Stratégies à privilégier pour permettre aux infirmières et infirmiers de déployer pleinement leur étendue de pratique.

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M. Sc.) en sciences infirmières option administration des services infirmiers

Raymond D. Adams, gigante de la neurología norteamericana

El profesor Raymond D. Adams (1911-2010) fue una de las figuras más prominentes de la neurología norteamericana en el siglo XX. Realizó sus estudios de medicina en la Universidad de Duke. Posteriormente, inició especialización en psiquiatría, pero optó por dedicarse al estudio de la patología del sistema nervioso y a la neurología en el Hospital de Boston durante 10 años. Luego fue contratado por el Hospital General de Massachusetts, donde dirigió del Departamento de Neurología por más de 25 años. Fue profesor emérito de neuropatología de la Universidad de Harvard y obtuvo distinciones de otras universidades y sociedades científicas en los Estados Unidos y en otros países. Contribuyó de manera decisiva a la consolidación de la neurología en Norteamérica creando una escuela de fama mundial. Describió varios síndromes, aportó al desarrollo de otras ramas de la neurociencia, publicó múltiples artículos científicos y, desde 1977, junto con el Dr. Maurice Victor, el libro Principios de neurología, que se ha convertido en un clásico en la materia, traducido a varios idiomas. Dirigió un Departamento en donde se ha formado un muy destacado grupo de neurólogos de varias nacionalidades que dan brillo a la neurología mundial.

Fiber architecture in remodeled myocardium revealed with a quantitative diffusion CMR tractography framework and histological validation

Background: The study of myofiber reorganization in the remote zone after myocardial infarction has been performed in 2D. Microstructural reorganization in remodeled hearts, however, can only be fully appreciated by considering myofibers as continuous 3D entities. The aim of this study was therefore to develop a technique for quantitative 3D diffusion CMR tractography of the heart, and to apply this method to quantify fiber architecture in the remote zone of remodeled hearts. Methods: Diffusion Tensor CMR of normal human, sheep, and rat hearts, as well as infarcted sheep hearts was performed ex vivo. Fiber tracts were generated with a fourth-order Runge-Kutta integration technique and classified statistically by the median, mean, maximum, or minimum helix angle (HA) along the tract. An index of tract coherence was derived from the relationship between these HA statistics. Histological validation was performed using phase-contrast microscopy. Results: In normal hearts, the subendocardial and subepicardial myofibers had a positive and negative HA, respectively, forming a symmetric distribution around the midmyocardium. However, in the remote zone of the infarcted hearts, a significant positive shift in HA was observed. The ratio between negative and positive HA variance was reduced from 0.96 +/- 0.16 in normal hearts to 0.22 +/- 0.08 in the remote zone of the remodeled hearts (p<0.05). This was confirmed histologically by the reduction of HA in the subepicardium from -52.03 degrees +/- 2.94 degrees in normal hearts to -37.48 degrees +/- 4.05 degrees in the remote zone of the remodeled hearts (p < 0.05). Conclusions: A significant reorganization of the 3D fiber continuum is observed in the remote zone of remodeled hearts. The positive (rightward) shift in HA in the remote zone is greatest in the subepicardium, but involves all layers of the myocardium. Tractography-based quantification, performed here for the first time in remodeled hearts, may provide a framework for assessing regional changes in the left ventricle following infarction.

Eye-trauma: Event driven control software for gesture recognition in medical simulation

Il progetto Eye-Trauma si colloca all'interno dello sviluppo di un simulatore chirurgico per traumi alla zona oculare, sviluppato in collaborazione con Simulation Group in Boston, Harvard Medical School e Massachusetts General Hospital. Il simulatore presenta un busto in silicone fornito di moduli intercambiabili della zona oculare, per simulare diversi tipi di trauma. L'utilizzatore è chiamato ad eseguire la procedura medica di saturazione tramite degli strumenti chirurgici su cui sono installati dei sensori di forza e di apertura. I dati collezionati vengono utilizzati all'interno del software per il riconoscimento dei gesti e il controllo real-time della performance. L'algoritmo di gesture recognition, da me sviluppato, si basa sul concetto di macchine a stati; la transizione tra gli stati avviene in base agli eventi rilevati dal simulatore.

Efficacy and Safety of Natalizumab in Crohn’s Disease Patients Treated at 6 Boston Academic Hospitals

BACKGROUND: Despite trials demonstrating its efficacy, many physicians harbor concerns regarding the use of natalizumab in the treatment of patients with refractory Crohn's disease (CD). The purpose of this study was to perform a descriptive analysis of a series of CD patients not currently enrolled in a clinical trial. METHODS: A retrospective case review of patients treated with natalizumab at 6 sites in Massachusetts: Boston Medical Center, Beth Israel Deaconess Medical Center, Brigham & Women's Hospital, Lahey Clinic, Massachusetts General Hospital, and UMass Medical Center. RESULTS: Data on 69 CD patients on natalizumab were collected. At the start of treatment, patients' disease duration was 12 years. A high proportion of patients were women (68%), presented with perianal disease (65%) and upper gastrointestinal tract involvement (14%). Prior nonbiologic therapies were steroids (96%), thiopurines (94%), antibiotics (74%), methotrexate (58%), and at least two anti-tumor necrosis factor agent failures (81%). Sixty-nine percent (44 of 64 patients) with available medical evaluation had a partial or complete clinical response. Loss of response was 13% after an average of 1 year of treatment. Adverse events were infusion reactions, headaches, fever, and infections. No case of progressive multifocal leukoencephalopathy was observed. CONCLUSIONS: In our clinical experience outside the context of a clinical trial, natalizumab is largely reserved for CD patients with extensive ileocolonic disease who have failed conventional immunosuppressants and of at least 2 anti-tumor necrosis factor agents. This drug is, however, well tolerated and offers significant clinical improvement for more than a year in one-third of these difficult-to-treat CD patients.

Factors Associated with Durable Response to Infliximab in Crohnʼs Disease 5 Years and Beyond: A Multicenter International Cohort

BACKGROUND: Infliximab (IFX) has been used for over a decade worldwide. Less is known about the natural history of IFX use beyond a few years and which patients are more likely to sustain benefits. METHODS: Patients with Crohn's disease (CD) exposed to IFX from Massachusetts General Hospital, Boston, Saint-Antoine Hospital, Paris, and the Swiss IBD Cohort Study were identified through retrospective and prospective data collection, complemented by chart abstraction of electronic medical records. We compared long-term users of IFX (>5 yr of treatment, long-term users of infliximab [LTUI]), with non-LTUI patients to identify prognostic factors. RESULTS: We pooled data on 1014 patients with CD from 3 different databases, of whom 250 were defined as LTUI. The comparison group comprised 290 patients with CD who discontinued IFX: 48 primary nonresponses, 95 loss of responses, and 147 adverse events. Factors associated with LTUI were colonic involvements and an earlier age at the start of IFX. The prevalence of active smokers and obese patients differed markedly, but inversely, between American and European centers but did not impact outcome. The discontinuation rate was stable around 3% to 6%, each year from years 3 to 10. CONCLUSIONS: Young age at start of IFX and colonic CD are factors associated with a beneficial long-term use of IFX. After 5 years of IFX, there is still a 3% to 5% discontinuation rate annually. Several factors associated with a good initial response such as nonsmoker and shorter disease duration at IFX initiation do not seem associated with a longer term response.

Notes about cases heard as Justice of the Peace, 1784-1795

This small paper-bound notebook contains notes Winthrop made concerning the cases he heard between 1784 and 1795 as a Justice of the Peace for Middlesex County. These notes provide insight into the nature of crimes being committed in Cambridge in the post-Revolutionary period, as well as the names and occupations of those accused and their victims. The cases involved the following individuals, among others: Samuel Bridge, Benjamin Estabrook, Joseph Jeffords, Cato Bordman, John Kidder, Spenser Goddin, Jacob Cromwell, Benjamin Stratton, Mary Flood, Bender Temple, John Willett, Joseph Hartwell, Nathaniel Stratton, Amos Washburn, Francis Moore, Thomas Malone, Thomas Cook, and Amboy Brown. The cases involved a range of offenses, and occasionally Winthrop decided that a case exceeded his jurisdiction and forwarded it to the General Court or the Supreme Judicial Court.

Letter from Edward Wigglesworth to John Lowell, 1781 January 3

Four leaves containing a four-and-a-half-page letter in the hand of Professor Edward Wigglesworth to John Lowell dated January 3, 1781. In the letter, Professor Wigglesworth describes the issues related to the deprecating value of paper money and the salaries of Harvard officers, and he provides recommendations for the General Court's grants to the College.

The Report of the Committee appointed to Consid'n of the Memorial of the Overseers of Harvard College, 1722 June 29

Two folio-sized leaves containing a handwritten copy of a June 29, 1722 report created by a Committee of the General Court responding to the June 13, 1722 memorial of the Board of Overseers. The report lists three points declaring that the Charter of 1650 intended the Tutors to be members of the Corporation "provided they exceed not five in number," that none of the Fellows be Overseers, and that the Charter of 1650 did not grant the Corporation the power to set salaries without the consent of the Overseers. The copy notes that the report was read and accepted on June 29, and signed by Governor Samuel Shute on July 2, 1722, with the stipulation that none of the current non-resident Fellows be removed from the Corporation.

I. Charlestown ferry bound volume, 1707-1806

This series contains sixty-nine documents related to the College's interest in the Charlestown ferry between 1707 and 1806 that were gathered together, arranged in chronological order, and pasted into a bound volume at an undetermined date. The majority of documents are leases and bonds with the ferrymen, as well as handwritten copies of Corporation petitions to the General Court regarding ferry fares and bridge development. The series also includes handwritten legal opinions composed by Levi Lincoln and Nathan Dane for the College analyzing the rights of the College to transportation-related income.

Volume I, original,

This volume is a tête-bêche, with texts beginning at both the front and back covers rotated 180⁰ from one another. The portion at the back, which is much shorter in length, contains transcriptions of acts and orders of the General Court from 1642, 1650, and 1657. It also contains the "Rules and Statutes Relating to the Hollis Professorship of Divinity" and those relating to the Hollis Professorship of Mathematics and Natural and Experimental Philosophy, as well as a transcription of a portion of Mary Saltonstall's will.

The Lawes and Orders of Harvard Colledge, 1655-1708

The 21-page handwritten copy of the College laws is laid out in two columns, and lacks a cover. In the left-hand column, in an unidentified hand, are the Laws of 1655 in English with additions dated April 9, 1660, August 24, 1663, and December 5, 1667, and an order of the General Court dated Sept. 4, 1656. In the right-hand column, in the hand of President John Leverett, are the Latin Laws of 1642-1646, with an occasional reference to the Latin Laws of 1686 and 1692, and two extracts from the Corporation records about the reading of the Scriptures dated January 26 and May 27, 1708.

Meeting minutes maintained by the Secretary, April 21, 1812; May 4, 1812; and June 3, 1812

These minutes pertain to discussions of the General Court's "act to repeal an act" (also called "the Act to alter and amend the Constitution of the Board of Overseers of Harvard College, and to regulate certain meetings of said Board") in February 1812, which repealed changes made in 1810 to the Constitution of the Board of Overseers. The Overseers present at these meetings doubted the act's legality and discussed ignoring and/or attempting to overturn the act.

Letter from Joseph Willard to John Lowell, 1799 January 17

One folded leaf containing a handwritten letter from President Willard to lawyer John Lowell of Roxbury, Mass. describing the papers accompanying the letter that relating to "the College business with the General Court."