Les neutrophiles infiltrent la muqueuse colique inflammatoire en maladie de Crohn (CD). Cependant, on ignore l’existence d’une corrélation entre la sévérité endoscopique et la fréquence et/ou l’activation des neutrophiles et autres granulocytes. Une cohorte de 73 patients atteints de CD fut recrutée prospectivement. Les participants furent stratifiés selon la Classification de Montréal ou subdivisés selon le phénotype endoscopique (phénotype typique vs apparence endoscopique « UC-Like »). L’index d’Harvey Bradshaw (HBI) et le Simple Endoscopic score (SES-CD) furent calculés au moment de la coloscopie. La fréquence et l’expression de CD66b et de CD64 sur les granulocytes furent évaluées en cytométrie de flux sur des échantillons sanguins et des biopsies coliques. Le SES-CD corrélait avec l’expression du CD66b sur les neutrophiles coliques et du CD64 sur les neutrophiles circulants en présence de maladie active avec comportement inflammatoire (B1). Les fréquences des neutrophiles et des basophiles mais non des eosinophiles étaient augmentées au sein de la muqueuse inflammatoire, mais la fréquence des neutrophiles coliques n’était corrélée avec le SES-CD uniquement en présence d’un phénotype endoscopique « UC-like ». Deux scores d’activation granulocytaire étaient discriminant entre les individus avec maladie légère et sévère dans l’ensemble de la cohorte avec maladie active. L’activation des granulocytes dans le sang et la muqueuse colique corrèle avec le SES-CD dans des sous-groupes de patients avec une maladie B1, alors que les scores d’activation granulocytaire pourraient être pertinent cliniquement pour évaluer la sévérité de la maladie et possiblement avoir une valeur prognostique parmi les individus avec maladie active. / Neutrophils infiltrate the inflamed colon in Crohn’s disease (CD). However, correlation between endoscopic severity, and frequency and/or activation of neutrophils and other granulocytes like basophils and eosinophils remains to be investigated. A cohort of 73 CD patients was prospectively enrolled according to endoscopic severity and treatment history. Patients with active disease were stratified according to Montreal classification or subdivided into typical CD and UC-like endoscopic features. Harvey Bradshaw Index (HBI) and Simple Endoscopic score (SES-CD) were performed at the time of ileocolonoscopy. Frequency and expression of CD66b and CD64 on granulocytes were assessed in paired blood and colonic biopsies using flow cytometry. SES-CD correlated with neutrophil CD66b expression in mucosa but not blood and conversely, with neutrophil CD64 expression in blood but not mucosa in CD patients with inflammatory (B1) active disease. Frequencies of neutrophils and basophils but not eosinophils, increased in inflamed colon, but only in a subgroup of CD patients presenting “UC-like” endoscopic features were the frequencies of colonic neutrophils correlated with SES-CD. Furthermore, a neutrophil activation score (CD66b X CD64 on neutrophils) and a blood granulocyte score (CD66b on eosinophils X CD64 on neutrophils) discriminated between mild and severe disease in the entire cohort of patients with active disease. Activation of granulocytes in blood and/or mucosa correlated with SES-CD in subgroups of patients with B1 inflammatory disease while granulocyte activation scoring systems may be clinically relevant to evaluate disease severity and predict prognosis in the entire cohort of active disease patients.

In 1994, Tennessee, the third largest tobacco-producing state in the U.S., preempted tobacco regulation. However, in 2005, higher educational institutions were exempted from this preemption and the 2007 Non-Smoker Protection Act required educational facilities to create smoke-free environment. To this date, while all higher educational institutions have some sort of smoke-free policy, East Tennessee State University is the only public institution with a tobacco-free policy. We investigated attitudes and behaviors of the university personnel, the most stable segment of the population, toward the policy and compliance with it using an internet-based survey. All employees (2,318) were invited to participate in a survey; 58% responded. Bivariate analyses found 79% of the respondents favored the policy. Multiple variable logistic regression analyses found support for the policy was higher among females [OR = 3.14; 95% CI (1.68, 5.86)], administrators/professionals [OR = 3.47; 95% CI (1.78, 6.74)], faculty [OR = 2.69; 95% CI (1.31, 5.53)] and those affiliated with the College of Medicine [OR = 4.14; 95% CI (1.45, 7.85)]. While only 67 employees (5.6% of sample) reported they have not complied with the policy, around 80.8% reported observing someone engaged in non-compliance. The high level of support for the policy suggests it should be promoted throughout the higher education system and nationwide. At the same time, in preemptive states, higher educational institutions should be targeted as venues for strong tobacco-free policies. The gap in compliance, however, implies in tobacco-friendly environments, a tobacco-free campus policy with no reporting and enforcement mechanisms could lead to high levels of non-compliance.

No description available.

No description available.

No description available.

No description available.

No description available.

A Computational Fluid Dynamics (CFD) tool is developed in this thesis to solve complex fluid-structure interaction (FSI) problems. The fluid domain is based on Smoothed Particle Hydro-dynamics (SPH) and the structural domain employs large-deformation Finite Element Method (FEM). Validation tests of SPH and FEM are first performed individually. A loosely-coupled SPH-FEM model is then proposed for solving FSI problems. Validation results of two benchmark FSI problems are illustrated (Antoci et al., 2007; Souto-Iglesias et al., 2008). The first test case is flow in a sloshing tank interacting with an elastic body and the second one is dam-break flow through an elastic gate. The results obtained with the SPH-FEM model show good agreement with published results and suggest that the SPH-FEM model is a viable and effective numerical tool for FSI problems. This research is then applied to simulate a two-dimensional free-stream flow interacting with a deformable, pressurized surface, such as an ACV/SES bow seal. The dynamics of deformable surfaces such as the skirt/seal systems of the ACV/SES utilize the large-deformation FEM model. The fluid part including the air inside the chamber and water are simulated by SPH. A validation case is performed to investigate the application of SPH-FEM model in ACV/SES via comparison with experimental data (Zalek and Doctors, 2010). The thesis provides the theory of the SPH and FEM models incorporated and the derivation of the loosely-coupled SPH-FEM model. The validation results have suggested that this SPH-FEM model can be readily applied to skirt/seal dynamics of ACV/SES interacting with free-surface flow. / Ph. D.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

L’assurance médicaments est un des facteurs qui peuvent influencer l’adhésion aux médicaments. Les objectifs de ce mémoire étaient d’évaluer l’impact du type d’assurance médicaments (publique versus privée) sur l’adhésion et le coût des antihypertenseurs et d’évaluer l’impact des procédures de remboursement et de la contribution du patient sur l’adhésion aux médicaments prescrits pour traiter une maladie chronique. Afin de répondre à ces objectifs, deux cohortes rétrospectives ont été construites à partir des bases de données de la RAMQ et reMed : une cohorte appariée d’utilisateurs d’antihypertenseurs couverts par une assurance médicaments privée ou publique et une cohorte de patients couverts par une assurance médicaments privée ayant rempli au moins une ordonnance pour un médicament traitant une maladie chronique. Les résultats montrent que le niveau d’adhésion aux antihypertenseurs était similaire entre les deux types d’assurance médicaments et que le coût des antihypertenseurs était 28,9 % plus élevé au privé. De plus, il a été observé que les procédures de remboursement n’affectaient pas l’adhésion, alors que le niveau de contribution des patients l’affectait. Les patients qui déboursaient un plus grand montant à l’achat de leurs médicaments étaient moins adhérents (différence : -19,0 %, Intervalle de confiance [IC] à 95 % : -24,0 à -13,0), alors que les patients qui n’avaient rien à débourser étaient moins adhérents (différence : -9,0 %, IC à 95 % : -15,0 à -2,0), que ceux qui devaient débourser une petite somme. Les résultats présentés dans ce mémoire montrent que l’assurance médicaments influence l’adhésion par l’entremise des caractéristiques des plans d’assurance. / Drug insurance is one of many factors that can influence medication adherence. The objectives of this thesis were to evaluate the impact of the type of drug insurance (private versus public) on adherence to antihypertensive medications and the cost of medications, and to evaluate the impact of drug reimbursement procedures and out-of pocket expenses on adherence to medications prescribed for chronic diseases. To meet these objectives, two retrospective cohorts were constructed from the RAMQ and reMed databases: a matched cohort of antihypertensive users covered by private or public drug insurance and a cohort of patients covered by private drug insurance who filled at least one prescription for a medication prescribed for a chronic disease. The results have shown that the level of adherence to antihypertensive medications was similar between the two types of drug insurance and that the cost of antihypertensive medications was 28,9% higher for those privately insured. It was also observed that drug reimbursement procedures didn’t affect medication adherence, while the level of out-of-pocket expenses affected it. Patients with the highest out-of-pocket expenses were less adherent (difference: –19.0%; 95% confidence interval [CI]: –24.0 to –13.0), while patients with no out-of-pocket expenses were less adherent (difference: -9.0%; 95% CI: –15.0 to –2.0) than those with low out-of-pocket expenses. The results presented in this thesis have shown that drug insurance affects medication adherence through the characteristics of drug insurance plans.