968 resultados para Critical Trends Assessment Program.


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A Santa Casa de Angra dos Reis é uma Instituição Filantrópica inaugurada em 06 de janeiro de 1839. A Unidade passa por Intervenção Municipal, recomendada pelo Ministério Público, no intuito de garantir o restabelecimento adequado de seus serviços, a eficiência desejável e para resgatar a credibilidade e sustentabilidade do Hospital. Da motivação pelos projetos da nova gestão emergiu a necessidade de conhecer a situação do desempenho desta unidade hospitalar, em especial a Maternidade, ponto de partida do projeto. Este estudo é relevante para a institucionalização da avaliação da qualidade nesta Unidade Hospitalar, bem como condição primária para construção de planos de trabalho. O Programa Nacional de Avaliação dos Serviços de Saúde PNASS é uma proposta do Ministério da Saúde, e é visto como uma ferramenta de gestão para monitoramento e avaliação. O programa pode apontar diversas oportunidades de melhorias e auxiliar a tomada de decisão tornando-se adequado seu emprego no levantamento das informações necessárias para o conhecimento do cenário da Maternidade, como base para um futuro plano de ação. Este estudo tem por objetivo aplicar o programa de avaliação normativa proposto pelo PNASS na Maternidade da Santa Casa, a fim de identificar seu desempenho, como primeiro passo para a construção do plano estratégico de ação em busca do aprimoramento da qualidade em saúde neste setor. Como metodologia, é uma pesquisa quantitativa onde foram utilizados padrões de conformidade, questionários fechados direcionados aos usuários e trabalhadores da Maternidade, e análise de indicadores. Resultados: foram entrevistadas 35 mulheres e 47 profissionais de saúde, num total de 85% da amostra desejada; ficou evidente a necessidade de intervenção e implementação de mudanças na área de Gerenciamento de Risco; e melhorias quanto às condições de trabalho relacionadas à infraestrutura e equipamentos. Os indicadores de internação apontam a necessidade de revisão do número de leitos disponíveis; a taxa de parto cesáreo, 59%, é extremamente alta e muito acima do preconizados pela Organização Mundial de Saúde. Este estudo mostrou um resultado positivo quanto à satisfação das parturientes com o serviço prestado, embora existam áreas carentes de melhorias. Melhorias também são necessárias para o dimensionamento efetivo do quadro de profissionais para atendimento à demanda. A interrupção do lançamento de relatórios sobre atuais avaliações feitas pelo PNASS e a pouca divulgação do mesmo são questões levantadas por este estudo. Considera-se que a aplicação do PNASS na Maternidade da Santa Casa de Angra dos Reis proporcionou embasamento para a elaboração de uma oportuna matriz de intervenção.

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The Barotse floodplain is an ecosystem characterized by a paradox of widespread poverty amidst high ecological and agricultural potential. The CGIAR Research Program on Aquatic Agricultural Systems (AAS) seeks to address this paradox on the assumption that the rural poor have the potential to transform their lives using the aquatic resources in their environment. Understanding the conditions for natural resources use and management is critical for a program that seeks to transform the livelihoods of households dependent on natural resources. The purpose of this report is to identify and analyze key governance variables influencing the livelihood outcomes of AAS program interventions in the Barotse floodplain system.

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Atlantic Croaker (Micropogonias undulatus) production dynamics along the U.S. Atlantic coast are regulated by fishing and winter water temperature. Stakeholders for this resource have recommended investigating the effects of climate covariates in assessment models. This study used state-space biomass dynamic models without (model 1) and with (model 2) the minimum winter estuarine temperature (MWET) to examine MWET effects on Atlantic Croaker population dynamics during 1972–2008. In model 2, MWET was introduced into the intrinsic rate of population increase (r). For both models, a prior probability distribution (prior) was constructed for r or a scaling parameter (r0); imputs were the fishery removals, and fall biomass indices developed by using data from the Multispecies Bottom Trawl Survey of the Northeast Fisheries Science Center, National Marine Fisheries Service, and the Coastal Trawl Survey of the Southeast Area Monitoring and Assessment Program. Model sensitivity runs incorporated a uniform (0.01,1.5) prior for r or r0 and bycatch data from the shrimp-trawl fishery. All model variants produced similar results and therefore supported the conclusion of low risk of overfishing for the Atlantic Croaker stock in the 2000s. However, the data statistically supported only model 1 and its configuration that included the shrimp-trawl fishery bycatch. The process errors of these models showed slightly positive and significant correlations with MWET, indicating that warmer winters would enhance Atlantic Croaker biomass production. Inconclusive, somewhat conflicting results indicate that biomass dynamic models should not integrate MWET, pending, perhaps, accumulation of longer time series of the variables controlling the production dynamics of Atlantic Croaker, preferably including winter-induced estimates of Atlantic Croaker kills.

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In March-April 2004, the National Oceanic and Atmospheric Administration (NOAA), U.S. Environmental Protection Agency (EPA), and State of Florida (FL) conducted a study to assess the status of ecological condition and stressor impacts throughout the South Atlantic Bight (SAB) portion of the U.S. continental shelf and to provide this information as a baseline for evaluating future changes due to natural or human-induced disturbances. The boundaries of the study region extended from Cape Hatteras, North Carolina to West Palm Beach, Florida and from navigable depths along the shoreline seaward to the shelf break (~100m). The study incorporated standard methods and indicators applied in previous national coastal monitoring programs — Environmental Monitoring and Assessment Program (EMAP) and National Coastal Assessment (NCA) — including multiple measures of water quality, sediment quality, and biological condition. Synoptic sampling of the various indicators provided an integrative weight-of-evidence approach to assessing condition at each station and a basis for examining potential associations between presence of stressors and biological responses. A probabilistic sampling design, which included 50 stations distributed randomly throughout the region, was used to provide a basis for estimating the spatial extent of condition relative to the various measured indicators and corresponding assessment endpoints (where available). Conditions of these offshore waters are compared to those of southeastern estuaries, based on data from similar EMAP/NCA surveys conducted in 2000-2004 by EPA, NOAA, and partnering southeastern states (Florida, Georgia, South Carolina, North Carolina, Virginia) (NCA database for estuaries, EPA Gulf Ecology Division, Gulf Breeze FL). Data from a total of 747 estuarine stations are included in this database. As for the offshore sites, the estuarine samples were collected using standard methods and indicators applied in previous coastal EMAP/NCA surveys including the probabilistic sampling design and multiple indicators of water quality, sediment quality, and biological condition (benthos and fish). The majority of the SAB had high levels of DO in near-bottom water (> 5 mg L-1) indicative of "good" water quality. DO levels in bottom waters exceeded this upper threshold at all sites throughout the coastal-ocean survey area and in 76% of estuarine waters. Twenty-one percent of estuarine bottom waters had moderate levels of DO between 2 and 5 mg L-1 and 3% had DO levels below 2 mg L-1. The majority of sites with DO in the low range considered to be hypoxic (< 2 mg L-1) occurred in North Carolina estuaries. There also was a notable concentration of stations with moderate DO levels (2 – 5 mg L-1) in Georgia and South Carolina estuaries. Approximately 58% of the estuarine area had moderate levels of chlorophyll a (5-10 μg L-1) and about 8% of the area had higher levels, in excess of 10 μg L-1, indicative of eutrophication. The elevated chlorophyll a levels appeared to be widespread throughout the estuaries of the region. In contrast, offshore waters throughout the region had relatively low levels of chlorophyll a with 100% of the offshore survey area having values < 5 μg L-1.

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In August 2011, the NOAA National Ocean Service (NOS) conducted an assessment of the status of ecological condition of soft-bottom habitat and overlying waters of the continental shelf in the northwestern Gulf of Mexico (GOM). The original sampling design included 50 randomly selected sites from the Mississippi River delta to the U.S./Mexican border, representing a total area of 111,162 square kilometers; however, vessel failures and inclement weather precluded sampling at 16 sites in the western-most part of the study region. Sampling was completed at the remaining 34 sites in offshore waters between the Mississippi River delta and Freeport, Texas, representing an estimated 75,591 square kilometers. Field sampling followed standard methods and indicators applied in prior NOAA coastal studies and EPA’s Environmental Monitoring and Assessment Program (EMAP) and National Coastal Assessment (NCA). A key feature adopted from these studies was the incorporation of a random probabilistic sampling design. Such a design provides a basis for making unbiased statistical estimates of the spatial extent of ecological condition relative to various measured indicators and corresponding thresholds of concern. Indicators included multiple measures of water quality, sediment quality, and biological condition (benthic fauna, fish tissue contaminant levels). Water depths ranged from 13 – 83 m throughout the study area. About 9 % of the area had sediments composed of sands (< 20 % silt+clay), 47 % of the area was composed of intermediate muddy sands (20 – 80 % silt+clay), and 44 % of the sampled area consisted of mud (> 80 % silt+clay). About 50 % of the area (represented by 17 sites) had sediment total organic carbon (TOC) concentrations < 5 mg/g and all of the sites sampled had levels of TOC < 20 mg/g, well below the range associated with potentially harmful effects to benthic fauna (> 50 mg/g). Surface salinities ranged from 23.4 – 36.5 psu, with salinity generally increasing with distance west of the Mississippi River delta. Bottom salinities varied between 31.1 and 36.5 psu, with lowest values occurring at shallow, inner-shelf stations. Surface-water temperatures varied between 29.8 and 31.5 ºC, while near-bottom waters ranged in temperature from 19.4 – 31 ºC. An index of density stratification (Δσt) indicated that portions of coastal shelf waters in the northwestern GOM at the time of this sampling were strongly stratified. Values of Δσt at 19 of the 34 sites sampled in this study (56 % of the study area) ranged from 2.2 to 12.4, which is within the range considered to be indicative of strong vertical stratification (Δσt > 2). Stratification was strongest close to the Mississippi River delta, and decreased with distance west of the delta.

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A study was initiated with field work in May 2007 to assess the status of ecological condition and stressor impacts throughout the U.S. continental shelf off South Florida, focusing on soft-bottom habitats, and to provide this information as a baseline for evaluating future changes due to natural or human-induced disturbances. The boundaries of the study region extended from Anclote Key on the western coast of Florida to West Palm Beach on the eastern coast of Florida, inclusive of the Florida Keys National Marine Sanctuary (FKNMS), and from navigable depths along the shoreline seaward to the shelf break (~100m). The study incorporated standard methods and indicators applied in previous national coastal monitoring programs — U.S. Environmental Protection Agency’s (EPA) Environmental Monitoring and Assessment Program (EMAP) and National Coastal Assessment (NCA) — including multiple measures of water quality, sediment quality, and biological condition. Synoptic sampling of the various indicators provided an integrative weight-of-evidence approach to assessing condition at each station and a basis for examining potential associations between presence of stressors and biological responses. A probabilistic sampling design, which included 50 stations distributed randomly throughout the region, was used to provide a basis for estimating the spatial extent of condition relative to the various measured indicators and corresponding assessment endpoints (where available). The study was conducted through a large cooperative effort by National Oceanic and Atmospheric Administration (NOAA)/National Centers for Coastal Ocean Science (NCCOS), EPA, U.S. Geological Survey (USGS), NOAA/Oceanic and Atmospheric Research (OAR)/Atlantic Oceanographic and Meteorological Laboratory in Miami, FKNMS, and the Florida Fish and Wildlife Conservation Commission (FWC). The majority of the South Florida shelf had high levels of dissolved oxygen (DO) in near-bottom water (> 5 mg L-1) indicative of “good” water quality.. DO levels in bottom waters exceeded this upper threshold at 98.8% throughout the coastal-ocean survey area. Only 1.2% of the region had moderate DO levels (2-5 mg/L) and no part of the survey area had DO <2.0 mg/L. In addition, offshore waters throughout the region had relatively low levels of total suspended solids (TSS), nutrients, and chlorophyll a indicative of oligotrophic conditions. Results suggested good sediment quality as well. Sediments throughout the region, which ranged from sands to intermediate muddy sands, had low levels of total organic carbon (TOC) below bioeffect guidelines for benthic organisms. Chemical contaminants in sediments were also mostly at low, background levels. For example, none of the stations had chemicals in excess of corresponding Effects-Range Median (ERM) probable bioeffect values or more than one chemical in excess of lower-threshold Effects-Range Low (ERL) values. Cadmium was the only chemical that occurred at moderate concentrations between corresponding ERL and ERM values. Sixty fish samples from 28 stations were collected and analyzed for chemical contaminants. Eleven of these samples (39% of sites) had moderate levels of contaminants, between lower and upper non-cancer human-health thresholds, and ten (36% of sites) had high levels of contaminants above the upper threshold.

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In June 2008, the NOAA National Ocean Service (NOS), in conjunction with the EPA National Health and Environmental Effects Laboratory (NHEERL), conducted an assessment of the status of ecological condition of soft-bottom habitat and overlying waters within the boundaries of Stellwagen Bank National Marine Sanctuary (SBNMS). The sanctuary lies approximately 20 nautical miles east of Boston, MA in the southwest Gulf of Maine between Cape Ann and Cape Cod and encompassing 638 square nautical miles (2,181 km2). A total of 30 stations were targeted for sampling using standard methods and indicators applied in prior NOAA coastal studies and EPA’s Environmental Monitoring and Assessment Program (EMAP) and National Coastal Assessment (NCA). A key feature adopted from these studies was the incorporation of a random probabilistic sampling design. Such a design provides a basis for making unbiased statistical estimates of the spatial extent of ecological condition relative to various measured indicators and corresponding thresholds of concern. Indicators included multiple measures of water quality, sediment quality, and biological condition (benthic fauna, fish tissue contaminant levels). Depths ranged from 31 – 137 m throughout the study area. About 76 % of the area had sediments composed of sands (< 20 % silt-clay), 17 % of the area was composed of intermediate muddy sands (20 – 80 % silt-clay), and 7 % of the sampled area consisted of mud (> 80 % siltclay). About 70 % of the area (represented by 21 sites) had sediment total organic carbon (TOC) concentrations < 5 mg/g and all but one site (located in Stellwagen Basin) had levels of TOC < 20 mg/g, which is well below the range potentially harmful to benthic fauna (> 50 mg/g). Surface salinities ranged from 30.6 – 31.5 psu, with the majority of the study region (approximately 80 % of the area) having surface salinities between 30.8 and 31.4 psu. Bottom salinities varied between 32.1 and 32.5 psu, with bottom salinities at all sites having values above the range of surface salinities. Surface-water temperatures varied between 12.1 and 16.8 ºC, while near-bottom waters ranged in temperature from 4.4 – 6.2 ºC. An index of density stratification (Δσt) indicated that the waters of SBNMS were stratified at the time of sampling. Values of Δσt at 29 of the 30 sites sampled in this study (96.7 % of the study area) varied from 2.1 – 3.2, which is within the range considered to be indicative of strong vertical stratification (Δσt > 2) and typical of the western Gulf of Maine in summer. Levels of dissolved oxygen (DO) were confined to a fairly narrow range in surface (8.8 – 10.4 mg/L) and bottom (8.5 – 9.6 mg/L) waters throughout the survey area. These levels are within the range considered indicative of good water quality (> 5 mg/L) with respect to DO. None of these waters had DO at low levels (< 2 mg/L) potentially harmful to benthic fauna and fish.

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In May 2006, the NOAA National Ocean Service (NOS), in conjunction with the EPA National Health and Environmental Effects Laboratory (NHEERL), conducted an assessment of the status of ecological condition of soft-bottom habitat and overlying waters throughout the mid-Atlantic Bight (MAB) portion of the eastern U.S. continental shelf. The study area encompassed the region from Cape Cod, MA and Nantucket Shoals in the northeast to Cape Hatteras in the south, and was defined using a one nautical mile buffer of the shoreline extended seaward to the shelf break (~100-m depth contour). A total of 50 stations were targeted for sampling using standard methods and indicators applied in prior NOAA coastal studies and EPA’s Environmental Monitoring and Assessment Program (EMAP) and National Coastal Assessment (NCA). A key feature adopted from these studies was the incorporation of a random probabilistic sampling design. Such a design provides a basis for making unbiased statistical estimates of the spatial extent of ecological condition relative to various measured indicators and corresponding thresholds of concern. Indicators included multiple measures of water quality, sediment quality, and biological condition (benthic fauna). Through coordination with the NOAA Fisheries Service/Northeast Fisheries Science Center (NFS/NEFSC), samples of summer flounder (Paralichthys dentatus) also were obtained from 30 winter 2007 bottom-trawl survey stations in overlapping portions of the study area and used for analysis of chemical-contaminant body burdens.

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© 2014, Springer-Verlag Berlin Heidelberg.This study assesses the skill of advanced regional climate models (RCMs) in simulating southeastern United States (SE US) summer precipitation and explores the physical mechanisms responsible for the simulation skill at a process level. Analysis of the RCM output for the North American Regional Climate Change Assessment Program indicates that the RCM simulations of summer precipitation show the largest biases and a remarkable spread over the SE US compared to other regions in the contiguous US. The causes of such a spread are investigated by performing simulations using the Weather Research and Forecasting (WRF) model, a next-generation RCM developed by the US National Center for Atmospheric Research. The results show that the simulated biases in SE US summer precipitation are due mainly to the misrepresentation of the modeled North Atlantic subtropical high (NASH) western ridge. In the WRF simulations, the NASH western ridge shifts 7° northwestward when compared to that in the reanalysis ensemble, leading to a dry bias in the simulated summer precipitation according to the relationship between the NASH western ridge and summer precipitation over the southeast. Experiments utilizing the four dimensional data assimilation technique further suggest that the improved representation of the circulation patterns (i.e., wind fields) associated with the NASH western ridge substantially reduces the bias in the simulated SE US summer precipitation. Our analysis of circulation dynamics indicates that the NASH western ridge in the WRF simulations is significantly influenced by the simulated planetary boundary layer (PBL) processes over the Gulf of Mexico. Specifically, a decrease (increase) in the simulated PBL height tends to stabilize (destabilize) the lower troposphere over the Gulf of Mexico, and thus inhibits (favors) the onset and/or development of convection. Such changes in tropical convection induce a tropical–extratropical teleconnection pattern, which modulates the circulation along the NASH western ridge in the WRF simulations and contributes to the modeled precipitation biases over the SE US. In conclusion, our study demonstrates that the NASH western ridge is an important factor responsible for the RCM skill in simulating SE US summer precipitation. Furthermore, the improvements in the PBL parameterizations for the Gulf of Mexico might help advance RCM skill in representing the NASH western ridge circulation and summer precipitation over the SE US.

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Child sex abuse increasingly is recognised as a societal problem that can no longer be ignored. In this paper definitions, prevalence, trends, assessment, and available diagnostic procedures are described and critically evaluated. It is argued that the lack of reliable diagnostic procedures remains one of the main difficulties in dealing effectively with the detrimental effects of CSA on the child or adult. The research challenge to find effective alternative procedures is outlined.

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The aims of this study were to examine preterm infant reactions to pain in detail over prolonged time periods using multiple measures, and to assess the value of including specific body movements of the Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) system to evaluate pain. Ten preterm infants born at 31 weeks mean gestational age (GA) and mean birth weight 1676 g were studied during a routine blood collection in a Level III neonatal intensive care unit (NICU). At 32-week post-conceptional age, computerized physiologic and video recordings were obtained continuously for 60 min (prior to, during and after lance). Motor and facial behaviors were coded independently, using the NIDCAP and the NFCS (Neonatal Facial Coding System), respectively, and compared with heart rate (HR) and oxygen saturation responses. Of the movements hypothesized to be stress cues in the NIDCAP model, extension of arms and legs (80%) and finger splay (70%) were the most common following lance. Contrary to the model, most infants (70%) had lower incidence of twitches and startles post-lance compared to baseline. Whereas all infants showed some NFCS response to lance, for three infants, the magnitude was low. HR increased and oxygen saturation decreased post-lance. Infants with more prior pain exposure, lower Apgar, and lower GA at birth, displayed more motor stress cues but less facial activity post-lance. Extension of extremities and finger splay, but not twitches and startles, from the NIDCAP, appear to be stress cues and show promise as clinical pain indicators to supplement facial and physiological pain measures in preterm infants.

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QUESTION UNDER STUDY: Emergency room (ER) interpretation of the ECG is critical to assessment of patients with acute coronary syndromes (ACS). Our aim was to assess its reliability in our institution, a tertiary teaching hospital. METHODS: Over a 6-month period all consecutive patients admitted for ACS were included in the study. ECG interpretation by emergency physicians (EPs) was recorded on a preformatted sheet and compared with the interpretation of two specialist physicians (SPs). Discrepancies between the 2 specialists were resolved by an ECG specialist. RESULTS: Over the 6-month period, 692 consecutive patients were admitted with suspected ACS. ECG interpretation was available in 641 cases (93%). Concordance between SPs was 87%. Interpretation of normality or abnormality of the ECG was concordant between EPs and SPs in 475 cases (74%, kappa = 0.51). Interpretation of ischaemic modifications was concordant in 69% of cases, and as many ST segment elevations were unrecognised as overdiagnosed (5% each). The same findings occurred for ST segment depressions and negative T waves (12% each). CONCLUSIONS: Interpretation of the ECG recorded during ACS by 2 SPs was discrepant in 13% of cases. Similarly, EP interpretation was discrepant from SP interpretation in 25% of cases, equally distributed between over- and underdiagnosing of ischaemic changes. The clinical implications and impact of medical education on ECG interpretation require further study.

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The historically-reactive approach to identifying safety problems and mitigating them involves selecting black spots or hot spots by ranking locations based on crash frequency and severity. The approach focuses mainly on the corridor level without taking the exposure rate (vehicle miles traveled) and socio-demographics information of the study area, which are very important in the transportation planning process, into consideration. A larger study analysis unit at the Transportation Analysis Zone (TAZ) level or the network planning level should be used to address the needs of development of the community in the future and incorporate safety into the long-range transportation planning process. In this study, existing planning tools (such as the PLANSAFE models presented in NCHRP Report 546) were evaluated for forecasting safety in small and medium-sized communities, particularly as related to changes in socio-demographics characteristics, traffic demand, road network, and countermeasures. The research also evaluated the applicability of the Empirical Bayes (EB) method to network-level analysis. In addition, application of the United States Road Assessment Program (usRAP) protocols at the local urban road network level was investigated. This research evaluated the applicability of these three methods for the City of Ames, Iowa. The outcome of this research is a systematic process and framework for considering road safety issues explicitly in the small and medium-sized community transportation planning process and for quantifying the safety impacts of new developments and policy programs. More specifically, quantitative safety may be incorporated into the planning process, through effective visualization and increased awareness of safety issues (usRAP), the identification of high-risk locations with potential for improvement, (usRAP maps and EB), countermeasures for high-risk locations (EB before and after study and PLANSAFE), and socio-economic and demographic induced changes at the planning-level (PLANSAFE).

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This research used a quantitative study approach to investigate the “boy crisis” in Canada. Boy crisis advocates suggest that boys are being surpassed by girls on reading assessments and promote strategies to assist male students. A feminist framework was used in this study that allowed for an investigation and discussion of the factors that mediate between gender and success at reading comprehension, interpretation, and response to text without ignoring female students. Reading scores and questionnaire data compiled by the Pan-Canadian Assessment Program were used in this research, specifically the PCAP-13 2007 assessment of approximately 30,000 13-year-old students from all Canadian provinces and Yukon Territory (CMEC, 2008). Approximately 20,000 participants wrote the reading assessment, while 30,000 students completed the questionnaire responses. Predictor variables were tested using parametric tests such as independent samples t-test, one-way ANOVA, chi-square analysis, and Pearson r. Findings from this study indicate that although boys scored lower than girls on the PCAP-13 2007 reading assessment, factors were found to influence the reading scores of both male and female students to varying degrees. Socioeconomic status, perceptions of the reading material used in language arts classrooms, reading preference, reading interest, parental involvement, parental encouragement for reading, and self-efficacy were all found to affect the reading performance of boys and girls. Relationships between variables were also found and are discussed in this research. The analysis presented in this study allows parents, educators, and policy makers to begin to critically examine and re-evaluate boy crisis literature and offers suggestions on how to improve reading performance for all students of all socioeconomic backgrounds.

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Refus global, le recueil, n’est pas « Refus global », le texte rédigé par Paul-Émile Borduas et cosigné par 15 membres du groupe automatiste. Partant de cette distinction entre le recueil automatiste et son texte éponyme et du constat selon lequel la partie éclipse le tout dans le discours critique, cette thèse a pour objectif d’expliquer l’occultation du recueil dans l’histoire sociale et artistique québécoise. À partir de l’étude de la réception de 1948 à 2008, j’interroge la constitution du récit commun entourant l’œuvre, duquel le recueil est exclu. Il s’agit donc de mettre au jour les obstacles qui se sont présentés dans le parcours de réception du recueil, nuisant à la formation d’un discours unifié et cohérent à son sujet et l’empêchant de s’inscrire dans l’histoire. Dégagés de l’étude du corpus composé de 639 objets sémiotiques secondaires (OSS, selon le concept proposé par Brigitte Louichon), les obstacles à la réception du recueil relèvent à la fois de facteurs pragmatiques, telles la composition hétérogène de l’œuvre ou sa disponibilité; de facteurs institutionnels ou historiographiques, comme la disciplinarisation du champ culturel ou l’impact du récit de la Révolution tranquille sur l’histoire littéraire; et de facteurs humains, reposant sur le rôle des auteurs et de certains critiques dans l’accueil réservé à l’œuvre. Les différentes étapes de la réception sont ainsi considérées : de l’horizon d’attente (Jauss) à la réception productive (Link), en passant par la publication, les premières critiques, les rééditions, les lectures savantes, l’historicisation et l’entrée de l’œuvre dans la mémoire à titre de symbole ou d’hypotexte. Or, plutôt qu’à ce parcours de réception exemplaire, c’est son envers qui est interrogé ici, c’est-à-dire les difficultés et les déviations de la réception du recueil Refus global. Cette thèse est divisée en trois parties. La première, théorique et méthodologique, situe mon propos dans les domaines de l’histoire culturelle et des études de réception, et présente diverses considérations concernant la constitution du corpus et le traitement des données. La deuxième aborde l’horizon d’attente et la première réception, moment crucial pour la survie de l’œuvre, comme l’ont montré Hans Robert Jauss et Daniel Chartier. On y observe notamment l’effet de verrou (Cambron) qu’a le renvoi de Borduas sur la constitution du récit de réception, de même que les critères éthiques et esthétiques en fonction desquels s’est opérée la hiérarchisation des composantes du recueil. La troisième partie couvre la réception subséquente (1950-2008). À l’étude des obstacles empêchant l’intégration du recueil dans l’histoire s’ajoute alors l’étude des réceptions parallèles, parcellaires et autonomes dont a bénéficié Refus global pour survivre – ponctuellement et partiellement – en dehors du récit commun formé autour de « Refus global ». Avec les différentes catégories d’OSS (directs, indirects, hypertextuels, métacritiques et parcellaires), ces trois types de réception font partie des outils heuristiques développés dans le but d’expliquer la réception partielle dont a fait l’objet le recueil. Selon l’approche quantitative et environnementaliste de l’histoire culturelle, Refus global est envisagé comme un microcosme de la culture, dans lequel certaines œuvres sont retenues et d’autres négligées. L’analyse d’un corpus critique large et varié permet ainsi de saisir non seulement les phénomènes conduisant à la consécration du texte éponyme ou à l’oubli relatif du recueil, mais aussi les tendances critiques, les parutions marginales, les critiques isolées, etc. qui, enfouies dans les angles morts de la réception, offrent au recueil et à ses composantes des voies de contournement du discours dominant. En somme, l’étude de la réception du recueil Refus global a permis à la fois de déplacer la focalisation critique depuis « Refus global » vers Refus global, de développer des outils pour envisager la réception d’œuvres marginalisées et de mettre en évidence des critères privilégiés dans la constitution de l’histoire et de la mémoire culturelles québécoises depuis 1948.