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The Biodome is part of Montreal Space for Life, the largest natural science museum complex in Canada, which also includes the Botanical Garden, the Insectarium, and the Rio Tinto Alcan Planetarium. The Biodome is a unique building filled with flora and fauna from five different replicated ecosystems from the Americas. Although these ecosystems are all under one roof, they vary greatly in terms of temperature, humidity and light requirements for hundreds of animal and plant species living within the dome. Four of the ecosystems--the Laurentian Maple Forest, the Gulf of St. Lawrence, the Sub-Antarctic Islands and the Labrador Coast--must be cooled year-round while the Tropical Rainforest must be heated. Here, Allard describes Biodome's ambitious energy-efficiency retrofit project aimed at significantly reducing energy consumption and greenhouse gas emissions.

PurposeTo compare mid-term anatomical and functional outcomes following laparoscopic sacrocolpopexy (LS) between women under and over 65.MethodsProspective and observational study involving patients with symptomatic pelvic organ prolapse (POP) undergoing LS. Study population was stratified according to patients’ age at the time of surgery. POP symptoms and impact on quality of life were assessed by PFIQ-7 and PFDI-20 questionnaires at baseline and during follow-up.ResultsAmong our study population (n = 72), 26 women were over 65 and 46 under 65. Mean follow-up duration was 17.6 months, and complete follow-up was available in 90% of patients. No differences between study groups were observed regarding surgery duration, length of stay, and peri-operative complications. Recurrence rate was 1.4% at 18 months of follow-up. Questionnaires analysis revealed a significant improvement in PFIQ-7 and PFDI-20 scores. We found no differences in post-operative scores between control and elderly groups. Sixteen patients experienced de novo stress urinary incontinence (22.2%), with no difference between groups (p = 0.7). Among them, seven required surgical management.ConclusionsLS was associated with high anatomical success rate and good functional outcomes, regardless of age at the time of surgery. LS should thus be considered in women over 65. Beyond age, the route of surgery should be driven by patient’s choice and medical condition.

Large loop excision of the transformation zone (LLETZ) is routinely performed for the management of high grade intracervical neoplasia (CIN). Several uncommon complications have been described, including postoperative peritonitis, pseudoaneurysm of uterine artery, and bowel fistula. We report a unique case of postoperative vaginal evisceration and the subsequent management. Case. A 73-years-old woman underwent LLETZ for high grade CIN. On postoperative day 3, she was admitted for small bowel evisceration through the vagina. Surgical management was based on combined laparoscopic and transvaginal approach and consisted in bowel inspection and reinstatement, peritoneal washing, and dehiscence repair. Conclusions. Vaginal evisceration is a rare but potentially serious complication of pelvic surgery. This case report is to make clinicians aware of such complication following LLETZ and its management.

Background Despite multimodality treatments including neurosurgery, radiotherapy and chemotherapy, glioblastoma (GBM) prognosis remains poor. GBM is classically considered as a radioresistant tumor, because of its high local recurrence rate, inside the irradiation field. The development of new radiosensitizer is crucial to improve the patient outcomes. Pre-clinical data showed that Poly (ADP-ribose) polymerase inhibitors (PARPi) could be considered as a promising class of radiosensitizer. The aim of this study is to evaluate Olaparib, a PARPi, as radiosensitizing agent, combined with the Stupp protocol, namely temozolomide (TMZ) and intensity modulated radiotherapy (IMRT) in first line treatment of partially or non-resected GBM. Methods The OLA-TMZ-RTE-01 study is a multicenter non-randomized phase I/IIa trial including unresectable or partially resectable GBM patients, from 18 to 70 years old. A two-step dose-escalation phase I design will first determine the recommended phase 2 dose (RP2D) of olaparib, delivered concomitantly with TMZ plus conventional irradiation for 6 weeks and as single agent for 4 weeks (radiotherapy period), and second, the RP2D of olaparib combined with adjuvant TMZ (maintenance period). Phase IIa will assess the 18-month overall survival (OS) of this combination. In both phase I and IIa separately considered, the progression-free survival, the objective response rate, the neurocognitive functions of patients, emotional disorders among caregivers, the survival without toxicity, degradation nor progression, the complications onset and the morphologic and functional MRI (magnetic resonance imaging) parameters will be also assessed as secondary objectives. Ancillary objectives will explore alteration of the DNA repair pathways on biopsy tumor, proton magnetic resonance spectroscopy parameters to differentiate tumor relapse and radionecrosis, and an expanded cognition evaluation. Up to 79 patients will be enrolled: 30 patients in the phase I and 49 patients in the phase IIa. Discussion Combining PARP inhibitors, such as olaparib, with radiotherapy and chemotherapy in GBM may improve survival outcomes, while sparing healthy tissue and preserving neurocognitive function, given the replication-dependent efficacy of olaparib, and the increased PARP expression in GBM as compared to non-neoplastic brain tissue. Ancillary studies will help to identify genetic biomarkers predictive of PARPi efficacy as radiosensitizer. Trial registration NCT03212742 , registered June, 7, 2017. Protocol version: Version 2.2 dated from 2017/08/18.

Real allergy to local anesthetic (LA) is very rare. This study was performed to report a case of anaphylaxis to multiple \"caine.\" A 25-years-old atopic nurse developed a very severe anaphylactic reaction on her third infiltration for low back pain with bupivacaine, lidocaine, and methylprednisolone: she developed a vagal reaction, followed during the next 30 minutes by a pruriginous skin rash, followed by a tongue edema and a severe bronchospasm. Adrenalin was injected with a poor response. She was intubated and transferred to the intensive care unit for a few days and, finally, she recuperated completely. Skin-prick tests were done on two occasions. In the first session, no reactions were observed with triamcinolone and methylprednisolone at 1 mg/cc, but a rapid extending maculopapular erythema developed with a final diameter of 50 mm with lidocaine 0.1% (group 2) and 25 mm with procaine 2% (group 1): control 0 mm, histamine, 3 mm. She also complained of itchiness in the neck and shoulder, which resolved in the next 90 minutes. In the second session, a test with bupivacaine 0.0005% (group 2) gave a papule with a diameter of >5 mm, and a test with mepivacaine 0.001% (group 2) was negative: control, histamine, 3 mm; no subsequent tests with mepivacaine were done because she developed a cough and throat pruritus, voice modification, and a sensation of throat narrowing, that resolved with treatment. We reported a case of anaphylaxis to multiple LA (groups 1 and 2), possibly via an IgE-mediated mechanism.

Selon Tillich, l’apologétique signifie « défendre » la foi chrétienne lorsqu’elle est menacée, et en « répondre » devant des adversaires. Dès lors, dans le contexte d’une culture en voie de sécularisation, où la religion se trouve de plus en plus contestée dans ses prétentions à organiser et à régir la société, il était normal que l’apologétique occupe une place importante dans la réflexion théologique.Chez Tillich, on note une évolution importante dans sa manière d’envisager cette notion. En effet, loin de proposer une approche purement dualiste de l’apologétique, qui opposerait par exemple la vérité chrétienne au doute athée, Tillich cherchera toujours à rencontrer son interlocuteur athée sur un « terrain commun » d’entente. Ce critère du terrain commun sera d’ailleurs le critère fondamental de sa compréhension de l’apologétique, même si cette dernière se reconfigure de différentes manières au fil du temps. En effet, d’autres critères seront également parfois soulignés, surtout durant toute la période allemande de son enseignement. Pour montrer les convergences et les discontinuités dans cette compréhension de l’apologétique, nous avons envisagé la recherche de manière chronologique, en nous basant sur les principaux textes qui abordaient explicitement le terme « apologétique ». Le résultat de notre recherche fut alors de constater qu’il existait deux grands paradigmes dans la compréhension tillichienne de l’apologétique, à savoir : une apologétique de l’attaque et une apologétique de la réponse. Schématiquement, nous rattacherons la première à la période allemande de son enseignement, et la seconde à la période américaine. Il faut aussi noter que notre recherche commence par aborder la question de l’apologétique à partir des écrits de l’année 1913, c’est-à-dire des écrits antérieurs à la période d’enseignement allemande, qu'elle contient également une reprise à rebours de son sujet, via une étude des rapports entre Tillich et Barth, qui mettent en jeu la possibilité, ou non, d’une démarche de type apologétique, et qu'elle ouvre à la question du dialogue interreligieux, ainsi qu'à une actualisation de la question apologétique.

A contribution to relevant conceptualization of decision-making processes in educational politics. Analysis of these processes should account for the relative looseness of the relationship between the educational system & societal constraints, for the importance of relative specialization & professionalization characterizing this system, for the impact of large-scale organization characteristics that pervade the system, & for the particular political status of the educational system within the state. A decision-making approach can do justice to the fundamental issues involved in the politics of education only: (1) if it is itself embedded in a theory of society which is able to relate variables of decision-making to other variables through a set of propositions concerning \"vital\" issues, & (2) if it is able to relate the results of its analysis to specific characteristics & functions of the educational system. This approach is tentatively applied to some findings concerning the politics of education in Colombia. AA.

Event patterns are a language construct for expressing relationships between specifications made at different levels of a hierarchical design of a concurrent system. This presentation (1) explains the use of event patterns in defining mappings between different levels of a design hierarchy, (2) defines a language for specifying event pattern mappings, and (3) shows how mappings can be used in debugging discrete event simulations. The concurrent system specification language used in this research is VHDL. VAL+ is an annotation language for VHDL, geared toward the specification of event pattern mappings. VAL+ features are its simplicity, its ability to define mappings as well as design constraints, its ability to report both pattern occurrences and incorrect ordering relationships in a simulation, and a semantics suitable for efficient implementation. The VAL+ mapping construct defines the relationship between one event at a (high) level of abstraction and a pattern of events at a (lower) level. To investigate the application of event pattern mappings, a debugger has been implemented and used in analyzing gate level simulations. Using mappings specified in VAL+, the debugger extracts, from a VHDL gate level simulation, simulations at the register transfer level and the instruction level. The higher the simulation level, the smaller the number of events. The mapping definitions help the designer trace a missing event at the instruction level down to one or more missing events at the register transfer level, and similarly from the register transfer level to the gate level. This method allows for fast bug detection and pinpointing.