Conditions de l'autonomie collective : une expérience alternative publique en éducation

Les écoles alternatives publiques québécoises sont souvent des initiatives mises sur pied par des parents engagés à s'impliquer activement dans l'éducation de leurs enfants. La mobilisation de ces acteurs sociaux nous amène à concevoir l'émergence des écoles publiques alternatives à la fois comme forme d'éducation par et pour la collectivité et comme résistance à l'hégémonie du système scolaire public. La présente recherche s'inscrit dans un cadre théorique critique et référera aux notions d'hégémonie culturelle, d'appareil idéologique d'état, de développement comme paradigme et d'autonomie individuelle et collective. Afin de comprendre les conditions de l'autonomie collective au sein de ce type de projet alternatif par rapport à l'institution scolaire dominante, une étude de cas a été réalisée dans une école publique alternative québécoise en milieu rural, soit l'école de la Tortue-des-bois à Saint-Mathieu-du-Parc en Mauricie (Québec). Cette recherche exploratoire démontre que le développement de l'autonomie collective au sein d'un projet éducatif alternatif envers le système scolaire régulier dépend de la cohérence entre la philosophie, les discours et les pratiques des personnes impliquées dans le projet éducatif. La capacité de celles-ci à exercer la démocratie participative constitue une condition inhérente à cette cohérence. Enfin, l'étude permet de conclure que la quête d'autonomie comporte en elle-même un caractère paradoxal étant donné la tendance de la société hégémonique à récupérer les initiatives alternatives. Néanmoins, la mobilisation et l'engagement des acteurs sociaux ont permis le développement d'un projet éducatif plus démocratique propice à l'émancipation et nécessaire au dynamisme, voire à la survie de la communauté rurale aux prises avec des enjeux liés à l'exode des jeunes vers les centres urbains et le phénomène de la dénatalité. - Public alternative schools in Quebec are often initiatives implemented by committed parents to get involved in the education of their children. The mobilization of these social actors lets us conceive of the emergence of such alternative schools both as a form of education for and by the collectivity and as a resistance to the hegemony of the public school system. This research is based on a critical theoretical framework and refers to the notions of cultural hegemony, ideological apparatus of the state, development as a paradigm and individual and collective autonomy. To understand the conditions of collective autonomy within that type of alternative project versus the dominant scholar institution, a case study has been realized at La Tortue-des-Bois à Saint-Mathieu-du-Parc en Mauricie (Québec). This exploratory research will demonstrate that the development of collective autonomy within the alternative education project depends on the consistency between the philosophy, discourses and practices of the people involved. Their capacity to exercise participative democracy is inherent to that consistency as well. Finally, the study will allow us to conclude that the quest for autonomy has a paradoxical effect due to the hegemonic society's tendency to reappropriate itself the results of alternative experiences. However, the mobilization and the commitment of the social actors have permitted the development of a democratic educative project conducing to emancipation and necessary to the dynamism - even to the survival - of a rural community where there are issues like exodus of young people to the urban centers and the phenomenon of depopulation

Enjeux théoriques et pratiques du développement régional : 30 Ans de recherche au GRIR

Le trentième anniversaire du GRIR a été souligné au printemps 2013 par un colloque regroupant plusieurs chercheurs dans le domaine du développement local et régional. Cet ouvrage est le produit de leurs réflexions tant sur le plan théorique que pratique. Ce livre est articulé autour de trois axes : 1) la présentation des divers courants en développement régional, 2) des réflexions sur le passé et le présent des Premières Nations et 3) la présentation de cas concrets sur la prise en main du développement par les différents acteurs du territoire. Cet ouvrage est un outil permettant de constater le travail accompli en développement local et régional et de dégager des pistes de réflexion sur les avenues possibles de développement

Timeliness of Clinic Attendance is a good predictor of Virological Response and Resistance to Antiretroviral drugs in HIV-infected patients

Ensuring long-term adherence to therapy is essential for the success of HIV treatment. As access to viral load monitoring and genotyping is poor in resource-limited settings, a simple tool to monitor adherence is needed. We assessed the relationship between an indicator based on timeliness of clinic attendance and virological response and HIV drug resistance

Evaluating complex interventions in real context: Logic analysis of a case management program for frequent users of healthcare services

Case management programs for frequent users of healthcare services are complex interventions which implementation and application are challenging to evaluate. The aim of this article was to conduct a logic analysis to evaluate a case management program for frequent users of healthcare services. The study proceeded in three phases: 1) establishing causal links between the program’s components by the construction of a logic model, 2) developing an integrated framework from a realistic synthesis, and 3) making a new reading of the case management program in regard of the integrated framework. The study demonstrated, on one hand, strengths and weaknesses of the actual case management program, and, on the other hand, how logic analysis can create a constructive dialogue between theory and practice. The evaluative process with decision-makers, clinicians and patients has helped to make connexions between theory, practice, experience and services organization

Generic self-reported questionnaires measuring self-management: a scoping review

This study aimed to (1) identify generic questionnaires that measure self-management in people with chronic conditions, (2) describe their characteristics, (3) describe their development and theoretical foundations, and (4) identify categories of self-management strategies they assessed. This scoping review was based on the methodological framework developed by Arksey and O’Malley and completed by Levac et al. A thematic analysis was used to examine self-management strategies assessed by the questionnaires published between 1976 and 2019. A total of 21 articles on 10 generic, self-reported questionnaires were identified. The questionnaires were developed using various theoretical foundations. The Patient Assessment of Self-Management Tasks and Partners in Health scale questionnaires possessed characteristics that made them suitable for use in clinical and research settings and for evaluating all categories of self-management strategies. This study provides clinicians and researchers with an overview of generic, self-reported questionnaires and highlights some of their practical characteristics

Tabletop imaging of structural evolutions in chemical reactions

The introduction of femto-chemistry has made it a primary goal to follow the nuclear and electronic evolution of a molecule in time and space as it undergoes a chemical reaction. Using Coulomb Explosion Imaging we have shot the first high-resolution molecular movie of a to and fro isomerization process in the acetylene cation. So far, this kind of phenomenon could only be observed using VUV light from a Free Electron Laser [Phys. Rev. Lett. 105, 263002 (2010)]. Here we show that 266 nm ultrashort laser pulses are capable of initiating rich dynamics through multiphoton ionization. With our generally applicable tabletop approach that can be used for other small organic molecules, we have investigated two basic chemical reactions simultaneously: proton migration and C=C bond-breaking, triggered by multiphoton ionization. The experimental results are in excellent agreement with the timescales and relaxation pathways predicted by new and definitively quantitative ab initio trajectory simulations

A Universal Bleeding Risk Score in Native and Allograft Kidney Biopsies: A French Nationwide Cohort Study

BackgroundThe risk of bleeding after percutaneous biopsy in kidney transplant recipients is usually low but may vary. A pre-procedure bleeding risk score in this population is lacking.MethodsWe assessed the major bleeding rate (transfusion, angiographic intervention, nephrectomy, hemorrhage/hematoma) at 8 days in 28,034 kidney transplant recipients with a kidney biopsy during the 2010-2019 period in France and compared them to 55,026 patients with a native kidney biopsy as controls.ResultsThe rate of major bleeding was low (angiographic intervention: 0.2%, hemorrhage/hematoma: 0.4%, nephrectomy: 0.02%, blood transfusion: 4.0%). A new bleeding risk score was developed (anemia = 1, female gender = 1, heart failure = 1, acute kidney failure = 2 points). The rate of bleeding varied: 1.6%, 2.9%, 3.7%, 6.0%, 8.0%, and 9.2% for scores 0 to 5, respectively, in kidney transplant recipients. The ROC AUC was 0.649 (0.634-0.664) in kidney transplant recipients and 0.755 (0.746-0.763) in patients who had a native kidney biopsy (rate of bleeding: from 1.2% for score = 0 to 19.2% for score = 5).ConclusionsThe risk of major bleeding is low in most patients but indeed variable. A new universal risk score can be helpful to guide the decision concerning kidney biopsy and the choice of inpatient vs. outpatient procedure both in native and allograft kidney recipients

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation:a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II–III (November 2011–December 2014 for Phase II, and January 2014–December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22–0.25] and 0.66 [0.61–0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67–1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76–0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH.</p

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

BackgroundPrevious studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study.MethodsFrom the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377.Findings34,421 patients were included (70.0&nbsp;±&nbsp;10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n&nbsp;=&nbsp;6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n&nbsp;=&nbsp;15,449, 56.1%) and North America (n&nbsp;=&nbsp;8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding.InterpretationOur results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis.FundingThe GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH