibited the pro-tumor functions of myeloid derived suppressor cells (MDSC), which are closely associated with the suppression of the anti-tumor immune response of host lymphocytes, by using preclinical sarcoma model. ONA was also found to enhance the effects of anti-cancer drugs by strengthening their anti-proliferation capabilities. Moreover, experiments on an ovarian cancer murine model that investigated the effects of orally administered ONA resulted in longer lifespans and inhibited ovarian cancer tumor development. This was considered to be a result of ONA's suppression of M2 polarized macrophages. The research shows that ONA reduces the progression of malignant ovarian cancer tumors by interfering with the pro-tumor function of myeloid cells. ONA appears to activate anti-tumor immune responses by nullifying the immunosuppressive function of myeloid cells. ONA has the potential to enhance existing anti-cancer drugs while also having little to no cytotoxic effects on normal cells. Additionally, side effects in animals have not been seen. With a little more testing, an oral ONA supplement should greatly benefit cancer patients. Risk of chronic diseases caused by exogenous chemical residues Dalian Institute of Chemical Physics (China), October 13, 2021 Chronic diseases are main killers affecting the health of human. The morbidities of major chronic diseases such as obesity, hypertension, diabetes, hyperuricemia and dyslipidemia are as high as 10% to 30%, showing a gradually upward trend as well. More and more studies have shown that environmental pollution is a major health risk factor that cannot be ignored. However, the evidence for their relationship is equivocal and the underlying mechanisms is unclear. Recently, a research group led by Prof. Xu Guowang from the Dalian Institute of Chemical Physics (DICP) of the Chinese Academy of Sciences (CAS) discovered the risk of chronic diseases caused by exogenous chemical residues through metabolome-wide association study. Their findings were published in Environment International on Oct. 8. Researchers from National Institute for Nutrition and Health of the Chinese Center for Disease Control and Prevention, and Tongji Medical College of Huazhong University of Science and Technology were also involved in this study. The researchers discovered positive associations of serum perfluoroalkyl substances (PFASs) with hyperuricemia, and revealed the mechanism of the relationship between the exogenous chemical residues in the serum and the risk of chronic diseases at the metabolic level. The researchers investigated the relationship between 106 exogenous chemical residues and five chronic diseases in 496 serum samples. They revealed the metabolic perturbations related to exogenous chemical residues and chronic diseases by the metabolome-wide association study combined with meeting-in-the-middle approach and mediation analysis, and investigated the further potential underlying mechanism at the metabolic level. "PFASs were the risk factor for hyperuricemia," said Prof. Xu. Lipid species including glycerophospholipids and glycerides presented the strongest correlation with exposure and disease, which were not only positively related to PFASs exposure but also the risk factor for hyperuricemia. "We also found that key mediation metabolites mediated 25% to 68% of the exposure-disease risk relationship," Prof. Xu added. This study provides in-depth etiological understanding for the occurrence and development of diseases, which may be helpful for the early detection of the disease and the identification of early warning markers.

prendre des antidépresseurs enceinte, et les orages plus forts en région ou en ville

Moteur de recherche

Play Episode Listen Later Sep 8, 2021 53:16

Le chroniqueur Alexandre Shields parle des conséquences des changements climatiques sur les courants marins et les courants d'air; la chroniqueuse Marie-Julie Gagnon explique comment s'organiser un voyage en France; Cathy Vaillancourt, professeure à l'Institut national de la recherche scientifique (INRS), se penche sur les risques et conséquences pour le bébé d'une mère qui prend des antidépresseurs pendant la grossesse; et Gabrielle Anctil nous explique s'il y a moins d'orages en ville que dans les autres régions.

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The Road to COP 26, Climate Science Confronts Fossil Power

Planet Haliburton

Play Episode Listen Later Aug 12, 2021 51:10

Join Terry Moore, for a discussion with Eddy Pérez, the Climate Action Network's International Climate Diplomacy Manager, about what climate science tells us needs to be done as the UN and world leaders prepare for the next big Climate Summit, COP 26, this fall in Scotland. Eddy Pérez Biographical Information CAN-Rac International Climate Diplomacy Manager Eddy Pérez joined Climate Action Network Canada in January 2018 after working in Geneva with the Intergovernmental Panel on Climate Change (IPCC) and as a Climate Action Network International consultant. He is the International Climate Diplomacy Manager at Climate Action Network Canada. Eddy is a lecturer at the University of Montreal and teaches Climate justice and international cooperation. Eddy is an expert on climate diplomacy, analyzing and monitoring international climate negotiations from a Canadian and North American perspective. He chairs the G7 Climate and Energy WG within the G7 Global Taskforce. He sits on the Canadian Domestic Advisory Group (CEDAG) for the Canada-European Union Comprehensive Economic and Trade Agreement (CETA). Eddy holds a Master of Science degree from the Institut national de la recherche scientifique du Québec (INRS). Eddy loves poetry and attributes part of his passion for climate justice to the work of Eduardo Galeano. One of his favourite quotes from this author is: “Recordar, from the Latin records, to pass back through the heart.” Information on CAN-Rac – Climate Action Network Canada: https://climateactionnetwork.ca/about-can-rac/ Information on COP 26: https://ukcop26.org Information on the Intergovernmental Panel on Climate Change (IPCC): https://www.ipcc.ch Information on IPCC Working Group 1 ”The Physical Basis for Climate Change”: https://www.ipcc.ch/working-group/wg1/

Le glyphosate au Canada, et la saison estivale des hôteliers québécois

Tout un matin

Play Episode Listen Later Jul 19, 2021 176:12

Karyn Nishimura-Poupée, journaliste indépendante au Japon, commente les premiers cas de COVID-19 au Village olympique de Tokyo; le Dr Réjean Thomas, spécialiste du VIH, décrit les répercussions de la pandémie sur les ITS; Louise Hénault-Éthier, professeure associée à l'Institut national de la recherche scientifique (INRS), réagit à la consultation de Santé Canada sur le glyphosate; Claudie Laberge, directrice principale des programmes d'urgence de la Croix-Rouge, raconte ses souvenirs du déluge du Saguenay il y a 25 ans; Christiane Germain, cofondatrice et coprésidente du Groupe Germain Hôtels, fait le point sur la saison estivale 2021 du secteur hôtelier québécois; et l'humoriste Taï livre ses impressions à quelques heures de son entrée en scène au Festival Juste pour rire.

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L'intégral du mercredi 9 juin

Play Episode Listen Later Jun 9, 2021 51:01

Le « Ben Voyons Donc ! » de Sophie Durocher: La réaction de Sophie face au commentaire de Justin Trudeau sur la loi 21 et la comparaison des masques. Discussion avec le collaborateur du jour: Jean-François Lisée, ancien chef du Parti québécois: Retour sur le drame de London et la loi 21 sur la laïcité Entrevue avec Mia Dansereau-Ligtenberg, historienne, agricultrice biologique et entrepreneure: Son livre des remèdes de grand-mère du Québec qui sortira en librairie le 11 juin. Entrevue Alain Lamarre, professeur et chercheur en immunologie et en virologie à l'Institut National de la recherche scientifique (INRS): Les femmes ressentent plus d'effets secondaires que les hommes suite au vaccin de la Covid-19. Une production QUB radio Avril 2021 Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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FranceFineArt

Play Episode Listen Later Jun 3, 2021 28:44

“Usimages 2021”Biennale de la photographie industriellesur les communes du territoire de l'Agglomération Creil Sud Oisedu 17 avril au 20 juin 2021Interview de Fred Boucher, co-directeur de Diaphane et direction artistique d'Usimages, biennale de la photographie du patrimoine industriel,par Anne-Frédérique Fer, enregistrement réalisé par téléphone, entre Paris et Clermont-de-l'Oise, le 2 juin 2021, durée 28'44, © FranceFineArt.Extrait du communiqué de presse :Commissariat par L'équipe Diaphane, Pôle photographique en Hauts-de-France, Fred Boucher, Direction artistique.Usimages, biennale de la photographie du patrimoine industriel, est organisée par l'Agglomération Creil Sud Oise (ACSO) et programmée et mise en oeuvre par Diaphane, pôle photographique en Hauts-de-France.Ce printemps, 13 expositions sont présentées en plein air dans les communes et invitent ainsi les habitants à une déambulation photographique à la découverte du territoire.Cette biennale est un temps fort qui met en valeur la photographie industrielle contemporaine et revisite des fonds photographiques issus de diverses collections, avec la volonté de questionner le regard des photographes sur le monde du travail et sa représentation.Fil rouge de cette édition, la thématique « Santé et sécurité au travail » est apparue comme une évidence dans cette période impactée par la crise sanitaire.Elle se décline à travers les photographies issues du fonds photographique de l'Institut national de recherche et de sécurité pour la prévention des accidents du travail et des maladies professionnelles (INRS), qui accompagne depuis 1947 les entreprises du régime général de la Sécurité sociale dans la prévention des risques au travail. En se plongeant dans ces images, on découvre l'évolution des conditions de travail issues de décennies d'automatisation. Des métiers disparaissent et l'iconographie nous présente ces bouleversements. En pénétrant dans les entreprises, les photographes ont réalisé des images à destination de la prévention, qui ont gagné au fil du temps en valeur historique et documentaire.Les photographies industrielles d'Émeric FEHER (1904-1966), conservées au Pôle images du Centre des monuments nationaux, révèlent une certaine approche commerciale des années 50 et 60. À travers des reportages très complets, suivis sur plusieurs années, le photographe était très attentif à la construction de son récit, qui se doit de documenter l'ensemble des process de production des entreprises commanditaires.On note chez FEHER une réelle attention à la mise en scène des corps en situation de travail. Les attitudes parfois stéréotypées répondent aux attentes d'une société en pleine reconstruction, où l'apologie de la modernité passe par ce type d'iconographie.De l'autre côté de l'Atlantique, un partenariat avec le Musée McCORD, musée d'histoire sociale de Montréal, permet de présenter les archives photographiques réalisées par plusieurs studios de photographes professionnels au début du XXe siècle. L'exposition « Montréal au travail » offre un panorama des différents métiers implantés dans le quartier Ville-Marie de la métropole québécoise.Le fonds de la société Créations artistiques Heurtier, conservé au Musée de Bretagne, est significatif d'une production d'images industrielles à destination commerciale. Réalisées par des opérateurs salariés, les photographies faites à la chambre moyen format sont d'une très grande qualité et magnifient l'objectivation des sujets photographiés.Les images semblent habitées de chuchotements et de bruitages étranges, et la présence des salariés mis en scène dans ces architectures des années 70, évoque les univers aseptisés et anonymes que traverse Monsieur Hulot dans le film « Playtime » de Jacques Tati.L'exposition collective « Au bureau », rassemble les photographies contemporaines de Julien BENARD, Laurent GÉLISE, Yannick LABROUSSE, et les images d'Émeric FEHER et du Fonds Bernard HEURTIER. Cette traversée d'un siècle d'espaces de travail nous éclaire sur les relations hiérarchiques induites par ces lieux où s'exercent la conception, la gestion et l'administration de multiples projets.La biennale reste ouverte sur le monde et sur les conditions de travail. Ioana CÎRLIG, dans sa série « Post Industrial Stories / The Last Shift » dépeint la classe ouvrière roumaine à la dérive dans un bassin houiller en mutation. Ces images ne sont pas sans nous rappeler le sort du bassin minier du Nord et de son secteur industriel.Dans le cadre des partenariats internationaux, Kaunas Photo festival (Lituanie) présente la série « LDPE, Polyéthylène à basse densité » d'Eugenijus BARZDŽIUS réalisée dans une des plus grandes usines de retraitement des déchets plastiques de Lituanie. Il y photographie les lieux et les outils de production qu'il associe à des portraits d'ouvriers mis en scène et habillés de plastique.Le festival Photolux (Italie) propose « Contingency Plans » (Plans d'urgence) du photographe Mattia BALSAMINI. Une plongée dans ces entreprises italiennes, qui au lendemain du confinement, ont bouleversé leur organisation et se sont réinventées pour faire face à la pandémie de la Covid-19.Dans cette période qui nous pousse à repenser l'organisation du travail, et aussi notre manière de consommer, le projet collectif « On n'est pas des robots. Ouvrières et ouvriers de la logistique » de Cécile CUNY, Nathalie MOHADJER et Hortense SOICHET nous invite à découvrir les conditions de travail et de vie des manutentionnaires de la logistique.Enfin, chaque édition d'Usimages est l'occasion de perpétuer les résidences dans les entreprises de l'Agglomération Creil Sud Oise, afin de contribuer à la construction d'une mémoire des activités du territoire.Cette année, deux jeunes photographes, Morgane DELFOSSE et Lucas CASTEL, tous deux issus de l'école du Septentecinq de Bruxelles, auront une carte blanche dans les quatre entreprises ayant accepté de participer à cette aventure.Le programme : Pour cette 4ème édition, 13 expositions gratuites et ouvertes à tous s'installent en extérieur dans les villes de Cramoisy, Creil, Maysel, Montataire, Nogent-sur-Oise, Rousseloy, Saint-Leu d'Esserent, Saint-Maximin, Saint-Vaast-lès-Mello, Thiverny et Villers-Saint-Paul.MONTATAIRE – Eugenijus BARZDŽIUS / LDPE – Polyéthylène à basse densitéROUSSELOY – Mattia BALSAMINI / Contingency PlansMAYSEL – Cécile CUNY, Nathalie MOHADJER, Hortense SOICHET / On n'est pas des robots. Ouvrières et ouvriers de la logistiqueTHIVERNY – Ioana CÎRLIG / Post Industrial Stories / The Last ShiftSAINT-MAXIMIN – Julien BENARD, Émeric FEHER, Laurent GÉLISE, Yannick LABROUSSE / Au bureauSAINT-VAAST-LÈS-MELLO – Lars TUNBJÖRK / OfficeVILLERS-SAINT-PAUL – INSTITUT NATIONAL DE RECHERCHE ET DE SÉCURITÉ / Sécurité, l'affaire de tousSAINT-LEU-D'ESSERENT – Émeric FEHER / Reportages industrielsNOGENT-SUR-OISE – La société Créations artistiques HEURTIER (1961-1978)CRAMOISY – Montréal au travailCREIL – Lucas CASTEL, Morgane DELFOSSE / Carte blanche en entreprise Voir Acast.com/privacy pour les informations sur la vie privée et l'opt-out.

Comment convaincre les jeunes à se faire vacciner?

faire les jeunes entrevue convaincre inrs

Play Episode Listen Later May 25, 2021 13:30

Entrevue avec Alain Lamarre, Spécialiste en immunologie rattaché à l’institut national de la recherche scientifique (INRS) : plus de 480 000 adultes de 18 à 29 ans n’ont pas de première dose ni de rendez-vous. Pour de l’information concernant l’utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

L'intégrale du mardi 25 mai

Évolution de la pandémie COVID-19

Play Episode Listen Later May 25, 2021 113:28

Entrevue avec Loan Laulanné, Coordonnatrice du secteur «Cyclisme pour tous» à la Fédération québécoise des sports cyclistes : l’année 2020 s’est soldée par le décès de 14 cyclistes dans la province, comparativement à 8 l’année précédente. Chronique d’Anaïs Guertin-Lacroix : le chanteur du groupe ayant remporté l'Eurovision est accusé d'avoir consommé de la cocaïne. Cinéma : un remake français des "Dents de la mer" tourné cet été. Entrevue avec Alain Lamarre, Spécialiste en immunologie rattaché à l’institut national de la recherche scientifique (INRS) : plus de 480 000 adultes de 18 à 29 ans n’ont pas de première dose ni de rendez-vous. Chronique de Geneviève Pettersen : la vaccination des jeunes. Chronique religion avec Alain Pronkin, spécialistes des religions : tous les québécois pourront s’approvisionner en vin de messe à la SAQ. Déconfinement: rien de précis annoncé pour les lieux de culte. Le prochain synode des évêques a été repoussé en 2023 au lieu de 2022. Segment d’actualité avec Alexandre Dubé : le bilan COVID-19 du jour. Les deuxièmes doses s’en viennent. Rassemblement à la plage du Cap-Saint-Jacques. Un gym clandestin à St-Hubert. Fermeture du pont de l’Île-aux-Tourtes. Entrevue avec Bernard Sévigny, coordonnateur et porte-parole du Comité consultatif sur la réalité policière : Le comité consultatif sur la réalité policière a présenté son rapport. Chronique politique provinciale et fédérale avec Antoine Robitaille et Caroline St-Hilaire : Le 3e lien, l’urgence sanitaire, Justin Trudeau ne mentionne aucunement la Journée nationale des Patriotes, des agents de la GRC liés à des accusations d’inconduite sexuelle et Dominique Anglade discute de son plan d’économie post-pandémique. Chronique politique internationale avec Loïc Tassé, politologue et chroniqueur au Journal de Montréal : L'enlèvement de l'opposant biélorusse Roman Protassevitch occupe l'avant-scène des médias, une nouvelle loi interdit aux plateformes numériques d'expulser des politiciens, un bandit devient un héro national, le gouvernement du Texas fait marche arrière et les températures sur Terre peuvent être beaucoup plus extrêmes qu'on le pensait. Chronique sports avec Jean-Charles Lajoie, animateur à TVA Sports : L’implication des jeunes dans l’alignement, Dominique Ducharme et le prochain duel. Une production QUB radio Mai 2021 Pour de l’information concernant l’utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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Pourquoi la vaccination des jeunes et des adultes est-elle différente?

Play Episode Listen Later Apr 30, 2021 14:59

Geneviève Pettersen (mise à jour - 30 avril 13h51) Entrevue avec Alain Lamarre, professeur et titulaire de la Chaire de recherche Jeanne et J.-Louis Lévesque en immunovirologie à l’Institut national de la recherche scientifique (INRS) : pourquoi la vaccination des jeunes et des adultes est-elle différente? Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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L'intégrale du vendredi 30 avril

Les Effrontées - Geneviève Pettersen et Vanessa Destiné

Play Episode Listen Later Apr 30, 2021 118:38

Entrevue avec Alain Lamarre, professeur et titulaire de la Chaire de recherche Jeanne et J.-Louis Lévesque en immunovirologie à l’Institut national de la recherche scientifique (INRS) : pourquoi la vaccination des jeunes et des adultes est-elle différente? Chronique de Nicole Gibeault, juge à la retraite : l’avocat de l'accusé dans l'affaire de la tuerie du Vieux-Québec le soir de l’Halloween a demandé un délai supplémentaire pour prendre connaissance de l’entièreté de la preuve, «compte tenu de son ampleur». Une jeune femme agressée et séquestrée par son conjoint. Une accusation d’homicide involontaire suite au décès lié à la COVID-19? Entrevue avec Luc Bonneville, professeur titulaire à l’Université d’Ottawa spécialiste en communication et santé : la vaccination est désormais ouverte à la population générale. Serait-il temps de déployer une campagne publicitaire d’envergure pour s’assurer du succès de cette opération d’envergure? Entrevue avec Anita Kapuscinska, porte-parole avec SPCA de Montréal : les animaux de compagnie très populaire au Canada selon un récent sondage fait pour la Journée nationale de l’adoption des animaux en refuge. Chronique de Martin Geoffroy, directeur du CEFIR et professeur de sociologie au cégep Édouard-Montpetit : débat et critiques du “loyer à 500$” : du populisme politique? Chronique de Léa Stréliski, humoriste et autrice : Québec songerait à vacciner les 12 à 17 ans d’ici le 1er juillet. Le premier ministre et les loyers à bas prix. Segment LCN avec Julie Marcoux : Des tenanciers de bars demandent d’être ouvert pour les personnes vaccinées. Entrevue avec Gabrielle Trépanier-Jobin, professeure en jeux vidéo et industries culturelles à l’École des médias de l’UQAM : la fausse prise d’otage chez Ubisoft, une possible vengeance d’un tricheur invétéré dans un jeu vidéo? Chronique de Danny St Pierre, animateur du balado L’Addition à QUB radio : les bars et restaurants ouverts seulement pour les vaccinés? Chronique Olivier Primeau, entrepreneur : comment convaincre les jeunes de se faire vacciner? Le Grand Prix a été annulé cette année. Chronique de Vincent Dessureault : des rendez-vous déplacés dus à la manifestation au Stade. Baisse du permis. Une production QUB radio Avril 2021 Pour de l’information concernant l’utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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Pourquoi la vaccination des jeunes et des adultes est-elle différente?

Les Effrontées - Geneviève Pettersen et Vanessa Destiné

Play Episode Listen Later Apr 30, 2021 14:59

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Encadrement de l’Intelligence artificielle: le Canada et le Québec devraient abandonner la mollesse et s’inspirer de l’Europe

Là-haut sur la colline - Antoine Robitaille

Play Episode Listen Later Apr 29, 2021 12:22

Entrevue avec Jonathan Roberge, Professeur à l’INRS, titulaire de la Chaire de recherche du Canada sur les nouveaux environnements numériques : intelligence artificielle. Pour de l’information concernant l’utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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L'intégrale du jeudi 29 avril

Là-haut sur la colline - Antoine Robitaille

Play Episode Listen Later Apr 29, 2021 34:57

Chronique droit criminel avec Nada Boumeftah, avocate : à l’ère du mouvement #MoiAussi, est-ce plus difficile qu’avant de représenter des agresseurs? Entrevue avec Sonia Lebel, ministre responsable des Institutions démocratiques et de la Réforme électorale : le mode de scrutin. Entrevue avec Jonathan Roberge, Professeur à l’INRS, titulaire de la Chaire de recherche du Canada sur les nouveaux environnements numériques : intelligence artificielle. Une production QUB radio Avril 2021 Pour de l’information concernant l’utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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L’évolution des prénoms et vieillir au Japon

Au fil du temps

Play Episode Listen Later Apr 20, 2021 56:02

De quelle génération est votre prénom? Chantal Dauray en discute avec Laurence Charton, sociodémographe à l’Institut national de recherche scientifique (INRS). Elle reçoit également Valérie Harvey, sociologue, qui nous cause des Japonais centenaires. Recherche et animation: Chantal Dauray Recherche: Catherine Bourderon Vous avez un récit de vie inspirant? Vous souhaitez venir en parler à l’émission?… Cet article L’évolution des prénoms et vieillir au Japon est apparu en premier sur Canal M, la radio de Vues et Voix.

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Faut-il imposer la loi 101 aux entreprises de moins de 50 employés?

Question d’intérêt

Play Episode Listen Later Apr 15, 2021 36:29

Près de 45 ans après l’adoption de la loi 101, le recul du français en inquiète plus d’un, particulièrement en milieu de travail. Si François Legault a promis d'amener des changements à la loi, le projet de réforme divise le milieu des affaires. Gérald Fillion en discute avec Karl Blackburn, PDG du Conseil du patronat, Camille Goyette-Gingras, DG de la Coop Couturières Pop et Mario Polèse, professeur émérite à l’INRS.

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S2E08 - Magali MANZANO - Comprendre la psychologie du travail

PEX - Partage d'Expérience de Prévention des Risques

Play Episode Listen Later Oct 20, 2020 58:18

J'accueille Magali MAZANO qui est Psychologue du travail pour le Service de Santé au Travail 72 basée dans la Sarthe. Recommandations de Magali Souffrancesautravail.fr Miniroue RPS Application CheckPoint.com, La prévention du stress au travail de ILO Le Dictionnaire des RPS de Philippe Zawieja 10 études de cas en psychologie du travail et des organisations CARSAT ; INRS; ANACT ; Ministère du travail Retrouvez Magali sur les réseaux sociaux LinkedIn

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L'INRS investira un million dans des projets de recherche québécois

Le retour de Mario Dumont

Play Episode Listen Later Oct 15, 2020 8:48

Entrevue avec Luc-Alain Giraldeau, directeur général de l’Institut National de la Recherche scientifique INRS : devant le besoin criant de mieux comprendre la COVID-19, l’Institut national de la recherche scientifique (INRS) investira un million $ dans des projets de recherche québécois ayant le potentiel de donner des résultats rapidement. Pour de l’information concernant l’utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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L'intégrale du jeudi 15 octobre

Le retour de Mario Dumont

Play Episode Listen Later Oct 15, 2020 107:53

Segment LCN avec Paul Larocque : l’Halloween sera permise aux enfants. Le tour de l’actualité avec Mario et Vincent : bilan des cas aujourd'hui. 30 000 cas déclarés en France. Contre-interrogatoire de Gilbert Rozon. YouTube ferme un compte québécois conspirationniste. Le DG de l'association québécoise de prévention du suicide défait une fausse nouvelle. Téo Taxi reprend du service. Chronique culturelle avec Anaïs Guertin-Lacroix : des infos sur le premier Gala de l’ADISQ. Un premier one-woman-show pour Guylaine Tremblay. Art numérique : ouvrez l'oeil à Montréal en fin de semaine. La prochaine comédie Netflix s’offre une distribution hallucinant. Entrevue avec Simon Jolin-Barrette, ministre de la Justice et Ministre responsable de la Langue française : dix des dix-neuf arrondissements de la métropole, ainsi que la Ville-Centre, n'ont pas de certificat de conformité à la Charte de la langue française, selon des données obtenues par TVA Nouvelles. Chronique sportive avec Jean-François Baril : Brendan Gallagher signe avec le Canadien. Marc Bergevin s’explique en conférence de presse. On semble pencher vers une division canadienne pour la reprise du hockey. 16h30 - Reprise des actualités avec Mario et Vincent : double ¨Town Hall meeting¨ ce soir pour Trump et Biden. Kamala Harris suspend ses déplacements. Première hausse de la population de caribous depuis 1993. Une dangereuse collision spatiale pourrait survenir ce soir. Des robots dauphins bientôt dans les parcs aquatiques? Entrevue avec Luc-Alain Giraldeau, directeur général de l’Institut National de la Recherche scientifique INRS : devant le besoin criant de mieux comprendre la COVID-19, l’Institut national de la recherche scientifique (INRS) investira un million $ dans des projets de recherche québécois ayant le potentiel de donner des résultats rapidement. Chronique de Richard Martineau : retour sur le procès de Gilbert Rozon. Montréal s’anglicise. Personne ne perd jamais sa job au Québec. Chronique politique avec Gilles Baril : jusqu'où vont aller les inquisiteurs et leur idéologie contre le Québec? Le racisme systémique. Segment LCN avec Pierre Bruneau : le confinement durera plus de 28 jours. Les enfants pourront passer l’Halloween. Une production QUB radio Octobre 2020 Pour de l’information concernant l’utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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L'INRS investira un million dans des projets de recherche québécois

Évolution de la pandémie COVID-19

Play Episode Listen Later Oct 15, 2020 8:48

Mario Dumont (mise à jour - 15 octobre 17h41) Entrevue avec Luc-Alain Giraldeau, directeur général de l’Institut National de la Recherche scientifique INRS : devant le besoin criant de mieux comprendre la COVID-19, l’Institut national de la recherche scientifique (INRS) investira un million $ dans des projets de recherche québécois ayant le potentiel de donner des résultats rapidement.Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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Ep4 - Burnout

Podcut

Play Episode Listen Later Oct 1, 2020 20:19

C'est la rentrée, on est fatigués voir épuisés. Mais comment s'assurer qu'il ne s'agit pas d'autre chose? Dans cet épisode, on verra comment le traitement de ce sujet a évolué et comment il se gère aujourd'hui *Ressources* - Etude de la Direction générale du travail (DGT) , l’Institut national de recherche et de sécurité (INRS) et l’Agence nationale pour l’amélioration des conditions de travail (Anact) https://travail-emploi.gouv.fr/IMG/pdf/Exe_Burnout_21-05-2015_version_internet.pdf - « Prévenir les risques psychosociaux : outils et méthodes pour réguler le travail » Ph. Douillet - « Epuisement professionnel ou burnout. Quand l’investissement professionnel devient trop lourd à porter » www.inrs.fr rubrique « Risques » - Article du Figaro : https://www.lefigaro.fr/social/ce-que-l-affaire-des-suicides-de-france-telecom-a-change-dans-les-entreprises-20190506 *Crédits* Ecriture: Karine Vendas Montage et illustrations sonores: Vincent Zuresco twitter @POLCA_Podcast POLCA est une production Podcut. Découvrez les autres podcasts du label sur http://podcut.studio/ Vous pouvez nous soutenir sur notre Patreon https://www.patreon.com/podcut

culture business leadership pr burnout dans direction quand institut entreprise figaro risques agence etude dgt podcut inrs

The Gary Null Show - 08.10.20

Paediatric Podcasts - Podiatrics

Play Episode Listen Later Aug 10, 2020 55:30

The Gary Null Show is here to inform you on the best news in health, healing, the environment. If you would like to sign up for the new PRN Newsletter provide your email to Prnstudio@gmail.com Professor Sunetra Gupta: the epidemic is on its way out Brendan O'Neill: The danger of the 'chattering class' Link confirmed between healthy diet and prostate cancer prevention University of Calgary, August 6, 2020 The Canadian Cancer Society estimates that more than 23,000 Canadians will be diagnosed with prostate cancer in 2020. Among other risk factors, more and more studies point to diet as a major factor in the development of prostate cancer, as it is for cardiovascular disease, diabetes, and obesity. Using data from a study conducted in Montreal between 2005 and 2012, a research team led by Professor Marie-Elise Parent of Institut national de la recherche scientifique (INRS) has shown a link between diet and prostate cancer in the article “Dietary Patterns Are Associated with Risk of Prostate Cancer in a Population-Based Case-Control Study in Montreal, Canada”, published in Nutrients in June. Three main dietary profiles analyzed INRS PhD student Karine Trudeau, the lead author of the study, based her analysis on three main dietary profiles: healthy diet, salty Western diet including alcohol, and sugar-rich Western diet with beverages. The first profile leans heavily towards fruits, vegetables, and plant proteins like tofu and nuts. The salty Western diet with alcohol includes more meat and beverages such as beer and wine. The third profile is rich in pasta, pizza, desserts, and sugary carbonated drinks. The study took age, ethnicity, education, family history, and date of last prostate cancer screening into account. Marie-Elise Parent and Karine Trudeau found a link between a healthy diet and a lower risk of prostate cancer. Conversely, a Western diet with sweets and beverages was associated with a higher risk and seemed to be a factor in more aggressive forms of cancer. The study did not show any clear link between a Western diet with salt and alcohol and the risk of developing the disease. Moving away from the typical approach used in epidemiological studies, which involves looking at one nutrient or food group at a time, the researchers collected data from a broader dietary profile. “It's not easy to isolate the effect of a single nutrient,” explained Ms. Trudeau. “For example, foods rich in vitamin C, such as citrus fruits, promote iron absorption. Calcium is often found in dairy products, which also contain vitamin D. Our more targeted approach takes this synergy into account to produce more meaningful results that public health authorities can use to formulate recommendations. Rather than counting on one miracle food, people should look at their overall diet.” “For a long time we've suspected that diet might play a role in the development of prostate cancer, but it was very hard to pinpoint the specific factors at play,” said Professor Parent. “This study is significant because it looks at dietary habits as a whole. We've uncovered evidence that, we hope, can be used to develop prevention strategies for prostate cancer, the most common cancer among men in Canadaand many other countries.” Compounds in 'monster' radish could help tame cardiovascular disease American Chemical Society, August 9, 2020 Step aside carrots, onions and broccoli. The newest heart-healthy vegetable could be a gigantic, record-setting radish. In a study appearing in ACS' Journal of Agricultural and Food Chemistry, scientists report that compounds found in the Sakurajima Daikon, or "monster," radish could help protect coronary blood vessels and potentially prevent heart disease and stroke. The finding could lead to the discovery of similar substances in other vegetables and perhaps lead to new drug treatments. Grown for centuries in Japan, the Sakurajima Daikon is one of the Earth's most massive vegetables. In 2003, the Guinness Book of World Records certified a Sakurajima weighing nearly 69 pounds as the world's heaviest radish. Radishes are good sources of antioxidants and reportedly can reduce high blood pressure and the threat of clots, a pair of risk factors for heart attack and stroke. But to date, no studies have directly compared the heart-health benefits of the Sakurajima Daikon to other radishes. To address this knowledge gap, Katsuko Kajiya and colleagues sought to find out what effects this radish would have on nitric oxide production, a key regulator of coronary blood vessel function, and to determine its underlying mechanisms. The researchers exposed human and pig vascular endothelial cells to extracts from Sakurajima Daikon and smaller radishes. Using fluorescence microscopy and other analytical techniques, the research team found the Sakurajima Daikon radish induced more nitric oxide production in these vascular cells than a smaller Japanese radish. They also identified trigonelline, a plant hormone, as the active component in Sakurajima Daikon that appears to promote a cascade of changes in coronary blood vessels resulting improved nitric oxide production. Placebos prove powerful even when people know they're taking one Michigan State University, August 7, 2020 How much of a treatment is mind over matter? It is well documented that people often feel better after taking a treatment without active ingredients simply because they believe it's real -- known as the placebo effect. A team of researchers from Michigan State University, University of Michigan and Dartmouth College is the first to demonstrate that placebos reduce brain markers of emotional distress even when people know they are taking one. Now, evidence shows that even if people are aware that their treatment is not "real" -- known as nondeceptive placebos -- believing that it can heal can lead to changes in how the brain reacts to emotional information. "Just think: What if someone took a side-effect free sugar pill twice a day after going through a short convincing video on the power of placebos and experienced reduced stress as a result?", said Darwin Guevarra, MSU postdoctoral fellow and the study's lead author. "These results raise that possibility." The new findings, published in the most recent edition of the journal Nature Communications, tested how effective nondeceptive placebos -- or, when a person knows they are receiving a placebo -- are for reducing emotional brain activity. "Placebos are all about 'mind over matter," said Jason Moser, co-author of the study and professor of psychology at MSU. "Nondeceptive placebos were born so that you could possibly use them in routine practice. So rather than prescribing a host of medications to help a patient, you could give them a placebo, tell them it can help them and chances are -- if they believe it can, then it will." To test nondeceptive placebos, the researchers showed two separate groups of people a series of emotional images across two experiments. The nondeceptive placebo group members read about placebo effects and were asked to inhale a saline solution nasal spray. They were told that the nasal spray was a placebo that contained no active ingredients but would help reduce their negative feelings if they believed it would. The comparison control group members also inhaled the same saline solution spray, but were told that the spray improved the clarity of the physiological readings the researchers were recording. The first experiment found that the nondeceptive placebos reduced participants' self-reported emotional distress. Importantly, the second study showed that nondeceptive placebos reduced electrical brain activity reflecting how much distress someone feels to emotional events, and the reduction in emotional brain activity occurred within just a couple of seconds. "These findings provide initial support that nondeceptive placebos are not merely a product of response bias - telling the experimenter what they want to hear -- but represent genuine psychobiological effects," said Ethan Kross, co-author of the study and a professor of psychology and management at the University of Michigan. Greater coffee intake associated with decreased depressive symptoms among older Japanese women Nakamura Gakuen University (Japan), August 5, 2020 According to news reporting originating from Fukuoka, Japan, by NewsRx correspondents, research stated, “Depression in elderly people is a major global concern around the world. Epidemiological evidence of the association of beverages with depressive symptoms has received research attention; however, epidemiological studies on the association of coffee and green tea consumption with depressive symptoms among the elderly population are limited.” Our news editors obtained a quote from the research from Nakamura Gakuen University, “The objective of this study is to cross-sectionally examine the association of depressive symptoms with the intake of coffee, green tea, and caffeine and to verify the antidepressant effect of caffeine. The subjects were 1,992 women aged 65-94 years. Intakes of coffee, green tea, and caffeine, as well as depressive symptoms, were assessed with a validated brief dietary history questionnaire (BDHQ) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (as) for depressive symptoms with adjustments for potential confounders. Coffee intake was associated with a lower prevalence of depressive symptoms, the ORs of which for the 4th versus the 1st quartiles of intake was 0.64 (95% CI, 0.46-0.88, P for trend = 0.01) in a fully adjusted model. Caffeine intake was marginally associated with depressive symptoms, but the association was not statistically significant (OR 0.75; 95% CL 0,55-1,02. P for trend = 0.058). The result suggests that the inverse association of coffee intake with depressive symptoms might be associated with not only caffeine intake but also some other substances in coffee or factors related to coffee intake.” According to the news editors, the research concluded: “Because of the cross-sectional design of the present study, longitudinal studies are required to confirm the present finding.” Sugary drinks and disease: Chugging 2 sodas per day increases your risk of premature death University College Dublin (Ireland), August 8, 2020 On top of raising blood sugar and contributing to abdominal fat, European researchers found that soda can also lead to an earlier death. Published in JAMA Internal Medicine, the study demonstrates that daily consumption of two or more sodas – diet or not – and other sweetened drinks corresponds to a 17 percent increase in the risk of premature death from all causes. The “bitter truth” of soda consumption: premature death To examine the relationship between soda consumption and the risk of all-cause and cause-specific mortality, the researchers studied 451,743 individuals living in 10 European countries, including Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden and the United Kingdom. The participants were from the European Prospective Investigation into Cancer and Nutrition (EIPC) study, one of the largest ongoing cohort studies on diet and its relation to cancer and other chronic diseases. None of the participants have any chronic conditions. The team studied their soda consumption for an average of 16 years. During that period, a total of 41,693 participants died from all causes, eleven percent of whom reported drinking at least two sodas daily, while nine percent reported drinking not more than one per month. The participants who drank two or more glasses of soda also had a higher risk of death from heart conditions. Meanwhile, those who reported consuming other beverages sweetened with either sugar or artificial sweeteners had a greater risk of death from digestive diseases. Participants who drank diet soda weren't off the hook either. The team reported that those who drank diet sodas also had a greater risk of earlier death from cardiovascular disease(CVD). Taken together, these findings indicate that the consumption of soda, diet soda and other sweetened beverages is linked to premature death from all causes, including CVD and digestive diseases. The researchers noted that their study supports public health campaigns aimed at limiting the consumption of sodas and other sugar-laden drinks. Fisetin derivative shows promise against Alzheimer disease in mice Salk Institute, August 5 2020. he September 2020 issue of Redox Biology published the finding of Salk Institute researchers of an ability for a compound derived from fisetin, a flavonoid occurring in many plants, to reverse memory loss in a mouse model of Alzheimer disease. The compound, known as CMS121, which was synthesized by Pamela Maher and colleagues, was recently demonstrated to slow brain cell aging. "This was a more rigorous test of how well this compound would work in a therapeutic setting than our previous studies on it," commented Dr Maher. "Based on the success of this study, we're now beginning to pursue clinical trials." In the current research, normal mice and mice that were genetically modified to develop Alzheimer disease were given CMS121 starting at nine months of age. Untreated Alzheimer mice and normal mice served as controls. At 12 months, memory and behavior tests revealed that treated Alzheimer mice performed as well as control mice and that Alzheimer mice that did not receive CMS121 performed worse. An increase in lipid peroxidation was observed in brains cells of untreated Alzheimer mice in comparison with Alzheimer mice that received CMS121. "That not only confirmed that lipid peroxidation is altered in Alzheimer's, but that this drug is actually normalizing those changes," remarked first author Gamze Ates. It was further determined that CMS121 lowered levels of the lipid-producing molecule fatty acid synthetase (FASN). Brain samples from human Alzheimer patients revealed that greater amounts of FASN were present in comparison with cognitively healthy patients, suggesting that FASN could be a drug target for Alzheimer disease. "There has been a big struggle in the field right now to find targets to go after," Dr Maher stated. "So, identifying a new target in an unbiased way like this is really exciting and opens lots of doors." REM sleep tunes eating behavior University of Bern (Germany), August 7, 2020 Despite our broad understanding of the different brain regions activated during rapid-eye-movement sleep, little is known about what this activity serves for. Researchers at the University of Bern and the Inselspital have now discovered that the activation of neurons in the hypothalamus during REM sleep regulates eating behaviour: suppressing this activity in mice decreases appetite. While we are asleep, we transition between different phases of sleep each of which may contribute differently to us feeling rested. During (rapid eye movement) REM sleep, a peculiar sleep stage also called paradoxical sleep during which most dreaming occurs, specific brain circuits show very high electrical activity, yet the function of this sleep-specific activity remains unclear. Among the brain regions that show strong activation during REM sleep are areas that regulate memory functions or emotion, for instance. The lateral hypothalamus, a tiny, evolutionarily well conserved brain structure in all mammals also shows high activity during REM sleep. In the awake animals, neurons from this brain region orchestrate appetite and the consumption of food and they are involved in the regulation of motivated behaviours and addiction. In a new study, researchers headed by Prof. Dr. Antoine Adamantidis at the University of Bern set out to investigate the function of the activity of hypothalamic neurons in mice during REM sleep. They aimed at better understanding how neural activation during REM sleep influences our day-to-day behaviour. They discovered that suppressing the activity of these neurons decreases the amount of food the mice consume. "This suggests that REM sleep is necessary to stabilize food intake", says Adamantidis. The results of this study have been published in the journal Proceedings of the National Academy of Sciences (PNAS). Long-lasting effect on neuronal activity and feeding behavior The researcher discovered that specific activity patterns of neurons in the lateral hypothalamus that usually signal eating in the awake mouse are also present when the animals were in the stage of REM sleep. To assess the importance of these activity patterns during REM sleep the research group used a technique called optogenetics, with which they used light pulses to precisely shut down the activity of hypothalamic neurons during REM sleep. As a result, the researchers found that the activity patterns for eating were modified and that the animals consumed less food. "We were surprised how strongly and persistently our intervention affected the neural activity in the lateral hypothalamus and the behaviour of the mice", says Lukas Oesch, the first author of the study. He adds: "The modification in the activity patterns was still measurable after four days of regular sleep." These findings suggest that electrical activity in hypothalamic circuits during REM sleep are highly plastic and essential to maintain a stable feeding behaviour in mammals. It is a question of quality These findings point out that sleep quantity alone is not solely required for our well-being, but that sleep quality plays a major role in particular to maintain appropriate eating behaviour. "This is of particular relevance in our society where not only sleep quantity decreases but where sleep quality is dramatically affected by shift work, late night screen exposure or social jet-lag in adolescents", explains Adamantidis. The discovered link between the activity of the neurons during REM sleep and eating behaviour may help developing new therapeutical approaches to treat eating disorders. It might also be relevant for motivation and addiction. "However, this relationship might depend on the precise circuitry, the sleep stage and other factors yet to be uncovered", adds Adamantidis. The key role of zinc in elderly immunity Federal University of Juiz de Fora (Brazil), August 7, 2020 According to news reporting originating from Juiz de Fora, Brazil, by NewsRx editors, the research stated, “The COVID-19 infection can lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mainly affecting patients aged 60 and older. Preliminary data suggest that the nutritional status can change the course of the infection, and on the matter, zinc is crucial for growth, development, and the maintenance of immune function.” Our news editors obtained a quote from the research from the Federal University of Juiz de Fora, “In the absence of treatment for this virus, there is an urgent need to find alternative methods that can contribute to control of disease. The aim of this paper is to establish the relation between zinc and COVID-19. From the prior scientific knowledge, we have performed a review of the literature and examine the role of zinc in immune function in the infection by COVID-19. Our findings are that the zinc as an anti-inflammatory agent may help to optimize immune function and reduce the risk of infection.” According to the news editors, the research concluded: “Zinc supplementation can be a useful strategy to reduce the global burden of infection in the elderly, there is a need the increased reporting to improve our understanding of COVID-19 and the care of affected patients.”

Episode 21 - Junior Doctor talk - Warfarin

Play Episode Listen Later Aug 1, 2020 33:57

How to prescribe warfarin and deal with common scenarios with out of range INRs and drug interactions

junior doctors warfarin inrs

The Gary Null Show - 07.28.20

News Diario Prevenzione Podcast

Play Episode Listen Later Jul 28, 2020 56:25

Consuming alliums like onions and garlic found to lower colorectal cancer risk by 79 percent China Medical University, July 24, 2020 In a recent study published in the Asia-Pacific Journal of Clinical Oncology, Chinese researchers found that eating high amounts of allium vegetables corresponded to a 79 percent reduction in colorectal cancer risk. According to senior author Zhi Li from The First Hospital of China Medical University, their findings highlight a trend: The greater the amount of alliums consumed, the better the protection against colorectal cancer. Higher allium consumption linked to a reduced risk of colorectal cancer For their research, the team compared the food intake of 833 colorectal cancer patients to that of 833 healthy participants (controls) who matched them in terms of age, sex and area of residence. The researchers used food frequency questionnaires to collect the participants' dietary information. The researchers found that those who consumed high amounts of allium vegetables had a 79 percent reduced risk of colorectal cancer. Li said that their findings shed light on the role of lifestyle intervention in the prevention of colorectal cancer. However, Mary Flynn, an associate professor of medicine at Brown University in Rhode Island, noted that although these findings are interesting, it bears stressing that the colorectal cancer patients had a greater family history of the disease than the controls. The colorectal cancer patients also smoked more and reported consuming less fruits, more alcohol and almost double the amount of red meat than the controls. Together, Flynn says that these factors may have influenced the significant reductions in colorectal cancer risk observed. On the other hand, the link between allium consumption and lower colon cancer risk remained even after these differences were factored into the analysis, suggesting that allium vegetables like onions, garlic, leeks and shallots do have strong cancer-fighting potential. The study is one of many that report the anti-cancer benefits of allium vegetables, which are attributed to their sulfur-containing active components. (Related: Researchers explore the anti-cancer potential of a local onion from Iran.) Garlic, onion and other alliums: promising candidates for holistic cancer treatment Alliums like onions and garlic are among the most studied cancer-fighting foods, besides cruciferous vegetables, because of their abundance of phenolic compounds. In a recent article published in the journal Cancer Prevention Research, a team of scientists from the U.S. highlighted the ability of allium vegetables to prevent different types of cancer. In particular, multiple mechanistic studies agree that the sulfur-containing compounds in alliums are responsible for their anti-carcinogenic properties. Some of these compounds include allicin, alliin and ajoene. Alliums also contain other potent plant compounds that contribute to their cancer-fighting potential. These compounds include flavonoids, oligosaccharides, arginine and selenium. According to several epidemiological studies, increased intake of these allium components is linked to a decreased risk of certain cancers, such as stomach, colon, esophageal and prostate cancer. In another recent article published in the journal Food Research International, researchers from the University of Guelph in Canada found a local variety of red onions to be the most effective at killing both colon and breast cancer cells. The team attributed the cancer-fighting potential of Ontario-grown red onions to their high quercetin and anthocyanin content. Both flavonoids have been studied in the past as chemopreventive agents in several cancer models. Taken together, these studies offer ample proof that allium vegetables are excellent natural medicines for various types of cancer. Link confirmed between a healthy diet and prostate cancer prevention An INRS team shows an association between eating habits and prostate cancer National Institute for Scientific Research (Montreal), July 28, 2020 The Canadian Cancer Society estimates that more than 23,000 Canadians will be diagnosed with prostate cancer in 2020. Among other risk factors, more and more studies point to diet as a major factor in the development of prostate cancer, as it is for cardiovascular disease, diabetes, and obesity. Using data from a study conducted in Montreal between 2005 and 2012, a research team led by Professor Marie-Élise Parent of Institut national de la recherche scientifique (INRS) has shown a link between diet and prostate cancer in the article "Dietary Patterns Are Associated with Risk of Prostate Cancer in a Population-Based Case-Control Study in Montreal, Canada", published in Nutrients in June. Three main dietary profiles analyzed INRS PhD student Karine Trudeau, the lead author of the study, based her analysis on three main dietary profiles: healthy diet, salty Western diet including alcohol, and sugar-rich Western diet with beverages. The first profile leans heavily towards fruits, vegetables, and plant proteins like tofu and nuts. The salty Western diet with alcohol includes more meat and beverages such as beer and wine. The third profile is rich in pasta, pizza, desserts, and sugary carbonated drinks. The study took age, ethnicity, education, family history, and date of last prostate cancer screening into account. Marie-Élise Parent and Karine Trudeau found a link between a healthy diet and a lower risk of prostate cancer. Conversely, a Western diet with sweets and beverages was associated with a higher risk and seemed to be a factor in more aggressive forms of cancer. The study did not show any clear link between a Western diet with salt and alcohol and the risk of developing the disease. Moving away from the typical approach used in epidemiological studies, which involves looking at one nutrient or food group at a time, the researchers collected data from a broader dietary profile. "It's not easy to isolate the effect of a single nutrient," explained Ms. Trudeau. "For example, foods rich in vitamin C, such as citrus fruits, promote iron absorption. Calcium is often found in dairy products, which also contain vitamin D. Our more targeted approach takes this synergy into account to produce more meaningful results that public health authorities can use to formulate recommendations. Rather than counting on one miracle food, people should look at their overall diet." "For a long time we've suspected that diet might play a role in the development of prostate cancer, but it was very hard to pinpoint the specific factors at play," said Professor Parent. "This study is significant because it looks at dietary habits as a whole. We've uncovered evidence that, we hope, can be used to develop prevention strategies for prostate cancer, the most common cancer among men in Canada and many other countries." In addition to INRS faculty and students Marie-Élise Parent, Karine Trudeau, Christine Barul, and Marie-Claude Rousseau, Ilona Csizmadi (Cumming School of Medicine) participated in the research. The study was funded by the Canadian Cancer Society (CCS), the Cancer Research Society (CRS), Fonds de la recherche du Québec--Santé (FRQS), and Ministère de l'Économie et de l'Innovation (MEI). Study reveals humans are impatient, even down to seconds Ohio University, July 28, 2020 An Ohio University study seeking to understand the psychological mechanisms of waiting for a larger reward in contrast to instant gratification with a smaller reward was recently published in the Journal of Experimental Psychology: General, a flagship journal of the American Psychological Association. The research team discussed in their paper how their findings show that people are impatient not only when thinking about whether to wait or not for a larger reward in the abstract, but they are even more impatient when they actually must wait to receive a larger reward. In the study, the amounts and delays were small (in cents and seconds), but even in the small-scale participants demonstrated myopic behavior, as in preferring the smaller payoff sooner. "In this particular paper, we're interested in how people make decisions that entail comparing the time that it takes to get something versus how much one will get," said Dr. Claudia González Vallejo, a professor in the College of Arts and Sciences Department of Psychology and second author of the paper. "Those types of experiments are under an umbrella of what is called intertemporal choice, which refers to studying how people make tradeoffs between amounts, either to gain or to lose, relative to the timing of those." The paper's lead author is Dr. Ping Xu, currently of Shenzhen University's School of Psychology, and the third author is Dr. Benjamin Vincent of University of Dundee's School of Social Sciences. The paper is based on Xu's dissertation from 2019 as she graduated from OHIO under Dr. González Vallejo's mentoring. "I feel lucky, honored and touched. I am proud of my team," Xu said of having the paper finally published. In the study, the researchers made a realistic situation in which participants could actually experience the time of waiting to receive something, with payoffs and units of time adjusted to be smaller altogether, while at a computer. This worked by having a participant make decisions between coins that were small and could be received immediately, or larger ones that required a waiting period in seconds before they could be picked up. For each choice, the participant could thus wait and get something larger, or take the smaller reward. Two groups received identical choice options but differed on whether they had to wait to receive the larger payoff after each choice was made or not. In other words, one group experienced the delay after each selection, whereas the other group did not and expected waiting at the end of the experiment instead. Before the results, González Vallejo thought that the time to wait was so small that it wouldn't matter to participants. If it was only a few seconds, surely they would take the larger reward every time, she thought. However, that was not the result. "We found that in both situations, people did make the tradeoff between time and money. It wasn't that they would just go for few more cents every time because the amounts of time were too small to even think about them. So, delays matter—even seconds to people matter," González Vallejo said. "In general, people are just very impatient." Xu said, "[The results] overturned our initial plans and predictions, and led us towards something surprising, or to a direction we had never thought of." Using mathematical modeling, two reasons for the findings include that time feels longer when experiencing it and the amount of the reward is devalued when it is delayed, with the study finding support for both reasonings. Future empirical tests are needed to test these ideas further. Although the research project was started a couple years ago, González Vallejo noted that the findings can be applicable to the current pandemic. For example, while some countries implemented earlier and longer lockdowns and mask mandates, others showed hesitation to implement such policies or did not wait through the mandates long enough for cases to decrease substantially, with cases continuing to grow. "I think a lot of experts right now come together and agree on some studies that have shown that if [the United States] had remained in lockdown, or if lockdowns were done earlier and longer, perhaps things would have unfolded differently," González Vallejo said. "Waiting is not easy, as our study showed, and I think future research in terms of analyzing different countries' policies with that in mind will show how some policies requiring patience ended up giving different outcomes for this pandemic." Publishing in a flagship APA journal is extremely competitive and difficult, thus relief exists among the team for the accomplishment to have the work finally published in Journal of Experimental Psychology: General after several months. "When I saw the final publication, I felt that I have graduated for the second time," Xu said. "I am lucky having [that] kind of experience." Low plasma 25(OH) vitamin D level associated with increased risk of COVID-19 infection Bar Ilan University (Israel), July 28, 2020 Vitamin D is recognized as an important co-factor in several physiological processes linked with bone and calcium metabolism, and also in diverse non-skeletal outcomes, including autoimmune diseases, cardiovascular diseases, type 2 diabetes, obesity and cognitive decline, and infections. In particular, the pronounced impact of vitamin D metabolites on the immune system response, and on the development of COVID-19 infection by the novel SARS CoV-2 virus, has been previously described in a few studies worldwide. The collaborative group of scientists from the Leumit Health Services (LHS) and the Azrieli Faculty of Medicine of Bar-Ilan University aimed to determine associations of low plasma 25(OH)D with the risk of COVID-19 infection and hospitalization. Using the real-world data and Israeli cohort of 782 COVID-19 positive patients and 7,807 COVID-19 negative patients, the groups identified that low plasma vitamin D level appears to be an independent risk factor for COVID-19 infection and hospitalization. The research was just published in The FEBS Journal. "The main finding of our study was the significant association of low plasma vitamin D level with the likelihood of COVID-19 infection among patients who were tested for COVID-19, even after adjustment for age, gender, socio-economic status and chronic, mental and physical disorders," said Dr. Eugene Merzon, Head of the Department of Managed Care and leading researcher of the LHS group. "Furthermore, low vitamin D level was associated with the risk of hospitalization due to COVID-19 infection, although this association wasn't significant after adjustment for other confounders," he added. "Our finding is in agreement with the results of previous studies in the field. Reduced risk of acute respiratory tract infection following vitamin D supplementation has been reported," said Dr. Ilan Green, Head of the LHS Research Institute. "According to our analysis, persons that were COVID-19 positive were older than non-infected persons. Interestingly, the two-peak distributions for age groups were demonstrated to confer increased risk for COVID-19: around ages 25 and 50 years old," said Dr. Milana Frenkel-Morgenstern, the leader of the Azrieli Faculty of Medicine research group. "The first peak may be explained by high social gathering habits at the young age. The peak at age 50 years may be explained by continued social habits, in conjunction with various chronic diseases," Dr. Frenkel-Morgenstern continued. "Surprisingly, chronic medical conditions, like dementia, cardiovascular disease, and chronic lung disease that were considered to be very risky in previous studies, were not found as increasing the rate of infection in our study," noted Prof. Shlomo Vinker, LHS Chief Medical Officer. "However, this finding is highly biased by the severe social contacts restrictions that were imposed on all the population during the COVID-19 outbreak. Therefore, we assume that following the Israeli Ministry of Health instructions, patients with chronic medical conditions significantly reduced their social contacts. This might indeed minimize the risk of COVID-19 infection in that group of patients," explained Prof. Vinker. Dr. Dmitry Tworowski and Dr. Alessandro Gorohovski. from the Frenkel-Morgenstern laboratory at Bar-Ilan University's Azrieli Faculty of Medicine, suggest that the study will have a very significant impact. "The main strength of our study is its being large, real-world, and population-based," they explained. Now researchers are planning to evaluate factors associated with mortality due to COVID-19 in Israel. "We are willing to find associations to the COVID-19 clinical outcomes (for example, pre-infection glycemic control of COVID-19 patients) to make the assessment of mortality risk due to COVID-19 infection in Israel," said Dr. Eugene Merzon. Oral N-acetylcysteine improved cone function in retinitis pigmentosa patients Johns Hopkins University, July 23, 2020 According to news reporting out of Baltimore, Maryland, by NewsRx editors, research stated, “In retinitis pigmentosa (RP), rod photoreceptors degenerate from 1 of many mutations, after which cones are compromised by oxidative stress. N-acetylcysteine (NAC) reduces oxidative damage and increases cone function/survival in RP models.” Our news journalists obtained a quote from the research from Johns Hopkins University, “We tested the safety, tolerability, and visual function effects of oral NAC in RP patients. Subjects (n = 10 per cohort) received 600 mg (cohort 1), 1200 mg (cohort 2), or 1800 mg (cohort 3) NAC bid for 12 weeks and then tid for 12 weeks. Best-corrected visual acuity (BCVA), macular sensitivity, ellipsoid zone (EZ) width, and aqueous NAC were measured. Linear mixed-effects models were used to estimate the rates of changes during the treatment period. There were 9 drug related gastrointestinal adverse events that resolved spontaneously or with dose reduction (maximum tolerated dose 1800 mg bid). During the 24-week treatment period, mean BCVA significantly improved at 0.4 (95% CI: 0.2-0.6, P< 0.001), 0.5 (95% CI: 0.3-0.7, P< 0.001), and 0.2 (95% CI: 0.02-0.4, P = 0.03) letters/month in cohorts 1, 2, and 3, respectively. There was no significant improvement in mean sensitivity over time in cohorts land 2, but there was in cohort 3 (0.15 dB/month, 95% CI: 0.04-0.26). There was no significant change in mean EZ width in any cohort. Oral NAC is safe and well tolerated in patients with moderately advanced RP and may improve suboptimally functioning macular cones.” According to the news editors, the research concluded: “A randomized, placebo-controlled trial is needed to determine if oral NAC can provide long-term stabilization and/or improvement in visual function in patients with RP.” Excessive screen time for toddlers linked to less physical activity, stunted development National University of Singapore, July 21, 2020 As the world continues to advance, technology is becoming a bigger part of every child's development. Playing on various digital devices for too long, however, can be just as bad for kids as it is for adults. A recent study says excessive screen time may stunt a child's growth, especially if they start using devices around age two or three. Researchers in Singapore examined over 500 children. Their findings lead them to recommend parents follow World Health Organization (WHO) guidelines, which advise limiting a child's screen time to one hour per day. This amount should be even less for children younger than five. Tracking the many forms of screen time Study authors say screen time tends to replace time children usually spend sleeping or engaging in physical activity. This can lead to a variety of health problems, including high risk of obesity and lower mental development. Until this report, researchers say most studies focus on school-aged children and adolescents, producing mixed results. “We sought to determine whether screen viewing habits at age two to three affected how children spent their time at age five. In particular we were interested in whether screen viewing affected sleep patterns and activity levels later in childhood,” researcher Falk Müller-Riemenschneider explains in a media release. Parents were asked to report on their children's screen time at age two and again one year later. Activities like playing video games, watching TV, and using a tablet or phone were all included in the results. When the children turned five, they continuously wore an activity tracker for seven days. That tracker monitors sleep, time spent sitting, and how much light-to-strenuous physical activity the youngsters get. How do youngsters spend their time? On average, the average child watches 2.5 hours of television. TV is the most used device. Children spending at least three hours a day in front of a screen are also spending an average of 40 more minutes sitting down compared to more active five year-olds. The results also reveal children at age five are also less active if they've been using devices too much early on. Those youths are getting about 30 minutes less light activity each day and 10 minutes less vigorous exercise as well. “Our findings support public health efforts to reduce screen viewing time in young children,” Bozhi Chen from the National University of Singapore says. Sleep habits do not seem to be heavily affected by too much screen usage. Room for improvement Researchers note the results also need to take into account biases by the parents. They believe some adults may leave out information on their child's diet, sleep patterns, and environmental factors such as childcare. Dr. Dorothea Dumuid of the University of South Australia, who is not a part of the study, argues the findings aren't enough to definitively link screen time with reduced physical activity. “In this rapidly evolving digital age, children's screen use is a key concern for parents and medical bodies. Guidelines to limit screen time have been released by many governments and WHO, however, screens offer digital and social connectedness and educational opportunities,” she says. “Future research is needed to assess the influence of media content, to determine optimum durations of screen time.” Chen and the team from the Saw Swee Hock School of Public Health say more studies are necessary to determine the long-term health effects of the growing digital influence on kids. Research shows Mexican walnut can protect the kidneys from ischemic injury Universidad Autónoma de Nuevo León School of Medicine (Mexico), July 24, 2020 Some species from the genus Juglans – the largest and most widely distributed of the eight genera in the walnut family – have diverse biological activities, such as anti-hypertensive, antioxidant, lipolytic (fat-metabolizing), anti-hyperglycemic, anti-lipidemic and anti-proliferative properties. Studies suggest that these activities may be useful in the treatment of a wide variety of ailments, ranging from minor complaints like diarrhea and stomach pain to more serious conditions like arthritis, diabetes and cancer. Juglans mollis, commonly known as Mexican walnut, is traditionally used to make medicine in northeastern Mexico. Parts of this medium-sized tree are said to be effective against microbial infections and ulcers. Although reports about its biological properties vary, the bark extract of the Mexican walnut tree has consistently been found to have antioxidant, hepatoprotective and anti-mycobacterial activities. In a recent study, Mexican researchers evaluated the biological activity of Mexican walnut bark extract. Specifically, they investigated whether it can protect against damage caused by ischemia-reperfusion (I/R). Also known as reoxygenation injury, I/R damage occurs when blood supply to a section of tissue or an organ returns (reperfusion) after a period of ischemia, or lack of oxygen. The researchers reported their findings in an article published in the journal BMC Complementary and Alternative Medicine. Mexican walnut bark exhibits kidney-protective activity Oxidative stress – an imbalance between the production of free radicals and antioxidants – and inflammation are two events involved in I/R injury. But recent studies suggest that Mexican walnut has antioxidant properties that can help reduce the damage caused by I/R. To determine if it can protect the kidneys from I/R damage, the researchers tested its bark extract on a rat model of I/R injury. They divided 24 rats into four groups, which were designated as the sham group, the I/R group, the extract group and the extract plus I/R group. The researchers pretreated two groups with the bark extract (300 mg/kg) for seven?days before inducing I/R. This step involved clamping the renal hilums for 45 minutes then reperfusing the kidneys for 15 hours. The researchers then took blood samples to evaluate the levels of kidney function markers (i.e., alanine aminotransferase (ALT), blood urea nitrogen and creatinine), oxidative stress markers (i.e., superoxide dismutase (SOD) and malondialdehyde (MDA)) and pro-inflammatory molecules (i.e., interleukin-1B (IL-1B), IL-6 and TNF-a). The researchers found that the extract plus?I/R group had lower creatinine, ALT, MDA, IL-1B, IL-6 and TNF-a levels than the I/R group. On the other hand, the extract plus?I/R group had higher levels of SOD, an antioxidant enzyme, than the sham group. These findings suggest that the Mexican walnut bark extract can not only reduce kidney injury but also improve blood antioxidant levels. In addition, compared with the sham group, the researchers observed no biochemical or histological damage in the rats treated with the extract. The rats in the extract?plus?I/R group also had less histological damage than the rats in the I/R group. (Related: Black cumin prevents kidney damage.) Based on these findings, the researchers concluded that the bark of the Mexican walnut tree can protect against I/R-induced kidney damage. This activity may be attributed to the plant's ability to decrease inflammation and modulate oxidative stress markers (SOD and MDA). Magnesium-Rich Foods and Why You Need Them GreenMedInfo, July 23, 2020 You may have a low level of magnesium in your diet that is preventing you from reaping important health benefits Magnesium (Mg) is considered a healthy mineral essential to your body, but it is estimated that 75% of Americans and people around the world are well below the recommended daily intake of Mg.[i] Luckily, there is an easy fix, since magnesium is bountiful in many foods. Bright leafy greens/veggies (magnesium gives them that rich green color) top the magnesium-dense list including spinach, chard, broccoli and kale, followed closely by legumes such as lima beans, black beans, peas and edamame (soybean).[ii] When it comes to snacks, seeds[iii] (pumpkin and flax), nuts[iv] (almonds, cashews, peanut butter) and dark chocolate[v] pack a high magnesium punch. Healthy omega-3 fats and magnesium are also abundant in salmon, tuna and avocado.[vi] Whole grains such as quinoa, brown rice, oatmeal, buckwheat and even wild rice (technically a grass) are filled with magnesium.[vii] For a list of the top 25 magnesium-rich foods, see Table 1. Table 1 25 Foods Rich in Magnesium Portions Magnesium (100% Daily Value = 420 mg) Spinach 1 cup cooked 157 mg (37%) Chard 1 cup 157 mg (37%) Seeds (Pumpkin and Squash) 1 ounce 156 mg (37%) Lima Beans 1 cup cooked 126 mg (30%) Black Beans 1 cup cooked 120 mg (29%) Quinoa 1 cup 118 mg (28%) Tuna 6 oz fillet (high in mercury) 109 mg (26%) Almonds ¼ cup 105 mg (25%) Cashews ¼ cup 90 mg (21%) Brown Rice 1 cup 86 mg (20%) Buckwheat 1 cup or 1 ounce dry 65 mg (15%) Dark Chocolate 1 ounce square (70% cocoa) 64 mg (15%) Oatmeal 1 cup 60 mg (14%) Avocado medium 58 mg (14%) Salmon ½ fillet (178 grams) 53 mg (13%) Wild Rice 1 cup 52 mg (12%) Edamame (Soybean) ½ cup 50 mg (12%) Broccoli ½ cup (don't overcook) 50 mg (12%) Figs ½ cup 50 mg (12%) Peas 1 cup cooked 50 mg (12%) Peanut Butter 2 Tablespoons 49 mg (12%) Yogurt 1 cup 47 mg (11%) Flaxseed Oil or Flaxseed 1 Tablespoon or ½ Tablespoon 42 mg (10%) Banana 1 cup sliced 41 mg (10%) Kale 1 cup (raw) 37 mg (8%) Benefits of Eating Magnesium-Rich Foods Magnesium in your diet helps to prevent diseases and lessen the harshness of some diseases if you get them. Magnesium has neuroprotective, cardio-protective, anti-hypertensive, anti-inflammatory, anti-obesity and hypoglycemic properties. A magnesium deficiency or low level of magnesium in your food creates an out of balance condition in your body linked to many diseases from diabetes, heart disease and metabolic syndrome to depression and neurological disorders. Diabetes Magnesium has many protective properties, such as glucose or blood sugar moderating and insulin regulating, lowering risk for Type 2 diabetes (T2D) and improving outcomes for Type 1 diabetes (T1D). Magnesium intake significantly improved glucose parameters in people with diabetes and also improved insulin-sensitivity parameters in those at high risk of diabetes in a review of 18 randomized clinical trials, including a total of 670 diabetic and 453 at risk for diabetes patients.[viii] In another meta-analysis of 637,922 individuals, the risk of T2D was reduced by 17% across all the studies; 19% in women and 16% in men when magnesium was increased in their diet.[ix] A magnesium deficiency is seen as a contributing factor in insulin resistance for T2D patients.[x] In a 2017 study of 71 children with T1D, magnesium supplementation improved glycemic control and lipid profiles while decreasing complications such as hypomagnesaemia (clinical magnesium deficiency).[xi] For the 52,684 without known diabetes, dietary magnesium was found to lower fasting glucose and insulin, two risk factors for diabetes.[xii] Heart Disease Because of chronic diseases, medications, decreases in food crop magnesium contents, and higher availability of refined and processed foods, the vast majority of people in modern societies are at risk for magnesium deficiency (often undiagnosed) and magnesium dietary supplementation is an easy and low cost way to lower the risks for a variety of heart diseases.[xiii] In a meta-analysis of 532,979 participants from 19 studies, the greatest risk reduction for cardiovascular disease (CVD) occurred when magnesium intake increased from 150 to 400 milligrams (mg) per day.[xiv] In a meta-analysis of 48 genetic studies with a total of 60,801 coronary artery disease (CAD) cases and 123,504 non-cases, researchers found that serum magnesium levels are inversely associated with risk of heart disease.[xv] Magnesium supplementation is also seen as a successful preventative mechanism (by improving lipid profiles, fasting glucose and blood pressure)[xvi] to heart disease complications (a leading cause of death from T2 diabetes).[xvii],[xviii] Metabolic Syndrome Generally, the triad of obesity, high blood pressure and impaired glucose tolerance, as in T2D (insulin resistance), is referred to as metabolic syndrome.[xix] In a meta-analysis of six studies, including a total of 24,473 individuals and 6,311 cases of metabolic syndrome, a higher dietary magnesium level lowered the risk of metabolic syndrome by 17%.[xx] Magnesium supplementation has also been shown to lower blood pressure measures significantly in those with high blood pressure taking anti-hypertensive medication (135 subjects); systolic blood pressure decreased by 18.7 points and diastolic blood pressure dropped by an average of 10.9 points. ...

covid-19 united states tv university head canada health children israel school moving college future mexico americans canadian parents ms chinese benefits sleep ohio psychology playing healthy western medicine arts risk table maryland iran mexican prof parent singapore ontario montreal studies tracking israelis public health researchers activities rhode island ir guidelines world health organization alt chen justin trudeau gonz thursday night football apa salmon institut social sciences sars cov minist 1b south australia db conversely subjects consuming reduced mg cad magnesium garlic linear broccoli american psychological association rp squash national university fonds ez prostate cancer dundee calcium guelph vallejo alternative medicine t2 figs nac nuevo le almonds xu cvd cashews mda sod t1d bar ilan university clinical oncology managed care t2d lhs israeli ministry oh d alliums gary null inrs claudia gonz experimental psychology general flaxseed oil daily value juglans bcva sciences department

Podcast Diario Prevenzione – 12 giugno 2020 – Puntata n° 69

Play Episode Listen Later Jun 12, 2020

In questa puntata parliamo di - Il lungo passaggio dentro la pandemia Covid-19. Come cambieranno istituzioni, politiche sociali e sanitarie. - I modelli manageriali toyotisti applicati in sanità pubblica sono stati il tallone di Achille nella fase della emergenza. - Francia.INRS. La Rivista Lavoro e sicurezza: numero di maggio-giugno 2020 - Inail.Esposizione a silice cristallina: ...continua a leggere "Podcast Diario Prevenzione – 12 giugno 2020 – Puntata n° 69"

covid-19 francia diario giugno achille prevenzione inail esposizione inrs

Priorité santé - Santé au travail

Priorité santé

Play Episode Listen Later Jun 10, 2020 48:30

Mis en place dans de nombreuses entreprises à l’occasion du confinement, le télétravail peut générer des risques pour la santé. Surmenage, difficulté à mettre des barrières avec la vie personnelle… Cette généralisation du télétravail interroge notre rapport au travail et les conséquences que celui-ci peut avoir sur notre santé. Quelles peuvent être les différentes formes de maladies professionnelles ? Quelle reconnaissance et quelle prise en charge ? Annie Thebaud-Mony, sociologue, directrice de recherche honoraire à l'Inserm, chercheure associée au Groupement d’intérêt scientifique sur les cancers d’origine professionnelle (GISCOP 93) à l’Université Paris 13, présidente de l’association Henri Pézerat (association de soutien aux luttes pour la santé en rapport avec le travail et l'environnement)Arouna Ouédraogo, chef de service de Psychiatrie au CHU Yalgado Ouédraogo de Ouagadougou au Burkina Faso, président de la Société burkinabè de santé mentaleDr Marielle Dumortier, médecin du Travail depuis 35 ans qui sillonne l'Ile-de-France avec son camion pour recevoir ses patientsMichel Héry, chercheur chargé de mission à la Direction des applications de l'Institut national de recherche et de sécurité (INRS), spécialiste de l'évaluation des expositions professionnelles et responsable du projet Prévention des cancers professionnels.

france pr direction quelle quelles mis soci travail burkina faso psychiatrie l'institut l'ile ouagadougou universit paris groupement surmenage inrs l'inserm priorit sant

FR_Entrevue__9

RCI Tam-tam Canada

Play Episode Listen Later Aug 15, 2019 6:35

Le chercheur principal dans le cadre des études qui ont mené à cette découverte est Albert Descoteaux, professeur à l’Institut national de recherche scientifique (INRS)présente les résultats des recherches sur Lishtenia

institut entrevue inrs

Episode 31 - Emergency Department Management of Patients Taking Direct Oral Anticoagulant Agents (Pharmacology CME)

EMplify by EB Medicine

Play Episode Listen Later Aug 6, 2019

Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine’s Emergency medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta. This month, we are tackling a topic for which the literature continues to rapidly change - we’re talking about the ED management of patients taking direct oral anticoagulants or DOACs, previously called novel oral anticoagulants or NOACs. Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: This month’s article was authored by Dr. Patrick Maher and Dr. Emily Taub of the Icahn School of Medicine at Mount Sinai, and it was peer reviewed by Dr. Dowin Boatright from Yale, Dr. Natalie Kreitzer from the University of Cincinnati, and Dr. Isaac Tawil from the University of New Mexico. Nachi: In their quest to update the last Emergency Medicine Practice issue on this topic which was published in 2013, they reviewed over 200 articles from 2000 to present in addition to 5 systematic reviews in the cochrane database, as well as guidelines from the American Heart Association, European society of cardiology, and the american college of cardiology. Jeff: Thanks to a strong literature base, Dr’s Maher and Taub found good quality evidence regarding safety and efficacy of the DOACs in relation to warfarin and the heparin-based anticoagulants. Nachi: But do note that the literature directly comparing the DOACs is far more limited and mostly of poor quality. Show More v Jeff: Fair enough, we’ll take what we can get. Nachi: Well, I’m sure more of those studies are still coming. Jeff: Agree. Let’s get started with some basics. Not surprisingly, DOACs now account for a similar proportion of office visits for anticoagulant use as warfarin. Nachi: With huge benefits including reduced need for monitoring and a potential for reduced bleeding complications, this certainly isn’t surprising. Jeff: Though those benefits are not without challenges - most notably the lack of an effective reversal agent and the risk of unintentional overdose in patients with altered drug metabolism. Nachi: Like all things in medicine, it’s about balancing and finding an acceptable risk/benefit profile. Jeff: True. Let’s talk pathophysiology for a minute - the control of coagulation in the human body is a balance between hemorrhage and thrombosis, mediated by an extensive number of procoagulant and anticoagulant proteins. Nachi: Before the development of the DOACs, vitamin K antagonists controlled the brunt of the market. As their name suggests, they work by inhibiting the action of vitamin K, and thus reducing the production of clotting factors 2, 7, 9, and 10, and the anticoagulant proteins C and S. Jeff: Unfortunately, these agents have a narrow therapeutic window and many drug-drug interactions, and they require frequent monitoring - making them less desirable to many. Nachi: However, in 2010, the FDA approved the first DOAC, a real game-changer. The DOACs currently on the market work by one of two mechanisms - direct thrombin inhibition or factor Xa inhibition. Jeff: DOACs are currently approved for stroke prevention in nonvalvular afib, treatment of VTE, VTE prophylaxis, and reduction of major cardiovascular events in stable cardiovascular disease. Studies are underway to test their safety and efficacy in arterial and venous thromboembolism, prevention of embolic stroke in afib, ACS, cancer-associated thrombosis, upper extremity DVT, and mesenteric thrombosis. Nachi: Direct thrombin inhibitors like Dabigatran, tradename Pradaxa, was the first FDA approved DOAC. It works by directly inhibiting thrombin, or factor IIa, which is a serine protease that converts soluble fibrinogen into fibrin for clot formation. Jeff: Dabigatran comes in doses of 75 and 150 mg. The dose depends on your renal function, and, with a half-life of 12-15 hours, is taken twice daily. Note the drastically reduced half-life as compared to warfarin, which has a half-life of up to 60 hours. Nachi: The RE-LY trial for afib found that taking 150 mg of Dabigatran BID had a lower rate of stroke and systemic embolism than warfarin with a similar rate of major hemorrhage. Dabigatran also had lower rates of fatal and traumatic intracerebral hemorrhage than warfarin. Jeff: A separate RCT found similar efficacy in treating acute VTE and preventing recurrence compared with warfarin, with reduced rates of hemorrhage! Nachi: Less monitoring, less hemorrhage, similar efficacy, I’m sold!!! Jeff: Slow down, there’s lots of other great agents out there, let’s get through them all first... Nachi: Ok, so next up we have the Factor Xa inhibitors, Rivaroxaban, apixaban, edoxaban, and betrixaban.As the name suggests, these medications work by directly inhibiting the clotting of factor Xa, which works in the clotting cascade to convert prothrombin to thrombin. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment. After taking 15 mg BID for the first 21 days, rivaroxaban is typically dosed at 20 mg daily with adjustments for reduced renal function. Nachi: The Rocket AF trial found that rivaroxaban is noninferior to warfarin for stroke and systemic embolism prevention without a significant difference in risk of major bleeding. Interestingly, GI bleeding may be higher in the rivaroxaban group, though the overall incidence was very low in both groups at about 0.4% of patients per year. Jeff: In the Einstein trial, patients with VTE were randomized to rivaroxaban or standard therapy. In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Continuing therapy beyond the acute period resulted in similar rates of VTE recurrence and bleeding episodes to treatment with aspirin alone. Nachi: Next we have apixaban, tradename Eliquis. Apixaban is approved for afib and the treatment of venous thromboembolism. It’s typically dosed as 10 mg BID for 7 days followed by 5 mg BID with dose reductions for the elderly and those with renal failure. Jeff: In the Aristotle trial, when compared to warfarin, apixaban was superior in preventing stroke and systemic embolism with lower mortality and bleeding. Rates of major hemorrhage-related mortality were also nearly cut in half at 30 days when compared to warfarin. Nachi: For the treatment of venous thromboembolism, the literature shows that apixaban has a similar efficacy to warfarin in preventing recurrence with less bleeding complications. Jeff: Unfortunately, with polypharmacy, there is increased risk of thromboembolic and hemorrhage risks, but this risk is similar to what is seen with warfarin. Nachi: And as compared to low molecular weight heparin, apixaban had higher bleeding rates without reducing venous thromboembolism events when used for thromboprophylaxis. It’s also been studied in acute ACS, with increased bleeding and no decrease in ischemic events. Jeff: Edoxaban is up next, approved by the FDA in 2015 for similar indications as the other Factor Xa inhibitors. It’s recommended that edoxaban be given parenterally for 5-10 days prior to starting oral treatment for VTE, which is actually similar to dabigatran. It has similar levels of VTE recurrence with fewer major bleeding episodes compared to warfarin. It has also been used with similar effects and less major bleeding for stroke prevention in afib. In the setting of cancer related DVTs specifically, as compared to low molecular weight heparin, one RCT showed lower rates of VTE but higher rates of major bleeding when compared to dalteparin. Nachi: Next we have Betrixaban, the latest Factor Xa inhibitor to be approved, back in 2017. Because it’s utility is limited to venous thromboembolism prophylaxis in mostly medically ill inpatients, it’s unlikely to be encountered by emergency physicians very frequently. Jeff: As a one sentence FYI though - note that in recent trials, betrixaban reduced the rate of VTE with equivalent rates of bleeding and reduced the rate of stroke with an increased rate of major and clinically relevant non-major bleeding as compared to enoxaparin. Nachi: Well that was a ton of information and background on the DOACs. Let’s move on to your favorite section - prehospital medicine. Jeff: Not a ton to add here this month. Perhaps, most importantly, prehospital providers should specifically ask about DOAC usage, especially in trauma, given increased rates of complications and potential need for surgery. This can help with destination selection when relevant. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Nachi: Extremely important to identify DOAC use early. Once the patient arrives in the ED, you can begin your focused history and physical. Make sure to get the name, dose, and time of last administration of any DOAC. Pay particular attention to the med list and the presence of CKD which could point to altered DOAC metabolism. Jeff: In terms of the physical and initial work up - let the sites of bleeding or potential sites of bleeding guide your work up. And don’t forget about the rectal exam, which potentially has some added value here - since DOACs increase the risk of GI bleeding. Nachi: Pretty straight forward history and physical, let’s talk diagnostic studies. Jeff: First up is CT. There are no clear cut guidelines here, so Drs. Maher and Taub had to rely on observational studies and expert opinion. Remember, most standard guidelines and tools, like the canadian and nexus criteria, are less accurate in anticoagulated patients, so they shouldn’t be applied. Instead, most studies recommend a low threshold for head imaging, even with minor trauma, in the setting of DOAC use. Nachi: That is so important that it’s worth repeating. Definitely have a low threshold to CT the head for even minor head trauma patients on DOACs. Basically, if you’re on anticoagulation, and you made it to the ED for anything remotely related to your head, you probably win a spin. Jeff: I suspect you are not alone with that stance... There is, however, much more debate about the utility of follow up imaging and admission after a NEGATIVE scan. Nachi: Wait, is that a thing I should routinely be doing? Jeff: Well there’s not great data here, but in one observational study of 1180 patients on either antiplatelet or anticoagulant therapy, a half a percent of them had positive findings 12 hours later, and importantly none required surgical intervention. Nachi: Certainly reassuring. And for those with positive initial imaging, the authors recommend repeat imaging within 4-6 hours in consultation with neurosurgical services or even earlier in cases of unexpected clinical decline. Jeff: Interestingly, though only a small retrospective study of 156 patients, one study found markedly reduced mortality, 4.9% vs 20.8% in those on DOACs vs warfarin with traumatic intracranial hemorrhage. Nachi: Hmm that actually surprises me a bit with the ease of reversibility of warfarin. Jeff: And we’ll get to that in a few minutes. But next we should talk about ultrasound. As always with trauma, guidelines recommend a FAST exam in the setting of blunt abdominal trauma. The only thing to be aware of here is that you should have an increased index of suspicion for bleeding, especially in hidden sites like the retroperitoneum. Nachi: And just as with traumatic head bleeds, a small observational study of those with blunt abdominal trauma found 8% vs 30% mortality for those on DOACs vs warfarin, respectively. Jeff: That is simply shocking! Let’s also talk lab studies. Hemoglobin and platelet counts should be obtained as part of the standard trauma work up. Assessing renal function via creatinine is also important, especially for those on agents which are renally excreted. Nachi: Though you can, in theory, test for plasma DOAC concentrations, such tests are not routinely indicated as levels don’t correspond to bleeding outcomes. DOAC levels may be indicated in certain specific situations, such as while treating life-threatening bleeding, development of venous thromboembolism despite compliance with DOAC therapy, and treating patients at risk for bleeding because of an overdose. Jeff: In terms of those who require surgery while on a DOAC - if urgent or emergent, the DOAC will need to be empirically reversed. For all others, the recommendation is to wait a half life or even multiple half-lives, if possible, in lieu of level testing. Nachi: Coagulation tests are up next. Routine PT and PTT levels do not help assess DOACs, as abnormalities on either test can suggest the presence of a DOAC, but the values should not be interpreted as reliable measures of either therapeutic or supratherapeutic clinical anticoagulant effect. Jeff: Dabigatran may cause prolongation of both the PT and the PTT, but the overall correlation is poor. In addition, FXa inhibitors may elevate PT in a weakly concentration dependent manner, but this may only be helpful if anti-fXa levels are unavailable. Nachi: Which is a perfect segway into our next test - anti-factor Xa level activity. Direct measurements of the anti-Fxa effect demonstrates a strong linear correlation with plasma concentrations of these agents, but the anticoagulant effect does not necessarily follow the same linear fashion. Jeff: Some labs may even have an anti-FXa effect measurement calibrated specifically to the factor 10a inhibitors. Nachi: While measuring thrombin time is not routinely recommended, the result of thrombin time or dilute thrombin time does correlate well with dabigatran concentrations across normal ranges. Jeff: And lastly, we have the Ecarin clotting time. Ecarin is an enzyme that cleaves prothrombin to an active intermediate that can be inhibited by dabigatran in the same way as thrombin. The ECT is useful for measuring dabigatran concentration - it’s not useful for testing for FXa inhibitors. A normal ECT value could be used to exclude the presence of dabigatran. Nachi: So I think that rounds out testing. Let’s move into the treatment section. Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation. Tourniquet application, direct pressure, endoscopy for GI bleeds, etc... should all be used as needed. And most importantly, for airway bleeding, pericardial bleeding, CNS bleeding, and those with hemodynamic instability or overt bleeding, those with a 2 point drop in their hemoglobin, and those requiring 2 or more units of pRBC - they all should be considered to have serious, life threatening bleeds. This patient population definitely requires reversal agents, which we’re getting to in a minute. Nachi: A type and screen should also be sent with the plan to follow standard transfusion guidelines, with the goal of a hemoglobin level of 7, understanding that in the setting of an active bleed, the hemoglobin level will not truly be representative. Jeff: Interestingly, in the overdose literature that’s out there, bleeding episodes appear to be rare - occurring in just 5% of DOAC overdose cases. Nachi: Finally, onto the section we’ve all been waiting for. Let’s talk specific reversal agents. Praxbind is up first. Jeff: Idarucizumab or Praxbind, is the reversal agent of choice for dabigatran (which is also called pradaxa). According to data from the RE-LY trial, it reverses dabigatran up to the 99th percentile of levels measured in the trial. Nachi: And praxbind should be given in two 2.5 g IV boluses 15 minutes apart to completely reverse the effects of dabigatran. Jeff: As you would expect given this data, guidelines for DOAC reversal recommend it in major life-threatening bleeding events for patients on dabigatran. Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. This recombinant factor has a decoy receptor for the FXa agents, thus eliminating their anticoagulant effects. Jeff: Recombinant factor Xa is given in either high or low dose infusions. High dose infusions for those on rivaroxaban doses of >10 mg or apixaban doses >5 mg within the last 8 hours and for unknown doses and unknown time of administration. Low dose infusions should be used for those with smaller doses within the last 8 hours or for last doses taken beyond 8 hours. Nachi: In one trial of 352 patients, recombinant factor Xa given as an IV bolus and 2 hour infusion was highly effective at normalizing anti-FXa levels. 82% of the assessed patients at 12 hours achieved hemostasis, but there were also thrombotic events in 10% of the patients at 30 days. Jeff: And reported thrombotic events aren’t the only downside. Though the literature isn’t clear, there may be limited use of recombinant factor Xa outside of the time of the continuous infusion, and even worse, there may be rebound of anti-Fxa levels and anticoagulant effect. And lastly, the cost is SUBSTANTIAL. Nachi: Is there really a cost threshold for stopping life threatening bleeding…? Jeff: Touche, but that means we need to save it for specific times and consider other options out there. Since this has only been around for a year or so, let’s let the literature play out on this too... Nachi: And that perfectly takes us into our next topic, which is nonspecific reversal agents, starting with prothrombin complex concentrate, also called PCC. Jeff: PCC is FDA approved for rapid reversal of vitamin K antagonist-related hemorrhagic events and is now being used off label for DOAC reversal. Nachi: PCC comes in 3 and 4 factor varieties. 3-factor PCC contains factors 2, 9, 10 and trace amounts of factor 7. 4 factor PCC contains factors 2, 9 10, as well as purified factor 7 and proteins C and S. Jeff: Both also contain trace amounts of heparin so can’t be given to someone with a history of HIT. Nachi: PCC works by overwhelming the inhibitor agent by increasing the concentration of upstream clotting factors. It has been shown, in healthy volunteers, to normalize PT abnormalities and bleeding times, and to achieve effective bleeding control in patients on rivaroxaban, apixaban, and edoxaban with major bleeding events. Jeff: In small studies looking at various end points, 4 factor PCC has been shown to be superior to 3 factor PCC. Nachi: Currently it’s given via weight-based dosing, but there is interest in studying a fixed-dose to decrease both time to medication administration and cost of reversal. Jeff: Guidelines currently recommend 4F PCC over 3F PCC, if available, for the management of factor Xa inhibitor induced bleeding, with studies showing an effectiveness of nearly 70%. As a result, 4F PCC has become an agent of choice for rapid reversal of FXa inhibitors during major bleeding events. Nachi: Next we have activated PCC (trade name FEIBA). This is essentially 4Factor PCC with a modified factor 7. Though traditionally saved for bleeding reversal in hemophiliacs, aPCC is now being studied in DOAC induced bleeding. Though early studies are promising, aPCC should not be used over 4factor PCC routinely as of now but may be used if 4Factor PCC is not available. Jeff: Next we have recombinant factor 7a (trade name novoseven). This works by activating factors 9 and 10 resulting in rapid increase in thrombin. Studies have shown that it may reverse the effect of dabigatran, at the expense of increased risk of thrombosis. As such, it should not be used as long as other agents are available. Nachi: Fresh Frozen Plasma is the last agent to discuss in this section. Not a lot to say here - FFP is not recommended for reversal of any of the DOACs. It may be given as a part of of a balanced massive transfusion resuscitation, but otherwise, at this time, there doesn’t seem to be a clear role. Jeff: Let’s move on to adjunct therapies, of which we have 3 to discuss. Nachi: First is activated charcoal. Only weak evidence exists here - but, according to expert recommendations, there may be a role for DOAC ingestions within 2 hours of presentations. Jeff: Perhaps more useful than charcoal is our next adjunct - tranexamic acid or TXA. TXA is a synthetic lysine analogue with antifibrinolytic activity through reversible binding of plasmin. CRASH-2 is the main trial to know here. CRASH-2 demonstrated reduced mortality if given within 3 hours in trauma patients. There is very limited data with respect to TXA and DOACs specifically, so continue to administer TXA as part of your standard trauma protocol without modification if the patient is on a DOAC, as it’s likely helpful based on what data we have. Nachi: Next is vitamin K - there is no data to support routine use of vitamin K in those taking DOACs - save that for those on vitamin K antagonists. Jeff: Also, worth mentioning here is the importance of hematology input in developing hospital-wide protocols for reversal agents, especially if availability of certain agents is limited. Nachi: Let’s talk about some special circumstances and populations as they relate to DOACs. Patients with mechanical heart valves were excluded from the major DOAC trials. And of note, a trial of dabigatran in mechanical valve patients was stopped early because of bleeding and thromboembolic events. As such, the American College of Cardiology state that DOACs are reasonable for afib with native valve disease. Jeff: DOACs should be used with caution for pregnant, breastfeeding, and pediatric patients. A case series of 233 pregnancies that occurred among patients on a DOAC reported high rates of miscarriage. Nachi: Patients with renal impairment are particularly concerning as all DOACs are dependent to some degree on renal elimination. Current guidelines from the Anticoagulation Forum recommend avoiding dabigatran and rivaroxaban for patients with CrCL < 30 and avoiding edoxaban and betrixaban for patients with CrCl < 15. Jeff: A 2017 Cochrane review noted similar efficacy without increased risk of major bleeding when using DOACs in those with egfr > 30 (that’s ckd3b or better) when compared to patients with normal renal function and limited evidence for safety below this estimated GFR. Nachi: Of course, dosing with renal impairment will be different. We won’t go into the details of that here as you will probably discuss this directly with your pharmacist. Jeff: We should mention, however, that reversal of the anticoagulant in the setting of renal impairment for your major bleeding patient is exactly the same as we already outlined. Nachi: Let’s move on to some controversies and cutting-edge topics. The first one is a pretty big topic and that is treatment for ischemic stroke patients taking DOACs. Jeff: Safety and efficacy of tPA or endovascular therapy for patients on DOACs continues to be debated. Current guidelines do not recommend tPA if the last DOAC dose was within the past 48 hours, unless lab testing specific to these agents shows normal results. Nachi: Specifically, the American Heart Association suggests that INR and PTT be normal in all cases. ECT and TT should be tested for dabigatran. And calibrated anti-FXa level testing be normal for FXa inhibitors. Jeff: The AHA registry actually included 251 patients who received tpa while on DOACs, which along with cohort analysis of 26 ROCKET-AF trial patients, suggest the risk of intracranial hemorrhage is similar to patients on warfarin with INR < 1.7 and to patients not on any anticoagulation who received tpa. However, given the retrospective nature of this data, we cannot exclude the possibility of increased risk of adverse events with tpa given to patients on DOACs. Nachi: Endovascular thrombectomy also has not been studied in large numbers for patients on DOACs. Current recommendations are to discuss with your stroke team. IV lysis or endovascular thrombectomy may be considered for select patients on DOACs. Always include the patient and family in shared decision making here. Jeff: There are also some scoring systems for bleeding risk to discuss briefly. The HAS-BLED has been used to determine bleeding risk in afib patients taking warfarin. The ORBIT score was validated in a cohort that included patients on DOACs and is similarly easy to use, and notably does not require INR values. Nachi: There is also the ABC score which has demonstrated slightly better prediction characteristics for bleeding risk, but it requires high-sensitivity troponin, limiting its practical use. Jeff: We won’t say more about the scoring tools here, but would recommend that you head over to MD Calc, where you can find them and use them in your practice. Nachi: Let’s also comment on the practicality of hemodialysis for removal of the DOACs. Multiple small case series have shown successful removal of dabigatran, given its small size and low protein binding. On the other hand, the FXa inhibitors are less amenable to removal in this way because of their higher protein binding. Jeff: Worth mentioning here also - dialysis catheters if placed should be in compressible areas in case bleeding occurs. The role of hemodialysis for overdose may be limited now that the specific reversal agent, praxbind, exists. Nachi: In terms of cutting-edge tests, we have viscoelastic testing like thromboelastography and rotational thromboelastometry. Several studies have examined the utility of viscoelastic testing to detect presence of DOACs with varying results. Prolongation of clotting times here does appear to correlate with concentration, but these tests haven’t emerged as a gold standard yet. Jeff: Also, for cutting edge, we should mention ciraparantag. And if you’ve been listening patiently and just thinking to yourself why can’t there be one reversal agent to reverse everything, this may be the solution. Ciraparantag (or aripazine) is a universal anticoagulant reversal agent that may have a role in all DOACs and heparins. It binds and inactivates all of these agents and it doesn’t appear to have a procoagulant effect. Nachi: Clinical trials for ciraparantag have shown rapid and durable reversal of edoxaban, but further trials and FDA approval are still needed. Jeff: We’ve covered a ton of material so far. As we near the end of this episode, let’s talk disposition. Nachi: First, we have those already on DOACs - I think it goes without saying that any patient who receives pharmacological reversal of coagulopathy for major bleeding needs to be admitted, likely to the ICU. Jeff: Next we have those that we are considering starting a DOAC, for example in someone with newly diagnosed VTE, or patients with an appropriate CHADS-VASC with newly diagnosed non-valvular afib. Nachi: With respect to venous thromboembolism, both dabigatran and edoxaban require a 5 day bridge with heparin, whereas apixaban and rivaroxaban do not. The latter is not only easier on the patient but also offers potential cost savings with low risk of hemorrhagic complications. Jeff: For patients with newly diagnosed DVT / PE, both the American and British Thoracic Society, as well as ACEP, recommend using either the pulmonary embolism severity index, aka PESI, or the simplified PESI or the Hestia criteria to risk stratify patients with PE. The low risk group is potentially appropriate for discharge home on anticoagulation. This strategy reduces hospital days and costs with otherwise similar outcomes - total win all around. Nachi: Definitely a great opportunity for some shared decision making since data here is fairly sparse. This is also a great place to have institutional policies, which could support this practice and also ensure rapid outpatient follow up. Jeff: If you are going to consider ED discharge after starting a DOAC - there isn’t great data supporting one over another. You’ll have to consider patient insurance, cost, dosing schedules, and patient / caregiver preferences. Vitamin K antagonists should also be discussed as there is lots of data to support their safety outcomes, not to mention that they are often far cheaper…. As an interesting aside - I recently diagnosed a DVT/PE in an Amish gentleman who came to the ED by horse - that was some complicated decision making with respect to balancing the potentially prohibitive cost of DOACs with the massive inconvenience of frequently checking INRs after a 5 mile horseback ride into town... Nachi: Nice opportunity for shared decision making… Jeff: Lastly, we have those patients who are higher risk for bleeding. Though I’d personally be quite uneasy in this population, if you are to start a DOAC, consider apixaban or edoxaban, which likely have lower risk of major bleeding. Nachi: So that’s it for the new material for this month’s issue. Certainly, an important topic as the frequency of DOAC use continues to rise given their clear advantages for both patients and providers. However, despite their outpatient ease of use, it definitely complicates our lives in the ED with no easy way to evaluate their anticoagulant effect and costly reversal options. Hopefully all our hospitals have developed or will soon develop guidelines for both managing ongoing bleeding with reversal agents and for collaborative discharges with appropriate follow up resources for those we send home on a DOAC. Jeff: Absolutely. Let’s wrap up with some the highest yield points and clinical pearls Nachi: Dabigatran works by direct thrombin inhibition, whereas rivaroxaban, apixaban, edoxaban, and betrixaban all work by Factor Xa inhibition. Jeff: The DOACs have a much shorter half-life than warfarin. Nachi: Prehospital care providers should ask all patients about their use of anticoagulants. Jeff: Have a low threshold to order a head CT in patients with mild head trauma if they are on DOACs. Nachi: For positive head CT findings or high suspicion of significant injury, order a repeat head CT in 4 to 6 hours and discuss with neurosurgery. Jeff: Have a lower threshold to conduct a FAST exam for blunt abdominal trauma patients on DOACs. Nachi: Assessment of renal function is important with regards to all DOACs. Jeff: While actual plasma concentrations of DOACs can be measured, these do not correspond to bleeding outcomes and should not be ordered routinely. Nachi: The DOACs may cause mild prolongation of PT and PTT. Jeff: Idarucizumab (Praxbind®) is an antibody to dabigatran. For dabigatran reversal, administer two 2.5g IV boluses 15 minutes apart. Reversal is rapid and does not cause prothrombotic effects. Nachi: Recombinant FXa can be used to reverse the FXa inhibitors. This works as a decoy receptor for the FXa agents. Jeff: Vitamin K and FFP are not recommended for reversal of DOACs. Nachi: Consider activated charcoal to remove DOACs ingested within the last two hours in the setting of life-threatening hemorrhages in patient’s on DOACs. Jeff: Hemodialysis can effectively remove dabigatran, but this is not true for the FXa inhibitors. Nachi: 4F-PCC has been shown to be effective in reversing the effects of the FXa inhibitors. This is thought to be due to overwhelming the inhibitor agent by increased concentrations of upstream clotting factors. Jeff: tPA is contraindicated in acute ischemic stroke if a DOAC dose was administered within the last 48 hours, unless certain laboratory testing criteria are met. Nachi: Emergency clinicians should consider initiating DOACs in the ED for patients with new onset nonvalvular atrial fibrillation, DVT, or PE that is in a low-risk group. Jeff: So that wraps up Episode 31! Nachi: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Jeff: And the address for this month’s cme credit is www.ebmedicine.net/E0819, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month!

american university talk practice european management medicine current abc patients negative emergency studies cincinnati new mexico crash fda iv albert einstein yale pe rates assessing gi icu drs oral amish american colleges aristotle reversal ems orbits mount sinai tt american heart association maher cardiology bid pcc np cns cme emergency departments pharmacology cochrane acs substantial icahn school ffp ect rct tpa taub xa inr ckd vitamin k dvt ptt vte gfr tourniquet acep hemoglobin pesi prolongation show more doac doacs iia txa anticoagulant rivaroxaban eliquis noacs xarelto apixaban apcc emplify dvts inrs crcl jeff well dabigatran jeff so pradaxa jeff there prbc jeff first jeff thanks jeff for chadsvasc has bled jeff not jeff let jeff also eb medicine jeff welcome

Annie Castoguay: Better molecules for better medicine

Canada Foundation for Innovation

Play Episode Listen Later Oct 19, 2018 17:07

Annie Castonguay, a researcher at Quebec’s Institut national de la recherche scientifique, works to mobilize metals to destroy cancer cells and drug-resistant bacteria when traditional antibiotics and cancer treatments fall short. Cancer treatments like chemotherapy aren’t perfect. The drugs meant to kill cancerous cells aren’t choosy, so they take out healthy cells too, which can mean serious side-effects for the patient. And if cancer cells develop a resistance, the therapies might not result in a complete remission. Engineering new molecules that incorporate the power of metals to destroy diseased cells could not only lead to more effective cancer treatments, but also better defences against another serious health threat — multidrug resistant bacteria. Return to the collection 00:00:05 - 00:05:02 This podcast is brought to you by the Canada Foundation for Innovation. My name is Annie Castonguay and I'm an Assistant Professor of chemistry at INRS institute Armand Frappier. Metals are at the heart of Dr. Annie Castoguay's research. Her programme involves both fundamental and applied research. She is interested in the design of new organic metallic complexes for their use as catalysts and as therapeutics such as anti cancer and antimicrobial agents. She and her collaborators at the INRS Institute Armand Frappier are engineering new molecules to overcome some of the problems with current cancer therapies. Unfortunately metal complexes often have a bad reputation as therapeutic agents. Very often people mistakenly believed that they are too toxic to be used in medicine. What they do not know though is that metal complexes are widely used in clinics every day. It is reported that approximately fifty percent of all cancer patients who undergo chemotherapy are at some point treated with a metal complex. So for example a compound known as cisplatin which contains a platinum metal atom which is widely used in the world for cancer therapy. The compound is injected to the patient intravenously undergo some transformations and reaches its main target believed to be DNA so then the cancer cells die and the patient survives. Unfortunately there are many problems associated with chemotherapy. As we know firstly therapeutic agents become less and less effective due to the development of cancer cell resistance. Cancer cells learn how to recognize the drug and adapt to survive in its presence so moreover theraputic agents are not only toxic to cancer cells but are toxic to healthy tissues as well leading to numerous side effects. I wish i could say that researchers have now solved all these problems. But unfortunately this is not the case. The part of my research program which aims at developing novel anti-cancer drug candidates attempts to address those two problems. So my team develops compounds based on routeenium. Some routeenium complexes are known to linked to DNA but also to act through other modes of action so previously reported routeenium complexes were found to be very promising as drug candidates and some of them even in third clinical trials during the last few years. For example, an ongoing research project in my lab involves the preparation of multitasking metal complexes which consistent in the synthesis of compounds based on routeenium to which are coordinated molecules that can themselves display an anti-cancer activity. So the creation of metallic compounds able to act through different mechanisms simultaneously could lead to the development of new efficient treatments that induce less cancer cell resistance. Another ongoing project in my research group is the design of metal complexes that can display a higher selectivity towards cancer cells so to reached his goal we create thermal sensitive linkages between metal complexes and targeting molecules which can be disassembled at higher temperatures so those targeting agents with the special affinity with cell receptors or orginels of certain cancer cells are carefully chosen so that they can act as shuttles and helped the metal complexes to reach cancer cells or tumors more efficiently before being released either slowly at body temperature, thirty seven degrees or more rapidly with the use of a laser. So we hope this strategy to be beneficial for cancer patients by reducing the occurrence of side effects during their treatment. Dr. Thomas Sanderson is a professor of toxicology and he works with Dr. Castonguay at the Institute Armand Frappier. They hope the complex's they're testing will also work at starving ER positive breast cancer cells of the estrogen that they need to grow. And the other action of the same molecule would be to enter the micro environments of the tumor and enter the cells around the tumor that are actually producing the estrogens that feed the tumour and the enzyme involved there is called aromatase and the organic metal compounds that is producing have several aromatase molecules attached to it which are then released in these cells at least, that is the hypothesis and we'll be able to inhibit the enzyme that feeds the tumour 00:05:02 - 00:10:28 So if one of the components the mental part that is killing the tumor cells directly and the second components, the aromatase inhibitor. that prevents the food source of the tumor by inhibiting the enzyme in the in the surrounding tumor cells. This type of research is a painstaking process. Dr Castonguay explains that she and her colleagues are closer to the start than the finish in terms of developing a viable chemotherapy alternative. We didn't reach to the point where we would test even our best drug candidates in mice. What we do for now is that we do in vitro studies and we also started to work with zebra fish models. So these are kind of accepted in vivo studies. Preliminary toxicity studies for drug design. Dr. Castonguay's work at the Institute Armand Frappier flows from a lifelong fascination with the scientific world. Her quest to understand the world around her began as a child long before she started building molecules. I come from Grandby which is a city located in between Montreal and Sherbrooke in Quebec. And i've always been interested in science. I remember finding myself in the basement of my parents house trying to challenge myself to work on a specific topic and try to learn as much as i could on the topic. Just by reading some of these Encyclopaedia that were available to me in that basement. I remember that I was interested in astronomy. Biology also in chemistry but not specifically in chemistry. I decided to go to Champlain regional college and i registered to a very broad scientific program. After that i started university and i went again to a general program because i chose to go in chemical engineering and so i i registered at the Ecole Polytechnic de Montreal and during that year and a half I really missed chemistry. I really understood that chemistry was missing. I really wanted to learn more about interactions between molecules so i decided to move on and registered to a bachelor degree in chemistry. So i registered to invest in Montreal, the building right beside but i remember that what really really caught my attention and what was really the highlight of my bachelor I would say was to take this course in the second year about mineral chemistry inorganic chemistry. It was a lab. I remember that I was amazed by the chemistry of metals. So after i decided that i really wanted to do a master degree in chemistry of metals so i chose to work with the group of David Sagarian at the University de Montreal and i also was directed at the time by Andre Beauchamps who is also very good inorganic chemists. So i worked with them I had an amazing time during my phd. I learned a lot of things. The main goal of my PhD was to prepare metallic complexes based on nickel which is a metal and i had to prepare... designing some complexes that we're going to be active to be catalysts for organic reactions so after my PhD I went to Tufts university in Boston and the during the training I worked with Molybdenum complexes. Molybdenum is another metal. It was a very challenging. When I was using a glove box so I had to work under inert atmosphere so i had to get very skilled at working with such compounds. Dr Castonguay's research into organic metallic compounds is driving cutting edge collaborations with scientists from a range of disciplines within the INRS. She began seeking out connections as a postdoctoral fellow where she worked at the intersection of chemistry, biology and therapeutics. I undertook to other post docs and both of them were at Mcgill University. The first of them was when i started to get more experienced. I would say a with organic synthesis and i undertook a very challenging project at preparing dendrimers. So I worked at preparing dendrimers that would have antimicrobial properties. So this is when i started to enter the world of biology and then i started to work with the collaborator of the group from do pharmacology and therapeutics department from McGill for my third post doctoral project so i was for the first time exposed to cell culture I was working with students would grow cancer cells in cell culture labs so that was very interesting to me. 00:10:28 - 00:15:02 I really enjoy doing that. When the INRS was seeking a professor of chemistry at the Institute Armand Frappier Dr. Castonguay said she was intrigued by the opportunity to work alongside so many different types of scientists. Her cross discipline research was seen as an asset. My experience in biology during my post doctoral studies allowed me to become interesting for people who were working here. And i found that i could establish a lot of different collaborations in different areas because i was a chemist, I was able to prepare molecules... interested in metals but i saw I had experience with anti-microbials in anticancer compounds. So here there are many researchers working in those areas along with immunology, toxicology, environment, .... There are all sorts of of research here. So i discovered that this place here was the size of a university department but there were so many different expertises in so many different fields of research. Metals may also be an innovative weapon in the fight against multi resistant bacteria. Dr Castonguay is testing some of her molecules on bacterial pathogens. Yeah as we know there is currently in an urgent need to develop new antibiotics that are active against multi-resistant bacteria so organometallic complexes are according to me not studied deeply enough for that purpose and this is why my group establishes collaborations with microbiologists from INRS with the hope to discover molecules with novel modes of action. So it was previously reported that some metallic complexes can interact with DNA... some enzymes and disrupt bacterial membranes. Complexes prepared in my lab are then tested against various multi resistant bacteria and some of those compounds recently screened were found to be highly active and selective against important patterns. Dr Frederic Verier is a researcher in microbiology at the Institute Armand Frappier. He's working with Dr. Castonguay to test compounds that may offer a much needed treatment for people infected with antibiotic resistant bacteria. So the research of professor Annie Castonguay is original in the sense that she synthesize organometallic molecule that are for the moment underexploited for the antibiotic properties. There are multiple evidence that this molecule could be the source of new antibiotics with ... properties. So with Annie we have already carry out several screen of different complex prepare in her laboratory to extract ... complex with bacteria... activity so we are now looking for the mode of action with the the hope that the mode of action we'd be original. And we also hope to discover molecules that act on several different targets simultaneously to avoid evolving resistance in the future. So in fact we have already identified a very promising molecule extracted from the screen which will soon be the subject of baton given it's high activity but also it's high selectively for some ample time pathogen specifically.... The professors INRS Institute Armand Frappier conduct their research in every corner of the scientific realm. But when Dr. Castonguay joined the team she identified a need for chemistry equipment that would make her work more efficient and she credits investments from the Canada Foundation for Innovation and the Quebec government for funding a suite of tools that are essential for the research she and her collaborators are doing. I'm very lucky. I got a lot of equipment and without that the equipment I would not have been able to make any of the research I'm doing right now. With what was what was available at the institute when i started because as you know there were not that many chemists here and that definitely not doing the same chemistry as I do. So as i mentioned earlier we have to prepare compounds under inert atmosphere. 00:15:02 - 00:17:02 So we have a trio of three really complimentary pieces of equipment. It's great now now that we are all fully equipped. It's very very nice. It's completely different than when i started four years ago. I mean there are many advantages for chemists to be here that's for sure but the downside is that if we need something that is chemistry related we cannot borrow it. We cannot use it from somebody else. We have to be self sufficient so this is where CFI was really really essential for me to be able to undertake my research program here because definitely yeah. I could not function if I could not have all that. We just want to emphasize on the fact that it's very very important for an early career researcher to be able to have to be allowed to apply for that equipment that CFI is providing because it is extremely important not only to be able to undertake the projects that these early researchers want to do but also to keep them at a competitive level with the other early researchers from other countries for example or other labs. The investments the CFI has made to further Dr. Castonguay's research help keep her on the leading edge of scientific study and in time, her innovations with organometallic complexes may offer new hope in the fight against cancer and drug resistant bacteria. Find more research stories like this at innovation dot ca slash stories and subscribe to the Canada Foundation for innovation through your favorite podcast app.

Circulation: Arrhythmia and Electrophysiology On the Beat November 2017

Circulation: Arrhythmia and Electrophysiology On the Beat

Play Episode Listen Later Nov 21, 2017 55:24

Paul Wang: Welcome to the monthly podcast On The Beat for Circulation, Arrhythmia and Electrophysiology. I'm Dr. Paul Wang, editor-in-chief, with some of the key highlights from this month's issue. We'll also hear from Dr. Suraj Kapa, reporting on new research from the latest journals in the field. In our first article, Elyar Ghafoori and associates examined the ability of late gadolinium enhancement MRI done immediately after ablation to predict edema and chronically even size. In a canine model, the authors created ventricular radiofrequency ablation lesions. All animals underwent MRI immediately after ablation. After one, two, four and eight weeks, edema and microvascular obstruction MVO, in enhanced volumes were identified in MRI. Immediately after contrast administration, the microvascular obstruction region was 3.2 times larger than the chronic lesion volume size in acute MRI. The authors found that microvascular obstruction region on acute late gadolinium enhancement images acquired 26 minutes after contrast administration most accurately predicts chronic lesion volume. In the next article, Elad Anter and associates characterized the atrial substrate in patients with paroxysmal atrial fibrillation and obstructive sleep apnea. The authors examined 86 patients with paroxysmal atrial fibrillation, 43 with moderate obstructive sleep apnea and 43 without obstructive sleep apnea. The right atrial and left atrial voltage distribution conduction velocities in electrogram characteristics were examined. The authors found that patients with obstructive sleep apnea had lower atrial voltage amplitude, slower conduction velocities, and higher prevalence of electrogram fractionation. Most commonly, the left atrial septum was an area of atrial abnormality while at baseline the pulmonary veins with the most frequent triggers for atrial fibrillation in both groups after pulmonary vein isolation in patients with obstructive sleep apnea had an increased incidence of extrapulmonary vein triggers, 41.8% versus 11.6%, p=0.003. The one year arrhythmia-free survival are similar between patients with and without obstructive sleep apnea, 83.7% and 81.4%, respectively. In comparison, control patients with paroxysmal atrial fibrillation and obstructive sleep apnea who underwent pulmonary vein isolation alone without ablation of extrapulmonary vein triggers had an increased risk of arrhythmia recurrence, 83.7% versus 64.0%, p=0.03, suggesting that ablation of these triggers resulted in improved arrhythmia-free survival. A randomized trial would be needed to prove this relationship. In the next article, Iolanda Feola and associates demonstrated that optogenetics may be used to induce and locally target a rotor in atrial monolayers. The authors used neonatal rat atrial cardiomyocyte monolayers expressing a depolarizing light-gated ion channel, calcium-translocating channelrhodopsin. These monolayers were subjected to patterned illumination to induce the single, stable, and centralized rotor by optical S1-S2 cross-field stimulation. Next, the core region of these rotors was specifically and precisely targeted by light to induce local conduction blocks of circular or linear shapes. Conduction blocks crossing the core region, but not reaching an unexcitable boundary, did not lead to termination. Instead, electrical waves started to propagate along the circumference of block. If, however, core-spanning lines of block reached at least one unexcitable boundary, reentrant activity was consistently terminated by wave collision, suggesting that this may be a key mechanism for rotor elimination. In our next study, Adam Barnett and associates used data from the outcomes registry for better informed treatment of atrial fibrillation ORBIT-AF to determine how frequently patients receive care that was concordant with 11 recommendations of the 2014 AHA, ACC, HRS A-fib guidelines pertaining to antithrombotic therapy rate control in anti-arrhythmic medications. The authors also analyzed the association between guideline concordant care and clinical outcomes at both the patient's level and center level. The authors study 9,570 patients with the median A 275, median CHA2DS2-VASc score of 4. A total of 62.5% or 5,5977 patients received care that was concordant with all guideline recommendations for which they were eligible. Rates of guideline concordant care was higher in patients treated with providers, with greater specialization in arrhythmias; 60.0%, 62.4%, 67.0% for primary care physicians, cardiologists and electrophysiologist, respectively; p less than 0.001. During a median of 30 months of follow up, patients treated with guideline concordant care had a higher risk of bleeding hospitalization; hazard ratio, 1.21. Similar risk of death, stroke, major bleeding can all cause hospitalization. In our next article, Hui-Chen Han and associates conducted electronic search of PubMed and Embase for English scientific literature articles to characterize the clinical presentation, procedural characteristics, diagnostic investigations and treatment outcomes of all reported cases of atrioesophageal fistula. Out of 588 references, 120 cases of atrioesophageal fistula were identified. Clinical presentation occurred between 0 and 60 days postablation with a median of 21 days. The most common presentations were fever 73%, neurological 72%, gastrointestinal 41%, and cardiac 40% symptoms. Computed tomography of the chest was the commonest mode of diagnosis, 68% although six cases required repeat testing. Overall mortality was 55%. In conclusion, the authors reported that atrioesophageal fistula complicating atrial fibrillation is associated with a very high mortality 55% with significantly reduced mortality in patients undergoing surgical repair 33% compared to endoscopic treatment 65%, and conservative management 97%. Odds ratio adjusted 24.9; p less than 0.01 compared to surgery. Neurological symptoms adjusted odd ratio 16.0. In GI bleed, adjusted odds ratio 4.2, were the best predictors of mortality. In the next article, Wei Ma and associates reported that the site origin of left posterior fascicular ventricular tachycardia may be predicted using 12-lead EC morphology in the HIS-ventricular or H-V interval. The authors studied 41 patients who underwent successful catheter ablation of left posterior fascicular ventricular tachycardia. The location of the site of origin was separated into proximal, middle, and distal groups with H-V being greater than zero milliseconds in the proximal group, H-V zero to minus 15 milliseconds in the middle group, and H-V less than negative 15 milliseconds in the distal group. The earliest presystolic potential ratio that is PP-QRS interval during VT divided by the H-V interval during sinus rhythm was statistically significantly different between the three groups, 0.59, 0.45 and 0.31, respectively. In addition, the QRS ratio in the proximal group 114 milliseconds was significant nearer compared to the middle group 128 milliseconds and the distal group 140 milliseconds. The QRS duration in the ratio R to S in leads V6 and lead-1 could predict a proximal or distal origin of left posterior fascicular ventricular tachycardia with high sensitivity and specificity. In our next article, Niv Ad and associates examined the safety and success of on-pump minimally invasive stand-alone Cox-Maze 3/4 procedure via right mini-thoracotomy in 133 patients with nonparoxysmal atrial fibrillation five years after surgery. The mean follow-up was 65 months in a patient population with a mean age of 57.3 years, mean left atrial size of 4.9 centimeters, mean AF duration of 51 months and 78% with longstanding persistent atrial fibrillation. All procedures were performed with no conversion to mid-sternotomy. No renal failure, strokes or operative mortality in less than 30 days. They reported a TIA in one patient, re-operation for bleeding in two patients, and median length of stay in four days. At five years, 73% of patients were in sinus rhythm off anti-arrhythmic drugs following a single intervention. In the next article, Richard Soto-Becerra and associates reported that unipolar endocardial electro-anatomic mapping may be used to identify scar epicardially in chagasic cardiomyopathy. In 19 sick patients, a total of 8,494 epicardial and 6,331 endocardial voltage signals in 314 epicardial and endocardial match pairs of points were analyzed. Basolateral left ventricular scar involvement was observed in 18 out of 19 patients. Bipolar epicardial and endocardial voltages within scar were low, 0.4 and 0.54 millivolts, respectively in confluent indicating a dense transmural scarring process. The endocardial unipolar voltage value with the newly proposed less than of equal to four-millivolt cutoff predicted the presence and extent of epicardial bipolar scar, p less than 0.001. In our next article, Bing Yang and associates reported the results of the stable SR study, which is a multicenter clinical trial of 229 symptomatic nonparoxysmal atrial fibrillation patients random-eyed one-to-one to two ablation strategies. In the stable SR group following pulmonary vein isolation, cavotricuspid isthmus ablation in conversion to sinus rhythm left atrial high density mapping was performed. Areas of low voltage and complex electrogram were further homogenized and eliminated, respectively. Dechanneling was done if necessary. In the step-wise group, additional linear lesions and defragmentation were performed. The primary endpoint was freedom of documented atrial tachyarrhythmias lasting 30 seconds or more after a single ablation procedure without anti-arrhythmic medications at 18 months. At 18 months, success according to intention-to-treat analysis was similar in the two arms with 74.0 success in the stable SR group and 71.5% success in the step-wise group; p=0.3. However, shorter procedure time reduced fluoroscopic time after pulmonary vein isolation and shorter energy delivery time were observed in the stable SR group compared to the step-wise group. In the final paper, Alan Sugrue and associates studied the performance of a morphological T-wave analysis program in defining breakthrough long QT syndrome arrhythmic risk beyond the QTc value. The author studied 246 genetically confirmed LQT1 patients and 161 LQT2 patients with a mean follow-up of 6.4 years. A total of 23 patients experienced more than one breakthrough cardiac arrhythmic event with 5 and 10-year event rates of 4% and 7%. Two independent predictors of future long Qt syndrome-associated cardiac events were identified from the surface ECG using a proprietary novel T-wave analysis program. The authors found that the most predictive features included the left slope of T-wave in V6, hazard ratio of 0.40, and T-wave center of gravity X-axis in lead-1, hazard ratio 1.9, C statistic of 0.77. When added to QTc, discrimination improved from 0.68 for QTc alone to 0.78. Genotype analysis showed weaker association between these T-wave variables in LQT1 triggered events while these features were stronger in patients with LQT2 and significantly outperformed the QTc interval. That's it for this month, but keep listening. Suraj Kapa will be surveying all journals for the latest topics of interest in our field. Remember to download the podcast On the Beat. Take it away, Suraj. Suraj Kapa: Thank you, Paul. This month, we will again focus on hard-hitting articles from across the electrophysiological literature. I am Suraj Kapa and we're particularly focusing on articles published in October 2017. The first article we will focus on is within the realm of atrial fibrillation specifically related to anticoagulation. In Journal of the American Heart Association in Volume 6, Issue 10, Lin, et al. sought to develop a prediction model for time in therapeutic range in older adults taking vitamin K antagonists. As we know, time in therapeutic range is critical for management of patients on vitamin K antagonists. As poor time in therapeutic range either due to subtherapeutic or supratherapeutic INRs, can lead to increased bleeding or thromboembolic risk. While novel oral anticoagulants have improved care of patients requiring anticoagulation, many patients either due to cost or due to other factors are unable to take the novel oral anticoagulants and thus must be maintained on vitamin K antagonists. In this study, Lin, et al. Used well-over 2,500 patients to create training and validation sets and thereby create two models for estimating time in therapeutic range. Through this, they created a simple model term PROSPER consisting of seven variables including pneumonia, renal dysfunction, prior bleeding, hospital stay more than seven days, pain medication use, lack of access to structured anticoagulation services, and treatment with antibiotics. Using this, they showed that they can predict time in therapeutic range greater than 70% as well as thromboembolic and bleeding outcomes better than other existing time in therapeutic range scoring systems, such as the same TT2R2 score. The reason these scores are important are both to help patients understand when they may be at risk for not maintaining a time in therapeutic range and to assist them in identification of the right anticoagulant methodology or strategy. Also, perhaps to prospectively consider if we can identify patients who may require more intensive monitoring or structured therapy strategies. However, one must also consider that for scores like this, utilization is always critical. In other words, continuous validation of the scoring system must be done in order to make sure it's applicable across populations and across different groups of people in different communities. Next, within the realm of anticoagulation and atrial fibrillation, we'll review the article by Chang, et al. published in JAMA in Volume 318, Issue 13 entitled Association Between Use of Non-Vitamin K Oral Anticoagulants With and Without Concurrent Medications and Risk of Major Bleeding Non-Valvular Atrial Fibrillation. With any new drug that comes out, there's always the possibility of various medication interactions. The source of these medication interactions might be variable. They might include direct effects of other medications on systems by which the primary drug is metabolized. Also, might be due to synergistic effects of medications that might be unpredictable or effects on different aspects of systems the drugs are trying to treat. Thus oftentimes, larger population studies are required before one can appreciate drug interactions that might exist. This is particularly true with novel oral anticoagulant drugs. Part of the promise of the novel oral anticoagulants was that because of the extensive medication interactions associating vitamin K antagonists, the availability of the drug perhaps with fewer medication interactions resulting in alteration and bleeding or thromboembolic tendency will be very important. In this important paper, Chang, et al. reviewed the effect of other medications on major bleeding events in patients on non-vitamin K oral anticoagulants such as dabigatran, apixaban, and rivaroxaban. Amongst over 91,000 patients, they noted that the concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the novel oral anticoagulant alone was associated with a significant increase many times by odds ratio of 100 in risk of major bleeding. Several drugs including atorvastatin, digoxin, erythromycin or clarithromycin when used concurrently with NOACs interestingly were associated with the reduced risk of bleeding without elevating thromboembolic risk. The recent advent of NOACs in clinical use especially in patients who might be taking other medications always need to be considered in the context of how the other medications might affect the bleeding or thromboembolic risk. One of the key findings in this publication is the potential interaction with amiodarone and how concurrent use of amiodarone may increase the risk of major bleeding. Because of the general lack of tools to monitor the effects of NOACs on bleeding risk in patients, one needs to consider these population studies and whether or not there might be synergistic effects between medications going forward. Unfortunately, we cannot adopt guidelines purely based on this data as to whether or not a dose adjustment should occur or whether or not the medication can be used at all. However, it does highlight the care that should be taken when using many of these drugs in conjunction with NOACs. Finally within the realm of anticoagulation and atrial fibrillation, we'll review the article by Cannon, et al. in The New England Journal of Medicine entitled Dual Antithrombotic Therapy with the Dabigatran After PCI in Atrial Fibrillation. In this study, Cannon, et al. sought to systematically review the role of a warfarin strategy post-PCI versus dabigatran strategy post-PCI. They randomized patients to use of a combination of warfarin, aspirin, and a P2Y12 inhibitors such as clopidogrel post-PCI versus using dabigatran plus a P2Y12 inhibitor. They demonstrated that dual therapy approach with dabigatran resulted in significantly lower bleeding events than the triple antithrombotic/antiplatelet therapy group. There was no difference in adverse events including thromboembolism, unplanned revascularization or death between the groups. These findings were irrespective of whether patients were on 110 mg of dabigatran or 150 mg of dabigatran. These findings suggest that a dual therapy approach in the post-PCI setting with the NOACs as the dabigatran and the P2Y12 inhibitors such as clopidogrel lowers bleeding risk without increasing risk of major adverse events including thromboembolism or stent thrombosis after PCI. However, it should be noted that one major criticisms of this trial is that the incremental bleeding risk conferred by aspirin could not be accounted for in the triple therapy cohort as aspirin was not used in the dual therapy cohorts. Thus, one cannot necessarily say whether the same finding would have been noted in a warfarin plus P2Y12 inhibitor versus dabigatran plus P2Y12 inhibitor especially given recent evidence suggesting no incremental benefit of aspirin particularly for thromboembolic risk associated with atrial fibrillation. However, the critical element of these findings is that a strategy excluding aspirin where dabigatran plus the P2Y12 inhibitor are used post-PCI might be actually safe. Changing gears, we will next focus on an article within the realm of cardiac mapping and ablation in atrial fibrillation. This was published in the Journal of the American College of Cardiology in Volume 70, Issue 16 by Prabhu, et al. entitled Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study. In this study, Prabhu, et al. studied in the multicenter randomized clinical trial the effect of catheter ablation for atrial fibrillation in the setting of left ventricular systolic dysfunction versus medical rate control. They looked at the change in ejection fraction over a follow-up of six months. A total of 68 patients were randomized in the study. They demonstrated an absolute improvement in EF by 18% in the ablation group versus 4% in the rate control group, with also a greater rate of EF normalization with ablation. In fact, over 50% of patients had EF normalization after ablation whereas only about 9% had a good medical rate control. Furthermore, the improvements in EF correlated with the absence of late gadolinium enhancement on MRI and in the medical rate control group an average heart rate less than 90 beats per minute was achieved across the population randomized this approach. These findings are somewhat contrary to other studies that suggested that a rate versus a rhythm control approach were not really much different in patients with reduced left ventricular systolic function. These challenges are paradigm by suggesting that in fact successful restoration of normal rhythm in patients postablation can actually confer improvement in ejection fraction in some patients even when rate controlled. The success rates that should be noted in this study were similar to those published in most existing literature with about 56% of patients without further atrial fibrillation after a single ablation off medications and a success rate of 75% after a single ablation on medications. While the number of patients included are small and thus may be difficult to challenge the paradigm that was created, the rate versus rhythm control are equivalent in patients with reduced systolic function. This finding should raise awareness that it is quite possible that there might actually be benefits in restoring normal rhythm by modern approaches in patients with reduced systolic function. Moving on, still within the realm of atrial fibrillation, however, we'll next review the article by Aronsson, et al. in Europace Volume 19, Issue 10 entitled Designing an Optimal Screening Program for Unknown Atrial Fibrillation: A Cost-Effectiveness Analysis. More and more with an understanding that atrial fibrillation is essentially of epidemic proportions, but many patients tend to be asymptomatic and yet having an elevated stroke risk. People are focusing on how do we screen these populations in a manner that is both cost-effective as well as strategic. Aronsson, et al. tried to use computer simulation modeling to determine what the optimal age was to initiate screening for atrial fibrillation. They ran more than two billion different design screening programs that could be implemented at different age ranges and using data from published scientific literature. They tested these various screening programs. They demonstrated that the screening starting at the age of 75 was associated with the relatively low cost per gained quality adjusted life year. The overall cost at this level was 4,800 euros across the population for quality adjusted life year gained across that population. The relevance of this publication while simulation model lies in highlighting the importance of considering what programs can we actually achieve in the modern day to better identify patients with atrial fibrillation who are not yet identified. Across the literature and in recent clinical meetings, there's a number of articles that are being published regarding the role of different strategies in identifying the asymptomatic, not yet diagnosed atrial fibrillation patients. This study presents an initial foray into systematizing programs that might be applied to recognition of these patients. Along a similar course, we'll also review an article by Reiffel, et al. in JAMA Cardiology Volume 2, Issue 10 entitled Incidence of Previously Undiagnosed Atrial Fibrillation using Insertable Cardiac Monitors in a High-Risk Population: The REVEAL AF Study. In this study, Reiffel, et al. Reviewed the incidence of atrial fibrillation identified using implantable loop recorders in those with a high risk of stroke nearly a CHADS2 score of 3 or greater, but had not been previously diagnosed. It should be noted that while these patients have never been diagnosed with atrial fibrillation, 90% had nonspecific symptoms such as fatigue, dyspnea or palpitations, then theory could be attributed to atrial fibrillation. A total of 385 patients received monitors. They noted that by 30 months of monitoring, about 40% of patients have been identified as having atrial fibrillation that had not been diagnosed. If patients were only monitored for the first 30 days, however, the incident rate of atrial fibrillation in terms of new diagnosis was only 6%. In fact, the median time from device insertion to first episode of atrial fibrillation was almost four months at about 123 days. In line with the previous discussed study by Arosson, et al., this study notes the importance of consideration of how we monitor patients at risk for stroke. The issue at hand is when we do screening, what is enough. The strategies used to identify atrial fibrillation of patients raised from advising on twice daily poll checks, which when done by the patient regularly might allow for identification of atrial fibrillation if they do it well to doing a single ECG, to doing a 24-hour Holter, to doing a 30-day monitor, to doing things like implantable loop recorders. However, this study by Reiffel, et al. suggests the a 30-day continuous monitor is truly insufficient if there is a high concern for atrial fibrillation. Thus with the goals to identify atrial fibrillation on high-risk patients or whether a significant clinical suspicion, one should always consider longer term monitoring by this study. Finally, within the realm of atrial fibrillation, we'll review the article by Tilz, et al. published in Europace Volume 19, Issue 10 on left atrial appendage occluder implantation in Europe, indications anticoagulation post-implantation, results of the European Heart Rhythm Association survey. Currently, there's a high level of utilization of left atrial appendage occlusion for patients with atrial fibrillation who cannot otherwise be on a novel oral anticoagulants in Europe. Tilz, et al. performed a survey of providers performing these procedures. They found that about 52% of those centers performing left atrial appendage occlusion had electrophysiologist performing it as opposed to the remainder using interventional cardiologists. The most common indication for implantation was in those with high risk for stroke and with absolute contraindication to oral anticoagulation or history of bleeding. However, was most interesting from their study was that there was a very wide ranging practice in management after implantation in terms of use of antiplatelets for anticoagulants with 41% prescribing no therapy after implantation. There is even greater variability in therapies for patients who are found to have a thrombus after left atrial appendage occlusion ranging from no therapy to surgery. These findings highlight the difficulty in managing practice patterns with novel technologist and in particular with left atrial appendage occlusion. The highly heterogeneous practice pattern found here suggests that large-scale population outcomes will be difficult to understand unless we understand the individual practice variation that is occurring such as considering what medications patients were prescribed on in the post-implant period or how patients were included in terms of whether or not they met the standard criteria. Furthermore, when a complication occurs such a thrombus septal left atrial appendage occlusion one might suspect that the implications of different strategies such as not doing any therapy all the way to routinely doing surgery tumor to clot should be considered. Next, we will move on to the realm of ICDs, pacemakers, and CRT. First, reviewing the article by Pokorney, et al. published in Circulation in Volume 136, Issue 15 entitled Outcomes Associated With Extraction Versus Capping and Abandoning Pacing and Defibrillator Leads. In this study, Pokorney, et al. reviewed these two different approaches in abandoned leads amongst 6,859 patients. They found that extraction was associated with the lower risk of device infection, but there was no association between difference in mortality, need for future lead revision, or need for future extraction. This involved patients in the Medicare age group, but extraction patients of note, tended to be younger with fewer comorbidities, more often female and had a shorter lead dwell time. While they're statistically different, however, the actual number of years by which patients tended to be younger or to have a shorter lead dwell time was only a year. The fact is that it is always hard to know what to do with an abandoned lead. Having more leads in the vascular system might lead to venous stenosis or might lead to patients having future problems when they need an extraction because of infection, or might make it harder to manipulate this in the vascular space. Thus whether extracting abandoned leads as opposed to just capping them and leaving there needs to be considered when taking any patient in for a lead revision or a lead addition for other reasons. These findings suggest that extraction confer similar mortality risk but lower long-term infection risk than capping them. However, it should be noted this is retrospective data set and given the extraction patients already were younger and had their leads for relatively shorter durations with your comorbidities, they might have reflected to healthier population anyway. However, these data are suggestive and highly the need for further study into whether a more aggressive approach with abandoned lead should be considered. Without randomized data, it will not be for certain. Next, also within the realm of lead extraction, we'll review the article by Bongiorni, et al. published in the European Heart Journal in Volume 38, Issue 40 entitled The European Lead Extraction Controlled Study: A European Heart Rhythm Association Registry of Transvenous Lead Extraction Outcomes. This prospect of registry on lead extraction the largest to dates, Bongiorni, et al. reviewed safety and complications in addition to relationship to the type of center. They noted that the overall hospital major complication rate was 1.7% with mortality rate of 0.5% associated with lead extraction. The most common complication was actually pericardial synthesis, need for a chest tube or need for surgical repair. Overall, success rates for lead extraction in terms of complete removal of all lead components was 97%. However, it should be noted the overall complication rate and success rates were better in high-volume centers than low-volume centers. These findings are consistent with prior data published by [Desmott 35:22] and others, suggesting that more experience associates with better outcomes in lead extraction. However, these data represent the largest prospective registry on lead extraction and confirm the safety and efficacy of overall current practices. These better data on modern lead extraction may help facilitate discussions with patients regarding actual outcomes and also decisions on whether or not extraction should be engaged in individual practices. Next, we'll review the article by Aro, et al. in the realm of sudden death cardiac arrest entitled Electrical Risk Score Beyond Left Ventricular Ejection Fraction: Prediction of Sudden Cardiac Death in the Oregon Sudden Unexpected Death Study in the Atherosclerosis Risk and Communities Study, published in the European Heart Journal in Volume 38, Issue 40. In this study, Aro, et al. reviewed what features beyond ejection fraction could predict sudden death in community cohorts. They specifically focus on the electrocardiogram and demonstrated an electrocardiogram risk score based on the presence or absence of a number of features related to heart rate, left ventricular hypertrophy, QRS transition zone, QTc, and others. They found that amongst those patients with a left ventricular ejection fraction greater than 35%, the presence of four more of these ECG abnormalities confer an odd ratio of sudden death of 26.1. The importance of this article is highlighting how more complex considerations of clinical risk might help in further adjudication of sudden death in poorly characterized cohorts. While most studies have concluded that addition of a variety of additional features such a T-wave alternans do not really confer incremental benefit beyond the ejection fraction in adjudicating sudden death risk and in helping decision making regarding ICD implantation. The fact is that more complex analyses that might exist in more nonlinear approaches or consider more advanced features, the ECG and combination, might confer some benefit in poorly characterized populations such as those with moderately reduced ejection fraction between 35 and 50. We know that while those with an ejection fraction less than 35% is a population have a higher risk within that population, the majority of patients who suddenly die do not have an EF less than 35%. Thus, identifying patients without an EF less than 35% who might be at risk is important. This study by Aro, et al. indicates one potential option to help discriminate patients who might not fit within normal categories for sudden death adjudication and did not fit neatly within the trials. However, prospect of evaluation of application of scoring systems either this one or others that may come in the future will be critical. Changing realms yet again, we'll focus on cellular electrophysiology on an article by Kofron, et al. entitled Gq-Activated Fibroblasts Induce Cardiomyocyte Action Potential Prolongation and Automaticity in a Three-Dimensional Microtissue Environment, published in The American Journal of Physiology, Heart and Circulatory Physiology in Volume 313, Issue 4. In this publication, Kofron, et al. demonstrated that in this three-dimensional microtissue model, fibroblasts cause effects on the normal action potential in the surrounding environment leading to proarrhythmogenic automaticity. This model effectively demonstrated the activation of this fibroblast alone taken out of context by other triggers such as abnormalities of innervation, et cetera, could probably contribute to arrhythmogenicity into these hearts. It is well recognized in other studies that fibroblasts don't just cause proarrhythmic effects because of myocardial disarray. In fact, they can have paracrine effects on surrounding cells. This study by Kofron, et al. further highlights those potential effects. The presence of fibroblast amidst cardiomyocytes do not cause proarrhythmic tendency purely by shift in myocardial conduction direction, but also results from the effects of fibroblast once activated on these running cardiomyocytes action potentials of cells. This study is suggesting specifically proarrhythmogenic arrhythmogenicity related to automaticity in those cardiomyocytes that are adjacent to fibroblast, highlights potential future targets for therapies and also highlights potential mechanisms by which arrhythmias might occurrence population. Changing gears, we next look at genetic channelopathies in one article within the realm of Brugada syndrome and the second article within the realm of predicting QT interval. First, Hernandez-Ojeda, et al. published an article in The Journal of the American College of Cardiology Volume 70, Issue 16 entitled Patients With Brugada Syndrome and Implanted Cardioverter-Defibrillators: Long-Term Follow-Up. Amongst the 104 patients with long-term follow-up nearly greater than nine years on average, they noted a rate of appropriate therapy was very common especially in secondary prevention patients, however, was as much as 9% in otherwise asymptomatic patients. Appropriate ICD therapies, however, especially amongst asymptomatic patients were exclusively in those spontaneous type I Brugada ECG patterns and inducible ventricular arrhythmias, or those obviously the secondary prevention devices who have prior spontaneous ventricular arrhythmias. However, what is more interesting is that more than 20% of patients had some ICD-related complication. Furthermore, the overall incidence of inappropriate shocks was 8.7%, nearly the same rate as appropriate ICD therapies in the primary prevention population. These findings highlight that there is in fact a reasonable incidence of ventricular arrhythmic events needing ICD therapy even in asymptomatic Brugada patients. However, I think the most striking finding is the high incidence of device-related complications of a follow-up, which highlights the need for considered selection and adequate device programming to avoid inappropriate ICD shocks and finally the need for regular follow-up of these relatively young patients receiving ICDs who might be more prone to complication with the long-term. Changing gears, we'll next review an article by Rosenberg, et al. published in Circulation Genetics in Volume 10, Issue 5 entitled Validation of Polygenic Scores for QT Interval in Clinical Populations. Using more extensive genomic analyses, Rosenberg, et al. used populations and real-world cohorts including 2,915 individuals of European ancestry and 366 individuals of African ancestry. They demonstrated that clinical variables could account for about 9 to 10% of variation in QTc in Europeans and 12 to 18% in African ancestry individuals. However, interestingly, polygenic scores provided incremental explanation of a QTc variation but only in individuals of European ancestry. The reason we find this article interesting is the importance of understanding how much genetics can actually tell us and how what it can tell us might vary between difference, individuals of different backgrounds thus how we apply findings from one study to any other study. In the area of genetic testing, the Holy Grail is fully identifying overall risk scores to tell the patient what they may have without having to rely on clinical studies or other clinical variables. However, we do know that there is both an environmental component as well as the genetic components. This study by Rosenberg highlights the importance of potentially considering both. The issue with the article, however, is the fact that while there was clear benefit of the polygenic score in patients of European ancestry, the African ancestry patients reflect the much smaller population almost one-eighth that of the patients included of European ancestry. Also, European versus African ancestry tend to be very broad-based terms. Whether or not there is greater polygenic variation within those of African ancestry as compared to those Europeans ancestry is relatively unclear. Thus while this study should be taken with grain of salt, it should also be considered in the context of providing a foray into seeing how polygenic scores could augment or understanding of how question intervals might vary in a population of people and might be identified immigrant patients. Moving to the realm of ventricular arrhythmias, we'll first review the article by Siontis, et al. published in Heart Rhythm Volume 14, Issue 10 entitled Association of Preprocedural Cardiac Magnetic Resonance Imaging with Outcomes of Ventricular Tachycardia Ablation in Patients with Idiopathic Dilated Cardiomyopathy. In this study, Siontis, et al. tried to identify whether or not use of preprocedural MRI had any impact on overall procedural outcomes. They compared in a more modern practice where they are routinely obtaining cardiac MRI versus prior practice where they do not routinely obtain preprocedural MRI for ablation in patients with idiopathic dilated cardiomyopathy. They demonstrated that moderate use of preprocedural MRIs was associated with significantly greater procedural success mainly 63% in the modern approach versus 24% previously. The importance of the study why is in trying to understand what the actual value of preprocedural cardiac MRI is when patients are undergoing VT ablation particularly with non-ischemic cardiomyopathy. VT ablation outcomes are notoriously even harder to predict in non-ischemic cardiomyopathy cohorts than ischemic cardiomyopathy cohorts. Improved procedural experience, however, or different technologies may also alter long-term outcomes. Thus, because the populations were not randomized and rather retrospective with a discrete change in practice that occurred temporally and just did not vary in terms of utilization over the course of periods of time when success rates might not have been affected just by incremental procedural success is difficult. However, these data suggest that future studies into the incremental role of MRI for VT ablation are needed to determine its utility. Next, we'll review an article by Ho, et al. published in The Journal of Cardiovascular Electrophysiology in Volume 28, Issue 10 entitled ECG Variation During Ventricular Fibrillation Than Focal Sources Due to Wavebreak, Secondary Rotors, and Meander. Ho, et al. in this publication reviewed the role of rotors and focal sources in ventricular fibrillation. They attempted VF induction of 31 patients and use the combination of surface ECG and biventricular basket catheters to create face mask. They showed there's three differences between those with ventricular fibrillation that was mediate by rotors and those with ventricular fibrillation mediated by focal sources. Specifically those with rotor-based VF had greater voltage variation, which they demonstrated zero wavebreak, secondary rotor formation and rotor meander. One of the most critical findings of this study is the fact that a one-size-fits-all approach to consideration of the mechanism of fibrillation is likely unreasonable in most patients. They discriminate between rotor-based ventricular fibrillation and focal source-based ventricular fibrillation and highlighted there are discrete features that differentiate the two populations. While this should be considered an initial foray into understanding these patients, clinical and computational size will be important into understand how we can discriminate mechanisms of complex arrhythmias between patients to help understand, which patients might most benefit from a specific ablation approach or therapeutic decision. This might also apply to atrial fibrillation where multiple mechanisms may coexist in the same patient for the pathogenesis of the arrhythmia. Finally, we'll review an animal model by Patterson, et al. published in The Journal of Cardiovascular Electrophysiology in Volume 28, Issue 10 entitled Slow Conduction Through an Arc of Block: A Basis for Arrhythmia Formation Postmyocardial Infarction. In this study performed in the University of Oklahoma, Patterson, et al. reviewed a novel basis for arrhythmia formation after MI in an animal model. Amongst 108 anesthetized dogs, they demonstrated the delay potentials may decrement over shorter pacing cycle lengths leading to potential premature ventricular beat initiation after sufficient delay of the second potential. Thus, they demonstrated that there is a Wenckebach-like patterns of delayed activation specifically within this arc of conduction block associated with the region infarcted. These findings suggest that even across line of apparent conduction block there may be a potential for premature beat formation due to very slow conduction and thus a novel mechanism of PVC formation following myocardial infarction. Furthermore, it might highlight the mechanism by which to induce PVCs in this patient population Just because there is conduction block the region of baseline mapping further provocative maneuvers to initiate or to discriminate where there might be very slow conduction might be critical to elicit arrhythmia in some patients. Next, within the realm of syncope. We focus on article by Baron-Esquivias, et al. published in The Journal of American College of Cardiology Volume 70, Issue 14 entitled Dual-Chamber Pacing With Closed Loop Stimulation in Recurrent Reflex Vasovagal Syncope: The SPAIN Study. In this randomized double blind control study, Baron-Esquivias, et al. study the value of closed loop stimulation in the specific cohort of patients with cardio-inhibitory vasovagal syncope above 40 years of age. They demonstrated amongst 46 patients the closed loops stimulation was associated with the more than 50% reduction in syncopal spells in nearly three quarters of patients. However, it should be noted that up to 9% of patients continue to have syncope in your consistent frequency to prior. However, it should also be noted that sham cohort 46% of patients continue to have syncope while only a quarter were relieved. Syncope is one of the most challenging diagnosis to manage in electrophysiologic practice. This is both due to the heterogeneity of manifestation of syncope in terms of cause as well as the lack of many therapies that affect some of the autonomic features that mediate syncope. Largely, vasovagal syncope can be strategized into cardio-inhibitory and vasodilatory groups. Generally, pacing will be more effective in theory for those more of a cardio-inhibitory than a vasodilatory component thus certainly patients can have both and thus that might be only partial attenuation of syncopal events by fixing the cardio-inhibitory by pacing but not the vasodilatory, which often requires medications. In this study, the use of closed loops stimulation seems to offer significant benefit in the specific population with cardio-inhibitory vasovagal syncope in age greater than 40 years. However, care should be taken not to necessarily apply these findings to patients not within this age group or within this diagnosis group. Next within the realm of electrocardiography, we'll review an article by Yasin, et al. published in The Journal of Electrocardiology Volume 50, Issue 5 entitled Noninvasive Blood Potassium Measurement Using Signal-Processed, Single-Lead ECG Acquired from a Handheld Smartphone. Yasin, et al. reviewed the ability to determine changes in potassium level using the ECG. They demonstrated amongst 22 patients undergoing hemodialysis in whom estimation models could then be trained. The mean absolute error of ambulatory follow-up between the potassium estimated off of a single lead handheld smartphone-enabled ECG in the actual blood potassium was 0.38 milliequivalents per liter or a difference of 9% of the average potassium level. These findings suggest that in terms of clinical robustness a single lead smartphone-enabled handheld base ECG might be sufficient to estimate ambulatory potassium levels in patients who might be at high risk especially of hyperkalemia. The fact is that electrolytes and other abnormalities of a body homeostasis may be reflected in the ECG. However, whether the ECG may in turn be used to finally determine changes in characteristics such as electrolytes levels has not been very well described. Previous work by the same group has suggested that the 12-lead ECG may be utilized to determine find potassium changes in patients undergoing hemodialysis. These findings while in small number of patients in this particular article highlights that ambulatory technologies such as the one they used here might in fact be utilized to discriminate potassium levels in patients who might be at risk of variations of potassium levels that can sometimes be life-threatening. Further validation will be required in larger populations, but this initial foray might create a paradigm for use of the ECG in ways beyond just looking for arrhythmias. The final article we'll review is by Calzolari, et al. published in The Journal of American College of Cardiology, Clinical Electrophysiology in Volume 3, Issue 10 entitled In Vitro Validation of the Lesion Size Index to Predict Lesion Width and Depth After Irrigated Radiofrequency Ablation in a Porcine Model. In this paper published in the special of JACCEP focused on biophysics of ablation, Calzolari, et al. reviewed in vitro validation of lesion size indexing using radiofrequency ablation. Specifically, they reviewed the novel measure that incorporates not just contact force, power and time, but also impedance into predicting lesion quality. They noted that while lesion with in depth did not correlate with power or contact force alone, it did with either the lesion size indexing tool that they created and also with the force-time integral. However, the lesion size indexing where impedance was included was incrementally better than force-time integral. The truth is that improved prediction model lesion size inadequacy are critical during radiofrequency ablation. Predicting lesion formation might help physicians know whether or not they have done adequate intervention at the time of application. They demonstrated incorporating impedance along with contact force, power, and time. The predictive value of their lesion indexing approach was quite good. However, further validation in association with an outcome is necessary to look at the incremental value. It also should be noted that this lesion size indexing tool did not necessarily predict steam pop formation, which is more often associated with power. I appreciate everyone's attention to this key and hard-hitting articles that we have just focused on from this past month of cardiac electrophysiology across the literature. Thanks for listening. Now back to Paul. Paul Wang: Thanks Suraj. You did a terrific job surveying all journals for the latest articles on topics of interest in our field. There's none an easier way to stay in touch with the latest advances. These summaries and a list of major articles in our field each month could be downloaded from Circulation, Arrhythmia, Electrophysiology website. We hope you'll find the journal to be the go-to place for everyone interested in the field. See you next month.

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Épisode 05 - Le mur de la connaissance

Balado Prévention

Play Episode Listen Later Nov 21, 2017 60:28

Dans cet épisode, en plus d’entendre les voix mielleuses de Julien et Samuel, vous entendrez l’intégralité de notre rencontre avec Marie-Soleil Cloutier, chercheuse et enseignante à l’INRS. Bonne écoute!

dans bonne lemur de la connaissance inrs

Émission du 29 juin 2015

L’œuf ou la poule

Play Episode Listen Later Jun 29, 2015

Aujourd'hui nous recevons Élyse Caron-Beaudoin, étudiante au doctorat à l'INRS, pour nous parler des néonicotinoïdes, des insecticides aux propriétés dévastatrices pour les abeilles, mais pas seulement... On fait le point sur les impacts sur la santé humaine. Marion Spée est de retour avec sa chronique d'actualité des sciences et nous présente des nouvelles surprenantes et ... émoustillantes. Bonne écoute ! photo : http://abeille.forumactif.org/ Pour en savoir plus : conseil municipal de Montréal (page 5) : http://ville.montreal.qc.ca/documents/Adi_Public/CM/CM_ODJ_ORDI_2015-05-25_13h00_FR.pdf Recherches à Sherbrook : http://ici.radio-canada.ca/regions/estrie/2015/06/29/003-impact-pesticides-cancer-universite-de-sherbrooke-luc-gaudreau.shtml

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FR_Entrevue__3

RCI Tam-tam Canada

Play Episode Listen Later Jun 3, 2014 7:54

Linda Guerry est membre du Collectif éducation sans frontières. Cette chercheuse, postdoctorante au Centre Urbanisation Culture Société (INRS) à Montréal, nous explique la situation des sans-papiers.

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Episode 36: Transfusions, Anticoagulants and Bleeding

Emergency Medicine Cases

Play Episode Listen Later Sep 20, 2013 88:18

In the first part of this epic 2 part must-hear episode, Transfusions, Anticoagulants & Bleeding, we have the triumphant return of Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will update you on the latest in transfusion indications & risks, managing INRs and how Wararin compares to Dabigatran, Rivaroxiban & Apixaban. They give you the authoritative low down on: Indications for red cell transfusions in different clinical scenarios (GI bleed, cardiac disease, vaginal bleeding etc) and how to give them, Risks of red cell transfusions including Host vs Graft Disease, TRALI & TACO and how to manage them, IV Iron as an alternative to red cell transfusions, Managing INRs: indications for Vit K, Prothrombin Complex Concentrates (Octaplex & Beriplex), adjusting Warfarin Dose, liver patients, and much much more......... The post Episode 36: Transfusions, Anticoagulants and Bleeding appeared first on Emergency Medicine Cases.

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Episode 36: Transfusions, Anticoagulants and Bleeding

Emergency Medicine Cases

Play Episode Listen Later Sep 20, 2013 88:18

hospitals risks gi taco bleeding indications transfusions anticoagulants transfusion medicine sunnybrook hospital apixaban vit k inrs dabigatran

Conférence sur les périodes troubles de 1929 à 1945 dans la région montréalaise

Play Episode Listen Later Feb 21, 2011 93:00

Alors que Montréal et la région occupent une position dominante dans les sociétés canadienne et québécoise, le monde occidental est aux prises avec la dépression des années 1930, qui débute avec le krach boursier new-yorkais d'octobre 1929 et à laquelle succède la guerre de 1939-1945. En somme, les années qui vont de 1929 à 1945 sont des années de crise, des années d'exception au sens fort du terme, où le cheminement historique auquel on s'attendait est bousculé. Sylvie Taschereau et Magda Fahrni présentent leurs Réflexions sur… les périodes troubles de la Grande Crise et de la Deuxième Guerre mondiale dans la région montréalaise dans une perspective générale, c'est-à-dire qu'elles abordent à la fois les dimensions politiques, économiques, sociales et culturelles de la société montréalaise. Animation : Dany Fougères, INRS-UCS Par Sylvie Taschereau (UQTR) et Magda Fahrni (UQAM) Cette conférence a eu lieu à l’Auditorium de la Grande Bibliothèque le mardi 22 février 2011. Présentée en collaboration avec l'Institut national de la recherche scientifique (INRS)

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Réflexions sur… l’économie de la région montréalaise depuis les années 1950

Ethnicity & Democratic Governance

Play Episode Listen Later Sep 6, 2010 92:00

Sur le plan économique, la région de Montréal se distingue par son capital physique, financier et humain, mais aussi par sa situation géographique. Cette région a évolué de pair avec l’économie mondiale où se sont succédé, depuis l’après-guerre, les Trente Glorieuses, puis des périodes de ralentissement, de récession et de reprise économique. Animation : Dany Fougères (INRS-UCS) Conférenciers : Mario Polèse (INRS-UCS) et Richard Shearmur (INRS-UCS) Présentée en collaboration avec l’Institut national de la recherche scientifique (INRS) dans le cadre du projet Histoire de la région montréalaise des origines à nos jours. Cette conférence a eu lieu à l’Auditorium de la Grande Bibliothèque le 7 septembre 2010.

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Immigration in Linguistically Divided Cities

Play Episode Listen Later Jul 13, 2010 64:17

Globalization, Urbanization and Ethnicity conference - December 3, 2009 Dirk Jacobs, ULB, Belgium; Annick Germain, INRS; Ricard Moren-Alegret, Spain; Discussant: Martin Papillon, University of Ottawa; Chair: Andre Lecours, University of Ottawa

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Réflexions sur...l’aide et l’entraide à Montréal avant 1930

Play Episode Listen Later Mar 15, 2010 79:00

La région montréalaise voit graduellement apparaître une société diversifiée, à la fois fragmentée et solidaire. L’histoire sociale de la région montréalaise reflète son rôle de plaque tournante des migrations humaines au Canada et en Amérique du Nord. Le phénomène de l’urbanisation confère à la ville-centre toutes les caractéristiques qu’on associe généralement à l’urbanité : divisions sociales, exclusion, appartenance, déviance, sociabilité, etc. Animation : Dany Fougères (INRS-UCS) Avec Janice Harvey (Collège Dawson) et Jean-Marie Fecteau (Université du Québec à Montréal) Présentée en collaboration avec l’Institut national de la recherche scientifique (INRS) dans le cadre du projet Histoire de la région montréalaise des origines à nos jours Cette conférence a eu lieu à l’Auditorium de la Grande Bibliothèque le mardi 16 mars 2010.

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Réflexions sur… l’économie montréalaise avant 1930