Recherche qualitative sur les perceptions de médecins québécois à l’égard du plan de développement professionnel continu du Collège des médecins du Québec

En 2007, le Collège des médecins du Québec a résolu d’adopter le plan d’autogestion du développement professionnel continu (DPC) comme outil de maintien de la compétence professionnelle. Bien que la plupart des médecins reconnaissent la nécessité de demeurer à la fine pointe des connaissances et des découvertes médicales, certains considèrent le plan d’autogestion comme une corvée administrative. Afin de mieux comprendre leurs perceptions à l’égard du plan de DPC, une recherche qualitative a été menée à l’été 2010, par le biais d’entretiens individuels semi-structurés, auprès d’un échantillon de vingt-sept médecins québécois. Un échantillonnage mixte, utilisant la technique « boule de neige » et faisant appel à des informateurs clés et à des cas dits « négatifs », a permis d’atteindre un bon niveau de diversification de l’échantillon et la saturation empirique des données. Bien que les médecins interrogés soient généralement favorables au principe d’un plan d’autogestion de DPC, les commentaires et suggestions formulés par certains d’entre eux devraient inciter le Collège à apporter certaines améliorations à ce plan. Certains irritants tels que la nécessité de tenir à jour un registre des activités de DPC et d’en rendre compte au Collège ont été soulevés. Par contre, la majorité des médecins interrogés considèrent que le plan de DPC d’un médecin témoigne des efforts qu’ils déploient pour rester à la fine pointe des progrès scientifiques et technologiques dans le domaine de la santé. Finalement, tous les médecins interrogés considèrent que le maintien de leur compétence professionnelle est une obligation morale et déontologique.

Construction d'une échelle décrivant les niveaux de compétence de collaboration, à partir d'indicateurs validés par des enseignants cliniciens en médecine

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences.

Key Agreement Against Quantum Adversaries

Key agreement is a cryptographic scenario between two legitimate parties, who need to establish a common secret key over a public authenticated channel, and an eavesdropper who intercepts all their messages in order to learn the secret. We consider query complexity in which we count only the number of evaluations (queries) of a given black-box function, and classical communication channels. Ralph Merkle provided the first unclassified scheme for secure communications over insecure channels. When legitimate parties are willing to ask O(N) queries for some parameter N, any classical eavesdropper needs Omega(N^2) queries before being able to learn their secret, which is is optimal. However, a quantum eavesdropper can break this scheme in O(N) queries. Furthermore, it was conjectured that any scheme, in which legitimate parties are classical, could be broken in O(N) quantum queries. In this thesis, we introduce protocols à la Merkle that fall into two categories. When legitimate parties are restricted to use classical computers, we offer the first secure classical scheme. It requires Omega(N^{13/12}) queries of a quantum eavesdropper to learn the secret. We give another protocol having security of Omega(N^{7/6}) queries. Furthermore, for any k>= 2, we introduce a classical protocol in which legitimate parties establish a secret in O(N) queries while the optimal quantum eavesdropping strategy requires Theta(N^{1/2+k/{k+1}}) queries, approaching Theta(N^{3/2}) when k increases. When legitimate parties are provided with quantum computers, we present two quantum protocols improving on the best known scheme before this work. Furthermore, for any k>= 2, we give a quantum protocol in which legitimate parties establish a secret in O(N) queries while the optimal quantum eavesdropping strategy requires Theta(N^{1+{k}/{k+1}})} queries, approaching Theta(N^{2}) when k increases.

Assessment of PEG on Polymeric Particles Surface, a Key Step in Drug Carrier Translation

Injectable drug nanocarriers have greatly benefited in their clinical development from the addition of a superficial hydrophilic corona to improve their cargo pharmacokinetics. The most studied and used polymer for this purpose is poly(ethylene glycol), PEG. However, in spite of its wide use for over two decades now, there is no general consensus on the optimum PEG chain coverage-density and size required to escape from the mononuclear phagocyte system and to extend the circulation time. Moreover, cellular uptake and active targeting may have conflicting requirements in terms of surface properties of the nanocarriers which complicates even more the optimization process. These persistent issues can be largely attributed to the lack of straightforward characterization techniques to assess the coverage-density, the conformation or the thickness of a PEG layer grafted or adsorbed on a particulate drug carrier and is certainly one of the main reasons why so few clinical applications involving PEG coated particle-based drug delivery systems are under clinical trial so far. The objective of this review is to provide the reader with a brief description of the most relevant techniques used to assess qualitatively or quantitatively PEG chain coverage-density, conformation and layer thickness on polymeric nanoparticles. Emphasis has been made on polymeric particle (solid core) either made of copolymers containing PEG chains or modified after particle formation. Advantages and limitations of each technique are presented as well as methods to calculate PEG coverage-density and to investigate PEG chains conformation on the NP surface.

Metabolomics analysis in rats with thiamine deficiency identifies key metabolites in vulnerable brain regions and suggests neural stem progenitor cells play a role in ameliorating metabolic dysfunction

La documentation scientifique fait état de la présence, chez l’adulte, de cellules souches et progénitrices neurales (CSPN) endogènes dans les zones sous-ventriculaire et sous-granulaire du cerveau ainsi que dans le gyrus denté de l’hippocampe. De plus, un postulat selon lequel il serait également possible de retrouver ce type de cellules dans la moelle épinière et le néocortex des mammifères adultes a été énoncé. L’encéphalopathie de Wernicke, un trouble neurologique grave toutefois réversible qui entraîne un dysfonctionnement, voire une défaillance du cerveau, est causée principalement par une carence importante en thiamine (CT). Des observations récentes laissent envisager que les facteurs en cause dans la prolifération et la différenciation des CSPN pourraient également jouer un rôle important lors d’un épisode de CT. L’hypothèse, selon laquelle l’identification de nouveaux métabolites entrant dans le mécanisme ou la séquence de réactions se soldant en une CT pourraient en faciliter la compréhension, a été émise au moyen d'une démarche en cours permettant d’établir le profil des modifications métaboliques qui surviennent en de telles situations. Cette approche a été utilisée pour constater les changements métaboliques survenus au niveau du foyer cérébral dans un modèle de rats déficients en thiamine (rats DT), particulièrement au niveau du thalamus et du colliculus inférieur (CI). La greffe de CSPN a quant à elle été envisagée afin d’apporter de nouvelles informations sur la participation des CSPN lors d’un épisode de CT et de déterminer les bénéfices thérapeutiques potentiels offerts par cette intervention. Les sujets de l’étude étaient répartis en quatre groupes expérimentaux : un premier groupe constitué de rats dont la CT était induite par la pyrithiamine (rats DTiP), un deuxième groupe constitué de rats-contrôles nourris ensemble (« pair-fed control rats » ou rats PFC) ainsi que deux groupes de rats ayant subi une greffe de CSPN, soit un groupe de rats DTiP greffés et un dernier groupe constitué de rats-contrôles (rats PFC) greffés. Les échantillons de foyers cérébraux (thalamus et CI) des quatre groupes de rats ont été prélevés et soumis à des analyses métabolomiques non ciblées ainsi qu’à une analyse visuelle par microscopie à balayage électronique (SEM). Une variété de métabolites-clés a été observée chez les groupes de rats déficients en thiamine (rats DTiP) en plus de plusieurs métabolites dont la documentation ne faisait pas mention. On a notamment constaté la présence d’acides biliaires, d’acide cynurénique et d’acide 1,9— diméthylurique dans le thalamus, alors que la présence de taurine et de carnosine a été observée dans le colliculus inférieur. L’étude a de plus démontré une possible implication des CSPN endogènes dans les foyers cérébraux du thalamus et du colliculus inférieur en identifiant les métabolites-clés ciblant les CSPN. Enfin, les analyses par SEM ont montré une amélioration notable des tissus à la suite de la greffe de CSPN. Ces constatations suggèrent que l’utilisation de CSPN pourrait s’avérer une avenue thérapeutique intéressante pour soulager la dégénérescence symptomatique liée à une grave carence en thiamine chez l’humain.

An Approach Towards The Development Of An Efficient Symmetric Key Encryption Scheme

n the recent years protection of information in digital form is becoming more important. Image and video encryption has applications in various fields including Internet communications, multimedia systems, medical imaging, Tele-medicine and military communications. During storage as well as in transmission, the multimedia information is being exposed to unauthorized entities unless otherwise adequate security measures are built around the information system. There are many kinds of security threats during the transmission of vital classified information through insecure communication channels. Various encryption schemes are available today to deal with information security issues. Data encryption is widely used to protect sensitive data against the security threat in the form of “attack on confidentiality”. Secure transmission of information through insecure communication channels also requires encryption at the sending side and decryption at the receiving side. Encryption of large text message and image takes time before they can be transmitted, causing considerable delay in successive transmission of information in real-time. In order to minimize the latency, efficient encryption algorithms are needed. An encryption procedure with adequate security and high throughput is sought in multimedia encryption applications. Traditional symmetric key block ciphers like Data Encryption Standard (DES), Advanced Encryption Standard (AES) and Escrowed Encryption Standard (EES) are not efficient when the data size is large. With the availability of fast computing tools and communication networks at relatively lower costs today, these encryption standards appear to be not as fast as one would like. High throughput encryption and decryption are becoming increasingly important in the area of high-speed networking. Fast encryption algorithms are needed in these days for high-speed secure communication of multimedia data. It has been shown that public key algorithms are not a substitute for symmetric-key algorithms. Public key algorithms are slow, whereas symmetric key algorithms generally run much faster. Also, public key systems are vulnerable to chosen plaintext attack. In this research work, a fast symmetric key encryption scheme, entitled “Matrix Array Symmetric Key (MASK) encryption” based on matrix and array manipulations has been conceived and developed. Fast conversion has been achieved with the use of matrix table look-up substitution, array based transposition and circular shift operations that are performed in the algorithm. MASK encryption is a new concept in symmetric key cryptography. It employs matrix and array manipulation technique using secret information and data values. It is a block cipher operated on plain text message (or image) blocks of 128 bits using a secret key of size 128 bits producing cipher text message (or cipher image) blocks of the same size. This cipher has two advantages over traditional ciphers. First, the encryption and decryption procedures are much simpler, and consequently, much faster. Second, the key avalanche effect produced in the ciphertext output is better than that of AES.

Role of social pressure as a key contributor of materialism and related status consumption

“At resale stores I have seen brand new clothes with original price tag still hanging from the sleeve. Some children have so many toys that they stay frustrated, not knowing which one to pick up for their next amusement. Presumably sensible adults trade in perfectly good cars just to have something shinier and newer. Didn’t us once live productive normal lives, without all these gadgets” [Cunningham (2005)]. During late eighties, nearly forty four percent of the participants, who took part in a consumer survey conducted in the US, responded positively to the question “My closets are filled with still 2 unopened items” [Faber and O’Guinn (1988)]. Reading such excerpts does not greatly surprise us anymore; as such reports have become common now. For many people shopping has moved beyond something that caters to their needs and wants and has become a hobby [Cunningham (2005)], an activity that they engage in to satisfy their hedonistic or pleasure-seeking goals [Ramnathan and Menon(2006), O’Cass and McEween (2004), Faber and O’Guinn (1989)]. Others look at their new possession as something that fills a void in their lives [Belk (1985), Diener et al. (1993)].

A key based cache replacement policy for cooperative caching in mobile ad hoc networks

Cooperative caching in mobile ad hoc networks aims at improving the efficiency of information access by reducing access latency and bandwidth usage. Cache replacement policy plays a vital role in improving the performance of a cache in a mobile node since it has limited memory. In this paper we propose a new key based cache replacement policy called E-LRU for cooperative caching in ad hoc networks. The proposed scheme for replacement considers the time interval between the recent references, size and consistency as key factors for replacement. Simulation study shows that the proposed replacement policy can significantly improve the cache performance in terms of cache hit ratio and query delay

Professional Skills and Competencies for Academic Librarian in an Electronic Environment

Development of new technologies in the field of library and information science especially in academic libraries has resulted in the need for library staff to be flexible in adopting new skills and levels of awareness. In addition to core technology skills, importance is to be given to other skills in communication, management, etc. This paper attempts to describe in brief the competencies and skills required for an academic library professional in the digital era .

Prediction of Key Symptoms of Learning Disabilities in School-Age Children Using Rough Sets

This paper highlights the prediction of learning disabilities (LD) in school-age children using rough set theory (RST) with an emphasis on application of data mining. In rough sets, data analysis start from a data table called an information system, which contains data about objects of interest, characterized in terms of attributes. These attributes consist of the properties of learning disabilities. By finding the relationship between these attributes, the redundant attributes can be eliminated and core attributes determined. Also, rule mining is performed in rough sets using the algorithm LEM1. The prediction of LD is accurately done by using Rosetta, the rough set tool kit for analysis of data. The result obtained from this study is compared with the output of a similar study conducted by us using Support Vector Machine (SVM) with Sequential Minimal Optimisation (SMO) algorithm. It is found that, using the concepts of reduct and global covering, we can easily predict the learning disabilities in children

Matrix based Key Generation to Enhance Key Avalanche in Advanced Encryption Standard

In symmetric block ciphers, substitution and diffusion operations are performed in multiple rounds using sub-keys generated from a key generation procedure called key schedule. The key schedule plays a very important role in deciding the security of block ciphers. In this paper we propose a complex key generation procedure, based on matrix manipulations, which could be introduced in symmetric ciphers. The proposed key generation procedure offers two advantages. First, the procedure is simple to implement and has complexity in determining the sub-keys through crypt analysis. Secondly, the procedure produces a strong avalanche effect making many bits in the output block of a cipher to undergo changes with one bit change in the secret key. As a case study, matrix based key generation procedure has been introduced in Advanced Encryption Standard (AES) by replacing the existing key schedule of AES. The key avalanche and differential key propagation produced in AES have been observed. The paper describes the matrix based key generation procedure and the enhanced key avalanche and differential key propagation produced in AES. It has been shown that, the key avalanche effect and differential key propagation characteristics of AES have improved by replacing the AES key schedule with the Matrix based key generation procedure

Investigation on key molecular targets responsible for antidiabetic properties of Symplocos cochinchinensis (Lour.) S. Moore

Diabetes mellitus is a heterogeneous metabolic disorder characterized by hyperglycemia with disturbances in carbohydrate, protein and lipid metabolism resulting from defects in insulin secretion, insulin action or both. Currently there are 387 million people with diabetes worldwide and is expected to affect 592 million people by 2035. Insulin resistance in peripheral tissues and pancreatic beta cell dysfunction are the major challenges in the pathophysiology of diabetes. Diabetic secondary complications (like liver cirrhosis, retinopathy, microvascular and macrovascular complications) arise from persistent hyperglycemia and dyslipidemia can be disabling or even life threatening. Current medications are effective for control and management of hyperglycemia but undesirable effects, inefficiency against secondary complications and high cost are still serious issues in the present prognosis of this disorder. Hence the search for more effective and safer therapeutic agents of natural origin has been found to be highly demanding and attract attention in the present drug discovery research. The data available from Ayurveda on various medicinal plants for treatment of diabetes can efficiently yield potential new lead as antidiabetic agents. For wider acceptability and popularity of herbal remedies available in Ayurveda scientific validation by the elucidation of mechanism of action is very much essential. Modern biological techniques are available now to elucidate the biochemical basis of the effectiveness of these medicinal plants. Keeping this idea the research programme under this thesis has been planned to evaluate the molecular mechanism responsible for the antidiabetic property of Symplocos cochinchinensis, the main ingredient of Nishakathakadi Kashayam, a wellknown Ayurvedic antidiabetic preparation. A general introduction of diabetes, its pathophysiology, secondary complications and current treatment options, innovative solutions based on phytomedicine etc has been described in Chapter 1. The effect of Symplocos cochinchinensis (SC), on various in vitro biochemical targets relevant to diabetes is depicted in Chapter 2 including the preparation of plant extract. Since diabetes is a multifactorial disease, ethanolic extract of the bark of SC (SCE) and its fractions (hexane, dichloromethane, ethyl acetate and 90 % ethanol) were evaluated by in vitro methods against multiple targets such as control of postprandial hyperglycemia, insulin resistance, oxidative stress, pancreatic beta cell proliferation, inhibition of protein glycation, protein tyrosine phosphatase-1B (PTP-1B) and dipeptidyl peptidase-IV (DPPxxi IV). Among the extracts, SCE exhibited comparatively better activity like alpha glucosidase inhibition, insulin dependent glucose uptake (3 fold increase) in L6 myotubes, pancreatic beta cell regeneration in RIN-m5F and reduced triglyceride accumulation in 3T3-L1 cells, protection from hyperglycemia induced generation of reactive oxygen species in HepG2 cells with moderate antiglycation and PTP-1B inhibition. Chemical characterization by HPLC revealed the superiority of SCE over other extracts due to presence of bioactives (beta-sitosterol, phloretin 2’glucoside, oleanolic acid) in addition to minerals like magnesium, calcium, potassium, sodium, zinc and manganese. So SCE has been subjected to oral sucrose tolerance test (OGTT) to evaluate its antihyperglycemic property in mild diabetic and diabetic animal models. SCE showed significant antihyperglycemic activity in in vivo diabetic models. Chapter 3 highlights the beneficial effects of hydroethanol extract of Symplocos cochinchinensis (SCE) against hyperglycemia associated secondary complications in streptozotocin (60 mg/kg body weight) induced diabetic rat model. Proper sanction had been obtained for all the animal experiments from CSIR-CDRI institutional animal ethics committee. The experimental groups consist of normal control (NC), N + SCE 500 mg/kg bwd, diabetic control (DC), D + metformin 100 mg/kg bwd, D + SCE 250 and D + SCE 500. SCEs and metformin were administered daily for 21 days and sacrificed on day 22. Oral glucose tolerance test, plasma insulin, % HbA1c, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total protein etc. were analysed. Aldose reductase (AR) activity in the eye lens was also checked. On day 21, DC rats showed significantly abnormal glucose response, HOMA-IR, % HbA1c, decreased activity of antioxidant enzymes and GSH, elevated AR activity, hepatic and renal oxidative stress markers compared to NC. DC rats also exhibited increased level of plasma urea and creatinine. Treatment with SCE protected from the deleterious alterations of biochemical parameters in a dose dependent manner including histopathological alterations in pancreas. SCE 500 exhibited significant glucose lowering effect and decreased HOMA-IR, % HbA1c, lens AR activity, and hepatic, renal oxidative stress and function markers compared to DC group. Considerable amount of liver and muscle glycogen was replenished by SCE treatment in diabetic animals. Although metformin showed better effect, the activity of SCE was very much comparable with this drug. xxii The possible molecular mechanism behind the protective property of S. cochinchinensis against the insulin resistance in peripheral tissue as well as dyslipidemia in in vivo high fructose saturated fat diet model is described in Chapter 4. Initially animal were fed a high fructose saturated fat (HFS) diet for a period of 8 weeks to develop insulin resistance and dyslipidemia. The normal diet control (ND), ND + SCE 500 mg/kg bwd, high fructose saturated fat diet control (HFS), HFS + metformin 100 mg/kg bwd, HFS + SCE 250 and HFS + SCE 500 were the experimental groups. SCEs and metformin were administered daily for the next 3 weeks and sacrificed at the end of 11th week. At the end of week 11, HFS rats showed significantly abnormal glucose and insulin tolerance, HOMA-IR, % HbA1c, adiponectin, lipid profile, liver glycolytic and gluconeogenic enzyme activities, liver and muscle triglyceride accumulation compared to ND. HFS rats also exhibited increased level of plasma inflammatory cytokines, upregulated mRNA level of gluconeogenic and lipogenic genes in liver. HFS exhibited the increased expression of GLUT-2 in liver and decreased expression of GLUT-4 in muscle and adipose. SCE treatment also preserved the architecture of pancreas, liver, and kidney tissues. Treatment with SCE reversed the alterations of biochemical parameters, improved insulin sensitivity by modifying gene expression in liver, muscle and adipose tissues. Overall results suggest that SC mediates the antidiabetic activity mainly via alpha glucosidase inhibition, improved insulin sensitivity, with antiglycation and antioxidant activities.

Competencies of Higher Education Graduates: A Case of Universitas Kristen Indonesia

This dissertation investigated higher education graduate competencies, acquired during their study period and required at work as perceived by the graduates themselves. This study also investigated whether graduates of professional, semiprofessional, and non-professional study programs acquired different levels of competencies during their studies and compared the gaps among the three groups of graduates. The case study is Universitas Kristen Indonesia graduates of graduation years 2001, 2003, and 2005, from the Faculties of Engineering, Economics and English, representing professional, semi-professional and nonprofessional study programs respectively.