Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

A previous population-based study of survival in Chronic Lymphocytic Leukemia (CLL) patients in the province of Manitoba demonstrated a lower five-year relative survival among CLL patients compared with the age- and gender-adjusted general population. This decreased relative survival was most pronounced among elderly male CLL patients. In this study, we have demonstrated that the reduced five-year relative survival observed in CLL patients compared to the general population of Manitoba may partially be attributed to increased risk of second cancers and non-referral to specialized CLL clinics. The increased risk of second cancers in CLL patients compared to Follicular Lymphoma (FL), a similar indolent B cell malignancy, was only observed after CLL diagnosis indicating that a CLL-specific factor may be responsible for the increased risk of second cancers in these patients. The risk of second cancers is independent of treatment and surveillance bias but is further increased with chemotherapy. A superior outcome in CLL patients who have been referred to the CancerCare Manitoba (CCMB) specialized CLL clinic was observed that was independent of age, gender, treatment and history of previous cancers. This superior outcome was most pronounced in the elderly CLL patients. We propose that CLL patients should be referred to CLL-specific hematologists and, where not possible, that guidelines created by such experts be followed. Appropriate screening for second cancers should be performed during routine follow up of CLL patients.

Innovation comprises the processes of invention and commercialization. While the importance of innovation, especially commercialization, has been widely recognized, existing studies have largely overlooked the commercialization process. By examining the determinants of uses and nonuses of patented inventions from firms at the levels of technology, organization, and project/invention, this study attempts to help fill a critical gap in the literature. In doing so, it enriches theoretical understandings of innovation and, in particular, builds on the evolutionary explanation of technology development, the Teecian framework on profiting from innovation, Transaction Cost Economics (TCE), the Knowledge-Based View (KBV), and open innovation and innovation network perspectives. It also reveals an empirical reality of commercial use and strategic nonuse of patents. The study is based on a novel dataset constructed from multiple sources: inventor surveys, the United States Patent and Trademark Office online database, and COMPUSTAT, among others. After examining the factors affecting overall propensity to commercialize patented inventions, this study explores the factors that affect the organizational paths of commercialization. The empirical estimation indicates that technological uncertainty and a strong internal position of complementary assets raise the propensity for internal commercialization. The study argues that openness of innovation processes and network relationships should affect the choice of commercialization paths. Consistent with the hypotheses, empirical estimations show that external industrial knowledge increases the propensity of internal commercialization. The study also indicates that collaboration has diverging effects on the choice of commercialization paths. While collaboration with firms in vertical relationships tends to favor internal commercialization, collaboration with firms in horizontal relationships tends to favor external commercialization (licensing, start-up). Finally, the study reports findings on the strategic use of patents and then tests hypotheses about the factors driving strategic nonuse. It concludes that a significant portion of U.S. patents are indeed filed for strategic reasons. It also finds that characteristics of technology and firms are significantly associated with different strategies. In particular, firms are more likely to use a patent for strategic defensive purposes when they have larger amounts of assets. The study concludes with discussing managerial and policy implications.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23760号 / 医博第4806号 / 新制||医||1056(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 平井 豊博, 教授 湊谷 謙司, 教授 森信 暁雄 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

O objetivo do estudo foi descrever e analisar as articulações que se realizam entre as equipes da Estratégia de Saúde da Família (ESF) e Centros de Atenção Psicossocial Infantojuvenil (CAPSi), tendo em vista as ações voltadas à atenção em saúde mental de crianças adolescentes. Além disso, visou-se conhecer os facilitadores e obstáculos encontrados no cotidiano do trabalho para sua efetivação; apreender a expectativa dos entrevistados sobre como elas deveriam ser; conhecer outras formas de apoio em saúde mental recebidas pelas equipes de SF. Para tanto, foram realizadas entrevistas semi-dirigidas com gerentes, ou outro profissional por ele indicado, de 5 CAPSi e 13 Unidades Básicas de Saúde com equipes de SF, de cinco regiões distintas no município de São Paulo, totalizando 18 entrevistas que foram transcritas e submetidas a técnicas de análise de conteúdo. Constatou-se que a articulação entre CAPSi e SF se dá prioritariamente por encaminhamento de casos, apoio matricial ou parceria para casos pertinentes ao CAPSi. O contato ocorre ocasionalmente, de acordo com a demanda e, nessas situações, se dá por telefone, pessoalmente ou por meio de relatório; ou regularmente, em reuniões entre os serviços, envolvendo, em algumas regiões, apenas os gerentes e, em outras, parte das equipes de CAPS e SF. Dentre as estratégias, foram mencionadas discussões de casos, intervenções conjuntas, reuniões gerenciais e fóruns de saúde mental. Quanto aos objetivos, destacam-se ampliar a resolutividade dos casos, fortalecer a rede e apoiar as equipes de SF para lidar com saúde mental. Os principais obstáculos apontados foram: problema de dimensionamento e recursos humanos do CAPS; sobrecarga de tarefas, agenda rígida, falta de capacitação, grande rotatividade dos profissionais das equipes de SF; falta de profissionais e equipamentos de saúde mental na rede. O conhecimento pessoal dos trabalhadores dos diferentes serviços foi considerado como importante facilitador para articulação, no entanto, uma maior proximidade foi mencionada como necessária. Todas as regiões pesquisadas contam com Núcleo de Apoio à Saúde da Família que auxilia as equipes nas questões que envolvem saúde mental. A lógica do encaminhamento e da desresponsabilização bem como a hegemonia do modelo biomédico, a departamentalização do trabalho por núcleos de especialidades e a consequente fragmentação dos cuidados se mostram vigentes no cotidiano dos serviços / The objective of this paper was to describe and analyze the articulation of interventions between Family Health Strategy (ESF) and Psychosocial Care Centers for children and adolescents (CAPSi) teams considering mental health care for children and adolescents. In addition, we aimed to identify the factors that facilitate or hinder the articulation of actions between the teams in daily work; to understand workers expectations of these factors and other kinds of mental health support received by ESF teams. In order to achieve these objectives, semi-structered interviews were conducted with five CAPSi and 13 ESF managers, or other professionals of the teams suggested by him/her, from five different regions of São Paulo city, Brazil. The 18 interviews have been transcribed and subjected to content analysis techniques. It was found that the relationship between ESF and CAPSi occurs mostly by referral of cases, matrix support or partnership for cases concerning CAPSi. The contact between them occurs occasionally, according to the demand and usually happens by phone, personally or through paper reports. In some cases, contact takes place via regular meetings between the services involving the managers or other workers of CAPSi and ESF teams, depending on the region. The strategies used for the contact of teams mentioned in the interviews were case discussions, joint interventions, management meetings and mental health forums. The main goals of the joint work were to increase case resolution, strengthen care networks and give support to the ESF teams to deal with mental health. The main obstacles mentioned were: lack of CAPSi in the city, lack of human resources in the existing services; overhead tasks, rigid schedule, lack of training in mental health and frequent changes of ESF professionals; as well as lack of services and professionals in the mental health network. Personal connection among workers from different services was considered an important factor to facilitate the development of partnerships between teams. All the surveyed regions have Family Health Strategy Support Centers that helps ESF teams on issues involving mental health. The referral of users to specialized services, the lack of responsibility for mental health cases, the hegemonic biomedical model, the departmentalization of work by specialized sections and the fragmentation of care have been found as main working procedures in the services

Encore peu étudiée, l’histoire des revues cinématographique françaises pendant la période de la Libération et de l’après-guerre (1945-1952) voit se dessiner une ligne de partage entre les revues spécialisées et les grandes revues populaires comme Cinémonde, Ciné-Miroir ou Mon Film qui reprennent des rubriques anciennes comme celle du « film raconté ». L’Ecran Français, en intégrant des éléments propres aux revues populaires (Courrier des lecteurs, publicité et fascination pour la star) et aux revues spécialisées (positionnement politique et discours averti sur le cinéma), propose un temps la synthèse inédite de ces deux courants. C’est autour de la visée didactique et morale que s’établit apparemment la distinction qui deviendra de plus en plus nette au fil des années. La volonté commune des revues spécialisées est en effet de faire partager un enseignement du cinéma en s’inscrivant dans la continuité des mouvements d’éducation populaire. Certaines revues sont issues de ciné-clubs laïcs (Ciné-Club et Informations-Ufocel) ou catholiques (Télé-Ciné). D’autres, telle la prestigieuse Revue du cinéma fondée par Jean George Auriol, et La Gazette du cinéma dirigée par Maurice Schérer, défendent avec force le cinéma américain : elles ont ainsi constitué un « terrain expérimental » pour les tout nouveaux Cahiers du cinéma. Proche dans l’esprit de la revue Raccords, Positif semble recueillir et transmettre l’héritage de deux revues assez confidentielles : Saint Cinéma des Prés, qui défendait autant le cinéma expérimental que le cinéma américain classique, et L’Age du cinéma, qui revendiquait une approche surréaliste tout en refusant les films relevant d’un avant-gardisme trop signifié. La grande cinéphilie des années cinquante et soixante s’avère indissociable de la cinéphilie méconnue de l’immédiat après-guerre. / Rarely touched as subject, the history of French cinematographic journals during the aftermath of the Second World War (1945-1952) was divided into two streams: those of specialized journals and those of generalized ones such as Cinémonde, Ciné-Miroir ou Mon Film. They transformed the columns of ancient journals into “film-telling”[Film raconté]. L’Ecran Français, however, was the only journal able to synthesize elements both from generalizing journals (i.e. readers’ letter, advertisement, and cult for stars) and from specializing journals (i.e. political position and comments regarding the cinema). Since then, the two streams of journals were more and more distinguished by their didactic and moral differences. The common point for specialized journals was their expectation for promoting cinematographic education alongside the popular educating movement. Some journals were issued from secular cine-clubs (Ciné-Club and Informations-Ufocel) while others were from catholic ones (Télé-Ciné). There were otherwise journals, which were meant to actively defend American cinema, such as the reputed Revue du cinéma founded by Jean George Auriol, as well as La Gazette du cinéma by Maurice Schérer. These journals also contributed to “experimental aspects” for the newly-born journal Cahiers du cinéma. Positif was a journal similar to that of Raccords in terms of spirit; it seemed to unite and transmit the legacy of two confidential journals: Saint Cinéma des Prés, which defended as well experimental cinema as American cinema, and L’Age du cinéma, which claimed a surrealist approach while denying those films that over-emphasized avant-gardism. In the long run, the great Cinephilia in the fifties and sixties were proved to be closely connected to the unfamiliar Cinephilia right after the Second World War.

[pt] O presente trabalho apresenta uma reflexão sobre a relação entre arquitetura e fotografia no contexto das revistas especializadas ao longo do período de modernização acelerada que se deu no Brasil a partir da década de 1950. Com o amparo de uma investigação sobre o histórico da fotografia de arquitetura e da consolidação do modelo de revista ilustrada moderna, foi realizada uma breve análise gráfica da revista Módulo em seu primeiro período de circulação (1955-1965), com o objetivo de verificar na publicação elementos identificados na pesquisa e discutir a importância da memória gráfica na historiografia da arquitetura moderna brasileira. / [en] This work presents an examination on the relationship between architecture and photography concerning the specialized magazines through the rapid process of modernization that took place in Brazil from the 1950s. Supported by an investigation on the history of architectural photography and the development of the modern illustrated magazine standard, we conduct a brief graphical analysis of the first circulation phase of Módulo magazine (1955-1965), aiming to relate some of the publication aspects to the research made and ratify the importance of graphic memory to the Brazilian modern architecture historiography.

A regulação de consultas especializadas tem se mostrado como uma das áreas mais problemáticas do Sistema Único de Saúde (SUS) no Brasil. Cabe aos gestores de saúde nos municípios, estados, e governo federal, estabelecerem mecanismos de regulação coerentes com o volume de recursos disponíveis e com o contingente populacional a atender. Diversas centrais de regulação para atendimentos especializados foram implantadas nas secretarias municipais de saúde e sistemas de informação foram criados como ferramentas para apoio a estas centrais. Seu escopo tem sido progressivamente ampliado, de maneira a incluir uma visão crítica das necessidades da população em relação à capacidade de atendimento dos prestadores de serviço. No processo de regulação de consultas especializadas, duas questões têm-se destacado: (1) para um dado caso, quais pacientes têm maior prioridade de atendimento, e (2) quais prestadores de serviço podem resolver melhor o caso? Fundamentado nestas duas questões, e a partir da consideração dos requisitos legitimados na área da assistência à saúde, este trabalho propõe um sistema para apoio à decisão de agendamento de consultas especializadas para servir às centrais de regulação. O sistema proposto integra análise de decisão multi-critério e programação linear para o agendamento das consultas, onde a alocação dos pacientes é definida em função da relevância relativa de um conjunto de critérios relacionados à noção de efetividade da assistência médica especializada e da capacidade de atendimento das unidades de assistência credenciadas. Da integração destes modelos resulta uma representação que leva em conta simultaneamente os aspectos relacionados ao diagnóstico médico e suas conseqüências na vida do paciente, os aspectos relacionados às instalações e processos disponíveis nas unidades assistenciais credenciadas, e os aspectos relacionados à dificuldade de acesso do paciente a estas unidades. O uso do sistema permite que as informações pessoais e médicas do paciente, assim como as informações sobre as unidades assistenciais, sejam incorporadas em um modelo de programação linear de maneira a maximizar a efetividade do conjunto de solicitações para cada especialidade. Os modelos foram implementados em um sistema informatizado, e aplicados em uma parcela dos serviços da Secretaria Municipal de Saúde de Porto Alegre para as especialidades de cardiologia e cirurgia vascular. O sistema e os resultados obtidos foram validados por um grupo de peritos, que confirmou a viabilidade do uso deste modelo como uma ferramenta para a otimização da alocação de recursos no atendimento especializado pelo SUS. / The regulation of specialized medical consultations has been one of the most problematic areas of the Government Unified Health System (SUS) in Brazil. It is the role of health managers from cities, states and federal government to establish coherent mechanisms of regulation with the amount of available resources and the population contingent to be assisted. Many regulation centers for specialized consultations had been created in public city health departments, and many information systems were developed to support these centers. Its target has been gradually extended, in a way to include a critical vision of the necessities of the population in relation to the capacity of attendance of the service rendering. On the specialized consultations regulatory process, two questions arise: (1) for a random situation, which patient has priority to be assisted? (2) Which health providers can better solve this problem? Based on these two questions, and from the consideration of the legitimated requirements in health care, this work considers a decision support system for the scheduling process of specialized consultations into regulation central offices. The considered system integrates multi-criteria analysis and linear programming for the scheduling process, where the allocation of the patients is defined in function of the relative relevance of a set of criteria related to the notion of effectiveness of the specialized medical assistance and the capacity of assistance of the credential service providers. By the integration of these models, a representation results that simultaneously takes in account the related aspects to the medical diagnosis and its consequences in the patient’s life, the aspects related to the installations and available processes in the credential assistance units, and the aspects related to the difficulty of access of the patient to these units. The use of the system allows that the personal and medical information of the patient, as well as the information on the assistance units, are incorporated in a model of linear programming in a way to maximize the effectiveness of the set of requests for each specialty. The models had been implemented in a decision support system, and applied in a parcel of the services of the Porto Alegre City Health Department for cardiology and vascular surgery. The information system and the outgoing results were validated by a group of experts, which confirmed the model viability for using as a tool to improve the resource distribution at the SUS's specialized assistance.

L’instruction des ADV (Aveugles et Déficients visuels) sous-tend leur apprentissage et leur intégration aussi bien scolaire que sociale, et est fondée sur des politiques mises en œuvre dans divers pays. En France et dans d’autres pays, sont conçues au profit des ADV des politiques d’intégration dont celles en milieu ouvert et en milieu spécialisé. Les études de terrain en France et en Tunisie montrent, qu’avec de supports et de matériels spécifiques, les ADV ont pu apprendre les mathématiques en concrétisation de ces politiques d’intégration. / Teaching the BVI (Blind and Visually Impaired) is the foundation of their learning and integration in both school and society, and is based on policies implemented in various countries. In France and in other countries, integration policies, in an open and specialized setting, are formed for the BVI. Field studies in France and in Tunisia show that with specific media and materials, the BVI were able to learn Math, thus concretizing these integration policies.

The exploratory study aims to explore mental health representations in workers of two specialized institutions, through qualitative methodology. A total of ten members of two specialized institutions were selected, five from each, who comprise the interdisciplinary team in the area: A psychiatrist, a psychologist, a nurse, a nursing technician and a social worker. A semi-structured interview was developed to access the speech of the workers. Results show the representational world of the workers, their general conceptions about mental health, the factors that promote or interfere with it, as well as the reactions that a person that suffers mental illness generates, as well as expectations of improvement. / El presente estudio busca explorar las representaciones de la salud mental en los trabajadores de dos instituciones especializadas. Se seleccionó un total de diez participantes, cinco por cada institución, representantes de los trabajadores que conforman el equipo interdisciplinario del área: un psiquiatra, una psicóloga, una enfermera, una técnica de enfermería y una asistenta social. Para acceder a la narración y al discurso de los participantes, se aplicó una entrevista semiestructurada. Los resultados dan cuenta del mundo representacional de los trabajadores, exponiendo desde lo subjetivo, sus concepciones generales en torno a la salud mental, los factores que favorecen o interfieren en la misma, las reacciones que genera una persona que sufre una enfermedad mental y las expectativas de mejoría.