Avaliação difratográfica da microestrutura de três resinas compostas submetidas à aplicação de um agente clareador a base de peróxido de hidrogênio

A odontologia moderna utiliza métodos e técnicas ultraconservadores no intuito de corrigir os diversos tipos de alterações cromáticas observadas clinicamente. Os meios empregados baseiam-se na utilização de substâncias químicas à base de peróxidos presentes em diversas concentrações. O presente estudo objetivou avaliar a microestrutura de três resinas compostas fotossensíveis submetidas à aplicação de um agente clareador a base de peróxido de hidrogênio a 35% (Whiteness HP Maxx - fabricante: FGM), ativado por uma fonte híbrida de energia luminosa (Aparelho de Laser-Led Whitening Lase, fabricante: DMC). Para isso, foram confeccionados 30 corpos de prova (CDP) 10 para cada grupo, no formato de discos, com 13 mm de diâmetro e 2,0 mm de espessura em uma matriz de teflon e aço inox, fotoativados por um aparelho de luz halógena convencional (Optilux 401 - Demetron/UR) por 40 segundos com densidade de potência média igual a 450 mW/cm2. Os grupos foram dispostos da seguinte forma: Grupo 1 - resina microparticulada (Durafill VS - fabricante: Heraeus Kulzer); Grupo 2 - resina micro-híbrida (Esthet-X - fabricante: Dentsply); e Grupo 3 resina nanoparticulada (Filtek Supreme XT fabricante: 3M ESPE). Todos os materiais restauradores utilizados eram da cor A2. Após serem submetidos à sequência de acabamento e polimento os CDP foram armazenados por sete dias em saliva artificial, limpos em ultra-som, envelhecidos artificialmente de acordo com a norma ASTM G 154. Os CDP dos três grupos foram aleatoriamente divididos em 2 subgrupos (ST sem tratamento e CT com tratamento) e finalmente submetidos aos experimentos. Os CDP dos subgrupos 1-ST, 2- ST e 3-ST foram triturados (SPEX SamplePrep 8000-series, marca: Mixer/Mills) seguido pela verificação dos materiais por meio de um espectrômetro (marca/modelo: Shimadzu EDX 720) para certificação da ausência de elementos pertencentes ao meio de moagem e por fim foram levados a um difrator de raios-X (marca / modelo: Philips -PW 3040 -X'Celerator- 40kV; 30mA; (λ): CuKα; 0,6; 0,2mm; 0,05 (2θ); 2s; 10-90 (2θ). Em seguida os CDP dos subgrupos 1-CT, 2- CT e 3-CT foram tratados com o peróxido de hidrogênio de acordo com o protocolo do fabricante para a fonte híbrida luminosa de energia selecionada, totalizando 9 aplicações de 10 minutos, onde eram respeitados os tempos de 3 minutos de ativação por 20 segundos de descanso, finalizando 10 minutos em cada aplicação. Mediante a este tratamento, os CDP dos subgrupos CT eram verificados e avaliados pelo mesmo método descrito anteriormente. Após interpretação gráfica, análise comparativa por meio do processamento digital das imagens no programa KS400 3.0 (Carl Zeiss Vision) e análise de concordância por cinco avaliadores calibrados utilizando um escore, pôde-se concluir que houve degradação estrutural e que as estruturas cristalinas das resinas estudadas foram afetadas de forma distinta quando tratadas pelo peróxido de hidrogênio; onde observou-se que: Grupo 1 > Grupo 3 > Grupo 2. Foi sugerido a realização de novos estudos, relacionados à interação do peróxido de hidrogênio às resinas compostas.

蓝藻磷脂磷酸酶基因的缺失对光合作用的影响

磷脂酰甘油(phosphatidylglycerol, PG)是类囊体膜(也叫光合膜)中唯一的一种磷脂。在蓝藻中，PG的合成途径为：磷脂酸(phosphatidic acid, PA)胞嘧啶双磷酸-二酰基甘油 (cytidine diphosphate diacylglycerol, CDP-DAG) 磷酸磷脂酰甘油 (phosphatidylglycerol phosphate, PGP)PG。其中最后一步反应是由PGP去磷酸化而生成PG，催化该反应的是PGP磷酸酶。然而迄今为止，PGP磷酸酶还没有在蓝藻和高等植物中得到克隆和鉴定。本工作在鱼腥藻Anabaena sp. PCC7120中通过将一个可能编码PGP磷酸酶的基因(alr1715)进行突变，获得缺失PG的突变体。与野生型相比，该突变体PG的含量降低了30%左右。突变后的蓝藻藻丝发黄、生长缓慢，叶绿素含量降低。整体细胞的光合作用活性、光系统II(photosystem II，PSII)的放氧活性以及PSII反应中心的光能转化效率显著下降，传递给PSII的激发能减少。

岷江上游景观可持续管理决策预案研究

岷江上游地区是我国一个重要的大尺度、复合型生态过渡带，也是一个生态系统脆弱区和敏感区，它不但影响当地和岷江下游的农业生产、生活用水和生态环境，而且影响长江上游地区生态环境改善，在长江上游生态安全格局中占有重要地位。近几十年来，在强烈的自然变化与人类活动干扰下，该区域景观发生了巨大变化，综合研究影响景观变化的自然、社会因子，制定以生态系统可持续为目标的景观管理决策，从而为改善区域生态环境，构建生态安全格局具有重要的科学意义和现实需求。本论文通过对岷江上游农、林、草复合景观诸多因子的研究，通过NetWaver和CDP（Criterium DecisionPlus）平台，分别建立基于模糊逻辑的景观评价知识库和基于多目标决策的景观管理决策模型，实现了岷江上游3种不同目标的景观管理决策预案。本论文取得了如下结论： (1). 景观格局分析表明，岷江上游景观以草地为基质，森林以及其他景观类型作为斑块镶嵌其中，草地类型影响到整个景观格局的生态过程，包括物质的传输与能量的流动。 (2). 通过建立人类活动强度这一可定量化测度的指标，分析了研究区森林、草地、耕地三种主要景观类型的格局变化，结果显示，人类活动视为信息熵输入，其强度大小对景观类型所起的作用不同，正确引导和控制一定范围、一定强度的人类活动可以实现景观的恢复。 (3). 基于NetWeaver系统，设计景观评价模糊知识库，对研究区进行了景观综合评价，整个流域除了四个子流域支持程度为低或者非常低外，其余子流域支持程度较好，景观管理的可行性和有效性水平较高。评价的结果为景观管理预案的设计提供了重要的数据支持。 (4). 综合研究区社会、经济和生态发展三个子系统，通过层次分析法，建立三层指标体系对研究区可持续能力进行评价。结果表明，岷江上游可持续发展能力综合评价值为0.22（理想值为1），反映出景观可持续能力差，实施区域生态系统管理，制订可持续管理预案具有重要性和紧迫性。 (5). 通过CDP（Criterium DecisionPlus）平台，综合所有对景观管理有潜在影响的因素，构建景观管理的决策模型，设计了三个基于不同管理目标的决策预案；并对所设计的管理预案进行了模型不确定性分析、灵敏度分析和因子贡献量分析，验证了预案模型的鲁棒性（robustness）；最后，结合生态系统管理系统EMDS（Ecosystem Management Decision System）和ARC/GIS的环境实现预案空间表达，并对决策结果进行了分析与讨论。论文的研究结果是研究区实施景观管理规划的关键性参考依据。

三维VSP技术的研究及应用

Today, because of high petroleum consumption of our country, society steady development and difficulty increase in new resources exploration, deep exploitation of the existing oilfield is needed. More delicate reservoir imaging and description, such as thin layer identification, interlayer exploitation monitoring, subtle structure imaging, reservoir anisotropy recognition, can provide more detail evidence for new development adjustment scheme and enhanced oil recovery. Now, the people have already realized the 3D VSP technique more effective than the general methods in solving these aspects. But VSP technique especially 3D VSP develop slowly due to some reasons. Carrying out the research of VSP technique, it will be very useful to the EOR service. 3D VSP techniques include acquisition、data processing and interpretation. In this paper, the author carried out some researches around acquisition and processing. The key point of acquisition is the survey design, it is critical to the quality of the data and it will influence the reservoir recognition as follows. The author did detailed researches on the layout pattern of shot point and geophone. Some attributes relate to survey design such as reflectivity, incidence angle, observation area, reflection points distribution, fold, minimum well source distance, azimuth angle and so on are studied seriously. In this geometry design of 3D-VSP exploration in deviated wells, the main problems to be solved are: determining the center position of shots distribution, the effect of shots missing on coverage areas and coverage times，locating the shots and receivers of multi-wells. Through simulating and analyzing, the above problems are discussed and some beneficial conclusions are drawn. These will provide valuable references to actual survey design. In data processing, researches emphasize on those relatively key techniques such as wavefield separation, VSP-CDP imaging, the author carried out deep researches around these two aspects. As a result, variant apparent slowness wavefield separation method developed in this article suit the underground variant velocity field and make wavefield separation well, it can overcome reflection bending shortage aroused by conventional imaging method. The attenuateion range of underground seismic wave is very important for amplitude compensation and oil/gas identification.In this paper, seismic wave attenuateion mechanism is studied by 3D-VSP simulateion and Q-inversion technique. By testing with seismic data, the method of VSP data attenuateion and relationship of attenuateion attribute variant with depth is researched. Also the software of survey design and data processing is developed, it fill the gap of VSP area in our country. The technique developed applied successfully in SZXX-A Oilfield、QKYY-B Oilfield、A area and B area. The good results show that this research is valuable, and it is meaningful to the VSP technique development and application of offshore oil industry and other areas in our country.

隐伏金矿床预测中的地震勘探险方法

Based on brief introduction of seismic exploration and it's general developing situation, the seismic exploration method in field work implementation and some problems frequently encountered in field, which should be pay attention to, are analyzed in detail. The most economic field work techniques are emphasized. Then the seismic data processing flow and it's interpretation technique about the processing results are presented. At last four examples of seismic prospecting in gold deposits are showed. The main conclusions of our research are: 1. Seismic prospecting technique is a very efficient method in the prediction of concealed gold deposits. With appropriate application, it can absolutely reflect the detail underground geological structure in the condition of rugged area and complicated geological environment. 2. The field geometry should be designed and changed according to different kinds of objective exploration depth and ground situation. The best field implementing parameters which include offset, the distance between two adjacent traces, the quantity of dynamite and the depth of hole for explosion, should be determined with examination. Only this way, the high quality original seismic data can be gotten. 3. In seismic data processing, the edition of invalid trace and source gather, signal enhancement, velocity analysis and migration are the key steps. It has some different points with conventional processing and needs a new processing flow and methods which is suitable to the data acquired in rugged area and complicated geological environment. 4. The new common reflection area stacking method in crooked line data processing is an efficient method to improve the signal to noise ratio of seismic data The innovations of our research work are: 1. In the areas which were considered to be forbidden zone, we implement the seismic exploration in several gold deposits in China through our application. All acquire distinguished effects. This show the seismic exploration method is a new effective method in the prediction of concealed gold deposits. 2. We developed a set of seismic field work techniques and data processing which is suitable to complex environment, especially find a effective method in stacking and noise elimination in crooked line data processing. 3. In the field of seismic profile interpretation, through our research work, we are convinced of that: in different kinds of geological condition, the seismic reflection character are not same. For example the lava, the intrusion rock and sediment layers are different in the character of reflection structure and strength. So we accumulate some experience about seismic data interpretation in the area of gold deposits.

弱各向异性介质中传播的地震波及其速度重建

We begin our studies to make the best of information of seismic data and carry out the description of cracks parameters by extracting anisotropic information. The researching contents are: (1) velocity and polarization anomaly of seismic wave (qP and qSV wave) in weak anisotropic media; (2) reflection seismic synthetic record in anisotropic media; (3) multiple scattering induced by cracks; (4) anisotropic structure inversion and velocity reconstruction with VSP (Vertical Seismic Profile) data; (5) multi-parameters analysis of anisotropy in time-domain and depth-domain. Then we obtain results as follows: (1) We achieve approximate relation of qP and qSV wave's velocity and polarization property in weak anisotropic media. At the same time, we calculate anisotropic velocity factors and polarization anomaly of several typical sedimentary rocks. The results show there are different anisotropic velocity factors and polarization anomaly in different rocks. It is one of the primary theoretical foundation which is expected to identify lithology; (2) We calculate reflection seismic synthetic record with theoretical model; (3) We simulate scattering induced by cracks with Boundary Element Method. Numerical studies show that in the presence of cracks; spatial and scale-length distributions are important and cannot be ignored in modeling cracked solids; (4) From traveltimes information of VSP data, we study the velocity parameter inversion of seismic wave under isotropic and anisotropic models, and its result indicate that the inversion imaging under anisotropic model will not destroy the original features of isotropic model, but it will bring on some bigger error if we adopt the method of isotropic model for anisotropic model data. Further more, basing on the study we develop the CDP mapping technology of reflecting structure under isotropic and anisotropic models, and we process real data as a trial of the methods; (5) We study the problem of initial model reconstruction of anisotropic parameters structure represented by Anderson parameter in depth domain for surface data.

Centro de Desarrollo Productivo de la Madera de Caldas. Visita de reconocimiento.

21 hojas.

Accurate and Efficient Gesture Spotting via Pruning and Subgesture Reasoning

Gesture spotting is the challenging task of locating the start and end frames of the video stream that correspond to a gesture of interest, while at the same time rejecting non-gesture motion patterns. This paper proposes a new gesture spotting and recognition algorithm that is based on the continuous dynamic programming (CDP) algorithm, and runs in real-time. To make gesture spotting efficient a pruning method is proposed that allows the system to evaluate a relatively small number of hypotheses compared to CDP. Pruning is implemented by a set of model-dependent classifiers, that are learned from training examples. To make gesture spotting more accurate a subgesture reasoning process is proposed that models the fact that some gesture models can falsely match parts of other longer gestures. In our experiments, the proposed method with pruning and subgesture modeling is an order of magnitude faster and 18% more accurate compared to the original CDP algorithm.

An operant determination of the behavioural mechanism of benzodiazepine enhancement of food intake

Rationale A recent review paper by Cooper (Appetite 44:133–150, 2005) has pointed out that a role for benzodiazepines as appetite stimulants has been largely overlooked. Cooper’s review cited several studies that suggested the putative mechanism of enhancement of food intake after benzodiazepine administration might involve increasing the perceived pleasantness of food (palatability). Objectives The present study examined the behavioral mechanism of increased food intake after benzodiazepine administration. Materials and methods The cyclic-ratio operant schedule has been proposed as a useful behavioral assay for differentiating palatability from regulatory effects on food intake (Ettinger and Staddon, Physiol Behav 29:455–458, 1982 and Behav Neurosci 97:639–653, 1983). The current study employed the cyclic-ratio schedule to determine whether the effects on food intake of chlordiazepoxide (CDP) (5.0 mg/kg), sodium pentobarbital (5.0 mg/kg), and picrotoxin (1.0 mg/kg) were mediated through palatability or regulatory processes. Results The results of this study show that both the benzodiazepine CDP and the barbiturate sodium pentobarbital increased food intake in a manner similar to increasing the palatability of the ingestant, and picrotoxin decreased food intake in a manner similar to decreasing the palatability of the ingestant. Conclusions These results suggest that the food intake enhancement properties of benzodiazepines are mediated through a mechanism affecting perceived palatability.

Níveis de actividade e participação das pessoas com afasia: desenvolvimento de instrumentos de avaliação portugueses

A International Classification of Functioning, Disability and Health (ICF) (WHO 2001) realça a necessidade dos profissionais de saúde considerarem, na intervenção que realizam com a pessoa, as possíveis consequências de uma doença em diferentes domínios, nomeadamente nas suas Funções e Estruturas do Corpo, nas suas Actividades diárias e na sua Participação em situações da vida real. Realça ainda a possível interferência dos Factores Contextuais neste processo. Em Portugal, os instrumentos existentes utilizados pelos terapeutas da fala (TFs) na sua prática clínica com pessoas com afasia (PCAs), não permitem avaliar estes domínios, o que poderá limitar uma intervenção mais alargada, que integre estas directivas. Pretendeu-se com este estudo efectuar a tradução e adaptação à língua portuguesa do Communication Disability Profile (CDP) (Swinburn and Byng 2006) e do Participation Objective Participation Subjective (POPS) (Brown, Dijkers et al. 2004), ambos desenvolvidos à luz da ICF, de modo a apetrechar os TFs do país, com instrumentos de avaliação que lhes permitam abordar os diferentes domínios referidos. Pretendeu-se ainda conhecer as reais necessidades de PCAs portuguesas, ou seja, efectuar um levantamento das consequências dos AVCs e da afasia na sua vida diária e verificar de que modo os instrumentos escolhidos permitem identificar com precisão estas necessidades. Foram envolvidos três grupos distintos de participantes, nomeadamente catorze PCAs, catorze familiares e amigos (F/A) e dez TFs, consultados em três fases distintas. Recorreu-se ao uso de diferentes métodos e instrumentos de recolha de dados, nomeadamente o brainstorming e o uso de entrevistas aprofundadas semiestruturadas, realizadas individualmente e em grupo. Construíram-se dois instrumentos de raiz (o TAPP e a GABF) que permitiram complementar os dados recolhidos junto das PCAs. A análise dos dados foi predominantemente qualitativa (Análise Temática). Da análise dos resultados obtidos nestas três fases, resultaram as primeiras versões portuguesas do CDP e do POPS. No que diz respeito às consequências dos AVCs e da afasia na vida diária das PCAs na componente das Funções e Estruturas do Corpo, os três grupos consideraram a categoria das Funções Mentais Especificas como sendo a mais perturbada. Relativamente à componente das Actividades/Participação, as consequências relatadas centram-se nas categorias das Interacções e Relacionamentos Pessoais, Vida Comunitária Social e Cívica e Áreas Principais da Vida. Quanto às Barreiras e Facilitadores, os TFs valorizam as Barreiras de Informação e as Barreiras Estruturais como as que mais interferem com a Participação social das PCAs, enquanto estas e os F/A valorizam os Factores Pessoais, as Barreiras Ambientais e as Barreiras Atitudinais. Os TFs realçam a importância de existirem “redes de suporte familiar” como Facilitadores. As PCAs e os F/A valorizam os Facilitadores Ambientais e os Facilitadores Atitudinais. No que diz respeito aos instrumentos em estudo, a maioria dos TFs assim como o grupo dos F/A considerou a apresentação visual do POPS e mais especificamente as escalas de notação usadas como sendo muito complexas, enquanto as PCAs envolvidas no estudo não fizeram qualquer referência ou crítica às mesmas. A maioria dos TFs considerou os itens do POPS como sendo relevantes para a população portuguesa com afasia. Contudo, metade destes mostrou preocupação com a ambiguidade de alguns dos seus itens e cerca de um terço considerou as instruções difíceis de compreender. As PCAs, assim como os F/A consideraram os itens do POPS, na sua generalidade, como sendo claros, relevantes e não ambíguos. A maioria dos TFs e dos F/A referem falta de clareza de algumas das imagens utilizadas no CDP. Contudo, o grupo das PCAs considera que estas são claras e facilitam a compreensão dos itens. Nenhum dos três grupos consultados fez referência ao tipo e tamanho de letra usada no CDP pelo que se considera ser adequada. A maior parte dos TFs não faz qualquer referência à falta de clareza dos itens do CDP, contudo metade considera alguns dos seus itens ambíguos e um terço questiona também a sua relevância. Os itens do CDP são considerados claros, relevantes e não ambíguos quer pelo grupo das PCAs quer pelo grupo dos F/A. Conclui-se que ambos os instrumentos vão, de uma forma geral, ao encontro das necessidades apresentadas pelas PCAs envolvidas no nosso estudo. Poderá afirmar-se também que estes mostraram ser ferramentas terapêuticas importantes para utilizar em Portugal. Contudo, ambos deixam a descoberto algumas áreas consideradas importantes pelos grupos envolvidos e pela literatura internacional, sugerindo-se a sua utilização simultânea de modo a poderem complementar-se, assim como o recurso a outras formas de avaliação disponíveis, no sentido de colmatar possíveis lacunas encontradas após a sua utilização. Sugere-se o desenvolvimento de investigações futuras que permitam o seu aperfeiçoamento.

Control design for multicast-aware class-based networks

The expectations of citizens from the Information Technologies (ITs) are increasing as the ITs have become integral part of our society, serving all kinds of activities whether professional, leisure, safety-critical applications or business. Hence, the limitations of the traditional network designs to provide innovative and enhanced services and applications motivated a consensus to integrate all services over packet switching infrastructures, using the Internet Protocol, so as to leverage flexible control and economical benefits in the Next Generation Networks (NGNs). However, the Internet is not capable of treating services differently while each service has its own requirements (e.g., Quality of Service - QoS). Therefore, the need for more evolved forms of communications has driven to radical changes of architectural and layering designs which demand appropriate solutions for service admission and network resources control. This Thesis addresses QoS and network control issues, aiming to improve overall control performance in current and future networks which classify services into classes. The Thesis is divided into three parts. In the first part, we propose two resource over-reservation algorithms, a Class-based bandwidth Over-Reservation (COR) and an Enhanced COR (ECOR). The over-reservation means reserving more bandwidth than a Class of Service (CoS) needs, so the QoS reservation signalling rate is reduced. COR and ECOR allow for dynamically defining over-reservation parameters for CoSs based on network interfaces resource conditions; they aim to reduce QoS signalling and related overhead without incurring CoS starvation or waste of bandwidth. ECOR differs from COR by allowing for optimizing control overhead minimization. Further, we propose a centralized control mechanism called Advanced Centralization Architecture (ACA), that uses a single state-full Control Decision Point (CDP) which maintains a good view of its underlying network topology and the related links resource statistics on real-time basis to control the overall network. It is very important to mention that, in this Thesis, we use multicast trees as the basis for session transport, not only for group communication purposes, but mainly to pin packets of a session mapped to a tree to follow the desired tree. Our simulation results prove a drastic reduction of QoS control signalling and the related overhead without QoS violation or waste of resources. Besides, we provide a generic-purpose analytical model to assess the impact of various parameters (e.g., link capacity, session dynamics, etc.) that generally challenge resource overprovisioning control. In the second part of this Thesis, we propose a decentralization control mechanism called Advanced Class-based resource OverpRovisioning (ACOR), that aims to achieve better scalability than the ACA approach. ACOR enables multiple CDPs, distributed at network edge, to cooperate and exchange appropriate control data (e.g., trees and bandwidth usage information) such that each CDP is able to maintain a good knowledge of the network topology and the related links resource statistics on real-time basis. From scalability perspective, ACOR cooperation is selective, meaning that control information is exchanged dynamically among only the CDPs which are concerned (correlated). Moreover, the synchronization is carried out through our proposed concept of Virtual Over-Provisioned Resource (VOPR), which is a share of over-reservations of each interface to each tree that uses the interface. Thus, each CDP can process several session requests over a tree without requiring synchronization between the correlated CDPs as long as the VOPR of the tree is not exhausted. Analytical and simulation results demonstrate that aggregate over-reservation control in decentralized scenarios keep low signalling without QoS violations or waste of resources. We also introduced a control signalling protocol called ACOR Protocol (ACOR-P) to support the centralization and decentralization designs in this Thesis. Further, we propose an Extended ACOR (E-ACOR) which aggregates the VOPR of all trees that originate at the same CDP, and more session requests can be processed without synchronization when compared with ACOR. In addition, E-ACOR introduces a mechanism to efficiently track network congestion information to prevent unnecessary synchronization during congestion time when VOPRs would exhaust upon every session request. The performance evaluation through analytical and simulation results proves the superiority of E-ACOR in minimizing overall control signalling overhead while keeping all advantages of ACOR, that is, without incurring QoS violations or waste of resources. The last part of this Thesis includes the Survivable ACOR (SACOR) proposal to support stable operations of the QoS and network control mechanisms in case of failures and recoveries (e.g., of links and nodes). The performance results show flexible survivability characterized by fast convergence time and differentiation of traffic re-routing under efficient resource utilization i.e. without wasting bandwidth. In summary, the QoS and architectural control mechanisms proposed in this Thesis provide efficient and scalable support for network control key sub-systems (e.g., QoS and resource control, traffic engineering, multicasting, etc.), and thus allow for optimizing network overall control performance.

The alternating least-squares algorithm for CDPCA

Clustering and Disjoint Principal Component Analysis (CDP CA) is a constrained principal component analysis recently proposed for clustering of objects and partitioning of variables, simultaneously, which we have implemented in R language. In this paper, we deal in detail with the alternating least-squares algorithm for CDPCA and highlight its algebraic features for constructing both interpretable principal components and clusters of objects. Two applications are given to illustrate the capabilities of this new methodology.

L’agence en oncologie de l’Ontario : actifs organisationnels et professionnels à l’amélioration des soins et des services

Cette thèse s’intéresse à l’amélioration des soins et des services de santé et touche aux relations entre 3 grands thèmes de l’analyse des organisations de santé : la gouvernance, le changement et les pratiques professionnelles. En nous appuyant sur l’analyse organisationnelle contemporaine, nous visons à mieux comprendre l’interface entre l’organisation et les pratiques cliniques. D’une part, nous souhaitons mieux comprendre comment l’organisation structure et potentialise les pratiques des acteurs. D’autre part, dans une perspective d’acteurs stratégiques, nous souhaitons mieux comprendre le rôle des pratiques des professionnels dans l’actualisation de leur profession et dans la transformation et l’évolution des organisations. Notre étude se fonde sur l’hypothèse qu’une synergie accrue entre l’organisation et les pratiques des professionnels favorisent l’amélioration de la qualité des soins et des services de santé. En 2004, le gouvernement ontarien entreprend une importante réforme des soins et services dans le domaine du cancer et revoit les rôles et mandats du Cancer Care Ontario, l’organisation responsable du développement des orientations stratégiques et du financement des services en cancer dans la province. Cette réforme appelle de nombreux changements organisationnels et cliniques et vise à améliorer la qualité des soins et des services dans le domaine de l’oncologie. C’est dans le cadre de cette réforme que nous avons analysé l’implantation d’un système de soins et de services pour améliorer la performance et la qualité et analysé le rôle des pratiques professionnelles, spécifiquement les pratiques infirmières, dans la transformation de ce système. La stratégie de recherche utilisée correspond à l’étude approfondie d’un cas correspondant à l’agence de soins et de services en oncologie en Ontario, le Cancer Care Ontario, et des pratiques professionnelles infirmières évoluant dans ce modèle. Le choix délibéré de ce cas repose sur les modalités organisationnelles spécifiques à l’Ontario en termes de soins en oncologie. La collecte de données repose sur 3 sources principales : les entrevues semi-structurées (n=25), l’analyse d’une abondante documentation et les observations non participatives. La thèse s’articule autour de trois articles. Le premier article vise à définir le concept de gouvernance clinique. Nous présentons l’origine du concept et définissons ses principales composantes. Concept aux frontières floues, la gouvernance clinique est axée sur le développement d’initiatives cliniques et organisationnelles visant à améliorer la qualité des soins de santé et la sécurité des patients. L’analyse de la littérature scientifique démontre la prédominance d’une vision statique de la gouvernance clinique et d’un contrôle accentué des pratiques professionnelles dans l’atteinte de l’efficience et de l’excellence dans les soins et les services. Notre article offre une conception plus dynamique de la gouvernance clinique qui tient compte de la synergie entre le contexte organisationnel et les pratiques des professionnels et soulève les enjeux reliés à son implantation. Le second article s’intéresse à l’ensemble des leviers mobilisés pour institutionnaliser les principes d’amélioration continue de la qualité dans les systèmes de santé. Nous avons analysé le rôle et la portée des leviers dans l’évolution du système de soins en oncologie en Ontario et dans la transformation des pratiques cliniques. Nos données empiriques révèlent 3 phases et de nombreuses étapes dans la transformation du système. Les acteurs en position d’autorité ont mobilisé un ensemble de leviers pour introduire des changements. Notre étude révèle que la transformation du Cancer Care Ontario est le reflet d’un changement radical de type évolutif où chacune des phases est une période charnière dans la transformation du système et l’implantation d’initiatives de qualité. Le troisième article pose un regard sur un levier spécifique de transformation, celui de la communauté de pratique, afin de mieux comprendre le rôle joué par les pratiques professionnelles dans la transformation de l’organisation des soins et ultimement dans le positionnement stratégique de la profession infirmière. Nous avons analysé les pratiques infirmières au sein de la communauté de pratique (CDP) des infirmières en pratique avancée en oncologie. En nous appuyant sur la théorie de la stratégie en tant que pratique sociale, nos résultats indiquent que l’investissement de la profession dans des domaines stratégiques augmente les capacités des infirmières à transformer leurs pratiques et à transformer l’organisation. Nos résultats soulignent le rôle déterminant du contexte dans le développement de capacités stratégiques chez les professionnels. Enfin, nos résultats révèlent 3 stratégies émergentes des pratiques des infirmières : une stratégie de développement de la pratique infirmière en oncologie, une stratégie d’institutionnalisation des politiques de la CDP dans le système en oncologie et une stratégie de positionnement de la profession infirmière. Les résultats de notre étude démontrent que l’amélioration de la qualité des soins et des services de santé est située. L’implantation de transformations dans l’ensemble d’un système, tel que celui du cancer en Ontario, est tributaire d’une part, des capacités d’action des acteurs en position d’autorité qui mobilisent un ensemble de leviers pour introduire des changements et d’autre part, de la capacité des acteurs à la base de l’organisation à s’approprier les leviers pour développer un projet professionnel, améliorer leurs pratiques professionnelles et transformer le système de soins.

Efficacy of Cluster- Based Approach for the revival of Handloom Co-operative Societies in Kerala- with special reference to Thiruvananthapuram and Kannur Districts

one of the key sectors, identified by the Department of Industries Government of Kerala, for the cluster development initiative is Handloom, which gives employment to over over 50,000 people directly. Despite its age old tradition and fame, the performance of the sector vis-à-vis power looms is not very rosy owing to (i) competition from cheap power loom cloth from other states (ii) scarcity of quality yarn (iii) price escalation of yarn, dyes, chemicals and other raw materials (iv) the shrinking market for handlooms in Kerala (v) non-demand based production and inadequacy of new designs and (vi) inefficiencies in the system, particularly in the co-operative sector. Cluster based approach is adopted in the handloom sector with the objective of providing necessary support mechanism to come out of the crisis that the sector faces now. While four cluster schemes are being implemented in Kerala, it is under IHDS-CDP that the State got a sizeable number of clusters benefiting a large number of societies and weavers- 24 handloom clusters, bringing 152 handloom co-operative societies and over 19,800 handloom workers under the Programme. This research attempts to revisit the underlying rationale and context of the new direction and would attempt to broadly analyze the growth trends under the influence of cluster model adopted by the State IHDS-CDP for the revival of handloom sector through a detailed study of the handloom co-operative societies in Kerala. If handloom sector in Kerala can be revived using cluster based approach, it can be easily concluded that cluster is capable of taking the MSME in Kerala to a ‘high growth path.’ The study is aimed at understanding how best clusters emerge as appropriate industrial organization suitable for the current global structure of manufacture