Screening primary-care patients forgoing health care for economic reasons.

BACKGROUND: Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients' health-care needs and financial resources. OBJECTIVES: Identify a screening question to, indirectly, rule out patients' social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians' attitudes toward deprivation. DESIGN: Multicenter cross-sectional survey. PARTICIPANTS: Forty-seven general practitioners working in the French-speaking part of Switzerland enrolled a random sample of patients attending their private practices. MAIN MEASURES: Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels. KEY RESULTS: Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question "Did you have difficulties paying your household bills during the last 12 months" performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R(2) = 0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times. CONCLUSION: General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.

Acute painful diabetic neuropathy: an uncommon, remittent type of acute distal small fibre neuropathy.

INTRODUCTION: Acute painful diabetic neuropathy (APDN) is a distinctive diabetic polyneuropathy and consists of two subtypes: treatment-induced neuropathy (TIN) and diabetic neuropathic cachexia (DNC). The characteristics of APDN are (1.) the small-fibre involvement, (2.) occurrence paradoxically after short-term achievement of good glycaemia control, (3.) intense pain sensation and (4.) eventual recovery. In the face of current recommendations to achieve quickly glycaemic targets, it appears necessary to recognise and understand this neuropathy. METHODS AND RESULTS: Over 2009 to 2012, we reported four cases of APDN. Four patients (three males and one female) were identified and had a mean age at onset of TIN of 47.7 years (±6.99 years). Mean baseline HbA1c was 14.2% (±1.42) and 7.0% (±3.60) after treatment. Mean estimated time to correct HbA1c was 4.5 months (±3.82 months). Three patients presented with a mean time to symptom resolution of 12.7 months (±1.15 months). One patient had an initial normal electroneuromyogram (ENMG) despite the presence of neuropathic symptoms, and a second abnormal ENMG showing axonal and myelin neuropathy. One patient had a peroneal nerve biopsy showing loss of large myelinated fibres as well as unmyelinated fibres, and signs of microangiopathy. CONCLUSIONS: According to the current recommendations of promptly achieving glycaemic targets, it appears necessary to recognise and understand this neuropathy. Based on our observations and data from the literature we propose an algorithmic approach for differential diagnosis and therapeutic management of APDN patients.

Collaborative reflection : supporting one practitioner's development of online learning communities /

This is a study of one participant's reflective practice as she worked to develop online communities in a face-to-face science course. Her process of reflective practice was examined in order to address factors that influenced her learning path, and the benefits and challenges of collaborative action research. These research goals were pursued using a collaborative action research methodology, initially chosen for its close match with Schon's (1983) model of reflective practice. The participant's learning fit vnth Mezirow's (1991) model of transformative learning. She began with beliefs that matched her goals, and she demonstrated significant learning in three areas. First, she demonstrated instrumental learning around the constraints of workload and time, and achieving online learning community indicators. Second, she demonstrated communicative learning that helped her to see her own needs for feedback and communication more clearly, and how other process partners had been a support to her. Third, her emancipatory learning saw her revisiting and questioning her goals. It was through the reflective conversation during the planned meetings and the researcher's reframing and interrogation of that reflection that the participant was able to clarify and extend her thinking, and in so doing, critically reflect on her practice as she worked to develop online learning communities. In this way, the collaborative action research methodology was an embodiment of co-constructivism through collaborative reflective practice. Schon's (1983) model of reflective practice positions a lone practitioners moving through cycles ofplan-act-observe-reflect. The results fi"om this study suggest that collaboration is an important piece of the reflective practice model.

Physiological reactivity and the perception of emotional stimuli as they relate to social adaptive functioning after traumatic brain injury / y Melonie Jane Hopkins.

Traumatic brain injury (TBI) often affects social adaptive functioning and these changes in social adaptability are usually associated with general damage to the frontal cortex. Recent evidence suggests that certain neurons within the orbitofrontal cortex appear to be specialized for the processing of faces and facial expressions. The orbitofrontal cortex also appears to be involved in self-initiated somatic activation to emotionally-charged stimuli. According to Somatic Marker Theory (Damasio, 1994), the reduced physiological activation fails to provide an individual with appropriate somatic cues to personally-relevant stimuli and this, in turn, may result in maladaptive behaviour. Given the susceptibility of the orbitofrontal cortex in TBI, it was hypothesized that impaired perception and reactivity to socially-relevant information might be responsible for some of the social difficulties encountered after TBL Fifteen persons who sustained a moderate to severe brain injury were compared to age and education matched Control participants. In the first study, both groups were presented with photographs of models displaying the major emotions and either asked to identify the emotions or simply view the faces passively. In a second study, participants were asked to select cards from decks that varied in terms of how much money could be won or lost. Those decks with higher losses were considered to be high-risk decks. Electrodermal activity was measured concurrently in both situations. Relative to Controls, TBI participants were found to have difficulty identifying expressions of surprise, sadness, anger, and fear. TBI persons were also found to be under-reactive, as measured by electrodermal activity, while passively viewing slides of negative expressions. No group difference,in reactivity to high-risk card decks was observed. The ability to identify emotions in the face and electrodermal reactivity to faces and to high-risk decks in the card game were examined in relationship to social monitoring and empathy as described by family members or friends on the Brock Adaptive Functioning Questionnaire (BAFQ). Difficulties identifying negative expressions (i.e., sadness, anger, fear, and disgust) predicted problems in monitoring social situations. As well, a modest relationship was observed between hypo-arousal to negative faces and problems with social monitoring. Finally, hypo-arousal in the anticipation of risk during the card game related to problems in empathy. In summary, these data are consistent with the view that alterations in the ability to perceive emotional expressions in the face and the disruption in arousal to personally-relevant information may be accounting for some of the difficulties in social adaptation often observed in persons who have sustained a TBI. Furthermore, these data provide modest support for Damasio's Somatic Marker Theory in that physiological reactivity to socially-relevant information has some value in predicting social function. Therefore, the assessment of TBI persons, particularly those with adaptive behavioural problems, should be expanded to determine whether alterations in perception and reactivity to socially-relevant stimuli have occurred. When this is the case, rehabilitative strategies aimed more specifically at these difficulties should be considered.

Exploring the experience of the pioneers of change

The world of work with Western society appears to be undergoing a major change. The literature has described this phenomenon as a change from an industrialbased economy to a knowledge-based economy. This change will represent a complete transformation of the world of work; some suggest that everything we have come to accept and know as normal will change. Our present society seems to be in a period of transition. It is a time with many challenges and problems, many of which cannot be solved with thinking patterns from an old industrial-based economy. A fundamental shift in thinking patterns consistent with a new emerging world of work must take place. This change in thinking represents a fundmental shift from traditional and linear ways of seeing the world (worldview), to more holistic ways of seeing the world. In this investigation the word paradigm was used to define how people see their world. A paradigm shift is defined as a change in how a person sees their world: a change from an old to new or different way of viewing the world. Those individuals who are the first to shift their paradigm are called paradigm pioneers. These individuals do not only shift their ways of seeing the world, but they also begin to act and behave in ways consistent with the new paradigm. Thus far the research literature has adequately described the concepts of paradigms and paradigm shifts. However, little is known regarding how people actually and eventually make a shift. As it will be important for each individual to make a personal paradigm shift, then it will be extremely valuable to learn more about the process itself. The purpose of this investigation was to explore these issues in more detail and specifically, describe the experience of paradigm shifts and explore the experience of paradigm pioneers. A qualitative research methodology involving in-depth interviews was used to investigate the experiences of four participants identified as paradigm pioneers. It is interesting to note that the participants in this study did not describe an allencompassing paradigm shift. In fact, each participant, defined a paradigm shift in several different ways. They did relate several examples of paradigm shifts. However, even among these examples, there was a high degree of variability. The findings of this investigation centered upon the participants' experience as pioneers. Each pioneer shared many of the same qualities, the first quality of which described how these pioneers dealt with change. I called this a change-sense quality. The pioneers viewed change in an open and positive manner, and were also aware of change taking place in their world. Finally, they displayed an understanding of change, and a bias to take positive action in the face it. The participants also shared an inner quality. The four pioneers demonstrated a personal purpose and vision, and were selfdirected individuals. They also had an innate curiosity which translated into a love of learning. They also displayed a quality where relationships with others were highly valued. Relationships were important to the pioneers because they played a support role to help them deal with the challenges of being a pioneer. Pioneers also valued relationships because, they relied on others to make change happen. The above mentioned qualities enabled pioneers to be effective in a changing world of work. The findings from this investigation have many implications for research and practice. First, the concept of paradigms and paradigm shifts must be further researched. A great deal more must be learned in order to better understand the kind of shift individuals must make to be effective in the new world of work. Second, the qualities displayed by pioneers are important for all members of the world of work to develop. The qualities shared by pioneers appeared to represent an enduring set of traits that can possibly help individuals deal more positively with uncertainty and rapid change taking place in today's North American world of work.

Out of the darkness and into the light : a study of inauthentic and authentic speech

Introduction Man can be described as the being who shows himself in speech, and from birth to death is continually speaking. Communication is so close to us, so woven into our very being, that we have little understanding of the way it is constituted; for it is as hard to obtain distance from communication as it is to obtain distance from ourselves. All communication is not alike. There are two basic modesl of communication, the inauthentic and the authentic, between which there occurs a constant tension. It is in the inauthentic mode, points out Heidegger, that we find ourselves "proximately and for the most part"; 1. Being and Time, pg. 68 Dasein decides as to the way it will comport itself in taking up its task of having being as an issue for it. " •.• it~, in its very being 'choose' itself and win itself; it can also lose itself and never win itself or only "seem" to do so. But only in so far as it is essentially something which can be authentic--that is, something of its own--can it have lost itself and not yet won itself." 2. therefore Heidegger also terms it "everydayness".2 Caught up in the world of everydayness, our speaking covers over and conceals3 our rootedness in being, leaving us in the darkness of untruth. The image of darkness may be inferred from Heidegger's use of the image of "clearing,,4 to depict being as 2. ibid. pg. 69 "Dasein's average everydayness, however, is not to be taken as a mere 'aspect'. Here too, and even in the mode of inauthenticity, the structure of existentiality lies ~ priori and here too Dasein's being is an issue for it in a definite way; and Dasein comports itself towards it the mode of average everydayness, even if this is only the mode of fleeing in the face of it and forgetfulness thereof." 3. ibid. pg. 59 "covering over" and "concealing" are 1;yays Dasein tries to flee its task of having being as an issue for itself. " ••• This being can be covered up so extensively that it becomes forgotten and no question arises about it or its meaning ••• n How everyday speaking accomplishes this will be taken up in detail in the second chapter which explores Dasein's everyday speech. 4. ibid, pg. 171 lI ••• we have in mind nothing other than the Existential - ontological structure of this entity (Dasein), that it is in such a way as to be its 'there'. To say that it is -' illuminated' [tlerleuchtet"] means that as Being-in-theworld it is cleared [gelichtetJ in itself7 not through any other entity, but in such a way that it is itself the clearing. Only for an entity which is eXistentially cleared in this way does what is present-at-hand become accessible in the light or hidden in the dark •••• " 3 dis-coveredness and truth. Our first task will be to explore the nature of communication in general and then to explore each of the modes manifested in turn. The structure of the inauthentic mode of communication can be explored by asking the following questions: What is this speaking about? Who is it that is speaking and who is spoken to? Does this speaking show man in his speech? The authentic mode is distinguished by the rarity with which we encounter it; as the inauthentic conceals, so the authentic reveals our rootedness in being. Yet this rarity makes it difficult to delineate its elusive structure clearly. Its constituent elements can be brought into focus by asking the same questions of this mode that we previously asked of the inauthentic mode. Our initial response to the disclosure of the authentic mode is to attempt to abandon the inauthentic mode and leave the darkness behind dwelling only in the "lighted place". All through the ages, some men pushing this to extreme, have, upon uncovering their relatedness to being, experienced a deep longing to dwell in such a "place" of pure truth and oft times denigrated or attempted to exclude the everyday world. Such 4. flight is twice mistaken: first it atbempts to fix truth as unchanging and static and secondly, it opposes this to untruth which it seeks to abolish. This is both the wrong view of truth and the wrong view of untruth as Heidegger points out in The Origin of The-Work of Art: The Way-to-be of truth, i.e., of discoveredness, is under the sway of refusal. But this refusal is no lack or privation, as if truth could be simply discoveredness rid of all covers. If it could be that, it would no longer be itself . ••• Truth in its way-to-be is untruth.5 Pure light is not the nature of Being nor is pure unconcealedness possible for man. Failure to remember this is the failure to realize that communication destroys itself in such flight because it no longer maintains the contingency of its task, i.e., the dis-closedness of being. We are reminded of the strong attraction this flight from darkness held for Plato. Light, truth and Being are all beyond the darkness and have nothing to do with it. In Book VII of the R~public, Socrates' explanation of the Allegory of the Cave to Glaucon points to a decided preference men have for the "lighted place". 5. The Origin Of The Work Of Art, pg. 42 5. Come then, I said, and join me in this further thought, and do not be surprised that those who attained to this height are not willing to occupy themselves with the affairs of men, but their souls ever feel the upward urge and yearning for that sojourn above. For this, I take it, is likely if in this point too the likeliness of our image holds. 6 Despite the attraction to pure truth, human communication is more complex than putting down one mode of communication and picking up another. Due to the fact that we are always on the way, the title of my thesis will have to be amended: OUT OF THE DARKNESS AND INTO THE LIGHT--AGAIN AND AGAIN. It must be this way because this is what it means to be human. This is the point made by Mephisto to Faust in pointing out that man, standing between God and the devil, needs both darkness and light: Er findet sich in einem ewigen Gl~t Uns hat er in die Finsternis gebracht, Und euch taugt einzig Tag und Nacht. 7 6. Republic z (517 c & d) It should be noted however, that while the philosopherking must be compelled to return to the cave for purely political reasons, once he has taken adequate view of the "brightest region of being" he has the full truth and his return to darkness adds nothing to the truth. 7. Faust, pg. 188 6. This thesis proposes to examine the grounds that give rise to communication, uncovering the structure of its inauthentic and authentic modes and paying close attention to tpeir interrelationship and to their relationship to language as "the house of Being": language that both covers and opens up man's rootedness in Being, transforming him as he moves along his way, taking up his "ownmost task" of becoming who he is. roots. He is the being who shows himself inn that reflects his forgetfulness or remembrance of his rootedness in being. Man comes into an already existent world and is addressedl through things in the world which are c

A five factor model of grief : a q-methodological study /

Q-methodology permitted 41 people to communicate their perspective of grief. In an attempt to clarify the research to date and to allow those who have experienced this human journey to direct the scientists, 80 statements were chosen to present to the participants based on the research from academic and counselling sources. Five different perspectives emerged from the Q-sorts and factor analysis. Each perspective was valuable for the understanding of different groups of mourners. They were interpreted using questionnaire data and interview information. They are as follows: Factor 1- Growth Optimism; Factor 2 - Schema Destruction and Negative Affect; Factor 3- Identification with the Deceased Person; Factor 4- Intact World view with High Clarity and High Social Support; Factor 5- Schema Destruction with High Preoccupation and Attention to Emotion. Some people grow in the face of grief, others hold on to essentially the same schemas and others are devastated by their loss. The different perspectives reported herein supply clues to the sources of these differing outcomes. From examination of Factor 1, it appears that a healthy living relationship helps substantially in the event of loss. An orientation toward emotions that encourages clarity, exemplified by Factor 4, without hyper-vigilance to emotion may be helpful as well. Strategies for maintaining schematic representations of the world with little alteration include: identification with the values of the deceased person, as in Factor 3 and reliance on social support and/or God as demonstrated by Factor 4. When the relationship had painful periods, social support may be accessed to benefit some mourners. When the person's frame of reference or higher order schemas are assaulted by the events of loss, the people most at risk for traumatic grief seem to be those with difficult relationships as indicated by Factor 5 individuals. When low social support, high attention to emotion with low clarity and little belief that feelings can be altered for the better are also attributes of the mourner devastating grief can result. In the end, there are groups of people who are forced to endure the entire process of schema destruction and devastation. Some appear to recover in part and others appear to stay in a form of purgatory for many years. The results of this study suggest that, those who experience devastating grief may be in the minority. In the future interventions could be more specifically addressed if these perspectives are replicated in a larger, more detailed study.

Facing Aggression: Cues Differ for Female versus Male Faces

The facial width-to-height ratio (face ratio), is a sexually dimorphic metric associated with actual aggression in men and with observers’ judgements of aggression in male faces. Here, we sought to determine if observers’ judgements of aggression were associated with the face ratio in female faces. In three studies, participants rated photographs of female and male faces on aggression, femininity, masculinity, attractiveness, and nurturing. In Studies 1 and 2, for female and male faces, judgements of aggression were associated with the face ratio even when other cues in the face related to masculinity were controlled statistically. Nevertheless, correlations between the face ratio and judgements of aggression were smaller for female than for male faces (F1,36= 7.43, p= 0.01). In Study 1, there was no significant relationship between judgements of femininity and of aggression in female faces. In Study 2, the association between judgements of masculinity and aggression was weaker in female faces than for male faces in Study 1. The weaker association in female faces may be because aggression and masculinity are stereotypically male traits. Thus, in Study 3, observers rated faces on nurturing (a stereotypically female trait) and on femininity. Judgements of nurturing were associated with femininity (positively) and masculinity (negatively) ratings in both female and male faces. In summary, the perception of aggression differs in female versus male faces. The sex difference was not simply because aggression is a gendered construct; the relationships between masculinity/femininity and nurturing were similar for male and female faces even though nurturing is also a gendered construct. Masculinity and femininity ratings are not associated with aggression ratings nor with the face ratio for female faces. In contrast, all four variables are highly inter-correlated in male faces, likely because these cues in male faces serve as ‘‘honest signals’’.

Asymmetries of Influence: Differential Effects of Body Postures on Perceptions of Emotional Facial Expressions

The accuracy and speed with which emotional facial expressions are identified is influenced by body postures. Two influential models predict that these congruency effects will be largest when the emotion displayed in the face is similar to that displayed in the body: the emotional seed model and the dimensional model. These models differ in whether similarity is based on physical characteristics or underlying dimensions of valence and arousal. Using a 3- alternative forced-choice task in which stimuli were presented briefly (Exp 1a) or for an unlimited time (Exp 1b) we provide evidence that congruency effects are more complex than either model predicts; the effects are asymmetrical and cannot be accounted for by similarity alone. Fearful postures are especially influential when paired with facial expressions, but not when presented in a flanker task (Exp 2). We suggest refinements to each model that may account for our results and suggest that additional studies be conducted prior to drawing strong theoretical conclusions.

The role of skeletal muscle PLIN proteins at rest and following lipolytic stimulation

This thesis investigated the subcellular location of skeletal muscle PLIN proteins (PLIN2, PLIN3, and PLIN5) as well as protein interactions with ATGL and HSL at rest and following lipolytic stimulation. In addition, the serine phosphorylation state of PLIN2, PLIN3, and PLIN5 was determined at rest and following lipolytic stimulation. An isolated whole muscle technique was used to study the effects of contraction and epinephrine-induced lipolysis. This method allowed for the examination of the effects of contraction and epinephrine alone and in combination. Further, the soleus was chosen for investigating the role of PLIN proteins in skeletal muscle lipolysis due to its suitability for isolated incubation, and the fact that it is primarily oxidative in nature (~80% type I fibres). It has also been previously shown to have the greatest reliance on lipid metabolism and for this reason is ideal for investigating the role of PLIN proteins in lipolysis. Immunofluorescence microscopy revealed that skeletal muscle lipid droplets are partially co-localized to both PLIN2 and PLIN5 and that contraction does not affect the amount of colocalization, indicating that PLIN5 is not recruited to lipid droplets with contraction (PLIN2 ~65%; PLIN5 ~56%). Results from the immunoprecipitation studies revealed that with lipolysis in skeletal muscle the interaction between ATGL and CGI-58 is increased (study 2: 128% with contraction, p<0.05; study 3: 50% with contraction, 25% epinephrine, 80% contraction + epinephrine, p>0.05). Further PLIN2, PLIN3, and PLIN5 all interact with ATGL and HSL, while only PLIN3 and PLIN5 interact with CGI-58. Among these interactions, the association between PLIN2 and ATGL decreases with lipolytic stimulation (study 2: 21% with contraction, p<0.05). Finally our results demonstrate that PLIN3 and PLIN5 are serine phosphorylated at rest and that the level of phosphorylation remains unchanged in the face of either contractile or adrenergic stimulation. In summary, the regulation of skeletal muscle lipolysis is a complex process involving multiple proteins and enzymes. The skeletal muscle PLIN proteins likely play a role in skeletal muscle lipid droplet dynamics, and the data from this thesis indicate that these proteins may work together in regulating lipolysis by interaction with both ATGL and HSL.

Étude du rôle des professionnels de l'information dans les systèmes d'information Web du Gouvernement fédéral canadien

Les professionnels de l'information traversent actuellement une période de redéfinition de leur profession provoquée par la transformation de l'information et des processus informationnels vers un mode de plus en plus électronique. Les systèmes d'information Web (SIW) — c'est-à-dire des systèmes d'information basés sur les technologies Web tels que les sites Web externes, les intranets, les systèmes de commerce électronique et les extranets — font partie des technologies à l'origine de ces changements. Ces systèmes sont de plus en plus adoptés par les organisations et, en particulier, par les gouvernements dans leur volonté de devenir électroniques. Le gouvernement fédéral canadien est reconnu comme un des plus innovateurs en matière de SIW et doit adapter son environnement informationnel, dont font partie les professionnels de l'information, à l'introduction de ces systèmes. Malgré l'innovation que les SIW représentent, peu d'études empiriques ont été menées pour identifier quels sont les intervenants nécessaires à leur mise en place. Aucun consensus n'émerge de la littérature quant à la nature de l'intervention des professionnels de l'information dans ces systèmes. Cette recherche vise à accroître les connaissances sur l'intervention des professionnels de l'information dans les SIW. Pour les besoins de cette recherche, les professionnels de l'information sont définis comme les personnes ayant une maîtrise en bibliothéconomie et sciences de l'information ou toute autre formulation équivalente. Cette recherche étudie quatre questions de recherche qui portent sur : (1) les rôles des professionnels de l'information décrits dans les politiques d'information pan-gouvernementales liées aux SIW ainsi que ceux des autres intervenants mentionnés en lien direct avec les SIW, (2) les types de SIW dans lesquels les professionnels de l'information interviennent, (3) les tâches des professionnels de l'information dans ces SIW, et (4) les autres intervenants qui travaillent dans ces systèmes. Une approche qualitative a été utilisée pour répondre à ces questions et implique quatre modes de collecte des données : (1) des entrevues en profondeur en personne avec des professionnels de l'information impliqués dans des SIW, (2) une analyse des SIW où interviennent ces professionnels de l'information, (3) une analyse des politiques pan-gouvernementales liées aux SIW, et (4) la documentation pertinente. Les professionnels de l'information rencontrés proviennent de sept ministères du gouvernement fédéral canadien, ministères retenus pour leur implication dans les SIW. Les résultats indiquent que les professionnels de l'information rencontrés interviennent dans les SIW aux niveaux micro et macro, c'est-à-dire dans des SIW spécifiques ainsi que globalement au niveau de l'ensemble des SIW d'un ministère ou du gouvernement fédéral. Ces professionnels de l'information sont impliqués dans toutes les dimensions et les phases de développement des SIW. Les tâches liées au contenu sont prédominantes mais les tâches technologiques sont aussi très présentes. Trois variables se dégagent de cette étude qui ont un impact sur l'intervention des professionnels de l'information dans les SIW : les types de SIW, les types de postes occupés par les professionnels de l'information et les types de gouvernance.

Les cadres intermédiaires et l’information : modélisation des comportements informationnels de cadres intermédiaires d’une municipalité en transformation

Un atout majeur des organisations consiste en leur capacité à créer et exploiter l’information et les connaissances, capacité déterminée entre autres par les comportements informationnels. Chargés de décisions stratégiques, tactiques et opérationnelles, les cadres intermédiaires sont au cœur du processus de création des connaissances, et leurs comportements informationnels doivent être soutenus par des systèmes d’information. Toutefois, leurs comportements informationnels sont peu documentés. La présente recherche porte sur la modélisation des comportements informationnels de cadres intermédiaires d’une organisation municipale. Plus spécifiquement, elle examine comment ces cadres répondent à leurs besoins d’information courante dans le contexte de leurs activités de gestion, c’est-à-dire dans leur environnement d’utilisation d’information. L’étude répond aux questions de recherche suivantes : (1) Quelles sont les situations problématiques auxquelles font face les cadres intermédiaires municipaux ? (2) Quels sont les besoins informationnels exprimés par les cadres intermédiaires municipaux lors de situations problématiques ? (3) Quelles sont les sources d’information qui soutiennent les comportements informationnels des cadres intermédiaires municipaux ? Cette recherche descriptive s’inscrit dans une approche qualitative. Les 21 cadres intermédiaires ayant participé à l’étude proviennent de deux arrondissements d’une municipalité québécoise fusionnée en 2002. Les modes de collecte de données sont l’entrevue en profondeur en personne et l’observation directe auprès de ces cadres, et la collecte de documentation pertinente. L’incident critique est utilisé comme technique de collecte de données et comme unité d’analyse. Les données recueillies font l’objet d’une analyse de contenu qualitative basée sur la théorisation ancrée. Les résultats indiquent que les rôles de gestion proposés dans les écrits pour les cadres supérieurs s’appliquent aussi aux cadres intermédiaires, bien que le rôle conseil ressorte comme étant particulier à ces derniers. Ceux-ci ont des responsabilités de gestion aux trois niveaux d’intervention opérationnel, tactique et stratégique, bien qu’ils œuvrent davantage au plan tactique. Les situations problématiques dont ils sont chargés s’inscrivent dans l’environnement d’utilisation d’information constitué des composantes suivantes : leurs rôles et responsabilités de gestion et le contexte organisationnel propre à une municipalité en transformation. Les cadres intermédiaires ont eu à traiter davantage de situations nouvelles que récurrentes, caractérisées par des sujets portant principalement sur les ressources matérielles et immobilières ou sur des aspects d’intérêt juridique, réglementaire et normatif. Ils ont surtout manifesté des besoins pour de l’information de nature processuelle et contextuelle. Pour y répondre, ils ont consulté davantage de sources verbales que documentaires, même si le nombre de ces dernières reste élevé, et ont préféré utiliser des sources d’information internes. Au plan théorique, le modèle de comportement informationnel proposé pour les cadres intermédiaires municipaux enrichit les principales composantes du modèle général d’utilisation de l’information (Choo, 1998) et du modèle d’environnement d’utilisation d’information (Taylor, 1986, 1991). L’étude permet aussi de préciser les concepts d’« utilisateur » et d’« utilisation de l’information ». Au plan pratique, la recherche permet d’aider à la conception de systèmes de repérage d’information adaptés aux besoins des cadres intermédiaires municipaux, et aide à évaluer l’apport des systèmes d’information archivistiques à la gestion de la mémoire organisationnelle.

La justification du droit d'auteur dans l'environnement numérique

"Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de Maître en droit (L.L.M.) option Technologies de l'information"

La souffrance et les vieux

L’expérience de souffrance des vieux, en perte d’autonomie physique, vivant dans un CHSLD comprend deux dimensions : la souffrance et les vieux. Les deux sont liées. L’hypothèse sur le sens de la souffrance tient compte de celui que les vieux ont donné et donnent à leur vie. Le sens de la souffrance dépend de celui de la vie. Selon qu’on est plutôt individualiste, humaniste agnostique ou humaniste religieux, le sens de la souffrance prend une couleur particulière. Tour à tour, le mémoire examine les deux parties du problème de recherche, dresse un portrait des vieux de l’an 2008, propose un fondement théorique au projet de recherche, établit un arrimage de sens entre la souffrance des vieux et le sens de leur vie. La vie des vieux en CHSLD est en discontinuité avec leur existence antérieure : leurs valeurs et leur rythme de vie sont remis en question. Leur présence dans une résidencesubstitut invite à une réflexion sur la place des vieux dans la société individualiste contemporaine et sur l’humanisation des services. Comment concilier individualisme et humanisation ? Comment vivre avec la perte de son autonomie, une souffrance globale, un certain isolement, ... ? Autant de sujets et d’enjeux qui interrogent l’ensemble de la société. Les personnes âgées réclament un entourage empathique, des intervenants dynamiques, des politiques de santé qui font de ces centres de vrais milieux de vie et de soins. Il s’agit d’une responsabilité collective face au mouvement d’exclusion sociale.

Le cyberpunk vernaculaire de l’Amérique latine : dystopies, virtualités et résistances

Héritière de la tradition fantastique borgésienne, imprégnée d’une réalité composée de mythes précolombiens et des résidus industriels de la modernité, et développée à l’ère de la mondialisation, du post-modernisme, des jeux vidéos, du cinéma numérique et d’animation, la tendance cyberpunk latino-américaine est cultivée du Mexique jusqu’en Argentine, en passant par Cuba et d’autres pays souvent méconnus dans le monde de la science-fiction comme le Paraguay et la Bolivie. Pressenti dans les œuvres de certains écrivains canoniques comme Ricardo Piglia, Carmen Boullosa ou Edmundo Paz-Soldán, le cyberpunk se manifeste avec force dans l’écriture de jeunes artistes interdisciplinaires et de collaborateurs assidus des fanzines. Cette adaptation du sous-genre dans un continent où la référence reste encore le réel merveilleux et le réalisme magique, malgré l’apport des générations plus récentes comme celle de « McOndo » ou celle du « Crack », essaie d’élaborer une série de réponses aux questions issues de la conjoncture historique et artistique dans laquelle nous vivons : comment situer l’identité latino-américaine dans la nouvelle cartographie culturelle mondiale à travers une littérature qui cherche à se renouveler par rapport au canon littéraire et à la marginalité de son propre genre? Quelles sont les stratégies d’assimilation et de résistance qu’adoptent des jeunes auteurs latino-américains devant le cyberpunk anglo-américain littéraire et cinématographique? Peut-on parler d’un impact esthétique et philosophique du cyberpunk sur la culture latino-américaine, perçue habituellement comme une consommatrice passive de ces produits culturels et non comme une productrice? Ce travail cherche à parcourir l’ensemble de ces questions à partir d’une réflexion sur les principaux dispositifs constitutifs du cyberpunk – la dystopie et la virtualité – dans les discours (post)identitaires en Amérique Latine. Représentation presque mimétique de l’espace socioculturel et historique latino-américain à travers la violence et la répression politique, militaire, ethnique ou sexuelle, la dystopie est un moyen d’articuler certaines figures spatiales aux mythes nationaux et à la politique identitaire dans le contexte de la mondialisation. Cette dernière réalité socioculturelle, ainsi que l’idéologie esthétique que véhicule celle-ci à travers le cyberpunk, crée un conflit avec ces discours identitaires nationaux, conflit qui est accentué ou dissous par la représentation de la réalité virtuelle. La réalité virtuelle, comprise ici comme la direction que le récit prend pour défaire ou consolider la figure dystopique, mène à réfléchir également sur les enjeux de la (post)identité. Penser à une (post)identité (en gardant bien à l’esprit cette parenthèse) à travers le cyberpunk signifie poser une question sur la résistance au passé identitaire des mythes nationaux, au présent de la mondialisation culturelle, et aux discours post-humanistes qui semblent marquer le futur. À l’appui de travaux sur la dystopie et la réalité virtuelle dans le cyberpunk anglo-américain, ainsi que des études culturelles latino-américaines, je parcourrai un corpus composé des romans écrits entre 1990 et 2005. Ce corpus comprendra La Primera Calle de la Soledad (1993) de Gerardo Horacio Porcayo, Santa Clara Poltergeist (1991) de Fausto Fawcett, Ygdrasil (2005) de Jorge Baradit, et les films argentins No muera sin decirme adónde vas (1992) d’Eliseo Subiela et La sonámbula (1998) de Fernando Spiner. Dans ces oeuvres, la dystopie se configure aux possibilités narratives de la virtualité et traverse des thématiques identitaires comme les mythes sexuels et nationaux, la mémoire et le traumatisme ainsi que les projets utopiques des minorités.