NCube/papyrus huggingface dataset:
Une intervention de pratique réflexive pour agir sur la détresse morale d’infirmières d’unités de soins curatifs offrant des soins de fin de vie : une étude pilote

Nurses who provide end of life care on acute care units suffer from moral distress as they can sometimes feel torn between what they aspire to give as quality of care at the end of life and what they can offer in reality. Yet, there is very little evidence of effective interventions to reduce such moral distress amongst nurses. However, reflective practice (RP) could allow these nurses to think back on their practice so that they can resolve the contradictions between their ideal of care and the clinical reality and thus lessen their moral distress. Hence, the purpose of this study is to assess the feasibility, acceptability, and preliminary effects of a RP intervention on the moral distress of nurses providing end-of-life care in an acute care setting. This study uses a preexperimental one-group pre-test/post-test design and was done at a teaching hospital in Montreal. A total of 19 nurses participated in the study and most of them (16/19) completed the RP intervention which included three group sessions lasting 45 to 75 minutes each. The majority of nurses (14/16) were satisfied with the intervention and noticed changes in their practice (13/16). In addition, the results of the study did not show a significant difference (3.97 points, p=0.62) in the mean of the moral distress of pre and post-RP of nurses. In sum, the RP intervention is feasible and acceptable, however, other studies evaluating RP intervention with greater intensity are needed to demonstrate the effects of RP on moral distress. Recommendations for these future studies have been formulated.

Keyphrases: Acute care, Moral distress, Reflective practice, Nursing, Nurse, Reflection, End of life care
La distraction par le clown thérapeutique pour le soulagement de la douleur et l’anxiété d’enfants en vaccination : une étude pilote

Children are frequently subjected to painful procedures, including those involving needles. However, few interventions are specifically put in place to relieve the pain associated with these procedures. Procedural pain is a source of anxiety for the children, their parents and the nurses involved during the procedure. In addition, children’s pain reaction, their parents, and the nurse appear to modulate children's pain and anxiety. Immunization is the most common pain procedure performed in children whose pain and anxiety can lead to avoidance of this procedure. Although clinical practice guidelines offer different interventions to reduce the child's pain and anxiety during this procedure, these procedures are used very little in clinical practice. Distraction by the therapeutic clown is an intervention that seems promising for the relief of children's pain and procedural anxiety. However, no studies have evaluated the effects of this intervention on children, their parents and nurses, and no studies have been conducted in the context of vaccination. Thus, a pilot study with an experimental design comprising two groups, therapeutic clown (TC) and usual care (UC), was conducted to evaluate the feasibility, acceptability and preliminary effects of this intervention on pain and pain. children's anxiety as well as the anxiety of their parents and the nurse when vaccinating the child. A total of 24 children aged 2 to 17 participated in the study. Children's pain was assessed using Face, Legacy, Activity, Cry, Consolability (FLACC) and anxiety with the Visual Analog Scale (VAS). All families covering the inclusion criteria approached agreed to participate and completed the study. Both the parents and the nurse felt that the CT intervention was helpful in managing the children's pain and anxiety. In addition, preliminary results show that both pain (median TC = 1 and IQ = 1.5 vs median UC = 2.5 and IQ = 2.5) than anxiety (median TC = 1 and difference IQ = 0.5 vs median UC = 4 and IQ = 2) were lower in children in the TC, as well as in their iv parent (median TC = 0 and IQ = 0 vs median UC = 2 and IQ = 4, 5) when vaccinating the children. The nurse felt no anxiety at all when vaccinating children in the TC group (median TC = 0 and IQ = 0) and only slight anxiety with children in the UC group (median UC = 0 and IQ = 2). Distraction by the therapeutic clown is a feasible and acceptable intervention in a vaccination context. This study demonstrates the effects of this intervention on the children's pain as well as the anxiety of the children, their parents and the nurse during the vaccination of the child.

Keyphrases: vaccination, Procedural pain, Therapeutic clown, Children, Needle-related procedure
Comprendre l'expérience vécue par les patients en oncologie active et leur famille en milieu rural

Cancer is the leading cause of death in Canada (CSC, 2017a). It is expected that an average of 206 200 people will be diagnosed in 2017 and there will be 80 800 deaths from cancer (CSC, 2017a). When diagnosed, the life of the person and his family is totally disrupted, as people often continue to associate cancer with death (Bernard, Stiefel, De Roten, and Despland, 2010). The treatment period is particularly difficult since it is accompanied by a struggle to preserve as much as possible the physical and psychological integrity of the person affected. Although the experience of cancer patients is generally known, studies are still insufficient to fully understand the experience lived by active oncology patients and their families specifically in rural areas. This is all the more important because rural areas have some differences, such as physicians who are less available, transport gaps, limited formal resources, lower socio-economic status (lower incomes), services that are inadequate because they do not respond well to the needs of the population, etc. Inspired by the humanist model of the Université de Montréal, this qualitative study of phenomenological type is to better understand the experience of patients, over 50 years, in active oncology and their families in rural areas. To reach our goal, semi-directed interviews were conducted with eight families. A logbook, socio-demographic questionnaires, a genogram, and an ecocard are the data collection tools. The main results indicate that the experience lived by the participating families is tinged with a balance between the disadvantages and the advantages of living in rural areas. The disadvantages of rural living with cancer documented in this study are limited access to specialists and treatments, lack of confidentiality and privacy, limited formal resources and lack of coordination in services. On the other hand, the benefits of families are that they have a broad network of support, their entourage is charitable and helps families, care is less impersonal, and rural areas are more peaceful.

Keyphrases: cancer, nursing, family, rural, cancer, experience, qualitative, oncology, treatments
« Toucher les sons » : la manipulation expérimentale des sons électroniques, de l'apprentissage à la transmission dans les pratiques improvisées contemporaines - enquête de terrain à Montréal auprès de musiciens improvisateurs (2013-2016)

In the field of music, our contemporary age is characterised by a scattered scene, an increasing number of musical genres and ubiquitous audio-digital techniques used in the process of production as well as in the broadcasting of recordings, themselves infinitely reproducible by an ever-growing number of computer-users. In the midst of this constellation we have chosen to highlight the art of free improvisation using electronic stringed-instruments. How do artists manage to find their way in such a fluctuating and problematical environment, and then convey their musical know-how? Rather than compiling data limited in time, we will attempt to understand what is being happening among contemporary improvisation in a specific context. The theoretical framework, inherited from jazz, points to a connection in the 20th century between recording and improvisation and operates on three levels: mechanical, analogue and digital. With the aid of two historical examples we try to understand how an improviser learns to play the keyboard while being at the same time confronted with a technical device of sound production and reproduction. The methodology / approach then presents a field investigation carried out in Montreal in 2013-2014 during a workshop involving six musicians. The monographs highlight the origins and sound memory of each artist which make up his musical individuality and allow him to perform when required. The improvised sessions under investigation do not represent a genre or identifiable musical tradition, as they derive indiscriminately from experimental music, electro-acoustics, free improvisation, free jazz and rock. However they cannot be dissociated from the context in which they emerged, i.e. the modern music scene in Quebec and the wider Montreal environment. Thanks to the concept of "audio-tactility", these practices are analysed focussing on how the artists use electronic circuits, i.e. what is the connexion between the material aspect of the devices and the sounds produced by listening and haptics. Does the improvisation stem from a mental construct, a building plan or engineered map and do the electronics have a bearing on the elaboration of the improvised discourse? Is there an underlying structure in the elaboration of an improvised discourse using electronic devices in combination with a live musical process? By feeding preexisting pieces through a sampler, improvisation can be thought of as a hypertext process. In this way we can observe whether digital techniques are an extension of mechanical and analogue recording techniques or whether indeed they break with them.

Keyphrases: free	jazz, tradition, Free electronic improvisation, Electro-acoustic improvisation, Sampling, Experimental music, Free jazz, Audio-tactility, Process
Optimization of Parameters Used in Predictive Models for Respirator Cartridge Service Life for Toxic Organic Vapors

Air-purifying respirators equipped with activated carbon cartridges are among the most widely used respirators in the workplace to protect against toxic organic vapors.  Because end-of-service-life-indicators (ESLI) are limited for organic vapors, mathematical models are recommended to yield the cartridge service life (CSL).  Moreover, in the case of mixture contaminants, the toxicity of the breakthrough vapors is not even considered in the estimation of CSL.  Hence, the main objective of this study was to improve predictive models by investigating three research topics: (1) developing an experimental approach to characterize the pore structure of activated carbons in respirator cartridges using adsorption isotherms obtained with different organic vapors of different vapor pressure at environmental conditions similar to the ones found in the workplace; (2) designing a miniaturized (Mini) cartridge device to allow better control of environmental conditions and reducing the amount of solvent used while providing reliable data; (3) integrating a toxicological approach in the estimation of CSL for vapor mixtures by using the Hazard Index (HI) principle to indicate the safe use of respirators.   The characterisation of the microporous structure of the activated carbons showed that a type I characteristic multi-vapor adsorption isotherm can be obtained with organic vapors of relative vapor pressures ranging from 0.001 to 0.1.  The obtained micropore values were used in the Dubinin-Radushkevich equation to calculate the micropore volumes and the adsorption capacities of the activated carbons, which showed agreement with the experimental data. The Mini cartridge device was designed to reproduce a small section of a given respirator cartridge and have the same carbon bed thickness as the full size respirator cartridge.  The Mini was able to reproduce symmetrical breakthrough curves of the full size cartridge and gave results comparable to the 10% breakthrough times and adsorption capacities of the cartridges.  This efficient approach provided better control over environmental conditions (temperature, humidity, and flow) in breakthrough tests to obtain reliable data, and reduced the amount of solvent used. The study on vapor mixtures involving a volatile and low toxic component showed that applying the Hazard Index (HI) was suitable for optimal and safe use of respirator cartridges. This approach was reliable at low concentrations of acetone (< 50 ppm) and when the ratio of the contaminants of the volatile to the less volatile was < 2.   Overall, this thesis has showed that the experimental and theoretical approaches have improved the predictive models for cartridge the service life by improving the precision of the intrinsic parameters of these models to better protect the workers.

Keyphrases: Organic vapors, Cartridge service life, Breakthrough time, Activated carbon, Models, Mixtures, Adsorption Capacity, Hazard index, Air-purifying respirator
An Analysis of the interventions to improve the geographic distribution of physicians in OECD countries

An imbalance in the geographic distribution of physicians has been observed in most member countries of the OECD. The number of practicing physicians, in relation to the general population density, is significantly lower in rural and remote regions, than in urban areas. Several interventions have been implemented to rectify the geographic maldistribution of physicians, however, reports indicate that sustainable solutions have not been identified. The purpose of this study is to understand the persistence of physician shortages in rural regions of OECD countries, despite the implementation of interventions. Two, theory-based evaluative approaches are used to evaluate the relevance and the plausibility of interventions. A strategic analysis allows for the prioritization of the causes of physician shortages, and the ranking of the interventions, based on their ability to target these causes. A logic analysis allows for the evaluation of the theoretical foundation of the interventions, to determine whether the interventions can achieve their intended outcome. The results of this research demonstrate that the interventions implemented in OECD countries to reduce physician shortages, are designed to target the causes of the problem, and are therefore relevant to the geographic maldistribution of physicians. Results also demonstrate that, with the exception of regulatory strategies, according to the theories of work motivation, the interventions can plausibly encourage physicians to choose rural medical practice. The persistence of physician shortages in rural regions is not due to the theoretical weakness of the interventions. Further research is required to evaluate the production process, and the implementation of the interventions.

Keyphrases: physician shortages, geographic maldistribution, choice of practice location, rural and remote regions, OECD countries, strategic analysis, intervention evaluation, logic models
Association entre les métaux, les amalgames dentaires, les phénols et les désordres hypertensifs de la grossesse

Very little remains known about the role of exposure to different metals or other chemical agents in the development of hypertensive disorders of pregnancy (HDP). In this thesis, we aimed to assess the potential association between the levels of metals (arsenic, lead, cadmium, mercury or manganese), bisphenol A (BPA), triclosan (TCS) or exposure to dental amalgams and HDP among Canadian women. We designed and conducted 3 analyses, all based on the databank of the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a cohort of 2001 pregnant women recruited in 10 Canadian cities between 2008 and 2011 and followed up with their children to study the relationship between chemical contaminant exposures and maternal and child health. The status of dental amalgams (presence or replacement) and blood concentrations of metals were evaluated in the first and third trimesters, while urinary concentrations of metals, BPA and triclosan TCS were measured in the first trimester. Blood pressure (BP) was measured in each trimester of pregnancy. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated by logistic and multinomial regression to measure the associations between metals, dental amalgams, BPA or TCS and HDP (gestational hypertension overall and its two subcategories: gestational hypertension and preeclampsia). Linear and logistic generalized estimation equations and linear regression were also performed to measure the associations with BP or gestational hypertension overall. The highest category of first trimester blood manganese level (> 9.89 μg /l)  was associated with a reduced risk of gestational hypertension overall (aOR= 0.68, 95% CI: 0.46, 0.99)  and  preeclampsia  (aOR=  0.48,  95%  CI:  0.23,  0.98).  With  the  stratified  analysis, this    association was observed only in mothers who gave birth to male babies (aOR= 0.41; 95% IC: 0.24, 0.70) as opposed to mothers of female babies (aOR= 1.00; 95% IC: 0.92, 1.08). However, when manganese and BP were measured concurrently during the same trimester of pregnancy, a positive association was observed (beta= 1.52 mmHg (0.80, 2.24)). A higher blood level of mercury in the third trimester (> 0.82 μg/l) was associated with a lower risk of gestational hypertension overall (aOR for the third tertile = 0.62; 95% CI: 0.39, 0.98). With respect to blood arsenic (in continuous variable) measured in the third trimester, it was associated with a high risk of preeclampsia (aOR= 1.16; 95% IC: 1.03, 1.30). No significant association was observed for lead, cadmium, urinary arsenic, dental amalgams status, BPA or TCS. Overall, the thesis showed an association between manganese, mercury or arsenic and HDP. However, it did not show a link between lead, cadmium, urinary arsenic, and dental amalgams, BPA or TCS and HDP.

Keyphrases: BPA, TCS, Hypertension, Metals, Dental amalgams, Dental restorations, Hypertension, Gestational hypertension, Preeclampsia, Pregnancy, Environmental contamination
Hacia un modelo de liderazgo inclusivo en las instituciones de educación superior en México : un estudio de caso con perspectiva de género

In the last decade, higher education has undergone a transformation in both internal and external fields. This transformation takes place in a context in which the educational and management models, under which institutions have long been governed, are abandoned. The search for harmonious environments within universities, that can generate better results, is encouraging the emergence of a different leadership in which both women and men participate. Today, inclusion defies traditional cultures and practices at all levels and this study seeks to develop an inclusive leadership model. Hence, it is a question of leadership in higher education in Mexico, taking into account the lack of participation of women in positions of power and trying to understand and interpret their recent inclusion. Considering that leadership in higher education is fundamental and strategic for educational success, the participation of women and men equally and equitably is essential to its progress. In this sense, the objectives of this thesis have been to identify, in a group of 29 executives of a Mexican university, first, contextual factors that facilitate or inhibit access to positions of power; second, the leadership styles adopted by the participants; to identify the elements needed for a leadership model that integrates the contributions of women and men. The proposal developed in this research is qualitative, using an exploratory approach of case study together with data collection through a semi-directed interview. To ensure inclusive management, the study uses a gender perspective, which offers the opportunity to achieve equality in the treatment of participation of both women and men, as well as in the analysis of data collected from both sexes. Based on Minztberg leadership role theory (1973, 2006) and on Baudoux (1988) leader’s mission, an analysis of the participants’ behaviors, expressed from their own contexts and from their perspective, was performed. The results offer the opportunity to develop an inclusive leadership model proposal. This model was built thanks to the contribution of women and men through their experiences in four dimensions: academic, management, communication and human. This model describes the missions of women and men who participated in the construction of a different way of exercising leadership.

Keyphrases: Leadership, Gender, Gender perspective, Higher education, Women and inclusive leadership, Femmes et le leadership inclusif
El uso de estrategias de adaptación y su efecto sobre la perseverancia de estudiantes adultos en un programa de bachillerato a distancia

Higher education in Mexico has undergone major transformations in the last decade. Today, the changes undergone challenge students' cultures and study strategies, as well as pedagogical management practices. This phenomenon was the main drive behind the undertaking of this study.  This research examines the strategies of adaptation implemented by adult pre-university students. In particular, the objectives of this thesis have been focused on the identification and analysis of factors that foster adaptability and contribute to perseverance in a group of 140 students who graduated from the baccalaureate system of a Mexican University.  This is an exploratory study, developed within the framework of a qualitative research. Based on the theoretical model proposed by David Kember (1995), our research has been able to identify and analyze the three adaptation strategies used by students: strategies of support, sacrifice, and negotiation. Among the methodological techniques used for data collection, we used online research through the Surveymonkey site using the DESP maintenance inventory (Distance Education Student Progress Inventory: Kember, 1995). Semi-structured interviews were carried out with the graduates, while administrative personnel were interviewed in person.  The results show that students who were able to continue until the end of the program used, at different levels, three types of adaptation strategies: support, sacrifice, and negotiation, in four domains of their life: family, professional, social, and personal. On the other hand, factors that favour adaptability and contribute to perseverance are linked in particular to the appropriation of the study modality as the main factor, followed by the quality of the work of the teacher responsible for the course. With regard to the support measures implemented by the institution to promote perseverance, the results indicate that the links between the program followed and the student’s occupational domain are the main factor contributing to perseverance, followed by intrinsic motivation, the desire to progress, family support and relationships with other students. Maintaining a high level of motivation with the creation of social bonds and good class management in the course, is equally part of the determining variables perceived by graduates.

Keyphrases: Adaptation strategies, Perseverance, Distance education, Dropout models, Distance learning