NCube/papyrus huggingface dataset:
Déconstruction et reconstruction des communautés de pratique dans les organisations de santé professionnelles : le cas des fusions d'hôpitaux universitaires

This study, which draws on the situated action approach, aims to understand the (re)construction of communities of practice (CoPs) in the context of a hospital merger. Combining documentary sources, semi-open ended interviews and observations data, the analysis strategy is twofold. A first method takes into account the merging process itself and the situation of action in time and place. A second method is guided by grounded theory as data are continuously categorized and compared throughout the data collection phase. Within this perspective, where the notion of process is a key figure, we have identified, in link with current literature, interrelated characteristics, such as mutual engagement, a joint enterprise, shared repertoire that intervene in the reconstruction of a community of practice (CoP). Our analysis points to the action domain as the common denominator of community practices, domain where tacit and explicit knowledge tend to converge in time. This shared practice, eminently social in nature, generates knowledge and negotiated rules that are upheld by its members within the framework of their meetings. This perspective has also brought forth how communities of practice take shape within processes of continuous learning that combine phases of intense participation that favor a shared understand of the action domain and the reification of their representations. In this specific study, the participation/reification dialectic reveals a “making sense” process where meaning of action and social regulation are intricately linked. Nevertheless, the resulting social regulation does not de facto, imply the encounter of a shared regulation. Rather, our results reveal an ensemble of regulations, sometimes concurrent, sometimes in equilibrium, in relation of the context within actors are situated. These findings on the dynamics of the reconstruction of communities of practice offer a new way of thinking changes within organizations such as the hospital, not only in respect to strategic dimensions and changes amongst team leaders but also in taking into account the lay actors and their capacities of thinking and acting out change.

Keyphrases: Merger, Communities of practice, Social regulation, Changement continu, Continuous change, Situated learning and knowledge
Les contrats de performance et les universités québécoises : une orchestration étatique de la subordination du champ universitaire aux règles du jeu économique

If Quiet Revolution made Quebec government to become first financial source for higher education institutions, questions concerning pertinence and use of public funds have started discussions concerning relations between State and universities. Thus, economic restrictions context of 1990 decade initiated major modifications for universities’ management and even their mission. We will look at performance contracts’ signatures in 2000-2001 between Ministry of Education and universities. When trying to find solution to under funding problems, these contracts have also created a redefinition of Quebec university field in accordance with economy field’s rules of the game. First, we will see university mutations in different times and societies. We will then analyze teaching evaluation and accountability in education. Finally, we will use discourse analysis with a sample of performance contracts. That operation will be methodological part of this dissertation and will allow us to conclude that performance contracts allow restriction of universities' autonomy by enforcing economic rules of the game.

Keyphrases: Performance, Efficience
Addressing Adherence to Antiretroviral Therapy in Ouagadougou, Burkina Faso: Insights from hospital ethnography

The human immunodeficiency virus (HIV) epidemic is the most pressing public health crisis of modern times. Present international focus targets expanding access to life-saving antiretroviral treatment (ART) for people living with HIV/AIDS – referred to as treatment scale-up- in contexts with limited resources. Near perfect adherence to ART regimens is required to maximize individual and public health outcomes. ART is being scaled-up in African countries with under-funded, fragile health systems. These health systems are further plagued by a shortage of health professionals who play a critical role in the implementation and sustainability of ART programmes, including the provision of adherence support.   This ethnographic study sought to explore the experience of health providers in addressing adherence to ART in settings of limited resources where ART is being scaled-up. The study took place in two hospital centres in the capital city of Burkina Faso; Ouagadougou.    The study led to three broad conclusions. First, good organization is imperative in the delivery of adherence support services, both in terms of logistics and materiality. This infrastructure must extend beyond the level of the hospital ward, to the level of the health sector in order to ensure a sustainable impact. Second, the provision of ART within a comprehensive package of care is an essential component of effective adherence support. This involves equipping providers with tools to assist them in their clinical practice (laboratory monitoring, treatment for opportunistic infections, and additional staff) as well as mechanisms for them to help patients negotiate the trials of daily life (gratuity of care, literacy support, psychosocial support). Third, there is a need for improved coordination of nationally and internationally-led HIV programming for coherent service provision at the local level. Limited and short-term external funding affects the long-term availability of material and human resources, as well as working conditions and service provision on the wards.   The results of the study contribute to the existing academic literature on ART adherence, to the design of future research projects, and to the organization of adherence support services.

Keyphrases: human immunodeficiency virus, antiretroviral treatment, adherence, health systems, hospital ethnography
Le processus d'adaptation de conjoints dont la femme est atteinte d'un cancer de l'ovaire

This research focuses on how nine men recall their adaptation trajectory to their spouses’ ovarian cancer. The qualitative analysis made use of the grounded theory approach; semistructured interviews were conducted with husbands accompanying their spouses during their treatments in an ultra-specialized unit for gynaecological cancers in a Montreal hospital. Our results show that after the initial shock initiated by the announcement, the respondents develop a set of strategies, first to protect their wives and themselves, and then to attack the illness. Accompanying their wives through the experience of cancer proves to be, for the husbands, a transformative experience at all levels: personal,conjugal, and social. The perceived efficacy of the health network and its preoccupation with the husband’s caretaker role may explain the sharp contrast we observe between results from the literature, insisting on the husbands’ helplessness in such a context, and our data, which underline their fighting spirit. Other factors identified are the strength of the conjugal link, forged in common ordeals, personality traits of both husbands and wives, and support from their personal network. Concerning nursing practice, this research suggests that the importance and the support given by the health professionals to the family caregivers is of utmost importance for the couple’s quality of life throughout this experience. Besides, the coordination of the health professionals, throughout the women’s illness, is crucial in diminishing the anxiety linked to the cancer diagnosis. The duplication of such a study in other cancer care units would allow a finer analysis of the impact the health network can have on the adaptation of both spouses to illness.

Keyphrases: Adaptation process, grounded theory, ovarian cancer, family caregivers, spouses, partners, family support, health professionals
Caractérisation de la toxicocinétique de l’octylphénol chez le rat en vue d’une meilleure analyse de risque toxicologique des perturbateurs endocriniens

p-tert-Octylphenol is a degradation product of alkylphenol ethoxylates that can be found in the environment. It has been reported to act as a weak estrogenic compound by binding to the estrogen receptor. This study was undertaken to 1) develop a sensitive method for the determination of octylphenol in blood and various tissues using gas chromatography coupled with detection by mass spectrometry, 2) characterize the blood and tissues toxicokinetics of octylphenol in male and female Sprague-Dawley rats and 3) develop a physiologically-based toxicokinetic model for octylphenol that can describe/predict unchanged blood and tissues octylphenol concentrations in rats. Male and female Sprague-Dawley rats were given a single dose of octylphenol either by oral gavage, intravenous injection or subcutaneous injection. In a repeated dosing experiment, rats were given octylphenol (oral) daily for 35 days (female) or 60 days (male). Blood and tissue samples were collected at various time following the onset of exposure and analyzed for octylphenol content using a method developed in our laboratory. These results showed that blood and tissues octylphenol concentrations were generally higher in female than male rats. Experiments done with rat liver microsomes confirmed that these differences were related to octylphenol metabolism. The results of the repeated exposure study indicate that there is no bioaccumulation of octylphenol at these exposure levels. A physiologically-based pharmacokinetic model for octylphenol was developed and validated using the data obtained in female and male rats. The model simulates adequately blood and tissues octylphenol concentrations following oral, intravenous or subcutaneous exposure. In conclusion, this study provided essential data on the toxicokinetics of octylphenol. These data are essential to predict the relationship between the internal and the external dose of octylphenol and will facilitate the risk assessment of octylphenol in humans.

Keyphrases: Toxicology, Endocrine disruptor, p-tert-Octylphenol, Analytical method, Toxicokinetic, Toxicokinetic modeling, Sprague-Dawley rats
La collaboration interprofessionnelle vers une transformation des pratiques au sein d’un GMF de deuxième vague

INTRODUCTION: Primary care in the Province of Quebec has undergone a substantial reorganisation over the last several years, on several fronts. Family Medicine Groups (FMG's), designated medical clinics, regional health boards, and local health networks, are only a few examples of new health care delivery components which have been created during this reorganisation. METHODS: This is a case study based on a single Family Medicine Group created during a second wave of innovation. Data was collected via semi-directed interviews with the head physician of the FMG, the group of physicians and nurses within the FMG, the nursing director of the FMG, and the director of nursing at the regional health board. Interviews were conducted until all available contacts were exhausted. The author also accessed the clinical guidelines and the documents used for communication within the FMG. RESULTS: Practice activities in the FMG did evolve over time as a result of mutual clinical and administrative interactions between nurses and physicians. Participants noted a visible improvement in health outcomes as well as increased accessibility to health care by patients. The impact on physician workload, and overall capacity in terms of number of patients followed, after creation of the FMG, were inconsistent. CONCLUSION: This proposed analytic model allows empiric measurement of the added value of FMG's for the development of inter-professional cooperation, and its impact on professional practices.

Keyphrases: leadership, group medical practice, leadership, mutual influences, reflexive practice, interactional determinants, organisational determinants
Les théories de la complexité et la systémique en gouvernance clinique: le cas des soins intensifs chirurgicaux

In Health Technology Assessment and Management, Evidence-Based Medicine and many tools available for clinical assessment reflect a positivistic and mechanistic approach to Health Care Organizations and scientific knowledge.    We argue that the Complexity Theories and the Systemic decision-making process give a different insight on those two aspects of Clinical Governance in a Surgical Intensive Care Unit (SICU).  In a case-study, we describe the nature of critically ill and unstable patients and the organizational structure of a SICU in a university based hospital.  We demonstrate all the characteristics of complexity in that setting, through the use of many examples and micro-situational analysis.  After an epistemological critical appraisal of EBM, we suggest that if a SICU is conceptualized as a dynamic non-linear adaptative system, then clinical knowledge and scientific thought processes must include hermeneutical, systemic and  abductive  types of reasoning.  Finally, we draw upon Karl Weick’s work and suggest that a SICU must be considered as a High Reliability Organization in order to aim for improving patient care and create better conditions for quality and performance in this complex environment.

Keyphrases: Non-Linear Dynamic System, Health Technology Assessment, Health Care Management, Medical Epistemology, EBM, High Reliability Organization, Surgical Critical Care, ICU, Complexity Theory, Systemic Thought Process
Régulation de l’expression du gène Six6 par les facteurs de transcription Lhx2 et Pax6 dans le contexte des cellules souches rétiniennes

Vertebrate eye developement is the result of multiple perfectly executed biological process. This tight orchestration is principaly controled by transcription factors. Homeobox-containing transcription factors are expressed in the presumptive eye field and are required to initiate eye development and for final retinal cell differenciation. The genetic control of these transcription factors are poorly understood. We analysed Six6’s nearby genomic sequence to caracterise potential promoter regions. Chromatin immunoprecipitations and luciferase assays confirmed the binding and the in vitro synergic trans-activation of Six6 potential promoter by Lhx2 and Pax6. This study also demonstrate the contribution of Lhx2 for the establishment of presumptive retina field at the neural plate stage. The detailed knowledge of genetic networks regulating the formation of a fonctional retina by retinal progenitor is crucial. Indeed, when these mecanisms will be eluciated, we will be able to establish regenerative retinal cell therapy.

Keyphrases: Lhx2, Pax6, Six6, Retina, Homeobox, Development, Transcription factor, Optic vesicle
Logiques sociales de recours aux antidépresseurs : le cas de la rupture conjugale

Depression and antidepressants are far more complex phenomenons than the biomedical order pretends. Some research show that these two entities are independant from one another, meaning that antidepressants are prescribed for reasons independant of mental health problems. In this master’s thesis we examine why individuals have recourse to antidepressants following a relationship break-up; the relationship (marital or not) break-up being a critical situation associated with the prevalence of depression.  Eight women who took antidepressants following a relationship break-up were interviewed for this study. The findings show that the recourse to antidepressants appears to respond to a logic that is non-medical. First, by the fact that only three of the eight women interviewed justified their recourse to antidepressants by receiving a diagnosis of depression. Second, by the discovery that these women relied on antidepressants because they are the embodiment of a relationship of trust with someone familiar to themselves, the doctor, and the symbol of a return to a ‘normal’ life.

Keyphrases: antidepressants, depression, relationship break-up, biographical disruption, women, social bond, drug representation, meaning
Étude du rôle régulateur de la lamine B1 dans l’activation plaquettaire : base moléculaire de la thromboprotection chez les patients porteurs d'anticoagulant lupique et d'anti-lamine B1

Anti-phospholipid antibodies such as lupus anticoagulant antibodies (LAC) are associated with recurrent thrombotic events in systemic lupus erythematosus (SLE) patients. However, the risk of thrombosis in LAC positive patients is markedly reduced in the presence of high titers of autoantibodies to lamin B1 (anti-LB1). To date, the implication of lamin B1 (LB1) and anti-LB1 in thromboprotection remains unclear. Our objective was to examine the mechanism whereby LB1 and anti-LB1 induced thromboprotection. Functional platelet and endothelial cell activation assays were used to determine the effects of recombinant LB1 and affinity purified anti-LB1 on these two cell types. LB1, contrarily to anti-LB1, was found to possess an intrinsic anti-platelet activity. This protein reduced the activation and aggregation of platelets in vitro and in vivo. This activity was likely due to the direct binding of LB1 to platelets, followed by its rapid internalization within clathrin coated-pits. Coimmunoprecipitation revealed that LB1 interacted with the insulin receptor located within the platelet membrane. The binding of LB1 to this receptor induced its internalization and inhibited at least one of the phosphorylation cascade stimulated by the receptor, which in turn inhibited platelet functions. The addition of affinity-purified anti-LB1 in our model markedly increased the persistence of LB1 within platelets, a finding supported by the detection of LB1 only in platelets from anti-LB1 positive SLE patients. Our results suggest that LB1 regulates haemostasis in normal subjects. The presence of anti-LB1 in SLE patients prolongs the persistence of LB1 within platelets, thus possibly vi preventing further platelet activation. This mechanism likely explains the reduced risk of thrombotic events in LAC positive SLE patients with circulating anti-LB1 autoantibodies.

Keyphrases: anti-lamine, autoantibodies, Systemic lupus erythematosus, lupus anticoagulant, lamin B1, platelets, thrombosis
Effet de l’atorvastatine sur la dysfonction endothéliale des artères coronaires épicardiques associée à l’hypertrophie ventriculaire gauche dans un modèle porcin

Effect of atorvastatin on endothelial dysfunction of epicardial coronary arteries associated with left ventricular hypertrophy in a porcine model.  Forcillo J, Aubin MC, Horn A, Shi YF, Carrier M, Tardif JC, Perrault LP  Background: Atorvastatin, through pleiotropic effects, may prevent or reverse the endothelial dysfunction associated with LVH. Methods: After performing a banding of the ascending aorta for 2 months leading to the development of LVH, groups have been treated with atorvastatin 40 or 80 mg for 60 and 90 day periods. LVH was evaluated by echocardiographic studies. Vascular reactivity studies were performed in organ chambers. In vitro endothelial function was evaluated by plasmatic nitrites/nitrates, the degradations products of nitric oxide, and cGMP quantification. To quantify and qualify oxidative stress, protein carbonyl and angiotensin II levels were assessed. Results: Following 60 and 90 days of aortic banding, the development of LVH was observed in these groups. Concentration-response curves from rings of epicardial coronary arteries of groups treated with atorvastatin 40 and 80 mg for 30 and 60 days showed a significant decrease of endothelium-dependent relaxations with worsening of the endothelial dysfunction. Levels of cGMP were significantly decreased in the 60 days treated sham group and levels of ANG II were increased in the latter and also in the 90 days banded groups treated with 80 mg for 30 days compared to controls. The expression of protein carbonyl increased in the sham group treated with atorvastatin 80 mg compatible with an increase in oxidative stress.  Conclusion: The administration of atorvastatin does not limit the development of LVH nor the endothelial dysfunction in our model. On the opposite, atorvastatin at a high dose has a toxic effect on epicardial coronary arteries by exacerbating the endothelial dysfunction.

Keyphrases: Left ventricular hypertrophy, Coronary arteries, Endothelial dysfunction, Oxidative Stress, Statin
Mécanismes de plasticité synaptique dans l’amygdale lors de la réactivation de la mémoire de peur auditive chez le rat : interaction dynamique des récepteurs NMDA et AMPA

Synaptic plasticity is necessary for the acquisition of memory in all studied species, from invertebrates to primates. Memory formation starts with a phase of plasticity that entails synaptic remodeling ; then follows the consolidation of these modifications, which contributes to long-term memory. Some memories return to a malleable state upon retrieval. Consequently, the memory trace enters a new phase of plasticity, during which some memory components are eventually updated, then reconsolidated. The aim of the present thesis was to study the cellular and molecular mechanisms that are engaged during memory retrieval. We used a model of Pavlovian conditioning in Sprague Dawley rats, combined to pharmacological manipulations and quantitative analysis of synaptic plasticity markers, in order to study the dynamics of auditory fear memory. The neuronal circuitry and the associative mechanisms involved in the neurobiology of this memory are well characterized, in particular the role of NMDA and AMPA glutamatergic receptors in synaptic plasticity and consolidation. Our results show that the return of the memory trace to lability requires activation of NMDA receptors in the basolateral amygdala during retrieval, whereas AMPA receptors are necessary for the behavioral expression of the conditioned fear response. Furthermore, the data identify retrieval as being much more dynamic than recognized, and suggest that conditioned fear expression involves NMDA receptor-dependent regulation of AMPA receptors’ trafficking. The present work attempts to advance our understanding of the fundamental neurobiology of memory. In addition, it offers an integrative view of the data with regards to animal modeling of human clinical issues related to traumatic memories, like phobias and post-traumatic stress disorders.

Keyphrases: Reconsolidation, Anisomycine, Pavlovian conditioning, Emotional memory, Associative learning, Retrieval, Reconsolidation, Amnesia, Anisomycin, Receptor trafficking
Phosphorylation du CTD de l'ARN polymérase II et impact de l'histone H2A.Z sur le
positionnement des nucléosomes chez S. cerevisiae

RNA Polymerase II is the molecular complex responsible for the transcription of class II genes. Proper transcription and associated events such as mRNA processing are thought to require the phosphorylation of its C-terminal domain. Here I show that this phosphorylation follows a similar pattern for most of the genes, althought some exceptions exist. These exceptions could be explained by alternative phosphorylation mechanisms. Also, this work provides data on how the variant histone H2A.Z influences chromatin structure. Previous studies have shown a role for H2A.Z in the positioning of some nucleosomes along the DNA, which would impact the ability to transcribe genes. Here I used a microarray technology to profile nucleosome positions in a genome-wide manner. My data provide further evidence that H2A.Z influences nucleosome positioning. Interesting results regarding the dynamics of H2A.Z incorporation into chromatin are also shown.

Keyphrases: transcription, expression, microarray, genome, genomics, chromatin, DNA chip, microarray, yeast