Le dossier de santé électronique (DSE) représente une application importante des technologies de l’information et des communications (TIC) pour le secteur des soins de santé. Le DSE est considéré comme ayant un grand potentiel pour améliorer la qualité, la continuité, la sécurité et l’efficacité des soins de santé. Or, ces avantages ne peuvent être atteints sans une implantation adéquate qui doit passer obligatoirement par l’adoption du DSE par les professionnels de la santé, notamment par les médecins qui en sont les principaux utilisateurs. La présente étude a pour but d’explorer la contribution des facteurs organisationnels dans la prédisposition organisationnelle à l’adoption et l’utilisation du DSE par les médecins dans les organisations de soins de santé de première ligne de l’est du Québec. Nous avons mené une étude quantitative exploratoire auprès des décideurs de 24 organisations de soins de première ligne de l’est du Québec. La collecte de données a été réalisée à l’aide d’un questionnaire adapté au contexte québécois et au secteur de la santé, et dont les caractéristiques psychométriques ont été vérifiées par la même occasion. La collecte de données a été réalisée entre mai et juillet 2011. Les analyses des données ont été effectuées dans le but d’améliorer l’outil de mesure, de démontrer sa validité sur le plan psychométrique et d’établir la pertinence du modèle théorique proposé. Nous avons mené des statistiques descriptives et nous avons exploré les corrélations possibles entre les différentes variables mesurées et la qualité de l’utilisation du DSE dans les organisations participantes. Notre travail a permis de traduire au français et d’adapter au contexte québécois un nouvel instrument de mesure pour évaluer la prédisposition organisationnelle à l’adoption des TIC au Québec. Nous avons pu mener la majorité des étapes de validation transculturelle de l’instrument élaboré. Les résultats de cette étude sont en accord avec les données de la littérature et permettent de noter une corrélation significative entre l’efficacité de la mise en œuvre et le climat de l’implantation. Aucune corrélation significative n’a été notée entre l’efficacité de l’implantation du DSE et les autres construits du modèle. Ces résultats fournissent des pistes intéressantes afin de poursuivre la recherche sur la prédisposition organisationnelle à l’adoption du DSE et contribuent à la compréhension des facteurs liés à l’implantation du DSE dans les organisations de soins de santé de première ligne au Québec. / Electronic health records (EHR) are an important application of information and communications technology (ICT) for the health care sector. The EHR is considered to have great potential to improve the quality, continuity, safety and effectiveness of health care. However, these benefits cannot be achieved without proper implementation witch must necessarily pass through the adoption of EHR by health care professionals, notably by physicians who are the main users. This study aims to explore the contribution of organizational factors in organizational readiness for adoption and use of EHR by physicians in primary health care facilities in eastern Quebec. We conducted an exploratory quantitative survey among decision-makers from 24 primary care organizations in eastern Quebec. Data collection was performed using a questionnaire adapted to the Quebec context and the health sector, and whose psychometric properties were tested at the same time. Data collection was conducted between May and July 2011. The data analysis was conducted to improve the measurement tool, and to demonstrate its psychometric validity and the relevance of the theoretical model proposed. We performed descriptive statistics and exploratory correlation analyses. Our results are consistent with the literature and we can note a significant correlation between the effectiveness of the implementation and the climate for implementation. However, only the dimension “time for utilisation” of the “climate for implementation” construct predicts the quality of the use of EHR by physicians. No significant correlations were noted between the effectiveness of the implementation and the other constructs. These results provide interesting avenues for further research on organizational readiness for EHR adoption and contribute to our understanding of organizational factors related to the implementation of the EHR in primary care organizations of Quebec.

No description available.

L’objectif de cette étude est de dresser un portrait du fonctionnement des adultes ayant subi un TCC léger à sévère. Un échantillon de 152 adultes ayant subi un TCC a été séparé en trois groupes d’âge et a été évalué un an après l’accident. Les effets de l’âge, de la sévérité du traumatisme et l’interaction entre l’âge et la sévérité ont été examinés pour des variables liés aux caractéristiques sociodémographiques et cliniques ainsi qu’au fonctionnement psychologique, physique, occupationnel, social et cognitif, évalué à l’aide d’une entrevue diagnostique pour les troubles psychiatriques de l’axe 1 du DSM-IV et de questionnaires auto-rapportés. Les résultats démontrent des différences sur le fonctionnement entre les groupes d’âge et de sévérité, ce qui permet de cibler les groupes plus à risque de développer des problèmes à la suite de l’accident et ainsi adapter les interventions auprès de ceux-ci.

Made available in DSpace on 2015-04-14T13:54:58Z (GMT). No. of bitstreams: 1 411013.pdf: 564182 bytes, checksum: c4b1a24a95bad17c417660dc3fd51af8 (MD5) Previous issue date: 2008-11-15 / Neste trabalho abordamos, na obra de F. Schiller, a reflex?o est?tica da arte e do belo. Saber e conhecer, sentimento e princ?pios, mat?ria e forma, sentir e pensar, s?o constituintes do homem em igualdade e medida, segundo Schiller, e constituem aqui o foco principal de nosso interesse. A arte e o belo relacionam-se intimamente no homem f?sico e moral. O impulso sens?vel e formal equilibram-se em unidade no impulso da beleza, l?dico e arte. A beleza por si s? seria suficiente para tir?-lo do estado natural e do estado passivo, ao que o belo leva-o a frui??o e ao jogo. Afian?a Schiller que, nele, o jogo suporta o fundamento da sua reflex?o filos?fica. No impulso est?tico, os impulsos vitais implicam-se e fundam-se a um s? tempo no ?nimo e no pensamento, na forma livre das coa??es externas. N?o obstante a vontade, querer e fazer implicam-se na reciprocidade est?tica, na conquista da autonomia e da liberdade do fazer-se humano e suas lides

Thesis (Ph. D.)--Rijksuniversiteit te Utrecht, 1988. / Includes bibliographical references (p. 233-242) and index.

Made available in DSpace on 2014-08-20T13:32:45Z (GMT). No. of bitstreams: 1 tese_daiane_de_pinho_benemann.pdf: 2735667 bytes, checksum: 56ce2e3c78770a1745bd363c525c5392 (MD5) Previous issue date: 2012-05-24 / Gerbera is one of the most important plants in the global ornamental market. Due to fierce competition in this market, obtaining different genotypes is necessary. Therefore, information on the genetic variability of this species may help breeding programs in order to select new promising genotypes. This study aimed to develop EST-SSR markers for gerbera, and to check the genetic variability among accessions by multivariate analysis using morphological (qualitative and quantitative), and molecular markers. Also to analyze the correlation between morphological and molecular markers to elucidate the genetic variability of Gerbera spp.. As a result, 17 EST-SSR markers were developed for use in studies of molecular characterization. These were highly polymorphic and allowed the differentiate of all gerbera accessions. The analysis of morphological (quantitative and qualitative) characters, by means of multivariate analysis and principal components enabled the delection of a wide genetic variability among accessions of gerbera. The correlation analysis between morphological characters show that there is some influence on other characters. The analysis of molecular and morphological data, using the sum of the dissimilarity matrices, it was possible to obtain a better grouping of the accessions studied. The results of this study may assist gerbera breeding programs in the selection of parental genotypes for controlled crossings. / A gérbera é uma das plantas mais importantes no mercado mundial de ornamentais. Dada a grande concorrência nesse mercado, a obtenção de genótipos diferenciados é uma necessidade constante, sendo assim, informações sobre a variabilidade genética desta espécie podem auxiliar programas de melhoramento, visando a seleção de novos genótipos promissores. No presente estudo buscou-se desenvolver marcadores EST-SSR para gérbera, com os objetivos de caracterizar molecularmente esta espécie, verificar a variabilidade genética entre acessos, por meio da análise multivariada utilizando caracteres morfológicos (qualitativos e quantitativos), analisar a correlação entre os caracteres morfológicos e moleculares para uma melhor elucidação da variabilidade genética de Gerbera spp.. Como resultados, 17 marcadores EST-SSRs foram desenvolvidos para uso em estudos de caracterização molecular. Estes foram altamente polimórficos e capazes de diferenciar todos os acessos de gérbera. A análise dos caracteres morfológicos (quantitativos e qualitativos), por meio de análise multivariada e componentes principais, possibilitou verificar a existência de ampla variabilidade genética entre os acessos de gérbera. Através da correlação entre os caracteres morfológicos, constatou-se que existe influência de alguns caracteres sobre outros. Na análise conjunta dos dados moleculares e morfológicos, por meio da soma das matrizes de dissimilaridade, foi possível obter um melhor agrupamento entre os acessos estudados. Os resultados obtidos neste estudo poderão auxiliar programas de melhoramento genético de gérbera na seleção de progênies promissoras para cruzamentos controlados.

Doctorat en sciences sociales, politiques et économiques / info:eu-repo/semantics/nonPublished

Orientadores: Anete Pereira de Souza, Antonio Augusto Franco Garcia / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-08T00:10:19Z (GMT). No. of bitstreams: 1 Oliveira_KarineMiranda_D.pdf: 6932327 bytes, checksum: 92b9fb104f8543695a1c804fd65bf912 (MD5) Previous issue date: 2006 / Resumo: A cana-de-açúcar (Saccharum spp.) está entre as espécies de maior importância econômica no mundo, constituindo uma das principais fontes de produção de açúcar e álcool. Apesar do Brasil ocupar posição de destaque, como o maior produtor mundial, os níveis de produtividade são considerados baixos. Os programas de melhoramento para obtenção de novas variedades de cana-de-açúcar, mais produtivas e resistentes a pragas e doenças, podem ser acelerados com o desenvolvimento de marcadores genéticos, PCR específicos, fortemente ligados a genes que controlam as características de interesse. A utilização de marcadores em estudos de mapeamento genético e de QTL¿s (Quantitative Trait Loci) tem proporcionado um importante progresso no conhecimento da estrutura genômica e na genética da cana-de-açúcar. Sabe-se que os ESTs (Expressed Sequence Tags) apresentam grande potencial para serem utilizados com tais finalidades. O projeto de seqüenciamento de ESTs (SUCEST), do programa Genoma da FAPESP, identificou cerca de 43 mil clusters que representam os genes de cana-de-açúcar, potenciais para serem utilizados no desenvolvimento de marcadores genéticos. Neste contexto, o presente trabalho teve como objetivo desenvolver e mapear marcadores EST-SSRs em uma progênie derivada do cruzamento entre duas variedades pré-comerciais de cana-de-açúcar, complementando os programas de mapeamento genético desta população. Uma busca no banco de dados do SUCEST resultou na identificação de marcadores microssatélites ou SSRs (Single sequence repeats) em 2005 clusters. Trezentos e setenta e dois locos EST-SSRs foram desenvolvidos e analisados e, destes, 149 foram selecionados para estudo de mapeamento genético. Um total de 2303 marcadores polimórficos (SSRs, EST-SSRs, RFLPs, EST-RFLPs e AFLPs) foi identificado nos 100 indivíduos da progênie F1, dos quais 1669 (72%) eram marcadores em dose simples (1:1 e 3:1), segregantes na população. As análises de mapeamento foram baseadas na metodologia de identificação de marcadores em dosagem única no genoma, com o auxílio dos programas JoinMap (versão 3.0) e OneMap. Para a formação dos grupos de co-segregação (GCs) utilizou-se LOD 5 e fração de recombinação de 0.35. A função de mapeamento de Kosambi foi adotada para conversão das freqüências de recombinação em distâncias de mapa em centiMorgans (cM). Dos 1669 marcadores segregantes, 664 (40%) foram distribuídos em 192GCs, gerando um mapa com 6261.1 cM de comprimento. Os 192 GCs foram agrupados em 14 prováveis grupos de homologia. Cento e treze dos 149 EST-SSRs avaliados foram mapeados e apresentaram homologia a genes conhecidos de outras espécies. A adição dos marcadores provenientes de seqüências expressas, aumentou a cobertura e densidade do mapa prévio desta população, possibilitando também a construção do primeiro mapa funcional de cana-de-açúcar. Os EST-SSRs desenvolvidos têm potencial de utilização na detecção de QTL¿s associados a características de importância econômica para a cultura da cana-de-açúcar / Abstract: Sugarcane (Saccharum spp.) is one of the most important cash crops, highly contributing towards the production of raw sugar and bioethanol produced worldwide. Even though Brazil is the major producer, sugar yield is considered low. Breeding programs for the attainment of new improved sugarcane varieties, which are more productive and more resistant to plagues and illnesses, could be sped up with the development of genetic markers that are PCR-specific and strongly linked to genes that control the desired agronomic traits. The use of genetic markers in genetic mapping and QTL (Quantitative Trait Loci) studies has allowed important progress in the knowledge of the genomic structure and genetics of sugarcane. It is a known fact that the ESTs (Expressed Sequence Tags) have great potential to be used with such purposes. The Sugarcane Expressed Sequence Tag Project (SUCEST) has identified about 43000 clusters that represent the sugarcane genes with a potential to be used in the development of genetic markers. In this context, the objective of the present work was to develop and map EST-SSR markers in a progeny obtained by the cross between two pre-commercial sugarcane varieties, complementing the genetic mapping programs of this population. A search in the SUCEST database resulted on the identification of the microssatellites or SSR (Single sequence repeats) markers in 2005 clusters. Thus, three hundred and seventy two EST-SSR loci had been developed and analyzed and, out of these, 149 were selected for mapping analyses. A total of 2303 polymorphic markers (SSRs, EST-SSRs, RFLPs, EST-RFLPs and AFLPs) were identified among the 100 F1 individuals, of which 1669 (72.5%) were single dose (SD ¿ segregated 1:1 and 3:1) markers. Map analyses were carried out using JoinMap (version 3.0) and OneMap algorithm, based on a single-dose marker approach. The linkage relationships of simplex markers were determined at a LOD score threshold of 5 and a recombination fraction threshold of 0.35 and map distances were derived from the recombination fraction using the Kosambi function. Out of these 1669 SD markers, 664 (40%) were scattered onto 192 co-segregation groups (CGs) with a total estimated map length of 6261.1 cM. Using both genomic and EST-derived SSR and RFLP, 120 of the 192 CGs were formed into fourteen putative homology groups (HGs). One hundred and thirteen of the 149 EST-SSRs evaluated were mapped and presented homology to previously studied genes of other species. The addition of the EST-derived markers increased the coverage and density of the previous map of this population, which also enabled the construction of the first functional linkage sugarcane map. The EST-SSRs developed have the potential to be used in the detection of QTLs associated to important economic traits for sugarcane culture / Doutorado / Genetica Vegetal e Melhoramento / Doutor em Genetica e Biologia Molecular

Un des objectifs ultimes en écologie évolutive est de comprendre les mécanismes responsables du maintien de la biodiversité en milieu naturel. La biodiversité englobe la diversité des écosystèmes, des espèces, des populations et aussi la diversité génétique associée à une espèce donnée. Même à l’intérieur d’une espèce, on peut observer une grande diversité de phénotypes et de génotypes résultant de l’interaction entre la sélection naturelle, le flux génique, la dérive génétique et les mutations. L’objectif central de cette thèse est d’évaluer la variabilité génétique et le potentiel d’adaptation chez le saumon atlantique, Salmo salar, en milieu naturel. L’analyse de 51 rivières à saumon aux marqueurs microsatellites révèle une structure de populations hiérarchique et suggère l’existence de sept groupes régionaux au Québec, Labrador et Nouveau-Brunswick, Canada. Les analyses en génétique du paysage suggèrent l’influence prédominante du flux génique et de l’adaptation thermique dans l’établissement de la différentiation génétique. Des évidences indirectes suggèrent également que les immigrants provenant d’un autre groupe régional ont un succès reproducteur moindre dans leur nouveau milieu que les résidents. Différents niveaux de structuration génétique ont aussi été observés à l’intérieur même de certaines rivières, remettant en cause la gestion par rivière chez cette espèce. La variabilité à grande échelle d’un gène d’immunocompétence, le gène du Complexe Majeur d’Histocompatibilité (CMH) classe IIβ, démontre que la diversité génétique au CMH augmente avec la température et la diversité bactérienne présente en rivière, contrairement au patron observé aux microsatellites. L’augmentation de la diversité au CMH avec la température est plus prononcée aux sites de liaison aux pathogènes qu’aux autres sites moléculaires, suggérant une influence plausible de la diversité des pathogènes, elle-même dépendante de la température, sur l’adaptation locale du saumon atlantique. Finalement, l’étude des infections pathogéniques chez les saumons juvéniles révèle un taux d’infection accru en début de saison estivale dans les rivières de la rive sud du Saint-Laurent, concordant avec les pressions de sélection du milieu. Un parasite prédominant et possiblement récemment introduit, un myxozoaire du genre Myxobolus, a été découvert chez les jeunes saumons et deux allèles CMH ont été identifiés comme étant associés à la résistance et à la susceptibilité face à cette infection, suggérant l’importance de la variation génétique présente au CMH pour faire face aux pathogènes dans un contexte de changement environnemental. Cette thèse ajoute à notre compréhension sur les mécanismes qui maintiennent la variabilité génétique et influencent l’adaptation locale chez le saumon atlantique sauvage grâce à des analyses novatrices en génétique du paysage, en structure de population et sur les patrons spatio-temporels d’infection en milieu naturel. / One of the central endeavors in evolutionary ecology is to understand the mechanisms responsible for natural biodiversity. Biodiversity is defined as the combined diversity of ecosystems, species, populations and the genetic diversity within a given species. Even within a species, a wide diversity of phenotypes and genotypes is often observed, resulting from the interaction between natural selection, gene flow, genetic drift and mutations. The central objective of this thesis was to assess the genetic variability and evaluate the potential for local adaptation in wild Atlantic salmon, Salmo salar. Analyses of neutral molecular markers in 51 salmon rivers revealed a hierarchical genetic structure and suggested the existence of seven regional groups in Québec, Labrador and New-Brunswick, Canada. Landscape genetic analyses suggested a predominant influence of gene flow and thermal regime adaptation in maintaining genetic differentiation. Indirect evidence also suggested that immigrants from a different regional group were less successful in establishing in the new environment compared to residents. Different extents of genetic structure were also found within some river systems, questioning the river-based management approach in Atlantic salmon. Large scale genetic variability at an immuno-competence gene, the Major Histocompatibility Complex (MHC) class IIβ gene, revealed that genetic diversity increased with increasing temperature and bacterial diversity in rivers contrary to patterns with neutral microsatelite markers. This increase in MHC diversity with temperature was more pronounced at the peptide-binding region involved in pathogen binding than at other molecular sites. These results agree with the hypothesized influence of temperature-associated pathogen diversity on local adaptation in Atlantic salmon. Finally, pathogen infections in juvenile salmon were found to be more frequent at the beginning of the summer in southern rather than northern rivers, in concordance with pathogen selection pressure in the wild. A predominant and possibly introduced pathogen, a myxozoa of the genus Myxobolus, was identified in juvenile salmon and two MHC alleles were found to be associated with resistance and susceptibility to that infection, suggesting the importance of MHC standing genetic variation for facing pathogens in a changing environment. This thesis contributes to our understanding on mechanisms maintaining genetic variability and influencing local adaptation in wild Atlantic salmon through analyses in landscape genetics, genetic population structure and patterns of spatio-temporal infectivity in nature.

Au Canada, il est estimé que 14 à 26 % des enfants de la population générale ont un parent atteint d’un trouble de santé mentale majeur, ce qui représente environ 12 000 enfants dans la région de Québec. Malgré les nombreuses recherches dans le domaine, les effets de vivre avec un parent atteint d’un tel trouble demeurent encore méconnus. En ce sens, la présente recherche a pour but d’explorer le vécu d’adultes ayant grandi avec un parent atteint d’un trouble de santé mentale majeur. Plus spécifiquement, les questions de recherche sont les suivantes : 1) Quels événements et points tournants ont influencé le parcours de vie de ces adultes? 2) Comment les relations familiales et sociales évoluent-elles pour eux? 3) Quelles distinctions dans leur vécu permettent de comprendre le fonctionnement global « allant bien » par rapport à celui « allant moins bien »? Pour ce faire, des entrevues semi-structurées auprès de douze participants, dont une moitié a été jugée comme « allant moins bien » et l’autre moitié comme « allant bien » par des informateurs clés, ont été réalisées. Par l’intermédiaire de la théorie du parcours de vie, une analyse par thématique a été effectuée. Cette dernière fait ressortir la prise de conscience du trouble mental du parent comme point tournant dans le parcours de vie des participants ainsi que les effets positifs et négatifs de leurs différentes relations familiales et sociales. Finalement, peu d’éléments différencient le groupe jugé comme « allant bien » de celui « allant moins bien ». / In Canada, it is estimated that 14 to 26 % of children within the general population have a parent with a mental illness, which represents approximately 12 000 children in Quebec region. Despite numerous studies on this subject, the effects of living with a parent with mental illness are not well known. The aim of this research is to explore the experience of adults who grew up with one mentally ill parent. More specifically, the research questions are: 1) What are the events and turning points that have influenced the life course of those adults? 2) How do the familial and social relationships evolved? 3) What are the distinctions between the group considered as “well-being” and the other considered as “not so well”? To do so, semi-structured interviews have been conducted among twelve participants, half of which being considered as “well-being” and the other half as “not so well”. According to the life course theory, thematic analysis was applied. This helped identifying the awareness of the parent’s illness as a turning point in the life course of the participants and the positive and negative effects of relationships with family members and other social relationships. Finally, results show that the elements studied do not differentiate the group considered “going well” from the one “not so well” in a life course perspective.