Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal.

The number of patients with diabetes mellitus has been increasing recently. The so-called diabetic leg and related amputation treatment belong to the complications of the disease. Amputation or removal of the end part of a limb obviously affects not only the physical aspect of a patient, but also the psychical, social and spiritual aspects. It is therefore vital that each nurse is able to choose from suitable techniques of communication with such patients and to provide them with sufficient support in the adaptation to a new life role. Callista Roy also dealt with this issue and developed a model named after her, which can be applied to patients adapting to a newly arisen situation, which amputation of a lower limb definitely is. Three goals were set in the thesis. The first one was to find out what kind of problems patients after amputation of a lower limb see in the individual adaptation modes according to C. Roy. Then we focused on the interventions applied by nurses to the support for the adaptation in the individual adaptation modes and to what extent nurses work with stimuli in Roy's conception. The research was based on the data collection by means of a qualitative method, the techniques of semi-structured interviews, and involved observation of patients after amputation of a lower limb and of nurses working at a standard surgery department. After the saturation of the research sample set the data was analysed and processed by means of the "pencil & paper" method. The research has shown that nurses devote particular attention to the physiologic adaptation mode and to the interdependence mode in their practice. In terms of the satisfaction of the basic physiologic needs they mostly mentioned the assistance in self-service activities, in the sphere of excretion and very often also interventions contributing to pain relief. In the self-concept group identity adaptation mode nurses mostly apply suitable communication and provision of sufficient information. In terms of the role function adaptation mode we can say that nurses search for this kind of information, but no activity supporting this mode was found among the nurses. Unlike nurses, who pay the highest attention to the satisfaction of the physiologic adaptation mode and thereto related interdependence mode, patients see shortcomings in all four adaptation modes. In the physiologic adaptation mode patients mostly pointed out problems with movement manifested themselves in the deficit of self-care. In the sphere of self-concept group identity, they mentioned the feeling of helplessness and inferiority. Nearly all patients see a problem in the dependence on the nursing staff and the disability to play the roles once played. Among the most frequent stimuli affecting a patient after lower limb amputation are pains that nurses relieve by means of analgesics prescribed by physicians, patients also often mention the approach of the staff and social interaction owing to the absence of family members. The research has shown that nurses approach patients with dignity and also respect the incoming visitors. The information obtained by this research can be used as a basis for seminars focused on this issue and lead to the improvement of the nursing care about patients with amputation of a lower limb.

Thesis advisor: Barbara E. Wolfe / Despite the chronicity and less than optimal outcomes of inpatient treatment (IPT) for anorexia nervosa (AN), treatment guidelines continue to reflect the common notion of one-size-fits-all and the process of weight restoration continues to be poorly understood. Weight restoration, a primary goal of IPT for AN, does not occur in isolation but rather reflects an adaptation process within internal and external environments. It is unknown whether or not there are unique patterns of change in body weight that are associated with factors identified in the existing literature as being predictors of weight gain. The purpose of this study was to explore the extent to which patterns of change in body weight existed among individuals during IPT for AN, and the relationship with factors identified in the existing literature as being predictors of weight gain (i.e., age at time of admission, admission caloric intake, percent of ideal body weight [IBW] at time of admission, body weight at time of discharge, body mass index [BMI] at time of discharge). Individuals who were diagnosed with AN and admitted to the inpatient unit of an eating disorder treatment facility in the Northeast between January 1, 2012 to December 31, 2015 were included in this retrospective, exploratory study (N = 500). Group-based trajectory modeling (GBTM) was used to identify distinct trajectories of change in body weight, and to determine the risk of being in a particular trajectory. Four distinct trajectories were identified: weight gain (n = 197), weight loss (n = 177), weight plateau (n = 82), and weight fluctuate (n = 44) groups. Significant predictors of trajectories were age, history of prior IPT for AN, admission caloric intake, body weight at time of admission and discharge, and length of stay. Results from this study suggest that a further understanding of patterns of change in body weight among individuals with AN, will help guide assessment and treatment interventions and consequently influence outcomes. Additionally, there is an opportunity to update treatment guidelines and recommendations for AN. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Callista Roy / <bold>Problem</bold>: Cancer patients lack information and support needed to make the transition to survivorship. This problem was addressed by testing a psycho-educational group intervention, the Mid-Life Directions Workshop, for its effect on hope and quality of life in midlife cancer survivors. <bold>Participants</bold>: Twenty-six midlife adults (23 women, 3 men, mean age = 54.3 years, range 40-65) with breast cancer (n = 19), colorectal cancer (n = 4), lung cancer (n = 2), and malignant melanoma (n = 1) stages I, II and III were recruited from two hospital-affiliated Cancer Centers in the Northeastern United States. Mean time since completion of active primary treatment was 11.5 months (SD = 6.67, range, 0-28 months). Most participants were non-Hispanic (96.2%) and white (100%) with some college or a college degree (88.5%). <bold>Method</bold>: A multimethod experimental design randomly assigned 17 participants to the treatment group, receiving the workshop in six 2-hour sessions, and 9 participants to the control group, receiving a nutrition program in six 1-hour sessions. Hope was measured pre- and post-intervention using the Herth Hope Index as was quality of life using the Quality of Life Instrument, Patient/Cancer Survivor Version. Written reflections were created by treatment group participants post-intervention. <bold>Findings</bold>: The quantitative measures revealed a significant increase in hope (p = .047) for the control group. The treatment group reported positive effects on hope and quality of life by means of written reflections. Six themes emerged: 1) examining what is, 2) feeling connected, 3) accepting what is, even the painful, 4) embracing one's life experiences, 5) exploring new possibilities, and 6) moving forward with enthusiasm. <bold>Implications</bold>: The Mid-Life Directions Workshop demonstrated positive effects on hope and quality of life for this group of midlife cancer survivors. The richness of the qualitative findings highlights the importance of multimethod design for future studies. The Nutrition Program also merits further study. This study provides an increased understanding of interventions that may support hope in midlife cancer survivors following active primary treatment. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

In this dissertation I analyze the figure of the East-Bengali refugee woman in Indian literature on the Partition of Bengal of 1947. I read the figure as one who makes visible, and thus opens up for critique, the conditions that constitute the category women in the discursive terrain of post-Partition/post-Independence India. The figure of the refugee woman, thereby, allows us to map the relationship between the category women and the collective imaginary, specifically the nation. I argue that the figure of the refugee woman explicates, interrupts, and critiques the relationship of women to the nation in the normative patriarchal nationalist discourse, which constructs women as a sign of the nation. The representational import of the refugee woman pushes the signification of women in relation to the collective from a sign to that of a subject. My analysis of the refugee woman is, thus, a critical engagement with the tension between women as figurative and women as historical-material categories, although both are imagined within the field of discursive signification. I develop my argument by analyzing three major texts from West Bengal, India that respond to the Partition to critically apprehend the radical charge inherent in the figure of the refugee woman. These texts are the film Meghe Dhaka Tara (Cloud-Capped Star; 1960) by Ritwik Ghatak, and the novels Epar Ganga, Opar Ganga (The River Churning; 1967) by Jyotirmoyee Devi and Swaralipi (The Notations; 1952) by Sabitri Roy. The larger argument of the dissertation is that the Partition, as a historical event, lies in contiguity and continuity with the normative regime of the gendered everyday world. Therefore, the Partition allows us to examine the historical configurations of power that make the gendered everyday but that cannot be easily discerned from within the everyday. Within the rubric of this larger argument lies my contention that the figure of the refugee woman has the radical potential to make visible the traumatic relationship between the extraordinary violence of the Partition and the gendered, ordinary, everyday life.

Abe Gaustad's first collection of stories, Welcome to Boomland, explores the lives of disparate characters longing for some escape. Whether a paraplegic blues aficionado or a boy who finds a strange object in the woods, they are each searching for a way out of their stagnation. Yet each character is trapped by their own unique circumstance: some of them by their mistakes, some by ruthless dictators, some by the very notion of death. As they search for their freedom, they find out new things about themselves and manage to wage quiet rebellions against those that would control them. In the end, they earn small victories, but noble ones.

This thesis presents an analysis of Edmund Burke's place in intellectual history by examining his commentary on the French Revolution as well as his role in the Enlightenment itself. In doing so, it brings to bear the previously unexplored ideas of the twentieth-century historian Roy Porter. The thesis proposes that Burke's indictment of French philosophy as the cause of the French Revolution created enduring historiographic connotations between radicalism and the notion of enlightenment. Consequently, British thinkers of the eighteenth-century were invariably dismissed as conservative or reactionary and therefore unworthy to be regarded as enlightened figures. Porter's reconsideration of the British Enlightenment reveals Burke to be a staunch defender of hard-won enlightened values which British society had already long enjoyed.<p>The source material is, for the most part, primary. For Edmund Burke, his correspondence and his Reflections on the Revolution in France. For Roy Porter, his most relevant essays, journal articles and monographs.

Les vieillards occupent une place importante dans les écrits autobiographiques de Gabrielle Roy. À travers le regard de la narratrice et à la lumière des théories narratologiques, cette étude cherche à définir la représentation de ces aînés fictifs et réels par l'analyse des caractéristiques physiques et des indices des caractères. L'étude porte sur les romans autobiographiques La Route d'Altamont et Rue Deschambault et l'autobiographie La Détresse et l'Enchantement. Au terme de la recherche sur les personnages, inspirée des théories narratologiques ainsi que des théories de la réception en ce qui a trait au rôle du lecteur, nous constaterons quels sont les caractéristiques et les indices récurrents qui participent à la construction de la représentation des vieillards. L'étape ultime de cette analyse devrait permettre d'établir une distinction entre la représentation des vieillards issus de la famille de la narratrice et ceux de l'extérieur, selon le point de vue de la narratrice. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Vieillards, représentation, caractérisation, indices, effet-personnage

The last two decades have brought about significant changes in the resource planning environment of electric power utilities throughout the world. The conventional generation technologies that have been the backbone of every electric utility i.e., coal, hydro, nuclear, oil and natural gas, are being re-examined to address environmental concerns and resource utilization. The research described in this thesis focuses on the adequacy and economic assessment of non-utility generation (NUG) and demand-side management (DSM) initiatives within a typical power system. The main objective was to examine and extend the ability of the contingency enumeration approach to evaluate the economic reliability benefits of incorporating NUG and DSM options separately or jointly in composite system adequacy assessment. Two test systems were employed in the evaluations. The studies undertaken in this thesis demonstrate the need for accurate load model representations which clearly reflect the mix of customer sectors at each bus.Chronological hourly load curves were developed for each load bus in the test systems recognizing the individual load profiles of the customers. The adequacy and economic implications of demand-side management initiatives in the test systems were examined at each load point in the composite generation and transmission configuration. This thesis illustrates the development of techniques by which system planners and operators can incorporate reliability cost/worth assessment power system applications. Focus is placed in the thesis on the utilization of reliability cost/worth concepts in integrated resource planning in the form of NUG additions and DSM initiatives. Methods for the joint implementation of NUG and DSM options in a composite power system are presented and examples from the studies conducted are used to illustrate the procedures. Studies are presented which illustrate the impacts of NUG additions and DSM initiatives on the test system planning reserve margins (PRM) and on the total societal cost of electrical energy. The total evaluated cost incorporates the explicit cost associated with customer failures but does not include the cost associated with DSM program implementation. The results of the studies conducted show that NUG facilities and DSM programs can have considerable reliability and economic impacts on electric power systems.

This thesis presents an analysis of Edmund Burke's place in intellectual history by examining his commentary on the French Revolution as well as his role in the Enlightenment itself. In doing so, it brings to bear the previously unexplored ideas of the twentieth-century historian Roy Porter. The thesis proposes that Burke's indictment of French philosophy as the cause of the French Revolution created enduring historiographic connotations between radicalism and the notion of enlightenment. Consequently, British thinkers of the eighteenth-century were invariably dismissed as conservative or reactionary and therefore unworthy to be regarded as enlightened figures. Porter's reconsideration of the British Enlightenment reveals Burke to be a staunch defender of hard-won enlightened values which British society had already long enjoyed.<p>The source material is, for the most part, primary. For Edmund Burke, his correspondence and his Reflections on the Revolution in France. For Roy Porter, his most relevant essays, journal articles and monographs.