Les mécanismes visant à assurer la qualité et la sécurité des soins en CMS sont-ils suffisants?

Résumé : Par l’adoption des Projets de loi 33 et 34, en 2006 et 2009 respectivement, le gouvernement du Québec a créé de nouvelles organisations privées dispensatrices de soins spécialisés, soient les centres médicaux spécialisés. Il a de ce fait encadré leur pratique, notamment dans l’objectif d’assurer un niveau de qualité et de sécurité satisfaisant des soins qui y sont dispensés. L’auteure analyse les différents mécanismes existants pour assurer la qualité et la sécurité des soins offerts en centres médicaux spécialisés, afin de constater si l’objectif recherché par le législateur est rencontré. Ainsi, elle expose les mécanismes spécifiques prévus dans la Loi sur les services de santé et services sociaux applicables aux centres médicaux spécialisés qui jouent un rôle quant au maintien de la qualité et de la sécurité des services, de même que des mécanismes indirects ayant une incidence sur ce plan, tels que la motivation économique et les recours en responsabilité. Ensuite, elle s’attarde aux processus issus de la règlementation professionnelle. Elle arrive à la conclusion que deux mécanismes sont manquants pour rencontrer l’objectif visé par le législateur et propose, à ce titre, des pistes de solution.

Low spatial frequency filtering modulates early brain processing of affective complex pictures

Recent research on affective processing has suggested that low spatial frequency information of fearful faces provide rapid emotional cues to the amygdala, whereas high spatial frequencies convey fine-grained information to the fusiform gyrus, regardless of emotional expression. In the present experiment, we examined the effects of low (LSF, <15 cycles/image width) and high spatial frequency filtering (HSF, >25 cycles/image width) on brain processing of complex pictures depicting pleasant, unpleasant, and neutral scenes. Event-related potentials (ERP), percentage of recognized stimuli and response times were recorded in 19 healthy volunteers. Behavioral results indicated faster reaction times in response to unpleasant LSF than to unpleasant HSF pictures. Unpleasant LSF pictures and pleasant unfiltered pictures also elicited significant enhancements of P1 amplitudes at occipital electrodes as compared to neutral LSF and unfiltered pictures, respectively; whereas no significant effects of affective modulation were found for HSF pictures. Moreover, mean ERP amplitudes in the time between 200 and 500ms post-stimulus were significantly greater for affective (pleasant and unpleasant) than for neutral unfiltered pictures; whereas no significant affective modulation was found for HSF or LSF pictures at those latencies. The fact that affective LSF pictures elicited an enhancement of brain responses at early, but not at later latencies, suggests the existence of a rapid and preattentive neural mechanism for the processing of motivationally relevant stimuli, which could be driven by LSF cues. Our findings confirm thus previous results showing differences on brain processing of affective LSF and HSF faces, and extend these results to more complex and social affective pictures.

L’accès aux ressources alimentaires : facteurs prédicteurs de l’insécurité alimentaire sévère parmi les ménages bénéficiers des programmes communautaires en sécurité alimentaire à Montréal

Objectif : Examiner la relation entre l’accès aux ressources alimentaires et le degré de l’insécurité alimentaire du ménage parmi les nouveaux utilisateurs des organismes communautaires d’intervention en sécurité alimentaire de Montréal. Méthode : Étude observationnelle transversale. Elle consiste en une analyse secondaire de données (n=785) qui proviennent du premier temps de mesure de l’enquête sur les effets des interventions en sécurité alimentaire à Montréal menée entre 2011 et 2012. La variable dépendante a été l’insécurité alimentaire. Les variables indépendantes ont été le mode de transport utilisé pour transporter les aliments, l’emplacement de l’épicerie la plus fréquentée par le participant, la distance entre l’organisme communautaire fréquenté par le participant et son domicile, la proximité de l’épicerie la plus fréquentée, la satisfaction quant à l’acceptabilité et le caractère abordable des aliments dans l’épicerie la plus fréquentée, et les difficultés d’accès aux aliments. Des régressions logistiques furent effectuées afin d’évaluer la relation entre les variables indépendantes et le degré de l’insécurité alimentaire, en utilisant l’insécurité sévère comme catégorie de référence. Résultats : Nos données suggèrent que la sévérité de l’insécurité alimentaire est associée à la difficulté d’accès aux aliments à cause de la cherté des aliments (pour la sécurité alimentaire, OR=0.13; CI : 0.07-0.25 et pour l’insécurité alimentaire modérée, OR=0.42; CI : 0.28-0.63), au fait de faire l’épicerie à l’extérieur du quartier ou de faire rarement l’épicerie (pour l’insécurité alimentaire modérée, OR=0.50, CI : 0.30-0.84), au fait d’avoir accès au transport collectif (pour l’insécurité alimentaire modérée, OR=1.73; CI : 1.09-2.73), au fait de résider à une distance moyenne (soit entre 1000 et 2000 mètres) d’un organisme communautaire en sécurité alimentaire (pour l’insécurité alimentaire modérée, OR=1.83; CI : 1.14-2.92), et à la difficulté d’accès aux aliments à cause de contraintes de transport (pour la sécurité alimentaire, OR=0.18, CI : 0.06-0.52). Conclusion : L’accès aux ressources alimentaires est associé au degré de l’insécurité alimentaire des nouveaux ménages participant aux interventions en sécurité alimentaire à Montréal.

The impact of CLIL: affective factors, content-related vocabulary & gender differences

[EN] The experiment discussed in this paper is a direct replication of Finkbeiner (2005) and an indirect replication of Jiang and Forster (2001) and Witzel and Forster (2012). The paper explores the use of episodic memory in L2 vocabulary processing. By administering an L1 episodic recognition task with L2 masked translation primes, reduced reaction times would suggest L2 vocabulary storage in episodic memory. The methodology follows Finkbeiner (2005), who argued that a blank screen introduced after the prime in Jiang Forster (2001) led to a ghosting effect, compromising the imperceptibility of the prime. The results here mostly corroborate Finkbeiner (2005) with no significant priming effects. While Finkbeiner discusses his findings in terms of the dissociability of episodic and semantic memory, and discounts Jiang and Forster’s (2001) results to participants’ strategic responding, I add a layer of analysis based on declarative and procedural constituents. From this perspective, Jiang and Forster (2001) and Witzel and Forster’s (2012) results can be seen as possible episodic memory activation, and Finkbeiner’s (2005) and my lack of priming effects might be due to the sole activation of procedural neural networks. Priming effects are found in concrete and abstract words but require verification through further experimentation.

A Feminist Affective Turn for Public Relations: Mothers, Passionate Publics, and the Childhood Vaccine Debate

This project proposes a feminist intervention in how affect and publics are theorized in public relations research. Drawing from extant literature, I argue that public relations theories of affect and publics have been apolitical and lack depth and context (Leitch & Motion, 2010a). Using the context of the online childhood vaccine debate, I illustrate several theories and concepts of the new feminist affective turn, as well as postmodern theories of affect, relevant to public relations research: (a) Public Feelings, “ugly” feelings, agency, and community (Cvetkovich, 2012; Ngai, 2007); (b) passionate politics (Mouffe, 2014); (c) postmodern assemblages, biopower, and body politics (Deleuze & Guattari, 1988; Foucault, 1984); (d) affective facts and logics of future threats (Massumi, 2010); and (e) affective ethics (Bertleson & Murphie, 2010). Scholarship in the areas of public relations, risk, feminist and postmodern affect theory, and the vaccine debate provided theoretical grounding for this project. My research questions asked: How is feminist affect theory embodied by mothers in the vaccine debate? How do mothers understand risks as affective facts in the vaccine debate (if at all)? What affective logics are used by mothers in the vaccine debate (if any)? And, What are sources of knowledge for mothers in the vaccine debate? Multi-sited online ethnographic methods were used to explore how feminist affect theory contributes to public relations research, including 29 one-on-one in-depth interviews with mothers of young children and participant observation of 15 online discussions about vaccines on parenting websites BabyCenter.com, TheBump.com, and WhatToExpect.com. I used snowball sampling to recruit interview participants and grounded theory (Glaser & Strauss, 1967) to analyze interview and online data. Results show that feminist affect theory contributes to theoretical and practical knowledge in public relations by politicizing and contextualizing understandings of publics and elucidating how affective facts and logics inform publics’ knowledge and choices, specifically in the context of risk. I also found evidence of suppression of dissent (Martin, 2015) and academic bias in vaccine debate research, which resulted in cultures of silence. Further areas of study included how specific contexts such as motherhood and issues of privilege and access affect publics’ experiences, knowledges, and choices.

Flooded with Information from Social Media: Effects of Disaster Information Source and Visuals on Viewers' Cognitive, Affective, and Behavioral Responses

While a variety of crisis types loom as real risks for organizations and communities, and the media landscape continues to evolve, research is needed to help explain and predict how people respond to various kinds of crisis and disaster information. For example, despite the rising prevalence of digital and mobile media centered on still and moving visuals, and stark increases in Americans’ use of visual-based platforms for seeking and sharing disaster information, relatively little is known about how the presence or absence of disaster visuals online might prompt or deter resilience-related feelings, thoughts, and/or behaviors. Yet, with such insights, governmental and other organizational entities as well as communities themselves may best help individuals and communities prepare for, cope with, and recover from adverse events. Thus, this work uses the theoretical lens of the social-mediated crisis communication model (SMCC) coupled with the limited capacity model of motivated mediated message processing (LC4MP) to explore effects of disaster information source and visuals on viewers’ resilience-related responses to an extreme flooding scenario. Results from two experiments are reported. First a preliminary 2 (disaster information source: organization/US National Weather Service vs. news media/USA Today) x 2 (disaster visuals: no visual podcast vs. moving visual video) factorial between-subjects online experiment with a convenience sample of university students probes effects of crisis source and visuals on a variety of cognitive, affective, and behavioral outcomes. A second between-subjects online experiment manipulating still and moving visual pace in online videos (no visual vs. still, slow-pace visual vs. still, medium-pace visual vs. still, fast-pace visual vs. moving, slow-pace visual vs. moving, medium-pace visual vs. moving, fast-pace visual) with a convenience sample recruited from Amazon’s Mechanical Turk (mTurk) similarly probes a variety of potentially resilience-related cognitive, affective, and behavioral outcomes. The role of biological sex as a quasi-experimental variable is also investigated in both studies. Various implications for community resilience and recommendations for risk and disaster communicators are explored. Implications for theory building and future research are also examined. Resulting modifications of the SMCC model (i.e., removing “message strategy” and adding the new category of “message content elements” under organizational considerations) are proposed.

THE INFLUENCE OF MOTIVATION ON EMOTION REGULATION AND MOTOR PERFORMANCE: EXAMINATION OF A NEURO-AFFECTIVE MODEL

Mental stress is known to disrupt the execution of motor performance and can lead to decrements in the quality of performance, however, individuals have shown significant differences regarding how fast and well they can perform a skilled task according to how well they can manage stress and emotion. The purpose of this study was to advance our understanding of how the brain modulates emotional reactivity under different motivational states to achieve differential performance in a target shooting task that requires precision visuomotor coordination. In order to study the interactions in emotion regulatory brain areas (i.e. the ventral striatum, amygdala, prefrontal cortex) and the autonomic nervous system, reward and punishment interventions were employed and the resulting behavioral and physiological responses contrasted to observe the changes in shooting performance (i.e. shooting accuracy and stability of aim) and neuro-cognitive processes (i.e. cognitive load and reserve) during the shooting task. Thirty-five participants, aged 18 to 38 years, from the Reserve Officers’ Training Corp (ROTC) at the University of Maryland were recruited to take 30 shots at a bullseye target in three different experimental conditions. In the reward condition, $1 was added to their total balance for every 10-point shot. In the punishment condition, $1 was deducted from their total balance if they did not hit the 10-point area. In the neutral condition, no money was added or deducted from their total balance. When in the reward condition, which was reportedly most enjoyable and least stressful of the conditions, heart rate variability was found to be positively related to shooting scores, inversely related to variability in shooting performance and positively related to alpha power (i.e. less activation) in the left temporal region. In the punishment (and most stressful) condition, an increase in sympathetic response (i.e. increased LF/HF ratio) was positively related to jerking movements as well as variability of placement (on the target) in the shots taken. This, coupled with error monitoring activity in the anterior cingulate cortex, suggests evaluation of self-efficacy might be driving arousal regulation, thus affecting shooting performance. Better performers showed variable, increasing high-alpha power in the temporal region during the aiming period towards taking the shot which could indicate an adaptive strategy of engagement. They also showed lower coherence during hit shots than missed shots which was coupled with reduced jerking movements and better precision and accuracy. Frontal asymmetry measures revealed possible influence of the prefrontal lobe in driving this effect in reward and neutral conditions. The possible interactions, reasons behind these findings and implications are discussed.

Psychological Ownership of Employees as a Mediator in the Justice - Affective Commitment Relationship

Numerous scholars have accumulated evidence on the positive effects that employees' organizational justice perceptions exert on work-related outcomes such as affective commitment. However, research still lacks understanding of the underlying mechanisms connecting the two constructs. In this article we aim to narrow this gap by examining the concept of psychological ownership as a possible mediator between organizational justice perceptions and affective commitment. Investigating a sample of 619 employees, we find distributive justice to be positively related to psychological ownership, and observe psychological ownership as a full mediator of the distributive justice and affective commitment relationship. These insights offer a new explanation in understanding the justice-commitment connection, contributing to both organizational justice and psychological ownership literature and opening up ways for promising future research

Les échecs de la mission canadienne en Afghanistan : déficits de sécurité humaine

La mission canadienne en Afghanistan constitue la plus longue intervention étrangère de l'histoire du pays et a été marquée par un effort important dans la province de Kandahar depuis 2006. Aujourd'hui, il s'avère que la mission à Kandahar présente des échecs importants. Afin d'appréhender la nature de ces échecs, ce travail propose des pistes de réflexions pour améliorer notre compréhension face à cet enjeu. Pour ce faire, le mémoire se questionne à savoir dans quelle mesure le Canada a-t-il respecté l'approche de sécurité humaine au sein de sa mission à Kandahar? La mission britannique dans la province de Helmand en Afghanistan est également utilisée comme outil de comparaison. En guise d'hypothèse, il est proposé que le Canada n'a pas respecté l'approche de sécurité humaine et que cela pourrait contribuer à la compréhension des échecs de la mission à Kandahar. D'abord, les bilans détaillés de ces missions sont présentés et il est démontré que la mission britannique a connu un meilleur bilan que la mission canadienne. Ensuite, à l'aide de la méthode de l'analyse de contenu et d'un codage, les missions canadiennes et britanniques sont analysées afin de déterminer leur correspondance respective face à l'approche de sécurité humaine. Les résultats démontrent que la mission britannique respecte l'approche de sécurité humaine de façon plus importante que la mission canadienne. Finalement, une analyse documentaire propose des pistes de réflexions afin de comprendre en quoi ce déficit de sécurité humaine pourrait permettre d'expliquer les échecs de cette mission lors de futures recherches. Ce mémoire apporte donc deux conclusions. D'abord, la mission canadienne n'a pas respecté l'approche de sécurité humaine malgré le fait que le Canada ait affirmé l'avoir fait. De plus, il est clair que le non-respect de l'approche de sécurité humaine constitue une avenue intéressante afin de comprendre les insuccès canadiens.

Étude sur la sécurité dynamique : le cas de Cité-des-Prairies

Travail dirigé présenté à la Faculté des études supérieures en vue de l’obtention du grade de maître ès sciences (M.Sc.) en criminologie option sécurité intérieure

Off-line and On-line Affective Recognition of a Computer User through A Biosignal Processing Approach

Physiological signals, which are controlled by the autonomic nervous system (ANS), could be used to detect the affective state of computer users and therefore find applications in medicine and engineering. The Pupil Diameter (PD) seems to provide a strong indication of the affective state, as found by previous research, but it has not been investigated fully yet. In this study, new approaches based on monitoring and processing the PD signal for off-line and on-line affective assessment (“relaxation” vs. “stress”) are proposed. Wavelet denoising and Kalman filtering methods are first used to remove abrupt changes in the raw Pupil Diameter (PD) signal. Then three features (PDmean, PDmax and PDWalsh) are extracted from the preprocessed PD signal for the affective state classification. In order to select more relevant and reliable physiological data for further analysis, two types of data selection methods are applied, which are based on the paired t-test and subject self-evaluation, respectively. In addition, five different kinds of the classifiers are implemented on the selected data, which achieve average accuracies up to 86.43% and 87.20%, respectively. Finally, the receiver operating characteristic (ROC) curve is utilized to investigate the discriminating potential of each individual feature by evaluation of the area under the ROC curve, which reaches values above 0.90. For the on-line affective assessment, a hard threshold is implemented first in order to remove the eye blinks from the PD signal and then a moving average window is utilized to obtain the representative value PDr for every one-second time interval of PD. There are three main steps for the on-line affective assessment algorithm, which are preparation, feature-based decision voting and affective determination. The final results show that the accuracies are 72.30% and 73.55% for the data subsets, which were respectively chosen using two types of data selection methods (paired t-test and subject self-evaluation). In order to further analyze the efficiency of affective recognition through the PD signal, the Galvanic Skin Response (GSR) was also monitored and processed. The highest affective assessment classification rate obtained from GSR processing is only 63.57% (based on the off-line processing algorithm). The overall results confirm that the PD signal should be considered as one of the most powerful physiological signals to involve in future automated real-time affective recognition systems, especially for detecting the “relaxation” vs. “stress” states.

A study of employee affective organisational commitment and retention in Pakistan:the roles of psychological contract breach and norms of reciprocity

Social exchange theory and notions of reciprocity have long been assumed to explain the relationship between psychological contract breach and important employee outcomes. To date, however, there has been no explicit testing of these assumptions. This research, therefore, explores the mediating role of negative, generalized, and balanced reciprocity, in the relationships between psychological contract breach and employees’ affective organizational commitment and turnover intentions. A survey of 247 Pakistani employees of a large public university was analyzed using structural equation modeling and bootstrapping techniques, and provided excellent support for our model. As predicted, psychological contract breach was positively related to negative reciprocity norms and negatively related to generalized and balanced reciprocity norms. Negative and generalized (but not balanced) reciprocity were negatively and positively (respectively) related to employees’ affective organizational commitment and fully mediated the relationship between psychological contract breach and affective organizational commitment. Moreover, affective organizational commitment fully mediated the relationship between generalized and negative reciprocity and employees’ turnover intentions. Implications for theory and practice are discussed.

Les échecs de la mission canadienne en Afghanistan : déficits de sécurité humaine

La mission canadienne en Afghanistan constitue la plus longue intervention étrangère de l'histoire du pays et a été marquée par un effort important dans la province de Kandahar depuis 2006. Aujourd'hui, il s'avère que la mission à Kandahar présente des échecs importants. Afin d'appréhender la nature de ces échecs, ce travail propose des pistes de réflexions pour améliorer notre compréhension face à cet enjeu. Pour ce faire, le mémoire se questionne à savoir dans quelle mesure le Canada a-t-il respecté l'approche de sécurité humaine au sein de sa mission à Kandahar? La mission britannique dans la province de Helmand en Afghanistan est également utilisée comme outil de comparaison. En guise d'hypothèse, il est proposé que le Canada n'a pas respecté l'approche de sécurité humaine et que cela pourrait contribuer à la compréhension des échecs de la mission à Kandahar. D'abord, les bilans détaillés de ces missions sont présentés et il est démontré que la mission britannique a connu un meilleur bilan que la mission canadienne. Ensuite, à l'aide de la méthode de l'analyse de contenu et d'un codage, les missions canadiennes et britanniques sont analysées afin de déterminer leur correspondance respective face à l'approche de sécurité humaine. Les résultats démontrent que la mission britannique respecte l'approche de sécurité humaine de façon plus importante que la mission canadienne. Finalement, une analyse documentaire propose des pistes de réflexions afin de comprendre en quoi ce déficit de sécurité humaine pourrait permettre d'expliquer les échecs de cette mission lors de futures recherches. Ce mémoire apporte donc deux conclusions. D'abord, la mission canadienne n'a pas respecté l'approche de sécurité humaine malgré le fait que le Canada ait affirmé l'avoir fait. De plus, il est clair que le non-respect de l'approche de sécurité humaine constitue une avenue intéressante afin de comprendre les insuccès canadiens.

Étude sur la sécurité dynamique : le cas de Cité-des-Prairies

Travail dirigé présenté à la Faculté des études supérieures en vue de l’obtention du grade de maître ès sciences (M.Sc.) en criminologie option sécurité intérieure

Les consultants face aux défis d’implantation de la Réforme du Secteur de la Sécurité (RSS)

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de Maître ès sciences (M. SC.) en Criminologie, option Sécurité Intérieure